Social Care (Local Sufficiency) and Identification of Carers Bill
(Limited Text - Ministerial Extracts only)
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Sir Tony Baldry (Banbury) (Con)
The Government published their White Paper, “Caring for our future: reforming care and support”, just before the summer recess, and I think we would all agree with its statement:
“Carers make a vital contribution to promoting the wellbeing and independence of the people they care for…The support provided by millions of carers is testament to the strength of our society and our communities. However, we also recognise that caring brings challenges. Providing better support to carers is therefore crucial to ensure that they can maintain their own health and wellbeing, care effectively and have a life of their own alongside caring.”
Earlier this year, various all-party groups, including the all-party group on social care, which is chaired by the hon. Member for Worsley and Eccles South (Barbara Keeley), who has so ably introduced this Bill, and the all-party group for carers, which I co-chair, met to consider the measures needed to do exactly what the Government say they want to do in their White Paper, namely provide better support for carers, so that they can
“care effectively and have a life of their own alongside caring.”
The hon. Lady was fortunate enough to come reasonably high in the ballot for private Members’ Bills and, with the help of a number of carer organisations, such as Carers UK, drafted a Bill that addresses the challenge of how we can give effective support to carers.
The Government then published their much-awaited White Paper on social care, which was widely welcomed. I am delighted to say that, for the first time, it makes substantial commitments to carers, which I will come to in a moment. Unfortunately, but perhaps understandably, most of the press commentary on the White Paper centred on what the cost of residential social care would be. The new policy and the contribution to the support of carers were not necessarily highlighted sufficiently, but they are included in the White Paper.
The hon. Lady and those involved in promoting the Bill examined the measures in the White Paper and considered what other measures would be of further benefit to carers. A number of the Bill’s provisions are, therefore, not included in the White Paper, but I acknowledge that there is some overlap. For example, clause 1, which would introduce a duty to ensure sufficient social care support, is probably covered by the provisions in the draft Care and Support Bill.
I am anxious to find a way forward whereby we do not wake up tomorrow morning to headlines stating that the Government have killed off a Bill that would give more support to carers. We need to find a grown-up way to do this. My hon. Friends the Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) are present, and I suspect that these sextons on duty—these pallbearers of private Members’ Bills—will make lengthy contributions that may well not enhance the nation’s understanding of the problems faced by carers.
Before we make any further progress, I therefore want to make a request to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), who I am delighted to see taking responsibility for this issue at the Dispatch Box for the first time. The White Paper contains a welcome chunk of policy on carers, but people involved with carers feel that some areas could be further enhanced. All I want my hon. Friend to do is give a clear undertaking that, between now and the eventual Second Reading and debate of the Government’s Bill on social care, he would be willing to have meetings with the relevant all-party groups to discuss how provisions relating to carers could be further enhanced.
I fully accept—the interventions on the hon. Member for Worsley and Eccles South demonstrated this—that there are tensions in relation to how one balances duties on various organisations and partners in ways that are reasonable to their costs, and to some of the changing patterns resulting from the fact that local governments are now seen more as enablers than deliverers. I want my hon. Friend to give an undertaking that he would be willing to have discussions with those of us who are concerned about carers policy, to try to ensure that, when the Government’s Bill on social care is presented to the House, those parts relating to carers are as robust and as resilient as possible.
I hope that my hon. Friend is willing to give that undertaking. Given that he has only taken up his brief this week and has probably yet to read the briefing for incoming Ministers in his red box, I would fully understand it if he felt unable to respond in detail today and say, “Well, I can accept those bits of the Bill, but not those bits.” That would be difficult. It would be disappointing, however, if there were any scintilla of a suggestion that the Government want to “kill off” this Bill because they do not want it to pass. I hope that my hon. Friend will see this as an opportunity to have a constructive debate on policy on carers and their needs, and trumpet his willingness to engage with us to make sure that those parts of the Government’s new Bill relating to carers are as good as possible.
The Minister of State, Department of Health (Norman Lamb)
I am grateful to my hon. Friend for his comments, and I am happy to give, straight away, the undertaking that he seeks. I will engage fully with the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the Bill’s promoter, and with the relevant all-party groups. It is important that we get this right and that we do not let down those people with caring responsibilities. I am very happy to give a firm commitment to engage fully between now and when the Government’s Bill is presented to this place.
Sir Tony Baldry
I am grateful to my hon. Friend for that undertaking. I would understand if the Government did not want the Bill under discussion to progress, but that must be balanced against his undertaking.
Sir Tony Baldry
Before I give way to the right hon. Lady, I want to say that I hope that the Government’s Bill will codify all the existing legislation relating to carers. Over the years, a whole number of private Members’ Bills, one of which was introduced by the hon. Member for Aberavon (Dr Francis), have enhanced the role of carers. It is confusing and difficult for people to find their way around different bits of legislation, so it would be good if all of the legislation relating to carers were collected in one piece of legislation.
Norman Lamb
I am grateful to my hon. Friend for allowing me to intervene again.
It is the Government’s ambition to codify all the provisions relating to carers and care and support in one Act of Parliament. A big problem, as he rightly identifies, is that the law has developed in a haphazard way. Getting it all into one Act of Parliament, written in plain English, would be of real benefit to carers and others in the sector.
Sir Tony Baldry
I am genuinely delighted to hear my hon. Friend say that. It is really good news. If we continue on that basis, we will make substantial progress.
Liz Kendall (Leicester West) (Lab)
I thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for bringing forward this excellent Bill, and warmly congratulate her on doing so. She is a long-standing advocate and champion of unpaid family carers and wider social care issues. Today, she has again displayed her invaluable contribution to these issues and the House.
The Bill is important because it seeks to change in two fundamental ways the way in which we support disabled people and the family members who care for them. First, it seeks to shift the care system away from focusing predominantly on the needs of people whose care is funded by the state, to recognising the millions of individuals and families who fund their own care. The vast majority of those people are not hugely wealthy, but live on low or modest incomes. When a person whom someone loves becomes frail or ill, it comes as not only an emotional shock, but a financial one, because they have to pay for the care. When they then ask for advice, information or support, they do not get it. People do not even receive the information that is available. That is a big and important change that the Bill seeks to achieve.
Secondly, the Bill seeks to shift the nature of the support that is available to disabled people and their family carers, so that people’s broader needs are met as individuals, not just as carers. That includes their health needs and their needs for skills and training, so that they can build a full and fulfilling life. Crucially, it includes their need or desire to get work and to stay in work. The Bill would make a significant difference in allowing disabled people and their carers to achieve a better quality of life. It would also provide better value for money for taxpayers.
There have been big improvements in the care system over the past decade, with new rights for carers to have their needs assessed, new rights to request flexible working, improvements in respite care, a training and support programme for carers, and strengthened rights for carers in their entitlements, for example to the state pension. However, like many hon. Members, I know from my constituents and my own family that a desperate daily struggle is still faced by too many people who are looking after someone whom they love and who is disabled, is physically frail or has Alzheimer’s—sometimes even all three.
As hon. Members have said, many people do not think of themselves as a carer, but are just trying to be a good daughter, son, husband or wife by looking after the person they love. They therefore do not realise what support is out there. Often, it is only when somebody reaches crisis point and can no longer cope that they look for support. However, people do not know where to go and often the right services are not available to them. The result is that millions of carers see their own health suffer. One in three unpaid family carers of working age has to give up work or reduce their hours, adding financial worries to their already stressful lives.
As has been said, that often happens to women aged 50 to 65, or even older, who still want, and may need, to work. Indeed, as the population is ageing, they will need to work for longer. They face the awful double whammy of having to care and work for longer, and may be unable to balance the two. Any kind of social life or leisure time—something that many people look forward to when they retire—is nothing but a pipe dream. That is not good for carers, and it costs us all more through increased costs to the NHS and a higher benefits bill.
One issue to consider is the statutory framework within which local councils work. Particularly when they are under intense financial pressure, as they are at the moment, they understandably and inevitably focus on delivering their statutory duty to provide care for those in the greatest need. Indeed, they are focusing more and more on a small number of people with intense needs, because of the financial pressures that they face. The bigger agenda of prevention and early intervention is going by the wayside. The Bill’s provisions are intended to change that framework so that councils have a duty to assess the range of care needs in their area and then stimulate the market to ensure that services are available to meet those needs.
The Bill also includes important provisions to ensure that schools and further and higher education bodies identify young carers. Many Members have spoken about that issue, and I will not go into detail because I want to give others time to come in. However, the idea of involving further and higher education providers is groundbreaking and very welcome.
The Bill also addresses how we can get NHS bodies to better identify people who are, or are about to become, carers so that their health needs are assessed too. Many Members have talked about changes that are already being made in some parts of the country to achieve that. My hon. Friends have talked about the work that is taking place in Stockton and Salford, and the hon. Member for South Thanet (Laura Sandys) mentioned Torbay care trust, which I visited earlier this year. It is doing brilliant stuff in schools, but also in hospitals. Its staff know that if an elderly person who has had a stroke comes in with a husband, wife or partner, the latter will probably end up being a carer. It has a package of measures in place to identify such people.
In my constituency, Leicester city council has recently set out its plan for improving support for carers. As far as I remember, the plan says a lot about what schools can do, but I do not believe it mentions Leicester college, Leicester university and De Montfort university. The Bill would ensure that such issues were considered in every area, which would make a big difference.
I want to take a few moments to talk about something that we have not focused on so far in the debate but that is critical, which is how the Bill could help our economy. Creating jobs and growth is the biggest challenge that the country faces at the moment. As my hon. Friend the Member for Worsley and Eccles South said, the business forum Employers for Carers has clearly spelled out the mounting costs not just to families but to businesses of a care system that is not helping families to juggle their work and caring responsibilities. As our population ages and people have to work, and probably care, for longer, we have to understand that changing our care system is as important as continuing to make improvements in child care in helping families balance those responsibilities.
Using research from the London School of Economics, Age UK has shown that the cost to the economy from carers’ inability to balance their working and caring responsibilities is now £5.3 billion in lost earnings and more than £1 billion in lost tax revenues and benefits bills.
Norman Lamb
Does the shadow Minister agree that extending the right to request flexible working is also important? It will enable people with all sorts of caring responsibilities to enter into a discussion with their employer to see whether there might be flexibility for them to be able to work in a different way.
Liz Kendall
I have always been a champion of the right to request flexible working, which has made a big difference. I hope the Minister will not listen to the voices of some Members sitting behind him who want employment rights, including the right to request flexible working, removed from those working for a business employing three or fewer people. That would be a mistake and would not help us to address the issue. Employers for Carers has stated that if we stimulate the care market, as measures in the Bill seek to do, that could—as my hon. Friend the Member for Worsley and Eccles South said—deliver a triple economic win: better services for families, infrastructure to help employers retain skilled staff, and a boost to economic growth.
The Bill introduces the big challenge of flipping the care system on its head. Instead of seeing the ageing population and growing care needs and demands as a drain and burden on the country, we should see it as an opportunity for growth. The population is changing; it is ageing. Demand for care and support services will grow, and there is a huge opportunity to develop and stimulate jobs, companies and growth in that area, as has been done in France. In 2005, the French Government launched a plan to develop what they call services à la personne—a range of home care services, home visits and domiciliary care, and different types of services such as those provided by handymen and handywomen, drop-in services and support.
Between 2005 and 2007, 100,000 jobs a year were developed through the different incentives introduced and, as my hon. Friend said, even after the financial crash, 50,000 jobs a year were stimulated in that way. I urge hon. Members to read the report by Carers UK, “Growing the Care Market”, which sets out an important challenge. As we seek to develop and rebalance the economy, growing the care market will deliver better services for families who desperately need them, and a better, bigger, vibrant care market in the future, which is vital.
My hon. Friend’s Bill builds on many of the previous Government’s improvements and on recommendations in the Law Commission’s review of adult social care legislation. That review began under the previous Government, and reflects many aspirations in the current Government’s White Paper and draft Bill on care and support. There is much cross-party consensus that we must move forward on these issues.
Norman Lamb
Does the hon. Lady also agree with the Law Commission’s view that it is best to get everything codified in one place so that one piece of legislation addresses all issues of care and support?
Liz Kendall
Opposition Members, myself included, want to ensure that the draft Bill on care and support covers all the issues that we wish to see progress. However, we also want to see the provisions in my hon. Friend’s Bill on the statute book. I welcome the Minister’s commitment to engage with my hon. Friend on the draft Bill, but when he rises to speak will he go further and commit to including those clauses for which he has specific responsibility in the Department of Health? Those will include the duty on local authorities to assess people’s needs, ensuring sufficiency of provision, and for NHS bodies to identify carers. I understand that the Minister needs to engage with colleagues in different Departments—notably the Departments for Business, Innovation and Skills and for Education—but it would be a welcome step forward if he committed to including in the Bill those clauses for which he has responsibility as a Health Minister.
I should, of course, welcome the Minister to his new role. He has a track record—certainly before the previous election—of commitment to social care. He will also know, however, that we cannot deliver the vision of a transformed system of care and support that Ministers claim to want in their White Paper and Bill, and which Opposition Members certainly want, without the money to deliver it. My hon. Friend’s Bill will make a big difference, but we cannot deliver without getting more money into the system.
As the Minister will know, there are two key challenges. First, we need to address the current funding gap in social care. Because local councils’ budgets are being cut by a third, social care services are being reduced and cut. That is inevitable. Adult social care makes up around 40% of local councils’ budgets, and up to 60% in some areas—it their biggest discretionary spend. When their overall budgets are being cut by a third, it is inevitable that those services will be cut. We need to address that immediate challenge and the immediate care crisis.
Secondly, we need to reform care funding in future. The Minister will know that the Opposition called for and initiated cross-party talks with his predecessor on the recommendations of Andrew Dilnot’s commission on the future funding of care and support. We remain completely committed to trying to achieve cross-party agreement and consensus on that vital issue. Will the Minister tell the House whether the quad of the Prime Minister, the Deputy Prime Minister, the Chancellor and the Chief Secretary to the Treasury have agreed to fund Andrew Dilnot’s recommendations, as was reported in the newspapers over the summer recess? I hope they have made such a commitment. We could then work with the Minister to secure the cross-party consensus on both the current gap and the future funding of care. That will enable us to make the vision that Opposition Members have of a better and fairer system of social care a reality.
The provisions in my hon. Friend’s Bill, which I hope will become legislation, would ensure that we deliver that better system of care and support for all those disabled people and family carers, whether they are funded by the state or self-funding, and whether they are younger or older carers. They will also ensure that we give people the decency and dignity they deserve when they are looking after frail, vulnerable and elderly relatives whom they love and whom they want to have a better life.
The Minister of State, Department of Health (Norman Lamb)
I thank the shadow Minister for her kind comments. I shall address her other comments in due course, but I should first thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the Bill and giving the House the chance to discuss the vital question of how carers of all ages can be supported effectively.
I pay tribute to the hon. Lady’s work over a long period. She has been a doughty campaigner and is deeply knowledgeable. Whatever disagreements we have on elements of the Bill or on how to proceed—[Interruption.] It is quite important that the hon. Lady hears what I am saying. Whatever disagreements we have, I am keen to engage with her and her colleagues to ensure that we get it right. My only interest is ensuring that we go through a proper pre-legislative scrutiny process before the Government introduce our Bill. I am happy to confirm now—I am happy also to write to her—that I will meet her before our consultation ends in October to go through all the issues raised in the Bill that are relevant to my Department.
The shadow Minister asked whether I would commit to including all the Bill’s clauses in the Government’s Bill. I have been in the job for four days so I shall not make any commitment of that sort, but I shall commit to discussing seriously all the issues to ensure we get it right. There are significant areas of overlap and some areas of disagreement about the approach we should take. I am concerned that a plethora of duties could end up introducing new bureaucratic processes that could—I think the hon. Member for Bury North (Mr Nuttall) made this point—take money from the front line that provides care and support and introduce costly processes that do not deliver any results for the people we want to help.
I accept absolutely that the proposal is well intentioned, but there is a risk of a plethora of duties. It is essential to have one code, written in plain English, that people understand. I will enter into discussions with her and her colleagues, and with the groups that support her measures, so that we can try to build a consensus. There has been a wide welcome for what the Government are doing in implementing the Law Commission proposals, the biggest reform for many years, so let us make sure that we get it right.
Barbara Keeley
I welcome what the Minister says, and it would help me and the organisations and individuals who have worked with me on the Bill if he confirmed it in writing. Opposition Members do not want a plethora of duties. The Bill, in imposing duties on local authorities, might be a little too extensive, but it contains two important points that must be taken forward. The first is to have a picture of sufficiency and not to have to do everything through freedom of information requests, which might require local authorities to go a bit further than they currently do. Secondly, although there is some wonderful practice among health professionals in identifying carers, we need to go further to ensure that health bodies understand that they must have policies in place. We need to do more than just encourage a few champions to take that forward. They are the people who will have the best picture of families and the caring situations of young carers. They are the only ones who can do it. I have wonderful practice in my constituency, as well as places where it is not happening at all and people are left to their own devices. Out of everything in the Bill, those are the two points that are important to take forward. One is—
Madam Deputy Speaker (Dawn Primarolo)
Order. I think the Minister gets the point.
Norman Lamb
There is a degree of overlap on the sufficiency issue. I commit to discussing with the hon. Lady whether we have the framework right in the Government draft Bill or whether it could be improved—let us have that discussion. I will seek to address in my remarks the interesting philosophical argument about how best to approach identification, but parts of her Bill go beyond the responsibilities of my Department. To be clear, I am happy to engage with other Ministers to seek to address some of the issues she raises and I will maintain a dialogue with her on that.
Laura Sandys
In response to the point made by the hon. Member for Worsley and Eccles South (Barbara Keeley), is there not also an opportunity to create a strong role for the health and wellbeing boards?
Norman Lamb
I am grateful to my hon. Friend for raising that point. Yes, absolutely, there is and I will come back to that. One concern I have is the focus in the Bill on social care, whereas the thrust of Government policy is the importance of integrated care. My hon. Friend and the shadow Minister referred to Torbay. I am passionate about that approach. We can do an awful lot more. The whole approach should be to integrate health and social care in our planning and our execution, rather than, as the Bills risks, silo-ing social care and assessments of social care and carers’ needs separately.
The shadow Minister commented on budgets. I absolutely understand that budgets are tight and that local authorities are in difficult times, but the new budget survey from the Association of Directors of Adult Social Services shows not huge cuts but that councils have risen rather impressively to the challenge and identified savings of £1.89 billion since 2010-11 by using resources more efficiently. Surveys show that councils’ spending on adult social care is due to fall by only £200 million or so. If the money can be used much more effectively, we can ensure that services are protected.
One thing I am interested in pursuing in my new role is how well we commission care. There is disturbing evidence of a race to the bottom, with care being commissioned on the basis of an hourly rate and the cheapest getting the contract. We need to do everything we can to ensure that commissioning provides incentives to improve health and well-being, prolong independence and improve mobility, thereby saving money and improving care, which is what we need to achieve. There is probably a widespread view that we do not commission care nearly effectively enough. There must be a substantial improvement in our expenditure on social care.
We agree with much of the intention of the Bill, but for a number of reasons we cannot support it. First, it would perpetuate the fragmentation of carers legislation, which we are seeking to end. My hon. Friend the Member for Bury North made the point that the Law Commission argued for a single statute. It seems irrational, at the very moment that the whole sector is celebrating the fact that we are seeking to bring everything together, to have a separate Bill introducing new duties. The debate about getting the framework right—putting everything together in one clear framework, written in plain English—needs to be part of the Government’s Bill.
Sir Tony Baldry
I urge my hon. Friend to be as conciliatory as possible. In fairness, when the hon. Member for Worsley and Eccles South (Barbara Keeley) started with her Bill, the Government had not published their social care White Paper, so she had no idea what it would contain. The important thing is to focus not on the Bill’s potential failings but on a process that enables us to look at its ideas and concepts and decide which will fit into the social care Bill that my hon. Friend will bring forward for Second Reading in due course.
Barbara Keeley
On timetabling, clearly I could have done anything with this slot for a Bill, but we need to get on with things. I do not know whether the Minister can say what he thinks the timetable is now, but when we proposed the Bill it was not clear. People are in desperate need: carers are not being identified and there are big issues. That was the point of introducing the Bill. It is elegant to have everything in one statute, but it does not help people if that takes for ever.
Norman Lamb
I am happy to write to the hon. Lady with more information about timetabling. I absolutely want to get on with this. Pre-legislative scrutiny is important because it will ensure that we get the legislation right, but I am not interested in delay. I want to get the Bill on to the statute book, but I also want to get it right.
Dr Francis
Will the Minister meet the all-party parliamentary group on carers at the earliest opportunity to outline his proposals? Will he also seriously consider consulting the health Ministers in Scotland and Wales, where considerable progress has been made?
Norman Lamb
The hon. Gentleman raised those points earlier. Yes, of course I am keen to engage with Scotland and Wales, and I would certainly be happy to meet the all-party group. I want to be as open and inclusive as possible in this process.
As I have said, there is also a concern that the Bill would impose a range of new, additional burdens on public and private bodies at a time when we are committed to reducing such legal duties. We agree with much of the intent of the Bill, but there are a number of ways in which we can pursue our common goals effectively. In July, the Government published the draft Care and Support Bill, which will undergo pre-legislative scrutiny later this year. That is information on the timetable for the hon. Lady. We can use that process to discuss the provisions relating to adult carers. In addition, earlier this week the Department for Education published draft legislation on the reform of provision for children and young people with special educational needs. That will also present an opportunity to consider how we might improve the identification of and support for young carers. I urge the hon. Member for Aberavon (Dr Francis) to engage with that process as well.
Private Members’ Bills have played a central part in the history of carers legislation. I would like to take this opportunity to pay tribute to the hon. Member for Aberavon for the significant contribution that he made by promoting the Carers (Equal Opportunities) Act 2004. He has been involved in these matters throughout the period since, and I want to express my gratitude to him for that. I also want to thank other parliamentarians, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), the right hon. Member for Croydon North (Malcolm Wicks) and Lord Pendry. Their contributions to the development of carers’ rights date back to the mid-1980s.
I also want to thank my predecessor, my hon. Friend the Member for Sutton and Cheam (Paul Burstow). He has championed carers, both from the Back Benches and while Minister with responsibility for care services, and I am certain that he will continue to do so. I want to take this opportunity to pay tribute to the work he has done as a Minister. He has shown utter dedication to the cause, and I know that that has been widely appreciated.
Carers make a vital contribution to society, as many Members have said, and we are taking concerted action to support them. We set out our priorities in “Recognised, valued and supported: next steps for the Carers Strategy”, in November 2010. Between 2011 and 2015, we will provide an additional £400 million to the NHS to support carers, including through the provision of carers’ breaks. My hon. Friend the Member for Bury North mentioned this earlier. The White Paper commits to over £125 million of additional resources being allocated to carers.
Carers are central to the Government’s proposals for care and support. For the first time, carers will be placed on the same legal footing as the people they care for. That is an incredibly important breakthrough. We will extend the existing right to a carer’s assessment and provide carers with a new entitlement to support to meet their needs. The hon. Member for Aberavon mentioned Scotland and Wales. Both are planning new legislation, but neither is proposing to require councils to meet the eligible needs of carers for support, as our draft Care and Support Bill does. That should be acknowledged. I understand that Wales and Scotland are proposing a discretionary power to provide services to carers. We are taking groundbreaking measures to improve the position of carers. We are providing resources to the Royal College of General Practitioners. In opening the debate, the hon. Member for Worsley and Eccles South referred to GPs in her own constituency and some of the interesting, innovative things they are doing. I accept that this is not widespread enough at the moment, but interesting things are happening around the country, which we should acknowledge. We are providing resources to the voluntary sector as well as to the Royal College of General Practitioners to help increase awareness among health professionals of the importance of supporting carers to identify themselves as such and to direct them to relevant information, advice and support.
Our care and support White Paper, “Caring for our future”, together with the draft Care and Support Bill published in July, set out the Government’s plans for the biggest transformation of care and support in England since 1948.
It is vital that carers are able to take a break from their caring responsibilities. To help support them to do this, the Government have made available an additional £400 million to the NHS between 2011 and 2015 to provide carers with breaks from their caring responsibilities to sustain them in their caring role. Under the White Paper proposals, carers would benefit from a diverse range of supportive personalised interventions. This might take the form of providing additional support for the care user either through respite care or in their own home; it might give the carer the opportunity to take a short break, perhaps a weekend away to see friends; it might mean being free to get a hospital appointment to look after the carer’s own health—a point raised by many hon. Members.
Liz Kendall
Will the Minister clarify how we will be able to keep track of the money allocated for respite care? It is often given out nationally but not ring fenced, which can be a problem when it sort of disappears. How will we know where the money is going? Is it going to clinical commissioning groups, for example? How will we keep an eye on it and how will we know that it has been spent effectively?
Norman Lamb
The hon. Lady makes a very good point. I remember challenging the Labour Government on similar grounds when I was in opposition. Money had apparently been allocated to primary care trusts to provide carers with support, but nothing ever happened. I made that point as strongly as I could at that time. I will come on to explain how we shall deal with the legitimate point that the hon. Lady raises.
This extra support might mean the carer and the cared-for person taking a day trip together, so they can spend time outside of the confines of the caring relationship. It might also be through a direct payment—pursued under the Labour Government and now developed under this Government—that could be used to buy a laptop so that the carer can keep in touch with family and friends. In all these matters, we need to be as open as possible to the different ways in which the money can be spent.
There are some excellent examples of good practice in the area of carers’ breaks. In Surrey, the new GP carers’ breaks pilot has been running since 1 December 2011. So far, 80% of the 136 practices in Surrey have signed up and over 250 breaks have been provided, with 75% to parent carers. Surrey has been working with Carers UK on the evaluation of the pilot to tie up with its work on the GP carers’ champions project. In Cambridgeshire, Crossroads Care is part of a very good scheme whereby PCT money for supporting carers is used to support a GP prescription service. This is really good, innovative stuff. The GP can simply prescribe a carer a break, send a request to Crossroads, which will quickly contact the carer to discuss what sort of break they would like, and then arrange it. I urge GP practices across the country and the emerging clinical commissioning groups to look at this best practice that is emerging around the country and to implement it in their own areas in a way that suits their own local circumstances. We must do more to spread the best practice that is starting to emerge.
Let me say a few words about the mandate. In July, we published for consultation the first draft mandate for the NHS Commissioning Board. The mandate will be at the heart of the accountability relationship between the Department of Health and the Commissioning Board from April 2013. The draft mandate contains a specific objective: to improve the support that carers receive from the NHS by early identification of carers—that is dealt with in the Bill—by signposting to advice, and by working collaboratively with local authorities and carers’ organisations to enable a range of support to be provided. The consultation on the mandate is currently taking place, and I welcome Members’ engagement in that process.
Barbara Keeley
The Minister may not know the answer to my question, but it would be interesting to know how progress will be reported. Will the NHS Commissioning Board report progress to the House? It is good that the provision has been included, but it will be only as good as its implementation.
Norman Lamb
Four days into the job I am not entirely sure of the details, but I will ensure that the answer to the hon. Lady’s question is included in the letter to her. I certainly want the process to be as transparent as possible.
The NHS operating framework for 2012-13, published last November, contains stronger requirements for supporting carers, and is more specific about the plans of PCT clusters. Those plans should be in line with the “Recognised, valued and supported: next steps for the Carers” strategy. Plans should be explicitly agreed and signed off both by local authorities and by PCT clusters. Local authorities and PCT clusters should identify the financial contribution for supporting carers. They should identify how much of the total is being spent on carers’ breaks—this deals with the point raised by the shadow Minister—with an indicative number of breaks that could be made available within that funding.
PCTs or PCT clusters should publish their plans on their website by the end of this month, so we shall be able to see which areas are doing the job well and which are failing. Area authorities need to be held to account, whether they are PCT clusters or commissioning groups. People need to know what is available in their areas. A number of PCTs have already put resources into support for carers, significantly enhancing their existing support for them.
The current legal framework for care and support is out of date, complex and confusing. More than a dozen Acts of Parliament relate to adult care and support, and four relate specifically to support for carers. We can imagine how hard it must be for people out there, beyond this place, to understand what their rights might be. People who need care, carers, and even those who manage the system find it difficult to understand how statutes operate and interrelate. That is why one of the overarching objectives of the Government’s draft Care and Support Bill is to consolidate the existing law on care and support into one clear Act, making the law far easier to navigate. Introducing yet another stand-alone Act would only prolong fragmentation and militate against the thrust of the draft Care and Support Bill, which is to consolidate provision for carers in Government legislation. That point has been made by my hon. Friend the Member for Banbury (Sir Tony Baldry).
As I said earlier, the Government’s Bill has been published for pre-legislative scrutiny, which we expect to begin later in the autumn. We should view that process as an opportunity to explore how we can make legislation fit to support carers in the 21st century.
I am afraid I must disagree with the assertion by the hon. Member for Worsley and Eccles South that her Bill will be cost-neutral. Placing new duties on public and private sector bodies inevitably involves cost. New processes must be developed and operated, and will surely be a potential drain on the already tight social care, NHS and education budgets. That goes against the Government's commitment to reduce the overall regulatory burden. Inevitably, organisations confronted with a new legal duty must establish processes enabling them to demonstrate, when challenged, that they are observing it, and that means costly bureaucratic processes. As other Members have pointed out, it is much better to ensure that the money is being spent on the front line. We are committed to spending significant amounts on carers in the coming years, and we should be spending that money on supporting people, not on expanding bureaucracy.
Liz Kendall
The Minister seemed to be coming to the end of his speech, but I hope he is going to reply to my question about whether the quad has agreed to fund Andrew Dilnot’s recommendations, as has been reported over the summer.
Norman Lamb
I am not a member of the quad, and I have not read any notes or minutes of the meeting. Obviously, the hon. Lady will understand that the whole issue of funding social care and the Dilnot proposals is high on my agenda. I am happy to talk to her about it in due course, once I have got my head around where we are with that debate, but I am in no doubt that we need to reach a settlement and ensure that adequate resources are available for them. We also need to ensure that the system gets the incentives right so that people who are committing their own resources to the system feel that it is worth doing and that it keeps them in good health and well-being.
The Bill seeks the early identification of carers in order better to support them. Although we fully support that notion, we do not think that a formal bureaucratic process is either the right or best way of going about it. As has been said, many people with caring responsibilities do not see themselves as carers. Indeed, many people do not wish to be labelled as such, and we must respect how they want to be seen. People with caring responsibilities should be able to choose for themselves whether they want to be identified as a carer, and that should be an informed choice by the individual.
Barbara Keeley
I really must challenge that. A process or procedure does not have to be formal, and nothing in any of the good practice that I have talked about seeks to force on a carer a recognition of being a carer. The people I know who work on this in primary and secondary care in Salford are very sensitive to these points. We have to make things available: information, support and referrals. The connection has to be made. We cannot proceed on the basis of, “This is bureaucracy and carers would be better off without it.” Carers are very rarely better off not knowing where they can go for help and support.
Norman Lamb
I absolutely agree with what the hon. Lady is saying: the information, guidance and support have to be made available. That is the key point, and I do not think there is any disagreement between us on it.
However, imposing a duty on public and private bodies to identify carers could be seen by some as intrusive. This depends on how the body seeks to exercise the duty, but it will be exercised in a variety of ways and this could conceivably be intrusive for some who want to be private about their family circumstances. We know that some families in which a young person is providing care can be very wary of letting others know. It is very important that they are given all the information, guidance and support they might need, but they may be afraid that the child will be taken into care, or they may be concerned about the opinions and reactions of others, including schoolteachers; the hon. Lady herself talked about the stigma that, outrageously, sometimes attaches to young carers. Public and private sector bodies need to be aware of such sensitivities, as I believe she accepts. They need to tailor the way they act and support carers in order to be responsive to the individual needs of the child and their family. This Bill runs the risk of preventing such sensitivity and flexibility.
In many areas, work is already under way to help to identify and support carers, without there being a specific legal duty in place. For example, NHS Surrey is developing a health care pathway to trigger the identification of carers, enabling them, where appropriate, to be pointed towards information and local authority carer assessments. The key issue—this is the point we have just debated—is not about labelling people as carers; it is about raising awareness and understanding of what a caring role can entail among those working in education, health and social care. We need to equip them with the knowledge to direct people to relevant sources of information, advice and support.
GPs and those working in the NHS have a vital role to play. Last year, the Department of Health funded a range of initiatives by the Royal College of General Practitioners, Carers UK and the Carers Trust to increase awareness in primary health care of the needs of carers and how to access support. GP carers champions and voluntary carer ambassadors have been appointed and much good practice in the early recognition of carers has already been identified. We will build on that programme and are considering how it can be extended to the acute health sector and community nursing services.
Awareness is already being raised in many areas. I know that in my constituency of North Norfolk, a new service to support carers has recently been piloted at GP surgeries. The initiative was developed by the North Norfolk clinical commissioning group and is being delivered by the Norwich and District Carers Forum in 20 GP surgeries in the north of the county. Two part-time support workers are available every month at each surgery to give support to anyone in an unpaid caring role and they have been able to refer carers for a carers’ assessment to help to meet their emotional and practical needs. They have also referred carers to other agencies for support as appropriate. Those are the sort of things that the hon. Lady’s Bill seeks to encourage and I am sure that she will welcome them as they emerge around the country.
The service was designed by North Norfolk’s CCG patient partnership, which was formed to give patients at the practices in North Norfolk the chance to influence and help to design local health services. That is exactly what we should be doing—involving patients. Subject to evaluation of the pilot, it is hoped that the service will be rolled out to other GP surgeries across the county.
Let me deal with young carers, as many hon. Members have mentioned the situation that they face. Local authorities already have a duty under the Children Act 1989 to safeguard and promote the welfare of children in need in their area. The Government are funding the Children’s Society and the Carers Trust to work with local authorities and voluntary organisations to encourage children’s and adult services to work more closely together and to adopt a “whole family” approach to identifying and supporting young carers.
Young carers involved in a recent series of whole family regional conferences, facilitated by the Children’s Society, were determined that they want to be seen as just like other children and young people. At the same time, they were very clear that timely and effective support for young carers and their families can make a real difference to their lives in a range of different ways. Their views have informed the development of a template for a memorandum of understanding between directors of children’s services and adult social services published last month by the Association of Directors of Adult Social Services, the Association of Directors of Children’s Services and the Children’s Society.
Let me say a word about students, whose situation was specifically raised by the hon. Lady and others. For students at university who are also carers, colleges and universities often have systems in place to identify specific needs through student unions and personal tutors. They provide a range of services, including the flexible provision of further and higher education, which can be very important in ensuring that students are not held in a straitjacket, and enabling learning on a part-time or distance learning basis, with students able to choose the best mode of study for them.
The Department has also has funded the National Institute of Adult Continuing Education to undertake a project to improve the lives of young adult carers and young adult carers with learning disabilities and, in particular, to support them in pursuing education and employment opportunities.
Diana Johnson
To return to the point about universities, can the Minister tell us how many have mechanisms in place to assist students with caring responsibilities?
Norman Lamb
I am grateful for that intervention. I do not have a specific figure but I am sure that the position varies around the country, with some universities being exemplars of good practice and others not. We must do everything we can. This debate is about whether to impose a specific legal duty or to use other, softer means, but I think we are agreed on the ambition that we must ensure that students with caring responsibilities get access to help and support through the institution where they are learning. We are completely agreed on that.
NIACE has produced the “Really Useful Book of Learning and Earning for Young Adult Carers”—RUBLE—that they can use to plan their time and plan ahead both in respect of their caring responsibilities and in pursuing education and employment opportunities. It also provides information about budgeting and money management. Young adult carers often manage finances on behalf of the whole family, which can be an incredibly onerous responsibility.
The national institute has also produced a resource pack for further education colleges about ways in which they can support young adult carers to engage effectively in learning. That has positive outcomes for young adult carers because it enables colleges and other support services to work together to ensure that the individual carer’s needs are met and that they do not fall through the gap in services at important times, such as the move from school to college, because those transitions are often the most difficult. The national institute is building on that work with the Carers Trust and Barnardo’s, especially so that its excellent resources are disseminated more widely.
One young adult carer who has used RUBLE said:
“The RUBLE has helped me to feel positive about myself. Last year I was really depressed. The RUBLE has reminded me that caring for my mum is really important. It’s also helped me to realise I have lots of positive attributes. I feel good about myself, what I do and my future. The RUBLE has improved my relationship with my mum and helped me to ask for help. Now I know what I’m doing and have plans for the future.”
Those are powerful words.
Some colleges, of course, are already supportive of young adult carers. For example, Loughborough has a transition mentor who engages with young adult carers, their families and staff to provide support that is tailored to individuals’ needs. Such support includes flexible timetabling and allowing the carers to keep their mobile phones switched on during classes so that they can keep in touch with what is happening at home. Although legislating to place a requirement on further and higher education establishments is seductive in many ways, it might override such emerging welcome, impressive and flexible arrangements.
Heidi Alexander
Far from undermining what universities and colleges are doing, would not legislating underpin their excellent work?
Norman Lamb
The hon. Lady makes a clever intervention. We need to have that debate, because we agree about the ambition of achieving much better support for young people with caring responsibilities who are in education.
The proposals set out by the hon. Member for Worsley and Eccles South include ensuring that there are “sufficient” local care services, and she spoke about that specific point. I assure the House that the Government are committed to supporting that outcome. We want care users and carers to have a real choice of a range of high-quality services—whether state funded or paid for by individuals—and to have the information that they need to make an informed choice that is right for them. The “Caring for our future” White Paper is clear that enabling people to choose from various care and support providers that offer different ways of meeting people’s needs and goals will drive up the quality of care and support, including support for carers. Under the provisions of the draft Care and Support Bill, we propose to place a duty on local authorities to promote diversity and quality in local care and support services, to facilitate choice, and to meet the care and support needs of all local people and their carers.
Enabling carers to have a life outside caring, and helping those with caring responsibilities to fulfil their employment potential, are among the key priorities outlined in our cross-Government strategy “Recognised, valued and supported: next steps for the Carers Strategy”. In designing local care provision and drawing up joint strategic needs assessments, local authorities should recognise the importance of identifying carers’ needs, including their need to work. Local authorities’ assessments and reviews should take account of a carer’s wishes to remain in or return to work, as well as whether a carer’s involvement in employment is at risk because of their caring role. It is extraordinary that carers are rarely asked about their wishes with regard to employment. By simplifying the law, we will ensure that this existing requirement is given far greater emphasis.
The White Paper also set out a commitment to offer support to every local authority in England to fulfil this duty and, in particular, to develop or improve its market position statements. Effective market position statements make public key market intelligence, including the data from the joint strategic needs assessment and data from local consumer surveys and specific groups. They will send a clear signal to the market about the current and future level and nature of local demand for care and support services. The hon. Member for Worsley and Eccles South specifically highlighted the importance of how we develop the local market. For the first time, organisations large and small, be they private companies or charities, will have a clear picture of the demand for care and support and be able to innovate and invest in their services and staff accordingly.
Barbara Keeley
It is obvious that the Minister’s officials have given him a lot of material. I do not know whether he intends speaking until 2.30 pm, but at least four other Members are anxious to speak. I am aware of the commitment that Members have made to be here today and I just wanted to make him aware of that.
Norman Lamb
I do not intend to speak until 2.30, and I am moving towards the end of what I have to say. I absolutely take the hon. Lady’s point.
Effective market position statements will also set out a local authority's future commissioning intentions, their brokerage plans and the types of services that it wants to see develop to meet the needs of local people and their carers, regardless of how they pay for their care. We expect to see a more flexible market develop; one that will enable carers and care users to pursue their own goals more easily, including education and employment opportunities.
The Bill also seeks to place a requirement on local authorities to conduct an assessment of what sufficient social care means in their area, and what steps they could reasonably take to address the gaps in service provision. The Health and Social Care Act 2012 already requires local accountability to produce and deliver on strategic health and care needs assessments through the new health and wellbeing boards. From April 2013, health and wellbeing boards will take over responsibility for undertaking joint strategic needs assessments and must develop joint health and wellbeing strategies to meet the priorities identified. These will inform local commissioning plans. This is already happening.
A Surrey-wide survey was undertaken in 2011 to seek carers’ views on their experiences of health care services and to ask them about their own health and well-being. This information has informed the development of the Surrey joint strategic needs assessment. The Act requires that these assessments cover all current and future health and social care needs for the local population, and as such we expect them to cover the needs of carers as well as the needs of care users. This will ensure that health, social care and other services are fully integrated locally. I suspect that the hon. Lady completely agrees with this. A separate assessment of social care, as proposed by the Bill, would militate against the integration of health and social care as well as duplicating the existing legal requirement to assess social care needs.
In July, we published draft statutory guidance on joint strategic needs assessments and joint health and wellbeing strategies for consultation. I will certainly commit to enhancing the message, already contained in the document, about including the needs of carers. I make that point specifically as a result of the hon. Lady raising these issues in the Bill today. The Department of Health will also work with sector leaders to develop a suite of wider resources to support health and wellbeing boards in undertaking these joint assessments and strategies.
I pay tribute to the hon. Lady’s long-standing commitment to improving the recognition and support of carers, which is widely recognised across the House. It is clear that we share the same objectives, but we differ in some respects in the way that they can best be achieved. Therefore, the Government cannot support the Bill, but I repeat my commitment to work with her and her colleagues and the caring organisations to ensure that we get the framework in a single Act as right as possible. I would be happy to have that further discussion with her and her co-sponsors of the Bill before the end of the consultation period on the draft Care and Support Bill, and we can maintain the dialogue as we head into pre-legislative scrutiny. We can then consider how we can progress our shared ambitions through Government legislation and other non-regulatory means.
As I have mentioned, hon. Members have a number of opportunities to engage in the work that is already under way: the draft Care and Support Bill, which is the draft legislation on reform of provision for children and young people with special educational needs; the guidance on the joint strategic needs assessments; and the programme of work relating to market position statements. That will ensure that the issues that this private Member’s Bill seeks to address will receive appropriate and proper focus.