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1 Apr 2008 : Column 211WH—continued
Ian Pearson: I will answer some of the questions put by my hon. Friend, but first, let me put on record the broader picture, in response to the hon. Member for Windsor (Adam Afriyie). It is a matter of fact that there has been a real-terms increase in the overall science budget. The Labour Government have more than doubled the science budget over the last 10 years; by 2010-11, the budget will have tripled since we came into power. However, science does not stand still and decisions will be taken on the basis of scientific priorities. Whatever budget is given to a research council, there will always be more projects that they want to support than they are able to fund. Therefore, decisions have to be taken, but they must be taken on the basis of the best available science.
It is for the Government to set the overall budgetary figures and to approve delivery plans for the research councils, and I think that that is what we do. As part of that process, we will scrutinise those delivery plans in some detail to ensure that they are in accordance with Government policy.
Ian Pearson: I am coming on directly to the point made by my hon. Friend. It is clearly Government policy to develop Daresbury and Harwell as science and innovation campuses. I would not have recommended approving a delivery plan for the Science and Technology Facilities Council if that plan did not include proposals to develop Daresbury as a science and innovation campus.
We do not have a regional policy, as such. As I have explained to my hon. Friend, research council decisions are made on the basis of a peer review of science. However, individual delivery plans must be in accordance with the strategic priorities of the Government, which includes a clear regional element, because we want to see Daresbury developed as a world-class centre for science and innovation. As part of that aim, I say to hon. Members that we accept the argument that there needs to be a critical mass of world-class scientists undertaking research at Daresbury. Over the coming months, I hope that hon. Members will be able to see clear demonstrations of the Government’s commitment to retaining that critical of scientists.
Graham Stringer: As ever, my hon. Friend makes fair points about the overall allocation of funding. However, it was a Government commitment that the STFC would be left with no legacy issues and yet, because of the overrun of the costs of Diamond by £75 million, the STFC has been left with a deficit. We are seeing part of the problems of dealing with that deficit in Daresbury, are we not?
Ian Pearson: No, we are not; that is not my understanding of the facts of the case at all. I have been informed that Diamond was built on time and on budget, and that its running costs position has been known for a number of years. I also must disagree with my hon. Friend when he calls the UK Centre for Medical Research and Innovation “a dog’s dinner” as a proposal. I do not believe that it is “a dog’s dinner” at all; it will be a centre for world-class research in the UK and it should be recognised as such.
As is the case with all these things, these proposals will have their scientific case evaluated and their business
case scrutinised. If those cases do not stand up to examination, these projects will not go ahead. Also, as a result of what is called the lion’s case, they will have to consider whether relocation outside of London would be appropriate.
Let me move on directly to the situation at Daresbury. First, I would like to address the situation regarding redundancies. Hon. Members will know that, as a result of decisions taken some time ago with regard to the SRS, there has been a redundancy situation. There has also been a redundancy situation with regards to voluntary redundancy across the STFC’s sites, as it looks to reprioritise the work that it does.
Yesterday the STFC issued nine notices of compulsory redundancy in relation to the planned closure of SRS and five more cases are being considered. The STFC will do everything that it can to minimise any further need for compulsory redundancies on SRS, but, as I said before, the situation has been known for some time.
Ian Pearson: I am afraid that I will not give way, because I need to respond to the points made by my hon. Friend the Member for Manchester, Blackley.
I want to make it clear that the STFC will develop the Daresbury science and innovation campus as a joint venture with the Northwest Regional Development Agency, the private sector, universities and Halton borough council. Furthermore, Daresbury will continue to be a major plank in the Government’s national science and innovation agenda.
The medium-term strategy is clearly to continue to develop the campus, both on the science side, where we need to have world-class expertise, and on the innovation side. The STFC will complete the current investment in the energy recovery Linac prototype project as a technology demonstrator.
I heard what my hon. Friend the Member for Weaver Vale said about the ALICE project; I hope to see it tomorrow when I visit Daresbury. The situation, as he will be aware, is that the STFC has conducted a number of programmatic reviews; it has consulted on them, but it has not taken any decisions on them. So I cannot confirm that ALICE will go ahead as a project, because those decisions have not yet been taken by the STFC, so we will be in a difficult limbo situation for some time to come. However, I hope that he will be able to receive good news on ALICE in the future.
The Government have already made it clear but I stress again that 19 out of the 25 people assigned to work on the new light source project are located at Daresbury. The project will be managed by Dr. Frances Quinn from Daresbury. As my hon. Friend knows, Professor Jon Marangos from Imperial college is the project leader and there is a NLS project board, chaired by Professor Tim Wess from Cardiff university, to ensure objectivity and independence.
I heard what my hon. Friend said about having a voice on the STFC, which I think relates to the general point that has been made that the north-west region feels its voice is not sufficiently heard. It is an issue that he will obviously want to take up with the STFC and I am sure it will be interested in his comments.
Tomorrow, I will be visiting Daresbury to make an important public announcement on a further phase of investment in the Daresbury science and innovation campus. I want to stress to everybody here today that I expect that to be the first of a series of announcements that we will make in the forthcoming months, which will further demonstrate the Government’s resolve to make a world-leading success of the Daresbury campus. We also want to see the Hartree Centre developed as a centre for detector systems and continued expansion of the Cockcroft institute. They will be essential planks of our policy as we move forward.
Elder Abuse
12.30 pm
Mr. Paul Burstow (Sutton and Cheam) (LD): I am grateful for the opportunity to raise the serious issue of elder abuse. This is not the first time that I have brought these concerns to the House, nor will it be the last. Over the past 10 years, I have urged Ministers to pay greater attention to elder abuse. I do not want to pretend in this debate that nothing has changed over those 10 years—an awful lot has done. I acknowledge that the Government have done much to develop standard setting, with the introduction of the protection of vulnerable adults scheme and a range of other initiatives that have improved the situation. Clearly, there has been improvement, but there is still much to be done if we are to expose and expunge the scourge of elder abuse from our society.
Today I want to focus on one issue: the use of medication as a chemical restraint. Before doing so, however, I must say that I am a firm believer in serendipity. As Members will know, MPs apply for a debate over a number of weeks and hope that their name will eventually come out of the hat in the lottery for the selection of Adjournment debates. I was therefore pleased when I received the news last Wednesday that this debate had finally risen to the point where it secured a slot. I was even more pleased when, 24 hours later, I learned that three of the issues that I had planned to discuss were being progressed: the closing of a loophole in the Human Rights Act 1998 that prevents a resident in a private care home who is funded by the state from benefiting from the protections of the Human Rights Act; issues around complaints; and the question of research on the prevalence of elder abuse in residential institutions.
That is all welcome news, particularly the news that, at long last, the loophole in the Human Rights Act will be closed, at least partially. It would be churlish to do anything other than welcome that news, and I applaud the fact that the Minister is to introduce amendments to achieve that end. However, I understand from the press release issued last week that the gap will be closed only for residents of care homes who are funded by the state; self-funders will not be protected by the Act. Therefore, when a self-funder crosses the threshold of an independent care home, the writ of the Act apparently will not apply.
I urge the Minister to set out the rationale for that decision, and explain why it is not possible to close the loophole completely. Extending the Act is just the beginning—it is essential but not sufficient. I have heard the Minister make the point in debate that what is required is a cultural change to bring every home up to the standard of the best. Will he therefore say a bit more today about how he intends to go about winning the hearts and minds of care home owners, managers and staff?
Turning to complaints, it is welcome that self-funders will have a right to refer complaints to an independent adjudicator, but, clearly, the devil is in the detail of such a scheme. Just how independent and powerful will the adjudicator be when it comes to settling disputes? Finally, on research, I have argued in debates over the years that we need to commission research into the prevalence of elder abuse in institutional care settings. Indeed, last year’s research funded by the Department and by Comic Relief revealed that elder abuse is a problem in the community, as some 342,400 people over the age of 66
are victims. That was a stark warning and reminder of the scale of the challenge that society faces in dealing with the issue. Research is certainly welcome, but it must not be a substitute for action, which is what I am calling for today.
For several years, I have taken an interest in the inappropriate and even abusive use of anti-psychotic medication in care homes. This is not simply a matter of poor standards in some of our institutions. It demands more than just a response from providers, commissioners and regulators. There is a growing body of evidence from studies and other research about the abusive prescribing and administration of drugs. That really ought not to be a matter just for regulators and commissioners but for the criminal justice system, the police and the courts.
A slap on the wrist from a regulator or social services is not sufficient to deal with the abusive and inappropriate use of medication. Frankly, people should go to prison. Prescribing anti-psychotic drugs to manage the behaviour of elderly people with dementia is a shocking abuse, because the evidence is clear, and has been for rather a long time, that the drugs cut lives short, increase the risk of stroke and have other harmful side effects that create the justification for further prescribing. The drugs create many of the symptoms that are used as a pretext for prescribing drugs in ever greater doses.
Some 100,000 care home residents are prescribed such drugs at any one time, according to research by the Alzheimer’s Association. Based on research presented to the Alzheimer’s Research Trust, I estimate that as many as 23,500 care home residents die prematurely as a result of taking anti-psychotic drugs, which are not even licensed for the treatment of dementia. I understand the difficulties in the ethics of testing drugs on people who are unable to give their consent, and Parliament has debated the issue. Nevertheless, a large part of our population is prescribed such drugs off-licence. That is not illegal: doctors can prescribe licensed drugs for an unlicensed purpose on their own authority. The General Medical Council makes it clear in its guidance to doctors on prescribing off-licence drugs that they must satisfy themselves that the drugs are safe, that good records are kept and that regular medicine reviews take place. However, on the face of it, the GMC’s guidance is routinely ignored by GPs. Prescribing anti-psychotic drugs has become the accepted norm, despite clear guidance issued by the National Institute for Health and Clinical Excellence and by the Social Care Institute for Excellence. Inappropriate and abusive prescribing is an infringement of human rights and should be prosecuted under the Mental Capacity Act 2005 as assault, ill treatment or wilful neglect.
When it comes to the administration of medicines in care homes, the most recent figures—there should be some out in the next couple of months—show that more than 4,000 care homes fall short of the minimum standard. We need to be clear about the fact that we are talking about a minimum standard. When the Commission for Social Care inspection looked at the matter, it concluded:
“People are given the wrong medication, someone else’s medication, medication in the wrong doses, or no medication at all.”
It found many care homes failing to attain or sustain the minimum standard—they get to the standard but then slip back—and that was a recurring theme in several inspections. Indeed, one only has to look at inspection reports to see that recurring deficiency.
The reports on care homes document concerns such as poor storage and record keeping, failure to safeguard residents, inadequate training and supervision, and lack of medicine reviews. Some homes are repeat offenders. How can doctors safely prescribe anti-psychotic medication for residents in homes that are habitual failures when it comes to the minimum standards of medicine management? That brings me to medicine reviews. In 2001, the Government published the national service framework for older people. It promised that by 2002, everyone over 75 should have their medicines reviewed at least annually, and people who take four or more medicines should have reviews every six months. Research by the Medicines Partnership, an agency that works with the Government, states that there remains a lack of clarity in the definition of medication or medicine review. That lack of clarity has led to various interpretations in different parts of the country by different practitioners and, therefore, to inevitable confusion and inconsistency in the application of medicine review practice.
Seven years after the undertaking in the national service framework, what is happening? Is there a clear definition? That is a question to which I do not have an answer. It is not obvious that there is a clear definition against which systematic audits are done to ensure that we gain traction. Does the Minister know how many medicine reviews take place every year? Apparently, that information is not collected centrally, and it is hard to obtain it locally. A lot can happen to someone when they are prescribed a range of anti-psychotic medicine for six months, which is one reason why, in the USA, monthly medicine reviews take place when an older person in residential care is prescribed four or more drugs, with quarterly reviews for those who are prescribed fewer than four. Surely, that should be the standard is this country, too.
Since 1999, the number of anti-psychotic drugs prescribed to people over 60 has risen by 38 per cent. That contrasts with the fact that the population of over-60s in this country over the same period has risen by just 6 per cent. What is going on with prescribing practice for those drugs? Prescribing is wrong if it aims to manage behaviour such as wandering, poor self-care, restlessness, impaired memory, depression without psychosis, unco-operativeness, and agitation. Those are all symptoms of dementia, but they are not a justification for prescribing. However, that is exactly what happens. Using drugs chemically to restrain vulnerable older people with dementia is no different from putting them in a straitjacket. It kills people.
NICE says that there is a two to threefold increase in the risk of death, and a twofold increase in the risk of stroke. Despite all the evidence, we lack the systems and safeguards to protect vulnerable people. Where are the robust clinical governance arrangements to audit prescribing practice? Why are commissioners and regulators so tolerant—one might even say complacent? Anti-psychotic drugs should not be prescribed to people with mild to moderate dementia. Even in severe dementia, the benefits are, at best, limited.
Will the Minister take steps to ban the use of anti-psychotic drugs in the treatment of people with mild dementia? Some people argue that without medication care homes could not cope, but research evidence demonstrates that there is an alternative, on which I think the Minister and I agree—person-centred care in
care homes. When staff are trained and supported, with the emphasis on alternatives to drugs for the management of agitated behaviour, older people’s quality of life can be transformed, and they may live longer. When I raised the issue at Health questions recently, the Secretary of State told me that the national dementia care strategy, which will be published later this year, has a part to play. That is the right approach, so will the Minister confirm that the strategy will be clear and unequivocal about ending the dependency on anti-psychotic drugs to manage dementia?
The guidance from NICE and the Social Care Institute for Excellence is clear about how to respond when dementia causes significant distress, or challenging behaviour develops. Drugs do not help. If the guidance is clear, what is missing? I believe that the answer is leadership. We need leadership by commissioners and regulators to put in place robust audit and action to stamp out bad medicine practice; leadership by the Crown Prosecution Service to send a message that abusive medication is a criminal offence; leadership by clinicians, care home owners, managers and staff to blow the whistle on bad practice and face up to the legacy of lethal prescribing; and, above all, there must be leadership from politicians and Ministers to do everything in their power to protect vulnerable older people from ill-treatment. I hope that the Minister will respond positively, as everyone with an elderly parent or grandparent expects nothing less.
12.43 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this important debate, and on the incredibly effective way in which he has raised issues concerning the dignity, care and protection of older people in a variety of ways while he has been in the House. As the Minister responsible for many of those issues, I genuinely welcome his passion. I also pay tribute to him for his balanced contribution, which recognised that some of the issues are complex, and concern the behaviour of clinicians and regulators. Gently, I say to him that his contribution to the debate is very different from his press release which stated:
“Government fail to act on warnings.”
When politicians complain about spin, and then spin themselves, it is no wonder that the public are sometimes a little sceptical. However, seriously, the hon. Gentleman is passionate about these issues, and not enough hon. Members talk about the needs of older people.
I shall reflect on the specific issues that the hon. Gentleman raised. First, the Government have a good record on the regulatory system. Soon after coming into office, we put in place, for the first time, national minimum standards for what is expected from care providers. We introduced a new regulatory system to ensure that providers’ performance is monitored robustly, and that has led to a significant rise in standards throughout the country, particularly in residential and nursing care. Of course, there are still homes that do not meet the appropriate standards, so we still have work to do.
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