NHS Commissioning (Pre-Exposure Prophylaxis)

Debate between Debbie Abrahams and Jane Ellison

Tuesday 7th June 2016 Commons Chamber

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

Will the Minister clarify the timescale for the decisions? Evidence reviews and trials can take months and years, but clearly, as other Members have said, people do not have months and years. Will she tell us what the process and the timescales will be, so that we can be reassured—or not?

[Jane Ellison]

We would expect to get the evidence review that we have called for in the autumn. NHS England is already working on plans for the pilot programme, which will happen over a two-year period. We hope to get that under way towards the end of this year. Both those pieces of work are under way. We expect the pilots to be informed by the review, hence we want to get it back in a relatively short time.

Dementia Care Services

Debate between Debbie Abrahams and Jane Ellison

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?

Working-Age Disabled People

Debate between Debbie Abrahams and Jane Ellison

Thursday 25th October 2012 Westminster Hall

[Jane Ellison]

rose—

[Debbie Abrahams]

I give way to the hon. Member for Newton Abbot (Anne Marie Morris).

[Debbie Abrahams]

I should also have said that I have to leave soon. I apologise because I will not be taking any more interventions, but I am happy to answer that question. What the Chancellor said in the emergency Budget in June 2010 was clear:

“It is right that people who are disabled are helped to lead a life of dignity. We will continue to support them, and we will not reduce the rate at which this benefit is paid. However, three times as many people claim it today than when it was introduced 18 years ago, and the costs have quadrupled in real terms to more than £11 billion a year, making it one of the largest items of Government spending.”—[Official Report, 22 June 2010; Vol. 512, c. 173.]

As my hon. Friend the Member for Aberdeen South said, there will be a 20% reduction in the number of people who are able to have a disability-related benefit awarded to them, and significant savings, again, can be identified within the Government’s impact assessment.

I want to unpick what the Chancellor said in that statement. He was, and is, saying that even if the prevalence of people with disabilities has grown by three times—there was a very unpleasant undertone implying that it had not—sorry, folks, it is just not sustainable. That is the key message that has been coming through, as my hon. Friend made clear. The impact assessment on the personal independence payment was, again, telling. It said:

“The new benefit will help to ensure that expenditure on DLA is sustainable and resources focused on those most in need of additional support.”

It goes on to assert that although there is an association between low income and poor health, there is limited evidence that providing money will improve health, which is correct. However, it continued:

“It is possible that the policy could have positive impacts on health if it leads to more disabled people moving into work.”

That, too, is very telling. First, the evidence was deflated or inflated, depending on what it said, to support the policy to get rid of DLA and replace it with PIP. The evidence was clearly manipulated and the lack of a comprehensive evidence base is shameful; my hon. Friend referred to that. There is real concern that the policy is being railroaded through. As we have discussed, there are a number of independent disabled people who are able to work. That is absolutely fantastic, but there are also some very vulnerable disabled people. The benefit should take them into account as much as it does those who are independent.

Secondly, the impact assessment makes an association with the positive impacts of work on health—which again, there are—when DLA has always been about helping contribute to the extra costs of being disabled. It is not an out-of-work benefit, so that relates to shifting the mindset of what the change is about. That is so important. The allowance has always been about supporting people with disabilities to lead as normal a life as possible.

For the record, the evidence on the trends in disability reflects our industrial heritage. The regions with heavy industries and occupations that did people’s health no favours have the highest rates of disability and ill health. There are diseases such as coal miners’ pneumoconiosis, asbestosis and silicosis. Of course, many of those diseases have long latencies, and there are industrial accidents that Members will be familiar with. Most work is good for people’s health, but not all, and there is strong evidence about that.

As I have said, we can agree—there is consensus across the House—that the DLA system, as it stands, is flawed. For example, a clear system for reviewing some awards is needed, but we should not restrict the access to support to overcome the barriers to day-to-day living that a person with a disability faces. That is what we need to address.

As I said before, the Government’s own estimates predict that more than 500,000 people will not receive this support. As many expert witnesses in the Select Committee’s inquiry concluded, cutting DLA is nothing more than a cost-cutting exercise. It is part of the wider erosion of the welfare state. As has been said, public buy-in is achieved by changing our view of what welfare is about. Unfortunately, the Government have a willing accomplice in the media to help them to do that.

I am really disappointed. We have talked about the role of the media. We have done a number of reports highlighting the importance of the media’s role and of responsible press releases and statements. However, this morning on the “Today” programme, the Secretary of State was talking as though people who are claiming benefits are a drain on society. It was a very inaccurate portrayal of benefit recipients. It was an attempt once again to suggest that the majority are workshy scroungers when the facts are that most people on benefits are in work and most are net contributors to the Treasury. That was not being reported; it was as though people were really abusing the system. There have been a number of such reports, and that has to change.

In addition to the reporting and the way in which attitudes to welfare are being changed, a system is being created in which people on higher incomes see themselves as separate to or outside the welfare state. We are not in post-war Britain. At that time, there was buy-in to the welfare state by everyone. Everyone saw themselves as contributing to and gaining from it. We were literally all in it together.

The final issue—this happened in the US under Reagan—is the putting in place of policies whose implications are unclear. Little has been done to assess the impact on the people they will affect. We have talked about the shameful impact assessment. My hon. Friend the Member for Aberdeen South talked about the lack of information available on the implications of this benefit change.

Despite a detailed, evidence-based inquiry by the Select Committee, the Government have rejected our recommendations out of hand. They seem determined to press on with what they are doing. I really have concerns about that. My hon. Friend mentioned the case in which a coroner reported that a suicide could be directly attributed to the pressure that was felt by someone with mental illness as a result of having to go through the work capability assessment. Is this really the type of society that we want to live in? I ask that question because I have—

[Jane Ellison]

Will the hon. Lady give way?