Care Services (Older People)

– in the House of Commons at 9:49 pm on 7th June 2011.

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Motion made, and Question proposed, That this House do now adjourn.—(Jeremy Wright.)

Photo of Stephen Lloyd Stephen Lloyd Liberal Democrat, Eastbourne

Thank you, Mr Speaker.

As an officer in the all-party parliamentary group for ageing and older people and an active member of the all-party parliamentary group on dementia, and as the Member of Parliament representing Eastbourne and Willingdon, an area that contains nearly 25,000 people over the age of 65, I called for this debate because the current system of care for older people is in crisis. The recent awful and shocking exposé by the “Panorama” programme is a desperate indictment of the worst in care provision, but it would be a naive mistake to believe that there are no other examples of bad practice out there. The growing age profile means that any Government will face difficult challenges for many years to come, and despite the growing demand, care provision has faced years of austerity with almost no net spending increase.

There are currently 291,000 people in residential and nursing homes in the United Kingdom, along with 6 million carers who allow people to live in their own homes. That means that an extremely large proportion of the United Kingdom’s population is directly affected by care service provision. Those who work in social care, or who care for someone on a voluntary basis, are the backbone of our society. They are the unsung heroes whose voices often go unheard, not least because they are simply too preoccupied with the enormousness of the task in hand.

A number of my colleagues who are present this evening will probably focus on several areas of care that affect older people, but I will focus mainly on dementia and on care service provision for dementia sufferers. I look forward to hearing the Minister’s response.

Photo of Penny Mordaunt Penny Mordaunt Conservative, Portsmouth North

I congratulate my hon. Friend on securing the debate. He mentions the increased demand resulting from an older population, but does he agree that we are starting from a very low base? In Portsmouth there are 1,000 people with dementia who have no access to services. It is necessary not just to improve the quality of services that people are already receiving, but to give people access to services in the first place.

Photo of Stephen Lloyd Stephen Lloyd Liberal Democrat, Eastbourne

I agree. My hon. Friend’s important intervention is relevant to one of the key issues with which I shall deal in my speech. Not only have the dementia figures risen hugely over the past few years—and they will clearly continue to rise—but there are still many tens of thousands of people with dementia throughout the UK for whom there is no provision whatsoever.

Let me put some of the figures into perspective. There are currently 750,000 people with dementia in the UK, and the number is set to rise to over 1 million in the next 15 years. One in three people in the UK over the age of 65 will die with dementia. People with dementia are significant users of both health and social care services. For example, people over 65 with dementia are currently using up to one quarter of hospital beds at any one time. That is an enormous problem.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

I congratulate the hon. Gentleman on securing this important debate. We have served together for some time now on the all-party group on dementia, and we have spoken on many occasions about the impact of dementia patients on primary health care. Does he agree that one way of addressing the problems of dementia patients receiving care in hospitals is by making sure that the professionals on the wards have mandatory training?

Photo of Stephen Lloyd Stephen Lloyd Liberal Democrat, Eastbourne

That is an important point. My partner is a community matron, and a wee while ago I made a rather foolish comment by asking why, with all the skills she and her colleagues have, they do not cover dementia as well. She gave me very short shrift, and emphasised, in her splendid way, “Stephen, dementia care is a very specific need. We all need more and better training on it, and also, to be honest, we need more specialist dementia nurses.” I certainly agree that it is essential that there is training for all professionals dealing with dementia.

The exponential growth of this debilitating condition is a result of the growing age profile. Today, we are dying in our 80s. That is a good thing of course, as many older people lead full and productive lives, but it also brings its own set of challenges, one of which is that one in six people over the age of 80 suffer from dementia.

I am grateful that the coalition Government have stated their commitment to the national dementia strategy. I have had meetings on this issue with the Minister, so I am also grateful that he is present this evening. I also congratulate the Government on revising the implementation plan. Under this revised plan, dementia will be a major priority for the coalition, which I welcome, but I also look forward to hearing some of the specific detail.

I remain very concerned about provision on the ground. In my constituency of Eastbourne, we are desperately short of specialised dementia day-respite provision, and even more so of overnight and longer term respite. The funding to my local county council has not kept up with demand. That has been the case over the last 10 to 15 years, so it is not a recent phenomenon, but as a result of funding restrictions East Sussex county council has had to close a couple of respite care centres over the past few years, and I know that there are similar situations across the country. To put it bluntly, we in Eastbourne need at least three to four times more specialist dementia respite care provision, and I suspect that, broadly, there is a similar shortage across England and Wales.

This is not a new problem, and I am glad the coalition is recognising it by pledging an additional £2 billion. It is very significant that that extra money is being made available, especially in the current difficult times, so I am grateful for that, but I also want the detail, because I still have concerns about the pledges at the top not filtering down to the grass roots. Early diagnosis and intervention are essential to ensure taxpayers get the best value out of the substantial amounts the Government are spending on health and social care, and that will guarantee the best quality of life for dementia sufferers. This step will also reduce crisis admissions to hospital and release significant cost savings.

My hon. Friend Tracey Crouch and I are members of the all-party group on dementia, and the Alzheimer’s Society has been tremendously helpful in providing support to our group. Recent evidence collated by the Alzheimer’s Society shows that only 40% of people with dementia have been given a formal diagnosis, and the figure varies considerably across the UK. Where people do receive a diagnosis, it often comes late on in their condition, limiting the choices that people with dementia and their carers can make.

In addition to being given a diagnosis of dementia, people with the illness need to be able to access support and care early on in their condition, as my hon. Friend Penny Mordaunt was saying. Services for people with dementia are skewed towards those in crisis situations, and people in the acute and long-term care sectors. As I have indicated, there is a lack of provision of support and care for the people with dementia who live in their own homes.

Despite the projection that more than 1 million people will have dementia by 2025, dementia research is severely underfunded in comparison with research into other major diseases such as heart disease or cancer. For example, the Government spend eight times less on dementia research than they do on cancer research. Not in a million years would I want to reduce the amount of money spent on cancer research but, as we all know from our constituencies, dementia is a time bomb ready to explode. I know that the Government are investing more on research but I want to hear some of the detail. Clearly more money must be spent on research into this condition, as developing new treatments has the potential to reduce significantly the number of people with dementia. For example, delaying the onset of dementia by five years would halve the number of deaths from the condition, thus saving 30,000 lives a year. I therefore welcome the coalition’s commitment—this was also a pledge in the Liberal Democrat manifesto—to prioritise dementia research within the health research and development budget, and I look forward to reading the Department’s plan to improve the volume, quality and impact of dementia research.

The Dilnot commission, which is due to report next month, provides an opportunity to resolve the historic and unsolved question of whether, as a society, we are able and willing to support people to live well in later life. The Dilnot commission must propose a road map for the delivery of a long-term settlement on the question of who pays for care and one that delivers significant improvements in access and quality. The funding envelope for social care must be increased to meet the needs of our ageing population, including the increasing number of people with dementia.

So what would I like to see happen? First, I wish to see a long-term settlement for social care that offers good quality care for people with dementia at a fair price, along with a set of guarantees about what people can expect to receive. As a starting point, I challenge the Minister by saying that the state should provide a minimum level of care and support for free. Guarantees about the care to be provided should include access to early intervention services, regular short breaks for carers and a guarantee that the care will be of high quality. One of the things to come out of recent research is that the earlier dementia is identified, and the earlier interventions are made and people with dementia are supported in a respite care background, the more the worse rate of dementia appears to be delayed—already we know that it is delayed by a good two or three years. So this is one of those things that really would save money in the long term.

If we are to revisit the Health and Social Care Bill, as I believe we may well do very soon, I would also like to see something else that is important. I know that the Minister feels passionately about this, so I am glad to be pushing at an open door. I am talking about better joined-up working between health and social care. However many years ago it took place and for whatever reason, it was a catastrophe that we split social care from the NHS. That has been appalling because social care budgets have been trimmed repeatedly over the years. In Eastbourne, as in every constituency, the social care sector deals with the respite care provision and the money has been cut every year, whereas the NHS, where money has not been cut—a lot of investment has gone into the NHS in the past 15 to 17 years—is dealing with people with dementia right at the crisis stage. It is an incredibly inefficient way of dealing with a desperate illness and it does not make financial sense. Better joined-up working between health and social care is essential for people with dementia.

I believe that integration of care pathways across health and social care services should also be considered a duty, similar to effectiveness, safety and quality, and should be applicable to all health bodies from the Secretary of State downwards. I recognise the important role that health and wellbeing boards could play in encouraging greater integration between health and social care and I strongly endorse their inclusion in the Bill. Health and wellbeing boards can also provide a strategic oversight for the development of local health and social care services and the proposed boards in the Bill must have a strong focus on dementia.

Finally, we come to multi-disciplinary commissioning. Let me use my partner as an example again: she is a community matron and her job is to go out into the community and to help people, mostly older people, to retain their independence by living at home. A lot of her work involves liaising with social services, the primary care trusts and the acute trust and doing all the multi-disciplinary co-ordination that is so necessary. We need to bring it into commissioning. I am concerned that most GPs might not necessarily know enough about dementia to commission effective services, so it would be beneficial in my view if a range of health and social care professionals could also be involved. I am not against GP consortia in principle, but I merely want more professionals from the different areas of health and social care to be involved in the commissioning process, such as nurses, occupational therapists and old age psychiatrists.

I suspect that we have all been touched personally by the impact of dementia on someone we love. In my family, two of my aunts had dementia and one still lives with it every day. It is a desperate illness that affects hundreds of thousands of people and it has an impact on millions. My aunt is an example: she is a lady who rode a scooter from Nairobi to Johannesburg and climbed Mount Kilimanjaro in the ’50s. She is an amazing, great woman who was a teacher for 50 years in east Africa. The dementia she has now is desperately sad—thankfully not so much for her, but for all the family around her. It is a desperate illness that affects many people and it is not going away any time soon. As a nation, we need to move up a gear. We need to get better at providing care for dementia sufferers and their families and we need to do it now.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health 10:17 pm, 7th June 2011

Let me start by congratulating my hon. Friend Stephen Lloydon securing the debate and setting out the issues so clearly, as well as for his work as an officer of the all-party group on dementia. I suspect that many of his colleagues in the Chamber listening to the debate have been inspired to be here by their association with that group.

Social care is seldom in the news for good reasons and my hon. Friend was right to begin by referring to some of the most recent scandals that the House discussed earlier today, not least the terrible abuse at Winterbourne View. As I said earlier, the events that took place in that hospital were appalling and, as I explained, I am determined to do everything I can to ensure that the lessons are learned, understood and acted on swiftly.

My hon. Friend has painted a fairly bleak picture of social care, and although I am not quite so gloomy I am not complacent about what needs to be done. The system of social care that the Government inherited last year was and still is fragile. The legal framework that governs social care was written for a bygone era and is now so complex and byzantine as to leave people confused and frustrated. The way that we pay for long-term care is a classic wicked issue of politics—one that is occasionally taken out of the “Too difficult to deal with” drawer, only to be looked at and shoved firmly back in again—because most people in this country are blissfully unaware of how social care is paid for. They are blissfully unaware of the fact that it is not free, that it never has been free and that many people face the potential of catastrophic costs when they come into the social care system.

My hon. Friend has rehearsed his views about what future funding arrangements might look like. I am clear that there is no perfect solution—no solution that can possibly please and satisfy everyone—but we need to strive to reach a settlement that requires trade-offs but also secures the necessary change and sustainability of a system for the future. That is why the Government have been quick to put in place the building blocks of a reform system—quickly establishing the Dilnot commission to recommend reform of how we pay for care and support, and securing the current system by committing an extra £2 billion for social care by 2014.

My hon. Friend talked about the importance of integration. I can tell him that the unprecedented transfer of NHS resources to social care, which this year amounts to £650 million, is indeed fostering new relationships between local government and the NHS to allow the greater integration and closer working that are essential to enable us to deliver better services for the public whom we are here to serve. He also talked about the schism between health and social care. It is worth noting that that schism was set into the very foundations of the NHS under the National Health Service Act 1946 and then the National Assistance Act 1948, so we have to look back a long way to see when that split occurred.

The main focus of my hon. Friend’s remarks has been the challenge of dementia. Each year, about 65,000 people are diagnosed with dementia, which touches the lives of many families, as he has demonstrated by relating his experience with his two aunts. The number of dementia cases is set to rise by 38% over the next 15 years. That rise reflects the fact that many more of us are living for longer, but we should not cast that in the language of consternation. We should see it as a cause for celebration that so many more people are living for so much longer; the key is making sure that in those extra years we have quality of life as well. That is why we need the NHS, as well as social care and society, to rise to the challenge.

Let me offer some hope to my hon. Friend. We can do much better for people with dementia and their carers. In coming to office, I took the view that we should stick with the existing national dementia strategy and deliver it in full, because at our heart the coalition Government are committed to the notion of greater personalisation so that people have real control over the services that affect their lives and so that carers have a much bigger stake in the system. As he has said, commissioning is key to delivering that vision and the objectives in the strategy. Good commissioning can make a huge difference.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

The Minister mentions carers, who have a very difficult job—none more so than those who care for people with dementia. Next week is carers week. Will he join me in congratulating those who care for people with dementia, which is particularly challenging? Those people are often the unsung heroes of our society.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I am very grateful to my hon. Friend for making that very important point. The 6 million or more carers in this country are undoubtedly the backbone of our care system and save us a large sum of money—over £100 billion according to the most recent estimate by Carers UK. I will go beyond thanking them and make the point that the Government have committed £400 million extra to supporting the extension of respite support for carers. We are determined to make sure that that money gets through to those who need it.

My hon. Friend the Member for Eastbourne’s remarks about commissioning and the need for it to be multidisciplinary, involving social care and other expertise, is undoubtedly right. Indeed, my Department is in the process of developing a pack to support health and social care commissioners, particularly in relation to dementia commissioning. It will offer guidance on key aspects of dementia care and the need for early diagnosis and intervention. My hon. Friend was right to refer to the under-diagnosis and late diagnosis of dementia and how that can reduce life chances and the opportunity to plan for the progression of the disease. There will also be guidance on offering better support for people at home and in care homes and on providing better care in hospitals, which means addressing issues of training that have been mentioned.

Photo of Chris White Chris White Conservative, Warwick and Leamington

Does the Minister agree that excellent examples of charities and social enterprises such as Castel Froma in my constituency that put social goals before short-term profit provide some of the best models for the future of care homes? Should the Government not do all that they can to encourage the provision of services by those organisations to the sector?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I am grateful for that point. Part of the Government’s growth strategy is about recognising the value that micro-enterprises and social enterprises can offer in delivering good-quality social care.

We are producing supporting guidance for commissioners on the reduction in the use of anti-psychotic medication, which is often overlooked by commissioners. Having spent a decade campaigning for an end to the inappropriate and over-prescribing of anti-psychotics, I was delighted when the previous Government finally commissioned an independent review that clearly revealed the cost of the use of those drugs—lives shortened, lives dimmed, and 1,800 deaths a year, which is truly shocking. That is why as a Minister I am determined to hold the system to account to deliver a two-thirds reduction in the prescribing of those drugs by November this year. That ambitious target was set in 2009, and it requires action by a number of agencies and the provision of the alternatives that my hon. Friend the Member for Eastbourne discussed.

To make that change, the Government need active support from the front line, the third sector and professional bodies, and we have worked closely with Dementia Action Alliance and many other organisations to support a national call for action to reduce the use of anti-psychotics, which will be launched later this week. My hon. Friend discussed the variation in services across the country, and it is worth saying that the NHS spends £8.2 billion a year on dementia. I do not think there is compelling evidence that it is all well used, which is why we are auditing service provision around the country to gauge progress, for example in the development of memory services. Taken with clear requirements on primary care trusts to publish their dementia plans and work with their social care partners, there will be more transparency than ever before, so commissioners will be held to account for delivery in that area.

My hon. Friend touched on a number of issues relating to NHS reforms, and discussed the need to improve research. I have the privilege of chairing the ministerial advisory group on dementia research, and one of the key issues in delivering more investment in dementia research is securing more quality bids for research funds in the first place. I am delighted that more than 121 new bids have recently been made and are being evaluated, making it very likely that I will be in a position later this year to announce good news about our moving towards significantly increased investment in dementia research. The key is not just throwing money at the problem but making sure that the talents in scientific skills in this country are brought to bear on it, and that expertise is brought into this area to make sure that we solve the problems effectively.

My hon. Friend made some important points about NHS reforms. Having just concluded the listening exercise, we are waiting for Steve Field and the NHS Future Forum to publish their conclusions next week. My hon. Friend discussed the role that health and wellbeing boards can play in integrating services. That is something that was part of the original legislation and which, I am pretty certain, will remain in the legislation. It is an essential building block in delivering more integration of health and social care.

In conclusion, health and social care reform is long overdue. My hon. Friend made a powerful case for acting swiftly on that reform. The Government have acted in a determined fashion to put in place the building blocks to enable that reform to take place. We have secured the funds to sustain the system while we put those reforms in place, and we are committed to delivering on dementia. I have no doubt that if we deliver good-quality dementia care services and model our services around the needs of dementia sufferers and their families, care and compassion will be built into the system, which will address many of the concerns that have rightly been rehearsed in the House over recent months. It will also enable us to get the very best out of the £8.2 billion that is already spent on dementia services, and ensure that the extra resources that this Government are putting into the NHS over the next few years get to the front line and deliver the improvements that all Members want to see.

I am grateful to my hon. Friend the Member for Eastbourne for raising the subject this evening, and I look forward to continuing to work with him through his all-party group to make sure that we keep these issues firmly in the spotlight, driving forward the improvements that all our constituents expect.

Question put and agreed to.

House adjourned.