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5.16 pm
Jeremy Wright (Rugby and Kenilworth) (Con): I shall focus on just one aspect of today’s discussion about the Government’s programme of activity for the forthcoming legislative Session: the national dementia strategy, to which the Secretary of State for Health referred in his opening speech. At the outset, I should say that I fully welcome the concept of a national dementia strategy, as, I suspect, do most Members. It is immensely important, and has been for a significant time.
In August 2007, the former care services Minister, the hon. Member for Bury, South (Mr. Lewis)—not the other Bury Member, the hon. Member for Bury, North (Mr. Chaytor)—said that we should work to bring dementia out of the shadows. He was entirely right to say that and I applaud the Government for acting on that impulse and arranging for a national dementia strategy to be brought forward. I hope that the House will forgive me if I cover the reasons why a national dementia strategy is so necessary and why dementia is such an important subject.
The figures may be well known to hon. Members, but I will repeat them. Some 700,000 people in the UK now have dementia. That figure will probably double in the next 30 years, and the cost to the UK economy will treble during that period. That is a significant figure, because the current estimated cost to the UK economy is £17 billion a year, which is more than the cost of heart
disease, stroke and cancer combined. Those are very significant figures, which is why the strategy is, as I said, extremely welcome.
The strategy is welcome, at least in part, because a problem of that scale should never be ignored. That fits into the context of what other hon. Members said earlier about mental health issues more generally. It is true, and worth recognising, that people do not like to talk about mental health issues in the same way as they like to talk about physical health issues. Some stigma is attached—and that is true of dementia.
It is not just recognition of the scale of the problem that we require. We also need people to have the courage to come forward and explain that it is happening to them, and how they are coping with it. In the context of dementia, one of those people is the author Terry Pratchett, who the House will know has recently revealed that he has a form of dementia. Since then, he has actively campaigned on the subject, talked a great deal about research, and described what has happened to him in terms of a tsunami that will hit the United Kingdom. He is right to talk in those terms.
Two aspects of a tsunami are important, and someone who is about to be hit by one will want to know two things. First, they will want to know how big the wave that is about to hit them is; I have said a little about that. Secondly, they will want to know when it will hit. How urgent is the problem? It is with regard to the urgency of the problem that I have some difficulties with the Government’s position. I have no doubt that the Government have done entirely the right thing in arranging to introduce a strategy, but I am becoming a little concerned, as I know others in the field are, that the Government’s sense of urgency has started to slip.
When the former care services Minister spoke about his intention to introduce a strategy, he said that he hoped that it would be available by the summer of 2008. However, the Department of Health issued a press release on 19 July that said:
“The full Strategy, to be launched in the Autumn, will have three main aims”.
I shall return to those aims in a moment, but it became clear at that point that the Government wished to introduce the strategy in the autumn. We know that the Government have a very flexible concept of autumn, but we are clearly no longer in the autumn now. We then asked the current care services Minister when exactly we might expect the strategy. I asked the Secretary of State that question today, too. The Minister has said that it will be introduced shortly and, under further cross-examination, that that might mean early in the new year.
I understand that things are difficult in government. Other priorities arise, and the Government sometimes find that time scales slip a little. However, an issue of such importance and urgency must be dealt with expeditiously. Those involved with dementia—those who have it, those who care for them, and the professionals working in the sector—regard the situation as urgent. They feel that they have persuaded the Government of that—indeed, the Government have made it clear that they regard dementia as a priority. With that must come a sense of urgency, but if time scales continue to slip, that urgency must fall into doubt, which would be extraordinarily regrettable.
The one aspect of the strategy that I urge the Government to regard as especially important is training. Training applies to various different aspects of dementia, and in various ways to those involved with it. The draft consultation document on the dementia strategy says that it will have three main aims. The first aim will be
“to increase awareness of dementia and remove the stigma associated with it,”
“ensure early diagnosis and intervention,”
“improve the quality of care that people with dementia receive”
There can be no argument about any of those aims, and training is key to delivering the second two.
I want to talk about two aspects of training, the first of which is training for general practitioners. They are, as the name suggests, practitioners of general medicine. No one expects them to be experts in every medical condition. However, one of the problems that we face in dealing with dementia is that general practitioners are extraordinarily reluctant to make diagnoses. I suspect that the failure to make such diagnoses is in many cases down to reluctance rather than inability.
It is often said—rightly, in my view—that where we are with dementia now is roughly where we were with cancer 30 or 40 years ago. There is sometimes a sense in the medical profession that it is not worth diagnosing dementia because nothing can be done. One of the problems is that that is largely true. There is currently no cure for dementia, and there are no effective treatments. However, it is not true that absolutely nothing can be done. Any support for or understanding of those with dementia is of such immense value to them and those who care for them that it is worth making any diagnosis as early as possible. If we expect general practitioners to make diagnoses, as we want them to, we will need to give them the training to allow them at the very least to recognise the signs, and to refer patients to a specialist medical practitioner who can then make a diagnosis.
Mr. Stewart Jackson: I pay tribute to my hon. Friend’s work on the all-party group on dementia. Does he agree that it is imperative that the review in the new year, if it arrives, should raise the disparity between government and other funds going into research into dementia, and those going into research into other conditions? We need a public debate, to ameliorate the problems that he has raised.
Jeremy Wright: My hon. Friend is absolutely right about that. The timetable for research is also slipping. The Government have quite rightly suggested that there should be a research summit, and when the Department of Health’s press release was issued, it said that that summit would be held over the summer—in other words, over this past summer. That clearly did not happen either; the timetables are slipping. My hon. Friend is also right to say that the level of funding for dementia research is minimal compared with the funding for so many other conditions. It becomes all the more important to invest in research when we have no cure and no effective treatments, because we are not going to find either unless a substantial amount of research is done.
Rob Marris:
The hon. Gentleman is making a well-informed and thoughtful speech. A moment ago, he referred to training. Does he agree that some general
practitioners need training in Alzheimer’s, for example, to make them aware that it can strike young people in their late 20s? As with other forms of dementia, it is often thought to be solely an older person’s disease but, sadly, that is not the case.
Jeremy Wright: I entirely agree. The problem with dementia is that they have got you coming and going. A doctor will often be unwilling to accept that young-onset dementia could possibly be the explanation, and in cases of older-onset dementia they might well say that there are plenty of other explanations for the symptoms, and that this is simply what happens when people get older. The hon. Gentleman is absolutely right to draw our attention to young-onset dementia, and we also need to persuade the medical profession to have the courage—as well as the knowledge—to make these diagnoses in cases of older-onset dementia.
Training is also important in another respect—training for those who care for people with dementia, either in a residential care home setting or as visiting social workers for people with dementia who live at home. It is crucial that such people have an understanding of what dementia is, how it affects people and what can be done to ameliorate its symptoms. It is remarkable that anyone who works in a care home has to receive training in lifting, handling, fire regulations and many other things, yet they do not have to undergo even one single hour of training in dementia. That is even more ridiculous when we consider that a substantial proportion of the care home population—perhaps some two thirds of them—have dementia, and that that proportion is likely to increase.
The policy of this Government is—as, I am sure, the policy of any future Government would be—that people should be cared for in their own homes for as long as possible, and for as long as they wish. That means that those who have to be cared for in a residential environment will, generally speaking, be those who cannot be cared for at home, and substantial numbers of those people will be in that position because they have an advanced form of dementia. It is therefore becoming more important than ever that those who work in a care home environment understand dementia and receive training in it. The Government’s dementia strategy states that training is important and that the strategy will cover it. I very much hope that when they put the final touches to the strategy, they will recognise how important that subject is, and that it should run through all the aspects of dementia that the strategy rightly seeks to address.
In my last point, I want to link what I have been saying to the theme that has rightly emerged in many hon. Members’ speeches today, by saying something about the tragedy of baby P and all that surrounds it. The argument for training for the broader social work profession is also relevant here. We need a better-trained social work profession. We know that numerous substantial mistakes were made in the case of baby P, and in other cases that we have heard about, and it seems to me that training is part of the answer. However, training can be of real value only if we can retain the staff who have been trained. One of the problems in the social work profession generally, and in the care home sector in particular, is that it is very difficult to keep members of staff in position for long. There is a huge amount of
churn in the profession. People do not stay in one job for long, and the training that they have received may go to waste if they move on to another job or occupation.
We need to examine ways of keeping people in their jobs for longer, and one of the ways of doing that is to recognise that the caring professions are just that. First, they are made up of people who wish to care. Secondly, they are made up of people who wish to be treated as professionals. We have to allow them to achieve both those aims. One of the counter-intuitive aspects of the baby P incident, it seems to me, is that when we hear about those terrible failures in the social work profession, we put down social workers as a result. As I say, however, counter-intuitively, the right answer may instead be to raise up the social work profession and say how important it is, if we expect people to act as qualified professionals with good judgment, and to give them the training and then the space to exercise it. That is a hugely important lesson to draw from this episode: it is not an easy lesson, but it is an extremely necessary one.
Let me finish where I began—on the dementia strategy—and say to the Government simply this: I welcome the strategy, as I think most sensible people would, but the Government have raised many hopes in bringing it forward, so they must not disappoint. The strategy must deliver not just the detail but the urgency that the Government promised. We must see it brought forward soon, because it seems to me that there are few more important things that any Government can do.
5.31 pm
Michael Gove (Surrey Heath) (Con): I thank you, Mr. Deputy Speaker, and the Government Front-Bench team for their understanding in allowing me to leave the Chamber briefly earlier in order to see my daughter’s nativity play. Even though we all face tough economic circumstances, I know that all hon. Members will want to find time in their schedules for seasonal festivities.
I was particularly pleased to read about the great fun had by all at the Christmas party held by the Secretary of State at the Department for Children, Schools and Families. I understand that, as well as wine and canapés, the Secretary of State also laid on for members of the press a Scalextric demonstration, a Nintendo Wii and some Star Wars light sabres. Those were not products acquired during the seasonal sale that Woolworths has just launched to celebrate the life-saving effects of the recent VAT cut; nor were they the toys that the Prime Minister threw out of his pram on hearing what the German Finance Minister thought of his policies. They were, in fact, there to help members of the press celebrate the first anniversary of the children’s plan.
I also understand that the climax of the party was a light sabre duel between the Secretary of State and Mr. Michael White of The Guardian, modelled on the epic duel between Darth Vader and Obi-Wan Kenobi in Star Wars—these are serious times and we need serious people. I also understand that the Secretary of State won, and I am sure that, as he triumphed, he uttered the words that the Home Secretary spoke to my hon. Friend the Member for Ashford (Damian Green) just the other week—“May the force be with you”. But whether or not we believe in the force, and the power of the dark side, I am sure that we can forgive light-heartedness at this time.
Of course, some hon. Members may have been in good spirits yesterday for reasons other than the formal anniversary of the children’s plan. They may have been listening to the Prime Minister taking pride in his global rescue plan. Well, we now know what the man in charge of Europe’s biggest economy thinks of that. The Prime Minister may believe, in his more modest moments, that he is Franklin D. Roosevelt, but the truth is that he is closer to a political Max Mosley: he thinks he is king of the world and he has clearly got money to burn, but all people remember is that he got a terrific spanking in German. [Interruption.] Thank you.
We have had a good debate this afternoon. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) brought his customary authority and gravitas to discussion of the NHS, underlining his reputation as a stalwart friend of health professionals everywhere. The Secretary of State for Health made the traditional partisan points with his customary lightness of touch and discussed forthcoming Bills in a way that reminded us why he is such a valued member of this Government.
The hon. Member for North Norfolk (Norman Lamb) brought his considerable intellect and passion to bear, and I welcome the increasingly reformist focus of Liberal Democrat health and education policy. The hon. Member for Huddersfield (Mr. Sheerman), the Chairman of the Select Committee on Children, Schools and Families, spoke comprehensively and well, and with particular authority on the need to improve child protection. My hon. Friend the Member for Gainsborough (Mr. Leigh), Chairman of the Public Accounts Committee, combined a proper regard for efficiency in the public sector with pungent prescriptions for reform, not all of which I necessarily share.
The hon. Member for Gateshead, East and Washington, West (Mrs. Hodgson) made a series of telling points on the need to improve support for children with special educational needs. My hon. Friend the Member for Ilford, North (Mr. Scott) spoke with great passion about the need to improve the service that his constituents get from the NHS. He also made a powerful plea on behalf of children with special educational needs.
The hon. Member for Mitcham and Morden (Siobhain McDonagh) spoke persuasively in favour of the NHS constitution, using her constituency experience to powerful effect. The hon. Member for Birmingham, Yardley (John Hemming) spoke, as he has done so often and with such passion, on child protection. In an intervention, he asked specifically whether we agreed with the terms of Lord Laming’s inquiry. We do not, as we made clear in a letter to Lord Laming. We fear that they are too narrow. We want Lord Laming to ask not just whether his 2003 recommendations are being followed, but whether we need to do more to reform the child protection system.
Lord Laming has said that the foundation of current children’s services is robust, but we are not persuaded of that assertion. He also argues that serious case reviews, including the serious case review in connection with baby P, should remain confidential. We disagree. We have nothing against Lord Laming as an individual—indeed, he was patron of the commission on social workers, chaired by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) just the other year, which produced many recommendations that the Secretary of State now appears to be
implementing—but we think that it is important, as I am sure the whole House would agree, for there to be no bar on serious questions being asked on raising the bar in child protection.
The hon. Member for Bury, North (Mr. Chaytor) made a characteristically thoughtful contribution on child protection and schools policy, and my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright) spoke movingly and effectively about what we can do to help those living with dementia.
I can freely praise one or two speeches that I was not able to hear in full, because the notes taken by my colleagues on the Front Bench have been so generous. I can also praise the Secretary of State’s speech, which I have not yet heard, because I know what is in it—not because it has been leaked to me by the Department for Children, Schools and Families, but because he displays an admirable consistency in the political message he propagates. Whatever the occasion, wherever the platform, whoever the opponent, he repeats the same line: we on the Government side are saints who are investing in stronger motherhood and much more apple pie, and the other guys—it can be Scottish nationalists, Liberal Democrats or even German Social Democrats—are monsters from the Jurassic era who will cut, cut and cut again.
Psychologists have a term for people who repeat the same behaviour over and over again, whatever the circumstances and whatever the efficacy. They call it obsessive-compulsive behaviour. But any such diagnosis of the Secretary of State’s approach would be mistaken. Another psychological term captures his approach much more accurately. It is called transference. Transference occurs when people accuse others of behaviour which they themselves exhibit. If Jeffrey Archer accuses someone of embroidering the truth, that is transference. If Simon Cowell accuses someone of arrogance, that is transference. If Peter Mandelson accuses someone of irresponsible leaking, that is transference. When the Secretary of State accuses others of wanting to inflict cuts, that is actually what he has been doing.
Before the last election, the Secretary of State told us that a Tory Government would reduce future spending by £35 billion, but now his Government are reducing spending by £37 billion. His own Department is not immune. Let us look at some of his budgets, such as the budget for Building Schools for the Future. On school building, he has failed so far. We were promised 200 new schools by the end of this year. We have had fewer than 20. Now local authorities have had to go cap in hand to the European Investment Bank for money for school building because none is available in Britain. The pre-Budget report says, ominously:
“DCSF is assessing the value for money of Building Schools for the Future”.
A senior Treasury source was quoted as saying of the school building programme that
“it’s clear we’re going to have to scale it back and scrap some considerable parts of the programme.”
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