Tobacco Products (Plain Packaging)

Tony Baldry Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Sir Tony Baldry (Banbury) (Con)]

When I was a child and until I was about 18, I spent every Christmas day on the wards of my father’s hospital. They were old Nightingale wards with beds on both sides. On one side of the male wards were the old soldiers whom my father and GPs had conspired to bring into hospital to give them a good Christmas. On the other side were men who were dying of lung cancer, which is a bloody awful way to die. In effect, sufferers drown because they cannot breathe. It is degrading, they fight for breath and they need oxygen tanks. It is a horrid way to go.

In the 1950s and 60s, many of the chaps who were dying had started smoking during the great war when the link between cancer and smoking was not clear. That is clear now, and although smoking rates have dropped significantly since the 1950s when my father was appointed a consultant, it is a striking and sad fact that one fifth of adults in the UK still smoke. More disconcerting is the fact that more than 200,000 children a year start smoking.

The point I want to make to the Minister—I understand her position of wanting an evidence-based approach—is that, having read the Library briefing and the briefing from various groups, which sensibly sent it to colleagues for the debate, it is not clear to me what research the Department of Health has done. We all know the desperate impact of smoking on people’s long-term health and the risks of dying prematurely, not only from lung cancer but from other illnesses. What research has been done to understand better why so many youngsters still take up smoking and what more can be done to discourage them from doing so?

Having a father whose study was full of cancerous lungs in jars was a pretty significant disincentive to taking up smoking, in addition to seeing people dying from cancer. There is a disconnect here. Human beings are supposedly rational and sentient, yet each year some 200,000 youngsters make a decision that will have serious long-term consequences on their health and that of others.

Hospital Mortality Rates

Tony Baldry Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

And for the second time, I say yes.

[Sir Tony Baldry (Banbury) (Con)]

Professor Brian Jarman observed that, until recently, the Department of Health seemed to be a “denial machine” and that there was suppression and spin. Will the Secretary of State and the whole House at least agree that there is no room for denial, suppression or spin in the NHS, and that what we need for the future are total transparency, accountability and a Care Quality Commission that performs properly and professionally?

[Mr Hunt]

My hon. Friend speaks wisely, because the first step towards sorting out these problems is to have a system that Ministers cannot interfere with so that when there is failure, regulators are able to speak out without any political pressure—without any Ministers leaning on them in the run-up to elections—in the interests of patients. That is why we are completely changing the CQC. We are introducing a chief inspector of hospitals, who will be the nation’s whistleblower and who will have the independence and freedom that the old CQC never had. I hope that will help the public feel more confident that where there are problems they are properly tackled and not swept under the carpet.

Carers

Tony Baldry Excerpts

Thursday 20th June 2013 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

It is good that the House has an opportunity today to debate the needs of carers. As co-chair of the all-party carers group, I welcome this debate. It provides us with an opportunity to be the collective voice for the 6.5 million carers in the UK.

In the run-up to carers week, Carers UK published a report entitled “Prepared to Care?” which had six important recommendations from carers about what they need to help them manage their caring role. They need better public understanding and recognition of carers. Carers should have access to information and the right support from the beginning. It is important to remember that every day 6,000 people take on new caring responsibilities in the UK, and from day one they need access to the right support, advice and information. Every day across the country there are people whose loved ones have a stroke or discover that they have been diagnosed with Parkinson’s or with age-related dementia, and they need support from day one.

Professionals need to understand the role of carers and share information, decision making and planning with them. The hon. Member for Worsley and Eccles South (Barbara Keeley) made the point about the GP who treated a patient for years but never asked about the carer. Carers can no longer be treated as invisible. They need access to high-quality practical and emotional support and information, as well as breaks from caring. The point made by the hon. Member for Birmingham, Selly Oak (Steve McCabe) about respite care is crucial. When Carers Oxfordshire surveyed carers in Oxfordshire last week about the issue that caused them greatest concern, not surprisingly access to respite care came very near the top of the list. Carers need flexible working practices, understanding from employers, financial support, and a fair and easy-to-navigate welfare system.

A growing recognition of the number of carers in the country is evidenced by the fact that each year carers week gathers further and greater momentum. Carers week took place between 10 and 16 June. Alongside Carers UK seven other national charity partners—Age UK, Carers Trust, Independent Age, Macmillan Cancer Support, Marie Curie Cancer Care, the MS Society and Parkinson’s UK—came together to celebrate the contribution that carers make and to signpost them to the advice, information and support that they need.

This year’s carers week was the largest ever, with more than 2,600 groups registering to take part and more than 10,000 events up and down the country—that is a lot of events. Those organising events included carers’ groups, service providers, local authorities, hospitals, domiciliary care services, hospices and GP services. Events in Oxfordshire included Carers Oxfordshire—the umbrella group for carers in the county—running outreach events and advice stalls at local Sainsbury’s, Asda and Waitrose stores. Last Friday, I visited an Oxfordshire branch of Sainsbury’s and lots of people came up and asked questions, which was fantastic, because people do not always recognise that they are carers. Outreach events to identify carers also took place in GP surgeries and town and church halls across the county.

In Parliament, there was a “Question Time” event in Portcullis House with the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), who is responsible for care and support. The event brought together the Association of Directors of Adult Social Care, Skills for Care, the Royal College of General Practitioners and Public Health England, alongside the campaign’s charity partners and carers, to debate how the NHS and social care can better support carers. Key issues discussed included the challenge of identifying and supporting carers when many people do not recognise themselves as carers, and how to ensure that carers are represented in the new NHS structures nationally and locally. Like all those taking part in today’s debate, I am sure, I was pleased when more than 100 parliamentary colleagues attended a parliamentary photocall in support of carers week. As the previous speaker mentioned, there was a useful speed networking event that enabled MPs to meet carers and hear their stories directly.

Interestingly and usefully, this year’s carers week saw increased engagement and involvement of employers in the campaign, which is important because, as Carers UK polling earlier this year showed, 2.3 million people have given up work at some point to care for loved ones, and census data published in May show that more than 3 million people are juggling work and care. That is a huge number of people, so getting employers involved in understanding the needs of carers is very important. I am glad to say that Sainsbury’s has continued its sponsorship of the employers for carers campaign, with nearly all its 1,200 stores running events, linking up with local groups and organisations to raise awareness of the support on offer to carers. Crucially, Sainsbury’s delivered information and advice not only to its customers but to staff with caring responsibilities.

I am also glad to say that Government Departments, such as the Foreign and Commonwealth Office and the Department for Environment, Food and Rural Affairs, held carers week sessions for their staff, as did a number of private organisations, as the hon. Member for Stretford and Urmston (Kate Green) mentioned. Those included the Michelin Tyre Company, KPMG, HSBC, British Gas, Northamptonshire police, the UK Border Agency, BT plc, Credit Suisse, Transport for London, the Financial Ombudsman Service and the London fire brigade. There is growing recognition from employers in the private and public sectors that they have a duty of care to those of their employees who are carers. In Oxfordshire, Employers for Carers, in partnership with Oxfordshire county council and Carers UK, launched a new membership hub for local employers large and small, which will give local employers the opportunity to share good practice in supporting carers to juggle work and caring and to raise awareness of the business benefits of keeping carers in the work force.

[Kate Green]

It is encouraging to hear that list of the many employers who want to support the carers in their work force, and I am interested in what the hon. Gentleman says about spreading good practice among employers. Does he agree that the large employers have a particular role to play in working with their supply chains to spread good practice?

[Sir Tony Baldry]

That is an extremely good point. These things are organic. A few years ago big employers such as Sainsbury’s would not necessarily have been involved in that way. Having been involved in carers policy over the years, what I find encouraging is that each year a further step is achieved.

[Barbara Keeley]

I had not intended to make this point earlier, but I will make it now because so much has been said about employers. The Independent Parliamentary Standards Authority does not allow MPs’ staff to take compassionate leave; it allows MPs to give only sick leave or maternity leave, as I discovered late last year. Given all the good work that has been done with employers, that is an issue the whole House should take forward.

[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

[Norman Lamb]

Does my hon. Friend agree that it is not simply about employers having a duty to look after employees who have caring responsibilities; it is also about enlightened self-interest? It is an enormous own goal when so many employers lose really good and experienced employees, who could otherwise contribute so much to a business, because they have caring responsibilities. It is in their interests to keep those employees.

[Sir Tony Baldry]

I entirely agree and hope that all employers see the enlightened self-interest in looking after carers. I think that there is a general recognition that everyone in the system has to start thinking about carers, particularly those who are caught in the sandwich generation and have to look after children and older relatives.

The two colleagues who have spoken in the debate have already set out the broad context of the research done in carers week: about three quarters of carers felt unprepared for their caring role; four in 10 had reduced their working hours because of caring; nearly a third had missed out on the chance of promotion; almost half had used savings to pay basic bills, such as those for heating and food; and more than a quarter had taken out a loan or fallen into debt as a result of caring.

I am conscious that many colleagues wish to speak. I will use the time remaining to highlight some specific concerns raised by Carers Oxfordshire. In anticipation of today’s debate, I asked Carers Oxfordshire about the concerns of local people. Unsurprisingly, there was a huge response from carers. I think that there is a feeling among many carers that one of the most important things is having their voice heard. The sorts of points raised were as follows:

“Carers would like to hear greater clarification about the implementation of the Care and Support Bill along the following lines: ‘Carers are very pleased to see the rights of all carers to have an assessment so clearly defined in law. The concern is that the regulations are written in the spirit of the legislation i.e. of widening the access to help and support for carers. The national eligibility framework needs to reflect this and ensure that the threshold of eligible needs is not set too high. The risk is that local authorities will use the framework to restrict “eligible needs” on the basis of limited resources, which could mean many carers will not be any better off in terms of the help and support they receive. We must ensure there is not a postcode lottery in the way the framework is operated by local authorities.’”

On respite for carers, respondents commented that it is

“too expensive and too hard to get currently as care homes often don’t ‘allow’ bookings to be made well enough in advance to allow carers to book holidays. There is very little financial help for ‘stay at home’ carers. What about care vouchers similar to child care vouchers being issued, or tax relief on care costs?”

With regard to GPs, the identification of carers is a really important issue. There

“needs to be more emphasis from GPs and a greater recognition of carers’ contribution and value, including their health and wellbeing.”

Another point was this:

“Poor quality of care provided by care agencies is a huge concern. Quality, reliability and accountability are ongoing concerns for carers.”

On carers in employment, concerns were expressed about the financial cost of care and the impact on those who have to give up work or reduce their working hours.

The respondents make an interesting point:

“Military carers and their family can suffer a significant disadvantage, to include homelessness due to ‘entitlement’ issues around properties when they take on caring responsibilities. Lack of recognition from the military.”

They continue:

“Carers want to see social care and nursing care fully combined as one discipline. As far as they are concerned they are one and the same thing. During one carer’s experience in the weeks prior to her mother’s hospital admission she had had three different teams visiting her throughout the day. They spent more time completing forms and leaving files than anything else. It was tiring and draining for her to have so many different people coming and going. Full integration of the two disciplines is key for continuity, to prevent duplication of effort and reduce needless bureaucracy.”

Finally, they state:

“Look at simplification of forms for applying for carers allowance and attendance allowance.”

It is really good news that the Care Bill will consolidate and simplify decades of social care legislation in England. We must not lose sight of the fact that it will include significant and welcome new rights for carers to improve access to carers assessments and new duties on local councils to provide care services. I share the concerns of the hon. Member for Worsley and Eccles South (Barbara Keeley) about young carers, but I am confident that those on the Treasury Bench have taken on those concerns and will table amendments to the Bill in the Lords to cover them.

We are making good progress. The direction of travel is a good one, but we have to recognise that a huge amount of distance still has to be covered if we are to be proper advocates and protectors of the millions of carers in the UK who selflessly give themselves to look after a loved one.

A and E Departments

Tony Baldry Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

It is a very important, complex and difficult decision, so I thought it was right to get independent advice from the Independent Reconfiguration Panel, and that is what I have done.

[Sir Tony Baldry (Banbury) (Con)]

There is a general acknowledgement and recognition that one of the problems for A and E departments, particularly at night and on weekends and bank holidays, is people going to them who do not need to. Does my right hon. Friend think there is scope for the new clinical commissioning groups to commission primary triage at the entrance of A and E departments, so that those who need only primary care treatment are directed towards to it, and those who need A and E treatment go through to A and E?

Oral Answers to Questions

Tony Baldry Excerpts

Tuesday 16th April 2013 Commons Chamber

[Norman Lamb]

I seem to be ready to agree to several meetings and I will certainly add that one to my list. I will be delighted to meet my hon. Friend—and I should also pay tribute to him for the work he is doing in this area.

[Sir Tony Baldry (Banbury) (Con)]

13. What steps he is taking to make the services of hospices more available to NHS patients.

[The Minister of State, Department of Health (Norman Lamb)]

We are supporting NHS England to develop a fairer and more transparent funding system for hospices, to be in place by 2015. We have made £60 million in capital available to hospices to improve their physical environments, and will continue to provide over £10 million in central funding for children’s hospices.

[Sir Tony Baldry]

Will my hon. Friend confirm that the new NHS commissioning arrangements should increase the opportunities for hospices in the voluntary sector, such as the excellent Katharine House hospice in my constituency, to provide palliative care and terminal care for NHS patients?

[Norman Lamb]

I pay tribute to the hospice movement, including Katharine House in my hon. Friend’s constituency. It is crazy that we are spending a lot of public money on caring for people at the end of life in places where they do not want to be. Most people do not want to end their life in hospital, yet about 50% of people still die in hospital. We are looking to create a new funding regime where money will follow the patient, to ensure people’s choice is respected so they can die where they want to, and so that hospices have fair funding.

Mid Staffordshire NHS Foundation Trust

Tony Baldry Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

Neither. The chief inspector will report to the CQC. The hon. Lady is right that one of the problems is the overlapping roles and the confusion of roles. What we are announcing today is a significant change in the responsibilities of the CQC. It will no longer be involved in putting right problems in hospitals: its job will simply be to identify problems, so it is not compromised in its ability to be the nation’s whistleblower-in-chief. The responsibility for putting right problems will lie with Monitor, the NHS Trust Development Authority, the NHS Commissioning Board and the wider NHS system. We want to make sure that the chief inspector is unconstrained and unconflicted, when his or her team goes into hospitals, from shouting loudly if there is a problem and continuing to shout loudly until it is solved.

[Sir Tony Baldry (Banbury) (Con)]

These changes all come against a background of other changes in the NHS, such as clinical commissioning groups, Healthwatch and health and wellbeing boards, and I wonder whether my right hon. Friend would be kind enough to put in the Library a plain person’s guide, so that we can understand how these new regulators, inspectors and various other bodies fit in with each other—who is accountable to whom—so we as constituency MPs will know whom to approach and on what occasion. I am sure that all these changes are very welcome, but we need to understand how they relate to each other.

[Mr Hunt]

I am sure that my hon. Friend’s sentiments are shared on both sides of the House. Indeed, I could have done with such a guide when I started this job last September. I am happy to do as he requests, but from today’s announcement the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place. It will be the chief inspector’s job to identify such failures and shout publicly about them, and that will be an important clarification that the system needs.

Immigrants (NHS Treatment)

Tony Baldry Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

Yes, they will.

[Sir Tony Baldry (Banbury) (Con)]

I am finding it rather difficult to ask a question, because I have been rendered speechless by the chutzpah of Labour Members in not saying that what the Secretary of State proposes is sheer common sense and in not agreeing with him. I have a simple question. How will GPs know which foreign nationals are entitled to NHS care and which are not?

[Mr Hunt]

My hon. Friend asks a very important question. We have to recognise the pressure on GPs and must be careful not to increase the bureaucratic burden on them. The long-term answer is to have proper digital patient records. If the first thing that people are asked for when they enter any part of the NHS is an NHS number that allows the person they are seeing to look at their medical history, which could be a trigger to identify someone who should be paying for their NHS care. We are seeing whether there is a non-bureaucratic way of achieving that in the short term, while we put that technological system in place.

Accident and Emergency Departments

Tony Baldry Excerpts

Thursday 7th February 2013 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

Our lives are measured out in minutes, Mr Speaker.

In paragraph 1.25 of his report, which was published yesterday, Robert Francis said:

“MPs are accountable to their electorate, but they are not necessarily experts in healthcare and are certainly not regulators. They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare.”

I am not sure how many Members of Parliament Robert Francis QC spoke to before writing that particular paragraph, but I suspect that every MP seeks to be a champion for their local hospital and for the NHS in their own area.

I have left instructions for my body to be given to Oxford university’s anatomy department, for various reasons: there is quite a lot of it and I certainly think that the liver of anyone who has been an MP for more than 30 years is worthy of anatomical examination. Most important, however, I want to ensure that when they open me up they will find inscribed on my heart the words, “Keep the Horton General”. Throughout my 30 years as an MP for north Oxfordshire, the one thing that has been of greatest importance to me, practically above all else, is ensuring that the Horton hospital in Banbury remains a general hospital—that is, one with consultant-led maternity and children’s services, 24/7 A and E services, and a facility for people to see doctors on a 24/7 basis.

I also readily recognise, however, that certain specialist trauma services cannot be provided at hospitals such as the Horton, and that they are best provided at hospitals such as the John Radcliffe in Oxford. That was best demonstrated to me by a constituent, a friend of mine, whom I met the other day. He had suffered a ruptured aorta. My paternal grandmother died of a ruptured aorta, but this constituent survived. I said to him, “You were jolly unlucky to have a ruptured aorta, but you were fantastically lucky to live.” He told me that the only reason he had survived was that the ambulance had taken him from Banbury directly to the John Radcliffe in Oxford, where he received the specialist treatment that he needed.

I echo the point that has been made by several hon. Members that we need total clarity about what people can expect from major trauma units, and what is meant by the terms “accident and emergency department”, “urgent care centre” and “major injuries unit”. We need national standards so that we can all be confident that we are comparing like with like. We could then be confident about the protocols that the ambulance services use—when they are dealing with major road accidents on the M40, for example—and patients, GPs and people generally in my constituency would know what to expect from the accident and emergency services in Banbury, and when it would be more appropriate for them to be directed to the major trauma unit at the JR in Oxford. People would also be clearer about when they ought not to be bothering the accident and emergency department at the Horton at all but should really be going to see their GP. All too often people tend to treat the accident and emergency department as an out-of-hours GP service, but it was not intended for that purpose.

We must also recognise that medicine is constantly changing. The general hospital in Buckinghamshire at which my mother was a sister tutor, and whose accident and emergency department I visited as a child, has long since closed. The general hospital at which my father was a consultant has now merged with St Peter’s hospital in Chertsey. There has been evolution in health care for a long time. The Horton hospital is changing in that medical technology is improving the pace at which patients can be treated. In the past, women who had hysterectomies might have had to stay in hospital for 10 days, but that procedure can now be done as day surgery with an overnight stay.

Changes are also resulting from the fact that we have a much larger older population, many of whom have age-related dementia issues, who need to stay in hospital much longer. We have to reconcile those two growing areas of change within one general hospital. We have to recognise that medicine and service provision will not remain static. We cannot apply a single model throughout the system. We need integrity and honesty about what services are being provided and where, and an acknowledgement that it is not always in the best interest of patients to have a single stand-alone hospital providing every service to every patient. That is not necessarily in the best interests of patient safety.

As this debate has demonstrated, we will all fight tenaciously to ensure that the national health service continues to provide the very best service for patients. The Mid Staffordshire report yesterday was a wake-up call to us all. We all love our NHS and see it as a representative of our national integrity and of the cohesion of citizens and society, but we must also acknowledge that it faces real challenges and that we must all contribute to tackling them.

Dementia

Tony Baldry Excerpts

Thursday 10th January 2013 Commons Chamber

[Hazel Blears (Salford and Eccles) (Lab)]

I am grateful for your guidance, Mr Deputy Speaker. It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow). In my capacity as vice-chair of the all-party parliamentary group on dementia—the right hon. Gentleman elevated me in his speech; our group is incredibly well led by Baroness Sally Greengross—I want to pay tribute to his work in this field. I appreciated his personal drive on this issue; it has made a big difference. I should like to thank the Backbench Business Committee for allocating the time for this debate. I should also like to thank all the Members here today. This is a fantastically good turn-out for a one-line Whip, Back-Bench business debate on a Thursday afternoon, and it indicates just how deeply people feel about this issue. The hon. Member for Chatham and Aylesford (Tracey Crouch) has been a tremendous help on the all-party group, and I am delighted to be vice-chair alongside her. Her personal drive and commitment have made a big difference.

Nearly 1 million people will be living with dementia by 2020, and the issue now touches the lives of virtually every family in Britain. It is a big issue for the NHS, but it is also a big issue for all the public services. I entirely endorse the right hon. Gentleman’s point that we have to join up the services right across Whitehall if we are going to make the progress that we need to make.

Ten years ago, when I was a Health Minister, it is fair to say that dementia was not at the top of the agenda for Ministers or for the NHS. As ever, there were more pressing issues, such as cancer, heart disease, waiting lists, maternity services—the list goes on. The voices raising the issue of dementia, and of care for older people more generally, were not heard as clearly then as, thankfully, they are today. This is now a massive challenge facing all of us, and I believe that increasing pressure from the public has helped to focus the minds of politicians and practitioners on what can and should be done to support those with dementia and, crucially, the people who care for them.

I also want to depart from normal practice and pay a warm tribute to the Prime Minister. He has put his personal weight behind this issue, and I know from having been a Minister that having the Prime Minister behind a project can give it momentum and get the system moving. It can provide a kick-start and a catalyst. I want to say a genuine thank you to the Prime Minister on this issue. That does not mean that there is not much more to do, and there are certainly concerns about ongoing funding issues, but having the Prime Minister say, “This is my challenge; I am behind it” will get things moving in the system.

Like most people, I got involved in this issue because someone I love has dementia. It is my mum. Over the past five years, I have seen and experienced the impact of that on her and on my dad, who, at the age of 83, is still her full-time carer. I want to raise three issues today. I want to talk about diagnosis, support in the community and the research challenge that we face.

My mum’s diagnosis was absolutely appalling. She had been having problems with her memory for about a year and a half and, like many people, she thought that it was just because she was getting older that she could not remember day-to-day details. However, when she could not remember the day of the week and when she started constantly to repeat herself, we as a family thought that she would benefit from a bit of expert advice.

Mum’s GP was not bad. He referred her to the mental health team for older people. She was just 70 at the time. What happened after that, however, was absolutely terrible. My mum and dad received a visit from a local psychiatrist whom they had never met before. She sat herself down on the settee without any formalities and proceeded to ask my mum 10 questions about the day, the date and who the Prime Minister was—I can think of lots of people who would not have known who the Prime Minister was—and after just a few minutes, announced to my mum and dad that it was very clear that my mum had Alzheimer’s. As Members can imagine, they were stunned and upset. They had no idea what that meant for them or what the future might hold. They were frightened and bewildered.

That was just the kind of brutal diagnosis that we used to hear about in relation to cancer sufferers, but here it was happening to the people I love. Suffice it to say that, after a formal complaint, we did not see that psychiatrist again, but the incident brought home to me how many people in those circumstances are subject to such hurtful and damaging insensitivity. Better dementia diagnosis has to be a priority. Yes, this is about earlier diagnosis, but it is also about sensitivity, understanding and finding the right circumstances in which to make a diagnosis that will fundamentally affect people’s lives.

Diagnosis rates in this country are low and incredibly varied. In general, just over 40% of people with dementia receive a formal diagnosis. The lowest rate is 26%, in Dorset, and the highest is nearly 70%, in Belfast. There must be a reason for such a dramatic variation. We have made little progress in recent years towards driving up diagnosis rates, yet diagnosis is key, because without it a person cannot gain access to the support services and the help that they need.

[Sir Tony Baldry (Banbury) (Con)]

Is it not part of the problem that many GPs are anxious not to diagnose dementia because they feel frustrated that they do not know what to do following such a diagnosis? They do not know what to offer the patient, and there seems to be an inclination to avoid that frustration by not making a diagnosis of dementia at all.

[Hazel Blears]

The hon. Gentleman is absolutely right. In fact, the recent all-party group inquiry into diagnosis revealed exactly that situation, which is a real concern. Many GPs are uncomfortable about making a diagnosis of dementia. They sometimes feel that such a diagnosis is pointless if the necessary drug treatments or wraparound care and support services are not available. Increasing the confidence of GPs at that point to enable them to make a diagnosis is of fundamental importance.

The figures on diagnosis are quite stunning. Only half the GPs questioned said that they had sufficient training in this area, and a third of them believed that a lack of access to drug treatments was a barrier to early diagnosis. Almost a third were not confident about making a diagnosis of dementia, and only a third felt that they had had enough training to go through the diagnosis process. Unless we tackle that, we will not get the increase in diagnosis that the Prime Minister and all of us want.

--- Later in debate ---

[Sir Tony Baldry (Banbury) (Con)]

I am sure everyone who listened to the right hon. Member for Cynon Valley (Ann Clwyd) describing on the radio the terrible passing of her husband will have been moved, and all the accounts she has given this afternoon are certainly appalling and unacceptable.

I want to be concise, so I shall touch on only a few key points. My first point is on training for care assistants, a topic the right hon. Lady talked about. After I was first elected to this House some 30 years ago, several years passed before I first heard the word “Alzheimer’s”. At Christmas I would visit nursing homes in my constituency, and they were mostly full of spry widows in their 70s, but it is now impossible to get into a nursing home or residential care home in my constituency unless one is suffering from severe Alzheimer’s or dementia. As a consequence, many more people with mild dementia are now living at home in the community, being looked after by carers.

We must greatly expand the number of care assistants in three environments: first, in hospitals. If we are to have a graduate nursing profession, we also need to ensure that caring assistants see that they have a vocation— that they are part of a profession and they have a set of skills. We also need to ensure that there are sufficient well-trained and motivated care assistants in nursing homes and residential care homes. For a long time nursing homes would recruit staff from overseas, very often from India, the Philippines or eastern Europe. They would train them, and then in due course those people would go and work for the national health service. Because of various changes to migration policy, however, that is no longer possible. Thirdly, we have more people with dementia and mild dementia living at home, and they also need proper care and support from care workers.

I raised this issue with Ministers earlier in the year, and my hon. Friend the Member for North Norfolk (Norman Lamb) kindly gave me a comprehensive response:

“We are doing lots of work with the sector to grow the workforce. We are, for example, aiming to double the number of social care apprentices to 100,000 by 2017 and expanding the current care ambassador scheme to promote a positive image of the sector.”

I have to say that I do not get the feeling that there are currently 50,000 apprentices in the social care or care worker sector, and I do not get a sense of there being many social care apprentices in my patch. That may be because they are not promoted as such, and how does one recognise a social care apprentice or a qualified social care worker in a residential care home or hospital?

The Minister rightly says that the Government acknowledge the importance of training and qualifications in supporting workers in their roles and in improving the quality of care services, and the Government are spending £285 million each year on training and developing the care worker work force. This may just be my view, but, again, I do not get a sense of how that is being demonstrated in outputs. I say to the Minister that we need a clearer focus on the training and development of that work force. We have made nursing a graduate profession but we must also ensure that those who are not graduate nurses—care workers in our hospitals, in our nursing homes and in the community—have a similar sense of vocation and similar training and apprenticeships. They need to be recognised as qualified care workers, and we must continue to invest in that work force.

As the right hon. Member for Cynon Valley said, compassion is key to all of that. When my mother and her generation trained as nurses, they saw compassion as an essential part of their vocation; that was inherent in being a nurse.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I wish to give a further anecdote. My mother trained as a nurse and she said to me that on the first day in her job she was taken by the matron to the bed and told, “This is your world. The patient, and nothing else, is what you are there to look after. I want to know exactly what is happening with each and every patient in your care.”

[Sir Tony Baldry]

That was absolutely the case. There are occasions when one is just going to be out of touch on this, but hospitals are changing. When I was young, my father was a consultant and he had three wards. He was responsible for them and each had a sister, who was identifiable and accountable, as were the staff nurses. Everyone was accountable and everyone knew what was happening. Hospitals are changing, and in some ways medical technology means that things move a lot faster: for example, hysterectomies can now be day cases. However, people are staying longer in other parts of hospitals. As my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) said, a large number of people in hospital are also suffering from dementia, and hospitals, as well as treating the acute problems of such people, need to respond to that. They need to work out where those people go once they leave the hospital. Very often someone’s dementia is not spotted until they are in hospital.

[Mrs Madeleine Moon (Bridgend) (Lab)]

My mother, too, was a nurse. Sadly, at the end of her life, she ended up in hospital far too frequently, and at the very end she also had dementia. She would say that the nurses would never have been allowed to work on the wards that she worked on, because they treat conditions, not people—that is the problem. They no longer see the person in the bed; they see only the condition. Until that focus moves back to the person and their needs, and away from the condition and the diagnosis, we will not get the change we desperately need.

[Sir Tony Baldry]

I entirely agree with the hon. Lady. Many of us took part in a Westminster Hall debate earlier this week on palliative and end-of-life care, when similar points were made. Sadly, all too often, what we read in our national newspapers demonstrates the desperateness that is occurring, as does the fact that the right hon. Member for Cynon Valley received 1,000 letters and e-mails in response to her tragic circumstances. This culture change in nursing needs to be reversed, because we must get compassion back into the NHS.

The second point I wished to discuss was carers, as I co-chair the all-party group on carers. It is estimated that 670,000 people in this country have dementia and the number is due to double in the next few years. As has rightly been said, most of us will either suffer from dementia or will know someone who will be a sufferer and so will be a carer at that time. One frustration for carers is that they do not get recognised as being carers, which is extremely frustrating, particularly when they are dealing with the GP of the person they are looking after—their loved one. I intervened on the right hon. Member for Salford and Eccles (Hazel Blears) to say that part of that frustration has arisen because GPs have been slightly in denial about people with dementia, because they are not sure what to do with them when they make the diagnosis.

However, I am pleased that the National Institute for Health and Clinical Excellence has proposed that GPs should follow three new indicators on caring for people with dementia. First, GP practices should be examined on the

“percentage of patients with dementia with the contact details of a named carer on their record.”

GPs must, therefore, diagnose someone with dementia because otherwise they will not know that they have a carer on their record. The second indicator is:

“The practice has a register of patients who are carers of a person with dementia.”

The third indicator is:

“The percentage of carers (of a person with dementia) who have had an assessment of their health and support needs in the preceding 12 months.”

There was criticism in some of the national press of the Prime Minister’s determination to ensure that people get a proper diagnosis of dementia if they are suffering from it, but unless people get such a diagnosis—unless GPs face up to the fact that their patients have dementia and start to care also about the carers of these people, by making sure that they get carers, assessments and so on—we will never get the qualitative and quantitative changes in how society is run to allow us to face up to a revolution, which has happened in the lifetime of many of us, in the number of people living in our society with dementia. This issue is going to grow.

I was very impressed by what the right hon. Member for Salford and Eccles said about Salford being a dementia-friendly community; many of us must go back to our constituencies and look at the challenge dementia poses, because, in comparison, my patch is simply in the foothills of that. Over the next few years, we will all have to try to make sure that we have dementia-friendly communities.

[Bob Stewart (Beckenham) (Con)]

I meet a lot of carers. I do not have the experience that some hon. Members have, but the one that struck me about so many of these carers is that they are deeply dedicated. It would be really good if they could be considered more professional. After all, we think of doctors as being in a profession, and nurses definitely have a profession. There is now a requirement for a profession of carers that is widely recognised and accepted in society. Does my hon. Friend think that that has merit?

[Sir Tony Baldry]

I do. I have been trying to encourage organisations such as St John Ambulance to think about providing training for carers. Some people find that, overnight, their wife or husband has a stroke or serious fall and they find themselves as the carer, and others must deal with a gradually deteriorating situation such as dementia. Such experiences are frightening and the people involved often have to grapple with bureaucracy, the health service and so on. I am sure that if it were possible for local training to be provided for carers, a lot of these people would feel much more empowered and much more competent. The question is finding the organisations that can deliver such training.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Does my hon. Friend agree that one key thing that also must happen is ensuring that Departments also demonstrate a lead on tackling dementia? The hon. Member for Plymouth, Moor View (Alison Seabeck) and I have been very impressed by what HMS Drake has been doing; the people there have been instrumental in Plymouth in fighting for more dementia awareness, including among Departments.

[Sir Tony Baldry]

That was an extremely good point, and it was one made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) in opening this debate; every Department has a part to play in tackling dementia. Nobody would immediately have thought of the Ministry of Defence as having a role to play in tackling dementia, but every Department, as part of collective, joined-up government, needs to consider what it is doing on dementia.

The last point I wish to make relates to research, attitudes and so on. One of the most depressing things about dementia is going into residential care homes and seeing people sitting doing nothing, staring at the wall. That is desperate. I have little fear of death—death at the worst can be eternal darkness—but I have a total fear of getting dementia. It must be a sort of living death for as long as one has it.

A number of organisations are coming forward with ideas of how to improve, if not people’s memory, how they can cope with dementia. An organisation with a strong following in Oxfordshire is the Contented Dementia Trust. Some of its work is supported by the Royal College of Nursing, and Oliver James’s book, “Contented Dementia”, is one of the best-selling books on dementia in the UK. The Contented Dementia Trust has a particular way of helping people with their memory, because from a carers’ perspective dementia, once diagnosed, is best understood as a person’s failure to store coherently the facts of what has just happened in their life—although associated feelings are stored—whereas facts stored long before the onset of dementia remain relatively intact and potentially useful. That is why when one goes to see people with dementia they can tell in graphic detail what they did during the second world war or their childhood, but they cannot say what they had for lunch. The Contented Dementia Trust has worked out a method that, it believes, helps people with that.

I hope that somewhere in the Department an evaluation of the various systems has been undertaken with an open mind, to consider what works. Clearly, what is required is consideration of how to stimulate people with dementia so they do not become part of the living dead. As my hon. Friend the Member for Chatham and Aylesford said, we want to ensure that those with dementia can live with dignity and can live lives of the best quality. That does not mean being stuck in a chair in a communal lounge all day between meals, perhaps getting some stimulation or perhaps not getting any. They require stimulation, help with their memory and the sorts of activities that the right hon. Member for Salford and Eccles identified as taking place in various day centres in Salford.

We all need to share and develop the practices that work best, to ensure that people do not get proprietary about there being one correct way of dealing with dementia. We must all recognise the limits of our knowledge. One of the desperate things about dementia is that those who suffer from it cannot tell us what is happening in their lives, as if they have moved on to another planet and cannot come back and tell us what is happening to them. It is a one-way journey and they cannot help us—we can only sense whether they are happier or more contented. I hope that Ministers and officials will consider the work of organisations such as the Contented Dementia Trust with an open mind.

The debate highlights for us all the sheer scale of the challenge over the next 20 to 50 years. It must continue to be a national priority if we are to get the compassion and care that every one of our constituents and loved ones deserves.

Liverpool Care Pathway

Tony Baldry Excerpts

Tuesday 8th January 2013 Westminster Hall

[Sir Tony Baldry (Banbury) (Con)]

When I first entered the House of Commons some 30 years ago, I became the founder secretary of the all-party hospice support group, and Jack Ashley was the founder chairman. I am glad to say that that group has now become the all-party parliamentary group on hospice and palliative care. During those 30 years, an enormous amount of work has been done on enhancing palliative care in hospitals. We are fortunate in this country in having an outstanding hospice movement. Part of the purpose of the Liverpool care pathway was to ensure that the good practice of palliative care, which had been developed in hospices, could be spread to other health care settings, such as hospitals and care homes. Extending it to people’s own homes was also important because if people are asked where they would like to die, most say at home. The reality for each one of us is that we will die.

The Liverpool care pathway requires staff to ensure that all decisions to continue or to stop treatment are taken in the best interests of each patient, and emphasises that patients should be involved in decisions about their care and that carers and families should always be included in the decision-making process. An evaluation in 2011 showed that in 94% of cases, there had been such involvement. The idea of documenting conversations, which the hon. Member for West Lancashire (Rosie Cooper) mentioned, is sensible. In our own professional lives, and, indeed, as Members of Parliament, we all know that people, especially family members, do not always take on board news that may be distressing. Often it is quite a shock to be told that a loved one is near to death. Very often, the instinctive reaction is to want to ensure that life can be preserved for as long as possible, but we also have a duty of care to ensure that in people’s last days and hours they die well and painlessly and with as much dignity as possible.

I was very struck by two contributions in the Library briefing. One was a brave article by a specialist registrar who herself is a terminally ill cancer patient. Of the Liverpool care pathway, she said:

“It prompts us to have open discussions with relatives, and, if possible, patients, to stop unnecessary medication, to discontinue futile medical interventions, and to shift our focus of care to symptom-control, comfort and dignity… Most patients on the LCP, in my experience, are too poorly to eat or drink, but where a patient is alert enough to swallow we certainly continue to offer them food and fluids in my hospital. They are not ‘starved to death’. The problem with intravenous fluids is that cannulae need to be inserted to administer them. This is painful, often very difficult and sometimes near impossible in patients who have been in hospital for a number of weeks.”

[Jim Shannon (Strangford) (DUP)]

Although the hon. Gentleman makes a pertinent point, surely the issue must also be about those people who are not convinced about the system and who are suspicious and worried about what they have been told. There are people who have been denied fluids, and also drink and food. Does the hon. Gentleman think that there should be some protection in the system for such families so that they can feel assured that there is care? The point I am trying to make is that this should be about care and not killing, but many of us suspect that there is more emphasis on the killing than on the care.

[Sir Tony Baldry]

Very few of us can have the confidence of Cardinal Basil Hume who, in his book “The Mystery of the Cross”, observed:

“Death is a formidable foe until we learn to make it a friend. Death is to be feared if we do not learn to welcome it. Death is the ultimate absurdity if we do not see it as fulfilment. Death haunts us when viewed as a journey into nothingness rather than a pilgrimage to a place where true happiness is found . . . Death is not the end of the road, but a gateway to a better place.”

Few of us, irrespective of our faith, have that clear courage and confidence, but we all recognise that we will die. There is nothing about 21st century medicine that is going to keep the hon. Gentleman or myself, or any of us, alive for ever. Death, and the process of death, can be extremely painful, and it is our collective duty and responsibility to try to ensure that people die as painlessly as possible and with as much dignity as possible.

I can assure the hon. Gentleman that people do not go into the medical profession to kill. My father became a doctor and my mother a nurse to ensure that they could give people the best quality of care. Although the press have published a number of stories about relatives who have expressed concern about how the local care pathway has been used, there is no systemic evidence to suggest that the policy is being abused. A consensus statement was published last year by several non-governmental organisations and charities, all of which are much respected in this House, supporting the Liverpool care pathway. They include Age UK, the Alzheimer’s Society, the British Heart Foundation, Help the Hospices, Macmillan Cancer Support, Marie Curie Cancer Care, the Royal College of General Practitioners, the Royal College of Nursing, the Multiple Sclerosis Society and the Royal College of Physicians.

[Jim Shannon]

rose—

[Sir Tony Baldry]

No, I will not give way because others want to speak. This is an important issue, but we must ensure that we put it in perspective. If we are not careful, all the work that has been done over the past 30 years by a whole number of organisations, including those that I have just mentioned, to enhance and improve palliative care could be undone. Sadly, people die every day; that is the reality. It is not a failure of the NHS that people die. It is only a failure of the NHS if people do not die well. We need to ensure that all improvements, whether they be to records or to communication with patients and their families, are undertaken, but nothing should deter us from trying to ensure that everyone in this country gets the best possible end of life and the best possible palliative care.