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Housing: Affordability

Question for Short Debate

6.05 pm

Asked by Baroness Ford

To ask Her Majesty’s Government what steps they are taking to increase the supply of affordable housing.

Baroness Ford (Non-Afl): My Lords, I am pleased to have secured this debate this evening. I should immediately remind the House of the housing interests that I have declared on the register. I am a director of Taylor Wimpey plc, the housebuilder, and Grainger, the residential landlord, and, as the House probably knows, I have previous form as chairman of English Partnerships, the predecessor agency to the HCA, and most recently of the Olympic Park Legacy Company.

Housing is fundamentally important to us as individuals and as a society, and once again the issues of the supply and, critically, affordability of housing have found their way to the top of the political agenda. We hear frequently that we live on a crowded island, and standing on the District line today, I could certainly relate to that, but I also use domestic flights frequently and as I look out occasionally, I am struck by how little of our country is developed. In fact, only 12% of the UK is developed but, as we all know, this 12% is very highly concentrated around our great cities and suburban areas, and it continues to be where demand lies for more housing, creating more and more pressure on land, transport and public services.

The fact is that we cannot separate successful economic areas from demand for housing and vice versa, which is why the intervention from Sir David Higgins, chairman of HS2, last week was particularly interesting. His hypothesis is that HS2 would start to move the economic centre of gravity away from London and attract high-value businesses out of the capital. He suggests that, among other things, this would begin to stabilise house prices in London. That remains to be seen but it starts a debate that is well worth having and intelligently makes the important link between housing and transport infrastructure. He is attempting to think long-term, which is how we must think if we are to make the breakthrough we need to increase the supply of affordable homes.

Housebuilding is highly cyclical in nature and very sensitive to changes in the banking environment and the mortgage market, so we have fallen into developing housing policy that mirrors that cycle and is often reactive and short-term. We react to today’s problem. Many very worthy policy initiatives have been undertaken over the past 20 years but, of themselves, have not led to the breakthrough in affordability and overall supply that I think we all recognise is required.

We do not need to look any further than Kate Barker’s excellent 2004 analysis to understand the scale of the problem. All of the issues that Kate set out still remain. The link between house prices and earnings has deteriorated still further in the past 10 years, and not enough affordable homes are being completed. Yet we know how to solve this because we have done it

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before. Housing completions in 2012 totalled 143,500. In 1968, completions totalled almost 430,000. In the peak year in the previous century for housebuilding, 1968, we delivered three times as many houses as we did in 2012.

More than half of those completions were from the private sector. The remainder came from councils and development corporations as well as an increasing contribution from housing associations, but this was not an accident. The consistently large supply of homes post-war and until 1968 was a direct result of the largest and most systematic ever release of development land that our country has ever seen. That land release continued to supply up to 200,000 homes a year until as recently as 1990. I am talking about the new towns programme that began with the designation of Stevenage in 1946. The housing statistics over that period show the affordable homes that were built by the new town development corporations but, critically, many of the private completions were also built on new town land due to deliberate policy rightly to create mixed and sustainable communities, so we accomplished scale across all tenures.

It is self-evident to me that the key to increasing supply is systematic, planned release of land. If we are serious about tackling supply, variety of tenure and affordability, we need to revisit the approach that served us so well from the immediate post-war period right up until 1990, when the programme begun in 1946 naturally started to come to an end. If you strip out the new town programme, private completions have always, and steadily, delivered about 130,000 houses a year if you smooth it over the cycle. It is therefore clear from the experience of the past 30 years that the incremental amount of homes that we can add to current stock through what I would call the normal planning regime is around 160,000 a year; this is taking private housebuilders and housing associations together. That adds less than 1% to the existing stock each year, which is plainly not dealing with the issue of supply and affordability, as Kate Barker pointed out a decade ago and we all see, day in, day out.

When Kate Barker proposed that we needed to build 250,000 homes a year, there was immediate opposition to this figure, notwithstanding that we had easily accomplished this almost every year—in fact, for 27 out of the 30 years between 1950 and 1980. However, 10 years after her seminal review, no political consensus has emerged on the way forward, which is a pity as it seems to me that the only way to deal thoroughly with this issue is through long-term planning and a cross-party approach.

Encouragingly, there seems to be recognition of that in recent months. Whether it is the Government’s suggestion of garden cities or the Labour Party’s announcement of a new generation of new towns, it feels as though there is a clearer understanding that if we are to do more than add incrementally to our housing stock and really tackle the issues of price and variety of tenure, we need to significantly release land for planned, thoughtful development.

As I said, we know how to do that. The development of the English new towns was not always perfect—we know that—but we learnt as we went along and the

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template has subsequently been copied in many other countries. They were also phenomenally successful in terms of public finance. I would point anyone who says that government cannot afford to make the direct investment in high-quality new communities to the return that the Treasury has enjoyed over decades from continual land sales in the new towns; as the last ever chairman of the Commission for the New Towns, I have direct experience of this.

We have created only a few development corporations in the past 20 years, and I had the pleasure of chairing one of them. The Queen Elizabeth Olympic Park is being developed by a mayoral development corporation, but one that recognises that there are existing communities around it and embraces those communities through its planning system and membership of its governing body. It is a modern corporation that accepts the challenges and opportunities that development in an established community naturally brings. We are all realists. We understand that there will be challenges in building new communities, but the Queen Elizabeth Park is a great exemplar and is being immensely successful. Planning consent is in place for almost 10,000 new homes around the park. By the end of this year, only two years after the Games, nearly 3,000 new homes will be occupied—not just starting to be built, but occupied—in the park. The next phase of building, of more than 800 homes, begins in June, and the next two phases are already out to the market, adding a further 1,500 homes. This demonstrates what you can do when you have a planned, thoughtful, systematic release and, critically, you have the community with you.

I have become increasingly convinced that this is how we do it. Whether it is on brownfield land, surplus public land or on greenfield sites, the principles are the same. If we want to convince communities to embrace development, it needs to be of the very highest quality. It needs to be sustainable and affordable. It needs to offer real community benefits and not burden already creaking infrastructure or public services. Experience has shown us that the very best way to do that is through larger-scale, long-term, thoughtful development, appropriately financed.

I ask the Minister tonight whether the Government have any intention of adopting this approach, taking a long-term view and committing the finance to enabling infrastructure that is required to open up large-scale developments. I contend that we know how to do this. The time is right to do it again.

6.14 pm

Lord Horam (Con): My Lords, we are all very grateful to the noble Baroness, Lady Ford, for introducing this debate on what is clearly a very important public subject. I am by no means an expert on housing, but I have a long-standing interest to the extent that, in the 1970s, I was the first chairman of the Circle 33 housing association, which is now part of Circle Anglia. I remember the noble Lord, Lord Best, from those days.

I strongly support what the Minister and her colleagues are doing in government, first in her own department, the Department for Communities and Local Government, where Nick Boles, for example, is doing a great deal to remove some of the distressingly difficult obstacles in the planning area and where my right honourable

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friend Eric Pickles has been talking about new towns, which I think are part of the solution. The Chancellor, in his help to buy measures, has got building going again. There is no doubt that it is on the up, from all that I hear from around the country, both in London and in the regions. All that is very good and I congratulate my noble friend on what the Government are doing.

I said that I had a long-standing interest in housing. It goes back a very long way. Some people my age and perhaps younger will remember when Harold Macmillan was Minister for Housing. The noble Baroness, Lady Ford, quoted some statistics from before then. The House will recall that Winston Churchill set Harold Macmillan the task of building 300,000 houses a year to cope with the housing crisis in the 1950s, and he achieved that target within three years. Even Emanuel Shinwell, one of the original red Clydesiders, who was then sitting for Easington, had to admit, “This Government does get things done”. In the following election, the Conservatives won 50% of the vote—I do not think that they have achieved that since then—and Harold Macmillan went on to become Prime Minister. I am not suggesting that that exact approach could be replicated today. Things have clearly altered a great deal. Council housing is a fraction of what it was then and housing associations did not exist in the 1970s in the way they do now. It is all very different. But the sort of priority that that Government had in the 1950s, when there was a similar sort of crisis, though different in prices and so forth, should be given to housing today. I agree with the noble Baroness, Lady Ford, that if we get that sort of priority and the long-term thinking implied in that —and, if possible, with cross-party support, so that whatever Government are in power, that level of building is carried on—we have the makings of a solution. Unless you have something like that, we will just patch and mend as best we can from Government to Government and we will have the situation that we have today.

Finally, at local level there is a wonderful opportunity to build more flats and houses in our high streets, many of which are run down as a result of the increase in online shopping. In Orpington, which I represented for many years in the other place, Tesco built a new store in the high street, with many flats above. Where I live now in Fulham, Sainsbury is doing the same thing, both above a superstore and a local store. All that will contribute to the revitalisation of our high streets, as well as providing good, cheap social housing. That is one way forward, along with the long-term measures that the noble Baroness suggested.

6.17 pm

Baroness Andrews (Lab): My Lords, I am very grateful for the opportunity to contribute to this debate. No one could have introduced it in a more authoritative or measured way than my noble friend, who has been so instrumental in showing us the way forward. As she spoke, the facts of the present Government’s housing policy appear only starker in my eyes. Consensus is that they are facing the wrong direction. I am sure that the Minister will tell us of the raft of initiatives on the demand side that the Government are putting in place, but she is sensible enough to know that that will not do anything to address affordability, accessibility or housing market failure.

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The fact is that, if the Government are serious about housing supply—it is very good to have the reference to the Barker report, which set the foundations a decade ago for very clear thinking—they have to be serious about an investment strategy based, first, on proper assessments of housing need across the country, linked to labour markets and local economies across boundaries, and having a planning system that enables that. As one example of what has been lost in recent years under this Government, the chair of the South West Housing Initiative told the inquiry chaired by the noble Lord, Lord Whitty, that,

“since the abolition of the regional spatial strategy housing target, planned new housing in this most stressed of regions”—

that is, the south-west—

“has been cut by 81,000”.

I do not know what it takes by way of evidence to convince the Government that they cannot rely on private housebuilders to supply the 240,000 homes that are needed. Clearly, the housebuilders themselves do not have the conviction that they can do that. They know that they do not have the scope, the competitive conditions or the incentives to step up to the scale of what is needed. Perhaps the noble Lord, Lord Best, will tell us about the challenges facing the housing associations following the welfare changes.

To compound all that, there is evidence that the local planning system is being increasingly driven not by local plans but by the high emotions of national policy and the appeals system. The Government complain that the planning system is not delivering when, in fact, 400,000 planning permissions have been granted for houses which are waiting to be built out. However, more insidious at the moment is how the local planning system is being undermined in two directions. A quarter of local authorities cannot show a five-year supply of land and, therefore, their local plans are out of date and they are in thrall to the development priorities of the National Planning Policy Framework. At the same time, even where there is a local plan in place, there is increasing evidence that the Planning Inspectorate is overturning local decisions because they are not delivering enough development. Endless appeals, constant uncertainty and longer delays mean fewer houses which are agreed by the local community. I should be very grateful to the noble Baroness if she could tell me how many local decisions have been overturned by PINS in the past five years, so that we can get some notion of trend here.

The tragedy is that the local authorities are the answer, but in order to become the answer the Government have to respond to some common-sense appeals—from the housebuilders as well as everybody else—not to limit but to remove the housing borrowing cap. Local authorities can then build 60,000 houses a year. We should get rid of the archaic arrangement whereby the HRA is still on the public books.

As regards what my noble friend said about new towns and land supply, my goodness I do not want to pile agony on the Liberal Democrats this week but what confusion there is. Who wants new towns? The Prime Minister wanted them at one time. Now he appears not to want them. The Deputy Prime Minister

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is desperate for them, but a report has been produced which has been hidden. The Communities Secretary says that he would like a couple of garden cities and that he does not know where the report is. He thinks that it is in another department. Will the noble Baroness please clarify the confusion that surrounds this policy? We would all be very grateful for that.

6.21 pm

Lord Shipley (LD): My Lords, I am very grateful to the noble Baroness, Lady Ford, for initiating the debate. I declare my interest as a vice-president of the Local Government Association.

As we know, affordable housing is the sum of affordable rent, social rent, intermediate rent and affordable home ownership. It is provided to eligible households whose needs are not met by the market, and that eligibility may reflect local authority allocation policies, local incomes and local house prices. However, for someone seeking housing, the question is a different one. It is: can I afford what is said to be affordable?

We have debated social housing on several occasions. We know that we have a waiting list of 1.8 million families. We know that house prices are rising, particularly in London, with a consequential rise in rents. We know that we need to build more and we know that large numbers of people can never aspire to home ownership and need to rent. This problem is compounded by reduced council tax support and the underoccupancy charge, together with the benefit cap, particularly in London, all of which are causing serious strain in the finances of many households. For them, their rents can become unaffordable when they used to be affordable.

What should be done? Many good ideas have been put forward—and we will hear some tonight—for the short to medium term, but I want to suggest a number of possible actions the Government could take quite quickly. First, it should be an absolute requirement that when one council home is sold it is replaced by another. This “one for one” is government policy but councils, unsurprisingly, can have great difficulty delivering it since they may not get enough money to meet the cost of the replacement home. They need help in that regard.

Secondly, will the Minister examine the realities of the underoccupancy tax? There are tenants who want to move to something smaller, and therefore something that is more affordable, but who cannot move because there is nowhere suitable to move to. Will the Government increase support to encourage more providers to modify more properties to create more units quickly to which people can downsize?

Thirdly, as regards the housing borrowing cap, in the autumn Statement the Government announced that borrowing limits for housing revenue accounts would be raised by £150 million a year in 2015-16 and 2016-17. This was very good news and something that many in this House have been urging the Government to do. If the cap did not exist, up to 60,000 new homes could be built over the next five years. The risk is minimal because the markets would set the cap, as the prudential borrowing required would be secured by the rental income. Removing the cap would of course bring local authorities into line with housing associations.

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So I hope that the recent announcement, which is welcome, could be followed by a further rise in the borrowing cap.

I recognise the measures the Government have taken since 2010 to try to drive up housing starts and affordable homes. The trouble is that the impact has been limited and further intervention is clearly needed if the supply is to be increased and the cost to individual households is to be made reasonably affordable.

6.25 pm

Lord Best (CB): My Lords, I thank the noble Baroness, Lady Ford, very much for initiating this debate and I pay tribute to her sterling work for regeneration and housing over many years.

I have two interests to declare and two bullet points to make. First, I am president of the Local Government Association and, in that capacity, I strongly support the LGA’s efforts to remove the current cap on council borrowing for housing purposes. Secondly, I chair the Hanover Housing Association. My second bullet point comes close, I think, to being a silver bullet in the quest for an increase in the availability of homes that the next generation can afford to occupy.

The Hanover@50 website displays the input from nine national think tanks on questions of housing and care for older people. In summarising these contributions to the debate that Hanover organised to mark its 50th anniversary, I contributed a 10th chapter, called, “Accommodating our extended middle age”. This addresses two of the most significant problems facing the UK: first, the escalating health and social care requirements for those in later life and, secondly, the acute shortages of homes for younger households. The proposed solution to both problems is to build attractive, well designed homes for those in their extended middle age—55 to 75 years-old—and create a sea change in attitudes in the UK to downsizing or “right sizing”.

If even a modest proportion of the rapidly growing number of older, single people and couples living in family homes could be enticed—by spacious, light, energy-efficient new homes—to downsize, there would be huge gains for them and for the nation: improved health and well-being for movers; liberation from looking after bigger homes and gardens; reduced accidents in the home or illnesses linked to cold or damp; and pre-empting, postponing and preventing loss of independence and enforced moves into expensive residential care in later life.

Downsizing retirees can access wealth by releasing equity, and this can pay for care, assist the next generation or simply fund happier retirement. Standards of living can be dramatically improved, and the setting of “sociable housing” for those in extended middle age can reduce the likelihood of loneliness and isolation, which are the chief causes of misery and mental health problems for older people.

However, these gains are equally for younger households. A shift in culture, whereby we downsize at a younger age, instead of waiting for a crisis when we hit our 80s, brings much-needed family housing, often with gardens, on to the market—usually for relatively

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low-cost sale. It frees up existing social housing for families at social rents, which means lower housing benefit costs that are hard to achieve when building new affordable housing. It even provides for those aged between 55 and 62 who need to move to avoid the dreaded bedroom tax.

I commend to the Minister and her colleagues the recommendations that flow from the Hanover@50 debate: building homes that attract us in our extended middle age can head off problems for our old age while enabling tens of thousands of younger people to move into family homes that they can afford.

6.29 pm

The Lord Bishop of Ripon and Leeds: My Lords, I, too, am deeply grateful to the noble Baroness, Lady Ford, for enabling us to tackle again the issue of the serious lack of affordable housing. I want particularly to concentrate on rural housing. The statistics abound—from a need for 11,000 new rural houses a year to the provision of just over 1,000 such houses by registered providers in 2011-12. The one thing on which there seems to be agreement is that there need to be far more than are currently being built.

I welcome the way in which the noble Baroness has stressed actual supply rather than wishful thinking. We need rural housing delivery strategies even more than housing needs strategies. We may be talking about small absolute numbers in terms of rural housing but they are key to the life of our rural communities in this country.

Faith in Affordable Housing is a churches’ project designed to help to release church land and property for affordable housing. It has worked particularly with the diocese of Gloucester to provide, for example, flats for young homeless people on a derelict vicarage site. It has had modest success but is having difficulty in finding partners for more challenging developments. Some of the earlier, very positive uses of church buildings and properties appear to be impossible for registered providers to contemplate today, and this seems an immense waste.

Churches are not the only organisations with underutilised land and property which could be released for affordable housing. However, in the case of churches, such developments can also provide new meeting places, worship areas and places which can be developed for community use and needs. Faith in Affordable Housing is seeking to raise the vision of churches to make such provision, but time and again it appears to be too complex for local authorities and registered providers to become partners and supporters in this enterprise.

Can the Government tell us how they will support rural communities, including churches, in imaginative plans to increase the supply of rural affordable housing through greater encouragement and through a more equitable financial provision?

6.31 pm

Lord Borwick (Con): My Lords, first, I declare my interests, as shown in the register, in land and property development companies, developing houses and building social houses.

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Private houses are so unaffordable in the south-east that we have to supply affordable houses or many people would be forced to move out of the area. Very, very few of the residents in many areas can afford to buy the houses that they live in. Their children become part of the demand side of this supply and demand problem. In addition, the rising levels of divorce will reduce the optimum size of a household. A couple with two children become, with divorce and shared custody, two households with three people each. All these family and demographic changes happen far faster than we can plan for them. The market can cope but only if it is freed from regulation.

What have we got wrong? As ever, it will be taxation and regulation. Home owners end up paying all the costs piled on to developers when homes are built. Property taxes, at 4% of GDP, are more than double the OECD average of 1.8%, yet certain other parties want to increase them still further. Added to that, regulation makes everything oh so slow. Supply is quite simply not meeting demand.

I am chairman of a property development business building a total of 2,500 houses on the outskirts of Bicester, including 700 social houses, but it will take 20 years from start to completion, despite having four housebuilders working simultaneously on the project. It took seven years just to get full planning permission on this uncontroversial site, and it was supported by the council. The Government should be applauded for the new planning guidance, led by my noble friend Lord Taylor of Goss Moor. That should certainly speed things up through magnificent simplification. However, the system is still rigid, with far too many officials involved.

I asked a social housing association whether it was going to change its proportion of four-bedroom houses to two-bedroom houses because of a change in demand as a result of the abolition of the spare room subsidy. It laughed, because the cost of changing the planning permission is so enormous.

I can buy an Apple iPad and get it made in China to my exact whimsical specification with my name printed on the back cover and get it delivered to me in London in less than a week. I can get a brand new Jaguar in any colour and specification I desire in less than eight weeks. Supply quickly meets demand. Why cannot the same be true for planning permission amendments? Surely this, along with numerous and burdensome taxes, is the real reason that we cannot build the homes we need to.

6.35 pm

Lord Whitty (Lab): My Lords, I declare an interest both as the chair of Housing Voice and as a vice-president of the LGA. I thank my noble friend Lady Ford for starting us out by looking for a new strategy in this area.

I have a few points to make. First, on terminology, as the noble Lord, Lord Shipley, said, affordability applies in all sectors of the housing market; it should not be regarded as synonymous with social housing. Moreover, a good bit of social housing is clearly not affordable for those who occupy it at its current level of rents, otherwise we would not have seen the huge

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increase in housing benefit which, in terms of government resources going into housing, is clearly a misallocation compared with actually increasing the supply of housing.

Secondly, I can hardly complain that the Government have been negligent in coming forward with new initiatives, apart from their very early cut in the affordable and social housing budget, which was plainly disastrous. They have come up with numerous schemes, from the New Homes Bonus, which admittedly the Select Committee down below said has not worked, to First Buy, Help to Buy, the NewBuy Guarantee scheme, mortgage guarantee, Right to Buy and so forth. There have been a whole lot of schemes but they have been piecemeal, inadequate and, in many respects, misdirected by emphasising demand, not supply. In terms of geographical balance, they have helped more to overheat the market in the south-east than to spread into the regions and rural areas.

I am not here to proclaim that the Labour Government did it any better. Frankly, we have all failed so let us have a political consensus that that failure should be driving us to seek a new approach and a new strategy. We also need to recognise the sheer size of the problem. I was looking at some of the statistics on household growth. The growth of households has slowed down a bit. Compared to the reference by the noble Lord, Lord Borwick, to divorce and split families, kids staying at home because of the economic recession has increased the size of families, so that it has slowed down a bit. Even on those figures, it is clear from the Cambridge study that we need 240,000 new homes to meet the new households being created—almost twice what we are building. We need to create a million new homes in the next five years, and that process needs to go on until 2031—a 20-year programme. That is a major strategic commitment and we do not have the mechanism to deliver it. We do not have the vehicles for delivering it and need to reinvent those vehicles.

One of those is the role of local authorities. I am simply repeating what the noble Lords, Lord Shipley and Lord Best, said. The most immediate role is for local authorities to be able to borrow and engage in developments on their own, with housing associations and the private sector, in different ranges of housing. Unless the cap is raised—we welcome £150 million, but it does not go very far—local authorities which are the most obvious ones to deliver at least part of this massive total will not be able to do so. Almost everybody in the housing world agrees with that except Her Majesty’s Treasury. Unless we raise that figure, we will not be able to deliver the beginning. We may need to do a lot of other things as well, but at least let us start with that.

6.39 pm

Lord Taylor of Goss Moor (LD): My Lords, first, I declare my interests both as chairman of the National Housing Federation and in various projects and businesses trying to deliver the housing needed. As has also been referred to, I am involved with a government project to supply planning guidance.

I very much welcome what the noble Baroness, Lady Ford, said. There was nothing with which I disagreed. In fact, there were things that I strongly champion.

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I just want to highlight three points in very little time. First, there is a myth among some that the demographic data showing the need for housing are somehow a finger in the wind. A local authority planning officer once said that to me.

However, with 20-year plans, we are not talking about housing for people who are not yet born but for the people who are born—not only the people of the baby boom of the 1990s and beyond who will be coming through soon, but the 3.3 million adults between 20 and 34 who, as the Financial Times highlighted today, are living with their parents. That is an increase of 669,000 since 1996 without any increase in that population age group. These people are living at home because they cannot afford to move out—even their own parents say that, when asked—and, as a father of three young children, it worries the heck out of me.

Secondly, there is a capacity issue in delivering the numbers we need. The large housebuilders have a grip on developable land through land options but, on their business model, they do not have the capacity to increase delivery, however much they and we might want it, because their business model will not allow such a growth in numbers. We have seen that historically. It is simply a fact.

I passionately believe that our country’s most successful social enterprise sector—the housing associations—has that capacity. It has it through the housing it already has and through its experience of delivering a not-for-profit, social purpose model. The housing association sector believes that some 2 million more homes will be needed between now and the early 2030s. This includes a mix of affordable homes to rent and homes for sale. That capacity can be unlocked by liberating the sector and giving it greater flexibility. We must allow that to happen, otherwise we will be unable to deliver the homes.

Most of all, we will be unable to deliver the homes without the land being made available. As long as we try to push denser and denser, smaller and smaller, and less and less attractive houses around our attractive historic communities on to the land on which people want to walk their dogs and to look at out of their window, the more and more unpopular it will be and the harder and harder politically.

That is why I passionately believe in freeing land for new communities, recreating the deal that said you can have green belt around existing communities to protect them but, in return, you must create new communities for those who so desperately need a home.

6.42 pm

Lord Sawyer (Lab): My Lords, I also pay tribute to my noble friend for bringing this debate to the House today and for her work in this field. The last time she initiated such a debate in this House we had a brief word afterwards about the importance of looking at the big picture, and I am pleased that she has returned to that issue as the main part of her contribution today.

I have also been looking for signs that the Government might understand and appreciate the importance of the strategy outlined by my noble friend Lady Ford. In March last year, I was pleased to read that the Prime

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Minister had called for a consultation on the appropriateness of the principles of garden cities with high potential for growth. This consultation may have floundered a little from a lack of support in certain sections of the Conservative Party—I do not know; perhaps we will hear more about that today—but, more recently, the Deputy Prime Minister has signalled his support, although using different language and with the emphasis on alternative locations. The Mayor of London, in admitting the failure of housing policy over the years, has called for a kind of new town, or new towns, contribution around the perimeter of London which might house some 80,000 to 100,000 people per conurbation.

We expect the Wolfson report this year to give guidance on the development of new towns and, most importantly for me, the Labour Party’s Lyons review of housing will, we hope, form the basis of a sound policy for the next Labour Administration.

On the longer, wider view, housebuilding and affordable homes can be achieved only by looking seriously at the new town and garden city approach, with populations of about 100,000 people. There is no other way possible to meet the needs of the future. In broad terms, we should look at the post-war model of development corporations, with the compulsory purchase of land at agricultural prices and with the planning uplift being passed on to the people. That was a fantastic model which worked really well after the war. Thirty-two new towns were created in this period. Imagine what Britain would be like today without those new towns if that generation had not made the right decision then.

In the period ahead in the 21st century, we can adapt the principles that were taken forward at that time, taking advantage of the large number of new possibilities in terms of design, materials, transport, communities and democratic involvement that people at the end of the war did not have the opportunity to benefit from. There is a great opportunity for us to bring this idea forward. We can bring an end to the current piecemeal approach of a developers’ free-for-all, planning as an afterthought or a great difficulty, and identical houses plonked miles from amenities of public transport—all the kind of things that we have seen in the past 10 to 20 years and the antithesis of what we really want, which is affordable and sustainable housing on a long-term basis.

6.45 pm

Lord McKenzie of Luton (Lab): My Lords, along with other noble Lords, I thank my noble friend Lady Ford for the opportunity of returning, however briefly, to the vital issue of the increase in the supply of housing, particularly affordable housing, provided for households whose needs are simply not met by the market.

That we have a housing crisis is beyond dispute, with home ownership falling and out of the reach of many, rents at record levels and rising faster than wages, 5 million in the queue for social housing, homelessness rising every year since this Government came to power, families in bed and breakfast accommodation at a 10-year high and rough sleeping up by a third. We should

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probably acknowledge the plethora of measures that the Government have initiated, but these cannot mask the paucity of delivery and lack of progress. Just 42,380 affordable homes were provided in 2012-13—a decrease of 26% on the previous year. In the social rented sector, just 24,550 were provided—a decrease of 36%. Overall, there were only 135,000 total completions, in comparison to the 219,000 delivered in 2006-07. Even that, of course, was substantially below the more than 350,000 achieved in the mid-1960s, when Harold Wilson was trumping Harold Macmillan.

Our briefing pack includes TCPA estimates of housing need and demand through to 2031, which extend the official projections. Whatever challenge might be made to these figures, they must surely show the broad order of magnitude of what is needed: just fewer than 5 million newly arising households in England, of which 1.5 million are estimated to be in the social sector, with a concentration in London, the south-east and the east. It will be interesting to see whether HS2 will reorientate some of that, let alone the prospect of an airport in the Thames estuary. This amounts to an annual increase in the order of 243,000, including 78,000 in the social sector—a huge challenge to any Government.

What would we do? For a start, we would be looking to build at least 200,000 homes a year by 2020. We continue to support the IMF in urging the bringing forward of £10 billion of infrastructure spending this year and next. A housing commission chaired by Sir Michael Lyons is drawing up a road map to help delivery of our ambition by looking to: reform the housing revenue account to produce a more flexible system that enables councils to build; give local authorities that want to expand a right to grow, with access to a fast-track process to resolve disputes with neighbours, something which is frustrating housing development; give councils proper compulsory purchase powers to tackle land hoarding; and ensure that when public land is given over to housebuilding, a proportion goes to smaller firms and custom builders. We also plan to offer a package of incentives to support a new generation of new towns and garden cities. That is perhaps where we can build the cross-party consensus that my noble friend Lady Ford rightly promotes. Whether there is a consensus or not, we would certainly abolish the wretched bedroom tax. Under the previous Labour Government, nearly 2 million more homes were built in England, including 500,000 affordable homes. More needs to be done next time.

6.49 pm

The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Stowell of Beeston) (Con): My Lords, I am grateful to the noble Baroness, Lady Ford, for securing this debate. As she says, the question of how best to meet our housing needs is one of the most significant facing the nation today. I am very conscious, through listening to the contributions today, just how great the expertise and experience is among noble Lords. I am grateful to the noble Baroness, Lady Ford, and the noble Lord, Lord Whitty, for acknowledging that as a country we have failed to build enough homes for decades.

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This is not a new issue but it was made worse by the financial crisis of 2008, with housebuilding collapsing to the lowest peacetime levels since the 1920s by the time the previous Government left office. It is important to stress that the collapse in building led to the construction industry suffering greatly in the aftermath of the crash. It is not surprising that it has taken time for the smaller construction companies in particular to respond to the return to growth and for us to get back a position where the industry has both the capacity and the confidence to respond. Housebuilding is now back to 2007 levels but that has not happened by accident. The Government have taken the necessary steps to tackle the situation and turn things around.

Before I go into greater detail on affordable housing, I will talk more generally about overall housing supply. I acknowledge the points made by the noble Baroness, Lady Andrews, and my noble friend Lord Borwick. We have reformed the planning system: we have simplified it and handed responsibility to local authorities to set their own housing requirements. The framework is clear that local authorities should plan to meet their full housing needs for both market and affordable housing. My noble friend Lord Borwick made quite a detailed point about greater flexibility; he was kind enough to give me advance notice of that and I will continue that dialogue with him outside the Chamber.

We are also providing significant finance for projects that cannot proceed without it and we are helping buyers who can afford mortgage payments but cannot afford the sorts of sums now necessary for a deposit. We are making progress but of course we still have a way to go. At this point I will respond to the topic—different noble Lords describe it in different ways: some people call them garden cities, some call them new towns—raised by the noble Baronesses, Lady Ford and Lady Andrews, my noble friends Lord Horam and Lord Taylor, and the noble Lord, Lord Sawyer.

The previous Government pledged what they described as 10 “eco-towns” but of course none of those was built. This Government are clear about our approach, which is to support locally led development through the large sites programme, which aims to unblock barriers to delivery of such sites through partnership working, provision of capacity funding to local authorities and access to capital funding through the £474 million local infrastructure fund. Under this programme, some success to date has led to 69,000 new homes already being “unlocked” in places such as Cranbrook, Sherford and Wokingham. In the Autumn Statement we committed a further £1 billion to the local infrastructure fund to support communities in delivering their housing aspirations over the next six years, and we will be publishing a prospectus inviting local areas to come forward with bids this spring.

To be clear, we most definitely support increasing the supply of homes but this must be locally led. In response to the noble Baroness, Lady Andrews, we have no plans to impose new developments on communities and, contrary to recent reports in the press, we have not been working on secret plans to build new towns in Yalding, Gerrards Cross or any other areas. I noted what the noble Baroness, Lady Ford, said about the Olympic Park. That has clearly been a great success

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but it is very different in its concept because it was built to serve the Olympics and its national importance justifies the greater involvement through the major infrastructure regime in a way that we do not believe the residential development does.

Let me turn specifically to affordable housing. We need more affordable housing. It is worth pointing out, particularly in response to the points made by the noble Lord, Lord McKenzie, that more council housing has been built in the first three years of this Government than in the 13 years of the previous Labour Government. But council housing is only a small part of the overall picture. Almost £20 billion of public and private funding is being invested in the Affordable Homes Programme over the four years to 2015. This will deliver 170,000 homes, nearly 100,000 of which have already been completed. These homes are being provided where they are most needed and in a range of areas. I say in response to the right reverend Prelate the Bishop of Ripon and Leeds that around half the affordable homes provided in 2011-12 were in rural communities. He is right to identify that need and we are responding to it.

From 2015, another £23 billion will be invested to deliver 165,000 more affordable homes by 2018. The Homes & Communities Agency will publish the prospectus for this latest programme shortly, inviting bids for funding to deliver that affordable housing outside London. As a result of all this work, we will achieve the fastest rate of affordable housebuilding for at least 20 years. Not only did the previous Government build very little but they oversaw the shrinking of the stock of social housing by 420,000 homes. My noble friend Lord Shipley mentioned Right to Buy and the one for one programme. I understand the point that he makes, but it is worth emphasising that that policy of replacing homes sold under Right to Buy is something that no other Government have done.

However, increasing supply in time of difficult economic conditions means that we have to look at different ways to attract investment. Our affordable housing guarantees programme lets housing associations use a government guarantee to secure private investment at more competitive rates. As part of this, we recently agreed a new deal with the European Investment Bank which will release £500 million to deliver up to 4,300 homes. We also announced the first eight housing associations to receive funding through the guarantee programme.

We believe that councils also have a role to play in building homes and have announced an independent review of councils’ role in housing supply. As has been acknowledged by noble Lords today, we have already increased the amount which councils can borrow to build homes in collaboration with housing associations.

Important points on this were raised by the noble Lord, Lord Whitty, both today and in a debate that we had last week on the local government finance settlement, and by my noble friend Lord Shipley. The noble Lord, Lord Whitty, spoke last week about ensuring that councils are able to take advantage of some of those housing guarantees so that they are part of the route to increasing supply—the right reverend Prelate also referred to this today. The noble Lord felt that local

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authorities were barred from being able to take advantage of some of these joint ventures and the source of funding. That is not true. Some councils are already doing just that, and are working with partners, housing associations and developers in joint ventures on housing for sale, private rentals and sub-market rentals. In the new scheme announced at the Autumn Statement to which I have just referred, we expect to see partnership working with housing associations through those joint ventures.

On the increase in the borrowing level, it is important that we do not underestimate the dramatic effect of the Government’s self-financing reforms. The point is not just this recent increase in the amount of borrowing but the way we have now made it possible for 165 council landlords to do this, with new freedom to plan their housing businesses for the benefit of their tenants and local communities. They now have that £2.8 billion borrowing headroom and the possibility of planning longer term than they were ever able to in the past.

Clearly, this is about not just supply but also making best use of existing stock. Social housing is one of our most precious resources. That is why we have introduced much greater flexibility into the system so that social landlords can make the best use of their holdings. Councils now offer shorter fixed-term tenancies as well as the traditional lifetime offer, meaning that they can better respond to families’ changing circumstances. Councils also now have much greater freedom to decide who qualifies for social housing.

The noble Lord, Lord Best, referred to the Hanover@50 report. I am not familiar with it but will make myself so in light of his raising it today.

Increasing supply is, as we have all acknowledged, the most important way to maintain affordable rates of rent. Our affordable housing programmes provide hundreds of thousands of homes at sub-market rents. There is much to do to tackle the national shortage of affordable housing. Not only do this Government have a comprehensive plan to turn this situation around but our plan is working. Working together with housing associations, councils and housebuilders, we are overcoming the problems we inherited and are set to deliver the homes the nation needs to house everyone properly in future.

Health: Dementia

Question for Short Debate

7.01 pm

Asked by Baroness Gardner of Parkes

To ask Her Majesty’s Government what action they are taking to inform the public of the particular problems associated with dementia and the support available for individuals suffering from that condition.

Baroness Gardner of Parkes (Con): My Lords, dementia is such an important issue that I am pleased to have the opportunity to focus attention on it tonight, at a time when it has been very much in the news. My belief is that people need to be informed. Without doubt, a degree of stigma attaches to the diagnosis of dementia. For this reason, many people prefer to use the word “Alzheimer’s” rather than the wider term “dementia”.

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I have found this to be the case for years and we need to ensure that that attitude changes. No stigma should attach to any medical diagnosis of a condition that the person did not bring upon themselves, be it dementia, epilepsy or cancer.

I am old enough to remember clearly when, in the 1950s and earlier, people would say when they heard of someone they knew being diagnosed with cancer, “I wonder what they did to get that”. The attitude was that cancer was a punishment for the wicked only. Over the years, people have had a much greater understanding of diseases and the internet has made it easy for them to learn about cancer and its causes. Because cancer is so widespread there has been marvellous research in the subject. Information has created an awareness of the great importance of early diagnosis as the best hope of a cure. Now people know that hereditary genes may cause additional vulnerability in some people.

Just last week, I read an interesting article on a change of diet being the way to avoid dementia. It recommended a high-fat diet, which has always been deplored in the past. It stated that all white bread, pasta and sugar—in fact almost all carbohydrates—should be eliminated from one’s diet, that gluten-free products should be used and that, in following the “five a day” health advice about fruit and vegetables, only certain fruits of the low-sugar type should be consumed. This new diet seems as extreme as the low-fat diet was, but in reverse. At present, these are the views of Dr David Perlmutter, a neurologist. The article in the Times on 18 January sets out much more detail about them.

Reading constantly conflicting dietary reports is not good for anyone; what we need is solid evidence-based research. At present, it is not possible to know who will develop dementia. It is no respecter of persons and can strike the most brilliant people. Research is essential to determine what measures can be taken to prevent dementia from developing and to control the progress of the condition.

In the early stages of dementia, often a person is aware of their mental deterioration but, as the condition progresses, they can lose all awareness. Usually, short-term memory goes first. There are therapies that can be applied to bring back happy memories from long ago that give pleasure to patients.

In the DailyTelegraph of 28 December last, there was a report to the effect that dementia patients were bedblocking to the extent that urgent cases could not be admitted to major hospitals. There were other very distressing press reports, for those who have relatives or loved ones needing special care, of horrible and degrading attacks on such patients, who could not defend themselves.

Solutions are needed. I think that it is time for us to rethink some of the treatments and facilities that we have thrown out of the NHS. More daycare provision would allow patients to enjoy those hours in a safe and caring environment while providing necessary relief for carers. Respite, on a daily or longer-term break basis, is essential for relatives and carers to enable them to fulfil that very important role.

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Cottage hospitals were ideal for dementia patients needing in-hospital care but who did not have urgent or immediate need for acute services. Both day centres and cottage hospitals require full-time nursing and genuinely caring staff. Those staff filled a need and were a valuable part of the NHS. Dementia cases need genuinely caring support.

I support the view—and the changed stroke care in London has proven this—that we need highly specialised centres where essential, urgent care can be provided for some life-threatening conditions. Such centres, which are being developed, should be used for cases in need of immediate and urgent high-intensity care, and the patient should remain in until ready to return home or to go to an appropriate intermediate-care facility.

Nursing is an essential part of any patient’s treatment at all levels. I think it is splendid that nurses now can obtain the highest qualifications, and I am a strong supporter of nurse practitioners. Specialist nurses in whatever field are invaluable to patients, consultants and the NHS. However, I remain convinced that it was a mistake to insist that all nurses must have A-levels and obtain full academic qualifications. The loss of the SEN qualification has done great damage. Some of the best nurses I have known—and I have been involved in most levels of the National Health Service—could never have gained sufficient A-levels for university entrance.

When I have taken part in health discussions at the Commonwealth Parliamentary Association international conferences, I have asked what other countries have done in nurse training. There is fairly wide agreement that nurses should be able to train at various levels to meet patients’ needs. Nurses with high clinical skills and qualifications are needed, but so, too, are less qualified but capable, compassionate, caring nurses who are willing to carry out the most mundane tasks where there is a need and to treat people as valuable human beings, not just cases.

In most Commonwealth countries, they have nurses train to the top level, but when they brought in academic degrees for nurses, they retained that intermediate level of nursing which we call the state enrolled nurse. I am convinced that the Government should be liaising with the nursing profession to look into the issue of our need at that intermediate level. It is no good saying that people can become “care assistants”. Even the talk of registering care assistants has not moved people in a way that would make them proud to bear that title. People consider it an honour to be called “nurse”, and so it is, but there can be nurses and nurses, and titles could be appropriately chosen to make clear those who had a degree and others.

Dementia can cause isolation as the patient becomes cut off from reality. It is only at the early stages of the condition that the patient is able to realise that they are losing contact with reality. Some treatments can delay progress, but, at present, nothing can turn back the clock. It is very hard for loved ones to see progressive dementia in a friend or relative, and it can be a great test of their patience, as often the sufferer becomes increasingly repetitious or even difficult.

The number of people likely to suffer from dementia is projected to double over the next 30 years, so there will be further pressure on services. The Local Government

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Association states that there will be a funding gap by 2020. It cites the Greenwich advanced dementia service as a new model of care for people with advanced dementia which, to date, has supported more than 100 people to stay in their own homes and is saving up to £265,000 a year on reduced care home costs and hospital admissions.

Dementia patients are more likely to die or suffer an injury than other patients. A study of more than 17 million hospital visits found that patients with the condition had far higher mortality rates, longer lengths of hospital stay and a higher likelihood of readmission than other patients. They are also three times more likely to suffer a fall while on a ward than other patients. There were 380,000 such incidents in a year.

As with so many health conditions, accurate, up-to-date and well presented information for patients, their families and friends is vital. Specialist charities can help with providing just such information and reassurance to support the information received from the health professionals. Today in my GP’s waiting room, I checked the large number of information leaflets for patients. These covered almost everything but there was nothing on dementia.

However, my doctor told me that the practice has put people in touch with the Contented Dementia Trust, which has proven to be of great help to carers. Often, dementia can be associated with changes in temperament, with some sufferers having spells of violence and others lengthy times of apathy. Carers find it valuable to know that these situations can arise and how to deal with or prevent them. It is an important point that these specialist charities, of which the Contented Dementia Trust is one and the Alzheimer’s Society is another, can help with providing such information and reassurance.

Marvellous progress has been made in healthcare and people are living so much longer that dementia, usually associated with ageing, is becoming a major issue. Florence Nightingale stressed the importance of the need for a patient’s cleanliness and comfort; to those, I would add caring. These essentials remain the same today. We must do more to see that genuinely caring help is provided while working towards having greater understanding, better information on the condition and a promising future due to continuing and developing research.

I thank all the speakers tonight, who can make a real contribution to the debate on this important issue. Research is the only real answer. Until we can fully establish the cause of dementia, we cannot develop methods of prevention or means of curing the condition. The Government can encourage research and increase awareness and understanding of the crucial need for genuine caring for dementia cases, and they should do so.

7.12 pm

Baroness Turner of Camden (Lab): My Lords, I thank the noble Baroness, Lady Gardner of Parkes, for introducing this timely debate. I have a personal interest in participating. My sister has recently been diagnosed with suffering from Alzheimer’s disease and has dementia. I spent the summer holiday and the recent Christmas

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break with her, trying to assist. My sister is a retired teacher and a widow, living alone in Wiltshire. Her late husband had also been a teacher. He was a former county councillor and had been chairman of the local parish council. My sister had also been active locally. The result is that she has had a great deal of local support, which has been very valuable in her current circumstances. The local Alzheimer’s Society has been very helpful and the county council has a mental health committee, which has been of assistance. An organisation called Carewatch has also helped.

While I was there in the summer, I arranged for people from those organisations to call and see her regularly. I also organised for a lifeline to be installed: an alarm system with a wrist-held alarm, which was to be rung if she needed to do so. The very nice people who call to see her regularly make sure that she takes the medicines prescribed for her and that she has the food she needs. She has very good neighbours to help, who arrange to drive her if she needs to go out. A neighbour also deals with the garden for her. I saw local solicitors and, through them, arranged for a relative to take on the responsibility of power of attorney so that she does not have to bother about her financial affairs, which are in good order. She has a pension, a widow’s pension and an attendance allowance. It is therefore possible for her to pay for the services that she needs. That is important, for any disability is expensive, and this is no exception. It is also expensive if you need to pay for assistance. The procedures in relation to power of attorney are of course extremely complicated, as well as expensive, and there is no reason why the Government should not intervene to make the arrangements less so.

I realise, of course, that not everyone is fortunate enough to have this kind of support. It is difficult, I am sure, to come to terms with what happens to people who have this disease. It was hard for me. My sister had had a successful career. When I saw her after she had become ill, it was difficult to cope with what had happened. She would sit in her well equipped kitchen and not know what to do. We saw representatives of the Alzheimer’s Society; she told them that she was frightened of the microwave, and they told me that I should not try to train her to use it again. She could not write. I wrote for her if she needed to do any writing, and got her to sign. She did not use her computer, of course, and had not done so for a very long time. Many people that she knew she no longer recognised. Gradually one worked out how best to arrange and organise living for her. The support of local people is invaluable.

That is why the campaign by the Alzheimer’s Society is so important. It understands that people with this illness are best looked after at home in familiar surroundings. That is what we have tried to arrange for my sister. She is able to lead a fairly normal life because of the support of friends, family and local organisations. Through the campaign that the Alzheimer’s Society has now embarked upon, I hope that we shall be able to do this for other sufferers. Many people who are alone and do not have this local support are, in my view, badly in need of assistance of the kind that the noble Baroness made very clear in introducing this debate.

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I am very grateful to the noble Baroness for giving the opportunity to debate this awful disease, but it can be dealt with if there is local support and if people understand what they are attempting to deal with. I hope that today’s debate will be a step in that right direction.

7.17 pm

Baroness Greengross (CB): My Lords, I congratulate the noble Baronesses, Lady Gardner and Lady Turner, on their excellent and very moving speeches.

I start by saying that I have rarely been as proud of being British as I was recently when this country—or, rather, the Prime Minister, because of his personal commitment—secured here in London the G8 summit on dementia. That was an enormously important achievement. I say that with real pride because I chair the All-Party Group on Dementia. We are an extremely active all-party group that has produced a lot of reports on many areas of interest. We have looked at the fact that dementia patients stay longer in hospital when they go in for a fractured femur and we were part of the campaign to reduce the use of anti-psychotics. We have had many quite successful inquiries and policies have radically changed because of the work of colleagues on the all-party group. However, there is still a huge way to go.

Dementia is certainly the new cancer, as the noble Baroness, Lady Gardner, said. It is not very long ago that you could not really talk about it. The interest in, and commitment to, doing something about dementia now is really important and it is excellent that we have got that far. There are still, however, many problems. Dementia is a disaster if you are suddenly diagnosed. You have no idea how to cope with the diagnosis or where to go for help. You are absolutely struck by your inability to move forward. However, it should not be seen in that way because a lot can be done. Of course we do not have all the research that needs to be done—the G8 made that clear. As a result, however, some very hopeful research work is being undertaken in the United States and the money is beginning to flow in as well. But there is still a long way to go on research.

In this debate we are looking at what has to be done now to alleviate the situation of people when they receive a diagnosis or even before, when they suspect, because of memory loss, that something is going wrong. It is a progressive and a terminal disease which, at least at the beginning, attracts social care funding and not health service funding. Over much of their life course many of those who have the disease will experience problems in getting financial help so that they can live adequately. It can be a disaster and we need to do something now. The noble Earl is doing a great deal to ensure that the Care Bill, which has now gone to the Commons, will help many people with dementia. However, a huge amount needs to be done.

We have to see dementia as one element of the comorbidities that many older people face—and it is usually older people, as the noble Baroness said, who get a form of dementia. We have to concentrate on the fact that if people have dementia, the other conditions

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from which they suffer are sometimes ignored, or vice-versa. Dementia also has to be seen in the light of the huge stigma that still surrounds its diagnosis. For many people, even GPs, it is better to ignore it than to diagnose somebody when they do not feel that there is a great deal they can do to help. Many people try very hard to forget that it is happening, and if they forget it is happening, their quality of life will be reduced enormously.

Much can be done. We have to take into account that local commissioning is an excellent way of improving the situation as long as it works properly. I chaired a meeting this morning with commissioners to look at what can be done to improve the lives of people right at the beginning when they know that something is wrong, before they are diagnosed and immediately afterwards. As soon as they feel that there is some memory loss or they begin to worry they need to get help and not wait for a diagnosis. They need to get help and start the process of making a plan of action and support for that person, the family and the wider community where possible. Things can be done to improve the quality of life.

We know that much can be done in preventive care, particularly with vascular dementia. A change in lifestyle can help a great deal to delay the worst aspects of that dementia and, indeed, some of the others. However, not all can be helped in that way. What is necessary then is the coming together of support mechanisms—that is, people—who can really help.

We have to be certain that the good measures in the Care Bill are introduced so that we have a co-ordinated plan of action for anybody who is diagnosed eventually with some form of dementia. The right now of carers as well as of patients to a proper assessment leads to action, and this is not easy. It is not easy for local authorities and not easy for commissioners in healthcare, because there is a shortage of funds. However, we have to find the funds because dementia is a priority. It is a terminal disease, so it is extraordinary that it gets primarily social funding from local authorities rather than health funding. We have to integrate. That is what the Care Bill is aiming to do, so we have to give it our total support.

Memory clinics need to be the first place that people go to when they feel there is something wrong. That is when the support services need to be brought together to help somebody to find their way through the maze of services. They need to inform themselves about them and make sure they are available to them. That is where other people in the local community can do so much, as the noble Baroness, Lady Turner, said. When there are good services around that can be brought in early, we can get this as right as possible. Even before the memory clinic people have to start recognising that something is wrong, and then you need to have a co-ordinated approach to care. That is essential. We need to have a navigator/co-ordinator who can go in and advise that person and that person’s family how to get the best care that is available locally so that their quality of life does not deteriorate. When they are diagnosed, this is even more important, so we need a navigator/co-ordinator of all the services. The services need to be brought together so that they are not difficult to find.

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We need people to understand that post-diagnosis, life can be very good. One of the participants at the meeting with about 30 commissioners this morning was an early-onset dementia patient. He was diagnosed at the age of 49—10 years ago, I think. He was still perfectly capable of taking a very active role in the debate we were having because he had the right support around him all the time. That is essential. You need one place where all the services are available, you need one navigator/co-ordinator to provide those services for somebody and you need to convince that person and the carers that life can be good for a very long time. We need to have contact with all the advisers straightaway, one service co-ordinator and a strategic service integration scheme. That is key. We need one location, one centre where all the services are brought together and, rather like when you have a baby, you need to have a list of the services given to you so that you know who to ask about everything. We can do that.

We can embed personalisation in what we do. We can look to the groups that really cannot cope, and which have no idea of local services, and to our minority groups, some of which do not even have a name for Alzheimer’s or dementia. There are huge problems there. We need to focus on those people. We really need above all to listen to, communicate with and involve people with dementia every step of the way because they have not lost their humanity and their ability to be part of society. We have to trust them to know what they need and want and bring the services close to them so that they can benefit from the many important new ways of delivering services which will be enhanced, I hope, by the Care Bill when it becomes part of our legislation.

7.28 pm

Lord Jones (Lab): My Lords, I most sincerely thank the noble Baroness, Lady Gardner of Parkes, for this debate and acknowledge the importance of the subject and the skilfully drafted Question that frames our debate.

I have no doubt that the Government are determined to address the issues of dementia. When I was a Health Minister in the 1970s, serving Prime Ministers Wilson and Callaghan, one scarcely heard the word “dementia”. The NHS then was a battleground between administrators, unions and consultants. A royal commission was hopefully deployed; the International Monetary Fund moved in, and there was competitive recruitment between unions. Ministers were moved out or sacked, and there were endless resource-allocation working parties. London was accused of gaining too much of the available moneys.

The question of the noble Baroness, Lady Gardner, is as strategic as any that faces administrators and politicians who now give leadership to the nation. The scale of the challenge of dementia socially and financially in the future is truly massive. The amount of money available is inevitably insufficient. The amount of research needs to be expanded, if not the quality. Already, our social services and NHS are stretched almost to breaking point. We have on our hands, in effect, an emergency. Longevity guarantees that this massive national challenge will not go away.

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In all of this, there is a shining light: the Alzheimer’s Society, one of Britain’s greatest and most relevant charities. It stands ready to assist and advise countless families whose happiness is blighted by the emergence of dementia in a loved family member. I have the privilege of being a dementia champion in Wales and, at the grass roots of community, I have seen the good done by ordinary people for those who are at their wits’ end struggling to cope with the challenges of domestic change. As president of the society in north Wales for some 20 years, I have seen the enthusiasm of volunteers and their assistance, encouragement, organisation and fund-raising—all of these positives are constant and most effective. These activities generate friendship, teamwork, humour and even expertise though training as a friend. I am sure that the Alzheimer’s Society and its headquarters will continue to harness this great reservoir of energy and goodwill at the grass roots.

The society has a deeply committed communicator as chief executive, and a wise, experienced chair in Dame Jill Morgan. My hope is that the Minister will listen carefully to the demands and advice of the Alzheimer’s Society’s leadership. The Minister is, after all, accessible and open-minded in his dedication to the health service. However, the national response to the dementia emergency will be at its most positive at the grass roots, by mobilising the volunteer and by appealing to the generosity, practicality and familial loyalty at local level. Facing up to the national challenge of dementia will require more than the findings and promulgations of the Westminster and Whitehall village.

There are exemplary approaches being made in my own country of Wales. The director for Wales, Mrs Sue Phelps, called a conference in Wrexham, north Wales, recently. It was packed out by an army of youthful volunteers, family members, and dementia sufferers. The society’s Flintshire office, led by Mrs Baldini, organised this hearteningly successful gathering in the principal town of north Wales. We heard of best practice. We had professorial insights and examples of families coping. It was an inspirational gathering, and pointed to—as the noble Baroness, Lady Gardner, seeks—the support available.

Two central questions emerged. First, what are the Government doing to increase the numbers of those receiving formal diagnosis? I hope there may be a reply from the Front Bench tonight. Secondly, what support is on offer for people following a diagnosis? If the Alzheimer’s Society is a shining light, the great European aerospace company, Airbus, is a white knight extraordinaire. It has made the Alzheimer’s Society its preferred national charity and it is on course to raise, in this calendar year, £220,000 or more for responses to dementia. The able charity organiser is Mr Phil McGraa, based in north-east Wales at the giant, world-class aerospace factory at Broughton, which is where I live. More than 6,000 women and men work at that plant; they are big-hearted, supportive and imaginative in their financial and organisational support. They are great people; they are skilled and caring citizens.

Airbus and the north-east Wales office of the Alzheimer’s Society joined forces to organise a giant memory walk for the purpose of fundraising for dementia

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sufferers. The walk took place in perfect, warm, sunny weather on an immaculately curated racecourse, Bangor-on-Dee, with superb views of our Welsh mountains. There were no horses, but many hundreds of Airbus workers, volunteers and families in the walk. This mass memory walk was a thundering success, with the Airbus sponsor, the Alzheimer’s Society, volunteers and countless families all co-operating at the grassroots. I should say that this racecourse does not have an all-weather surface.

Quite simply, Airbus is magnificent. It exports billions of pounds of product, outperforms its great competitor, Boeing, and raises tens of thousands of pounds for dementia suffers. It has encouraged families with dementia sufferers in their midst in the most practical way, by being alongside them. I was fortunate to be on the memory walk, and it was heartening to meet a family of 17, and all of them were working for who they knew as their granddad. The support services on the walk were partly provided by high school pupils from Castell Alun High School, who showed great promise on that day.

My message to the Minister and to the Alzheimer’s Society is to invest in the localities and to use the great reservoir of experience, good will and practicality of all the volunteers. After all, they—the ordinary families—experience the distress and bewilderment when this dreadful condition enters the family. Every high school with involvement in that community could begin what might become a lifelong commitment to helping dementia sufferers. After all, the future years will see much more domiciliary care for dementia sufferers, and perhaps our youth will be able to tackle this emergency.

7.38 pm

Lord Hunt of Kings Heath (Lab): First, I refer noble Lords to my health interests as chair of a foundation trust, president of GSI and consultant and trainer with Cumberlege Connections. I, too, would like very much to thank the noble Baroness, Lady Gardner of Parkes, for allowing us to debate this important issue tonight. I also echo the tribute paid by my noble friend Lord Jones to the Alzheimer’s Society, both for the work that it does and for the very helpful briefing that I have received tonight.

If we come back to the question put by the noble Baroness, Lady Gardner, she is surely right about the important focus on improving information to the public, and trying to get over some of the stigma problems to which she referred. She referred to cancer—and I remember when, in the 1950s, people would not actually use the word “cancer”. It was almost hidden away. Clearly, there are issues with dementia, which we must tackle with enthusiasm. My noble friend Lady Turner spoke eloquently of the terrible impact that dementia can have on loved ones.

On a more optimistic note, both the noble Baroness, Lady Greengross, and the noble Lord, Lord Jones, said that much can be done. However, the problem is that often people do not know that that is the case. A major problem is the lack of information in many cases when a diagnosis is made. That, of course, assumes that a diagnosis is made. My understanding is that diagnosis

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rates are currently only 48% in the UK, and vary widely across the country. This suggests that more than half of people with dementia do not receive a formal diagnosis and therefore do not get access to vital treatment and support. How does the noble Earl think that we might improve diagnosis rates? Will he also consider the Alzheimer’s Society’s priorities for improving post-diagnostic support, to which my noble friend Lord Jones referred? That society’s priorities are that health and care professionals should provide post-diagnosis information packs, that information must be accessible and useful to people with dementia and not just available digitally—a very important point—and that commissioners must also consider the needs of carers of people with dementia in their local plans.

When a diagnosis is made of any condition, not just dementia, why is the information provided by societies such as the Alzheimer’s Society not automatically given to patients? It has long been a puzzle to me why the health service in particular finds it so difficult to give out this information. Any help the noble Earl can give in that regard would be appreciated.

Will the noble Earl say a little more about research? A number of noble Lords have referred to this. Research into dementia has improved but there is a long way to go compared with research into other diseases. I hope that the noble Earl will be prepared to comment on his own department’s policies on this issue and on the influence of the Medical Research Council in this area.

My noble friend Lady Turner said that people with dementia are best looked after at home. That must surely be right. However, the noble Earl will know that at the moment many patients with dementia are in National Health Service acute hospitals. Some people use the wretched term “bed blocking”, which I think is very unfortunate. However, there is no doubt that one of the problems for accident and emergency departments is the difficulty of discharging patients with dementia once they get to hospital, and, of course, those patients often suffer from co-morbidities. Has the noble Earl looked at the report of the Royal College of Physicians which suggests that, rather than having specialised hospital consultants, we need general physicians who can treat patients with co-morbidities? This is very relevant to people with dementia. Will he write to me on that issue if he cannot comment on it today?

The noble Baroness, Lady Gardner of Parkes, referred to nursing. I very much agree with her that in retrospect the phasing out of state enrolled nurses was an absolute disaster. I am afraid that it was done at the behest of the nursing profession. It is not satisfactory that we now have only one tier of registered nurse. I will not go back to the issue of healthcare assistant regulation, although rumours reach one of a Bill that will allow us to debate that again at some point in the near future. However, the substantive point the noble Baroness made was that we need to look at nurse training and, I think, healthcare assistant training, in this area.

We can tackle this issue only in a wider context. My noble friend Lord Jones said that the Question posed by the noble Baroness is a strategic one. I very much agree with that. The noble Baroness, Lady Greengross, talked of the need, in the case of an individual with dementia, for a navigator and co-ordinator. My argument

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would be that we need the equivalent at the national level also. We have the national dementia strategy for England but my understanding is that it is due to end in April 2014. I ask the noble Earl whether he thinks that the Government would be prepared to run with another national strategy.

This is a terrible illness. It impacts on 850,000 people at the moment; I believe that that figure is estimated to increase to 1 million or so by 2021. The need for national leadership and a national strategy is overwhelming. The noble Earl might not be able to commit to that tonight but I hope that he will take the message from noble Lords here, which is that this is a terrible illness, much can be done to help people with dementia if we have co-ordinated action, much more research ought to be done, and we need greater co-ordination at local level.

I hope that the noble Earl will pick up the suggestion of the noble Baroness, Lady Greengross, that local co-ordinators and navigators of care would be extremely helpful. Perhaps he will also pick up the point raised by my noble friend Lord Jones about the role of business and industry in supporting local societies. He gave a brilliant example of how that can pull people together and provide real support for organisations such as the Alzheimer’s Society at local level.

7.46 pm

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, this has been an excellent short debate. I thank all contributors but, in particular, my noble friend Lady Gardner for having tabled this important subject and for having introduced it with such insight.

As has been said, dementia is one of the biggest challenges society is facing, but it is a challenge that we are determined to get to grips with. That is why dementia is a major priority for the UK Government, and my right honourable friend the Prime Minister launched the dementia challenge last year. We must fight back on an international scale, which is why we hosted the first G8 summit on dementia in December, as the noble Baroness, Lady Greengross, kindly mentioned, and we will continue to provide global leadership.

Five years ago, the national dementia strategy was developed. It has achieved a lot and laid the foundations for real change in how people with dementia and their carers are helped to live well with the condition. However, we recognised the need to build on the strategy and that is why the Prime Minister’s challenge on dementia is the main vehicle driving change and improvement across health and care in the community and for research. The Prime Minister’s challenge runs to 2015, not just outliving the dementia strategy but broadening its vision and providing better accountability. The challenge sets out the Government’s commitment to increase diagnosis rates, raise awareness and understanding, and double funding for research into dementia by 2015.

There are 670,000 people in England with dementia, a number expected to double in the next 30 years. Dementia costs society an estimated £19 billion a year, and currently less than half of all people with dementia have a formal diagnosis. One of the main aims of the

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Prime Minister’s challenge is to improve awareness of the condition by creating dementia-friendly communities. If we are to help people to live well with dementia, we need all areas of society to become dementia-friendly—not just health and social care but banks, supermarkets, bus stations, post offices and all the different forms of local public services. All those places can become more dementia-aware and supportive of people with dementia and, if they do, people with dementia will benefit enormously, continuing to connect with society in ways we all take for granted.

Last October, Lloyds Bank and the Alzheimer’s Society launched a charter encouraging banks and building societies to join them in becoming dementia-friendly, and we need other companies to follow suit. I was impressed by all that I heard from the noble Lord, Lord Jones, about Airbus. The noble Baroness, Lady Turner, in her moving speech, referred to the importance of local support for people with dementia, and I wholeheartedly agreed with what she said.

The Dementia Friends scheme, which aims to make 1 million people more aware and understanding of dementia, is helping to break down the barriers between people with the condition and their local communities, with funding from the Department of Health and the Cabinet Office. The noble Lord, Lord Jones, was absolutely right in all that he said on this subject. My right honourable friends the Prime Minister and Deputy Prime Minister and Ministers at the Department of Health are all Dementia Friends, as are more than 500 Department of Health staff. I myself am a Dementia Friend. It has helped me to understand the impact that this condition has not just on the individual but on their families who care for them. Dementia Friends is one of several components in creating dementia-friendly communities. Alzheimer’s Society guidance sets out the criteria for becoming a dementia-friendly community, and already 34 communities, from York to Plymouth, have signed up to the scheme, with others having expressed an interest in doing so.

This spring, Public Health England, working with the Alzheimer’s Society, will launch a three-year £12 million social movement to make the nation more aware of dementia and enable people to understand how they can help those with the condition. The “Dementia Movement” will aim to do three main things. The first will be to reduce fear and stigma through activity that improves public attitudes towards dementia and gives more people the confidence to engage with those with dementia. It will also aim to increase social connectedness—for example, by prompting and supporting conversations between people in the early stages of dementia and their families, friends and neighbours. It will aim, too, to improve skills by recruiting people into the Dementia Friends programme so that more people know how to help those with dementia. The movement will target business partners in the private, public and voluntary sectors, and urge them to continue to implement the Dementia Friends programme within their organisations, giving their employees an understanding of the supportive action that they can take to help people with dementia.

The noble Baroness, Lady Greengross, spoke with great authority about the importance of diagnosis,

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co-ordinated care and support, and I very much agreed with what she said. The noble Lord, Lord Jones, also laid emphasis on timely diagnosis. Raising awareness of the signs and symptoms of dementia is the first step towards getting a formal diagnosis—one that will lead to people being able to access advice, information, care and support. The number of people with a diagnosis is increasing year on year, but the noble Lord, Lord Hunt, was right: still only just under half of all people with dementia have a diagnosis. That is simply not good enough and it is why NHS England has committed to raising the diagnosis rate to two-thirds by 2015.

Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean that they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.

The noble Baroness, Lady Greengross, and the noble Lord, Lord Hunt, asked about steps being taken to ensure the identification and treatment of comorbidities in people with dementia. If I may say so, that question is extremely pertinent. NHS England has committed to increasing the dementia diagnosis rate, as I mentioned. A diagnosis of dementia is vital in accessing support and treatment across the board, not just for dementia but for all comorbid conditions.

Once people have a diagnosis. they need to understand the implications of the condition and how they can access advice, information and support to help them and their carers to live as well as they can with the condition. If the condition is advanced, some people will need care and support immediately, but those diagnosed at an earlier stage may need only advice and information. The noble Lord, Lord Hunt, rightly stressed the need to provide information post-diagnosis.

My noble friend Lady Gardner mentioned the important role of charities, as did the noble Lord, Lord Jones, who rightly praised the work of the Alzheimer’s Society. The dementia guide is given to a person with dementia when they receive a diagnosis, and almost 100,000 copies have been distributed since last July. The NHS Choices website has dedicated pages for dementia, highlighting the range of services and support available to people with dementia and their carers. Regional NHS websites, such as myhealthlondon.nhs.uk provide details of healthcare and voluntary services available locally. A free national helpline helps carers to access information about local and national services and individual advice and support.

My noble friend referred to the need for good nursing. Services are no good without a skilled workforce. That is why Health Education England is ensuring

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that staff are dementia-trained. In November, it hit its target to deliver dementia training to 100,000 staff ahead of schedule, and it will continue to roll out training to improve the skills of the workforce. We want people with dementia to receive a better quality of care from informed and trained staff through the CQUIN programme. NHS England has asked all hospitals to identify a senior clinical lead for dementia, to ensure that carers of people with dementia are adequately supported, and that this is reported at board level. Every person joining the social care workforce will undertake common induction standards, which include aspects of dementia awareness. In addition, a number of units and qualifications at vocational levels 2 and 3 have been developed by Skills for Care and Skills for Health to support the development of the social care and health workforce, working with people with dementia.

The noble Lord, Lord Hunt, and my noble friend Lady Gardner asked about research. Doubling funding for research, as I mentioned, is part of the Prime Minister’s challenge, and the quality and quantity of research proposals for dementia are improving. Last year £20 million was awarded to six proposals which will look at areas such as Living Well with Dementia and dementia-associated visual impairment. All the G8 countries signed up to the communiqué at the end of the conference and one of the pledges was significantly to increase the amount spent on dementia research.

As I have outlined, there are a range of services and information sources available to support people with dementia and their carers, but this is only the beginning and we have a long way to go until everyone with dementia is able to live as well as they can with the condition. We are not resting on our laurels. The Government are committed to doing more. We are currently working with our partners in the NHS, social care, local government, public health and the Alzheimer’s Society on a call to action to improve post-diagnosis support for people with dementia and their carers—support on which the noble Lord, Lord Jones, rightly laid emphasis. The work is at an early stage but, over the next couple of months, we will be developing an offer of what should be available to everyone to ensure that we have achieved the Government’s goal of people with dementia and their carers having access to services to help them live well within our society for longer.

Transparency of Lobbying, Non-party Campaigning and Trade Union Administration Bill

Returned from the Commons

The Bill was returned from the Commons with reasons and amendments.

House adjourned at 7.58 pm.