Norman Lamb
Main Page: Norman Lamb (Liberal Democrat - North Norfolk)Department Debates - View all Norman Lamb's debates with the Department of Health and Social Care
(11 years, 5 months ago)
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The Minister of State, Department of Health (Norman Lamb)
The hon. Lady said that we have so far ignored what she has been arguing for in terms of action. I just wanted to reassure her that I have absolutely not ignored that. I have said, I believe in the debate on the Queen’s Speech, that I would seek to meet the Minister dealing with the Children and Families Bill, and I have done that. I take the point the hon. Lady makes very seriously and I want to see action to address the concerns that she and others have raised.
Barbara Keeley
I thank the Minister for that point, but I have to tell him that he and the children’s Minister have to start to accept that making reassuring noises and having meetings is not enough.
Sir Tony Baldry
One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.
Norman Lamb
Does my hon. Friend agree that it is not simply about employers having a duty to look after employees who have caring responsibilities; it is also about enlightened self-interest? It is an enormous own goal when so many employers lose really good and experienced employees, who could otherwise contribute so much to a business, because they have caring responsibilities. It is in their interests to keep those employees.
Sir Tony Baldry
I entirely agree and hope that all employers see the enlightened self-interest in looking after carers. I think that there is a general recognition that everyone in the system has to start thinking about carers, particularly those who are caught in the sandwich generation and have to look after children and older relatives.
The two colleagues who have spoken in the debate have already set out the broad context of the research done in carers week: about three quarters of carers felt unprepared for their caring role; four in 10 had reduced their working hours because of caring; nearly a third had missed out on the chance of promotion; almost half had used savings to pay basic bills, such as those for heating and food; and more than a quarter had taken out a loan or fallen into debt as a result of caring.
I am conscious that many colleagues wish to speak. I will use the time remaining to highlight some specific concerns raised by Carers Oxfordshire. In anticipation of today’s debate, I asked Carers Oxfordshire about the concerns of local people. Unsurprisingly, there was a huge response from carers. I think that there is a feeling among many carers that one of the most important things is having their voice heard. The sorts of points raised were as follows:
“Carers would like to hear greater clarification about the implementation of the Care and Support Bill along the following lines: ‘Carers are very pleased to see the rights of all carers to have an assessment so clearly defined in law. The concern is that the regulations are written in the spirit of the legislation i.e. of widening the access to help and support for carers. The national eligibility framework needs to reflect this and ensure that the threshold of eligible needs is not set too high. The risk is that local authorities will use the framework to restrict “eligible needs” on the basis of limited resources, which could mean many carers will not be any better off in terms of the help and support they receive. We must ensure there is not a postcode lottery in the way the framework is operated by local authorities.’”
On respite for carers, respondents commented that it is
“too expensive and too hard to get currently as care homes often don’t ‘allow’ bookings to be made well enough in advance to allow carers to book holidays. There is very little financial help for ‘stay at home’ carers. What about care vouchers similar to child care vouchers being issued, or tax relief on care costs?”
With regard to GPs, the identification of carers is a really important issue. There
“needs to be more emphasis from GPs and a greater recognition of carers’ contribution and value, including their health and wellbeing.”
Another point was this:
“Poor quality of care provided by care agencies is a huge concern. Quality, reliability and accountability are ongoing concerns for carers.”
On carers in employment, concerns were expressed about the financial cost of care and the impact on those who have to give up work or reduce their working hours.
The respondents make an interesting point:
“Military carers and their family can suffer a significant disadvantage, to include homelessness due to ‘entitlement’ issues around properties when they take on caring responsibilities. Lack of recognition from the military.”
They continue:
“Carers want to see social care and nursing care fully combined as one discipline. As far as they are concerned they are one and the same thing. During one carer’s experience in the weeks prior to her mother’s hospital admission she had had three different teams visiting her throughout the day. They spent more time completing forms and leaving files than anything else. It was tiring and draining for her to have so many different people coming and going. Full integration of the two disciplines is key for continuity, to prevent duplication of effort and reduce needless bureaucracy.”
Finally, they state:
“Look at simplification of forms for applying for carers allowance and attendance allowance.”
It is really good news that the Care Bill will consolidate and simplify decades of social care legislation in England. We must not lose sight of the fact that it will include significant and welcome new rights for carers to improve access to carers assessments and new duties on local councils to provide care services. I share the concerns of the hon. Member for Worsley and Eccles South (Barbara Keeley) about young carers, but I am confident that those on the Treasury Bench have taken on those concerns and will table amendments to the Bill in the Lords to cover them.
We are making good progress. The direction of travel is a good one, but we have to recognise that a huge amount of distance still has to be covered if we are to be proper advocates and protectors of the millions of carers in the UK who selflessly give themselves to look after a loved one.
Sarah Newton (Truro and Falmouth) (Con)
I am pleased to have the opportunity to speak in this debate. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has made a huge contribution not only today but throughout his parliamentary career—as a Minister and now from the Back Benches—in raising these issues.
I had the great privilege of being parliamentary ambassador for carers week for the Conservative party, along with my coalition partner, my right hon. Friend the Member for Sutton and Cheam. Rather than trying to cover what was an encyclopaedic summary of the issues affecting carers, the excellent research communicated during the week or, indeed, many of the points made by colleagues on the Opposition Benches, I would instead like to back up everything that he said in describing so well the challenges and opportunities and summarising the Government’s position. I will then make some reflections and observations on my time as an ambassador.
I would like to congratulate the organisations that came together to form carers week, because they achieved something quite remarkable. More than 26,000 organisations across the UK came together and put on more than 100,000 events. Why is that important? From the events I attended, I realised it was vital to raise awareness of the services and financial help available for carers. Like many other Members, I am sure, I often find in my casework and when visiting organisations in my constituency that those who most need help are often the least likely to access it, and we have to work hard to ensure that the legislation, the benefits and the rights that we provide for in the House get into the hands of the people who really need it.
When attending the events in my constituency, I was struck by a fundamental problem touched on by the hon. Member for Ceredigion (Mr Williams): many carers do not identify themselves as such. I spent some time in the lobby of the Royal Cornwall hospital trust alongside volunteers and care support workers from the Cornwall Rural Community Council. They would approach people who were clearly carers—elderly people pushing people in wheelchairs, coming into hospital, attending appointments or leaving hospital—and ask them, “Are you a carer?” They would ask them very nicely and in a friendly manner, with a view to engaging with them to ensure they were getting the help to which they were entitled, but the people would hurry on saying, “No, I’m not a carer.”
If, however, we asked whether they looked after someone—a husband, wife, child or loved one—they replied yes. If we asked them, “Do you regularly provide support perhaps through cooking meals or going shopping?”, they replied yes. We need to think about that a bit more in our desire to find out who carers are and ensure they get the support they need, whether from the NHS, councils, employers or the voluntary sector and wider community. We need to think about how we frame the conversation to enable people to identify themselves as carers, because most of the people I spoke to said, “Well, I’m just doing what any family member would do. This is what families do.” If somebody is ill or has a disability or care need, families gather round. I took that from my meetings last week, and it is particularly important in literature. Central Government produce a lot of literature, and a lot of benefits leaflets go out through the Department for Work and Pensions and throughout the health service, so we should think about the terms we use and how we can engage with people in that literature.
Another thing I reflected on after speaking with carers last week—this came out in the reports—was the evidence on the number of people who gave up work to care. This can have a detrimental impact on the carer: they miss the social contact provided at work and can feel quite isolated and often trapped at home, especially in remote rural areas, such as those in my constituency, where it is difficult to use public transport and connect to wider society. It also has a detrimental impact on household incomes and pension provision. The main question that Carers UK is asking the whole nation is the right one: are we prepared to care? It is a question for the whole of society. Are employers prepared to provide those flexible working opportunities to enable people both to attend to their caring responsibilities and to work?
We have to be realistic, however, because many people are worried about their job at the moment, and so, for fear of losing their job, are unlikely to talk to their employer about the need to work flexible hours. The Government need to engage with employers—there are exemplars, such as BT, with a long track record of recruiting and retaining older workers and enabling flexible working—about the research and the issues and to get them thinking about making it easier for their staff to request flexible working. The huge triumph in employment in the past century was to enable women to juggle caring responsibilities for children and work. In this century, as we respond to significant demographic changes, we need a massive shift to enable workers of all ages to combine other caring responsibilities. For older people and people with disabilities, that is a very important lesson from carers week.
Carers told me that even if they wanted to carry on working—if they had the income and were prepared to pay for care, or have a mixture so that they would do part of the caring but pay for people to come into the home to support them, and their loved ones agreed to that—they were anxious about the quality of the care they would be inviting into their homes. All of us were horrified by recent revelations about some of the carers going into people’s homes, whether they were paid for by individuals or local authorities as part of their domiciliary care service. Until we crack the nut of ensuring that high-quality, well-trained and well-paid carers are going into people’s homes, people will have a great fear and reluctance to try and combine caring responsibilities with employment.
We find a sad position in too many local authorities. We all understand that councils’ budgets are under a lot of pressure. I was a councillor and I know that it is difficult to balance all the needs of one’s community with conflicting demands on what the council should be spending its money on. No two people agree on what a council’s priority should be. For me, it is straightforward: a council’s responsibility, like central Government’s responsibility, is to prioritise the care of the most vulnerable people in society. However, in contracting for domiciliary care, local authorities are cutting their payments so low that it is difficult for private care providers to provide a good quality of care while remaining economically sustainable. That reduces the options available for the vast majority of people who self-fund care.
Norman Lamb
I agree very much with the points my hon. Friend is making. Instead of commissioning on the basis of a quarter of an hour and a race to the bottom with the lowest bidder winning the contract, does she agree that commissioning that provides incentives to improve the well-being of the individual being cared for—maintaining their mobility and improving their capacity to remain independent—is the way in which local authorities should be contracting providers of care at home?
Sarah Newton
I absolutely agree that local authorities should be remorselessly focused on the best possible outcomes for the people they have a duty to provide care for. They should also understand that while the vast majority of people are not eligible for local authority care, local authorities have a responsibility as market shapers in their localities to ensure that private, third and voluntary sector organisations are able to provide the care services that most people pay for themselves. By constantly engaging in a race to the bottom, they are undermining the ability of those organisations to provide services to the community. Most private or third sector domiciliary care providers need a certain amount of contracts or business from the local authority.
Sarah Newton
I back what my hon. Friend says. The Joint Committee’s report was excellent and showed Parliament at its best. People with tremendous experience from the House of Lords and this place worked together to scrutinise and improve that excellent Bill. The Government should be commended for introducing it at a time of economic restraint, especially as it has financial consequences: spending more money on supporting carers is a bold thing to do at the moment and it underlines the great value we put on carers. I back my hon. Friend in his call for an amendment, because if local authorities are tempted to avoid doing what we would all regard as the right thing—to look after the most vulnerable people in our society—we need to tighten up the law to remove that temptation from them.
I would like to share another issue that was raised in carers week. The strong message from carers was that they do not always feel involved in the decisions made by professionals about the people they are caring for. The Government have, rightly, enshrined in their health and social care reforms the principle that “No decision should be taken about me without me.” I would like to extend that so that “No decision is taken about the person I am caring for without me.” I have heard far too many cases, in my own case work and during carers week—particularly from parents caring for children with disabilities—where substantial decisions, on whether their children should be cared for away from their home many hundreds of miles away, were considered without proper discussion with the parents. That is absolutely wrong. There is a prevalent attitude among some professionals that they know best: “Trust me, we know what is best for your child. Trust me, we know what is best for your wife or your husband.” While I would like to be able to trust all professionals—we think that by and large they do have the best interests of people at heart—there should be openness and transparency. Carers should be involved in decisions, so that there is a joint agreement and an understanding about what is in the best interests of the person being looked after.
On a more positive note, I would like to share some of the good practice I saw during carers week. I saw great examples of innovation involving the voluntary sector, in particular. We have talked about statutory provision and what employers can do, but broader civil society and the voluntary sector have an enormous role to play too. I would like to share two examples from Cornwall, one of which is from my own constituency.
A group of people in Falmouth in my constituency responded to the Prime Minister’s dementia challenge by wanting to ensure that everybody in the community supported people with dementia. More than 200 organisations in Falmouth got together to make it a dementia-friendly community. I was proud, in my hometown, to be at the launch a couple of weeks ago, and I was proud that it was the first town in Cornwall, and probably one of the first in the country, to be a dementia-friendly community.
What does it mean to be a dementia-friendly community? It means that the shopkeepers in the high street have gone through awareness training. It means that we have dementia cafes and that the people in the youth centre are aware of people with dementia. Overall, it means that people who suffer from dementia, or are caring for someone who suffers from dementia, can go into Falmouth with confidence, knowing that they will receive a warm welcome in the shops, libraries, public spaces and the youth centre. The people there will understand more about dementia and some of the behaviour that comes with it. Some people might find that behaviour a little bit challenging and scary, which often makes the people who care for someone with dementia want to stay at home. They can be fearful of the response they will receive in a public space and end up becoming isolated. I can honestly say that people with dementia will receive a very warm welcome in Falmouth, thanks to the huge amount of work done by a small group of volunteers ably led by the Bridges, who are Rotarians in Falmouth.
The whole community has got behind this exciting project—indeed, so much so that another group of people in Falmouth, led by a former nurse, Lisa Dann, has been working with Dementia UK over the last year to raise enough money for two admiral nurses. For those who do not know, admiral nurses, who are similar to Macmillan nurses, are specialist nurses who work alongside those with dementia and their carers, providing a lifeline for people coping with what can be a very difficult condition. Lisa was motivated to set up the charity and raise funds because of the poor support that her mum and her family received when her dad was suffering, before sadly dying from dementia.
Lisa has created a fantastic legacy in recognition of her father by raising enough funds—£60,000 in one year, which is a great credit to her, her team and the community—for the whole of Cornwall to have two admiral nurses. Her group is working innovatively in a partnership with a large social enterprise in Cornwall—Cornwall Care, which is the largest independent care provider in the county—to make the scheme sustainable. The group will be raising more money for more admiral nurses, which will provide a huge amount of support for carers, as well as people suffering from dementia. That is a good example of how the voluntary sector and volunteers can create a caring environment for carers.
Norman Lamb
I came across another example in my hon. Friend’s county called Changing Lives, where GPs work together—
Norman Lamb
I very much agree with my hon. Friend about the role of civil society. That will be a vital collaboration if we are to meet the challenge, given the rise in the number of people who need care.
Steve McCabe
I certainly agree with that, although I would be reluctant for us to have a complex system that the carer has more difficulty accessing. I take on board the right hon. Gentleman’s point, however.
In arguing for a champion, I am looking for someone like a councillor, with sufficient clout to intervene and right wrongs and cut through the madness and bureaucracy that all too often ends up punishing, rather than protecting, the carer. That does not mean we should not also have further review and appeal processes, but I want us to have something simple that people can make use of and that will make a difference.
A champion might also do more to make sure the voices of ordinary carers are heard. I am thinking about the hidden carers that so many Members have mentioned—the people who are too busy caring to have time to attend the consultation sessions, which are organised to suit the convenience and working hours of the NHS and local authority officials, so these people are never heard.
Norman Lamb
I totally agree with what the hon. Gentleman says about giving a voice to carers, who sometimes are treated appallingly, not only by providers of care, but by some of the statutory services and local authorities. With providers, we have introduced, through the NHS Choices website, the ability for people, in TripAdvisor style, to speak out and have their say about poor standards of care, and we may need to do something similar for local authorities, because there should be no hiding place when people are let down in that way.
Steve McCabe
I welcome what the Minister says. I am able to identify these people in my constituency, and I do not understand why it is so hard for the caring organisations to identify them.
I wonder why we do not say that at the point when an individual qualifies for attendance allowance the local authority should be notified and instructed to commence consultations with the person and their carer, with a view to establishing a long-term care plan and review strategy. That could reduce the occurrence of crisis care episodes, and the authority could simultaneously start to develop a support plan for the carer, so the needs of the carer are at the centre of the care plan.
Steve McCabe
One of the penalties of having been a Member of this House for quite a long time is that we get fed up with hearing such excuses. We know fine well they are nonsense; if we want it to happen, we can make it happen. That is the approach we should take.
My hon. Friend the Member for Corby (Andy Sawford) talked about older carers and carers who have been caring for older relatives, and I want to touch on one particular aspect of that. What will happen under the Government’s deferred payment equity release plans to surviving spouses who are carers, or elderly children caring for even older parents—it is not uncommon these days for a 70-year-old to be the carer for somebody who is 95 or 96, for instance? What rights will they have? In such situations, when the person who is being cared for enters residential care, what will happen to a carer whose name is not on the deeds of the house, although it may be their family home and they may well have lived there since marriage, or even childhood?
We must ensure that these carers do not end up homeless, destitute individuals with no pot of money to support them when they end up needing care themselves. I am not sure that the deferred payment scheme as currently structured takes account of the risk for those carers, and it would be the cruellest of rewards if, after a lifetime of care, we left them in this predicament.
Norman Lamb
At present, when someone goes into a care home and they have to sell the home to pay for care, the position of the carer could be very precarious, but the arrangements for the right to defer payment potentially provide greater stability for the carer. The hon. Gentleman raises an important point, however, and I will be happy to write to him directly about it.
Steve McCabe
I am grateful to hear that the Minister will look at the issue. I acknowledge that the current system is far from perfect, but interest-related deferred payments could mean more of the pot being consumed, and therefore less for the remaining carer.
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.
The Minister of State, Department of Health (Norman Lamb)
I am grateful to the shadow Minister, the hon. Member for Leicester West (Liz Kendall), for her thoughtful speech, much of which I agreed with. This has been a thoughtful debate in which many good points have been made and I thank Members for raising this very important issue. Many Members who have taken part in the debate have been long-standing advocates for carers and I welcome their interest and commitment. I completely understand why various Members constantly pursue issues such as those to do with young carers and will not accept my determination to help with that problem until it is dealt with. I accept that that is their role and it is their right to do so. The debate has been a good one and I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for securing it, together with his colleagues, and for all the work and championing he has done over the years for carers.
Let me make a preliminary point. Some of the Opposition speeches, including that made by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), focused on the difficult financial circumstances for local government, the impact of welfare reforms and so on. We could have a partisan battle about the issues, condemning the Government and so on. However, the shadow Minister recognised at the start of her speech the scale of the challenge we face, not just today but in the future. The numbers of people growing older with care needs, often with multiple conditions and a mix of mental and physical health needs, just keep growing. If we are all honest, both in this Chamber and with the public outside, we must admit that any Government of any political persuasion would face this challenge.
There is no easy solution. We cannot just find a magic pot of money to throw at the problem. There is an obligation on us all, as the shadow Minister made clear, to find ways of using the money we have available much more effectively than we do. We know that there is massive waste in the system because of the care silos—between health and social care, between mental and physical health and between general practice and secondary care. There is an absolute obligation on us all to engage in a debate about using money more effectively to achieve better care and support for people and to ensure that the system remains sustainable. I want to ensure that we elevate the debate by recognising the challenges we face.
The speech made by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) was, I think, really valuable. Ultimately, we need collaboration among statutory services, which should not abandon their responsibilities, the voluntary sector and, crucially, people—that is, the community, families, neighbours and friends. We need to unleash particularly the power of the many people who have entered retirement fit and healthy and want to give something back, but often do not know how to do so. An army of people out there are able and willing to help to meet the enormous challenges. Some of the schemes that my hon. Friend the Member for Truro and Falmouth alluded to in her county are happening in many parts of the country, and they point us to a better future—a more caring future, where community strength is rebuilt.
I wish to join everyone else in this debate in paying tribute to the extraordinary work that carers do, giving of themselves; it is self-sacrifice, and they get no plaudits from anywhere else. They are just committing to helping someone they love, often doing so in challenging and troubling circumstances, particularly where dementia is concerned, as the loss of recognition can be very distressing for a loved one. We also know that many carers are themselves frail, struggling to cope on their own. My hon. Friend the Member for Ceredigion (Mr Williams) mentioned the challenges in rural areas. My constituency of North Norfolk contains many elderly people who are often living in isolated communities and are struggling to get access to the services they need. We owe an enormous debt of gratitude to the work of every carer in our community. As we have identified in this debate, without carers the cost to the public purse would be enormous.
I therefore very much welcome this debate, coming, as it does, immediately after carers week. It gives us the opportunity to discuss how carers of all ages can be properly supported in their role and helped to have a better quality of life. That is what we should be focusing on: putting quality of life and well-being at the heart of the Care Bill. We should not be thinking about what service we deliver to passive recipients; we should always be thinking, “How do we make your life better? How do we make you happier in your life? What might you, as an older person, be able to offer to other people?” It should be about that, rather than about these people sensing that they have nothing more to offer and just facing dependency as they move towards the end of their life in a rather distressing way.
Carers are central to the Government’s proposals for improving care and support. The Care Bill, currently being discussed in another place, puts carers on the same footing as those for whom they care. We propose to simplify the assessment process for adult carers by extending their right to an assessment. The hon. Member for Birmingham, Selly Oak (Steve McCabe) made an absolute point: people need simplicity and they must not be faced with bureaucratic jungles to fight their way through. Our simplified procedures will consider the impact of caring responsibilities on the carer in order to help them to lead as independent a life as possible. We intend to remove the requirement that a carer must be providing
“a substantial amount of care on a regular basis”—
that is the test—in order to be entitled to an assessment. That will mean that many more carers—in essence, all carers—will be able to access an assessment. In addition, the Care Bill seeks to place a new duty on councils to meet carers’ eligible needs for support. Those measures will be underpinned by a Department of Health commitment to provide new resources for carer assessment and support, rising to £175 million per annum by 2020.
Barbara Keeley
Has the Minister really taken on board the message that has come from my colleagues in this debate, which is that assessment is not always the answer? A lot of carers do not go near local authorities and are not likely to know of, hear of or ask for an assessment. The people they are in contact with are GPs, doctors and nurses, so there must be much more onus on the NHS and its staff to undertake the task of identifying carers at the earliest stage and ensuring that they get information, advice and support.
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.
Paul Burstow
Will my hon. Friend confirm that the Government will be publishing amendments to give effect to this within the next week or two? Will he set out the timetable? Will the Government also address the other gap, which is the one regarding parents who are caring for disabled children? We need to make sure that none of those who have caring responsibilities get left behind.
Norman Lamb
I cannot give my right hon. Friend a specific time scale for what might happen—he needs to watch this space, and I am sure he will. On the question of parent carers, the view of my hon. Friend the children’s Minister is that there is sufficient provision under section 17 of the Children Act 1989 to provide for the assessment and support of disabled children and their parents. In addition, special educational needs reforms in the Children and Families Bill will give parents more choice in and control over the support they and their children receive.
Ian Mearns (Gateshead) (Lab)
It is a sad fact of life, though, that when a social worker visits the home of someone who needs care, they go with that client in mind. If a child in the household is caring for that adult, for example, but the social worker focuses on the adult client, all too often the social worker does not think to cross-reference the child’s needs with colleagues in the social work department.
Norman Lamb
I completely agree. That is why the whole-family approach is so important. When dealing with the care needs of one individual, we need to look at the impact of those care needs on the whole family.
Grahame M. Morris
I am grateful, and I compliment the Minister on his response. Does he recognise that, particularly in relation to young carers, it is quite right to place additional duties and responsibilities on local authorities, but local authorities must be given sufficient resources to discharge those additional duties and responsibilities?
Norman Lamb
I am not sure whether the hon. Gentleman was present when I said that we need to be much smarter about how we use the money available. One of the things we need to do—I think there is a degree of agreement here—is integrate health and care. It is a crazy silo situation that we face. We are not using the money effectively. We could achieve much better support if we combined the disparate parts of the system to provide support shaped around the needs of the individual and their family.
The last spending round provided local government with a challenging settlement. That is why we decided to provide extra funding to help local authorities maintain access to services. However, local authorities ultimately have discretion over how they use their resources. Improving care and support is not simply a case of more money. Local authorities must look at how they can transform care through innovation and new ways of working. As I said earlier, collaboration with the voluntary sector is critical to this. Many local authorities are successfully integrating health and care services to improve quality, and we are developing the concept of “pioneers” to act as exemplars to support the rapid dissemination and uptake of lessons learned across the country.
Some hon. Members talked about the role of doctors and other health care workers. I agree that much more needs to be done. We can look at incentives such as the GP survey mentioned in the exchange that I had with the shadow Minister, the hon. Member for Leicester West, and we have provided funding for the Royal College of General Practitioners and others to encourage GPs to think about the role of carers, but what we see from examples around the country, such as Changing Lives in Cornwall, is that once GPs start to collaborate and work as a partnership—as a team—with carers and the family, they begin to see that their burden is relieved because others can help them in the role that they have to perform. That is the essential change that it is so important to achieve.
My right hon. Friend the Member for Sutton and Cheam referred to the £400 million funding over four years for carers’ breaks. It is deeply frustrating that that has not been used as intended in all parts of the country. There are some areas, including Surrey and many others, which have done good, innovative things as a result of that. The Department asked the policy research unit in economic evaluation in health and care intervention to conduct a survey of a number of PCTs to gain their views on the benefits of NHS support for carers’ breaks. The findings will be published shortly and will help inform our understanding of what has happened. The early indications are that there may be more good things happening than we sometimes recognise, but clearly there have been significant gaps and much more needs to be done.
I appreciate that time is almost up. I entirely agree with my right hon. Friend and many others about the importance of work. I make the point again that providing help and assistance to enable people to remain in work is in employers own self-interest, as they maintain the skills in the work force while enabling that person to continue their caring responsibilities.
This has been a good debate. There has been some informed discussion and I am very grateful to hon. Members for their contributions.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I call Paul Burstow. We have about 40 seconds.