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"Decisions about the nature, number and funding of the memory clinics will be made locally by primary care trusts, depending on local circumstances."-[ Official Report, 23 February 2009; Vol. 488, c. 202W.]
What sort of a promise is that? The question for the Secretary of State today remains this: what is the precise number of planned and existing memory clinics and how many specially trained staff are there in the country?
John Mann: I thank the hon. Gentleman for giving way. I discussed memory clinics, among other issues, with my PCT last week. Nottinghamshire's Tory county council has privatised care homes in my constituency and elsewhere, with the result that day care services will go, among them day care memory clinics. Does he agree with that approach? Is it what we will see should he ever be in power, or would he adopt a different approach? We want to know.
Mr. O'Brien: I note that the hon. Gentleman did not answer his own question about whether there were any memory clinics in his constituency's towns. It is vital that he applies that scrutiny to his Government's policies. This debate is taking place because the Government have to be held to account.
Angela Browning (Tiverton and Honiton) (Con):
I am a member of the PAC, and we took evidence on this issue on Monday. However, another issue arose that cannot wait-the appointment of dementia champions. We asked the civil servants before us how many of them
there were, and where. They could not answer, although I believe that they will respond in writing to my hon. Friend the Member for Gainsborough (Mr. Leigh). The practical implementation of many aspects of the strategy does not need to wait and the Government can get on with that. Having dementia champions in PCTs and hospitals saves money and introduces the efficiency savings needed to implement the strategy.
Mr. O'Brien: I am grateful to my hon. Friend for that excellent point. It is an example of how we need to make sure that people at the front line get actions rather than words.
It seems that the Government have got into a habit of making unfunded pledges of late. Not only was their dementia strategy riddled with spending loopholes, but the Minister's announcement last week of safeguarding vulnerable adults boards for every local area was equally vague about where the resources to implement the boards would come from. He made no mention of how the boards would co-ordinate with the dementia strategy, despite dementia sufferers being some of the most vulnerable people in our communities.
I hope that the Secretary of State will take this opportunity to explain why he claimed in a statement last week to be implementing a system of registration for home care workers with the General Social Care Council, when the GSCC has informed some of its stakeholders that plans for the system are actually on hold. Clearly, the Secretary of State is too busy trying to bolster his party's manifesto to worry about making sure that these ambiguous claims are given the necessary detail, and the action points that have been highlighted.
Last week, we uncovered figures on malnourishment in our hospitals. The problem has not been dealt with, despite repeated pledges from Ministers. Evidence shows that it is the elderly who are most at risk from malnourishment in hospital, as they are often unable to express their needs to nurses. Over the last three years, I have been hammering away at this outrageous and scandalous issue. We need only look at the new year press coverage of the widespread unnecessary tube-feeding of the elderly in care homes-particularly those with Alzheimer's-to see the harm that can be done to patients if the caring professions are under-equipped to meet the demands of dementia, both in terms of training and resources.
John Mann: Will the hon. Gentleman give way on that point?
Mr. O'Brien: No, I will not give way to the hon. Gentleman any more. He is clearly rather excited.
The Royal College of Physicians undertook a review of tube feeding and deplored the practice as "completely unethical". That the Government is content to let the elderly and Alzheimer's sufferers be subjected to such appalling treatment as a result of overworked and under-trained care home staff is simply unacceptable. The Government have been sitting on the report of the nutrition action plan delivery board since July last year. I am glad that the amendment states that it will be published "shortly". Given that it is six months overdue, I hope that the Minister will undertake to publish it tomorrow.
If the unnecessary tube-feeding of the elderly was not enough of a wake-up call for the Secretary of State, in November, the Government published a report overdue by 10 months on the inappropriate use of anti-psychotic drugs to treat dementia patients. Such drugs have a number of serious side effects that pose a particular risk to the elderly. They make patients unsteady and increase the risk of falls, they cause individuals to become socially withdrawn and they can accelerate cognitive decline, exacerbating the effects of dementia. Can the Secretary of State tell us what, if any, action has been taken as a result of the report? After three months, and after an initial delay of a year, all that the Government have done is appoint a national clinical director this week, although that is a welcome move.
It is a sobering thought that the suffering of millions could be prevented if we found a cure for dementia. That might or might not be possible in future, but today anything that can be done to slow the onset of the disease is to be encouraged and welcomed. The Opposition believe that the Government should not resign themselves to the status quo but press ahead in support of research into new treatments for Alzheimer's, which is why we pledged in 2007 to increase the proportion of research budgets for work on dementia. Our policy has put Ministers under pressure to focus the Government's attention on dementia, and I was pleased see that in November, a new ministerial group was launched to support dementia research and to help increase the proportion of the Government's £1 billion research budget that is assigned to dementia research.
Hon. Members will be aware of the concerns recently expressed by third sector groups that the Personal Care at Home Bill will hit those research budgets very hard. I have secured a categorical commitment from Ministers that that will not be the case, but until the details of where the money is coming from for the Bill are completely disclosed, inevitably the third sector will continue to raise those concerns. Will the Secretary of State undertake to place in the Library detailed accounts to show where the money is coming from?
Chris Ruane (Vale of Clwyd) (Lab): On where the money is coming from, the hon. Gentleman will be aware that the health budget has risen from £32 billion to more than £100 billion over the past 13 years. Dementia services are an important issue, so can he guarantee the funding that will be available if he is fortunate enough to become a Health Minister in May or June this year?
Mr. O'Brien: It would be very nice if the Government would match our promise and say that there will be real-terms increases to the NHS budget going forward. It is an interesting point to be made by someone from Wales, which is a devolved region. My constituency borders Wales, and my constituents are aware of the differences between health services in Wales and services in England.
Investing in high-quality research is a vital step towards discovering new and better dementia treatments. However, making drugs available to the wider population, to people who have just received a diagnosis of dementia, and to people with advanced dementia already in need of full-time care, is an altogether different challenge. Uniquely, we have pledged to change the remit of the National Institute for Health and Clinical Excellence to
include a calculation of the wider societal costs of a given treatment when undertaking NICE appraisals. It is clear that dementia, as with other diseases, has an impact on local authority budgets and on public spending as a whole. Along with our commitments to value-based pricing, and to streamlining the NICE process, that will pave the way for dementia sufferers to access better drugs.
We need to offer those who are faced with a diagnosis today, and those for whom a cure may not be found for a number of years, the chance to guarantee their care needs so that they can be reassured that whatever the impact of dementia on their lives and their loved ones, they will be able to access residential care should they ever require it. I have explained to the House before the merits of our home protection scheme, and the careful calculations behind what we have promised. It was designed precisely to meet those concerns and allay the fears first raised by Tony Blair 13 years ago about a need that has remained unmet over a period of Labour government. People can now look forward to a Conservative Government delivering a well-designed scheme that deals with people's fear of going into residential care. We need to look at the context of social reform-
Andy Burnham: Will the hon. Gentleman give way?
Mr. O'Brien: Of course. Perhaps the Secretary of State can answer the same question.
Andy Burnham: If that is the hon. Gentleman's big idea, can he explain how that will possibly help people who want to live at home with their family in the community, and not receive care in a care home?
Mr. O'Brien: The Secretary of State knows that that intervention was completely unnecessary, because it has never been claimed that it would help people to stay in their home. The idea is to meet the fears of people who have to go into residential care, by making it affordable and so that we do not discriminate against those who cannot afford it. It would not have the perverse incentive that he suggested, because of the national assessment criteria on care needs. The Prime Minister's knee-jerk reaction in the Personal Care at Home Bill did nothing to address that issue, and deliberately discriminates against people who need residential care. Doubtless that will be debated in the other place on 1 February.
Mr. Swire: What my hon. Friend says about the proposal is interesting, because in my constituency of East Devon, we are dealing with the case of Mr. Mejor, a former Spitfire pilot, which has attracted national attention. His care is being reassessed at the moment. His daughter is his carer and he has an elderly wife, but they may have to forfeit their home. Such isolated cases are becoming increasingly prevalent around the country, but they could be avoided if we adopted Tory policies. [ Interruption. ]
Mr. O'Brien: I am grateful to my hon. Friend.
Angela Browning: On a point of order, Mr. Speaker. Is it in order for a Minister from a sedentary position to accuse my hon. Friend the Member for East Devon (Mr. Swire) of being ignorant? Is that appropriate behaviour for Ministers in the House?
Mr. Speaker: On the whole, I have good hearing. I must admit that I did not hear that remark.
Mr. Speaker: Order. I am grateful to the hon. Gentleman. I was not disputing the word of the hon. Member for Tiverton and Honiton (Angela Browning)-I was simply making the point that I did not hear it. What I would say-and I am grateful to her for her point of order-is that it would be a good thing if the House settled down. I know that this is a highly charged matter on which strongly held views are being expressed, but that must be done in a seemly way that will command the respect of the country.
Mr. O'Brien: It is indeed a serious subject, Mr. Speaker. I am grateful to my hon. Friend the Member for East Devon for raising a case that has become widely known. Our reforms would enable his constituent to be better served and to receive the care appropriate for his needs.
To summarise, the issue of how we provide sustainable and affordable options for residential care is part of a wider debate on social care reform. The Government have played fast and loose with the challenge of reforming social services. Despite promises made in 1997, they ignored their own royal commission and, indeed, the whole problem, until 2008. We have had a vague Green Paper following an even vaguer consultation which has, in Lord Lipsey's words, been blown out of the water by the Prime Minister's announcement of free personal care late last year.
Having rushed the Personal Care at Home Bill through the House, the Government have still not given any assurances on the costings of the Bill, or its robustness in the face of a potential legal challenge under the Human Rights Act 1998. Nor will the Bill help any of the significant number of dementia sufferers already in care homes. With the Secretary of State keen to make the Bill a top-three issue in Labour's election campaign, the House would do well to acknowledge the fact that dementia sufferers and, indeed, all older people with care needs, deserve more than political posturing on something that has not yet been properly costed.
I hope that the Government will treat today's debate as an opportunity to discuss how we can work together to ensure that the public reap the benefits of the dementia strategy through action on the ground, and to reflect on how we build on the strategy to meet the demands that dementia will inevitably make on our health service in the coming years. We need such action, rather than words, and the Government must act quickly. It is time for Government to step up to the challenge posed not only by this devastating disease but by an unreformed social care sector, not with words or another vacant pledge, but with action at the grass roots of the NHS and social services and a concerted leadership effort at the helm of Government. A national care service does not simply come about or, indeed, become a national service simply by our using those words. It is important that the Government answer serious questions about provision, portability and, not least, who will pay. We are not just talking about the prioritisation and allocation of funding within the health budget. We are talking about supporting the work that funding enables: offering tailor-made training to staff at the front line; researching a cure; ensuring that the public have easy access to the
best drugs on the market; and enabling all older people, no matter what their care needs, to guarantee their residential care in old age. All that will greatly enhance the quality of life for those diagnosed with dementia and for all elderly people seeking dignity and security in old age.
Mr. Lindsay Hoyle (Chorley) (Lab): I thank the hon. Gentleman for giving way. He is extremely generous. Does he also believe in the establishment of memory centres?
Mr. O'Brien: The Government announced the establishment of memory clinics, rather than memory centres, in every town. That has been amended, on occasion, to memory services. Clearly, what matters is not the building, but the training and the skills of the people offering all the NHS and care services, who need upskilling so that those services are better known by all who come into contact with patients. That will enable them to deal with many who remain undiagnosed, which was one of the earliest points made in the debate.
The issue of dementia and the challenge posed by our ageing population cry out for leadership. It is one of the greatest and completely known and predictable challenges for our political generation. I urge all Members across the House to come together on the issue and to make the difference for some of the most deserving and vulnerable people by supporting the motion.
John Mann: On a point of order, Mr. Speaker. When the House adopted the Nolan principles and rules, which it did by resolution, there were two specific requirements on hon. Members, were they to receive finances or other assistance from outside bodies. The first was that the interest should be registered, which is signified by the letter R by convention and has been done in a fairly widespread way. The second is more important.
The second Nolan rule adopted by the House, as I recall, is that for 12 months after receiving such money, the Member is not able to initiate any legislation whatsoever that impacts directly or indirectly on the donor of that money. It is my understanding that a company called Care UK donated £21,000 to one of the signatories to the motion. If that were the case, can you confirm that it would not be in order for the motion to go forward?
Mr. Speaker: I am grateful to the hon. Gentleman for his point of order. I will respond as follows, and I hope this is helpful to the House.
First, of course, responsibility for the registration of interests rests with individual Members. Secondly-I listened very carefully to what the hon. Gentleman said-if any Member has anxieties or is discontented about the conduct of another Member, the Member who is dissatisfied should complain to the Parliamentary Commissioner for Standards. At this very tense and competitive time, I should hope that Members would not air these matters on the Floor of the House when they are matters not for the Chair, but for the Registrar of Members' Interests and the Parliamentary Commissioner for Standards.
If Mr. O'Brien wishes to respond to the point of order, he is welcome to do so, but he is not under any obligation to do so.
Mr. O'Brien: I am happy, Mr. Speaker, to take the opportunity to say that that is an extraordinary thing to be raised as a point of order, as you somewhat indicated. I can assure you, and through you the House, that any money that has been received by the office of any right hon. or hon. Member, particularly in opposition, to support their parliamentary work and particularly in relation to research, has been fully, openly and transparently declared at all times with the Electoral Commission and with the Registrar of Members' Interests, on time and in proper conformity with all the rules, and that no possible conflict of interest could arise.
Mr. Speaker: I am very grateful to the hon. Gentleman. The point of order has been raised. The response has been made. I hope that if it is pursued, it will be pursued elsewhere.
Before we proceed, I should like to say that the hon. Member for Eddisbury (Mr. O'Brien) gave way generously in the course of his contribution. I am sure that was appreciated by the House. This is an Opposition day. There is another debate to follow. Several Back-Bench Members wish to speak in this debate, and I hope that further Front-Bench contributions will be tailored accordingly.
1.23 pm
The Secretary of State for Health (Andy Burnham): I beg to move an amendment, to leave out from "charities" to the end of the Question and add:
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