Carers

Liz Kendall Excerpts

Thursday 20th June 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to follow the excellent speeches made by Members on both sides of the House today. I thank the Backbench Business Committee for giving us the opportunity to debate this crucial subject, and I particularly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Banbury (Sir Tony Baldry).

One in 10 of all adults are now caring for an older or disabled person—6.5 million in total, up 600,000 from 10 years ago. The biggest increases are among those aged over 65 and those caring for more than 50 hours a week. This is a huge change in society that we all need to do more to understand and get to grips with. Our care system simply would not function without the vital support family members provide for their loved ones; as many Members have said, their financial contribution is estimated at more than £100 billion every single year. Despite that, all too often, carers go without the support they deserve and desperately need to look after the people they love. That is why today’s debate is so important.

The last Government made important progress in improving support for carers. We introduced new rights for carers, including the right, for the first time, to request flexible working. We improved information and advice, and had training programmes for carers such as the expert carers programme, the benefits of which I have seen in my own constituency through the brilliant work of CLASP, the carers centre in Leicester. We funded breaks for carers. Many Members have spoken powerfully about how important breaks are. If carers who are caring for many hours a week have a bit of a break in sight, it really helps them to carry on. We also introduced financial incentives for GP surgeries to identify carers and refer them to local councils for support. That was part of the quality and outcomes framework, which was introduced as part of the 2004 GP contract, and was the very first step in providing a specific financial incentive for GPs to identify carers.

However, as all Members have said, far, far more needs to be done. Like many Members, I have seen in my constituency and within my own family the often desperate daily struggle that is still faced by too many people who look after a loved one who is disabled, physically frail or has dementia—sometimes all three. I pay tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who powerfully explained her own experience of the physical and emotional demands of caring for a loved one. As she said, there are the physical demands of helping someone to get up in the mornings. Carers can be exhausted from getting up two, three or four times in the night to help someone go to the toilet, and from helping them move around the home. There are also the emotional demands. When a carer sees the person they fell in love with become frail and perhaps lose some of their pride and strength, it is terribly upsetting. If a son or daughter sees the parent who brought them up and taught them about the world—for good or for ill—begin to fade as a result of dementia, and they begin to feel as if they themselves are becoming the parent, it changes something essential in the nature of that relationship. I have always believed that relationships are essentially what make us human. If someone has dementia and begins to forget the relationships they have, it takes something away from the carer, as well. Caring for a loved one is physically and emotionally demanding. Many Members have talked about the role of public services. Health professionals are taught to understand physical and mental illness, but not necessarily the wider emotional and social issues.

I want to talk about three critical areas where we need to make progress, the first of which is identifying carers. If we do not know who they are, we will not get them the help and support they need. The second is ensuring they get the right information, advice and support from the NHS as well as social care. The third is helping carers to stay in employment, which many Members have talked about. That is particularly important as we all live longer and need to work for longer. If the public finances are to remain stable, we must do everything we can to help people in that regard. My hon. Friends the Members for Worsley and Eccles South and for Birmingham, Selly Oak (Steve McCabe) talked about the importance of identifying carers. The hon. Member for Ceredigion (Mr Williams) said that there is a great deal of awareness of carers and of the use of that term, but lots of people still do not realise they are a carer or think of themselves as such; they are simply trying to be a good daughter, son, husband or wife. Others do not ask for support because they worry that people will think they cannot cope; there is a lot of associated guilt. We need to identify these hidden carers.

There are many examples of good practice, but perhaps the best I have seen is in Torbay, where the issue of identifying carers in GPs’ surgeries and hospitals has been closely examined. If someone who has had a stroke comes in with a family member, it is recognised that that family member is likely to be a carer. A great range of support is provided. The approach taken in Torbay starts with the person who may need health care; as a result, they immediately talk about their family member.

I want to offer some practical suggestions to the Minister on how to make further progress. Will he consider amending the quality and outcomes framework? At the moment, it provides a points incentive and a financial incentive for GPs to refer carers to social care services; but why not to other health services, if carers’ health needs are so important? Secondly, will he give guidance on the best questions used to indentify carers? When I recently registered with a new GP, the leaflet provided asked, “Are you a carer?” I knew what that meant because I am familiar with the policy debate, but most people would wonder what that meant—paid carer, unpaid carer?

I spoke at the event that launched the research into attendance allowance claimants by the Strategic Society Centre and Independent Age. There are 1.3 million older and disabled people in England with very high levels of need. The research shows that 35% of attendance allowance claimants are cared for by a son or daughter, 30% by a partner, and 15% by another family member. The DWP has that information. I hope the Minister will talk to his DWP colleagues about drawing up a proper action plan.

Thirdly, I want to join my hon. Friends in pressing the Minister on what action will be taken through the draft Care and Support Bill to identify young carers. Will he update us on his meeting with the Education Minister? What is the obstacle to amending the Children and Families Bill, the draft Care and Support Bill, or both? I tell the Minister that the Opposition will table relevant amendments if the Government do not.

I turn now to improving information and advice for carers. Carers UK says that a third of those caring full time for an older disabled or seriously ill friend or relative receive no practical support, and those who do often find that services do not fit around their particular needs, especially if they are struggling to hold down a job. As many Members have said, these services still too often end up offering last-minute help and support, when families have already reached crisis point. I pay tribute to my hon. Friend the Member for Corby (Andy Sawford), who talked about his nan. Before she got any support, a crisis point had already been reached. That was no good for her, and it is no good for taxpayers. More than one in five carers who have been admitted to hospital as an emergency case in the last three years say that it could have been prevented, had they been helped to look after their own health, or been given a break from caring or other forms of support. Given that money is so tight across the NHS and council care services, we have to get those up-front preventive services and support in place.

I have another practical suggestion for the Minister. As he knows, there is a brilliant national GP patient survey, run by Ipsos MORI, which provides detailed information about the needs of patients registered at a surgery. The last time I looked through it, I do not think there were any questions about whether the respondent was a family carer. It was about the needs of the individual patients, not carers. Such a question would provide us with some brilliant data that could be given back to individual surgeries as the basis from which to start developing support.

[Norman Lamb]

The GP survey is absolutely something that we can consider. If we can demonstrate how individual surgeries are performing against their responsibilities towards the whole family, and not just towards the person who is receiving medical treatment, we might well drive changes of behaviour in the surgery.

[Liz Kendall]

I am very pleased to hear that from the Minister and I will continue to follow it up with him. Including such questions in the survey would not cost any more and the data are collected by individual practice, so we would all be able to look at the GP surgery data in our own constituencies and ask what action plans were being followed. Clinical commissioning groups could be required to follow that up.

The third issue that many hon. Members have talked about is helping carers to stay in paid work. Families need the income carers get from paid work and our economy needs the skills and talents of carers. That challenge will only increase as our population ages and as more people live for longer and have to care for longer.

The biggest group of carers are people aged 50 to 65, many of whom still want and need to work. Many are women who, as hon. Members have said, are stretched at all ends. Some are looking after their children or grandchildren, or sometimes both, as well as caring for a frail partner or elderly relative and trying to hold down a job. To have one in three carers being forced to give up work or reduce their hours because the right services and support are not available does not make sense for our economy as a whole. The right hon. Member for Sutton and Cheam talked about the LSE and Age UK research that shows that that is costing more than £5 billion a year in lost tax revenues and increased benefit bills.

I strongly urge the Minister to talk to his colleagues in the Department for Business, Innovation and Skills about how the Government can do more to promote flexible working among family carers. We have made great progress in arguing that child care is part of our economic infrastructure, and, as the population ages, social care must be too. I believe that from cradle to grave, child care and social care must be the twin pillars of a reformed welfare state.

In conclusion, the draft Care and Support Bill is an important step forward and is very welcome. It builds on the recommendations of the Law Commission’s review into adult social care legislation, established and initiated under the previous Labour Government. Indeed, many of its recommendations were set out in our White Paper on social care, produced just before the general election. On its own, however, the Bill will not be enough.

Rights in law simply will not be delivered on the ground if the services are not available locally to make them a reality. Local council budgets for adult social care have been under pressure for many years, but they are now at crisis point as council budgets have been cut by a third under this Government. The Local Government Association says that councils have had to reduce their adult social care budgets by £2.7 billion over the past three years—that is a staggering 20%. The LGA says that

“eligibility thresholds cannot be raised much higher, 87% of councils are now at the substantial/critical threshold”.

That affects not just the statutory services, but the voluntary organisations that several hon. Members have rightly championed. Cuts from Leicestershire county council mean that CLASP carers centre in Leicester wonders whether it will even be able to survive. Many Members have talked about the important role of the voluntary sector, but without state funding many such organisations will not exist in future.

Will the Minister back calls from Opposition Ministers for £1.2 billion of this year’s NHS underspend, handed back to the Treasury in March, to be given to social care to ease the short-term funding crisis over the next two years? What representations has he made to the Chancellor on council care budgets for the spending review? Has his Department made the clear economic and social justice cases for preventing them from being slashed further? If any NHS funds are to be transferred to local councils in next week’s spending review, will they be specifically ring-fenced so that money gets through to the front line?

Ultimately, we need a bigger and bolder response to meet the needs of our ageing population and to help Britain’s carers. We need a fully integrated NHS and social care system with one budget. We should take the £15 billion spent on social care and the more than £100 billion spent on the NHS and join them together so that we get better care and better value for money for taxpayers. I believe that that is what Britain’s carers deserve.

--- Later in debate ---

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

[Liz Kendall]

Does that mean that there will be a requirement on schools, and on further and higher education bodies, specifically to identify young carers?

[Norman Lamb]

It is not my job to speak on behalf of the Department for Education, and the hon. Lady will have to be a bit more patient in waiting for further news on that subject.

Key principles to inform that work and discussion over the summer are, first, that the starting point should be assessing the needs of the adult or child who needs care and then seeing what remaining needs for support a young carer in the family has. The presence of a young carer should trigger either an assessment or the offer of an assessment to the person needing care. Secondly, a whole-family assessment is key when assessing an adult needing care where children in the family are providing care to the adult or undertaking wider family responsibilities. The adult’s assessment and eligibility for support should take into account their parenting responsibilities and the functioning of the family. Thirdly, assessments should establish why a child is caring and how to prevent—this is the crucial point—excessive or inappropriate caring responsibilities which could have an adverse impact on their education, social activities, emotional development or health. As much as possible we ought to be enabling a youngster to grow up like any other youngster can, without having inappropriate burdens on them that impact on their education and social life.