Older People: Health Care (Hansard, 16 May 1994)

§ Baroness Cumberlege
My Lords, health promotion and sickness prevention are important at any age. In the Health of the Nation White Paper we made it clear that all the key areas are relevant to older people; and many of the targets apply as much to older people as to younger.

§ Lord Stallard
My Lords, I am grateful to the Minister for that Answer. But does she recall that the Health of the Nation White Paper stated that rehabilitation and the health of older people were strong candidates for further development and that research was necessary before they could become targets? Is she aware that since then—some years on—many experts believe that the time is now right for those aspects to be made targets? For example, research into Alzheimer's disease and other forms of dementia is crucial. Access to chiropody, physiotherapy, occupational therapy and district nursing services is also crucial and could be targeted now if we had the will. Will the Minister give us an assurance that those matters will be considered for urgent inclusion as key areas in the national strategy?

§ Baroness Cumberlege
My Lords, we keep the key areas under review. I hear what the noble Lord is saying, but your Lordships will remember that only last week a plea was made that we should include asthma. I am aware that there are many lobby groups—those who want to see children's and women's health included and others ethnic health. One of our difficulties is to ensure that we have priorities, because if every area is a. priority then we shall have no priorities.

§ LordMolloy
My Lords, will the Minister consider that there are many ex-servicemen and women who 7 suffer various ailments which are due simply to their war service? Will she once again ensure that they suffer no penalty for having lived so long?

§ Baroness Cumberlege
My Lords, I think that I replied to that debate quite fully a few minutes ago.

§ Lord Hailsham of Saint Marylebone
My Lords, I should, I suppose, declare an interest as I am 86, which is one year above the maximum age mentioned by the noble Lord, Lord Molloy. Does my noble friend agree that the health service is to be very much congratulated in some fields upon the help that it gives to older people? I know of at least one case where an old lady of 91 was given a hip replacement operation within a matter of days and another case where a similar operation was carried out on a man of 80.

§ Baroness Cumberlege
My Lords, my noble and learned friend is absolutely right. If we just look at the statistics we see that 60 per cent. of the NHS budget is spent on those who are over retirement age and who constitute only 16 per cent. of the population. I think that that indicates some priority towards elderly people.

§ Baroness Seear
My Lords, will the Minister confirm that there is no discrimination against old people within the district nursing service? I benefited recently very greatly from the district nursing service, and I certainly come into the "aged" group.

§ Baroness Cumberlege
My Lords, I am a great fan of district nurses. I think that they do a tremendous job.

§ Baroness Hooper
My Lords, does my noble friend agree that GP services, particularly services relating to a number of aspects—chiropody and so forth—referred to by the noble Lord, Lord Stallard, have developed in such a way as greatly to benefit older people? That is an element of the reforms upon which the Government can be congratulated.

§ Baroness Cumberlege
My Lords, yes, I thank my noble friend for that. When we look at nearly all the indicators that affect older people, we find that the Government have increased the service.

§ Lord Murray of Epping Forest
My Lords, the Carnegie Report cites that something like 2.5 million people over the age of 50 are engaged in caring for parents, spouses or disabled children in their own homes and that two-thirds of those people are suffering physical and mental problems as a result of caring. Will the Minister therefore ensure that specific provision is made for improving the resources available to voluntary organisations such as the Winged Fellowship and Crossroads which help provide care, especially by way of respite, to carers? Will she ensure that that is given a main priority position in the strategy and the definition of targets?

§ Baroness Cumberlege
My Lords, yes, we support a number of associations that specifically benefit carers, not least the Carers' National Association. We give not only considerable sums of money. We are also working closely with carers in formulating local policies and 8 priorities because we believe it important that they are involved in plans for the care of the people they look after.

§ Lord Jenkin of Roding
My Lords, would my noble friend care to comment on the recent article in The Times which cast doubt on the value of the specialty of geriatric medicine? Does she recognise that many of the problems of older patients are specific to them, often involving multiple illnesses, and that the profession of geriatric medicine, or care of the elderly as it is increasingly called, is an enormously valuable part of the NHS?

§ Baroness Cumberlege
My Lords, I endorse fully the comments made by my noble friend.

§ Baroness Fisher of Rednal
My Lords, will the Minister consider much more obviously that respite care is important for many of the elderly? To follow what the noble Lord has just said, if they go into a hospital or nursing home for a period of time some of their problems can often be dealt with so that when they leave the carers have a less onerous job. It is just as important that carers have respite as that the people themselves can go in for what we call geriatric medicine.

§ Baroness Cumberlege
My Lords, yes, the noble Baroness is absolutely right. Respite care is often the one factor that enables carers to keep going. It is an area that we have drawn to the attention of district health authorities as they look at the services which will be needed in the future. We ask them to work closely with voluntary organisations on that aspect.

§ The Countess of Mar
My Lords, does the Minister agree that there are factors apart from medical ones which affect the health of the elderly, for example, that they should have suitable housing and a proper diet? Will she say what measures are being taken to advise them of the best way to keep healthy?

§ Baroness Cumberlege
My Lords, there are a number of ways, including the primary healthcare team, district nurses and health visitors—those involved in going into people's homes—and also through voluntary organisations which are sometimes expert in that field. As to specific housing concerns, I am afraid that I cannot reply to that as it is not part of my remit.

§ Lord Rea
My Lords, the Minister is right to point out that achieving the existing targets in the Health of the Nation would improve the quality and length of life of older people. But does she agree that the most important of those is a reduction in smoking? Will that be possible without the Government backing a ban on the advertising of tobacco?

§ Baroness Cumberlege
My Lords, we are working very closely with the industry to reduce the amount of advertising. We are targeting young people in particular because we know that they are more greatly influenced by tobacco advertising.

Lord Richardson
My Lords, does the Minister welcome the advent of a new enterprise, the re-enablement units? The units are experimental— 9 certainly the one in my area is—and the idea behind them encompasses many of the remarks made by noble Lords. All available facilities are co-ordinated, including those in the voluntary sector. The underlying philosophy is that the chiropodist as a detail can be extremely valuable, even in the light of advice from cardiologists. The philosophy is directed to all disabled people but mainly and specifically to the elderly.

§ Baroness Cumberlege
My Lords, I am conscious that this country is full of innovation and new ideas. I am not fully apprised of the idea outlined by the noble Lord, but I shall discuss it with him to see how we can further it if it is of great value.

§ Baroness Jay of Paddington
My Lords, does the Minister agree that the Questions asked by my noble friends Lord Molloy and Lord Stallard indicate a general anxiety about the level of special services for older people within the National Health Service? The Minister referred my noble friend Lord Molloy to the recent report of the Royal College of Physicians which ensures equity and quality of care for elderly people. Is she prepared to say that the Government will act on the recommendations directed at them? They are: Clear guidance is needed from central government to facilitate planning between health and local authorities to provide for the older person and there is a need for government to clarify the rules concerning whether and under what medical circumstances care for individual patients is to be funded by health authorities or local authorities". The final comment is of great concern.

§ Baroness Cumberlege
My Lords, we want local authorities, health authorities and voluntary organisa-tions to work closely together. That is why we are giving all public authorities involved in the field the responsibility of developing joint community care plans. We are doing what the Royal College of Physicians is advocating.

§ Lord Stallard
My Lords, my Question was not a criticism of the existing services. It was designed to ensure that older people have access to those services, which is not general throughout the country. Access is better in some places than in others, and I am trying to make it more general, which will ease many problems. Does the noble Baroness know that early in the next century more than 1 million people will suffer from Alzheimer's disease but we are not giving priority to the medical and social problems connected with that illness?

§ Baroness Cumberlege
My Lords, the director of research and development, the recommendation of whose appointment is due to the work of your Lordships, has looked at the issue of Alzheimer's disease. He wants more research into the disease. We respect the views of the noble Lord and appreciate that the disease is crippling and causes a great deal of misery not only to sufferers but to families and friends.

§ Baroness Jay of Paddington
My Lords, as we have a little time perhaps I may press the Minister further about funding, which relates directly to the question asked by my noble friend about access to care. Will the 10 Minister say whether the NHS will continue to fund continuing care for elderly people, which is of great concern?

§ Baroness Cumberlege
My Lords, each year the National Health Service has an increased budget. We in the Conservative Party have given an undertaking to ensure that funding continues in line with prices and inflation. We have honoured that agreement, but clearly there are enormous demands on the National Health Service. We must take those into account, but every single year we have increased the amount of money spent on the NHS.