Social Care (Local Sufficiency) and Identification of Carers Bill

Liz Kendall Excerpts

Friday 7th September 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for bringing forward this excellent Bill, and warmly congratulate her on doing so. She is a long-standing advocate and champion of unpaid family carers and wider social care issues. Today, she has again displayed her invaluable contribution to these issues and the House.

The Bill is important because it seeks to change in two fundamental ways the way in which we support disabled people and the family members who care for them. First, it seeks to shift the care system away from focusing predominantly on the needs of people whose care is funded by the state, to recognising the millions of individuals and families who fund their own care. The vast majority of those people are not hugely wealthy, but live on low or modest incomes. When a person whom someone loves becomes frail or ill, it comes as not only an emotional shock, but a financial one, because they have to pay for the care. When they then ask for advice, information or support, they do not get it. People do not even receive the information that is available. That is a big and important change that the Bill seeks to achieve.

Secondly, the Bill seeks to shift the nature of the support that is available to disabled people and their family carers, so that people’s broader needs are met as individuals, not just as carers. That includes their health needs and their needs for skills and training, so that they can build a full and fulfilling life. Crucially, it includes their need or desire to get work and to stay in work. The Bill would make a significant difference in allowing disabled people and their carers to achieve a better quality of life. It would also provide better value for money for taxpayers.

There have been big improvements in the care system over the past decade, with new rights for carers to have their needs assessed, new rights to request flexible working, improvements in respite care, a training and support programme for carers, and strengthened rights for carers in their entitlements, for example to the state pension. However, like many hon. Members, I know from my constituents and my own family that a desperate daily struggle is still faced by too many people who are looking after someone whom they love and who is disabled, is physically frail or has Alzheimer’s—sometimes even all three.

As hon. Members have said, many people do not think of themselves as a carer, but are just trying to be a good daughter, son, husband or wife by looking after the person they love. They therefore do not realise what support is out there. Often, it is only when somebody reaches crisis point and can no longer cope that they look for support. However, people do not know where to go and often the right services are not available to them. The result is that millions of carers see their own health suffer. One in three unpaid family carers of working age has to give up work or reduce their hours, adding financial worries to their already stressful lives.

As has been said, that often happens to women aged 50 to 65, or even older, who still want, and may need, to work. Indeed, as the population is ageing, they will need to work for longer. They face the awful double whammy of having to care and work for longer, and may be unable to balance the two. Any kind of social life or leisure time—something that many people look forward to when they retire—is nothing but a pipe dream. That is not good for carers, and it costs us all more through increased costs to the NHS and a higher benefits bill.

One issue to consider is the statutory framework within which local councils work. Particularly when they are under intense financial pressure, as they are at the moment, they understandably and inevitably focus on delivering their statutory duty to provide care for those in the greatest need. Indeed, they are focusing more and more on a small number of people with intense needs, because of the financial pressures that they face. The bigger agenda of prevention and early intervention is going by the wayside. The Bill’s provisions are intended to change that framework so that councils have a duty to assess the range of care needs in their area and then stimulate the market to ensure that services are available to meet those needs.

The Bill also includes important provisions to ensure that schools and further and higher education bodies identify young carers. Many Members have spoken about that issue, and I will not go into detail because I want to give others time to come in. However, the idea of involving further and higher education providers is groundbreaking and very welcome.

The Bill also addresses how we can get NHS bodies to better identify people who are, or are about to become, carers so that their health needs are assessed too. Many Members have talked about changes that are already being made in some parts of the country to achieve that. My hon. Friends have talked about the work that is taking place in Stockton and Salford, and the hon. Member for South Thanet (Laura Sandys) mentioned Torbay care trust, which I visited earlier this year. It is doing brilliant stuff in schools, but also in hospitals. Its staff know that if an elderly person who has had a stroke comes in with a husband, wife or partner, the latter will probably end up being a carer. It has a package of measures in place to identify such people.

In my constituency, Leicester city council has recently set out its plan for improving support for carers. As far as I remember, the plan says a lot about what schools can do, but I do not believe it mentions Leicester college, Leicester university and De Montfort university. The Bill would ensure that such issues were considered in every area, which would make a big difference.

I want to take a few moments to talk about something that we have not focused on so far in the debate but that is critical, which is how the Bill could help our economy. Creating jobs and growth is the biggest challenge that the country faces at the moment. As my hon. Friend the Member for Worsley and Eccles South said, the business forum Employers for Carers has clearly spelled out the mounting costs not just to families but to businesses of a care system that is not helping families to juggle their work and caring responsibilities. As our population ages and people have to work, and probably care, for longer, we have to understand that changing our care system is as important as continuing to make improvements in child care in helping families balance those responsibilities.

Using research from the London School of Economics, Age UK has shown that the cost to the economy from carers’ inability to balance their working and caring responsibilities is now £5.3 billion in lost earnings and more than £1 billion in lost tax revenues and benefits bills.

[Norman Lamb]

Does the shadow Minister agree that extending the right to request flexible working is also important? It will enable people with all sorts of caring responsibilities to enter into a discussion with their employer to see whether there might be flexibility for them to be able to work in a different way.

[Liz Kendall]

I have always been a champion of the right to request flexible working, which has made a big difference. I hope the Minister will not listen to the voices of some Members sitting behind him who want employment rights, including the right to request flexible working, removed from those working for a business employing three or fewer people. That would be a mistake and would not help us to address the issue. Employers for Carers has stated that if we stimulate the care market, as measures in the Bill seek to do, that could—as my hon. Friend the Member for Worsley and Eccles South said—deliver a triple economic win: better services for families, infrastructure to help employers retain skilled staff, and a boost to economic growth.

The Bill introduces the big challenge of flipping the care system on its head. Instead of seeing the ageing population and growing care needs and demands as a drain and burden on the country, we should see it as an opportunity for growth. The population is changing; it is ageing. Demand for care and support services will grow, and there is a huge opportunity to develop and stimulate jobs, companies and growth in that area, as has been done in France. In 2005, the French Government launched a plan to develop what they call services à la personne—a range of home care services, home visits and domiciliary care, and different types of services such as those provided by handymen and handywomen, drop-in services and support.

Between 2005 and 2007, 100,000 jobs a year were developed through the different incentives introduced and, as my hon. Friend said, even after the financial crash, 50,000 jobs a year were stimulated in that way. I urge hon. Members to read the report by Carers UK, “Growing the Care Market”, which sets out an important challenge. As we seek to develop and rebalance the economy, growing the care market will deliver better services for families who desperately need them, and a better, bigger, vibrant care market in the future, which is vital.

My hon. Friend’s Bill builds on many of the previous Government’s improvements and on recommendations in the Law Commission’s review of adult social care legislation. That review began under the previous Government, and reflects many aspirations in the current Government’s White Paper and draft Bill on care and support. There is much cross-party consensus that we must move forward on these issues.

[Norman Lamb]

Does the hon. Lady also agree with the Law Commission’s view that it is best to get everything codified in one place so that one piece of legislation addresses all issues of care and support?

[Liz Kendall]

Opposition Members, myself included, want to ensure that the draft Bill on care and support covers all the issues that we wish to see progress. However, we also want to see the provisions in my hon. Friend’s Bill on the statute book. I welcome the Minister’s commitment to engage with my hon. Friend on the draft Bill, but when he rises to speak will he go further and commit to including those clauses for which he has specific responsibility in the Department of Health? Those will include the duty on local authorities to assess people’s needs, ensuring sufficiency of provision, and for NHS bodies to identify carers. I understand that the Minister needs to engage with colleagues in different Departments—notably the Departments for Business, Innovation and Skills and for Education—but it would be a welcome step forward if he committed to including in the Bill those clauses for which he has responsibility as a Health Minister.

I should, of course, welcome the Minister to his new role. He has a track record—certainly before the previous election—of commitment to social care. He will also know, however, that we cannot deliver the vision of a transformed system of care and support that Ministers claim to want in their White Paper and Bill, and which Opposition Members certainly want, without the money to deliver it. My hon. Friend’s Bill will make a big difference, but we cannot deliver without getting more money into the system.

As the Minister will know, there are two key challenges. First, we need to address the current funding gap in social care. Because local councils’ budgets are being cut by a third, social care services are being reduced and cut. That is inevitable. Adult social care makes up around 40% of local councils’ budgets, and up to 60% in some areas—it their biggest discretionary spend. When their overall budgets are being cut by a third, it is inevitable that those services will be cut. We need to address that immediate challenge and the immediate care crisis.

Secondly, we need to reform care funding in future. The Minister will know that the Opposition called for and initiated cross-party talks with his predecessor on the recommendations of Andrew Dilnot’s commission on the future funding of care and support. We remain completely committed to trying to achieve cross-party agreement and consensus on that vital issue. Will the Minister tell the House whether the quad of the Prime Minister, the Deputy Prime Minister, the Chancellor and the Chief Secretary to the Treasury have agreed to fund Andrew Dilnot’s recommendations, as was reported in the newspapers over the summer recess? I hope they have made such a commitment. We could then work with the Minister to secure the cross-party consensus on both the current gap and the future funding of care. That will enable us to make the vision that Opposition Members have of a better and fairer system of social care a reality.

The provisions in my hon. Friend’s Bill, which I hope will become legislation, would ensure that we deliver that better system of care and support for all those disabled people and family carers, whether they are funded by the state or self-funding, and whether they are younger or older carers. They will also ensure that we give people the decency and dignity they deserve when they are looking after frail, vulnerable and elderly relatives whom they love and whom they want to have a better life.

--- Later in debate ---

[Norman Lamb]

The hon. Gentleman raised those points earlier. Yes, of course I am keen to engage with Scotland and Wales, and I would certainly be happy to meet the all-party group. I want to be as open and inclusive as possible in this process.

As I have said, there is also a concern that the Bill would impose a range of new, additional burdens on public and private bodies at a time when we are committed to reducing such legal duties. We agree with much of the intent of the Bill, but there are a number of ways in which we can pursue our common goals effectively. In July, the Government published the draft Care and Support Bill, which will undergo pre-legislative scrutiny later this year. That is information on the timetable for the hon. Lady. We can use that process to discuss the provisions relating to adult carers. In addition, earlier this week the Department for Education published draft legislation on the reform of provision for children and young people with special educational needs. That will also present an opportunity to consider how we might improve the identification of and support for young carers. I urge the hon. Member for Aberavon (Dr Francis) to engage with that process as well.

Private Members’ Bills have played a central part in the history of carers legislation. I would like to take this opportunity to pay tribute to the hon. Member for Aberavon for the significant contribution that he made by promoting the Carers (Equal Opportunities) Act 2004. He has been involved in these matters throughout the period since, and I want to express my gratitude to him for that. I also want to thank other parliamentarians, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), the right hon. Member for Croydon North (Malcolm Wicks) and Lord Pendry. Their contributions to the development of carers’ rights date back to the mid-1980s.

I also want to thank my predecessor, my hon. Friend the Member for Sutton and Cheam (Paul Burstow). He has championed carers, both from the Back Benches and while Minister with responsibility for care services, and I am certain that he will continue to do so. I want to take this opportunity to pay tribute to the work he has done as a Minister. He has shown utter dedication to the cause, and I know that that has been widely appreciated.

Carers make a vital contribution to society, as many Members have said, and we are taking concerted action to support them. We set out our priorities in “Recognised, valued and supported: next steps for the Carers Strategy”, in November 2010. Between 2011 and 2015, we will provide an additional £400 million to the NHS to support carers, including through the provision of carers’ breaks. My hon. Friend the Member for Bury North mentioned this earlier. The White Paper commits to over £125 million of additional resources being allocated to carers.

Carers are central to the Government’s proposals for care and support. For the first time, carers will be placed on the same legal footing as the people they care for. That is an incredibly important breakthrough. We will extend the existing right to a carer’s assessment and provide carers with a new entitlement to support to meet their needs. The hon. Member for Aberavon mentioned Scotland and Wales. Both are planning new legislation, but neither is proposing to require councils to meet the eligible needs of carers for support, as our draft Care and Support Bill does. That should be acknowledged. I understand that Wales and Scotland are proposing a discretionary power to provide services to carers. We are taking groundbreaking measures to improve the position of carers. We are providing resources to the Royal College of General Practitioners. In opening the debate, the hon. Member for Worsley and Eccles South referred to GPs in her own constituency and some of the interesting, innovative things they are doing. I accept that this is not widespread enough at the moment, but interesting things are happening around the country, which we should acknowledge. We are providing resources to the voluntary sector as well as to the Royal College of General Practitioners to help increase awareness among health professionals of the importance of supporting carers to identify themselves as such and to direct them to relevant information, advice and support.

Our care and support White Paper, “Caring for our future”, together with the draft Care and Support Bill published in July, set out the Government’s plans for the biggest transformation of care and support in England since 1948.

It is vital that carers are able to take a break from their caring responsibilities. To help support them to do this, the Government have made available an additional £400 million to the NHS between 2011 and 2015 to provide carers with breaks from their caring responsibilities to sustain them in their caring role. Under the White Paper proposals, carers would benefit from a diverse range of supportive personalised interventions. This might take the form of providing additional support for the care user either through respite care or in their own home; it might give the carer the opportunity to take a short break, perhaps a weekend away to see friends; it might mean being free to get a hospital appointment to look after the carer’s own health—a point raised by many hon. Members.

[Liz Kendall]

Will the Minister clarify how we will be able to keep track of the money allocated for respite care? It is often given out nationally but not ring fenced, which can be a problem when it sort of disappears. How will we know where the money is going? Is it going to clinical commissioning groups, for example? How will we keep an eye on it and how will we know that it has been spent effectively?

[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.

[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.

[Liz Kendall]

The Minister seemed to be coming to the end of his speech, but I hope he is going to reply to my question about whether the quad has agreed to fund Andrew Dilnot’s recommendations, as has been reported over the summer.