Adult Social Care

Fiona Bruce Excerpts

Thursday 8th March 2012 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on the sensitive and caring way in which she brought this debate to the House. I also pay tribute to the 6 million unpaid carers in the UK. Unsung and often unseen, they are heroes and heroines who daily and sacrificially dedicate their lives to caring for others, often for 24 hours a day, seven days a week, 52 weeks a year. They deserve our utmost respect and appreciation, and I wish to record mine here.

I therefore wish to focus on the need to support carers in this era of an increasingly elderly population and greater longevity and with the exponential Treasury challenges that it will undoubtedly bring. Two million people currently move in and out of a caring role each year, but an ageing population and people living longer with chronic conditions mean that this figure is likely to rise significantly, so we must give serious consideration to how such carers, caring charities and community organisations can be better supported.

It is essential that we encourage a major cultural shift to consider how more support can be provided to carers, especially those who care for their families, and to charitable organisations that support carers. Caring charities, such as Crossroads Care Cheshire East, of which I am privileged to be patron, and the Prince’s Royal Trust for Carers, provide disproportionately greater value for money in the support they give than purely publicly funded social care services would ordinarily provide. As one former employee of the Prince’s Royal Trust for Carers told me, they supplement that work with volunteer support and the ability to act flexibly and go the extra mile, while all the time operating to high professional standards.

A significant caring role can affect a carer’s emotional, physical and financial health, but by supporting carers more positively, we can not only help them and those they care for but save the public purse considerable expense, which, as my hon. Friend the Member for Banbury (Tony Baldry) so eloquently said, will be increasingly important in the coming decades—to a degree that we have only just begun to glimpse. Crossroads Care Cheshire East writes:

“A clear agenda to support carers is an essential component of adult social care strategic planning.”

Caroline Hebblethwaite, who has been a volunteer worker with a caring charity in Cheshire, then an employee and now a full-time carer, speaks with unchallengeable authority and has told me of the many ways in which she believes we could support charities that in turn support carers more effectively. She says that longer-term funding commitments would help—beyond, say, two years—because shorter-term commitments make it difficult for organisations to plan and result in unhelpful churning, loss of experienced staff and disruption to well-established, cost-effective services. As Crossroads Care Cheshire East writes:

“Constantly having to reinvent well developed and user led services simply to fit another funding criterion is not a good use of time and money. Innovation is essential but experience should not be ignored.”

Both Caroline Hebblethwaite and Crossroads Care refer to the essential need for carer breaks. Crossroads says that carer breaks

“should not be paid for out of any benefits received by the person with care needs but should be a carer’s service for the benefit and health and wellbeing of the carer. It is not appropriate to assume that service users will use their own personal budgets to allow their carer a break—we know that often this does not happen. Without practical support carers and families will break down—this can be avoided by low level investment at an earlier stage.”

I will give examples of some of the many ways in which relatively low-level investment can be made.

Local authority funding could make a huge difference if a little more was channelled through carers charities, to be paid out at the discretion of the charities’ trustees. Caroline Hebblethwaite tells me that when she worked for the Princess Royal Trust, small grants paid directly to carers—not means-tested—made a disproportionate difference. She tells me, for example, of an elderly man caring full time for his wife for whom that small grant paid for a shed, in which he could pursue his hobby. It gave him that little bit of extra space and helped him to keep going. For another carer, there was a one-off spring clean, while yet another received computer literacy training, and another the occasional massage.

Provision to enable carers who work to remain in work—by having someone call in, just two or three times a day, to check that their loved one is all right—can make such a difference. A sitting service is also helpful, so that carers can go out. One way that local authorities can offer support—at a very modest cost, but making a real difference for those who care—is by funding befriending groups. Such groups enable carers to share experiences, but they need to be local, because carers do not have the time to travel far. Those that have helped in Cheshire include befriending groups that have provided talks on such matters as how to redecorate on a budget or how to make a hanging basket, and have even given advice on healthy eating. That might seem mundane, but it can make a real difference to carers, who often feel run down or a little bit depressed. Such small amounts of support can have a disproportionate benefit, and we need more of this.

Carers, often low on energy and self-esteem, find it hard to get information, advice and support, and I am advised that social workers often do not have much time to signpost them. However, local charities for carers can perform an important function in offering a great source of advice. Another function that they perform is by acting as a counselling service, providing counselling time—again, something that social workers cannot provide. There is a real need to recognise and support carers—for example, by giving them help in adapting to change, or to loss, or grief for a life once lived, or a life that might have been.

Caroline Hebblethwaite also told me about how much carers days have meant to those whom she has supported. Carers days in Cheshire have been held at local hotels, or even at a golf club. Carers are invited to come for special “feel good” days, where they are affirmed and told how much they are valued, and where high-level speakers talk to them, acknowledging the vital role that carers play. More of this is what we need as we move forward.

Local authorities could also ask professional advisers in carers charities to carry out more assessments of carers. This would not only be a valuable source of additional funding for carers’ charities, but also a likely cost-saver for local authorities. Incidentally, I am informed that assessments of carers’ needs are not made as frequently as they should be in many circumstances.

I would like now to deal with one or two other points. First, my constituent Barry Smith has written to me about higher attendance allowance:

“My parents-in-law are both 89, my father in law has advanced Alzheimer’s and my mother in law, in poor health herself, and lacking easy mobility after having broke both hips, is his primary care…We have spent the last few days trying to fill out the forms for…Higher Attendance Allowance and have come to the conclusion that the application itself constitutes a form of discrimination against the elderly. We had been warned…that the form is extremely difficult to fill in…and that the rate of success is only 60%,”

but it seems that

“for most elderly people it is simply impossible to complete…It is as though it has been carefully designed to ensure that the minimum number of applicants receive their entitlement”.

Hopefully that is something the Minister will look at.

I commend the proactive work of Cheshire East council, the local authority area in which my constituency lies, to support older people, as illustrated in its innovative “Ageing Well in Cheshire East” programme, 2012-17, which has just been launched. It focuses on how to support people from as early as 50 upwards—a little depressing for some of us at that age!—on the basis that the earlier we plan, the better those plans will be for later life, given that we all want to live well for as long as possible.

The aim of the programme is to ensure that older people live well and have access to the right levels of different services and support, including crisis support, at appropriate times in their lives. The programme aims to ensure also that they have a strong voice in influencing local policy and services; remain healthy, active and independent; receive help to plan their finances long-term; live in a safe environment, with appropriate housing; access appropriately constructed public transport; benefit from and contribute through employment, volunteering and learning; keep their links with family and friends; are actively involved in their communities; and maintain their roles as partners, carers and grandparents.

I commend in particular the wide-ranging network of relevant public, private and voluntary sector bodies which the Ageing Well programme has fostered, garnering a commitment to the programme that will be essential if we are to maximise our support and provide the effectively integrated care that has been talked about today. The programme has secured a commitment from agencies as wide-ranging as Cheshire fire and rescue, the police, clinical commissioning groups, local councils, the faith sector, housing providers, care charities and even the chambers of commerce.

The programme is already tackling older people’s concerns, such as those about disjointed services, the variable quality of care and social and economic isolation, and it is also improving volunteering opportunities. Such forward-thinking work is an essential component of our successfully rising to the challenge of caring for the elderly in the years ahead, and it is particularly important in an area such as Cheshire East, which has a rapidly ageing population and, in fact, the largest elderly population of any area, per head of population, in the north-west of England. The number of over-65s in the area will grow by 50%, and the number of over-85s is set to double, by 2025.

Cheshire East has funding challenges, however. The Government funding for the area is among the lowest of any in the country, despite the challenges that we are going to face and, indeed, already face in caring for such a large elderly population. We are given £191.62 per head, while Tower Hamlets, by way of comparison, is given £968.18, meaning that we can afford to spend per head £753.42, while Tower Hamlets has almost double, £1,428.16.

The funding context of each local authority area is an important influence on the services that can be provided, and in an area such as Cheshire East, with low funding but an increasingly elderly population, that is going to be a challenge, so I ask the Minister to consider it as we move forward.

I commend the Minister’s commitment to build on community capacity as the way forward, helping people to stay independent, healthy and well for as long as possible. Indeed, perhaps a better term for independent living would be inter-dependent living, recognising the importance of, and the need for, all of us to give and receive care at various stages of our lives. The more we can encourage caring within families, by friends and in communities, the healthier our society will be. We need to do all that we can to foster support and to encourage the sharing of caring, and we need to treat with gratitude and respect those who do care.

The words of the chief executive of Carers UK are apt:

“Our health and social care services could not function without the contribution of the unpaid care provided by families—which we estimate to be the equivalent of £119 billion a year.”

The basic building blocks of a healthy society are found in relationships—the networks of reciprocal responsibility that are found in the family, in friendships, in church, in community life, in work, and in schools. Through these basic building blocks, individuals meet the needs of their community. It is as much, if not more, the role of Government to help society to meet its needs through those relationships rather than seeking to take control and trying to meet those needs itself. As human beings, one of the ways we grow is through the challenge of meeting the needs of others in our relationships within our communities. Our national mindset needs to be increasingly directed towards that goal. Looking to the selfless example of our country’s 6 million carers would be a very good place to start.