Dementia Care and Services
Debate between Norman Lamb and Hazel Blears(10 years, 10 months ago)
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Norman Lamb
That was unexpected; I have never had this happen to me before, so I apologise for looking confused! I shall carry on.
It makes sense to understand the success—and, indeed, sometimes the failures—of the current strategy and the Prime Minister’s challenge before designing what follows on afterwards. It is absolutely clear—I have tried to demonstrate this on other occasions—that something must follow; there must be a continuation. This disease has such a profound impact on people and on society that we have to keep developing our understanding and maintaining the momentum.
Hazel Blears
I am grateful for the Minister’s commitment that there will be a follow-on from the dementia strategy. He is right to look at what has worked and what might not have worked quite so well. My concern is that whatever comes next must find a way of uniting the whole system. In proceedings on the Care Bill, we debated integration and how important it was, particularly for dementia, because it will save us money. When the Minister looks at the next set of strategies, I urge him to bear in mind that the country must not have in place a set of fragmented relationships that are not bringing the system together to make things better for people with dementia and their carers. The economic impact on the country is also important.
Norman Lamb
I very much agree with the right hon. Lady on that. I think that what she argues for is developing. We are not there yet, but it is important that we have developed this ambition to achieve a diagnosis rate of two thirds, which encourages every part of the system to focus on what it needs to do. It is not a nationally imposed arbitrary target; it was based on getting every part of the system to think about what it can achieve by setting ambitious objectives. Collectively, that amounts to an ambition to achieve a two-thirds diagnosis rate, but in itself, of course, a two-thirds diagnosis rate is not good enough. We should not be satisfied when we achieve that; we have to press on. We know that the community in Gnosall has a diagnosis rate of close to 100%, so we should not be satisfied until everyone is getting properly diagnosed on a timely basis. I agree with the right hon. Lady’s point. Under the new system, with the health reforms making clinicians much more involved in the commissioning of care locally, there is a greater chance of getting the engagement of general practice across the country than we perhaps had in the past through the primary care trust route.
Norman Lamb
My hon. Friend is absolutely right and there are still GPs who do not really believe in the importance of a timely diagnosis. I have heard GPs say, “What’s the point, because it will make no difference?” However, we know it does make a massive difference not only to the person with dementia but to the rest of their family, in understanding the condition and what they can do to help. Education among GPs is incredibly important, and attitudes are changing but we still have a way to go.
Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.
Health Education England has prioritised dementia training and has already delivered 100,000 dementia-trained staff. Again, ensuring the work force within health and care have a proper understanding of dementia is critically important.
Hazel Blears
I am pleased the Minister has now come on to the area of the work force. He will know that many of the carers in this area are paid the national minimum wage if they are lucky. Many of them are on zero-hours contracts. Many of them do not get paid for travelling between the appointments they undertake. We ask them to do some of the most difficult work that one can ever imagine but the rewards and the training and support they get is minimal. Is the Minister committed to tackling some of these issues in the care sector, which in my view are unacceptable?
Norman Lamb
I feel as strongly as the right hon. Lady does about this. We can never get good care on the back of exploiting very low-paid workers. It is not acceptable to not pay a care worker when they are travelling from one home to another. That is a breach of the minimum wage legislation unless their rate overall comes above that level. HMRC has specifically targeted the care sector and has found quite widespread abuse of, or failure to comply with, the national minimum wage. It is very important that it is complied with.
It is also important for councils commissioning care to be absolutely clear with those they contract with that they expect total compliance with the law. If a council is commissioning in a way which almost becomes complicit in a breach of the law, that is completely unacceptable. Some of the commissioning around the country is very poor and we have got to move on from commissioning on these 15-minute, short-time periods resulting from contracts being opened up for bids and there being a race to the bottom with the cheapest offer winning the contract. We have got to move on to commissioning for quality and for better outcomes.
Wiltshire has now introduced commissioning for home care based on outcomes and quality. One of the care providers now pays salaries to its care staff. So the whole attitude and approach changes and the incentive on the care provider is to improve care, not to get away with the quickest possible care visit.
It comes down very often to the way in which the care is commissioned. That is what has to change and we are working with the Association of Directors of Adult Social Services and the Local Government Association to change the way in which commissioning is undertaken. There is also an amendment to the Care Bill which will require that commissioning takes into account an individual’s well-being. Councils cannot commission on the basis of 15 minutes of care when important care work needs to be undertaken. They will not meet their obligation under the Care Bill if they are doing it in that way. That change will also help to drive up standards. Care workers need to be respected. They do incredibly important work, and they are undervalued by society.
Since 2009-10, Government-funded dementia research in England has almost doubled, from £28.2 million to £52.2 million in 2012-13. Over the same period, funding by the charitable sector has increased, from £4.2 million to £6.8 million in the case of Alzheimer’s Research UK and from £2 million to £5.3 million in the case of the Alzheimer’s Society. In July 2012, a call for research proposals received a large number of applications, the quality of which exceeded expectations. Six projects, worth a combined £20 million, will look at areas including: living well with dementia; dementia-associated visual impairment; understanding community aspects of dementia; and promoting independence and managing agitation in people with dementia.
The hon. Member for Liverpool, Walton (Steve Rotheram) made the point about doing research into how we can prevent the onset of dementia in the first place. We know that vascular dementia is often related to lifestyle, including factors such as heart condition, smoking and alcohol consumption. If we can understand better how to prevent dementia from occurring, we will achieve a massive advance. Research needs to focus on that as well as on finding a cure and on living better with dementia, which is another critical area of research. It is essential that we do all this collaboratively and internationally. We cannot simply find all the results by ourselves, here in the UK. There needs to be an international effort.
The coalition Government have clearly demonstrated their commitment to dementia, but there is a massive amount still to do. We are not looking inwards to solve the problems that we are facing. At the G8, we brought the world together to work collaboratively and to look for solutions. By leading the way with the G8 summit, and with our own domestic agenda of the Prime Minister’s challenge, the UK is mobilising all available resources. We should be proud of the leadership we have shown as a nation to date, but as ever, we will continue to push much further, and we must never be complacent.
Question put and agreed to.
Care Bill [Lords]
Debate between Norman Lamb and Hazel Blears(10 years, 11 months ago)
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Hazel Blears
My hon. Friend makes an extremely powerful point. I am pleased that the Bill strengthens support for carers. I draw the House’s attention to the Bill introduced by the other Member for Salford, my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), which seeks to make sure that carers have the right to stay in work and the support to be able to do that. We must consider the cost to our economy of people having to give up work in order to care. We have talked a lot today about perverse incentives and false economies, and that has absolutely been a false economy for a long time.
I wish to say a word about diversity of provision and commissioning new models of care that can help with prevention. In my city we have been working on that for a long time, and I look forward to showing the Minister some of our examples when he visits. Social adVentures is a social enterprise that helps people with mental health problems, and one of its projects is “garden needs”. It has taken control of a garden centre, and people with dementia and people with mental health problems are now attending. The way it is keeping people active in the community and able to do many more things than they would if they were isolated and at home is amazing. Unlimited Potential is another fabulous social enterprise, which stands on its own two feet, is not grant-dependent and is able to invest more money back into the community. Last week, I had the pleasure of launching a website called Really Useful Stuff, which is just what it says on the tin—it is a website where people can get aids, adaptations and kinds of social care that are modern, innovative and creative. Those are just a few examples of what is already happening in the community.
I say to the Minister that at a time when money is tight, and will be, no matter which Government are in power, the imperative to innovate and be more creative with the funds we have has never been greater. Therefore, investing, in particular, in the social enterprise sector, which often has these great ideas, and in enabling those ideas to get to scale so that provision can be made across the country, is really important. Another company in my constituency, 2ergo, has recently developed an app for the iPhone where people can see what provision is available in Salford for care, respite care and activity, and how to book it. They can book it over their iPhone—families can do that; they can help the people they are caring for. So this use of new technology is now developing apace, and, again, we have to take advantage.
I commend the Government for organising the G8 summit last week in London—an amazing event where we gathered support from countries across the world. I hope that next year we will be able to expand that to a global event examining dementia, not just one involving the G8 developed countries. Part of that G8 meeting was about how we get more research. I would like to see far more research on the quality of care. There is a lot, but not enough, research on the bioscience, but hardly any research on the interventions we do, particularly for people with dementia. We all know that “singing for the brain” has a great reputation. It helps cognitive development, as do art, drama and reminiscence work. There is no evidence base behind that, so if we are to have a better system of social care, we need better research into therapeutic interventions that work. That will enable commissioners to commission packages of care that they know will make a difference. If money is tight, we need to spend it on things that we know will be effective, and I ask the Minister to support that.
The Alzheimer’s Society has also done a lot of work on dementia-friendly communities. That is not expensive. It is a matter of mobilising the good will of local people, shops and arts centres. In Salford, a taxi firm has trained 400 drivers to look after people with dementia. Such care does not cost a lot of money if we can mobilise ordinary people in their communities. In Japan, 4.5 million people are signed up to be dementia friends. Our ambition is to have 1 million such friends. Again, I push the Government to be more ambitious to see what more we can do.
Clause 5 is about not just diversity and shaping the market, but quality, and that is an area about which we all feel passionate. How can we in this country tolerate a situation in which those who do the most difficult job in caring for our friends and family are actually some of the least regarded workers? It is utterly unacceptable to have zero-hours contracts in the social care sector. The carers who care for my dad come in for 15 minutes. They will do more if they can. They have to ring up to be assessed when they have done 12 minutes. They get no payment for travelling and no expenses for their petrol. They came out one Sunday. They started at 8 o’clock in the morning and went home at 9 o’clock at night, but because they only had five hours of 20-minute slots, they got paid only for five hours. Members should try being out on a Sunday for 13 hours and going home with five hours of minimum wage payment. It is an absolute disgrace and a scandal that we tolerate that in this country. I hope the Minister will assist in bringing such practice to an end.
I want to say something about my own local authority. My hon. Friend the Member for Worsley and Eccles South mentioned the fact that Salford has recently had to change its eligibility criteria from moderate to substantial and critical. We were the last authority in Greater Manchester to have to make that decision, and it was heartbreaking. Our social services have always merited four stars. When I was a councillor 30 years ago, cuts were bad, but we always prioritised social care and nursery care for children. The decision to change the criteria was not made lightly, and the cuts have been absolutely horrendous.
Let me again say to the Minister that we need creativity and imagination to deal with this matter. I want to draw the House’s attention to my unpaid interest in social finance, which appears in the Register of Members’ Financial Interests. We have a real opportunity to draw extra funds into the social care system. If we could have a social investment bond that aimed to keep people with dementia in their own homes for longer, we would save the NHS a fortune. People with dementia are admitted to hospital more often. They stay longer in hospital and many more of them die there. If we could mobilise social investment to offer a reward for keeping people in their own homes, funded by the savings to the NHS, we could bring in some new money, not just what we are getting from local authorities.
Norman Lamb
I am very interested in the right hon. Lady’s proposition, and would be happy to talk further with her about it.
Hazel Blears
I am grateful to the Minister for that. In these difficult times, we all have a responsibility to look at creative and innovative ways of funding and to try to carry them through. The whole area is becoming very exciting. It was the legacy that the UK agreed to take on from the G8 meeting last week. We are global leaders. We have 14 bonds in this country; America only has one. For once, we are well ahead of the United States, and I am delighted that the Minister wants to discuss that issue.
All of us could talk for at least 20 or 30 minutes on that issue. As I come to the end of my contribution, I will just say that the Bill is a step in the right direction. I am disappointed—I say this to the Minister in the kindest way I can—that we have not been more ambitious. If we want to move towards whole-person care, we will have to be much bolder than we have been. I remember when we said, “We are at our best when we are at our boldest,” and that applies in this case. Nevertheless, over the next few weeks and months, I shall keep holding the Government to account, holding their feet to the fire and pushing them on to see what more we can do. We all feel a personal, deep and emotional responsibility for the most vulnerable people in this country who look to us to care for and support them at a difficult time in their lives.
Norman Lamb
I will just finish this point.
There is also a focus on protecting everyone from catastrophic care costs, ensuring that people will no longer have to sell their homes during their lifetimes to pay for care. The Bill reforms a fundamentally unfair system, drives up standards in GP surgeries, hospitals and care homes through the new chief inspectors, adds a new statutory duty of candour so that hospitals, care homes and other care providers are open with patients when mistakes are made, and introduces valuable new rights to carers. Of enormous significance is that it signals the first ever big step, as the Chair of the Select Committee said, towards joining up our health and care systems through the better care fund, which is worth £3.8 billion.
The best description of the Bill was in a letter forwarded to me by a Labour MP, which said that the Bill is a groundbreaking piece of legislation that has the potential to make a big difference for older people. Despite that, the Labour party is declining to give it its support.
Hazel Blears
The debate this evening has been fabulous and has engaged people from across the House on one of the biggest challenges we face. Earlier in the debate I asked the Secretary of State whether, on reflection, he thought that he could have been more ambitious about the integration of health and social care. The costs to our system are now unsustainable, and this was an opportunity to seize the moment. The Minister has tinkered around the edges of integration, so may I press him to be more ambitious, to think bigger and to be more committed to greater integration that will benefit us all?
Norman Lamb
I note the challenge, but I have been passionate about integrating care for many years. I made the case for it on many occasions when I was my party’s spokesman in opposition, and I remember not getting much of a response from the right hon. Lady’s party when it was in government. The Bill is really ambitious and marks the potential for a fundamental change in how our system works.
The right hon. Member for Stirling (Mrs McGuire) welcomed the principles of the Bill and rightly said that it is the duty of the Opposition to challenge and to probe. However, to use her expression, I think that many Opposition Members have been “churlish” in their response, with a few honourable exceptions, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke). I say that because in 13 years, Labour had two manifesto commitments, one royal commission, another promised commission, a Select Committee report, a White Paper, a Green Paper and numerous independent reviews on the issue, and what was the net result of all that talk? Absolutely nothing. In 1997, Tony Blair told the Labour party conference:
“I don’t want our children brought up in a country where the only way pensioners can get long-term care is by selling their home.”
That is exactly what happened throughout Labour’s time in government. In contrast, the coalition Government are getting on with reform.
Even now, we have no idea what the Opposition’s policy is. The shadow Health Secretary has hinted that he prefers an all-in approach—everything free, paid for by new taxes on death and by cutting hospital beds—but he has clearly failed to persuade his own colleagues about the plan or to set out how he would pay for it. Opposition Members’ criticisms can only be of any real value if they can answer the question about how they would pay for anything that costs more. So it was good to hear the right hon. Member for Salford and Eccles, who seemed to be about the only Opposition Member who recognised the scale of the challenge that we face, whoever is in power, and the fact that we need to think afresh about where money can come from. Her ideas about innovation using social investment bonds are welcome, and I would like to talk further to her about them.
We want to reshape care and support so that it is focused on enabling people to live more independent lives and giving them a good life. The Bill provides a new framework that places people’s well-being right at the centre and empowers them to take control of their care and support. It consolidates 60 years of legislation and pulls a dozen Acts together into a single legal framework, and it has been roundly welcomed. The King’s Fund has said:
“The government’s proposals for funding reform are an important achievement against the odds in a daunting fiscal and economic climate.”
Baroness Pitkeathley of Carers UK has described the Bill as the “most significant development” in the history of the carers movement.
Oral Answers to Questions
Debate between Norman Lamb and Hazel Blears(11 years, 12 months ago)
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Norman Lamb
I am grateful to my right hon. Friend for that question. Atlases of variation are an important way of raising standards and we will be discussing their future use with the new commissioning organisations. He is also right to highlight the absolute importance of having parity of esteem between physical and mental health. The Government’s mandate makes it absolutely clear that there must be parity between mental and physical health services.
Hazel Blears (Salford and Eccles) (Lab)
There are 800,000 people in this country who are living with the effects of Alzheimer’s and dementia. For some of those people, challenging behaviour is a serious issue. Will the Minister ensure that every clinical commissioning group has a lead for dementia in the mental health field so that that can be taken seriously in every community in the country?
Norman Lamb
That is absolutely a priority for the Government and the right hon. Lady is right to highlight its importance. The NHS Commissioning Board will work with local clinical commissioning groups to ensure that we raise the standards of health and care services, but she is absolutely right to highlight the importance of substantially improving access to dementia services.