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24 Oct 2007 : Column 118WH—continued
On the question of expert carers—hon. Members should listen, because I do not think that this is widely known—we are developing an expert carers programme that we will launch in the summer of next year. Up and down the country, local training courses will be available for carers to help them with practical issues such as lifting and handling and with some emotional issues, so that they feel confident in taking on and working with the professionals and the public services not
confrontationally, but to represent the best interests of the person whom they love. Empowering people is an important part of improving services. Yes, we can improve the leadership, structures and funding, but we also need to give those who use the services and family members far more control, power and confidence to fight for their needs and rights.
As well as the new deal for carers, I should mention that the Prime Minister has established a standing commission on carers under the leadership of Philippa Russell, a well-known activist for disabled people. She is a carer herself, with an adult son with learning disabilities. The idea behind the standing commission is to consider the long-term challenges that we face with caring responsibilities in our country. Inevitably, at the heart of that will be the ageing society and dementia. That standing commission will be an important step forward.
My hon. Friend the Member for Worsley also raised the question of respite. We have just announced a significant investment, as a result of a lot of all-party support, for disabled children and their families, with a particular focus on respite. One of the things that the new deal for carers must consider is respite care for adults. We have recently put some money into the system, and into local authorities specifically, for emergency respite care. Carers have told us that that is often a problem. When they have an emergency, it is very difficult to access respite care, and we need to build on that.
I am proud of the fact that the Government have given an annual grant to local authorities since 1999 specifically to support carers. It is a ring-fenced grant, and it is transparent. In recent years, it has not been ring fenced in the sense that we cannot force local authorities to spend it in the way in which we want them to, but a transparent and clear amount of money has gone to every local authority since 1999.
Barbara Keeley: On raising the quality of respite care, does my hon. Friend agree that it is not strictly a cost issue, but a regulation issue? The discussion I had with local carers about quality standards raised a question about regulating to minimum standards. When the homes that were being complained about in my constituency were checked, they were at minimum standards and then they slipped below them between times. The problem is regulation, rather than cost.
Mr. Lewis: I agree with my hon. Friend, although to some extent I think that there is a combination of factors. We have a regulatory system that secures minimum standards for the first time, and such standards did not exist before we introduced them. However, we need to do far more than secure minimum standards. People are entitled to expect quality personalised care. The next challenge for our health service and our society is to regard public services as offering people not only minimum standards, but highly personalised services. That is the next part of the mission when it comes to strengthening the public services at the heart of a decent society.
Jeremy Wright: If the Minister is about to move on to this subject, I apologise. Before he leaves the subject of the voluntary sector—
Mr. Lewis: I was just coming on to that.
Jeremy Wright: In that case, I will happily let the Minister proceed, and may intervene again.
Mr. Lewis: I was about to echo the comments made by the hon. Gentleman, other hon. Members, the Princess Royal Trust for Carers, Crossroads, Age Concern and Carers UK—we could go on and on. The voluntary sector is at the heart of our capacity to provide quality services and to enable people to feel comfortable about accessing services. We know that for some people, the voluntary sector is closer to communities than the statutory sector can ever be, and we also know that because there is a different history to the growth and development of the voluntary sector, it is in a position to advocate for people, often in an incredibly powerful way.
When, as the Minister responsible, I talk about integration of services in local communities, I do not just talk about the local NHS and local government—I always talk about the voluntary sector and the private sector. If we harness all the resources effectively that are being spent on care through those different sectors, we will end up with much higher quality, better services for people by simply using existing resources, without debates about the ongoing need for additional resources.
Jeremy Wright: On the single point of contact, the Minister has talked about the desirability of involving the voluntary sector, and I am sure that we all agree about that. However, does he think that it would be a good idea for the single point of contact to be provided by the voluntary sector rather than by the state?
Mr. Lewis: That is a difficult point. I personally believe that in every community there should be a single point of contact, which I would describe not as a one-stop shop, because that is unrealistic, but as a first-stop shop. If someone logs on to a website, visits a place or makes a call, somebody should ensure that they end up in the right place for the support that they need. We should aim to achieve that in every community.
Who would end up providing that service is open to debate. In some communities, the voluntary sector is undoubtedly best placed to do so. In other communities, the voluntary sector is underdeveloped, and the service would have to be provided by a statutory agency. Securing the notion of first-stop shops in every community, particularly in terms of older people, carers and the ageing society, should be an objective and ambition that we promote.
Turning to the strategy, first, we want to raise awareness about dementia, so that people begin to spot the signs at the earliest conceivable stage. Awareness-raising has to be not only about professionals, but about friends, family members and workmates. We know, as the hon. Member for Southport has said, that early intervention makes a difference. Recognising and spotting the signs, and not dismissing the symptoms as something entirely different, is incredibly important. Raising awareness and trying to remove some of the stigma is also crucial, and we will consider the best ways in which to do that.
Secondly, we want early diagnosis and intervention. All hon. Members know that GPs cannot be expected
to be experts on every single condition. We have to ensure that primary care professionals have the maximum possible knowledge about dementia and a professional commitment that, if there is doubt or uncertainty, they will ensure that the person is referred appropriately to someone with specialist knowledge and expertise, rather than dismissing them or telling them that it is nothing to worry about. A major part of the strategy will be to consider how people access professional support and to ensure that we get those professionals to work with us to ensure early diagnosis and intervention.
Jeremy Wright: Does the Minister agree that we need to recognise people’s concerns about, and fear of, a diagnosis of dementia, and to look at what is being done in Croydon, I believe, where what used to be called a dementia clinic has been renamed a memory clinic, and where referrals are now taken up more fully?
Mr. Lewis: I agree with the hon. Gentleman that it is important to recognise models of best practice. There is a lot of very good provision out there from which we can learn. We need the standards of all to be brought up to the standards of the best. Part of our strategy needs to involve highlighting places such as the Croydon memory centre and other services that already are providing the kind of support that we want to provide to everyone.
Mr. Graham Stuart: Given that dementia is the subject of today’s debate, will the Minister comment on dementia in young people, which is an extremely serious condition and, as has been said, a fatal diagnosis?
Mr. Lewis: One of the benefits of the reshuffle is not only that I retain my job, but that, for the first time, I am responsible for all mental health provision in the Department. That means that I am responsible for the mental health of children, adolescents and adults and for dementia as whole, which is one of the issues that I need to address in assuming those integrated responsibilities. I agree entirely with the hon. Gentleman, and his question is a new question being asked of our society. Quite frankly, the system cannot cope with younger people who develop dementia. The hon. Member for Southport has also referred to that point.
The third focus of the national strategy is on improving the quality of care, whether it is provided in people’s homes, hospitals or care homes. I have a really important point to make here: there can be no excuse for the neglect of older people, whether it is on a hospital ward, in a nursing home or through a home care service. We must continue to campaign to put respect for dignity at the heart of all care services. I do not accept the idea that we should always blame a lack of resources. There are certain non-negotiables and practices in the way that older people are treated that bring nursing and the NHS into disrepute.
I also believe, however, that managers, as well as front-line staff have a responsibility in this matter. Wards where more than 50 per cent. of the patients have dementia require different staffing arrangements from those where that is not the case. We pay NHS managers to make those decisions and to get that right. In the
same way that there has been a debate about pupil-teacher ratios in the education system, we ought to have a debate, not about Ministers prescribing a certain number of nurses per patient on every ward in the country—that is not our job—but about managers, whose job it is to ensure appropriate staffing arrangements, especially if staff are having to cope with a ward on which dementia sufferers predominate, and if we want to give dementia sufferers high quality, personalised care.
I agree with the hon. Member for Southport and others about offering an integrated service to the patient and family members. Service users—patients and family members—are not interested in whether the service is provided by someone who describes themselves as a health professional or a social care professional; they are interested in a joined-up, integrated service that is sensitive and that meets their needs. They do not want to be passed from pillar to post between different administrative structures, so we need clear lines of accountability and responsibility at a local level.
Jeremy Wright: I appreciate that the Minister is running out of time, but I do not want him to run out of it before touching on co-ordination, and specifically on a possible national dementia services director. Some very heavy hints have been dropped by the chief executive of the NHS about the desirability of that. Will the Minister tell us if, or when, that will happen?
Mr. Lewis: Professor Banerjee, who is leading on that, is the Department’s clinical advisor on dementia. He is not a national director for dementia, and I need to give further consideration to that proposal. The difficulty is that, understandably, every area in the health service wants a national director. I have just appointed somebody in the Department to lead on autism. Previously, no official was leading on that issue, which is presenting a growing challenge for our society where children and young people are concerned. Indeed, the problem of adults with Asperger’s is now raising many issues. I cannot give a cast iron commitment today, but I shall reflect on the hon. Gentleman’s point. Certainly, that issue must be addressed as part of the national strategy. As David Nicholson has said, however, there is a strong case for having such a director. We have an excellent national clinical director for older people, Professor Ian Philp, who is highly regarded but who is not a dementia specialist. We will consider that possibility as part of the national strategy.
Clearly, training front-line staff is crucial, and we need a combination of universal basic knowledge and highly specialist skills. However, we still have a long way to go. For example, let us consider domiciliary care workers. As more and more people choose to remain in their own homes, rather than to go into hospital or institutionalised care, more of the service will have to be provided by home care workers. We need, therefore, to have a particular look at their expertise, knowledge and sensitivity to the needs of people with dementia; that applies to all professionals. On one hand, we need some minimum knowledge among the universal professionals and system, and on the other, we need a cadre in every community of people with specialist knowledge and expertise in dementia.
Finally, of course, we need to look at the relationship between national policy and leadership, and what happens
on the ground with local priorities. I say gently to the hon. Member for Rugby and Kenilworth that all political parties are united around the notion of localism and devolution and of not doing things from offices in Westminster and Whitehall. As we develop the national strategy, therefore, we must consider the pressures, incentives, levers and accountability mechanisms that we can put into the system, but which will not compromise the right of people on the front line to make key decisions. We must ensure, however, that they do not neglect people with dementia, and that those with dementia and their families are given greater priority and a greater status in decisions than has been the case thus far.
One of the reasons why we are debating this issue today is the lack of a national policy in the past, and another is the fact that people in local communities continually tell us that they are not getting the expert, personalised services that they need and want. Carers frequently tell us that they are not being treated with respect when decisions are being taken about dementia sufferers.
We have a long way to go. The challenge is to create the right balance and dynamic between providing clear national policy, leadership, standards and objectives, and understanding that in the end we are heavily dependent on the managers and professionals on the ground to make a difference. Furthermore, putting more powers in the hands of users and their families, through individual budgets, direct payments and simply giving them a greater ability to complain and to articulate their views, will have a major impact on raising standards and the quality of care in this area, as in many others.
I end by paying tribute to hon. Members for the all-party way in which they have approached this incredibly important issue. We are all committed to bringing dementia out of the shadows, and we have a solemn responsibility to those with dementia and their families and to ensure that we improve the quality of their lives.
Illegal Immigrants
3.59 pm
Mr. Philip Hollobone (Kettering) (Con): I thank Mr. Speaker for giving me permission to raise this important subject today, and I warmly welcome the Minister to the debate to listen to what I and other colleagues have to say, and to respond in due course.
The control of illegal immigration is a very important topic, and the Minister is a very important person. Indeed, I reckon that she is one of the most important Ministers in the Government, because the first duty of Her Majesty’s Government should be to defend our island and control our borders. In that regard, we put a lot of faith in her and her Department. However, I must draw to her attention the fact that all is not working as it should. In places as land-locked as Northamptonshire, illegal immigrants are turning up on our doorstep, and it is causing huge concern to local residents, particularly because of the advice that the Border and Immigration Agency has given to Northamptonshire police whenever they have apprehended those people.
There have been in Northamptonshire two recent cases that I want to draw to the Minister’s attention. The first in mid-September was reported faithfully by the Northampton Chronicle & Echo on its front page. It said, “16 immigrants caught by police...were told to make their own way” to the immigration offices in Croydon. Those 16 illegals jumped off the back of a lorry, and three were apprehended by the police, who quite rightly phoned the Border and Immigration Agency, only to be advised to encourage those three to make their own way to the immigration offices in Croydon. Effectively, they were released.
If that was not bad enough, later in the same month, a group of African immigrants were found hiding in the back of a lorry in a Northamptonshire village. They were dropped off at a railway station by police and also told to make their way to the same immigration centre.
Mr. Peter Bone (Wellingborough) (Con): I congratulate my hon. Friend on yet again bringing forward for debate a topic that is very important to the people of Northamptonshire. In fact, half the MPs for Northamptonshire are in the Chamber. Does he agree that one problem for Northamptonshire is that if illegal immigrants do not get off the lorries as soon as they arrive from across the channel, the next stop for the lorries is Northamptonshire, where they get out?
Mr. Hollobone: I am most grateful to my hon. Friend for that pertinent intervention. That is exactly the case. The Northampton Chronicle & Echo reported the second case that I mentioned, and it has a quotation from the lorry driver concerned, Mr. Adrian Coe, who found the men in the back of his truck. He said:
“We’d come from France and loaded the lorry up in Paris. But we had to park up in Dunkirk for a break and we reckon that’s where they got in.
When we got to Long Buckby and found them, we held them and rang the police.
We thought they’d take them away somewhere, we didn’t realise they were just going to drop them off at the railway station.”
According to the paper, a spokesman for Northamptonshire police confirmed that the men had been taken to Long Buckby railway station. She said:
“We called the immigration service to advise them we had these people. We were told to advise them how to get to the nearest immigration centre,”
which in Northamptonshire’s case is Croydon.
In the space of less than a week in the middle of September, there were two nonsensical cases in which illegal immigrants were released to do whatever they liked illegally in this country.
Mr. Nigel Evans (Ribble Valley) (Con): My hon. Friend calls it nonsensical, I call it bonkers. If one travels from the Gare du Nord, there is proper security, including British officials who check one’s passport before one is allowed to board the Eurostar train. Surely that should be replicated at all ports where lorries get on vessels to travel to the United Kingdom, and heat-seeking technology should be used that would be able to show whether any bodies were on the lorries. The best way to control illegal immigrants is to ensure that they do not come to the United Kingdom in the first place.
Mr. Hollobone: I am most grateful for that very wise intervention. My hon. Friend is absolutely right. The Government must ensure that lorries are searched when they arrive in this country.
Mr. Evans: Before they arrive.
Mr. Hollobone: Before they arrive. I would check them on as many occasions as I possibly could.
There is also an important point about the welfare of those poor individuals. There have been horrible examples of lorries packed with illegal immigrants in dreadful conditions, and some people have died on their way into the country, which is why we need to secure our borders and ports. Being an island nation, it ought to be relatively straightforward.
I have mentioned two cases in Northamptonshire, but I am afraid that it is not just a Northamptonshire problem.
Mr. Brian Binley (Northampton, South) (Con): I was the person fortunate—or unfortunate—enough to receive a phone call from the lorry driver in the first incident, and I not only raised the matter with the local police but wrote to the Home Secretary, arguing that although those people were supposed to come from Iraq, we did not know whether they were infiltrators from Iran, terrorists, healthy, criminal or whatever. We were amazed at the response. I therefore wrote to the Minister—
Mr. David Marshall (in the Chair): Briefly.
Mr. Binley: May I say what I wrote, Mr. Marshall? It is pertinent, if you will allow it.
Mr. David Marshall (in the Chair): Interventions should always be brief, so please hurry up.
Mr. Binley: I shall try to keep my intervention as brief as possible.
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