Dementia: Community Care (Hansard, 4 July 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, my honourable friend the Parliamentary Under-Secretary of State for Health has received a number of representations from the Alzheimer's Disease Society to which he has responded.

§ Lord Stallard
My Lords, I had hoped that the response would be more positive. Is the noble Baroness aware that this is the beginning of national Alzheimer's Awareness Week, which highlights the problems of people suffering from dementia who live alone in the community? Some 154,000 people with dementia live alone in our community. They will need continuing care sooner rather than later. Can the Minister give any indication of the Government's intentions regarding how they will provide that continuing care, given the growing number of people who will need it?

§ Baroness Cumberlege
My Lords, it is provided through district health authorities and social services departments assessing the health needs of their population, setting contracts as to quality and quantity of service with trusts, mostly, mental health trusts, and other agencies and ensuring that monitoring systems are in place to see that those services are delivered.

§ Lord Cledwyn of Penrhos
My Lords, can the noble Baroness confirm whether or not the excellent Alzheimer's disease research unit in London has been closed and part of the staff transferred to the United States? In those circumstances can she say where research into this terrible disease is now being undertaken in this country?

§ Baroness Cumberlege
My Lords, I understand that the Alzheimer's Research Trust —if that is the unit referred to by the noble Lord—has recently launched an appeal to establish a multi-disciplinary research centre in Cambridge dedicated to finding a way to ameliorate the effect of the disease. There is also a lot of national research going on, principally under Professor Anthony Mann, who is looking at the quality of homes for people with Alzheimer's disease. The Medical Research Council is also conducting a large multi-centre study into the needs of elderly people.

§ Baroness Faithfull
My Lords, can the Minister say what is the position when a serious case of Alzheimer's disease reaches the stage when residential care is necessary but relations who cannot manage in the home are unable to pay the costs of an Alzheimer's hostel?

§ Baroness Cumberlege
My Lords, first there is an assessment made jointly with the social services and National Health Service professionals involved. If the requirement is that the person should go into residential 986 care not under the auspices of the National Health Service, an assessment is made of the family's means and whether it can support that person in the home. Assessment of means and ability to pay are a requirement on the social services department before it levies a charge.

§ Lord Rea
My Lords, does the Minister agree mat her answer to that question reveals that the crux of the matter—as shown in last Thursday's debate on this very topic—is that those cases of very severe dementia who receive care through the National Health Service will receive a better and more appropriate service without any penalty at all to their families and without having to go through the assessment process? Will she accept that I can testify to how amazingly relieved those relatives are when what is in fact a subtle form of torture is lifted from them, whereas those who receive care in the community, however good that may be, will often be penalised financially? Will she further accept that that is happening at a time when National Health Service provision is not keeping pace with the increase in demand? Is it not an example of what was criticised by the Bishop of Birmingham as being uncharitable and unchristian National Health Service reforms?

§ Baroness Cumberlege
My Lords, I do not want to go into what the Bishop of Birmingham said except to say mat I think he misunderstood the purpose of the reforms and what they are achieving. With regard to the charges that the social services make for residential care, if the assessment reveals that a person needs health care under the National Health Service that person receives it, whether it is in a nursing home or hospital facility. Also, if the person lives in the community and needs community psychiatric nursing help or NHS support, that clearly is free. But the general principle of local authorities charging for residential care has been established since 1948. We have not in any way altered that as a result of the community care changes. It is reasonable that people should pay for the provision of services in accordance with their means. Otherwise, people with assets would be unnecessarily maintained at the expense of the taxpayer.

§ Lord Monson
My Lords, is the noble Baroness aware that recent research in the United Kingdom, the United States and the Netherlands indicates that nicotine has an ameliorating effect on Alzheimer's disease and that smokers are 50 per cent. less likely than non-smokers to develop symptoms of the disease? In the light of that finding, will the Government consider easing up on their anti-tobacco campaign, certainly so far as concerns the over-60s?

§ Baroness Cumberlege
My Lords, there may be an element of wishful thinking in what the noble Lord says. There is also an element of research. But that is for debate on another day, a day which I believe will be upon us quite shortly.

§ Baroness Fisher of Rednal
My Lords, is the noble Baroness aware that the fifth report of the Mental Health Act Commission asks for a serious review of the early discharge of patients and calls for urgent action as 987 regards in-patient beds in urban areas? Will she accept that one of the comments made by the Bishop of Birmingham, which may relate to that issue, has been wildly applauded in the city?

§ Baroness Cumberlege
My Lords, every year we put more and more resources into community care. The figure stands at £1.2 billion this year; it will rise to £1.8 billion next year. Of course we look at the residential provision. But many new schemes enable people with dementia, who are very dependent, to be kept at home with enough support from social services and the NHS. Some schemes are extremely imaginative. We must get away from judging the National Health Service and the social services by the number of residential places available. We know that many alternatives are being produced by which people benefit enormously.

§ Lord Annan
My Lords, have the Government any plans for reviewing priorities in medical research? Enormous quantities of money are spent on research into heart disease and cancer. Well, we all have to die. But there are people who, from the age of 40, live in agony due to arthritis and related diseases. Should not more money be put into orthopaedic research rather than into research of diseases which in the end are bound to be mortal?

§ Baroness Cumberlege
My Lords, the director of research and development of the NHS Executive agrees with the noble Lord and is trying to ensure that more research goes into mental illness—in the past, we believe, a neglected area—and also research generally into conditions that affect elderly people.