Social Care (Local Sufficiency) and Identification of Carers Bill

Philip Davies Excerpts

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

I do, and I will come on to the issue of student carers. The Bill explores student carers for the first time. I do not know why the issue has not been discussed more in the House, but it is vital that we, as constituency Members, take note of it.

Joint strategic needs assessments done at local level do not link care provision with work, and that is why the clause is important. The Department of Health has an upcoming event on developing care markets, the invitation to which we received yesterday. It says:

“the ability to choose from a variety of high-quality services should be available to all people in a local area, regardless of who pays for their care.”

Age UK, in its support for my Bill, commented on that Government aim to give people who need care and support a greater choice. It said:

“this cannot become a reality unless local care markets work effectively to provide people, including those with specialised needs, with appropriate services. Whilst we welcome proposed duties in the draft Care and Support Bill that would require local authorities to take steps to ensure that appropriate services are available this falls a long way short of a requirement to ensure sufficiency. We will certainly be advocating for a Bill or subsequent regulations that will include more specific duties on local authorities.”

[Philip Davies (Shipley) (Con)]

I congratulate the hon. Lady on introducing the Bill and bringing the plight of carers to the House. We all owe carers a big debt of gratitude. The Bill is littered with phrases such as “practical steps”, “reasonable steps” and “sufficiency”. What does she consider sufficient and reasonable, because the Bill does not make that clear, and how much would those steps cost?

[Barbara Keeley]

I will come on to the sufficiency measures, which are similar to a provision in the Childcare Act 2006, which placed a duty on local authorities to report on the sufficiency of child care in their area. The key thing is to ensure, first, that local authorities have a good enough picture. At the moment, the only picture they have is of what they are commissioning and providing, and, as I said, 80% of people who need care are self-funding, and their needs and whether they are being met are not looked at all. We therefore have a huge gap in information on the needs of those people and whether they are being met. There might be a need for nursing home beds for people with certain categories of dementia, and unless they were paying for them, local authorities would have no idea whether those existed. That information does not exist for all the people living in an area who needed that provision. As I said, health bodies and local authorities do joint strategic needs assessments, but they are not taking account of the fact that that can help people to work. We are trying to ensure that, as with child care, there is such provision, so it is similar to that measure.

The Bill does not go into detail because that is usually done in regulations which would be decided after the Bill had been passed. These are matters that can be debated and decided in Committee. However, in placing new duties on local authorities we are aware that we want regulation to be as light touch and low cost as possible. That is why some of the language is hedged around with phrases such as “reasonable steps”. We do not want to put expectations on local authorities that they cannot meet in the present environment.

[Philip Davies]

That was a helpful response. To get to the nub of the issue, does the hon. Lady believe that the House should pass legislation to provide certain duties, at whatever cost, which should be met, or does she accept that only a certain amount of money can be afforded and that the question then is how best that can be allocated?

[Barbara Keeley]

We are talking about a reporting duty. If local authorities, working with their health partners, do not report on social care provision, no one else will. Those of us interested in these matters ask questions, but we do not get very good information. Sending freedom of information requests to every social care authority in the country is not the best way for national organisations or Members of the House to get such information. We are asking for a picture of the market to be held in each local area. I am not suggesting a move in a direction in which the Government are not already going. The Government now expect local authorities to be what they call “market shaping”, taking action to drive the market. We are saying that they do not even have a picture of what exists now. Until we have such a picture, which is not just gathered by freedom of information requests, the expectation of the Department and the Government of local authorities is perhaps not reasonable. It is not a budgeting duty but a reporting duty.

I was dealing with sufficiency and the reporting duty and saying that organisations such as Age UK believe it is important that local authorities have a view of the sufficiency of their local care services. To expand on a point my hon. Friend the Member for Leicester West has made, the way local authorities are currently cutting back on what they pay in fees for social care beds and nursing home beds is actually creating market distortions, because some providers are simply moving to areas where there are more self-funders. In Greater Manchester, for example, all the nursing home providers might move to Trafford, which is a wealthier borough, and we would not have proper provision in Salford, part of which I represent. What is happening in the market could result in that kind of distortion, and that should be spotted.

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[Barbara Keeley]

I agree; that is a very good point.

[Philip Davies]

I wonder whether the hon. Lady is being unfair to universities by saying that there is a gap in the provision of information for student carers. I do not doubt that she knows more about the subject than I do, but my local university, Bradford, has a very extensive policy on student carers, with lots of information about what help could be provided. In saying that there is a gap, does she think that he might be doing a disservice to universities such as Bradford, which are clearly doing an awful lot to help student carers?

[Barbara Keeley]

I am very glad to hear that Bradford does that. Professor Luke Clements of Cardiff university, who helped to draft the Bill, says that it depends on having the right sort of vice-chancellor with go-ahead policies. It is not only I who believe that there are gaps; so does the National Union of Students, which understands these things. Particularly in Scotland, the websites of people who are standing for representative positions in the NUS show that they are all campaigning on Fair to Care and asking universities to have a carers strategy. It must therefore be the case that lots of universities, including those in Scotland, do not have a carers strategy. We are asking that a policy be put in place to recognise carers’ needs and tell them where to go for support. I am glad that the Bill would remedy the situation whereby perhaps hundreds of thousands of student carers are left to struggle alone with the difficult demands of juggling their caring responsibilities alongside studying.

The Bill deals with vital issues for carers and for disabled people. I thank Professor Luke Clements and Carers UK for their help in drafting the Bill. Emily Holzhausen and Chloe Wright of Carers UK have provided much extra support in preparing for today’s debate, and I thank them for that. I also thank Kate Emms of the Public Bill Office for her sound advice and help. I thank all the co-sponsors of the Bill for their support for the measures it contains. It has been good to know, as we have worked on this, that the issues involved in social care and the need to identify carers, young carers and student carers generate such great cross-party support.

The provisions in the Bill should be taken forward, and I hope that we will get the chance to discuss and, if necessary, modify them in Committee. Five million carers, including young carers and student carers, depend on our progress on measures that will help them, and I hope that we do not let them down.

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[Sir Tony Baldry]

It is very rare that an area of public policy, particularly on something as important as carers, can be dealt with by just one Department. I have absolutely no doubt that the Government’s White Paper on social care is the subject of an enormous amount of interdepartmental discussion. One task of the various all-party groups is to highlight to the Department of Health the issues that relate to other Departments, so that it can negotiate with those Departments before bringing forward its Bill. There will be cost implications in different areas, and I am sure there will be a robust debate about money on Second Reading of the Care and Support Bill. We have not yet come to that.

I say to the hon. Lady that the White Paper was published only shortly before the summer Adjournment. There has been little opportunity for any of us to interrogate Ministers in other Departments about policy areas such as those that she rightly identifies. Of course, a number of Ministers, like the one who is here today, have only just taken on new ministerial briefs. I believe that at Minister of State and Parliamentary Under-Secretary of State level, only 11 Ministers will be opening the same red boxes this weekend as they did last weekend. Those of us who have been Ministers know that it takes two or three weeks just to absorb the briefing for incoming Ministers, so we should not be impatient. What is important is to ensure that those of us who are in all-party groups relating to carers, or who are concerned about carers policy, can support the Government’s social care Bill on Second Reading.

[Philip Davies]

Will my hon. Friend give way?

[Sir Tony Baldry]

I give way to the other sexton.

[Philip Davies]

I am grateful. I have been trying to decode what my hon. Friend said about me and my hon. Friend the Member for Bury North (Mr Nuttall). I do not know whether he was trying to be insulting, but in his characteristically charming way, or whether he was merely saying that we take a close interest in each private Member’s Bill, which I would say was a compliment, even though perhaps a rather ham-fisted one.

Is my hon. Friend trying to say that if we get the undertakings that I am sure we would all like from the Minister today—he has already made some—it would be helpful if the hon. Member for Worsley and Eccles South (Barbara Keeley) were to withdraw her Bill?

[Sir Tony Baldry]

We all have to be grown-up about this. The hon. Member for Worsley and Eccles South has come up in the ballot, and it is a matter for her how she deals with the Bill. She is perfectly entitled to take it forward. I am just concerned to ensure that there is no scintilla of a suggestion that we will get ourselves into a hole. I was in the House when Nick Scott was the Minister responsible for the disabled. We got ourselves into a terrible hole over a private Member’s Bill by giving the impression that we were not interested in policy relating to the disabled, which of course was totally untrue. I do not want there to be any suggestion of that happening in relation to carers. I hope that we have now found a constructive way forward.

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[Mr Nuttall]

That would appear to be the case. If the survey used the wider definition, which I believe it might have, it would indeed indicate that the number of people affected by the Bill would be fewer as a result of its using the statutory definition.

After the Carers Trust’s definition of a carer as

“someone of any age who provides unpaid support to family or friends who could not manage without this help”,

it goes on to state:

“This could be caring for a relative, partner or friend”—

we should note that this definition includes friends as well—

“who is ill, frail, disabled or has mental health or substance misuse problems.”

At this point, we come to what I submit are some of the problems with the interpretation of the Bill. What exactly constitutes a “substantial” amount of care? Who is to be the judge of whether care is substantial or not? One man’s definition of what is “substantial” may not be the same as another’s. Therein lies the first of a number of uncertainties in the Bill.

[Philip Davies]

I am looking at the 1995 Act, too. As my hon. Friend makes clear, it defines a carer as someone who

“provides or intends to provide a substantial amount of care”,

but it also includes the phrase, “on a regular basis”. Does my hon. Friend agree that while there might be a lot of debate about what constitutes “substantial”, there might be quite some debate, too, about what constitutes a “regular” basis of support?

[Mr Nuttall]

My hon. Friend is quite right that there are two legs to the definition. It is not just a question of whether it is “substantial” but of whether it is “regular”. It could be once a year. If someone visits their elderly granny once a year, that is regular, but it is not the same as going around morning, noon and night to look after an elderly mother who needs care almost constantly. I therefore think there are difficulties with the definition, and I submit that it needs clarification. The Bill is silent on that and I fear that the explanatory notes, which are excellent in many ways, as I shall explain later, are silent on it, too.

[Philip Davies]

On that point, does my hon. Friend agree that the wider definition is more helpful than the one set in statute? There might well be cases—I am sure we have all come across them; I have certainly come across them in my constituency—where people need some kind of care and help, yet the local authority, probably for financial reasons above all else, has decided that it is not going to give them the support they need. Many people are looking after relatives or friends who need care, but who have not passed the test of being assessed as such by a local authority.

[Mr Nuttall]

My hon. Friend touches on an important point. I fear—I am sure others will, too—that this Bill may unreasonably raise the expectations of that group of carers covered by the wider definition. They may think, “This is me; I’m a carer”, but would they be a carer under the much narrower definition in the Bill? As I say, there is a danger that many carers will feel that this debate is about them, when under the statutory definition in clause 8—it is clear, referring back to section 1 of the Carers (Recognition and Services) Act 1995—they may not be covered.

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[Philip Davies]

Before my hon. Friend continues his speech, may I urge him not to be distracted by the tactics of the hon. Member for Kingston upon Hull North (Diana Johnson), who is trying to do something that might be described as rather despicable? She is trying to argue that the fact that someone does not support a particular Bill means that that person is against the whole concept of the aim of the Bill or the subject area. Anyone who knows my hon. Friend will be aware that he is passionate about helping carers and people who need this kind of support. He should not be distracted by those who try to characterise his opposition to certain elements of a piece of legislation as opposition to the welfare of carers as a whole. I urge him to continue in his current vein.

[Mr Nuttall]

I am grateful to my hon. Friend. I feel that there is a danger that some of the content of the Bill may cause scarce resources to be diverted from front-line services to carers for the purpose of the production of assessments, surveys and strategies, rather than providing real, genuine help for those who need it most.

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[Mr Nuttall]

I have already made my support for carers absolutely clear. My hon. Friend the Member for Banbury (Sir Tony Baldry) has also secured a helpful undertaking from the Minister on ensuring that the Government engage with the Bill’s supporters about the subjects that it deals with in the context of the draft Care and Support Bill.

[Philip Davies]

Has my hon. Friend noted the irony that Labour Members who regularly troop through the Lobby to vote against Government programme motions, because they say that those motions allow insufficient time for debate and effective scrutiny, now take the view that this Bill should go through the House without any scrutiny whatsoever just because it happens to have their support? Our duty in this place is to scrutinise legislation, whether Labour Members like it or not.

[Mr Nuttall]

There is indeed such an irony. Legislation of all kinds should receive proper scrutiny.

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[Mr Nuttall]

I am certainly not trying to destroy the Bill. I will stick to my point, because I think that we need to look at this—[Interruption.] [Hon. Members: “In Committee.”] It is an important part of the Bill. Existing legislation covers all members of the public, so I do not think that we need to single out a specific group.

[Philip Davies]

Opposition Members talk about these matters being considered in Committee. Given that the Government have published a draft Bill on this very subject, does my hon. Friend not agree that Opposition Members, if their overwhelming priority is to discuss these matters in Committee, will have an amazingly good opportunity to do so at length in relation to the draft Bill? That can be done without this Bill progressing any further.

[Mr Nuttall]

That is indeed the case. I am sure that it will be possible to consider all these matters in detail when we look at the draft Bill in Committee.

The NHS operating framework for 2012-13 already provides that carers must receive help and support from local NHS organisations. Primary care trusts are required to agree policies, plans and budgets to support carers with local authorities and carers’ organisations and make them available to local people. It states:

“Following a joint assessment of local needs, which should be published with plans, PCT clusters need to agree policies, plans and budgets with local authorities and voluntary groups to support carers, where possible using direct payments or personal budgets. For 2012/13 this means plans should be in line with the Carers Strategy and: be explicitly agreed and signed off by both local authorities and PCT clusters; identify the financial contribution made to support carers by both local authorities and PCT clusters and that any transfer of funds from the NHS to local authorities is through a section 256 agreement; identify how much of the total is being spent on carers’ breaks; identify an indicative number of breaks that should be available within that funding; and be published on the PCT or PCT cluster’s website by 30 September 2012 at the latest.”

So there is already a lot going on within the NHS. Let us not forget that the Department of Health is providing the NHS with £400 million over the four-year period from 2011-15 to support carers in taking breaks from their caring responsibilities. The Department has also funded the national carers strategy demonstrator sites programme, which is focused on three areas of support to improve carers’ health and well-being, carers’ breaks and health checks, with better NHS support. The new idea of national carers strategy demonstrator sites has been independently evaluated by the Centre for International Research on Care, Labour and Equalities at Leeds university, which has prepared an excellent report on how successful it has already been.

Clause 5 seeks to place a duty on a local authority to ensure that within 12 months of Royal Assent

“it takes all reasonable steps”—

again, we have no idea of what “reasonable” may amount to—

“to ensure that in relation to…any school within its area and under its control, and…any functions it discharges…there is in place a policy”

to identify and support young carers. However, the clause makes no mention of academy schools. Perhaps when the hon. Member for Worsley and Eccles South winds up she will be able to explain why academy schools would not be covered, because they are state schools that are independent of local authorities but still funded—

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[Philip Davies (Shipley) (Con)]

Thank you, Mr Deputy Speaker. I have not been left with much time, but I am conscious of the fact that other people wish to speak. I will therefore try to be as quick as possible, as is customary for me on such occasions. It is a pleasure to have you back in the Chair.

I commend the hon. Member for Washington and Sunderland West (Mrs Hodgson) for her closing remarks, because they got to the nub of the debate. What is important is that today’s debate has raised the issues that are important to all of us. We all want to support carers. Like my hon. Friend the Member for Bury North (Mr Nuttall), I remember my mum acting as a carer for my granddad and her father, Charlie, who had cancer. She dedicated many hours to looking after him and other family members came and helped. I understand from first-hand experience how important it is that we give as much support to carers as possible.

The most important thing about today’s debate, which the hon. Member for Washington and Sunderland West made clear as she summed up, is that we have gone through the issues that we hope will be addressed by the Government. They have produced a draft Bill and presumably legislation will come before the House in the not-too-distant future. All the issues that have been debated today, including the contents of the private Member’s Bill, can be debated during the passage of the Government Bill. Amendments can be made at the Committee and Report stages of that Bill, and far more time than we have been allowed today will be available to scrutinise those measures. We all hope that, at the end of all of that, we will have a measure that we can all agree upon, if that is possible, and that gives the best possible support to the carers who need it. The important thing is not whether this specific Bill gets through to the next stage, but what the overall outcome is. That will be determined by the Government’s draft Bill, and that is where it is best left.

I will move on to discuss the specific issues. It is important to look back at the history. The hon. Member for Worsley and Eccles South (Barbara Keeley), who presented the Bill, said when I intervened on her— I apologise if I get this wrong—that the Bill is about putting reporting responsibilities on local authorities. It goes far beyond that, however. Clause 1 introduces a

“duty to ensure sufficient social care support”.

That goes far beyond the reporting of that support.

As my hon. Friend the Member for Bury North said in dealing with an intervention, the Bill comes after more than a decade of the hon. Lady’s party being in government, and she is now calling for more to be done. It was only in 2008—I seem to remember that the hon. Lady was a Minister at that time, although I could be wrong about that as well—that her Government published an update to the carers strategy that was introduced in 1999. The update stated:

“By March 2011, we will have invested over £1.7 billion for councils to use to support carers in a range of ways through the annual Carers Grant. This includes £25 million a year announced as part of the New Deal for Carers for emergency break provision.

We have also committed a further £22 million to cover the costs of the establishment of information services via a helpline and a training programme for carers and information service, and £3.4 million to directly support young carers through extended Family Pathfinders and support for whole-family working.

We are now investing over £255 million on new commitments as part of this strategy.”

It seems to me that the hon. Lady is asking in the Bill for things that her Government claimed were already happening. Perhaps she will explain why her Government did not do what she seeks.

[Barbara Keeley]

It is quite clear from all the excellent contributions to the debate that Members understand that this is not just about allocating budgets. It is about having the right processes and about people taking their duties seriously. We can throw any amount of money at carers’ breaks or anything else, but if carers are not identified, if GPs ignore the fact that people are carers or if young carers are not taken seriously at school and are bullied and intimidated, it does not make any difference how much money is sloshing about. That is why the specific reporting and other duties in the Bill are so important. The Bill is mostly about having processes and procedures in place and ensuring that health and other professionals take them seriously.

[Philip Davies]

I could not agree more. I totally and utterly endorse what the hon. Lady says. Joking aside, it is refreshing to hear an Opposition Member say that it is not just spending money but getting results that is important. All too often, spending money was all it was about under the previous Government. It was about input rather than output. I am delighted that she wants to concentrate on output, as I do.

I contend that much of what the hon. Lady seeks to do in the Bill is already happening in one form or another. She might argue that it is not happening as well as it should, and I am sure that it could always be better. She may well argue that it is happening better in some parts of the country than others, and I suspect that will always be true whether or not there is legislation. When she referred to the lack of support for carers at universities, I pointed out the excellent work that Bradford university does to support carers. I believe that the same work is done at Leeds university. I have certainly seen a document from that university about the support that it wants to give to students who are carers. I argue that much of what she wants is happening anyway in various places, and there is certainly nothing to prevent them from happening even without the Bill. I am sure that if all of us, including the Minister and the hon. Lady, contacted universities, showed them best practice from other universities and urged them to follow suit, their vice-chancellors would be happy to do so without the need for further legislation. There are other, more imaginative and perhaps quicker ways of achieving her aims than going through the rigmarole of passing the Bill.

Much of what the hon. Lady seeks is covered in the Government’s draft Bill and White Paper. I take the point made by my hon. Friend the Member for Banbury (Sir Tony Baldry) that the hon. Lady introduced her Bill before any of that was known, so she was absolutely right to do that, but we are where we are. Given that the Government have adopted in the White Paper much of what she wants, we can safely leave the Minister to carry on. We all accept that he is a capable and decent person, and he has given the House assurances today that will have reassured us all about how he intends to proceed. He has said that he wants to involve the hon. Lady in the discussions about the Government’s draft Bill before it proceeds, and I am sure she knows that he means that. We can rely on the Government to introduce the best aspects of her Bill, so we do not need to proceed with it.

My hon. Friend the Member for Bury North made the point, which the Minister reiterated, that some of the duties that the hon. Lady’s Bill would place on local authorities, although well meant and with a positive element to them, could take money away from the front-line resources that we want to go to people who need them. It could instead have to be spent on further reporting, strategies, documents and other things that could eat up a considerable amount of local authorities’ money before we know it. I am not sure whether that approach is desirable. As I said, there might be some desirable ends, but overall it is more likely to take money from carers than to give them support.

[Barbara Keeley]

Do the hon. Gentleman and his colleague, the hon. Member for Bury North (Mr Nuttall), have a view on the billions of pounds that could remain in the economy if people do not give up work to become carers? If local authorities draw up the local sufficiency picture, it will help carers to stay in work. If carers stay in work, they are earning money, they are not on benefits and they pay tax and national insurance. Does the hon. Gentleman not see that there is a balance to be struck? I am sure that the sufficiency reporting duty will in no way match the billions of pounds that would be lost if 1 million carers give up work to care.

[Philip Davies]

The hon. Lady makes a fair point although I cannot speak for my hon. Friend the Member for Bury North. If he had not been cut short we might have learned his view of the sufficiency measures, but perhaps we will hear it at a later date. I do not want to get bogged down or I will be criticised for trying to talk out a Bill that I have no intention of talking out. On this occasion—one for the record books—I endorse what the Government are doing. I wish the Minister well in developing the strategy, and I hope that we get the outcome we seek. In all honesty, however, we can do that without the Bill, and if the hon. Member for Worsley and Eccles South had known the Government’s plans at the time of the ballot for the private Members’ Bills she might have chosen a different issue. As she must acknowledge, the Government are doing much to go down the route she has advocated today.