Dementia Care Services

Ann Coffey Excerpts

Wednesday 9th September 2015 Westminster Hall

[Ann Coffey (Stockport) (Lab)]

It is a pleasure to serve under your chairmanship again, Mr Davies. I congratulate the hon. Member for Charnwood (Edward Argar) on securing this important debate and on his commitment to making life better for dementia sufferers and their relatives. I will not take up much time, and my observations are probably from a more personal point of view.

I completely support the Government’s objective to be a world leader in fighting dementia, but it is a challenging objective at a time of cuts in social care and given the difficulties in recruiting people to work in jobs that have traditionally been poorly skilled and badly paid. Social care is fundamentally task-orientated. It best supports people with physical disabilities and frailty, but it is not necessarily the best way to help people who have dementia.

In an area in which I have some personal experience, I know that the quality of the relationship between the carer and the dementia sufferer is vital in enabling the dementia sufferer to feel reassured and cope with anxiety, which is a common consequence of the illness. One of the symptoms of dementia is a complete loss of short-term memory, which results in the inability to do simple tasks. For example, a dementia sufferer may see a cup, a tea bag and a kettle, but not the connection among them. Making the cup of tea is, of course, an important task to ensure that the person does not become dehydrated. However, once the tea is made, the elderly person may be reluctant to drink it and may need continuous prompting. If the carer is new and does not know the person, and can spend only 15 minutes with them, the cup of tea may never get drunk.

A person’s relationship with their carer and the amount of time they can spend together is vital. It is sometimes forgotten how important relationships, emotional support and encouragement are to people with dementia, and how vital it is not to add to their confusion with multiple carers. Particularly when a person has no near relatives, the carer has to get to know them to understand when something is wrong with them, because a person with dementia cannot tell the carer themselves that their dentures are too tight.

Dementia sufferers need good quality care, and carers must have good antennae to be able to spot, for example, the signs of a urinary tract infection by changes in the person’s behaviour or level of confusion. We therefore need to move from a task-centred social care system in which multiple carers make short visits to a system that involves skilled care in which continuity of care and carers’ skills are a high priority. Simply integrating the health and social care system does not necessarily do that, as my experience in Scotland shows.

Of course, we cannot produce a vast army of skilled carers now or in the near future, particularly given population changes, so we need to look at how we can better use existing resources, including relatives, who at the moment seem to spend most of their time negotiating the system. The constant rounds of phone calls to doctors, nurses, occupational therapists and social workers leave relatives exhausted and with less time to spend with family members on social activities. There needs to be more support for relatives, who are important for ensuring the continual wellbeing of their family members.

We also need to be more imaginative about using technology to help people with dementia to free up the time for relatives and carers to build those important, high-quality relationships. We still tend to think of aids in practical terms, such as hand rails, bath mats or clocks with large faces, but I am interested in how we can use new technology to promote emotional wellbeing. For example, carers could help people to communicate with their relatives via Skype or smartphones, or set up digital photo frames that can be programmed to show photographs, which can help spark memories and support conversations. Relatives can link cameras to their smartphones and computers to check whether the person is all right at home, and they can use technology such as personal alarms and health monitoring devices. For example, bed pressure sensors can help reassure from a distance that the person has got out of bed, and a front door sensor can ensure that they have not left the house.

Hopefully, a cure will be found for this devastating illness, but until then we need to use the resources that are currently available better. In particular, we should develop technology, which, if it can free social carers from monitoring and supervision, would be very helpful in freeing up resources. We also need to use the resources of relatives, neighbours and the community. I hope that in the future we will be able to look at what the whole system can provide.

--- Later in debate ---

[Dr Whitford]

I absolutely would. In my previous life as a breast cancer surgeon, when I was also doing breast cancer immunology research, I watched what became Herceptin go from its development on the bench-top into common use. That took 21 years. This is something we often do not recognise when we moan about big pharmaceutical companies: they are investing in something that may turn out to be a mirage. The more that we can look at supported or shared R and D, the cheaper the drug will be when it finally comes to market. I would commend something like that.

The current problem is that most patients face living with dementia, and we must think about how we help them and their families to do that. We should be challenging ourselves to make dementia-friendly our surroundings and all the agencies that sufferers may interact with, whether through visual aids, through other people recognising them or, as the hon. Member for Stockport (Ann Coffey) said, through technology. The eHealth programme in Scotland is working on that, including devices in patients’ homes that it can interact with and establish whether the person is okay. Much of the care that people receive is the 15 minutes that the hon. Lady mentioned. How can we improve that? How can we ensure that the faces are not different every day? Some patients and families report 100 carers in a year. We should look at how we organise the care and remember who the real carers are: the family.

It is predicted that one in three of us will be carers for someone with dementia. We have a vested interest in ensuring that we look after them. The carer’s allowance is currently £60 a week, which does not even match jobseeker’s allowance, for a job that could be 164 hours a week, so we need to think of how we support carers and the work that they do. In Scotland, things are slightly different as we have free personal care, so the family does not pay for the carer who comes into the home. If that person has to go into a care home or nursing home, they do not pay for the personal care. The system has been expanded and deepened and actually allows us to keep more people at home for longer.

One problem is that care jobs attract lower earners. How can we motivate people and attract high-quality candidates if they are being paid the lowest possible amount?

[Ann Coffey]

On free personal care, the budget in Scotland is capped. Free personal care is probably welcome, but the problem is that sufferers do not necessarily get the required level of care because demand is managed by stopping the supply. That is the problem with a capped budget. Free personal care is not really a panacea for families seeking the care that their relatives need.

[Philip Davies (in the Chair)]

Order. Before I call Dr Whitford, may I ask that she bring her remarks to a close?