Dementia

Lord Allan of Hallam Excerpts

Thursday 18th January 2024 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the noble Baroness, Lady Browning, for this debate. There are some repeated themes to our questions and debates that we need because these are complex challenges affecting millions of people that require a hard slog and real attention to detail. I have learned a lot about the specific challenges and solutions from all the speakers in the debate.

I will first return to some of the issues raised in the Oral Question on social care today. The noble Baroness, Lady Donaghy, rightly flagged it is not just the number of care workers, but their skills, which are quite different for carers who have to deal with people with dementia. I hope the Minister will talk, as he did earlier, about the Government’s intention to upskill care workers.

On the numbers, it is important that much of this care will be delivered in the home, over the long term, yet the skills care data shows that vacancy rates are higher in the domiciliary sector than in care homes. They are still running at over 10% and are barely improving. Does the Minister agree that we need to make social care roles more attractive, which must involve decent salaries that increase as skill levels increase? Is he concerned about the acute problems in the domiciliary sector? The numbers suggest that the Government’s actions to date have not had the same effect there that they may have had in care homes.

Another key issue that I want to raise is around long-term conditions generally and specifically dementia. There is a lot of discussion about who pays for these services and which budget they come from. The noble Baroness, Lady Berridge, highlighted this with a very graphic example. The questions are about who pays, where the budgets sit and, critically in this area, self-pay, which was referred to by the noble Lord, Lord Warner. These questions are still wide open; they have not been resolved. No one can say, hand on heart, that they understand what the long-term path is when someone has a diagnosis, who is going to pay for their care and how that will be resolved over the long term.

The split between the NHS and local authorities has long been recognised as an issue. Integrated care boards have been highlighted as the solution that bridges that divide. Can the Minister say how this is going for dementia services? Are there now examples of real pooling of resources for patient-focused services, which is the promise of the integrated care board? The noble Lord, Lord Weir, talked about the example of Northern Ireland, and my fear is that people are already queuing up to see the integrated care boards fail and that they will be booking another reorganisation of the NHS in England.

The example of Northern Ireland given by the noble Lord, Lord Weir, was very telling: he said that no one would go back. I hope that we do not go back; I am not wishing for that outcome. However, unless we see real pooling of resources, real patient focus and a genuine overcoming of this crazy divide where some public money is in Pot A and some in Pot B, we will not have made the progress that we needed. I hope the Minister agrees that dementia services in particular are a prime example of a test case on whether ICBs can deliver the promise that was in the legislation.