Dementia

Tracey Crouch Excerpts

Thursday 10th January 2013 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

It is an honour and a pleasure to follow what ended as a very moving speech by the right hon. Member for Salford and Eccles (Hazel Blears). She is a fantastic fellow vice-chairman of the all-party group, and a real champion on this issue. I would also like to take the opportunity to pay tribute to the right hon. Member for Sutton and Cheam (Paul Burstow), who I thought progressed this issue as a Minister much further and much quicker than did previous Ministers.

I start my comments this afternoon with an explanation of what sparked my interest in this incredibly important issue. As a parliamentary candidate, two events collided and aroused an immense passion about dementia that will stay with me for ever. I cannot quite recall the precise sequence of events, but one was personal and one was professional.

The first was my father calling me to tell me that his mother, Nana Crouch, had been diagnosed with dementia. My beloved grandfather passed away when I was a teenager. Following her diagnosis with this awful condition, nana regressed quickly and was transferred into residential care for her own safety. I went to see her, but she was so confused about who I was that she became quite frightened and I left concerned for her own mental well-being. It was very upsetting to see a lady I respected and loved hide in a corner cowering with fear.

The second event involved me knocking on the door of a man called Maurice. He and I remain friends today, despite our political differences. At the time, Maurice’s wife was still alive but was in a care home suffering from dementia. Maurice is a great man, one with a military background and one who had his whole world of traditional male-female relationships turned upside down when he suddenly had to care for his wife. The challenges that Maurice faced are ones that many carers are exposed to, but his real concern—one I now share—was the poor care his wife received while she was in hospital for a minor injury, where her health care needs were exacerbated by her dementia.

This issue of inadequate hospital care for dementia sufferers is a substantial one. While there is much evidence of good practice, there is an unacceptable variation in the quality of care. Maurice has become a pain in the proverbial, albeit in a good way, to local health care organisations. He champions the need for better care for dementia sufferers in hospitals—and rightly so. Of the carers responding to the Alzheimer’s Society’s “Counting the Cost” report, 77% stated that they were dissatisfied with the overall quality of care provided to people with dementia in hospitals. The key reasons included nurses not recognising or understanding dementia, lack of person-centred care, patients not being helped to eat or drink and patients being shown a lack of dignity and respect.

The issue has been highlighted many times, most recently in a report from the Royal College of Nursing. Staff training, for which nurses themselves are calling, would constitute a vital step towards the addressing of those inadequacies. However, we must also achieve the correct balance between health care assistants and nursing staff, which is vital to the provision of personalised care in hospitals. All too frequently the problem is not the number of staff, but the fact that the ratio of health care assistants to nurses is too large, and nurses are therefore unable to support staff sufficiently.

Unnecessary admissions and prolonged stays in hospital are expensive, and much too often they have negative effects on health and well-being. The all-party group looked into that and the cost to the NHS. I personally favour the notion of the halfway house: a service that could provide a primary care facility for those requiring medical attention for, say, a broken bone or a superficial wound, but in a less hospitalised environment. Not only might that be more cost-effective for the NHS, but it could address the issue of institutionalisation. One in four people in hospital beds have dementia, and, on average, people with dementia stay in hospital a week longer than those without dementia who are being treated for the same injury.

People with dementia often become extremely distressed by ordinary events, such as meal times, and need extra help. If food is just left in front of them, they will not necessarily eat it even if they are hungry. It might be helpful for carers or family members to be present when they are served their food, but most hospitals do not currently allow visitors at meal times. I am keen to hear from the Minister what measures are being introduced to make hospitals more dementia-friendly, and, in particular, what action is being taken to increase dementia awareness and understanding among hospital staff.

I am delighted that the Prime Minister is personally taking an interest in the issue after launching the dementia challenge. One of the more creative aspects of the challenge relates to the importance of dementia-friendly communities. I have observed three local initiatives that, although they have only just begun, have the potential to evolve into wonderful examples of how to meet that challenge. The first was the Alzheimer’s Society roadshow that took place recently at a local Tesco store. More than 55 people visited the vehicle in two days to obtain help, support and advice, 17 of them engaging in one-to-one sessions. Six new people accessed local dementia cafés as a direct result of the roadshow. I must say that I am a huge fan of dementia cafés: I think that they are bringing real value to our local communities.

The second initiative is run by Asda Chatham, which rather movingly granted Christmas wishes to those in a local dementia care home. I was there to help, and talked to the manager during the event. He is keen to ensure that his staff have a better awareness and understanding of dementia, so that they can understand and help when someone is standing at the till feeling confused by something as simple as the coinage in their purse—coins that they do not recognise as the coins from their childhood. We have seen instances in which people stand and stare at oranges, for instance, for a significantly long time, and someone comes along and helps them to understand, making them feel less confused and more relaxed about the environment that they have suddenly realised they are in. I think that our local supermarkets have a key role to play in that regard.

The third example is the fabulous work of Kent fire and rescue service in preventing vulnerable people from harming themselves while living at home. It is a trusted service, and it is doing its bit to help. We heard on the radio recently that in Kent—although not in my constituency—a man with dementia had rather sadly put his pyjamas in the microwave, and had almost set his house on fire. Members of the fire and rescue service arrived and sprayed a retardant over most of the house to ensure that he and his wife could live there safely without the risk of fire.

As the right hon. Member for Sutton and Cheam pointed out, dementia is not just a problem for the Department of Health and local authorities, but an issue for the whole community. Every individual, organisation and department needs to play a part in changing society and its attitudes to a disease from which more than a million members of the population will be suffering by 2021. We need better collaboration and integration across different sectors, and we need to establish how limited resources can be used more efficiently and effectively.

People can and should be able to live well with dementia. We want people to live in their own homes for longer, not only because that is better for them but because it is financially prudent. Early intervention via better, quicker diagnosis is essential. Medication and memory clinics mean that we can now live well with dementia for longer if it is identified early, but at present only 40% of people with dementia receive a formal diagnosis, and that is not good enough.

I recently undertook an anonymous survey of GPs in my constituency. The problem highlighted most frequently was limited time with the patient. A standard 10-minute appointment is not necessarily sufficient in view of the complexity of the disease. When I asked what authorities could do to improve diagnosis rates, one key theme emerged: the need for quicker access to specialised staff, whether that would mean nurses in the community or shorter memory-clinic waiting times. There is such a difference between the worst case of a nine-month waiting time for memory-clinic services and a waiting time of 24 hours, which is best practice. If a day’s wait is possible somewhere, it should be possible everywhere.

Another vital aspect of ensuring that people live well in their own communities is support for carers. We must do all that we can to give those whose world has been turned upside down the time, advice and respite they need. My constituent, Ron, had quite a good experience of the support that was available, and when his late wife was diagnosed with dementia, organisations and services contacted him very soon afterwards. He was provided with a range of support, aimed at the needs of a carer, by Crossroads Care, Admiral Nurses and the Maidstone & Malling Carers Project, but that does not always happen. Other constituents who have contacted me have been completely lost and alone, dealing with the volatile and confused behaviour of their loved ones with little or no support.

It is imperative that we ensure that, following diagnosis, all carers receive a list of services and support in their area. That does not naturally happen at present, but it is important for the person suffering from dementia and for the carers. Ron told me about a book that one of the charities had given him providing a comprehensive list of common difficulties that arise for a person caring for someone with dementia, along with simple and straightforward ways to overcome them. He told me that it was a lifeline and a bible. Will the Minister ensure that a copy is available on the new “Our Health” website as it is rolled out across the country between now and March? It is an essential tool for carers.

Ron’s carers were wonderful, but when his wife passed away shortly before Christmas, all his support was discontinued from the moment of her death. Now the only support he has comes from his neighbours, who help him with his shopping, and it has taken him six weeks to secure an appointment with a befriending service. We have come so far, achieving great improvements in carers’ rights and dementia awareness, but we have such a long way to go. The fact that the person being cared for has died does not mean that the carer has as well. Indeed, that may be the time when help is most important to a carer.

Finally, I want to say something about funding. We must, absolutely must, find the correct way of funding health and social care budgets. My constituent Frank went into a care home with social care needs, and, as a self-funder, was initially charged £650 a week. After he arrived, he was diagnosed with dementia, a defined health condition, and his weekly charge has now increased to £1,200 a week owing to additional care costs. However, a state-funded person is charged only £550 a week, and there is no explanation for that. I am helping Frank’s family to explore the issue, but the fact remains that his lifetime savings and assets will be depleted in no time as they pay for his care.

We must get on with implementing the Dilnot recommendations, particularly the cap on care costs, and we must remember that the cap does not include accommodation costs. In my view, the £75,000 that was rumoured in last week’s papers is far too high, as it will make little difference to most people. I know that budgets are tight, and that the £35,000 recommended by Dilnot would cost the taxpayer £1.7 billion, but we need to consider our priorities. I am a defender of our international aid efforts, but we must consider whether it was right to spend nearly £1 billion over the past five years in India, a country with its own space programme and nuclear arsenal.

The Department for International Development needs to spend an extra £3 billion in the next two years if it is to fulfil the Government pledge of 0.7% of GDP. In cash terms, that is an increase from £7.8 billion in 2010-11 to £11 billion in 2014-15. Governments are judged on their morality, and perhaps it is now time that we recalibrated our priorities and considered spending the extra billions of pounds earmarked for aid projects abroad on funding quality care for the elderly at home.

Benjamin Franklin famously, but rather gloomily, noted:

“In this world nothing can be said to be certain, except death and taxes.”

As we begin another year in the 21st century and teetering on the cusp of having a significantly ageing population, we could probably add a third item to his short list: sadly, we are likely to know someone who is suffering or has suffered from some form of dementia.

This is an important debate, and I am very pleased that the Backbench Business Committee gave time for it. Ultimately we, as elected politicians with the power to change how we deal with those with dementia, owe it to Maurice, Ron, Frank, Nana Crouch and every constituent who suffers from, or cares for, or is a friend or family member of, someone with this awful condition, that actions really do follow the words.

Polycystic Kidneys

Tracey Crouch Excerpts

Tuesday 6th November 2012 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

I would like to begin by declaring an interest. I am a joint chair of the all-party parliamentary kidney group. Earlier this year, the group heard a moving presentation from representatives of the Polycystic Kidney Disease charity, led by Tess Harris, its chief executive. I would also like to mention my constituent Judith French, who suffers from polycystic kidney disease. It is the testimony I have heard from those two ladies that brings me to the Chamber today.

We have known about polycystic kidney disease since the 1500s, but in spite of such a long history, significant breakthroughs in research have been achieved only in the past 20 years. King Bathory is regarded as one of Poland’s most successful monarchs. During his short 10-year reign, he reformed the army and judicial system, and notably saw off Ivan the Terrible in 1581. Sadly, he died early because he suffered from polycystic kidney disease. His diagnosis was confirmed only 400 years after his death, when academics analysed his case.

Since King Bathory’s reign, our ability to treat and cure a wide range of complex conditions has developed beyond what many would have thought was possible. Sadly, that progress has not been felt by those diagnosed with polycystic kidney disease, known as PKD. That is all the more surprising because it is not a rare condition. The cause is a mutation in one gene that leads it to function abnormally. The disease is characterised by the progressive enlargement of cysts in both kidneys. There are two types of PKD: autosomal dominant PKD, which affects 85% of patients, and autosomal recessive PKD. The second type is rare, affecting 1 in 20,000 live births. Tragically, newborn babies with that condition have a high mortality rate in the first month of life. Those who survive are likely to have a much reduced life expectancy. I shall focus my remarks on ADPKD.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate the hon. Lady on securing this Adjournment debate. Does she agree that although the condition might not be rare, it is relatively unknown, and as a consequence of the lack of awareness, unfortunately mistakes can be made, for example in the assessment of the ability of people with PKD to work? I have had recent experience of such a case involving a constituent of mine.

[Mrs Moon]

The hon. Lady is absolutely correct. This is a little-known condition, and the horrific nature and impediments caused by the condition as it progresses are little known and little appreciated. Often, people can look quite normal but be suffering tremendously. I commend her work in trying to raise awareness.

For individuals with ADPKD, it is a truly disabling, painful and limiting condition. Kidneys become enlarged, leaving patients disfigured and appearing prematurely pregnant. The kidneys continue to function normally, but eating, sleeping and even breathing can be difficult because of the size of the kidney and the pain experienced. The liver can be affected, too, and many patients are often diagnosed with PKD and liver disease. Besides the effects on the kidneys and the liver, there is a range of other complications: heart disease, bowel problems, hernias, infections and a high risk of intracranial aneurysms.

The kidneys can weigh up to 17 lb—upwards of 10% of a person’s body weight—and in one case a patient was recorded as having kidneys weighing 48 lb. An affected liver can grow more quickly than the kidneys, effectively squashing them. PKD affects people of working age and is characterised by premature mortality. Tragically, end-stage kidney failure is common at an average age of 55—within working age, as the hon. Member for Chatham and Aylesford (Tracey Crouch) mentioned.

PKD affects an estimated 12.5 million people around the world and is the fourth most common cause of kidney failure. It is more common than sickle-cell anaemia, cystic fibrosis, autonomic dystrophy and Down’s syndrome combined. We simply do not know how many people are affected by PKD in the UK. On the one hand is the answer to my parliamentary question in July. The Department of Health said that a total of 1,100 hospital admissions in 2010-11 were identified as resulting from PKD, although I was informed that that might include repeat visits by the same individuals. On the other hand, PKD Charity’s own figures suggest that the number is far higher. On the basis of the number of people requiring a kidney transplant and dialysis as a result of PKD, it estimates that as many as 60,000 to 70,000 people could have the condition in the UK.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate the hon. Member for Bridgend (Mrs Moon) on securing the debate; I know that this is an issue she campaigns on regularly. I pay tribute not only to her work, but to the excellent work of the Polycystic Kidney Disease Charity right across the UK in raising awareness of the condition and supporting those with it. I am of course more than willing to meet her and the charity and look forward to doing so. I think it will be a very worthwhile meeting.

I will do all I can to answer the hon. Lady’s many questions and deal with her requests, and not only in my remarks this evening, because, as she knows, I will not be able to respond to everything tonight. It might well be that a letter can deal with her questions, so I will certainly take away all she has said. I hope to give her some assurance about the work that is being done. As I know she understands, I can respond only as the Minister responsible in England, because health is a devolved matter. I am confident that she will raise these matters with the Welsh Assembly.

The Welsh Assembly Government—we have made inquiries—published in April 2007 a national service framework and policy statement, “Designed to Tackle Renal Disease in Wales”. Improving the quality of care for people with renal disease, or at least at risk from it, is the cornerstone of that policy statement and of the national service framework—the NSF.

In 2008, the Welsh Assembly Government issued a further three-year strategic framework, for 2008 to 2011, setting out the key interventions required of the NHS in Wales in implementing NSF standards. In England, we have successfully introduced a number of programmes to change outcomes for people with kidney disease. For example, we have introduced into the quality outcomes frameworks—known as QOF—the identification and management of chronic kidney disease and the inclusion of chronic kidney disease in the NHS health checks programme. Having raised awareness of chronic kidney disease in primary care, we now have 2.3 million people on primary care registers in England, but we want to do still more.

The NHS health checks programme is being rolled out across England this year and next. The programme invites everyone between the ages of 45 and 74 to a vascular health check. It is estimated that up to 20,000 cases of diabetes and kidney disease will be detected earlier every year. Such early identification is key to the better management of people with these conditions and ensuring they receive optimum treatment and improved outcomes.

On the particular issues raised about polycystic kidney disease, unfortunately, as the hon. Lady mentioned, PKD is not preventable; it is a genetic disorder. I pay tribute to how she has relied on the various experiences of her constituents and others connected with her work to explain with great compassion and care how the disease affects so many people and to set out its awful nature.

I am pleased to hear that international studies are currently under way, three of which are being hosted by the National Institute for Health Research, looking at the viability of new drug therapy and disease management to give improved quality of life for those with PKD. I very much heard the hon. Lady’s comments about clinical drug trials and the gathering of data. As she said, the £50,000 cost seems large, but it may be argued that in the overall sum of things it seems like a drop in the ocean, although of course I cannot make any promises. I am sure that somebody somewhere will take that on board and we will explore the matter more when we meet.

The hon. Lady asked for increased access to radiological and ultrasound scanning, and rightly so, and I would welcome the development of guidelines about best practice in that area. I know that a quality standard for chronic kidney disease was published last year by the National Institute for Health and Clinical Excellence. That sets out what high-quality, cost-effective care looks like so that commissioners and providers can assess standards of care and target improvement efforts where they are most needed.

The NICE quality standard clearly states that patients with a genetic family history of PKD over 20 years of age should be referred to secondary specialist care. Chronic kidney disease, or CKD, is associated with reduced quality of life. Quality of life varies depending on the disease stage, medical management and the presence of co-morbidities and complications. It is crucial, therefore, that those diagnosed with PKD have access to specialist care to help them deal with this long-term condition and to support them and their families emotionally. As we have heard, it is a genetic disorder.

[Tracey Crouch]

The Minister will have heard from my intervention that a constituent of mine suffers from polycystic kidneys. He was recently assessed under the Work programme as fit for work despite suffering from that horrific condition. The decision has been reversed, as there is now proper understanding of the condition and its impact on his ability to work. However, will the Minister work with the Department for Work and Pensions in issuing guidance so that unnecessary pressure is not put on people suffering from this debilitating disease during assessments?

[Anna Soubry]

I thank my hon. Friend for that helpful intervention; as ever, she makes a good case. I will take the issue up and explore it further. If she will be good enough to put her points in a letter, that will help me in my consultations and discussions with the Department for Work and Pensions.

We estimate that up to one in 1,000 of the population has PKD globally. Based on that estimate, more than 60,000 people in the UK are at risk of developing PKD. However, we do not currently collate centrally the numbers of people with PKD in England, a point raised by the hon. Member for Bridgend. I will ask the national clinical director for kidney disease to see what further action can be taken accurately to determine national incidence in England.

If the hon. Lady is good enough to make the same representations to the Welsh Assembly and indeed the Scottish Assembly, we will have a far better picture of the situation throughout the United Kingdom. [Interruption.] I should also include Northern Ireland, of course, as the hon. Member for Strangford (Jim Shannon) is urging me to do. Looking at the care received by people with polycystic kidney disease, most patients are seen in general renal clinics, and they may receive little or no genetic counselling or specific disease management advice, or a thorough needs assessment. I am aware that in the early stages there may be no symptoms, and sometimes the cysts may not be noticed until adulthood or through family screening. However, some children present early with symptoms that can be confused with another form of PKD called, as the hon. Lady said, autosomal recessive PKD. The common symptoms will vary by individual and may include back or abdominal pain, recurrent urinary infections or blood in the urine, kidney stones, and kidney failure.

People with polycystic kidney disease can require special consideration for dialysis and transplantation due to the nature of their disease and size of the cysts. I welcome all the comments made by the hon. Member for Strangford about transplants and donors and the urgent need to make sure that more people donate their kidneys—indeed, all their organs.

Health

Tracey Crouch Excerpts

Tuesday 17th July 2012 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

I am very fortunate never to have been in a situation where I have continuously required alcohol to blot out misery or pain. I am fortunate enough to have never been so drunk in a public place that my safety or personal dignity was compromised. In fact, I abhor drunkenness, public or otherwise. It upsets and frightens me that some people become so inebriated that they are incapable of standing, speaking or securing their safety.

Although I do go to the pub, like hundreds of thousands of professional women up and down the country, I do most of my drinking at home. I probably do not think I am doing anything wrong because, every day, women go home after work and pour themselves a large glass of wine—and then another. How can it be wrong? I do not get drunk, throw up in the street, or wake up with a hangover. Yet could that be why alcohol consumption among women is becoming a problem, albeit one that may not present itself for decades?

Alcohol consumption by women has been rising steadily since the 1960s. Since 2002 alone, the number of alcohol-related admissions accounted for by women has more than doubled, from just below 200,000 to more than 400,000 in 2010. Although I accept that there is some debate about those sets of figures, the trend is undeniably upward, not downward. Alcohol consumption by women remains at a historic high, but it is interesting to note that it is falling at a faster rate among 16 to 24-year-olds. However, a significant number of middle-aged and older women, usually on higher incomes, prefer to drink at home to dangerous levels. It is the silent majority of drinkers we should be looking to prevent from becoming risky, harmed or dependent drinkers.

[Justin Tomlinson (North Swindon) (Con)]

This is a very serious issue. Does my hon. Friend agree that the silent majority are very much the problem, because they simply do not seek help?

[Tracey Crouch]

I agree entirely. We should remember that a significant number of people in this country do not drink at all; it is those who drink to excessive levels whom we need to be concerned about.

Since the 1960s, many more women have entered the work force. Some have put off raising families and the associated responsibilities in favour of pursuing their career. As a result, they have much more money and time to spend drinking. That is statistically demonstrated by the fact that women in managerial or professional roles admit to drinking almost double the amount drunk by women on lower incomes.

Where the drinking takes place, and not just the quantity, is a cause for concern. While men still account for the majority of regular pub goers, women are more likely to drink at home, drinking cheaper supermarket wine that is aggressively marketed and probably bought in bulk.

[Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP)]

Does the hon. Lady agree that providing calorific information, as opposed to just the unit content of alcohol, on a bottle might have a significant impact on a large number of women who care a lot about the calories that they consume? If that was set out on alcohol packaging, it might help to alleviate the problems that she mentions.

[Tracey Crouch]

The hon. Gentleman makes a good point. Labelling of alcohol has improved significantly over the past few years, particularly in relation to pregnant women.

In many ways, drinking at home poses a real issue. It is difficult to assess the true extent of the problem of home drinking because the only data we have to go on are results from surveys, and many respondents are likely to under-report their consumption. However, recent studies have shown a clear link between harm and home drinking. An overwhelming 93% of recent interviewees who had all suffered alcohol-related harms bought the majority of their alcohol from off-licences and supermarkets. With alcohol now part of most people’s weekly shop, and women less likely to buy alcohol in pubs, it is no surprise that the impact of home drinking on a person’s health is likely to be more pronounced among women. Little stigma attaches to home drinking, and it is perhaps only later in life that women realise that there was any drawback to what they have been doing. Liver damage is an obvious related condition, but breast cancer and dementia are also often cited as conditions with a link to alcohol.

Given that what somebody does in their own home is a matter for them, what role is there for the Government in tackling the issue? The introduction of a minimum unit price for alcohol is a welcome development and will tackle many alcohol-related problems, but I doubt very much that it will tackle the high level of drinking among well-off and professional women. It may dissuade somebody who is doing the weekly shop from taking advantage of deep discounting, and prevent the pre-loading that goes on among some younger drinkers, but more needs to be done on education and awareness.

For professional women drinking at home who do not come into contact with the traditional services that offer alcohol-based education and interventions, the workplace could prove particularly important. Alcohol Concern is championing the need for businesses to take a responsible approach to alcohol, calling for the inclusion of an alcohol policy in the corporate governance code. In principle, workplace interventions should definitely be encouraged, and I hope that the Government will support that campaign.

Undoubtedly, home drinking is extremely difficult to quantify. The only indication we have of the scale of the harm done is the level of alcohol-related admissions. It is therefore a concern that the official measurements used to calculate alcohol-related hospital admissions could be altered in the near future to reflect only those admissions where alcohol is a primary diagnosis. That could potentially exclude the reporting of conditions for which excessive alcohol consumption were partly responsible, such as a broken leg as a result of falling at home, or even domestic violence. I urge the Government to reconsider carefully the changes to the measurements. If they do not, we may never truly understand the scale of the problem, and the idea that we could achieve the targets set out by the Prime Minister for reducing alcohol dependency could be simply farcical.

A vast number of women, especially in professional roles, are steadily drinking at home to the detriment of their health. That is an issue on which it is difficult to provide direct intervention, but not one that we should simply ignore. I hope that this Government, who are responsibly trying to tackle alcohol misuse, will recognise the problem and do whatever they can to ensure that it is not simply left to fester behind the closed doors of homes up and down the country.

Care and Support

Tracey Crouch Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

The hon. Gentleman will know that we are making resources available for HealthWatch. It also has additional powers and a remit that extends in a way that the remit of LINks never did. There is therefore a patient and care users’ voice, and a much more effective power to enter, view and report. The link of HealthWatch England to the Care Quality Commission is important. We have increased the resources of the latter. I am sure that when he sees its annual report, he will appreciate the steps it is taking to extend its inspection more reliably on an unannounced basis, including into domiciliary care provision.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I have a great deal of respect for the Secretary of State, but I agree with the chief executive of the Alzheimer’s Society, who has said:

“Every day without a funding decision is another day where people…with dementia…face huge costs for…substandard care.”

Will the Secretary of State therefore take this opportunity to assure the House that any new system of funding will end the current dementia tax, under which those with dementia are penalised as a result of their condition with some of the highest social care costs?

[Mr Lansley]

In this instance, I completely understand where the Alzheimer’s Society is coming from. We all want to achieve what Andrew Dilnot made very clear in presenting his report. Any of us or any members of our families could be subject to catastrophic care costs as a consequence of a diagnosis of dementia and several years’ need for care. We want people to be able to plan and prepare, and to protect themselves against that. From the Government’s point of view, and as I have said today, the Dilnot commission’s report is the basis for a funding model for that, but it must be paid for. As with anything else, we are not going to start promising things that we do not know we can pay for. We therefore have a job of work to do, and I am determined that we will do it as speedily as we can.

Oral Answers to Questions

Tracey Crouch Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I will gladly write to the hon. Gentleman if my recollection is wrong, but I think that something in the order of 25,000 staff have been transferred into social enterprises since the election. That represents something like £900 million-worth of NHS activity across England.

[Tracey Crouch (Chatham and Aylesford) (Con)]

Pension reform is important to those of my constituents who work in the public sector—and, indeed, to the taxpayers who do not. With that in mind, does the Secretary of State agree that the heath service unions should work constructively with the Government on public sector pension reform rather than go on strike next week, potentially putting patients’ lives at risk?

[Mr Lansley]

Yes, I am grateful to my hon. Friend. It is very important to me that NHS staff, and other public servants, are valued in their remuneration, including the pensions that they receive. That is precisely why I have myself engaged in discussion with the NHS trade unions and staff side and continue to be engaged directly in negotiations with them about that, on the basis of the conditional offer that the Chief Secretary to the Treasury announced to the House recently, which I think would be fair to NHS staff and to taxpayers. On that basis, I think it is completely irresponsible and unacceptable for some unions in the NHS—not the Royal College of Nursing or the British Medical Association—to intend to go on strike next week.

National Health Service

Tracey Crouch Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House recalls that the Prime Minister made a series of personal pledges on the NHS in the run up to the General Election which were carried over to the Coalition Agreement; believes it is now clear he has failed to honour three of the headline commitments in the Coalition Agreement; notes firstly that Treasury figures from July 2011 confirm that NHS spending fell in real terms in 2010-11, contrary to the guarantee that health spending will increase in real terms in each year of the Parliament; notes secondly recent central approval of changes to hospital services, in breach of a moratorium on such changes; notes thirdly the Prime Minister’s continuation, despite widespread opposition, with the Health and Social Care Bill, contrary to the pledge in the Coalition Agreement to stop top-down reorganisations of the NHS; believes there is mounting evidence that the combination of an unprecedented financial challenge combined with the biggest reorganisation in the history of the NHS is damaging patient care and leading to longer waiting times; is concerned that huge cuts to adult social care in England will further limit hospitals’ ability to cope with coming winter pressures; and calls on the Government to listen to GPs and NHS staff, drop the Bill and accept the offer of cross-party talks on reforming NHS commissioning.

We read today that the Government were in open retreat last night on their Health and Social Care Bill in the House of Lords. Given that, we thought it only right to bring the Secretary of State here today to be held to account by this elected House. He tried to shuffle off his responsibilities and dug in when the Bill was in this place, only to give in down there. That came just hours after he had to confirm that he would still take oral questions in this House, despite a claim to the contrary by his preferred candidate to take over the running of the NHS. The Secretary of State may be on the run, but we will not let him hide. Our NHS is too precious to too many people in this country to be carved up in dodgy coalition deals in the unelected House. His Bill is unravelling before his eyes, and coalition health policy is in chaos. Today, we hold him to account for that.

To be fair to the right hon. Gentleman, the responsibility is not all his. It goes right up to the door of No. 10 Downing street. People will remember only too well, in the run-up to the general election, the then Leader of the Opposition’s ostentatious shows of affection for the NHS, his airbrushed face on the posters and three very personal promises—real-terms increases in every year of this Parliament, no accident and emergency or maternity closures, and no top-down reorganisation of the NHS. He protested his love for the NHS, and at photo call after photo call on the wards he routinely wore his heart on his sleeve. As we now know, he was protesting a little too much, and today we expose the hollowness of his promises.

[Tracey Crouch (Chatham and Aylesford) (Con)]

May I take this opportunity to congratulate the right hon. Gentleman on his new post? He is back where he once was, but on the other side of the House.

Last year, in The Guardian, the right hon. Gentleman stated that it was

“irresponsible to increase NHS spending in real terms”.

Does he still stand by that statement?

Care (Older People)

Tracey Crouch Excerpts

Tuesday 6th September 2011 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

Thank you very much, Mr Streeter, for calling me to speak. It is a pleasure to serve under your chairmanship for, I believe, the first time, which is an honour.

I am grateful for the opportunity to hold this important Adjournment debate on care and services for older people. As part of the younger generation of MPs, I am proud to initiate a debate on a subject that I hope will be of interest not only to those who are in their third phase of life but to the next generation and to the generation after that who will one day find themselves in need of care and services. The statistics show that those of us who are in our thirties will fuel the ticking time bomb that is the ageing population, so it is incumbent on us to try to provide solutions to meet this challenge.

My initial interest in care for the elderly stemmed from my late grandmother, who worked in community care for much of her life. She strongly believed, as I do, that people want to live in their own home and community for as long as they can physically do so, and that the delivery of certain services can prevent people from entering residential care, which benefits both them and the state. It was with that in mind that I chose such a wide-ranging title for this debate. It is very easy to focus entirely on the issue of funding care, but there is more to looking after our older generation than the issue of how to pay for their care. Services for older people, whether delivered by volunteers, charities or local authorities, also need our attention if they are to be developed and improved.

I want to start, however, by expressing my very strong support for the campaign to appoint an older people’s Minister. I believe that if that post had a cross-departmental remit, as there is for equalities or for women and equalities, it would be of huge value to the Government. Some of the issues to which I will refer do not fall within the portfolio of the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), and although I have the greatest respect and admiration for what he is doing to improve social care, he is not responsible or accountable for issues such as transport policy, local authority spending or the provision of financial products and education.

Having said that, if the Government maintain their opposition to the creation of another ministerial post, perhaps they would consider two other options. First, we could establish a new Cabinet Committee on older people’s issues that would effectively scrutinise emerging policies. Secondly, we could consider introducing a new test within regulatory impact assessments that would specifically examine the effect of proposals on the over-65s, as other tests do for other defined sectors of society. We need to pay much closer attention to the impact of national Government policies on the older generation, and I believe that a Minister for older people or a new Cabinet Committee would help to do that. However, there should also be a far greater assessment of the impact of policies at local level and I would welcome the Minister’s views on that matter when he responds to the debate.

The publication of the report of the Commission on Funding of Care and Support—the Dilnot report—was welcomed as a much-needed examination of how to fund care in the future. It is an accepted fact that we are all living longer and that our care needs are greater but that funding in social care has not increased by anywhere near enough to match our requirements. Significant demographic change is not something that should surprise us—it has been predicted for many years—yet the long-term care system has remained unreformed. Dilnot’s findings are very sensible, and hopefully they will achieve the better and fairer funding system that we need. However, there are some questions that arise from the report that I hope the Minister will address.

The Commission set out a reasonable timetable for the implementation of reforms. If we are to begin a new programme of funding, one that should perhaps be aligned to some of the other changes affecting future pensioners, we need to ensure that legislation is passed soon. It may be brazen for me to say so as a new MP, but Governments of all colours appear to be adept at pushing difficult issues into the long grass and waiting for the next Government to address them. We are seeing that at the moment on public sector pensions, which is another ticking time bomb issue that was ignored for decades; dealing with it now will cause more pain than if it had been dealt with sooner. We must not let the funding of social care become the next big but continuously ignored problem.

With that in mind, I should be grateful if the Minister provided us with an update on the public consultation on the Commission’s proposals and told us when he will publish the White Paper on social care. Does he expect a Bill on this issue to be included in the 2012 Queen’s Speech and will implementation of changes to funding begin in 2013, as per the Commission’s timetable? It would help all of those who are involved in delivering care and those people who are planning for their retirement if we received some clarification at the earliest opportunity about the timetable for implementing the Commission’s proposals.

The Dilnot report rightly focuses on the issue of financial advice, guidance and product availability. It is estimated that about 130,000 people enter residential care each year. Under the current system, around 41% of those people are self-funders—in other words those who have assets exceeding £23,250. The increase in the threshold will raise that figure to £100,000, but given how much wealth is tied up in fixed assets such as housing, that will not necessarily change the numbers dramatically.

I am concerned that self-funders deplete their assets paying for care and end up becoming reliant on local authorities for future care funding. Earlier this year, the Local Government Information Unit estimated that a quarter of all self-funders fall back on the state, costing local authorities up to £1 billion per year. The unit’s own report indicates that key decision makers in councils are unaware of the problem or underestimate its cost by 50%. I was shocked to read that 61% of authorities did not know how many self-funders they have or how many self-funders fall back on state funding.

While we need to improve local authorities’ understanding of funding liabilities, it is also clear that those who are in a position to fund themselves need much better financial advice and planning to mitigate the premature exhaustion of funds. Dilnot mentions the variety of financial products that are available, and I should say at this point that although I entered Parliament after working for an insurance provider I have no registered interest in the sector. Nevertheless, from my time in the industry, I think that it is fair to say that there is an appetite for providing products in this area, but the market is not as wide or as competitive as it could be.

I recently met representatives of Partnership, a provider of immediate needs annuities, which is a product to which Dilnot refers to in his report. Like the Dilnot report, Partnership made it very clear that there is a need for improved advice and education. Raising awareness of long-term care needs is essential, not least because people’s expectation is that when they get old they will be looked after for free. I am not convinced that the Dilnot report changes that expectation. Although care costs will be covered, the so-called “hotel costs” of food and board will not be covered, so we need to improve individuals’ understanding of what they will be required to fund themselves.

[David Simpson (Upper Bann) (DUP)]

I thank the hon. Lady for giving way and I congratulate her on securing this very important debate. I have not read the Dilnot report, but I understand that it indicates that we may have to increase taxes or cut public spending to provide care for senior citizens. All right-thinking hon. Members will agree that it is paramount that we provide that care. I may have misunderstood the hon. Lady, but is she suggesting that we should consider having some form of insurance policy to provide for future care rather than increasing taxes or cutting public spending?

[Tracey Crouch]

I am suggesting that we need to look at various ways to fund care in future. I believe that a market exists for this type of care insurance. There are people who can afford to take out such insurance, but they do not necessarily know that there are products out there that could prevent them from having to fall back on the state. For example, they could afford to take out a premium. It may be a hefty premium at the outset, but it could prevent them from draining all the assets from their home and then relying on state funding for residential care. Such insurance policies are certainly an option that we should look at, and indeed Dilnot himself looks at the financial services sector as one that could relieve some of the burden on state funding.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate my hon. Friend on securing this debate. With regard to the use of resources, we have looked at taxation but we must also look at Medway council, which is the local authority that she and I share and which was rated “excellent” in its use of resources by the Department of Health. Rather than increasing taxation, local authorities have a key obligation to ensure that resources for the elderly are available and are funded. For example, in Medway there is free swimming for the over-60s, concessionary bus fares start at 9 am rather than 9.30 am, and home library services are available for the elderly, so this issue is not simply about increasing taxation; it is about making better use of resources. Medway has done so and it is rated “excellent” by the Department.

[Tracey Crouch]

Indeed. This issue is about using resources wisely. However, it is very well discussing how resources are used now, but the problem lies in the future. At the moment, one in six people are over 65, but by 2050 one in four people will be over 65, and resources will only be able to stretch so far.

We spend a lot of time—rightly so—talking about financial education for young people, but I am enormously sympathetic to the suggestion that we should consider providing free financial health checks for people in their 50s and early 60s, possibly funded by using unclaimed assets in banks and insurance companies, and possibly delivered by financial advisers, charities or through the new money advice service. The provision of good quality care is an emotive matter for all involved. Standards of care, and indeed of care homes, differ dramatically, not just across the country but across constituencies. I recently visited Amherst Court in Chatham, a purpose-built Avante Care and Support home that supports residents with dementia. I was really impressed with what it offered and could tell that a lot of thought had gone into the building and the care provision. Such quality, however, has to be paid for, and unfortunately not all residential homes offer the same standards. When homes close, sometimes because the buildings are no longer fit for purpose, there can be uncertainty for residents and their families. It is that postcode lottery of care that we need to mitigate as best we can through the consideration of our long-term care requirements, which is why one policy that we need to get absolutely right for the benefit of our elders is the one on building more homes.

We have a massive housing shortage in the UK, but it is the older generation who have the least choice as to where they live. If they decide to downsize from their family home, they find that there are few bungalows or smaller houses being built. There are not many purpose-built retirement complexes, whether flats or houses, and any new development with social housing rarely, in my view, considers the needs of the elderly.

[Jim Shannon (Strangford) (DUP)]

There is a great focus on residential homes, but does the hon. Lady feel, as I do, that there should be a greater focus on letting people stay in their own home? They feel more confident there, and it is cheaper. I think that if they had a choice, a great many people would rather be in their own home than in residential care.

[Tracey Crouch]

That is precisely my point, and I hope that it will be the key theme to emerge from my speech. Homes must provide good-quality care for people who have to go into residential care, but we need to try to keep people in their own home for as long as possible. My late grandmother certainly believed, as do I, that if good-quality services can be provided people will have to rely less on expensive residential care, and we should therefore provide a greater choice of available private homes. Not many bungalows are being built, because their capital value is not that of a seven-storey apartment block on the same land, which poses a problem for our older people, who then have the choice of staying in their family home, which is incredibly expensive to heat and often impractical, or of moving into residential care.

We want to rely less on the state to fund our residential care, and it seems logical to put greater emphasis on ensuring that new developments have as much of a duty to provide for older people as for other younger sectors of society. The issue of choice extends into the social housing sector too. In my constituency, a few areas of social housing are allocated to the over-55s, but there is a huge difference in the lifestyles of 55-year-olds and 75-year-olds, which often leads to antisocial behaviour problems. I doubt that many people would consider 55 to be old, and therefore we perhaps ought to consider revising the age allocation up, to the over-65s.

I am pleased to say that Kent Housing Group, which is a partnership of developers and local authorities across the county, is looking precisely at housing for older people, and I look forward to seeing the outcomes of that work soon. However, I fundamentally believe that there is a role for the new homes bonus, which could incentivise authorities to build bungalows or complexes for older people and lead to much more housing choice for those who wish to stay out of residential care. That could be one policy that would have a positive impact on the welfare of older people, and it would also benefit the Treasury by keeping people out of the more expensive residential system.

The funding of social care might be the hardest single problem to overcome in this policy area, but we often forget that the services side is equally, if not more, important. Good delivery of services can prevent people from needing to enter residential care, or from staying in hospital longer than the average patient. We have some excellent charities and volunteers who provide an essential community service, and they can be vital to the health and well-being of the people they look after. As brilliant as individual schemes are, however, our overall community service for the elderly needs to be much better. I heard a heartbreaking story from the WRVS about a lady whose light bulbs broke. She was unable to fix them herself, and so for a month she sat in the dark. As she used her television for light, the electricity company noticed that her bills were unusually high, contacted her and discovered what the problem was. A WRVS buddy was sorted out, and her light bulbs were changed, but it took a month and a concerned utility worker to alert others before she was helped. In these modern days of instant connectivity, I find such isolation utterly unforgivable.

[Penny Mordaunt (Portsmouth North) (Con)]

I congratulate my hon. Friend on securing this debate. Does she think that when we are considering Dilnot and the future funding of care, we need to look not just at the baseline and at our well-recognised ageing population, but at the unmet need to which she has just referred? In Portsmouth, for example, which is a fairly compact city, we have 1,000 people with dementia who have no access to services.

[Tracey Crouch]

We need to improve the services available for different people with different needs as they age. I am vice-chair of the all-party group on dementia, but I decided not to talk specifically about dementia today because I am hoping for a future opportunity to do so. There are, however, some very good services. They are very localised, but often people do not know about them. For example, the wife of a constituent of mine who happens to be a good friend, has just been diagnosed with dementia. He found out about the excellent Admiral Nurses service by word of mouth; there was no one there to signpost him to it. He could have been provided with a hugely valuable service at the outset of his wife’s diagnosis. We need fundamentally to improve services across the country.

The Centre for Social Justice has produced a report, which I highly commend and which is entitled “Age of Opportunity: Transforming the lives of older people in poverty”. The report states that more than 1 million people aged 65 and over feel lonely, and a similar number feel trapped in their home. Charities can do so much but, as the CSJ says, there is a fundamental role for the state in preventing such isolation. So many older people are already known to statutory bodies, so providing the link to charities is essential. The CSJ recommends a greater role for neighbourhood policing teams, in engaging with extremely isolated older people, and the extended use of the increasing number of health visitors. Those are sound recommendations, which would help to deliver a new relationship between the voluntary and public sectors, and also reduce social isolation.

The authorities and partnership organisations to which I speak are desperate to provide good services, but they are hampered by finances. Although we have to be realistic about the need to make efficiency savings across various services in the short term, that needs to be balanced by an understanding that good-quality services can benefit public finances in the long term. Keeping retired people active, for example, keeps them healthy and less in need of acute primary care. Helping those nearing retirement to plan financially prevents them from draining their assets before falling back on the state. Providing company for people in social isolation not only enriches their lives but improves mental and physical well-being. Good-quality housing designed for the older generation provides greater choice for people wishing to remain in their communities. All those areas are interlinked, and better delivery could save the state a significant amount of money in the long term, but for the people who need care we must ensure that it is of good quality and sustainable for our ageing population, but also fairly funded.

If we are to improve the standard and delivery of care and services for older people we need to deal with this issue today, and I urge the Minister not to let it get kicked into the medium or long grass, and to consult on and implement reform of the system as soon as possible, for the benefit of this and future generations of pensioners.

--- Later in debate ---

[Jack Dromey]

I accept that some of the issues that Dilnot identified will have to be worked through, but I think that there is a broad welcome for Dilnot ending what has caused so much grief in the past. People have had to sell their homes. People who spent their lives hoping to pass on wealth to their children have found in the twilight of their years that that is not possible. We can have an intelligent debate about the detail of Dilnot, but the cap is welcome. The sooner we implement Dilnot, the better. The problem is that, even if everyone gets a move on, that might be some years away, in which case we must address the here and now during the next two to three years.

WRVS has done excellent work in the field, and has said rightly that the Government must both address the adequacy of the funding that they have made available and ensure that it is wisely spent and properly monitored. The inescapable reality is that the consequences of the cuts to public expenditure are devastating for the most vulnerable in our society. To use the city that I represent as an example, Birmingham city council has cut £212 million from its budget this year—the largest cut in local government history. It cut £51 million from the social care budget, rising to £118 million over three years, and consequently sought to remove substantial need provision for 4,100 people. The council was prevented from going down that path only by a judicial review taken by four brave families, whose cases were heart-breaking.

I have seen some of the consequences in my own experience. One example is an absolutely wonderful couple, Faith and Frank Bailey. Faith Bailey is terminally ill. She left hospital some months ago, so that she could spend the remainder of her time on earth with her husband. They are a devoted couple; it is wonderful to see them holding hands at the age of pushing 80. The problem was that when she left hospital, her night-time care was restricted to two nights a week. She struggled as a consequence, and the impact on her husband was devastating. He was becoming increasingly exhausted, and neither of them could cope. The situation was causing them great distress. I am pleased to say that they are now in the admirable New Oscott village, where they will be cared for properly. However, those decent people who built Birmingham and Britain looked forward, in the twilight of their years, to being together for the remainder of her time, and to see them suffer in such a way was heart-breaking.

This is not just about the human consequences. As the hon. Member for Chatham and Aylesford was right to highlight, it is also about the financial folly of failing to recognise that not investing might cost more in the medium to long term. The King’s Fund report charts what happens in social care as a result: the number of people admitted to hospital rises. I am sure that we have all seen that in our respective constituencies. I remember one example in the constituency next door to mine in Birmingham. A fine young man who was seriously assaulted spent 18 months in hospital as the consequence of a failure to provide a social care package. After he had spent just over 12 months in hospital, he was told that he could leave if an adequate social care package were provided for him, but because it was not, he stayed in hospital. He was desperate to go home and his family wanted him back, and it was costing the national health service £2,400 a week in net additional costs to support him. That cannot be right. The impact on the national health service is an issue.

To give another example from Birmingham, all parties supported building 10 centres, such as the admirable Perry Tree centre, across Birmingham to provide intermediate care as a bridge between leaving hospital and going back home or into a home. Perry Tree is outstanding, and the atmosphere is wonderful. However, sadly, no more centres will be built. That will mean bed blocking on a massive scale in the national health service.

[Tracey Crouch]

Is the hon. Gentleman aware of the report by the all-party group on dementia that highlights that issue specifically? Dementia patients are extending their stays on hospital wards because they cannot go straight back to their residential care homes, and it is costing the NHS about £20 billion a year. It is a massive issue. Intermediate provision must be considered more closely to alleviate that financial pressure on the NHS.

[Mr Gary Streeter (in the Chair)]

Order. Before the hon. Gentleman responds to that point, I would like to say that five other colleagues are seeking to catch my eye and the wind-ups will begin at 12.10 pm. If colleagues can moderate their speeches, I would be most grateful.

Care Services (Older People)

Tracey Crouch Excerpts

Tuesday 7th June 2011 Commons Chamber

[Stephen Lloyd]

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.

[Tracey Crouch (Chatham and Aylesford) (Con)]

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?

[Stephen Lloyd]

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 the Member for Chatham and Aylesford (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 the Member for Portsmouth North (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.

[The Minister of State, Department of Health (Paul Burstow)]

Let me start by congratulating my hon. Friend the Member for Eastbourne (Stephen Lloyd)on 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.

[Tracey Crouch]

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.

[Paul Burstow]

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.

Maidstone Hospital (Maternity Services)

Tracey Crouch Excerpts

Tuesday 14th September 2010 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) on securing this important debate, and I thank her for allowing me to take up some of her valuable time to make a few points. Although she has led on this issue, it significantly affects my constituents, too. For expectant mothers in Aylesford, Larkfield, Ditton, Snodland, and the three villages of Burham, Eccles and Wouldham, the town of Maidstone—and the closest hospital—is only a few miles away.

This is an emotive issue and it is fundamentally founded on concerns about practicalities. I do not know whether the Minister has been to Maidstone and made the journey from the current hospital site to the new unit in Pembury. My hon. Friend the Member for Maidstone and The Weald, the doctors, and the several hundred expectant mothers who have campaigned on this issue would, I am sure, be delighted to show her that even if someone is transferred by ambulance, it will take a significant amount of time to reach the unit. That could be critical in an emergency. Furthermore, mothers who have further to travel to a hospital tend to leave earlier, possibly at the first twinge. Instead of arriving at the appropriate time, they end up arriving too early and using valuable resources that would otherwise be available to others. Evidence suggests that the longer a mother stays at home before giving birth, the better the outcome. Therefore, moving the unit further away could have the opposite effect to that intended in the proposals, namely better maternity outcomes.

I promised my hon. Friend that I would take up only a few moments of time, so I conclude by saying that I fear the impact that the reconfiguration will have on the busy maternity ward at the Medway Maritime hospital. Earlier this year, the hospital reported a record month for childbirth, with a staggering 434 babies born in May. Midwives at the Medway Maritime hospital already deliver about 4,500 babies per year, and I believe that a further 8% increase on that is expected each year. The hospital is fortunate to have good facilities and it is recognised as the largest unit in Kent. However, it too is bracing itself for the fallout from the reconfiguration. We have already seen some worrying near-misses, with babies being born in ambulances that were diverted from Maidstone.

At present, about 50 women from Medway choose to have their babies in Maidstone, but I expect that figure to be revised, and I suspect that it will be much higher following the reconfiguration. Although I appreciate that funding will follow the mother from West Kent primary care trust to Medway, the pressure that will be put on resources could prove dangerous.

The Medway Messenger newspaper has recently covered incidents of babies sadly dying due to what mothers have described as stress in the service. Clearly, any complaint should go through the proper process, so I do not intend to say anything on individual cases, but even though the Maritime is well prepared for an increase in capacity, concerns remain that increased pressure on maternity units could lead to further cases of infant mortality.

I am in no doubt that the intention behind the proposals is to improve maternity services for my constituents and others, but it is not right to do so in a manner that could put mothers and babies at risk. I urge the Minister to listen to the excellent case made by my hon. Friend the Member for Maidstone and The Weald and to reconsider the proposals in order to ensure that expectant mothers in mid-Kent are given the best possible chance to deliver their babies safely and locally.

Supporting Carers

Tracey Crouch Excerpts

Thursday 1st July 2010 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

This is not my maiden speech, but it is the first time that I have spoken in Westminster Hall and under your chairmanship, Mr Benton, and it is an honour to be doing so in this debate.

I want to speak briefly to signal my interest in the important issue of supporting carers. I am not an expert, a carer or a mother, and my parents are, thankfully, still physically and mentally well, so I literally have no personal experience of caring for anyone. However, in the past few years of being a candidate, and now as an MP, I have met many people who care or have cared for loved ones, and that has opened my eyes to an area of policy, a set of issues and a group of almost invisible workers who need our support.

The first carer I met in my constituency was a man called Maurice. He wrote to me about dementia and his views on the service that his wife had received. When I went to see him, I asked him to explain what had happened from start to finish. The point of the story that had most impact on me was when he started to tell me how his wife had ended up in full-time residential care because he could no longer cope with caring for her. This brave man, who has served his country and who now fights and fights for improved health services for other local people with dementia, welled up in front of me as he recalled his guilt when he realised that he could no longer care for his wife. Although so many parts of his story needed attention, it was that very point that made me wonder why he had felt so alone and unable to cope. What help had he received? Where was the support network? It might well have been there, but if a man who wears a military badge with honour suddenly realises that he cannot cope, something is not quite right.

I appreciate that caring for someone with dementia is difficult and that dementia is not the only condition that requires full-time care. To learn more, I recently visited the Medway carers centre, which is run by the Princess Royal Trust for Carers. There are 21,000 carers across the Medway authority, which includes the Chatham part of my constituency, but only about 5% of them are known to the centre, which demonstrates, as all of us in the Chamber know, that a huge number of carers out there are forgotten, unrecognised and probably inadequately supported.

I had the good fortune to meet some carers who were at the centre on the now departed caring with confidence course—I would welcome an opportunity to speak to the Minister further about his announcement about that in his opening remarks. As I spoke to those carers, a number of things became clear. The first supremely obvious point was that carers come from all backgrounds—rich, poor, male, female, old and young. Requiring care does not discriminate. I met carers who looked after their husbands and wives, and a carer who looked after her mentally ill son. I met a carer who looked after her mother and her children—she was part of the sandwich generation that the Minister mentioned. I met a carer who looked after two disabled children, but who never had a day off because respite services would take only one of them at a time.

That leads me to my second point: no two carers are the same. They might share experiences, but their needs are often very different, so the support for them needs to be flexible so that it recognises those different needs. As the hon. Member for Hartlepool (Mr Wright) mentioned, what a young carer needs is very different from what a senior carer requires. We talk a lot in policy terms about flexible working for carers, which is welcome, but many carers require flexible living, and respite care is still patchy. Supporting carers’ physical and mental well-being is essential if we are to help them to carry out their role safely and effectively.

Although direct payments are excellent in principle, we still need to ensure that carers are supported so that they can make the right budgetary decisions. The carers I met were genuinely anxious about becoming, in their words, “self-employed business men”. The fear of doing the wrong thing and making the wrong decision should not outweigh the benefit of giving carers more control and purchasing power. There are agencies and charities that can help, but the signposting needs to be strong and available at the earliest possibility.

I made it clear at the start of my speech that I am no expert and that I would talk only briefly. I have only a new interest in this issue as a result of meeting so many dedicated carers recently. As someone who will turn 35 shortly, and who is at the start of what I hope will be a long political career, I cannot begin to comprehend how other people suddenly change their lives to care for a member of their family or a loved one. However, I am sure that I would join the 6 million carers who do that if I needed to.

Of course, people who care for their loved ones often want to do so, but they do so more often because they need to. When I think of the many young carers who give up playing on their bikes or going out with their friends because they need to look after mum or dad, or of the working woman who gives up her job to wash and bath a parent who struggles to remember her name but can recall the time she bought a loaf of bread, my heart breaks for them. Carers really are the unrecognised heroes of society, and it is our responsibility as a Government to do as much as we can to support them.