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Dementia

My Lords, I also thank my noble friend Lady Murphy for this debate and her excellent introduction to it. In 1999, just after my retirement from chairing the Broadcasting Standards Commission, I was asked to be one of the judges for ITV’s best documentary of the year. It turned out to be an interesting assignment. It was also my personal introduction to the subject of today’s debate. The film that made by far the most vivid impression on me was "Malcolm and Barbara: A Love Story", created by Paul Watson. Malcolm and Barbara were husband and wife and Paul Watson their long-standing close friend. When Malcolm, a talented musician then in his early 50s, was diagnosed with Alzheimer’s, they reacted to the bad news by agreeing that, however horrifying the developments, Watson would film the disease as it developed over the years ahead. It was indeed horrifying and distressing to watch the stages of the disease unfold on film, and, at the same time, to observe the lack of appropriate support for Barbara that occurred along the way. If anything was needed to alert me to the huge sums that carers save the national budget in this area, as well as to wake me up to the need for a totally different national approach to dementia, it was to see just how much Barbara was able to—indeed, had to—achieve, by coping so heroically with fearful mood swings, not excluding violence, from her distressed husband. It is therefore no wonder that I was particularly glad to see that Barbara featured in a recent Honours List—a more than well-deserved recognition of the love and dedication that she and so many other carers in these situations provide. Currently 500,000 family carers are providing, unpaid, some £6 billion worth of care. In the 10 years which have elapsed since I first saw that documentary I think that we have all become increasingly aware that we are indeed an ageing population, and increasingly aware of the many implications that this has and will have for our own and for our children’s future. I am certainly aware that I am 10 years older, and I am beginning to recognise my own moments of tell-tale forgetfulness. So, against that background, it is more than fitting that I should congratulate the Government on their decision this year to publish and roll out a National Dementia Strategy. I hope that that way forward will include the contribution that employers also can make by retaining for as long as possible the valuable skills of dementia sufferers via means such as flexible working. We should all give considerable priority to the Government’s plan because it is clearly in everyone’s interest. In its 2008 report The Dementia Tax, the Alzheimer’s Society predicted that the number of people with dementia will rise rapidly from 700,000 today to over 1 million by 2025. I know that different people will quote different figures but another of its reports predicted that one in three people over 65 will end their lives with a form of dementia. Bluntly, the financial cost of all this will be unmanageable if we continue as we are now. As the Alzheimer’s Society points out, dementia is the UK’s biggest health and social care challenge. So the more I read about the strategy, the more important four aspects of it seem. Other noble Lords have already mentioned many of these. The first and most urgent aspect is the Government’s commitment to a national public awareness campaign. It is essential that the stigma—indeed, the fear—that dementia engenders must be confronted and changed. The second aspect is earlier diagnosis. It is good to know that the Government believe that with earlier diagnosis, more effective and well-researched medication and, above all, improved training and awareness among doctors, nurses and all those involved with the care of these patients, "living well with dementia" can be achieved. That is particularly important for end-of-life care, which is manifestly inadequate at present. This whole area needs to improve, as currently only 31 per cent of GPs believe that they received sufficient basic and post-qualification training in diagnosing and managing dementia. Only this week I heard from an Australian friend that every GP in that country is already required to test all their 70 year-old patients for dementia. So we are clearly behind other countries. Thirdly, for those with dementia and for their carers, the crucial need which they themselves identified in the consultation process was to have, ""someone with them on their journey"." In other words, they need a local, knowledgeable contact who, from the moment dementia has been diagnosed—and, equally important, before then—can give support, information, advice and access to the services needed. One important feature to bear in mind is the evidence showing that people want to stay in their own home and, preferably, ultimately, to die there. In many ways that is so much the better—not only do they fare better out of hospital; another tangible benefit is considerable financial relief for the NHS budget. As we have heard, 70 per cent of acute hospital beds are occupied by older people receiving inadequate care. That does not make any sense. However, if dementia patients are to be able to stay at home while at the same time enjoying the benefits of companionship, they will ideally need to find themselves in a diverse as well as comprehensive community. Most people—patients and carers alike—would prefer access when wanted to personalised social activity, from bingo to bridge, and short breaks for carers within a peer group with whom they can share activities and compare experiences. Fourthly, dementia is a disease. I was glad to hear a number of other noble Lords say that it is quite wrong for its treatment effectively to be classified as social rather than medical care and therefore means-tested. For dementia patients, that is all too often the practical consequence of the present system of charging for care. This fundamental point is most clearly spelt out by the Alzheimer's Society in its report The Dementia Tax. And what a value we have in the Alzheimer’s Society—without it, I do not think that we would not know half of what we know. I look forward most to the Minister’s reply on this point. Is the treatment and care of dementia likely in future to be managed and financed on the same basis as any other disease tackled by the NHS? If not, why not?