Dementia

Hazel Blears Excerpts

Thursday 10th January 2013 Commons Chamber

[Hazel Blears (Salford and Eccles) (Lab)]

I am grateful for your guidance, Mr Deputy Speaker. It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow). In my capacity as vice-chair of the all-party parliamentary group on dementia—the right hon. Gentleman elevated me in his speech; our group is incredibly well led by Baroness Sally Greengross—I want to pay tribute to his work in this field. I appreciated his personal drive on this issue; it has made a big difference. I should like to thank the Backbench Business Committee for allocating the time for this debate. I should also like to thank all the Members here today. This is a fantastically good turn-out for a one-line Whip, Back-Bench business debate on a Thursday afternoon, and it indicates just how deeply people feel about this issue. The hon. Member for Chatham and Aylesford (Tracey Crouch) has been a tremendous help on the all-party group, and I am delighted to be vice-chair alongside her. Her personal drive and commitment have made a big difference.

Nearly 1 million people will be living with dementia by 2020, and the issue now touches the lives of virtually every family in Britain. It is a big issue for the NHS, but it is also a big issue for all the public services. I entirely endorse the right hon. Gentleman’s point that we have to join up the services right across Whitehall if we are going to make the progress that we need to make.

Ten years ago, when I was a Health Minister, it is fair to say that dementia was not at the top of the agenda for Ministers or for the NHS. As ever, there were more pressing issues, such as cancer, heart disease, waiting lists, maternity services—the list goes on. The voices raising the issue of dementia, and of care for older people more generally, were not heard as clearly then as, thankfully, they are today. This is now a massive challenge facing all of us, and I believe that increasing pressure from the public has helped to focus the minds of politicians and practitioners on what can and should be done to support those with dementia and, crucially, the people who care for them.

I also want to depart from normal practice and pay a warm tribute to the Prime Minister. He has put his personal weight behind this issue, and I know from having been a Minister that having the Prime Minister behind a project can give it momentum and get the system moving. It can provide a kick-start and a catalyst. I want to say a genuine thank you to the Prime Minister on this issue. That does not mean that there is not much more to do, and there are certainly concerns about ongoing funding issues, but having the Prime Minister say, “This is my challenge; I am behind it” will get things moving in the system.

Like most people, I got involved in this issue because someone I love has dementia. It is my mum. Over the past five years, I have seen and experienced the impact of that on her and on my dad, who, at the age of 83, is still her full-time carer. I want to raise three issues today. I want to talk about diagnosis, support in the community and the research challenge that we face.

My mum’s diagnosis was absolutely appalling. She had been having problems with her memory for about a year and a half and, like many people, she thought that it was just because she was getting older that she could not remember day-to-day details. However, when she could not remember the day of the week and when she started constantly to repeat herself, we as a family thought that she would benefit from a bit of expert advice.

Mum’s GP was not bad. He referred her to the mental health team for older people. She was just 70 at the time. What happened after that, however, was absolutely terrible. My mum and dad received a visit from a local psychiatrist whom they had never met before. She sat herself down on the settee without any formalities and proceeded to ask my mum 10 questions about the day, the date and who the Prime Minister was—I can think of lots of people who would not have known who the Prime Minister was—and after just a few minutes, announced to my mum and dad that it was very clear that my mum had Alzheimer’s. As Members can imagine, they were stunned and upset. They had no idea what that meant for them or what the future might hold. They were frightened and bewildered.

That was just the kind of brutal diagnosis that we used to hear about in relation to cancer sufferers, but here it was happening to the people I love. Suffice it to say that, after a formal complaint, we did not see that psychiatrist again, but the incident brought home to me how many people in those circumstances are subject to such hurtful and damaging insensitivity. Better dementia diagnosis has to be a priority. Yes, this is about earlier diagnosis, but it is also about sensitivity, understanding and finding the right circumstances in which to make a diagnosis that will fundamentally affect people’s lives.

Diagnosis rates in this country are low and incredibly varied. In general, just over 40% of people with dementia receive a formal diagnosis. The lowest rate is 26%, in Dorset, and the highest is nearly 70%, in Belfast. There must be a reason for such a dramatic variation. We have made little progress in recent years towards driving up diagnosis rates, yet diagnosis is key, because without it a person cannot gain access to the support services and the help that they need.

[Sir Tony Baldry (Banbury) (Con)]

Is it not part of the problem that many GPs are anxious not to diagnose dementia because they feel frustrated that they do not know what to do following such a diagnosis? They do not know what to offer the patient, and there seems to be an inclination to avoid that frustration by not making a diagnosis of dementia at all.

[Hazel Blears]

The hon. Gentleman is absolutely right. In fact, the recent all-party group inquiry into diagnosis revealed exactly that situation, which is a real concern. Many GPs are uncomfortable about making a diagnosis of dementia. They sometimes feel that such a diagnosis is pointless if the necessary drug treatments or wraparound care and support services are not available. Increasing the confidence of GPs at that point to enable them to make a diagnosis is of fundamental importance.

The figures on diagnosis are quite stunning. Only half the GPs questioned said that they had sufficient training in this area, and a third of them believed that a lack of access to drug treatments was a barrier to early diagnosis. Almost a third were not confident about making a diagnosis of dementia, and only a third felt that they had had enough training to go through the diagnosis process. Unless we tackle that, we will not get the increase in diagnosis that the Prime Minister and all of us want.

[Nick de Bois (Enfield North) (Con)]

I have listened carefully to what the right hon. Lady has said. She mentioned that Belfast had a high rate of diagnosis, at 70%. The figure in my constituency is around 36%. During her inquiry, was there any attempt to establish why best practice or prevailing factors could not be transferred and learned across the spectrum, in order to improve the situation?

[Hazel Blears]

Yes, there was. The all-party group had an interesting presentation from the Scottish Health Department. Diagnosis rates in Scotland are very high indeed, and we learned that the highly organised, managed and focused system there was driving up diagnosis. It is driven, to some extent, from the centre, and I know that that is not always popular these days, but the drive from the centre out to the GPs is really making a difference. I think that there is room for us to adopt a more driven process—it need not necessarily be more centralised—in which GPs are more accountable and in which they report back on rates of diagnosis. There is much more that we can do in that regard.

Diagnosis is a problem, but once a diagnosis has been made, the availability of support in the community becomes relevant. There are many problems in that area. Our inquiry revealed that many carers felt that nothing happened after the diagnosis, because there was no help or support available. In my area in Salford, we are lucky. We have one of the 10 national demonstration projects established under the national dementia strategy in 2009, and we are developing some really innovative services in the community. I should perhaps declare an interest: my mum attends the centre two days a week, and I sit on the strategic board that drives the process there. I have seen that when people are really committed to such projects, they can make a huge difference.

Our centre is the result of a partnership between the local authority and the Humphrey Booth charity, which has existed in Salford since the year 1600. It is a marvellous example of people working together. The centre is known as the Poppy centre, and its facilities include a dementia singing group, on a Wednesday, which attracts 150 people. That is an incredible resource. The centre also offers day centre services, art work, music, personal tailored care, a dementia café for when friends and family drop in, living history, hairdressing and hand massage. It is a wonderful place, staffed by brilliant people.

[Alison McGovern (Wirral South) (Lab)]

I apologise to my right hon. Friend and other Members because I cannot stay for the whole debate. The lesson I have learned from her expertise and from the evidence I have heard about Salford on this and other occasions is that we cannot think in the old way about how we help people with dementia; we have to be creative and provide the best range of services possible.

[Hazel Blears]

My hon. Friend is absolutely right. We are at the beginning of the kind of innovative care that she talks about. One thing we need to do is to get more young people and more young clinicians involved in this area, because that is how we will see innovation coming through.

We have a brilliant centre in Salford run by the manager Sue Skeer. There is also Sue Smyth and Nicola Fletcher, and users and carers are on our board. Margaret and Fred Pickering are an inspiration: Fred has dementia, Margaret is his carer and the whole of our practice is driven by users and carers at the centre. We are lucky, but many places have nothing like the Poppy day centre to support them.

We want to make Salford a dementia-friendly community and to make sure that transport, housing, leisure and local shops are all aware of the issues around dementia. My local university in Salford is setting up a dementia centre—a collaboration between the department of the built environment, including architects, and the department of social care. Design is being looked at really seriously. A marvellous Italian Professor Ricardo Codinhoto and a wonderful nurse, Natalie Yates-Bolton have inaugurated not just the design centre at Salford university, but now a European collaboration so that we will have an international design network on how we can make dementia-friendly communities work.

My question to the Minister on dementia-friendly communities, which we hope to be in Salford and which York, Plymouth and other places are pursuing, is: what resources have the Government committed to support the work of these communities, and how will it be sustained in the long term? We can push on, but we need a resource to make it happen. Yesterday, I met Duncan Selbie, the new director of Public Health England, who is going to make dementia a national priority for public health, so there really is commitment and energy behind all this. I want to hear from the Government what they can do to help.

Let me briefly cover my second theme—I have accepted two interventions—which is about the research challenge. I met the Wellcome Trust this week, and I was hugely encouraged by its willingness to put serious research funding into this area. It is looking not just at clinical research, which it might have done in the past, but at research on “living well with dementia”, recognising the importance of a holistic approach. I was impressed, too, when I met David Lynn and Dr John Williams. They acknowledged the difficulty of this area because there is so much that we still do not know about the brain. Nevertheless, despite the failure of the recent clinical trials, the data from them could prove very useful in taking us forward to the next steps, which we hope will help us find drugs that will at least slow down or delay the onset of Alzheimer’s. What everyone who has Alzheimer’s wants is a cure; they are desperate to get some progress here.

If we have a really big push on research, I feel that progress could be made. Our scientists are some of the best in the world in this area, yet for every six scientists working on cancer, only one works on dementia. Only 2.5% of the Government’s research budget goes to dementia, with 25% going to cancer. We should look at the progress made in cancer over the last 20 or 30 years; I do not want to wait another 25 or 30 years to make the same progress for the hundreds of thousands of people who are suffering from dementia now. The Government really must press on.

There are many people out there who want to help us. Just this week, the Daily Mail featured a long article about the possible benefits of coconut oil and the work done on that at Oxford. I have no idea whether that is likely to help people. It has helped some families, but we can see from that the absolute desperation people have to try to find something that can help the life of their loved one. Research is thus a huge challenge, as is help in the community.

I want to express some concerns about where we are at the moment. It is a time of great change in the health service. We are moving from primary care trusts to clinical commissioning groups, and it could be a time of instability. I am worried about the expertise—or lack of it—in the clinical commissioning groups when it comes to commissioning for something as complex as dementia. I want every CCG to have a lead for dementia, developing expertise and knowledge so that they know how to get the best from the money available. I would like to hear the Minister say that he wants to see a dementia lead in every CCG.

My final point is about the resources available to us. Over the last three years, my local authority has faced cuts of £876,000—30% of the adult social care budget. I know the Government will say that they have put £1 billion back in and that £1 billion has been lost, but when the budget is not ring-fenced, it can easily get spent on other issues. It is virtually impossible for councils to meet their targets without looking at the adult social care budget, which is 40% of their overall expenditure. That is why we can see day centres closing. They are an essential support network, providing a lifeline for carers, yet they are being cut. I am very worried indeed—not just about local authority cuts, but about buddying services provided by Age Concern. These voluntary and third-sector groups, so essential to people, are now quite fragile.

I am sure that the future funding of social care is going to be discussed. I make a plea: please may we have the cap at a level that helps the majority of families that need to be helped? If it is set at £75,000, I will be worried that those who really need the help will not receive it.

I think we are now at a point where progress can be made of the kind that has probably not been made for years. I really hope that we can press forward on a cross-party basis. We need a long-term settlement so that we can support people at what is probably the most difficult and frightening time of their lives.

I remember what it felt like to discover that my mum had dementia and that her future would be so different from the one that her and my dad planned together. We have been lucky in that we have been able to speak up and get help and support from the fantastic caring people at the Poppy centre, but it is hard for many people who might not have a strong voice or someone to advocate on their behalf. My mum instilled in me that sense of justice and fairness, which has driven me throughout my political life. I know that she would want me to continue to fight for all those who often find themselves bewildered and powerless, and to make sure that they are treated with care and dignity. We owe them all nothing less.

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[Steve Rotheram (Liverpool, Walton) (Lab)]

Nothing I say will equal the power of the contribution of my hon. Friend the Member for Bridgend (Mrs Moon)—a personal account that I am sure will resonate far beyond this place. I congratulate members of the Backbench Business Committee on choosing this important topic for debate and praise the spirit in which Members in all parts of the House have engaged with issues of dementia.

This topic is particularly close to my heart. Anyone who has watched helplessly as a loved one battles with dementia, often forgetting your name and your relationship to them, knows the agony that is felt and the feeling of hopelessness. As people will know from their own experiences, it is all the more painful when it is a close relative, especially when, as in my own case, it is your own mother who is suffering from this cruel condition. Words cannot begin to describe the heartbreak of seeing a vacant expression etched across the face of a person once so full of vibrancy as they struggle to fathom what is going on or why they feel in such a strange state of confusion.

As I was coming to terms with my own mum’s condition and the fact that this condition had stolen her mind, I was left with the same unanswered questions that thousands are now asking: why was she not diagnosed earlier? Why did not my brothers, sisters and I recognise the signs earlier? Why was there not better advice on the different treatments available? Why was the support that she received from relevant authorities at best patchy but at worst totally inadequate? My mum was not lucky enough to have had the expert advice, care or treatment that is available today when she died.

We can ill afford to kick social care into the long grass and avoid the realities of an ageing population that will undoubtedly present challenges for dementia health care professionals in future. With no new treatments having been released on to the market for 10 years, it was right for the Prime Minister to guarantee money for research by the Alzheimer’s Society following the work of the national dementia strategy presented to this place by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and rightly highlighted by the right hon. Member for Sutton and Cheam (Paul Burstow) in his opening speech.

Today I want to talk about ways in which the city of Liverpool is sourcing innovative treatments for dementia. It is estimated that the number of people in Liverpool with dementia will rise from 4,382 in 2010 to 5,209 in 2021, ranking the city third highest in the north-west. Alarmingly, of those in Liverpool who were suffering from dementia in 2010, only 51% had actually received a diagnosis. That means that almost half of our city’s dementia sufferers were unknowingly living with this debilitating condition. That is why in our city we have decided to tackle dementia head on as part of Liverpool’s decade of health and well-being, which was officially launched in 2010.

Although most hospitals treat dementia patients by using a group of medications called—I wrote this down earlier thinking it would be easy to deliver in Parliament— cholinesterase inhibitors or the drugs donepezil and memantine, in Liverpool we have tried and successfully tested the use of art and culture in dementia treatment. Our non-pharmaceutical approach to dementia treatment is a unique model and one that other cites and regions across the country may wish to follow as they cope with increasing demand on decreasing resources.

After Liverpool’s highly successful year as the European capital of culture in 2008, we worked with international partners to collate evidence that proved that art and culture have the potential to improve well-being and have a positive role to play in mental health care.

Museums and art galleries are the gatekeepers to history. They play a crucial role in society, which is to protect and preserve what has gone before so that we can learn for the future. During our evidence-gathering we received a report entitled, “Museums of the Mind”, which encouraged museums to think about the role that they could play in their local communities with regard to mental health issues more broadly. National Museums Liverpool recognised the growing problem with dementia in our city and decided that it wanted to work specifically on the issue, drawing on the expertise of the Museum of Modern Art in New York, which ran an internationally acclaimed programme where gallery staff engaged with individuals living with dementia. And so House of Memories was born on Merseyside.

The scheme is training and delivering programmes built around the objects, archives and stories held in the Museum of Liverpool. The idea is to provide social and health-care staff with new skills and resources to share with people living with dementia and to promote and enhance their well-being and quality of life as a potential alternative to medication.

As the total cost of dementia to the UK economy rose to a staggering £23 billion in 2012—a figure that is unsustainable in an age of austerity that has been extended to 2017 by this Government—the work of National Museums Liverpool is a blueprint for other cities and regions to follow as we look to improve dementia care and reduce the cost to the NHS. As always, however, funding pressures are endangering the future of such innovative programmes. I believe that Liverpool’s non-pharmaceutical approach can and should be adopted by other cities and regions in the United Kingdom, thereby saving millions of pounds for the NHS.

One of the most worrying aspects of dementia care is the fact that public awareness of dementia remains scandalously low and that we as a society almost ignorantly allow dementia to be excused as nothing more than the ravages of old age. Liverpool therefore began by drawing together a partnership of major businesses from a variety of sectors that went beyond health care professionals and included many organisations from our thriving cultural sector. This meant that Tate Liverpool, the Bluecoat and the Liverpool biennial festival worked alongside Liverpool universities, Age Concern, BBC Radio Merseyside, the police and fire services and charities such as Dare to Care and Crossroads Care.

Last year the decision was taken by Liverpool Hope university, in conjunction with the chief executives and managers of Liverpool city council, the Alzheimer’s Society, NHS Merseyside, Mersey Care NHS Trust, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool Community Health NHS Trust and Age Concern Liverpool and Sefton, to dedicate 2013 as the year of dementia, as part of Liverpool’s decade of health and well-being.

Liverpool’s ability to make a difference for dementia patients would not be possible were it not for the excellent work of the Alzheimer’s Society. When I was the lord mayor of Liverpool, I chose the Alzheimer’s Society as one of my five sponsored charities and was extremely proud to award it with its largest ever cheque at that time of £115,000, in recognition of the vital work it does in our city.

[Hazel Blears]

My hon. Friend is making an incredibly innovative speech about developments in Liverpool. He mentioned the Alzheimer’s Society. Does he agree that without the drive, commitment and imagination of the Alzheimer’s Society, we would not be seeing the current progress and momentum?

[Steve Rotheram]

My right hon. Friend is right. It is not until somebody who is close to you needs the support of services such as those provided by the Alzheimer’s Society that you understand just how good and supportive they are. When I gave the Alzheimer’s Society that money as lord mayor, I also gave money to Alder Hey children’s hospital. It is much easier to raise money for sick children than for people whom some others see as just getting a bit old and going a bit loopy. That was one of the accusations against my mother. People said, “She’ll be okay, she’s just losing it a bit!” That is not the same thing as dementia. That is why it is important to raise awareness of dementia and why it is fantastic to see that this debate has been so well subscribed to.

In Liverpool, the Alzheimer’s Society facilitates services for dementia patients that use art and culture to assist sufferers and their carers in better understanding the condition. For instance, dance therapy is offered which invites

“movers and shakers of all ages to come and enjoy themselves and shake off the shackles of dementia”.

Additionally, multi-sensory stimulation is provided through art therapy and music therapy, which stimulate emotional, social and cognitive connections between dementia patients, their carers and their families. There is also a memory clinic, like those mentioned by the hon. Member for Chatham and Aylesford (Tracey Crouch), in Walton in my constituency, which is a weekly meeting that offers support, advice and guidance to sufferers and their loved ones.

In other words, Liverpool is dedicated to a creative approach to stimulate rather than medicate dementia patients wherever possible, and to prolong their quality of life as much as is possible. I hope that Members will use the example set by Liverpool to encourage similar partnerships across the cities, towns and communities in their regions. A recent participant in National Museums Liverpool’s House of Memories scheme recalled a lesson that they had learned as a member of the programme, which MPs may wish to consider on leaving this debate:

“The House of Memories scheme has enabled me to come into the world of the person living with dementia, rather than expect them to enter mine. After today, my approach will be very different.”

By changing the emphasis of dementia treatment to a more pioneering approach such as the one successfully tried and tested in Liverpool, we can begin to change the stigma of dementia and improve patients’ lives. In doing so, we can aim to educate sufferers about the advantages of owning up to the problems that they face and improve the rates of early diagnosis, while at the same time ensuring that the wider public are more aware of the early signs of the condition. Only then can we, as a society, forgive our collective ignorance and really begin to support our patients and dedicated carers in tackling this country’s fastest growing health priority.

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[Sarah Newton]

My hon. Friend makes his point well. I know that other hon. Members have very worthwhile points to make, so I do not wish to take up too much of the limited time available. However, I wish to make just a few points about how we in Cornwall are rising to the Prime Minister’s dementia challenge. It is right for us to set strategies nationally and to agree nationally on the overall frameworks to tackle one of the greatest challenges of our century. However, it is also important to look for the solutions locally. We should set the strategies nationally but enable everybody in communities around the country to come together to find their solutions. As the right hon. Member for Sutton and Cheam (Paul Burstow) rightly said in his opening remarks, we will all have to rise to the challenge. Every single part of society and every part of the public sector has its role to play. Indeed, as my hon. Friend the Member for Chatham and Aylesford said, the private sector, including supermarkets and other organisations in the public domain, has an important role.

What have we done in Cornwall of which I am so proud and which I want to share with right hon. and hon. Members? Let us start with the NHS, because when people seek a diagnosis that is where they start off on their journey with dementia. We have set up the Kernow clinical commissioning group, which is very successful and has got off to a flying start. It has attracted a large sum from the dementia challenge—well over £500,000. What is it doing with that money? It is working very effectively in partnership with other parts of the public sector, voluntary organisations and other parts of the NHS to ensure that there is an integrated, joined-up approach in Cornwall.

The CCG has targeted an issue mentioned by many Members, which is the need to ensure that everybody working in health and social care is properly trained, from carers through to doctors and nurses in the acute sector, to ensure that they are aware of dementia and how to talk to and relate to the people with this condition with whom they come into contact, as well as their families, friends and informal carers. The group is also using the money to ensure, among other things, that from the moment of diagnosis of dementia through to the end of life, sadly, there is a named individual available for that person and their family and carers. Obviously, it is early days as it just got the funding in November, but its ambitions are very important and will make a real difference to the quality of life of families in Cornwall.

Another issue that has been mentioned today is the lack of care from some nurses in parts of the acute sector. I want to share with hon. Friends a great initiative in the Royal Cornwall hospital, which is our only acute hospital in Cornwall. The friends of the Royal Cornwall hospital, who have worked so well with nurses, doctors and managers over a long period, are addressing some of the issues raised today. They have a very good system of mealtime companions, specially trained volunteers who work alongside care assistants and nursing staff. When the staff are too busy, they provide the extra time, care, compassion and consideration that needs to be given to a range of patients, including those with dementia, to ensure that they have a drink and something to eat. The hospital is also open to family members and others at mealtimes. I recommend that hon. Friends take that issue up with their hospital trusts and use the example of Royal Cornwall, which has clearly found a way around the problem.

The voluntary sector and society as a whole will have a hugely important part to play. Like many other hon. Members who have spoken, I am involved with the memory café in my constituency, in Falmouth. There are 24 other memory cafés in Cornwall and they are really important. People with dementia and other memory loss conditions, their families and their carers can come along to a safe, supportive environment, have some fun and do some interesting activities, talk to each other and get information. That is very important.

In Cornwall, we are fundraising for Admiral nurses. Those Members who have Admiral nurses in their constituencies will know the very important work they do to support families in much the same way as Macmillan nurses support cancer patients and their families. Admiral nurses provide an invaluable service for people with dementia and I shall be working hard alongside those who are fundraising so that we soon, I hope, have Admiral nurses in Cornwall.

I could talk about a lot of things, but for the sake of brevity let me simply say that many of the activities I have mentioned must be co-ordinated and planned. I want to reassure my Opposition colleagues that that is possible. Our health and wellbeing board in Cornwall has got off to a really good start. It works very closely with public health providers and all the different parts of the community, from housing to environmental health, to pull together a strategy for dementia and turn the good ideas and aspirations into action. I see the reforms to the NHS giving a great deal of power to doctors, other health professionals and people across the public sector to come together to work in partnership to deliver local solutions that work for communities. Salford is quite different from Cornwall and we all need to work together to find what works in our communities.

A great deal of good work has been going on in Cornwall and will continue in years to come, but I am not complacent. We are a part of the country with a fast- ageing population and have yet to find ways to diagnose dementia accurately. We have some of the lowest levels of detection of dementia. I will work hard with colleagues in Cornwall in all sectors to drive that up.

[Hazel Blears]

Like the hon. Lady, I am keen to foster the sense of consensus and cross-party working on this essential issue, but the elephant in the room in this debate is the severe cuts that have had to be made to local authority social care over the past three years—nearly £1 million in Salford. I wonder how in her community in Cornwall, which will be facing similar issues, she is dealing with the impact of substantial cuts in day-to-day care.

[Sarah Newton]

I thank the right hon. Lady for that question, because it gives me a good opportunity to praise Cornwall council. Undoubtedly all local authorities are facing tough decisions as a result of having to make cuts. There have been no politics in this debate so I will not go on to say why we are faced with the mess and why we have to make those difficult decisions, which I am sure we would rather not have to make. Cornwall council has not cut at all its expenditure on adult social care.

It gives me great pride to be able to stand up here and publicly thank Cornwall council for that. It is making sure that every penny that it receives from the Government—every single penny of the extra money to integrate NHS services with Cornwall council’s adult social care service—and the entitlement money and the money for carers’ respite is being spent. The council is not cutting front-line services for the most vulnerable people. The current settlement coming from the Government is increasing the amount of money into Cornwall for further improving and integrating the quality of care between adult social care and the NHS.

Those of us who have been around this subject and who have been campaigning on it for years, which includes many of the Members in the Chamber, know that the future lies in joined-up, integrated services. It is not about throwing ever more millions of pounds at the problems. It is about being smarter and wiser and linking all those services around the patient, the carers and the families. That is what is going on in Cornwall.

To summarise, I am in no doubt about the challenges that we face and I am not at all complacent. We need to build on the very good momentum and leadership shown by the Prime Minister on the issue to ensure that every family and everyone suffering from the condition gets the best possible care from us.