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16 Mar 2010 : Column 193WH—continued
"This should include an immediate requirement for acute hospitals to have an older people's mental health liaison team in place to ensure that unnecessary admissions are avoided and that discharge to appropriate care is as swift as possible."
I can only report that I have not yet come across an older people's mental health liaison team in the Oxford Radcliffe Hospitals NHS Trust.
The next recommendation states:
"Early diagnosis of dementia is crucial in providing timely and appropriate care and in preventing more costly hospital or residential care. The Department should work with Primary Care Trusts to ensure they urgently commission good quality and effective memory services."
I have another suggestion that will help. Most general practitioners are stressed for time, but the condition of a large number of people who are suffering from Alzheimer's or dementia in its early stages will have been picked up by their family or their husbands or wives much more quickly than by the GP. If we asked GPs to set up a voluntary register of people who are carers, and if carers were recognised much more in the NHS system, I suspect that there would be greater opportunity for carers to say to GPs, "I think my husband or wife is in the early stages of some difficulties with memory and perhaps dementia." It can often be difficult for an individual to acknowledge or admit that they are in the early stages of dementia or Alzheimer's. We need to encourage more people, as carers, to discuss candidly and frankly with their GPs the suffering of their loved one or the fact that they are in the early stages of dementia.
I am sure that all hon. Members, as friends, relatives and constituency MPs, see people who are finding life slightly difficult and who will, in a couple of months or
so, start going downhill fairly fast. It is not that people are insensitive or unthinking, it is just that unless someone says to their GP, "Look, this person needs some help", a diagnosis will not necessarily be picked up early. If we are talking about continuing professional development for GPs, one thing they need to consider much more in their surgeries is how they respond to and work with carers for those who are suffering from dementia, particularly if the Government's policy is that ever more people should be looked after at home and not necessarily in care homes.
"There is unacceptable regional variation in access to diagnostic services for dementia and in access to dementia drugs...Local leadership is still lacking in NHS hospitals, in primary care and in the social care and care home sectors."
That is a pretty damning conclusion. The PAC advises that every acute hospital should have a "senior clinical leader" by the end of this month, who should
"work with the new Care Homes Champion to develop dementia 'Champions' across the care home sector."
That takes me back to my original point, which is that everyone wants to be confident that there are people in the system who have a grip and who provide leadership, whether in respect of an acute hospital trust, a social services department or within the care homes sector.
"Most people with dementia receive their day-to-day care from domiciliary carers or care home staff, who have little understanding of dementia, which therefore puts at risk the quality of care and safety of some of the most vulnerable people in society. After six years of debate and discussion, plans to introduce registration of social care staff, many of whom are without qualifications, appears to have been abandoned. As a result these staff will remain unregulated for some time to come."
It is not just a question of regulation; it is about staff being valued and appreciated, and about who takes the lead and who should be responsible for ensuring that we have enough domiciliary carers or care home staff who are properly and fully trained and who feel valued, just as nurses in a hospital feel valued. The work that domiciliary carers and care home staff do is crucial and invaluable in our society and deserves to be appreciated, valued and recognised. Registration should not be regarded as some sort of indictment. If there is registration, it should be regarded as a qualification that is considered worthwhile.
Lastly, like a number of previous reports, the PAC notes:
"There is inappropriate and excessive prescribing of anti-psychotic drugs for people with dementia, particularly those living in care homes, which has contributed to up to 1,800 additional deaths each year."
That situation often comes about because care homes have to look after people with dementia with too few staff, and the only way they can manage the numbers is by putting patients on those terrible cocktails of anti-psychotic drugs.
An enormous amount of work still has to be done, and if we are to get a grip on it, there needs to be leadership from Ministers downwards. This is a growing issue-a growing challenge to us all, wherever we live in the country-and we need to ensure as a starting point that in future if the Government make pledges on dementia or other issues, those pledges are not broken.
10.27 am
Greg Mulholland (Leeds, North-West) (LD): It is a pleasure to serve under your leadership, Mr. Streeter, and to have the chance to speak in such an important debate. I congratulate my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) on securing it. Throughout this Parliament and his career, he has been a champion for older people and has led the debate on many issues regarding older people, particularly those unfortunate people suffering from the range of conditions that we term dementia, and their families and friends who also suffer.
I do not intend to make a long speech, because my hon. Friend and the hon. Member for Banbury (Tony Baldry) have already covered most of the salient points in their excellent speeches. I am sure that this will be our last chance before the election to debate the important issue of health and social care, so it is a chance to assess where we are with the national dementia strategy and what progress has been made during this Parliament. Equally-almost more importantly-all hon. Members have to call for whoever is in government after the election to make dementia a clear priority. I commit myself and the Liberal Democrats to that and to being part of it.
This is not the time for more warm words. It is time for a clear commitment to deliver and to work together to deliver: we are starting to do that more, which is positive. We have to do that because all hon. Members are committed to real breakthroughs in dementia. It is important to say that, and we all want to say it. It is about making a commitment-saying that it will happen.
I want to pick up a few points that have been made and to emphasise some of the questions that have been put to the Minister. First, there is ongoing concern about the apparent lack of prioritisation for dementia care and the fact that the recently published NHS operating framework did not refer explicitly to dementia, which was not considered to be a tier 1 priority, or even a tier 2 or 3 priority. Why is that? More importantly, will the Minister give the strongest assurance that it will be included in subsequent operating frameworks and will not suffer in the meantime from being excluded? Similarly, we have been told that the vital signs indicators have been laid out, but if there are new priorities for the nation's well-being, why can those vital signs not be updated as we go along?
The second important area is research, about which my hon. Friend spoke strongly. I, too, have referred to it on several occasions. We have heard the figures and about the imbalance at the same time as the ticking time bomb of an ageing population and its effect on costs. It has been estimated that the cost of dementia in England will treble over the next generation from £17 billion to £50 billion. That is simply unsustainable, so clearly there must be an increase in the spending on dementia research. My question echoes that asked by my hon. Friend. Will the Minister indicate the outcome of the welcome ministerial taskforce meeting, and may we see the minutes? Crucially, what timelines do the Government envisage for increasing funding for dementia research? That is what we need to see. Will there be an announcement around the time of the Budget? I would warmly welcome that. If timelines were in place, it would be for other
parties to say whether they would commit to them, and that would move the debate on in a way that we would all welcome.
I turn to some of the specific issues of the dementia strategy. My hon. Friend and the hon. Member for Banbury mentioned the NAO report, and I shall refer to a few of the concerns and criticisms. First, I recently referred on the Floor of the House to memory clinics. In the light of the apparent change in commitment, will the Minister confirm whether the vital services provided by specialist memory clinics will be available to some extent throughout the United Kingdom even if it is not possible to locate one in every town? Secondly, training remains an enormously important part of the strategy, and as hon. Members have said, we still have inadequate training on dementia care for health and social care professionals. Will the Minister give an assessment of what progress has been made, and explain what discussions he has had with the professional colleges, such as the Royal College of General Practitioners, the British Medical Association and the Royal College of Nursing, about developing the dementia care skills of health service staff?
Carers have rightly been an important part of the debate, and we have all spoken on many occasions during this Parliament about their huge importance. The hon. Member for Castle Point (Bob Spink), who is not now in his place, reminded us that if they were not caring for loved ones, friends and neighbours, there would be a huge additional burden on the social care sector and the NHS. The startling sum of £87 billion is the contribution that carers make our economy, but carers' organisations remain deeply dissatisfied about whether the carers' strategy is being implemented and the money that is specifically allocated goes to the key area of respite for carers.
The Princess Royal Trust for Carers estimates that only 80 per cent. of the money allocated has been used to support carers. It also pointed out the synergy with the dementia strategy and the end-of-life-care strategy in terms of the money being allocated, which is about £1 billion in total. That is simply not being spent on the purposes and important areas to which the Government allocated it. The trust made a powerful point when it said:
"There is a systemic failure in the way that Government attempts to implement or monitor the progress of national strategies."
We all agree that national strategies are good, but if they are not being implemented and properly monitored, they will fail. None of us must allow that to happen.
Mr. Burstow: Does my hon. Friend agree that a stark contrast has emerged from the National Audit Office's work? The NAO gave a glowing report on the national stroke strategy's progress and identified two key differences. First, the money for that strategy was clearly identified in advance and, secondly, clear national priorities were attached to it through the operating framework. Those are missing from other strategies, which his why there is systemic failure.
Greg Mulholland:
My hon. Friend is absolutely right, which is why there is concern that the strategies, which we all agree are important, are simply not biting or having the impact that we all agree they need to have. I note that 12 leading charities approached the Secretary
of State for Health, offering to meet and to work together to share findings and to look for solutions. Unfortunately, that offer was not taken up. Will the Minister say whether that decision could be reconsidered, even at this late stage? I can commit the Liberal Democrats' health team to working with leading charities in that way and to share findings and advocate solutions.
I pay tribute to my hon. Friend who has championed the cause against anti-psychotics. It remains a scandal that they are still used inappropriately from a health point of view and infringe the human rights of some of those for whom they are wrongly prescribed. Will the Minister update us on progress? Clearly, he and the Secretary of State take the matter seriously, so will he give us some firm timelines on when the use of such drugs will be ruled out once and for all in inappropriate cases? This is an important policy area to which we are all committed. We must look forward to the next Parliament, and I will certainly do what I can to continue to raise these issues, as will all Liberal Democrats. I hope that others will also do so. It is time to ensure that the dementia strategy delivers. Warm words are fine, but they must be turned into action and the real breakthroughs that we need.
10.39 am
Mr. Stephen O'Brien (Eddisbury) (Con): I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this important debate, which succeeds a series of such debates in this House. I also congratulate my hon. Friend the Member for Banbury (Tony Baldry) on his predictably excellent contribution.
I welcome the opportunity to debate the dementia strategy today, and to keep up the pressure that we put on the Government in our Opposition day debate to ensure that funding for the strategy breaks free from Whitehall and primary care trust bureaucracy, and reaches patients on the front line, who live each day with the knowledge that their memory is gradually slipping away from them. Dementia is a debilitating and frightening disease, and those who suffer from it rightly want to know what action the Government are taking now to ensure that they may access appropriate care, and what research they are undertaking to discover new treatments for the disease.
It is right to pay tribute to the thousands of carers who look after loved ones, and to those charities that tirelessly campaign in the cause of those who suffer from dementia. As if a diagnosis of dementia were not enough to deal with, the last few weeks have added new cause for concern for those suffering from Alzheimer's. In addition to the National Audit Office's criticism of the Government's implementation of the dementia strategy, news headlines have been filled with reports of the Government's convoluted proposal for a death tax; the inappropriate tube-feeding of elderly and dementia patients in care homes and hospitals; and a rise in cases of malnutrition among older people in the NHS. Alongside that, there has been a political debate about how to tackle the decade-long silence from the Government on social care reform.
Against that backdrop of existing problems surrounding dementia care, we must acknowledge the scale of the challenge ahead. Of the 8.2 million people aged over 65, and the 6 million people using social care, there are
currently 700,000 people diagnosed with dementia in the UK, and that figure is set to double over the next 30 years. As we consider how we might deliver better care to dementia patients, it is important to remember that without wider social care reform, the needs of dementia patients will remain unmet.
It is not only the Opposition who have concerns about the Government's implementation of the dementia strategy. As we have heard, the NAO report published in January criticised the Government on several counts for their actions since the publication of the strategy. To my mind, the NAO's findings raise three pivotal concerns. The first concern is the lack of accountability in place to ensure that PCTs spend the £60 million from the strategy for 2010-11 on dementia services. We need only look at the recent carers strategy to see how urgently that accountability is needed. Before Christmas, it emerged that the £50 million dispersed for emergency respite care this year hardly reached the front line, having been soaked up by local PCT bureaucracy, and we have had some exchanges on that.
Given that disturbing precedent, I hope that the Minister will tell us how the Government intend to ensure that they keep a grip on the allocation of resources that have been identified and earmarked for the dementia strategy. During the Opposition day debate, the response by the Secretary of State for Health was deeply worrying. On the dementia strategy, he said that he had
"given PCTs the freedom to determine their spending based on local needs."-[Official Report, 27 January 2010; Vol. 504, c. 831.]
Although autonomy for PCTs should be promoted, that does not mean that the Department should lose track of local spending decisions and have no capacity to check how central funds that are assigned for specific purposes, such as dementia, have been spent.
When the Minister, the hon. Member for Sutton and Cheam and I met the Princess Royal Trust for Carers last week, I was pleased to see the Minister make a U-turn on his line that it was up to each MP to chase up their own PCT on the issue of the carers strategy funding. [Interruption.] The Minister laughs because he is embarrassed, but he said that the PCTs would now be directly accountable to him, and the hon. Member for Sutton and Cheam was there to witness that. It is important that the Minister takes the opportunity to shed some light on how PCTs will be expected to report to him, and tells us what measures he will introduce to ensure that the accountability now in place will be maintained in the long term.
Mr. Burstow: I thank the hon. Gentleman for mentioning that important point. Although it is incumbent on the Minister to spell out how he will ensure that accountability, given the proximity of the general election, surely it is incumbent on us all to say how we will ensure that the money gets to the front line. Will the hon. Gentleman do that?
Mr. O'Brien:
The hon. Gentleman is right to ask me about that. If there were time to do so, I would be more than pleased to develop that point. [Laughter.] Suffice it to say, before the Minister has complete hysterics, that the NHS board and the NHS autonomy and accountability Bill, which will be introduced in the first year of a Conservative Government, would be the chaser and enforcer of such matters. That is what is so absent
from the Government's plans-they give headline announcements but have nothing to chase them through, so the accountability fails.
I hope that the Minister will take that point seriously, rather than seek to laugh it off, and that we can move to the second concern, which is the vagueness with which the dementia strategy laid out its funding sources for the next decade. To date, the Government's impact assessment has identified only £533 million of efficiency savings over 10 years, which leaves nearly three quarters of the £1.9 billion budget unaccounted for. The Government have yet to give a detailed indication of where the money will come from, and I hope that the Minister will provide details on that. Clearly, those savings have already been announced, and we do not need to wait for the Budget for them-that is the normal cover claimed by Ministers at the moment. There is an opportunity this morning to put those details on the record at last.
The third concern with the strategy was highlighted by my hon. Friend the Member for Banbury and also mentioned in the NAO report; it is the Government's need to tackle the gaping hole in the skills set of all professionals who encounter dementia patients as part of their job. We sought reassurance on that matter during the Opposition day debate, and the Secretary of State said that he had commissioned Skills for Health and Skills for Care to assess training needs. However, he did not specify whether the Government were looking specifically at dementia training or at the broader work force agenda, and I hope that the Minister will take the opportunity to clarify that point.
The hon. Member for Sutton and Cheam mentioned the important issue of the evolving discussion that started with the early-hit headline announcement of memory clinics in every constituency. That was downgraded to memory services, and then to services that seem to exist already, mainly psychiatric services and centres. Perhaps the Minister will update us on where he has got to with putting a memory clinic "in every town", to be precise with the quote. Let us see whether the strategy has been delivered on and has fulfilled the hopes that were raised by the headlines that were secured by the Government's announcement.
Dementia research is another vital area. We must ensure that we match the commitment to research-particularly where that research has Government funding-that involves tracking the anticipated and known demography coming down the track. We have pledged to give greater priority to research on dementia and Alzheimer's within Government research budgets, and we hold to that pledge. Hopefully, that will be matched, and I am encouraged by the Government's more recent announcement of a new ministerial group on dementia research. It would be helpful to find out what progress has been made to date-I think that there has been a meeting-and to learn what support is on offer. We can then ensure that our research, which is world-class and in which we are leaders, can be capitalised on, so that benefits to patients can be developed and accelerated.
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