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16 Dec 2009 : Column 289WH—continued

Our pledge, of which the Minister is well aware, to introduce a payment by results tariff for palliative care will help to ensure that there are services on offer for
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older people who are terminally ill and who want a dignified and comfortable death. It was with great regret that I witnessed the Government voting against the Palliative Care Bill presented by my hon. Friend the Member for Meriden (Mrs. Spelman) earlier this year. The Bill was intended to give people the right to choose where they die, whether at home, in a hospice or in hospital. Too many older people do not have that choice and are forced to die in hospital because palliative care cannot be made available elsewhere.

I have already mentioned the case of Stafford and the more recent revelations about the standards of care at Basildon and Thurrock University Hospitals NHS Foundation Trust and elsewhere. Those cases have emphasised the fact that a hospital's foundation trust status does not offer patients a guarantee of quality health care. It is more important than ever that we should have an effective and rigorous system of regulation at an appropriate level to ensure that hospitals that are failing vulnerable patients such as the elderly do not slip through the net. What is more, regulation must penetrate deeper into standards of care than tick-box targets. The news headlines of recent months only accentuate further the disparity that can exist between a hospital's record on paper and the reality of the care it delivers. So often it is the elderly who are caught in the vortex.

It is vital that inspections should be carried out in person by professionals equipped with the expertise needed to identify poor care. Serious questions have been raised about the effectiveness of the Care Quality Commission, and the Government must prove to patients that they can establish a robust and trusted regulator who can act on their complaints and root out poor practice in the NHS-a regulator who is not at anyone's beck and call, least of all of politicians, but who acts independently on the basis of evidence. Effective regulation is more important than ever in the case of many elderly people who are not in a position to stand up for their own rights or treatment.

I want to touch on the subject of cancer care. It goes without saying that older people's health needs are typically more complex than those of other NHS patients, yet it is older people who face the brunt of discrimination in the NHS. Cancer predominantly affects older people, and the risk of developing many cancers increases with age. Nearly two thirds of cancer diagnoses occur in those over the age of 60, yet despite the high proportion of elderly people who face a cancer diagnosis, access to treatment is far from fair.

Women aged over 70 are not automatically called for breast cancer screening, despite evidence that eight out of 10 breast cancer cases occur in post-menopausal women. What is more, a Roche report reveals that only 30 per cent. of oncologists would prescribe the cancer-fighting drug Herceptin for breast cancer in a 73-year-old patient, compared to 90 per cent. who would prescribe the drug to a 55-year-old.

Inequalities are also prevalent in the treatment of lung cancer. The findings of the national lung cancer audit indicate that the proportion of lung cancer patients in England and Wales who receive active anti-cancer treatment falls with age from more than 60 per cent. for those under 54 to 50 per cent. at 70 to 74 and less than 30 per cent. at 80 to 84. Older people also struggle to get access to stroke treatment and cardiology services-a point that has already been made in the debate-and
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find that they are frequently pushed to the back of the queue for referral to a specialist and for preventive treatments.

In conclusion, in the next 20 years the number of people over the age of 65 will double, and the number over the age of 100 will quadruple. As pressure on the NHS increases, it is more important than ever to iron out discrimination and ensure that health care is delivered on the basis of need, not age. I hope that the Minister will today give a firm pledge to tackle discrimination head on and ensure that our elderly people, many of whom come to the NHS in a vulnerable and fragile state, are treated with the dignity and respect that they deserve, and above all equally.

3.23 pm

The Minister of State, Department of Health (Phil Hope): I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this debate.

The Government believe-we always have believed and will always believe-that we must do everything we can to end discrimination against all age groups, including older people. Today's debate focuses primarily on discrimination against older people, which is a defining issue of our times. It gives me an excellent opportunity, unlike some other Westminster Hall debates, to lay out the breadth of the Government's response to the issue of discrimination in health care for older people and what we are doing to address it, as well as to deal with some of the issues that hon. Members raised during the debate.

It has been interesting for me to hear the views of the Front-Bench spokesmen-the hon. Member for Leeds, North-West (Greg Mulholland) for the Liberal Democrats and the hon. Member for Eddisbury (Mr. O'Brien) for the Conservatives-on what their priorities are, or are not, and the commitments that they are making at this stage in the electoral cycle. Older people will be paying attention to that. I did not hear a single commitment from either party, but it is for those listening to and observing the debate to draw their own conclusions.

As demography reshapes society, Governments, employers and public services have to find new ways to improve the support that is available to older people, not just in sickness but in health. We need to create a society of all ages, and that is the explicit goal of our new ageing strategy, which none of the hon. Members who have spoken in the debate have mentioned. I agree that high-quality, patient-centred health services are a key to that.

Hon. Members will know that when the Equality Bill, which is now being considered in the other place, is enacted-and I hope that it will be-it will make age discrimination illegal across all sectors, including health and social care, and will extend the public sector equality duty to cover age. We plan to bring the new public sector equality duty into force from April 2011 and the discrimination ban from 2012. Hon. Members have failed during the debate to mention the NHS constitution, which makes the commitment to a

Those are powerful statements of intent from the Government and will certainly sharpen minds in the years ahead. However, they must be backed up by real action on the ground.


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Before I come to the specifics, I want to highlight the broader sweep of the action that we are taking. The recent age equality review by Sir Ian Carruthers and Jan Ormondroyd will help us to make further inroads. It contains many of the sentiments expressed in the Age Concern and Help the Aged report published yesterday. It has also been commended by the Equality and Human Rights Commission, which produced a briefing for today's debate, and which has welcomed the fact that its recommendation of a 2012 deadline for implementation of the ban has been taken up by the Government. It is good to know that the commission is powerfully on the side of the Government in this case. I hope that it is not among the organisations that the Opposition threaten to close if they ever return to power.

The age equality review recognises that the national health service has made progress on reducing age discrimination and provides sensible ideas on how to move things forward. We are consulting on the best way to put those recommendations into practice. One of the important messages coming out of the review was that reducing discrimination first and foremost means improving the quality of the existing services. If we can create the preventive, person-centred NHS described in Lord Darzi's report, "High quality care for all", and more recently in another report that hon. Members have failed to refer to in the debate, "From good to great", which is the new five year plan for the NHS, we shall automatically remove many of the problems that hon. Members have spoken about today.

Specific aspects of treatment and care for older people have been a problem in the past, but we have taken measures to address them. The main engine of change is the 2001 national service framework for older people, a 10-year programme to improve access to screening, treatments and other services. I am delighted to say, as others have not, that the framework has led to significant increases in the number of hip replacements and cataract operations, and a more than doubling in breast screenings for the over-65s, for instance. The next steps for the framework will be to address shortcomings in audiology and to improve the commissioning of services in connection with falls, fractures and osteoporosis.

Alongside the framework, many other Government programmes are directly or indirectly improving the quality of care for older people. No mention has been made this afternoon, for example, of the dignity champions campaign. We have 11,000 dignity champions in every part of our health and social care system, from front-line care workers to chief executives of primary care trusts and local authorities, making sure that older people are treated with respect and dignity. There is a drive to abolish mixed-sex accommodation, which is a particular concern for older patients. All hospitals must abolish mixed-sex wards next year unless they are clinically necessary, or face a financial penalty. That is another important milestone for the Government.

As hon. Members said-this is something that has been mentioned-we introduced the national dementia strategy, which I was proud to launch earlier this year. It will deliver real change in the quality and scope of services for people-mainly older people, as we know-who are affected by dementia. "Living well with dementia" is the title of the strategy, and it includes new measures for diagnosis so that we can get earlier intervention and
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treatment for older people and support them at the outset. New ideas such as memory clinics are being developed around best practice, better services and care.

The issue that Members have particularly highlighted is dementia research, which is one of 17 key objectives in the national dementia strategy. I opened and launched a national summit on dementia research in July. It was not then but in November that I announced the creation of a ministerial group on dementia research. I am putting the hon. Member for Sutton and Cheam right on the date on which I made the announcement in Harrogate. It is my intention that the first meeting of the group will be held on 24 February. I hope that that specifically answers his question. He has a habit in debates like this of getting information out of me on specifics, and I am always delighted, if I can, to take the opportunity to give him such information.

Spending on dementia research is the key issue that the group will look at. The hon. Gentleman read out the group's terms of reference-what it is all about. We know that by next year there will be a £1 billion ring-fenced budget for research on health services in this country. The question is how much of it will be allocated to dementia. This is not about Ministers saying, "This amount of money will be put in." It is about independent clinicians looking at the bids coming in from the various sectors that seek research funds. Part of the problem that we have had is that the dementia researchers have not been putting in quality bids to win cash from the large pot of money, which has been growing year on year, that we spend on research in this country.

My concern is that the Dementias and Neurodegenerative Diseases Research Network, or DeNDRoN, is fully equipped and supported to improve the quality of its bids and to win more of the resource for dementia research, whether on analysis of the causes of dementia-we are a long way from finding a cure-on the care of people with dementia, on how people are treated using dementia drugs and so on. There is a great deal of work to be done. Dementia is where cancer was 20 years ago in terms of there being a talented group of individuals in research who are coming up with good ideas. The work that the third sector does in raising money and resources in its own way, international collaboration and co-ordination are all things that need to be driven forward, which is why I created a ministerial group to do just that, and to ensure that we raise our game on dementia research.

Mr. Burstow: One thing that was not clear from the written answer I received was whether there will be direct involvement at a ministerial level by the Department for Business, Innovation and Skills.

Phil Hope: I am happy to take suggestions of any kind about how we make the group work well. I want to ensure that it covers the broadest aspects around dementia research and involves all the key players such as researchers in the public sector and the private sector, if that be the case, and advice from the business community-frankly, wherever and whenever we can do the work that we need to do. We need to make the group manageable, so we must think about its membership. I have come up
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with a list of people. In practice, I am sure that we can engage many of the people out there, not just in this country but abroad as well.

Mr. Burstow: Perhaps I sat down prematurely. The point I am making is that that Department has an overall brief in respect of science and technology. Therefore, having ministerial input from it is rather important.

Phil Hope: The hon. Gentleman makes a good point, and I shall certainly liaise with ministerial colleagues. However, it will be my group. I will run it and ensure that it works well.

Another key aspect and plank of Government policy that hon. Members failed to mention is the end-of-life care strategy. It is worth mentioning in the tour d'horizon-the line of work that we are carrying out-as something that the Government are taking forward. The strategy is improving how older people are treated at the end of their lives, and deals with how and where they die. In addition, we are undertaking vital work in social care as well as health care.

The putting people first programme provides £500 million of extra resources to local councils. It is ring-fenced and helps them to build more personalised care services, not least for older people. In the partnerships for older people project, health and social services have joined charities and community groups to take action to reduce the incidence of people falling in their own homes, and to increase older people's independence.

Of course, as mentioned by the hon. Member for Eddisbury, we have introduced radical proposals for social care which involve creating a national care service for the future. Despite all the arguments made in the House on Monday on Second Reading of the Personal Care at Home Bill, both Opposition parties decided not to oppose it and, I am delighted to say, it has gone to Committee. Clearly, this Government have touched on something, and we are leading the way and ensuring that those people with the greatest needs-mainly older people living in their own homes-are supported so that they can continue to live in their own homes independently, with choice and control over their life.

Another strategy that the Opposition parties failed to give the credit it deserved is the carers strategy. We will not be bringing it forward because it is a 10-year strategy-it is defined by that length of time. We have a three to five year delivery programme in place to make it a reality. It includes extra cash-not least for respite care-for local authorities, primary care trusts and groups in the community.

The hon. Member for Eddisbury raised a particular issue concerning carer's allowance. I was intrigued by his query, because, as we know, carer's allowance is an income replacement benefit. Someone cannot be paid two benefits at the same time, which is why carer's allowance comes to an end when somebody receives a pension. The pension is paid, and there are premiums on top of that-the carers premium-for pensioners in particular circumstances.

Mr. Stephen O'Brien: Will the Minister give way?

Phil Hope: I will be intrigued if the hon. Gentleman is about to tell me that his party will do something different with the carer's allowance from what is occurring at present. I am all ears.


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Mr. O'Brien: As the Minister seeks to challenge me, I was drawing an analogy to show where a great deal of age discrimination is institutionalised within the process. I did not make any of the allusions that he spoke about. It is well known that carer's allowance is an income replacement benefit, although it is often perceived very differently by those who are in receipt of it. That is one of the challenges and issues that he and, indeed, all of us face.

On the subject of respite care, the Princess Royal Trust for Carers has come up with the shocking finding that, of the £50 million out of the £150 million allocated under the Government's strategy to cover respite care-we would hope planned care as much as emergency respite care-£40 million has gone missing, yet the only response so far from Ministers is that it is up to all MPs to harry their local trust. That is obviously an inadequate answer, and I hope that the Minister can tell us where the £40 million has gone.

Phil Hope: So no change on carer's allowance. When parliamentary representatives from the Opposition ask me questions, it implies that they are going to do something, but clearly not in this case.

On respite care spend, the hon. Gentleman is right to highlight the question raised by many carers organisations: is the money that we have allocated to the non-ring-fenced devolved budget being spent? The Liberal Democrats have fought very hard for that in their localist agenda, yet they press me hard in the national setting on why it is not being spent locally. However, to point out that contradiction, I would need to repeat something that I have already said in many debates in the past. There is an obvious contradiction in the Liberal Democrat position.

In fact, I have met the Princess Royal Trust for Carers and others from the carer's allowance unit to discuss this particular concern, to see whether we can do more to monitor the work that is being done on the spend of the resource, to find out where there may not be sufficient allocation, as they would see it, and to see what more strategic health authorities, for example, might do with the PCTs in their area to ensure that the respite care that is needed is properly commissioned through the new guidance that we are issuing to PCTs on how to commission services for carers, and to see that that happens in practice.

Mr. Burstow: That is all very well. In previous debates on this issue I have mentioned the need for transparency to the Minister. If we are to have local accountability for decisions made by local primary care trusts about the spending of this money, we need transparency locally. However, that is missing, which is why we have not been able to hold PCTs to account locally. Surely the Minister can help with transparency.


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