Inequalities in Dementia Services

Debate between Andrew Gwynne and Andrew Rosindell

Thursday 16th May 2024 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Rees. I yet again commend my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for securing this debate and for her ongoing advocacy on the issue. I also thank the other hon. Members here; we are a small but perfectly formed debate.

I particularly thank my hon. Friend the Member for Halifax (Holly Lynch) for her important contribution. She is absolutely right to champion not only the important services being provided in her patch and across the country, but that desire to want better and to want more so that no person or family looking after somebody with dementia is left behind. That wraparound support is absolutely crucial. I also commend her and my hon. Friend the Member for Oldham East and Saddleworth on thanking those national and local organisations and charities, and the wonderful army of volunteers who keep dementia on the public policy platform.

I thank the hon. Member for Romford (Andrew Rosindell) for his important interventions. It is absolutely right that we have to approach how we deal with dementia in the 21st century on a cross-party basis. I hope that we can reach some consensus on what needs to be done, because never has the need for a clear, concerted focus on dementia been more pressing. It is one of the biggest health and social care issues facing our society. As my hon. Friend the Member for Oldham East and Saddleworth pointed out, almost 1 million people in the United Kingdom live with dementia—a figure that is expected to rise to 1.4 million by 2040.

Behind those numbers lie individual people with their own distinct circumstances and challenges and their own unique stories of living with dementia. It is a cruel condition that strips people of their fondest memories and causes devastation for families.

Dementia can impact anyone at any time. It is indiscriminate in the impact it can have, but we know that certain groups are at increased risk. We know that women are more likely to develop dementia than men. They are also more likely to be caring for a loved one living with dementia. We know that those from poorer and disadvantaged backgrounds are more susceptible to key dementia risk factors, with often limited access to health services.

My hon. Friend the Member for Oldham East and Saddleworth is absolutely right to refer to these conditions as health inequalities, because it is often those living in the poorest, most adverse circumstances who face the hardest challenges, not just with this condition, but with a whole number of conditions. If we want to live in a better, fairer, more equal society, we have a duty to bear down on those inequalities. I completely agree with my hon. Friend about referring to such conditions as health inequalities. People from ethnic minority backgrounds are also at higher risk, as are those with conditions such as Down’s syndrome, but the population living with dementia is expanding all the time; it is not restricted to any single group, and we must be ready to tackle the challenges that presents head on.

Nowhere is that challenge clearer than in adult social care. Around 60% of people drawing on home-based care and support services live with dementia, rising to 70% for those in residential care. We need long-term solutions that reshape social care into a service that is fit for the future and fit for the challenges of the future. That is why I am proud of Labour’s commitment to a 10-year plan for fundamental reform of adult social care, culminating in the creation of a national care service.

The NCS will employ robust central frameworks and standards, but it will be underpinned by locally led delivery. Every community will have its own unique set of needs, face unique challenges and require unique solutions. One of our aims will be to gradually reduce the postcode lottery that operates within social care that causes people living with dementia and their families so much distress. However, a reformed and reshaped social care sector alone cannot and will not meet the needs of an ever-growing population of people living with dementia.

[Andrew Rosindell]

I am very interested in some of the hon. Member’s comments. I am glad that he approaches the issue from a cross-party point of view. In my own borough of Havering, there are a vast number of older people. So many services for people who suffer with dementia depend on local authorities. In Havering, we do not get the additional funding we need to deal with the older population who need those services. If there were to be a change of Government, would he commit to helping boroughs like Havering by giving them more resources? Will that boroughs with large populations of older people who suffer with dementia get more support from the Government that the hon. Member may well serve in?

[Andrew Gwynne]

I would certainly hope and expect so. The way we are going to deal with the national care service is not to create a big, monolithic organisation to rival the NHS as some kind of super-organisation employing lots of people. The NCS will be about the centre setting out a clear national direction of how we deal with the challenges of social care: what the pay, terms and conditions of the workforce should be, and what the outcomes should be for people drawing on social care services. That strong centre sets out the “what”. The “how” has to be determined locally, because what works in Oldham will not work in Romford. There will be best practice in Oldham, which will transfer over and can be upscaled to Halifax, Lewes or Romford. That is also a job of the centre—to promote that best practice and what works, encouraging other authorities to do that—but the funding challenges require an integrated approach, and I saw at first hand how that could work in my own local authority.

For a very small period of time, now unpicked by the latest round of structural changes, Tameside council was also the clinical commissioning group for Tameside and Glossop. By bringing the local authority and the CCG together under a single leadership with a single budget, some really smart decisions were made on dealing with adult social care. I know what integration looks like, I know it works, and I know how we can get better use of the public pound, by stripping out some of the duplication.

--- Later in debate ---

[Andrew Rosindell]

I am very pleased by what the hon. Gentleman is saying, but have just a small point of clarification. There should be common cause over this issue, but does he agree that the important thing is that the funding follows the individual? It should not matter which part of the country someone lives in or if they are on a certain side of the boundary of a borough. My borough is within Greater London, and we get very poor funding because all the money goes into the centre for all sorts of local services, and Essex County Council is just up the road, so we always get caught. Can the hon. Gentleman assure me that in any policies he may bring forward, the money will go directly to the needs of the individual, rather than one person on one side of a boundary getting the funding, while a mile down the road they do not get the support they need?

[Andrew Gwynne]

That is why we need to have a strong national framework with an expectation that these services are delivered to the required outcomes, with very strong targets across the whole of England. I get the nuance between local government finance and the interrelationship with adult social care and NHS budgets. We have to be smarter at working around all of this. As a former shadow Secretary of State for Communities and Local Government, I realise that this is not a debate on local government finance, but the two are interrelated. I take on board the point made by the hon. Member for Romford.

In order to get this reformed, reshaped social care sector, and particularly within the scope of there being an ever-growing population of people living with dementia, we need to fix the crisis in our NHS, which is intrinsically linked with our social care system, to address the inequalities in dementia care. As we have already heard, that care starts with timely and accurate diagnosis. A third of those currently living with dementia in the UK do not have a diagnosis, and that prevents them from accessing the vital care, support and treatment they need.

This is also about allowing people to have some degree of certainty and to make different life choices based on that. If I found out that I had early-onset dementia, I could hopefully access some of these new drugs available. In doing so, I would very much hope that I could tick off a few more things on my bucket list. I might want to spend more time with my family and take them on a chance-of-a-lifetime holiday, making memories. People are deprived of making those choices. I do not think it is good enough to have a third of people left undiagnosed. That is the national target being met, and as we have heard, in large parts of the country it is not being met.

I want us to get to a much more rigorous national target. If Stoke can diagnose 90% of people with dementia, so can the rest of the country because Stoke is not a rich area or a well-sourced local authority. Its NHS is not awash with any more cash than other areas of the country; if they can get 90%, so can the rest of the country, with concerted effort. That is why having a strong central target, and an emphasis from the Minister to make that a priority, is going to be important. It will be the priority of the next Labour Government to increase that target and demand that local systems not only meet but exceed it, because this is people’s lives that we are talking about.

As we know, earlier diagnosis means better care and outcomes—it could not be simpler. The national target of two thirds is not good enough. I am not content that a third of people, and even more in many areas failing to meet the target, are living with dementia and going without vital care. With primary care under such immense strain, people simply cannot get through the front door. That is why the next Labour Government will be committed to making the future of general practice sustainable, and to taking pressure off those currently working in the system. We will bolster the workforce so that all patients, including those with dementia, can get timely care. That is why Labour will deliver on the NHS long- term workforce plan to train the staff the NHS needs, now and in the future.

Once a diagnosis has been made, continuity and ease of access to care is crucial to long-term outcomes. That is why one of the fundamental shifts that the next Labour Government will deliver in our health and care system is taking focus of care out of hospitals and into the community. Unlike the last time that was done, principally for people with dementia and learning disabilities, the money has to flow from hospital to community as well, which scandalously did not previously happen.

Labour will work with the NHS and social care providers to bring services together in local communities. It is by having those services embedded where people are that we will deliver another crucial shift to a health and care service relentlessly focused on prevention. Alzheimer’s Society research shows us that mild dementia costs £29,000 per person per year, compared to £81,000 for severe dementia. That provides proof, if ever we needed it, that the case for focused prevention is clear for not just patient outcomes but the financial sustainability of services.

As well as looking at the here and now, we must also look at the challenges on the horizon. Our understanding of dementia is constantly evolving. That is why continued leadership in research and embracing the latest technological advances and developments are so vital to ensuring we stay ahead of the game. Labour is committed to putting Britain at the front of the queue for new treatments by boosting clinical trial activity in the NHS. We will speed up recruitment to trials, and give more people the chance to participate. We will link clinical trial registries to create a national standing registry and harness the power of the NHS app to invite eligible participants to take part in research studies.

I pay tribute to a group that is so vital but yet so often forgotten: unpaid carers. Hundreds of thousands of people care selflessly for their loved ones living with dementia. Make no mistake: without the work of unpaid carers the system would simply collapse. With 63% of the total cost of dementia being borne by those living with the condition and their families, we know just how raw a deal they are getting. They are a vital part of the fight against dementia, and they will be at the heart of Labour’s plans in Government.

There will be a carers strategy under the next Labour Government, because we value the vital work our carers do. It will be a cross-Government strategy with the Department for Work and Pensions, Department for Education and the future of work review all feeding into it along with the Department of Health and Social Care. There is a brighter future for those living with dementia and their families and carers. Labour will deliver it.