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Mr. Anthony Steen (Totnes) (Con): I am delighted to have this opportunity to raise a matter of considerable concern to the people of Devon. I am concerned that the Devon Partnership NHS trust, with its budget of £85 million this year, may not place the care of patients as the priority. I am concerned about the total absence of day care facilities in Brixham for Alzheimer's and dementia sufferers since the unilateral closure of the Briseham unit on 20 December 2004. I am concerned about the lack of available NHS respite care, which is forcing those who look after very sick people to pay for their own respite provision out of their own pockets. I am concerned that we are not facing up to the reality that, as our population gets older, more people will need mental health care and that the NHS must be equipped to cope with the rapid increase in demand.
There are more than 750,000 people in the UK with dementia. The vast majority are over 65 and the incidence of dementia increases with ageone in 20 people over 65 have dementia, which increases to one in five among people over 80. My constituency has the 13th largest proportion of pensionable citizens and there are approximately 1,155 people with dementia in the area. They are among the most vulnerable people in our society. Dementia does not just leave sufferers with failing memoriesas the condition worsens, many people cannot feed, bathe or dress themselves. Dementia is a forgotten disease. One carer said:
"This cruel disease does not just affect one personit has affected everyone we come into contact with. It has forced an end to my husband's career; it has affected my career quite dramatically. It has changed our standard of living and our lifestyle. It has changed everything we have lived and worked for."
As medical advances lengthen our life expectancy, the proportion of our population with dementia and requiring the support of the mental health services will increase. The problems presented by an ageing population are much discussed in relation to pension provision, but we are yet properly to address what it means in terms of the changing demands placed on our health services, particularly our mental health services. It is estimated that, by 2010, there will be 870,000 people with dementia in the UK. That is the same as the population of Manchester and Liverpool put together. In five years' time, there will be that number of people with dementia or Alzheimer's. By 2050, nearly 2 million people will have dementia or Alzheimer's. That will require a significant expansion of mental health service provision and availability of day and residential care.
Since 2001, the care and treatment for those with dementia in my constituency has been the responsibility of the Devon Partnership NHS trust, which provides mental health and learning disability services to the population of Devon. There is a staff of 2,800 and in 200405, it spent approximately £80 million. One of its problems is the absurd position whereby it is funded by
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nine different sources. There are therefore nine paymastersseven primary care trusts in Devon and Torbay, Torbay unitary authority and Devon county council. That makes for unnecessary problems with priorities and management. Will the Under-Secretary investigate how to simplify the funding arrangement?
In the 200506 financial year, the trust budget has been significantly increased, with Devon county council alone increasing its contribution to nearly £1 million, yet front-line service provision is often incoherent, unequal throughout the county and seemingly not patient-driven. More money has not meant better services for the Alzheimer's and dementia sufferer.
The Briseham unit in my constituency provided specialist treatment and assessment services to those over 65 with dementia. The building was specifically designed for the purpose of caring for the elderly mentally ill. That made it an especially suitable environment, more so than wards that had not been specifically built for the purpose. It had 16 beds, as well as offering day care seven days a week and a small respite facility, which was fully utilised. It was unilaterally closed on Monday 20 December 2004, although the trust remains insistent that it has not been closed but simply suspended. It remains suspended six months later. As a member of staff who was at Briseham recently said to me:
"I cannot believe that they have closed a purpose built, secure unit with access to an enclosed garden for patients to wander freely, and left open a ward on the first floor of a hospital where it is very difficult to observe patients, where they have no freedom to move, and the only view they have is the top of cars and buses."
The unit did not provide long-term residential care but day care and respite care. It provided the essential back-up to allow carers to continue looking after their loved ones at home. As the majority of carers are the spouses of the person for whom they are caring, they are likely to be elderly. Carers can cope and continue their role only with appropriate support. If they fall ill or cannot provide all the necessary care, sufficient respite and day care must be available. If it is lacking, everybody suffers, and people with dementia will need full-time residential care at the cost of millions to the taxpayer.
The chief executive of the Devon Partnership NHS trust personally told me that he intended to wait until the Sainsbury centre for mental health published its report on "Future Development of Mental Health Services for Older People" in Devon before deciding about any change in the services that Briseham provided. Instead, he did the opposite. He closed the unit before the publication of the report, which came out in January, but to which the trust has still not responded. In a letter following the closure of Briseham, Mr. Tulley, the chief executive, stated:
What happened after Briseham was closed reminds us that administrative decisions have a genuine and profound impact on people's lives. A few patients were offered care at the Harborne unit in Totnes, which is at least a 30-minute drive away. Such is the stress and strain of the journey that some patients have had to be
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medicated. However, the majority of people who previously received day and respite care at Briseham have been offered no alternative care by Devon Partnership NHS trust since it suspended the unit.
Mr. Gosling of Brixham is 85 this month. He devotedly cares for his wife who has Alzheimer's. When Briseham was open, he could count on it to provide day care when he needed time off, for example, to go to the dentist. In addition, the unit would care for his wife once every four weeksthe only respite Mr. Gosling got. Since Briseham was closed, Mr. and Mrs. Gosling have had to pay for respite care elsewhere. They have had to spend more than £1,000 of their hard-earned money for that purpose as the Devon Partnership NHS trust has offered them no alternative care. Mr. Gosling cannot understand how the powers that be could be so inhuman as to wipe out something that people need and rely upon, and that the NHS has a duty to provide.
Mr. Barber of Higher Furzeham road, Brixham is 77 and cares for his wife, who has been battling with Alzheimer's for 10 years. Before its closure, the Briseham unit provided day care on a four-day-a-week basis for him, as well as residential care for a couple of days when Mr. Barber was unwell or unable to care for his wife. Since it closed, no day care has been available for Mrs. Barber and, at a meeting of the Devon Partnership NHS trust, Mr. Barber was told that the other units that provided care for elderly people with mental health problems were unable to care for his wife, even if he could not do so through illness or for other reasons, as they were already seriously overloaded.
Mrs. Bovey of Golden close, Brixham cares for her husband, who has progressive supranuclear palsy. She cannot even pop out to get a pint of milk or loaf of bread unless someone can stay with him as he needs round-the-clock care. Prior to the closure of the Briseham unit, he had day care there two days a week and a week's respite care roughly every four weeks. Mrs. Bovey says that that was her "lifeline". She was never offered alternative care in any other unit. It is only in the past few weeks that social services, not the Devon Partnership NHS trust, have come forward with an offer of some respite care, yet Mr. Tulley, the chief executive, gave me a personal assurance that everyone who used Briseham is better off under the new arrangements.
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