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15 Jan 2008 : Column 197WH—continued

10.23 am

Mike Penning (Hemel Hempstead) (Con): I join other hon. Members in congratulating the hon. Member for Twickenham (Dr. Cable) on securing this debate. As we have already heard, it runs on the back of the debate on 24 October 2007, which was secured by my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright). My hon. Friend has not vanished; he is acting as Whip on the Health and Social Care Bill Committee. I understand that he apologised before he left us.

We need to address this massively serious area of public health. I congratulate the hon. Member for Twickenham on raising not only the very important issue of his own constituency but also the excellent work that Age Concern and others have done in this field over recent months. I want to take this opportunity to praise Age Concern for its report and the work it has been doing. I know that the Minister has read the report, and I wonder whether he will respond to the 35 points that the organisation has raised in its summary and conclusion. Will the Minister let us know how many of those recommendations he will accept and how many he will reject?

I am conscious that this is not a bipartisan debate; it is too serious for that. I am also conscious that, on this issue, we are seeking guidance from the Minister about how he intends to take forward certain issues. I am sure that he will consider the constituency problems of the
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hon. Member for Twickenham, but there are other issues. Following the speech and the comments made by the Minister last summer, he built up expectation levels among those who care for older people with mental health problems. Some 3.4 million older people may be suffering from mental health disease. That means that about one fifth of the population is involved in caring for such people. That is a very large lobbying group. It is also a very vocal group, who will demand concrete proposals from the Minister to back up the comments that he made in the summer.

I will quickly comment on some of the interventions. My hon. Friend the Member for Castle Point (Bob Spink) raised a very important point, even though the hon. Member for Twickenham did not quite grasp what he was referring to. We all get correspondence about people who need specialist equipment, and this particular issue is very relevant to those who are looking after and caring for people with mental illness in their older age.

My hon. Friend the Member for Rugby and Kenilworth is a member of the all-party parliamentary group on dementia which, as I am sure the Minister knows, is about to take evidence on the usefulness of the medication that is being used in this area. From the evidence I have seen, I have grave concerns about it. A witness statement from the Age Concern report said:

I partly understand where the GPs are coming from. Given the time scales within which they have to operate, it is very difficult to treat someone who comes in suffering from depression. I think that depression is the forgotten subject in this area and it needs to be highlighted. It is very difficult when someone says to the doctor, “I need some time to talk to you.” We need to find ways in which that person can get the help that they need, rather than offering them the simplistic solution of putting them on drugs, to which they will almost certainly become addicted in the short term. In the long term, the drugs could have an even more adverse effect on their health. I look forward to the conclusions of the report from the all-party parliamentary group on dementia.

On Christmas day, I had the honour of visiting my local acute hospital. I visited the 14 wards that were open and the accident and emergency department. On many of the medical wards, half the beds were empty. When I spoke to the sister in charge of the wards she said that wherever possible they had sent people home over Christmas. I think that we all understand that. I noticed that the vast majority of the people still in hospital were elderly and, clearly, in most cases, suffering from some degree of mental health problems. In many cases, people with mental health problems had gone home over Christmas because they had loved ones and carers to look after them. For those who did not go home, the lack of provision within the NHS is stark. All too many of our wards are full of people who should not be there, but in a specialist unit being cared for by experts.

The hon. Member for Twickenham alluded to the time, some 40 years ago, when he first went on to a ward to work. In 1973, just before I joined the armed forces, I spent a year working at my local hospital on the geriatric
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ward, as it was known then. That is not a derogatory term; it is exactly what it was. I, too, at such a young age was astounded by the dedication and professionalism of those who looked after the patients. As we have heard, people were often unable to thank them or give them the credit that they deserved. Today, we may change the terminology that we use, but having gone round the different facilities that look after those with mental health problems, particularly among the older generation, in my constituency, I pay tribute to those who specialise in this field, whether in the public or private sector. In my constituency, Robin Hood house specialises in patients with dementia.

There is an issue that we have not had an opportunity to discuss this morning, and perhaps the Minister will write to me if he does not have the relevant figures before him. Each time I visit the different facilities it has been put to me that the age profile of people suffering from dementia, and Alzheimer’s in particular, is lowering, so that people in their early 60s are suffering from dementia. I appreciate that dementia is a catch-all term and that there are many different areas, but clearly something is going on. Have the Government been looking into any research in that respect?

We have had discussions about whether consultation has been done correctly and not only in relation to the constituency of the hon. Member for Twickenham. He clearly touched a nerve with the Minister when he mentioned the word “consultation”. It is an emotive subject in the community. The Minister is right to say that if a small piece of the NHS, such as a ward, is being moved or small facilities are changing, there cannot be full consultation in the public arena. I think that we accept that. However, when facilities as specialist as those that we are talking about are in the same position, everyone would expect the public and those concerned, particularly the carers, to be involved in the consultation process.

As the Minister knows, I am quite critical of the way in which the consultation process has continued to be operated across the country. We do not want a consultation process to take place in which the public, the experts and the other people involved voice a view, which is then ignored, because that causes even more anxiety and concern. I know that the Minister is aware of that. In my constituency, there was a public consultation in which 86 per cent. of the consultees opposed the relevant closure, but that fact was ignored. That just causes more and more anxiety.

We are talking about the NHS, which is publicly funded by the taxpayer. It is right and proper that major changes in the infrastructure should go out to consultation and that the views expressed in that consultation should be properly listened to. It should not just be a listening exercise, after which those views are ignored. All too often we hear that the decision was made before the consultation process even started, which just causes more problems. The primary care trusts and the different relevant bodies should consider a much more open way of conducting the process early on, so that people have a better understanding of what is happening.

The figures used in today’s debate are quite shocking, but other figures, which have not been discussed, are also frightening and shocking. I passionately believe
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that depression among older people is one of the undiscussed, quiet areas that does not quite receive the publicity that it deserves—it is a major problem. According to figures produced by Age Concern in its report, one in four older people have symptoms of depression, but sadly only one third of those with depression ever seek medical advice or ever discuss it with their GP. Sadly, as we heard from witness statements in the report, even when they do discuss the matter with their GP, they do not receive the type of care that they deserve. That leads to a disproportionately higher suicide rate for older people. We should consider the figures in the report. It cannot be right that the older generation, who have done so much for us—the generations who follow them—have a disproportionately higher suicide rate because they are not receiving the help that they often need.

I fully understand, and I am sure that the whole House would understand, that people are often frightened of talking about the fact that they have depression or that they feel they have the early signs of Alzheimer’s or dementia. It is for us as a community to come up with ideas to assist them, so that there is no stigma in any shape or form should people feel that they have a problem or others feel that they are starting to have problems.

We have rightly praised Age Concern, Help the Aged, the Alzheimer’s Society and Mind, and there are many other groups—small and large groups in our constituencies that do so much work—which we will not have an opportunity to talk about today. However, I would like to talk in more depth about carers—the carers who do so much for their loved ones. They do so not for money and not because they have been asked to go along and help as a volunteer, but mostly because it is their loved ones who are suffering.

I, too, have family experience. By the time I was 15 or 16, my great-aunt, who was mostly responsible for bringing me up, had no idea who I was. She had no recollection at all of the wonderful life that she had lived in the 62 years before the most difficult stages of her Alzheimer’s. Sadly, she lived for nearly another 20 years. That sounds like a terrible thing to say, but she had no life. She destroyed my great-uncle’s life, but he would not let her go into a home—he would not let her be taken away. In those days, there was not much respite. There is some respite today, although there are great concerns that some respite care centres are closing as well. In my constituency, there are real problems in that respect.

Without those wonderful people, what would the state do? What would we be able to do without those generous, caring, loving people who look after their loved ones in such a way? So when they do seek help and a little respite care, it is very difficult for them to learn that units are possibly closing and that there is not the necessary back-up from acute services, which we heard about. More training is needed in the acute sector to help people with this type of medical condition when they arrive at acute facilities.

I praise the Government for the increased expenditure that is there today in the NHS. However, it is difficult for the public to understand when units are clearly closing or being reconfigured or care is being transferred to other service providers because of money. There must be a better way of sorting out the situation and funding services through the system. I accept that there
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is a conflict between the local government funding side and the NHS side of mental health provision, but we need much more joined-up thinking. Actually, what we need is not more joined-up thinking, but more joined-up action—action that the Minister promised. The talk has happened and perhaps the action will now start.

10.38 am

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate and on setting its tone. We have had a high-quality discussion, free of the usual party politics and, as the hon. Member for North Norfolk (Norman Lamb) said, we have been addressing one of the great public policy challenges that faces our society and all political parties and it is the responsibility of Government. May I also say to the hon. Member for Twickenham that the way he talked about his own experience with his mum was very moving? We should remember that the situation that we are discussing is reflected in an increasing number of families throughout the country. It does the body politic good that occasionally we talk in the language of our own families and life experiences, which shows that we are not as out of touch as sometimes politicians of all colours are accused of being.

As the hon. Member for North Norfolk said, this issue is one of the great challenges that our society faces. I refer to the fact that we live in a society in which people live longer and, in doing so, have increasingly complex conditions such as dementia. In his recent speech on the NHS, the Prime Minister said that demography was one of the top challenges facing the NHS. That is an important step forward because, often, the debate is solely about social care, but demography is every bit as important. As the hon. Gentleman for Hemel Hempstead (Mike Penning) said, if one goes to an acute hospital, one will see an incredibly high number of older people receiving care. That is a challenge for the social care system, but, equally, it is a challenge for the NHS and, arguably, for all public services. If the demography of our society is changing, the future development of all kinds of public policy will have to reflect it.

People’s expectations are very different now. The vast majority of people wish to remain in their own homes rather than enter institutionalised care. That does not mean that there is no need for specialist, high-quality residential nursing units—there is, and there always will be—but the reality is that the vast majority of people, given the choice, would wish to stay in their own homes. The baby boomer generation—I shall not fit any particular Member into any particular generation—have much higher expectations of care than our grandparents’ generation, both in terms of the quality of care and of the level of personalisation.

As I have said before, I intend to bring dementia out of the shadows. For too long, individual families have struggled and battled with dementia, but public policy has almost been in denial about it, instead focusing on the generic needs of older people without recognising that dementia brings with it particular issues. Anybody who has seen the powerful and shocking documentary in which Barbara Pointon allowed the filming of her husband Malcolm’s deterioration could not help but
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understand the power of the condition for the individual and the family member. I am delighted that I have got to know Barbara recently and that she is playing an active role in the development of our national dementia strategy, and in the Department’s work with carers.

I have also focused on making the case for putting the dignity of older people at the heart of our care services, and I shall continue to provide leadership on that. I do not believe that there are easy solutions or magic wands, or that we can run every hospital, GP surgery and social care service, but providing national leadership that says that dignity at all times must be at the heart of care for older people would begin to make a difference and to get the debate going in every care establishment up and down the country.

The hon. Member for Twickenham talked about a number of issues. He was on to something when he put dementia alongside cancer, stroke and heart disease as a condition that challenges the NHS. Dementia should be given a much higher status and reflect the priority that we give to it. He was good enough to say that practice on older people’s mental health has improved in the past 10 years, but we are beginning in deficit, because practice is nowhere near as good as it needs to be. However, he said that we have seen advances in the way in which care is provided in the past decade.

The hon. Gentleman raised the issue of Marble lodge in St. John’s hospital in his constituency. Quality of life without medication is the ethos of that institution, which provides a calming environment——as he said, an oasis of peace. Those are the qualities, characteristics and attributes that people with dementia and their families in every part of the country would want. However, I must tell him that I cannot instruct local NHS organisations how to do their business. He made a powerful case when he said changes should not be made in advance of the national dementia strategy, without, perhaps, all the evidence on the direction of policy. The people charged with making such difficult decisions—it is a difficult change to make—should consider whether it would be appropriate. I should also like to put on record that the national dementia strategy will be published in the autumn, but a consultation document will be presented in June and people will have the opportunity to comment before the final strategy is produced.

The hon. Gentleman may want to acknowledge that carers have been involved in the tendering process—they have had input and oversight. To say that there has been no engagement or consultation in the case he mentioned is not fair, because significant attempts to engage and consult were made. Indeed, the matter was originally referred to the overview and scrutiny committee of his local authority, which chose not to express any reservations about the change. It subsequently had second thoughts and raised its concerns, but to say that there was no consultation is not fair. The hon. Gentleman did not say that there was no consultation, but the hon. Member for Hemel Hempstead spoke of consultation in a derogatory way. Genuine attempts to engage on the issue were made, but because of the unique nature of the unit, there is a great deal of emotional attachment to it and a great belief that the clinical care it provides is of the highest possible standard. I would be happy to speak privately to the hon. Member for Twickenham about that particular situation.

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The hon. Member for Rugby and Kenilworth (Jeremy Wright), who has left the Chamber, does an excellent job as the chairman of the all-party group on dementia, and the group makes an important contribution to the debate.

The hon. Member for North Norfolk made a constructive and helpful contribution, and I echo his tributes to Age Concern, Help the Aged, the Alzheimer’s Society, Action on Elder Abuse, Mind and, indeed, to carers organisations such as Carers UK, the Princess Royal Trust for Carers, Crossroads, Partners in Policymaking, and the Royal College of Psychiatrists. Those organisations frequently ensure that older people’s needs are placed far higher on the political agenda than they would be by constantly pressuring parliamentarians and using the media, and by championing the interests of older people and their families, so I pay tribute to them.

The hon. Gentleman talked about funding. We spend large amounts of money, in every community through the NHS and local government, both on social care and on mainstream well-being services through the benefits system, but that is not often not referred to in debates such as this. We spend money, for example, on the disability living allowance, the attendance allowance, housing, and, indeed, we spend money through excellent third and voluntary sector organisations. We need to get to a situation in which we have a joined-up, integrated approach to health and well-being in every local community that shifts us toward early intervention and prevention. We signed the “Putting People First” concordat before Christmas with local government and the NHS. I believe that in the next three years, a radical transformation of the social care system in partnership with the NHS, focused on a shift to early intervention and prevention, and on giving people maximum control and power through personal budgets, universal information and advice to people, including those who fund themselves, is massively important. It would begin to transform well-being services in every community in every part of the country.

Norman Lamb: Is the Minister indicating that he sees a need to integrate fully the funding that comes through the benefits system? For example, attendance allowance could be provided through the care system so that there is one mechanism for providing funding and support.

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