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1 Apr 2009 : Column 257WH—continued
“Where health and social care services were integrated at both team level and management level, it was more likely that services offered a higher standard of care and a greater range of services...Carers in less integrated services said they could often spend a large amount of time and energy trying to find out who they needed to go to for what problem.”
We hear that common theme all the time from carers.
Carers were also concerned about the closure of some services. It is slightly odd and ironic that we have the strategy, but still hear reports about the closure of services and support care for people who are at home. Some trusts did not provide day services. In my own patch, in Cranleigh, the day hospital has closed. It was an important lifeline for family and friends. The report states:
“Carers said some staff in general wards at acute hospitals were not being trained or were not equipped to deal with patients with mental health problems, especially dementia”,
and training has been mentioned in the debate.
I should like to pick up on a few of the other issues raised by my hon. Friend. He said that diagnosis is crucial and that the remainder of the strategy is utterly useless unless a diagnosis is made. The hon. Member for Leeds, North-West (Greg Mulholland) said that something like only 40 per cent. of people with dementia have been diagnosed, so 60 per cent. of people with the condition are without a diagnosis.
As someone who has worked in the health service, I find it appalling that training needs are so great. A recent report and investigation into the care of people with learning disabilities said that staff needed training to make them more fully aware. Not only do I find it extraordinary that there is such a big gap in people’s knowledge, but I am surprised that general practitioners cannot recognise or do not look for dementia when it is clearly such a common problem. We need to ensure that staff at all levels, not only GPs, access the right training and that they are aware of looking out for those sorts of problems.
My hon. Friend the Member for Beckenham (Mrs. Lait) talked about services in Bromley and single-handed practices. Much of what she said was connected to training needs and ensuring that care can be delivered in the right settings. The hon. Member for Westmorland and Lonsdale (Tim Farron) talked specifically about care for people with mental health problems.
The Department of Health website states:
“The National Dementia Strategy is backed by £150 million over the first two years. It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive.”
Of course, like everybody else, I hope that those aspirations will be fulfilled. However, not only does the quality of care need to be improved, but the quantity needs to be increased, not only for those with dementia, but for their carers and families. We need early diagnosis and intervention, and appropriate treatment, care and support for families and carers. I could apply all those things to a range of other mental health issues. However, we need some detail from the Government, which I hope the Minister will provide.
The hon. Member for Castle Point (Bob Spink) was the first to mention research. He said that £11 is spent on research for every Alzheimer’s patient, and £289 on research for every cancer patient. It is a difficult situation: one does not want cancer research to have less money, but we need reassurance that the Minister is aware of what I call disease and illness-related discrimination in the allocation of services and resources. Alzheimer’s and related diseases have a difficult time levering in money. Will the Minister reassure us that there will be an even-handed and non-discriminatory approach to dementia research and care, and clarify the research money situation? I would not like him to miss the opportunity to make an announcement, should he wish to do so.
Will the Minister also clarify where the £150 million will come from and whether that is new and additional money for primary care trusts? Does he intend to monitor PCTs so that the Government’s headlines on the strategy are assessed by future performance? The Government are right to be proud of their strategy, and they have had quite a lot of good press coverage for it, but I do not want to ask a parliamentary question in a few months’ time only for them to reply that the information that I want is not held centrally. They need to publish performance statistics and say what PCTs are doing.
Does the Minister anticipate any money to spend on specialist dementia nurses? They often play a very significant and, if I may say, cost-effective role in care. Do the Government have any plans for additional money? Is he going to increase the number of specialist nurses?
John Bercow (in the Chair): Order. May I just say to the hon. Lady that there are quite a lot of questions for the Minister to answer, and it is now more than time for him to do so? I am sure that she is bringing her remarks to a close.
Anne Milton: Thank you, Mr. Bercow; I will bring my remarks to a close.
This is not an unfamiliar feeling in this place: we have a warm welcome for the Government’s words, but strategies on care and summits on research do not always make a difference on the ground. The anticipation and frustration that people felt when they were waiting for the strategy turned to a warm welcome when the words and commitment finally came. However, the Minister should not underestimate how quickly that will turn to anger and disillusionment if action is not taken and if my questions are not answered.
10.49 am
The Minister of State, Department of Health (Phil Hope): I am pleased to reply to this debate under your excellent guidance, Mr. Bercow. I know of your personal interest in such matters. I congratulate the hon. Member for Rugby and Kenilworth (Jeremy Wright) on securing the debate. He plays an important role in increasing our understanding of dementia through his chairmanship of the all-party group on dementia. I wish to place on record my thanks and congratulations to him for his efforts.
Interventions and contributions have been knowledgeable and passionate. People have referred to constituency cases and discussed their family experiences. My hon. Friend the Member for North-West Leicestershire (David Taylor) in particular highlighted the needs and responsibilities of those who care for people with dementia. As well as implementing the carers strategy discussed in the dementia strategy, providing extra resources for respite care and so on, we have a specific objective to develop peer support and learning networks for those caring for people with dementia. From my experience in my constituency, I know how highly people caring for people with dementia value the ability to share their experiences with each other and get support.
It is clearly unacceptable that many people with dementia do not receive the care and support that they need. However, that is not the case everywhere. Some people with dementia receive excellent support from dedicated health and social care teams that provide high-quality services, such as the Croydon Memory Service. It is not exactly year zero. Our policy dates back to 2001 and the older people’s national service framework, which was built on by the “Everybody’s Business” service guide, the “Let’s Respect” campaign and the driving up of various standards in commissioning by new guidelines on dementia from the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence.
However, the national dementia strategy was published because there was clearly a need to take a huge leap forward. I am grateful to hon. Members who have acknowledged that the new strategy will do exactly that with an initial two years’ funding of £150 million. It will require services to transcend existing boundaries between health and social care—this is the point made by the hon. Member for Guildford (Anne Milton)—and between service providers and people with dementia and their carers.
Questions were asked about funding levels. It might be helpful to remind the House that the national health service and local authorities in England invested at least £1.8 billion in older people’s mental health services in 2006-07, that the direct costs of dementia to the NHS are about £3.3 billion a year and that the total investment by the NHS in England in all adult mental health services rose from £3.1 billion in 2001-02 to £5.5 billion in 2007-08. I will make this point only once: Conservative Members who have been talking about providing more money for dementia—something that we are doing and that I support—might like to speak to the Leader of the Opposition, who has made it clear that he wants to cut £5 billion from public spending over the next two years. That will make investment in dementia by their party a little hard to achieve.
Jeremy Wright: Will the Minister give way?
Phil Hope: If I give way, I will not be able to answer some of the hon. Gentleman’s questions, so he will forgive me if I do not.
The process of developing our strategy was not confined to professionals. The voices of people with dementia and their carers were critical to its development. I want to put on record my gratitude to the many people and organisations that contributed, not least Neil Hunt, chief executive of the Alzheimer’s Society, who chaired the strategy’s external reference group. His work was central to the delivery of the strategy. We had a board meeting yesterday, as the hon. Member for Leeds, North-West (Greg Mulholland) suggested, to begin the process, with people from the organisations helping us drive delivery forward.
On the question of memory clinics and Bromley raised by the hon. Member for Beckenham (Mrs. Lait), I cannot specifically say what the people and commissioners in Beckenham and Bromley should do, but I encourage her to draw their attention to the analysis in the strategy, which says:
“With a disorder as common as dementia it is tempting to assume that this should be completed by primary care. However, this is in effect the status quo which has delivered the low levels of activity that we have summarised above...the primary care role should be that of identifying those with worrisome symptoms that might mean that their patient has dementia, excluding any other explanatory disorder, and referring on to a specialist service for that individual to receive a definitive diagnosis, not only of dementia, but also of the sub-type of dementia.”
She might want to draw that guidance to the attention of her primary care trust if it is going down a route that does not appear to reflect the analysis that a GP’s role is to identify early symptoms and refer people on to specialist services.
Phil Hope: I will not give way, because I need to cover one or two other points.
To respond to the point made by the hon. Member for Westmorland and Lonsdale (Tim Farron), I stress that one of the strategy’s key objectives is for care homes and hospitals to identify a senior staff member to lead on dementia care and drive improvements in the quality of care in those institutions. We will issue guidance on best practice in dementia care to care homes in the coming year, but they need to start gearing up now for the challenges set out in the strategy.
We want those senior staff to develop their plans for the management and care of people with dementia in every care home and hospital. They need to be able to commission specialist in-reach services from older people’s community mental health teams, and they should be responsible for ensuring that all staff caring for people with dementia receive appropriate training and guidance. I know that the all-party group is considering the issue. We look forward to seeing its findings in due course.
There are good examples of local training in dementia across the country, notably in some care homes, but we must ensure that everyone who works with people who have dementia has the right skills and knowledge. We will therefore work with the royal colleges and professional bodies, as well as with the sector skills councils, Skills
for Health and Skills for Care and other training bodies, to address that need and ensure that appropriate changes are made to vocational, undergraduate and postgraduate curricula where needed.
I understand the concerns expressed about research. We have a long history of significant investment in dementia research. In 2007-08, for example, the Department of Health and the Medical Research Council spent £32 million on research into dementia and related neurological conditions. Within our current health research strategy, we have expanded the Department’s research programme. Dementia research will benefit as a result.
We plan to spend some £20 million over the next five years on a dementia and neurodegenerative disease research network modelled on the highly successful cancer research network. Dementia was also a priority of the first round of the National Institute for Health Research scheme of programme grants for applied research. As a result, the NIHR has awarded grants worth almost £6.5 million. Last October, the MRC and the Wellcome Trust announced a new £30 million fund to boost research into neurodegenerative diseases. We will also be holding a research summit on dementia during the summer that will include a wide range of experts in dementia research covering prevention, cause, care and cure—I am having to hasten along, Mr. Bercow, as time is not on my side.
The review of the prescribing of anti-psychotic drugs for people with dementia remains a priority for the Department. Unfortunately, research into the issue could not be completed within the original time scale because of the work that we were putting into the strategy. However, we must get it right, and we want to get it right first time. I am pleased to be able to tell the House that the antipsychotics review will be completed shortly: that is, in May this year—I think that May counts as spring, by the way. We have taken evidence from a wide range of stakeholders, and we are currently conducting a literature review. The chairman of the all-party group met Professor Sube Banerjee and officials from the Department a few weeks ago as part of our consultation.
I have not been able to answer all the questions in the time available, but in conclusion, we are driving matters forward at national, regional and local levels. I want the strategy to be implemented at a local level. I hope that I have demonstrated that we are firmly committed to improving dementia services. We cannot afford to fail. I am fully confident that the objectives outlined in our strategy and our programme to support the implementation of that strategy over the next five years will deliver the high-quality dementia services that we all wish to see.
Photography (Public Places)
11 am
Mr. John Randall (Uxbridge) (Con): I am grateful for the opportunity, given by Mr. Speaker, to raise this important issue. This is the first time that I have seen you in the Chair in this Chamber, Mr. Bercow, and it is a great but slightly overdue honour to sit under your chairmanship. I see that the Minister is now in his place.
For me, this is a difficult subject in many respects, because I have sympathy with both sides of the argument, as I shall discuss, but first, let me give the Minister some background. As a student, I spent a lot of time in eastern Europe, where much photography anywhere near anything considered strategic was not only frowned upon, but policed rigorously. I am also a keen birdwatcher, as some hon. Members will know, so I am not unaware of the problems of going into sensitive areas armed with optical equipment of various sorts.
Some important issues have come to the fore lately, and there are three main threads that I want to address, the first of which is the taking of photographs in public places by amateurs, which initially drew the matter to my attention. Many of the arguments that I shall make on that point, and many of those against it, have been changed by the recent advent of Google Street View, which is the second issue. I hope that I have enough time to address the final issue, which is the journalistic angle on taking photographs in public places.
Let me now discuss amateur photographers going out and about in our public places and taking photographs. Many colleagues have come to me since I secured the debate to tell me about incidents similar to the one I shall describe, and I have several examples from my constituency. Last summer, a well-known local business man, Mr. Alberto Wusche, who has a thriving business on Windsor street in Uxbridge, took photographs of properties that he thought were in bad repair, which he wanted to pass on to the council. He had not noticed, but in front of one of those buildings was a police car containing police community support officers, who had parked on a double yellow line as they popped into a sandwich bar to get a no-doubt well-earned sandwich. It appears that they thought the photograph was going to be used in evidence against them for parking on a double yellow line.
Parking in Windsor street has always been a hot issue and has perplexed me for many a year while I have been here. One of the PCSOs went over to Mr. Wusche—he probably will not mind me telling the Chamber that he is in his 70s and has been a model citizen all his life, having fled fascist Italy—and told him that he must immediately delete the photographs. When Mr. Wusche asked why, he was handed a notice and pretty much cautioned. That upset him a great deal, and I understand why.
Another incident involved Mr. Lee, who has just come out of the RAF. He was stopped taking photographs outside the Chimes shopping centre by another PCSO, who ran a police check over the radio and handed Mr. Lee a leaflet on terrorism. Mr. Lee said:
“I have just come out of the Royal Air Force after serving 19 years and to be questioned in public for doing nothing wrong left me extremely upset.”
I think we would all be upset by such a thing.
When I started looking into the matter, a number of incidents were related to me. My son told me that a year or so ago, when he was still at school, a fellow pupil was questioned for taking photographs at Moor Park underground station for his art project, and his school was called to get his bona fides. I found another case on the internet of a young lad called Fabian Sabbara, who was stopped when taking photographs—in his school uniform—for a school project.
Mr. Andrew Pelling (Croydon, Central) (Ind): May I add to the hon. Gentleman’s list of incidents? I was stopped and searched on suspicion of terrorism for taking pictures of roadworks near East Croydon station, as he will probably be aware, and I showed my identification as a Member of Parliament. It would be a particularly audacious terrorist who disguised himself as a Member of Parliament, given that there are a limited number of them and they can be easily identified. Is not this ultimately a waste of police time when they should be concentrating on other issues?
Mr. Randall: As a Whip, I am tempted to say that I am suspicious of all fellow MPs, but seriously, I find it concerning that such action was taken against the hon. Gentleman. We had bombs in Uxbridge during the IRA problems, as well as a variety of terrorist incidents, so I am acutely aware of the potential for terrorism, particularly in shopping centres such as the Chimes shopping centre in my constituency. We have to look out for such things, but common sense seems to have escaped police officers—or, very often, PCSOs—in some of the cases that have been mentioned.
Hugh Bayley (City of York) (Lab): I congratulate the hon. Gentleman on provoking the debate and I am alarmed to hear of someone being stopped for taking pictures in a tube station. I seem to have had a lucky escape, because I had intended to submit a photograph of a billboard in a tube station to a parliamentary photographic competition. I strongly agree that the ability to document what happens in this country through writing and photography is a fundamental civil liberty. Does he agree that countries that impose restrictions on that freedom show that they do not share the democratic values that are so important to this country?
Mr. Randall: That is exactly the point that I have been trying to make. I am not surprised that the hon. Gentleman, with his surname, has been involved in the all-party group on photography.
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