Dementia

Baroness Berridge Excerpts

Thursday 18th January 2024 Grand Committee

[Baroness Berridge (Con)]

My Lords, I am grateful to my noble friend for tabling this debate. As well as having family experience, I also served on the Joint Committee on the Draft Mental Health Bill.

Lack of parity has created complex administrative processes for practitioners, patients and families. It is clear to me, from having two elderly relatives needing support, that you risk not getting the best outcome if you do not understand the system and are not able to advocate for them. With the first relative, we had the baptism of fire of continuing healthcare assessments. Putting aside the obvious distress to the patient and relatives caused by these meetings, there is also the time off work and lost income. The typical cast at these meetings would be the nurse, manager and staff of the nursing home, the discharge team from the hospital, social workers, patient and relatives. Meetings last one to two hours, plus travel time for the professionals, of course, as they have to take place in the nursing home. They may also need to be repeated or paused as the patient may be in and out of lucidity or competence.

The amount of resource gobbled up by these meetings was remarkable, and we had three attempts at it. Often the agenda seemed not to be about nursing care requirements, just whose pot of money it would be coming from—it is all taxpayers’ money, of course. Can my noble friend the Minister outline what assessment has been made by the Government of how much the process of continuing healthcare assessments is costing the NHS? If there was the parity outlined by my noble friend Lady Browning, this resource could of course be saved.

By the second relative, we were no longer newbies but, in that case, we bumped into the Mental Health Act. Some forms of dementia include mental health symptoms, such as delusions or hallucinations. My relative, who had such symptoms but had not yet been diagnosed with dementia, consented to going into a secure mental health hospital. I was quite affronted when a friend who commissions local authority services said to me, “Shame they consented and weren’t detained under the Mental Health Act”. Later, when I was on the draft Bill committee, I knew what he meant: Section 117, on aftercare. Although not automatic, it includes accommodation and can include all your care, hence the Times newspaper headline back in 2014: “The ‘secret’ law that means dementia care can be free”. It is not means-tested and you do not have any more continuing healthcare assessment meetings.

Can my noble friend the Minister outline whether there is data on how many people with dementia are detained under the Mental Health Act without any pre-existing history of disease? Also, is he aware of the anecdotal reports of clinicians now feeling under pressure to detain people when relatives know that it will not alter the care but could save them tens or hundreds of thousands of pounds? Are we at risk of this coming to be seen like the EHCP situation, where relatives know that the Mental Health Act will lead not only to the best care but to the taxpayer funding it? More importantly, is this adding to the pressure on NHS mental health beds?

Nothing that I have said detracts from the amazing care staff, who were often as bemused as we were by this not so wonderful world of administration and bureaucracy. Surely there must be a better, kinder and more efficient system.