Westminster Hall
Wednesday 1 April 2009
[John Bercow in the Chair]
National Dementia Strategy
Motion made, and Question proposed, That the sitting be now adjourned.—(Barbara Keeley.)
9.30 am
Jeremy Wright (Rugby and Kenilworth) (Con): I am delighted to open this debate, but I would rather have listened to the Minister do so on the Floor of the House in a Government debate in Government time on this Government strategy. Such a debate has been asked for, as you know, Mr. Bercow, several times. I asked for one during business questions recently, when the Leader of the House responded:
“I shall take that as a suggestion for a future topical debate.”—[Official Report, 5 February 2009; Vol. 487, c. 986.]
My hon. Friend the Member for Rutland and Melton (Alan Duncan) raised the matter again the following week, also at business questions, when the Leader of the House said:
“I will look at the forthcoming business of the House and see whether we have enough opportunities to debate those important issues”.—[Official Report, 12 February 2009; Vol. 487, c. 1516.]
No debate was forthcoming, so the hon. Member for Leeds, North-West (Greg Mulholland)—I am delighted to see him in his place—asked whether we could have a debate in Government time to talk about this important initiative, but the Leader of the House replied:
“These issues are important, and this might, perhaps, be the subject of a Westminster Hall debate.—[Official Report, 5 March 2009; Vol. 488, c. 995.]
The hon. Gentleman, not to be daunted, returned to the matter at Health questions, when the Minister said:
“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.”—[Official Report, 24 March 2009; Vol. 490, c. 153.]
Yet despite the Minister’s enthusiasm for a debate on the strategy and, I am sure, his delight at having the opportunity to respond to one today, it should not have been left to me, with the indulgence of Mr. Speaker, to initiate it. The Government’s apparent reluctance to debate their own strategy is mystifying because it seems that they can be justifiably proud of it. It is a huge step forward for those with dementia, those who care for them, and those who campaign for them. It is an important part of the country’s response to a challenge of staggering scale.
Hon. Members will know the numbers, but they are worth repeating. In the UK, 700,000 people have dementia, and that number will double in 30 years. Dementia costs us £17 billion a year, more than the cost of cancer, heart disease and stroke combined, and that sum will treble in 30 years.
Bob Spink (Castle Point) (Ind): The hon. Gentleman is talking about the cost of dementia, and he will be aware that if we are to understand, prevent and treat it, a lot of research is needed. The amount spent on research in this country is only about one third per head of that spent in the USA. No doubt he will come to that. The total amount spent on dementia in this country is about the cost of one mile of motorway each year. That puts the issue into context, and shows that the Government must spend much more on research.
Jeremy Wright: I agree with the hon. Gentleman, and I hope that he listens to that part of my speech when, as he correctly predicts, I come to it a little later. He is absolutely right, and emphasises my point that we simply cannot afford to ignore dementia, yet for years we have effectively done just that.
The Minister’s predecessor used to say that his objective was to bring dementia out of the shadows. With the help of campaigning groups such as the Alzheimer’s Society and some immensely courageous individuals, the Government have largely succeeded in that objective. Dementia is unquestionably higher up the political agenda than even two or three years ago. But now that we have the strategy and it stands in the glare of new-found and welcome public attention, it is vital that it stands up to scrutiny, so we must discuss what happens next: how will the strategy be put into practice? I hope that the debate will focus on that.
The national dementia strategy is wide-ranging, as it should be, and I cannot do justice today to everything in it, so I shall concentrate on several aspects of what it seeks to achieve. I shall begin in a logical place—diagnosis. The strategy recognises that we do not diagnose dementia as often and as early as we should. Unless a sufferer’s dementia is identified, none of the strategy comes into play. Encouragingly, the Government have said that they intend to look at the training of general practitioners, so that those who are often confronted first with the early signs of developing dementia may have more confidence to make the appropriate diagnosis. Perhaps the Minister will update us on precisely what is to be done.
We all recognise that general practitioners are just that—general practitioners—and cannot be expert in every condition. They must also have the opportunity to refer to specialists, as the strategy states. It is crucial that, following diagnosis, appropriate advice and support is offered, and I am pleased that the strategy both recommends that and recognises that the voluntary sector has a lot to offer in fulfilling that role. It is not only GPs who need more training. Objective 13 of the strategy refers to
“An informed and effective workforce for people with dementia”.
As the Minister knows, the all-party group on dementia, which I chair, is working on an inquiry into the training needs of those who provide care for people with dementia in residential care homes or in their own homes. I do not want to pre-empt any conclusions, but I want to make some personal comments about a matter that is crucial to the strategy’s success.
Given that two thirds of the care home population is estimated to have some form of dementia, it is shocking that no training in dementia is required for those who work in care homes. How can good quality care be provided to those people if those providing it have no
real understanding of the condition? Surely we must have such training for all those who work with the elderly throughout the health and social care sectors, and we must have it soon. That is why I am worried about what the strategy impact assessment says. Paragraph 5.109 on page 30 states that
“in developing the strategy we have become aware of the complexity in making change to undergraduate and vocational curricula and in terms of securing the ability to deliver training in social care settings, especially those that are outsourced or provided by private companies. We have therefore made such change a longer-term goal that needs to follow a period of at least two years detailed consultation and joint development work co-ordinated by the Department but including all training providers.”
I hope that the Minister can reassure me that the sense of urgency that should run through this part of the strategy is present in Government thinking. If the Government are to succeed—I fervently hope that they will—in persuading providers and commissioners of care to pay much more attention to the need for the caring work force to understand dementia better, we must ask who will provide the necessary training. The strategy deals with that on page 29 and states:
“There is currently a range of training and education providers in dementia care but there is no nationally recognised system of quality assurance. Some form of ‘kite-marking’ of good practice would assist commissioners and care providers in selecting effective training.”
That seems to understate the problem. If the market for training expands, as it must, so will the number of signs above doors stating “dementia trainers”. There must be a way to distinguish which training providers offer a product of the requisite quality, and again I hope that the Minister can offer us some reassurance on that.
I would also like some reassurance on anti-psychotic drugs. As the Minister knows, the all-party group produced a report on the subject last year, which concluded that the over-prescription of such drugs for people with dementia was widespread and had very damaging consequences. We made several recommendations about how such overuse might be reduced, so we were pleased that the Department of Health press release of 19 June 2008, which announced the consultation on the national dementia strategy, stated:
“The Government’s announcement today includes a number of immediate actions, as well as other proposals which will be consulted on over the coming months. These include: An immediate review”—
“into the prescribing and use of anti-psychotic drugs to treat sufferers of dementia. This work will be completed before the publication of the National Dementia Strategy in the Autumn.”
We know that the timetable for publishing the strategy itself was subject to change, although I do not want to cover that this morning. The point that I do want to draw from that quote is the sequence to which it refers, of a review of anti-psychotic drugs coming before the strategy’s publication. That sequence is important because if, as we concluded in the report, the overuse of those drugs is a serious problem for people with dementia and the solution is to be found in better training of staff, more frequent reviews of medication and closer involvement of family and friends in prescribing, among other things, all of which are central to other objectives of the
national dementia strategy, it would surely be sensible to integrate the response to the over-prescription of anti-psychotic drugs into the strategy itself.
Mr. Paul Truswell (Pudsey) (Lab): I congratulate the hon. Gentleman on securing a debate on such a crucial issue. Is it not also vital that, at the moment and in the future, we adopt a much more robust inspection regime to ensure that staffing levels are adequate to meet the needs now of people living with dementia, that in due course staff are properly trained and that issues such as the abuse of anti-psychotic drugs can be addressed as soon as possible?
Jeremy Wright: I agree entirely. The two issues that the hon. Gentleman mentions of training and inspection—regulation, in fact—are extraordinarily important. Unless we get those right, the strategy will not fulfil its aims. If he will forgive me, I shall return to both matters, or certainly regulation, in a few moments. I just want to finish what I was saying about the review of anti-psychotic drugs.
I am sorry to say that, having read carefully what the press release of 19 June said about what would be done on the review, we were somewhat disappointed by the answer to a written question from the hon. Member for Sutton and Cheam (Mr. Burstow), to whom I pay tribute for his extremely hard and long-standing work on this subject. On 15 October, the Minister said:
“The strategy”—
the national dementia strategy—
“is now likely to be published in mid-November, and we anticipate that the results of the anti-psychotics review will be published early in 2009.”—[Official Report, 15 October 2008; Vol. 480, c. 1339W.]
In other words, not only had the timetable slipped, but the order of events had changed. We were told then that the review of anti-psychotic drugs would take place after publication of the strategy.
Then matters slipped yet further, because in answer to another written question, from my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the Minister confirmed:
“The work of the review will be concluded in spring 2009.”—[Official Report, 24 February 2009; Vol. 488, c. 640W.]
I hope that the Minister can confirm today that we will not have to wait any longer than spring this year for the results of that vital review.
Unfortunately, it is not only the timetable for the anti-psychotics review that seems to be slipping. There is also the matter referred to by the hon. Member for Castle Point (Bob Spink)—research. A research summit was promised initially in the Department of Health press release of 19 June. It stated:
“The government will hold a summit over the summer with key stakeholders and research organisations to consider a planned programme of research into dementia and the potential for further development.”
The summit should have taken place in the summer of 2008. Here we are in the spring of 2009 and it still has not happened. That matters because the importance of research should not be underestimated. Only more research can give us effective treatments for dementia and, one day, a cure. Only more research can give those affected by dementia the hope that they so desperately need, yet
in Britain we give dementia research a low priority, as the hon. Gentleman rightly said. It is worrying that, like the review of anti-psychotics, the promised research summit seems to trail further and further behind the national strategy instead of being a full and important part of it.
David Lepper (Brighton, Pavilion) (Lab/Co-op): I, too, congratulate the hon. Gentleman on securing the debate. I am sure that, like me, he will agree that funding is vital to taking forward all aspects of the dementia strategy and, indeed, of the carers strategy, which is related to it. I welcome the additional funding that the Government are providing, but does he share my concern that that funding and the money for the carers strategy is not ring-fenced and that therefore organisations, particularly at local level, such as the Alzheimer’s Society, carers organisations and the local dementia strategy organisation in my constituency, of which I am a trustee, need to be particularly vigilant in seeing that primary care trusts use the money properly?
Jeremy Wright: I am always gratified to be in tune with the mood of the House, and once again the hon. Gentleman anticipates something that I am going to say. I agree entirely: it is right to be concerned about the lack of ring-fencing. There is another issue of concern, too. I am conscious of the time and that other hon. Members wish to speak, but I wish to make two more points. The lack of ring-fencing is one, but if he will forgive me, I shall deal with the other first.
I hope that today marks a new dawn in the regulation of dementia care—a matter that the hon. Member for Pudsey (Mr. Truswell) raised. During the last all-party group inquiry into the overuse of anti-psychotic drugs, we took evidence from the Healthcare Commission and from the Commission for Social Care Inspection, and the gap between them was striking. In essence, CSCI told us that it was not responsible for regulating the prescription of those drugs, because drug prescribing was a health care matter, and the Healthcare Commission told us that it was not responsible for it either, because the drugs were being used in a social care setting.
The creation of the Care Quality Commission, which begins work today, means that the gap has disappeared. As a regulator of both health and social care, it can, I hope, do a great deal to improve dementia care, which, as we know, awkwardly straddles the artificial boundary between the two. However, the CQC will need to focus on dementia care to make that happen. Therefore, will the Minister tell us today that dementia will be a priority for the CQC, as well as for the health and social care systems that it regulates?
Finally and perhaps inevitably, we need, as the hon. Member for Brighton, Pavilion (David Lepper) said, to talk about money. When the national dementia strategy was published on 3 February this year, the Department of Health press release that accompanied it referred to
“The first National Dementia Strategy, backed by £150 million over the first two years”.
I think that most of us who read that press release assumed that that was £150 million of new money and that it was to be devoted to delivery of the dementia strategy. I am not sure that we were right to assume either of those things.
I had a letter from the chairman of my local PCT. He wrote to me, in part about the strategy, on 3 March, and said:
“The PCT and Warwickshire County Council are planning to consider together how to deliver the Dementia Strategy through redesign of existing spend, given the financial challenges facing both the Council and the PCT currently.”
That, as hon. Members might imagine, caused me some concern, given what I had read about £150 million of apparently new money, so I asked the chairman of the PCT for clarification of what he meant by that statement. In his letter of 12 March, he gave this explanation:
“The money does not come ring fenced”—
just as the hon. Gentleman said—
“and alongside of the block funding come a number of priorities that the Government would like the local health and social care economy to address. The local health and social care economy then has to decide how it prioritises addressing these within the block funding, and on a value for money basis, what possibilities exist within existing funding streams for service redesign.”
My point is not that it is wrong in principle for local PCTs to have a degree of discretion over how they spend their money. However, it is interesting that the Minister himself had given further clarification a few days before, on 24 February—again in answer to a written question from my hon. Friend the Member for South Cambridgeshire. He explained:
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