Social Care (Local Sufficiency) and Identification of Carers Bill

Laura Sandys Excerpts

Friday 7th September 2012 Commons Chamber

[Laura Sandys (South Thanet) (Con)]

It gives me great pleasure to follow the hon. Member for Aberavon (Dr Francis), in particular because of his history; he has been involved in the carers agenda for many years. I am pleased to be a sponsor of the Bill. The hon. Member for Worsley and Eccles South (Barbara Keeley), who introduced it, has a huge track record on social care and carers.

The issue of carers not only impacts the constituents of every Member of Parliament; there is probably not one MP who does not have a friend, a friend of a friend, a cousin or other family member who is caring or very close to somebody who is. Carers permeate every part of society, and every socio-economic and age group. For that reason, it is crucial that carers legislation and policy are taken extremely seriously.

I am pleased that the Government have taken the initiative to develop a White Paper that, for the first time in many years, deals with the gritty, extremely complicated—it does not lack pain—policy on long-term social care. We are facing a big problem in this country and globally. Carers are very much at the heart of how the policy needs to develop and evolve. In many ways, they are front-line troops.

The legislation and media coverage is all about care homes—the scandals involve the institutional support for people who are not well—but the important thing is what happens behind closed doors, and we need to address the quantity of people who need care and support. Those people are in some ways hidden from the system. They are invisible to the authorities, but they need both recognition—they need to know that we know and respect them—and practical support. We need policies to ensure that they are given the support they need and deserve because of the sacrifice that they are making.

Support for carers is a crucial long-term health care policy, but it hit me personally and changed my life. I was 17 when my father had a massive stroke and it changed our life dramatically. I was going to go to university, but I went out to work as a dispatch rider. My mother’s life changed dramatically. I did not go to university—I helped her to care for my father. Over the five-year period that it took for my father ultimately to die, my mother probably aged by about 15 years. That is the example of my life, but those things are happening around the country. People who are frail and have health problems find the moral responsibility of caring both physically and sometimes financially extremely difficult.

My experience changed my life and certainly my education, but it also taught me of the extraordinary self-sacrifice around the country. The issue of young carers is very important. I have done a lot of work in my constituency with them. The Bill needs to ensure that local authorities and all institutions around young people look to identify those who take responsibilities way beyond their years. I go regularly to a young carers group. The young children in the group look and behave as though they are older than their age. That is fantastic—they are maturing and taking extraordinary responsibilities—but caring changes how they grow up, including their access to a social life. They age before their time.

I make the situation clear to my local schools, but I am very lucky because they have taken a lot of personal responsibility to identify those young people. I appreciate, however, having listened to other Members, that some schools and even some people in social services do not understand the dynamic of these households and the additional responsibilities being put on these children.

Identification is extremely important for another slightly more controversial reason. A teacher in my area said to me, “Although the parents of some of these children have been ill, they are no longer ill but have become dependent on the child delivering care services to them.” There are all sorts of issues within this pathway of being a young carer that need to be identified so that support can be provided. We need to ensure that schools, social services and the institutions around these young people understand the issues, and we need to ensure that clear action is taken to alleviate the situation of children providing support to parents who have entered into this relationship of dependency.

[Dr Francis]

The hon. Lady talks about lessons and is making a powerful case, but however much we sympathise with carers, surely the real lesson is that there is no substitute for legislation.

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[Laura Sandys]

Legislation is important and is part of what the Government are doing to get a grip on the situation. The forthcoming social care Bill is extremely welcome and it is important that these measures be considered and incorporated in it. I do not question the importance of legislation.

Humanity is also important, however, and that is about education, understanding and people being able to identify the problems in front of them. On the long-term care issue, let us consider the system operating in Torbay. That did not need legislation. It needed common sense and an understanding of how to integrate the provision of care. It needed agencies to talk to each other and to think about how to deliver service to individuals and families, rather than thinking of themselves as institutions.

[Diana Johnson]

I am listening carefully to what the hon. Lady says. She points to examples of good practice, but those often require a champion who sees young carers as an important issue that needs to be addressed. Unfortunately, however, not all head teachers, heads of colleges or vice-chancellors take the same view about young carers or student carers, so having legislation to underpin what is required of those institutions is important, as too are champions.

[Laura Sandys]

I do not dispute the need to ensure that everybody within these institutions has a responsibility towards carers. There is no question about that. They also have responsibility for the welfare of children. They have to understand that this is bigger than just the responsibility of carers. It also involves attainment at school and young people’s mental health. It is interesting and a bit concerning that some teachers do not even know that there is such a thing as a child carer. I find that remarkable, but solving that problem does not require legislation; it requires the education of the educators. This private Member’s Bill is part of the way to ensure that we start to normalise what is required from these organisations and institutions.

We have an opportunity here. Perhaps we, as the Bill’s sponsors, should be making representations to the Select Committee on Health, which will be doing the pre-legislative scrutiny of the forthcoming social care Bill. We should ensure that the Committee appreciates the importance of the measures in the private Member’s Bill and puts in its report provisions to ensure that the Government respond not only to this debate and the private Member’s Bill but to the Select Committee’s report.

There is also an opportunity, in this legislation and the wider general practice of local authorities, in respect of the health and wellbeing boards. Health and wellbeing boards and the doctors’ commissioning units need to be focused not just on the patient who walks in the door but on the person looking after that patient. I am sure that many of us in the Chamber—and, I hope, beyond—always, as I do, say to the doctor, “You look at the patient, but do you always ask, ‘How is the carer? How well is that carer?’” Sometimes the carer will be less well than the so-called patient, but they will not present to doctors. It is crucial that doctors take the initiative and understand that if the carer ends up in hospital, we end up with two people in crisis, not just one. I would welcome clear statements from the Secretary of State and the Minister that GP commissioning and what I call practices of humanity need to be drilled through the health service in order to address these problems, which will present themselves and which will cost everybody in money and suffering.

I am very supportive of the provisions in the Bill, and I urge the Government to consider them as part of their overall legislation. The hon. Member for Worsley and Eccles South is a member of the Health Committee and I am sure she will be a great advocate, but it would be useful if proponents of this legislation were also to put in a submission to the Committee. I hope that this Bill will be encapsulated in the forthcoming Government Bill.

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[Norman Lamb]

There is a degree of overlap on the sufficiency issue. I commit to discussing with the hon. Lady whether we have the framework right in the Government draft Bill or whether it could be improved—let us have that discussion. I will seek to address in my remarks the interesting philosophical argument about how best to approach identification, but parts of her Bill go beyond the responsibilities of my Department. To be clear, I am happy to engage with other Ministers to seek to address some of the issues she raises and I will maintain a dialogue with her on that.

[Laura Sandys]

In response to the point made by the hon. Member for Worsley and Eccles South (Barbara Keeley), is there not also an opportunity to create a strong role for the health and wellbeing boards?

[Norman Lamb]

I am grateful to my hon. Friend for raising that point. Yes, absolutely, there is and I will come back to that. One concern I have is the focus in the Bill on social care, whereas the thrust of Government policy is the importance of integrated care. My hon. Friend and the shadow Minister referred to Torbay. I am passionate about that approach. We can do an awful lot more. The whole approach should be to integrate health and social care in our planning and our execution, rather than, as the Bills risks, silo-ing social care and assessments of social care and carers’ needs separately.

The shadow Minister commented on budgets. I absolutely understand that budgets are tight and that local authorities are in difficult times, but the new budget survey from the Association of Directors of Adult Social Services shows not huge cuts but that councils have risen rather impressively to the challenge and identified savings of £1.89 billion since 2010-11 by using resources more efficiently. Surveys show that councils’ spending on adult social care is due to fall by only £200 million or so. If the money can be used much more effectively, we can ensure that services are protected.

One thing I am interested in pursuing in my new role is how well we commission care. There is disturbing evidence of a race to the bottom, with care being commissioned on the basis of an hourly rate and the cheapest getting the contract. We need to do everything we can to ensure that commissioning provides incentives to improve health and well-being, prolong independence and improve mobility, thereby saving money and improving care, which is what we need to achieve. There is probably a widespread view that we do not commission care nearly effectively enough. There must be a substantial improvement in our expenditure on social care.

We agree with much of the intention of the Bill, but for a number of reasons we cannot support it. First, it would perpetuate the fragmentation of carers legislation, which we are seeking to end. My hon. Friend the Member for Bury North made the point that the Law Commission argued for a single statute. It seems irrational, at the very moment that the whole sector is celebrating the fact that we are seeking to bring everything together, to have a separate Bill introducing new duties. The debate about getting the framework right—putting everything together in one clear framework, written in plain English—needs to be part of the Government’s Bill.