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Dementia

My Lords, it is a privilege to begin to sum up at the end of what has been a highly informed and at times very moving debate. I pay particular tribute to the speeches by the noble Baronesses, Lady Murphy and Lady Perry, and my noble friend Lady Thomas of Walliswood. I should declare an interest as one of the 18 per cent of Members of your Lordships’ House who does not qualify for a bus pass. In response to the noble Lord, Lord Walton of Detchant, with every passing year, I become more inclined to think that I ought to carry a card that says, "in case of an emergency, please note, she has never been any good at remembering people’s names—do not assume that she has got Alzheimer’s." In thinking about this debate and reading this document today, I was trying to place this disease in its historical context. I think we have moved from an age in which Alzheimer’s, or dementia, was a thing of such fear and dread that it was locked away and ignored. Dementia has become something which people talk about in euphemism. When I talk to older people, something I do quite often, and they talk to me about other older people they know, they will say things like, "She is really losing the place", or "You know Mrs So-and-so? She doesn’t know her husband any more." Recently, I was talking to some younger people and they were telling me that one of them is practising for his driving test. They said, "It is really good, because his nan lives with them and she’s got Alzheimer’s and one thing that calms her down is that she loves being driven around in the car, so he is driving her around all over." The point is that Alzheimer’s and dementia are beginning to become part of family and community life. The thing that is missing from this document, good though it is in many ways, and the thing that restricts it as a strategy, is that it does not really address the key issues about how this disease becomes part of community and family life, with effects way beyond the narrow confines of health and social care. I think that that is the point my noble friend Lady Thomas of Walliswood was making when she talked about the disparate nature of this debate. This document, laudable and welcome though it is, is a series of unconnected points. That is unfortunate, when we are going to be looking at its implementation at a time of severe restrictions in public expenditure. If the department had been bold, this would have been a strategy to enable individuals and communities to manage what the noble Lord, Lord Walton, rightly called one of the biggest public health developments that we have. It would have acknowledged, for example, that this is a disease with a greater incidence in areas of affluence. It is a disease that happens when people are sufficiently well and are not affected by other co-morbidities, so that they live longer. It is a disease the incidence of which is a manifestation of other health inequalities, or what I would call health poverty. It is no surprise that people who have had very distinguished careers get this disease more than others, because they have not been affected by other things. At the beginning of setting out a strategy, we on these Benches ask, how is it that we can enable individuals, families and the state to deal with this issue as it grows? There is no doubt that responsibility for care will rest on a partnership between individuals and the state for a very long time to come. I want to talk briefly about a strategy for research. A lot of people have talked about research into early diagnosis. Noble Lords who listened to the Reith lecture on Radio 4 will have noted the very interesting point made by this year’s Reith lecturer that much of the commercial investment in this sort of research is about early diagnosis. This is in order to produce drugs which not only help people who have dementia, but people who are beginning to go through those very early forms of forgetfulness and who wish to maintain their brain performance. The noble Baroness, Lady Murphy, said in her introduction, that there is going to be a research summit. Will the strategy for research be about discovering treatments and mitigations for early onset of the disease, which will enable people to remain economically active for longer, or will it be about research into treatments and mitigations for those who are significantly older and will therefore live longer with other co-morbidities? Will the research be about improvements in quality of life for people who have this disease and their carers, or about prevention for a younger group? Noble Lords listening to Radio 4 this morning will have heard what has been happening with the cancer strategy and the cancer plan. I agree with the noble Baroness, Lady Greengross, that it was interesting to note that the cancer strategy has not worked as well for older people. Having said that, the cancer plan and the way the cancer plan has worked, bringing together academic research, the NHS, charities and principally to focus the involvement of sufferers is exemplary. For breast cancer, for example, it has led to the establishment of centres of clinical excellence in research and treatment, but it has done so in a way that has enabled those who have the disease to make improvements in their social care. It was very interesting that when Professor Mike Richards was tackled recently about the cancer plan and how our cancer survival rates are not as good as those of other countries, he defended the plan, saying that any plan had to address cancer prevention and treatment as well as early diagnosis and care, and there has been an all-round improvement. If we were to have a strategy for dementia that worked in that way, it would be worth investing a very great deal of money in it. I echo the point made by the noble Lord, Lord Rix—I never repeat his points, as he makes them far more eloquently than I do. There is a growing need for people throughout the whole of health and social care to understand dementia as it affects their discipline. Dentists, for example, need to know what to do when somebody with dementia presents to them. I would go much further and say that in the commercial world, smart companies will recognise that dementia will have a huge impact on family life. When housebuilders start building houses again, will they build very small boxy units or will they actually build houses into which three generations will at some stage move, as families with younger children will be looking after people with dementia? I think that it could go much further. The noble Baroness, Lady Murphy, referred to the comments made by Joan Bakewell. I have been saying for some considerable time that the process of tendering for social care is wreaking a great deal of havoc, particularly upon specialist services. It is increasingly the case that a service—information and advice, domiciliary care, or whatever—is commissioned not on the basis of need or of client groups but of all people over the age of 60. I think that in future there will be many fewer specialist agencies around, particularly in the voluntary sector, to help implement some of the worthy but at times very unrealistic ambitions of this document.