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The Minister for Social Care (Helen Whately)
It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my right hon. Friend the Member for Ashford (Damian Green) on securing this debate. I also commend the campaigning of several charities in this area, including Alzheimer’s Research UK, the Alzheimer’s Society, Dementia UK, Age UK and many others that do so much to raise awareness of dementia, fund research, and support people with dementia and their carers.
I commend my right hon. Friend on his speech. Like many, he has his own experience of dementia with his father, which has clearly informed the significant work that he has done in this area. He spoke about some of the statistics, which I will come on to, and about how a dementia diagnosis can be a bleak prospect. He also spoke about some glimmers of hope for people with dementia and for us as a society—for instance, the fact that dementia can be preventable for some people; our growing understanding of the importance of brain health and how we achieve it; and the progress being made towards treatments that can genuinely make a difference in the future for people with dementia. I heard his specific question about the evaluation by NICE of the treatments and whether the evaluation approach is fit for purpose; I will come on to that shortly.
My right hon. Friend also talked about the importance of better and earlier diagnosis. Indeed, he mentioned that, at the moment, more than a third of people who have dementia are estimated not to have a diagnosis, although, clearly, the other side of that is that about two thirds of people do have a diagnosis. Although we know that the pandemic hit our ability to diagnose people, we have seen some recovery in the diagnosis rate since the pandemic. It is now at the highest level for three years. He rightly said that, overall, for this area, as for many others, prevention is at least as important as a cure. He spoke about the opportunity, in that dementia diagnosis should no longer be a life sentence for this generation, which is an uplifting prospect for all of us involved.
We also heard from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), who spoke about her experience with dementia and how she cared for her mother Angela when she had Alzheimer’s, until she died. I have huge respect for her, knowing how difficult that must have been. She is also extremely knowledgeable about dementia and spoke about the many different sub-types of dementia, and I thank her for her work as the chair of the all-party group on dementia.
The hon. Lady spoke about hospital stays for people with dementia; a significant number of people are in hospital with dementia. As part of my brief, I have oversight of discharges from hospital and urgent emergency care, and I have spent a lot of time thinking about the flow through hospitals. I think a lot about people with dementia and how we can support them to be discharged to the best place for their care afterwards, or how we can avoid long stays in hospital for them. It can then be so difficult for them to be discharged, given the potential deconditioning that happens to people in hospital.
The hon. Lady rightly talked about how dementia is now the No. 1 cause of death in the UK, but it should not be seen as inevitable for us as we age, and in an ageing society. I heard her three asks, calling for dementia to be diagnosed more often at an early stage; for us to do better at diagnosing sub-types of dementia; and for us to improve access to PET scans and lumbar punctures for diagnosis. I will come to some of those points in a moment. I can definitely agree with the Opposition spokesperson, the hon. Member for Bristol South (Karin Smyth), that we have heard speeches from formidable colleagues in the debate, as well as from a number of others who joined us and contributed through interventions.
I will start with the impact of dementia. We know that close to 1 million people in the UK suffer from dementia. Around 900,000 people over the age of 65 and almost 50,000 people under the age of 65 are estimated to have dementia. We expect those numbers to increase to more than 1 million by next year and more than 1.5 million by 2050.
The stats are one thing, and they clearly point to the scale of dementia in our society, but they do not necessarily bring to life the human cost of dementia—what it means for people who have it, their families and friends, what it means practically for someone with dementia and those close to them, and what the challenges are of living with dementia or caring for somebody with it. There are significant financial burdens, both on people working who are then diagnosed and may be unable to work, so they have lost income, and on carers, who may have to cut back their work hours or leave work altogether. There are then the financial costs of professional care, whether that is state-funded social care for those who receive it, or self-funded care.
Most significantly, there is the emotional cost of dementia—what the diagnosis means for the individual who learns what is making life so difficult for them and knows the prospects ahead as the disease progresses, what it means for those they love, and what the experience is like for people who are close to them and care for them. It can be very difficult to care for somebody while at the same time feeling as if the person they know and love is being stolen from them. That emotional cost is unquantifiable, but we know that it hits very hard.
Like other hon. Members, I feel that I have painted a pretty bleak picture of what dementia means to our society, but I have no doubt that there are real reasons for optimism. First, we now understand that a significant proportion of dementia—it is estimated to be around 40%—is either preventable or at least delayable, and that we can actually make a difference. Secondly, real progress is now being made in the research into treatments, and there is the prospect of treatments becoming available that will genuinely make a difference to the progress of the disease. There are real reasons for optimism, although, as a Government Minister, I feel that optimism on its own is not enough.
The question that I am sure hon. Members would like me to answer is what we are actually doing to realise this potential and turn the optimism into improved outcomes. To prevent and delay the onset of dementia, we are and have already been acting and intervening to influence the risk factors. We know that we can influence them. For instance, the known risk factors for dementia, similar to other conditions such as cardiovascular disease, include high blood pressure, obesity, diabetes, smoking, poor diet and lack of physical activity. These are things that we can and are intervening in.
For instance, we offer a health check for all adults aged between 40 and 74 in England to identify the early signs of stroke, kidney disease, heart disease, type 2 diabetes and, indeed, dementia. Dementia was incorporated specifically into that health check, in part to raise awareness of the fact that people can make a difference and reduce their risk of dementia, and to motivate people to take steps to reduce that risk. There is a much greater awareness that people can make a difference and reduce their risk of suffering from heart disease or diabetes. Alzheimer’s Research UK has found that about 70% of people know that they can reduce those risks, but less than a third of people know that they can reduce their risk of and prevent themselves from getting dementia. We have offered that health check to over 9 million people, and about 3.7 million people have had it already. We will continue to encourage people to take that up.
Looking ahead, there is more that we can, should and, indeed, will do to prevent people from suffering ill health, prevent dementia and help people to maintain their health. That is at the core of our major conditions strategy, to which my right hon. Friend the Member for Ashford referred. Crucially, that includes dementia, alongside the five other major conditions that represent the major burden of ill health in the country, including cancer and cardiovascular disease.
The hon. Member for Bristol South questioned the point of having a standalone dementia strategy. Actually, it is very important to include dementia with other major conditions and major causes of ill health, partly because we are moving towards having a society in which many people suffer from multiple health conditions. In fact, many older people will have dementia alongside other health conditions, so it makes sense to look at people’s health in the round, not just pick one condition.
As I mentioned a moment ago, dementia is a common risk factor for many major conditions, so it makes sense for our health system not to look at any condition in isolation, but to look at how we can improve people’s health in the round and reduce their risks. The major conditions strategy is absolutely the place where I point right hon. and hon. Members to look at our evolving Government strategy to address some of the health and lifestyle factors, to move into prevention and to support people in the event that they receive a dementia diagnosis.
The other area where there is cause for optimism is the progress that is being made in the research and development of new treatments. Finding a treatment to slow or, indeed, cure dementia, rather than just manage it, would change the implications of receiving a diagnosis and make such a difference to thousands or even millions of people in the UK and globally. This is a challenge that we share with many other countries, particularly those in the developed world, and we are rightly collaborating internationally on research.
Since 2018, the Government have spent over £454 million on supporting dementia research. In 2019, we made a manifesto commitment to double our funding for dementia research to at least £160 million a year. We have since launched the Dame Barbara Windsor dementia mission, backed by £95 million of Government funding. The UK Dementia Research Institute, of which the Government are a founding member, recently announced a new partnership with the British Heart Foundation to establish a centre for vascular dementia, backed by £9 million-worth of funding. Vascular dementia is the second most common form of dementia, affecting around 150,000 people in the UK. We are determined to be a world leader in dementia research and to be recognised as such.
I turn to some of the new treatments. My right hon. Friend the Member for Ashford referred to lecanemab and donanemab as two of the treatments about which there is great excitement. Crucially, the Government want to make sure that treatments are made available to people as soon as possible through the national health service. It is important to sound a note of caution, because we know that such treatments do not come without side effects; in fact, the trials saw some significant side effects, such as the risk of brain bleeds. As ever, it is very important that we follow the proper processes that we have in place to assess the use of treatments by the national health service. That includes both licensing through the MHRA and evaluation by NICE. For the two drugs I mentioned, those processes will happen during the course of this year.
My right hon. Friend asked what NICE takes into consideration in its evaluation. I can assure him and other Members that NICE takes into account all health-related costs and benefits, including the health benefits to carers of a treatment. It also considers the publicly funded cost of social care, so there is a social care element taken into consideration by NICE. I say that very specifically: I wanted to make sure, so I have double-checked in order to be accurate in saying it in this Chamber this afternoon.
I acknowledge and recognise the points that my right hon. Friend and others have made about the impact on unpaid carers and the economic cost. It is true that there is a limit to the costs that NICE considers. Clearly, looking at all the possible broader economic costs involved would have implications not only for dementia treatments but for the many other treatments that NICE considers. As that is a very big question, not just one that is pertinent to dementia, it is probably worthy of a separate conversation in its own right. Nevertheless, I assure him and other hon. Members here today that the publicly funded cost of social care is taken into account by NICE in its evaluation process.
There is also the question of the readiness of the national health service to make drugs available if they are successful through both the licensing process and the NICE evaluation. I assure hon. Members that NHS England is indeed working to ensure that the NHS is ready to support the adoption of new treatments, including the diagnosis processes that will be needed, while recognising—I believe the hon. Member for Oldham East and Saddleworth referred to this—that new treatments are likely to require greater access to forms of diagnosis such as PET scans and lumbar punctures, and also recognising that such treatments are likely to require earlier diagnosis in order to be effective.
One thing that I look forward to is that, particularly as treatments that require an earlier diagnosis become available, more people will come forward to seek a diagnosis, as they recognise that getting an earlier diagnosis will really make a difference, and then there will then be access to treatment. I feel optimistic that we will see a virtuous cycle where people learn that getting an early diagnosis can really make a difference in getting access to treatment.
Debbie Abrahams
I am reassured to some extent by what the Minister says, and I am grateful for her tone and her positive approach. Given the inequality—let us call it what it is—in current diagnosis, and these are non-specific dementia diagnosis rates, have she and her Department conducted any analysis of the gaps in more specific PET and CSF testing? Can she publish that data or write to us with it? That would reassure us, because rather than just hoping something will happen, we could identify it: “Yes, in Greater Manchester we are at 90% of the level we need for all these tests,” and similarly in Kent and so on. If she could do that, it would be very helpful.
Helen Whately
I fully appreciate the hon. Member’s question, and I can assure her that I do look at the variation in diagnosis rates between different areas, as she rightly pointed out in her speech. I would be happy to write to her with further detail on the specific question of more sophisticated diagnosis techniques and our readiness for new treatments and for carrying out earlier and more sophisticated diagnoses.
I assure hon. Members of the Government’s ambition for the UK to be a world leader in dementia research, diagnosis and treatment; I would also like us to lead the world in the prevention of dementia. That is why the Government are investing in research. We are getting ready to make new treatments available and building on what we are already doing in prevention with our major conditions strategy. Given the scale and impact of dementia on our society, successful prevention and treatment are not just a nice-to-have, but an imperative for individuals, for their families, friends and loved ones, and for our society.