Social Care (Local Sufficiency) and Identification of Carers Bill

Jacob Rees-Mogg Excerpts

Friday 7th September 2012 Commons Chamber

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

I warmly congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on her success in coming third in the ballot for private Members’ Bills and on securing the slot this morning. As always, it is a great pleasure to follow the hon. Member for Stockton North (Alex Cunningham), who speaks with such authority on these issues. The hon. Lady’s interest in the matter is well known, and she should be congratulated on her determination in pursuing what is undoubtedly an extremely important issue.

Many private Members’ Bills cover only a narrow area or a specific point of law and are often technical in nature. Some of them are just one-clause Bills. This Bill is quite the opposite. No one could accuse the hon. Member for Worsley and Eccles South of lacking ambition, given the scope and depth of her wide-ranging Bill, which would affect millions of our fellow citizens.

An increasing number of families are involved in the care of another family member—often, but not exclusively, an older relative. In many cases, this can involve a younger person with a disability who requires care on either a temporary or a permanent basis. We are fortunate that the hon. Lady has succeeded in introducing her Bill, as it enables us to spend time today considering the plight of carers and highlighting the problems they face. We are also able to publicise some of the excellent help that is already available to carers. The debate also gives us an opportunity to highlight what the Government have done and are continuing to do for carers.

The Queen’s Speech at the beginning of this Session included a commitment to publish a draft care and support Bill. Some people might have been surprised, in the light of that announcement, that the hon. Lady’s Bill was introduced at all. It first saw the light of day on 20 June this year, when it received its First Reading. It was published the following month, on 10 July. Unfortunately for its promoter, the following day saw the publication of the Government’s own draft Care and Support Bill, which had been announced in the Queen’s Speech. I submit that this issue is so important, and has such huge ramifications for the public purse, that it should be the subject of a Government Bill. One of the problems with this private Member’s Bill is the lack of information on the likely cost of the measures it contains.

As I said earlier, caring for another person can take many forms. When I was a child, my family cared for my grandmother. Looking back, I do not recall the terms “carer” or “caring” being used that often. We simply said that grandma—or nana, if I am to be strictly accurate about the name we used—lived with us. I cannot remember how young I was when my mother’s mother came to live with us, but I cannot recall a time in my childhood when grandma was not around. Unfortunately, as she progressed through her 70s and 80s, she became increasingly afflicted by ill health, and undoubtedly needed caring for.

The catalyst for my grandmother leaving her own home and coming to live with us was her arthritis, especially in her knees. She found it difficult to walk and, particularly, to climb stairs. That disability meant that grandma had to sleep on a bed settee in the lounge. If truth be told, she would have had to sleep downstairs anyway, as we had only two real bedrooms—one for mum and dad, and one for my brother and me. Unfortunately, in addition to her arthritis, grandma also suffered from Parkinson’s disease and, in her final years, from Alzheimer’s. By that stage of her life, she was therefore heavily dependent on the rest of us to look after her. We might not have used the term, but we were her carers.

Other than having what in those days was an orange badge for the car—which enabled my dad to park near to where we were going so that grandma did not have far to walk—and attendance allowance or some other benefit to which we were entitled, I do not recall any other specific assistance or any group being around to help. It is a testament to how far we have developed as a society that there is now far more help available for those who need and want it.

There are many reasons that the provision of care has risen up the political agenda in recent years. There have been enormous advances in medicine and in man’s ability to conquer disease. New treatments and technological developments have united to increase life expectancy. Sadly, however, increased life expectancy does not always bring with it the ability to continue to live as we did when we were younger. It comes with a price.

Living to an advanced age after enjoying good health for many years does not guarantee that that good health will continue. Indeed, the opposite is often the case. Later-life conditions, as the human body effectively wears out, inevitably mean that many people become increasingly reliant on others to look after them. Changes in working practices mean that fewer families are able to take in an elderly relative as we did when I was a child. There are now many more women in the workplace, and far fewer families in which the wife stays at home. That means that, in many cases, care still takes place but at some distance, with a son or daughter travelling great distances each day to look after their elderly relative so that they can continue to live in their own home. We must never underestimate the enormous value of that care.

Statistics from the Department for Work and Pensions’ family resources survey for the United Kingdom for 2010-11 give us an idea of the scope and scale of the problem, and of the number of disabled people and carers in this country. The survey found that 4.8 million people were carers, which equates to about 8% of the total UK population. Of that number, 3.5 million were adults of working age, and 1.3 million were adults over the state pension age. There were also about 100,000 children acting as young carers. The distribution of carers, broken down by age group, has remained broadly stable over the past 10 years.

The survey also found that the prevalence of disability in the United Kingdom involved 19% of the population. That means that about one in five people in this country was classed as having some form of disability. Not surprisingly, the prevalence varied considerably between age groups, ranging from 6% among children through 15% among working-age adults to 45% among adults over the state pension age.

According to that same survey, some 27% of adults of working age worked full time, equating to about 1.5 million people, with another 10% working part time. It is interesting to note that the comparative figures for all adults of working age were 68% and 20%.

I note that in clause 8, to which we have not yet referred this morning, subsection (1) deals with interpretation and it helpfully defines some of the key terms in the Bill. The biggest key term of all, of course, is what constitutes “a carer”. For the purposes of the Bill, a carer is defined as having

“the same meaning as in section 1 of the Carers (Recognition and Services) Act 1995”,

so it may be useful at this juncture to remind hon. Members of precisely what that statutory definition of a carer is. Section 1 of the 1995 Act defines a carer as an individual who

“provides or intends to provide a substantial amount of care on a regular basis”—

not for just anyone, but for someone who is classed as “a relevant person”, and a relevant person is someone who has had their needs assessed by a local authority under section 47(1)(a) of the National Health Service and Community Care Act 1990.

It should be noted that this statutory definition is not the same definition as that used by many charities. For example, the Carers Trust defines a carer as

“someone of any age who provides unpaid support to family or friends who could not manage without this help.”

[Jacob Rees-Mogg (North East Somerset) (Con)]

Will my hon. Friend clarify whether the survey he mentioned used the legal definition or a broader definition of carers when it came up with the 8% figure?

[Mr Nuttall]

My belief is—I stand to be corrected on it—that the survey used a wider definition rather than the strict statutory definition contained in section 1 of the 1995 Act.

[Jacob Rees-Mogg]

That is a helpful answer. Does my hon. Friend suggest, then, that this Bill will apply to a much smaller number of people than it would if it used the survey definition rather than the definition in the previous Act?

[Mr Nuttall]

That would appear to be the case. If the survey used the wider definition, which I believe it might have, it would indeed indicate that the number of people affected by the Bill would be fewer as a result of its using the statutory definition.

After the Carers Trust’s definition of a carer as

“someone of any age who provides unpaid support to family or friends who could not manage without this help”,

it goes on to state:

“This could be caring for a relative, partner or friend”—

we should note that this definition includes friends as well—

“who is ill, frail, disabled or has mental health or substance misuse problems.”

At this point, we come to what I submit are some of the problems with the interpretation of the Bill. What exactly constitutes a “substantial” amount of care? Who is to be the judge of whether care is substantial or not? One man’s definition of what is “substantial” may not be the same as another’s. Therein lies the first of a number of uncertainties in the Bill.

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[Mr Nuttall]

Absolutely. I completely agree. We want to hear from as many Members as possible, including the hon. Lady.

[Jacob Rees-Mogg]

If my hon. Friend managed to go on for a further two hours and 25 minutes, his speech would be of such an heroic nature that he would deserve an award rather than criticism. However, I do not think that even he will manage that, so there is clearly enough time for others to speak.

[Mr Nuttall]

I am trying to be as generous as possible in taking interventions, many of which, I would point out very gently, have come from the other side of the Chamber. I shall move on and try to deal with matters as quickly as possible, but they are genuine matters of concern which I think need to be heard. After that, we can hear from other Members.

As I was saying before the various interventions, the Bill has two general aims. The first is to place a duty on local authorities to ensure that there are sufficient social care services to support carers and those who are disabled, and in particular to aid them to enter or remain in the labour market or undertake work-related education or training. The Bill also seeks to secure the early identification of carers by health bodies such as clinical commissioning groups and foundation trusts, schools, and further and higher education establishments.

As we have heard, clause 1 imposes a general duty on

“every local authority to take steps to ensure that, as far as reasonably practicable, a range and level of social care services are provided to meet the reasonable requirements of disabled people and carers who are ordinarily resident in their area.”

I was grateful to the hon. Member for Worsley and Eccles South for indicating that the definition of “reasonably practicable” was designed to be set down in future legislation, through delegated legislation. I am prepared to accept that assurance, but it does mean that we are effectively being asked to sign a blank piece of paper.

Clause 2 provides that in order to demonstrate that a local authority has discharged its general duty under clause 1,

“every local authority shall be under a specific duty to secure, so far as reasonably practicable, the provision of social care services sufficient to meet the reasonable requirements of all people aged 18 or over with a disability and carers who require such support to enable them to—

(a) take up, or remain in, work, or

(b) undertake education or training which could reasonably be expected to assist them to obtain work.”

In just those first two clauses, we see that the test of “reasonableness” is key; the idea crops up time and again. Perhaps it would have been helpful if we could have known at this juncture how that will be defined.

What we do have, however, is information from the Institute for Social and Economic Research at the university of Essex. Last year, it published a paper entitled “Trends in the Employment of Disabled People in Britain”, which was a detailed analysis of the series of general household surveys published between 1974 and 2005, and covered adults between the ages of 20 and 59. The report found that the prevalence of disability has gradually increased, stating that the proportion of working age adults who report a limiting long-standing illness

“rose from 14% in 1975 to 18% in 1996, before falling back again to 16% in 2004.”

It went on to state that

“disabled people are less likely to have a job than other people, even after taking account of other characteristics such as their age and educational background.”

The paper presented an important concept—the idea of the disability employment penalty—and undertook an analysis for the period between 1995 and 2005 of its impact. It stated that

“the ‘disability employment penalty’ has been calculated as the difference between the actual proportion of disabled people in work, and what the proportion would have been if those same people were not disabled, but all their other characteristics (gender, education and so on) remained the same. So the actual outcome for disabled people is compared with the hypothetical situation in which their disadvantage was switched off. For the straightforward model covering the last ten years of the period under analysis:

80% of non-disabled people in the age range covered were in work, averaged over the ten year period 1996-2005.

76% of disabled people would have been in work if their disability had no effect

48% of disabled people were actually in work.

So

4% (80-76) is a measure of how much disabled people were disadvantaged by their other observed characteristics (such as age and education).”

However, on the basis of this research,

“28% (76-48) is the true disability penalty.”

The author actually cautioned that that penalty figure might be an underestimate because the “limiting long-standing illness” definition

“is probably too broad (including many adults with only slight impairments), this is probably a smaller penalty than would be observed if a tight definition of disability were used, restricted to people with more serious impairments. Note too that the estimate of 28% is the average effect of a range of conditions, impairments and severities, all bundled into a single category labelled ‘limiting long-standing illness’. Previous analysis of a much more detailed disability survey has shown that the penalties affecting different types of disabled people range from 0 to 100%, and helps to show that they are not all facing the same experience.”

The paper also considered how the penalty had changed over time, finding that it had risen

“from 17 percentage points to about 28 percentage points”

between 2000 and 2004. It also found

“that people with severely disadvantaging sets of health conditions have been more, not less, affected by the trends.”

Under this Bill, local authorities would need to ask why disabled people are less likely to be in employment. The Office for National Statistics published the results of the first wave of its life opportunities survey in December 2011, using evidence gathered during the period from June 2009 to March 2011. It described the LOS as a major new national survey of disability in Britain that

“aims to measure people’s use of local facilities, including public transport and health services, and their participation in leisure activities and employment opportunities.

It also aims to find out why people don’t take part in work or leisure activities that they would like to, or why they may experience difficulties in using public services.”

The survey investigated the barriers and what it called the enablers to employment for three groups of adults aged 16 and over: the employed, who were in employment but were limited in the type or amount of paid work that they did by their impairment status; the unemployed, who were unemployed and seeking employment but were limited in the type or amount of paid work that they could do by their impairment status; and the economically inactive, who were neither in employment nor actively seeking work. The top barrier to employment opportunities for adults with an impairment in each group was their health condition, illness or impairment. The second top barrier for the employed was family responsibility, whereas for the unemployed it was the lack of job opportunities and for the economically inactive it was disability-related.

As for what the researchers called the “enablers”, most respondents did not indicate the most important factor at all. In so far as they did, the most often stated enabler was modified hours or days or reduced work hours. We know from the DWP family resources survey, to which I referred earlier, that the majority of carers balance their caring responsibilities with paid work. Those in full-time employment made up the largest group of carers in the United Kingdom, at 35%, and the next largest, at 24%, were those in retirement, followed by the economically inactive, at 21%, and those in part-time employment, at just 17%. Among the working-age population, 60% of carers worked full time whereas 27% worked part time, compared with 68% and 20% among all working-age adults.

A survey by the NHS information centre, published in December 2010 and entitled “Survey of Carers in Households 2009/10”, provides an insight into how caring responsibilities affect the employment and education of carers. That survey found that caring duties did not adversely impact on the employment of most people, although they did for a sizeable minority. All carers who were under 70, regardless of their personal status, were asked whether their ability to take up or stay in employment had been affected by the assistance they gave the main cared-for person. Although just over a quarter of that group, 26%, felt that their caring responsibilities had affected them in such a way, nearly three quarters, or 74%, did not feel that that was the case.

The survey also gave some further detail of the backgrounds of those whose employment was so affected. The groups who were most likely to say that their employment prospects had been affected by the care they provided were: those aged 35 to 44, who represented 34% of carers, and those aged 45 to 54, who represented 30%; those looking after the home or a family, who represented 46%, and those working part time, who represented just 35%; those who were caring for someone in the same household, who represented 38%; those providing care for 20 hours or more per week, who represented 40%; and those in bad or fair health, who represented 34% and 32% respectively.

As for the specific impacts, just over a third, or 35%, of working-age carers who were looking after the home or family had to leave employment altogether, compared with 10% on average, whereas 23% of carers who were working part time, or almost one in four, had reduced their employment hours compared with an average of 8%.

It is of course important to understand why carers are less likely to be in employment. The “Survey of Carers in Households 2009/10” stated that

“the intensity of care provision has an impact upon interest in taking up paid employment.”

Of those who were caring for less than 20 hours a week, 24% were interested in taking up paid employment in the near future, compared with only 11% of the high-intensity group of carers. Of those interested in returning to work, 51% indicated that they would like to work part time, while 38% wanted full-time work and 11% did not know. On the possible barriers to employment, saying, “I cannot work because of my caring responsibilities,” was the third most popular explanation for not working, with 37% of people choosing that response.

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[Mr Nuttall]

There is indeed such an irony. Legislation of all kinds should receive proper scrutiny.

[Jacob Rees-Mogg]

It is worth noting that if Labour Members were so committed to the Bill, they would have been able to get 100 Members here to support a closure motion. Alternatively, they could move a motion that would force an hon. Member to bring their speech to an end, but they have not asked to use either of those mechanisms.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Actually, the speech of the hon. Member for Bury North (Mr Nuttall) could be terminated only if the occupant of the Chair—myself—told him to resume his seat because of tedious repetition. Whatever hon. Members might think of his contribution, he has not got to that point. I would be grateful if we could allow the hon. Gentleman to continue his speech so that others may then participate.

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[Mr Nuttall]

Thank you, Madam Deputy Speaker. I have indeed been helped by the Library’s document, which is extremely useful in analysing the Bill.

I will move on, if I may. As I understand it, there is nothing to prevent local authorities from carrying out the various actions proposed by the Bill, so it might be worth asking why they are not already going down that route.

[Jacob Rees-Mogg]

Is my hon. Friend referring to the general power that the Government’s Localism Act 2011 gave to local authorities, allowing them to carry out a much wider range of activities than was the case under the previous limitation whereby everything had to be identified by statute? Are parts of this Bill therefore unnecessary because of the abilities that local authorities already have?

[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.

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[Jacob Rees-Mogg (North East Somerset) (Con)]

The question before us is not so much quis custodiet ipsos custodes, as Juvenal put it—who guards the guards themselves?—but who cares for the carers themselves? The hon. Member for Worsley and Eccles South (Barbara Keeley) introduced the Bill with amazing foresight, because the very next day Her Majesty’s Government took a lot of what she was proposing and put it in their own White Paper and draft Bill. That is an almost visionary achievement by a Back Bencher, unknown in the history of the House, and she should be commended for it.

Let me say what a pleasure it is to welcome the Minister to his place, but what a loss he will be to us in the European Committee debates, where I enjoyed discussing trade with him. However, many people regard him highly in the new role that he has undertaken.

Let me turn to the Bill. Everyone is concerned about carers. In my constituency there is a fantastic carers centre—