Supporting Carers

Paul Burstow Excerpts

Thursday 1st July 2010 Westminster Hall

[The Minister of State, Department of Health (Mr Paul Burstow)]

It is a great pleasure to open the debate and to do so as a Minister. I look forward to working with the hon. Member for Worsley and Eccles South (Barbara Keeley) in her new role as an Opposition spokesperson on health. I forgot to welcome her to her role at Question Time the other day, so I put that right now.

We are here to debate a very important issue for our society: how we offer proper support for the nearly 5 million adults in England who spend a significant proportion of their life providing unpaid support to family members or friends. Among those 5 million adults, there is real diversity with respect to the amount of care they provide, how long they provide it for, and when they provide it during their lives.

For instance, the biggest group of carers is made up of older people in their 60s or 70s, or even their 80s. Typically, they are looking after a husband or wife who is in declining health, although they themselves might be in poor or frail health. They are often devoted to their husband or wife, yet they are deeply concerned about what the future holds. The existence of that group reinforces the need for better identification of carers, for better ongoing support to ensure that they stay healthy and well, and for better integration of services across health and social care to ensure that those carers are fully involved in the treatment and ongoing care of their spouse.

Next, there are carers of my generation—people in their 40s or 50s—who find themselves caring for a parent or partner for several years, or perhaps longer. Those people need real flexibility and control to ensure that they can balance their caring duties with their work responsibilities and bringing up their own families. They are the “sandwich generation” that is often talked about.

There are also significant numbers of lifelong carers, who might have a son or daughter with a physical disability or a learning disability. They can become carers in their 20s. They have a lifelong commitment to support a loved one, which means that we are looking for support that can help them to lead a life outside caring, and to have a career, a marriage, friendship and hobbies—all the things that the recent carers week survey told us that so many of them do without.

Let us not forget about young carers. Officially, there are 175,000 of them, but I think that we all know that that figure is just the tip of the iceberg and that there are significantly more. Young carers are children who do not have a recognisable childhood because of their caring responsibilities. They do amazing things to support parents, brothers or sisters, but they need considerable support themselves. They need tailored and integrated support, with schools, social services and community groups working together to ensure that they have the same opportunities as other young people: a good education; good health; training opportunities; a social life; and, yes, the ability just to be children and have fun, which is what childhood should be about.

I am making the point that the policies that we introduce and the support that we offer must reflect that kaleidoscope of carers’ backgrounds, experiences and needs. Although many carers enjoy their caring responsibilities, I have no doubt that hon. Members in the Chamber have met carers in their constituencies who are at the end of their tether. Those carers feel undervalued and overlooked, and frustrated that the care and support available is not tailored to fit their families’ needs. Sometimes they feel a whole host of emotions: anger that such a thing could have happened to their family; grief at a life forgone out of love and duty; and guilt for feeling that they need a break, a breather and a bit of time to themselves.

That is why mainstream statutory services can make a massive difference. A comparison of the findings of the personal social services survey by the Department of Health, which was published yesterday, with the findings of the recent Carers UK survey entitled “No life of my own” reflects that point. The Department of Health survey of 35,000 carers, all of whom were in contact with statutory services, found that only 13% reported having no time to do anything that they valued or enjoyed. In contrast, the Carers UK survey of more than 3,000 carers who may have had little contact with the NHS or social services reported that 76% of respondents did not have a life outside their caring role.

What does that tell us? I think that it suggests that when carers have contact with services—whether in the voluntary sector, the local authority sector or the private sector—they are more likely to have a positive experience. That makes it all the more important that such services work harder for carers.

There are four points that I want to emphasise today. First, we must identify more carers so that we can put them in contact with the services that can help them. Many people simply do not identify themselves as a carer and hence do not come forward to get the help to which they are entitled. This is an area in which GPs can play a role, which was reinforced to me recently when I visited an excellent GP centre in Lambeth.

Just a few days ago, I attended a round-table event organised by the Afiya Trust at which a number of speakers told me about the specific challenges faced by certain ethnic groups. On that point, I intend to look at how we can break down some of the barriers that exist and ensure that we get culturally sensitive support to those who need it.

Secondly, we must ensure that there is effective integration across the whole system. We need joined-up planning, joined-up commissioning and joined-up delivery for carers and the people for whom they care. Public services need to talk to each other, but not just to each other—they also need to talk to the voluntary sector. They must respond to the whole picture of a family’s circumstances, rather than just considering their own specific area of expertise. We need one system pulling together, rather than different systems pulling apart.

Better integration across health and social care is particularly vital. Such integration has been talked about for years—I have attended debate after debate about it. If we want to make progress for carers, councils and health authorities will have to make such integration happen on the ground, along with their partners in the third and independent sectors.

Thirdly, we must make personalisation a reality for everyone and ensure that packages of support genuinely fit around a family’s needs and the way in which they want to live their lives. We plan to do that by encouraging the far wider use of direct payments, which is already a very popular way of giving carers more flexibility and control. The Government have made a clear commitment in the coalition programme that we will encourage more local authorities to offer direct payments. We will also challenge local authorities to provide those payments, and we will encourage others to hold local authorities to account so that they provide them.

One thing that we will not do, however, is to make promises that we cannot keep, which was what the previous Government did when they promised £150 million for breaks for carers. Thanks to the Princess Royal Trust for Carers, it is now well documented that primary care trusts siphoned off that money to spend on other things. Speaking from my personal experience, I can say that getting information from PCTs about how they were spending that money was like pulling teeth. Despite the fact that inquiries and freedom of information requests were made, some PCTs conspicuously failed to answer the local population that they exist to serve.

Let me be clear that local NHS commissioners should have full autonomy and control over how they spend the money that is allocated to them. Therefore, if we are putting money into the baseline, a Minister cannot claim credit by saying that they are going to spend the money on x when they know perfectly well that they cannot guarantee that.

I stress, however, that if we agree to loosen Whitehall’s grip, it is important that there is much greater local accountability. As part of a series of far-reaching reforms, we will set out shortly a programme for much greater transparency and accountability for the NHS at local level. Hon. Members and their constituents will be able to hold their local health services to account for how they spend taxpayers’ money. As a starting point, strategic health authorities have already reviewed how PCTs actually go about prioritising support for carers. We will publish the results of that audit and they will be put in the House of Commons Library in the near future.

I am afraid that I have to inject a dose of realism into this debate, as we also have to deal with the repercussions of the financial legacy that the Government inherited. As the recent Budget made clear, the Government will need to make significant cost savings to help the country to reduce the deficit. There will be a premium on efficiency and on ensuring that every penny of taxpayers’ money counts, reaches the front line and makes a difference to carers’ lives.

That may involve difficult judgment calls. For example, I have just made the decision to terminate the caring with confidence training programme on the grounds that it was not delivering value for money or giving carers training where it mattered. We will be providing the training materials from that programme free of charge to carers’ centres and others so they can carry on, with local partners, delivering training for the benefit of carers who need it. Having cancelled that programme, we can now ensure that the money does much more to benefit carers on the ground. We will shortly roll out a training programme to raise GPs’ awareness of their role in, and contribution to, supporting carers.

Better support is not necessarily about spending more money; it is about spending more wisely, which is what we intend to do. At the same time, the state should not over-reach itself. There are limits to what the Government and statutory services can do on carers’ behalf. As demography and patterns of disease remould our society, the wider community has a responsibility to adapt to those changes. That involves a big role for charities and voluntary groups, which can do much to stimulate grassroots response to many of the day-to-day issues that carers face. As a Member of Parliament for 13 years, I come to this debate not because of my personal experience in a caring role but because I have been taught and shown the issues confronting carers by my own carers’ centre in the London borough of Sutton.

Whether we call it active communities, social capital or the big society, we need to reignite the latent sense of collective responsibility that leads people to look out for each other and make the small gestures that can help in a big way. Employers also have a big role to play in making it easier for carers to stay in work. We pledge to extend the right to request flexible working to all employees, but a right to request is not a right to have. I am conscious that change depends on whether organisations across the private and public sectors grasp the economic arguments about what making such a commitment will deliver. We will be making those arguments strongly in the coming weeks and months, and I hope that all hon. Members in the Chamber will make the case when talking to employers and employers’ organisations in their constituencies. We must also make staff much more aware of the opportunity to ask for a break. The right to request was introduced four years ago, yet recent research indicates that half of those entitled to it did not even know that they had that right.

In conclusion, carers are and will remain a vital thread holding our society together. We pick at that thread at our peril. We will use this summer to develop a fresh, new carers strategy. We will build on what went before and acknowledge what the last Government did, but ensure that what we have is deliverable and affordable, and that it addresses carers’ concerns. I hope that today’s debate will play its part in shaping that refreshed strategy, and I look forward to hearing hon. Members’ contributions.

[Several hon. Members]

rose—

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[Mr Burstow]

I absolutely agree with that point, and that is why we will not promise to pay cash sums into the NHS baseline that therefore cannot be delivered to where Ministers claim that they will be delivered, and it is why we will ensure that we, as a Government, will provide both leadership and, when appropriate, direction to deliver the sorts of things that hon. Members on both sides of the Chamber have outlined today.

This helpful and useful debate will help to take our thinking forward as we begin our work on refreshing the carers strategy. Hon. Members cited many examples of good practice on the ground, and they offer beacons of hope for how services might look across the country. Challenging those who commission services locally to ensure that they learn from such examples of good practice is a task for not just the Government, but everyone. Examples of best practice do not come from the statutory sector alone, even though the most innovative parts of that sector are themselves beacons. As many hon. Members have said, we also have to applaud and encourage the social enterprises and social entrepreneurs who have spotted opportunities to do something for their communities and found the resources to do so.

I have identified a number of key issues from this debate: what we can do better to identify carers, whether they are young, old or from ethnic minority communities; what we can do to provide information and support for carers so that they can navigate their own way through the system; and what we can do to make the system simpler so that it is not the maze of benefits and complex rules about which we have heard so much in the debate. We realise that people who wear the label “carer” are not all the same. Carers are unique individuals confronting unique circumstances that require individualised and personalised responses. I agree entirely with hon. Members’ points about the need to empower carers as well as the people being cared for.

I will try my best to answer the questions that have been put today, but if I miss anything out, I guarantee that I will write to hon. Members with a fuller response than I can give today. I will also ensure that the points that have been made, particularly in respect of benefits, are raised in cross-ministerial and cross-departmental discussions on the carers strategy at the right place and at the right time. I want them to be taken into account as the work around simplifying and modernising the benefit system is taken forward.

The hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke for the Opposition, made a number of points, many of which we can work on together. Many hon. Members will be aware of her track record inside and outside the House. Elements of her speech made me feel that she expected me to take full responsibility for the things that the previous Government did not quite get right, such as the times when their implementation of a measure was flawed or when they failed to take note of representations. Although it is entirely fair for her to rehearse the points that I made in opposition—I certainly take those to heart—she will understand if I say to her that the last Government’s record left a lot to be desired, by which I mean that the improvements for which carers were hoping were not actually delivered.

Reference has been made to the huge financial pressures in many of our public services at the moment. I was struck quite strongly by the way in which the cuts that have been in train in local authorities for many months are somehow being laid at the door of this Government. In reality, those cuts were initiated and conceived under the last Government, and I just wish that there was a bit more humility and understanding of that. We have a shared challenge when it comes to dealing with the huge public sector deficit in this country. It is all well and good challenging this Government about what they will do in terms of the spending review over the next few months, but it would also be appropriate for a responsible Opposition to offer up suggestions that they believe would be painless that we could do instead.

[Barbara Keeley]

I do not know whether the Minister has experienced this during his parliamentary career, but the constituency that I represented between 2005 and 2010 covered two local authorities, and it was interesting to see the different priorities that those authorities gave to their work in social care and for carers. We heard a very good example of that in the debate, as Hammersmith and Fulham is adopting a swingeing policy that could take away a vital resource from carers, which I hope that something can be done about. I have heard the leader of Salford council hotly defend the fact that he would rather spend money on adult social care than on potholes, yet quite a lot of people in the city want money spent on potholes. Transparency and localism is one thing but, as with other aspects of health and support services, we could end up with a situation whereby a council such as Hammersmith and Fulham could remove a service, leaving its carers with nothing, while another area, such as Salford, would have excellent voluntary organisations and a council that prioritised social care.

[Mr Burstow]

The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.

[Mr Slaughter]

For the avoidance of doubt, I just want to say that it is not so much the financial situation in my area that I am concerned about, because my local authority says that it will, in due course, provide a service for carers. I am more concerned about the impropriety and mismanagement that has led to a long-standing service being simply dissolved overnight although there is no provision in place for the best part of a year to come. I would have thought that that was something in which a Minister and the Government would be interested. It is not to do with involvement in individual cuts; it is to do with the fact that a local authority is unable to manage its own affairs.

[Mr Burstow]

The hon. Gentleman has been a Member for some time, so he will know that there are regulatory systems in place that would deal with local authorities that were performing in the way that he describes. I am not aware that the authority’s activity has been reported in such a way. However, I stand by the offer that I have made, and I will be happy to receive further representations about the impact of tendering arrangements.

I want to pick up on the references that were made to the operating framework because the hon. Member for Worsley and Eccles South was right to point out that, in the operating framework that the Government issued just last week, we identified a requirement in the local priorities for the publication of dementia strategies. We think that that is an important signal. It was a signal to local PCTs that we wanted them to be more public facing and accountable to their local communities, and that they should account for why they have chosen not to spend money on dementia strategies. The signal was not specifically about dementia, but that we expected more of that sort of transparency in general. People should not need freedom of information requests to get information from PCTs about how public money is being spent, and I hope that that message will be understood by our local organisations that deliver such services.

The hon. Lady also talked about ring-fencing more broadly. The Government are determined to ensure that there is as much flexibility as possible for local authorities to make choices about how they prioritise their resources to deliver what is necessary to meet the needs of their local communities. We have made it clear that because we see the social care transformation grant as such a priority for investment in changes to services, so that they are genuinely personalised in the future, the budget for the final year in which it is available to local authorities will continue to be ring-fenced. We wanted to send the signal that we considered that grant to be important, and we want to ensure that local authorities deliver that grant during the course of this year.

The hon. Lady made a number of very useful points about good practice and the way in which GPs, schools and others play a part in delivering early identification of carers, whether those carers are young, old or otherwise. That should certainly inform the thinking of any Government when it comes to delivering a good carers strategy.

The hallmark of this important debate has been the great consensus about what needs to be done and the value that Members from all parties place on carers. I shall now try to address some of the other points that have been made.

The hon. Member for Stretford and Urmston (Kate Green) talked about financial issues and benefit changes, and such concerns were echoed by others. The carers cross-government programme board, which is charged with providing cohesion around the carers strategy, will look at those issues and hold cross-government discussions about them to ensure that the way in which we go about simplifying the benefit system actually delivers the right results at the end of the day.

The hon. Lady also expressed concern about the impact of public service cuts, which was also referred to by several hon. Members. Again, it is important to remember that some of the measures that are already in place were not initiated by this Government. Nevertheless, we have to be mindful about the impact of any budget decisions that we make through the spending review process. That will certainly be at the forefront of Ministers’ thinking in the coming weeks and months as we consider all the options that will have to be considered as part of the review.

The hon. Lady also talked about the difficulties faced by carers coming back into the workplace—the cliff edge, as she described it. The coalition Government’s programme sets out very clearly a desire to improve this country’s tax system significantly so that we raise the amount at which someone starts to pay income tax to £10,000. We believe that as we move towards implementing that change, we will begin to smooth out some of that cliff edge and start to have a significant impact on easing people’s return to work.

The hon. Member for Kingswood (Chris Skidmore) made a very good speech in which he set out a number of the challenges that we face. In particular, he rightly discussed the current complexity in the benefit system and the way in which it can be an obstacle to take-up of benefits.

The hon. Member for Hartlepool (Mr Wright) made a very good speech. He set out a range of issues relating to young carers in particular, but he also raised other points. He made a very important point about the Hartlepool carers centre, which he mentioned a lot in his speech, and it clearly provides an important service in his area. He also cited the £150 million a year that it saves taxpayers by reducing pressures on NHS resources. We need to ensure that such examples of social enterprises playing a part in easing pressure on public services and helping carers are considered. Such mutual operations can really make a difference.

The hon. Gentleman, like several hon. Members, talked about the role of GPs. He also made some comments about benefits. I refer him to what I have said about how we intend to move forward on benefits.

The hon. Gentleman also asked specifically about young carers. The key point I would make is that the Department of Health is piloting personal health budgets. In my written ministerial statement on Monday, I announced how we intend to evaluate those schemes. The schemes should give us yet another way of smoothing and removing some of the cliff edge that we have heard about by providing access to resources for care and health in a way that allows people to exercise real control over them and therefore much more control over their lives. That is particularly important for managing and smoothing the transition from childhood into adulthood, and we all want to ensure that that transition is made smoother.

The hon. Member for Chatham and Aylesford (Tracey Crouch) spoke about the key issue of the identification of carers. She said that only 5% of carers in her area had been identified by the local carers centre. A large number of people are hidden at the moment and do not necessarily identify themselves as carers. The identification of carers is a key challenge as part of the process of refreshing the carers strategy.

We have heard about the importance of flexible support for carers. Again, that is why personalisation will remain an absolutely central part of how the Government take forward the development of services. Such services should be tailored to fit around people’s lives, rather than requiring people constantly to navigate around them, often for the convenience of the service provider rather than the convenience of the person or family themselves. We want to accelerate towards achieving that vital aim, and we also need increased use of more user-led organisations that are much closer to the circumstances of the family, meaning that they can play an important part in advocacy, brokerage and helping families to navigate around the system.

I think that I have already addressed the main point made by the hon. Member for Hammersmith, who clearly put on record a number of powerful testimonies from his constituents about the value that they place on the centre to which he referred. However, as I have said, I will not attempt to micro-manage the decisions of local government colleagues of any particular party persuasion, as it is for them to account to their electorate for the way in which they spend public money.

The hon. Member for Totnes (Dr Wollaston) discussed young carers and talked about the devastating impact that alcohol can have on people’s lives. She offered advice about some of the ways in which the Government might tackle that issue, such as a pricing policy, and cited advice that the NICE has given. I can tell her that we will be publishing a White Paper on public health later this year setting out the Government’s approach on such challenging issues. I hope that my right hon. Friend the Secretary of State for Health will say more about that White Paper in the not-too-distant future.

The hon. Lady also talked about safeguarding, and we have announced a review of the vetting and barring system. I am one of the Health Ministers with responsibility for safeguarding, so I will receive the recommendations from that review. We need to ensure that the system is proportionate to the risk and that it delivers the appropriate safeguards, but it must not be so bureaucratic and difficult that it actually becomes a barrier to people participating as volunteers, so that is one of the tests that we will apply to the system.

The hon. Member for Liverpool, Wavertree (Luciana Berger) talked about the USDAW campaign, as well as the importance that she attaches to the role of carers in her constituency, some of whom she has already visited. She also discussed the plight of working carers, their interaction with the benefits system and the need for an examination of tapering as a way in which people could retain an element of carer’s allowance. All I can say at this stage is that the Government are committed to reviewing the system with a view to simplifying it.

The hon. Lady also asked how we could ensure that there is greater awareness of the right to seek flexible working. Again, that is not just a challenge for the Department of Health. We will need a cross-government approach on the issue involving my colleagues in the Department for Business, Innovation and Skills and the Department for Work and Pensions. Together, we have a part to play in ensuring that people are genuinely aware of that right.

The hon. Member for Blackpool North and Cleveleys (Paul Maynard) spoke very effectively. I was in the House when he made his maiden speech and it was one of the most impressive that I have heard. I know that his speech was excellent compared with mine 13 years ago.

[Mr Wright]

Hear, hear.

[Mr Burstow]

I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.

We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.

The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.

The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.

The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.

The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.

[Barbara Keeley]

As with other developments, I did not hear about this in the House; I heard about it from carers organisations. Does the Minister realise the extent to which carers support groups and organisations are concerned? They were geared up and trained to deliver the programme. Having useful materials will be a good thing, but materials are not enough to run a course. They need somewhere to run it, a trained person—probably paid—and resources during the day. It would be useful if some of the money could be diverted to training GPs, but that is a mainstream NHS matter. I emphasise that there is a great deal of concern among carers organisations about the programme, so anything that the Minister can do will be a help.

[Mr Burstow]

I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.

[Tony Baldry]

Will my hon. Friend tell us when the general issue of funding for carers will be addressed, and whether it will be addressed in the carers strategy?

[Mr Burstow]

I am looking at my notes on the points about benefits that the hon. Gentleman made and the precise time scales. Obviously, I am not the Minister responsible for the review of welfare benefits, which several hon. Members have mentioned, but it is clear that the timetable is quick and that reports back will be made during the spending review. Hon. Members who have representations to make about how we ensure that carers’ interests are served within those changes should therefore make them now. This debate is a good part of that process, and I will ensure that the matter is kept in the minds of Ministers and officials.

There will be tough decisions, one of which has been my decision about caring with confidence. We will need to ensure that every penny we spend has an impact on the lives of carers, but we must make no false economies. One of the themes of this debate is that we must ensure that the investments that we make deliver good outcomes, and that when we must reduce public expenditure, we do not just shunt costs around the system. We understand that point.

I hold to the view that carers are an important thread that holds communities together. We need to do more to support them. Their value will grow as our society ages and people with disabilities live longer. We must ensure, both across parties and within the coalition, that the refreshed strategy delivers tangible results, rather than being just a statement of intent. It must be clear about delivering change for carers. That is this Government’s commitment, and I look forward to making the difference, along with colleagues, as we go forward.

Question put and agreed to.