Dementia

Tracey Crouch Excerpts

Thursday 10th January 2013 Commons Chamber

[Tracey Crouch (Chatham and Aylesford) (Con)]

It is an honour and a pleasure to follow what ended as a very moving speech by the right hon. Member for Salford and Eccles (Hazel Blears). She is a fantastic fellow vice-chairman of the all-party group, and a real champion on this issue. I would also like to take the opportunity to pay tribute to the right hon. Member for Sutton and Cheam (Paul Burstow), who I thought progressed this issue as a Minister much further and much quicker than did previous Ministers.

I start my comments this afternoon with an explanation of what sparked my interest in this incredibly important issue. As a parliamentary candidate, two events collided and aroused an immense passion about dementia that will stay with me for ever. I cannot quite recall the precise sequence of events, but one was personal and one was professional.

The first was my father calling me to tell me that his mother, Nana Crouch, had been diagnosed with dementia. My beloved grandfather passed away when I was a teenager. Following her diagnosis with this awful condition, nana regressed quickly and was transferred into residential care for her own safety. I went to see her, but she was so confused about who I was that she became quite frightened and I left concerned for her own mental well-being. It was very upsetting to see a lady I respected and loved hide in a corner cowering with fear.

The second event involved me knocking on the door of a man called Maurice. He and I remain friends today, despite our political differences. At the time, Maurice’s wife was still alive but was in a care home suffering from dementia. Maurice is a great man, one with a military background and one who had his whole world of traditional male-female relationships turned upside down when he suddenly had to care for his wife. The challenges that Maurice faced are ones that many carers are exposed to, but his real concern—one I now share—was the poor care his wife received while she was in hospital for a minor injury, where her health care needs were exacerbated by her dementia.

This issue of inadequate hospital care for dementia sufferers is a substantial one. While there is much evidence of good practice, there is an unacceptable variation in the quality of care. Maurice has become a pain in the proverbial, albeit in a good way, to local health care organisations. He champions the need for better care for dementia sufferers in hospitals—and rightly so. Of the carers responding to the Alzheimer’s Society’s “Counting the Cost” report, 77% stated that they were dissatisfied with the overall quality of care provided to people with dementia in hospitals. The key reasons included nurses not recognising or understanding dementia, lack of person-centred care, patients not being helped to eat or drink and patients being shown a lack of dignity and respect.

The issue has been highlighted many times, most recently in a report from the Royal College of Nursing. Staff training, for which nurses themselves are calling, would constitute a vital step towards the addressing of those inadequacies. However, we must also achieve the correct balance between health care assistants and nursing staff, which is vital to the provision of personalised care in hospitals. All too frequently the problem is not the number of staff, but the fact that the ratio of health care assistants to nurses is too large, and nurses are therefore unable to support staff sufficiently.

Unnecessary admissions and prolonged stays in hospital are expensive, and much too often they have negative effects on health and well-being. The all-party group looked into that and the cost to the NHS. I personally favour the notion of the halfway house: a service that could provide a primary care facility for those requiring medical attention for, say, a broken bone or a superficial wound, but in a less hospitalised environment. Not only might that be more cost-effective for the NHS, but it could address the issue of institutionalisation. One in four people in hospital beds have dementia, and, on average, people with dementia stay in hospital a week longer than those without dementia who are being treated for the same injury.

People with dementia often become extremely distressed by ordinary events, such as meal times, and need extra help. If food is just left in front of them, they will not necessarily eat it even if they are hungry. It might be helpful for carers or family members to be present when they are served their food, but most hospitals do not currently allow visitors at meal times. I am keen to hear from the Minister what measures are being introduced to make hospitals more dementia-friendly, and, in particular, what action is being taken to increase dementia awareness and understanding among hospital staff.

I am delighted that the Prime Minister is personally taking an interest in the issue after launching the dementia challenge. One of the more creative aspects of the challenge relates to the importance of dementia-friendly communities. I have observed three local initiatives that, although they have only just begun, have the potential to evolve into wonderful examples of how to meet that challenge. The first was the Alzheimer’s Society roadshow that took place recently at a local Tesco store. More than 55 people visited the vehicle in two days to obtain help, support and advice, 17 of them engaging in one-to-one sessions. Six new people accessed local dementia cafés as a direct result of the roadshow. I must say that I am a huge fan of dementia cafés: I think that they are bringing real value to our local communities.

The second initiative is run by Asda Chatham, which rather movingly granted Christmas wishes to those in a local dementia care home. I was there to help, and talked to the manager during the event. He is keen to ensure that his staff have a better awareness and understanding of dementia, so that they can understand and help when someone is standing at the till feeling confused by something as simple as the coinage in their purse—coins that they do not recognise as the coins from their childhood. We have seen instances in which people stand and stare at oranges, for instance, for a significantly long time, and someone comes along and helps them to understand, making them feel less confused and more relaxed about the environment that they have suddenly realised they are in. I think that our local supermarkets have a key role to play in that regard.

The third example is the fabulous work of Kent fire and rescue service in preventing vulnerable people from harming themselves while living at home. It is a trusted service, and it is doing its bit to help. We heard on the radio recently that in Kent—although not in my constituency—a man with dementia had rather sadly put his pyjamas in the microwave, and had almost set his house on fire. Members of the fire and rescue service arrived and sprayed a retardant over most of the house to ensure that he and his wife could live there safely without the risk of fire.

As the right hon. Member for Sutton and Cheam pointed out, dementia is not just a problem for the Department of Health and local authorities, but an issue for the whole community. Every individual, organisation and department needs to play a part in changing society and its attitudes to a disease from which more than a million members of the population will be suffering by 2021. We need better collaboration and integration across different sectors, and we need to establish how limited resources can be used more efficiently and effectively.

People can and should be able to live well with dementia. We want people to live in their own homes for longer, not only because that is better for them but because it is financially prudent. Early intervention via better, quicker diagnosis is essential. Medication and memory clinics mean that we can now live well with dementia for longer if it is identified early, but at present only 40% of people with dementia receive a formal diagnosis, and that is not good enough.

I recently undertook an anonymous survey of GPs in my constituency. The problem highlighted most frequently was limited time with the patient. A standard 10-minute appointment is not necessarily sufficient in view of the complexity of the disease. When I asked what authorities could do to improve diagnosis rates, one key theme emerged: the need for quicker access to specialised staff, whether that would mean nurses in the community or shorter memory-clinic waiting times. There is such a difference between the worst case of a nine-month waiting time for memory-clinic services and a waiting time of 24 hours, which is best practice. If a day’s wait is possible somewhere, it should be possible everywhere.

Another vital aspect of ensuring that people live well in their own communities is support for carers. We must do all that we can to give those whose world has been turned upside down the time, advice and respite they need. My constituent, Ron, had quite a good experience of the support that was available, and when his late wife was diagnosed with dementia, organisations and services contacted him very soon afterwards. He was provided with a range of support, aimed at the needs of a carer, by Crossroads Care, Admiral Nurses and the Maidstone & Malling Carers Project, but that does not always happen. Other constituents who have contacted me have been completely lost and alone, dealing with the volatile and confused behaviour of their loved ones with little or no support.

It is imperative that we ensure that, following diagnosis, all carers receive a list of services and support in their area. That does not naturally happen at present, but it is important for the person suffering from dementia and for the carers. Ron told me about a book that one of the charities had given him providing a comprehensive list of common difficulties that arise for a person caring for someone with dementia, along with simple and straightforward ways to overcome them. He told me that it was a lifeline and a bible. Will the Minister ensure that a copy is available on the new “Our Health” website as it is rolled out across the country between now and March? It is an essential tool for carers.

Ron’s carers were wonderful, but when his wife passed away shortly before Christmas, all his support was discontinued from the moment of her death. Now the only support he has comes from his neighbours, who help him with his shopping, and it has taken him six weeks to secure an appointment with a befriending service. We have come so far, achieving great improvements in carers’ rights and dementia awareness, but we have such a long way to go. The fact that the person being cared for has died does not mean that the carer has as well. Indeed, that may be the time when help is most important to a carer.

Finally, I want to say something about funding. We must, absolutely must, find the correct way of funding health and social care budgets. My constituent Frank went into a care home with social care needs, and, as a self-funder, was initially charged £650 a week. After he arrived, he was diagnosed with dementia, a defined health condition, and his weekly charge has now increased to £1,200 a week owing to additional care costs. However, a state-funded person is charged only £550 a week, and there is no explanation for that. I am helping Frank’s family to explore the issue, but the fact remains that his lifetime savings and assets will be depleted in no time as they pay for his care.

We must get on with implementing the Dilnot recommendations, particularly the cap on care costs, and we must remember that the cap does not include accommodation costs. In my view, the £75,000 that was rumoured in last week’s papers is far too high, as it will make little difference to most people. I know that budgets are tight, and that the £35,000 recommended by Dilnot would cost the taxpayer £1.7 billion, but we need to consider our priorities. I am a defender of our international aid efforts, but we must consider whether it was right to spend nearly £1 billion over the past five years in India, a country with its own space programme and nuclear arsenal.

The Department for International Development needs to spend an extra £3 billion in the next two years if it is to fulfil the Government pledge of 0.7% of GDP. In cash terms, that is an increase from £7.8 billion in 2010-11 to £11 billion in 2014-15. Governments are judged on their morality, and perhaps it is now time that we recalibrated our priorities and considered spending the extra billions of pounds earmarked for aid projects abroad on funding quality care for the elderly at home.

Benjamin Franklin famously, but rather gloomily, noted:

“In this world nothing can be said to be certain, except death and taxes.”

As we begin another year in the 21st century and teetering on the cusp of having a significantly ageing population, we could probably add a third item to his short list: sadly, we are likely to know someone who is suffering or has suffered from some form of dementia.

This is an important debate, and I am very pleased that the Backbench Business Committee gave time for it. Ultimately we, as elected politicians with the power to change how we deal with those with dementia, owe it to Maurice, Ron, Frank, Nana Crouch and every constituent who suffers from, or cares for, or is a friend or family member of, someone with this awful condition, that actions really do follow the words.