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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate my hon. Friend the Member for Hemel Hempstead (Mr. McWalter) on securing the opportunity to debate this important issue. However, I cannot possibly agree with his comments about Glasgow. Having lived there for several years, I must leap to the defence of that fair city. If that ensures that I am called promptly in future debates, that is even better.
My hon. Friend described some of the problems that face people with dementia and their carers. Dementia can doubtless have a dramatic effect on individuals, their families and friends. My hon. Friend is right to take the matter seriously and raise it in the House.
Debates such as this are bound to concentrate on what is going wrong. I should therefore like to start by saying that a great deal is going right as regards how we care for people with dementia. It is important to put that into context, because about 600,000 people in this country have dementia in various degrees of seriousness. When dementia is diagnosed, it is important that the individual and the family approach it as far as possible with a positive outlook. That is difficult if we give the impression that it is awful for everybody all the time.
Some of the care and support comes from people's families and friends, who work tirelessly to ensure that partners, parents and neighbours are cared for in the best possible way. However, the statutory and voluntary sectors provide much support. They increasingly provide a range of person-centred services. The statutory and voluntary sectors also provide a range of support services to enable carers to continue caring.
Lady Hermon : I am most grateful to the Minister for taking this intervention. I had not intended to intervene, particularly in another hon. Member's Adjournment debate. As the wife of a dear husband who has only recently been diagnosed with Alzheimer's, I urge the Minister to consider the fact that, somehow, GPs should look much more closely at the symptoms. I went to our GP five years ago, but my dear husband was diagnosed only last year. With the greatest respect to the Minister, he can tell me how much is being done now, but early diagnosis would have helped my husband and our two children a great deal.
Dr. Ladyman: First, may I offer my sympathy to the hon. Lady and my best wishes to her husband? I entirely agree that, if we can diagnose these conditions and begin to manage the problem much earlier, it is often much easier to deal with the matter. Early diagnosis and early intervention in long-term conditions can often be key to their proper management, and I am sorry that that has not happened in her case.
The point that I was making was that many people who have been diagnosed with dementia can have many happy, quality years of life before the condition becomes serious. If there is a positive aspect to the situation, it is that people in the hon. Lady's situation should be aware of that. A story that I often tell is that it is reputed that, not that many years ago, one of our own Prime Ministers was diagnosed as having dementia while still living at No. 10 Downing street, and stayed there and ran the country for a year or so after he had received the diagnosis. It is important, therefore, that we put this into perspective. Such a diagnosis is not an immediate death sentence, and we need to manage the condition as positively as we possibly can. I think that that was probably the thrust of the argument of my hon. Friend the Member for Hemel Hempstead. There is a great deal of quality of life to be drawn from even the most difficult of situations.
Let me give an example. Hon. Members might have heard of the Jackdawe scheme, a specialist home care service in Nottingham for people with dementia, which recently won a health and social care award. On average, the people using the service receive 10 hours of care a week, and the care provided is in line with what
As my hon. Friend intimated, most people do not want to go into a care home, and one of the things that the Government are doing is to look for alternatives to that. We have put a huge amount of money into intensive home care packages for older people, including those with dementia, and many people with dementia can be kept in their own home for a considerable period. About 27,000 more intensive home care packages are in place already.
We can also make available the extra care model of housing, an example of which is Alexandra House in Coventry, which I visited fairly recently. I met a lady with dementia and her husbandwho was in his mid-eightieswho was looking after her, living in their own flat in that extra care community. For about a decade, he had done nothing but look after his wife, and that was now taking its toll on him. Because they were living in an extra care facility, however, she was able for the first time to get the care that she needed, and he was able to take a break from caring and to start to lead his own life again. I met him on the day before he was due to start a computer course at the local adult education college, at the age of 87. He was able to leave his wife for the first time in many years because he was confident that she would be looked after when he was out of the house. There are, therefore, many alternatives to care homes, and we must explore them.
My hon. Friend talked about the shortage of care home beds for people with dementia for whom that is the only option. He criticised the Government for leaving the responsibility for that in the hands of local councils, but the reality is that that is where we place the responsibility for judging local capacity. We cannot possibly judge it from Whitehall, because we do not know the situation in his area or in other areas around the country. We therefore put a responsibility on local councils to do that planning, and we have given them adequate resources to do so. My hon. Friend talked about the resources available in his area, and about Hertfordshire's financial position, but since 1997 we have increased by 25 per cent. over and above inflation the funding for personal social services across the country.
My hon. Friend talked about standard spending assessments. Actually, we do not have those any more: we have formula spending shares, which reflect deprivation levels and other local issues, and determine how much each council receives. Councils are, however, supposed to top up spending on those services from council tax. That is what council tax is forto add extra money. We give councils responsibility for judging local needs, and trust them to balance the availability and capacity of services against those needs.
The availability of care home places is also an issue when social services departments are working out how to reduce the number of delayed discharges from acute hospitals. To enable acute beds to be used to maximum effect, Hertfordshire offers patients and their relatives the opportunity to move to the homes of their choice, but in the interim, until a vacancy becomes available, people may have to wait in homes that are not in Hemel
Hertfordshire has a block contract for 60 nursing home beds for people suffering from dementia, all of which are in the Hemel Hempstead area. A further 74 beds are contracted with nursing homes in Luton and Harpenden. I am assured that Luton is the furthest area in which people are placed and that, if relatives experience problems visiting the home, the council uses the carers grant to assist them. At least, that is what I am told. If my hon. Friend has evidence to the contrary, I hope he will bring it to my attention, because when councils tell me porky pies I take that seriously. There is also access to 460 residential care home beds for people suffering from dementia who do not require nursing careall in Hertfordshire.
As I said earlier, the local authority offers choice through the preferred choice option. When people have been placed outside Hertfordshire, they return to the Hemel Hempstead area as soon as there is a suitable vacancy. Some take up that option; others do not.
My hon. Friend mentioned the important issue of carers. Most people with dementia are cared for at home, and we have made extensive efforts to improve support for carers. We shall more than double the money currently given to councils to support carers. It is £100 million this year, £125 million next year, and £185 million by 2006. Councils can use that money to give people short breaks from caring, and to provide them with other help.
Let me stress a point that I always stress when speaking about this subject. We have introduced a regime enabling carers to demand their own assessments. Many carers do not realise that they can go to their local social services departments and demand assessments of their needs. I urge them all to do so.
My hon. Friend mentioned pre-nursing care, personal care and the costs involved. In October 2001 the Government delivered their commitment to bring in free care from registered nurses for people paying all their own nursing home fees. That also applies to people receiving nursing care at home. It ends the anomaly of people having to pay for care in nursing homes that would be provided free in residential accommodation or at home.
The Government recognise that caring for someone with any form or level of dementia often requires the involvement of a registered nurse. The complexity of the problems experienced by sufferers, including behavioural change, means that frequent review and supervision of their care may be needed to maintain
As for personal caredescribed as "social care" by my hon. Friendin responding to the royal commission on long-term care we decided not to make personal care free for everyone. However, I can tell my hon. Friend that some or all of the personal care costs of almost seven in 10 people are met by the state.
Those whose personal care costs are not met by the state have assets in excess of £19,500. By making that decision, we will be able to redirect an additional £1 billion a year by 2006 into services for everybody. Were we to provide free personal care for such individuals, we would not have as much money to spend on other services. The intensive home care packages, the carers grant, and the so-called access grant, which makes the services available to allow us to keep people in their own home, are all paid for by not making personal care free for people who have significant assets. If we made personal care free for such individuals, all that would disappearwe would be unable to provide that level of support, and all older people, including those with dementia and mental health problems, would suffer as a result.
I put it to my hon. Friend and to you, Mr. Speakeryou have an interest in these matters from the Scottish perspectivethat the Government in Scotland came to a different view. They decided to fund personal care for everybody. Now, more people in Scotland than in England are having to enter care homes, and in a few years that divergence will be very dramatic indeed. People in England will start to see the merit of the Government's decision, and I suspect that people in Scotland will start to ask their Government why they took the line they did.
In addition to what I have described is something called NHS continuing care. When an individual's medical needs outweigh their personal care needs, as sometimes happens to people with dementia, they become eligible for NHS continuing care, whereby the NHS pays not only for their nursing care and personal care, but their accommodation costs. That is the third level of care, about which people who engage in this debate often forget. It is true that the ombudsman criticised