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Elder Abuse

In view of some of the things that I am reported to have said over the weekend, if I start speaking for the Ministry of Justice in debates such as this it may be one step too far. We need to consider the end point. If people are state- funded and are unhappy with their provider, they can refer to the local authority's complaint procedure. Ultimately, they can go to the local government ombudsman if they are still dissatisfied. We must examine the chain for people to get proper and appropriate redress. However, I shall not make any specific commitments on that today. I urge the hon. Gentleman to contribute to our review of ““No Secrets””, which is starting now and will go on for the next few months. We will put out a consultation document in the summer, and I urge him to respond to it. I offer to meet him to discuss his views. We need to focus on prevention and early intervention in relation to crime and safety, to encourage a new wave of innovative practice, to increase responsiveness and local accountability, to empower local and vulnerable people and those who have not previously been adequately safeguarded, and to develop new forms of support and encouragement so that people can improve their own health and safety. I urge him to be part of the debate about where we go next with ““No Secrets””, and I will meet him specifically to consider his views, as he has taken a particular interest in the issues. On the question of medication, the Government have done a number of things, but we need to reflect on the emerging evidence and, if appropriate, act in the short term. However, we will have to act following the publication of the national dementia strategy in the autumn. If we are to have a credible, robust national strategy to improve the quality of life and standard of care for people with dementia and their families, we cannot avoid tackling the issue. If measures can be taken in advance of the publication of that strategy, I am more than willing to consider them. The hon. Gentleman may be aware that, on 26 March, I met the hon. Member for Rugby and Kenilworth (Jeremy Wright), who is the chairman of the all-party group on dementia. He is another hon. Member who does an excellent job championing what was once an unfashionable cause. Last August, we said that we would bring dementia out of the shadows, and we have been able to do that with the assistance of parliamentarians on both sides of the House. As the hon. Member for Sutton and Cheam will be aware, the all-party group is about to publish a report. The hon. Member for Rugby and Kenilworth was good enough to give me some advance notice of the kind of issues that were likely to be raised and the recommendations. We focused on a number of specifics. One of the major messages was the need for the training of front-line staff. There was a need for friends and families to be more involved in the oversight of care, to ensure consultation when crucial decisions are made about medication. There will also be a recommendation along the lines of a three-monthly review of medication for all residents. I cannot be specific about how the Government will respond to such recommendations, but we will take the all-party report seriously and respond to it, both in the short and long term. That will be a key element of the first ever national dementia strategy in the autumn. The hon. Member for Sutton and Cheam might be interested in some specific statistics. Through the new general medical services contract, medication reviews for patients being prescribed four or more repeat medicines were included as one of the performance indicators in our quality and outcomes framework. In 2005-06, 95.8 per cent. achieved an acceptable level for that indicator. In the year ending 31 March 2007, 7 per cent. of homes inspected against the national minimum standards for care homes for older people failed the medication standard. Some 33 per cent. almost met the standard—I will give him more details about what that might mean—59 per cent. met the standard, which is a significant majority but nowhere near enough, and 2 per cent. exceeded the standard. That represents some minor improvement, but the figures are pretty stubborn: in the previous year, 8 per cent. failed the standard, 33 per cent. almost met it, 58 per cent. met it and 1 per cent. exceeded it. A hard core of providers are not meeting acceptable standards. One of the difficult issues in this debate is professional judgment. I am not a doctor and some of the judgments are made by professionals using best available clinical evidence and acting, as they would see it, in the best interests of the patients. Ministers cannot possibly second-guess some of those clinical judgments. However, I agree with the hon. Gentleman that it is not acceptable for a modern health and social care system, as a first instinct, to drug inappropriately people who, as a consequence of dementia, are exhibiting potentially challenging behaviour. The approach is about cultural change, training and regulation. Commissioning also has an important role to play in protection. If private homes are not fulfilling their responsibilities with regard to dignity or appropriate care, local authorities should stop commissioning services from them. There is not a magic bullet or a quick fix; we must do a whole series of things to ensure that people with dementia are not inappropriately drugged in a way that none of us would find acceptable for members of our own family. The Government will say more about that as we develop a national strategy this autumn.