Vern Pitt asks three of the politicians responsible for their parties’ adult social care brief what they will do for dementia care if they form the next government
FUNDING FOR DEMENTIA RESEARCH
Cancer research receives 12 times more investment than dementia research. Campaigners have called for the current £50m spent on researching the condition to be trebled. How would you better support dementia research?
Phil Hope (Labour) By making it a themed call for bids (which would set aside money from the medical research budget for dementia) we are, in effect, making it a priority. You need good research bids. You need to make sure that people are asking for the money. Previously that wasn’t the case.
That’s why I’m funding the Dementias and Neurodegenerative Diseases Research Network (Dendron) and others to build up the capacity for research within the dementia community and when that has got better, we will get more and better bids in and they will win more funding.
Stephen O’Brien (Conservatives) Our older people’s manifesto backs the increased priority of dementia research funding. We will also increase access to dementia drugs. As we know, there are many types of, and scales of, dementia and Alzheimer’s and therefore there needs to be a range of drugs and treatments available and the way we can best offer that is to ensure we are focused on outcomes and the well-being of patients.
We will also look at the statutory remit of the National Institute for Health and Clinical Excellence to make sure the wider societal costs and benefits are taken into account when it approves drugs.
Norman Lamb (Liberal Democrats) We haven’t put a figure on how much we would increase the dementia research budget by because I think it has to be guided by advice from the scientific community. What is absolutely essential is that we increase significantly the financial commitment to research on dementia.
Doubling it, or something around that, would be a guide, but I don’t want to promise something we can’t deliver so I can’t commit to a figure. This is the biggest health challenge of the 21st century and that is not reflected in the amount going into research budget.
USE OF DRUGS
A Department of Health-commissioned report last year found just one-fifth of the 180,000 people with dementia who were prescribed antipsychotic drugs benefited. Can their use be reduced by two-thirds over three years as suggested?
Phil Hope (Labour) The Labour government was first to recognise the widespread concern about antipsychotic drugs and commissioned Sube Banerjee’s independent report into this issue. We have made a commitment to act on the recommendations, which has been welcomed by the Alzheimer’s Society and we are working closely with them.
Our aim is to reduce the use of antipsychotics by two-thirds and we can achieve this by ensuring every area develops best practice, that local health and social care organisations work together to implement change, and that prescriptions take full regard of Nice guidance.
Stephen O’Brien (Conservatives) We think we need to go faster and be better than Labour in reducing the use of antipsychotics. They should immediately be used only as a very last resort and only for patients’ own safety and the safety of those around them.
The target is aspirational, what matters is the outcomes. In terms of the actual delivery, that is down to the protocols, the culture, the training and the expectations of those in care homes and those around them. That’s why in measuring outcomes you have to be more patient and that in itself is a much better way of measuring the result.
Norman Lamb (Liberal Democrats) Providers of dementia care need to be held to account for their use of antipsychotic drugs. It needs to be a quality mark which they are assessed against by the Care Quality Commission. At the moment whatever is contained in its assessment isn’t yet working.
The CQC is a fairly new body and as it builds up its approach it needs to ensure this is a very clear focus. Local authorities are obviously critical players in commissioning care and so they need to use their power to effect change as well.
NATIONAL DEMENTIA STRATEGY
Two-thirds of primary care trusts cannot account for their share of £150m from the DH to support implementation of the national dementia strategy. How do you make PCTs and councils accountable for delivering improved dementia care?
Phil Hope (Labour) Crucially, there has never been a dementia strategy before. It was groundbreaking, and one of the first in the world. Local organisations must do their own assessments to make sure the needs of people with dementia are met; that has to be a local responsibility. But they need to be accountable for how they go about doing that.
So we are doing a complete audit, not just on the extra money, the £150m last year and this year, but for the £8bn that is spent on dementia annually. It’s not just another layer of icing on the cake – we are re-baking the cake.
Stephen O’Brien (Conservatives) I have asked lots of questions about this very subject and I have not been impressed with the answers I have been given by Labour ministers. The government is giving money, without knowing where that money has gone. It would be our job to make sure that the money reaches the frontline services it is designed for and is not absorbed by inefficiencies or overhead costs or trying to bolster PCT budgets.
Community Care: So you would monitor the budget at a national level and ring-fence it at a local level?
S O’B: Yes, I can’t understand why government didn’t do that in the first place.
Norman Lamb (Liberal Democrats) We see this problem time and again. The government makes grand commitments knowing full well they have no mechanism to make sure the money gets to where it is intended. One solution is ring-fencing but there’s real danger because then you end up with everything in silos and perverse effects.
It is much more effective if those organisations are accountable to the communities they serve [through the establishment of elected health boards to replace PCTs]. If they can be voted out of office if they don’t deliver you will begin to see real pressure for delivery according to the money they have been allocated.
DEMENTIA AS A NATIONAL NHS PRIORITY
The National Audit Office has warned that the absence of dementia among the NHS’s national priorities in its operating framework has hampered progress on delivering the strategy. Would you make dementia a national priority for the NHS?
Phil Hope (Labour) The national dementia strategy has been and will continue to be a priority for the Labour government. In terms of the NHS operating framework we will be in discussions about the future operating framework so I can’t say for sure what will happen. I certainly want to make sure that dementia remains a priority for a future government.
Stephen O’Brien (Conservatives) We have said that this would be very sensible thing to do. Clearly under the Conservatives we will have to review all the frameworks. I’m confident that we would be able to include dementia as a priority.
Norman Lamb (Liberal Democrats) Yes. We have a government strategy which has been largely well-received as a good approach. But unless it is given priority, given the competition from other areas of care and financial constraints of the NHS, we all know nothing significant will happen.
It’s a barrier to achieving the national dementia strategy. The danger is that it’s a good policy on paper but the reality on the ground remains very different.
FUTURE CUTS IN DEMENTIA STRATEGY
With increasing budgetary pressure in all public services and no party promising to protect adult social care services, cuts in spending on dementia area a real possibility after the election. How would you prevent this?
Phil Hope (Labour) We are protecting frontline health services from cuts. In the longer term the current system is not viable, that’s why we published the social care White Paper. You are going to see much more social care and health funding combined.
We know it’s sensible to put more health funding into care – it’s good for the health service as it reduces the burden on them. We are going to mandate councils and health services to work together but what will happen at the next spending review (which will set spending limits for departments) I cannot say.
Stephen O’Brien (Conservatives) We haven’t said that we will protect social care funding for dementia, only the NHS budget. A lot of dementia patients who have continuing care on the NHS will benefit from that. We have also developed a one-off premium of around £8,000 so people can protect themselves from the costs of residential care.
We are looking to see how we might be able to extend that principle to the domiciliary setting. We would also ring-fence and promote public health. A lot of the reablement and other support for people with dementia will be accessible from the public health budget.
Norman Lamb (Liberal Democrats) The most important thing is our commitment is to get reform for the funding of care for elderly people. We all agree if we can get on and implement the reform that means extra money for families with dementia. The most important thing is our commitment to bring an end to the unacceptable delay in implementing reform.
As soon as we are through this election I want to use our influence in the next parliament to get all parties around the table to set up a commission to secure agreement within a year then act immediately to implement it. I think that’s realistic.
This article is published in the 29 April 2010 edition of Community Care under the headline “Dementia: If we win the election…”