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3.31 pm
Jeremy Wright (Rugby and Kenilworth) (Con): I begin by joining the tributes that have been paid to Neil Hunt, the departing chief executive of the Alzheimer's Society. He has done a great deal, as most people involved in this issue know, to drive the subject up the political agenda to where it rightly deserves to be.
I also regret the absence from this debate of David Taylor. I know that he would have been here to contribute, as he always did on these issues. He was a well-respected and assiduous member of the all-party group that I chair, and he will be missed in this debate, as he will be in many others.
The numbers that we discuss whenever we talk about dementia are staggering. Hundreds of thousands are affected now, millions will be affected in the future and billions are being spent on the treatment and management of dementia at the moment; it is possible to become immune to those numbers and to forget the scale of the challenge that we face. However, some numbers still have the capacity to shock. The review of anti-psychotic medication undertaken by Professor Sube Banerjee recently reported to the Government and is, I think, one document that contains such figures. To know, as we stated in the all-party group's report on this subject some time back, that there is a substantial degree of over-prescription of anti-psychotics among people with dementia is one thing, but to hear from Professor Banerjee that he thinks that some 140,000 people are wrongly on those drugs-the deleterious effects of which have already been discussed in the debate-and that, worse yet, an additional 1,800 deaths a year result from that excessive prescription, as do 1,600 or so strokes and the like, truly, in my view, puts this scandal into its proper context and underlines the need for action.
I, like others, welcome the appointment of a national clinical director in dementia. That is a positive move forward, and I hope that the Minister will confirm that one of that clinical director's first priorities in office will be to address this serious issue. One suggestion from Professor Banerjee to deal with the trouble caused by the over-prescription of anti-psychotics is to address the fundamental issue of training. The Minister knows,
not least from the other report produced by my all-party group, how strongly I feel about that subject and how central it is to the issues of dementia care in general. I shall not dwell on it now-I do not have time-but I simply repeat a request that I have made to him in the past, which is that he should keep it very much at the forefront of his mind, that we should set up substantive mechanisms to ensure that qualifications are available for those in the caring profession, that career paths should be set out in specialist dementia care and that everybody who has contact with those with dementia, which includes a large number of people across a variety of fields, has some understanding of the condition that is being dealt with.
I concede that training features as part of the national dementia strategy. I repeat my welcome for the strategy, as it is a very positive move forward and contains a great deal that needs to be done. The Secretary of State was right to say that we should not expect everything to be done by now, less than a year into a five-year strategy. I accept that it will take time to complete, and the Government have been right to say repeatedly that dementia is a priority for them. It is a national and a Government priority, but in this debate we should ask what that means. For example, does that mean that more money will be made available for researching a condition that has become a Government priority? As others have said, it is not apparent that that is what it means. The level of research has not increased at all, let alone dramatically. Greater priority should be given to dementia research; if it is not, we will not be able to address that widespread problem in a fundamental way or start to reduce the costs to the Exchequer that it incurs.
Does a Government priority on dementia mean that the Government will take action more quickly, or that they will radically change the operation of the relevant systems in the fields of health and social care? Does it mean that the Government will spend substantial amounts of new money specifically on this priority? I regret to say that I do not think that the evidence suggests that making dementia a Government priority means any of those three things, as I shall briefly explain.
First, have the Government been quick to set our their response to the challenge? Although I welcome the national dementia strategy, it was promised repeatedly-from August 2007 right up to its publication in February 2009. An implementation plan with any significant detail came only later still. I have said that the review of anti-psychotic drugs is welcome and important, but it was originally promised a long time before the strategy. The review was finally published on 12 November of last year, some seven months after the strategy was published and some two years after it was originally promised. Those delays do not have the hallmark of action that is a Government priority.
Secondly, has making dementia a Government priority initiated radical change in how this country's health and social services are run? The context is important here. This is a Government who set considerable store by central control. They set targets that they consider important, and which those delivering services must meet.
Earlier, the Secretary of State said that the Opposition cannot have it both ways, but neither can he. If the Government believe that that is how the health service
and social services should operate-with a great degree of central control exerted by means of the levers attributed to Whitehall-then they cannot simultaneously refuse to pull those levers and make something happen, saying that doing so is not their department.
Reference has been made to the NHS operating framework, the mechanism by which the Government communicate their priorities for the NHS. Due to the delays that I have described in bringing the dementia strategy forward in the first place, the Government missed the boat entirely in the operating frameworks for 2008-09 and 2009-10.
As we have discussed, those frameworks set out three tiers of priorities for the NHS-the things that all PCTs must do, national priorities for local delivery and priorities to be set locally. Dementia is not mentioned specifically or substantively in any of those tiers. Worse still, the 2009-10 framework published in December 2008-before the strategy was published, but after the substantive work that there must have been to enable the Government to know what they were seeking to achieve-stated that there would be no new national targets in the NHS until the next spending review. We are, of course, still waiting for that review. Even in the 2010-11 version of the framework that was published in 2009, there is only a brief reference to dementia, and that was about the improved outcomes and efficiencies to be gained by early diagnosis of the condition.
It is not true either that GPs, as part of the NHS, are being asked to do a great deal of specific work on dementia. The existing qualities and outcomes framework has only two criteria relating to dementia, and they are about maintaining a register and having 15-monthly reviews. I accept that those criteria are important, but they are not as fundamental as perhaps they should be. That is a good Government priority, and it is a substantial issue that should be addressed, but there is not much evidence of their doing so in the control mechanisms that they have put in place for the NHS. There is no evidence of a speedy response or of significant changes in the systems that deliver care.
What about the money? Have the Government given substantial extra resources to those who deliver care and said that those resources must be spent on the new priority of dementia care? Again, the answer is no. There is no ring-fencing, and there is no reporting requirement for PCTs to tell the Government whether, in fact, they have spent the £150 million allocated over two years across the country on dementia care. We must ask, in all common sense, how confident we can be that cash-strapped primary care trusts facing an array of different Government targets are necessarily going to spend all that money on dementia care. We have to wait for the Government's audit to find out, but I am not immensely optimistic.
If the Government priority does not mean urgent action, if it does not mean substantially changing the systems, and if it does not mean substantially increasing the resources allocated specifically to the problem, what on earth does it mean? The danger is that the Government have set up tremendous expectations by rightly isolating dementia as a huge challenge that we must confront. If a Government priority is nothing more than a soundbite, and if a national dementia strategy is nothing more than a title, we run the risk of not only disappointing the hundreds of thousands of people with dementia
now, their carers and the people who love them, but disappointing millions more in future and failing to face up to the challenge that we must face up to in the next few years. If the Government, who are running out of time, are unwilling to take on the challenge and take the necessary action, I fear that it will fall to the next Government to do so.
3.41 pm
Mr. Shailesh Vara (North-West Cambridgeshire) (Con): It is a pleasure and privilege to follow my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright).
Let us be clear about one thing. When we talk about dementia, we are effectively talking about people who have given the best years of their life to contribute to society and to make sure that the rest of us are in a better position than they were when they were living active lives. It is only right and proper that we, in turn, should look after them and treat them with the dignity and respect that they deserve. Sadly, however, that is not always the case. In fact, analysis shows that Britain is in the bottom third of European countries for diagnosis and treatment of dementia-below almost all northern and western European nations.
There are a number of reasons for that, including the stigma attached to dementia. It is not right that in the 21st century people should still be afraid to admit that they have dementia or that they have relatives with dementia. I was pleased that the Secretary of State said that there is going to be a publicity campaign to highlight the issue of dementia, and to reduce the stigma attached to it. I very much hope that it will highlight the early warning signs-for example, confusion, forgetfulness, problems with speech and so on. If someone thinks that they have those symptoms, they might take advice, and go and see a doctor.
Early diagnosis is a good way of dealing with the problem, and we have heard a great deal about the need for specialist doctors and other medical professionals to provide that. At present, as we have heard, one in three people receive formal diagnosis at any time in their illness. That statistic has simply got to change. We need to ensure that far more people experiencing the onset of dementia know that that is the case, to allow them to plan them for the future, when the illness will undoubtedly become worse. It means that families can become involved, especially in making plans for people who wish to receive care at home. It also enables people to talk to medical experts and social care services.
One of the crucial themes of the debate has been the repeated mention of support for families. May I add my appreciation of the superb work done by hundreds of thousands of family members throughout the country in supporting their loved ones who are suffering? In many cases the care is given at home, which eases the pressure on the social care services-something that is not often commented on. It also ensures that those who are suffering are able to maintain a sense of independence and dignity.
We must recognise that many family members themselves have other problems and illnesses, a point mentioned by the hon. Member for Broxtowe (Dr. Palmer). As well as the pressure of looking after somebody who is suffering, they have to endure the personal pain of seeing a loved
one decline. Relatively older people are looking after even older people who are suffering. In many instances, pensioners are looking after their elderly relatives and parents.
Given the importance of the subject, it is worth while considering the Government's record. The Government gave it priority only after receiving a couple of critical reports. In 2007 the King's Fund reported that the scale of dementia in the UK was considerable. The National Audit Office report in July 2007 highlighted the poor diagnosis, poor quality of care, and the disjointed approach taken by health and social care services.
It was only after these reports that the Department of Health could bring itself to admit that dementia should be a priority. That was in 2007, when the Government had been in place and running the administration for 10 years. At that time Age Concern summed up the situation by stating:
"For far too long, vulnerable older people with dementia and their families have been treated as second-class citizens".
It took a further two years for the Government to produce their national dementia strategy-10 years to recognise that the matter deserved priority, and a further two years to produce a strategy.
What is the position a year on? The report issued less than two weeks ago by the National Audit Office was anything but complimentary. It spoke of local leadership for improving dementia care still not being in place. It said that most primary care trusts and local authorities were still awaiting guidance from the Department of Health before beginning their baseline reviews of dementia needs and services. The Alzheimer's Society has commented that a third of GPs still lack confidence in diagnosing dementia, and that nurses have so far received no information on the Government's strategy. Indeed, dementia is not included in the nurses' core subjects when they are training. Yet the Labour party, in its 1997 manifesto, spoke of ensuring that the views of pensioners would be heard, and said:
"Everyone is entitled to dignity in retirement."
I conclude by adding my praise of the Alzheimer's Society, Age Concern, Help the Aged and the many other similar charities and organisations that continue to do such sterling work.
3.48 pm
Anne Milton (Guildford) (Con): Some 700,000 people have been diagnosed with dementia, although there may be many more undiagnosed. That figure will rise to 1.4 million in the next 30 years, and includes one in 14 people over the age of 65, rising to one in six over the age of 80, and predicted to rise further. One way or another, dementia touches the lives of half the population, with close friends or family suffering the effects.
We have heard a great deal this afternoon about the importance of early diagnosis, early treatment and intervention, and proper and effective support for the person with dementia and for those caring for people with dementia. Rehabilitation has not been mentioned much in the debate, but it is extremely important for those with dementia to be able to carry on and be as active as they can. All these aspects are vital, but what is needed is more than a strategy, although that would be welcome. Effective implementation is needed, which I do not believe the Government truly understand.
I was a bit disappointed that the Secretary of State took the debate at such an early stage into party politics- [ Interruption. ] No, it was he who mentioned it first. He confused priorities with targets, but we do not need targets; we need outcomes. We need implementation that will make a real difference to people's lives-implementation that improves the outcomes for people suffering from dementia.
I was also surprised and very disappointed, actually, to hear the truly scurrilous remarks and unfounded allegations about an influence on our policy making. There is no such influence, and no conflict or possibility of conflict; everything that we do is open and fully disclosed. The hon. Member for Bassetlaw (John Mann) is no longer in his seat, but before he throws stones across the House, he should more appropriately ask his own Government about the money that independent sector treatment centres received for not doing operations.
I pay tribute to my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), who has made not only a valuable contribution today but a significant impact in raising awareness of dementia through the all-party group on dementia and his interventions in many other debates. The hon. Member for Broxtowe (Dr. Palmer) shared his very personal experiences, and his concluding remarks about a continuous spectrum of care and treatment were apt and particularly pertinent.
My hon. Friend the Member for East Devon (Mr. Swire) mentioned, in particular, the needs of carers and the hidden carers, including our child carers, who are often forgotten in the debate. My hon. Friend the Member for North-West Cambridgeshire (Mr. Vara), whose contribution was sadly cut so short, rightly spoke of the need to treat people with dignity and respect, and I pay tribute also to the hon. Member for Bridgend (Mrs. Moon), who made a number of insightful points. My hon. Friend the Member for Bosworth (David Tredinnick) raised a number of issues that are important to many of his constituents, not least his concerns about the funding shortfall for his local authority.
The National Audit Office report said that £8.2 billion has been spent inefficiently on dementia care every year. It found that although some steps had been taken and some improvements made, much more needed to be done to improve care and save literally millions of pounds. It found also that more than half of GPs surveyed had not had adequate training, and that one third remain unconfident about diagnosing dementia. Only one in five said that a senior clinician had taken the lead for improving dementia services in their hospital; and only 15 per cent. of psychiatrists said that their primary care trust had invested extra funds in the service.
Nurses, the report continued, received no information on the strategy; joined-up health and social care working is patchy; people who are admitted to hospital increasingly have longer stays and end up in residential care prematurely; only two strategic health authorities are actively working with the care home sector; there has been no improvement in GP knowledge and awareness in the past five years; dementia is not included in the core requirements for nursing degrees; it is not a priority in the 2010-11 operating framework; and it is not part of a national set of priorities against which the performance of organisations has been measured.
The fact that literally billions of pounds is spent inefficiently is truly appalling, and never has there been a greater need to ensure that all money is spent effectively and efficiently, and that above all else it is directed to and centred on the people who need the care. In the meantime, as my hon. Friend the Member for Leeds, North-West (Greg Mulholland) pointed out-
Anne Milton: The hon. Member, perhaps I should have said. The savings made from families, friends and charities, who deliver probably the majority of care, are huge, and I pay tribute to those charities and carers-the unsung heroes in our communities-without whom the care of people with dementia would surely suffer.
We are still not clear about where all the funding will come from. In their briefing for this debate, Age Concern and Help the Aged state that the Government's Green Paper is
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