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24 Oct 2007 : Column 112WH—continued
The hon. Member for Barnsley, Central (Mr. Illsley) is not with us today, but at Prime Minister’s Question Time he raised the issue of Aricept and the fact that the National Institute for Health and Clinical Excellence has not issued the data model that it used. NICE can
play a significant part in the care of people with dementia, but its role has been overlooked. NICE does not currently take into account the social costs of care, but they are extremely important in evaluating the cost-effectiveness of any drugs that come on to the market to treat conditions such as dementia. I agree with the hon. Gentleman that it is important for us all to have sight of the data model that NICE used.
Mr. Graham Stuart: Will my hon. Friend join me in congratulating the Minister on two fronts: first on recognising the failures of the current system for dealing with people with dementia, and secondly on announcing the development of a new strategy to deal with dementia? Does she share my concern that the missing link, as Help the Aged has called it, is research—my hon. Friend the Member for Rugby and Kenilworth mentioned that point? Will she join me in hoping that the Minister will deal with that aspect of the matter today?
Anne Milton: I thank my hon. Friend for that intervention. His points were well made. Of course, I should not do otherwise than join him in his two points of congratulation, and in making the point that more research money is crucial.
The other issue that has been touched on today is the 1 per cent. increase in the supporting people budget. An important aspect of it is cost shifting between the NHS and social services, and the feeling among local authorities in some parts of the country that their budgets and the money that they get from central Government are for ever shrinking—it is becoming extremely difficult for them to give effective care in people’s homes and to support carers of people with dementia. It is crucial that, given such resource constraints, we ensure that every penny is well spent.
Mr. Stuart: My hon. Friend has mentioned pressure on council budgets. The current number of dementia sufferers in the East Riding of Yorkshire is 4,700. It is expected to be more than 7,700 by 2021—a very few years from now. I hope that the Minister will take on board the need for additional funding, to take account of what is probably the biggest issue facing British society—dealing with an ageing population.
Anne Milton: My hon. Friend has made the point extremely well, and I expect that the Minister and hon. Members all agree that one of the main issues, and one on which we at times have our heads in the sand, is how to cope with our ageing population; how, as the hon. Member for Southport has suggested, to create a society that is not ageist in its approach; and how to look after those who will have to carry the burden of caring for those who cannot care for themselves.
In conclusion, I should like the Minister to deal with the points raised by my hon. Friend the Member for Rugby and Kenilworth, whom I again congratulate on obtaining the debate. However, I also want to ask him a question: who will care for carers if we do not? There will be no one to save the Government £6 billion a year as those carers now do—it has been estimated that £1 of Government money spent in the voluntary sector provides between £11 and £15 in services—and there will not be enough care home beds in which people with dementia
can be looked after, or enough residential home places. I hope that the dementia care strategy will address the problems not only of people with dementia, but of the people who care for them.
I am sure that the Minister agrees that this is not a party political issue. He looked slightly nervously at me, as if I were going to attack the Government, but I do not want to do that. All that I want to do is make the lot of people with dementia, and those who care for them, better, and this debate is an important step towards securing that goal for the future.
3.23 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Rugby and Hamilton—
Mr. Lewis: I am well briefed. I congratulate the hon. Member for Rugby and Kenilworth (Jeremy Wright) on securing this debate on a crucial issue. It seems that the issue will touch an increasing number of families—indeed, we know that that is happening. Many people seem incredibly uncomfortable talking about it, but it will become a growing challenge for our society. I have said that we need to bring dementia out of the shadows. It asks questions of the health and social care system—and of families and society—and we have not been able to address that issue thus far. Together we need to find a solution. We need to match our ambition to find a solution to the scale of the challenge.
I thought that the hon. Gentleman’s speech was thoughtful. I am delighted that he is to be the chairman of the all-party parliamentary group, and I look forward to working with the group to make a difference. In response to an important point that he made, I shall talk about the national strategy, but developing and announcing that strategy will be only the beginning of the journey. The key will be the delivery and implementation of change in every community, so that people who use services, and their families, have a very different experience from the one that many have so far had. The parliamentary group and, indeed, Parliament, have an important role in making sure that that happens.
I pay tribute to the hon. Member for Guildford (Anne Milton). I was not looking anxiously at her, but at the hon. Member for Beverley and Holderness (Mr. Stuart), because he and I know each other rather well. I congratulate the hon. Lady on making this one of the rare occasions when an Opposition spokesman has not made a partisan point of any kind. That inspires tremendous respect for her, because this debate needs to be conducted on an all-party basis.
I also pay tribute to the hon. Member for Southport (Dr. Pugh) for a thoughtful speech in which he raised issues that have not been raised elsewhere in the context of dementia. He raised the matter of elder abuse, which is sadly another growing problem in our society. I suspect that our public discourse on elder abuse is now at the same stage as our public discourse on child abuse was 20 or 30 years ago. Sadly, as I said this week, society is not as outraged by the abuse of an older person as it is by the abuse of a child—something that we should all want to address.
The hon. Member for Southport also referred to therapeutic interventions. Older people need to be supported in maintaining their health for as long as possible, so early intervention and prevention are crucial. My view is that not enough work is going on in communities to deal with loneliness and isolation among older people. Politicians of any colour never said, in passing the 1990s community care legislation or in developing policies since 1997, that it was not the responsibility of local communities, local authorities or anyone else to treat older people’s loneliness and isolation as a shared responsibility, and programmes were introduced to address those issues. In our thinking about social care, addressing loneliness and isolation should be an integral part of the system.
Anne Milton: Will the Minister join me in paying tribute to groups such as one in Cranleigh in my constituency, which started walking for health programmes for older people, with the unexpected benefit that, having been set up to give older people in particular more exercise, the programme has also provided an important social outlet for people who might not otherwise get out and who feel isolated?
Mr. Lewis: I am delighted to pay tribute to that group in the hon. Lady’s constituency. It is important to remember that, although the notion of an ageing society is presented as being all about burdens and negativity, many of the present generation of older people are healthier than any previous generation, which is a trend that will continue as a result of medical advances and improved affluence. We should also remember that many of the current older generation are more affluent than the previous generation. We should not present the situation as just negative. There is a challenge that requires us to think differently about our communities and public services, but it is by no means a negative. Politicians all have a responsibility to think about what that means for policy.
I want to mention in response to the remarks of the hon. Member for Southport that we are reviewing the entire regulatory system on protecting older people from abuse. “No secrets” was guidance issued to local authorities some years ago, and we are undertaking a fundamental review of it. We are examining the case for legislation. I am not a believer in introducing vast amounts of regulation and legislation, unless it can be proved that it adds value and will make a difference. However, if the absence of that regulation or legislation is failing adequately to protect older people, we have a responsibility to consider toughening the system.
The hon. Member for Beverley and Holderness is right that we must include research in our process. Although that is not one of the primary objectives of the national review, I have made it clear, as the lead Minister on these issues, that we must look at research if the process is to have credibility and integrity. We will be looking at investment in research.
Mr. Graham Stuart:
I am grateful to the Minister for giving way and for the words that he has just uttered. When can we expect to hear the result of the examination of potential improvements in research
spending, which, as my hon. Friend the Member for Guildford pointed out, halved from 2001 to last year?
Mr. Lewis: We intend the national dementia strategy, when it is published, to reference our view on going forward on research, so it will be clear as part of the process. At the moment, that is not identified as one of the priorities for the development of the strategy, but I am willing to include it and to look seriously at research.
I say gently to the hon. Gentleman that the Conservative party has made no commitments, as far as I am aware, significantly to increase investment in local government. If it has, there will be tax implications about which we would be delighted to hear a little bit more. Hon. Members in Opposition parties are constantly stacking up all sorts of spending commitments, which is worthy indeed, but, of course, Governments must fund such commitments.
Mr. Stuart: The Minister has been party to creating joint working between health and social care in order to try to create a seamless system. In that context, the decision of his Government to make such a discrepant allocation of funds between local government and health looks peculiar. I am not responsible for my Front Bench’s position. Personally, I would prefer to see a clearer and more balanced allocation between health and social care, so they can move forward together. If anything, social care’s need for cash seems even greater than that of health at the moment.
Mr. Lewis: There was an era not that long ago when nothing plus nothing came to nothing, and those of us in the House who remember it know the dreadful state in which public services were left as a consequence. Frankly, it is a little disingenuous of the hon. Gentleman to make that point, when there have been record levels of investment in all public services year on year in the past 10 years, but I will address the serious issue.
If we are going to transform services for older people and disabled people in our society, we need a far more integrated approach between the NHS locally and local government, and between the voluntary and private sectors. We certainly need to look at the balance of resources between the NHS and services that are commissioned—not necessarily provided—by local government. I do not think that there is any difference between us in terms of direction of travel. The White Paper, “Our health, our care, our say”, committed us to considering, where appropriate, a redirection of resources from the NHS to local government in terms of the provision of certain services. I shall tease the hon. Gentleman by saying, “Watch this space.”
Jeremy Wright: The Minister is right; this is the wrong subject for political knockabout. The key point is that the Government, by setting out their objectives in a strategy, will properly raise expectations in the dementia community as to what can be done. If those objectives are not supported with the necessary funding, we will find a good deal of disappointment among the dementia community, which is why concerns are being expressed about where the money will come from, in addition to the worthwhile policy objectives.
Mr. Lewis: Yes, I agree entirely with that. But the hon. Gentleman must accept that his party is not saying to the people of England, “We are going to spend a lot more money on dementia.” There has been no such policy commitment.
Let me make it clear that there will be a 1 per cent. real-terms increase going into local government, and the NHS will receive roughly a 4 per cent. real-terms increase. The combination of those increases is significant. The Department of Health has an amount of money specifically for social care, the detail of which has yet to be announced.
In the spring next year, the Prime Minister will announce a new deal for carers. He has set up a consultation process, meetings are taking place throughout the country and in the spring there will be an announcement about additional enhanced support for carers, the funding of which has not yet been committed or announced as part of the comprehensive spending review. In addition, some of the commissioning decisions at a local level should be different from the current ones, in terms of the use of existing resources and, certainly, with regard to joint and integrated commissioning between the health service and local authorities. It is easy for an Opposition Member to suggest that this is just about more and more money, and then not make any commitments to spend any.
This is also about using existing resources more effectively and getting the decision makers on the ground to take dementia more seriously. The chief executive of the national health service appeared before the Committee and had to acknowledge that the system is letting too many people down, and to make commitments in that area, which is important. However, that has to be reflected in decisions made locally by those who run NHS and local authority organisations and those who make commissioning decisions. Part of the strategy will be to ensure that dementia is given a much greater focus and a much greater priority, which is consistent with the scale of the challenge that dementia now presents to communities and families.
I want to talk a little bit about how we are approaching the strategy. I deliberately appointed somebody with an NHS background, Professor Sube Banerjee—head of mental health and ageing at the Institute of Psychiatry and a clinical director for the mental health of older adults at the South London and Maudsley NHS Foundation Trust—and Jenny Owen, who is executive director of adults, health and community well-being in Essex, jointly to develop this national strategy. Health and social care are working together, arguably for the first time, to ensure that the strategy is truly joined up, and the strategy delivery should reflect that.
I have also appointed Neil Hunt, the chief executive of the Alzheimer’s Society, to play a central role in the strategy’s development and to make sure that we are engaging with and consulting all those out there who have specialist knowledge and concern and passion about the needs of people with dementia. Our external reference group, for example, will include Barbara Pointon, the lady who incredibly courageously allowed a documentary about the deterioration in her husband’s condition to be filmed. After that documentary, all that was debated in the media was whether her husband died on camera or not. What an outrage! Why did the media not generate a debate about Alzheimer’s and dementia,
rather than having an insider techie debate about whether the actual death was filmed? That really makes people angry. Meeting a person like Barbara Pointon, who has been through that hell and is prepared to go on platforms everywhere and argue the case for better, improved services for dementia, makes one realise that such people are the true people of courage in our country.
Anne Milton: I would like to associate myself with the Minister’s comments. The courage of people who have been through such an experience is extraordinarily humbling. I agree with him that without people such as Barbara Pointon, our ability to debate and find solutions to some of these problems would be much less apparent.
Mr. Lewis: I agree with the hon. Lady’s sentiments. Neil Hunt and the Alzheimer’s Society have done a tremendous job in raising awareness of these issues and pressuring the system to take them far more seriously than it has done hitherto.
I pay tribute to my hon. Friend the Member for Worsley (Barbara Keeley). She has used her experience and her passion for both social care and the needs of carers ever since she became a parliamentarian. She has made a tremendous impact in raising the profile of these issues in Parliament and more widely. Although, as she said, this is not a very sexy issue, it is important that individual parliamentarians champion issues that are less sexy than others. Out there, for the families and people in our communities and our constituencies, these are the issues that arguably matter far more than some of the others on which we spend a lot of parliamentary time. I pay tribute to her for the work that she continues to do in this area.
My hon. Friend has made a number of important points. The effect of caring on the health of the carer is something that we need to consider as part of our work on the new deal for carers and on the national dementia strategy. She is absolutely right on that point. She also referred to the fact that carers are usually the experts on the people for whom they care, which professionals forget too often. The relative—the husband, wife, son or daughter—knows far more about that person and what they need and want than a professional will ever be able to. In some of our public services, we have to change the culture of how carers are treated. Arguably, we need to do so more in the NHS than in the social care system.
Mr. Graham Stuart: Will the Minister pick up the point made by my hon. Friend the Member for Rugby and Kenilworth about expanding the voluntary sector and the role that it has to play?
Mr. Lewis: The hon. Gentleman is even reading my mind now. I was just going to come on to that point.
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