Carers

Thursday 20th June 2013 Commons Chamber

23:20

[Paul Burstow (Sutton and Cheam) (LD)]

I beg to move,

That this House has considered the matter of carers.

I start by thanking the Backbench Business Committee for choosing this as the first debate of this parliamentary Session since the re-establishment of that Committee. I very much appreciate the fact that within the space of a few days after the celebration of national carers week, the Backbench Business Committee was able to grant us this time to examine how better to support carers in this country and to recognise the extraordinary contribution that each and every carer makes to their families and our society. I am grateful to my hon. Friend the Member for Banbury (Sir Tony Baldry) and the hon. Member for Worsley and Eccles South (Barbara Keeley) for their support for this application and for the contributions that I look forward to hearing from them later in the debate.

As I said, last week was national carers week. With over 10,000 events up and down the country—I am sure that many hon. Members will have had the opportunity to participate in them in their constituency—this was the biggest carers week so far. Here in Westminster, MPs were invited to a variety of events, including a speed dating event with carers with a wide range of life experiences. I had the opportunity to meet, among others, a woman called Karen whose husband has Parkinson’s. She told me about her experience of being a carer for someone with that particular condition and about the isolation she felt, having taken on that caring role. She conveyed a sense of being increasingly excluded from participating in many aspects of society. I met other carers involved with Marie Curie, who told me how, because of the nature of the diagnosis and the rapid progression of the cancers in question, they experienced additional strains and burdens in trying to get the right support at the right time for their loved ones. The week concluded with a lively carers question time event, in which the Minister and a range of experts participated.

This year’s theme was “Prepared to Care?” It highlighted the fact that people who take on caring roles are often not prepared for the physical and emotional impact of caring, nor for its impact on their lives in other ways, not least financially. In that sense, it is worth stressing that this is not a “them and us” issue. It is easy to think about this as something that is going to happen to other people, whereas the figures clearly show that three out of five of us will be a carer at some point in our lives. It will touch all of us, either through personal experience or through our family’s experiences.

I want to pay particular tribute to the carers I have met over the years in my constituency during my time as a Member of Parliament. I want to thank the Sutton Carers Centre for being a lifeline for thousands of carers—young and old alike. The carers centre in Sutton has been my guide and teacher on carer issues over the past 15 years. Whether through shadowing carers to learn directly from them or meeting carers at the centre, I have found that the things they want—the things they tell me they want—are not impossible or unreasonable. They do not want to feel that everything is a constant battle—a battle to get a diagnosis, a battle to get an assessment, a battle to get support, a battle to get a break, or, indeed, a battle to navigate around the system.

Over the years, I have met and listened to many carers in my constituency and I have met carers for whom the lifeline that keeps them sane and keeps them connected is not the formal social care support, nor even the carer centre. It may be, for instance, the local bowling club, as I learned from one of the carers whom I shadowed. The determination of the club’s members to support a friend was the most important thing in that person’s life. Not enough is made of such informal, often fragile networks of support, although they often represent the vital difference between just surviving and having a life.

There is clear evidence that the caring role takes its toll on people, physically, emotionally and financially. Six out of 10 carers report experiencing depression because of their caring role, and, as I have said, caring can be a lonely business: three out of five carers say that they have experienced difficulties in maintaining relationships with friends. Another problem is the desire of many carers to stay in the workplace so that they can remain connected through their work. More than 3 million are trying to balance their caring responsibilities with paid work, often at the expense of working hours or their career prospects.

Last June I hosted a carers summit with the forum Employers for Carers, led by BT. The aim was to explore opportunities to help carers to remain in the workplace. BT and other members of the forum, such as British Gas, have a good track record in that regard. They invest in their staff and want to retain them, so identifying and supporting carers seems logical to them. The cost to the bottom line of a business of replacing a member of staff can be huge, and one of the purposes of the summit was to enable more employers to see the business case for carer-friendly employment practices. The Government subsequently established a “task and finish” group to consider ways of creating an environment in which people could balance their caring responsibilities with their careers. That work is vital.

According to a recent survey conducted by YouGov for Carers UK, an estimated 2.3 million people have given up work at some point to care for an older or disabled loved one. One in four gave up work or reduced their working hours because the cost of replacement care was too high, and a similar number reported that services were not flexible enough to meet their needs. The impact of being forced to give up work to care for a loved one on an individual’s finances alone is clear, but the London School of Economics has estimated that the hidden cost to the economy—in benefits and lost tax revenues—is a staggering £1.3 billion a year, every year. When lost earnings are taken into account, the figure can rise to as much as £5.3 billion. That is not a cost that the United Kingdom can continue to bear as a consequence of a failure to act and provide the safeguards, supports and systems that would enable carers to remain in employment.

There is an urgent need to us to reframe the debate. We must stop focusing on the burden on the economy, and see caring as an asset and an opportunity. We must begin to view it in the way we view child care support and services. Carers must be entitled to more flexibility at work, although the Government have done much in that regard. Given the scale of demographic change—the over-85s are now the fastest-growing section of the population, and their number is set to double by 2030—and the growing proportion of “sandwich workers” who are attempting to juggle paid work with the demands of caring for both children and older relatives, the provision of flexibility is becoming an imperative. The Government must also think about how the market for low-level support services such as cleaning, shopping, gardening and befriending can be increased and, crucially, brought into the formal labour market.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate the right hon. Gentleman on securing the debate, which is timely given some of the things that have been happening in old people’s homes. Does he agree that there is a case for asking employers to help people who have to care for a family member? Such people are often under stress, and if they have to give up their jobs, their standard of living will fall as well.

[Paul Burstow]

That is a key point, and one that I want to put to the Government very strongly. Carers can only be helped to remain in the work force and balance their working lives with their caring responsibilities if the right substitute care and flexibility are available, and if employers have the right attitudes in the first place.

[Kate Green (Stretford and Urmston) (Lab)]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will take one more intervention, but I must not take too many more, because I have only 15 minutes in which to speak.

[Kate Green]

Could not public sector employers be exemplars in this respect? Can the right hon. Gentleman suggest any ways in which such good practice could be spread throughout the public sector?

[Paul Burstow]

The hon. Lady is absolutely right to say public sector employers should be—and could be, and must be—exemplars in this. Indeed, it would be great if the NHS itself was an exemplar in this area, yet as I will come on to say, I think in too many ways institutionally the NHS is rather biased against carers, and certainly blind to their needs in too many cases.

There is an economic reason why we need to do more in this area. It is estimated that as many as 50% of those involved in personal and household services operate in the grey economy. This represents a further missed opportunity in terms of job creation and lost revenue to the Exchequer. Looking across the channel to France where work began almost a decade ago to address a number of these issues, market development for homecare services has led to the creation of an additional 2 million jobs, with the industry becoming one of the biggest growth sectors in that economy.

There are clearly lessons to be learnt in how to support and strengthen carers’ ability to care in a way that supports the wider UK economy. I hope the Minister will be able to tell us when the “task and finish group” recommendations will be published.

Moving on, one of the most practical ways to support carers is to provide them with breaks from caring. That can help reduce the stress and the often constant demands that caring involves, and allow them to have the time to improve their own physical and mental health.

In recognition of the value of carers breaks, the Government committed in the 2010 spending review to spend £400 million over four years on breaks for carers living in England. As the Minister at the time, I was convinced of the importance of giving carers a break and knew that it would make a huge difference to their lives. I therefore regret that the evidence suggests that that has not happened. Monitoring by the Carers Trust for the year 2011-12 found that action on the ground had often been slow or non-existent. Despite clear reporting requirements, in many areas it was impossible to track how money had been spent, and in a small minority of cases nothing at all had been spent on services for carers. Some fantastic work has been done, but progress has remained appallingly slow. To be fair, this problem has dogged not just the coalition Government, but successive Governments.

I ask this question: what is the common factor? The common factor is the institution we are using to direct the money, which is the NHS. It does not see carers as significantly important contributors to it, and therefore it does not see this money as worth spending on them. That has to change.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I acknowledge the right hon. Gentleman’s efforts when in government, and I agree that this issue has dogged successive Governments. I wonder whether we have reached the stage where we have to give some clear statutory rights to carers in respect of respite care, because whatever organisation has the budget, it does not seem able to recognise that this is an essential need if a person is going to continue to be a carer. Would the right hon. Gentleman entertain that approach?

[Paul Burstow]

To be honest, in this area the NHS is probably drinking in the last-chance saloon. If we do not see progress, legislation may be necessary. There is another way in which the money could, and should in future, be earmarked for this purpose. There have been transfers from the NHS to local authorities for the support of social care more generally, and in some local authority areas that has happened with the carers break money as well; it has been transferred. It has not happened everywhere, however, and I think it should now become mandatory, so this money gets spent for the purpose the Government said in their spending review it was for. That is a perfectly reasonable thing to expect, and the Government need to reflect on three years of this money not getting where it needed to be, after a number of years of that under the last Government as well.

A survey by Carers UK found that in one in five cases where a person who was receiving care from family or friends was admitted to hospital as an emergency, that could have been prevented if the carer had received more respite care and support. This makes big differences financially to the NHS. It uses resources better, and that is why it beggars belief that the NHS has not yet made sufficient progress, with its partners in local government, to improve access to breaks for carers.

Under the health service reforms, with clinical commissioning groups taking the lead, there have been some examples of improvement, such as in Huntingdon, where there is an interesting carers breaks project led by GPs. Partnered with Crossroads Care, they identify carers by meeting them socially, and prescribe breaks. Carers who are met in that way tell me they have for the first time had the experience of having raised their needs as carers and seen that translated into tangible action that made a difference for them. We need to see more of that. It is a vital lifeline.

As has already been said, there are huge issues to do with identification of carers. Research by Macmillan has found that while over 70% of carers came into contact with GPs, doctors and nursing staff, only 11% of all carers reported that they had been identified as a carer by a health professional. We as a Government talk about making every contact count, and we should do so when it comes to identifying carers. I hope the Minister can look afresh at what we can do to challenge NHS England to fulfil its obligations. I hope the National Audit Office will take a look at how successive Governments have attempted to engage the NHS with the carers agenda.

I want to finish by talking briefly about the Care Bill. It is no small thing that this is the first ever Government Bill to provide for carers’ rights. Until now, the cause of carers has been advanced by private Members’ Bills. Let me place on the record my appreciation for the work of the late Malcolm Wicks, whose Carers (Recognition and Services) Act 1995 was a landmark in the rights of carers and a fitting legacy for such a thoughtful and generous Member of this House. For the first time, the Care Bill enshrines in legislation carers’ rights to an assessment of their needs and, importantly, establishes a duty to meet those needs which are eligible. It also establishes clearly the need to consult and involve carers in decisions about the care of those they care for.

Although the Care Bill is hugely welcome, inevitably there are gaps and unintended consequences that must be addressed if all carers are to get the support they are entitled to. Following the Government’s welcome announcement last week of their intention to amend the Children and Families Bill to ensure that the rights of young carers are as strong as those proposed for adult carers, we must see the necessary changes to it and the Care Bill, and ensure that the rights of parent carers of disabled children, which have so far been neglected in both Bills, are not allowed to fall through the cracks.

I look forward to colleagues’ contributions and hearing them draw on their experience of engaging with carers in their constituencies. I know from talking and listening to carers, and from tweeting about carers’ issues, the genuine and palpable outrage they feel because all too often they are overlooked and under-supported. We need to change that. The Government are making good progress, but more still needs to be done.

11:36

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The number of carers is growing, as is the impact of caring on the lives and health of carers. The right hon. Member for Sutton and Cheam (Paul Burstow) has touched on some of those issues, but I will go further.

Analysis by Carers UK of data published from the 2011 census has shown that the number of carers has increased substantially, by 11%, since 2001, and there are 35% more carers over the age of 65. We know that carers often combine paid work with raising their own children, as well as caring for other family members. In fact, one in four women and one in six men aged 50 to 64 have caring responsibilities for family members who are older or disabled. If we think about that for a moment, we start to realise the difficulties. Of course, many of us know people in that situation, or may be in it ourselves. Some 3 million carers juggle caring with paid work, so it is not surprising to learn that full-time carers are more than twice as likely to be in poor health as people without caring responsibilities.

Given all these stresses, carers should be getting advice and information to help them care, but it is becoming ever clearer that they are not. During the recent carers week, to which the right hon. Gentleman referred, Members met carers to find out about their issues. Last week I went to a speed networking event, as I think it is called, here in the House, at which I met six carers. Two were carers of family members with cancer, two had cared for a partner or family member at the end of their life, and two were carers of spouses with Parkinson’s. Despite the differences in their caring, the one thing they shared was not having been given the information, advice and support they needed to be carers. As the right hon. Gentleman touched on to an extent, Macmillan Cancer Support tells us that carers of people with cancer come into contact most with health professionals, by whom they need to be identified and signposted. However, 95% of cancer carers are not getting a carers assessment.

It was revealing to talk to carers of people with cancer about how this had affected them. Cancer patients, as we know, may have long days of treatment in hospital, yet no one had told the carers I spoke to that a discount was available on expensive hospital car parking costs. One of the carers had to buy a hospital bed for use at home by her daughter, yet she was given no advice on where to buy one.

Similar issues crop up for carers of people with a terminal illness, but those carers are also juggling with the knowledge that they only have a limited time with the person for whom they are caring. Carol and Lucy were the two carers I met. One had cared for a partner and the other for her mother, both through to the end of their lives. Both said how much financial hardship they had had to accept to undertake that caring. The carer of her terminally ill mother could only get unpaid leave from her job and took it for 11 months. She lost her flat because she could no longer afford to pay the rent. It seems wrong that carers have to struggle on unpaid leave while caring for someone who is terminally ill. She never told her mother that the leave was unpaid or of the difficulties she was having.

Carers of people with cancer and of people who are terminally ill both cited the same issue: as carers, they were mainly ignored by the health professionals they encountered. They rarely asked them if they were coping and they did not signpost them to carers centres or carers associations for help and advice. In the cases of the very few carers of people with cancer who managed to have a carer’s assessment, that had most often been prompted by a referral from a GP. As the right hon. Member for Sutton and Cheam says, 70% of cancer carers surveyed had come into contact with a GP, doctor or nursing staff, but they are in the health world—the NHS world—not the local authority world. Very few of them have contact with local authority staff.

I think I met the same people at the event as the right hon. Gentleman, because I met John and Karen, who were each caring for a spouse with Parkinson’s. We have already heard some of the points that those carers made, but John said:

“In more than 30 years caring for my wife, my own GP has never asked how I am. He provides excellent support for my wife, but has never asked me how I am coping as her carer”.

Karen cares for her husband, who has Parkinson’s and was diagnosed only shortly after they were married. She says:

“I gave up work to help support him. I’ve never been told about a carer’s assessment nor has my GP asked how I am. It’s as if you are invisible.”

Parkinson’s is a long-term condition, but despite the fact that they might be caring for many years, only one in 10 Parkinson’s carers have been offered a carers’ assessment. Parkinson’s UK tells us that most are full-time carers, caring for someone for more than 50 hours a week—even up to 24 hours a day as the Parkinson’s progresses. Such carers are those most in need of advice, support and respite care or breaks.

That all matters because the Care Bill puts great emphasis on carers’ assessments rather than the identification of carers and the need to signpost them to sources of advice and support. Last September, I introduced a private Member’s Bill, the Social Care (Local Sufficiency) and Identification of Carers Bill. Three sponsors of that Bill are in the Chamber. The Government, sadly, did not support my Bill and their Back-Bench Members talked it out. The clauses on the identification of carers would have ensured that NHS bodies had the procedures in place to identify carers, promote their health and well-being and ensure they receive information and advice. Those are the exact areas from which the carers to whom I have talked would benefit. As I said during the debate on the Bill, I believe that the key focus in identifying carers should be those with the heaviest caring commitments.

The 2001 census found that 10% of all UK carers were caring for more than 50 hours a week. By 2011, that figure had more than doubled to 22%. It is worth noting, as I said during the debate on my Bill, that the proportion of carers in Salford who provide full-time care at that level has been higher for all of the last decade. It has not just changed, and I am sure that it is related to health inequalities.

Two wards in my constituency have high numbers of people caring for people with stroke disease, heart disease or cancer, which means that they have the heaviest caring commitments. We know that full-time care can take a toll on the carer’s health, and the health needs of those carers must be recognised. We know that those caring for more than 50 hours a week are twice as likely to suffer ill health and that those caring for a person with dementia or stroke diseases are even more at risk. Early identification and support for those carers would mean that they can maintain their health and sustain their caring role better.

The Carers Trust has a centre in Salford with a project to identify carers within primary care and at the Salford Royal hospital. Let me take this opportunity to pay tribute to that centre for its work in identifying carers, which it has been doing within primary care for many years. GPs and primary health care teams in my constituency have started to tackle the task of identifying carers, but there is much more to do. The manager of the centre tells me that having established a network of links within GP practices to identify carers, local GPs made 300 referrals last year, but we have 20,000 carers in Salford, 5,000 of whom will be caring at the heaviest levels. So we need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them to advice and support.

Young carers are the most hidden of all carers, and my Bill would have required local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. It would also have placed a duty on colleges of further and higher education to identify students who are carers and have in place policies to support them. Young adult carers at university or college have to balance giving care with their academic studies and learning. Some do that by caring at a distance, returning home at weekends or holidays to provide care, whereas others have to balance care and study by continuing to live at home and travelling to their local university so that they can maintain their regular caring roles. Hardly any of the carers I have talked about in my speech are in contact with local authorities or are likely to have had a carers assessment from a local authority. So the duty on carers assessments in the Care Bill would not help the carers I have met recently—the carers of people with cancer or of people who are terminally ill. And, as I have said, the local authorities are reaching only one in 10 of carers of people with Parkinson’s disease.

Young carers are also not being reached or supported adequately. The Carers Trust feels that the current law surrounding identification, assessment and support for young carers is complex and incoherent. Young carers are vulnerable and compared with other children they are at risk of poorer outcomes if they take on excessive and inappropriate caring roles because the adult’s needs are not being met. We know that inappropriate caring roles have an adverse effect on a child’s educational and emotional development.

The current position we have reached on that issue is most unsatisfactory. In its evidence to the Joint Committee on the draft Care and Support Bill, the Law Commission made it clear that it felt that young carers should be given the same rights as adult carers, so that the Bill became a single statute covering carers. Yet, young carers still do not have the same rights as adult carers in the Care Bill and there is no mention of them at all in the Children and Families Bill. That is not acceptable. The care services Minister and the children’s Minister have been making reassuring noises about meetings they have had to discuss this and about their intentions, but they have so far ignored a cross-party consensus among MPs and peers that they should act to improve young carers’ lives. Young carers should not be left with unequal rights compared with adult carers.

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Lady said that we have so far ignored what she has been arguing for in terms of action. I just wanted to reassure her that I have absolutely not ignored that. I have said, I believe in the debate on the Queen’s Speech, that I would seek to meet the Minister dealing with the Children and Families Bill, and I have done that. I take the point the hon. Lady makes very seriously and I want to see action to address the concerns that she and others have raised.

[Barbara Keeley]

I thank the Minister for that point, but I have to tell him that he and the children’s Minister have to start to accept that making reassuring noises and having meetings is not enough.

[Paul Burstow]

The hon. Lady is absolutely right to be pushing this issue forcefully. We were given a commitment by the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson) last week that amendments would be drafted, and presumably they will be tabled in the House of Lords. It would helpful for us to know, and to hear from this Minister, that the Government will shortly be publishing the amendments that will be made to the Care Bill as well as those that will be made to the Children and Families Bill.

[Barbara Keeley]

I thank the right hon. Gentleman for that point. I am, however, going to push the matter with the Minister because there was an opportunity in this regard. New clauses were moved during the remaining stages on the Children and Families Bill last week that were copies of clauses from my Bill, and they would have required those bodies that I talked about to have policies in place. We are not talking about a large financial commitment; we are talking about bodies having policies in place. Our schools, our colleges and our higher and further education institutions should have policies in place to recognise young carers, but up and down the country they do not have those. The disappointment that organisations outside here that support young carers will have felt results from the fact that the debate was managed last week so that those new clauses were not reached. That does not show good faith, and if I were a member of the coalition of organisations that support young carers, I would look at that and say, “I don’t know what the Government are going to do.” The Minister will have to accept that they are still disappointing people who have not been protected sufficiently by the law.

I conclude by touching quickly on the financial context of social care and how it affects carers. Giving carers rights in the Care Bill is indeed a positive step, but the Local Government Association reminds us that the Government’s austerity programme and the need for further savings do not fit well with the aspirations of the Bill. Councils have had to reduce their adult social care budgets by 20% over the past three years. At least a quarter of those cuts are from reductions in services and increases in charges. Almost 90% of councils only meet needs that are at the substantial or critical threshold.

Staff at our local carers centre told me that carers are being affected by the bedroom tax, the increase in the value of non-dependent deductions, fewer sources of grant funding, and reductions to care packages that appear to be driven by cutting costs, not by changes in need. That is particularly true where they are caring for somebody with a learning or physical disability. Worries continue into the future when the change from disability living allowance to the personal independence payment starts to affect carers. The Government’s own impact assessment published in February indicated that almost 10,000 fewer carers will be entitled to carers allowance by 2015 as a knock-on consequence of the loss of disability benefits following the introduction of PIP. Carers UK has calculated that this represents a £31 million cut in support to carers. We should bear in mind that if those carers were left unable to care as a result of not having access to those carers benefits, replacing the care that they provide would cost at least £300 million in replacement adult social care services. That is a serious point.

This morning I asked a question about the loss of £28.3 billion of income for disabled people over the next five years through the combination of the welfare changes being made. We must take on board the fact that that loss of income will hit the carers of those disabled people. Carers, as we learned during carers week, are prepared to care. We must do better in supporting them.

11:51

[Sir Tony Baldry (Banbury) (Con)]

It is good that the House has an opportunity today to debate the needs of carers. As co-chair of the all-party carers group, I welcome this debate. It provides us with an opportunity to be the collective voice for the 6.5 million carers in the UK.

In the run-up to carers week, Carers UK published a report entitled “Prepared to Care?” which had six important recommendations from carers about what they need to help them manage their caring role. They need better public understanding and recognition of carers. Carers should have access to information and the right support from the beginning. It is important to remember that every day 6,000 people take on new caring responsibilities in the UK, and from day one they need access to the right support, advice and information. Every day across the country there are people whose loved ones have a stroke or discover that they have been diagnosed with Parkinson’s or with age-related dementia, and they need support from day one.

Professionals need to understand the role of carers and share information, decision making and planning with them. The hon. Member for Worsley and Eccles South (Barbara Keeley) made the point about the GP who treated a patient for years but never asked about the carer. Carers can no longer be treated as invisible. They need access to high-quality practical and emotional support and information, as well as breaks from caring. The point made by the hon. Member for Birmingham, Selly Oak (Steve McCabe) about respite care is crucial. When Carers Oxfordshire surveyed carers in Oxfordshire last week about the issue that caused them greatest concern, not surprisingly access to respite care came very near the top of the list. Carers need flexible working practices, understanding from employers, financial support, and a fair and easy-to-navigate welfare system.

A growing recognition of the number of carers in the country is evidenced by the fact that each year carers week gathers further and greater momentum. Carers week took place between 10 and 16 June. Alongside Carers UK seven other national charity partners—Age UK, Carers Trust, Independent Age, Macmillan Cancer Support, Marie Curie Cancer Care, the MS Society and Parkinson’s UK—came together to celebrate the contribution that carers make and to signpost them to the advice, information and support that they need.

This year’s carers week was the largest ever, with more than 2,600 groups registering to take part and more than 10,000 events up and down the country—that is a lot of events. Those organising events included carers’ groups, service providers, local authorities, hospitals, domiciliary care services, hospices and GP services. Events in Oxfordshire included Carers Oxfordshire—the umbrella group for carers in the county—running outreach events and advice stalls at local Sainsbury’s, Asda and Waitrose stores. Last Friday, I visited an Oxfordshire branch of Sainsbury’s and lots of people came up and asked questions, which was fantastic, because people do not always recognise that they are carers. Outreach events to identify carers also took place in GP surgeries and town and church halls across the county.

In Parliament, there was a “Question Time” event in Portcullis House with the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), who is responsible for care and support. The event brought together the Association of Directors of Adult Social Care, Skills for Care, the Royal College of General Practitioners and Public Health England, alongside the campaign’s charity partners and carers, to debate how the NHS and social care can better support carers. Key issues discussed included the challenge of identifying and supporting carers when many people do not recognise themselves as carers, and how to ensure that carers are represented in the new NHS structures nationally and locally. Like all those taking part in today’s debate, I am sure, I was pleased when more than 100 parliamentary colleagues attended a parliamentary photocall in support of carers week. As the previous speaker mentioned, there was a useful speed networking event that enabled MPs to meet carers and hear their stories directly.

Interestingly and usefully, this year’s carers week saw increased engagement and involvement of employers in the campaign, which is important because, as Carers UK polling earlier this year showed, 2.3 million people have given up work at some point to care for loved ones, and census data published in May show that more than 3 million people are juggling work and care. That is a huge number of people, so getting employers involved in understanding the needs of carers is very important. I am glad to say that Sainsbury’s has continued its sponsorship of the employers for carers campaign, with nearly all its 1,200 stores running events, linking up with local groups and organisations to raise awareness of the support on offer to carers. Crucially, Sainsbury’s delivered information and advice not only to its customers but to staff with caring responsibilities.

I am also glad to say that Government Departments, such as the Foreign and Commonwealth Office and the Department for Environment, Food and Rural Affairs, held carers week sessions for their staff, as did a number of private organisations, as the hon. Member for Stretford and Urmston (Kate Green) mentioned. Those included the Michelin Tyre Company, KPMG, HSBC, British Gas, Northamptonshire police, the UK Border Agency, BT plc, Credit Suisse, Transport for London, the Financial Ombudsman Service and the London fire brigade. There is growing recognition from employers in the private and public sectors that they have a duty of care to those of their employees who are carers. In Oxfordshire, Employers for Carers, in partnership with Oxfordshire county council and Carers UK, launched a new membership hub for local employers large and small, which will give local employers the opportunity to share good practice in supporting carers to juggle work and caring and to raise awareness of the business benefits of keeping carers in the work force.

[Kate Green]

It is encouraging to hear that list of the many employers who want to support the carers in their work force, and I am interested in what the hon. Gentleman says about spreading good practice among employers. Does he agree that the large employers have a particular role to play in working with their supply chains to spread good practice?

[Sir Tony Baldry]

That is an extremely good point. These things are organic. A few years ago big employers such as Sainsbury’s would not necessarily have been involved in that way. Having been involved in carers policy over the years, what I find encouraging is that each year a further step is achieved.

[Barbara Keeley]

I had not intended to make this point earlier, but I will make it now because so much has been said about employers. The Independent Parliamentary Standards Authority does not allow MPs’ staff to take compassionate leave; it allows MPs to give only sick leave or maternity leave, as I discovered late last year. Given all the good work that has been done with employers, that is an issue the whole House should take forward.

[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

[Norman Lamb]

Does my hon. Friend agree that it is not simply about employers having a duty to look after employees who have caring responsibilities; it is also about enlightened self-interest? It is an enormous own goal when so many employers lose really good and experienced employees, who could otherwise contribute so much to a business, because they have caring responsibilities. It is in their interests to keep those employees.

[Sir Tony Baldry]

I entirely agree and hope that all employers see the enlightened self-interest in looking after carers. I think that there is a general recognition that everyone in the system has to start thinking about carers, particularly those who are caught in the sandwich generation and have to look after children and older relatives.

The two colleagues who have spoken in the debate have already set out the broad context of the research done in carers week: about three quarters of carers felt unprepared for their caring role; four in 10 had reduced their working hours because of caring; nearly a third had missed out on the chance of promotion; almost half had used savings to pay basic bills, such as those for heating and food; and more than a quarter had taken out a loan or fallen into debt as a result of caring.

I am conscious that many colleagues wish to speak. I will use the time remaining to highlight some specific concerns raised by Carers Oxfordshire. In anticipation of today’s debate, I asked Carers Oxfordshire about the concerns of local people. Unsurprisingly, there was a huge response from carers. I think that there is a feeling among many carers that one of the most important things is having their voice heard. The sorts of points raised were as follows:

“Carers would like to hear greater clarification about the implementation of the Care and Support Bill along the following lines: ‘Carers are very pleased to see the rights of all carers to have an assessment so clearly defined in law. The concern is that the regulations are written in the spirit of the legislation i.e. of widening the access to help and support for carers. The national eligibility framework needs to reflect this and ensure that the threshold of eligible needs is not set too high. The risk is that local authorities will use the framework to restrict “eligible needs” on the basis of limited resources, which could mean many carers will not be any better off in terms of the help and support they receive. We must ensure there is not a postcode lottery in the way the framework is operated by local authorities.’”

On respite for carers, respondents commented that it is

“too expensive and too hard to get currently as care homes often don’t ‘allow’ bookings to be made well enough in advance to allow carers to book holidays. There is very little financial help for ‘stay at home’ carers. What about care vouchers similar to child care vouchers being issued, or tax relief on care costs?”

With regard to GPs, the identification of carers is a really important issue. There

“needs to be more emphasis from GPs and a greater recognition of carers’ contribution and value, including their health and wellbeing.”

Another point was this:

“Poor quality of care provided by care agencies is a huge concern. Quality, reliability and accountability are ongoing concerns for carers.”

On carers in employment, concerns were expressed about the financial cost of care and the impact on those who have to give up work or reduce their working hours.

The respondents make an interesting point:

“Military carers and their family can suffer a significant disadvantage, to include homelessness due to ‘entitlement’ issues around properties when they take on caring responsibilities. Lack of recognition from the military.”

They continue:

“Carers want to see social care and nursing care fully combined as one discipline. As far as they are concerned they are one and the same thing. During one carer’s experience in the weeks prior to her mother’s hospital admission she had had three different teams visiting her throughout the day. They spent more time completing forms and leaving files than anything else. It was tiring and draining for her to have so many different people coming and going. Full integration of the two disciplines is key for continuity, to prevent duplication of effort and reduce needless bureaucracy.”

Finally, they state:

“Look at simplification of forms for applying for carers allowance and attendance allowance.”

It is really good news that the Care Bill will consolidate and simplify decades of social care legislation in England. We must not lose sight of the fact that it will include significant and welcome new rights for carers to improve access to carers assessments and new duties on local councils to provide care services. I share the concerns of the hon. Member for Worsley and Eccles South (Barbara Keeley) about young carers, but I am confident that those on the Treasury Bench have taken on those concerns and will table amendments to the Bill in the Lords to cover them.

We are making good progress. The direction of travel is a good one, but we have to recognise that a huge amount of distance still has to be covered if we are to be proper advocates and protectors of the millions of carers in the UK who selflessly give themselves to look after a loved one.

12:06

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

Thank you, Mr Deputy Speaker, for calling me to speak in this important debate. I congratulate the right hon. and hon. Members listed on the Order Paper on securing it.

I want to make a relatively short contribution to place on the record my view that the work that carers do for little or often no reward should never be underestimated or forgotten. They provide care and compassion of the highest level in the most challenging of circumstances.

I believe we need a far bigger and bolder response to meet the challenges of our increasingly ageing population. We need to recognise that in many circumstances a complicated mix of care is delivered by a combination of professional carers, family members or both. Carers need more support and that can only come from the Government. I want to address two issues in order to make that point.

First, we should acknowledge the importance of creating a care industry that people aspire to work in by appropriately rewarding the work they do. Secondly, the Government need to recognise further the work of thousands of unpaid carers up and down the country.

The demographic make-up of our population is obviously changing, which is already starting to stress our care system. That is happening against the backdrop of large-scale cuts across the system. According to the Local Government Association, local authorities have had to cut their adult social care budgets by 20% over the past three years, which means that in many places, such as Tameside, the metropolitan borough that my constituency covers, the amount of respite care available is being severely squeezed. I have seen some appalling cases in my surgeries—the kinds of cases that stay on my mind and often prevent me from sleeping at night because of the situation that many people face when the care they need is being taken away.

Against the backdrop of cuts, many carers work day in, day out, delivering excellent care but for poor pay, whether they work in a residential home or in a person’s home. Many of them are paid little more than the minimum wage for a job that should not just be a job, but a rewarding career for life. If we as a society want to demand the highest standards of care for ourselves when we get old, we should at the very least be prepared to pay a living wage for those who seek to deliver it.

That should happen alongside a concerted effort to improve skills across the care industry, investing in training and development to make the sector one in which people aspire to work. It could be a huge source of employment for the future—it is not possible to outsource care in the same way as we outsource other industries to another country—but I do not think that we even have a strategy to get us to that point.

Secondly, I want to discuss the impact on non-professional carers of the current pressures in the care system. In Tameside, approximately 2 million hours of unpaid care are given every year. If purchased from a paid carer, that would cost in the region of £22.5 million. That puts a high strain on carers, as has been mentioned. In Tameside, people are substantially more likely to be in ill health if they are carers, and that is in an area that already has poor public health. We should all take the time to recognise the stressful and important work that carers do.

Several of my constituents who are dedicated carers for the people they love have told me that they receive no recognition for the valuable work they do. That is why debates such as this are important. Many of them have had to give up their jobs, and in several cases the person for whom they are caring feels responsible for that, even though it is no fault of theirs.

The burden on many of those who care for loved ones has increased since the Government introduced their welfare reforms in April. In Tameside, increasing numbers of carers are reporting stress due to financial worries. The Government’s impact assessment into the changes to disability living allowance and carer’s allowance and the introduction of the personal independence payment shows that almost 10,000 fewer carers will be entitled to carer’s allowance. That is a massive blow for those who care full time. Locally, the number of people who are seeking support to complete their benefit forms is increasing. How can it be right that we are penalising these people for the work that they do? Where are the Government to support these people when they so desperately need and deserve it?

To conclude, I welcome the principle in the Care Bill of capping care costs. I do not think that it is set at the right level, but it is a welcome first step in reducing the burden of care. However, I believe that we need to explore a genuinely integrated health and social care system. That would not only help people to stay independent in their own homes for as long as possible, but reduce the burden on family members who deliver care each and every day. That is the challenge. I hope that we will see a developing political consensus, with Members on both sides of the House moving towards such a system, so that we can enshrine it, secure it and give people the system that they deserve and need for the years ahead.

12:11

[Mr Mark Williams (Ceredigion) (LD)]

I thank the Backbench Business Committee for giving us this timely opportunity to talk about the role of carers in society. All the organisations that the hon. Member for Banbury (Sir Tony Baldry) talked about were UK-wide organisations. If I may, I will talk from a Welsh perspective, representing as I do the great Ceredigion constituency, although I appreciate that the Minister will not be able to address all the matters that are rightly devolved to our National Assembly in Cardiff.

As we have heard, this year’s carers week seeks to highlight how those in the UK’s carer population are coping with their role as a carer and how well the Government are supporting them in that role. That is a huge issue and it is of growing importance. There are currently 6.5 million carers and that is predicted to grow to 9 million carers in 25 years’ time. We need to ensure that people in the wider population are prepared for their future caring responsibilities.

I represent a rural constituency and we talk a lot in mid and west Wales about rural isolation. If we add to that the isolation that carers experience, it is a highly toxic mix and a huge challenge. That is coupled with the challenge of identifying carers, which the hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about. I represent a huge tract of rural Wales that has scattered and sparse communities, including 147 villages. That makes it even more challenging to identify people and to build the networks that my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) talked about.

Ceredigion county council is attempting to rise to that challenge. It is taking part in this year’s carers week. The carers officer, Heather West, has informed me of an internal campaign that it has run to highlight the change in the known number of carers in the county. There was a 10% increase between 2001 and 2011 to 8,603 carers. There is also a huge number of people who provide care in excess of 50 hours a week. The numbers have grown and are set to grow further. The challenge in rural areas is to build networks so that we can initiate the support that is needed.

I am sure that hon. Members have read the Carers UK report. That research shows that seven out of 10 carers in the UK state that they were not prepared for all aspects of caring. Eight out of 10 were not prepared for the emotional impact of caring. Eight out of 10 were not prepared for the changes to their lifestyle because of a new caring role. Seven out of 10 carers were not prepared for the change in the relationship with the person for whom they care. I met somebody in my surgery a few weeks ago who, in the wake of his golden wedding anniversary, received the bombshell that his wife had a terminal condition. That couple had envisaged having a parity of caring roles in their old age. To have that responsibility shift in such a dramatic way to the husband was a huge shock. Seven out of 10 carers were not prepared for the financial impact of their caring role. As we have heard, 6,000 people take on new caring responsibilities every day.

The landscape has changed. In a previous life, 25 years ago, my first job was down the corridor in the House of Lords. I worked with pioneers in the carers movement, such as Baroness Nancy Seear and Baroness Jill Pitkeathley, who were trying to get official recognition for the term “carer” in statute. They achieved a great deal and we have achieved a great deal, but there is a long way to go.

In January this year, Ceredigion county council launched its e-learning carer awareness course, which can be done online. As is necessary in west Wales, it is fully bilingual. I took it this week. The course consists of four main sections: “Who cares?”, “Carers and the law”, “Meeting the needs of carers” and a test. That concept was initiated by Dudley metropolitan borough council and has been adopted by 40 local authorities across the UK. It is an excellent way to prepare people for the role of carer. It is just one small tool that can raise awareness. Many of my constituents are online and can access such courses.

The council is holding various events across the county focused on the “Prepared to Care?” theme. It has a widely distributed and widely read newsletter to update Ceredigion’s carers if they cannot attend the events.

The authority has also taken the opportunity of carers week to promote the Carers Count, Count Me In campaign, which seeks to register the 8,603 carers in the authority who were identified by the 2011 census data, only a small proportion of whom are officially registered. The aim is to get all carers registered with the Ceredigion carers development office. The sound logic behind that is that the more carers who are registered, the stronger the voice they will have in our area and with the local authority when campaigning for resources from the Welsh Assembly Government. It will also ensure that carers are recognised and valued, and that they have better services to equip them for the role. This year, the staff of the county council who juggle work and caring responsibilities, many of whom did not realise that they were carers, were targeted and a number did join the register.

A fantastic partnership has emerged between our carers development office and Aberystwyth university. They are researching the barriers and challenges in relation to carers needs assessments from the carer’s point of view. The research aims to highlight the support and advice that is available to carers and hopes to make the system more accessible. Critically, it will be independent research so that it can present an accurate and unbiased picture of what life is like for carers in our county.

Aside from preparing us to care, carers in my constituency also raised the issue of the spare room subsidy, or bedroom tax, during carers week. The carers office of Ceredigion county council has spoken to a large number of worried carers who are having to deal with new payment requirements even though they require a second room because of their extensive caring demands. A number of them are going through the appeals process, having already applied for discretionary housing payments. Although the local officers are doing their utmost to support carers, I think that the rules are inappropriate for such constituents. Above all, the stress caused by such matters and—to be frank—the stress that a number of welfare reforms have created for carers in our community gives me a great deal of anxiety.

In July, Carers Wales will hold a number of local sessions across Wales to meet local carers and try to allay some of their fears. Concerns have also been expressed about the attitude of banks to Court of Protection enduring power of attorney, and the mismatch between the banks’ policy and its delivery on the ground has caused a huge number of practical difficulties for carers. The Government can assist our carers in all those areas, and alleviate—at least in part—some of the stresses and strains that they experience.

As I have said, the debate has moved on and more people in the country are fully aware of what being a carer means—MPs certainly are from our casework every week and the people who come to our surgeries, and a new role needs to be pursued with employers and in the world of work. I wish the Government well in what they are doing, and I hope they will look at what I believe have been some helpful precedents across the border in Wales.

12:21

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) and his colleagues on initiating this debate, and we have heard some interesting and well-informed speeches.

Some of my colleagues referred—understandably—to legislation, and they have high hopes of the Bill currently going through Parliament. A long time ago I had the privilege of piloting through Parliament the Disabled Persons (Services, Consultation and Representation) Act 1986. It was widely welcomed, but between then and now I discovered that although we can have an Act of Parliament, if it is not fully implemented it makes much less of an impression on people’s problems than we would like.

For example, section 8 of that Act dealt with the duty of local authorities to take the abilities of carers into account. I am sorry to say that I have not seen great enthusiasm among local authorities to implement that provision, although there are some excellent exceptions. When legislation is passed, including the 1986 Act, we all have a responsibility to work with carers organisations, which do a great job, and with carers in our constituencies, to ensure that the wishes of the House are implemented by health authorities, local authorities, the Department for Work and Pensions, and all those who have an influence on the lives of carers.

Together with Lord Brian Rix, I co-chair the all-party group on learning disability, and we are worried about the issue of carers and return to it often. We recognise, as other hon. Members have done, the hard work that carers do every day for the most vulnerable people, and that often their voices are not heard. That is largely because their role in looking after young people—or young people looking after elderly people—is a 24-hour, seven-day-a-week job.

As colleagues have said, caring is a stressful job and people receive few breaks to support what they are doing. In many cases, their commitment to the role is absolutely outstanding, touching and—as colleagues have said—deserving of statutory support that must be fully implemented. This is not my most important point, but carers have drawn my attention to the economics of what is happening, and it is right to mention that according to Carers UK, voluntary acts by carers save the UK public purse £119 billion per year. Do we not have a responsibility to respond? I believe we do.

Let me explain why short breaks are important. Family carers need time off and a break from the constant work of caring. Some families access short break centres or schemes that involve placements with families. Others receive direct payment to purchase their own support—I very much welcome that and was involved in that legislation. As hon. Members have indicated, the current review of welfare has had many effects. My niece and nephew are carers at weekends and look after people with learning disabilities. They stay overnight and therefore need a room for themselves. Under the Government’s legislation, however, and the tax we all deplore—the bedroom tax—we find that it might not be possible for them to continue doing that job. It would also be hard for their clients to find a smaller house that can be adapted in the way their current houses are, quite apart from the problems and upset that such a move would mean.

In 2003, a report by Mencap showed that eight out of 10 carers were at breaking point. Its 2006 report showed that the number had fallen to seven out of 10, but new research indicates that it is now back to eight out of 10. I do not believe that we in Parliament distinguish ourselves if we allow such conditions to continue throughout our country and in individual homes and communities in our constituencies.

The vast majority of carers are not being offered the short breaks they desperately need. One carer stated:

“When you care for someone 24 hours per day and you know it’s going to be for ever, sometimes a short break is your only hope.”

I am sorry to say that we do not often deliver that. Of the few carers who access short breaks, most do not feel that the services are adequate, and seven out of 10 say that they do not receive services that fully meet their family’s needs.

I acknowledge the Government’s recent investment of £1.2 billion in services for people caring for children and adults, but according to Mencap—a well-informed organisation that does work on the ground—there have been no improvements in the well-being of family carers a decade after the issue was first highlighted.

I speak as a former councillor and former president of the Convention of Scottish Local Authorities, but I am disappointed with the role of local councils. Many are failing to meet their duty to assess needs and regularly review care arrangements. Despite the role of local authorities—I do not mention health boards, although they are important too—the startling facts are that six out of 10 carers have never had a carer’s assessment to identify their needs. Worse than that, two out of 10 said that they had been refused an assessment altogether. Mencap says that after 10 years that is simply unacceptable, but I would put it much more strongly: it is a blight on all of us.

The big issue is that families simply do not know how to access those vital short breaks. Three out of 10 family carers have never had a short break and do not know how to access them. Much more must be done. The fundamental failure of some local authorities to provide information about what is available is not acceptable, even from a statutory point of view. Carers are being left in the dark, without support and on their own. Local authority spending is in decline. According to Mencap, spending by local authorities on children’s short break services peaked in 2010-11, but 63% of local authorities reduced this expenditure in 2011-12. In the current economic climate, money must be saved—we understand that—but not on the back of those who have already sacrificed so much for the most vulnerable, including family members and others.

Spending on adult services has also fallen consistently over the past three years, with 54% of local authorities reducing their spending on short breaks for adults in 2012-13 compared with the previous year. We need to listen to what carers take the time to tell us. One carer felt “absolutely devastated” and continued:

“I have sobbed over the way”

the council

“has informed us of their decision to close this wonderful care home.”

I say again that we cannot balance the books on the backs of hard-working people or build a better society by disregarding those who give the most.

So what needs to be done? We need substantial and meaningful action from the Government, local authorities, health bodies and service providers. No family carer should be left to reach breaking point and every family that needs a short break should get one. Each carer should have their needs identified and should not feel that they are alone and without support. Money that is intended for short breaks should be spent on providing short-term breaks. We need services that are person-centred and able to meet the differing care needs of the people who use them. Information about local need for short breaks should be collected more consistently, distributed accordingly and used to inform what services are made available to all the public.

I end with a quote provided by Mencap. This parent said:

“I love my children and that keeps me alive but I’m worn down…When I can’t cope I self-harm as I have to carry on but it’s too much to handle at times.”

Carers’ voices must be heard, their needs must be met and they must never feel defenceless and alone.

12:33

[Sarah Newton (Truro and Falmouth) (Con)]

I am pleased to have the opportunity to speak in this debate. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has made a huge contribution not only today but throughout his parliamentary career—as a Minister and now from the Back Benches—in raising these issues.

I had the great privilege of being parliamentary ambassador for carers week for the Conservative party, along with my coalition partner, my right hon. Friend the Member for Sutton and Cheam. Rather than trying to cover what was an encyclopaedic summary of the issues affecting carers, the excellent research communicated during the week or, indeed, many of the points made by colleagues on the Opposition Benches, I would instead like to back up everything that he said in describing so well the challenges and opportunities and summarising the Government’s position. I will then make some reflections and observations on my time as an ambassador.

I would like to congratulate the organisations that came together to form carers week, because they achieved something quite remarkable. More than 26,000 organisations across the UK came together and put on more than 100,000 events. Why is that important? From the events I attended, I realised it was vital to raise awareness of the services and financial help available for carers. Like many other Members, I am sure, I often find in my casework and when visiting organisations in my constituency that those who most need help are often the least likely to access it, and we have to work hard to ensure that the legislation, the benefits and the rights that we provide for in the House get into the hands of the people who really need it.

When attending the events in my constituency, I was struck by a fundamental problem touched on by the hon. Member for Ceredigion (Mr Williams): many carers do not identify themselves as such. I spent some time in the lobby of the Royal Cornwall hospital trust alongside volunteers and care support workers from the Cornwall Rural Community Council. They would approach people who were clearly carers—elderly people pushing people in wheelchairs, coming into hospital, attending appointments or leaving hospital—and ask them, “Are you a carer?” They would ask them very nicely and in a friendly manner, with a view to engaging with them to ensure they were getting the help to which they were entitled, but the people would hurry on saying, “No, I’m not a carer.”

If, however, we asked whether they looked after someone—a husband, wife, child or loved one—they replied yes. If we asked them, “Do you regularly provide support perhaps through cooking meals or going shopping?”, they replied yes. We need to think about that a bit more in our desire to find out who carers are and ensure they get the support they need, whether from the NHS, councils, employers or the voluntary sector and wider community. We need to think about how we frame the conversation to enable people to identify themselves as carers, because most of the people I spoke to said, “Well, I’m just doing what any family member would do. This is what families do.” If somebody is ill or has a disability or care need, families gather round. I took that from my meetings last week, and it is particularly important in literature. Central Government produce a lot of literature, and a lot of benefits leaflets go out through the Department for Work and Pensions and throughout the health service, so we should think about the terms we use and how we can engage with people in that literature.

Another thing I reflected on after speaking with carers last week—this came out in the reports—was the evidence on the number of people who gave up work to care. This can have a detrimental impact on the carer: they miss the social contact provided at work and can feel quite isolated and often trapped at home, especially in remote rural areas, such as those in my constituency, where it is difficult to use public transport and connect to wider society. It also has a detrimental impact on household incomes and pension provision. The main question that Carers UK is asking the whole nation is the right one: are we prepared to care? It is a question for the whole of society. Are employers prepared to provide those flexible working opportunities to enable people both to attend to their caring responsibilities and to work?

We have to be realistic, however, because many people are worried about their job at the moment, and so, for fear of losing their job, are unlikely to talk to their employer about the need to work flexible hours. The Government need to engage with employers—there are exemplars, such as BT, with a long track record of recruiting and retaining older workers and enabling flexible working—about the research and the issues and to get them thinking about making it easier for their staff to request flexible working. The huge triumph in employment in the past century was to enable women to juggle caring responsibilities for children and work. In this century, as we respond to significant demographic changes, we need a massive shift to enable workers of all ages to combine other caring responsibilities. For older people and people with disabilities, that is a very important lesson from carers week.

Carers told me that even if they wanted to carry on working—if they had the income and were prepared to pay for care, or have a mixture so that they would do part of the caring but pay for people to come into the home to support them, and their loved ones agreed to that—they were anxious about the quality of the care they would be inviting into their homes. All of us were horrified by recent revelations about some of the carers going into people’s homes, whether they were paid for by individuals or local authorities as part of their domiciliary care service. Until we crack the nut of ensuring that high-quality, well-trained and well-paid carers are going into people’s homes, people will have a great fear and reluctance to try and combine caring responsibilities with employment.

We find a sad position in too many local authorities. We all understand that councils’ budgets are under a lot of pressure. I was a councillor and I know that it is difficult to balance all the needs of one’s community with conflicting demands on what the council should be spending its money on. No two people agree on what a council’s priority should be. For me, it is straightforward: a council’s responsibility, like central Government’s responsibility, is to prioritise the care of the most vulnerable people in society. However, in contracting for domiciliary care, local authorities are cutting their payments so low that it is difficult for private care providers to provide a good quality of care while remaining economically sustainable. That reduces the options available for the vast majority of people who self-fund care.

[Norman Lamb]

I agree very much with the points my hon. Friend is making. Instead of commissioning on the basis of a quarter of an hour and a race to the bottom with the lowest bidder winning the contract, does she agree that commissioning that provides incentives to improve the well-being of the individual being cared for—maintaining their mobility and improving their capacity to remain independent—is the way in which local authorities should be contracting providers of care at home?

[Sarah Newton]

I absolutely agree that local authorities should be remorselessly focused on the best possible outcomes for the people they have a duty to provide care for. They should also understand that while the vast majority of people are not eligible for local authority care, local authorities have a responsibility as market shapers in their localities to ensure that private, third and voluntary sector organisations are able to provide the care services that most people pay for themselves. By constantly engaging in a race to the bottom, they are undermining the ability of those organisations to provide services to the community. Most private or third sector domiciliary care providers need a certain amount of contracts or business from the local authority.

[Paul Burstow]

My hon. Friend is making an important point about the patchy quality of domiciliary care. There are good examples, such as in Wiltshire, where the service has been remodelled to focus on outcomes. However, there is an issue about whether the Government have the necessary powers to ensure that where poor commissioning practice is allowing contracting by the minute, which is resulting in sub-standard care to an individual, they can ensure good quality commissioning practice in the future. The Joint Committee on the draft Care and Support Bill has recommended a change in the law and the Government are doubtful of its need. Does she agree that the Government need to keep thinking about that and perhaps come back with an amendment?

[Sarah Newton]

I back what my hon. Friend says. The Joint Committee’s report was excellent and showed Parliament at its best. People with tremendous experience from the House of Lords and this place worked together to scrutinise and improve that excellent Bill. The Government should be commended for introducing it at a time of economic restraint, especially as it has financial consequences: spending more money on supporting carers is a bold thing to do at the moment and it underlines the great value we put on carers. I back my hon. Friend in his call for an amendment, because if local authorities are tempted to avoid doing what we would all regard as the right thing—to look after the most vulnerable people in our society—we need to tighten up the law to remove that temptation from them.

I would like to share another issue that was raised in carers week. The strong message from carers was that they do not always feel involved in the decisions made by professionals about the people they are caring for. The Government have, rightly, enshrined in their health and social care reforms the principle that “No decision should be taken about me without me.” I would like to extend that so that “No decision is taken about the person I am caring for without me.” I have heard far too many cases, in my own case work and during carers week—particularly from parents caring for children with disabilities—where substantial decisions, on whether their children should be cared for away from their home many hundreds of miles away, were considered without proper discussion with the parents. That is absolutely wrong. There is a prevalent attitude among some professionals that they know best: “Trust me, we know what is best for your child. Trust me, we know what is best for your wife or your husband.” While I would like to be able to trust all professionals—we think that by and large they do have the best interests of people at heart—there should be openness and transparency. Carers should be involved in decisions, so that there is a joint agreement and an understanding about what is in the best interests of the person being looked after.

On a more positive note, I would like to share some of the good practice I saw during carers week. I saw great examples of innovation involving the voluntary sector, in particular. We have talked about statutory provision and what employers can do, but broader civil society and the voluntary sector have an enormous role to play too. I would like to share two examples from Cornwall, one of which is from my own constituency.

A group of people in Falmouth in my constituency responded to the Prime Minister’s dementia challenge by wanting to ensure that everybody in the community supported people with dementia. More than 200 organisations in Falmouth got together to make it a dementia-friendly community. I was proud, in my hometown, to be at the launch a couple of weeks ago, and I was proud that it was the first town in Cornwall, and probably one of the first in the country, to be a dementia-friendly community.

What does it mean to be a dementia-friendly community? It means that the shopkeepers in the high street have gone through awareness training. It means that we have dementia cafes and that the people in the youth centre are aware of people with dementia. Overall, it means that people who suffer from dementia, or are caring for someone who suffers from dementia, can go into Falmouth with confidence, knowing that they will receive a warm welcome in the shops, libraries, public spaces and the youth centre. The people there will understand more about dementia and some of the behaviour that comes with it. Some people might find that behaviour a little bit challenging and scary, which often makes the people who care for someone with dementia want to stay at home. They can be fearful of the response they will receive in a public space and end up becoming isolated. I can honestly say that people with dementia will receive a very warm welcome in Falmouth, thanks to the huge amount of work done by a small group of volunteers ably led by the Bridges, who are Rotarians in Falmouth.

The whole community has got behind this exciting project—indeed, so much so that another group of people in Falmouth, led by a former nurse, Lisa Dann, has been working with Dementia UK over the last year to raise enough money for two admiral nurses. For those who do not know, admiral nurses, who are similar to Macmillan nurses, are specialist nurses who work alongside those with dementia and their carers, providing a lifeline for people coping with what can be a very difficult condition. Lisa was motivated to set up the charity and raise funds because of the poor support that her mum and her family received when her dad was suffering, before sadly dying from dementia.

Lisa has created a fantastic legacy in recognition of her father by raising enough funds—£60,000 in one year, which is a great credit to her, her team and the community—for the whole of Cornwall to have two admiral nurses. Her group is working innovatively in a partnership with a large social enterprise in Cornwall—Cornwall Care, which is the largest independent care provider in the county—to make the scheme sustainable. The group will be raising more money for more admiral nurses, which will provide a huge amount of support for carers, as well as people suffering from dementia. That is a good example of how the voluntary sector and volunteers can create a caring environment for carers.

[Norman Lamb]

I came across another example in my hon. Friend’s county called Changing Lives, where GPs work together—

[Sarah Newton]

I was just about to come to that.

[Norman Lamb]

I very much agree with my hon. Friend about the role of civil society. That will be a vital collaboration if we are to meet the challenge, given the rise in the number of people who need care.

[Sarah Newton]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. When the hon. Lady addresses that point, will she also pay attention to the fact that there are other Members who wish to speak and that she has been speaking for nearly 18 minutes?

[Sarah Newton]

I am grateful for your advice, Madam Deputy Speaker, and I am sorry. It is just that I am so passionate about this subject that I have lost track of time.

I am pleased that the Minister remembers that experience—this was the final point I was coming to—and has agreed to meet Tracey Roose from Age UK and Ian Jones from Volunteer Cornwall quite soon to take forward what he experienced first hand in Cornwall with some more ideas. Changing Lives is a fantastic example of how volunteers can work with GPs to ensure that people have access to all the care and support that they need to live happy, fulfilled lives in their communities. The pilot in Cornwall has had some quite dramatic results, not only in terms of carers feeling better supported and the vulnerable, frail older people concerned having a better quality of life, but in huge savings for the NHS, with 30% fewer unplanned admissions in our acute trust.

These are all the things that we instinctively and intuitively know—that if people get good advice, the help and support they need and opportunities to play their part in society, they can live independent lives at home. The Government can be proud of much of what they are doing, but given the concerns of carers we have heard throughout the week there is clearly still much more to do. I for one look forward to supporting the Government’s efforts to make this a proud country and a great place to grow old and care for people.

12:53

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on organising this debate. I am grateful for the opportunity to speak after such thoughtful contributions. I want to focus on unpaid carers; I will leave others to talk about the care system as a whole.

As we have heard, carers play a vital role, not just for their family members and friends but for the country. In the past decade, the number of carers has grown from just under 5 million to nearer 7 million. By 2037, it is estimated that the number will have increased to nearly 9 million. In my constituency, there are 11,076 unpaid carers, nearly a quarter of whom provide care for more than 50 hours a week. As has been said, we know that this is an underestimate of the actual number who provide care. My hon. Friend the Member for Worsley and Eccles South talked about the lack of information and advice, which has certainly been identified in my constituency. Age UK in Oldham recently opened an information and advice centre, and I hope that people will avail themselves of that. Like other Members, I, too, have had the plight of carers increasingly brought to my attention in my surgeries. Their situation is a growing problem.

In today’s terms, the role played by carers saves the economy £119 billion a year. That is more than the total NHS budget and nearly six times the adult social care budget. The country could not survive without the work that carers do, and that is even more so today, with the crisis that social care is facing. We are facing the double whammy of an ageing society—it is great that we are, on the whole, living longer, although austerity is certainly having an impact on life expectancy—and a meltdown in social care in local authorities, with cuts to their budgets having an impact on social care budgets. Unfortunately, carers are picking up the tab. A recent Carers UK survey showed that a third of those caring for more than 35 hours a week have no support at all. Although 3 million carers juggle work with caring responsibilities, one in five has been forced to give up work.

In addition to the lack of support for caring, carers across the UK are starting to see the impact of the Welfare Reform Act 2012. Changes to financial support with housing and council tax in some areas mean that many families are experiencing reduced financial support from more than one of the changes. The discretionary funding set aside by councils to support people affected by the bedroom tax is enough to help only one in 10 disabled people. Carers who require an additional room because they cannot share with partners who sleep in hospital beds, or parents of disabled children who need the space for care workers to provide overnight care are being seriously let down. More than 5,000 families with care needs are faced with either moving or finding an extra £700 a year.

The cumulative effects of the economic downturn, a squeeze on wages and the increasing costs of essentials such as food and fuel, along with the cuts in social security support, are making it more difficult for carers to manage. More than four in 10 carers in the Carers UK survey said they had been in debt as a result of caring. This year will see other changes to the benefits system, as the transfer of disability living allowance to the personal independence payment and the universal credit are introduced, which is also of considerable concern to many carers. DLA was the gatekeeper to carer’s allowance. The changes mean that 10,000 fewer carers will not be entitled to carer’s allowance. Many of us have already called on the Government to review these changes and undertake a cumulative impact assessment of the effects of these welfare reforms. For many, they will be the tipping point.

In addition to that, and as a consequence of debt and a lack of support, there are significant effects on the health of carers. Eight out of 10 carers report that their caring role affects their physical health and nine out of 10 say that their mental health has suffered. This is not only a human tragedy; we are storing up problems for the future by not caring for our carers.

I know about that from my personal experience of caring for my mum—I have spoken about her before—who died of Alzheimer’s last September. She had Alzheimer’s for 10 years, and for the last three years was unable to communicate or to feed or toilet herself. Although my mum lived in the States, I provided respite care during leave, so I can personally attest to the physical and emotional toll that it had on me. In the last few months of her life she was bedridden. I am little, but I am fairly fit and strong, yet physically trying to lift her to bathe her or change her continence pads was something I found really difficult to manage. The worst thing was the emotional toll, however, as I worried how everyone was coping.

I want to spend the last few minutes talking about young carers. One of the last research projects I worked on before I was elected to this place concerned the effect on young carers’ health of their caring role. Many people will be surprised to learn that, according to recent census figures, there are more than 178,000 young carers in England and Wales. Those are the official figures, but we know that they are an underestimate. Children as young as five are looking after family members who are physically or mentally ill or disabled, their roles ranging from doing household chores to providing nursing or personal care.

The effects on those children and young people are immense and lifelong. Because of their caring responsibilities, nearly a quarter of young carers often miss school or have educational difficulties. Young carers are also more likely to grow up in poverty, to be socially excluded, to have low aspirations and achievement and to have relationship issues. Those problems can follow them throughout their lives. There is also evidence of significant effects on their physical and mental health, with anxiety, depression and self-esteem issues being particularly prevalent. It has been shown that, after a year of caring, morbidities fail to return to pre-caring levels.

Services do not always respect young carers and the role that they play. My research indicated that many young people felt excluded from discussions about their family member’s care, even though they were providing much of it. Some of the responses to questions on whether the young carers should be allowed to see their parents in hospital, for example, were quite heartbreaking. Similarly, many young carers felt that there was a lack of understanding and support from their teachers and schools. I echo what my hon. Friend the Member for Worsley and Eccles South said about this. We must ensure that schools take seriously their role in supporting young carers.

[Barbara Keeley]

I have mentioned the fact that we have a young carers project in Salford that is doing great work. It was interesting, however, that one of the schools involved came back to the project and said, “We have no young carers at all”, when the project knew that it did. The perception among some head teachers is that they do not have any. Is my hon. Friend worried about that as well?

[Debbie Abrahams]

I totally agree with my hon. Friend; that is very worrying, and we must try to do better by those young people.

I am encouraged by what the Minister has said today about the discussions, but I reiterate my hon. Friend the Member for Worsley and Eccles South’s sentiment that warm words are not enough. Will he tell us when we can expect to have the amendments included in the Children and Families Bill? The rights of parent carers of disabled children are also still in limbo, and the Government must bring forward changes to the Bill to ensure that the rights of that group of carers are not left behind. I recognise the Government’s commitment to carers’ rights, but I reiterate my earlier remarks: no matter how much we legislate for assessing carers’ needs, it is meaningless without the means to implement it. Local authority budgets have been pared to the bone, and that is having an impact on social care budgets. How are we going to deliver those assessments? A further £800 million of cuts are planned for this year alone. I would be grateful if the Minister would address that point as well.

13:03

[Mr Iain McKenzie (Inverclyde) (Lab)]

I congratulate the Backbench Business Committee and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this important debate. It is a pleasure to contribute to it. I was delighted to be invited last week to Inverclyde’s national carers week event, the theme of which was “Prepared to Care?” A marvellous week of activities was organised to highlight caring, and special thanks must go to the secretary of the local carers forum in Inverclyde, Mrs Christina Boyd, who put together an interesting week of activities for the carers who attended.

On the day I attended, my local leisure company demonstrated keep fit with carers. It was announced as low-impact seated aerobics, and of course I took part. It is difficult to describe it, and perhaps difficult for Members to visualise it, without the accompanying music. Perhaps we should consider introducing it in the House, although I dare say that some members of the public think that we already have.

The focus should be on carers all year round, not just for one week. We need to recognise and support the work that they contribute, both on a personal level and to our community and society as a whole. That contribution has never been greater. The statistics on caring up and down the country are quite staggering. One in eight adults is a carer, which equates to about 6 million people. Every day, another 6,000 people take on a caring responsibility, equating to more than 2 million people a year. More than 1 million people care for more than one person. It has been estimated that carers save the economy £119 billion a year—an average of more than £18,000 per carer.

[Katy Clark (North Ayrshire and Arran) (Lab)]

I congratulate my hon. Friend on making those points. He will appreciate that many carers are older people. Has he, like me, been approached by constituents—women in particular—who are upset that they will lose their carer’s allowance when they reach retirement age? Does he agree that it would be appropriate to have some form of carer’s supplement for such people, not only in recognition of their contribution but to meet the additional costs involved in caring?

[Mr McKenzie]

I agree wholeheartedly with my hon. Friend. Many of my elderly and women constituents have approached me with that very big worry in mind. It is something that we need to look at, and that the Government need to respond to.

More than 3 million people juggle care with work, but the significant demands of caring mean that many carers are forced to give up work altogether. The main carers benefit is £58.45 for a minimum of 35 hours. That is the equivalent of £1.67 per hour, which falls far short of the national minimum wage. However, 1.25 million people provide more than 50 hours of care per week.

Carers’ health can also suffer. People providing high levels of care are twice as likely to fall sick. The fact that 625,000 people suffered mental and physical ill health last year as a direct consequence of the stress and physical demands of caring illustrates the true impact on carers’ health. Research by Carers Scotland found that almost half of carers with health problems reported that their conditions began after they started caring. Of those whose condition pre-dated their caring role, a quarter said that their condition had worsened since becoming a carer.

Caring clearly takes a huge toll on carers’ physical and mental health, and those not receiving respite are far more likely to suffer from mental health problems. The impact is often exacerbated by carers being unable to find time for medical check-ups or treatment for themselves, with two in five carers saying that they are forced to put off treatment because of their caring responsibilities. Research by Carers UK includes cases of carers discharging themselves from hospital because of an absence of alternative care.

I took questions from carers at the carers forum last Friday, and it was no surprise that their biggest worry at the moment is the bedroom tax. The Government should urgently review the impact that the charge is having on carers, because the vast majority of care in the UK is provided by family and friends. The work that family and relatives do so willingly is often ignored or goes unseen. Family carers are truly the unsung heroes of our communities. Social services and the NHS rely on carers’ willingness and ability to provide care, yet we as a society seem to put very little value on carers or recognise their commitment.

Social isolation and social exclusion are often remarked on by carers. They feel very isolated and report not having enough respite to have personal relationships of their own. They also report the stress and guilt associated with taking time off from their caring role. Many have not had even a day off in a whole year.

Many carers and carer households are often in poverty because carers have had to give up work or take on part-time work. They say that they could not otherwise fulfil their role as a carer. Of those in part-time work, many are in low-paid employment, and young carers are more often found in the NEET category—not in education, employment or training—or leave school with fewer qualifications.

What of the professional carers? According to a recent report on the plight of carers in the UK by the union Unison, the current system of home care is failing the people who receive it and the people who provide it. Unison describes the treatment of those receiving care and of workers as an outrage. It says private home care workers are being exploited—effectively paid below the minimum wage and given little or no training. Care workers are among the most poorly paid workers in the country; most are on the minimum wage, and there has been an increase in the number of zero-hours contracts. More than half of the care worker respondents to the recent survey reported that their terms and conditions had worsened over the last year.

What about the level of training? Can we say it is adequate? Well, 41% of care staff are not given specialist training to deal with their clients’ specific medical needs, such as dementia and stroke-related conditions. Standards and training are insufficiently regulated. We should compare this with Germany, where carers require several years’ training.

What of the care provided by our local authorities? Local authorities are being squeezed at this time of austerity and having made all the efficiency savings they can, they are now in a dilemma—at least they are in Scotland. They have to make very hard decisions and have to meet the challenge of delivering core services such as care with reduced funding while maintaining the same level of quality. I fear that things will only get more difficult for local government to continue to deliver high-quality care.

In conclusion, we owe the millions of carers out there the respect and all the assistance we can give them because some day we may just find ourselves performing a caring role or being cared for ourselves.

13:12

[Andy Sawford (Corby) (Lab/Co-op)]

I am grateful for the opportunity to take part in this important debate, which affects so many of our constituents around the country. I add my appreciation and congratulate the Members who requested the Backbench Business Committee to provide time for this debate, and indeed the Backbench Business Committee itself on recognising the significance of this issue. This debate is timely because many Bills and other measures either before the House or to be debated over the coming weeks and months will have a huge impact on carers.

Before dealing with that, I want to speak about why this issue is so important to many of my constituents. There are 14,980 carers in Corby and East Northamptonshire —a rise of 23% over the last 10 years, which is higher than the 11% rise nationally. There are nearly 3,500 carers in Corby and East Northamptonshire who care for more than 50 hours a week—a rise of 40% over the last 10 years, which is far higher again than the national average increase of 25%. Of those nearly 15,000 carers in my constituency, more than 8,000 are juggling work and caring, which presents many issues.

I support the points that other hon. Members have made about the need for employers to demonstrate really good practice in this area and support employees who have caring responsibilities. I agree with my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) in deploring the fact that the Independent Parliamentary Standards Authority is not prepared to set a good standard in this place, where Members are not allowed to grant their staff compassionate leave. I think we should be an exemplar in this and should work together across the House to urge IPSA to change its practice.

In my constituency, many people are employed through employment agencies. Even where there are opportunities for employers to show their employees that they are good and caring, many of my constituents will not be touched by that. They will find that they are not able to continue working and caring. My hon. Friend the Member for Inverclyde (Mr McKenzie) referred to the amount of the carer’s allowance. It does not compare well with jobseeker’s allowance, for example. We should have an aspiration to improve it. In recognising the significant number of people involved and the huge cost implications of trying to increase the support for carers out there, we must also recognise that the carer’s allowance provides a very small amount for our constituents to live on. The financial challenges, as other Members have said, are getting much tougher at the moment.

I attended various events during national carers week, including the event here in Parliament. I want to congratulate all the organisations that came together to organise national carers week. I met people from the Multiple Sclerosis Society, Marie Curie and other organisations, who told me about their experiences. I think they were absolutely right to bring carers themselves to talk to us here in Parliament about their experiences. They reflected many of the conversations I have had with my own constituents. I met a carer who cares for his wife who has MS and a former carer who cared for her husband who had cancer. They both asked me to champion raising the carer’s allowance. That is what I want to do today.

Carers UK’s analysis of the recent census shows that the fastest-growing group of carers are people over 65 with caring responsibilities. There has again been a much more significant rise in those numbers in my constituency than nationally, with a 35% rise of older carers nationally compared with a 62% rise in Corby and East Northamptonshire. I am determined to engage with local organisations—including charitable and voluntary organisations that work with carers, but also local authority and local health bodies—to try to understand why the rise is so significant in my constituency, the extent to which those bodies have been able to respond to it and whether that trend will continue.

Carers over 65 who receive the state pension are, as hon. Members have said, unable to receive carer’s allowance—despite the fact that they still face additional costs as a result of caring and have often lost earnings from retiring early to care. What plans do the Government have to provide more practical and financial support to people who spend their retirement caring for their partners, adult disabled children or their own older parents? My own parents are approaching retirement and they, like many people nowadays, find themselves part of what is called the sandwich generation. They not only help me to bring up my children, providing lots of extra help and support for child care, but increasingly find that they are taking on a care and support role for their parents. That matter should concern all of us. It is particularly important in the context of our full knowledge that we have an ageing population, which will present a growing challenge for us.

Carers UK figures show that carers are out of work for an average of five years as a result of giving up work to care for an older or disabled loved one. Many struggle to return to work afterwards, yet find that their carer’s allowance stops very quickly. What support can be provided to help carers when caring comes to an end to ensure that they do not fall into financial hardship as a result of losing carers’ benefits? What can we do to help them return to work, retraining where necessary?

I recently met a lady who came to my surgery in Raunds to talk to me about her experience. Her particular concern was about the impact of the bedroom tax, but she also told me how her life of caring for her husband had come to an end as he sadly passed away. She told me how unsupported she felt in the months afterwards, as some of the help and support she had hoped for—previously in place in part because of her caring responsibility—was taken away from her. She then found she had to contend with the bedroom tax on her large family house. She had no choice—either move from her family home quickly as she grieved for her husband or face financial destitution. I felt incredibly sad that she faced that situation.

I was recently visited by my constituent, Mags Maguire, who told me about her mum, Mrs McKay. She asked for my help in trying to ensure that a care package was in place for her mother. I have tried on her behalf; I have, unfortunately, not made sufficient progress, but I will keep trying. Mags herself is a resourceful person. She recently contacted the occupational therapist again to describe the situation she faced. The occupational therapist replied:

“Hi Mags, just to let you know...We rarely prioritise cases as critical, as this is for cases where if something is not done immediately it will be a case of life or death and if there is nothing else that can be done and provided to reduce that risk in the interim and the major adaptations are the only way to reduce risk. We can still be waiting 12+ months for works to be done under a ‘critical’ priority as the amount of funding available will affect the waiting list times.”

Mags is merely requesting some small adaptations to the home in which her mum lives, and it seems to me that that ought to be possible.

The occupational therapist continued:

“I could not prioritise the case as urgent as Mrs McKay has a care package to meet her personal care needs and meals and also family to support.”

The “care package” is, in fact, the family support. The family get Mrs McKay up in the morning, and the family provide the meals. The “care package” is not provided by anyone other than the family members themselves.

I have personal experience, in that my granddad cared for my nan for many years. He died on the day after Boxing Day, 18 months ago. He undertook those caring responsibilities without any help or support—which, of course, saved the taxpayer a huge amount of money—and he undertook them willingly because he loved my nan hugely and they had spent their whole lives together, but by the end of his life his own health had suffered greatly because of the extra responsibility that he had taken on as a carer. He would have been happy to continue that responsibility, but an intervention should have been made earlier to provide him with at least some additional help and support.

What was even worse was that after granddad died, we tried to arrange care and support for my nan, but for a long time were unable to do so. Then, late last year, I walked up her garden path to find that she was not sitting in her usual chair. I tapped gently on the window, as I always do, in order not to alarm her, and saw that she was lying on the floor. Fortunately there was a key in a safe and I was able to get into the house, where I called 999. My nan was unconscious for four days, and only after that were we able to obtain the care and support package that she needed. It should not take a stroke to secure a decent package of help and support, it should not take such a long time, and it should not be at the huge cost of the health of a partner, children or other carers.

I think it important to look at the opportunities with which Parliament will be presented in the coming weeks and months. The Care Bill will consolidate and simplify decades of social care legislation in England, and I welcome some aspects of it, but it is disappointing that the new rights that it confers will apply only to adults. I was a member of the Committee that considered the Children and Families Bill. We pressed the points about young carers, and we were given some assurances. We received the same assurances on Third Reading, but the Government have still not explained fully how young carers will be supported in the same way as adults. I should like to see the details of their amendments as soon as possible.

There are, of course, significant areas of disagreement between Government and Opposition on both those Bills, but we also welcome their positive aspects, which are due in no small measure to all the outside organisations that have helped to inform Parliament throughout the passage of the two Bills. Those organisations have contributed a huge amount, but I fear that, unless we see those amendments soon, they will have no real opportunity to contribute to the shaping of measures to help young carers.

I want to say something about social care funding, but I must be briefer than I intended to be, so that other Members can speak. I should like the Government to think about the fact that the Dilnot cap does not cover charges for carers’ services. They may say that they do not intend local authorities to charge for those services, but we must recognise that all authorities face a huge funding challenge, and charges are therefore quite possible.

As for the Welfare Reform Act 2012, the carers to whom I have spoken welcome the Government’s decision to retain carers allowance as an independent benefit rather than subsuming it in universal credit. However, there is serious concern about other aspects of the Act. Following the introduction of personal independence payments, 600,000 fewer disabled people will be entitled to support—600,000 people whom I think we should be trying to help. Moreover, 10,000 fewer carers will be entitled to carers allowance and about 5,000 will be subject to the household benefit cap, losing an average of more than £100 a week.

Two thirds of those affected by the bedroom tax are disabled, but the discretionary money set aside for councils to support disabled people would be sufficient to support only one in 10 of them. Local authorities are in a very difficult position. I have been in touch with my own council in an attempt to secure discretionary support, but it simply does not have the money to provide the help that it knows is needed.

[Mark Durkan (Foyle) (SDLP)]

As the hon. Gentleman knows, the Government constantly say that their aim is to help those who play by the rules and do the right thing. It is clear from what he and other Members have said that carers are people who do the right thing—who are motivated to do the right thing—and who play by the rules. Why should they be victimised by cruel rules that are being introduced as part of the Government’s welfare reform measures?

[Andy Sawford]

I entirely agree with the hon. Gentleman. Some of my constituents who are affected by those measures do feel victimised. What the hon. Gentleman said about fairness is absolutely right. We all want changes to be made in a fair way, but many of my constituents—not just the disabled people and carers who are affected—recognise the unfairness of the measures. The Government should think again about many of their proposals. I urge them in particular to take account of what Members have said today about the bedroom tax.

There is much more that I could say, but I know that other Members wish to speak, so I shall end my speech.

13:26

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I congratulate the Members who helped to secure today’s debate.

During the debate on the Queen’s Speech, I referred to the experiences of two carers in my constituency. One was Lynne Hanslow, who cares for her 96-year-old father, keeping him out of residential care. All that she asks for is a fortnight’s respite break each year, but this year, despite having given the council four months’ notice, she was denied that break and was abused by a local authority employee when she complained about her treatment. Not surprisingly, Ms Hanslow ended up having to go to her GP. A carer had been made ill by neglect and worry.

I have spoken to the council’s director of adult services, but so far Ms Hanslow has not received the full apology that she deserves, along with a promise that that will not happen again. I believe that the council’s chief executive should make the apology, thus sending the signal that he means to take the needs of carers seriously and will not stand for his staff treating them with contempt. Ms Hanslow’s experience is one of the reasons for my conclusion that statutory respite care should become a legal, enforceable right for carers. We have tried the other approaches for too long.

I also mentioned the case of Margaret McGarry. She cares for her frail elderly mother, who suffers from dementia. Her direct payments have been suspended, apparently in retaliation for her having had the temerity to go to a solicitor because she felt that the local authority was being unreasonable in terms of the flawed level of support that it was prepared to provide. There should be a much simpler independent review process for carers like Margaret McGarry who are treated in such an appalling way. The current system seems almost to be weighted in favour of officials and bureaucrats, at the expense of carers. I wonder whether the time has come for local authorities to create carers champions to look out for carers’ interests. I have come to the conclusion that local authority complaints procedures in much of the NHS these days are not about problem solving at all. They are about process. They are almost a game to create an illusion of accountability. I think we need a champion who will listen to carers’ concerns.

[Paul Burstow]

I think it is worse than that. The balance of power is entirely wrong. It is too much on the side of the local authority to which the individual is complaining. That is why we need advocacy, but it is also why we need to look at the case made in the Joint Committee report on the draft Care and Support Bill for the need for a tribunal service, to start to address these matters in a more impartial way, detached from the local authority. How can a local authority investigate itself?

[Steve McCabe]

I certainly agree with that, although I would be reluctant for us to have a complex system that the carer has more difficulty accessing. I take on board the right hon. Gentleman’s point, however.

In arguing for a champion, I am looking for someone like a councillor, with sufficient clout to intervene and right wrongs and cut through the madness and bureaucracy that all too often ends up punishing, rather than protecting, the carer. That does not mean we should not also have further review and appeal processes, but I want us to have something simple that people can make use of and that will make a difference.

A champion might also do more to make sure the voices of ordinary carers are heard. I am thinking about the hidden carers that so many Members have mentioned—the people who are too busy caring to have time to attend the consultation sessions, which are organised to suit the convenience and working hours of the NHS and local authority officials, so these people are never heard.

[Norman Lamb]

I totally agree with what the hon. Gentleman says about giving a voice to carers, who sometimes are treated appallingly, not only by providers of care, but by some of the statutory services and local authorities. With providers, we have introduced, through the NHS Choices website, the ability for people, in TripAdvisor style, to speak out and have their say about poor standards of care, and we may need to do something similar for local authorities, because there should be no hiding place when people are let down in that way.

[Steve McCabe]

I welcome what the Minister says. I am able to identify these people in my constituency, and I do not understand why it is so hard for the caring organisations to identify them.

I wonder why we do not say that at the point when an individual qualifies for attendance allowance the local authority should be notified and instructed to commence consultations with the person and their carer, with a view to establishing a long-term care plan and review strategy. That could reduce the occurrence of crisis care episodes, and the authority could simultaneously start to develop a support plan for the carer, so the needs of the carer are at the centre of the care plan.

[Paul Burstow]

The hon. Gentleman’s point about attendance allowance is interesting and important. He may know that this week the Strategic Society Centre think-tank published an interesting report setting out how this area might be reformed in a way that provides just what he has described: a front door into the social care system. Does he share my surprise that we have a system that does not talk to social care at least in part because it is entirely paper-based? It is not electronic, and perhaps the Department for Work and Pensions needs to consider putting it on that basis, so the information can be shared more freely.

[Steve McCabe]

I think I probably would agree with that, although the right hon. Gentleman must recognise that the Government are moving increasingly towards systems that do not allow for face-to-face exchange. I understand that that is one of the major disputes about what is happening in the DWP. I think it would make classic sense, however. All of us hear enough about joined-up government, and this is one area where a bit of joined-up government could save money and provide a much better service.

[Barbara Keeley]

I was at an event the other day—as was the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall)—at which somebody from the DWP was talking about this issue. They said they had tried a project to get their data to talk to the local authority’s data, but had given up because the local authorities all used different forms. That seemed to me to be appalling. The Minister might like to think about whether there could be guidance for local authorities. If local authority forms are all that is stopping this vital sharing of data, it is about time we dealt with that.

[Steve McCabe]

One of the penalties of having been a Member of this House for quite a long time is that we get fed up with hearing such excuses. We know fine well they are nonsense; if we want it to happen, we can make it happen. That is the approach we should take.

My hon. Friend the Member for Corby (Andy Sawford) talked about older carers and carers who have been caring for older relatives, and I want to touch on one particular aspect of that. What will happen under the Government’s deferred payment equity release plans to surviving spouses who are carers, or elderly children caring for even older parents—it is not uncommon these days for a 70-year-old to be the carer for somebody who is 95 or 96, for instance? What rights will they have? In such situations, when the person who is being cared for enters residential care, what will happen to a carer whose name is not on the deeds of the house, although it may be their family home and they may well have lived there since marriage, or even childhood?

We must ensure that these carers do not end up homeless, destitute individuals with no pot of money to support them when they end up needing care themselves. I am not sure that the deferred payment scheme as currently structured takes account of the risk for those carers, and it would be the cruellest of rewards if, after a lifetime of care, we left them in this predicament.

[Norman Lamb]

At present, when someone goes into a care home and they have to sell the home to pay for care, the position of the carer could be very precarious, but the arrangements for the right to defer payment potentially provide greater stability for the carer. The hon. Gentleman raises an important point, however, and I will be happy to write to him directly about it.

[Steve McCabe]

I am grateful to hear that the Minister will look at the issue. I acknowledge that the current system is far from perfect, but interest-related deferred payments could mean more of the pot being consumed, and therefore less for the remaining carer.

13:38

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to follow the excellent speeches made by Members on both sides of the House today. I thank the Backbench Business Committee for giving us the opportunity to debate this crucial subject, and I particularly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Banbury (Sir Tony Baldry).

One in 10 of all adults are now caring for an older or disabled person—6.5 million in total, up 600,000 from 10 years ago. The biggest increases are among those aged over 65 and those caring for more than 50 hours a week. This is a huge change in society that we all need to do more to understand and get to grips with. Our care system simply would not function without the vital support family members provide for their loved ones; as many Members have said, their financial contribution is estimated at more than £100 billion every single year. Despite that, all too often, carers go without the support they deserve and desperately need to look after the people they love. That is why today’s debate is so important.

The last Government made important progress in improving support for carers. We introduced new rights for carers, including the right, for the first time, to request flexible working. We improved information and advice, and had training programmes for carers such as the expert carers programme, the benefits of which I have seen in my own constituency through the brilliant work of CLASP, the carers centre in Leicester. We funded breaks for carers. Many Members have spoken powerfully about how important breaks are. If carers who are caring for many hours a week have a bit of a break in sight, it really helps them to carry on. We also introduced financial incentives for GP surgeries to identify carers and refer them to local councils for support. That was part of the quality and outcomes framework, which was introduced as part of the 2004 GP contract, and was the very first step in providing a specific financial incentive for GPs to identify carers.

However, as all Members have said, far, far more needs to be done. Like many Members, I have seen in my constituency and within my own family the often desperate daily struggle that is still faced by too many people who look after a loved one who is disabled, physically frail or has dementia—sometimes all three. I pay tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who powerfully explained her own experience of the physical and emotional demands of caring for a loved one. As she said, there are the physical demands of helping someone to get up in the mornings. Carers can be exhausted from getting up two, three or four times in the night to help someone go to the toilet, and from helping them move around the home. There are also the emotional demands. When a carer sees the person they fell in love with become frail and perhaps lose some of their pride and strength, it is terribly upsetting. If a son or daughter sees the parent who brought them up and taught them about the world—for good or for ill—begin to fade as a result of dementia, and they begin to feel as if they themselves are becoming the parent, it changes something essential in the nature of that relationship. I have always believed that relationships are essentially what make us human. If someone has dementia and begins to forget the relationships they have, it takes something away from the carer, as well. Caring for a loved one is physically and emotionally demanding. Many Members have talked about the role of public services. Health professionals are taught to understand physical and mental illness, but not necessarily the wider emotional and social issues.

I want to talk about three critical areas where we need to make progress, the first of which is identifying carers. If we do not know who they are, we will not get them the help and support they need. The second is ensuring they get the right information, advice and support from the NHS as well as social care. The third is helping carers to stay in employment, which many Members have talked about. That is particularly important as we all live longer and need to work for longer. If the public finances are to remain stable, we must do everything we can to help people in that regard. My hon. Friends the Members for Worsley and Eccles South and for Birmingham, Selly Oak (Steve McCabe) talked about the importance of identifying carers. The hon. Member for Ceredigion (Mr Williams) said that there is a great deal of awareness of carers and of the use of that term, but lots of people still do not realise they are a carer or think of themselves as such; they are simply trying to be a good daughter, son, husband or wife. Others do not ask for support because they worry that people will think they cannot cope; there is a lot of associated guilt. We need to identify these hidden carers.

There are many examples of good practice, but perhaps the best I have seen is in Torbay, where the issue of identifying carers in GPs’ surgeries and hospitals has been closely examined. If someone who has had a stroke comes in with a family member, it is recognised that that family member is likely to be a carer. A great range of support is provided. The approach taken in Torbay starts with the person who may need health care; as a result, they immediately talk about their family member.

I want to offer some practical suggestions to the Minister on how to make further progress. Will he consider amending the quality and outcomes framework? At the moment, it provides a points incentive and a financial incentive for GPs to refer carers to social care services; but why not to other health services, if carers’ health needs are so important? Secondly, will he give guidance on the best questions used to indentify carers? When I recently registered with a new GP, the leaflet provided asked, “Are you a carer?” I knew what that meant because I am familiar with the policy debate, but most people would wonder what that meant—paid carer, unpaid carer?

I spoke at the event that launched the research into attendance allowance claimants by the Strategic Society Centre and Independent Age. There are 1.3 million older and disabled people in England with very high levels of need. The research shows that 35% of attendance allowance claimants are cared for by a son or daughter, 30% by a partner, and 15% by another family member. The DWP has that information. I hope the Minister will talk to his DWP colleagues about drawing up a proper action plan.

Thirdly, I want to join my hon. Friends in pressing the Minister on what action will be taken through the draft Care and Support Bill to identify young carers. Will he update us on his meeting with the Education Minister? What is the obstacle to amending the Children and Families Bill, the draft Care and Support Bill, or both? I tell the Minister that the Opposition will table relevant amendments if the Government do not.

I turn now to improving information and advice for carers. Carers UK says that a third of those caring full time for an older disabled or seriously ill friend or relative receive no practical support, and those who do often find that services do not fit around their particular needs, especially if they are struggling to hold down a job. As many Members have said, these services still too often end up offering last-minute help and support, when families have already reached crisis point. I pay tribute to my hon. Friend the Member for Corby (Andy Sawford), who talked about his nan. Before she got any support, a crisis point had already been reached. That was no good for her, and it is no good for taxpayers. More than one in five carers who have been admitted to hospital as an emergency case in the last three years say that it could have been prevented, had they been helped to look after their own health, or been given a break from caring or other forms of support. Given that money is so tight across the NHS and council care services, we have to get those up-front preventive services and support in place.

I have another practical suggestion for the Minister. As he knows, there is a brilliant national GP patient survey, run by Ipsos MORI, which provides detailed information about the needs of patients registered at a surgery. The last time I looked through it, I do not think there were any questions about whether the respondent was a family carer. It was about the needs of the individual patients, not carers. Such a question would provide us with some brilliant data that could be given back to individual surgeries as the basis from which to start developing support.

[Norman Lamb]

The GP survey is absolutely something that we can consider. If we can demonstrate how individual surgeries are performing against their responsibilities towards the whole family, and not just towards the person who is receiving medical treatment, we might well drive changes of behaviour in the surgery.

[Liz Kendall]

I am very pleased to hear that from the Minister and I will continue to follow it up with him. Including such questions in the survey would not cost any more and the data are collected by individual practice, so we would all be able to look at the GP surgery data in our own constituencies and ask what action plans were being followed. Clinical commissioning groups could be required to follow that up.

The third issue that many hon. Members have talked about is helping carers to stay in paid work. Families need the income carers get from paid work and our economy needs the skills and talents of carers. That challenge will only increase as our population ages and as more people live for longer and have to care for longer.

The biggest group of carers are people aged 50 to 65, many of whom still want and need to work. Many are women who, as hon. Members have said, are stretched at all ends. Some are looking after their children or grandchildren, or sometimes both, as well as caring for a frail partner or elderly relative and trying to hold down a job. To have one in three carers being forced to give up work or reduce their hours because the right services and support are not available does not make sense for our economy as a whole. The right hon. Member for Sutton and Cheam talked about the LSE and Age UK research that shows that that is costing more than £5 billion a year in lost tax revenues and increased benefit bills.

I strongly urge the Minister to talk to his colleagues in the Department for Business, Innovation and Skills about how the Government can do more to promote flexible working among family carers. We have made great progress in arguing that child care is part of our economic infrastructure, and, as the population ages, social care must be too. I believe that from cradle to grave, child care and social care must be the twin pillars of a reformed welfare state.

In conclusion, the draft Care and Support Bill is an important step forward and is very welcome. It builds on the recommendations of the Law Commission’s review into adult social care legislation, established and initiated under the previous Labour Government. Indeed, many of its recommendations were set out in our White Paper on social care, produced just before the general election. On its own, however, the Bill will not be enough.

Rights in law simply will not be delivered on the ground if the services are not available locally to make them a reality. Local council budgets for adult social care have been under pressure for many years, but they are now at crisis point as council budgets have been cut by a third under this Government. The Local Government Association says that councils have had to reduce their adult social care budgets by £2.7 billion over the past three years—that is a staggering 20%. The LGA says that

“eligibility thresholds cannot be raised much higher, 87% of councils are now at the substantial/critical threshold”.

That affects not just the statutory services, but the voluntary organisations that several hon. Members have rightly championed. Cuts from Leicestershire county council mean that CLASP carers centre in Leicester wonders whether it will even be able to survive. Many Members have talked about the important role of the voluntary sector, but without state funding many such organisations will not exist in future.

Will the Minister back calls from Opposition Ministers for £1.2 billion of this year’s NHS underspend, handed back to the Treasury in March, to be given to social care to ease the short-term funding crisis over the next two years? What representations has he made to the Chancellor on council care budgets for the spending review? Has his Department made the clear economic and social justice cases for preventing them from being slashed further? If any NHS funds are to be transferred to local councils in next week’s spending review, will they be specifically ring-fenced so that money gets through to the front line?

Ultimately, we need a bigger and bolder response to meet the needs of our ageing population and to help Britain’s carers. We need a fully integrated NHS and social care system with one budget. We should take the £15 billion spent on social care and the more than £100 billion spent on the NHS and join them together so that we get better care and better value for money for taxpayers. I believe that that is what Britain’s carers deserve.

13:55

[The Minister of State, Department of Health (Norman Lamb)]

I am grateful to the shadow Minister, the hon. Member for Leicester West (Liz Kendall), for her thoughtful speech, much of which I agreed with. This has been a thoughtful debate in which many good points have been made and I thank Members for raising this very important issue. Many Members who have taken part in the debate have been long-standing advocates for carers and I welcome their interest and commitment. I completely understand why various Members constantly pursue issues such as those to do with young carers and will not accept my determination to help with that problem until it is dealt with. I accept that that is their role and it is their right to do so. The debate has been a good one and I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for securing it, together with his colleagues, and for all the work and championing he has done over the years for carers.

Let me make a preliminary point. Some of the Opposition speeches, including that made by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), focused on the difficult financial circumstances for local government, the impact of welfare reforms and so on. We could have a partisan battle about the issues, condemning the Government and so on. However, the shadow Minister recognised at the start of her speech the scale of the challenge we face, not just today but in the future. The numbers of people growing older with care needs, often with multiple conditions and a mix of mental and physical health needs, just keep growing. If we are all honest, both in this Chamber and with the public outside, we must admit that any Government of any political persuasion would face this challenge.

There is no easy solution. We cannot just find a magic pot of money to throw at the problem. There is an obligation on us all, as the shadow Minister made clear, to find ways of using the money we have available much more effectively than we do. We know that there is massive waste in the system because of the care silos—between health and social care, between mental and physical health and between general practice and secondary care. There is an absolute obligation on us all to engage in a debate about using money more effectively to achieve better care and support for people and to ensure that the system remains sustainable. I want to ensure that we elevate the debate by recognising the challenges we face.

The speech made by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) was, I think, really valuable. Ultimately, we need collaboration among statutory services, which should not abandon their responsibilities, the voluntary sector and, crucially, people—that is, the community, families, neighbours and friends. We need to unleash particularly the power of the many people who have entered retirement fit and healthy and want to give something back, but often do not know how to do so. An army of people out there are able and willing to help to meet the enormous challenges. Some of the schemes that my hon. Friend the Member for Truro and Falmouth alluded to in her county are happening in many parts of the country, and they point us to a better future—a more caring future, where community strength is rebuilt.

I wish to join everyone else in this debate in paying tribute to the extraordinary work that carers do, giving of themselves; it is self-sacrifice, and they get no plaudits from anywhere else. They are just committing to helping someone they love, often doing so in challenging and troubling circumstances, particularly where dementia is concerned, as the loss of recognition can be very distressing for a loved one. We also know that many carers are themselves frail, struggling to cope on their own. My hon. Friend the Member for Ceredigion (Mr Williams) mentioned the challenges in rural areas. My constituency of North Norfolk contains many elderly people who are often living in isolated communities and are struggling to get access to the services they need. We owe an enormous debt of gratitude to the work of every carer in our community. As we have identified in this debate, without carers the cost to the public purse would be enormous.

I therefore very much welcome this debate, coming, as it does, immediately after carers week. It gives us the opportunity to discuss how carers of all ages can be properly supported in their role and helped to have a better quality of life. That is what we should be focusing on: putting quality of life and well-being at the heart of the Care Bill. We should not be thinking about what service we deliver to passive recipients; we should always be thinking, “How do we make your life better? How do we make you happier in your life? What might you, as an older person, be able to offer to other people?” It should be about that, rather than about these people sensing that they have nothing more to offer and just facing dependency as they move towards the end of their life in a rather distressing way.

Carers are central to the Government’s proposals for improving care and support. The Care Bill, currently being discussed in another place, puts carers on the same footing as those for whom they care. We propose to simplify the assessment process for adult carers by extending their right to an assessment. The hon. Member for Birmingham, Selly Oak (Steve McCabe) made an absolute point: people need simplicity and they must not be faced with bureaucratic jungles to fight their way through. Our simplified procedures will consider the impact of caring responsibilities on the carer in order to help them to lead as independent a life as possible. We intend to remove the requirement that a carer must be providing

“a substantial amount of care on a regular basis”—

that is the test—in order to be entitled to an assessment. That will mean that many more carers—in essence, all carers—will be able to access an assessment. In addition, the Care Bill seeks to place a new duty on councils to meet carers’ eligible needs for support. Those measures will be underpinned by a Department of Health commitment to provide new resources for carer assessment and support, rising to £175 million per annum by 2020.

[Barbara Keeley]

Has the Minister really taken on board the message that has come from my colleagues in this debate, which is that assessment is not always the answer? A lot of carers do not go near local authorities and are not likely to know of, hear of or ask for an assessment. The people they are in contact with are GPs, doctors and nurses, so there must be much more onus on the NHS and its staff to undertake the task of identifying carers at the earliest stage and ensuring that they get information, advice and support.

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

[Liz Kendall]

Does that mean that there will be a requirement on schools, and on further and higher education bodies, specifically to identify young carers?

[Norman Lamb]

It is not my job to speak on behalf of the Department for Education, and the hon. Lady will have to be a bit more patient in waiting for further news on that subject.

Key principles to inform that work and discussion over the summer are, first, that the starting point should be assessing the needs of the adult or child who needs care and then seeing what remaining needs for support a young carer in the family has. The presence of a young carer should trigger either an assessment or the offer of an assessment to the person needing care. Secondly, a whole-family assessment is key when assessing an adult needing care where children in the family are providing care to the adult or undertaking wider family responsibilities. The adult’s assessment and eligibility for support should take into account their parenting responsibilities and the functioning of the family. Thirdly, assessments should establish why a child is caring and how to prevent—this is the crucial point—excessive or inappropriate caring responsibilities which could have an adverse impact on their education, social activities, emotional development or health. As much as possible we ought to be enabling a youngster to grow up like any other youngster can, without having inappropriate burdens on them that impact on their education and social life.

[Paul Burstow]

Will my hon. Friend confirm that the Government will be publishing amendments to give effect to this within the next week or two? Will he set out the timetable? Will the Government also address the other gap, which is the one regarding parents who are caring for disabled children? We need to make sure that none of those who have caring responsibilities get left behind.

[Norman Lamb]

I cannot give my right hon. Friend a specific time scale for what might happen—he needs to watch this space, and I am sure he will. On the question of parent carers, the view of my hon. Friend the children’s Minister is that there is sufficient provision under section 17 of the Children Act 1989 to provide for the assessment and support of disabled children and their parents. In addition, special educational needs reforms in the Children and Families Bill will give parents more choice in and control over the support they and their children receive.

[Ian Mearns (Gateshead) (Lab)]

It is a sad fact of life, though, that when a social worker visits the home of someone who needs care, they go with that client in mind. If a child in the household is caring for that adult, for example, but the social worker focuses on the adult client, all too often the social worker does not think to cross-reference the child’s needs with colleagues in the social work department.

[Norman Lamb]

I completely agree. That is why the whole-family approach is so important. When dealing with the care needs of one individual, we need to look at the impact of those care needs on the whole family.

[Grahame M. Morris (Easington) (Lab)]

rose—

[Norman Lamb]

I will give way, but I then need to reach the end of my speech.

[Grahame M. Morris]

I am grateful, and I compliment the Minister on his response. Does he recognise that, particularly in relation to young carers, it is quite right to place additional duties and responsibilities on local authorities, but local authorities must be given sufficient resources to discharge those additional duties and responsibilities?

[Norman Lamb]

I am not sure whether the hon. Gentleman was present when I said that we need to be much smarter about how we use the money available. One of the things we need to do—I think there is a degree of agreement here—is integrate health and care. It is a crazy silo situation that we face. We are not using the money effectively. We could achieve much better support if we combined the disparate parts of the system to provide support shaped around the needs of the individual and their family.

The last spending round provided local government with a challenging settlement. That is why we decided to provide extra funding to help local authorities maintain access to services. However, local authorities ultimately have discretion over how they use their resources. Improving care and support is not simply a case of more money. Local authorities must look at how they can transform care through innovation and new ways of working. As I said earlier, collaboration with the voluntary sector is critical to this. Many local authorities are successfully integrating health and care services to improve quality, and we are developing the concept of “pioneers” to act as exemplars to support the rapid dissemination and uptake of lessons learned across the country.

Some hon. Members talked about the role of doctors and other health care workers. I agree that much more needs to be done. We can look at incentives such as the GP survey mentioned in the exchange that I had with the shadow Minister, the hon. Member for Leicester West, and we have provided funding for the Royal College of General Practitioners and others to encourage GPs to think about the role of carers, but what we see from examples around the country, such as Changing Lives in Cornwall, is that once GPs start to collaborate and work as a partnership—as a team—with carers and the family, they begin to see that their burden is relieved because others can help them in the role that they have to perform. That is the essential change that it is so important to achieve.

My right hon. Friend the Member for Sutton and Cheam referred to the £400 million funding over four years for carers’ breaks. It is deeply frustrating that that has not been used as intended in all parts of the country. There are some areas, including Surrey and many others, which have done good, innovative things as a result of that. The Department asked the policy research unit in economic evaluation in health and care intervention to conduct a survey of a number of PCTs to gain their views on the benefits of NHS support for carers’ breaks. The findings will be published shortly and will help inform our understanding of what has happened. The early indications are that there may be more good things happening than we sometimes recognise, but clearly there have been significant gaps and much more needs to be done.

I appreciate that time is almost up. I entirely agree with my right hon. Friend and many others about the importance of work. I make the point again that providing help and assistance to enable people to remain in work is in employers own self-interest, as they maintain the skills in the work force while enabling that person to continue their caring responsibilities.

This has been a good debate. There has been some informed discussion and I am very grateful to hon. Members for their contributions.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I call Paul Burstow. We have about 40 seconds.

14:14

[Paul Burstow]

In that case, I shall be very brief indeed, Mr Deputy Speaker, and simply thank all those who contributed to this debate, ask the Minister to write to all Members who have taken part in the debate about the issues that he did not have time to address, and underscore the fact that this debate recognises the invaluable work of carers and the fact that they are the backbone of our care system. Without them we would not have a health and social care system worth its name. We owe them a great debt, and as a result of that debt we must strive to do more.

Question put and agreed to.

Resolved,

That this House has considered the matter of carers.