Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

Overall access to NHS dentistry is good, but it does vary from area to area, and West Yorkshire, as the hon. Member for Dewsbury (Paula Sherriff) well knows, is one of the areas that worries us and that we are trying to do something about. Work is being undertaken in the West Yorkshire area to look at issues around NHS dentistry. I have met a number of hon. Members to discuss this matter. It has my attention, so I will be monitoring it closely, and my hon. Friend was right to raise it.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The King’s Fund analysis revealed that there will be not a £10 billion, but a £4.5 billion real-terms increase to the NHS. Will the Health Secretary apologise for misleading not just this House but the public as a whole?

[Mr Speaker]

Order. The hon. Lady must not accuse a Member of misleading the House. If she wishes to insert the word “inadvertently” she would spring back into order, which is where I am sure that she wishes to be. Do I take it that the word “inadvertently” has been inserted?

[Debbie Abrahams]

I am happy to insert “inadvertently”.

[Mr Jeremy Hunt]

The hon. Lady may inadvertently have not been listening to my previous answers. Let us look at what Simon Stevens, the chief executive of the NHS, actually said about that spending settlement. He said that the Government had listened to and “actively supported” the NHS case for public spending.

NHS: Learning from Mistakes

Debbie Abrahams Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

My colleague, the hospitals Minister, will have those discussions with the Northern Ireland Health Minister. However, the hon. Gentleman is right that if we are going to have a learning culture, it needs to be across the UK, not just in England. That is why I welcome the discussions we have with the Scottish NHS and the Welsh NHS. There are things that we can learn from each other, and we should be very open-minded in doing so.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

We must all strive to improve safety and quality in the NHS, but the Health Foundation report that the Secretary of State referred to stated that 40% of patients said there were too few nurses to care for them—this is three years after the Francis report. The Government say that the NHS must learn more, but what are they doing to learn from the inquiries that have been held?

[Mr Hunt]

Well, quite a lot. For example, we have increased the number of nurses by more than 10,000 since the Francis report was published, to ensure that we do not have a problem with safety on our wards. We recognise that it is incredibly important not to have short-staffed wards, and we are making more reforms in this Parliament to ensure that we recruit even more nurses. It would be good to have some support from Labour on that.

NHS and Social Care Commission

Debbie Abrahams Excerpts

Thursday 28th January 2016 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate the right hon. Member for North Norfolk (Norman Lamb), my hon. Friend the Member for Leicester West (Liz Kendall) and the other Members who secured this debate. We have heard some thoughtful speeches and different views from both sides of the House. I reflect on the comments of the hon. Member for Faversham and Mid Kent (Helen Whately), whom it is a pleasure to follow. I, too, believe that the commission, although in principle a good idea, would be a distraction.

My hon. Friend the Member for Walsall South (Valerie Vaz) talked about what was different in 2009. In 2011, just after the coalition Government formed, we had the opportunity to hold a cross-party roundtable. It was proposed by my right hon. Friend the Member for Leigh (Andy Burnham), but rejected by the coalition. It comes down to what many people have said about the difficulty of taking politics out of such a debate. It is down to political will.

There are a few points I want to talk about. The hon. Member for Bracknell (Dr Lee) made the point—and, although coming from a different viewpoint, I fundamentally agree with him—about having different ideological perspectives. I want to focus for a moment on the Health and Social Care Act 2012. I served on two Bill Committees with the hon. Member for Stafford (Jeremy Lefroy)—who really embodies the term “honourable Gentleman”, so I am sorry I disagree with him on this point. At the time, the Opposition made real efforts to explore and provide the evidence base for the implications of the Bill and what would happen, and I am afraid that much of that has come true.

All this is based on the fact that the Government, and at that time the coalition Government, have a different view of the NHS and, I suspect—although I cannot recall whether this is on the record—how it should be funded. We believe absolutely passionately—we fought the general election on this basis, as we did on a number of issues—in a publicly funded NHS, funded through general taxation, with the NHS as a preferred provider. We have committed to repeal the Health and Social Care Act, because we believe that its basis—section 75, which compels all providers to put their contracts out to tender—is wrong, and it has been proven wrong.

[Caroline Flint]

My hon. Friend is right: we do support a publicly funded NHS, but it has also been Labour party policy in social care that we think people should make a contribution. The problem with the politics is that we cannot come to a defined space where we can all agree on what is a reasonable contribution. We have to be up front about these things, because we need a system, particularly in social care, where we have to look at other models of how we provide those services and what will be expected for people to finance them, do we not?

[Debbie Abrahams]

I would not disagree with my right hon. Friend, but to pretend—and that is what it would be—that we could reach that conclusion on a cross-party basis would be an illusion. That does need to happen, but we come from completely different perspectives, and that needs to be considered.

In the first year of the legislation, contracts worth £16.8 billion of public money went out to tender under the Health and Social Care Act, with 40% going to private healthcare companies. We could track that because it was on Supply2Health, a public website that was taken down, which meant we could no longer monitor it. Care UK won 41 contracts worth £110 million; and again, the association of donations to different political parties is on the record. Some £5 million has been wrapped up in funding for competition lawyers. In my constituency in Oldham, my community trust, which also provides our mental health services, has said that the amount of time and money wrapped up in competing for tenders has increased inexorably. That is a distraction, and having a commission, getting away from these central points, would also be a distraction. As I say, we come from different ideological perspectives.

[Mark Durkan]

Given what my hon. Friend has said about the impact of the legislation in the last Parliament, does she believe that a commission would have a more adverse impact on the long-term future of the health service than that legislation is having, which is based on the old way of doing business?

[Debbie Abrahams]

We come from completely different perspectives, as I have just mentioned to my right hon. Friend the Member for Don Valley (Caroline Flint). My hon. Friend the Member for Walsall South said this had been mooted back in the ’60s, but if we think that now, just a few months after our debate on the Health and Social Care Act, something has suddenly changed, I would respectfully ask, what has changed?

Again, a commission would be a distraction from what we really need to have our eye on: what is happening in health and social care at the moment. We know that the decisions made about staffing and training, for example, have put our workforce plans in jeopardy. One reason why we have financial problems is that three out of four trusts are now in deficit—currently a deficit total of about £840 million, which will run up to £1 billion by the end of the year.

[Norman Lamb]

Is there not a danger with the approach that the hon. Lady advocates? We can continue to have a go at the Government and say how awful the pressure on staff and the deterioration of services are—I accept that a lot of that is happening—but is it not better to try to achieve a solution rather than wait in the hope that at some point in the future, a Government might take a decision to provide the necessary funding and other necessary changes?

[Debbie Abrahams]

As I teased the right hon. Gentleman last week at a Radio 5 Live interview, “so says the former Minister who was saying something quite different just a few months ago”! I do not want anyone to be under any illusion about this. I am not saying that we should not be planning for 30 and 40 years hence. I am saying that, given the vastly different ideological perspectives —I have provided one example, showing how much we disagree about the Health and Social Care Act 2012—trying to pretend that we can agree is naive.

In the last Parliament, I was chair of the parliamentary Labour party’s health committee, and we undertook an inquiry that looked into the effectiveness of international health systems—it is published on my website for everyone to have a look at. We were particularly concerned about quality and equity in access and outcomes, because we knew there was a vast difference in both those respects. The inquiry showed quite conclusively that where there was competition, privatisation or marketisation in the health system, health equities worsened. It revealed that there was no compelling evidence to show that competition, privatisation or marketisation improves healthcare quality. In fact, there is some evidence to show that it impedes quality and increases hospitalisation rates and mortality. This was peer-reviewed evidence—a review of a review of evidence—not one-off studies. It was the strongest type of evidence showing that marketisation and privatisation worsen health equity and worsen the quality of care.

We need to take a forward view, 30 or 40 years hence, about how to continue to fund the NHS and social care. This is a distraction, however, from the crisis that we have right now. We have seen A&E waits up 34% since 2015, failure to meet cancer 62-day treatment standards up 14%, and diagnostics up 36%. It goes on and on. Mental health cuts in 2014 meant the equivalent of £600 million-worth of cuts to mental health trusts. What has changed in the last few months? Delayed discharges reflect the care crisis, with £3.6 billion taken out of the budget for social care in the last Parliament. There is supposed to be £4.3 billion and a 2% precept, but it has been rightly said that it will not make up the difference. As my hon. Friend the Member for Leicester West said, since 2010, half a million fewer older and disabled people have received state-funded support.

In my constituency, I was doing my regular door knocks when I encountered an elderly lady in her 70s. She opened the door and presented me with a bubble pack of medicines and told me that she did not know what she had to do. She had never met me before. She was dishevelled and wearing a dressing-gown in the middle of the afternoon. This was a woman who clearly needed our help and needed support. She was all on her own and did not know what the medications were. I managed to get somebody there. I wonder, though, how much more this is likely to be happening up and down the country. The system is in a crisis, which is a real concern.

[Dr Wollaston]

In many instances around the country, the use of care co-ordinators and the existence of a single point of contact are not only providing better care for individuals, but saving money for the whole system by avoiding the need for admissions and allowing people to go home early. We should focus on the good examples, and on how services can be made available in a more co-ordinated way.

[Debbie Abrahams]

I entirely agree. That was another of our manifesto pledges. I also thought that what the hon. Lady said in her speech was spot on.

Let me return to what I was saying about distractions. We also need to look at the issue of funding and resources. The hon. Member for Totnes (Dr Wollaston) said something about that as well. Real-terms growth in spending in the last Parliament was the lowest in the history of the NHS, at less than 1%, whereas between 1997 and 2009 it was about 6%. The figure in the last Parliament was about 7.5% of GDP, slipping below the European Union average. We are now moving towards the bottom of the league, which is where we started in 1997.

So far, we have not even talked about devolution. I am a Greater Manchester Member of Parliament. The devolution offer to Greater Manchester was £6 billion, although the current collective health and social care economy is worth £10 billion. There has been no talk of contingency arrangements for, say, a flu pandemic. It is an absolute disgrace.

I also agree with the hon. Member for Totnes about the lack of an evidence base for decisions. I have provided an evidence base: our committee looked into resources and funding and how both quality and equity could be improved, and found vast disparities across the country, as well as disparities in outcomes for different groups of people. We should repeal the Health and Social Care Act and ensure that the NHS is the preferred provider.

[Maria Caulfield]

Will the hon. Lady give way?

[Debbie Abrahams]

I hope the hon. Lady will not mind if I do not. I have spoken for some time, and I am being pressed by you, Mr Deputy Speaker—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Not by me.

[Debbie Abrahams]

Go on, then.

[Maria Caulfield]

The hon. Lady spoke of repealing the Act. As a former NHS employee, I am frustrated by the fact that there has been too much reform, reorganisation and reinventing of the wheel. I issue this plea: please do not make any more structural changes.

[Debbie Abrahams]

I have chaired a trust, I am a former public health consultant, and I entirely agree with the hon. Lady. In the run-up to the election, we committed ourselves to repealing the Act without a reorganisation, because we thought that we could integrate and bring together health and social care in a better way that would not have required that reorganisation.

We need to feel confident that our NHS and care system is there for all of us, and for our parents and our children. It should be based on people, not on profit.

[Several hon. Members rose—]

--- Later in debate ---

[Alistair Burt]

I accept that. I was not in this post in the period from 2012 to 2015. I am certainly ensuring that we are progressing. I am glad that we have sorted that out. The coalition’s involvement with and commitment to this issue have been immense, and I am very proud to carry that on in the way I am doing.

My hon. Friend the Member for Lewes (Maria Caulfield) brought her experience to this debate. She spoke about the integration of budgets for social care and for local authority expenditure in the national health service, which is absolutely crucial. For me, integration is not about getting two groups of people to sit down in the same room every few months or so to have a discussion. It really cannot be done without a combined budget. So long as there are perverse incentives for one budget or another, it will not work.

We are making progress on that and have clear plans to get it done by 2020. We will follow our progress with a scorecard to find out where we are. We have spoken for too long about finding the holy grail, but we are further towards it than anyone has been before. That is not a bad place to be, but we must ensure that we make progress. A lot of this is about relationships; it is not just about organisations being in the same room. Unless people really talk to each other and have a real sense of what can be done collectively, we will not get anywhere.

My hon. Friend made the heartfelt plea, “Leave us be from time to time.” That would certainly be echoed by virtually everybody I have ever been involved with in the public sector during the past 30 years. They just wish we would decide what is to be done and let them get on with it for a while before changing it again. I am quite sure that this Government have absolutely absorbed that lesson.

The hon. Member for Don Valley—[Interruption.] Will she forgive me? Once I have been in the House for a few years, I will get all such distinctions right. The right hon. Member for Don Valley (Caroline Flint) speaks from a position of great experience and great success. She spoke about the successes and the failures in the system, which we all know about, and about how the commission could look at them. Again, I am not quite sure that it could bear the weight of doing so.

The right hon. Lady addressed the political issues and how difficult some of them are. If she will forgive me for saying so, she made an intervention on the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that exemplified the point. There are difficult political challenges within parties as well as between parties across the Floor of the House, and I noticed the little challenge that was made.

I must say to the hon. Member for Oldham East and Saddleworth, who spoke with great passion about her party’s commitment to a publicly funded or taxpayer-funded NHS with no deviation from the line, that that is simply not true. It suits her to say it, but it is not true. Let me quote from an article from the New Statesman of 27 January 2015, under the headline “Labour can’t escape its Blairite past on the NHS, so it should stop crying ‘privatisation’.” It said that Alan Milburn

“serves as one of many reminders that not so long ago, during the New Labour years, the Labour party was driving through dramatic reforms in the NHS and did not shy away from private money in doing so.”

There are variations on a theme, even for the hon. Lady, and she perhaps protested about the public nature of the NHS a little too much.

[Debbie Abrahams]

I am grateful to the Minister for giving way as he did not challenge me when I made that point. Does he, however, accept that Labour stood on the platform of saying that the NHS should be the preferred provider? As other hon. Members have said, we have learned how important it is that policy driving the NHS should be based on evidence. We now have evidence that a health system with an internal market, or a marketised or privatised health system, which is what this Government are seeking, does not help to improve quality or to reduce inequity in healthcare. That was our platform.

[Alistair Burt]

Well, the platform was clearly stunningly successful. I am not embarrassed by being reminded of the Labour party’s NHS platform at the last election, because it did not succeed. For one reason or another, the public did not believe the stories run about us and the NHS, and they did not believe in Labour’s competence to handle the NHS. As we know, the amount of private sector involvement in the NHS is extremely small, and I am not sure that I accept the hon. Lady’s description of how it has all turned out. This is an example of how careful we must all be in dealing with such issues. We must not pretend to our publics that we are something we are not and that our opponents are something that they are not.

My hon. Friend the Member for Stafford (Jeremy Lefroy)—he has great experience, given the work he has done with the NHS—spoke about best practice. He wanted the commission, but again added more pressure in the things it would be doing and considering. I would make the point that such a commission happens at a point in time. I know that it would be designed to look ahead, but it would inevitably consider the circumstances pertaining at the time. We need a process for discussing the NHS and its funding—where the money is coming from and how it is spent. We need to make the process work, rather than thinking that one push into the grass will do the job. Again, I am not sure that the weight will be borne in that way.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

I am grateful to my hon. Friend for raising this issue. We share his view: we want to see greater choice in end-of-life care so that people are able to be cared for and die in the place they choose and which is appropriate to their needs, whether that is a hospice, a hospital or their own home. The recent Choice review set out a vision of enabling greater choice at the end of life. I am working with NHS England to see how this can be best achieved and the Government expect to comment on that soon.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The Health Secretary recently received a letter from a range of social care organisations and charities panning the spending review offer, saying it

“is not sufficient to resolve the care funding crisis”

and warning of an

“increasing number of older people”

without sufficient support,

“increasing pressure on the NHS.”

Will the Health Secretary finally admit that the offer in the autumn statement is just not good enough?

[Alistair Burt]

That social care was an important part of the Chancellor’s spending review was noted by all. Up to £2 billion will be available through the social care precept—that will be added to council tax—and there is a further £1.5 billion available by 2020, so all in all £3.5 billion will be available by 2020. We all know resources for social care are tight; that is why we need best practice everywhere to make the best use of resources, which many leading authorities are already doing.

Mental Health

Debbie Abrahams Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I do not share the hon. Lady’s view. Just in the last week, I have written down a list of 10 things about which I have asked the Government for figures, but about which I have been told that they do not hold information centrally. Many of the statistics that were available previously are no longer available. The central request we are making today is to restore the transparency, particularly on how much is spent on mental health, which the Government took away in 2011-12. Many Members on both sides of the House would like to know those figures.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech. On prevention, is she as concerned as I am that a recent report by the University of Liverpool has estimated that an additional 590 suicides were associated with the work capability assessment process, a Government policy, between 2010 and 2013?

[Luciana Berger]

I am fully aware of the research that my hon. Friend mentions. It was carried out by a number of academics from the University of Liverpool, including one of my constituents. I have studied the research very carefully. It highlights many areas of concern, particularly the changes and reforms made by the Department for Work and Pensions that have had a negative impact. I will address the very point she raises later in my remarks.

Nowhere is this gap between Ministers’ rhetoric and the reality more evident than when we look at investment in our mental health services. Only last year, funding for mental health trusts was cut by 20% more than that for other hospitals. In 2011-12, total investment in mental health dropped for the first time in a decade. Perhaps unsurprisingly, in the same year the Government stopped publishing how much they invest in mental health.

Last year, I had to use freedom of information requests to get to the bottom of how much clinical commissioning groups were allocating to mental health: 67% of those who responded spent less than 10% of their budget on mental health, despite the fact that mental health accounts for 23% of the total burden of disease. This year, the Minister for Community and Social Care promised to do something about this. He said he would ensure that investment in mental health by clinical commissioning groups increased in this financial year in line with the increase in their overall budgets. However, as the Government do not publish a central record of these data, I had to use the Freedom of Information Act to find out for myself. Over the past summer, I found that more than one in three CCGs were not meeting the Government’s expectation. That is just one of many Government pledges on mental health that have not been translated into reality.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right, and I commend him for the work he does on the all-party group. The truth is that it is still early days when it comes to a proper understanding of mental illness. According to the latest Times Higher Education league table, this country has five of the top 10 health research universities worldwide, so we have a huge contribution to make to that research; he is absolutely right to make that point.

[Debbie Abrahams]

I have already mentioned the 590 suicides associated with the work capability assessment. In addition, the Royal College of Psychiatrists has raised concerns about the cut to the employment and support allowance work-related activity group, given that many of those affected have mental health or behavioural disorders. According to the RCP, there is potential for exacerbating mental health issues and self-harming, and even for people to take their own lives. Will the right hon. Gentleman meet the Secretary of State for Work and Pensions to deal with this matter?

[Mr Hunt]

We have close working relations with the Department for Work and Pensions, which I shall come on to explain. I would urge caution, however, on the issue of suicide rates. The BMJ study said that no conclusions could be drawn about cause and effect from it. When it comes to work, we need to remember the many studies that talk about the improved health and wellbeing that comes from being in work, and the tremendous progress made, with 2 million additional jobs created over the last Parliament.

Dementia Care Services

Debbie Abrahams Excerpts

Wednesday 9th September 2015 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Charnwood (Edward Argar) on securing this debate, on his excellent speech and on how he approached the debate, engaging and seeking consensus. I look forward to working with him over this Parliament as co-chair of the all-party parliamentary group on dementia.

I speak today not only the behalf of the Opposition, but as someone with personal experience of caring for someone with Alzheimer’s disease. My mum was 64 when she was diagnosed and I provided her care. I have spoken about it in the past, but it has certainly informed my view and led me to want to champion the Alzheimer’s Society and working together on this issue.

I will keep my comments brief because much has already been said about the challenge that our society faces. As has been said, 850,000 people are currently living with dementia in the UK, and the number is set to reach 1 million by the end of this Parliament. It is a distressing disease because of the impact not only on the person living with the condition, but on the carers, as it affects relationships with loved ones. I was lucky that my mum was in good health for much of the time, but the first time she could not recognise me really did have an impact.

As has been mentioned, the previous Labour Government made much progress on dementia. They launched the first ever national dementia strategy, which began the process of establishing memory clinics, providing better training for staff and improving the quality of dementia care for people in hospitals. They appointed the first national clinical director for dementia and commissioned a quality standard for dementia from the then National Institute for Health and Clinical Excellence. The current Government have built on that work, and I am delighted to support the Prime Minister’s challenge. There has also been welcome progress on the number of people with dementia receiving a diagnosis. However, I want to mention three areas where we need to push for more progress.

First is awareness. People are often frightened of dementia because they think nothing can be done, but it is important to remember that, although there is currently no cure, people living with dementia can live well with the right level of support. Like so many who spoke in today’s debate, I have been a big supporter of the Dementia Friends programme. Politicians have a responsibility to lead by example in this area, and I was pleased to see that the Minister recently underwent her training.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

A year ago!

[Debbie Abrahams]

Fantastic. As the first MP to become a Dementia Friends champion, I ran a Dementia Friends session in Parliament to launch the “dementia-friendly parliament” last year.

We have also heard about the importance of involving young people. A lot of work has been done in my constituency, where, for example, the youth council has received training to be Dementia Friends. Making Oldham a dementia-friendly community is a priority of mine and, after starting with just a few hundred, we now have 2,000 Dementia Friends. I am proud that Oldham is one of more than 100 communities across the country that is working towards becoming dementia friendly, but we need to go further. Our ambition should be to ensure that everyone living with dementia feels included in their community and feels that they have control over their lives.

Secondly, we need improvements in the quality of care and support for people with dementia and their carers, which, as we heard today, is just not good enough in some parts of the country. Too often, people with dementia receive no care and their families get no support. Over the last Parliament, cuts of £3.5 billion were made to adult social care services, which have had a real impact on people with dementia and their families. Some 87% of social services departments can provide care only for people with critical or substantial need. For example, I called on a woman in her late 70s in the middle of the afternoon during one of my regular door knocks. She opened the door, looking dishevelled and confused, and had an empty bubble pack of medication in her hands. Her first words to me were, “I don’t know what I have to do.” I was able to call the pharmacy and to get support for her, but what if I had not been there? She obviously needed support and was not getting it.

Councils are doing their best to save money through changing the way that care is provided and working more closely with the NHS, but the scale of the cuts is forcing many to cut the support that would have helped to keep people out of hospital. As a consequence, more and more people with dementia are ending up in hospital, with some estimates suggesting that one in four hospital beds are occupied by someone with dementia. The NHS has also seen delayed discharges from hospital hit a record high in recent months, costing some £526 million since 2010. Once people are in hospital the support is simply not in place in the community to enable them to return home.

In 2009 the then Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), called for national care services to be developed and to be provided on the same basis as for health. He has repeated that call. We will not be able to improve the quality of dementia services until we find a solution to the funding crisis facing social care.

At a meeting with the Saddleworth carers group in my constituency, I listened to predominantly elderly carers describing the hundreds of hours of often back-breaking work that they were providing for their loved ones. They did that because no support or respite was available. How are they meant to cope? Given that the Government have delayed the implementation of the care cap until 2020, or possibly later, and have gone back on their promise to raise the £118,000 assets threshold before someone has to pay for their own care, will the Minister tell us what assessment has been done to estimate the number of families with a family member with dementia who will be affected by that between now and 2020? In addition, is the Minister committed to the Alzheimer’s Society proposal to drive up the quality of residential care for people with dementia? If so, how is that being monitored, for example in the use of anti-psychotics?

My final point is about research. Research for a cure for dementia provides hope for people in the future. In addition, however, we must focus research into the cause and prevention of the different forms of dementia, and into how we can best care for people who are living with dementia today. The Government’s commitment to double dementia research by 2025 is welcome, but we are starting from a low baseline. Other countries have shown much greater ambition.

Last month Alzheimer’s Disease International called for a significant upscale in research support, given the 35% increase in the global cost of dementia since 2010. It estimated that by 2018 the cost will have increased to $1 trillion, equivalent in size to the 18th largest economy in the world. Will the Minister report on the progress made, as has been asked by other Members?

[Philip Davies (in the Chair)]

Order. I have to ask the shadow Minister to bring her remarks to a close.

--- Later in debate ---

[Debbie Abrahams]

We need to give hope to people who are experiencing dementia and to their families.

Health and Social Care

Debbie Abrahams Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is an honour to follow my hon. Friend the Member for Neath (Christina Rees), and I congratulate everybody who has made their maiden speech today; they have certainly put the rest of us under pressure.

My right hon. and hon. Friends have talked about cuts in social care. I will start by giving an example of what those cuts mean in practice. I called at a house one afternoon during the election campaign and an elderly woman in her 70s answered the door. She was dishevelled, distressed and clearly confused. She had an empty bubble-wrap pack of medication in her hands and she said to me, “I don’t know what I have to do”. I called the pharmacist, and she came straight out, but this was clearly a very vulnerable woman on her own. What if I had not called? We saw £3.5 billion cut from social care in the last Parliament, while 87% of local authorities provide care only for people with substantial needs, and, as we know from the Institute for Fiscal Studies, the Office for Budget Responsibility and the International Monetary Fund, the pressure on public services and funding for local authorities is going to get much worse over the next three years. Some 450,000 fewer people are being supported, and the number of cases like that of the woman I called on is only going to increase.

We have also heard from right hon. and hon. Friends about the crisis in the NHS, which we can land firmly at the door of the Conservative party and the Health and Social Care Act 2012. In addition, this top-down reorganisation, which is wasting billions, is underpinned by an agenda to privatise the NHS. The Secretary of State refused to acknowledge that section 75 of the Act was entirely about compelling all health services to be put out to tender and that four out of every 10 health services put out to tender have been awarded to private healthcare companies.

At the time, the Government argued—I know because I was on two health Bill Committees—that increasing competition would improve service quality, but there is no evidence for that; in fact, international evidence shows exactly the opposite. In addition to not improving quality, we know—again from international evidence—that it will actually reduce health equity, in terms of access to care and health outcomes. Other effects of the Act have already been mentioned: hospital A&Es not meeting their four-hour targets for 97 weeks on the trot; an increase in the number of urgent operations being cancelled—up 40% on last year—and one in four people not able to see a GP within a week, or two in three in my constituency, according to a survey that I undertook. I think also of the shocking care that our children and young people have to face if they are suffering from a mental health condition—being kept in police cells or shipped hundreds of miles from their families, if they have an acute episode. And, of course, all of that is underpinned by the appalling state of the finances. Unfortunately, these trends will only increase over the course of this Parliament. The pace of the privatisation agenda will increase, and the principles of the NHS as a universal, comprehensive and free service will be under threat.

We heard the Secretary of State refer to the party mantra: “We have a strong economy, and we will have a secure NHS”. But do we really have a strong economy? We have had a flatlining economy for the past three years, with only a tiny spurt of growth in the last year, while the Government have borrowed £219 billion more than they said they would in 2010. They did not clear the deficit; instead, they broke their own law. The debt to GDP ratio is 81%. Even after a global crisis, it was only 60%. They have increased that ratio. Our productivity is the second lowest in the G7, and the 19th lowest in terms of average productivity—the worst since 1992. Where are we going to get all the money needed to invest in our health service, social care and child care?

The Government do not get it. As any successful business will say, its most important asset is its people. Our people should be valued, but instead of supporting, enabling and investing in people—in our skills, our health and our care—the Government’s approach is reminiscent of a Victorian workhouse. Amanda Story is a case in point. In her late 50s, she came to me saying she had always worked as a teacher, but that 18 months before she had been diagnosed with breast cancer. As she went through her treatment, she became more and more poorly and had to take time off work. Eventually, she was made redundant. She applied for and was granted employment and support allowance. Months later, she was also able to take her teacher’s pension. Imagine her horror when she received a letter from the DWP last December informing her that she was being investigated for fraud, because she had not notified DWP that she was now receiving a pension. In the physical and emotional rollercoaster that she was going through—cancer, treatment, redundancy—she had not realised that although ESA is a non-means-tested benefit, she was meant to inform the DWP about changes to financial circumstances. Although she explained this in her interview under caution, she was told by the authorities that she was still going to be pursued. This is beyond sense.

One thing I recognise that the Government have done very skilfully—and other parties have done the same—is to demonise certain groups of people. Using language such as “shirker” or “scrounger”, they try to point the finger at others, making us angry and likely to blame others for our lot. They have successfully created the perception that all people in receipt of social security are on the take, lazy or not worthy of support. The facts are against them. Whenever people hear this language, I urge them to think of Amanda and the thousands of honourable people like her—because tomorrow, “it could be you”.

G8 Summit on Dementia

Debbie Abrahams Excerpts

Thursday 28th November 2013 Commons Chamber

[Hazel Blears]

I am delighted that the hon. Gentleman has mentioned Plymouth, because it is one of the pioneers in this area. Plymouth, Torquay, Bradford and other towns all over the country want to ensure that dementia is not something shocking that we do not know how to deal with, and that everyone is dementia-friendly and aware. They are tackling the stigma, which is a huge issue. People do not like to talk about the fact that their families and friends are afflicted with this disease.

The search for a cure is essential. No one wants to have dementia, and everyone wants to be able to cure it. However, at the G8 I want just as much importance to be ascribed to research on the quality of care. The Evington initiative, which is backed by a number of business leaders including Terry Leahy—who used to chair Tesco—and Sir Marc Bolland are putting their weight behind that initiative. They are asking two questions. First, how can we change the system so that it is driven by users and carers rather than simply by clinicians and producers? Secondly, how can we establish a good, rigorous evidence base in relation to therapeutic interventions, quality and consistency of care and tackling stigma, so that clinical commissioning groups can be confident that the services they are commissioning actually work?

I think that the research is very exciting, but we are not likely to find a cure for 10, 15 or 20 years, and in the meantime 800,000 people are living with dementia. At present, there is virtually no evidence base relating to the quality of care. “Singing for the brain” is fantastic, but does it work, and if so, why does it work? Then there are the arts, the drama, and all the memory work that goes on. We need that rigorous evidence base, so that the commissioners can take the right packages off the shelf.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will my hon. Friend give way?

[Hazel Blears]

I am afraid that I do not have enough time.

We also need research on prevention. The Alzheimer’s Society is working on a system that helps care home staff to reduce the use of anti-psychotic drugs by intervening in other ways to deal with people’s behaviour. That system is being rolled out in 150 care homes, and has reduced the use of anti-psychotic drugs by 50%. It is saving money, and it is making a huge difference. The G8 presents us with a fabulous opportunity to press for further research. I do not want it to be a one-off: I hope that there will be another summit of this kind next year. I also hope that work will continue between now and the next summit. This issue is not going away—it will be with us for a long, long time—and it would be fabulous if we could secure that international collaboration.

I invite the Minister to visit our university institute after we have launched it tomorrow, so that he can observe the fabulous work that is being done there and, perhaps, meet some of the people in Salford who are taking a whole systems approach that I think will prove helpful.

Let me end by saying that we owe a duty to every single one of the people who have dementia or are caring for people with the condition. It is the worst thing in the world to lose the person with whom you once had a connection. We have an absolute duty to do whatever we can, here in the House and in our communities, to give those people support and help.

[Richard Graham (Gloucester) (Con)]

It is a pleasure to follow the right hon. Member for Salford and Eccles (Hazel Blears), who has spoken so well and done so much work on this subject along with her colleagues, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Sutton and Cheam (Paul Burstow). All three major parties now have at least one significant dementia champion to raise this important issue. I know that the Minister will enjoy responding to the debate, because he has covered a number of debates on the subject before. Much has been said on dementia, and much action has been taken. The right hon. Lady was right to mention the Prime Minister’s initiative and his championing of this issue. Many people are suffering as a result of dementia, not only those suffering directly from the disease, and there is still no cure, so it remains a significant challenge for science and society.

I have just a few points to add to what has already been said. The Minister will recall that I led a debate recently in Westminster Hall on what was being done about dementia in Gloucestershire and on the ways in which I believed we had adopted best practice. However, a critical question is: do we really know what best practice is? How do we measure the quality of what is being done in our local hospitals and care services? How do we measure the contribution of organisations such as the Barnwood Trust, a mental health charity specialising in these conditions which we are lucky enough to have in our area?

As the right hon. Lady said, it would be useful if the Minister could share his thoughts on a guide to best practice, not only for commissioners—although I agree that that is important—but for MPs. Representatives of the Gloucestershire family of NHS services recently told me in a meeting that they had received an award for the care and services they provided for old people in general and for dementia sufferers in particular. That was terrific news—I am always delighted when people win an award—but it would be useful to know what we are doing best, and what is being done better in different areas, so that we can have a nice, easy frame of reference. People could then see whether their area offered a four-star or a five-star dementia service, for example, and we could assess how we might attain a higher standard if we did certain things differently.

[Debbie Abrahams]

Is the hon. Gentleman suggesting that, in addition to building up the evidence base through randomised controlled trials that establish a causal relationship between therapies and outcomes, some kind of action-based research would be appropriate? Such research could be carried out and interventions could be offered and evaluated while providing the service at the same time. It would be a case of learning as we went along. Does he agree that we need different approaches because of the scale of the issue that we are facing?

[Richard Graham]

I think I agree with the hon. Lady. Different things need to be tried. Singing and music were mentioned earlier. In my mother’s case, they were the last things she was able to relate to and enjoy before Alzheimer’s closed over her. So I agree that different things are always worth trying, and that is where the charities can play a role as well.

My first question to the Minister is: could we have star ratings for dementia services and, if so, how would we identify and measure best practice? My second point relates to how we are using the Prime Minister’s initiative to get dementia on to the G8 summit agenda for the first time. We should work with other countries on this. A number of us have received briefings suggesting that the United States and France, among others, are also doing great things in dementia research. Should we not all be able to share our findings? Perhaps we could have what is known as a global inter-operative data sharing base, so that all the work being done by organisations such as Alzheimer’s Research UK could be shared, rather than being duplicated. Effort could then be spent on taking research forward, rather than replicating it.

The aim of trying to join up what organisations around the world are doing is a key reason for the Prime Minister getting this topic on to the G8 summit agenda, and I hope that the result will be an international plan involving more pooling of thinking, research and ideas. I sense that science is beginning to feel more confident about finding solutions to this ghastly disease, and if the G8 summit can give an enormous turbo-boost to pooling research and getting closer to finding solutions, the actions of the Prime Minister and the Government will have been worth while, not only for the 800,000 people in this country who have dementia today but for the many millions who will suffer in the future.

Carers

Debbie Abrahams Excerpts

Thursday 20th June 2013 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on organising this debate. I am grateful for the opportunity to speak after such thoughtful contributions. I want to focus on unpaid carers; I will leave others to talk about the care system as a whole.

As we have heard, carers play a vital role, not just for their family members and friends but for the country. In the past decade, the number of carers has grown from just under 5 million to nearer 7 million. By 2037, it is estimated that the number will have increased to nearly 9 million. In my constituency, there are 11,076 unpaid carers, nearly a quarter of whom provide care for more than 50 hours a week. As has been said, we know that this is an underestimate of the actual number who provide care. My hon. Friend the Member for Worsley and Eccles South talked about the lack of information and advice, which has certainly been identified in my constituency. Age UK in Oldham recently opened an information and advice centre, and I hope that people will avail themselves of that. Like other Members, I, too, have had the plight of carers increasingly brought to my attention in my surgeries. Their situation is a growing problem.

In today’s terms, the role played by carers saves the economy £119 billion a year. That is more than the total NHS budget and nearly six times the adult social care budget. The country could not survive without the work that carers do, and that is even more so today, with the crisis that social care is facing. We are facing the double whammy of an ageing society—it is great that we are, on the whole, living longer, although austerity is certainly having an impact on life expectancy—and a meltdown in social care in local authorities, with cuts to their budgets having an impact on social care budgets. Unfortunately, carers are picking up the tab. A recent Carers UK survey showed that a third of those caring for more than 35 hours a week have no support at all. Although 3 million carers juggle work with caring responsibilities, one in five has been forced to give up work.

In addition to the lack of support for caring, carers across the UK are starting to see the impact of the Welfare Reform Act 2012. Changes to financial support with housing and council tax in some areas mean that many families are experiencing reduced financial support from more than one of the changes. The discretionary funding set aside by councils to support people affected by the bedroom tax is enough to help only one in 10 disabled people. Carers who require an additional room because they cannot share with partners who sleep in hospital beds, or parents of disabled children who need the space for care workers to provide overnight care are being seriously let down. More than 5,000 families with care needs are faced with either moving or finding an extra £700 a year.

The cumulative effects of the economic downturn, a squeeze on wages and the increasing costs of essentials such as food and fuel, along with the cuts in social security support, are making it more difficult for carers to manage. More than four in 10 carers in the Carers UK survey said they had been in debt as a result of caring. This year will see other changes to the benefits system, as the transfer of disability living allowance to the personal independence payment and the universal credit are introduced, which is also of considerable concern to many carers. DLA was the gatekeeper to carer’s allowance. The changes mean that 10,000 fewer carers will not be entitled to carer’s allowance. Many of us have already called on the Government to review these changes and undertake a cumulative impact assessment of the effects of these welfare reforms. For many, they will be the tipping point.

In addition to that, and as a consequence of debt and a lack of support, there are significant effects on the health of carers. Eight out of 10 carers report that their caring role affects their physical health and nine out of 10 say that their mental health has suffered. This is not only a human tragedy; we are storing up problems for the future by not caring for our carers.

I know about that from my personal experience of caring for my mum—I have spoken about her before—who died of Alzheimer’s last September. She had Alzheimer’s for 10 years, and for the last three years was unable to communicate or to feed or toilet herself. Although my mum lived in the States, I provided respite care during leave, so I can personally attest to the physical and emotional toll that it had on me. In the last few months of her life she was bedridden. I am little, but I am fairly fit and strong, yet physically trying to lift her to bathe her or change her continence pads was something I found really difficult to manage. The worst thing was the emotional toll, however, as I worried how everyone was coping.

I want to spend the last few minutes talking about young carers. One of the last research projects I worked on before I was elected to this place concerned the effect on young carers’ health of their caring role. Many people will be surprised to learn that, according to recent census figures, there are more than 178,000 young carers in England and Wales. Those are the official figures, but we know that they are an underestimate. Children as young as five are looking after family members who are physically or mentally ill or disabled, their roles ranging from doing household chores to providing nursing or personal care.

The effects on those children and young people are immense and lifelong. Because of their caring responsibilities, nearly a quarter of young carers often miss school or have educational difficulties. Young carers are also more likely to grow up in poverty, to be socially excluded, to have low aspirations and achievement and to have relationship issues. Those problems can follow them throughout their lives. There is also evidence of significant effects on their physical and mental health, with anxiety, depression and self-esteem issues being particularly prevalent. It has been shown that, after a year of caring, morbidities fail to return to pre-caring levels.

Services do not always respect young carers and the role that they play. My research indicated that many young people felt excluded from discussions about their family member’s care, even though they were providing much of it. Some of the responses to questions on whether the young carers should be allowed to see their parents in hospital, for example, were quite heartbreaking. Similarly, many young carers felt that there was a lack of understanding and support from their teachers and schools. I echo what my hon. Friend the Member for Worsley and Eccles South said about this. We must ensure that schools take seriously their role in supporting young carers.

[Barbara Keeley]

I have mentioned the fact that we have a young carers project in Salford that is doing great work. It was interesting, however, that one of the schools involved came back to the project and said, “We have no young carers at all”, when the project knew that it did. The perception among some head teachers is that they do not have any. Is my hon. Friend worried about that as well?

[Debbie Abrahams]

I totally agree with my hon. Friend; that is very worrying, and we must try to do better by those young people.

I am encouraged by what the Minister has said today about the discussions, but I reiterate my hon. Friend the Member for Worsley and Eccles South’s sentiment that warm words are not enough. Will he tell us when we can expect to have the amendments included in the Children and Families Bill? The rights of parent carers of disabled children are also still in limbo, and the Government must bring forward changes to the Bill to ensure that the rights of that group of carers are not left behind. I recognise the Government’s commitment to carers’ rights, but I reiterate my earlier remarks: no matter how much we legislate for assessing carers’ needs, it is meaningless without the means to implement it. Local authority budgets have been pared to the bone, and that is having an impact on social care budgets. How are we going to deliver those assessments? A further £800 million of cuts are planned for this year alone. I would be grateful if the Minister would address that point as well.

Dementia

Debbie Abrahams Excerpts

Thursday 10th January 2013 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate right hon. and hon. Members on securing this important debate. The speeches have been moving and thoughtful. Today has demonstrated the best of Parliament, with MPs coming together and contributing to how we can resolve the dreadful issues around dementia. I am grateful to have the opportunity to speak today as, in addition to representing a constituency in Oldham where, in 2010, 2,318 people were diagnosed with Alzheimer’s, the most common form of dementia, I have personal experience of being the daughter and carer of someone with Alzheimer’s. I would like to bring that personal experience to the debate.

In September last year, my mother died of Alzheimer’s. She was only 74. In 1992, she remarried and moved to the US, and it was there, 10 years later, that she was diagnosed with the disease.

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

Does the hon. Lady agree that those who have experienced these sorts of incidences first hand can bring to debates a remarkable amount of insight to, and understanding of, these conditions? Does she also agree that it is important for us all, especially Government, to listen to those experiences, so that we might be able to learn from them?

[Debbie Abrahams]

I am very grateful to the hon. Lady for her intervention. I totally agree.

My mother was 64 when she was diagnosed and was still working. She told me that she stood in the middle of the office where she worked and could not remember why she was there. Not only did she find it abhorrent to be diagnosed with this devastating degenerative disease, but the financial consequences of having to give up her job were a severe blow too.

To watch her decline was nothing short of heartbreaking. Two years after she was diagnosed, the penny dropped for me when we went to a restaurant and she was given a menu. As my hon. Friend the Member for Bridgend (Mrs Moon) said, it is so important to make sure that people with dementia still have as much control over their lives as possible. She looked at the menu, and kept on looking at it again and again. She did not understand what she had to do with the menu—one of the practical consequences of the disease. She became a different person—not a better or a worse person, just different. As much as I loved my old Mum, I loved my new Mum too. I will remember until the day I die the first time she did not recognise me, which was about four years after she was diagnosed. She was very distressed, because she knew that I was someone of importance to her, but she did not know her relationship to me. Needless to say, the pain I felt was—well, I cannot explain.

My mother went from being a brilliant, vivacious, caring woman—a woman who invented the term social justice before it entered the lexicon—to a woman who gradually lost her ability to communicate, feed or toilet herself. In the last year of her life, she became wheelchair-bound and in her final month completely bedridden. She was unable even to lift her head and the end came shortly after she lost her ability to swallow.

In many ways we were very lucky because my mother remained physically well for so long, but also because up until the last year of her life she seemed relatively content, smiling and laughing, particularly around animals and children, as she had always been. I agree with my hon. Friend the Member for Bridgend that people with dementia understand far more and we have to find ways of communicating with them. My hon. Friend the Member for Liverpool, Walton (Steve Rotheram) also talked about different ways of engaging with people with dementia.

Unfortunately, the care arrangements in the final year of Mum’s life, and ultimately the circumstances around her death, can only be described as shameful. She was in the US at this stage. After much consideration, I have decided to talk about this now because dementia has such consequences for everybody in this country and across the world. Up until 2011, my stepfather, who is 81, had been Mum’s main carer, although he paid for a carer to help Mum get up in the morning in their New York home. I used to provide respite for him during my leave, but the physical and emotional toil and strain was taking its toll and he began looking for caring support.

That support was offered by an acquaintance of his who offered to provide care for my mum for an agreed fee. Over a few months, unbeknown to me or my family, the new carer moved into the house, got access to their finances, sold their home and drove them more than 800 miles away from my stepfather’s family in New York to South Carolina, where they knew nobody. Within a week of the move, my mum was admitted to hospital and we were told that she had days to live. When I arrived, I was shocked to see their circumstances: they had moved from a comfortable family home to what can only be described as a hovel, and the female carer had gained almost complete control over their lives. I alerted Adult Protective Services in South Carolina to my concerns for my mum’s and stepdad’s welfare on 24 August. After week’s of chasing it, including through the Governor’s office, I got a reply on 19 October saying that it deemed my father, whom it had never even met, to be competent and would not be taking it any further. Unfortunately, my mum had died by then.

My mum’s story is not unique. The stages in her decline and her and my family’s experiences are being replicated in this country and across the world. My story happened in the US and, based on my discussions with adult protection teams in this country, I am confident that the casual response from Adult Protective Services in South Carolina would not be reflected here, but there are still lessons to learn. We must ensure that the regime we set up around carers protects people with dementia from exploitation. I fear that, as has happened in other areas of the world where personal health budgets and individual social budgets have been introduced, some of the moves towards personal budgets here will lead to fraud and exploitation.

I could speak for hours about what I believe we need to do, but I would like to raise just a few points. First, as individuals, families and communities, we need to be more aware of the disease, as has already been mentioned. The odds are that most people will be affected by this disease. It might not be themselves or their family, but it might be their friends or neighbours, and we need to do more to protect ourselves against the disease. The Alzheimer’s Society is a wonderful resource, as we just heard, for information and support. We need to keep active and healthy, not smoke and so on—all the messages we know so well.

We need to do more on research. I fully support and recognise what the Government are doing in increasing research funding—it is such an important area—but the moneys being dedicated are paltry next to the scale of the problem. We need to address that. I was pleased to hear what my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said about the Wellcome Trust funding, and I hope that we can pursue that more.

Finally, we need to do far more at health and care service levels. As I said, 2,318 people in Oldham were diagnosed with Alzheimer’s in 2010 and more than 800,000 across the country. By 2020, it is estimated that this number will have increased to 1 million. Most worryingly, however, as we have already heard, that is an underestimate and is probably half the actual scale of the disease. Apart from the human cost, £23 billion is spent treating and caring for Alzheimer’s patients every year. This will rise to £27 billion by 2018 and will continue to increase. There is already a care crisis in this country, with cuts to adult care services in the NHS, and this will only get worse, not better. Care services are already at breaking point. How will families cope with Alzheimer’s? It is a ticking time bomb. I urge the Government and the Opposition to work together to reach a cross-party consensus on how we fund and deliver a national care service, and that must include the Treasury teams. We cannot afford to kick this issue into the long grass any longer.