Tuesday, 27 March 2012

The challenge of tackling dementia

Yesterday, the Prime Minister launched the Government’s Challenge on Dementia – a new initiative to tackle one of Britain’s most serious health concerns. As Vice-Chair of the All Party Parliamentary Group on Dementia, I believe that our approach to dementia care in Britain is unsustainable, with the figure of 800,000 people who currently live in the UK projected to rise to 1 million within a decade and 1.7 million by 2051.

Aside from the obvious human tragedy of the condition, which affects one in three people over the age of 65, there are serious financial consequences of dementia. Through increased healthcare costs and other expenses, the condition costs the economy £23bn, compared to £12bn for cancer and £8bn for heart disease which, per patient, means that a single dementia patient will cost the economy £27,000 – four times higher than a cancer patient and five times higher than someone with heart disease.

Despite this, research into the condition receives significantly less funding than research into other diseases. The Government’s announcement that it will double dementia research funding to £66m by 2015 is therefore extremely welcome and represents not only a fantastic opportunity for greater research into the cause, cure, care and prevention of dementia, but a greater recognition from Government that this is an issue that must be addressed.

The Prime Minister’s announcement yesterday was timely as APPG is investigating how to improve the rate of dementia diagnosis. The Group has heard from a range of people involved in the condition, including clinicians, social workers, those with the condition and those working to support them. The Government’s additional commitment to funding an additional £54m to help increase early diagnoses of the condition represents a fundamental appreciation of the importance that early identification of the disease plays in transforming dementia care.

There are important benefits to diagnosing dementia as early as possible and early diagnosis is key to living well with the condition. It means that GPs can work together with patients from an early stage to help plan their care and start treatment to slow down the progression of the disease. This can help to lower the risk of dementia-related accidents and complications, reducing both the probability that a patient will need to go into residential care as well as the overall cost of dementia to the health service.

Despite this, only between thirty and forty percent of those with dementia are diagnosed, with huge variations in diagnosis rates not just across the UK but within counties themselves. In Medway, for example, 44% of those with dementia are diagnosed compared to just 38% in West Kent. Additionally, only five to ten percent of diagnoses are made at an early stage of dementia, meaning that many of the benefits of its early identification are lost.

Some of the evidence that the Group heard suggests that a huge barrier to people coming forward for assessment is that stigma associated with dementia and it is essential that the media plays a role in helping to change the perception of those with the condition. The image of people with dementia on television is one of invalidity and ineptitude while it is often the case that a patient diagnosed early enough can live independently and with a high quality of life for many years. As with many medical conditions in the past, changing the image of dementia in the media to show it in a more realistic light is essential in getting people to visit their GP if they have concerns.

It is also therefore essential that clinicians are appropriately trained in recognising the symptoms of dementia and knowing which services are available to refer patients to. Amazingly, a quarter of GPs say that they do not receive enough training on dementia and it is therefore unsurprising that so many people with dementia slip through the net and get misdiagnosed with other conditions such as depression.

However, we cannot just rely on patients going to see the GP to get diagnosed because they are concerned about symptoms; professionals across a range of fields must work to actively recognise symptoms of dementia when interacting with older people. One of the doctors giving evidence to the Group pointed out that if a patient went into a hospital for an unrelated medical condition, it would be inconceivable for health care professional to notice potential symptoms of cancer and not follow it up, but that is not the case if they spot some early symptoms of dementia. It is only through this kind of proactive approach that we will significantly increase the rate of diagnosis.

While I look forward to the Group’s publication of the report in the summer, it is clear that we must take action to raise awareness about how important early diagnosis is and remove the stigma that stops people going for assessments while ensuring that all our healthcare professionals are properly trained to spot the early signs of dementia. The Prime Minister’s challenge to tackle dementia and improve both diagnoses and care for the condition is extremely welcome and, I hope, represents the turning point in the fight to end the unsustainable dementia status quo.

There are many groups and charities in Kent which can provide support for those with dementia and their carers. For more information, contact my office on 020 7219 2828.

Tuesday, 20 March 2012

Tackling loneliness in older people

On Thursday, I attended the Summit to Combat Loneliness, organised by the Campaign to End Loneliness and the Department for Health. The event brought together those from the business and charity sectors with doctors, academics, Ministers and those from local government to discuss tackling the problem of loneliness in older people. Apart from being tragically sad, socially isolated older people are more likely to suffer from associated health conditions such as stroke, hypertension, dementia and depression with the associated financial costs those conditions bring alongside the tragic human cost. Shockingly, loneliness in older people is a greater health risk than lifelong smoking or obesity.

They paint an even bleaker picture of the situation, the number of older people experiencing loneliness is much larger than might be imagined, with over one in ten older people feeling lonely always or often and heart-breaking, half citing television as their main form communication. With such high levels of social isolation and such devastating consequences, it is clear that action must be taken to end this tragedy.

Despite the prevalence of the problem, there are many wonderful charities and services which provide help for those who find themselves socially isolated, such as the WRVS in Medway and other organisations across Kent and the UK such as the Good Neighbour’s Scheme. These charities and others provide an essential range of services which can act as a lifeline for older people, ranging from individual befriending services – which see volunteers go and older people regularly – to organised events such as coffee mornings, dinner and hobby clubs for older people to interact with others.

While these fantastic organisations exist, the challenge in tackling loneliness is to ensure that those older people who are socially isolated are identified and then connected with the schemes which can help them. As those older people suffering from loneliness are, by definition, isolated socially, it is essential that those who do have contact with them are able to recognise the signs of loneliness. In Merseyside, the Fire Service use regular smoke detector tests to “check up” on older people and identify those who are isolated. This is something which all manner of service providers can do, be they doctors, social workers or the police. It is then essential that these services know what organisations are available to help in order to connect them with the older person and, this role has been performed well by independent sector third parties, such as the Good Neighbours Scheme in parts of Kent.

Before Christmas, I tabled an adjournment debate on the fight against loneliness in the House of Commons and managed to highlight some of the fantastic work done by the Campaign to End Loneliness and the countless charities which provide a lifeline to socially isolated older people. Tackling this issue will not only help thousands of older people in communities across the country but will help to save on the massive cost of loneliness for local authorities at a time of squeezed budgets. It is therefore essential that policymakers raise the issue of social isolation to ensure that all communities are able to connect older people with those that can help them.

Of course, individuals have a role to play as well and in my debate in the House of Commons, I mentioned the paradox that as we have become more socially connected through technology, many of those in our communities have become lonelier. Alongside the work of local authorities and charities therefore, perhaps we should all take a moment to think of the difference that a few minutes of our time popping in to see that older neighbour or relative could have on their lives.

My speech in the House of Commons is available here.

Saturday, 8 October 2011

Time to improve care for dementia patients on hospital wards

I was shocked to hear on BBC Radio Kent yesterday morning the story of an 80-year-old dementia patient who had been badly treated on a Kent hospital ward after breaking her hip. The patient was left on a trolley in excruciating pain and in desperate need of the toilet for over five hours before she was finally seen by a doctor. While this story is both heartbreaking and shocking, what is even more outrageous is the fact that stories of dementia patients receiving poor treatment on hospital wards are not uncommon.

At any one time, up to a quarter of hospital beds are occupied by dementia patients over the age of 65, yet studies by the National Audit Office suggest that two-thirds of these patients no longer needed to be there. While this costs almost £6.5 million which could otherwise be invested in other NHS and care services, I am concerned that the hospital ward is an unsuitable care setting for people with dementia. Those with dementia in hospitals are more prone to complications such as delirium, infection and falls. Worryingly, hospital care can also exacerbate the symptoms of dementia and have a negative impact on their condition as the institutional and disempowering environment of hospitals upsets patients’ routines.

As Vice-Chair of the All Party Parliamentary Group for Dementia, myself and other colleagues have been in the position to hear from charities which do excellent work supporting those with Dementia, such as Age UK and the Alzheimer’s Society, on ways in which we can limit the negative impact of hospital care for dementia patients.

Relatively simple changes to the hospital environment can significantly improve the experience and quality of care for dementia patients. Minor changes to ward layouts, colour coded doors and simpler signs are just some of the suggestions which would reduce stress and confusion for those patients while freeing up nursing staff who would otherwise be assisting those in their care who were confused and disoriented and reducing associated falls and injuries.

Better training of ward nurses is essential. Most of the time nurses do a hard job fantastically well but there is much improvement required when it comes to dealing with patients with dementia. Having met with a number of carers it is clear that the “care” element of nursing those with dementia is sometimes lacking for example at meal times. Investment in better training is something we should now be considering and could save money in the long term.

More importantly however, it is vital that the number of unnecessary hospital admissions is reduced. This can only be achieved by the invaluable support of the community care which is available to people with dementia and those who care for them. I have previously and will continue to voice my support for reform of the social care system because of how proper care can transform the life of both patients and carers. If proper community support and assistance is in place 24 hours a day, the number of incidents such as falls which result in hospital admissions could be reduced significantly. I don’t want to keep hearing of appalling experiences like the one I heard on the radio this morning so it is a no-brainer really: it is time to urgently look again about how we treat our dementia patients in hospital.

Monday, 19 September 2011

We should bury our electricity cables

When I drive home from Parliament there is a high point on the M2, just past Bluewater, where you can see miles and miles of Kent countryside. A first time visitor would be preparing themselves to gasp at the potential beauty of the Garden of England but instead join us regular motorists at gasping at the horrible vista that actually greets us – the large number of pylons transporting electricity to and from the north Kent sub-stations to wherever they are required. They are ghastly and every time I drive into the M2 valley I think whoever allowed our countryside to be overrun with these giant steel statues should hang their head in shame.

I am opposed to any proposal which would see more overhead pylons built through our countryside. In Kent, there are plans to build new high voltage pylons and upgrade existing lines which could see a further prolification of steel and cable. Given we have the technology now to bury cables, which could see huge savings in maintenance costs in the long term, I see no reason why we have to continue with overhead pylons. Where existing electricity routes need upgrading I also think we should remove the pylons and bury the cables. The short term cost will not only be mitigated by the long term financial savings but most of all it will provide a far more aesthetically pleasing response to supplying our electricity.

If we wish to build Jerusalem, In England’s green & pleasant Land we could do worse than start by burying future and existing electricity cables.

Wednesday, 7 September 2011

Caring for older people

Yesterday I initiated a Parliamentary debate on Care and Services for Older People. Having purposely chosen a wide-ranging a title for the debate, to allow for the diverse nature and varied issues that older people currently face in the UK, I am pleased that so many of my colleagues joined me in using the opportunity to highlight topics across different Government Departments. These included financial education, housing needs, funding of care, service delivery and appropriate levels of care being available to older people to allow them to stay in their own homes for longer.

The increasing size of our ageing population and increased longevity of life is not new information; it is something that we have been aware of for many years. Therefore, I am pleased that in his response to my debate, Paul Burstow, Minister for Care Services, agreed with me that it is time to take action and ensure that this Government does not act as previous governments have by kicking this issue into the long grass. We should celebrate the fact that people are living longer; it is a great credit to our society that many people in the UK are having a longer third phase of life and we must act to support them rather than let fears for those later years of life daunt and overwhelm.

The Minister made it clear that not only funding but delivery of care and services for older people is something that has not previously been given the priority it deserves. I welcome the Minister outlining the Government’s actions to move forward, next April, on implementing a White Paper for Social Care, including the recommendations of the Dilnot Report to secure a new funding system for social care. This will be a system which is both sustainable and fair whilst still ensuring that the quality of care is the greatest priority.

While I was disappointed to hear that the Government is not currently minded to create an Older Person’s Minister, I was pleased that the Government will look at my suggestion to establish a new Cabinet Committee on Older People’s issues and a new test within regulatory impact assessments that specifically looks at the effect of proposals on the over 65s in the way that it does for other defined sectors of society.

It was hard to get everything that people wanted to speak about on this issue into a 90 minute debate and I’m sure we could have covered even more topics but I am pleased I got the debate and highlighted the concerns of many people, young and old, across my constituency and beyond about the way we care for older people. But what was absolutely clear is that this is an issue we can no longer ignore.

The full debate can be read HERE.

Tuesday, 16 August 2011

Disappointing increases to train fares

It was announced today that train fares next year are going to go up across the country by an average 8%, i.e. RPI plus 3. I am really disappointed that yet again my commuting constituents are going to face astronomical fare rises, which is why, as the more generous local residents have recognised, I have long advocated a more favourable deal in the South East. I will say more about what I intend to do later in this post but first, while not apologising for the increase, I want to just address some of the more political points that are being made on this issue.

Most people who follow my commentary on various issues know that I understand that party politics tends to turn most of the electorate off and so I save my partisan points for the Chamber. However, it is important to note that this is not something the Coalition Government has just dreamt up; the formula of RPI plus 3 was introduced for Southeastern customers under the last Labour Government, while the rest of the country faced increases of only RPI plus 1. And yes, before someone says in the comments, I know we’ve been in Government for a year, but as most people also recognise we’ve taken the reins at a time that this country faces the largest deficit since the Second World War. I also acknowledge that in that time we’ve had High Speed 1 built, which is great if you live anywhere near the route and can afford the extra premium you pay as a customer to use. And maybe the increases are as a consequence of privatisation, but Labour had 13 years with large majorities in the Commons to renationalise the rail service and didn’t.

So now I’ve got that out of my system and hopefully put it in a bit of political context I would like it firmly placed on the record that I don’t agree that Southeastern customers should be continuing to pay the plus 3 formula. I think commuters across Kent and neighbouring counties have paid their fair share. Any future investment in nationwide rail services should be paid for by other train users. If the South East commuters paid for HS1 then why should they now be asked to stump up for HS2? In my view they shouldn’t. The money Southeastern get from the commuters already should be enough for investment in stations, rolling stock etc but the main thing constituents ask me for is simply a better service. They want a service that gets them to their destination on time (preferably with a seat), stops at the stations it is scheduled to stop at, that the staff are polite, and that the toilets are clean. If five years of the highest increases in train fares in the country cannot deliver that then we have more than a problem of simply being an additional squeeze on the wallets of commuters.

Train operating companies have some leeway in how they implement their fare increases and I will be writing to the Chief Executive to ask for some leniency in how the fares are increased on various routes. I know people will read this beyond my constituency boundaries, and I apologise that this may impact you adversely, but I will be making representations for consideration to be given to lower increases for those travelling from stations in my constituency. I will also be making further representations to Government Ministers to try and ensure that the plus 3 formula is reduced in the South East before other parts of the country – we’ve paid our fair share and now it is time for a fair fare.

Saturday, 13 August 2011

Social Networks & Riots

Last week’s violence, riots and disturbances were a disgrace. A criminal minority gathered to opportunistically cause damage and take what they wanted from shops and businesses up and down the country. These mindless thugs apparently used social networks to organise themselves thus giving the networks a bad name and which has now opened up a debate about whether they should be shut down in times of unrest to prevent scenes like those we witnessed last week.

On Thursday, I intervened on the Home Secretary during her statement in the Commons about the use of social networking during the riots and disturbances in London and elsewhere. I wanted to make the point, in the confines of a short interjection, that there is a difference between open networks (Twitter, Facebook etc) and closed networks (Blackberry Messenger) and that future consideration of their advantages and disadvantages to public order should be distinguished as such. However, and I can not be clearer than this – not for one second do I think they should be closed down. Monitored, yes; accessible to the police in certain circumstances, yes; shut down, no and especially if we want our voice heard when we condemn the practices of other regimes that restrict access to social networks or a free press.

During the recent revolutions in the Middle East and North Africa, we in the West, with our wide and free access to technology, social media and non-state controlled communication networks congratulated those who used, for example, Twitter to their advantage. In fact the Foreign Secretary, William Hague, said in the Commons the following:

“there is no doubt that social networking sites have played an important role, particularly in Tunisia. That was very apparent from the young people I met and talked to there, many of whom, especially the young women, had taken part in the revolution on social networking sites rather than out in the streets. They were very proud of the way that they had co-ordinated their messages in the days before the revolution in order to intensify the action and demonstrations that took place. Those sites have played an important role and it is something that we should be positive about overall. The world is changing in a very significant way: people of all ages have access to communicating in that way and it is important that their freedom to do so is preserved. One way in which the Egyptian authorities have gone wrong in the past couple of weeks has been in trying to suppress access to the internet and misuse mobile telephone networks. People now have the right to use those things in a relatively open way”
We cannot have it both ways. We cannot on the one hand think that protests against an oppressive regime (a regime that viewed the “protests” as violent civil disturbances) organised on social networks is fine and should be encouraged and congratulated, but on the other hand violent civil disturbances in a democracy organised on social networks is not OK and should be curtailed. I do not for one minute condone the use of social networks by criminals, and the activities of last week were shocking, but the answer is not to oppress the use of Twitter, Facebook and even Blackberry Messenger, but to understand them, embrace their capabilities, and where necessary allow the authorities to use social network messages as evidence against perpetrators.

Many police forces, my local Kent police being one, used technology to great effect earlier on in the week. Clearly open networks allowed for arrests to be made for inciting public disorder, as well as providing the police with a means of monitoring potential targets. But they also enable the police to get clear messages out to the public. With rumours flying around the social networks about looting and rioting, police forces and other authoritative sources, were able to dispel the myths using the same networks that were propagating them. If networks were closed, as some suggest, then the rumours would still be flying around via other means of communication (dare I mention via good old fashioned oral communication) but without the instant truth also being known, and in a bitesize 140 characters.

I worry more about closed networks such as Blackberry Messenger, which is a safe, secure and encrypted instant communication tool, and one that I use myself. It is as far as I am aware impossible to monitor in real time, thus taking away from the police the intelligence advantage of Twitter etc. But I see no reason why it should not be used to prosecute those involved in criminal activity, and if there is not already existing legislation then this is a potential area of exploration.

So like my colleague Robert Halfon, I feel very uneasy about shutting down networks in times of civil disobedience. I campaign for greater civil liberties in other countries, so that fellow citizens of the world can enjoy the freedoms we in the UK have. It would be hugely hypocritical, and a massive victory for the oppressive dictatorial regimes we as a nation criticise, if we were to control social networks enjoyed by the law abiding majority because they can be abused by a criminal minority.