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Lord Davies of Oldham: My Lords, we will discuss with British Shooting the whole question of the legacy from Woolwich. We are optimistic that there will be a considerable one, including part of the range to be relocated. The House will appreciate that British Shooting has been strong in its view that Bisley ought to have been the location. The decision is final that Woolwich is the better option in the overall strategy for the Games. It is important that the Olympic authorities now relate closely to British Shooting and all those with the interests of the sport at heart to guarantee that this issue of legacy is promoted satisfactorily.
Lord Davies of Oldham: My Lords, Woolwich has a certain connection with shooting: it is the home of the Royal Artillery. I understand what my noble friend is saying about this sport. The same issue could be presented for the equestrian events, another contentious issue that we have discussed. Everybody knows the worldwide renown of Burghley and of Badminton. The decision that those events should be taken in Greenwich Park, close to the Olympic Village, is on exactly the same logic. These are the London Games. The integrity of these sports, which are often somewhat distant from the focal points of the Games, will be, in the London instance, closely related to the excitement round the immediate area of the Olympic village.
Baroness Trumpington: My Lords, was it considered a good idea to destroy a football ground and cricket pitch for the sake of a car park for the equestrian competitions? Why could that event not have been held at Windsor, which was suitable and willing?
Lord Davies of Oldham: My Lords, there is always some sacrifice involved in concentrating the Games in an urban area. The Greenwich Park initiative involves some considerable change to the contours of the park. That is to be done sensitively. There is a clear obligation on the Olympic authorities to restore the areas and facilities that they command to their best, proper state after the Games are over.
The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Davies of Oldham): My Lords, following the collapse of Dairy Farmers of Britain, the Governments prime objective, shared with the industry and the
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Lord Livsey of Talgarth: My Lords, the Minister will know that dairy farming is in crisis and that 46 per cent of UK dairy farmers have ceased production since 1997. The Milk Marketing Board, shut down by the Official Opposition when they were in government in the 1990s, had a contract obligation to every dairy farmer to collect all their milk however remote their location. The collapse of Dairy Farmers of Britain, referred to by the Minister, leaves 200 dairy farmers without guaranteed milk collection from their farms. Will the Government step in and ensure collection of this milk, underwrite these producers May milk cheques and bring forward a new milk marketing Act, as in the 1930s, to ensure that these dairy farmers get a fair price for their milk which is above their production costs? The 10p per litre currently being given to these 200 dairy farmers is a disgrace.
Lord Davies of Oldham: My Lords, we do not intend to interfere with the milk market to the extent that the noble Lord suggests. The milk market is a commercial operation and reflects the fact that the milk production industry in the United Kingdom and in Europe is suffering from the recession because demand has dropped. However, the Government are optimistic about the future of the British industry. If the noble Lord is using the recent collapse of Dairy Farmers of Britain as an instance of crisis, he may be exaggerating the point because, as I indicated in my Answer, 96 per cent of the milk being produced has found another buyer.
Baroness O'Cathain: My Lords, do the Government have any idea of the implications of what has happened? It is all very well for the Minister to say that 96 per cent of the milk will be collected, but that does not necessarily mean that 96 per cent of dairy farmers are protected, because the milk that other buyers do not want very often comes from small, family farms. Will the Minister also comment on how much of the agricultural industry as a whole will be affected? We are talking not just about dairy farmers but about feed merchants, the transport business and the productionor at least the processingareas. As for the Ministers latest comment about the industry being in good heart, can he explain why it seems necessary to reopen intervention for butter and skimmed milk powder?
Lord Davies of Oldham: My Lords, certain areas of discrete intervention are always open and are necessary. I am saying that milk production in this country cannot be identified as being in crisis. It is no more in crisis than is the whole of the British economy in relation to the slump in world demand arising from the present recession. I marvel at the fact that, although noble Lords opposite continually advocate the free market, the moment they identify a stick with which to beat the Government they demand government subsidy and intervention.
The Countess of Mar: My Lords, does the Minister appreciate that milk is a staple part of our diet in this country and that we should be very sure that we are self-sufficient in it? We were at one time self-sufficient, and we were exporting milk. We are now importing milk in the thousands of gallons from France. Is he satisfied that our milk industry is in good heart while we are importing from another country?
Lord Davies of Oldham:But, my Lords, we are also exporting milk as well. Therefore, I do not think that it will stand up to suggest that the milk industry is in crisis in those terms. There are certainly pressures on some small producerswe recognise that and we have sympathy for them. We are concerned. We called a meeting to analyse this problem and to give a reassurance that every mechanism would be employed to sustain as many of the small farmers concerned as possible. I am pleased to report that it was quite clear from that meeting that constructive action was being taken by all those concerned. However, we cannot extrapolate from that that the British milk industry is facing a bleak future, because it is not. What it is suffering from, in certain very exposed areas, such as the very small producers, is reduced demand, but we all recognise the reasons for that.
Lord Taylor of Holbeach: My Lords, it is proper that the Minister is made aware of the seriousness of the situation, but I am not sure that he has totally taken it on board. Is he satisfied that the Government can do no more as dairies close and jobs are lost? Has he considered the impact of government weakness and indecision on issues such as bovine TB and the huge cost to dairy farmers of NVZ regulations?
Lord Davies of Oldham: My Lords, both those last two factors are very important considerations that we need to address, and we are addressing them as very important problems indeed. I maintain, however, that the long-run future of the dairy industry and the milk-producing industry looks good. There are problems in the interim, but, as I indicated, milk production in this country will be reduced by a fraction of 1 per cent by the loss of these farms. The loss of production on these farms is a personal tragedy for each of the farmers concerned and their familiesI am not underestimating that at allbut when considering the industry, which is what the noble Lord addressed his Question to, I do not accept that the industry is going through anything other than short-term difficulties with a long-run prosperity beckoning it.
Lord Bassam of Brighton: My Lords, with the leave of the House, my noble friend Lord West of Spithead will repeat as an oral Statement an urgent Question
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Baroness Murphy: My Lords, the average age of Peers in this House is 68, so I can tell noble Lords here today with some confidence that one third of us will die with dementia. It is us next. Dementia is the most feared illness of all. The writer AA Gill memorably described it recently as,
Dementia is dying of the self, bit by bit. Not just memories goindeed, that is often the easiest thing to cope withbut our speech, emotions, ability to reason, to retain social relationships and to participate in life; they all desert us.
I should declare my interest at this point. I am a psychiatrist, and for 25 years was professor of old age psychiatry at the University of London. That is a rather grand title but actually, much of my work was as a jobbing community psychiatrist for older people living in Lewisham and Southwark, working with the local authorities for patients and their families. Half of all my patients had one of the variants of dementia.
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When I was younger, I was often asked why I chose this field, which carried so much stigma for those who undertake it as well as the sufferers. Of course, ones personal motivations are never straightforward, but mine owed much to growing up at home with my grandmother, who developed dementia in her mid-80s, and gradually becoming aware of the terrible stress that that imposed on my parents. Later I came under the influence of one of the truly great visionaries of his medical generation, Tom Arie, whose influence on service developments for older people, both here and abroad, has been remarkable. He taught me the fun, the fascination, the extraordinary personal rewards, that come from working in a highly professional multidisciplinary service with patients and their families.
The National Dementia Strategy has the potential to be one of this Governments triumphs. It is a splendid piece of work, achieved under the excellent leadership of Professor Sube Banerjee and Jenny Owen, to whom I pay tribute. Its provisions are comprehensive and it is all good stuff. I do, however, worry about the £150 million notionally allocated from central funds to support its implementation; it will not be ring- fenced by primary care trusts, so we can assume that in some places even this small amount of pump-priming money will be rapidly diverted elsewhere the minute the expected NHS period of austerity begins to bite. How do the Government intend to monitor the spending and the progress of the implementation of the strategy?
There is still precious little understanding by health and social care services of the impact of dementia on families or on the economy. The £17 billion spent annually is the direct costs of care on those already diagnosed. Well over 80 per cent of the money spent on adult social care is spent on people with dementia, although most local authorities do not seem to have twigged this yet. We even waste £200 million or so in acute hospitals on inappropriate care.
If we are to begin to get services in to help families in the early stages, then diagnosis is the key, as the strategy recognises. Like any other neurodegenerative disease, dementia and its clinical precursor, cognitive decline, need to be diagnosed and treated. I used to rage at the NHS and local authority services which said my patients must be assessed, going direct for a social care package, when everyone else got a diagnosis for care and treatment. This does not happen to people with Parkinson's and motor neurone disease. Too often, people with this catastrophic disorder have been dismissed as a social problem to be tidied up. About half of all people with dementia will not get a diagnosis and there are some very perverse reasons for this.
The first is straight ageisma false belief that dementia is senility, and that senility and ageing are synonymous. It is worth reminding ourselves that even
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If you have a nasty label such as Alzheimer's, you are supposed to go to an expensive EMI home rather than an ordinary one, which is probably of no better quality than an ordinary care home, and quite often worse. The family does not want that, the hospital waiting for a discharge will not want that and the local authority certainly will not pay the extra. We need to be honest about it and we will not be until the Government sort out this funding problem.
Dementia is a terminal illnesspatients survive only two to three years in their final care home. Homes are, in effect, providing end-of-life care for patients with a neurological disease the way hospices provide care for terminally ill cancer patients. The difference is that you get hospice or hospital care free but if you have dementia you have to pay for your own care until your money has more or less run out. This is what the Alzheimers Society has called the dementia tax. For care at home, 26 per cent pay for it all themselves; another 42 per cent pay a significant proportion. More than half of those in residential care pay more than £300 a week towards the costs of being cared for. Can you imagine the outcry if the Government decided to charge hospital patients that amount?
I have never campaigned for social care to be provided free out of current taxation. I think rather it would be better if all health and social care was provided on a level playing field, with a mixture of state and personal investment. I am a fan of the minority report by the noble Lords, Lord Lipsey and Lord Joffe, on the Royal Commission on Long Term Care and very attracted to Sir Derek Wanlesss analysis, Securing Good Care for Older People, published in 2006. We still wait with bated breath for the social care Green PaperI believe it is expected any day now. I hear a rumour about next Tuesday, but it had better be good as social care is in meltdown out there. There are so few services, and often of such poor quality, that these new dementia advisers, described so well in the strategy, are going to have a very thin time trying to put a package together. Some of the NHS and local authority commissioning practices have been disgraceful.
Joan Bakewell recently commented in the Times on the online e-auction system of tendering care for older people with dementia. Costs are driven down to rock bottom, meaning that authorities accept levels of care we would not tolerate in a well-run zoo. She is right. These were her words, not mine.
The training of both domiciliary and residential care staff is almost non-existent. They have no idea how to manage behavioural problems. We have a high
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Once a person is in care they get less access to healthcare than at homeless nursing, less physio, less speech therapy, less chiropody, less doctoring, less mental health nursing. Often the primary care trust feels they do not need to access community health services because they are somehow being paid for as part of the private care package. Authorities pay far more for similar residential care for younger adults with disabilities. This is straight age discrimination and perhaps we will need to challenge this under the new equality legislation.
I know that after this speech I shall be inundated with letters from care homes proud of the quality of their care. It is true there are some reasonable ones but they are a minority and I would guess that there are many noble Lords here today who have tried to find a suitable care home for their own parents, only to be disappointed and disheartened by the quality of what they saw around them. Training is vital. Has the Minister had an opportunity to read the report of the All-Party Parliamentary Group on Dementia on training needs called Prepared to Care? That seems to me to be a good start on training requirements but we have to solve the workforce issue.
Turning to research, the Government are holding a summit in July with the great and the good, academics and funders, to talk about possibly having a plan. I hope it is a plan for a proper strategy for research development. There is more money than ever before in research programmes into the science of the dementias, about £32 million, but the Government invest eight times less in dementia research than cancer research and similarly less than in cardiovascular disease, even though economically, and tragically for families, the impact of dementia is greater. Furthermore, they do not invest in a long-term predictable way, but in sporadic bursts when pushed. How can the Government continue to justify that, given the economic and personal impact of this disease?
We have a science base in the UK that is world beating. All bar one of the genes that have been discovered to be predictors of the familial types of dementias have been discovered here in the UK. Here, we get far better bangs for our bucks investing in basic molecular science, and better quality outcomes for smaller investment, than does the United States. The NHS is well organised to do clinical research in this country and we also have university departments of social research that are set up to do the researchif only they could get the research funds.
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