Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

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

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

[Dr Poulter]

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

Social Care Funding

Barbara Keeley Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I absolutely agree with my right hon. Friend’s points; he speaks wisely, as ever. I, too, want to pay tribute to the work that my predecessor, our right hon. Friend the Leader of the House, did in laying the ground and making the big call that we needed to have the Dilnot commission, and in last year publishing the care and support White Paper, which moved this agenda much further forward than in any of the 13 years of the previous Labour Government. My right hon. Friend is also right about the fundamental randomness and unfairness. Of course, we are not saying that the Government will pay for all the social care costs we encounter—public finances could not possibly be in a state to allow that to happen. However, this provides certainty and allows people to plan, so that they can cope with the randomness and unfairness of the current system and know that it will not put their precious inheritance at risk.

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

At £75,000 the cap on social care is far too high to help people in an area such as Salford. The Secretary of State has talked about insurance products developing to help people meet the costs of the cap. In our inquiry into social care, we on the Select Committee on Health were told that this country has no market at all in long-term care insurance—not only that, but no country in the world has a working market in pre-funded long-term care insurance. Is it not wishful thinking of the highest order to talk about people being able to rely on products that do not exist either here or anywhere else in the world?

[Several hon. Members]

rose—

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.

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

At the last Health questions, the Secretary of State told me:

“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]

Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?

[Mr Hunt]

With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.

Dementia

Barbara Keeley Excerpts

Thursday 10th January 2013 Commons Chamber

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

It is a pleasure to speak in this Back-Bench debate on dementia. I congratulate my right hon. Friend the Member for Salford and Eccles (Hazel Blears), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing the debate and on their excellent contributions. I join others in saying how much I appreciated the moving and personal contributions from right hon. and hon. Members this afternoon. It must have been very difficult for them to talk about their personal experiences, but they did it very well.

My right hon. Friend the Member for Salford and Eccles has worked unstintingly on this issue, locally and nationally. Like her, I want Salford to become a dementia-friendly community. I share her pride that Salford contains one of the 10 national demonstration sites, in the Humphrey Booth centre in Swinton, which has its own day centre, the Poppy centre. I also agree with her that more needs to be done to improve our community services, to reduce hospital stays, to increase rates of diagnosis of the condition—many Members have mentioned that today—and to end the stigma that is so often associated with it.

I want to talk specifically about carers for people with dementia. As others have pointed out, about 10% of our 6.5 million carers are caring for a person with dementia, which means that at least 2,000 of our 22,000 carers in Salford must be in that position. The nature of the symptoms of dementia clearly makes providing such care particularly difficult. People with dementia can grow agitated, and they may wander at night and call out when asleep, which means that the carers themselves get little sleep. The personal care needs of those with dementia can be very great, as has also been mentioned today. Many people are performing a caring function for more than 100 hours a week. As we have heard, family members caring for a person with dementia must cope with personality change and loss of memory. Those very serious changes cause them to suffer feelings of grief and loss, similar to the experience of bereavement but before bereavement.

Dealing with that heavy caring work load also means that shortcomings in the provision of appropriate care services will be keenly felt. If carers do not have confidence in the quality or appropriateness of care, they will not have the confidence to take the respite breaks they so badly need. In 2007, when I was parliamentary champion for carers week, I visited some local carers and talked to them about our local services. One of them, a remarkable woman, was caring for her husband, who had vascular dementia. When she and I introduced ourselves, she told me “I am his nurse.” That was the change that had come about in her relationship with her husband.

The woman also told me how impossible it was proving to be to find adequate respite care locally. On one occasion, a week’s respite care had been arranged, with her husband staying at a local nursing home. Owing to a catalogue of problems at the start of the week, she then had no confidence that the home would manage her husband’s care properly, and she began to visit him there every day. By Wednesday, when family members found him lying unshaven in a soiled bed, she said that enough was enough, and brought him home. The end result of all her worries during those four days was that she developed eczema and had to visit her GP. That was her one week’s respite care.

One aspect of that woman’s life that she did praise was the support given by Crossroads Care, which is now part of the Carers Trust. Twice a week it provided two hours of respite care that she trusted. During one two-hour slot, she did her shopping at the local supermarket; during the other, she went to play bingo. When I asked her what we politicians could do for her and what changes she wanted to see, she told me that she wanted regulators who inspected care or nursing homes to ask carers for feedback about their experiences, and that, for herself, she wanted occasionally to have respite care lasting longer than two hours, so that she could wander around the shops rather than racing to get back home.

That was more than five years ago. I wish I could record that the situation for carers for people with dementia had improved radically in that time, but, given the increasing number of people with dementia and the crisis in the funding of social care—which has been touched on by several Members—the amount of respite care per individual carer cannot be stepped up dramatically, which is a pity. Crossroads Care told me that in 2008 it had provided 9,000 hours of respite care for 398 carers. This year it will provide some 13,800 hours of respite care for 567 carers. As I said earlier, we probably have some 2,000 carers for people with dementia, so the support is reaching only just over a quarter of the people who might need it.

The Health Committee’s recent report on our accountability hearing with the Care Quality Commission concluded that the regulator inspecting our care homes still did not have the confidence of carers, families and residents. It recommended that feedback from carers and other members of the public should start to be regarded by the commission as “free intelligence”, and that the regulator should act swiftly when complaints were brought to light.

In 2007 I introduced a ten-minute rule Bill, the Carers (Identification and Support) Bill, which required health bodies

“to identify patients who are carers or who have a carer”

and take steps to promote their health. I have introduced similar Bills subsequently, including, on 7 September this year, the Social Care (Local Sufficiency) and Identification of Carers Bill. I am still convinced of the need for health bodies—hospitals or, in primary care, GPs and their teams—to identify carers and ensure they receive information, advice and health checks. That would help avoid the isolation carers feel, which my hon. Friend the Member for Bridgend (Mrs Moon) talked about. They would be connected with professionals and other carers.

[Martin Horwood (Cheltenham) (LD)]

I agree with what the hon. Lady is saying, and, indeed, we might mention institutions such as the National Institute for Health and Clinical Excellence in this context. When I worked for the Alzheimer’s Society, we had the experience of trying to persuade NICE that evidence from carers about some quite difficult-to-research things such as behaviour and daily living skills was valid evidence when collected systematically and at scale—and, indeed, just as valid in its way as the evidence from things such as clinical trials and cognitive scales?

[Barbara Keeley]

Yes, and probably more so. The key concept here is that of the expert carer. Reference has been made to the professional carer, but I think expert carer is the right term. I shall talk about NICE shortly.

My Bill stated that health bodies should promote and safeguard the health and well-being of carers. They should ensure that effective procedures exist to identify patients who are carers or who are about to become carers, and ensure systems are in place to make sure that carers receive information and advice and that general medical services are rendered to patients who are carers. The reason for that is that carers will ignore their own health. They will entirely put the person they are caring for first, and put their own health to the back of the queue.

I was interested to see that this week NICE started a consultation on the topics prioritised for development in the quality and outcomes framework for 2014-15. The hon. Member for Banbury (Sir Tony Baldry) discussed the three indicators, the first of which is:

“The percentage of patients with dementia with the contact details of a named carer on their record.”

The second indicator is:

“The practice has a register of patients who are carers of a person with dementia.”

The third indicator is:

“The percentage of carers (of a person with dementia) who have had an assessment of their health and support needs in the preceding 12 months.”

I would have welcomed this development, as the identification and support of carers is a crucial issue, but I have some comments to make on the indicators. I doubt whether the QOF is the best way to achieve progress, and in some respects this issue is a higher priority. We currently give three QOF points to GP practices that keep a register of carers, but they could, in fact, have a small and static register of carers that they did not consult on, improve and develop. They would still get three points, however. The task of properly identifying carers and making sure they get the advice and support and the health checks they need is certainly worth more than the £400 that these three QOF points averages out as being worth. Is that what we think these tasks are worth? They surely must be worth more than that.

I have taken advice on this matter and I suggest that a better solution would be to tier the indicator payment based on the percentage of carers identified. Sufficient QOF points should be given properly to recognise the achievement of the task as well. It will take a number of people quite a bit of time to perform it, particularly if it is performed at the higher levels of achievement. Carers trusts tell me it is hard to find GP practices where more than 3% of carers are identified. The figure should be about 10%.

I fully support the indicator measuring the percentage of carers who have had an assessment of their health and support needs in the preceding 12 months, as that is a very important development, but why does it cover only carers of people with dementia? In my constituency there are carers of people who have had a stroke who have a very heavy, and very similar, work load to carers of those with dementia. It would be better to specify a small range of long-term conditions that lead to carers having a heavy caring work load, and they should be identified and receive assessments.

I want to record my thanks to organisations in Salford and elsewhere that do a wonderful job in supporting carers of people with dementia. I have mentioned the Humphrey Booth centre, and Age UK in Salford has a dementia support service. Those services are very important. They provide buddy cafés that support both people with dementia with activities and carers with respite. A buddy café lasts for five hours. That is a welcome period of respite for carers. There is a drop-in café at the HBC as well as a carers training programme, and it offers vital information, advice and advocacy services. It is a key partner in Salford, providing better quality services to people with dementia.

Last, but definitely not least, I should mention Salford Carers Centre, which plays a key role in identifying carers and helping them with information, advice and support. I believe that our practice in identifying carers, both in primary care and acute settings, is making a real and vital difference to helping our carers to care. I have invited the Minister, just as I invited his predecessor, to come to Salford to see what we do. The key other part of that now is Crossroads Care, which provides vital respite care.

I will finish on the issue about the funding of care, as many hon. Members have done. The right hon. Member for Sutton and Cheam referred to the moving speech made by a carer at the meeting earlier in the week to launch a pamphlet he wrote. In her contribution, that carer described the difficulty of managing catastrophic care costs for a person with dementia. She said:

“A £35,000 cap, as proposed by Dilnot (or even £50,000 or £60,000) could give me back my life. Our liabilities would be over. I could concentrate on my frail mum instead of the practical and emotional burden of single-handedly selling our family home. My mother has an incurable disease that has robbed us both of our lives; must it rob us of our assets too?”

I could not put it better than that, so I will not try to do so. As other hon. Members have said, we must consider setting the cap, up and down the country, at a lower level than £75,000, which will help people such as this carer. I have outlined a number of ways to support the carers of people with dementia, and I hope we give them the priority they deserve.

NHS Funding

Barbara Keeley Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

They are certainly sheepish today; they need to get back to their offices pretty sharpish to amend their websites in light of the letter from the chair of the UK Statistics Authority.

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

The website of the Conservatives in Salford says, on the budget that was going to increase,

“we would see more investment in our local NHS”

under a Conservative Government, but in Salford Royal hospital, 750 jobs have been cut. Between them, all our local hospitals have had 3,100 jobs cut in the past couple of years, and two walk-in centres have closed. If the budget is the same, why all these cuts?

[Andy Burnham]

This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.

What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.

According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 27th November 2012 Commons Chamber

The Secretary of State was asked—

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

1. How many (a) health visitors and (b) nurses there were in the NHS in May 2010 and the latest month for which figures are available.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The number of full-time equivalent qualified nurses and midwives employed in the national health service in England in May 2010 was 310,793, and in August 2012 it was 304,566. The number of full-time equivalent health visitors in May 2010 was 8,092 and in August 2012 it was 8,067, with an additional 226 health visitors employed by organisations not using the electronic staff record.

[Barbara Keeley]

I thank the Secretary of State for that answer. The recent Care Quality Commission report found that 10% of NHS hospitals did not meet the standard of treating people with respect and dignity, and underpinning that poor care were high vacancy rates and hospitals that have struggled to make sure they have enough qualified staff on duty at all times. That shows us the real impact of losing those thousands of nurses. So does he agree that it is urgent that this Government take action when understaffing in the NHS results in poor care?

[Mr Hunt]

I absolutely agree with the hon. Lady that nowhere in the NHS should allow low staff numbers to lead to poor care. What was interesting about the CQC report, which was a wake-up call for the whole NHS, was that institutions under financial pressure, as the whole NHS is, are delivering excellent care in some places and delivering care that is unsatisfactory and not good enough in other places. On her specific question about nurses and nurse numbers, it is important to recognise that across the NHS as a whole the nurse-to-bed ratio has increased. Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.

Regional Pay (NHS)

Barbara Keeley Excerpts

Wednesday 7th November 2012 Commons Chamber

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

Like many right hon. and hon. Members in this and earlier debates—we are lucky to have two debates today—I am against the Government’s move to regional pay in both the NHS and other parts of the public sector. I am a little less clear about the speech of the hon. and learned Member for Torridge and West Devon (Mr Cox), who talked a lot about the pay bill. If we were not spending £1.6 billion on redundancies or £3 billion on an unnecessary NHS reorganisation, the pay bill would not be quite the worry to the NHS that it is—but let us leave that aside.

One of the most important reasons for opposing regional pay is that, as we have heard—I think the hon. and learned Gentleman was saying something similar—regional or local market-facing pay is bad for the economy not only in the south-west but in the north-east, Yorkshire and the north-west. Public sector workers are already suffering. They have had a two-year pay freeze and have suffered greatly from budget cuts and redundancies. The TUC believes that local or regional pay would effectively mean a further freeze, holding back public sector pay for years. That would take even more demand out of our regional economy, with staff having even less income to spend in the local shops and businesses that the hon. and learned Gentleman mentioned. In the north-west, which has 780,000 public sector employees, a 1% reduction in earnings would take almost £190 million out of the regional economy.

A key point is that any reductions would particularly affect women, who account for around two thirds of public sector jobs on average, although the figure is higher in some parts of the north-west. For instance, the neighbouring authority to my local authority of Salford is Bolton, where female employment in the public sector is over 71%, and a number of my constituents work in Bolton hospitals. Proposals that would cut public sector pay would therefore be a further attack on the living standards of women, who we know are already being hit hardest by the recession and the policies of this coalition Government. Figures from Personnel Today show that since May 2010 the number of qualified nursing, midwifery and health-visiting staff has fallen by 6,588, as my right hon. Friend the shadow Secretary of State said earlier. Indeed, between June and July this year, a further 808 posts were lost, which is serious.

That fall in the number of front-line nurses, midwives and health visitors has been clear in my local area for some time, due to the level of efficiency savings being forced on to the NHS to pay for the reorganisation. Figures in The Guardian show that Central Manchester University Hospitals Foundation Trust has announced that up to 1,400 jobs are to go, with Salford Royal Foundation Trust announcing a reduction of 750 posts—including 146 nursing posts so far—Wrightington, Wigan and Leigh Foundation Trust planning a reduction of 533 posts between 2010 and 2014, and Bolton Royal Foundation Trust planning to make a reduction of 248 posts, with two thirds of the first 61 posts removed being nursing and midwifery posts. Even our regional cancer hospital, the Christie, plans a reduction of 213 posts between 2010 and 2015, including, sadly, 43 posts in nursing. That means a total of more than 3,100 jobs going at just five foundation hospital trusts in the Greater Manchester area over three to five years. These are the jobs and careers of my constituents, and we know that women’s jobs are disproportionately affected, because women account for 80% of the jobs covered by “Agenda for Change”. It is in that context—the attack on women and their standard of living—that regional pay in the NHS is a cause for further concern.

The British Medical Association believes that the move from national terms and conditions for NHS staff would have a significant negative impact on the NHS because, as a number of Members have said, the national pay system in the NHS provides benefits for both staff and employers. It has maintained good industrial relations, prevents the duplication of negotiating efforts and has helped to support the recruitment and retention of staff. The Royal College of Nursing believes that any move towards local and regional pay would lead to damaging competition between trusts for staff, because it would entrench low pay in certain areas. There is great concern that places such as Cheshire, which could perhaps offer higher pay, would attract staff from Greater Manchester. That would entrench low pay in areas that are already deprived, such as parts of the north-west, where it would become difficult to attract and retain staff. Regional pay would therefore be unfair and bad for the economies of regions such as the north-west, as well as hitting women harder than men.

The TUC also argues that the case for regional pay is not backed up by evidence, and it makes some important points. As we have heard, comparing public and private sector pay is not comparing like with like. Half the employees in the public sector have a degree, compared with only one in three in the private sector. Importantly, the public sector has a smaller gap between top and bottom pay, and a lower gender pay gap, both of which are welcome. We want to hold on to those. The RCN argues that a move to replicate the pay structures of the private sector would also lead to the replication of inequalities in the private sector, which would be a backwards step. Indeed, I want to challenge the notion put by advocates of regional pay that the public sector somehow crowds out the private sector. In my constituency, there are six people chasing every job vacancy, which is more than the national average. In some parts of the country, such as Hull, as many as 30 people are chasing every job vacancy. It is the lack of growth, jobs and demand in our region that is causing the problem. Budget cuts and redundancies in the public sector, which have already hit our local economy, would be made worse by regional pay.

It is argued that local pay is what the private sector does. However, I worked for many years in the IT industry. I worked in London, the west midlands and Manchester, and we did not have different pay arrangements in those places; in fact, my company would not have been able to persuade people to move from place to place if it did. Of course there is London weighting; that has been with us for a long time. Regional pay would be unfair and bad for the economy of our regions. The arguments are not backed up by evidence. Regional pay is not what the private sector does and it would hit women harder than men. There is no reason a nurse in Salford should be paid less than a nurse in another part of the country. As my hon. Friend the Member for York Central (Hugh Bayley) said, it is important that the NHS should have a work force of the same quality in different parts of the country.

Let me make my last two comments. A nurse in my constituency wrote to tell me that she was against the move from national pay because it would

“pit…employers against each other in bidding wars for staff,”

and would also be completely unfair. A midwife in my constituency told me:

“I have, like all other NHS staff, received no annual pay rise for three years now despite the cost of living rising. The cost of raising four children (one of whom has profound disabilities) on one wage is challenging, as my husband provides 24/7 nursing care. Basic pay for a nurse or paramedic should be the same whether they are saving lives in Preston, Peterborough or Plymouth. Anything else is unfair.”

I support the motion tabled in the name of my right hon. Friend the Member for Leigh (Andy Burnham) on behalf of nurses and midwives such as those.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

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

7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.

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

Providers of services are responsible for the safety and quality of the care they provide. All staff must be properly qualified and vetted, and the Care Quality Commission can and must take action against providers who fail in that regard. Action can range from a warning notice to, ultimately, cancelling a provider’s registration. The commission must be willing to take that action if necessary.

[Barbara Keeley]

But the Minister knows that a recent BBC programme showed that 217 providers of care at home use staff who are not properly qualified, and that dozens of people with criminal records have not been vetted and are working unsupervised in people’s homes. The Care Quality Commission has reached only just over one in four of its target inspections, with 40% of care at home providers never having been inspected by it. What will the Minister do to ensure that we can have more confidence in care provided at home to vulnerable people and that it is up to a better and safer standard?

[Norman Lamb]

I absolutely share the hon. Lady’s concern about this. It is intolerable that people receiving domiciliary care do not get high-quality care and that in some cases people are inappropriately employed. The Care Quality Commission must take action where there is evidence of employers not taking sufficient action to guarantee the quality of their staff. It is essential that the people who run those services are held to account if they fail in that regard.

Social Care (Local Sufficiency) and Identification of Carers Bill

Barbara 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.

--- Later in debate ---

[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.

--- Later in debate ---

[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

Barbara 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?