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15 July 2008 : Column 12WH—continued
My hon. Friend the Member for Sutton and Cheam mentioned anti-psychotic drugs—an issue on which he has campaigned tirelessly. Other Members mentioned it, too, but I know that the issue is dear to my hon. Friend’s heart, and I pay tribute to him for highlighting the scandalous way in which those drugs have been used and, unfortunately, in too many circumstances, are still being used inappropriately as a chemical cosh to suppress rather than to treat. The chilling reality is that, in some cases, the use of those drugs shortens people’s lives when they simply should not be used, or are not being used for an adequate medical purpose. I support his calls for a review by the National Institute for Health and Clinical Excellence—I should be interested to hear the Minister’s comments—on Risperdal and on the general principle. It is extremely important.
I also echo the comments, made particularly strongly by the hon. Member for Worsley (Barbara Keeley), and by the right hon. Member for Oxford, East (Mr. Smith), that we must ensure that there is joined-up thinking between the national dementia strategy and—something else that the Minister has championed—the national carers strategy. I sit on the Select Committee on Work and Pensions, which is examining carers’ roles from the point of view of the responsibilities of the Department for Work and Pensions, and there clearly has to be joined-up thinking. In this debate, we have heard powerful accounts of the reality of life for families, carers and spouses—elderly spouses, who so often care for people with dementia. All of us who have witnessed such situations, either through families or through constituents, know that they are incredibly distressing. People have to care for their loved one while they are grieving for the loss of that person to dementia. It is tragic, and our society must do all it can to support them.
We are all aware of the role that carers play in society, and I am pleased that their importance is being pushed up the agenda, and that their contribution to society is being increasingly recognised. We must acknowledge that carers for dementia sufferers save the social and health services about £6 billion a year, and I hope that we all echo the calls of organisations such as Help the Aged, which want the everyday rights of carers throughout the country to be acknowledged and the care and support system to be fundamentally overhauled, particularly for people with dementia, who have specific needs.
This debate has been very positive, and I look forward to the Minister’s response to the points that my hon. Friend the Member for Sutton and Cheam made. We all agree about how pleasing it is that these issues are firmly on the agenda, that we are talking about them and that things are moving forward. All parts of the House want to be part of the process, and we have to ensure that the results of the consultation and the subsequent national carers strategy transform the lives of people who are affected by that most tragic of conditions, and help their families. I hope that as a society we will then stop brushing dementia under the carpet, and I applaud all the attempts to bring the condition out of the shadows. The fact that we are talking about it today is a very positive step.
10.16 am
Mr. Stephen O'Brien (Eddisbury) (Con):
I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this important debate, which is timely, given
the recent review by the all-party dementia group, ably chaired by my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), on the use of anti-psychotic drugs; the report on the dementia tax by the Alzheimer’s Society; the consultation on the Government’s national dementia strategy, including the focus on anti-psychotic drugs as a direct result of the work by the all-party group; and, embracing all that, the Government’s consultation on the future of care and support.
In addition, as the baby boomer generation becomes involved in long-term care for older people, and the demographic bulge brings bigger pressures to bear on our health and social care services, the issue is, and will remain, a key area of debate now and during any forthcoming general election, whenever it is called, although that does not necessarily mean that it must be an issue of dispute. Many of us who regularly take part in such debates recognise in our constituents the demand, as well as the hope and expectation, that we can find a consensual way forward.
Many Members fully understand that dementia is a collective term for a range of medical conditions. There are more than 100 different forms of dementia. Alzheimer’s disease is the most common cause, accounting for about 55 per cent. of cases, while vascular dementia accounts for about 20 per cent. The Alzheimer’s Society says that there are about 700,000 people in the UK with dementia, and that about 163,000 new cases of dementia occur in England and Wales each year. It is a life-shortening illness, although another illness is often the main cause of death. However, average life expectancy is unpredictable: the disease can progress for up to 10 years, with average life expectancy being about six years.
From a public policy point of view, that gives the disease particular complexity. About one in three or four people will need long-term care, and of that number about a fifth will have some form of dementia. Furthermore, about a third of those with dementia need institutional care and two thirds of the care home population either has, or will have, some form of dementia. Although the incidence of dementia increases significantly with age, particularly among those aged 85 and over, it is important to note that there are approximately 18,000 people under 65 in the UK who have dementia. I would be interested to hear from the Minister what account will be taken of those people in the dementia strategy.
As we know, in the next 20 years, the number of people aged 85 and over in England is set to increase by two thirds compared with a 10 per cent. growth in the overall population, according to Derek Wanless’s 2006 predictions. That is expected to lead to an increase in dementia occurrence. In August 2005, results from the Medical Research Council’s cognitive function and ageing study showed that improved health and mortality were not likely to guard people against the risk of developing dementia. Although there is no vaccination or cure, dementia is most common at an advanced age, so a fairly modest delay of a few years in the onset of the disease, or in its progression, could mean a significant reduction in the numbers suffering from it.
Under Wanless’s predictions on social care, an estimated £14 billion gross spend in 2006-07 is forecast to double to between £24 billion and £31 billion by 2026, depending on the decisions that we make now. It is likely that the cost of dementia in 2026 will be about £12 billion to £14 billion. At a personal level, the Wanless review
estimated that the cost of residential care for the elderly mentally infirm was 14.1 per cent. higher than for “ordinary” elderly residents, and that the cost of nursing care was 4.7 per cent. higher. The report, “The Dementia Tax”, by the Alzheimer’s Society highlighted the unfairness of the situation for people who need care because of dementia, and for their families: dementia it is a medical condition, but invariably it requires social care.
There are wider issues in dementia care than the actuarial estimations about current and future support. It is easy, as we consider the commitment of the British taxpayer to this issue, to forget that we are dealing with individuals such as ourselves and families similar to our own, with all the emotional, spiritual and physical needs that come with our humanity. It is right that we bear in mind those people that we know—friends and family—who have dementia, or who care for someone with it, as we debate these issues.
One big area of work, which has recently given rise to public outcry, is the use of antipsychotic drugs in care settings, which was touched on by all the contributors to the debate, and by those who intervened. I pay tribute to the work of the all-party group on dementia, particularly my hon. Friend the Member for Rugby and Kenilworth for his chairmanship. In its report, “Always a Last Resort”, the group made a key point:
“There are serious concerns that there is widespread inappropriate prescribing, for example, antipsychotics are being used for people with dementia who have mild behavioural symptoms and prescribing is often continued for long periods of time...This is despite the fact that antipsychotics have limited benefit for people with dementia, particularly when prescribed for long periods, and despite the serious side effects associated with their use...Side effects include excessive sedation, dizziness and unsteadiness, which can lead to increased falls and injuries, as well as body rigidity and tremors. Research shows that there is almost a doubling in the risk of mortality and an increase the risk of stroke by up to three times.”
I am therefore glad that the Government have taken up the report’s criticisms in their consultation on the national dementia strategy, and I pay tribute to the Minister for doing so.
Another concern is the closure across the country of care homes for the elderly mentally infirm. There is concern not only about the provision of places to those who need them, but about the provision of places in locations that are convenient for friends, family and, in some cases, spouses, who might well be dependent on public transport to get there. We heard in an intervention about the vital need to emphasise ways in which we can best try to keep couples together. I have tabled parliamentary questions on the matter, but I was told that the Department of Health does not collect the relevant data centrally. I would therefore be grateful if the Minister would consider writing to me, and anybody else who is interested, to outline what information the Department does collect in this area. I was hoping that I might even get a quick nod of agreement from him, but I have not quite seen that happen so far. Perhaps he will address this issue in his response, but it would be helpful if we could at least know what data are collected, or whether he thinks that the Department should start collecting those data centrally, to ensure that we look at the geographic spread of places for the elderly mentally infirm, and whether
provision is being lost or maintained, so that we can start examining how we keep families and communities together.
Another key area of policy is telecare, which enables individuals to live independent lives and carry on living in their own home even as their dementia progresses. That is clearly a very large and wide subject, and I think it may be the subject for another debate. However, it is important to mention it briefly, as it is a key issue. Finally, there is the issue of drugs, particularly for the early stages of Alzheimer’s. I pay tribute to all those who have campaigned on this issue, not least one of my own constituents, Leila Potter, who has been engaged for many decades with all the issues arising from caring and support for those with dementia. It is only right that NICE take into account as part of its criteria wider societal costs, such as the earlier requirement for care that would otherwise not be needed if drugs were prescribed at an early stage.
As the Minister knows, for more than a year, we have proposed as policy that NICE should make its judgments taking into account those wider costs. That is important, because it would require a change in NICE’s statutory remit, and thus would require primary legislation. It is something to which my party is committed, and I was very pleased to hear the hon. Members for Sutton and Cheam, and for Leeds, North-West (Greg Mulholland), confirm their interest in, and support for, that policy. I just hope that the Government can tell us, either today or very shortly, that they, too, are minded to support that policy and will introduce the necessary legislative proposal.
The report, “The Dementia Tax”, highlights one of the key questions facing the Government: do they deal with dementia as part of the discussion on care and support, or do they deal with it separately? What is certain is that we would have been in a much stronger position to confront the growing issue of dementia if the Government, having waited for so many years, indicated how they propose to resolve the question of funding long-term care.
I do not need to remind the Minister that the former leader of his party, Tony Blair, said in his 1997 conference speech:
“I don’t want to live in a country where the only way pensioners can get long term care is by selling their home”.
That promise has been around for more than a decade, but only a little has been done about the issue. I think that the Minister would have to admit that the take-up for what has been made available has been paltry. In fact, the present Prime Minister, in launching the consultation, said that
“younger adults are aware that much of their parents’ hard earned housing wealth may disappear...at some point in the future they may have to sell a treasured home to pay for their own care...too many people fear the prospect of selling their homes”.
He therefore continues to ape his predecessor, rather than take the requisite action. The Government rejected the proposals from their own royal commission; they rejected the requests made by Derek Wanless to conduct a review for the Treasury into long-term care; and they rejected his findings when he was able to conduct such a review through the King’s Fund.
When the hon. Member for Birmingham, Hodge Hill (Mr. Byrne) was Parliamentary Under-Secretary of State for Health, he announced a review group, which barely met, to introduce a policy following the comprehensive spending review. The Minister who is with us today gave countless assurances that he was winning his tussles with the Treasury, which were all to no avail when the CSR was actually published. We do not have as yet the results of those consultations, which we hoped would give the Treasury the competence it needs to deliver the “new settlement”, to quote the Minister, that he hoped to announce.
We now have a consultation preceding a Green Paper—in his winding-up speech, the Minister might want to outline the difference between a consultation and a Green Paper. At best, the debate on the future of care and support shows that the Government are still searching for an idea; at worst, it is another attempt to dodge the issue until after the latest date for the next general election. Perhaps, therefore, I could invite the Minister to confirm the Government’s intent to resolve this issue before 2010 or, if the polls are anything to go by, to leave it to others to do so after that date.
10.29 am
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 debate and, perhaps more importantly, on the work that he has done over many years to raise the importance of dementia care within and outside this place. It is now acknowledged as one of the big health and social care challenges of our time, and he deserves significant credit for our having reached the stage that we are at today.
Before I address some of the substantive points made by the hon. Member for Eddisbury (Mr. O'Brien), I would like to point out that we sit in debate after debate in which he simply reels out a narrative about the nature of the challenge, the statistics and the existing situation. He is a spokesman for Her Majesty’s official Opposition, but he never knowingly comes up with a tangible policy solution to any of the major public policy challenges. I do not blame him, because we all know the situation. The shadow Chancellor has made it clear that there are to be absolutely no spending commitments from his party before a general election, but it is rich for the hon. Member for Eddisbury to lecture me when in fact the Opposition do not appear to have any credible policies whatsoever on these issues.
Let me return to the substance of the debate, during which hon. Members discussed the context. Demographic change is one of the biggest challenges that now face our society. Arguably, it is every bit as much of a challenge as globalisation, climate change or fundamentalist terrorism, but rarely does it feature on the list of the top four or five priorities. As people live longer, an increasing number will have long-term conditions. Alongside that, people’s expectations about and aspirations for the quality of care and support that they will receive are radically different from those of the previous generation.
As the hon. Member for Eddisbury rightly said, two thirds of people in care homes have dementia. It is estimated that over the next 20 years, one third of those over 65 at death will have the condition dementia. It is
one of the biggest issues that the health and social care system faces. Last summer, I committed the Government to bringing it out of the shadows.
As my hon. Friend the Member for Worsley (Barbara Keeley) rightly said, it is important that we do not simply look for solutions to the challenge presented by dementia, or develop a dementia strategy in isolation. It is incredibly important that we look at the reform agenda in the round. Therefore, when the hon. Member for Eddisbury accuses the Government of a lack of action in such areas, it is because he seems blissfully unaware of the radical reform agenda that the Government have laid out in the past year for health and social care in this country. From 1 April this year, the “Putting People First” transformation agenda, which is supported by more than £500 million of investment, will be rolled out in every local authority area. We are shifting the system to prevention and early intervention, providing universal information and advice, and moving to a system in which the vast majority of people have personal budgets so that they can exercise maximum control and choice over their own care.
Lord Darzi’s report only last week—it coincided with the 60th anniversary of the national health service—has a strong emphasis on the working parties in each strategic health authority, and his national enabling report discusses the importance of mental health issues. The primary and community care strategy that we launched last week deals with the need to look again at the incentives, quality and outcomes framework—QOF—points and so on that inform the behaviour of general practitioners and other health care professionals involved in primary and community care.
As hon. Members have said, we have also embarked on a national consultation on the review of the care and support system. What care and support do people have a right to expect in the 21st century, and what are the respective responsibilities of the state, the family and the individual in that context?
Within the past three or four weeks, we launched the national carers strategy, and, a couple of weeks ago, the consultation on the first ever dementia strategy. In the very near future, we will launch the first ever end-of-life care strategy. I would gently say to the hon. Member for Eddisbury that there has never been as much policy focus, investment of resources and facing up to big challenges as there has been during the most recent period.
I shall respond directly to some of the points that the hon. Member for Sutton and Cheam raised. First, he and other hon. Members mentioned the impact on families. Unless one has met a family who are dealing with dementia, it is difficult to understand the scale of the trauma, anxiety and guilt that the condition causes. I agree entirely with my hon. Friend the Member for Worsley about the test that we should set for health and social care services. I have used it myself. If the care would not be good enough for my mother or father, why should it be good enough for somebody else’s mother or father? That is the test that, over time, we should seek to establish.
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