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Dementia Strategy

There is a huge accountability deficit here. PCTs cannot be held to account, and sometimes getting an answer to any such questions is like getting blood out of a stone. I first asked Ministers about the matter eight months ago; I was admonished for doing so and was told that I should be asking my PCT. It took months to get an answer out of them. That answer was disappointing, and the Princess Royal Trust for Carers has had similar responses across the country. In fact, 25 per cent. of PCTs plan to reduce spending on services for carers, despite the extra resources specifically put into budgets to help with those services. A small number of PCTs continue to provide no services whatever for carers, and that picture is reinforced by the fact that, across the country, up to £1 billion that has been allocated may not be reaching its intended recipients. That is scandalous and a disgrace. Of the £150 million committed in 2009 to 2011, 24.5 per cent. will be used to increase support for carers; the rest has gone somewhere else. The problem is that the issue is not just about the carers strategy; there is clearly a problem with the implementation of other strategies as well—the child health strategy, the end-of-life care strategy and the dementia strategy. All four strategies represent important Government announcements of nearly £1 billion in new spending. It is proving very hard for most of the charities that cover those areas to establish precisely how that £1 billion is being used. I welcome what the Minister recently said about personally holding PCTs to account. That is very important. However, that positive announcement leads us to ask what the Minister will do to ensure that the PCTs really deliver. What does such an announcement mean in practice? Many PCTs have been advised that they would not be setting budgets until late March. PCTs have known about the extra money since June 2008, and the best committed their spending at an early opportunity. That has to happen, because many of the strategies involve working in partnership with local authorities and, moreover, with the voluntary sector in a local area. Lead times have to be considered if there is to be cost-effective delivery of new services, so why has none of that happened, and why do we not have the mechanisms to hold PCTs to account? In the Public Accounts Committee hearings, the question of the cost of NHS continuing health care was raised. At the end of the session, I asked the Department of Health to write back to me with further information on the subject. I got the reply the other day, which stated:""The Regulatory Impact Assessment which accompanied the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care in England (2007), estimated, based on existing data about the costs of care, the overall cost of implementing the new Framework…in the first full year as £219 million."" The cost of delivering continuing care, funded by the NHS, is £219 million. The important question is: what happens next? Where does that money come from? This is what the Department said:""The costs of implementation will include a cost shift from Local Authority budgets"." Some £219 million is needed to deliver the Government's framework. How much of that £219 million will come from a cost shift from local authority budgets? We all know that social care budgets are under pressure. Social care budgets deliver most of the dementia services that make a different to families' lives. How on earth can we find £219 million out of local authority budgets to pay for that? Will the Minister give some reassurance about what is intended by those words? If they are to be interpreted literally, as I fear they should be, they are very scary. I am grateful to have been given the opportunity to initiate the debate, but I want to bring my remarks to a close. There is clearly now an acknowledgement that dealing with dementia is a huge challenge and that we need to invest in services. Doing so will save money in the long run and transform lives. We need to make sure that that is a clear priority. We cannot just leave individual NHS organisations to choose whether they invest in dementia services, as if they were a luxury item. Those services are no luxury; they are essential. That is why the Government's rhetoric on dealing with dementia as a priority must be translated into action on the ground. I hope that we will hear a positive response from the Minister on the issue of research, and some indication of a commitment to moving those matters forward. I look forward to hearing the other contributions to the debate, and I hope that the Minister will respond in detail at the end.