Care Services (Older People)

Paul Burstow Excerpts

Tuesday 7th June 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

Let me start by congratulating my hon. Friend the Member for Eastbourne (Stephen Lloyd)on securing the debate and setting out the issues so clearly, as well as for his work as an officer of the all-party group on dementia. I suspect that many of his colleagues in the Chamber listening to the debate have been inspired to be here by their association with that group.

Social care is seldom in the news for good reasons and my hon. Friend was right to begin by referring to some of the most recent scandals that the House discussed earlier today, not least the terrible abuse at Winterbourne View. As I said earlier, the events that took place in that hospital were appalling and, as I explained, I am determined to do everything I can to ensure that the lessons are learned, understood and acted on swiftly.

My hon. Friend has painted a fairly bleak picture of social care, and although I am not quite so gloomy I am not complacent about what needs to be done. The system of social care that the Government inherited last year was and still is fragile. The legal framework that governs social care was written for a bygone era and is now so complex and byzantine as to leave people confused and frustrated. The way that we pay for long-term care is a classic wicked issue of politics—one that is occasionally taken out of the “Too difficult to deal with” drawer, only to be looked at and shoved firmly back in again—because most people in this country are blissfully unaware of how social care is paid for. They are blissfully unaware of the fact that it is not free, that it never has been free and that many people face the potential of catastrophic costs when they come into the social care system.

My hon. Friend has rehearsed his views about what future funding arrangements might look like. I am clear that there is no perfect solution—no solution that can possibly please and satisfy everyone—but we need to strive to reach a settlement that requires trade-offs but also secures the necessary change and sustainability of a system for the future. That is why the Government have been quick to put in place the building blocks of a reform system—quickly establishing the Dilnot commission to recommend reform of how we pay for care and support, and securing the current system by committing an extra £2 billion for social care by 2014.

My hon. Friend talked about the importance of integration. I can tell him that the unprecedented transfer of NHS resources to social care, which this year amounts to £650 million, is indeed fostering new relationships between local government and the NHS to allow the greater integration and closer working that are essential to enable us to deliver better services for the public whom we are here to serve. He also talked about the schism between health and social care. It is worth noting that that schism was set into the very foundations of the NHS under the National Health Service Act 1946 and then the National Assistance Act 1948, so we have to look back a long way to see when that split occurred.

The main focus of my hon. Friend’s remarks has been the challenge of dementia. Each year, about 65,000 people are diagnosed with dementia, which touches the lives of many families, as he has demonstrated by relating his experience with his two aunts. The number of dementia cases is set to rise by 38% over the next 15 years. That rise reflects the fact that many more of us are living for longer, but we should not cast that in the language of consternation. We should see it as a cause for celebration that so many more people are living for so much longer; the key is making sure that in those extra years we have quality of life as well. That is why we need the NHS, as well as social care and society, to rise to the challenge.

Let me offer some hope to my hon. Friend. We can do much better for people with dementia and their carers. In coming to office, I took the view that we should stick with the existing national dementia strategy and deliver it in full, because at our heart the coalition Government are committed to the notion of greater personalisation so that people have real control over the services that affect their lives and so that carers have a much bigger stake in the system. As he has said, commissioning is key to delivering that vision and the objectives in the strategy. Good commissioning can make a huge difference.

[Tracey Crouch]

The Minister mentions carers, who have a very difficult job—none more so than those who care for people with dementia. Next week is carers week. Will he join me in congratulating those who care for people with dementia, which is particularly challenging? Those people are often the unsung heroes of our society.

[Paul Burstow]

I am very grateful to my hon. Friend for making that very important point. The 6 million or more carers in this country are undoubtedly the backbone of our care system and save us a large sum of money—over £100 billion according to the most recent estimate by Carers UK. I will go beyond thanking them and make the point that the Government have committed £400 million extra to supporting the extension of respite support for carers. We are determined to make sure that that money gets through to those who need it.

My hon. Friend the Member for Eastbourne’s remarks about commissioning and the need for it to be multidisciplinary, involving social care and other expertise, is undoubtedly right. Indeed, my Department is in the process of developing a pack to support health and social care commissioners, particularly in relation to dementia commissioning. It will offer guidance on key aspects of dementia care and the need for early diagnosis and intervention. My hon. Friend was right to refer to the under-diagnosis and late diagnosis of dementia and how that can reduce life chances and the opportunity to plan for the progression of the disease. There will also be guidance on offering better support for people at home and in care homes and on providing better care in hospitals, which means addressing issues of training that have been mentioned.

[Chris White (Warwick and Leamington) (Con)]

Does the Minister agree that excellent examples of charities and social enterprises such as Castel Froma in my constituency that put social goals before short-term profit provide some of the best models for the future of care homes? Should the Government not do all that they can to encourage the provision of services by those organisations to the sector?

[Paul Burstow]

I am grateful for that point. Part of the Government’s growth strategy is about recognising the value that micro-enterprises and social enterprises can offer in delivering good-quality social care.

We are producing supporting guidance for commissioners on the reduction in the use of anti-psychotic medication, which is often overlooked by commissioners. Having spent a decade campaigning for an end to the inappropriate and over-prescribing of anti-psychotics, I was delighted when the previous Government finally commissioned an independent review that clearly revealed the cost of the use of those drugs—lives shortened, lives dimmed, and 1,800 deaths a year, which is truly shocking. That is why as a Minister I am determined to hold the system to account to deliver a two-thirds reduction in the prescribing of those drugs by November this year. That ambitious target was set in 2009, and it requires action by a number of agencies and the provision of the alternatives that my hon. Friend the Member for Eastbourne discussed.

To make that change, the Government need active support from the front line, the third sector and professional bodies, and we have worked closely with Dementia Action Alliance and many other organisations to support a national call for action to reduce the use of anti-psychotics, which will be launched later this week. My hon. Friend discussed the variation in services across the country, and it is worth saying that the NHS spends £8.2 billion a year on dementia. I do not think there is compelling evidence that it is all well used, which is why we are auditing service provision around the country to gauge progress, for example in the development of memory services. Taken with clear requirements on primary care trusts to publish their dementia plans and work with their social care partners, there will be more transparency than ever before, so commissioners will be held to account for delivery in that area.

My hon. Friend touched on a number of issues relating to NHS reforms, and discussed the need to improve research. I have the privilege of chairing the ministerial advisory group on dementia research, and one of the key issues in delivering more investment in dementia research is securing more quality bids for research funds in the first place. I am delighted that more than 121 new bids have recently been made and are being evaluated, making it very likely that I will be in a position later this year to announce good news about our moving towards significantly increased investment in dementia research. The key is not just throwing money at the problem but making sure that the talents in scientific skills in this country are brought to bear on it, and that expertise is brought into this area to make sure that we solve the problems effectively.

My hon. Friend made some important points about NHS reforms. Having just concluded the listening exercise, we are waiting for Steve Field and the NHS Future Forum to publish their conclusions next week. My hon. Friend discussed the role that health and wellbeing boards can play in integrating services. That is something that was part of the original legislation and which, I am pretty certain, will remain in the legislation. It is an essential building block in delivering more integration of health and social care.

In conclusion, health and social care reform is long overdue. My hon. Friend made a powerful case for acting swiftly on that reform. The Government have acted in a determined fashion to put in place the building blocks to enable that reform to take place. We have secured the funds to sustain the system while we put those reforms in place, and we are committed to delivering on dementia. I have no doubt that if we deliver good-quality dementia care services and model our services around the needs of dementia sufferers and their families, care and compassion will be built into the system, which will address many of the concerns that have rightly been rehearsed in the House over recent months. It will also enable us to get the very best out of the £8.2 billion that is already spent on dementia services, and ensure that the extra resources that this Government are putting into the NHS over the next few years get to the front line and deliver the improvements that all Members want to see.

I am grateful to my hon. Friend the Member for Eastbourne for raising the subject this evening, and I look forward to continuing to work with him through his all-party group to make sure that we keep these issues firmly in the spotlight, driving forward the improvements that all our constituents expect.

Question put and agreed to.