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16 Dec 2009 : Column 283WH—continued
I share my hon. Friend's passion for pushing the dementia issue up the agenda, both in our hospitals and care homes and on the research side. That point was made by the hon. Member for Eddisbury (Mr. O'Brien), who speaks for the Conservatives. Unless we can start to ameliorate the effects of the many distressing conditions that come under the umbrella of dementia-and hopefully prevent those conditions and perhaps even find the cure-the real concern remains not only that we will fail to tackle the problem of inadequate health care for older people, but that we simply will not deal with the financial time bomb that will affect the NHS and the care system.
The amount of funding for dementia care-I have raised this issue directly with the Prime Minister-remains inadequate. We are all aware that the recession and the reduced funds available to the Government and to us all is an issue; nevertheless, we must look at the impact of not investing more in dementia research. Dementia still receives only 3 per cent. of the medical research budget. I suspect we would all agree that that simply does not add up to a sensible proportion, considering the number of people currently suffering from forms of dementia, the effect on their families and on their ability to work, and the huge demographic increase in the number of older people projected to take place in the coming years.
The report, "New Horizons: A shared vision for mental health", states that funding for mental health research will triple. Will part of that be research on dementia, or is that a separate budget? Where will that money come from: is it from the existing research budget or a different pot of money? Can he say where the money will be targeted specifically? Will it deal with some of the mental health issues facing older people that we have raised today?
This is an important debate and I am pleased to have been able to contribute; it is a shame that more hon. Members have been unable to do so, perhaps because of the timing, as I am sure it is a matter of concern to many of us. Until older people receive the same care and service from our national health service as everyone else, there will still be a feeling that the institutional ageism that has been commented on by our leading physicians does exist.
3.1 pm
Mr. Stephen O'Brien (Eddisbury) (Con): I am well aware that St. Nicholas will be rushing down chimneys across the country in the coming week. He was born in 270 A.D. and is still going strong, so he should be a model for us all as we head into mature age. I have also discovered that the etymology of Nicholas is "victory of the people"-it may sound amazing, but it is-so it seems fitting to invoke him here in the mother of Parliaments. Whether he is a redistributive socialist or a right-wing philanthropist is a debate for another time, I suspect, however much hon. Members might encourage me to stray from our subject. All that allows me to wish you, Mr. Cook, the Minister and the hon. Members for Sutton and Cheam (Mr. Burstow) and for Leeds, North-West (Greg Mulholland) a very merry Christmas.
The issue we are discussing is serious and one on which it is our job to hold the Government to account. I hope that the Government's response will be redolent of the spirit of good will to all men, and all women, and
not disproportionately to some who are not old. It is also right during our debate, in thinking about discrimination, age, health care and general well-being, that we remember that many people cannot look forward to Christmases as we do, because of poverty or loneliness in this country or due to war abroad.
However much we disagree in this place, we are all here with equal mandates to make a difference and, through our aspirations, in their diverse ways, to make this country, and indeed this world, a better place for all people of all ages. I congratulate the hon. Member for Sutton and Cheam on securing the debate and giving the matter the airing it indubitably merits, and the hon. Member for Leeds, North-West on the reinforcement he provided.
With the Equality Bill having received its Second Reading in the other place only yesterday, it seems apt to begin with the Government's pronouncements in that Bill on age discrimination. The Opposition have made it clear that we welcome the Government's inclusion of age discrimination in the debate surrounding the Bill. The Minister for Women and Equality asserted on Second Reading of the Bill in this place:
"No one should suffer the indignity of discrimination-to be told, 'You're old, so you're past it'".-[Official Report, 11 May 2009; Vol. 492, c. 553.]
Although she no doubt intended her words to apply primarily to the workplace, they highlight a chasm in the Government's thinking on age discrimination-the NHS and social services.
Our social care system is still predicated on age banding, at 18 and-topically-at 65. Indeed, the Government are clutching somewhat desperately to the 65 cliff edge in their rapidly collapsing attempts to reform social care. Disability living allowance has been safeguarded for those under 65, but not for those over 65, under the recent pronouncements and the very words of the Secretary of State for Health. I say "rapidly collapsing" because last week the Secretary of State said, as we all heard, that there would be "no cash losers" among those currently receiving attendance allowance and disability living allowance. Given that the reforms in the Green Paper are based on the roll-up of such benefits into the funding package, presumably the Government are not planning to reform social care for those in receipt of those benefits.
Furthermore, the Government have given no pledge that people in the future who have needs similar to those who currently receive attendance allowance and disability living allowance will receive an equivalent cash benefit. That is why we continue to hold them to account over that issue. To pick up on the Prime Minister's pre-election report, we will soon be fighting an election to protect not only today's pensioners, but those of the future.
The great irony is that if the Government had not played politics with the Green Paper; if they had been open and honest and published the full modelling that we and all the charities in the Care and Support Alliance called for in advance of the deadline for responses to the Green Paper consultation, but which was not forthcoming-I stress that point in case they reply that they have published something; and if the Prime Minister had not decided to run an election manifesto through
the reform with his attempted but failed dividing lines, they might never have caused that confusion over the issue in the policy world, in charities and, above all, in the minds of older, and often vulnerable, people.
The reforms of social care being debated by the Government have also failed to address carers and their benefits. Nothing has been done about the cliff edge that exists for carers who earn; I am focusing on the reference to age discrimination in the title of the debate. There is no ability set out in the reforms to smooth benefits to reward work. More pertinent to the debate is the Government's failure to instigate a discussion of the fact that carer's allowance stops at 65. Where will the equality legislation leave that issue? I hope the Minister clarifies that.
Mr. Burstow: Would it not also be helpful if the Minister said whether he is minded to bring forward the timetable for doing something about benefit reform? The carers strategy refers to 2018, which is a rather long time to wait.
Mr. O'Brien: That is a fair request, so perhaps the Minister will take the opportunity to address it. It is particularly fair in the light of how the social care reform Green Paper has been transmuting and transforming itself over recent days, rather than over a planned period of years, or even weeks or months. It has undergone the most radical transformation of policy in the past few days, some would say on the hoof.
The hon. Gentleman's point is fair, because the Government seem to be inconsonant with the timetable, which seems to be advancing rapidly on one side, but with the benefits not being addressed effectively and being postponed until 2018. The Minister will have the opportunity to respond to that.
Only last month a report commissioned by the former Secretary of State for Health, the right hon. Member for Kingston upon Hull, West and Hessle (Alan Johnson), found that elderly people frequently receive worse health care than their younger counterparts-a point that has already been referred to. It laid the serious charge that, in an institutional sense, the NHS discriminates against those people. That was covered fairly extensively in media reports at the end of October. Doctors identified patients over the age of 65 and suffering from mental illness as particularly prone to discrimination, as has been emphasised.
I turn now to mental health. A Royal College of Psychiatrists report found that tens of thousands of people over 65 are being denied access to specialist mental health services because of the "arbitrary" age limits, which is precisely the point that has already been referred to. Mental health services have traditionally been configured by age, which means that someone aged 65 can receive a wide range of support through adult mental health services, but a person who is only one year older, regardless of their need, might be placed in an older people's service where the same support is simply not available.
The over-65s are also denied access to a range of services available to younger adults, including psychological therapies, early intervention, and rehabilitation and addiction services. The hon. Member for Sutton and Cheam placed particular emphasis on that point. I should therefore emphasise equally the fact that I hope
that the Minister will clarify the situation, particularly given that several interventions were made, which have been answered.
The written answer that the hon. Gentleman received restates the Government's priorities, but omits mental health, which we thought was one of the three issues to have been promulgated as being of great importance over the past decade.
The other question that has arisen relates to the priority that will be given to different areas. Will there be a reallocation of resources? Will there be any extra resources? The issue cropped up during our most recent proceedings on the Personal Care at Home Bill in our debate about the potential for an increase or a reduction in the cash available to dementia research, commensurate with the demographics. We would expect the research effort to match the curve of rising demand.
I hope that the Minister explains what impact the Equality Bill will have. I hope, too, that he tells us what work his Department is doing to change cultures in our NHS. He will readily agree that the blunt weapon of legislation is simply not enough to bring about systemic change.
Earlier this year, as a result of a large exercise involving written parliamentary questions and freedom of information requests, the shocking number of older people who suffer malnutrition in our NHS hospitals became clear to me, and I decided to expose it. The figures show that 70 per cent. of all malnutrition deaths occur among the elderly. The Minister will know that every year-certainly over the past 12 years-an average of 204 people have died of malnutrition. In 2006-07, the number of patients discharged from hospital with a diagnosis of malnutrition, nutritional anaemia or other nutritional deficiencies was 139,127-an 84 per cent. increase over 1997-98 levels. There was a 12 per cent. increase in the number of patients discharged from hospital in such a state in the last year alone.
Such things matter because the number of patients leaving hospital with a diagnosis of malnutrition was 8,533 more than the number of people entering hospital in a malnourished state. That includes those who, unfortunately, went into hospital and, whatever their condition, died there, so the number is all the more worrying. The figures suggest that the nutritional status of at least that number of patients worsened while they were in hospital in 2007.
Malnutrition is not a condition that we associate with Britain, and least of all with our NHS, but the Government have presided over that increase. My colleagues and I have exposed the figures, and we wait to see what the Government response will be to these malnutrition cases, particularly those among the elderly. Surely, such things can be avoided.
The rise of malnutrition among the elderly points to underlying problems in the most basic forms of care that our elderly receive. If our elderly cannot even guarantee that they will be fed well in hospital, no wonder an increasing number of older people and their relatives are expressing concerns about the standard of care that the elderly receive through the NHS.
That is not to run down the NHS. There are solutions and there are some absolutely marvellous examples of best practice, such as the red tray system, which provides an alert without the need to face down the older person
over their need for help with feeding. Above all, however, we need enough capacity so that nurses can sit at an older person's bedside and help them feed, rather than sitting behind a screen filling out target forms.
It is important to explain how we create a stronger voice for patients, particularly the elderly and the vulnerable. Legislation may make the NHS accountable to the Government, but the patients should be given the real power to hold the NHS to account. The local involvement networks initiative, or LINks, betrays the Government's failure to create an effective and prominent platform to allow patients to voice their views about the NHS. The Government have not been prepared to make the initiative independent of the NHS. It has been a mark of this Government that they have consistently sought to undermine the patient voice.
In that respect, I am particularly critical of the Government. At Prime Minister's questions, I exposed the former Prime Minister, Tony Blair, who said that he had consulted before axing community health councils. He then had to write me a grovelling three-page apology to say that the Government had done no such thing and that they just did not like CHCs because they criticised the NHS. All but four of the 107 CHCs were excellent, but Labour abolished them without consultation. They did not like the criticism from CHCs, which were able to amalgamate much of the evidence. In that respect, things such as Bedwatch were very important.
The CHC system was not particularly comfortable for the Government or, let us face it, the previous Conservative Government, because CHCs were independent. However, patients trusted them because they felt that they could have their hands held without being put offside with the NHS, whose services they still needed because they were vulnerable. Patients needed the respect that they could get from organisations that they could trust, and that was possible because CHCs were independent.
Having replaced CHCs with patient and public involvement forums, the Government found that those, too, were too outspoken-particularly the Commission for Patient and Public Involvement in Health, which was the national voice. The Government therefore abolished those forums and replaced them with LINks. The contempt in which the Government held the patient voice was shown by their tagging of the issue on to another portmanteau Bill-this time, a local government Bill.
Now, Ministers are starving LINks of the resources that they need to become established and effective. I dare say that many hon. Members are receiving representations from LINks that are trying to make it clear that they do not have the resources that they need to do the job that they are required to do.
Mr. Burstow: How does the hon. Gentleman see the arrangement with LINks going forward? One reason why CHCs were successful and trusted was that they had been around for a long time-a feature that we have not seen for the past decade because of the constant changes. Do we not now need some stability and an opportunity for LINks to bed down? That is certainly true in my patch, where they have been delivering some quite interesting reports, including on age discrimination.
Mr. O'Brien:
I am grateful to the hon. Gentleman for raising that important point. Some of the better-performing
LINks have often been those that bravely stuck with it through the changes. They have provided continuity and a sense of expertise, and they have benefited from a familiarity with the labyrinthine processes of the NHS, social care and other areas.
Rather than completely abandoning LINks, the solution is to ensure that they develop healthily and fit into the context of the Health Watch policy, which the hon. Gentleman will know well, because the Conservative party has had it in the public domain for the past four years, and I will describe it in a second. That will help to cover the point.
One lesson to be learned from what recently took place in Stafford relates in part to the Government's poor support for LINks and to the lack of a strong local patient voice that can hold trust executives, NHS executives and, ultimately, Ministers to account. That is an ongoing problem. The Conservative party has therefore suggested a national and local independent voice to allow patients to highlight their concerns, as well as increased choice over services, which will enable patients to vote with their feet.
As we begin to move towards a system of payment under which local NHS services are funded according to the outcomes that they achieve for patients, rather than top-down bureaucratic targets, the patient's perspective on their treatment will become increasingly important.
As I made clear to the Older People's Advocacy Alliance earlier this year, we must ensure that older people, particularly those who lack the capacity to express concerns about their care, are given equal access to forums through relatives and appointed advocates. Again, we return to the important distinction between central legislation and grass-roots activity. Legislation can go only so far before older people require local advocates and trained, sympathetic staff-sometimes NHS staff-to ensure that the care they receive off the national radar is of a high quality.
As a corollary to that, I am pleased that the Government are finally conceding that quality is a far better indicator of improved health care than activity-based targets. However, cases such as that of Staffordshire general hospital and, most recently, that of Basildon and Thurrock University Hospitals NHS Foundation Trust demonstrate the distance that there is to travel before the rhetoric penetrates to the grass roots of patient care.
Conservatives strongly advocate a shift towards clinical outcomes as a measure of performance in the NHS. With that shift comes a great deal of responsibility towards vulnerable older people, in whose cases it may not be possible to achieve a better outcome or a full recovery. That is an important qualification.
We must ensure that measures such as dignity, nutrition and comfort are rewarded as highly as clinical outcomes in caring for the elderly. There must be no disincentive to delivering quality care to a person whose health is unlikely to improve. On the contrary, we must incentivise NHS staff to ensure that older people receive the care that is appropriate to their needs, regardless of their health.
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