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The Minister of State, Department of Health (Mr Paul Burstow)
It is a great pleasure to open the debate and to do so as a Minister. I look forward to working with the hon. Member for Worsley and Eccles South (Barbara Keeley) in her new role as an Opposition spokesperson on health. I forgot to welcome her to her role at Question Time the other day, so I put that right now.
We are here to debate a very important issue for our society: how we offer proper support for the nearly 5 million adults in England who spend a significant proportion of their life providing unpaid support to family members or friends. Among those 5 million adults, there is real diversity with respect to the amount of care they provide, how long they provide it for, and when they provide it during their lives.
For instance, the biggest group of carers is made up of older people in their 60s or 70s, or even their 80s. Typically, they are looking after a husband or wife who is in declining health, although they themselves might be in poor or frail health. They are often devoted to their husband or wife, yet they are deeply concerned about what the future holds. The existence of that group reinforces the need for better identification of carers, for better ongoing support to ensure that they stay healthy and well, and for better integration of services across health and social care to ensure that those carers are fully involved in the treatment and ongoing care of their spouse.
Next, there are carers of my generation—people in their 40s or 50s—who find themselves caring for a parent or partner for several years, or perhaps longer. Those people need real flexibility and control to ensure that they can balance their caring duties with their work responsibilities and bringing up their own families. They are the “sandwich generation” that is often talked about.
There are also significant numbers of lifelong carers, who might have a son or daughter with a physical disability or a learning disability. They can become carers in their 20s. They have a lifelong commitment to support a loved one, which means that we are looking for support that can help them to lead a life outside caring, and to have a career, a marriage, friendship and hobbies—all the things that the recent carers week survey told us that so many of them do without.
Let us not forget about young carers. Officially, there are 175,000 of them, but I think that we all know that that figure is just the tip of the iceberg and that there are significantly more. Young carers are children who do not have a recognisable childhood because of their caring responsibilities. They do amazing things to support parents, brothers or sisters, but they need considerable support themselves. They need tailored and integrated support, with schools, social services and community groups working together to ensure that they have the same opportunities as other young people: a good education; good health; training opportunities; a social life; and, yes, the ability just to be children and have fun, which is what childhood should be about.
I am making the point that the policies that we introduce and the support that we offer must reflect that kaleidoscope of carers’ backgrounds, experiences and needs. Although many carers enjoy their caring responsibilities, I have no doubt that hon. Members in the Chamber have met carers in their constituencies who are at the end of their tether. Those carers feel undervalued and overlooked, and frustrated that the care and support available is not tailored to fit their families’ needs. Sometimes they feel a whole host of emotions: anger that such a thing could have happened to their family; grief at a life forgone out of love and duty; and guilt for feeling that they need a break, a breather and a bit of time to themselves.
That is why mainstream statutory services can make a massive difference. A comparison of the findings of the personal social services survey by the Department of Health, which was published yesterday, with the findings of the recent Carers UK survey entitled “No life of my own” reflects that point. The Department of Health survey of 35,000 carers, all of whom were in contact with statutory services, found that only 13% reported having no time to do anything that they valued or enjoyed. In contrast, the Carers UK survey of more than 3,000 carers who may have had little contact with the NHS or social services reported that 76% of respondents did not have a life outside their caring role.
What does that tell us? I think that it suggests that when carers have contact with services—whether in the voluntary sector, the local authority sector or the private sector—they are more likely to have a positive experience. That makes it all the more important that such services work harder for carers.
There are four points that I want to emphasise today. First, we must identify more carers so that we can put them in contact with the services that can help them. Many people simply do not identify themselves as a carer and hence do not come forward to get the help to which they are entitled. This is an area in which GPs can play a role, which was reinforced to me recently when I visited an excellent GP centre in Lambeth.
Just a few days ago, I attended a round-table event organised by the Afiya Trust at which a number of speakers told me about the specific challenges faced by certain ethnic groups. On that point, I intend to look at how we can break down some of the barriers that exist and ensure that we get culturally sensitive support to those who need it.
Secondly, we must ensure that there is effective integration across the whole system. We need joined-up planning, joined-up commissioning and joined-up delivery for carers and the people for whom they care. Public services need to talk to each other, but not just to each other—they also need to talk to the voluntary sector. They must respond to the whole picture of a family’s circumstances, rather than just considering their own specific area of expertise. We need one system pulling together, rather than different systems pulling apart.
Better integration across health and social care is particularly vital. Such integration has been talked about for years—I have attended debate after debate about it. If we want to make progress for carers, councils and health authorities will have to make such integration happen on the ground, along with their partners in the third and independent sectors.
Thirdly, we must make personalisation a reality for everyone and ensure that packages of support genuinely fit around a family’s needs and the way in which they want to live their lives. We plan to do that by encouraging the far wider use of direct payments, which is already a very popular way of giving carers more flexibility and control. The Government have made a clear commitment in the coalition programme that we will encourage more local authorities to offer direct payments. We will also challenge local authorities to provide those payments, and we will encourage others to hold local authorities to account so that they provide them.
One thing that we will not do, however, is to make promises that we cannot keep, which was what the previous Government did when they promised £150 million for breaks for carers. Thanks to the Princess Royal Trust for Carers, it is now well documented that primary care trusts siphoned off that money to spend on other things. Speaking from my personal experience, I can say that getting information from PCTs about how they were spending that money was like pulling teeth. Despite the fact that inquiries and freedom of information requests were made, some PCTs conspicuously failed to answer the local population that they exist to serve.
Let me be clear that local NHS commissioners should have full autonomy and control over how they spend the money that is allocated to them. Therefore, if we are putting money into the baseline, a Minister cannot claim credit by saying that they are going to spend the money on x when they know perfectly well that they cannot guarantee that.
I stress, however, that if we agree to loosen Whitehall’s grip, it is important that there is much greater local accountability. As part of a series of far-reaching reforms, we will set out shortly a programme for much greater transparency and accountability for the NHS at local level. Hon. Members and their constituents will be able to hold their local health services to account for how they spend taxpayers’ money. As a starting point, strategic health authorities have already reviewed how PCTs actually go about prioritising support for carers. We will publish the results of that audit and they will be put in the House of Commons Library in the near future.
I am afraid that I have to inject a dose of realism into this debate, as we also have to deal with the repercussions of the financial legacy that the Government inherited. As the recent Budget made clear, the Government will need to make significant cost savings to help the country to reduce the deficit. There will be a premium on efficiency and on ensuring that every penny of taxpayers’ money counts, reaches the front line and makes a difference to carers’ lives.
That may involve difficult judgment calls. For example, I have just made the decision to terminate the caring with confidence training programme on the grounds that it was not delivering value for money or giving carers training where it mattered. We will be providing the training materials from that programme free of charge to carers’ centres and others so they can carry on, with local partners, delivering training for the benefit of carers who need it. Having cancelled that programme, we can now ensure that the money does much more to benefit carers on the ground. We will shortly roll out a training programme to raise GPs’ awareness of their role in, and contribution to, supporting carers.
Better support is not necessarily about spending more money; it is about spending more wisely, which is what we intend to do. At the same time, the state should not over-reach itself. There are limits to what the Government and statutory services can do on carers’ behalf. As demography and patterns of disease remould our society, the wider community has a responsibility to adapt to those changes. That involves a big role for charities and voluntary groups, which can do much to stimulate grassroots response to many of the day-to-day issues that carers face. As a Member of Parliament for 13 years, I come to this debate not because of my personal experience in a caring role but because I have been taught and shown the issues confronting carers by my own carers’ centre in the London borough of Sutton.
Whether we call it active communities, social capital or the big society, we need to reignite the latent sense of collective responsibility that leads people to look out for each other and make the small gestures that can help in a big way. Employers also have a big role to play in making it easier for carers to stay in work. We pledge to extend the right to request flexible working to all employees, but a right to request is not a right to have. I am conscious that change depends on whether organisations across the private and public sectors grasp the economic arguments about what making such a commitment will deliver. We will be making those arguments strongly in the coming weeks and months, and I hope that all hon. Members in the Chamber will make the case when talking to employers and employers’ organisations in their constituencies. We must also make staff much more aware of the opportunity to ask for a break. The right to request was introduced four years ago, yet recent research indicates that half of those entitled to it did not even know that they had that right.
In conclusion, carers are and will remain a vital thread holding our society together. We pick at that thread at our peril. We will use this summer to develop a fresh, new carers strategy. We will build on what went before and acknowledge what the last Government did, but ensure that what we have is deliverable and affordable, and that it addresses carers’ concerns. I hope that today’s debate will play its part in shaping that refreshed strategy, and I look forward to hearing hon. Members’ contributions.
Mr Joe Benton (in the Chair)
Order. Before I call the next speaker, I refer again to the fact that 10 Members have so far indicated that they want to speak. As Members know, the debate will finish promptly at 5.30 pm. Obviously, I will do my best to accommodate everybody, but that is not a matter for me. However, I ask hon. Members to bear that in mind so that everyone can speak.
Kate Green (Stretford and Urmston) (Lab)
I am pleased to have the opportunity to speak in this debate, not least because it is an important chance for us to pay tribute to the tremendous contribution made by carers across the country. I pay tribute particularly to the carers in my constituency.
As the Minister rightly said, many people do not even identify themselves as playing a caring role, yet they make a substantial contribution to supporting family members. That, of course, saves the public purse an enormous amount of money, but it frequently puts such individuals and their families under great pressure and stress.
I want to highlight the importance of providing carers with the financial support needed to participate fully in a life beyond care. That is at the heart of all the other forms of engagement and support rightly identified by the Minister, such as service support and measures enabling carers to get out into the community and, if they want to and can, to take up paid work.
I am concerned that carers are facing a raw deal financially. Many carers are placed in a position of relative poverty as a result of their caring role. I am concerned that recent announcements and the effect of the spending cuts that are still expected could put them in a yet more difficult position.
I am particularly anxious that, in the medium term, linking the value of safety net benefits to the consumer prices index will depress the value of carers’ income. I think that we would all agree that carer’s allowance is far from generous. Many other benefits important to families that include carers will be hit by the same constraint. The financial resources available to carers are a concern. Clearly, adequate financial resources are a prerequisite of every form of social participation: for example, the ability to take time out to go to the cinema, to go swimming or even just to have the pleasure of a cup of coffee in the town centre down the road.
The second issue about which carers have expressed concerns to me, not because it directly affects them individually but because of its effect on the people for whom they care, is the Government’s intention to test eligibility for disability living allowance. Carers recognise that their entitlement to carer’s allowance is affected in many cases by the assessment made of the individual for whom they care and whether that person is entitled to DLA.
I alert the Minister to the difficulties already arising in the processes for testing people for the new employment and support allowance. If testing is to be widened significantly, it is important that those problems are not replicated and that people’s eligibility for benefits to which they are entitled can be confirmed quickly. It is extremely retrograde to run people through medical tests for a disability living allowance intended not specifically to meet medical needs but to support much wider social participation needs. This is about meeting the extra costs that come with disability and long-term ill health. Medical assessments do not get to the nub of those problems.
Another of the Government’s financial announcements affecting carers that is causing concern is the decision not to continue with the savings gateway. Caring eats into savings, leaving families with little to fall back on. The savings gateway has been a success story, enabling people to set aside modest amounts in the knowledge that their saving plan would be supplemented and supported by Government investment. Many carers are disappointed that it will not continue.
I am sure that my hon. Friends and other hon. Members will also want to speak about the impact on the wider service network available to carers and concerns about the implementation of public service cuts. The cuts must be made in a way that protects carers and ensures that their needs continue to be met. I highlight particularly the concerns in my constituency about the tremendous time lag in assessing family members’ needs that frequently leaves carers without any support at all. Often, in due course, that support is put in place, but it is quite unacceptable that assessments should take weeks, months or, in some cases, even years. In the meantime, carers are put under great pressure to manage as best they can.
Other hon. Members will also want to draw attention to the opportunities for carers to participate more fully in paid work. I was pleased that the Minister referred to the need to ensure that people are aware of their right to request flexible working and acknowledged that we have a significant job to do with regard to employers. I certainly accept his challenge to ensure that the employers in my constituency are well aware of the issue. There is a particular imperative on the public sector to lead the way and to show that it can be the sort of employer that exemplifies the highest of standards in this field.
Of course, the real problem for carers entering paid work is the massive financial disincentive that they face as soon as they earn only a modest amount of money and the cliff-edge threshold that comes in as soon as they are on earnings of more than £97 a week. I think that we can all agree that that is a modest sum—for a large number of carers, work simply does not pay. We cannot afford the carer’s allowance to become the new equivalent of the much criticised dumping ground that, in effect, incapacity benefit became, when it was used as a way of massaging people out of the workplace on to some other form of inadequate benefit. It is important that carers can make work pay through a more generous disregard of earnings and a more gradual withdrawal rate as they move into paid work.
Everyone understands the financial pressures on public expenditure, but it is absolutely wrong that carers, who contribute so much and who are among the poorest, should take the biggest hit. They are being hit by the triple whammy of poor benefits, a difficulty in making work pay and a worry about the future investment in the services on which they rely. Those factors cumulatively add up to a severe limitation on the ability of carers to participate in the activities outside caring that so many of them desire to undertake. I very much hope that the public spending round of the comprehensive spending review will provide more generosity towards that vital group of people than the Budget has given us cause to hope for so far.
Chris Skidmore (Kingswood) (Con)
As a member of the Select Committee on Health and secretary of the all-party group on disability, I take a keen interest in this important matter, and I am very grateful to the Government for arranging the debate.
The figures mentioned in the debate are clear. As a nation, we rely on a silent army of carers—some 6 million people or 10% of our population—to look after and support the most vulnerable in society. Those people dedicate and sacrifice their own time and lives for the sake of those whom they love. Family members depend upon such people—as we all do—to ensure that those in the greatest need live the best possible lives, as they deserve.
We should not have this debate today without admitting the enormous emotional and, at times, physical cost that the role of a carer can bring. Some 1.9 million people care for more than 20 hours a week and around 1.25 million people care for more than 50 hours a week, although I suspect that the hidden figures—those that no Department is able to calculate—are probably far greater. Often the people who have to care for a relative, husband or wife—with whom they have spent their entire lives—who is incapacitated by dementia or physical frailty are themselves elderly. It is estimated that over-65s account for around a third of all carers who provide more than 50 hours of care a week. As a result, it is sadly of little surprise that carers are twice as likely to suffer from ill health, because they are providing such substantial care.
As the Minister said, caring comes to dominate the lives of such people, and as the recent figures released by Carers UK reveal, 76% of carers have no time left at all in their lives to do anything other than care for the relative concerned. We know that carers, through their selfless dedication, make an enormous contribution to society—estimated at some £87 billion a year—yet we must realise that carers do not do what they do for money or see their role in terms of the economic benefits. Carers looking after a relative or a member of their close family—a son or daughter, their father or mother—do so because of love.
I suspect that each of us in this Chamber has in some way cared for a relative—either in the final days of their life or through some period of illness or accident—and at times have been the single person responsible for that person’s well-being. That is an awesome burden to bear on one’s shoulders, yet we must consider that it is carried by some people every day, with tireless devotion. However, with that devotion, comes the sheer exhaustion of wanting to do one’s best to ensure that a loved one is best looked after. There may also be frustrations caused by the fact that such love is not reciprocated by the person being cared for and that, for whatever reason, they are unable to say thank you.
If a relative has a degenerative condition, a carer will also have anxiety about what the future might hold. At the same time, for a carer, considering having a few hours break or a temporary escape seems a betrayal of the love that is so clearly there. Too often, it is easy for politicians and policy makers to revert to statistics and jargon that is in many ways all too familiar to us in such debates. We must not forget that every carer has a personal story that cannot always be easily told—one that we can never put a price upon. However, we must accept that caring will take an ever greater role in the structure of our society.
As a result of improvements in the quality of treatment and medical technology, more children and young people are surviving with complex health conditions. It is estimated that 1.7 million more people will need care and support by 2026, because they are living longer, and they will need that care and support for a longer period. More people are living longer, with the number of people expected to live beyond 90 soaring. However, one in four of those people will probably suffer from some form of dementia. We must therefore recognise that, in this decade, more people than ever before will become carers.
The new Government are determined to do all that they can not just to recognise, but to improve the lives of carers across the nation—we must do so at every level—and I welcome the fact that the Secretary of State for Work and Pensions has said that the Government want to
“enhance and support that role”—
of carers—
“ensuring that carers are valued throughout what we do”.—[Official Report, 14 June 2010; Vol. 511, c. 600.]
There is a need to ensure that the benefits system is easier for carers to access. Carers UK has said that:
“carers want to see the benefits system simplified since its complexity often prevents people from finding out about their entitlements”.
The welfare system that was inherited from the previous Government is hugely complicated, and simplifying the system should encourage fairness and responsibility. It is encouraging that the Government have stated that they
“will consider carefully the needs of carers as we develop our thinking on welfare reform.”—[Official Report, 7 June 2010; Vol. 511, c. 5W.]
I, for one, thank them for that.
There is an urgent need to balance the needs of carers who work—something that has been touched upon already in the debate. It is estimated that as many as one in five carers have left or turned down a job because of their caring responsibilities or because they feel social care support is insufficient. As the Minister has outlined, there is a strong case for increased flexible working. Currently, flexible working is available to employed parents of children aged under 17, disabled children under 18 and carers of certain adults. Therefore, approximately 10.5 million employees benefit under the current legislation, including 8 million parents and 2.65 million carers of adults, yet Carers UK points out that up to 79,000 carers do not request flexible working
“because of the way that the complex definition of carer has been put together.”
That must change.
Extending the right to request flexible working to all employees should help those carers. The coalition agreement contains the commitment to
“extend the right to request flexible working to all employees, consulting with business on how best to do so”.
Following on from that, the Government have maintained that extending the right to request flexible working to all will ensure that individuals within the wider caring structure—for example, grandparents and neighbours—can also take a more active role in caring and managing their work and family lives effectively. That extension will also remove the stigma attached to flexible working requests, as the Minister has mentioned. Both those developments are welcome.
I welcome what the new Government are setting out to achieve in improving the lives of carers and in granting them greater independence, so that they can live their lives as best they possibly can. As the Prime Minister has said,
“carers are the unsung heroes of our society…the work they do to help disabled people is simply invaluable. Just imagine what would happen if all the carers in this country suddenly packed their bags and left. It’s not just that the financial cost of looking after so many disabled people would be a massive burden on the state. It’s the sheer emotional effect on all the people who depend, day in, day out, on their love and care.”
Carers across the country do so much for so little. We must do even more to ensure that they are supported and looked after, which I know the new Government will do their best to achieve.
Mr Iain Wright (Hartlepool) (Lab)
It is a pleasure to serve under your chairmanship, Mr Benton. I remember with affection the long hours we spent together on the Housing and Regeneration Bill. I know that you will keep us in order to the best of your ability. I welcome the Minister to his new role and I wish him all the best in making sure that there is a real champion for carers in Government.
I shall concentrate on some of the issues for carers in my constituency. I know that many hon. Members will disagree with this, but I am fortunate to represent Hartlepool, as it is the best place in the country. Hartlepool is a strong, close-knit community, and a sense of community and family remains an enduring part of the Hartlepool character. Despite the knocks and disappointments that we have had over the years, and the social and economic challenges we have faced, that selfless sense of wanting to help one’s neighbour down the road, or to assist one’s partner, parents or grandparents as they get older, runs strongly through the Hartlepool character.
It might often be derided in sophisticated, metropolitan circles, but in Hartlepool it is not unusual for three or four generations of the same family to live on the same street or in the same estate, all providing help and support to each other. That could be a grandmother caring for her grandchildren so that the parents can work, or a son or daughter caring for older relatives. That sense of caring is very strong in Hartlepool, where people do it almost without thinking and where it is seen simply as part of being a member of a family, or as part of the “in sickness and in health” vow.
The hon. Member for Kingswood (Chris Skidmore) referred to the silent army of carers—an apt phrase—in his excellent and thoughtful contribution, and he is absolutely right. The strong sense of community is obviously demonstrated by the high quality of carers in my constituency. In a town that has a high-quality third sector, a local charity, Hartlepool Carers, stands tall with its great blend of professionalism and informality. In the past 12 months, Hartlepool Carers has provided help to more than 1,200 people. Led by Tracy Jeffries, chaired by Ruby Marshall, and with 11 paid members of staff and more than 100 volunteers, the charity provides long-term support to 560 adult carers and 125 young carers. It is estimated that the charity saves taxpayers about £150 million every year by reducing pressure on NHS resources and keeping those being cared for out of care homes and the formal care system.
The hon. Gentleman mentioned the overall national bill for the work done by carers. If we were to send such a bill to the Exchequer, it would be for more than £87 billion, more than four fifths of the NHS budget, which puts into perspective the invaluable contribution carers make. Carers provide not only an invaluable and personal service for their loved ones or neighbours, but a huge and often unrecognised contribution to the national finances. We owe them a huge debt of gratitude.
I think that we all agree that, as a country, we should be doing much more to assist carers. As the hon. Gentleman and my hon. Friend the Member for Stretford and Urmston (Kate Green) have said, carers often feel isolated and unsupported. Caring for someone can be physically demanding, and if a loved one has dementia or some form of degenerative disease such as Alzheimer’s, that can be psychologically distressing. As the hon. Gentleman rightly pointed out, that can affect a carer’s own health. They might feel a failure, or they might need a stiff upper lip to keep going.
In Hartlepool, many carers have given up employment because of their caring responsibilities. Not going out to work can be not only isolating, but result in real financial hardship. That is why the events that charities such as Hartlepool Carers provide are so vital for carers’ well-being. They provide drop-in services so that carers can take a break and have a good cup of tea and a chat. In addition, the charity provides volunteer services, which offer carers access to low-level, but vital, support services such as gardening, dog walking and collecting prescriptions. That extra help and support might not sound like much to us, but it is absolutely vital in providing a degree of respite.
I have several questions for the Minister, and my main line of questioning follows the comments on finance made by my hon. Friend the Member for Stretford and Urmston. Frankly, I was worried by some of the comments the Minister made in what was, I thought, a decent and civilised speech, as he might have been lining us up for further cuts to the care sector. Rather than cuts, I would like to see some of the £87 billion that has been saved given back to carers. What can the Government do to encourage carers to receive what they are entitled to? Carers in Hartlepool, in keeping with the Hartlepool character to which I have referred, are far too modest and reticent to request all that they are entitled to, but it is right and proper that we should do our utmost to ensure that that happens.
I genuinely do not want to make narrow, partisan points on the matter—the remarks I am about to make do not apply to the Minister—but I am concerned that the rhetoric from the new Ministers in the Department for Work and Pensions somehow suggests that all benefit claimants are not to be believed or that they are somehow scroungers. Given the enormous contribution carers make to society and the savings to the public finances that have already been outlined in the debate, what steps will the Government take to ensure that carers are able to come forward and receive what they are entitled to with confidence? In an era of tight public finances, what will the Minister do to ensure that some of those savings are handed back to carers?
In a similar vein, some of the low-level support services that Hartlepool Carers provides, which really enhance a carer’s quality of life, are very much dependent on finances from local government. There is a strong partnership between Hartlepool borough council, Hartlepool Voluntary Development Agency and Hartlepool Carers, but the local authority is expected to find £1.7 million of savings from its area base grant this year and is bracing itself for cuts of about 30% from its total budget over the next couple of years, so tensions will naturally arise between local government and the voluntary sector. What reassurance can the Minister give to carers in my constituency that those vital services will be safeguarded?
That brings me to a particular concern about young carers. Those young people have their whole lives ahead of them and should be able to fulfil their potential, but because a family member might be ill and require support, they often sacrifice their education, their free time, their friends and their future, all because they love their family and want to help. Young carers in my constituency are ably helped by Karen Gibson of Hartlepool Carers, but I would like the Government to do so much more for them. When I was a Minister in the Department for Children, Schools and Families, I looked into the life chances of young carers, which was absolutely heartbreaking. Young carers tend to underperform in educational attainment, which in turn limits their job prospects. The Government should be giving them as much help and support as possible in order to break that artificial barrier.
Again, I do not want to make narrow party political points, but I am concerned that the Government are cutting specific programmes that could be used to help young carers, such as the future jobs fund, the working neighbourhoods fund and, in Hartlepool, a quarter of the education element of the area-based grant, which was helping young carers fulfil their potential. When I had some responsibility in government for apprenticeships, I tried to prioritise young carers for places. What work will be done across the new Government to ensure that more help will be given, particularly to young carers, to help with training places and apprenticeships that will allow them to fulfil their potential so that their love for their family is not a barrier to a successful future?
My final point relates to foster carers. This week I received an e-mail from a constituent, Dawn Robinson, who demonstrates her commitment to the local community not only by being joint secretary of the Burn Valley North Residents Association, a great residents’ association where I enjoyed a fantastic pie and pea supper on Saturday night—I urge hon. Members to come along and sample the next one—but by being a foster carer and a carer to her husband. Dawn has expressed concern about the lack of flexibility for young people in foster care, as support tends to end abruptly when they reach the age of 18. She has been looking after a young person for about three and a half years, and he is fast approaching 18. She writes:
“He is autistic, diabetic and epileptic. Over the years he has grown in self confidence but still needs help regarding taking insulin etc. and constantly needs someone with him. He now goes to college and for the first time has started to make friends. His teacher at his review said he didn’t want his home life to affect his education and moving him on would be the worst thing to happen to him.”
When he is 18, he will have to leave Dawn’s home, and a carer and a warden-run placement will have to be found, which will obviously put additional pressure on hard-pressed resources. It would be reasonable to have the flexibility to allow Dawn to continue the current situation for several years beyond the age of 18, so will the Minister ensure that greater personalisation? He mentioned direct payments and personalisation in his opening comments, so what extra flexibility can be put into the system to ensure that the artificial break point at age 18, when the young person becomes an adult, does not hinder their progress?
The positive role that carers play across the country, especially in Hartlepool, is absolutely invaluable, as other hon. Members have said, and I hope that the Minister will recognise that in his closing remarks, as he did in his opening comments. I also hope that he will ensure that the appreciation of the role that carers play, which has been evident throughout the debate, is demonstrated by giving hard-working carers something back.
Tracey Crouch (Chatham and Aylesford) (Con)
This is not my maiden speech, but it is the first time that I have spoken in Westminster Hall and under your chairmanship, Mr Benton, and it is an honour to be doing so in this debate.
I want to speak briefly to signal my interest in the important issue of supporting carers. I am not an expert, a carer or a mother, and my parents are, thankfully, still physically and mentally well, so I literally have no personal experience of caring for anyone. However, in the past few years of being a candidate, and now as an MP, I have met many people who care or have cared for loved ones, and that has opened my eyes to an area of policy, a set of issues and a group of almost invisible workers who need our support.
The first carer I met in my constituency was a man called Maurice. He wrote to me about dementia and his views on the service that his wife had received. When I went to see him, I asked him to explain what had happened from start to finish. The point of the story that had most impact on me was when he started to tell me how his wife had ended up in full-time residential care because he could no longer cope with caring for her. This brave man, who has served his country and who now fights and fights for improved health services for other local people with dementia, welled up in front of me as he recalled his guilt when he realised that he could no longer care for his wife. Although so many parts of his story needed attention, it was that very point that made me wonder why he had felt so alone and unable to cope. What help had he received? Where was the support network? It might well have been there, but if a man who wears a military badge with honour suddenly realises that he cannot cope, something is not quite right.
I appreciate that caring for someone with dementia is difficult and that dementia is not the only condition that requires full-time care. To learn more, I recently visited the Medway carers centre, which is run by the Princess Royal Trust for Carers. There are 21,000 carers across the Medway authority, which includes the Chatham part of my constituency, but only about 5% of them are known to the centre, which demonstrates, as all of us in the Chamber know, that a huge number of carers out there are forgotten, unrecognised and probably inadequately supported.
I had the good fortune to meet some carers who were at the centre on the now departed caring with confidence course—I would welcome an opportunity to speak to the Minister further about his announcement about that in his opening remarks. As I spoke to those carers, a number of things became clear. The first supremely obvious point was that carers come from all backgrounds—rich, poor, male, female, old and young. Requiring care does not discriminate. I met carers who looked after their husbands and wives, and a carer who looked after her mentally ill son. I met a carer who looked after her mother and her children—she was part of the sandwich generation that the Minister mentioned. I met a carer who looked after two disabled children, but who never had a day off because respite services would take only one of them at a time.
That leads me to my second point: no two carers are the same. They might share experiences, but their needs are often very different, so the support for them needs to be flexible so that it recognises those different needs. As the hon. Member for Hartlepool (Mr Wright) mentioned, what a young carer needs is very different from what a senior carer requires. We talk a lot in policy terms about flexible working for carers, which is welcome, but many carers require flexible living, and respite care is still patchy. Supporting carers’ physical and mental well-being is essential if we are to help them to carry out their role safely and effectively.
Although direct payments are excellent in principle, we still need to ensure that carers are supported so that they can make the right budgetary decisions. The carers I met were genuinely anxious about becoming, in their words, “self-employed business men”. The fear of doing the wrong thing and making the wrong decision should not outweigh the benefit of giving carers more control and purchasing power. There are agencies and charities that can help, but the signposting needs to be strong and available at the earliest possibility.
I made it clear at the start of my speech that I am no expert and that I would talk only briefly. I have only a new interest in this issue as a result of meeting so many dedicated carers recently. As someone who will turn 35 shortly, and who is at the start of what I hope will be a long political career, I cannot begin to comprehend how other people suddenly change their lives to care for a member of their family or a loved one. However, I am sure that I would join the 6 million carers who do that if I needed to.
Of course, people who care for their loved ones often want to do so, but they do so more often because they need to. When I think of the many young carers who give up playing on their bikes or going out with their friends because they need to look after mum or dad, or of the working woman who gives up her job to wash and bath a parent who struggles to remember her name but can recall the time she bought a loaf of bread, my heart breaks for them. Carers really are the unrecognised heroes of society, and it is our responsibility as a Government to do as much as we can to support them.
Mr Andy Slaughter (Hammersmith) (Lab)
It is a pleasure to serve under your chairmanship, Mr Benton, although the matters that I have to deal with are somewhat distressing. I wish to address the proposed closure of the Hammersmith and Fulham carers centre, which is the main carers centre in my constituency. Hammersmith and Fulham council is closing the centre at the end of July in the most irregular and arbitrary way, and that will leave no service for carers in the borough for the foreseeable future.
I should perhaps begin by declaring an interest. The centre was set up in 1998, when I was the leader of the council, and I have been a strong supporter of it over the past 12 years. The centre occupies substantial premises in Hammersmith road, which is about five minutes’ walk from Hammersmith Broadway, so it is located in the centre of the borough and highly accessible for the carers who use it. It has a lot of space, so it can run activities, and it has—or had—six staff. It has provided a service to many thousands of people, and I shall read some of their testimonials in a moment, but let us just say for present purposes that it has run a good service. It should now be delivering a service to adults and young people using its budget of £300,000, which is split roughly 70:30 between those two groups. In addition to providing services in the main building, it also provides outreach services across the borough.
In 2008, the then relatively new Conservative council decided to conduct a tendering exercise. It is a moot point as to whether that was necessary, and the council failed to identify whether the body involved should be voluntary or whether staff would be employed by the council, but it went ahead. The problem was not the exercise itself, but the fact that it was so incompetently managed that three separate tendering exercises were carried out over the ensuing two years with no successful resolution. Despite the council going to great lengths and spending a lot of money on the process, the most recent exercise had only one bidder, which was the existing carers centre. The centre passed its appraisal, at least as far as the adult part—the majority part—of the quality assessment was concerned, so it anticipated being awarded the contract. However, at that point—again, entirely arbitrarily—the council decided that it would terminate the contract with immediate effect. Indeed, it should have been terminated yesterday, on 30 June, but a winding-up extension has now been granted until the end of July.
Some people thought that these events might be connected with the fact that the council, as part of its fire sale of most of the borough’s capital assets, wanted to sell off the building for an estimated £1.7 million. It had initially tried to move the centre into small, unsuitable premises in a less accessible location, which had to be accessed through another charity’s premises, but it then decided to get rid of the centre altogether.
Events then take a more remarkable turn. The chair of the management committee, Kamaljit Kaur, who has an extensive background in the voluntary sector, has been trying to run the centre in an exemplary way over the past few years since taking over that role. She met the council’s director of adult services on 23 June and failed to persuade him—because his mind had already been made up by politicians—to reconsider or even to extend the centre’s tenure while alternative provision was made. We now know that there will be no alternative provision until at least April. After the failure of that meeting, she wrote a letter to carers and other interested parties, including me, in very mild terms given the circumstances. Part of her letter read as follows:
“The Council went through a tendering process for Carers Support Services and made three attempts to attract potential bidders for this contract. However, we were the only bidders for their adult and young carer’s contracts. Our bid was evaluated by the Council's TAP: our bid was successful in the adult carer’s contract and was recommended for funding by the TAP, but eventually turned down at senior officer level.
The Council have been informed that the prime reason for the lack of interest in this contract for potential bidders was the requirement to employ existing centre staff and the financial liabilities that go with this requirement. We now believe that the Council's sole intention behind closing down the Carers Centre is part of its strategy to remove existing staff, thereby removing the requirement for new bidders to take on this financial responsibility. We also believe that this will attract national organisations to bid for this contract.”
That is quite likely, because that is a method that the council has used before—getting rid of local organisations and bringing in national ones that they believe can handle matters cheaply if not as well.
The response to that letter, which also explained how people could protest about what was happening, was an extraordinary six-page letter from the director of adult services making serious personal allegations against the chair, including an allegation of an improper family relationship with someone who had a pecuniary interest in the contract. Late last night, the councillor responsible—Councillor Carlebach—and the director of community services had to issue an apology:
“Since issuing our letter of 28th June on this matter, we have received a single representation that we have misunderstood and mis-stated the position”.
They state that they are
“writing to clarify that it has now been made clear”
to them that the individual in question
“is not the brother of Kamaljit Kaur.”
The letter continues in an exculpatory way to try to excuse them for what happened. The chair informed me earlier that she now feels under an obligation to resign and is taking legal advice with a view to an action for defamation. I do not want to pursue that matter, but I simply set out those facts to show that the local authority is out of control and behaving in a highly improper way—as it is in many other respects.
Leaving aside the process, what is the effect on carers? Hon. Members might have seen in the debate pack an article from The Guardian of 16 June, part of which I shall quote:
“For 12 years, Margaret Turley has known where to go in a crisis. Eighteen months ago, when the 26-year-old learning-disabled son she cares for developed epilepsy and began going blind, Turley headed for the Princess Royal Trust Hammersmith and Fulham Carers Centre.
‘You’re among people who know what carers do,’ she says of the Hammersmith Road centre in west London. ‘I can come in here just because I’ve had a horrendous day.’ The centre provides advice and peer support, and runs a Department of Health-funded programme, Caring with Confidence, offering free training for carers who want to develop their caring skills.”
Later the article says:
“Pat Williams, who cares for her disabled son and runs the Caring with Confidence sessions, says: ‘It’s a fait accompli—get us out of the building, don’t give us the contract, and run the organisation down.’ ”
Hon. Members will not be surprised to learn that I have received an extraordinary number of letters about this matter. I will not take up too much time, but I want to read excerpts from some of them, as I think that hon. Members should realise what a serious matter this is for thousands of carers in my constituency. I shall not give names, but one letter states:
“I have been a member of Hammersmith and Fulham Carers Centre for the last 10 years and have relied on the Centre for support through all my times of crisis during those years…I am shocked and devastated at the closure of the Carers Centre…Not only will the Centre close, but there will be no co-ordinated service for carers…How can the Council close down our service and offer nothing in its place? What on earth are the Council playing at?”
The letter continues:
“I can get no sense from anybody at the Hammersmith and Fulham Council…In the meantime, where will we H and F Carers meet for our support groups? Who will we talk to when we need help? Will a building be made available to us? Without a place to come to, when we are in distress, how will we manage?”
Another carer wrote:
“Dear Andy, I am one of the borough’s many fulltime carers and have learned this week that after some 12 months of what the council has termed ‘review’, they have pulled all funding from the carers centre…My 2 sons use the services of the Young Carers Group, and get the kind of support and respite that we will not, again, find anywhere else. I feel passionately that carers are such a soft target, as our responsibilities make it so hard to mount the kind of defence of these services that they deserve.”
Another of my constituents writes:
“I care for my mother who is over 90 years, and also my daughter who is disabled. I do use the carers centre and found that the people who run it are very helpful.”
A further letter reads:
“I have been caring for my wife with severe dementia for 20 years, and the aspect that worries me most is the fact that the centre holds the emergency contact to look after my wife, if anything happened to me; an accident or such like.”
This is the letter that touched me most:
“I am an eleven year old boy. I have a brother with cerebral palsy. My dad died when I was seven from a heart attack. I love my brother so much but I had to face very difficult things. Children have made fun of me because of my brother’s condition. People that don’t understand my brother’s condition treat me differently to other people. I didn’t go on holidays. People made fun of me when I was near my brother. I missed a lot of school. I felt stressed and unsure. I was unsure if I was doing the right or wrong thing. I didn’t have anyone to talk to.
When I first went to the young carers project I made friends quite quickly. I told them my experiences and they told me theirs. The young carers project took me on trips and I was able to express my emotions and feelings. They helped me to understand bullies and that there was nothing wrong with me. They helped me realise that I did do things correctly. They also took me camping, which was lots of fun and taught me different dances for example street dancing and martial arts style dancing. It is a chill out zone for all young carers and adult carers. It gives us freedom from our caring role.
If you close the young carers project, you'll be closing a family of people who came together because of difficulties. Which is unfair for all young carers and adult carers. I just can’t believe you’re closing down the young carers project for all the good work they have done.”
There is, of course, substantial resistance to the decision. There are daily pickets outside the town hall. I have written to the leader of the council to ask him, at the very least, to extend the contract until alternative provision is in place, and to allow the carers centre to bid again for the contract. The matter was debated at full council last night on a motion from the Labour opposition, but of course that was voted down by the Conservative majority on the council. Given the exceptional circumstances that I have set out, I ask the Minister to take a personal interest and to look at the matter. I believe that the situation has arisen not simply because the council is a Conservative one; the local authority is acting without its jurisdiction, in a highly improper way.
What I have described is not an isolated incident. Some hon. Members might know about the council newspaper in Hammersmith and Fulham. Last weekend, the Secretary of State for Communities and Local Government, referring in part to the Hammersmith and Fulham council newspaper, said:
“Councils should spend less time and money on weekly town hall Pravdas…our free press should not face state competition from propaganda on the rates dressed up as local reporting.”
To read the paper in question one would think that everything was well at the carers centre. According to its front page, the leader of the council says:
“We will sell assets we no longer need because, when times are tough, we have to put services before buildings.”
Last night, the council announced a fire sale of most of the public buildings in the borough, ranging from the Irish centre in Hammersmith Broadway, which has an international reputation, to Fulham town hall and many voluntary sector buildings, including one that was referred to in the article in The Guardian, Palingswick House, which is home to more than 20 voluntary groups but is to be sold later this year.
Lest there be any doubt, the incident that I am recounting is not a mistake or isolated incident; it is a calculated attack on the poorest and most vulnerable people in the borough of Hammersmith and Fulham, in the guise of putting through a policy that was never agreed. It is being put through not just callously, but without the remit of the local authority. I ask the Minister to take a particular interest in what is happening in Hammersmith and Fulham not just because of the staff and the build-up of expertise in the past 12 years, which will be lost for ever at the end of next month if a stop is not put to what is happening, but on behalf of the thousands of people—we believe that there are more than 11,500 adult carers and many young carers in the borough—who rely on an excellent service, but will be without it from next month.
Mr Joe Benton (in the Chair)
Before I call the next speaker, I ask all hon. Members to ensure that they have switched off their mobile phones.
Dr Sarah Wollaston (Totnes) (Con)
I am grateful for the opportunity to speak in this important debate. After 24 years as a doctor, I do not need to be told how important carers are, and I pay tribute to the many whom I have met in my experience as a doctor—they really are extraordinary people.
I would like to focus on young carers in particular, and to draw hon. Members’ attention to the fact that the average age of a young carer is 12, which is extraordinarily low. The 2001 census showed that there were 175,000 young carers in the UK, 13,000 of whom cared for more than 50 hours a week. Those young carers provide not only help with cooking, cleaning and shopping, but often very intimate and personal care, and emotional support to parents with severe mental illness. Organisations such as Barnardo’s need our thanks for their work, particularly in helping young carers to cope and in identifying them before they find themselves in crisis.
My constituency takes in much of Torbay, where there are 350 identified young carers. Those children suffer low attainment at school, which is partly due to their poor attendance as a result of their caring work. They are also particularly prone to living in poverty. I would like to draw the Minister’s attention to a particular subset of young carers: the 20% of the children and young people in the Torbay area who are carers as a result of alcohol and drug abuse, and associated mental illness. Those who have been identified are the tip of the iceberg. Some fear coming forward for help because they worry that they might be taken into care. Those children have no access to the carer’s allowance. They are particularly prone to living in poverty and to going on to misuse drugs and alcohol themselves, and also at risk of domestic violence.
My interest is in prevention as well as cure. We know that drinking adversely affects up to 1.3 million children in the UK, and that group especially needs our help. Police forces estimate that 40% of all child abuse cases and 62% of incidences of domestic violence are directly related to alcohol. I would like the Minister to look again at the evidence on what works to reduce alcohol-related crime and violence, and therefore the number of children becoming young carers. The evidence shows that that is about pricing and availability, so I hope that there will be support for the Health Committee and NICE, which is clearly on the side of minimum pricing as the way forward.
I pay tribute to the caring organisations in my constituency. A fortnight ago, I was privileged to attend the opening of the Brixham carers centre. Brixham is particularly fortunate as it is also home to Brixham Does Care, which supports 150 carers and has 150 volunteers. Those organisations asked me to raise with the Minister the time that volunteers’ Criminal Records Bureau checks take. Only this morning I was told that some checks submitted in April were still pending. We need to look closely at how we reduce the barriers to volunteering, because volunteers are a lifeline for carers. I welcome the review of the vetting and barring procedure that has been announced by the Home Secretary, but I would like the Minister to look at the time that the checks take.
Respite care is another concern of carers in my constituency. Will the Minister consider the issues facing the John Parkes unit, which provides respite care for some of the most severely disabled children in my constituency and is used by many of my constituents?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
This is the first time that I have served under your chairmanship, Mr Benton, or made a speech in Westminster Hall, and I am delighted to be taking part in the debate.
Two recent experiences in my constituency have led me to understand better the challenges faced by many people who care for a parent, child or other dependent. I recently spent a morning at the Liverpool carers centre, which is run by Local Solutions, a social enterprise in my constituency. I heard at first hand about the experience of many carers, who come together weekly for a couple of hours in a supported environment to do activities such as tai chi and to use the gym. Many carers told me about the numerous challenges they face, such as feeling isolated or seeing a loved one’s condition deteriorate. Those carers were the fortunate ones, however, as they were able to join a support group at which they could share their load each week.
Unfortunately, not every carer has the opportunity to have some respite and to mix with other carers and share experiences, as I saw when I spent time at a local supermarket for parent and carers day—a campaign run by the Union of Shop, Distributive and Allied Workers. Its object was to raise awareness among the staff of the help available. As my hon. Friend the Member for Hartlepool (Mr Wright) highlighted, while it was striking that most parents knew of the support available to them, carers were significantly less aware of the support that they could access, such as carer’s allowance, help at home, aids and equipment, vouchers and direct payments. I met a teenager who had left school at 16 to care for her disabled mother. She was working at the supermarket for 20 hours a week, but did not qualify for carer’s allowance as she was earning slightly more than the £97 limit. She was struggling to get by and to pay her bills.
That leads me to the focus of my speech: the plight of working carers. I support USDAW’s campaign to end barriers to work by extending the carer’s allowance to low-paid workers who earn up to £150 a week. If the allowance was tapered at the same rate as tax credits, all full-time carers earning up to £300 a week would receive some support. I also support USDAW’s call for carer’s allowance to be improved. It is £53.90 a week for anyone who cares for more then 35 hours a week, but that is one of the lowest rates in Europe, amounting to £1.54 an hour—less than a third of the national minimum wage. I would like carer’s allowance to be increased to at least the same amount as jobseeker’s allowance, as that would provide better support to the estimated 4.8 million carers of working age. Yes, that would come at a cost of about £1.1 billion at a time when cuts are being made, but considering that carers save our economy an estimated £87 billion a year, I believe that that is a small price to pay.
USDAW recently carried out a survey of its members that highlighted some of the pressures faced by people who juggle paid work with caring for a disabled, elderly or vulnerable relative or friend. Some of the comments highlight the challenges that a working carer can face, such as
“pressure and more pressure, the dreadful feeling when the phone rings and you have to ask for time off.”
Another comment states:
“My mum is regularly committed to hospital, usually at the drop of a hat. My personnel manager refuses to recognise me as a carer because my mum’s condition fluctuates.”
A further comment is:
“The pressure of looking after my elderly mum and working full-time was getting too much for me. I had no support whatsoever from my employer. I had to leave because I felt if I had a breakdown I would be no use to my mum.”
The situation for carers at work has to be improved and the enormous pressures on those with caring commitments who work must be relieved. What will the Minister and his Department do to ensure that carers know about their rights? He mentioned the right to request flexible working hours, but has he considered introducing the right to paid time off work at times of family illness or emergency?
During the week before last, we celebrated carers week in the House. Its theme was that carers deserve a life of their own. Whether we are talking about the 4.8 million working carers or the 1.2 million carers not of working age, whom many hon. Members have spoken about this afternoon, I urge the Minister to do everything to ensure that carers have a life of their own.
Paul Maynard (Blackpool North and Cleveleys) (Con)
It is a great pleasure to serve under your chairmanship, Mr Benton, for my first speech in Westminster Hall.
I was pleased to hear from the Minister that we will have a new carers strategy—it is very much needed. I would like to focus today on three aspects that I believe are important in allowing carers to have a life beyond caring.
The first aspect—working carers—has been touched on by the hon. Members for Stretford and Urmston (Kate Green) and for Liverpool, Wavertree (Luciana Berger). I would like to take a slightly more specific approach than they did when they spoke about the cliff-edge factor in earnings, and look at the needs of carers who want to work and go to Jobcentre Plus hoping to find a job. When they get there, they do not get the help that they need, for several specific reasons revealed in a National Audit Office report, “Supporting Carers to Care”, at this time last year. I shall highlight those reasons for the Minister.
There is an enormous army of carers, as we have recognised today, but they form a small part of the work load at Jobcentre Plus. Many advisers rarely deal with more than one or two carers each month. It is vital that the centres have specialist advisers to deal with carers who are looking for employment. Because of their caring duties, many carers do jobs that, inevitably, are part-time. Therefore, they do not form part of what Jobcentre Plus has to submit to meet its targets for placing people in full-time employment. Because carers do not help Jobcentre Plus to hit the targets that central Government want it to achieve, they are seen by Jobcentre Plus not as a priority but as a marginal part of its business.
I am also concerned by what I read in the NAO report about many Jobcentre Plus advisers not being certain of what they are doing. For example, the report found that two thirds did not realise that carers who claim only carer’s allowance do not need to attend work-focused interviews. It worries me that two thirds of the staff do not understand a crucial part of the needs of carers. Finally, as an example of a Kafkaesque bureaucracy gone mad, Jobcentre Plus advisers are encouraged to hand out carer’s allowance application forms but are not allowed to help fill them in. “Here’s a form, but don’t ask me any questions, please, because I can’t answer them”—I am afraid that we hear that so often. I hope that the new carers strategy will try to address some of those specific issues so that those who go to Jobcentre Plus to look for work get the help that they need.
The second area that I would like to focus on is the need for respite care. I welcome what the previous Government did in recognising that it is good to give carers respite care, but I regret the fact that, for one reason or another, as the Minister said, much of the money never quite made it to the front line. That shows the danger of raising expectations within a group of people that are then not fulfilled.
I pay tribute to organisations such as Vitalise, a charity that provides space for 7,000 people to have respite breaks each year. Its work stretches from Cornwall in the south to Southport in the north; I regret that it cannot manage an extra 20 miles to make it to Blackpool and provide breaks there, but perhaps I can encourage it to do that bit more—who knows? As its part of carers week this year, it set up a care to share forum, which was an opportunity for people who need respite breaks to share experiences of what they had had and, indeed, what they did not get, having expected something as a result of the previous Government’s announcements. That was a useful thing for Vitalise to do, because carers’ nervousness about going abroad, going away, or leaving the person for whom they care, is a significant issue. There are many hurdles to overcome if they are to have that ambition, and the more that we share information and allow carers to feel more confident about leaving the people for whom they care, even for just 24 hours, the easier it will be for respite care to become an established part of the caring agenda.
Will the Minister therefore ensure, in the national health service operating framework and in NHS Vital Signs, that provision of carers support is not just an optional extra for primary care trusts but critical—either tier 1 or tier 2? By having it at tier 3, PCTs are basically given permission not to bother with it. Unfortunately, that is just one of the ways in which micro-management from the centre can become an excuse for not providing a service.
I would also ask that when this or any Government make new moneys available, they make the announcement only when they are confident that they can monitor implementation and ensure that the money is spent on what it is supposed to be spent on. It is not acceptable to raise the hopes of vulnerable groups so that they think that they will get something but then, through no fault of Ministers, the Government or Departments but just because the layers of bureaucracy absorb the money bit by bit, it does not happen further down the line. That simply is not fair.
I echo what my hon. Friend the Member for Totnes (Dr Wollaston) said about young carers. She was right to identify in particular the needs of the 20% who do not do what I would call traditional caring, where the relative has a progressive disease associated, perhaps, with old age. I think that the figure is higher than 20% in a constituency such as mine. Blackpool North and Cleveleys is a deprived area with many public health needs, and I would have thought that many younger carers are dealing with relatives who have a drug addiction, alcohol or mental health problem.
At the back end of carers week this year, I went to the local branch of Frankie and Bennys near the Odeon cinema in Blackpool. The local carers centre, which is funded by the Princess Royal Trust for Carers, as so many carers centres are, has a particular interest in the needs of young carers. Nigel McMurdo, who runs the project, does a fantastic job in trying to give them treats every now and again. One of the treats was dinner at Frankie and Bennys, so I trundled off to meet them, to listen to their stories and to understand a bit more about what they go through.
Nigel told me one tale about how caring can impact on education. A young man caring for his mother, who had a mental health problem, had a geography exam one day, but she would not let him out of the house. There was a real battle just to get him to school to sit the exam. That demonstrates how caring for parents, as an act of love, can be a bar to educational attainment. For many of our young carers, caring has an impact on their health, education and ability to have a social life.
The inadequacy of child and adolescent mental health services is a long-standing problem. If mental health services are the Cinderella service of the NHS, CAMHS is Cinderella’s daughter—it is a Cinderella service within a Cinderella service. I have raised this matter with the Minister in respect of autism but, more widely, I have great concerns about the condition of CAMHS in this country, and how it excludes far too many people who need help. It is a real problem.
In addition, in terms of education, bullying has a major impact on the lives of many young carers. It occurs when someone is seen to be different. If they have a caring responsibility, it means that they cannot hang around outside the school gates after school, or they might be 15 minutes late, or they might not always get their homework done on time. Inevitably, bullying takes place, and young carers need support in relation to that.
Young carers in Blackpool are at present trying to draw up a young carers charter. At the top of their list is a demand that every school should have a nominated teacher who can pay attention to the needs of young carers, as a kind of early warning system. Such a system is needed, and I do not think that we can place the burden entirely on general practitioners, as we always seem to try to do, to act as early warning gatekeepers. There is a difficulty in identifying young carers. We know of about 200 in Blackpool, but we are certain that there are some 600 more whom we simply do not know about—we cannot find them, they are not there. We often speak about the unmet need and how to reach the hard to reach. I fear that that is a perennial question in public health policy.
Platitudes abound in the debate on carers. I desperately try to avoid platitudes in anything that I do, but it is often difficult to avoid them when mentioning this topic. I should like some concrete steps to be taken that benefit carers, including benefit simplification. I have lost count of the number of times that I have tried to explain to people in my constituency that to be able to apply for the carer’s premium they must first apply for pension credit, which they know that they are not entitled to. The people that I explain that to find it illogical, and so do I, but it still seems to go on. Can we please try to change that?
When I first became involved in health policy some 10 years ago, the file in my office marked “Care” focused on the width of doors for wheelchairs as described in the Care Standards Act 2000. I watched the Minister raising care issues many times in the House of Commons. Carers week was regarded as a peripheral matter 10 years ago. The large queue in Portcullis House during carers week, for the photo opportunities and so on, was testament to the progress that is being made, but I still think that we have to go one step further. I may be a new MP, but I am already a little bit tired of photo opportunities—during which I stand beneath a Perspex stand, smile and shake hands—that are somehow meant to provide evidence of my commitment to an issue. I would rather MPs took fewer photo opportunities and visited more local carers centres, as many hon. Members in this Chamber have, to hear what is going on and speak to real carers. That would bring a bit more reality into this place.
It was good that the previous Government recognised that carers have a role to play, and I welcome that. However, we now have to focus on how we enable carers to live a more ordinary life: a life beyond caring. We need to start to fit provision around the needs of carers. As with too much in public life, we expect people to fit into existing tick-boxes on forms and woe betide them if their circumstances do not enable them to fit neatly into those boxes. That is not good enough.
We need to build provision around the individual. I know that that will be difficult, but not every carer wants to play bingo and not every young carer wants to go to the cinema of an evening. We all have individual requirements as carers. We are all individuals, after all, and we should remember that. I hope that the carers strategy that is being drawn up over the summer will mean that we will start to regard carers not just as a group with a label attached and a set of demands, but as individuals who need to be empowered. I look forward to seeing what emerges after the summer.
Nia Griffith (Llanelli) (Lab)
I will try not to repeat things mentioned by my hon. Friends and other colleagues in this important debate, but it is difficult when several have spoken previously.
We all recognise the huge savings that carers make for the economy—some £87 billion a year—and we recognise that they are not just economic savings. With some understandable and notable exceptions, the majority of people who are cared for by carers have a far better quality of life if they can stay at home, being looked after by their friends and family, and can take part in their social life as fully as possible, rather than going into an institution, no matter how good it is. However, unless we put in the support yet more people will reach crisis point, with carers not being able to cope any longer. Other solutions have to be found. However, some of the solutions are often not satisfactory, either for the family or the person being cared for.
Of course, for economic reasons, carers like to stay in work if they can. Many people become carers gradually over time, rather than suddenly, so they try to keep going, but they face a number of barriers. I am a member of the Union of Shop, Distributive and Allied Workers and I have supported its campaign for carers. I am pleased that the Labour Government introduced the right to request flexible working for carers some four years ago, but as hon. Members have mentioned, there is still a mentality in some workplaces that does not allow that. This is a serious issue, because it affects not only whether people can ask for flexible working, but attitudes towards promotion. Women carers are particularly affected, and although they might like to do something different or something new, they do not like to ask because they feel that they might have to go through an interview and explain about being a carer, and they feel that that might be viewed negatively. We are missing talent and not using people to the full.
It is well documented that, often, carers take a job below their qualifications or have to compromise what they do in other ways. That is a great shame, because we are missing out on a lot of talent. Yet with a bit of flexibility and understanding—as long as employers understand that there may be certain needs: people should be able to take their loved ones to hospital, or whatever—a lot more can be done to help.
Many carers suffer financial hardship because they cannot work much or have to give up work altogether. I implore the Minister to make certain that there is no cut to the carers allowance. I am worried about the current economic situation, because the rise in VAT will put additional pressures on families with the lowest incomes. I implore the Minister to ensure that, in addition to not reducing the carers allowance, at every opportunity an increase is made to it to try to keep up with the increasing costs of living.
As my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) explained, a great step forward would be to increase the earnings disregard to £150, for example, with an additional tapering—similar to how tax credits work—so that people earning up to £300 a week receive some benefit from it; doing so would target help to people who need it most. Targeting is important during a period of economic restraint throughout the country.
I am considerably worried about the provision of respite care. Many carers can only cope throughout the year if they have the opportunity to take advantage of respite care, even though doing so may be difficult, as the hon. Member for Blackpool North and Cleveleys (Paul Maynard) said, because they worry about leaving somebody, even for a short while. Respite care is not just an opportunity for carers to gallivant around the world. Often, it allows them to paint a room in the house, for example, because it would not be practical to do so while the person they care for was there. Perhaps the carer wants to attend their son’s wedding a couple of hundred miles away, or to do something similar. Without some respite care, such simple tasks can become impossible. This is not just about residential respite care. Respite care can involve someone sitting and looking after the person being cared for, allowing the carer to do the shopping.
People in my constituency are being denied respite care opportunities, where previously they were offered them. I am worried that that might be regarded as an easy cut for local authorities to make and that it might be an invisible cut, because, for example, one family would not know that another family had also had their request for care turned down. The criteria can be confusing and families can find that although in the past it has been possible for a family member to go into care, that is no longer so.
In taking up such matters with the local authority, I have found that some of the reasons given are economic, but it also says that it does not have the proper equipment. An increasing number of people who need to be cared for need hoists, for instance. An increasing number of carers are therefore coping at home with quite complicated issues, and when the person whom they care for goes away, equipment such as hoists, which is needed, is no longer available in an easily accessible form through the local authority.
Clearly, we must ensure that respite care does not become a Cinderella service, because it is often the only way in which people keep going. If it is not provided, the obvious alternative is that carers will stop doing the job and we will have to find full-time care for the person who was being cared for. Obviously, that is to everyone’s detriment, and the situation may end up being not so happy. Whether provided by the council or charitable organisations—help comes from many different funding streams, including third sector organisations and so on—we must ensure that funding for care in the community does not diminish.
The incoming Government must take a national care strategy by the horns, because we all know that in the next 20 or 30 years the number of older people will increase, people will live longer and the number of those who need various forms of care will increase. If we do not have a national care strategy in place quickly, cuts will be made, homes will be closed and all sorts of care services will be withdrawn. We will build up a dangerous backlog of problems that will have to be sorted out. We must get that national care strategy moving quickly, because it will have enormous implications for funding. It must be a long-term proposal; it cannot be adopted tomorrow. I beg the Government to take up the excellent work that has been done on that to date.
Finally, I want to speak about research into conditions such as dementia and Alzheimer’s disease. We all know how distressing a physical illness may be, but at least the sufferer can carry on a dialogue with loved ones and negotiate, discuss and decide the best thing to do. Sadly, diseases such as dementia and Alzheimer’s are often the Cinderella of medical research services. But the long-term impact on families of the distress caused by someone who does not recognise them and makes all sorts of accusations may be difficult, added to which sufferers may be kept alive for a long time and remain physically well. Sadly, I have seen cases of early onset dementia, which is distressing because the sufferer often needs 24-hour supervision. We must prioritise the research that may not attract big funders. Some research subjects are fashionable, but for others, such as dementia, it is much more difficult to attract funding, often because they are not pinpointable as specific diseases. There are many generalised and different forms of dementia, and we need support and backing for research.
Thank you, Mr Benton, for giving me the opportunity to speak. I hope that the Minister will be able to answer some of my questions.
Tony Baldry (Banbury) (Con)
I am grateful to you, Mr Benton, for giving me the opportunity to contribute to the debate. With Baroness Pitkeathley in another place, I co-chair the all-party group on carers. We succeeded the hon. Member for Aberavon (Dr Francis), who during the last Parliament carried out that task alone and so brilliantly that it took two of us to succeed him. I pay tribute to his work—I am sure that he will continue to be a contributing member of the group—and many of those who have contributed to the debate have joined the all-party group because we want to be a strong collective voice in the House for carers.
The Minister is in a privileged position because the hon. Gentleman, the Minister and I were made parliamentary champions for carers during carers week earlier this year. It is rare to move from being a parliamentary champion to being a ministerial champion for carers within a few days. We will see how my hon. Friend delivers in his new and challenging task on behalf of carers. It is rare in Whitehall for a Minister to walk into a Department understanding part of the brief that he has been asked to cover.
Tony Baldry
The hon. Gentleman may say that, but I think that it provides a phenomenal opportunity for my hon. Friend to stride out and seize the agenda. I will try to keep my comments short. During carers week, I made a long speech which, for hon. Members and others who are new to Hansard and who may wish to read it, is on my website at tonybaldry.co.uk/campaigns/carers. We are all in the new technological world, and I do not want anyone to believe that only the new intake is up to date with the internet. Some of us who have been around for a bit can keep up with the new global technology.
I want to make various points to my hon. Friend the Minister. I am glad that we frequently have debates on carers, largely as a consequence of carers week and the previous Prime Minister’s intervention. Last year, we had a topical debate, and I am glad that we are having a full afternoon’s debate in Westminster Hall. One of the first issues is identifying carers. Many carers do not recognise themselves as carers, so they are not recognised in the system as carers. It would help them enormously if social services and the health service recognised and encouraged people to recognise themselves as carers. We would then have a much more accurate picture of the number of carers in the community.
GPs may have thought—I defer to my hon. Friend the Member for Totnes (Dr Wollaston) on this—that it would not be beneficial to identify carers because they could do little for them. The ability to recommend respite care for carers may have prompted GPs to ask themselves, “Is this person a carer; is there something I can do to help them and to support them through respite care?”
We are about to move to GP commissioning for services. I will try to ensure on my patch that I identify which partner in every GP practice in my constituency has the lead responsibility for carers. One objective of organisations such as the Princess Royal Trust for Carers and Carers UK is for them and us collectively to encourage GPs to engage with carers and to recognise and note those GP practices that are particularly helpful in supporting carers. With the best will in the world, the picture is patchy. Some practices work hard to support carers, but others, which may not be insensitive, have not taken such support fully on board in their list of priorities.
We must all recognise that the number of carers will inevitably increase with an ageing population. There is something else, which I fully appreciated only recently during carers week. At a reception in the Jubilee Room, I listened and talked to a number of carers who were looking after relatives with Parkinson’s disease. My mother was a theatre sister during the blitz in Coventry, and people either survived or died. People from earlier generations went into hospital for one acute incident from which they either recovered or died. Generally, the Greco-Roman medicine of western Europe works on the basis that people are given drugs or medicine and they get better.
The truth, however, is that an increasing number of people in our society have to care for people whom they love very much, but who are progressively getting worse and know that they will never get better. There are people who have Parkinson’s disease, dementia or Alzheimer’s disease, and in addition to the financial and other challenges that carers face, the psychological drain of knowing that, however much someone is loved and cared for, they simply are not going to get better but will progressively get worse must be enormous.
The number of people who have to care for people with age-related dementia and Alzheimer’s is increasing. When I was first elected nearly 30 years ago, each Christmas I would go round every nursing home in my constituency. Most of the residents were frail widows in their 70s who were perfectly spritely and intellectually sound. I have now given up going around nursing homes on my patch at Christmas, because almost everyone is suffering from some form of age-related dementia and they have absolutely no idea who I am at all. There is that standard joke where an MP goes in and says to a resident, “Do you know who I am?”, and they say, “No dear, but if you go and ask matron she may be able to help you.”
The pressure on staff is enormous, and if someone is old and frail, their chances of getting into a residential care home are increasingly less, so people have to be looked after at home by carers. Furthermore, the number of people who have early, pre-senile dementia and are waiting for places to get into a nursing home is increasing, and those people have to be looked after by carers. Therefore, the number of carers in our communities will increase substantially over time, and we must ensure that any carers strategy takes account of that.
We must ensure that new policy initiatives, such as GP commissioning, help carers and do not work against them. There are also other initiatives. For example, local authorities are, quite rightly, being enjoined to ensure that they get value for money in all services, including carer services.
In Oxfordshire, as in the constituencies of other hon. Members I am sure, carer services are going to be tendered. However, in Oxfordshire, we already have three good carers centres that are manned—or womaned—by volunteers. There is the Princess Royal Trust for Carers and other carers centres that have grown up over a period of time. The North and West Carers Centre in Banbury won the Queen’s award for unsung volunteers. Those people are not going to go away; they are committed to supporting carers.
However, there is a risk of an inevitable momentum, and that the county council social services department might feel that it has an obligation under some EU or Government directive to put services out to tender. It might feel obliged to contract out carers services to some completely different provider in some other part of the country. That does not seem to go with the grain of what I understand when I hear colleagues from all sides of the coalition talk about the big society. If the big society—as opposed to the big state—means something, it means building on the work of those volunteers and on the community spirit within one’s own community. It means building on civic pride and local roots, not undermining those things. I hope that ministerial colleagues in the Department of Health and other Departments will understand that although we should ensure that every Department gets value for money, that should not undermine the volunteers who have the competencies that are needed.
That brings me on to how we train carers, and I make this point simply so that my hon. Friend the Minister can respond to it should he wish. There has been some concern about the Department’s contract with Caring with Confidence, which is an organisation that has trained carers at carers centres. The Department has felt it appropriate to cancel that contract, possibly because it felt that sufficient carers were not being trained. However, there is an issue about how one ensures that carers and people who, often late in life, find themselves as carers can acquire the skills and competencies that will help them.
I make my final point so that we can have some clarity on this issue, either now or at some stage in the future when the carers strategy is published. Hon. Members from all parties have drawn attention to the carer’s allowance. At present, the only assistance that a working carer receives is the carer’s allowance, but those who are retired—many carers are above retirement age—get no further recognition in the system because Treasury rules state that people cannot claim two benefits. That is not new; it is a long-standing rule. If someone draws a state retirement pension, they can draw only that and cannot get anything more for being a carer.
During the previous Parliament, a couple of Select Committee reports were published on this subject, and that work should not be lost. The new Government must respond to those reports, and either make it clear that they cannot afford any further financial support for carers, or give some indication that they may be willing to consider recalibrating the benefit and financial system in support of carers.
In 2008, the Work and Pensions Committee recommended an overhaul of the benefits system. A report entitled, “Valuing and supporting carers”, which was the fourth report of the 2007-08 Session, recommended a new two-tier support system with a carer support allowance paid at the same rate as jobseeker’s allowance and a caring cost payment that would be available to all carers in intensive caring roles, similar to child benefit and set at between £25 and £50. That element would be available to some carers who were unable to claim the first element, including those carers in receipt of a state pension. The Committee also recommended that the Department for Work and Pensions commission an urgent examination into introducing a taper to the carer’s allowance earnings limit and lifting the 21-hour study rule.
Like so many Select Committee reports in the last Parliament, that report got lost in a review—I do not wish to criticise; it is just a fact, a process. The then Government said that they were introducing the carers strategy and would take the report on board and think about it, but I cannot recall anything coming out at the other end on what they thought about the Committee’s recommendations.
Last year, the Public Accounts Committee published a report on “Supporting Carers to Care”, which criticised the confusing and complex processes and poor communication involved in the support that carers received from the Department for Work and Pensions, including benefits and employment support—that point was made tellingly in a good contribution by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard). The Committee found that one fifth of carers who received benefits struggled with the application process, which is not surprising if no one helps them to fill in the forms. It found that the complexity of the system discouraged applications, and that Jobcentre Plus advisers were not given enough incentive to help carers to find part-time work. I am not sure that we ever had a response from the last Government to the Public Accounts Committee’s report.
It would be helpful if, early in the life of the present Government, we had an indication of how Ministers collectively see the opportunities for supporting carers financially. Of course, everyone recognises that that is set against a background of very difficult financial constraints and circumstances. That is a given. It should not be necessary, every time that one makes a speech now, to explain that we are the country with the largest amount of debt in the world, due to circumstances. However, it would be helpful, with a view to taking forward policy on carers, if we had an understanding of how the Government see the ability to give carers further support. I am referring to support that is valuable not only in financial terms, but because it makes carers feel that they are being recognised by the wider community for the work that they do and the role that they play.
My hon. Friend the Member for Totnes rightly raised the issue of young carers and my hon. Friend the Member for Blackpool North and Cleveleys raised the issue of young carers being bullied. I am always at a loss to understand why, in the 21st century, schools, the education system and all the people involved are not capable of being more supportive of young carers. That goes back to the point about identifying carers. Young carers deserve to be identified just as much as any other carer. One would hope that the education system and schools were capable of recognising young carers, that social services, GPs and others would try to ensure that schools knew who the young carers were and that schools would give young carers support. Often, they deserve double the support for the tasks that they are undertaking.
Many hon. Members, at different times in their lives as constituency MPs, come across families that include young carers and find out that the stress is incredible because they are often asked to take on adult responsibilities. Another difficulty is that the parent for whom they have taken on responsibility is sometimes able to look after themselves and be a parent, and sometimes is unable to look after themselves and is being cared for. For a child, having to cope with a parent who sometimes acts as a parent and an adult and sometimes is not capable of looking after themselves must be incredibly difficult, because they never know when they go home whether their mother will be poorly, drunk or whatever and whether they will be the carer or the child.
Schools and the system therefore need to give young carers particular support. I do not understand why every year when carers week comes round, we continue, a bit like groundhog day, to have the same debate about young carers. This area does not require huge amounts of extra money; it just requires the system and the community—society—to work out how we give younger carers greater support.
It is clear from the debate and I can tell the Minister that it is clear simply from the number of hon. Members who have joined the all-party carers group—I am sure that many more Members of both Houses have not yet got around to joining it but are equally interested—that there is considerable interest in and support for carers in Parliament. Those Members will be anxious and keen, in the course of the Parliament, to see what further work we can do in support of carers. Particularly for Government Members, if what my right hon. Friends in the coalition Government are saying about the big society and about engaging the community is to have any meaning at all, a very good test of that will be how we deliver enhanced and better lives for those who are caring in our society.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Benton, and to speak in this important debate on carers. I thank the Minister for his comments on my new role. He may know that carers issues were of importance to me before I came to this place. I have always made it a priority to champion carers and carers organisations. It is very important that a number of hon. Members who have spoken today feel the same way and might take on that role, too. If we believe that carers have been a silent army, it is up to us, as Members of the House, to be a voice for them in relation to Government. Many hon. Members here today will be able to do that, and I hope that they do.
I pay particular tribute to the work of the all-party carers group, which has always been a very strong voice in the House. The chair, the hon. Member for Banbury (Tony Baldry), has just spoken. The group is ably supported by Carers UK. I pay tribute to the work of the Princess Royal Trust for Carers, Crossroads Care, Age Concern and the many other organisations that provide vital advice and support to carers. I also pay tribute to the standing commission on carers—whose chair, Philippa Russell, is with us today—because it provides a voice for carers.
In relation to supporting carers to have a life outside caring, I think that the key issues are respite care and breaks, supporting carers financially and supporting young carers and the people for whom they care, so that those young people do not have to take on the heavy burden of caring that many of them do. In the debate, we have already touched on most of those issues.
The Labour Government’s vision for carers as detailed in the updated national carers strategy identified the following outcomes. It stated that
“carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role; carers will be able to have a life of their own alongside their caring role”—
the subject of our debate—
“carers will be supported so that they are not forced into financial hardship by their caring role; carers will be supported to stay mentally and physically well and treated with dignity; children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive, to enjoy positive childhoods and to achieve against all the Every Child Matters outcomes.”
I hope that the Minister supports those or similar outcomes in the refreshed carers strategy that he announced. New Members may not know that we did not have a national carers strategy at all until 1999. It has been refreshed once, but however good those strategies are, looking at them again and taking them forward is very welcome.
I support the comments of the hon. Member for Blackpool North and Cleveleys (Paul Maynard). The revised NHS operating framework mentioned making dementia a priority, but did not mention support for carers, which carers organisations have noted. I hope that it is an omission that can be corrected in the next revision. We did not have an oral statement in the House when the important changes in the revised operating framework were announced, so today has been the first chance that we have had to ask questions about that. I hope that it can be taken on board. Ministers and civil servants need to understand that these days there is so much support in the House for carers that if carers are not mentioned in a document, it will be noticed pretty quickly.
My hon. Friend the Member for Llanelli (Nia Griffith) and other hon. Members rightly highlighted the importance of respite care and breaks for carers. The coalition agreement states that the Government will use better community-based provision to improve access to respite care. I asked the Minister yesterday to tell the House how the Government planned to deliver that promised increase in access to respite care through improved community support provision, because support provision is already starting to fall away. Carers organisations are reporting that cuts in local authority funding are already leading to cuts in funding for charities and other providers of care. The Minister repeated the commitment that the Government will deliver on their promises to carers, but he did not give us any more information. Carers and carers support organisations need to know exactly how community support provision will be improved.
A 25% cut in local authority budgets, together with further pressure from the council tax freeze, could pose a substantial risk to essential care and support services. My hon. Friend the Member for Hammersmith (Mr Slaughter) made a passionate case against the local council action to axe the carers centre in his area. I am very glad that he was able to do that. I hope that his contribution helps to highlight the case against what sounds like a damaging and unnecessary action by that council.
In debates last year, both the Minister and the former shadow Minister for care services, who is now the Under-Secretary of State for International Development, expressed concerns about whether the £150 million allocated to primary care trusts for emergency respite care was used for the purpose for which it was intended. If the Minister and his Conservative colleagues were concerned to see ring-fencing of budgets for respite care, I hope that now that they are in government, they will be committed to ring-fencing of budgets for essential social care services. I am not convinced that the transparency at local level that he mentioned is enough. History has proved that ring-fencing is the best way to ensure that money goes where it is intended to go.
The coalition Government say that they understand the urgency of reforming the social care system to provide much more control for individuals and their carers and to ease the cost burden that they and their families face. The Minister said yesterday that an announcement will be made soon about the commission on long-term care; I should be grateful if he would tell us more about that today. I am pleased that all the options for funding care will be considered, including an inheritance levy, which the Opposition support.
The Government have pledged to extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power. The Labour Government made the social care reform grant available to local authorities to enable the development of personalised care and personal budgets, but that grant is now in its final year. How will the Government encourage local authorities to extend the roll-out of personal budgets and to provide more control to individuals and their carers, given that, as we heard earlier, local authorities are facing cuts to their social care budgets?
I shall touch on the caring with confidence programme. Training for carers in their caring role is a vital way of supporting them and giving them confidence. The hon. Member for Banbury mentioned that aspect. The Minister announced the decision to cancel the caring with confidence programme; will he consider how local carers groups and carer centres are to fund that vital training? Offering materials for free is to be welcomed, but the organisations also need trainers and premises and to have their costs covered if they are to run that training. The carers strategy aims to ensure that carers will be supported so that they are not forced into financial hardship through their caring role. I hope that the Minister will support that aim. However, many carers are now concerned about Government plans that will hit disability and carer benefits. We have heard quite a bit about that this afternoon, and rightly so.
Concern was expressed this afternoon about the measure to increase benefits annually by the consumer prices index rather than the retail prices index. Carers UK estimates that indexing carers allowance by the consumer prices index over the past 10 years would have cost carers £5 a week, or about £270 a year. The Labour Government did not do that. As my hon. Friend the Member for Stretford and Urmston (Kate Green) said, whatever the country’s financial difficulties, carers should not have to take the biggest hit. Under the coalition Government’s plans for indexing benefits, carers allowance would be worth £62.95 by 2015 if uprated by the retail prices index, but only £60.35 if the consumer prices index is used. That is a difference of some £130 a year. Does the Minister think it fair to hit carers in that way? Carers and those whom they care for will also be affected by a similar change to the attendance and disability living allowances. Carers UK has said that single parents caring for a disabled child, a partner or elderly parent may have to rely on carer’s allowance, disability living allowance and the other means-tested benefits as their only source of income. Carers UK believes that making savings in that way will hit hard the incomes of the most vulnerable—those who are already struggling to make ends meet—and I agree.
Hon. Members have referred to the extreme concern among unpaid carers caring for relatives with disabilities about the introduction of a medical assessment for the disability living allowance. If the person cared for becomes ineligible for the allowance, the carer’s own income would be hit, as carer’s allowance and other benefits are based on the disabled person receiving a certain level of disability living allowance. A poor medical assessment could spell financial disaster for carers and their families. I understand that the Office for Budget Responsibility questions whether savings could be achieved, given the cost of implementation and the large volume of subsequent appeals. I urge the Minister and his colleagues to ensure that any changes are fully thought through, and that they avoid the stress and anxiety that a new system or poor decision making, or both, could cause.
My final thought about carers and financial hardship is on the axing by the Government of the savings gateway scheme, mentioned by my hon. Friend the Member for Stretford and Urmston. The savings gateway would have given carers in receipt of carer’s allowance an additional 50p for every £1 that they saved. I am sure that Members will have seen research by Carers UK showing that carers spend their savings over the years, which leaves many of them caring unpaid around the clock, and with no savings and no buffer against large purchases. That places an enormous strain on carers.
My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) made a strong case for raising carer’s allowance. When the Minister was in opposition, he asked the then Minister for a timetable by which carer’s allowance would be raised. He also asked for its eligibility to be extended so that pensioner carers would get proper recognition in the payments that they receive. Will the Minister take on board comments about the coalition’s plans for benefits for carers and those whom they care for, and will he consider giving us the timetable that he asked for when in opposition for increasing carer’s allowance and dealing with the eligibility of pensioner carers?
A further matter is the work being done by carers organisations, with primary care trusts and schools, to identify carers and refer them to sources of advice and support. In Salford, The Princess Royal Trust for Carers has two excellent projects to identify and support carers. One works with primary care teams and the other with local schools. The primary care project run by the excellent Julia Ellis has developed effective partnership working with teams at Salford primary care trust and at Salford Royal hospital. Over recent years, Salford has moved from having a low level of recognition of carers to a situation that sounds as good as might exist elsewhere. There is a carers link in most GP practices and a new GP toolkit; NHS staff and staff at the Salford Royal hospital act as the lead on carers issues; there are carers information files on all wards at Salford Royal; and there is increased awareness among carers’ social workers at the hospital. Another recent development is that pharmacists and other professionals in Salford are now supporting the work of identifying carers.
The coalition Government propose radical changes to primary care trusts; they also propose that schools could opt of local authority control. I am anxious that excellent practice in identifying carers, such as that developed in Salford, will be affected by the changes. How can carers organisations ensure that a strategic view of the needs of carers in an area can be taken once GPs and schools are acting independently?
The importance of signposting carers to sources of information should not be underestimated. Signposting is done by carers centres and carers support groups, but I believe that it can and should be done more by GPs, their primary care teams and by hospital staff. However, we must be realistic about the work that it entails. Members have spoken of the big society and volunteers, but identifying carers means reaching a large number of people working throughout the health service. The figures for NHS and social services staff in 2008 are as follows: there are 33,730 GPs and 88,435 hospital doctors; 92,000 people working in primary care trusts, including 4,200 doctors involved in primary care delivery; and 49,800 social workers, of whom 2,205 provided health-related social work.
The role of reaching out to all those GPs and primary care staff, hospital doctors and health-related social workers cannot be left to primary care projects such as the one in Salford. The Princess Royal trust has recently worked with the Royal College of General Practitioners in developing an action guide to help GPs and their teams to support carers. That guide has been distributed to every GP practice. The royal college also piloted a training programme for GPs. I believe that the Government could give more of an incentive for GPs to undertake the vital task of identifying carers.
I commend to the Minister and the House the private Member’s Bill that I introduced to the House in April 2007—the Carers (Identification and Support) Bill. The Bill would require health bodies to identify patients who are carers or who have a carer, and would require identified carers to be referred to sources of help and support. It would also require health bodies to ensure that health services for patients and carers took the carers’ needs into account. In a second version, it would have required schools to have a policy to identify and support young carers. Without such legislation, GPs have as an incentive only three points in the quality and outcomes framework awarded for work undertaken to identify carers in their practice population. That does not seem much of an incentive. I hope to reintroduce my Bill to the House, and I hope that the Minister and all present today will support it. I understand that the Minister has said that he wants to see GPs identifying carers more often.
An important link has been identified today—that of raising the matter with GPs and developing similar guidance for schools. Ofsted highlighted in a report that local authorities were identifying fewer young carers than might have been expected. We do not know the precise number of children and young people who care for family members. In my Worsley and Eccles South constituency, the young carers project supported by Salford carers centre is doing some excellent work on identifying and supporting young carers in two local high schools. I met the young carers on an adventure day out and also when they launched their DVD on bullying—bullying is a serious problem for young carers.
Family pathfinder projects have done some good work on improving support for young carers. The Labour Government provided funding to the Princess Royal Trust for Carers and the Children’s Society to help them raise awareness of the issue and to build skills in supporting young carers. They published guidance for schools, developed information sheets for GP practices and produced other materials, such as DVDs on listening to young carers. I hope that the Minister and his colleagues in the now Department for Education support the continuation of that funding, and adopt and develop the good practice coming out of the 19 young carer pathfinder projects.
My hon. Friend the Member for Hartlepool (Mr Wright) spoke movingly about the needs of young carers and the difficulties that vulnerable young people have in their transition to adult services. A possible impact of the personalisation agenda might be that a family that includes a young carer of a person who is self-funding through an individual budget may have little or no contact with professional agencies. If professional agencies are not good at identifying carers when they have contact, they will definitely not be good at it if the family is managing the budget themselves. There is concern about that, and it makes awareness-raising work with professionals important. The role of schools and GPs in identifying carers becomes crucial to ensure that the child or young person gets help and support.
It has been a pleasure to be part of this debate today. Some 10 Members and the Minister have made contributions. As the hon. Member for Banbury said, the Minister understands the issues for carers and for social care. He also understands, I think, the strength of our expectations that he will continue to be a champion for carers. It is delivery on commitments that matter to them.
Mr Burstow
I absolutely agree with that point, and that is why we will not promise to pay cash sums into the NHS baseline that therefore cannot be delivered to where Ministers claim that they will be delivered, and it is why we will ensure that we, as a Government, will provide both leadership and, when appropriate, direction to deliver the sorts of things that hon. Members on both sides of the Chamber have outlined today.
This helpful and useful debate will help to take our thinking forward as we begin our work on refreshing the carers strategy. Hon. Members cited many examples of good practice on the ground, and they offer beacons of hope for how services might look across the country. Challenging those who commission services locally to ensure that they learn from such examples of good practice is a task for not just the Government, but everyone. Examples of best practice do not come from the statutory sector alone, even though the most innovative parts of that sector are themselves beacons. As many hon. Members have said, we also have to applaud and encourage the social enterprises and social entrepreneurs who have spotted opportunities to do something for their communities and found the resources to do so.
I have identified a number of key issues from this debate: what we can do better to identify carers, whether they are young, old or from ethnic minority communities; what we can do to provide information and support for carers so that they can navigate their own way through the system; and what we can do to make the system simpler so that it is not the maze of benefits and complex rules about which we have heard so much in the debate. We realise that people who wear the label “carer” are not all the same. Carers are unique individuals confronting unique circumstances that require individualised and personalised responses. I agree entirely with hon. Members’ points about the need to empower carers as well as the people being cared for.
I will try my best to answer the questions that have been put today, but if I miss anything out, I guarantee that I will write to hon. Members with a fuller response than I can give today. I will also ensure that the points that have been made, particularly in respect of benefits, are raised in cross-ministerial and cross-departmental discussions on the carers strategy at the right place and at the right time. I want them to be taken into account as the work around simplifying and modernising the benefit system is taken forward.
The hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke for the Opposition, made a number of points, many of which we can work on together. Many hon. Members will be aware of her track record inside and outside the House. Elements of her speech made me feel that she expected me to take full responsibility for the things that the previous Government did not quite get right, such as the times when their implementation of a measure was flawed or when they failed to take note of representations. Although it is entirely fair for her to rehearse the points that I made in opposition—I certainly take those to heart—she will understand if I say to her that the last Government’s record left a lot to be desired, by which I mean that the improvements for which carers were hoping were not actually delivered.
Reference has been made to the huge financial pressures in many of our public services at the moment. I was struck quite strongly by the way in which the cuts that have been in train in local authorities for many months are somehow being laid at the door of this Government. In reality, those cuts were initiated and conceived under the last Government, and I just wish that there was a bit more humility and understanding of that. We have a shared challenge when it comes to dealing with the huge public sector deficit in this country. It is all well and good challenging this Government about what they will do in terms of the spending review over the next few months, but it would also be appropriate for a responsible Opposition to offer up suggestions that they believe would be painless that we could do instead.
Barbara Keeley
I do not know whether the Minister has experienced this during his parliamentary career, but the constituency that I represented between 2005 and 2010 covered two local authorities, and it was interesting to see the different priorities that those authorities gave to their work in social care and for carers. We heard a very good example of that in the debate, as Hammersmith and Fulham is adopting a swingeing policy that could take away a vital resource from carers, which I hope that something can be done about. I have heard the leader of Salford council hotly defend the fact that he would rather spend money on adult social care than on potholes, yet quite a lot of people in the city want money spent on potholes. Transparency and localism is one thing but, as with other aspects of health and support services, we could end up with a situation whereby a council such as Hammersmith and Fulham could remove a service, leaving its carers with nothing, while another area, such as Salford, would have excellent voluntary organisations and a council that prioritised social care.
Mr Burstow
The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.
Mr Slaughter
For the avoidance of doubt, I just want to say that it is not so much the financial situation in my area that I am concerned about, because my local authority says that it will, in due course, provide a service for carers. I am more concerned about the impropriety and mismanagement that has led to a long-standing service being simply dissolved overnight although there is no provision in place for the best part of a year to come. I would have thought that that was something in which a Minister and the Government would be interested. It is not to do with involvement in individual cuts; it is to do with the fact that a local authority is unable to manage its own affairs.
Mr Burstow
The hon. Gentleman has been a Member for some time, so he will know that there are regulatory systems in place that would deal with local authorities that were performing in the way that he describes. I am not aware that the authority’s activity has been reported in such a way. However, I stand by the offer that I have made, and I will be happy to receive further representations about the impact of tendering arrangements.
I want to pick up on the references that were made to the operating framework because the hon. Member for Worsley and Eccles South was right to point out that, in the operating framework that the Government issued just last week, we identified a requirement in the local priorities for the publication of dementia strategies. We think that that is an important signal. It was a signal to local PCTs that we wanted them to be more public facing and accountable to their local communities, and that they should account for why they have chosen not to spend money on dementia strategies. The signal was not specifically about dementia, but that we expected more of that sort of transparency in general. People should not need freedom of information requests to get information from PCTs about how public money is being spent, and I hope that that message will be understood by our local organisations that deliver such services.
The hon. Lady also talked about ring-fencing more broadly. The Government are determined to ensure that there is as much flexibility as possible for local authorities to make choices about how they prioritise their resources to deliver what is necessary to meet the needs of their local communities. We have made it clear that because we see the social care transformation grant as such a priority for investment in changes to services, so that they are genuinely personalised in the future, the budget for the final year in which it is available to local authorities will continue to be ring-fenced. We wanted to send the signal that we considered that grant to be important, and we want to ensure that local authorities deliver that grant during the course of this year.
The hon. Lady made a number of very useful points about good practice and the way in which GPs, schools and others play a part in delivering early identification of carers, whether those carers are young, old or otherwise. That should certainly inform the thinking of any Government when it comes to delivering a good carers strategy.
The hallmark of this important debate has been the great consensus about what needs to be done and the value that Members from all parties place on carers. I shall now try to address some of the other points that have been made.
The hon. Member for Stretford and Urmston (Kate Green) talked about financial issues and benefit changes, and such concerns were echoed by others. The carers cross-government programme board, which is charged with providing cohesion around the carers strategy, will look at those issues and hold cross-government discussions about them to ensure that the way in which we go about simplifying the benefit system actually delivers the right results at the end of the day.
The hon. Lady also expressed concern about the impact of public service cuts, which was also referred to by several hon. Members. Again, it is important to remember that some of the measures that are already in place were not initiated by this Government. Nevertheless, we have to be mindful about the impact of any budget decisions that we make through the spending review process. That will certainly be at the forefront of Ministers’ thinking in the coming weeks and months as we consider all the options that will have to be considered as part of the review.
The hon. Lady also talked about the difficulties faced by carers coming back into the workplace—the cliff edge, as she described it. The coalition Government’s programme sets out very clearly a desire to improve this country’s tax system significantly so that we raise the amount at which someone starts to pay income tax to £10,000. We believe that as we move towards implementing that change, we will begin to smooth out some of that cliff edge and start to have a significant impact on easing people’s return to work.
The hon. Member for Kingswood (Chris Skidmore) made a very good speech in which he set out a number of the challenges that we face. In particular, he rightly discussed the current complexity in the benefit system and the way in which it can be an obstacle to take-up of benefits.
The hon. Member for Hartlepool (Mr Wright) made a very good speech. He set out a range of issues relating to young carers in particular, but he also raised other points. He made a very important point about the Hartlepool carers centre, which he mentioned a lot in his speech, and it clearly provides an important service in his area. He also cited the £150 million a year that it saves taxpayers by reducing pressures on NHS resources. We need to ensure that such examples of social enterprises playing a part in easing pressure on public services and helping carers are considered. Such mutual operations can really make a difference.
The hon. Gentleman, like several hon. Members, talked about the role of GPs. He also made some comments about benefits. I refer him to what I have said about how we intend to move forward on benefits.
The hon. Gentleman also asked specifically about young carers. The key point I would make is that the Department of Health is piloting personal health budgets. In my written ministerial statement on Monday, I announced how we intend to evaluate those schemes. The schemes should give us yet another way of smoothing and removing some of the cliff edge that we have heard about by providing access to resources for care and health in a way that allows people to exercise real control over them and therefore much more control over their lives. That is particularly important for managing and smoothing the transition from childhood into adulthood, and we all want to ensure that that transition is made smoother.
The hon. Member for Chatham and Aylesford (Tracey Crouch) spoke about the key issue of the identification of carers. She said that only 5% of carers in her area had been identified by the local carers centre. A large number of people are hidden at the moment and do not necessarily identify themselves as carers. The identification of carers is a key challenge as part of the process of refreshing the carers strategy.
We have heard about the importance of flexible support for carers. Again, that is why personalisation will remain an absolutely central part of how the Government take forward the development of services. Such services should be tailored to fit around people’s lives, rather than requiring people constantly to navigate around them, often for the convenience of the service provider rather than the convenience of the person or family themselves. We want to accelerate towards achieving that vital aim, and we also need increased use of more user-led organisations that are much closer to the circumstances of the family, meaning that they can play an important part in advocacy, brokerage and helping families to navigate around the system.
I think that I have already addressed the main point made by the hon. Member for Hammersmith, who clearly put on record a number of powerful testimonies from his constituents about the value that they place on the centre to which he referred. However, as I have said, I will not attempt to micro-manage the decisions of local government colleagues of any particular party persuasion, as it is for them to account to their electorate for the way in which they spend public money.
The hon. Member for Totnes (Dr Wollaston) discussed young carers and talked about the devastating impact that alcohol can have on people’s lives. She offered advice about some of the ways in which the Government might tackle that issue, such as a pricing policy, and cited advice that the NICE has given. I can tell her that we will be publishing a White Paper on public health later this year setting out the Government’s approach on such challenging issues. I hope that my right hon. Friend the Secretary of State for Health will say more about that White Paper in the not-too-distant future.
The hon. Lady also talked about safeguarding, and we have announced a review of the vetting and barring system. I am one of the Health Ministers with responsibility for safeguarding, so I will receive the recommendations from that review. We need to ensure that the system is proportionate to the risk and that it delivers the appropriate safeguards, but it must not be so bureaucratic and difficult that it actually becomes a barrier to people participating as volunteers, so that is one of the tests that we will apply to the system.
The hon. Member for Liverpool, Wavertree (Luciana Berger) talked about the USDAW campaign, as well as the importance that she attaches to the role of carers in her constituency, some of whom she has already visited. She also discussed the plight of working carers, their interaction with the benefits system and the need for an examination of tapering as a way in which people could retain an element of carer’s allowance. All I can say at this stage is that the Government are committed to reviewing the system with a view to simplifying it.
The hon. Lady also asked how we could ensure that there is greater awareness of the right to seek flexible working. Again, that is not just a challenge for the Department of Health. We will need a cross-government approach on the issue involving my colleagues in the Department for Business, Innovation and Skills and the Department for Work and Pensions. Together, we have a part to play in ensuring that people are genuinely aware of that right.
The hon. Member for Blackpool North and Cleveleys (Paul Maynard) spoke very effectively. I was in the House when he made his maiden speech and it was one of the most impressive that I have heard. I know that his speech was excellent compared with mine 13 years ago.
Mr Burstow
I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.
We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.
The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.
The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.
The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.
The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.
Barbara Keeley
As with other developments, I did not hear about this in the House; I heard about it from carers organisations. Does the Minister realise the extent to which carers support groups and organisations are concerned? They were geared up and trained to deliver the programme. Having useful materials will be a good thing, but materials are not enough to run a course. They need somewhere to run it, a trained person—probably paid—and resources during the day. It would be useful if some of the money could be diverted to training GPs, but that is a mainstream NHS matter. I emphasise that there is a great deal of concern among carers organisations about the programme, so anything that the Minister can do will be a help.
Mr Burstow
I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.
Tony Baldry
Will my hon. Friend tell us when the general issue of funding for carers will be addressed, and whether it will be addressed in the carers strategy?
Mr Burstow
I am looking at my notes on the points about benefits that the hon. Gentleman made and the precise time scales. Obviously, I am not the Minister responsible for the review of welfare benefits, which several hon. Members have mentioned, but it is clear that the timetable is quick and that reports back will be made during the spending review. Hon. Members who have representations to make about how we ensure that carers’ interests are served within those changes should therefore make them now. This debate is a good part of that process, and I will ensure that the matter is kept in the minds of Ministers and officials.
There will be tough decisions, one of which has been my decision about caring with confidence. We will need to ensure that every penny we spend has an impact on the lives of carers, but we must make no false economies. One of the themes of this debate is that we must ensure that the investments that we make deliver good outcomes, and that when we must reduce public expenditure, we do not just shunt costs around the system. We understand that point.
I hold to the view that carers are an important thread that holds communities together. We need to do more to support them. Their value will grow as our society ages and people with disabilities live longer. We must ensure, both across parties and within the coalition, that the refreshed strategy delivers tangible results, rather than being just a statement of intent. It must be clear about delivering change for carers. That is this Government’s commitment, and I look forward to making the difference, along with colleagues, as we go forward.
Question put and agreed to.