Health

Baroness Keeley Excerpts

Tuesday 21st December 2010 Commons Chamber

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

I want to talk about support for the 6 million unpaid carers who provide social care to a family member or friend. More people are having to step in to provide high levels of care to family members. The 2001 census, about which we have heard so much today, found that 10% of all carers in the UK were caring for more than 50 hours per week, but figures published more recently by the NHS information centre show that that has now more than doubled to 22%. In Salford, the proportion has been much higher for some time: 24% of Salford carers cared for more than 50 hours per week in 2001, which was more than twice the national figure.

Carers are key partners in care for the NHS, but full-time care takes a toll on the carer’s own health, and their health needs should be recognised. Carers who care for more than 50 hours a week are twice as likely to suffer ill health as the general population, and those caring for a person suffering from dementia or stroke disease are also more at risk. Importantly, carers who do not receive a break from caring are much more likely to suffer mental health problems—that is, 36% of carers compared with 17% who do get a break.

The Government have announced £400 million of funding for carers’ breaks over four years, to be delivered through primary care trusts initially, but there are problems with this because the funding is not ring-fenced. The Labour Government allocated £150 million over three years to primary care trusts for carers’ breaks, but a survey by the Princess Royal Trust for Carers in 2009 found that less than a quarter of the first tranche of that funding had been used as intended to support carers. Given the financial pressures that are now facing primary care trusts, and their impending abolition in the NHS reorganisation, it is hard to see them doing a better job for carers now than they did last year when they did not have those pressures. There is great concern among carers and carers’ organisations about the impact of the NHS reorganisation and cuts to local authority budgets. Carers UK says that carers are worried that when commissioning is handed over to GPs they will lose services on which they rely. Many carers have negative experiences of dealing with GPs who do not have a good understanding of social care or of the specialist conditions that are giving rise to the care.

There is also much concern about cuts to social care that councils are making in response to the 27% cuts in their budgets over the next four years. The cuts are front-loaded, so together with the loss of area-based grants that were targeted at deprived areas, councils such as those in my area of Salford will have to make cuts of £40 million next year alone. The Government are putting £2 billion into councils’ social care budgets over four years, but that is only half of the £4 billion that the Association of Directors of Adult Social Services has estimated is needed to meet increasing levels of need. In addition, social care is one of the biggest areas of each council’s budget, yet the new money is not ring-fenced either, so councils are facing budget cuts of £5.6 billion over the same period. It is hard to imagine that social care will not be part of that.

We have already seen councils cutting funding to social care. Even before the comprehensive spending review, five councils with a “moderate” threshold were proposing to tighten their eligibility criteria to “substantial”. Birmingham council and the Isle of Wight have now proposed to raise their thresholds to meet critical needs only, and other councils are considering that. North Yorkshire county council plans to reduce its number of residential care homes by two thirds, and others are taking similar action. Councils are increasing their hourly rates for care and removing maximum weekly caps, which can mean charges doubling. For very many people, that will mean that the care is not available or they cannot afford it.

In Salford, we are very fortunate to have an excellent carers centre run by the Princess Royal Trust for Carers, with Dawn O’Rooke as the manager and Julia Ellis doing a fantastic job as the primary care project worker. Staff there are concerned about what they see as a marginalisation of carers support services owing to the twin changes of GP commissioning and council budget cuts. Salford carers centre has worked with GP practices to enable GPs to identify many carers and refer them on for advice and support. That identification and referral can make a significant difference for carers in their getting benefits, using personal budgets and getting checks on their own health. However, with GPs handling commissioning, there will be significant extra pressures of time. One reads day in, day out about GPs being very concerned about that. There is a real fear that GPs in Salford will no longer prioritise the development of support for carers.

Given our record in Salford, I hope that our GP consortiums and the city council will continue to support carers’ services so that the excellent work can continue. However, with GPs handling commissioning, there will be significant extra pressures, and it is hard to see councils and GP consortiums up and down the country prioritising carer support when they have so many other calls on their time and resources. Many people rely on unpaid carers, and more will have to do so over time. It is projected that that figure will reach 9 million in 25 years’ time. I therefore urge Health Ministers to put their support for carers high on their agenda and to keep it there throughout 2011.

It is an unusual experience for me to speak in this pre-recess Adjournment debate rather than answer it, which is what I used to do. I think that the Deputy Leader of the House has opted out a little bit by cutting his work load. However, I would like to wish everybody a very happy Christmas.

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[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I welcome all the contributions. We have had an excellent run-around of some hon. Members’ interests and specific issues relating to their constituencies.

I start with the hon. Member for Worsley and Eccles South (Barbara Keeley). As she rightly pointed out, the Government have recently announced that they will provide additional funding of £400 million to the NHS in the next four years to enable more carers to take breaks from their caring responsibilities. I commend her for her continued interest in the subject. I trained as a nurse and worked in the NHS for 25 years, and the question is now, as it always has been: who cares for the carers? The hon. Lady is right to highlight the problems that carers suffer—the impact on their physical and mental health and well-being, as well as the immense emotional burden that many bear.

The spending review has made available additional funding in primary care trust baselines to support the provision of breaks for carers. The new moneys will go into PCT budgets from April 2011 and into GP consortium budgets from 2013. The 2011 NHS operating framework, which was published on 15 December, makes it clear that PCTs should pool budgets with local authorities to provide carers with breaks as far as possible via direct payments or personal health budgets, which will doubtless ensure some progress.

The new funding is part of a package of measures that we announced in the recently published update to the carers strategy. The next steps set out the priorities for action in the next four years, focusing on what will make the biggest impact on carers’ lives. It is important to recognise that the subject is of interest to hon. Members of all parties. I do not think there is division along party lines. The hon. Lady’s insight into and knowledge of what is happening on the ground will be important to ensure that future policy and direction is well informed.

[Barbara Keeley]

Will the Under-Secretary say more about what will happen if PCTs do not spend the money on carers’ breaks? The Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for social care, campaigned in the House when the Labour Government had a similar problem. As I said earlier, the problem is that, according to a survey, only a quarter of the money had been spent on carers’ breaks. It is fine to allocate it, but the trouble is getting the PCTs to spend it.

[Anne Milton]

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.