G8 Summit on Dementia

Richard Graham Excerpts

Thursday 28th November 2013 Commons Chamber

[Richard Graham (Gloucester) (Con)]

It is a pleasure to follow the right hon. Member for Salford and Eccles (Hazel Blears), who has spoken so well and done so much work on this subject along with her colleagues, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Sutton and Cheam (Paul Burstow). All three major parties now have at least one significant dementia champion to raise this important issue. I know that the Minister will enjoy responding to the debate, because he has covered a number of debates on the subject before. Much has been said on dementia, and much action has been taken. The right hon. Lady was right to mention the Prime Minister’s initiative and his championing of this issue. Many people are suffering as a result of dementia, not only those suffering directly from the disease, and there is still no cure, so it remains a significant challenge for science and society.

I have just a few points to add to what has already been said. The Minister will recall that I led a debate recently in Westminster Hall on what was being done about dementia in Gloucestershire and on the ways in which I believed we had adopted best practice. However, a critical question is: do we really know what best practice is? How do we measure the quality of what is being done in our local hospitals and care services? How do we measure the contribution of organisations such as the Barnwood Trust, a mental health charity specialising in these conditions which we are lucky enough to have in our area?

As the right hon. Lady said, it would be useful if the Minister could share his thoughts on a guide to best practice, not only for commissioners—although I agree that that is important—but for MPs. Representatives of the Gloucestershire family of NHS services recently told me in a meeting that they had received an award for the care and services they provided for old people in general and for dementia sufferers in particular. That was terrific news—I am always delighted when people win an award—but it would be useful to know what we are doing best, and what is being done better in different areas, so that we can have a nice, easy frame of reference. People could then see whether their area offered a four-star or a five-star dementia service, for example, and we could assess how we might attain a higher standard if we did certain things differently.

[Debbie Abrahams]

Is the hon. Gentleman suggesting that, in addition to building up the evidence base through randomised controlled trials that establish a causal relationship between therapies and outcomes, some kind of action-based research would be appropriate? Such research could be carried out and interventions could be offered and evaluated while providing the service at the same time. It would be a case of learning as we went along. Does he agree that we need different approaches because of the scale of the issue that we are facing?

[Richard Graham]

I think I agree with the hon. Lady. Different things need to be tried. Singing and music were mentioned earlier. In my mother’s case, they were the last things she was able to relate to and enjoy before Alzheimer’s closed over her. So I agree that different things are always worth trying, and that is where the charities can play a role as well.

My first question to the Minister is: could we have star ratings for dementia services and, if so, how would we identify and measure best practice? My second point relates to how we are using the Prime Minister’s initiative to get dementia on to the G8 summit agenda for the first time. We should work with other countries on this. A number of us have received briefings suggesting that the United States and France, among others, are also doing great things in dementia research. Should we not all be able to share our findings? Perhaps we could have what is known as a global inter-operative data sharing base, so that all the work being done by organisations such as Alzheimer’s Research UK could be shared, rather than being duplicated. Effort could then be spent on taking research forward, rather than replicating it.

The aim of trying to join up what organisations around the world are doing is a key reason for the Prime Minister getting this topic on to the G8 summit agenda, and I hope that the result will be an international plan involving more pooling of thinking, research and ideas. I sense that science is beginning to feel more confident about finding solutions to this ghastly disease, and if the G8 summit can give an enormous turbo-boost to pooling research and getting closer to finding solutions, the actions of the Prime Minister and the Government will have been worth while, not only for the 800,000 people in this country who have dementia today but for the many millions who will suffer in the future.

Immigrants (NHS Treatment)

Richard Graham Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely. NHS professionals on the front line have been conscious of the problem for a long time, but have been frustrated that nothing has been done. I therefore hope that they very much welcome today’s announcement.

[Richard Graham (Gloucester) (Con)]

Now that Labour has realised it is legitimate to discuss immigration, does my right hon. Friend agree that it is time for the Opposition to acknowledge that legitimate charges by the NHS to EU and other residents were not collected properly for 13 years; that identifying the £20 million as the tip of the unpaid iceberg is the right thing to do; and that a tightening of procedures on debt collection will be welcomed by my constituents and fair to all our constituents throughout the country?

[Mr Hunt]

Absolutely. It is astonishing that the Labour party complains in one breath about pressures on A and E, and the next moment tries to make light of the serious attempts the Government are making to get a grip of the problem.

Dementia Services (Gloucestershire)

Richard Graham Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Richard Graham (Gloucester) (Con)]

In the dementia debate in the House a fortnight ago, sadly I was tail-end Charlie and time prevented me from contributing a Gloucestershire perspective, so I am very grateful for this opportunity to put that right. I am also very grateful to the Minister for coming to Westminster Hall this afternoon.

Dementia can be an emotional topic. In that earlier debate, many Members—mostly female Members—from all parties in the House talked about the very human side to the disease. It was a reminder that we are no more and no less than a reflection of those we serve; a mirror of the human sadness and strength that are part of the disease of dementia. Perhaps it is not given to men to be as open or as eloquent as women in discussing our experience of family suffering. However, I will embarrass my father briefly, for he looked after my mother at home through many years of dementia. And after my mother’s death, when I said that I could not have done what he had done, my father replied quietly, “You never know what you can do until you have to.” It falls to our generation to “have to” do something about dementia, before we too—one in four of us, including one in four of us in Westminster Hall today—are overtaken by this disease.

In Gloucestershire—an ageing shire—the need is even more pressing. So there are three areas that I would be grateful to hear my hon. Friend the Minister’s views about in this brief debate, and two on which I would like to share our practice in Gloucestershire. Then I will finish by issuing an invitation.

The first area is research. It is good that Government research expenditure has doubled, and that the Aricept brand of new drug can delay the speed at which the disease spreads. However, although that is valuable—not least for giving families a chance to plan—Aricept may not work for much more than a year. Furthermore, although the Government have recently invested £22 million in research into 21 new products, can my hon. Friend the Minister confirm that it may be years before we know if any of them are successful? Since the goal of a cure is such a precious one—way beyond even the estimated heavy financial cost of treating sufferers, which is about £19 billion a year—can he also say if any drug development is close to the stage where the NHS could really financially back its development? On this issue, surely everyone would love to see science and Government working together to back a winner.

[Jim Shannon (Strangford) (DUP)]

I will intervene, if for no other reason than to give the hon. Gentleman a chance to catch his breath.

In Northern Ireland, dementia diagnosis is at 63%, which is well above other parts of the UK. The support services are not as high; in other parts of the UK, support services are much higher than they are in Northern Ireland. Does the hon. Gentleman agree that it is time there should be a UK strategy that takes all the diagnosis and support services together, and that develops a strategy not only for Gloucestershire but for Northern Ireland and the rest of the UK?

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[Richard Graham]

I am grateful to the hon. Gentleman for that intervention. I know his constituency well, and I am sure that there are points on which we could exchange information. My hon. Friend the Minister will have heard and noted his comment: it is probably a subject for a separate debate, and we may come back to that issue another day.

Secondly, I want to talk about diagnosis. Currently, less than half of people with dementia in England are formally diagnosed with the disease, even as dementia affects more of us. Gloucestershire is the county with the highest number of people with dementia in the south-west, and it has one of the highest diagnosis rates in the region. However, although the number of people diagnosed with dementia in Gloucestershire rose by 12% last year, to 4,037, another 4,800 people in the county are thought to have the condition but have not yet been diagnosed. Consequently, although the diagnosis rate of our primary care trust is good regionally, at 46%, one can see that we have a long way to go in absolute terms, especially if the county council is right that our population of people over the age of 75 will increase by 30% by 2022.

Where is the best practice currently in the country? Could my hon. Friend the Minister tell us from whom we can learn best how to drive up diagnosis rates within tight budgets? As the Alzheimer’s Society says, low-ish diagnosis rates prevent sufferers from accessing support and medical treatments that can help them to live better with the condition.

The third area is care. In the main debate in the House a fortnight ago, other Members spoke about the link between dementia and care, and about the growing need for a “fair” solution to the problem of caring for an ageing population. Again, it falls to our generation to resolve this situation. Across the country, the number of people over the age of 65 is set to double during the next 20 years, and in counties such as mine the rate of growth will be worse, and faster.

I know that, in the wake of the Dilnot commission’s proposals, the Government will make formal proposals shortly about how they believe this issue can be settled. I wonder if my hon. Friend the Minister can say anything today about whether dementia will have a part in that process, and whether it will perhaps encourage the speed of implementation of the plans that the Government are considering.

At the same time, will my hon. Friend the Minister join me in congratulating Gloucestershire county council for entirely ring-fencing its budget on adult social care during these difficult years of local government spending freezes? In the last debate in the House on dementia, we heard from several Members whose authorities were not doing that, and it would be interesting to know how many other authorities are doing the right thing for the most vulnerable—a group that definitely includes dementia sufferers—as Gloucestershire has been doing.

I have promised to mention two local initiatives on dementia, as I believe they show that Gloucestershire may be leading the way. First, I pay tribute to the development in Gloucestershire of the community dementia nurse, or CDN, service, which was launched in December 2011 by the 2gether NHS Foundation Trust. The CDN service provides specialist and direct dementia support to GPs, with each surgery in the county being allocated such a nurse.

Secondly, we are fortunate to have a local charitable foundation, the Barnwood Trust, and it is working closely with the Gloucestershire clinical commissioning group, which has won £500,000 from the NHS dementia challenge to create dementia-friendly communities. That means having community workers who are trained as dementia link workers—people who are connecting to local communities.

[Rebecca Harris (Castle Point) (Con)]

On that point, does my hon. Friend agree that it is quite often the local voluntary community groups such as the Mickey Payne Memorial Foundation, which was set up by my constituent Caroline Dearson, that are leading the way in spreading best practice, support networks and awareness within their communities?

[Richard Graham]

My hon. Friend is absolutely right. Community groups, such as the one in her constituency that she has mentioned and championed, are exactly the groups of people that are driving forward best practice at the local level. Of course, if they are able to win funds from the NHS dementia challenge then so much the better, because those funds would enable them to spread their good deeds further.

In Gloucestershire, we also benefit from local charities. The Guideposts Trust’s dementia web for Gloucestershire is a web-based support site that provides information for people with Alzheimer’s and other forms of dementia. We also have two very good-value day centres, one run by Age UK Gloucestershire and the other by Gloucester Charities Trust. They enable people to stay in their own homes for longer, while at the same time enabling them to meet friends and access general facilities, and enabling their carers or loved ones to leave them safely for a couple of hours while they go shopping.

Lastly, there is a very helpful purple butterfly recognition scheme for dementia sufferers that the Gloucestershire Hospitals NHS Foundation Trust has introduced in both its hospitals, Gloucestershire royal hospital and Cheltenham general hospital. Therefore my constituents are benefiting all round from an increasing range of services and ways of managing and dealing with dementia better.

However, that is not to say—as my hon. Friend the Minister will understand—that all is perfect, or that we are necessarily doing all the best things that can be done. The important thing is that the barriers are down. All of us can talk openly, in my county and across the country, about dementia. There is no stigma and no shame, just shared sadness and sometimes that surprising strength that I alluded to earlier.

I am sure there are other things being done elsewhere that I would like to know more about and that my constituents would benefit from. So I would be grateful today if my hon. Friend the Minister could do a favour to us all—I mean all parliamentarians—by giving some ideas of the best practice that he has noticed in different ways of handling the disease and managing the suffering that goes with it. Even if he cannot do so comprehensively today, perhaps he can do so later by letter.

Sometimes, too, our own cities and towns need to widen our eyes, stretch out beyond us and allow us to see ideas from further afield that we can bring back, and the Minister can help to steer us. What role, for example, is there for faith groups? Who is doing the best work across different ethnic minorities? Are there particular extra sensitivities, such as elderly immigrants reverting to the languages of their youth, of which we need to be more aware? What more can be done to support GP surgeries in diagnosing dementia? How can people be enabled to stay in their own homes for longer without that feeling of helplessness if something goes wrong?

Finally, like all good pitches must, this speech ends with an invitation for the Minister to visit Gloucestershire to see what is happening; to meet the Barnwood Trust and hear its ambitions and vision for what it might be able to do; and to share with us what he likes, what he has seen across the country and what we can perhaps do more of. I would be delighted if the Minister can accept my invitation, because dementia matters very much to all of us in Gloucestershire, as it does to him, and we want to continue being adventurous by pushing the boat out and actively considering new ways to help people living with this ghastly disease and their families, who are so intimately affected by all elements of it. As I said at the start, we never know what we can do until we have to do it, and we must do it.

Adult Social Care

Richard Graham Excerpts

Monday 16th July 2012 Commons Chamber

[Sarah Newton]

I accept that there is genuine disappointment, but people equally understand that all parties in the House must be committed on where the billions of pounds each year will come from, so that the proposals are sustainable for the long term, and so that people can save and invest without fear of the rug being pulled from beneath them.

The proposals are a sticking plaster—there is no doubt about that—but if only people could hear the facts, they would appreciate that more money is being put into the system while the problem is being resolved for the long term. It is not true that all councils are cutting back. Cornwall council has not cut its adult social care. It is working in extremely innovative ways with the NHS and the voluntary sector to ensure that services are improved. I do not accept the shroud waving from Opposition Members, who say that every part of the country is in crisis.

[Richard Graham (Gloucester) (Con)]

My hon. Friend has a high interest in, and knowledge of, these matters. Does she agree that counties such as hers and mine—Cornwall and Gloucestershire—that prioritise adult social services precisely because of their ageing populations, are helping to find a solution to the problem, which is so badly needed by constituents all round the country?

[Sarah Newton]

I agree. I encourage people to read the good report published today by the all-party parliamentary group on local government, because it contains good examples from all over the country of how proper integration of social services with housing and the NHS is beginning. There is every possibility, as a result of HealthWatch and the health and wellbeing boards, that such integration innovation will deliver the joined-up services for families and carers that will lead to an agenda focused on public health and the prevention of the problems that lead people into acute settings such as A and E and hospitals. People currently end up in such settings far more than they need to.

I am confident that, in a years’ time, hon. Members on both sides of the House will come here to share best practice from those parts of the country that grasp the opportunities of the Health and Social Care Act 2012 and make the most of the changes. We can then encourage other parts of the country that do not prioritise those matters to do the best they can for older people and carers in their societies. All hon. Members want them to have higher-quality and better care so that they can live in dignity for the rest of their lives.

NHS Risk Register

Richard Graham Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Sajid Javid (Bromsgrove) (Con)]

rose—

[Richard Graham (Gloucester) (Con)]

rose—

[Alan Johnson]

I will give way again later.

The most important reforms that are necessary now are to integrate health and social care, to improve care for people with long-term conditions and to move from a hospital-based service that was designed for a different age. All three reforms—

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[Richard Graham]

On a point of order, Mr Deputy Speaker. As the business of the day is specifically focused on the publication of the NHS risk register, is it in order to describe the register as a secondary issue?

[Mr Deputy Speaker (Mr Nigel Evans)]

May I advise all Members that they should not resort to a device such as this, as it is an argument in continuation of the debate. Many Back Benchers want to get into the debate, so Members should not misuse points of order. That was not a point of order for the Chair.

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[Alan Johnson]

My hon. Friend makes an important point.

As Health Secretary, I cancelled ITC contracts where there was sufficient NHS capacity, and I approved them where there was not. I recall a visit to the Derwent centre in Bournemouth, where the NHS had taken over a hospital from BUPA and was doing knee and hip replacements more quickly than the private sector. That transformed elective surgery, but although competition is good for elective surgery it is far less important than collaboration in managing chronic disease. I agree with the NHS Future Forum, which said in a report last year:

“The place of competition should be as a tool for supporting choice, promoting integration and improving quality. It should never be… an end in itself.”

The NHS is not a collection of separate and autonomous units of varying degrees of independence, responding to the invisible hand of the market. It is, above all, an integrated health care system. The fear of the vast majority of clinicians is that the Bill will damage that crucial principle.

[Richard Graham]

rose—

[Alan Johnson]

I shall not be taking an intervention from the hon. Gentleman.

When it comes to integrating social care with health, people want an adult social care system that resembles the NHS, not an NHS that resembles the current adult social care system. The very real fears about the Bill, particularly in respect of commissioning, were highlighted recently by the Health Committee. If the necessary economies are to be made, the provision of health and social care must be planned together, and, despite its title, the Bill is hindering that process. Yes, it includes the word “integration”, at a late stage, but the word just sits there doing nothing more than suggest that this is the spirit that the Bill will introduce, and it is not.

The one sensible decision made by the Health Secretary was the one to retain the services of Sir David Nicholson as chief executive of the NHS. The goal of achieving efficiency savings of 4% a year to reinvest in patient services is a noble one, but its achievement will be particularly difficult for the acute sector. What seems to be happening at present is that hospitals are cutting services to save money. What needs to happen, and what the Nicholson challenge envisaged, is the transformation of services to eliminate waste by, for instance, reducing readmissions and bringing care much closer to the patient. Of the £80 billion spent by PCTs in 2009-10, nearly half went to hospitals, the most expensive form of care, while primary care received only a quarter.

When I asked the distinguished colorectal surgeon Ara Darzi to lead 2,000 clinicians in moving the NHS to the next stage of its development by focusing remorselessly on quality, he produced a report that was radical in its concept if a little boring in its detail. Government Members could do with a bit of “dull and boring” on the NHS at the moment. The proposals required no reorganisation and very little legislation.

At that time, the Conservative party was promising a bare-knuckle fight to defend the district general hospital, and siding with the British Medical Association to stop patients accessing GP surgeries later in the day and on Saturday mornings. If the Nicholson challenge is to work, it must be accepted that the vision of the district general hospital as all-singing, all-dancing, and capable of providing all clinical procedures must change. There is no political leadership on that, there is no leadership from the Government—

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[Mike Freer (Finchley and Golders Green) (Con)]

The issues underpinning the debate are purely ideological, and no amount of amendment—[Interruption.] Exactly. It is not about making the NHS better; it is about purely ideological opposition to reform.

[Richard Graham]

I am very grateful to my hon. Friend for giving way, which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) did not do.

Does my hon. Friend agree that the speech we have just heard from the right hon. Gentleman had nothing whatsoever to do with the motion under discussion? He did not mention the NHS risk register once, except to say that it was a “secondary issue”. To all the rest of us here, it is “the” issue under discussion. Was not the right hon. Gentleman’s speech simply a whitewash of his own time as Secretary of State for Health?

[Mike Freer]

My hon. Friend has made a very good point. The issues that have been raised have nothing to do with the risk register. This is simply a new stick with which to beat the Government. No amount of amendment and no amount of rational argument will appease those who are simply philosophically opposed to reform of the NHS.

Oral Answers to Questions

Richard Graham Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

I heard many things, including the nurses’ concerns about front-line services, which I share; Dr Peter Carter has said time and again that he is very worried that the NHS might go through a process of trying to salami-slice services to the detriment of patients when it is actually possible to deliver greater efficiency through cutting out waste, administration and bureaucracy. I agree with many of the things I heard and I want to make sure, as a matter of urgency, that right across the country that efficiency is achieved and we do not act to the detriment of front-line services.

[Richard Graham (Gloucester) (Con)]

Will the Secretary of State join me in congratulating GP practices in Gloucestershire, all of which have decided to participate in the single consortium taking forward the commissioning of health services? Will he reassure those of my constituents who still have concerns that this whole process is about protecting front-line services and that it is absolutely not about the back-door privatisation of the NHS?

[Mr Lansley]

Yes. My hon. Friend makes an extremely important point and his pathfinder consortium in Gloucestershire is focused on how it can deliver more integrated services. One of the things that we are looking for is the integration of services, which has not happened sufficiently in the past. In Gloucestershire, both in the commissioning consortium as it comes together and in the work done by the local authority, we can see how, on the ground, there is determination and enthusiasm to make the modernisation of the NHS work for patients. We must ensure that the legislation supports it.

Oral Answers to Questions

Richard Graham Excerpts

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

My hon. Friend might be interested to know that the Ministry of Justice is reviewing sections of the Coroners and Justice Act 2009 and how they will be implemented. That review will include the subject of how deaths are reported to coroners. In fact, the statutory requirements to report deaths of mental health patients to coroners are the same as those for other patients, and NHS providers must report deaths of service users that occur during, or as a result of, care or treatment that they are providing.

[Richard Graham (Gloucester) (Con)]

17. What recent representations he has received on the management and administration costs of the NHS; and if he will make a statement.

[The Minister of State, Department of Health (Mr Simon Burns)]

As I said to my hon. Friend the Member for Pendle (Andrew Stephenson) earlier, administration costs across the whole health sector will reduce by a third in real terms over the spending review period. This is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.

[Richard Graham]

I am grateful to the Minister for his reply. Can he reassure my constituents in Gloucester that this is broadly the degree of savings that we should expect from NHS Gloucestershire’s expenditure on management, and that those savings will be spent on the rising demand for front-line services, including in the new, soon-to-be-opened women’s centre?

[Mr Burns]

Yes, I can give my hon. Friend the assurance that he seeks. We have made it quite clear that we will reduce management costs throughout the NHS by more than 45% over the next four years, and establishing GP consortiums will allow us to strip out the costly top-down bureaucracy that now exists. All the money that will be saved through these initiatives will be reinvested in front-line services, which will benefit the constituents of my hon. Friend and those of every other right hon. and hon. Member throughout England.

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[Mr Lansley]

The right hon. Gentleman is in no position to make that point, given that his party wanted to cut the NHS budget. What my right hon. and learned Friend said this morning about our working together is indeed true. However, this is not a case of our diverting patients; it is about ensuring that people who have mental health problems are dealt with appropriately rather than there being a failure to deal with them. That applies whether they are in prison or in hospital. We are working together on that, and I know that my right hon. and learned Friend will be making a statement shortly.

[Richard Graham (Gloucester) (Con)]

T8. Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?

[Mr Burns]

Yes, I can certainly give my hon. Friend that assurance. The money will be ring-fenced to ensure that local communities can enhance the quality of public health for all constituents both in Gloucestershire and throughout the country.