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House of Commons

Tuesday 24 March 2009

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Community Children’s Nurses

1. Sir Nicholas Winterton (Macclesfield) (Con): What recent assessment he has made of the effectiveness of community children’s nurses. [265611]

The Parliamentary Under-Secretary of State for Health (Ann Keen): Developing high-quality community children’s nursing services is crucial to the provision of safe, integrated and comprehensive care in the home or close to home for children with complex or continuing care needs. We are embarking on a wide-ranging programme of action dedicated to transforming community services. Within this programme, we are taking forward a project looking at the benefits and the opportunities arising from investment in community children’s nursing services.

Sir Nicholas Winterton: I know that the Minister is aware that a reception was held in the House earlier this month that was sponsored by the Royal College of Nursing, of which the Minister was a member, and the WellChild charity, which was intended to encourage primary care trusts to employ community children’s nurses in order to help not only children with long-term complex health needs, but their families. Will the Minister tell me what steps the Government are taking to ensure that these nurses are employed, as they will help children and their families to co-ordinate packages of not only medical but local care, which might help them to spend more time at home rather than commuting to hospital on a regular basis, as this is often painful to them?

Ann Keen: I congratulate the Royal College of Nursing and WellChild on holding that reception, which highlighted some very important issues; as the hon. Gentleman said, we were both present. Government funding of £340 million established through our recent child health strategy will help local areas to support the development of more care packages in the location preferred by the child and family. To provide the safe, comprehensive and sometimes highly complex packages of care that these children need takes time to co-ordinate. There are no quick fixes, as was highlighted at the reception. In many cases, delays are caused by the time taken to
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resolve issues such as housing and adaptations rather than the lack of community nurses, but we are committed to the work force and to the planning of community children’s services. I believe that this area will be addressed in the Prime Minister’s commission on the future of nursing and midwifery.

Mary Creagh (Wakefield) (Lab): Will the funding allocated to primary care trusts for community children’s nurses be ring-fenced? As we often see with PCTs, if the money is not ring-fenced, it can sometimes be diverted to other priorities. How will the nurses work and interact with the local authority, which often provides the child’s basic care needs in terms of getting the child up, ready and dressed?

Ann Keen: As I was saying, the complexity of the package is very evident, so we have to co-ordinate not only with local authorities, but with other agencies. Commissioners need to consider how the new funding established through the recent child health strategy can enable the development of children’s community nursing services capable of providing a more all-round care package, including palliative care and, sadly, sometimes end-of-life care in the home or closer to home. It is for the commissioners to decide within the local community how best to manage those funds.

NHS Services (Economic Downturn)

2. John Howell (Henley) (Con): What assessment he has made of the likely effect on demand for NHS services of the economic downturn; and if he will make a statement. [265612]

The Minister of State, Department of Health (Mr. Ben Bradshaw): The evidence from Britain and other countries is that demand for health services increases in an economic downturn. However, thanks to funding already agreed for the period to 2011, we believe that the NHS is in a strong position to manage this well.

John Howell: As more and more families pull out of private health care, what pressure is the Minister seeing on primary care providers, and what assessment has he made of how well they are able to cope?

Mr. Bradshaw: It is quite difficult to get reliable figures on how many people withdraw from private health care, as it is obviously a matter for the private sector itself. A few months ago, Laing and Buisson said—the hon. Gentleman may have picked it up—that there has been a 10 per cent. reduction in people deciding to pay privately for their operations, but that actually preceded the economic downturn. Laing and Buisson believes that it has more to do with the very short waiting times on the NHS: there is now almost no difference at all between waiting times in the NHS and waiting times in the private sector. We are confident that, given the increase in investment that the NHS will receive over the next two years, even if all the people in this country choose to use NHS care—I hope that they would like to do so, given the short waiting times—the NHS will be able to cope very well.

Barry Gardiner (Brent, North) (Lab): My hon. Friend will be aware of the problems that Brent primary care trust was facing a couple of years ago with a £25 million deficit, so will he join me in congratulating Brent for
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turning that deficit into a projected £12 million surplus this year, which means that more services are now being directed to the right people in my local area?

Mr. Bradshaw: My hon. Friend is absolutely right that two or three years ago, Brent PCT was in a parlous state. In fact, as recently as three years ago, 104 NHS organisations were in deficit, whereas now the figure is just 3 per cent. There has been a remarkable turnaround, so I would like to pay tribute not only to the management of the PCT in my hon. Friend’s area—as he rightly says, the PCT will now be able to deliver sustainable and constantly improving NHS services to his constituents—but to all the managers throughout the country who have turned around their health care organisations in such a way.

David Tredinnick (Bosworth) (Con): Many of my constituents are very worried about the possibility that the proposed redevelopment of Hinckley and Bosworth community hospital will not go ahead because of the economic downturn. Will the Minister please look into the proposed public-private partnership, hold discussions with Leicestershire County and Rutland primary care trust, and then write to me?

Mr. Bradshaw: I shall be happy to do that. It is worth mentioning that a week or two ago our ministerial colleagues in the Treasury made an important announcement about the PFI which I hope will prevent the outcome at the hospital that the hon. Gentleman fears, but I will happily write to him to confirm that.

Mr. Lindsay Hoyle (Chorley) (Lab): My hon. Friend is aware of the effects of the economic downturn and the pressures that it has placed on the NHS, but is he aware that those effects are nowhere more evident than in the mental health service? People really do suffer, and we always feel that the mental health service is underfunded. Will my hon. Friend ensure that more resources will be provided if they are required, given that there will certainly be further pressure on the service in the future?

Mr. Bradshaw: Yes. Labour Members certainly do not agree with the Conservatives that a recession is good for people’s health. We know from experience both in this country and abroad that when it comes to such issues as mental health, more men consult their GPs if they are unemployed. That can be an advantage, as men are notoriously reluctant to seek health care and advice. However, as my hon. Friend will know, mental health funding has risen by 40 per cent. in real terms in the last seven years. We do not think that the recession should just take its course, we do not think that it is a price worth paying, and we will be there to ensure that the NHS supports people who may be affected by the economic downturn.

Mr. John Leech (Manchester, Withington) (LD): If demand for the NHS is increasing during the economic downturn, it is even more vital for hospitals that have lost money in collapsed Icelandic banks to get that money back. Given the Prime Minister’s recent comments in Manchester about Christie hospital’s missing £7.5 million, what is the Department doing to ensure that Christie gets its money back?

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Mr. Bradshaw: We are working closely with both Christie and the other hospital that has money in Icelandic banks. We are also working to ensure that all charities that are eligible claimants under the Financial Services Compensation Scheme receive their money in full.

Jim Sheridan (Paisley and Renfrewshire, North) (Lab): My hon. Friend is absolutely right to say that it is wrong to suggest that a recession is good for people, particularly an economic downturn of this kind. Can he assure us that he will continue to focus investment on public services such as the NHS, and will not be diverted into cutting taxes such as inheritance tax?

Mr. Bradshaw: Yes. I think that we will face a clear choice at the next general election, between a Labour Government who are committed to continuing sustained investment in the NHS and a Conservative party which is committed to a tax cut for millionaires.

National Dementia Strategy

3. Mrs. Jacqui Lait (Beckenham) (Con): When he expects the national dementia strategy to be fully implemented in England. [265613]

5. Jeremy Wright (Rugby and Kenilworth) (Con): What progress has been made on delivery of the national dementia strategy. [265615]

The Minister of State, Department of Health (Phil Hope): The first national dementia strategy was published on 3 February this year, and will be implemented over a five-year period. Improving services for people with dementia is a Government priority, and we have already identified it as a priority for the national health service in the operating framework. That will help to ensure that dementia is prioritised locally where further improvement may be needed.

Mrs. Lait: The London borough of Bromley contains the highest percentage of retired people in London. What can I tell my constituents about the quality of the services that they can expect, and whether those services will be delivered through GP centres?

Phil Hope: The national dementia strategy covers a range of services, but it emphasises the importance of early diagnosis. We intend every area in the country—including the hon. Lady’s constituency—to contain memory clinics, to which suitably trained GPs will refer people who show early symptoms of dementia. There they can be given an accurate diagnosis and assessment—as there are different forms of dementia—and then receive the specialist help and intervention that they require. We know that early intervention enables us to help people with dementia and their carers, and to ensure that people live much better with their dementia and stay in their own homes for longer.

Jeremy Wright: The Minister is well aware that objective 13 of the national dementia strategy is to provide

He also knows that two thirds of the care home population has a form of dementia. Does he agree that it will be important to provide training for the entire work force
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in the care home and, indeed, the home care setting? When the all-party group, which I chair, has completed its inquiry into work force skills in this area, will he meet me to discuss the inquiry’s conclusions and consider how they might be included in the implementation of the strategy?

Phil Hope: The hon. Gentleman, as chair of the all-party parliamentary group, and I have met regularly. He and the all-party group have made their welcome for the new dementia strategy public, and I am grateful for that. I would be happy to meet him once his group has concluded its investigation into trainees. It is right that we need to ensure that people, whether in hospitals—nurses and doctors—or in care homes, have the right skills, knowledge and understanding of the needs of people with dementia and their carers. That is why the dementia strategy states that a senior member of the hospital or care home should be responsible for ensuring that all staff in the hospital or care home know and understand the needs of people with dementia, so that they can ensure that the response that people get is the best response to meet their needs. It is certainly a matter for both the NHS and social care sector that staff be properly trained. We will publish our work force development strategy for the adult social work force in the near future.

David Lepper (Brighton, Pavilion) (Lab/Co-op): May I place on the record the fact that I am a trustee of a local dementia charity in Brighton and Hove supporting those with dementia and their carers? I am sure that the Minister will recognise the vital role of those caring for people with dementia in their own homes and know how welcome has been the additional funding for breaks for carers. What steps will he take to ensure that primary care trusts make use of the money to support breaks for carers, which is not ring-fenced? For example, in Brighton and Hove I think that £800,000 is available over two years.

Phil Hope: I congratulate my hon. Friend on the work that he does in his constituency in support of people in need of social care and in support of people with dementia. He is right to draw attention to the fact that the best care we can give to people is in their own homes, where people are with their family, neighbours and loved ones. Interventions that help that to happen for as long as possible are always in the best interests of the patient. What we need to include, of course, is support for the carers. Respite care is critical. He is right to say that more money has been provided for the next two years. It has been put into PCT baseline budgets. We have announced more money for carers through the carers strategy. I hope that not only in his constituency but throughout the country local organisations will ensure that that money is spent and that respite care is provided for those people who support people with dementia in their own homes.

Mr. David Crausby (Bolton, North-East) (Lab): What extra support can the Minister give to general practitioners to ensure that they detect the early signs of dementia, which is vital?

Phil Hope: My hon. Friend raises an important point because two thirds of people do not have their diagnosis of dementia undertaken formally. Many people therefore
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do not get diagnosed until two and a half or three years after they have contracted that destructive disease. Therefore, it is important that front-line staff such as GPs are better trained to spot the early symptoms. If they are not a specialist themselves, and many of them are not, it is important that they refer people to the specialist memory clinics in their areas, which can conduct a proper diagnosis. It is not just about conveying the diagnosis but about the way in which that is communicated to people with dementia and to their family, which can be an important part of coping and living well with dementia. We are ensuring that training for GPs is increased, so that they can spot the signs early, people can be diagnosed earlier, there is earlier intervention to help people to live with dementia better, and that that is the outcome across the country.

Greg Mulholland (Leeds, North-West) (LD): There is much to be welcomed in the national dementia strategy and I again ask the Government to find time for Parliament fully to debate that important strategy. But there is one notable gap in the strategy: there is nothing to tackle the grossly inadequate level of research into the various conditions that come under the dementia umbrella. How is the Minister getting on with persuading his colleagues the Chancellor and the Prime Minister to up the research budget for dementia? I know that that is something that the Minister is concerned about, and he knows that he has everyone’s support on that.

Phil Hope: If the hon. Gentleman wants to debate the strategy in the House, he can use the usual channels to arrange for such a debate on a Liberal Democrat Opposition day, but I am very happy to debate the strategy because it is an excellent strategy that has been welcomed across the country. The hon. Gentleman is right to highlight the importance of research. The truth is that we do not have a cure for dementia; that is part of the tragedy of this disease. There is research happening not just in this country, but around the world, to examine what more can be done. But this is not only about cure; it is also about research into what helps people who have dementia and how they can be assisted to live with dementia better in their own homes and be treated better in care homes or in the NHS. I will be chairing a summit in July, where we will be bringing together people from different parts of the country and, indeed, from different countries, to look at what the state of research is and to see where the gaps in the evidence base are and what more we can be doing to improve that evidence base, drawing on the best knowledge not only in this country, but from countries around the world.

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): I welcome my hon. Friend’s reply to the hon. Member for Rugby and Kenilworth (Jeremy Wright), who chairs the all-party group, and I look forward to meeting him to discuss the report. As well as looking at work force development, will he be looking at what the regulators can do in their assessment of care in homes and the community, and also of training, to drive up improvement in skills in dementia care?

Phil Hope: I am grateful to my hon. Friend for raising the important point that, as well as providing better services, we need to make sure we have inspection systems and regulation systems that drive up the quality
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of care. She will know that on 1 April the care quality commission comes into being, which will integrate the three current inspection and regulation organisations. That will help to integrate health and social care for patients with dementia, and their loved ones and carers, to ensure we have an integrated system of inspection and regulation to raise standards right across the health and social care system for patients with dementia.

Robert Key (Salisbury) (Con): The Minister knows how warmly I welcome the strategy, because he was good enough to meet my constituent, Sir Terry Pratchett, along with the Prime Minister and myself, at No. 10 Downing street to discuss it. I must press the Minister, however; he has just said that he will hold a summit in July, and that is very welcome, but the Government have already announced that there will be no new money for research into dementia. How can he justify that decision?

Phil Hope: We had a good meeting with the Prime Minister, who takes a personal interest in these matters and who met Terry Pratchett. I must put on record the huge courage Terry Pratchett is displaying in allowing everyone to see how he is coping with the disease—with the diagnosis and then with living with the early stages. Indeed, many public figures have now been talking about their experiences. That is an important part of the process of raising awareness among the professions and the wider community about this disease and its consequences, and how we can help people live with it. On research, the Wellcome Trust is spending £30 million this year and more money is going into research. We need to ensure that before the summit we have done an analysis of all the research that is going on, and where the evidence base is insufficient or has gaps in it, so that we can plan and direct our resources to those areas where research will be most effective.

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