Social Care (Local Sufficiency) and Identification of Carers Bill

Baroness Keeley Excerpts

Friday 7th September 2012 Commons Chamber

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

I beg to move, That the Bill be now read a Second time.

I welcome the Minister to his new role and to his first debate, I think, in the main Chamber as Minister responsible for care services. After being drawn third in the ballot for private Members’ Bills, I knew that I wanted to introduce a Bill to improve quality of life for carers. I have been able to introduce a ten-minute rule Bill on the identification of and support for carers three times in the past, in 2006, 2007 and 2010. A number of the sponsors of this Bill also supported the earlier Bills. I particularly highlight the support of the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who both supported each of those three Bills. I also want to highlight the support of the former Minister for social care, the hon. Member for Sutton and Cheam (Paul Burstow), who supported my Bills in 2006 and 2007. I thank the former Minister for his work on this Bill and for meeting me and the Bill’s sponsors to discuss the issues.

The issues addressed by this Bill are of great importance to carers and the people for whom they care. The Bill is supported by 28 national organisations and I shall mention some of them now: Age UK, the Alzheimer’s Society, the Carers Trust, Carers UK, Independent Age, Leonard Cheshire Disability, Marie Curie Cancer Care, Parkinson’s UK, the Royal National Institute of Blind People and the National Union of Students. In addition, 57 local organisations and three NHS bodies support the Bill, as well as more than 2,000 individual carers.

Clauses 4 to 6 focus on the identification of carers. I will talk about them later, but first I shall speak to clauses 1 to 3, which address the sufficiency of social care. We know that demographic pressures are increasing the demand for care services, which is often described as the care crisis. I, like other hon. Members, have argued many times that we need to close the funding gap for social care. The provision of sufficient social care is complex. As Andrew Dilnot says in the report of his commission on the funding of care and support:

“It is a matter for celebration that people are living longer. For many, these are extra years of good health and quality of life. For others whose care needs grow, we see much fear and uncertainty. Caring for and supporting each other should be something to celebrate. In the life and work of individuals and carers we can see dignity and independence made possible, and much that is good about our communities and society.”

We should indeed celebrate the fact that we are living longer and that more than 5 million carers are willing to provide care and support to a family member or friend, but we should also ensure that we support those carers and acknowledge that they have a right to work, and to have a social life and leisure, alongside their caring commitments. The Government frequently express that as their aspiration in carer strategy documents, but it is not what happens in many parts of the country.

A lack of identification of carers and of appropriate support for them has costs for not only the individual but our economy. Carers UK estimates that 1 million carers have given up work or reduced their working hours so that they can care. Its 2011 survey found that 31% of working age carers gave up work or reduced their working hours to care because support services were insufficiently flexible, because the person for whom they cared did not qualify for support, because there were no suitable services in the area, or because the services were too expensive or not reliable enough.

There are many case studies showing the great impact that giving up work to care has had on carers’ lives. Salford carers centre told me of carers who, after seeing no way of avoiding giving up the work that they loved in order to care, felt “desperate” or

“upset at being pushed into a corner”.

Carers UK cites the example of Susan who cares for her adult son, Tom, who has severe autism. Tom needs a lot of care, including constant supervision, because he regularly has fits. He has no sense of danger and does not eat unless prompted. Susan used to be head of English at her local school, but she was forced—she had no alternative—to give up her job to care for Tom because his college holidays did not fit the school holidays, and it was impossible to find suitable replacement care for him. Susan would like to work but, without appropriate care services, she can fit in only 12 days of supply teaching each year around caring for Tom.

Age UK told me about Christine who cares for her mother, Margaret. After Christine’s father died, and owing to her mother’s mobility problems, Christine offered her mother the chance to live with her. She intended to carry on working, but her mother’s mobility deteriorated, and the strain of caring and also working in a demanding job led to the total collapse of her health. After giving up work and using all her savings, Christine found that she had to go on benefits, which wounded her pride and played on her health. Employers for Carers, a business forum of 55 employers representing nearly 1 million employees, supports the Bill as a measure that is important for our country’s future economic productivity.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Given the country’s economic circumstances, we all recognise the importance of keeping people in jobs whenever possible and of creating jobs as part of an attempt to grow the economy. Does my hon. Friend agree that the Bill would go some way towards helping that to happen?

[Barbara Keeley]

Absolutely; I thank my hon. Friend for that point.

The Bill is also supported by British Gas, BT, Bright Horizons and PricewaterhouseCoopers because they believe that its measures are important. Caroline Waters OBE, the director of people and policy at BT and the chair of Employers for Carers, says:

“We are seeing the mounting costs, not just to families but to business of a care system that often cannot support carers trying to juggle work with care. Stimulating the care market can deliver an economic triple win—better services for families, the infrastructure to help employers retain skilled staff and a real boost to economic growth. The debate started 20 years ago with childcare and there is now a pressing need to bring the same focus and progress to care for older and disabled people. This Bill would start this important process by placing a duty on local authorities to ensure a supply of care as is already the case for childcare.”

Members of the Employers for Carers forum increasingly report staff leaving work at short notice to take on caring responsibilities. The peak age for caring is between 45 and 65, and that age frequently coincides with the peak of an employee’s skills, knowledge and experience. Losing such employees can lead to large retraining costs on top of recruitment costs.

A recent report by Dr Linda Pickard of the London School of Economics shows that carers giving up work to care costs about £1.3 billion a year in lost tax revenue and benefits. Also on costs to the economy, a recent report by Carers UK suggests that the failure to address the funding of adequate care provision, as other countries have done, means that we are missing out on jobs and growth.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Does my hon. Friend agree that it is vital that we support carers of working age who are reducing their work hours and days because of the disproportionate impact it has on their pension savings and entitlements? The prospect of becoming a poor pensioner is not the right reward for those who give so much to families and our communities.

[Barbara Keeley]

Sadly, that is the case. We know that the care sector is underpaid, but that is nothing compared with the financial impact of giving up work to take on a caring commitment.

[Roberta Blackman-Woods (City of Durham) (Lab)]

I was interested in my hon. Friend’s points about employers. Does she agree that it is in employers’ interests to learn more about the needs of carers, and to support them better, so that they do not lose valuable, well-trained staff and have to recruit new ones?

[Barbara Keeley]

I very much agree, and I am sure that that is why the Bill has received such strong support from Employers for Carers.

Other countries have put in place development strategies for home care. In France, the first phase of its development strategy for the home care sector led to a growth of 100,000 jobs year on year. However, even after the worldwide recession, such strategies have led to 50,000 more jobs there each year.

There is a real need for care and support services to enable carers and disabled people to work, but the social care picture in England is one of growing need, shrinking provision, and totally inadequate information and advice about what is available. I have discussed the cuts to social care budgets during previous debates on social care funding.

[Dr Hywel Francis (Aberavon) (Lab)]

My hon. Friend makes a powerful case. Is she aware of good practice in Scotland and Wales that England should be following?

[Barbara Keeley]

I have not followed that as closely as I might have done, so I hope that we will hear from my hon. Friend later about the practice in Wales. However, we have much to learn from other countries.

It is important that we bear in mind the shrinking provision of social care because we know that demand is growing. Since 2010, local councils’ adult social care budgets have been cut by more than £1 billion, and a further £1 billion of cuts is expected. The number of vulnerable older and disabled people who have their home care services fully paid for by their local authority has fallen by 11% over the past two years. According to a survey by the Care and Support Alliance, services have been cut to 24% of disabled adults. Research by Age UK shows that cuts to council budgets mean increased fees for services—in fact, service fees have increased by 13% over two years. Almost half of all local councils are charging more, or making new charges, for home help or day care. One in six councils has reduced personal budgets for care packages, and almost half of all councils have frozen the rates that they pay for residential care. In addition, the fees for both residential care and nursing home care have increased by 5% on average during the past year.

Those are important statistics, but sadly they are not routinely gathered so that they can be scrutinised by, for example, the Health Committee. They were mainly gathered through freedom of information requests by my hon. Friend the Member for Leicester West (Liz Kendall) and various organisations. Local authorities do not have a full picture of local care provision, particularly that needed by the 80% of care users who are self-funding. Those self-funders—people whose assets exceed the means test for local authority support—spend £5.5 billion a year on care, with top-ups to statutory services costing them another £1.15 billion. It is vital that we have a better and more complete picture of social care provision, including that very large amount for self-funders.

Clauses 1 and 2 introduce a strategic duty on local authorities in England to ensure that sufficient social care services exist in their local area to meet the care needs of disabled people and carers. They seek to move towards local authorities having a total and accurate picture of what is purchased and provided in their area. Existing duties on local authorities relate only to those for whom the local authority has a statutory responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds.

It might be argued that the Government’s draft Care and Support Bill introduces a duty on local authorities to establish and maintain the provision of information and advice relating to care and support for adults and carers. The draft Bill says that a local authority must promote the efficient and effective operation in its area of a market in services for meeting care and support needs. However, that duty does not cover an assessment of local sufficiency, and it is that picture that can truly help carers and disabled people, particularly in terms of working, as we have just discussed.

Andrew Dilnot, in his 2011 report, set out the need to place duties on local authorities to provide information, advice and assistance services in their area, and to stimulate and shape the market for services. Moving to embrace a duty to develop a full picture of care and support services, and to assess the sufficiency of those services, will assist local authorities in developing their role as market shapers.

Clause 2 includes a duty to promote sufficiency of the supply of care, which, as we have discussed, would bring a new focus on the importance of social care in promoting and enabling work for disabled people and unpaid family carers. Carers UK has analysed local authority joint strategic needs assessments, which is really the only assessment that we have, but this analysis has shown that the majority of those assessments do not link care provision with work, so clause 2 would link well with Government strategies around work for carers and people with disabilities.

[Kerry McCarthy (Bristol East) (Lab)]

A couple of weeks ago in my constituency, I met a group of young adult carers aged from 18 to 24 who, for the most part, look after disabled parents, but sometimes siblings as well. They have particular needs because they are at the stage when they want to get on with their careers and perhaps go to university, and they have to make the choice between that and putting their life on hold to care. Does my hon. Friend agree that we need particularly to look at the needs of that group, who do not fall into the same category as other adult carers?

[Barbara Keeley]

I do, and I will come on to the issue of student carers. The Bill explores student carers for the first time. I do not know why the issue has not been discussed more in the House, but it is vital that we, as constituency Members, take note of it.

Joint strategic needs assessments done at local level do not link care provision with work, and that is why the clause is important. The Department of Health has an upcoming event on developing care markets, the invitation to which we received yesterday. It says:

“the ability to choose from a variety of high-quality services should be available to all people in a local area, regardless of who pays for their care.”

Age UK, in its support for my Bill, commented on that Government aim to give people who need care and support a greater choice. It said:

“this cannot become a reality unless local care markets work effectively to provide people, including those with specialised needs, with appropriate services. Whilst we welcome proposed duties in the draft Care and Support Bill that would require local authorities to take steps to ensure that appropriate services are available this falls a long way short of a requirement to ensure sufficiency. We will certainly be advocating for a Bill or subsequent regulations that will include more specific duties on local authorities.”

[Philip Davies (Shipley) (Con)]

I congratulate the hon. Lady on introducing the Bill and bringing the plight of carers to the House. We all owe carers a big debt of gratitude. The Bill is littered with phrases such as “practical steps”, “reasonable steps” and “sufficiency”. What does she consider sufficient and reasonable, because the Bill does not make that clear, and how much would those steps cost?

[Barbara Keeley]

I will come on to the sufficiency measures, which are similar to a provision in the Childcare Act 2006, which placed a duty on local authorities to report on the sufficiency of child care in their area. The key thing is to ensure, first, that local authorities have a good enough picture. At the moment, the only picture they have is of what they are commissioning and providing, and, as I said, 80% of people who need care are self-funding, and their needs and whether they are being met are not looked at all. We therefore have a huge gap in information on the needs of those people and whether they are being met. There might be a need for nursing home beds for people with certain categories of dementia, and unless they were paying for them, local authorities would have no idea whether those existed. That information does not exist for all the people living in an area who needed that provision. As I said, health bodies and local authorities do joint strategic needs assessments, but they are not taking account of the fact that that can help people to work. We are trying to ensure that, as with child care, there is such provision, so it is similar to that measure.

The Bill does not go into detail because that is usually done in regulations which would be decided after the Bill had been passed. These are matters that can be debated and decided in Committee. However, in placing new duties on local authorities we are aware that we want regulation to be as light touch and low cost as possible. That is why some of the language is hedged around with phrases such as “reasonable steps”. We do not want to put expectations on local authorities that they cannot meet in the present environment.

[Philip Davies]

That was a helpful response. To get to the nub of the issue, does the hon. Lady believe that the House should pass legislation to provide certain duties, at whatever cost, which should be met, or does she accept that only a certain amount of money can be afforded and that the question then is how best that can be allocated?

[Barbara Keeley]

We are talking about a reporting duty. If local authorities, working with their health partners, do not report on social care provision, no one else will. Those of us interested in these matters ask questions, but we do not get very good information. Sending freedom of information requests to every social care authority in the country is not the best way for national organisations or Members of the House to get such information. We are asking for a picture of the market to be held in each local area. I am not suggesting a move in a direction in which the Government are not already going. The Government now expect local authorities to be what they call “market shaping”, taking action to drive the market. We are saying that they do not even have a picture of what exists now. Until we have such a picture, which is not just gathered by freedom of information requests, the expectation of the Department and the Government of local authorities is perhaps not reasonable. It is not a budgeting duty but a reporting duty.

I was dealing with sufficiency and the reporting duty and saying that organisations such as Age UK believe it is important that local authorities have a view of the sufficiency of their local care services. To expand on a point my hon. Friend the Member for Leicester West has made, the way local authorities are currently cutting back on what they pay in fees for social care beds and nursing home beds is actually creating market distortions, because some providers are simply moving to areas where there are more self-funders. In Greater Manchester, for example, all the nursing home providers might move to Trafford, which is a wealthier borough, and we would not have proper provision in Salford, part of which I represent. What is happening in the market could result in that kind of distortion, and that should be spotted.

[Mr David Nuttall (Bury North) (Con)]

I am grateful to the hon. Lady for giving way and, indeed, for bringing the matter before the House; she is making a valuable contribution. Does she not share my concern that there is a danger that imposing new duties to prepare the various assessments and reports that the Bill would require could actually take funding away from the provision of front-line services?

[Barbara Keeley]

I have run through some of the details. Front-line services have already been greatly reduced. In fact, local authorities are no longer primary providers, given that they are meeting the needs of a very small group of people.

Let me get back to the point about sufficiency. The all-party group on local government has recently conducted an inquiry into adult social care, supported by the local government information unit. We looked at the role of local government in shaping the local market for social care and took evidence from local authorities that are already acting on that. Interestingly, Nottinghamshire county council told us that it monitors and records occupancy and availability of care home beds for self-funders, which is unusual. Lancashire county council told us that it provides advice and information to all on mainstream services, and signposting to them, regardless of whether people would be eligible for council services, and it is one of the first authorities to do that. The inquiry found some examples of market-shaping activities by local authorities, but the final report was clear that that was only an emerging role for local authorities, and we could not find many examples.

Clause 3 therefore provides that local authorities should assess local care needs and existing social care provision, and if supply does not meet demand, as the hon. Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) have just touched on, the local authority would have a duty to consider the necessary steps to address the gaps. They would not have to take those steps; it is just that nothing will happen unless they have some idea of how it might happen. In their market-shaping role, for instance, they might try to encourage more nursing home providers of a particular type. That is similar to measures set out in the Childcare Act 2006, through which the Government sought to ensure sufficient local child care.

Clause 4 would ensure that NHS bodies had procedures in place to identify carers, promote their health and well-being and ensure that they received appropriate information and advice. I first sought to introduce such a measure in 2006 through a ten-minute rule Bill, and then again in 2007. I acknowledge that progress has been made, but there is still much to do. As we know, many carers do not recognise that they are carers; they see their caring role as part of being a wife, husband, son or daughter. Many are hidden, particularly at the start of caring.

I believe that a key focus in identifying carers should be concern for the health of 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. Interestingly, figures published by the NHS Information Centre show that that figure had doubled, to 22%, by 2010. In Salford, the proportion of carers who provide full-time care has actually been at a higher level for some time. In 2001, around one in four carers in Salford provided care for more than 50 hours a week, and even at the time that was more than twice the national figure for carers with the heaviest commitment. I am almost certain that that is related to health inequalities and poor health.

Two wards in my constituency have very high levels of people caring for relatives with stroke disease, heart disease or cancer, which mean the heaviest commitments. We know that full-time care can take a toll on a carer’s health, so the health needs of 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 those caring for a person with dementia or stroke disease are even more at risk. Early identification and support for those carers means that they can maintain their health and manage and sustain their caring role better.

The Princess Royal Trust for Carers centre in Salford has a project to identify carers both within primary care and at the Salford Royal hospital. I want to take this opportunity to pay tribute to The Princess Royal Trust for Carers for its work in primary care over many years in centres such as the one at Salford. Its work has been done by a primary care worker, Julia Ellis, and the centre manager, Dawn O’Rooke. In fact, the previous Minister responsible for care services, the hon. Member for Sutton and Cheam, visited my constituency to hear about the trust’s project to identify carers within primary care. I extend an invitation to the new Minister to do the same.

Different local GP practices do the work of identifying carers differently. For example, practice nurses from the Limes medical centre carry out their identification work when making home visits to patients who seem to have a carer. They run through a series of questions with the patient and carer about who does certain tasks and then fill in a referral card for the practice to ensure that the health team knows about the carer so that they can be referred to sources of advice and support. The Dearden Avenue medical practice has a different approach. Its staff carried out a search on the practice’s computer. For all those patients over 70 who are not in residential care, a letter was sent to the next of kin asking if they were the patient’s carer. Of 149 letters sent, 90 were returned by carers. The carers centre could then send information about the care and support available to the carers, including having an assessment of their own needs.

I am pleased to know that GPs and primary health care teams in my constituency are tackling that work, but there is much more to do. The manager of the carers centre tells me that, having established a network of links within GP practices to identify carers, over 300 referrals a year are made to the centre by local GPs. However, we have some 20,000 carers in Salford, of whom around 5,000 will be caring for more than 50 hours a week. We need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them for advice and support.

Clause 5 would require local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. Young carers are the most hidden of all carers. The 2001 census recorded some 175,000 young carers, but more recent research by the BBC indicates the much higher number of 700,000, which is around 8% of secondary school pupils. Most young carers care for a parent, often a single parent. The care they give might involve much physical care or the difficult task of providing emotional support for a parent with a mental health problem or substance addiction.

The Carers Trust tells us that the identification of young carers remains a key issue, as many young carers seek help only in a crisis. As we have discussed in previous debates, many young carers find that their extra responsibilities lead to their failing to complete work for school, doing badly in exams and, worst of all, being bullied. Although teachers and social workers are the best people to identify and support young carers, there is a lack of professional awareness about their needs and concerns. Young carers report that they can feel stigmatised by teachers, and they might leave school or college prematurely without completing qualifications.

[Roberta Blackman-Woods]

My hon. Friend makes a wonderful point about the need to support young carers more. I have been a school governor for more than 20 years but have never heard the governing body talk about the needs of young carers. That needs to be addressed and more information needs to be given to governors and head teachers.

[Barbara Keeley]

My hon. Friend is absolutely right. Indeed, the carers centre in Salford has a young carers project that has developed to the point of having a presence in all but one of the secondary schools in Salford. It has also started a more limited level of work in primary schools. It is vital, because it is identifying young carers and spreading awareness among teachers and pupils about the role of young carers. It is only that work with other pupils that will stop them bullying and picking on young carers.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Further to that point, does my hon. Friend agree that it is vital that all professionals who come into contact with young carers get together and communicate more, especially with regard to young people who are trying to stay under the radar and doing everything possible not to be identified as carers? The one person in their lives who could probably identify them as carers is the GP, because the GP would know the needs of the parent they are no doubt caring for.

[Barbara Keeley]

Very much so. It sometimes involves social workers and very often teachers. Teachers need this awareness because young carers may fail to turn up at school, not do their work on time, and not be there for exams. It is often said by young carers’ organisations and projects that GPs and health professionals ignore young carers. A 10 or 11-year-old is expected to care for someone with perhaps an alcohol problem or a mental health problem, and yet the GP or doctor involved in that situation simply ignores them, treating them as if they were not there.

[Diana Johnson]

Given what my hon. Friend is saying about young carers, there appear to be similarities with looked-after children. Measures have been put in place in schools to ensure that looked-after children are given the support they need in difficult circumstances. Could we transfer those measures to children who are caring for siblings or parents?

[Barbara Keeley]

I am sure that there are similarities. This field of work is opening up, but much more needs to be done.

It is interesting to talk to organisations such as the Carers Trust and the Children’s Society, which run the young carers projects, about identification, which my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) mentioned. Young carers are already eligible for assessment under carers legislation and as “children in need” under the Children Act 2004, but very few of them are identified or ever assessed for support. In supporting the Bill, the Carers Trust says that

“clear duties on local authorities and further and higher education institutions to identify and support young carers will help ensure that inappropriate caring is prevented or reduced so that young carers can enjoy the same opportunities and outcomes as other children and young people.”

[Dr Francis]

Does my hon. Friend agree that as the Bill progresses it will be important for the Minister to look at the excellent work that Crossroads Care did in the recent past in supporting young carers through projects of the kind that she has described?

[Barbara Keeley]

I am sure that it will. The difficulty with capturing this in the Bill, as in any legislation, is that it spreads across Departments. It is something for us to work on, and there is much to be done.

Young carers do not enjoy the same opportunities and outcomes as other children and young people. The Carers Trust tells us that young carers frequently experience worry, stress, anxiety, depression and feelings of loss and panic, as well as mental health problems and risk of self-harm. They fear for the condition of the person they care for, but they often have more fear of being taken into care. They feel angry and resentful because they have such responsibilities, yet they are not recognised. Most of all, they experience a lack of time for play, leisure and sport, and miss out on social time with their own age group. A serious consideration for all of us, given that we are talking about 8% of the secondary school population, is that a caring role also leads to missed educational opportunities, poor educational outcomes, and, later on, reduced employment opportunities. Over a quarter of young carers aged 11 to 16 miss school owing to caring, and that figure rises to 40% when the parent is mentally ill or misusing drugs or alcohol. Young adult carers are twice as likely as their peers not to be in education, employment or training. It is common for them to move into full-time caring after they finish compulsory education, particularly if they are receiving no support.

Clause 6 would place a duty on colleges of further and higher education to identify students who are carers and to have in place policies of support for them. When we included this proposal in the Bill, I did not realise that it was quite ground-breaking and new. A report in 2008 by Young Carers International for the Princess Royal Trust for Carers reported that there were 290,000 young adult carers in the UK. The figures move between 300,000 and 800,000; nobody really has any idea. The report said that apart from statistics that could be obtained from the census,

“Little is known about young adult carers aged 16-24 in the UK”

and:

“Information is sparse about the issues and challenges that they face due to being carers”.”

Young adult carers at university or college have to balance giving care with their academic studies and learning. Some do this by caring at a distance, returning home at weekends or holidays to provide care, but 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. The report told us that none of the young adult carers at university it surveyed was aware of any specific carer support being available at their university. Similarly, they were often unaware of local services for carers that might be able to support them because, sadly, those services have not reached out to university student populations. There is a mismatch in that regard.

That was the situation in 2008. It is interesting that only this year greater awareness of the needs of student carers seems to be developing. The Fair to Care campaign in Scotland is lobbying for the development of carers’ strategies in universities.

[Mr Nuttall]

What is the problem that the hon. Lady is seeking to address in this clause? Is it that she feels that student carers do not have access to information?

[Barbara Keeley]

The problem we are trying to address is that the people who are responsible for the welfare of these students and their progress through their courses do not recognise that caring will get in the way of what they can achieve at university, given all the potential difficulties—for example, a sudden deterioration of the cared-for person’s condition. Policies are often in place for parent carers with children and mature students, but there is a complete gap in what universities have considered for other carers.

[Mrs Hodgson]

I hope that the Bill will deal with a situation that I fear my daughter’s best friend will otherwise fall foul of. They have both just done their GCSEs, they are both as able and bright as each other, and they both want to go on to university. My daughter plans to go away to university while her friend is considering staying in the local area, for the reasons my hon. Friend has highlighted. I worry that without the Bill her aspirations may never be fulfilled, because if she does not get the support it suggests she might start at university but then find that she is unable to continue. That would be so sad, because at 16 the two friends are as bright as each other.

[Barbara Keeley]

I agree; that is a very good point.

[Philip Davies]

I wonder whether the hon. Lady is being unfair to universities by saying that there is a gap in the provision of information for student carers. I do not doubt that she knows more about the subject than I do, but my local university, Bradford, has a very extensive policy on student carers, with lots of information about what help could be provided. In saying that there is a gap, does she think that he might be doing a disservice to universities such as Bradford, which are clearly doing an awful lot to help student carers?

[Barbara Keeley]

I am very glad to hear that Bradford does that. Professor Luke Clements of Cardiff university, who helped to draft the Bill, says that it depends on having the right sort of vice-chancellor with go-ahead policies. It is not only I who believe that there are gaps; so does the National Union of Students, which understands these things. Particularly in Scotland, the websites of people who are standing for representative positions in the NUS show that they are all campaigning on Fair to Care and asking universities to have a carers strategy. It must therefore be the case that lots of universities, including those in Scotland, do not have a carers strategy. We are asking that a policy be put in place to recognise carers’ needs and tell them where to go for support. I am glad that the Bill would remedy the situation whereby perhaps hundreds of thousands of student carers are left to struggle alone with the difficult demands of juggling their caring responsibilities alongside studying.

The Bill deals with vital issues for carers and for disabled people. I thank Professor Luke Clements and Carers UK for their help in drafting the Bill. Emily Holzhausen and Chloe Wright of Carers UK have provided much extra support in preparing for today’s debate, and I thank them for that. I also thank Kate Emms of the Public Bill Office for her sound advice and help. I thank all the co-sponsors of the Bill for their support for the measures it contains. It has been good to know, as we have worked on this, that the issues involved in social care and the need to identify carers, young carers and student carers generate such great cross-party support.

The provisions in the Bill should be taken forward, and I hope that we will get the chance to discuss and, if necessary, modify them in Committee. Five million carers, including young carers and student carers, depend on our progress on measures that will help them, and I hope that we do not let them down.

--- Later in debate ---

[Sir Tony Baldry]

Having been a Minister in the last Government and as a grown-up and senior Member of this House, the right hon. Lady has a clear understanding of how legislation works and evolves. A large number of private Members’ Bills during the 13 years of the last Government did not make progress in the form in which they were drafted. The point is not that the Bill must pass today in this form, but that it contains a number of provisions, some of which are not in the White Paper.

The grown-up and responsible undertaking that I have received from the Minister is that he will have intelligent discussions with all of us who are concerned about carers policy over the next few months to see whether we can get some of these provisions into the Government Bill when it is brought forward. If not, all of us will want to hear good reasons why, given that some of the work in the private Member’s Bill builds on previous legislation, for example on child care, where there are clear precedents for what we are seeking to achieve.

[Barbara Keeley]

It is not without precedent for Conservative or Labour Governments to accept private Members’ Bills relating to carers. I think that I am right in saying that of the three pieces of legislation brought forward by Labour MPs, one was brought forward with the agreement of a Conservative Government and the other two with the agreement of a Labour Government. For all the pious aspirations in the carers strategy documents that are rolled out by Governments, it is the concrete rights and measures in those private Members’ Bills that have made the difference, as I said in my speech. It is important to recognise that sometimes a specific measure is needed, rather than a lot of consolidation and aspiration, which make no difference to carers on the ground.

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[Barbara Keeley]

I value my hon. Friend’s support given his knowledge of passing previous measures. May I take this opportunity to say that I intend to press the Bill to a Division and have no intention of withdrawing as it was suggested earlier I should do? As I said in the conclusion to my speech, the measures are needed by carers of all ages. That is why I introduced the Bill and I am grateful for his support.

[Dr Francis]

As a vice-chair of the all-party parliamentary group on carers, I warmly welcome my hon. Friend’s intervention. I am sure the group endorses her decision.

As I said, the Bill has massive support throughout the country. There is considerable support from employers, but—this has not been said—there has also been considerable support historically, as there is currently, from trade unions, and particularly the Union of Shop, Distributive and Allied Workers, which has always campaigned for carers. I warmly welcome the endorsement of the Bill by Caroline Waters OBE, director of people and policy for BT group and chair of Employers for Carers. Furthermore, the Association of Directors of Social Services and many individual directors of social services have endorsed the Bill.

A number of hon. Members have spoken of the importance of young carers and supporting young people going through university. I commend the work of the Open university, which has identified carers as a target group to support. I am very pleased with the work done by my good friend Rob Humphreys, the excellent director of the Open university in Wales, who is organising a conference on carers and higher education, which will take place later this year.

The Prime Minister only this week spoke of the importance of all Government Departments focusing on regenerating the economy. What better way to achieve that than by identifying our valued, unpaid carers so as to assist them back to work or into training, or by supporting our young carers in their studies? He could do so today by supporting this admirable Bill.

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[Mr Nuttall]

My hon. Friend touches on an important point. I fear—I am sure others will, too—that this Bill may unreasonably raise the expectations of that group of carers covered by the wider definition. They may think, “This is me; I’m a carer”, but would they be a carer under the much narrower definition in the Bill? As I say, there is a danger that many carers will feel that this debate is about them, when under the statutory definition in clause 8—it is clear, referring back to section 1 of the Carers (Recognition and Services) Act 1995—they may not be covered.

[Barbara Keeley]

It is important for the House to understand that this is a Second Reading debate, and that there will be plenty of opportunities in Committee to look further at interpretations and definitions and to alter those definitions if they are too narrow. First, I hope that the hon. Gentleman will not take up an awful lot more time as others are waiting to speak. Secondly, is he prepared to support the Bill on the basis that if any of the definitions in the interpretations clause were too narrow, they could be looked at further?

[Mr Nuttall]

I am grateful. I was dealing with the point about definitions in response to an intervention from my hon. Friend the Member for Shipley (Philip Davies), but it is part of my wider concerns about the Bill. The Bill’s general aims are entirely laudable. Who would not want to help those who provide care for others, particularly for those who need help, assistance and care? All of us can unite on that. I am fully behind the idea of providing what care we, as a society, can afford to provide for those who need it. However, I think that there is a genuine debate to be had about how much further we can go at present, and about whether the Bill is the right vehicle to provide such support or whether—and I think this is an important point—we should heed the substantial report from the Law Commission, which stated in its first and very clear recommendation that a single Act should replace all the existing legislation. I think that we should give further thought to what has been said this morning about the possibility of incorporating the provisions of this Bill in the draft social care Bill.

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[Barbara Keeley]

The hon. Gentleman should be aware that many carers and disabled people, and their organisations, are following the debate. He has been speaking for more than 40 minutes and rambling around a lot of statistics, and it is now being said on social media that he and his colleagues are talking out a Bill of great value. He should know that people who are following what was a reasonable and proper debate on the Bill do not appreciate the tenor of what he is saying. He is destroying the debate.

[Mr Nuttall]

I have already made my support for carers absolutely clear. My hon. Friend the Member for Banbury (Sir Tony Baldry) has also secured a helpful undertaking from the Minister on ensuring that the Government engage with the Bill’s supporters about the subjects that it deals with in the context of the draft Care and Support Bill.

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[Mr Nuttall]

Thank you, Madam Deputy Speaker.

Let me make a further quick point about the statistics that I was citing. The largest single barrier to employment that was highlighted—by 63% of respondents—was a lack of suitable local job opportunities, so an area’s prevailing employment market is obviously pre-eminent when determining whether a carer or disabled person is able to get into the workplace.

Clauses 1 to 3 would impose a sufficiency duty. The explanatory notes state that the duty

“goes beyond the existing duties and focus of local authorities which are only on those for whom they have direct responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds. There are currently no duties on local authorities to assess or address supply of non-statutory services for individuals privately purchasing care, by encouraging the development of new services.”

The notes go on to say:

“This clause would ensure that local authorities build a complete and accurate picture of the services needed, provided and purchased in their area.”

It would have been helpful if this duty could have been road-tested somewhere on a trial basis. There could perhaps have been a pilot before the Bill was introduced.

Clause 1(2) states that in discharging the sufficiency duty a local authority must have regard to statutory guidance issued by the Secretary of State. It might be expected that such guidance would clarify the terms necessary to determine what amounts to compliance with this sufficiency duty. The explanatory notes helpfully suggest:

“Placing a strategic duty on local authorities to ensure adequate social care would mean local authorities need to assess the care available in their area looking at the supply and demand of care and the affordability, accessibility and quality of provision. They would also need to identify gaps in provision and how these will be addressed. Local authorities would work in partnership with local providers to assess how services could support disabled people and carers to work, where appropriate.”

I will skip a large part of my prepared notes because, as we have heard this morning, where there is a difference between this Bill and the Government’s Bill, the Minister will look at trying to ensure that that requirement is included in the Bill.

The explanatory notes do not tell us the likely cost for every local authority to undertake the assessments that the Bill requires, and that is one of its principal problems. We have no idea of the cost of carrying out an assessment of the social care needs of disabled people and carers in any given area, which is why I suggested that a pilot project might have given us some idea of the likely cost.

[Barbara Keeley]

So that we do not spend a great deal more time on this, will the hon. Gentleman accept that it is not part of the private Member’s Bill procedure in any way to run pilots? That is a matter for the Government. The Bill was introduced a short time ago and that was not possible. It is really not worth his spending a lot of time on that suggestion.

[Mr Nuttall]

I am grateful for that intervention. I appreciate that a pilot cannot be done in the same way that the Government could have done it, but as we have already heard this morning, there are many initiatives going on in local authorities throughout the country, and I am sure that it would have been possible for one local authority to have picked this up and trialled the Bill to at least give us some idea, or put some information before us this morning, of the likely cost, even if it was a matter of someone sitting down and trying to work it out for themselves. There will inevitably be a substantial cost.

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[Mr Nuttall]

The hon. Gentleman is absolutely right. We all want as many people as possible to be able to return to the workplace, and what we are trying to do this morning is arrive at the best solution for achieving that common aim.

Clause 4 relates to the promotion of carers’ health. It would impose a duty on health bodies to:

“(a) promote and safeguard the health and well-being of carers;

(b) ensure that effective procedures exist to identify patients who are about to become carers;

(c) ensure that appropriate systems exist to ensure that carers receive appropriate information and advice”.

Although there are currently no legislative requirements for health bodies to promote the health and well-being of carers specifically, there are already statutory duties on health bodies to promote the health and well-being of people who use health and social care services and members of the public generally. The obvious question is this: what is the point of singling out carers? Surely they are included as a group within the existing legislative provisions.

[Barbara Keeley]

The reason for singling out carers is that they have responsibility for not only their own health, but that of the person they care for, and in many cases they do not take care of their own health and do not have time for doctors’ appointments. We are asking for health bodies to have a specific, extra concern for carers. Given that their whole day can be taken up with caring, that extra duty can sometimes be fulfilled by a GP offering them first or last appointments. The hon. Gentleman has now been speaking for more than 50 minutes. Second Reading is not meant for this sort of line-by-line review; that is meant to happen in Committee. He is pushing it to the point where it is being said outside this place that he is attempting to destroy the Bill and the debate.

[Mr Nuttall]

I am certainly not trying to destroy the Bill. I will stick to my point, because I think that we need to look at this—[Interruption.] [Hon. Members: “In Committee.”] It is an important part of the Bill. Existing legislation covers all members of the public, so I do not think that we need to single out a specific group.

[Mr Nuttall]

That is indeed the case. I am sure that it will be possible to consider all these matters in detail when we look at the draft Bill in Committee.

The NHS operating framework for 2012-13 already provides that carers must receive help and support from local NHS organisations. Primary care trusts are required to agree policies, plans and budgets to support carers with local authorities and carers’ organisations and make them available to local people. It states:

“Following a joint assessment of local needs, which should be published with plans, PCT clusters need to agree policies, plans and budgets with local authorities and voluntary groups to support carers, where possible using direct payments or personal budgets. For 2012/13 this means plans should be in line with the Carers Strategy and: be explicitly agreed and signed off by both local authorities and PCT clusters; identify the financial contribution made to support carers by both local authorities and PCT clusters and that any transfer of funds from the NHS to local authorities is through a section 256 agreement; identify how much of the total is being spent on carers’ breaks; identify an indicative number of breaks that should be available within that funding; and be published on the PCT or PCT cluster’s website by 30 September 2012 at the latest.”

So there is already a lot going on within the NHS. Let us not forget that the Department of Health is providing the NHS with £400 million over the four-year period from 2011-15 to support carers in taking breaks from their caring responsibilities. The Department has also funded the national carers strategy demonstrator sites programme, which is focused on three areas of support to improve carers’ health and well-being, carers’ breaks and health checks, with better NHS support. The new idea of national carers strategy demonstrator sites has been independently evaluated by the Centre for International Research on Care, Labour and Equalities at Leeds university, which has prepared an excellent report on how successful it has already been.

Clause 5 seeks to place a duty on a local authority to ensure that within 12 months of Royal Assent

“it takes all reasonable steps”—

again, we have no idea of what “reasonable” may amount to—

“to ensure that in relation to…any school within its area and under its control, and…any functions it discharges…there is in place a policy”

to identify and support young carers. However, the clause makes no mention of academy schools. Perhaps when the hon. Member for Worsley and Eccles South winds up she will be able to explain why academy schools would not be covered, because they are state schools that are independent of local authorities but still funded—

[Barbara Keeley]

To ensure that the hon. Gentleman does not mislead the House or any of the very large number of people who are watching him try to destroy this debate, let me point out that as the promoter of the Bill I do not have an opportunity to wind up. That is not how these debates work.

[Mr Nuttall]

That is absolutely right. I should have said that the hon. Lady might explain by way of intervention why these schools are not included, as she did not mention it in her opening speech.

There is already a lot of very good work going on in this area. In 2009, the Association of Directors of Adult Social Services and the Association of Directors of Children’s Services published a model local memorandum of understanding entitled “Working Together to support Young Carers”, which was aimed at providing staff in schools and other adults with a framework to develop support for young carers and their families.

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[Mr Nuttall]

My hon. Friend is right that, under the Localism Act, local authorities now have a general freedom to do what they want without being given specific powers by central Government.

I pay tribute to the important and valuable work of various charities in this sector, for which they should be warmly commended. The Carers Trust charity’s website is a good source, packed with useful information. A particularly useful function enables anyone who is seeking help to find the location of their nearest centre simply by typing in their postcode. It covers the Princess Royal Trust for Carers network and the Crossroads care schemes.

[Barbara Keeley]

On a point of order, Madam Deputy Speaker. Is it not now the case that the hon. Gentleman is departing too far from the Bill’s content? I do not think that a discussion of the website of the Princess Royal Trust for Carers has anything to do with this Second Reading debate.

[Madam Deputy Speaker (Dawn Primarolo)]

This is a matter for the Chair. There is an argument that reference to the trust’s details is relevant to the Bill. The trust is also identified clearly in the House of Commons research paper.

Although this is not on a point of order, while I am on my feet I remind the hon. Member for Bury North (Mr Nuttall) that, in principle, it is not permitted to read a speech in the Chamber. It is permissible to refer to notes and read short extracts from documents, but I think that he is stretching that widely now. He is in order and I hope that he will stay in order. I am sure that he is about to conclude to allow others to speak.

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

I thank the shadow Minister for her kind comments. I shall address her other comments in due course, but I should first thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the Bill and giving the House the chance to discuss the vital question of how carers of all ages can be supported effectively.

I pay tribute to the hon. Lady’s work over a long period. She has been a doughty campaigner and is deeply knowledgeable. Whatever disagreements we have on elements of the Bill or on how to proceed—[Interruption.] It is quite important that the hon. Lady hears what I am saying. Whatever disagreements we have, I am keen to engage with her and her colleagues to ensure that we get it right. My only interest is ensuring that we go through a proper pre-legislative scrutiny process before the Government introduce our Bill. I am happy to confirm now—I am happy also to write to her—that I will meet her before our consultation ends in October to go through all the issues raised in the Bill that are relevant to my Department.

The shadow Minister asked whether I would commit to including all the Bill’s clauses in the Government’s Bill. I have been in the job for four days so I shall not make any commitment of that sort, but I shall commit to discussing seriously all the issues to ensure we get it right. There are significant areas of overlap and some areas of disagreement about the approach we should take. I am concerned that a plethora of duties could end up introducing new bureaucratic processes that could—I think the hon. Member for Bury North (Mr Nuttall) made this point—take money from the front line that provides care and support and introduce costly processes that do not deliver any results for the people we want to help.

I accept absolutely that the proposal is well intentioned, but there is a risk of a plethora of duties. It is essential to have one code, written in plain English, that people understand. I will enter into discussions with her and her colleagues, and with the groups that support her measures, so that we can try to build a consensus. There has been a wide welcome for what the Government are doing in implementing the Law Commission proposals, the biggest reform for many years, so let us make sure that we get it right.

[Barbara Keeley]

I welcome what the Minister says, and it would help me and the organisations and individuals who have worked with me on the Bill if he confirmed it in writing. Opposition Members do not want a plethora of duties. The Bill, in imposing duties on local authorities, might be a little too extensive, but it contains two important points that must be taken forward. The first is to have a picture of sufficiency and not to have to do everything through freedom of information requests, which might require local authorities to go a bit further than they currently do. Secondly, although there is some wonderful practice among health professionals in identifying carers, we need to go further to ensure that health bodies understand that they must have policies in place. We need to do more than just encourage a few champions to take that forward. They are the people who will have the best picture of families and the caring situations of young carers. They are the only ones who can do it. I have wonderful practice in my constituency, as well as places where it is not happening at all and people are left to their own devices. Out of everything in the Bill, those are the two points that are important to take forward. One is—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I think the Minister gets the point.

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[Norman Lamb]

I completely agree with my hon. Friend.

[Barbara Keeley]

On timetabling, clearly I could have done anything with this slot for a Bill, but we need to get on with things. I do not know whether the Minister can say what he thinks the timetable is now, but when we proposed the Bill it was not clear. People are in desperate need: carers are not being identified and there are big issues. That was the point of introducing the Bill. It is elegant to have everything in one statute, but it does not help people if that takes for ever.

[Norman Lamb]

I am happy to write to the hon. Lady with more information about timetabling. I absolutely want to get on with this. Pre-legislative scrutiny is important because it will ensure that we get the legislation right, but I am not interested in delay. I want to get the Bill on to the statute book, but I also want to get it right.

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[Norman Lamb]

The hon. Lady makes a very good point. I remember challenging the Labour Government on similar grounds when I was in opposition. Money had apparently been allocated to primary care trusts to provide carers with support, but nothing ever happened. I made that point as strongly as I could at that time. I will come on to explain how we shall deal with the legitimate point that the hon. Lady raises.

This extra support might mean the carer and the cared-for person taking a day trip together, so they can spend time outside of the confines of the caring relationship. It might also be through a direct payment—pursued under the Labour Government and now developed under this Government—that could be used to buy a laptop so that the carer can keep in touch with family and friends. In all these matters, we need to be as open as possible to the different ways in which the money can be spent.

There are some excellent examples of good practice in the area of carers’ breaks. In Surrey, the new GP carers’ breaks pilot has been running since 1 December 2011. So far, 80% of the 136 practices in Surrey have signed up and over 250 breaks have been provided, with 75% to parent carers. Surrey has been working with Carers UK on the evaluation of the pilot to tie up with its work on the GP carers’ champions project. In Cambridgeshire, Crossroads Care is part of a very good scheme whereby PCT money for supporting carers is used to support a GP prescription service. This is really good, innovative stuff. The GP can simply prescribe a carer a break, send a request to Crossroads, which will quickly contact the carer to discuss what sort of break they would like, and then arrange it. I urge GP practices across the country and the emerging clinical commissioning groups to look at this best practice that is emerging around the country and to implement it in their own areas in a way that suits their own local circumstances. We must do more to spread the best practice that is starting to emerge.

Let me say a few words about the mandate. In July, we published for consultation the first draft mandate for the NHS Commissioning Board. The mandate will be at the heart of the accountability relationship between the Department of Health and the Commissioning Board from April 2013. The draft mandate contains a specific objective: to improve the support that carers receive from the NHS by early identification of carers—that is dealt with in the Bill—by signposting to advice, and by working collaboratively with local authorities and carers’ organisations to enable a range of support to be provided. The consultation on the mandate is currently taking place, and I welcome Members’ engagement in that process.

[Barbara Keeley]

The Minister may not know the answer to my question, but it would be interesting to know how progress will be reported. Will the NHS Commissioning Board report progress to the House? It is good that the provision has been included, but it will be only as good as its implementation.

[Norman Lamb]

Four days into the job I am not entirely sure of the details, but I will ensure that the answer to the hon. Lady’s question is included in the letter to her. I certainly want the process to be as transparent as possible.

The NHS operating framework for 2012-13, published last November, contains stronger requirements for supporting carers, and is more specific about the plans of PCT clusters. Those plans should be in line with the “Recognised, valued and supported: next steps for the Carers” strategy. Plans should be explicitly agreed and signed off both by local authorities and by PCT clusters. Local authorities and PCT clusters should identify the financial contribution for supporting carers. They should identify how much of the total is being spent on carers’ breaks—this deals with the point raised by the shadow Minister—with an indicative number of breaks that could be made available within that funding.

PCTs or PCT clusters should publish their plans on their website by the end of this month, so we shall be able to see which areas are doing the job well and which are failing. Area authorities need to be held to account, whether they are PCT clusters or commissioning groups. People need to know what is available in their areas. A number of PCTs have already put resources into support for carers, significantly enhancing their existing support for them.

The current legal framework for care and support is out of date, complex and confusing. More than a dozen Acts of Parliament relate to adult care and support, and four relate specifically to support for carers. We can imagine how hard it must be for people out there, beyond this place, to understand what their rights might be. People who need care, carers, and even those who manage the system find it difficult to understand how statutes operate and interrelate. That is why one of the overarching objectives of the Government’s draft Care and Support Bill is to consolidate the existing law on care and support into one clear Act, making the law far easier to navigate. Introducing yet another stand-alone Act would only prolong fragmentation and militate against the thrust of the draft Care and Support Bill, which is to consolidate provision for carers in Government legislation. That point has been made by my hon. Friend the Member for Banbury (Sir Tony Baldry).

As I said earlier, the Government’s Bill has been published for pre-legislative scrutiny, which we expect to begin later in the autumn. We should view that process as an opportunity to explore how we can make legislation fit to support carers in the 21st century.

I am afraid I must disagree with the assertion by the hon. Member for Worsley and Eccles South that her Bill will be cost-neutral. Placing new duties on public and private sector bodies inevitably involves cost. New processes must be developed and operated, and will surely be a potential drain on the already tight social care, NHS and education budgets. That goes against the Government's commitment to reduce the overall regulatory burden. Inevitably, organisations confronted with a new legal duty must establish processes enabling them to demonstrate, when challenged, that they are observing it, and that means costly bureaucratic processes. As other Members have pointed out, it is much better to ensure that the money is being spent on the front line. We are committed to spending significant amounts on carers in the coming years, and we should be spending that money on supporting people, not on expanding bureaucracy.

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[Norman Lamb]

I am not a member of the quad, and I have not read any notes or minutes of the meeting. Obviously, the hon. Lady will understand that the whole issue of funding social care and the Dilnot proposals is high on my agenda. I am happy to talk to her about it in due course, once I have got my head around where we are with that debate, but I am in no doubt that we need to reach a settlement and ensure that adequate resources are available for them. We also need to ensure that the system gets the incentives right so that people who are committing their own resources to the system feel that it is worth doing and that it keeps them in good health and well-being.

The Bill seeks the early identification of carers in order better to support them. Although we fully support that notion, we do not think that a formal bureaucratic process is either the right or best way of going about it. As has been said, many people with caring responsibilities do not see themselves as carers. Indeed, many people do not wish to be labelled as such, and we must respect how they want to be seen. People with caring responsibilities should be able to choose for themselves whether they want to be identified as a carer, and that should be an informed choice by the individual.

[Barbara Keeley]

I really must challenge that. A process or procedure does not have to be formal, and nothing in any of the good practice that I have talked about seeks to force on a carer a recognition of being a carer. The people I know who work on this in primary and secondary care in Salford are very sensitive to these points. We have to make things available: information, support and referrals. The connection has to be made. We cannot proceed on the basis of, “This is bureaucracy and carers would be better off without it.” Carers are very rarely better off not knowing where they can go for help and support.

[Norman Lamb]

I absolutely agree with what the hon. Lady is saying: the information, guidance and support have to be made available. That is the key point, and I do not think there is any disagreement between us on it.

However, imposing a duty on public and private bodies to identify carers could be seen by some as intrusive. This depends on how the body seeks to exercise the duty, but it will be exercised in a variety of ways and this could conceivably be intrusive for some who want to be private about their family circumstances. We know that some families in which a young person is providing care can be very wary of letting others know. It is very important that they are given all the information, guidance and support they might need, but they may be afraid that the child will be taken into care, or they may be concerned about the opinions and reactions of others, including schoolteachers; the hon. Lady herself talked about the stigma that, outrageously, sometimes attaches to young carers. Public and private sector bodies need to be aware of such sensitivities, as I believe she accepts. They need to tailor the way they act and support carers in order to be responsive to the individual needs of the child and their family. This Bill runs the risk of preventing such sensitivity and flexibility.

In many areas, work is already under way to help to identify and support carers, without there being a specific legal duty in place. For example, NHS Surrey is developing a health care pathway to trigger the identification of carers, enabling them, where appropriate, to be pointed towards information and local authority carer assessments. The key issue—this is the point we have just debated—is not about labelling people as carers; it is about raising awareness and understanding of what a caring role can entail among those working in education, health and social care. We need to equip them with the knowledge to direct people to relevant sources of information, advice and support.

GPs and those working in the NHS have a vital role to play. Last year, the Department of Health funded a range of initiatives by the Royal College of General Practitioners, Carers UK and the Carers Trust to increase awareness in primary health care of the needs of carers and how to access support. GP carers champions and voluntary carer ambassadors have been appointed and much good practice in the early recognition of carers has already been identified. We will build on that programme and are considering how it can be extended to the acute health sector and community nursing services.

Awareness is already being raised in many areas. I know that in my constituency of North Norfolk, a new service to support carers has recently been piloted at GP surgeries. The initiative was developed by the North Norfolk clinical commissioning group and is being delivered by the Norwich and District Carers Forum in 20 GP surgeries in the north of the county. Two part-time support workers are available every month at each surgery to give support to anyone in an unpaid caring role and they have been able to refer carers for a carers’ assessment to help to meet their emotional and practical needs. They have also referred carers to other agencies for support as appropriate. Those are the sort of things that the hon. Lady’s Bill seeks to encourage and I am sure that she will welcome them as they emerge around the country.

The service was designed by North Norfolk’s CCG patient partnership, which was formed to give patients at the practices in North Norfolk the chance to influence and help to design local health services. That is exactly what we should be doing—involving patients. Subject to evaluation of the pilot, it is hoped that the service will be rolled out to other GP surgeries across the county.

Let me deal with young carers, as many hon. Members have mentioned the situation that they face. Local authorities already have a duty under the Children Act 1989 to safeguard and promote the welfare of children in need in their area. The Government are funding the Children’s Society and the Carers Trust to work with local authorities and voluntary organisations to encourage children’s and adult services to work more closely together and to adopt a “whole family” approach to identifying and supporting young carers.

Young carers involved in a recent series of whole family regional conferences, facilitated by the Children’s Society, were determined that they want to be seen as just like other children and young people. At the same time, they were very clear that timely and effective support for young carers and their families can make a real difference to their lives in a range of different ways. Their views have informed the development of a template for a memorandum of understanding between directors of children’s services and adult social services published last month by the Association of Directors of Adult Social Services, the Association of Directors of Children’s Services and the Children’s Society.

Let me say a word about students, whose situation was specifically raised by the hon. Lady and others. For students at university who are also carers, colleges and universities often have systems in place to identify specific needs through student unions and personal tutors. They provide a range of services, including the flexible provision of further and higher education, which can be very important in ensuring that students are not held in a straitjacket, and enabling learning on a part-time or distance learning basis, with students able to choose the best mode of study for them.

The Department has also has funded the National Institute of Adult Continuing Education to undertake a project to improve the lives of young adult carers and young adult carers with learning disabilities and, in particular, to support them in pursuing education and employment opportunities.

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[Norman Lamb]

The hon. Lady makes a clever intervention. We need to have that debate, because we agree about the ambition of achieving much better support for young people with caring responsibilities who are in education.

The proposals set out by the hon. Member for Worsley and Eccles South include ensuring that there are “sufficient” local care services, and she spoke about that specific point. I assure the House that the Government are committed to supporting that outcome. We want care users and carers to have a real choice of a range of high-quality services—whether state funded or paid for by individuals—and to have the information that they need to make an informed choice that is right for them. The “Caring for our future” White Paper is clear that enabling people to choose from various care and support providers that offer different ways of meeting people’s needs and goals will drive up the quality of care and support, including support for carers. Under the provisions of the draft Care and Support Bill, we propose to place a duty on local authorities to promote diversity and quality in local care and support services, to facilitate choice, and to meet the care and support needs of all local people and their carers.

Enabling carers to have a life outside caring, and helping those with caring responsibilities to fulfil their employment potential, are among the key priorities outlined in our cross-Government strategy “Recognised, valued and supported: next steps for the Carers Strategy”. In designing local care provision and drawing up joint strategic needs assessments, local authorities should recognise the importance of identifying carers’ needs, including their need to work. Local authorities’ assessments and reviews should take account of a carer’s wishes to remain in or return to work, as well as whether a carer’s involvement in employment is at risk because of their caring role. It is extraordinary that carers are rarely asked about their wishes with regard to employment. By simplifying the law, we will ensure that this existing requirement is given far greater emphasis.

The White Paper also set out a commitment to offer support to every local authority in England to fulfil this duty and, in particular, to develop or improve its market position statements. Effective market position statements make public key market intelligence, including the data from the joint strategic needs assessment and data from local consumer surveys and specific groups. They will send a clear signal to the market about the current and future level and nature of local demand for care and support services. The hon. Member for Worsley and Eccles South specifically highlighted the importance of how we develop the local market. For the first time, organisations large and small, be they private companies or charities, will have a clear picture of the demand for care and support and be able to innovate and invest in their services and staff accordingly.

[Barbara Keeley]

It is obvious that the Minister’s officials have given him a lot of material. I do not know whether he intends speaking until 2.30 pm, but at least four other Members are anxious to speak. I am aware of the commitment that Members have made to be here today and I just wanted to make him aware of that.

[Norman Lamb]

I do not intend to speak until 2.30, and I am moving towards the end of what I have to say. I absolutely take the hon. Lady’s point.

Effective market position statements will also set out a local authority's future commissioning intentions, their brokerage plans and the types of services that it wants to see develop to meet the needs of local people and their carers, regardless of how they pay for their care. We expect to see a more flexible market develop; one that will enable carers and care users to pursue their own goals more easily, including education and employment opportunities.

The Bill also seeks to place a requirement on local authorities to conduct an assessment of what sufficient social care means in their area, and what steps they could reasonably take to address the gaps in service provision. The Health and Social Care Act 2012 already requires local accountability to produce and deliver on strategic health and care needs assessments through the new health and wellbeing boards. From April 2013, health and wellbeing boards will take over responsibility for undertaking joint strategic needs assessments and must develop joint health and wellbeing strategies to meet the priorities identified. These will inform local commissioning plans. This is already happening.

A Surrey-wide survey was undertaken in 2011 to seek carers’ views on their experiences of health care services and to ask them about their own health and well-being. This information has informed the development of the Surrey joint strategic needs assessment. The Act requires that these assessments cover all current and future health and social care needs for the local population, and as such we expect them to cover the needs of carers as well as the needs of care users. This will ensure that health, social care and other services are fully integrated locally. I suspect that the hon. Lady completely agrees with this. A separate assessment of social care, as proposed by the Bill, would militate against the integration of health and social care as well as duplicating the existing legal requirement to assess social care needs.

In July, we published draft statutory guidance on joint strategic needs assessments and joint health and wellbeing strategies for consultation. I will certainly commit to enhancing the message, already contained in the document, about including the needs of carers. I make that point specifically as a result of the hon. Lady raising these issues in the Bill today. The Department of Health will also work with sector leaders to develop a suite of wider resources to support health and wellbeing boards in undertaking these joint assessments and strategies.

I pay tribute to the hon. Lady’s long-standing commitment to improving the recognition and support of carers, which is widely recognised across the House. It is clear that we share the same objectives, but we differ in some respects in the way that they can best be achieved. Therefore, the Government cannot support the Bill, but I repeat my commitment to work with her and her colleagues and the caring organisations to ensure that we get the framework in a single Act as right as possible. I would be happy to have that further discussion with her and her co-sponsors of the Bill before the end of the consultation period on the draft Care and Support Bill, and we can maintain the dialogue as we head into pre-legislative scrutiny. We can then consider how we can progress our shared ambitions through Government legislation and other non-regulatory means.

As I have mentioned, hon. Members have a number of opportunities to engage in the work that is already under way: the draft Care and Support Bill, which is the draft legislation on reform of provision for children and young people with special educational needs; the guidance on the joint strategic needs assessments; and the programme of work relating to market position statements. That will ensure that the issues that this private Member’s Bill seeks to address will receive appropriate and proper focus.

--- Later in debate ---

[Philip Davies (Shipley) (Con)]

Thank you, Mr Deputy Speaker. I have not been left with much time, but I am conscious of the fact that other people wish to speak. I will therefore try to be as quick as possible, as is customary for me on such occasions. It is a pleasure to have you back in the Chair.

I commend the hon. Member for Washington and Sunderland West (Mrs Hodgson) for her closing remarks, because they got to the nub of the debate. What is important is that today’s debate has raised the issues that are important to all of us. We all want to support carers. Like my hon. Friend the Member for Bury North (Mr Nuttall), I remember my mum acting as a carer for my granddad and her father, Charlie, who had cancer. She dedicated many hours to looking after him and other family members came and helped. I understand from first-hand experience how important it is that we give as much support to carers as possible.

The most important thing about today’s debate, which the hon. Member for Washington and Sunderland West made clear as she summed up, is that we have gone through the issues that we hope will be addressed by the Government. They have produced a draft Bill and presumably legislation will come before the House in the not-too-distant future. All the issues that have been debated today, including the contents of the private Member’s Bill, can be debated during the passage of the Government Bill. Amendments can be made at the Committee and Report stages of that Bill, and far more time than we have been allowed today will be available to scrutinise those measures. We all hope that, at the end of all of that, we will have a measure that we can all agree upon, if that is possible, and that gives the best possible support to the carers who need it. The important thing is not whether this specific Bill gets through to the next stage, but what the overall outcome is. That will be determined by the Government’s draft Bill, and that is where it is best left.

I will move on to discuss the specific issues. It is important to look back at the history. The hon. Member for Worsley and Eccles South (Barbara Keeley), who presented the Bill, said when I intervened on her— I apologise if I get this wrong—that the Bill is about putting reporting responsibilities on local authorities. It goes far beyond that, however. Clause 1 introduces a

“duty to ensure sufficient social care support”.

That goes far beyond the reporting of that support.

As my hon. Friend the Member for Bury North said in dealing with an intervention, the Bill comes after more than a decade of the hon. Lady’s party being in government, and she is now calling for more to be done. It was only in 2008—I seem to remember that the hon. Lady was a Minister at that time, although I could be wrong about that as well—that her Government published an update to the carers strategy that was introduced in 1999. The update stated:

“By March 2011, we will have invested over £1.7 billion for councils to use to support carers in a range of ways through the annual Carers Grant. This includes £25 million a year announced as part of the New Deal for Carers for emergency break provision.

We have also committed a further £22 million to cover the costs of the establishment of information services via a helpline and a training programme for carers and information service, and £3.4 million to directly support young carers through extended Family Pathfinders and support for whole-family working.

We are now investing over £255 million on new commitments as part of this strategy.”

It seems to me that the hon. Lady is asking in the Bill for things that her Government claimed were already happening. Perhaps she will explain why her Government did not do what she seeks.

[Barbara Keeley]

It is quite clear from all the excellent contributions to the debate that Members understand that this is not just about allocating budgets. It is about having the right processes and about people taking their duties seriously. We can throw any amount of money at carers’ breaks or anything else, but if carers are not identified, if GPs ignore the fact that people are carers or if young carers are not taken seriously at school and are bullied and intimidated, it does not make any difference how much money is sloshing about. That is why the specific reporting and other duties in the Bill are so important. The Bill is mostly about having processes and procedures in place and ensuring that health and other professionals take them seriously.

[Philip Davies]

I could not agree more. I totally and utterly endorse what the hon. Lady says. Joking aside, it is refreshing to hear an Opposition Member say that it is not just spending money but getting results that is important. All too often, spending money was all it was about under the previous Government. It was about input rather than output. I am delighted that she wants to concentrate on output, as I do.

I contend that much of what the hon. Lady seeks to do in the Bill is already happening in one form or another. She might argue that it is not happening as well as it should, and I am sure that it could always be better. She may well argue that it is happening better in some parts of the country than others, and I suspect that will always be true whether or not there is legislation. When she referred to the lack of support for carers at universities, I pointed out the excellent work that Bradford university does to support carers. I believe that the same work is done at Leeds university. I have certainly seen a document from that university about the support that it wants to give to students who are carers. I argue that much of what she wants is happening anyway in various places, and there is certainly nothing to prevent them from happening even without the Bill. I am sure that if all of us, including the Minister and the hon. Lady, contacted universities, showed them best practice from other universities and urged them to follow suit, their vice-chancellors would be happy to do so without the need for further legislation. There are other, more imaginative and perhaps quicker ways of achieving her aims than going through the rigmarole of passing the Bill.

Much of what the hon. Lady seeks is covered in the Government’s draft Bill and White Paper. I take the point made by my hon. Friend the Member for Banbury (Sir Tony Baldry) that the hon. Lady introduced her Bill before any of that was known, so she was absolutely right to do that, but we are where we are. Given that the Government have adopted in the White Paper much of what she wants, we can safely leave the Minister to carry on. We all accept that he is a capable and decent person, and he has given the House assurances today that will have reassured us all about how he intends to proceed. He has said that he wants to involve the hon. Lady in the discussions about the Government’s draft Bill before it proceeds, and I am sure she knows that he means that. We can rely on the Government to introduce the best aspects of her Bill, so we do not need to proceed with it.

My hon. Friend the Member for Bury North made the point, which the Minister reiterated, that some of the duties that the hon. Lady’s Bill would place on local authorities, although well meant and with a positive element to them, could take money away from the front-line resources that we want to go to people who need them. It could instead have to be spent on further reporting, strategies, documents and other things that could eat up a considerable amount of local authorities’ money before we know it. I am not sure whether that approach is desirable. As I said, there might be some desirable ends, but overall it is more likely to take money from carers than to give them support.

[Barbara Keeley]

Do the hon. Gentleman and his colleague, the hon. Member for Bury North (Mr Nuttall), have a view on the billions of pounds that could remain in the economy if people do not give up work to become carers? If local authorities draw up the local sufficiency picture, it will help carers to stay in work. If carers stay in work, they are earning money, they are not on benefits and they pay tax and national insurance. Does the hon. Gentleman not see that there is a balance to be struck? I am sure that the sufficiency reporting duty will in no way match the billions of pounds that would be lost if 1 million carers give up work to care.

[Philip Davies]

The hon. Lady makes a fair point although I cannot speak for my hon. Friend the Member for Bury North. If he had not been cut short we might have learned his view of the sufficiency measures, but perhaps we will hear it at a later date. I do not want to get bogged down or I will be criticised for trying to talk out a Bill that I have no intention of talking out. On this occasion—one for the record books—I endorse what the Government are doing. I wish the Minister well in developing the strategy, and I hope that we get the outcome we seek. In all honesty, however, we can do that without the Bill, and if the hon. Member for Worsley and Eccles South had known the Government’s plans at the time of the ballot for the private Members’ Bills she might have chosen a different issue. As she must acknowledge, the Government are doing much to go down the route she has advocated today.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mrs Mary Glindon (North Tyneside) (Lab)]

2. What steps he is taking to bring forward legislative proposals on the funding of social care.

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

15. What steps he is taking to bring forward legislative proposals on the funding of social care.

[The Minister of State, Department of Health (Paul Burstow)]

The draft Care and Support Bill contains clauses that support our commitment to introduce a universal deferred payments scheme and a national eligibility threshold. We have set out our intention to base a new funding model on the principles of the Dilnot commission model and we will take a decision in the next spending review.

[Paul Burstow]

It does not need legislation to sort out the amount of money that goes into social services; it does need legislation, however, to put in place a universal deferred payments scheme. We have made it clear that we will fully fund the commitment that we have already announced and we will work with the Local Government Association and others on its detailed design and implementation.

[Barbara Keeley]

The verdict of the Care and Support Alliance on the delay in introducing legislation to reform social care funding is this:

“Each day of delay condemns greater numbers of older and disabled people to the risk of isolation and neglect,”

trapping people in hospital and pushing many more carers to “breaking point”. Just when will the Government realise the damage done by delaying the decision to do anything about funding social care?

National Health Service

Baroness Keeley Excerpts

Monday 16th July 2012 Commons Chamber

[Mr Burns]

I will now make progress.

Treatments available on the NHS are based on clinical need. There should never be any arbitrary rationing based on cost either locally or nationally—[Interruption.] The right hon. Member for Leigh shouts from a sedentary position, “There is”, and waves a piece of paper a little like Chamberlain on his way back from Munich, but if the piece of paper that the right hon. Gentleman is waving is his NHS health check, which officials in my Department have looked at, it is as worthless as the piece of paper that Chamberlain brought back from Munich.

If the right hon. Gentleman has any genuine evidence based on the cost of care, I and the Department of Health will certainly investigate it. Such practices are totally unacceptable, and we will take them very seriously indeed, but until then, although the motion talks about “the evidence presented”, the truth is that there is none.

The right hon. Gentleman claims that the number of cataract operations has fallen significantly since we came to power, but the reason for the fall is that clinicians have advised that the surgery is inappropriate in many cases—on clinical grounds. Surgery is available, however, for those patients who are clinically eligible, and they will receive it when there is a clinical reason.

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

Will the Minister give way?

[Mr Burns]

No, I am making progress.

The motion notes the growing involvement of the private sector, insisting that it represents evidence of growing privatisation. Not only is that unadulterated tosh, but I personally find it offensive to be accused of seeking to privatise the NHS, when in my political philosophy one of my core beliefs is in an NHS free at the point of use for all those eligible to use it.

Not only does the right hon. Gentleman have some difficulty understanding the meaning of “privatisation”, but he forgets his own record in government. The only plan to increase the private provision of NHS services came under the previous Government when he was Minister, when his hon. Friend the Member for Leicester West (Liz Kendall) was the special adviser and when Patricia Hewitt was Health Secretary. In May 2007, the right hon. Gentleman said:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”

Those are his words. It was his Government who saw private companies paid 11% more than NHS providers for doing the same work, and who wasted £297 million on operations that never happened at independent sector treatment centres. Given that he may have forgotten, I must tell him that the Labour party manifesto in 2010, when he was the Secretary of State for Health, stated:

“Foundation trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values”.

That suggests that, as Secretary of State, he was prepared to have in his own party’s manifesto a policy allowing and encouraging foundation trusts to attract more work from the private sector.

This Government’s Health and Social Care Act 2012 specifically prohibits the Secretary of State, Monitor or the NHS Commissioning Board from favouring any type of provider, be they from the NHS, the charitable sector or the independent sector. It does so because this Government understand something that the right hon. Gentleman’s never did—it is not the nature of the provider, but the quality of the outcomes that matters most to patients.

Care and Support

Baroness Keeley Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

I am grateful to my right hon. Friend. It was neglectful of me not to mention that the White Paper and the announcement that I have made also drew on the recommendations and work of the Health Committee, and I am pleased to have been able to respond to its report as well.

First, matters relating to the legislative programme for the next Session will be announced in the normal way in the Gracious Speech. Secondly, I am determined that we will not only, I hope, have continuing cross-party talks but that they will be conducted, as I think that the shadow Secretary of State himself would wish, with the sector in a more open, public debate. If we were able to arrive at a position whereby, notwithstanding the fact that funding decisions might be made in the spending review, there was scope to put in place legislative provisions that allowed that to happen and could be agreed in time for the introduction of the draft Care and Support Bill, then we would look to make that happen. However, that is conditional at this stage.

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

The Secretary of State seems to forget two things. First, his Government did not implement the Personal Care at Home Act 2010, which would have made a difference to people. Secondly, they did not ask Dilnot to consider where the money was coming from, so he can hardly be blamed for not putting forward suggestions. The Secretary of State has committed to a few of Dilnot’s principles but ignored the fact that he advised the closure of the current funding gap in social care. Will he back Labour’s call for the Treasury to use £700 million of this year’s health underspend to close that funding gap, which is the cause of the crisis in social care?

[Mr Lansley]

First, it is ironic that the shadow Secretary of State said that local authorities would be aghast if they were asked to do extra things without resources given that we are providing those resources and that the Personal Care at Home Act was completely unfunded, which is why local government was desperate for us not to proceed with it. Andrew Dilnot and his colleagues are very clear, as are we, that there are, as I said in my statement, baseline funding pressures on local authorities in relation to social care. That will be addressed in the next spending review, as it was necessarily addressed in the previous spending review in direct response to recommendations that Andrew Dilnot gave us in 2010.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

My hon. Friend will be aware, as other Members are, that this is an independent review conducted by the joint committee of primary care trusts. On that basis, I will not comment directly on anything said in that context. I simply reiterate what was made clear in last year’s debate that the joint committee will not conduct its review solely on the basis of the options set out in its original consultation.

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

Regarding the answer given to my hon. Friend the Member for Leicester West (Liz Kendall), the Government did not promise to give us a progress report on funding, but to legislate in this Session to reform social care funding. Social care is now widely seen as being in crisis. When will the Secretary of State commit to acting urgently—because urgency is needed now—to tackle this crisis?

[Mr Lansley]

I must correct the hon. Lady. We did not say that we would legislate in the current Session. What we made clear was that we would publish a White Paper—which we will do—and that we would publish a progress report on funding reform. We were also clear—as we still are—about the fact that, as part of the coalition programme, we would act urgently, and we will continue to do so.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 27th March 2012 Commons Chamber

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

For both end-of-life care and social care more generally, the Budget was a real missed opportunity, in that the Government did not signal what they were going to do about the future funding of social care. Will the Secretary of State now update us on the discussions that he has had with the Treasury about what will be done about the gap in the future funding of social care?

[Mr Lansley]

On the contrary, the Chancellor set out very clearly his intention that a White Paper on the reform of social care would be published in the spring. The hon. Lady may wish to know that we are in direct discussions with the Opposition to seek consensus about the long-term reform of social care funding.

Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 20th March 2012 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

Thank you for calling me, Mr Speaker, for what I hope will be a brief intervention prompted by the remarks of my hon. Friend the Member for Banbury (Tony Baldry) and the right hon. Member for Wentworth and Dearne (John Healey).

Later this evening, the House will consider—yet again, many of us would say—the Health and Social Care Bill, but the issue for consideration now is whether the Government should publish the transitional risk register on the Bill. The right hon. Member for Wentworth and Dearne was explicit that he was not arguing that all strategic risk registers should be published, and acknowledged the argument that there needed to be private space in which civil servants could give advice to Ministers secure in the knowledge that it would remain private, because there was an important interest of good government that that discipline and space should exist. That is an argument that he explicitly accepted and of which I am a strong supporter.

My hon. Friend the Member for Banbury reminded the House that only yesterday two retired former heads of the civil service told peers in the other place of the importance of the principle that Ministers must be able to receive advice from civil servants on policy issues, including the risks associated with them, without that advice later becoming public. The issue that the right hon. Member for Wentworth and Dearne did not cover but which is important is that there needs to be confidence within the civil service about which side of the line advice will fall. If civil servants can give advice to Ministers believing that it will remain confidential and if, after the advice is given, the line is moved and the advice falls to be published, we run the risk that across Whitehall the space that he advocates will, in truth, not exist, because there will not be the confidence that the advice will not later fall to be published.

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

The right hon. Gentleman is talking about advice. It has been made clear that this is not advice but a management assessment of risks relating to the Bill and the reorganisation. It is not about policy or advice, which is why it is important that it is released.

[Mr Dorrell]

It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential or whether they will be published. The important principle is certainty.

Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 20th March 2012 Commons Chamber

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

Will the Minister give way?

[Paul Burstow]

No, I am going to make some progress and then I will be more than happy to give way. [Interruption.] I am sure there will be more opportunities and I will give way in a moment.

On how Monitor exercises its powers, the Government have supported amendments made in the House of Lords, which were tabled by my noble Friend Baroness Williams, providing that the Secretary of State can give Monitor guidance to help ensure it exercises its functions in a manner consistent with the Secretary of State’s duty to promote a comprehensive health service. The amendments also help to ensure that the Secretary of State can discharge effectively his responsibility for the health service in England and to ensure that Monitor carries out its functions to that end. I therefore commend the amendments to the House. Both this House and the Lords have stressed the need for Monitor to use its powers to support integrated services and co-operation between providers. The Government therefore tabled amendments in the other place to provide express powers for Monitor to set and enforce licence conditions that would enable integration and co-operation between providers.

On the detail of Monitor’s specific regulatory powers, Monitor would have powers to intervene proactively to support commissioners in ensuring continued access to NHS services if a provider became unsustainable. Amendments tabled by the Labour peer Lord Warner, which we agreed in the other place, provide that Monitor will have to identify and publish evidence where it identifies risk that it considers arises from unsustainable service configurations. Those amendments would require commissioners to act on that information where necessary. Hence, they make clear the expectation that commissioners will address problems proactively and ensure that patients continue to have sustainable access to the services they need. These are sensible provisions that had support from all parts of the House of Lords and I hope that this House will also agree to them.

I want to say a bit more about the powers and responsibilities of Monitor, which relate to further amendments made in the other place. The extent of the various matters that Monitor would have to take into account was the subject of considerable debate in this House and the other place. I want to be absolutely clear about where we are regarding the overarching duty that Monitor has to take into account. Monitor will have a single, unequivocal duty—to protect and promote the interests of patients by promoting provision of NHS services that is economic, efficient and effective and that maintains or improves the quality of services. Beyond that overarching duty there is no hierarchy. No preference is given to competition or integration because integration is clearly a responsibility that sits with commissioners and Monitor’s role is to support it.

Peers also raised concerns about proposals for the Competition Commission to undertake seven-yearly reviews of competition in the provision of NHS services. The Government were sympathetic to the arguments and were concerned that it might be taken to suggest that competition was being given a higher status than the interests of patients. In order to avoid that, we accepted an amendment tabled by my noble Friend Lord Clement-Jones that removed the provision in the Bill for Competition Commission reviews. We also supported other amendments tabled by my noble Friend Lord Clement-Jones requiring the Office of Fair Trading to seek advice from Monitor whenever it considers mergers or potential mergers involving foundation trusts. The amendments will help to ensure that benefits to patients are evaluated on an informed basis by a sector-specific regulator giving its expert advice to the OFT in the discharge of its responsibilities and as a paramount consideration.

--- Later in debate ---

[Paul Burstow]

Absolutely not; the reports to which the hon. Gentleman refers, which had a substantial exposé in The Mail on Sunday, really do not bear as close an examination as he would like of them. We know that the relationship that existed in terms of contracting McKinsey to provide services was one that the previous Government engaged in far more freely than the current Administration. The amounts that this Government have contracted and the nature of the relationships that this Government have are far smaller.

[Barbara Keeley]

I have asked the Secretary of State about McKinsey and Co. in this Chamber and through a written question, but neither he nor anybody in the Department seems able to confirm whether it has access to the risk register. It seems very strange to me that the Department is not able to answer the question of an hon. Member about what access that organisation has to those documents. It is a very strange set-up.

[Paul Burstow]

The hon. Lady says it is a strange set-up and refers to her endeavours to get an answer to the question. I have not seen details of her exchange with the Secretary of State, but I will look at that and write to her with an answer to the question.

--- Later in debate ---

We expect Monitor to oversee foundation trusts’ proposals to increase their income from non-NHS activity. As my noble Friend the Minister said in the debate in the Lords on Report, if a foundation trust is increasing its non-NHS income by more than 5% of its total income in a year, we will expect Monitor in every instance to review whether there is any cause to intervene in order to safeguard the ongoing provision of NHS services. That is a proportionate and reasonable response and a proportionate role for Monitor to assume.

[Barbara Keeley]

I do not know whether I am alone in this—I do not think so—but the notion of foundation trust governors having to approve an increase in private patient income does not feel like much of a safeguard, especially as the governors are inclined to balance the books. It just means that the proportion of private patient income will slowly grow to 49%, rather than jump to it straight away. While we are thinking about this aspect of clause 163, I understand that the Department of Health still has an explicit target in the operating framework to increase the proportion of non-public sector provision purchased with NHS funding. There are so many pressures and drivers that the denial that it is privatisation and the influx of competition—[Interruption.] It is privatisation that will slowly grow to 49%.

[Paul Burstow]

Absolute nonsense. That is part of the rhetoric and fantasy that we have heard throughout the Bill’s passage. Let me deal directly with it by reference to examples of current practice. The Royal Marsden and the Royal Brompton and Harefield all earn very high levels of private income but are consistently rated highly as providers of NHS services. They use those resources to reinvest in NHS services.

Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 13th March 2012 Commons Chamber

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

I want to speak in support of the motion, which notes the e-petition and declines to support the Bill in its current form. As has been said but deserves repeating, the Conservative-led Government have no democratic mandate for the Bill; quite the opposite, given the Prime Minister’s promise that

“with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures”

of the NHS. Yet this reckless and unnecessary top-down reorganisation will cost £3.5 billion, which could be spent on patient care.

Already in my local area and many others, patients are losing services, waiting longer and receiving poorer treatment than before. Salford primary care trust has ended its active case management service for people with long-term conditions—the service had been both popular and effective. NHS budget cuts have meant that a community matron service was ended in a local area.

The Select Committee on Health recently dealt with the impact of the NHS reorganisation in its report on public expenditure—my right hon. Friend the Member for South Shields (David Miliband) quoted it. The report concluded:

“The reorganisation process continues to complicate the push for efficiency gains...it more often creates disruption and distraction that hinders the ability of organisations to consider…effective ways of reforming service delivery and releasing savings.”

Cuts are having a direct effect on treatment. A staff member of the local branch of the Parkinson’s Disease Society told me recently that NHS cuts mean that GPs and pharmacists are switching to cheaper brands of drugs for patients with Parkinson’s, many of which are much less effective. One person was admitted to hospital. She became ill following a switch to a cheaper, less effective medicine. The hospital staff told her that she should be “firm with her GP” and insist on the more expensive brand.

The Bill brings competition into the NHS at a level that is unhealthy and unwanted. The PIP breast implants saga showed us the dangers for the NHS of a vast increase in private provision when regulation of medical products for use in surgery is so poor. In January, 14 consultants, GPs and public health experts wrote a letter to The Times about the expansion of private provision and the issues arising from PIP implants. They warned that the Health and Social Care Bill

“provides much less protection for patients should their provider fail than is available to people booking package holidays”.

With PIP implants and private surgery, there was a strong marketing sell to patients of the benefits of surgery but little information about risks, and little or no interest in aftercare. That is an important warning. We know that there are potential health issues with metal-on-metal hip implants, yet there will be pressure on patients waiting for a hip or knee replacement to go for private surgery to avoid the waiting lists that we know are building up.

The Bill risks creating a two-tier NHS and a return to the long waiting lists experienced under Conservative Governments in the 1990s—the Government have already watered down guarantees on NHS waiting times. I recall meeting a patient in 1997 who had been waiting up to two years for vital heart surgery, yet more recently in my constituency I have met people whose lives have been saved in a matter of days by the rapid diagnosis and treatment of cancers.

A number of local GPs have written to me calling on the Government to drop the Bill because they feel it undermines the bond of trust between doctor and patient. One GP told me:

“The reforms are being made on the cheap. GPs are being asked to do the work of the PCTs with half of the funding and all of the blame when problems arise. The Bill drives a wedge between primary and secondary care.”

That GP actually supports the theory of clinicians being given more input and supports a reduction in bureaucracy, but says that the Bill “does the exact opposite” because it introduces new layers of bureaucracy such as the clinical senate. He says that people coming in

“are doing so at different levels of understanding…leading to confusion.”

He feels that, ultimately,

“it will be the patients who will suffer…no one has asked the patients what they want.”

[Bill Esterson]

My hon. Friend describes a GP in her constituency, but a GP in mine described his concern to me. He said that he is there to be a doctor and wants to care for patients, and that he does not have the expertise to be a manager. That is the overwhelming concern of his colleagues around the country. Does she agree that that is the danger of that part of the Bill?

[Barbara Keeley]

I very much agree. Only quite recently have GPs expressed such concern. I have never known GPs to come to their MPs in numbers, as they are doing, to complain about the implementation issues they are already finding. As I said, the GP I quoted supported the idea of GPs being more involved with decisions about patients, but he now thinks that the Bill is

“simply a mask for a cost cutting exercise…a way to deal with the NHS on the cheap. A way of farming out support systems…e.g. clinical support, into the private sector.”

He says:

“More money will be taken out of the NHS and put into the private sector.”

The hon. Member for South West Bedfordshire (Andrew Selous) asked us to trust the wisdom of our GPs. That is a damning indictment by a Salford GP, and one that I believe is echoed by GPs up and down the country. Trusting the wisdom of my local GP, I urge hon. Members to support the motion.

Adult Social Care

Baroness Keeley Excerpts

Thursday 8th March 2012 Commons Chamber

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

May I start by congratulating the hon. Member for Truro and Falmouth (Sarah Newton) on leading the debate and on the way in which she has just opened it? It is good to work with her on the all-party group on social care. In debates such as this we work together to ensure that social care receives the focus that it needs to have in the House.

I want to discuss two aspects of the future of social care. The first is the current crisis in care and the need to bring in extra resources to close the funding gap. The second is the recommendations of the Dilnot report, which the hon. Lady has already touched on, which mainly focused on dealing with the catastrophic cost of sustained high-level care and support.

On the funding gap, the Minister told me and the Health Select Committee recently:

“We don’t accept the position that there is a gap. We have closed that gap in the spending review.”

However, Age UK’s “Care in Crisis” report says:

“This year spending on older people’s social care in England has fallen by £500 million and the funding gap is growing. … We project that by 2011-13 the Government would need to spend £1 billion more than this year to stop the situation getting any worse. … The current system is at breaking point.”

Research by Age UK showed that 82% of local authorities now provides care only to those with substantial or critical needs. Fewer than one in five local councils still provide care for those with moderate needs. I have to say I am happy that that includes my own local authority of Salford.

The Economic and Social Research Council centre for population change has looked at the issue of unmet need for social care. It concludes that, regardless of the data source used,

“there is significant unmet need for care among older people.”

For example, 66% of people aged over 65 who need help with bathing were not receiving any support. That figure was based on data from 2008 and since then we have had front-loaded cuts to local authority budgets. I am sure that, although there is no up-to-date estimate, there are greater levels of unmet need than the figure I have given.

The Association of Directors of Adult Social Services has reported £1 billion of cuts to adult social care budgets in 2010-11, with further cuts predicted for next year.

This week many of us were involved when about 1,000 campaigners and 60 organisations lobbied Parliament for the urgent reform of social care and an end to the care crisis. For the first time, thousands more who could not attend Parliament joined the lobby online. A statement from those care and support organisations to MPs and Ministers said:

“Our social care system is broken. It cannot cope with a rapidly ageing population and positive impact of people living longer with illness and disability. Those who use our social care system can no longer tolerate a social care system which leaves many with no support and others with poor quality services. The public are angry that they can face huge care charges and end up losing all their savings or being forced to sell their home.”

One of the 1,000 people who came to Parliament to lobby MPs was a deaf-blind woman from Manchester who got up at 5 am to travel down because she said she was so worried about the future of social care. The Care and Support Alliance said that MPs heard personal experiences from people who need care but are receiving none, disabled people unable to access the support needed to live independently, families paying huge bills for care and carers pushed to breaking point.

I wanted to test the situation in my local area before the debate. Over the past few days I checked with three organisations that support older people and carers in Salford and the neighbouring area in Greater Manchester. This drew a depressing but familiar picture of services worsening, mainly due to budget cuts, but also due to cuts and organisational changes brought about by the NHS reforms. A staff member at Parkinson’s UK in Greater Manchester told me about her clients, people who have worked hard all their lives but are now struggling to pay for services that are essential to them. In some cases she had to apply for grants to help people with Parkinson’s buy a profiling bed or even pay off debts.

The staff member told me about a couple struggling to pay for the care needed by the husband, who has Parkinson’s. To help get him out of bed and dressed costs £22 an hour, and having someone sit with him while his wife does the shopping costs £11 an hour. Another carer of someone with Parkinson’s and dementia had her respite care cut from two weeks a year to one week. She feels that she cannot cope without those two weeks of respite. The staff member also told me that budget cuts mean that people with Parkinson’s can wait for a year for a stair lift, and she knows one man who has to go to bed at 7 pm because later in the evening his mobility gets worse and he cannot manage the stairs.

The staff member also told me that NHS efficiency targets mean that GPs are switching to cheaper brands of drugs for patients with Parkinson’s, but many of these are less effective. One person she told me about was admitted to hospital after becoming ill following a switch to a cheaper, less-effective medicine. The hospital staff had told her to “be firm with her GP” and insist on the more expensive brand. We have to be realistic that that is a difficult thing to do. NHS budget cuts in the local area have meant the loss of the community matron service, a service that was used by Parkinson’s UK staff for many of their clients but has now ended. In Salford—I have raised this point before—the primary care trust ended the pilot of active case management for people with long-term conditions, which was proving popular and effective.

Locally, Age Concern has told me that it has now lost the funding for a “Friends for Life” pilot scheme, which was part of the national dementia strategy. Its dementia support service has a planned income reduction of 40% over three years. It has had to make seven staff redundant and reduce its dementia support. Funding for day centres is being reduced by one fifth and will then be ended owing to the switch to direct payments from individual budgets. We all support personalisation and individual budgets, but not if it is a cover for cuts. I was disturbed to hear of a couple of cases where that is happening. In one case I was told about, a carer who had previously had two hours of respite care was given a budget of £9 and told, “Do what you want with the money.”

Our carers’ centre manager in Salford told me of her own experience of such cuts, this time to the personal budget of a family member she cares for with a learning disability who lives in Sheffield. Following what she described as a “fairly perfunctory” re-assessment that was done solely with the person with the learning disability, with no input from a carer or guardian—that is an important point—the personal budget was cut by £10,000. In that case, the carers’ centre manager was able to lodge a complaint and get legal help from a community care lawyer, but she knows that such an intervention would not be possible for other carers. These examples are what we mean when we talk about a care system in crisis.

However, those are not the worst examples. As I mentioned earlier, we know that some 800,000 older people are left without basic care. They have been described as

“lonely, isolated and at risk”.

Those are the words of 60 experts in social care in their recent letter asking the Government to make social care reform a top priority. We therefore know that the problem of unmet need is getting worse. Much of the additional burden will fall on unpaid family carers, many of whom are already overburdened. Statistics from the NHS Information Centre show that the proportion of carers providing more than 50 hours a week has doubled in the past 10 years. I think that that is the level at which it can be counted as a 24/7 caring job, as was discussed by the hon. Member for Brentford and Isleworth (Mary Macleod).

Many organisations have sent us briefings for this debate. There is a consistent call for a solution to the care crisis. Carers UK calls for the capped costs model that the hon. Member for Truro and Falmouth talked about. It sees a cap on costs as essential. It favours the cap being set at £35,000, which it feels would give carers and families the ability to plan for care arrangements and costs, and provide an opportunity for the development of care insurance products. I agree with that assessment and would caution against setting the cap at a higher level, such as £60,000, which has been discussed in the media. That is the value of some properties in Salford, so it could mean a family losing the entire value of their home, which would be wrong.

Carers UK believes that if families know that costs will be capped, they might be more willing to buy care and support earlier. That would help to promote independence and reduce the pressure on carers, which can result in ill health, giving up work or reducing working hours. It is thought that it will be harder to produce that shift in behaviour and move towards a new market in insurance products without a capped costs model.

Care and Support Alliance members argue for an additional £5 billion to be put aside over the next three years to meet the growing demand for social care. The cases that I have mentioned show that there is a clear need for additional resources to meet the growing demand, address the unmet need and tackle the shortfall in resources that has been growing for some years.

The Dilnot commission was given the task of making recommendations on how to achieve an affordable and sustainable funding system for care and support. Its report confirmed what has been said repeatedly for years: the current system is unfair and unsustainable, and without reform it will deliver ever-poorer outcomes for individuals and families. That includes the 1,000 people we saw here this week. The report also said that the funding of social care is inadequate and that people are not receiving the care and support that they need.

Although we may not have time to discuss this today—I certainly will not—the provision of advice and information is poor and very limited. People struggle to find financial information and advice, and there is little information and advice for carers. Worst of all—perhaps we can understand this—because the system is complex and difficult to understand, most people do not plan for, or even think about, the future care provision that they may need.

There is much consensus around the capped costs model. There is support for setting a cap at £35,000 and, as the hon. Member for Truro and Falmouth mentioned, for setting an asset threshold for means-tested support at £100,000. There are other important aspects, such as the need for national eligibility criteria and the need for local authorities to meet the eligible needs of carers. I think that those points are equally important. What still needs to be discussed, and I am not sure whether we will get into it today, is how to pay for the capped costs model and the additional resources that are needed to close the funding gap.

Care and Support Alliance members believe that there is a public appetite for reform. I think that we must take the debate across the country and ensure that the issues and solutions that I have talked about start to be debated. I have spoken about social care issues for the past seven years and I believe that they are now well understood. The 60 organisations that have lobbied Parliament this week have been lobbying on these issues for many years. The people in those organisations and the people they represent are tired of being consulted on the future of social care. What they want is action.

[Andrew George (St Ives) (LD)]

I congratulate my colleague on the Health Committee on her contribution to the report on social care. Does she agree that underlying the issue of care in crisis is an issue with the work force, who often work on the minimum income, are poorly regarded and are subjected to a lot of unfavourable reporting in the press? Does she think that we take them for granted when we look at the overall sector?

[Barbara Keeley]

Indeed, the work force issues are very important. I will not have time to discuss them today, but perhaps other Members will. The things that we hear about, such as tasks being reduced to one-minute periods and visits being cut down to very short periods, must make it a distressing and difficult job. We also have to recognise that personalisation leads to people working in an isolated way. Whereas before they might have been part of a local authority work force, they are now individually employed by care agencies and may not see anyone else. There are some new issues for us to consider, including the one that the hon. Gentleman mentions.

In 2009, after much consultation, my party brought forward plans to establish a national care service. As my right hon. Friend the shadow Secretary of State knows, Labour’s proposals for funding social care were treated as a political football, and there were some regrettable political attacks on them during the general election. That was unfortunate, and we cannot allow it to continue. I congratulate him on going back into the cross-party talks with great willingness, which must have been difficult knowing what happened to him during the election. We must work to achieve consensus across parties and across the country, because the issues that I have mentioned are becoming more pressing than ever before.

I believe I have found a unique way to link two speeches today, both of which you have heard, Madam Deputy Speaker. I talked earlier about women in sport, and this Sunday I will be running in a 10 km race to raise funds for Age UK’s “Spread the Warmth” campaign, which is aimed at making life better for older people in winter and avoiding needless deaths from the cold.

--- Later in debate ---

[Paul Burstow]

I am most certainly aware of that. Social isolation is a huge burden on the individuals affected by it and has huge consequences for health care. That is why, when I talk about independence, I also mean interdependence—the recognition of the value of family support and carers, and of the fact that people need to be active in their community throughout their life. Social care has a role to play in enabling people to do just that, rather than become institutionalised in their own home or a care home. I absolutely agree with the hon. Gentleman about that.

The Dilnot commission made a number of recommendations on the development of a system such as I mentioned, and my hon. Friend the Member for Truro and Falmouth described them well. In the spending review, we allocated an additional £2 billion by 2014-15 —£7.2 billion over the spending review period as a whole. In November 2010, we also set out our vision for social care reform, including the roll-out of personal budgets and greater personalisation. I agree that we need to ensure that that is genuinely about how we enrich people’s lives, not just an opportunity to reduce the available resources to individuals. We are also investing £400 million over four years to help to give carers much needed breaks. We are ensuring that the NHS is held firmly to account for delivering the money in the coming year by making sure that it has to account directly to carers’ organisations locally, and agree with local authorities the plans to provide breaks, spell out how many there will be and the size of the budget for that purpose.

It is also important to dispel a myth about social care, which has been hanging around for far too long—that, in some way, it is just like the NHS and free. As my hon. Friend the Member for Truro and Falmouth said, it is not free and never has been. If people assume that the state will pick up the bill, they are unlikely to prepare themselves. If they do not prepare and they need help, the impact can be truly devastating for them and their families: life savings wiped out, family homes full of memories sold off, and thoughts of a comfortable retirement turned to dust.

We therefore recognise the problem, which is getting worse. Our population is ageing, and that should be a cause for celebration. Too often, debates about ageing in our media are couched in terms of demographic time bombs and the like. However, the current care and support system is not fit for purpose. I agree with the Care and Support Alliance about that. It is broken, and patching and mending it is no longer acceptable.

However, reforming social care will not be easy. As has been said, it will require bold thinking and difficult decisions. The Dilnot commission shed much needed light on the reality of social care funding. Soon, we will publish a White Paper and a progress report setting out our response to the recommendations.

[Barbara Keeley]

Perhaps the Minister will enlighten us on what is meant by “spring”. There is speculation that spring might extend to May, June or July. When I was in government, I spent a lot of time answering questions about what spring meant in relation to Government reports. Will he tell us what it means now?

[Paul Burstow]

On that basis, the hon. Lady knows the answer that I would give and I shall therefore not tire her by saying what she would have said if she were in my place. We are anxious to publish a White Paper as soon as we can in a way that ensures that we have successful dialogue with the Opposition on funding. Those two matters are interdependent.

We are considering not just funding reform, but the legal structure that governs social care, which must be updated. The Law Commission has done a sterling job of making recommendations for replacing the patchwork that has built up in the past 60 years with a legal framework fit for the 21st century. A new social care law will bring clarity where today there is a complicated and confusing system, facilitate personalisation and support staff, service users and carers.

Beyond that, we need high-quality, integrated care, which focuses on early intervention, prevention and the needs of the individual. Better care is about not just spending more money, but spending it much more wisely. The Health Committee made that point powerfully to us. Some councils do that well; others could do it better. That is why the Government are jointly funding with the Local Government Association work to support councils to release savings while improving the care and support they provide.

The Health and Social Care Bill will foster far greater integration between the NHS, social care and, importantly, other public services. Health and wellbeing boards will bring together democratically elected local councillors, directors of children’s services, adult social services and public health services, clinical commissioning groups, and, importantly, the public through Healthwatch, to improve services in our communities. They will identify local needs now and for the future and, importantly, be accountable for setting the strategy to meet those needs. The unprecedented transfer of money from the NHS to social care is creating new opportunities for joint working.

However, we have a long way to go to improve the quality of social care, especially for older people. Clinical audits on fractures or continence care; the parliamentary inquiry into the human rights of older people in health and social care; and damning reports by charities such as the Alzheimer’s Society and Age UK all point to the fact that health and social care in England is far from universally excellent. In too many cases, it is very far indeed from being excellent. There can be no excuses and no mitigating circumstances. Yes, there are excellent staff working in our services, but some staff need to be challenged, and some need to leave the profession because they do not do the right thing. We need to be honest. We need to applaud the good, but to shine a light where there is no good.

It is not a matter of not having enough staff. In some places—

--- Later in debate ---

[Tony Baldry (Banbury) (Con)]

I am grateful for the opportunity to contribute to this debate, not least as co-chair with Baroness Pitkeathley of the all-party group on carers. The first point I want to make is about the phrase “adult social care”. One of the difficulties in this area is that if we are not careful we develop a secret garden of policy and we all start to descend into shorthand—referring to Dilnot as though everyone understands the five paragraphs that follow from that. I thought that the shadow Secretary of State for Health made a good point when he said that, for many people, this is all about being afraid of getting old. I think that this should be about not adult social care but care of the elderly.

When the Law Commission was asked to define social care, the best that it could come up with was the phrase

“promote or contribute to the well-being of the individual.”

That was pretty otiose. We should focus on care for the elderly because we will need to enlist in our constituencies many more people to get involved in this, not least local councillors, with the introduction of health and wellbeing boards. I do not know about other hon. Members but, although I think that the provisions in the Health and Social Care Bill on integration are really good news—I will come on to that in a second—I do not sense that county councillors and others have yet woken up to the fact that shortly they will be part of the boards and will be involved in delivering integrated care. Part of the reason for that is that this has been a bit of a secret garden of policy. One of the things that Ministers will have to do in the near future is go out and talk to, in two-tier authorities such as mine, county councillors, but in others those councillors who are responsible for running social services, to get across the fact that the whole way in which services are delivered will fundamentally change.

About half the speeches this afternoon have been what I would describe as old-fashioned speeches to Ministers, saying, “Please can we have some more money?” The truth of the matter, as we all know, is that there is no more money. It is actually more challenging than that. We have the Nicholson challenge of 4% efficiency savings in the NHS over four years. We will make this work only if we completely rethink the way in which we deliver services. We all know of far too many people who are in hospital but could be moved elsewhere if intermediate beds were available. That would mean they could be moved out of acute beds, such as those at the John Radcliffe hospital or the Horton general hospital in Banbury, but that would require someone working out how to provide more community facilities and intermediate beds and how they would be paid for, and that will require a lot of rethinking by county councillors and GP commissioning bodies working together.

We have to start to put this in a language that everyone understands. When the White Paper is published in the “spring”—that leaves only April—there is a danger that we will all get fixated on Dilnot and the cap. It seems to me that that is just one part of the whole equation for improving care for the elderly and, increasingly, elderly people suffering from dementia. The figures on dementia are really pretty scary. Among the many organisations that produced briefings for today’s debate is the Alzheimer’s Society, which reports—I had forgotten this—that there are now nearly 750,000 people in the UK with dementia, and that figure is set to rise to over 1 million by 2021, when many of us expect still to be in the House.

Dementia costs the UK economy £20 billion a year. When I was first elected to the House, most Christmases I would visit the homes for the elderly in my constituency. The residents then were mostly spry widows in their 70s, but now all the homes are almost totally full of people suffering from dementia or age-related dementia. This is about how we care for the elderly and, increasingly, elderly people with dementia, many of whom are having to stay at home longer. Indeed, the Alzheimer’s Society says that more than half of the people suffering from dementia have not yet been diagnosed as such because their families or those are caring for them are probably disguising the fact.

[Barbara Keeley]

I do not know whether the hon. Gentleman thought that my speech was one of the old-fashioned ones asking for more resources, but he probably did. However, I gave three examples of cuts to services for people with long-term conditions: the support services for people with dementia that Age Concern was running; a community matron service; and active case management for people with long-term conditions. It is inexcusable for those to be cut. If the Nicholson efficiency reforms are causing those services to be cut there is no way forward, because those are the supports in the community that will keep people out of hospital. It seems crazy. I now have three examples, whereas at Christmas I had only one. I am distressed to think that those services are being cut, because they are the way to support those people in the community.

[Tony Baldry]

One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.