Dementia Services in Ukraine

Rupa Huq Excerpts

Wednesday 10th January 2024 Westminster Hall

[Sir Gary Streeter]

The hon. Member makes a very strong point in support of my case that the Government could perhaps support the project we are talking about today and make a real difference to people on ground. I am conscious of time, but once I have finished my formal speech I will read some current testimonies from families of dementia sufferers in Ukraine, to further underline the reasons to bring forward this proposal.

Dementia care in Ukraine before the war lacked strategy, trained professionals, infrastructure and support for people with dementia and their carers. Russian attacks have attacked fundamental services, including power, water, hospitals and so on, so the situation for many people with dementia in Ukraine is now dire. Many older people have refused to leave their homes; meanwhile many women have left with their families, leaving a lack of carers. Specific data on the number of people living with dementia, their location and their needs is lacking. The urgent need now is to build systems and structures to support people living with dementia and their families in both urban and rural Ukraine.

There is no available capacity for dementia sufferers within the Ukrainian healthcare system and there also exists no national programme to advise or support the families and carers of those affected. Nezabutni engaged in a consultation with the Ukrainian Government on this issue in 2021. Although the need has been recognised, perhaps understandably, there has been no progress on the proposal from either the Ministry of Health or the Ministry of Social Policy in Ukraine since that consultation.

It is likely that hundreds of thousands of dementia sufferers in Ukraine are impacted by the insecurity and the bombing to a greater extent than their non-afflicted peers. They are unable to access formal medical support through Government medical services. The proposal that the team would like to put in place is a programme to be delivered in three phases. Phase 1 is to carry out groundwork in-country, which will take approximately four months. Phase 2 is to set up and pilot the work programme and is roughly one year in length. Phase 3 is the main programme delivery, which will take two years.

The project will engage with key stakeholders in Ukraine identified by the team, including clinical, academic, charity and Government expertise in health, social care and support. There will also be engagement with international partners, including the WHO, Alzheimer’s Europe, Alzheimer’s Australia and Alzheimer’s USA.

During phase 1, it is envisaged that a UK team of dementia specialists will visit Ukraine, hopefully during 2024, to meet the stakeholders; to review the existing systems and structures; to ensure that its training and support programmes are embedded in Ukrainian practice and culture; to review existing data on diagnosing dementia and care and support; to carry out rapid needs assessment on key training and support priorities; to agree the organisational structure for the programmes to come; and then to report the agreed plans for the subsequent phases.

Phase 2 envisages the setting up and piloting of work programmes. It involves establishing a national training and support co-ordination team, hosted by Nezabutni, to manage the training and support programme, to undertake the in-country needs assessment and priority setting and to agree and document key deliverables. It would also establish a dementia training and support unit, which would agree the delivery systems for the programme, including digital systems, plan a programme of training and awareness courses, and plan and pilot the roll-out in urban and rural settings.

However, the project would then move on to the all-important delivery phase, which would see dementia training and support rolled out across the country, using both digital and traditional efforts—in particular, training doctors, nurses, health workers, social services and care workers in updated dementia awareness and knowledge. It would involve the development of a range of courses for people living with dementia and their carers, alongside raising general awareness and support. Finally, there would be a period of monitoring and evaluating the training outcomes and the time, cost and quality of the training. I know the Minister is keen that anything supported by the Government should be properly evaluated, and that is very much part of our thinking.

What would this excellent work cost? The answer is very little for the likely benefits returned. It is estimated that phase 1 would cost around £150,000, which would include the work undertaken by the Ukrainian charity and its staff and the cost of the visit by three members of the UK team, who are likely to be Ian Sheriff, Professor Rupert Jones and a project manager, to carry out all the stakeholder engagement described previously. For phase 2, the estimated cost is £250,000. For phase 3, the cost would be determined during phase 2.

My simple request to the Minister today is for his Department to be willing to fund the cost of phase 1 to enable this project to get off the ground, whereupon funding applications to others will be made. Of course, we would be delighted if the Foreign, Commonwealth and Development Office would like to engage more fully with the project throughout its length. The cost would be small change compared with the sums we are spending on munitions for Ukraine, and the project would make a massive difference to many lives. It needs the sort of funding that might come from a departmental underspend, or possibly from an under-utilised budget for the mission in Kyiv or elsewhere. The Minister is looking askance at me, but he and I know that these things sometimes get discovered.

I hope the Minister will confirm that his Department is willing to discuss our proposal with members of the UK team to see whether a way forward can be found. The project embraces the best principles of active citizenship, which the Foreign Secretary might describe as “big society”—dedicated professionals having the compassion and drive to use their expertise to benefit people in a troubled part of the world who are less well off, and to put together a coherent, professional plan that will make a real difference. All they need is a little help from the Government to get things up and running.

I will conclude by reading just three of a number of testimonies sent to me by family members of those with dementia in Ukraine. They speak for themselves. Yulia, who lives in Kyiv, says:

“We live in the Solomianski district of Kyiv, which was severely affected by shelling on January 2. We reside in a nine-storey building on the top floor. Our house shook, probably due to falling debris, even though we don’t live near the building where the debris fell. At the first sounds of explosions, we went into the corridor. Mom was with us. Luckily, she doesn’t fully comprehend what’s happening and doesn’t resist when we all gather in the corridor or even in the vestibule.

But over the years of full-scale war, her condition has worsened, and aggression has emerged. She might start shouting at me that the enemies are about to come. In the last such episode, she grabbed a slipper, threatened me, and demanded that I also must shout because the enemies were coming. I don’t know how to handle such situations. During the last outburst, we called an ambulance, and she was administered a sedative.”

Olga, who is also in Kyiv, says:

“As loud as the past few days have been, we haven’t heard anything like it before. Unfortunately, or fortunately, my mom doesn’t understand what’s happening. It’s impossible to take her to a shelter because she doesn’t want to sit; she constantly walks, tries to go outside somewhere, either puts on a pile of clothes or undresses. So, alarms and explosions don’t affect her, but we are hostages because we can neither take her with us nor leave her alone.”

Finally, Natalia, who is also in Kyiv, says:

“We live in the city centre. We didn’t hear the shelling of Kyiv on December 29, 2022, but it was very loud on January 2. My mum and I woke up from the explosion. She no longer understands what’s happening around her; she doesn’t react. Initially, during the full-scale war, she responded and was afraid, but then her condition deteriorated sharply, so now my mom lives in her own world. I can’t even get her to the corridor during an alarm, to a supposedly safer place. She doesn’t want to. I used to lead her out. I tried, but she would return and lie down on her bed.

I realise that it is important for me to stay calm during the shelling. If I get nervous, my mom senses it and gets anxious too. So, during alarms, I do nothing. I stay calm with her, and pray.”

[Dr Rupa Huq (in the Chair)]

The debate’s new finishing time is now quarter to 5, and the hon. Member has no right of response because it is a 30-minute wonder. I call the Minister, Andrew Mitchell, for the second debate in a row.

[The Minister of State, Foreign, Commonwealth and Development Office (Mr Andrew Mitchell)]

May I say at once, Dr Huq, that it is a great privilege, for only the second time in our joint parliamentary careers, to appear before you today? I am extremely grateful to my hon. Friend the Member for South West Devon (Sir Gary Streeter) for securing this debate, and for his tireless work in supporting the development of dementia-friendly communities. We must ensure that reform and recovery efforts in Ukraine meet the needs and priorities of the entire population, including vulnerable and marginalised groups. My hon. Friend has set out, with great eloquence, a plea in support of one of them.

The Minister for Europe, my hon. Friend the Member for Aldershot (Leo Docherty), would have been delighted to take part in this debate, but I am afraid that he is currently in Uzbekistan on ministerial business. It is therefore my pleasure to respond on behalf of the Government.

The impact of Russia’s illegal and unprovoked invasion has been devastating for the Ukrainian people. Families, children, and elderly and disabled people are forced to make ends meet while sheltering from Russian missiles. My hon. Friend the Member for South West Devon set out in graphic terms what that means for some families.

We know that the disruption caused by the war poses significant risks to social, political and economic stability in Ukraine, and that the insecurity across the frontlines has made it extremely difficult for humanitarian organisations to establish a sustained presence and support those who need it most. The war has severely impacted livelihoods and income, placing huge strains on Ukraine’s social safety net system. The poverty rate increased from 5.5% in 2021 to 24.1% in 2022, thereby increasing the demand for social assistance.

At least a quarter of Ukraine’s population was over the age of 60 before the Russian invasion. As a result, Ukraine has the largest percentage of older people affected by a conflict in the world. About 80% of single older Ukrainians—[Interruption.]

[Dr Rupa Huq (in the Chair)]

Order.

--- Later in debate ---

On resuming—

[Dr Rupa Huq (in the Chair)]

We were rudely interrupted by all these blooming Divisions today. Minister, the new, completely hard stop for this debate is 5.20 pm on the clock in this Chamber, so there are nine minutes left.

[Mr Mitchell]

As I was saying, Dr Huq, before we were interrupted by Divisions elsewhere in the House, about 80% of single older Ukrainians live below the poverty line and many of them are reliant on their pension as their sole income. Older people, particularly those living with health conditions such as dementia, struggle to evacuate and face barriers in accessing health services and social support.

In the Foreign Office’s disability inclusion and rights strategy, we have committed to a “life course approach”, striving to protect the rights of all people at all stages of their lives. We must recognise that older people and people with disabilities are experts in their own lives, and their full, active and meaningful participation in decision making is critical for a recovery that meets their needs.

I turn to British action in this respect. To date, we have pledged almost £5 billion in non-military support to Ukraine, which includes funding for humanitarian aid, social protection, and disability inclusion and rehabilitation services. In 2022, we established a civil society grant fund to support organisations, including those helping vulnerable and marginalised groups.

In June last year, along with Ukraine, we co-hosted the Ukraine Recovery Conference in London. Not only did that raise more than $60 billion in international support for Ukraine’s immediate reconstruction and long-term recovery, but our advocacy supported the Government of Ukraine to create a civil society dialogue platform for gender and inclusive reform. I had the honour of attending and speaking at that conference.

Through our multi-donor Perekhid initiative, we are working with Ukraine’s Ministry of Social Policy and UNICEF to strengthen Ukraine’s social protection systems and services. On 23 November last year, our ambassador in Ukraine spoke at a HelpAge International event on age-inclusive reform and recovery, where the Deputy Minister of Ukraine’s Ministry of Social Policy joined him on the panel. In his contribution, our ambassador was clear that the war has hit older people the hardest and that they must play a crucial role in Ukraine’s recovery. Britain supports the inclusive policies and programmes that meet older people’s needs. We must give them a voice and recognise their role in rebuilding their lives and communities, and my hon. Friend the Member for South West Devon made very clear the priority that we all expect to be attached to that.

We are also funding the World Health Organisation, which will partner with HelpAge International to conduct an updated national survey analysing the barriers and risks to older people in Ukraine in relation to healthcare. The WHO aims to provide humanitarian services to older people in the most affected oblasts of Ukraine, including support for their basic needs and case management of older people to access health and social services.

During his visit to Washington last month, the Foreign Secretary announced further programme allocations, including about £8 million for humanitarian activities focusing on the needs of the most vulnerable in Ukraine, such as older people and people with disabilities. We will continue to support the Government in Ukraine in pursuing recovery, reconstruction and modernisation that puts people at its heart.

Our diplomatic response has been comprehensive. We have helped to build a united international coalition against Russia’s invasion and in support of Ukraine. Russia remains internationally isolated, having lost 18 international elections in 2022 and 2023. The United Nations General Assembly vote in February last year demonstrated that the international community is overwhelmingly united behind Ukraine, with nearly three quarters of the entire membership voting for Russia’s immediate withdrawal and an end to the war. We have also worked with allies to strengthen NATO, expedite membership for Finland and Sweden and provide long-term NATO assistance for Ukraine. Without that activity, none of the things that my hon. Friend the Member for South West Devon spoke about would be possible.

To conclude, reform and recovery efforts in Ukraine must be inclusive and take into account the needs of the ageing population. We will continue to work with our allies to ensure that Ukraine gets the support that it needs to win this war, secure a lasting peace and build back better. We commend the bravery and resilience of the Ukrainian people in the face of Russian aggression, and we remain united across the House in our desire for them to prevail.

To my hon. Friend and his eloquent request for support for a very good cause, I pledge the interest of and help from officials in the Foreign Office to advance that cause. I cannot promise him, as he suggested, that there might be some pot of money available, but I can promise him that he and I share the same desire to drive forward this agenda, and we will do everything we can to help him in that respect. I remain confident that this will continue, and Ukraine can always count on the UK to stand by it.

Question put and agreed to.