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16 Mar 2010 : Column 186WH—continued
That research demonstrated that the money is not delivering what it was intended to deliver, and that PCTs planned to spend only 25 per cent. of the £100 million to increase services for carers-that is, from this April. That is a tiny improvement on last year's situation, but it is still woefully less than what was promised. A significant proportion of the money that is being spent is probably being double-counted against the money allocated for other Government strategies. In my patch, the carers strategy money has been double-counted alongside money for the dementia strategy. The two strategies have been put together, so that the PCT can claim that it is achieving its spend.
Mr. Stephen O'Brien (Eddisbury) (Con): The hon. Gentleman is developing a very cogent argument. I dare say that he was as shocked as I was by the bare-faced cheek of these PCTs, who have been given the money and put on notice by him, me and others that the Minister's wish has not been delivered. The Minister's answer has always been that MPs should chase the PCTs for a resolution to the matter, rather than getting a grip on the problem himself. However, he said last week that he would get a grip of the issue, but the future projection of the spend is hardly any better than the figures that we have already had. It looks as though the PCTs are spitting in the face of the Minister's obvious wish.
Mr. Burstow: There is a huge accountability deficit here. PCTs cannot be held to account, and sometimes getting an answer to any such questions is like getting blood out of a stone. I first asked Ministers about the matter eight months ago; I was admonished for doing so and was told that I should be asking my PCT. It took months to get an answer out of them. That answer was disappointing, and the Princess Royal Trust for Carers has had similar responses across the country. In fact, 25 per cent. of PCTs plan to reduce spending on services for carers, despite the extra resources specifically put into budgets to help with those services. A small number of PCTs continue to provide no services whatever for carers, and that picture is reinforced by the fact that, across the country, up to £1 billion that has been allocated may not be reaching its intended recipients. That is scandalous and a disgrace.
Of the £150 million committed in 2009 to 2011, 24.5 per cent. will be used to increase support for carers; the rest has gone somewhere else. The problem is that the issue is not just about the carers strategy; there is clearly a problem with the implementation of other strategies as well-the child health strategy, the end-of-life care strategy and the dementia strategy. All four strategies represent important Government announcements of nearly £1 billion in new spending. It is proving very hard for most of the charities that cover those areas to establish precisely how that £1 billion is being used.
I welcome what the Minister recently said about personally holding PCTs to account. That is very important. However, that positive announcement leads us to ask what the Minister will do to ensure that the PCTs really deliver. What does such an announcement mean in practice? Many PCTs have been advised that they would not be setting budgets until late March. PCTs have
known about the extra money since June 2008, and the best committed their spending at an early opportunity. That has to happen, because many of the strategies involve working in partnership with local authorities and, moreover, with the voluntary sector in a local area. Lead times have to be considered if there is to be cost-effective delivery of new services, so why has none of that happened, and why do we not have the mechanisms to hold PCTs to account?
In the Public Accounts Committee hearings, the question of the cost of NHS continuing health care was raised. At the end of the session, I asked the Department of Health to write back to me with further information on the subject. I got the reply the other day, which stated:
"The Regulatory Impact Assessment which accompanied the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care in England (2007), estimated, based on existing data about the costs of care, the overall cost of implementing the new Framework...in the first full year as £219 million."
The cost of delivering continuing care, funded by the NHS, is £219 million. The important question is: what happens next? Where does that money come from? This is what the Department said:
"The costs of implementation will include a cost shift from Local Authority budgets".
Some £219 million is needed to deliver the Government's framework. How much of that £219 million will come from a cost shift from local authority budgets? We all know that social care budgets are under pressure. Social care budgets deliver most of the dementia services that make a difference to families' lives. How on earth can we find £219 million out of local authority budgets to pay for that? Will the Minister give some reassurance about what is intended by those words? If they are to be interpreted literally, as I fear they should be, they are very scary.
I am grateful to have been given the opportunity to initiate the debate, but I want to bring my remarks to a close. There is clearly now an acknowledgement that dealing with dementia is a huge challenge and that we need to invest in services. Doing so will save money in the long run and transform lives. We need to make sure that that is a clear priority. We cannot just leave individual NHS organisations to choose whether they invest in dementia services, as if they were a luxury item. Those services are no luxury; they are essential. That is why the Government's rhetoric on dealing with dementia as a priority must be translated into action on the ground. I hope that we will hear a positive response from the Minister on the issue of research, and some indication of a commitment to moving those matters forward. I look forward to hearing the other contributions to the debate, and I hope that the Minister will respond in detail at the end.
10 am
Tony Baldry (Banbury) (Con): The hon. Member for Sutton and Cheam (Mr. Burstow) is to be congratulated on initiating this important debate.
On the point about the money that has supposedly been allocated to primary care trusts for carers, particularly for respite care, the further figures produced by the Princess Royal Trust on how the forward allocation will not be spent are disappointing. The frustrating point is that the Government all too often give the impression
that something will happen-that a group such as carers will be looked after-but then in reality it does not happen. In my most recent constituency surgery I heard from a constituent who has been looking after his elderly wife, who is suffering from dementia, at home. He has been asking for respite care and some help with physiotherapy for some time now, but he has received absolutely nothing. I put the Minister on notice that I happen to be No. 1 on the list for Prime Minister's questions tomorrow, so Mr. Speaker cannot fail to call me. I advise the Minister to give some help to No. 10 on the matter, because I may well put that point to the Prime Minister.
The fact of the matter is that men who reach the age of 65 today have an average life expectancy of 82, and for women of that age the life expectancy is 85. The advances of medical science over the past century mean that we now have longer life expectancies than at any time in the history of civilisation, so we can celebrate the fact that more people than ever before will live longer and, broadly speaking, healthier lives. The number of over-60s will therefore increase over the next two decades, both as a proportion of the total population and significantly in absolute numbers, as the post-war baby boomers move into retirement.
However, the human species is not indestructible, and although improvements in medical science mean an increase in life expectancy, the statistical fact, sadly, is that a proportion of those people living longer will succumb in due course to age-related illness. For example, the incidence of dementia rises sharply for those over 80, from around 6 per cent. for those aged 75 to 79 to 12 per cent. for those aged 80 to 85 and 21 per cent. for those aged over 85. I understand that one in three people aged over 65 will die with some form of dementia. In the Cherwell district in North Oxfordshire, in my constituency, the population aged over 65 is due to increase by 60 per cent., which is significant, over the next decade, largely because Banbury was something of a new town in the 1960s. However, nowhere do I see evidence of a 60 per cent. increase in nursing home provision in the district.
When I was first elected a Member of Parliament 27 years ago, every Christmas I would visit every nursing home in my constituency to meet the residents, who were, by and large, spry widows in their 70s, with the occasional widower. I do not think I heard the word Alzheimer's until I had been an MP for some years. I no longer visit nursing homes at Christmas, not because I am disinterested-I frequently visit them at other times-but simply because every nursing home in my constituency, almost without exception, is filled with elderly residents suffering from increasingly severe dementia or Alzheimer's.
I welcome the recent campaign to raise awareness about dementia, led by the Department of Health supported by the Alzheimer's Society. It has the theme, "Dementia: the more we understand, the more we can help". As few of us will live lives untouched either directly or indirectly by dementia, it is important that we all have the greatest understanding about it. Indeed, in my constituency I have set up an advisory group, called the successful ageing group, which consists of local people from Help the Aged, Age Concern and the local carers' centre, because in Banbury we too are fortunate enough to have one of the first Princess Royal Trust for Carers centres, which do excellent work. The group also consists
of representatives of the WRVS-formerly the Women's Royal Voluntary Service-which does some really good work at the Cornhill centre, providing support for older residents in the community. There are representatives from Oxfordshire Links and from specific charities and organisations, such as the Alzheimer's Society, the Multiple Sclerosis Society and Parkinson's Disease Society. The intention is to meet reasonably regularly to try to understand what is happening locally in that landscape, because sometimes it is difficult to relate national initiatives to what is happening locally.
That takes me to the Public Accounts Committee report on improving dementia services in England, to which the hon. Member for Sutton and Cheam, who is a member of the Committee, has referred. It might be helpful if I go through the report's conclusions. The first conclusion is:
"Although the Department said dementia would be a national priority, it has not afforded it the same status as other national priorities such as cancer and stroke."
The Committee recommends that strategic health authorities should
"agree with each Primary Care Trust a local dementia implementation plan, comprising costed actions and a timetable, by July 2010."
Who is leading on that? Will PCTs lead, or in an area such as mine will county council social services departments lead in trying to ensure proper services for those suffering with dementia? The reality, in my experience, is that comparatively few people suffering from dementia will stay in acute hospitals for a significant length of time. They might go into an acute hospital because they have broken a hip, for instance, which is often when their dementia is discovered, but because-understandably-their long-term needs can rarely be met in an acute general hospital, help in a care home or in the community will be sought for them fairly speedily.
One of my concerns is that I often do not think that there is a sense of grip on who is leading. If the PCTs are meant to be leading, they also need to be gripping social services departments, because all too often we have a situation in which everyone is pointing and saying that it is the other person's responsibility. Indeed, on several occasions I have found that the only way Oxfordshire MPs can sort things out is by getting everyone involved, such as the PCT and social services, in the same room at the same time to discuss blocked beds, for instance. The PCT will say that it would like to move people out more quickly but cannot get beds in community nursing homes, while social services will say that hospitals are not getting the appraisals done quickly enough. We need to know who is leading on that.
Mr. Stephen O'Brien: The other element is accountability, because whoever is in charge and takes a grip needs to be accountable for what they are doing so that there is transparency and visibility. Has my hon. Friend's successful ageing group expressed a view on where it would like the leadership to come from? There must be some kind of recognition of where it expects the lead to come from. Does it want it to be the PCTs, the local council, or indeed the Government? It would be helpful to know whether the group has expressed a view, because we could then take something forward.
Tony Baldry:
My hon. Friend makes a good point. People would like to feel that they know who has a grip on the matter. There are similar concerns about who is
managing the continuing care budget. Is it being managed by county council social services departments, or by the PCT? If it is being managed by the PCT, as it seems to be, what are the implications for social services if there is some tweaking in applying the budget? Someone has to be accountable, so let us know who it is. That is the important issue.
Mr. O'Brien: My hon. Friend raises a very interesting point. I do not want to take him too far away from his prepared remarks, but one of the biggest problems that all of us, the Minister included, contend with is that even when polling takes place to find out what the country's priorities are, caring for our elderly population is not an item that is polled. It is subsumed in the health service or pensions and is never an item on its own. One of the problems of the demographics we face-based on what my hon. Friend has just said, I dare say that he has picked up on it-is that we find it difficult to identify precisely how people feel about putting it as a priority because it is never disaggregated as an issue of concern.
Tony Baldry: My hon. Friend makes a good point. I suggest to the House that concerns about caring for the elderly will start moving significantly up the political agenda over the next few years. I am sure I am not alone among Members of Parliament who constantly meet constituents who feel incredibly stretched. The husband and wife trying to maintain two jobs while they look after children on the one hand and aged parents on the other feel very much part of the sandwich generation. One comes across an ever-increasing number of elderly carers who are looking after a husband or wife. It is a growing trend and, as I shall say, I am not sure where we will find sufficient carers as we move forward.
In its second recommendation, the PAC states:
"Dementia is like cancer in the 1950s, still very much a hidden disease. There is a need for a massive campaign to promote openness and debate on this important and challenging issue."
Dementia is distressing for those suffering from it and their families. Obviously, it is difficult for people suffering from dementia to interrelate socially as they once would have done. The disease tends by definition to get hidden away, and it can sometimes be frightening. The behaviour of people with dementia, Alzheimer's in particular, can sometimes be extremely unpredictable. We all need to make every effort to explain the challenge that dementia poses, and if we are a caring society in which we have a regard to and a concern for the welfare of everyone, we will need to learn much more about dementia and ensure that those who are suffering from it are better cared for.
The PAC's third recommendation has a familiar ring:
"The Department does not know how the first £60 million of dementia funding has been spent by Primary Care Trusts. The Department has only recently commissioned an audit of costs of dementia services which is expected to be completed in summer 2010."
I understand that Ministers have a dilemma. On the one hand, they cannot dictate or micro-manage from Richmond house how every PCT spends every parcel of money allocated to it, but one would have thought that the very least the Department could do when it allocates money
for a specific function, such as dementia services, is to ask PCTs simply to give an account of how the money is spent. It cannot be right that the Department and PCTs cannot give the PAC an explanation of how PCTs are spending the money.
Mr. Burstow: Does the hon. Gentleman agree that there should not be national announcements about sums of money allocated to national strategies unless they are accompanied by a clear plan of how local organisations-NHS and PCTs-will account for how they use it? A clear audit trail has to be set up when the money is announced.
Tony Baldry: I entirely agree; otherwise, confidence in public policy and the machinery of government is very much undermined. Increasingly, people do not give credence to announcements made by Ministers. They believe that there is double accounting, window dressing or double dipping, and that nothing will materialise. When nothing happens, they understandably feel cheated, which is unfair on everyone involved. The hon. Gentleman makes a reasonable proposal: why should there not be a straightforward audit trail of money that is specifically allocated by the Department of Health for a specific purpose, whether it be for dementia or for carers, so that everyone knows where it has gone?
The PAC's next recommendation states:
"The implementation of the Strategy is dependent on achieving"-
"£1.9 billion of efficiency savings by increasing care in the community and reducing reliance on care provided in care homes and acute hospitals."
Let us take that apart a bit. As I understand it, the dementia strategy that the Government are introducing will require somewhere a saving of nearly £2 billion by reducing the spend on acute hospitals and care homes and by increasing care in the community.
Where does care in the community come from? "Care in the community" is shorthand for people being looked after at home by a mixture of carers and care workers, yet the Government's attempts to give further support to carers at home, by allocating money to help them, have fallen at the first hurdle.
I am sure that when the hon. Member for Sutton and Cheam meets carers at his local carers centres and asks them about their needs, he finds-as I do-that they almost always first articulate the need for a break, or respite care. It varies from person to person: some ask for a weekly break, or a few hours off so that they can do shopping and so on. The all-party carers group, of which I am a member, had a meeting with the Prime Minister last year and all of us-officers and members-articulated that need. In fairness, the Department came forward with a chunk of money for carers. It was intended for carers' breaks, but it is not being used for that by PCTs. What confidence can carers have that the Government will support them if they fail at the first hurdle by not ensuring that PCTs allocate carers the money that was meant to be allocated to them?
Where are the care workers to come from? I have a real concern that nursing homes on my patch seem to be manned almost entirely by good-quality nurses from the Philippines and Bulgaria. I do not mean that facetiously. The nurses are recruited and trained by UK nursing
homes, but as soon as they are trained, they are often poached by the local NHS and move into it. Nursing homes are continuously having to train and retrain people. It is an ongoing experience.
I do not see a co-ordinated programme to ensure that jobs in nursing homes are seen as worth while, rewarding and valued in their own right by society. I see no evidence of local further education colleges or universities laying on courses at, for example, national vocational qualification level 4 so that we can have more qualified care workers. [Interruption.] I would be happy if the Minister told me in his summing up that I am wrong. I just do not see evidence of that in Oxfordshire. Whenever I visit nursing homes, I am told that one of their great concerns is recruitment of staff. If we are to have far more people providing care in the community, it will require a considerably larger number of qualified, caring care workers. One can introduce the policy only if such people are available.
The shorthand for that move is "personalisation of care services", which is the jargon that is being used. May I put down a marker? If people are to be looked after more in the community, that should not be shorthand for their being isolated at home; they still need to be able to get to day centres to interact with others and to have a community life. I am concerned that pressures are being put on social services departments and county councils, on one hand to increase the amount of money that they are giving for care in the community, which is shorthand for people being looked after at home, whereas on the other hand, as a consequence, there is less money for day centres and other provision for the elderly.
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