[John Bercow in the Chair] — National Dementia Strategy

Part of the debate – in Westminster Hall at 10:36 am on 1st April 2009.

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Photo of Anne Milton Anne Milton Shadow Minister (Health) 10:36 am, 1st April 2009

I congratulate my hon. Friend Jeremy Wright on not only securing this important debate but the fantastic work that he has done with the all-party parliamentary group. Many of us come here to make a difference, and there is no doubt that he will have made a difference for dementia sufferers and their families, friends and carers.

I share my hon. Friend's disappointment that the Government have not allowed time for such an important and significant issue. None the less, I, too, welcome the strategy. I want to pay tribute to high-profile people such as Terry Pratchett, who have a much greater impact, possibly than they ever imagined, on highlighting some of the issues related to dementia. I also pay tribute to all the families and carers around the country who save the Government, as I am sure the Minister is aware, literally millions of pounds in delivering care to people with dementia. They are unsung heroes. As has already been pointed out, they are often older themselves and have to care for sufferers in very difficult circumstances, often without support.

David Taylor made a very moving speech about care and caring. I pay tribute to my own branch of the Alzheimer's Society in Guildford and all the other voluntary bodies which give support, care and money. There are more than 100 different forms of dementia, with Alzheimer's being the most common, accounting for just over a half of all cases. A significant minority of people suffer from vascular dementia.

One person every three minutes is diagnosed with dementia. It is a life-shortening illness with an unpredictable life expectancy. The disease can progress for up to 10 years, with an average of around six years, which places a burden on families who often have no idea of the course that the disease will take. Although one in three people over 65 will die with dementia, the UK is in the bottom third of Europe for dementia care. A third will need institutional care; yet if we consider it the other way around, two-thirds of people in care homes have, or will have, some form of dementia. Mr. Truswell raised the issue of younger people with dementia. Although we tend to concentrate on the over-65s, it is important to note that 18,000 people under the age of 65 have dementia in the UK.

My hon. Friend mentioned anti-psychotic drugs. As the Minister is aware, that issue has been rumbling on for some time. The all-party parliamentary group produced an important report on the matter and highlighted some of the issues. Research shows that such drugs double the risk of mortality and treble the risk of stroke. It is disappointing that the Government have dropped their investigation into the use of antipsychotics, which it promised to publish alongside the national dementia strategy. I would be grateful if he clarified the situation and tell us exactly when it will be published. Spring is here—we are in British summer time—and my daffodils are out, so if he says "spring" again, I shall get very angry. What does he mean by "spring"? Are we actually talking about summer?

Up to 400 care homes for the elderly and mentally infirm have closed in the past four years, as was mentioned. There is therefore a concern not only about the provision of places for those who need them, but for the provision of places in locations where people can be visited by family and friends. The hon. Member for North-West Leicestershire mentioned the crucial issue of carers. Carers themselves need care and, often, temporary respite care can be a vital lifeline to ensure that they can continue to care.

We have not talked much about drugs, in particular for the early stages of dementia. I pay tribute to the many people who have campaigned on the issue. My party and I believe that it is only right that the National Institute for Health and Clinical Excellence reflects wider societal costs when it makes judgments about new drugs. Again, that could transform outcomes for people in those early stages.

The swan-song of the Healthcare Commission was a report into older people and mental health. Although it welcomed much of the practice in the country, the report showed that older people were often unable to access the full range of services, including out-of-hours and crisis services and psychological therapies. Those crisis services can be crucial, especially given that those caring for dementia sufferers are often older people.

The report showed that older people are often prevented from accessing care because of stretched services or a lack of age-appropriate care and talked about the fact that the number of over-65s is set to increase by 15 per cent. by 2019 and that the number of people with dementia is set to rise by more than 1 million by 2025, as has been said. It also highlighted the importance of making services for those groups accessible and robust enough to cope with those statistics.

The report is lengthy, but it highlights other important issues. It says that the integration of health and social care is very patchy. In no other area is it more important for those to be integrated, yet we still see people working in silos and being protective of their budgets, unwilling to pool them and their resources. The report states:

"Where health and social care services were integrated at both team level and management level, it was more likely that services offered a higher standard of care and a greater range of services...Carers in less integrated services said they could often spend a large amount of time and energy trying to find out who they needed to go to for what problem."

We hear that common theme all the time from carers.

Carers were also concerned about the closure of some services. It is slightly odd and ironic that we have the strategy, but still hear reports about the closure of services and support care for people who are at home. Some trusts did not provide day services. In my own patch, in Cranleigh, the day hospital has closed. It was an important lifeline for family and friends. The report states:

"Carers said some staff in general wards at acute hospitals were not being trained or were not equipped to deal with patients with mental health problems, especially dementia", and training has been mentioned in the debate.

I should like to pick up on a few of the other issues raised by my hon. Friend. He said that diagnosis is crucial and that the remainder of the strategy is utterly useless unless a diagnosis is made. Greg Mulholland said that something like only 40 per cent. of people with dementia have been diagnosed, so 60 per cent. of people with the condition are without a diagnosis.

As someone who has worked in the health service, I find it appalling that training needs are so great. A recent report and investigation into the care of people with learning disabilities said that staff needed training to make them more fully aware. Not only do I find it extraordinary that there is such a big gap in people's knowledge, but I am surprised that general practitioners cannot recognise or do not look for dementia when it is clearly such a common problem. We need to ensure that staff at all levels, not only GPs, access the right training and that they are aware of looking out for those sorts of problems.

My hon. Friend Mrs. Lait talked about services in Bromley and single-handed practices. Much of what she said was connected to training needs and ensuring that care can be delivered in the right settings. Tim Farron talked specifically about care for people with mental health problems.

The Department of Health website states:

"The National Dementia Strategy is backed by £150 million over the first two years. It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive."

Of course, like everybody else, I hope that those aspirations will be fulfilled. However, not only does the quality of care need to be improved, but the quantity needs to be increased, not only for those with dementia, but for their carers and families. We need early diagnosis and intervention, and appropriate treatment, care and support for families and carers. I could apply all those things to a range of other mental health issues. However, we need some detail from the Government, which I hope the Minister will provide.

Bob Spink was the first to mention research. He said that £11 is spent on research for every Alzheimer's patient, and £289 on research for every cancer patient. It is a difficult situation: one does not want cancer research to have less money, but we need reassurance that the Minister is aware of what I call disease and illness-related discrimination in the allocation of services and resources. Alzheimer's and related diseases have a difficult time levering in money. Will the Minister reassure us that there will be an even-handed and non-discriminatory approach to dementia research and care, and clarify the research money situation? I would not like him to miss the opportunity to make an announcement, should he wish to do so.

Will the Minister also clarify where the £150 million will come from and whether that is new and additional money for primary care trusts? Does he intend to monitor PCTs so that the Government's headlines on the strategy are assessed by future performance? The Government are right to be proud of their strategy, and they have had quite a lot of good press coverage for it, but I do not want to ask a parliamentary question in a few months' time only for them to reply that the information that I want is not held centrally. They need to publish performance statistics and say what PCTs are doing.

Does the Minister anticipate any money to spend on specialist dementia nurses? They often play a very significant and, if I may say, cost-effective role in care. Do the Government have any plans for additional money? Is he going to increase the number of specialist nurses?