Health and Social Care

Debate between Roberta Blackman-Woods and Baroness Keeley

Monday 13th May 2013 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

[Barbara Keeley]

I am absolutely bound to agree with that point, and I will come on to it shortly.

As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

Social Care (Local Sufficiency) and Identification of Carers Bill

Debate between Roberta Blackman-Woods and Baroness Keeley

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

Sadly, that is the case. We know that the care sector is underpaid, but that is nothing compared with the financial impact of giving up work to take on a caring commitment.

[Roberta Blackman-Woods (City of Durham) (Lab)]

I was interested in my hon. Friend’s points about employers. Does she agree that it is in employers’ interests to learn more about the needs of carers, and to support them better, so that they do not lose valuable, well-trained staff and have to recruit new ones?

[Barbara Keeley]

I very much agree, and I am sure that that is why the Bill has received such strong support from Employers for Carers.

Other countries have put in place development strategies for home care. In France, the first phase of its development strategy for the home care sector led to a growth of 100,000 jobs year on year. However, even after the worldwide recession, such strategies have led to 50,000 more jobs there each year.

There is a real need for care and support services to enable carers and disabled people to work, but the social care picture in England is one of growing need, shrinking provision, and totally inadequate information and advice about what is available. I have discussed the cuts to social care budgets during previous debates on social care funding.

--- Later in debate ---

[Barbara Keeley]

I have run through some of the details. Front-line services have already been greatly reduced. In fact, local authorities are no longer primary providers, given that they are meeting the needs of a very small group of people.

Let me get back to the point about sufficiency. The all-party group on local government has recently conducted an inquiry into adult social care, supported by the local government information unit. We looked at the role of local government in shaping the local market for social care and took evidence from local authorities that are already acting on that. Interestingly, Nottinghamshire county council told us that it monitors and records occupancy and availability of care home beds for self-funders, which is unusual. Lancashire county council told us that it provides advice and information to all on mainstream services, and signposting to them, regardless of whether people would be eligible for council services, and it is one of the first authorities to do that. The inquiry found some examples of market-shaping activities by local authorities, but the final report was clear that that was only an emerging role for local authorities, and we could not find many examples.

Clause 3 therefore provides that local authorities should assess local care needs and existing social care provision, and if supply does not meet demand, as the hon. Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) have just touched on, the local authority would have a duty to consider the necessary steps to address the gaps. They would not have to take those steps; it is just that nothing will happen unless they have some idea of how it might happen. In their market-shaping role, for instance, they might try to encourage more nursing home providers of a particular type. That is similar to measures set out in the Childcare Act 2006, through which the Government sought to ensure sufficient local child care.

Clause 4 would ensure that NHS bodies had procedures in place to identify carers, promote their health and well-being and ensure that they received appropriate information and advice. I first sought to introduce such a measure in 2006 through a ten-minute rule Bill, and then again in 2007. I acknowledge that progress has been made, but there is still much to do. As we know, many carers do not recognise that they are carers; they see their caring role as part of being a wife, husband, son or daughter. Many are hidden, particularly at the start of caring.

I believe that a key focus in identifying carers should be concern for the health of those with the heaviest caring commitments. The 2001 census found that 10% of all UK carers were caring for more than 50 hours a week. Interestingly, figures published by the NHS Information Centre show that that figure had doubled, to 22%, by 2010. In Salford, the proportion of carers who provide full-time care has actually been at a higher level for some time. In 2001, around one in four carers in Salford provided care for more than 50 hours a week, and even at the time that was more than twice the national figure for carers with the heaviest commitment. I am almost certain that that is related to health inequalities and poor health.

Two wards in my constituency have very high levels of people caring for relatives with stroke disease, heart disease or cancer, which mean the heaviest commitments. We know that full-time care can take a toll on a carer’s health, so the health needs of carers must be recognised. We know that those caring for more than 50 hours a week are twice as likely to suffer ill health, and those caring for a person with dementia or stroke disease are even more at risk. Early identification and support for those carers means that they can maintain their health and manage and sustain their caring role better.

The Princess Royal Trust for Carers centre in Salford has a project to identify carers both within primary care and at the Salford Royal hospital. I want to take this opportunity to pay tribute to The Princess Royal Trust for Carers for its work in primary care over many years in centres such as the one at Salford. Its work has been done by a primary care worker, Julia Ellis, and the centre manager, Dawn O’Rooke. In fact, the previous Minister responsible for care services, the hon. Member for Sutton and Cheam, visited my constituency to hear about the trust’s project to identify carers within primary care. I extend an invitation to the new Minister to do the same.

Different local GP practices do the work of identifying carers differently. For example, practice nurses from the Limes medical centre carry out their identification work when making home visits to patients who seem to have a carer. They run through a series of questions with the patient and carer about who does certain tasks and then fill in a referral card for the practice to ensure that the health team knows about the carer so that they can be referred to sources of advice and support. The Dearden Avenue medical practice has a different approach. Its staff carried out a search on the practice’s computer. For all those patients over 70 who are not in residential care, a letter was sent to the next of kin asking if they were the patient’s carer. Of 149 letters sent, 90 were returned by carers. The carers centre could then send information about the care and support available to the carers, including having an assessment of their own needs.

I am pleased to know that GPs and primary health care teams in my constituency are tackling that work, but there is much more to do. The manager of the carers centre tells me that, having established a network of links within GP practices to identify carers, over 300 referrals a year are made to the centre by local GPs. However, we have some 20,000 carers in Salford, of whom around 5,000 will be caring for more than 50 hours a week. We need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them for advice and support.

Clause 5 would require local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. Young carers are the most hidden of all carers. The 2001 census recorded some 175,000 young carers, but more recent research by the BBC indicates the much higher number of 700,000, which is around 8% of secondary school pupils. Most young carers care for a parent, often a single parent. The care they give might involve much physical care or the difficult task of providing emotional support for a parent with a mental health problem or substance addiction.

The Carers Trust tells us that the identification of young carers remains a key issue, as many young carers seek help only in a crisis. As we have discussed in previous debates, many young carers find that their extra responsibilities lead to their failing to complete work for school, doing badly in exams and, worst of all, being bullied. Although teachers and social workers are the best people to identify and support young carers, there is a lack of professional awareness about their needs and concerns. Young carers report that they can feel stigmatised by teachers, and they might leave school or college prematurely without completing qualifications.

[Roberta Blackman-Woods]

My hon. Friend makes a wonderful point about the need to support young carers more. I have been a school governor for more than 20 years but have never heard the governing body talk about the needs of young carers. That needs to be addressed and more information needs to be given to governors and head teachers.

[Barbara Keeley]

My hon. Friend is absolutely right. Indeed, the carers centre in Salford has a young carers project that has developed to the point of having a presence in all but one of the secondary schools in Salford. It has also started a more limited level of work in primary schools. It is vital, because it is identifying young carers and spreading awareness among teachers and pupils about the role of young carers. It is only that work with other pupils that will stop them bullying and picking on young carers.

Child Benefit

Debate between Roberta Blackman-Woods and Baroness Keeley

Tuesday 22nd May 2012 Westminster Hall

[Roberta Blackman-Woods (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I thank Gingerbread, the Child Poverty Action Group, the Institute of Chartered Accountants in England and Wales and the House of Commons Library for producing excellent briefings for today’s debate.

Eleanor Rathbone, the great advocate for family allowances, which we now know as child benefit, entered politics in 1909. It is extraordinary that, more than a century later, we have once again had to secure a debate in Parliament to champion the basic principles of child benefit. There have been threats to child benefit before, but since 1945 when family allowances legislation was introduced—a watered-down version of the child support that Eleanor Rathbone and others had campaigned for—only the coalition Government have introduced legislation for the demise of the principle of universality that underpins child benefit.

Not everyone on the Government side is happy with the proposed changes, as demonstrated by the lack, bar one or two, of any Back Benchers on the Government side who wish to take part in this debate. In an earlier debate, the hon. Member for Christchurch (Mr Chope) pointed out that the Government’s proposals ask those on higher incomes with families to contribute more, while those on higher incomes without children are not asked to contribute more. I do not see how that can be fair. I do not usually quote from the hon. Gentleman, especially in agreement, but he has hit the nail on the head.

I would like to concentrate on two issues: the destruction by the Government of the universal principle, and the unfairness and unworkability of the proposed changes. The principle long established and supported on a cross-party basis is that society as a whole should contribute towards the upbringing of children, because we all share in the benefits of a properly supported future generation. Arguing for family allowances, Eleanor Rathbone captured that exactly:

“Children are not simply a private luxury. They are an asset to the community”.

The logic of accepting that view is that in a properly functioning society transfers are made to families with children—not away from them to pay for tax cuts to millionaires.

Her Majesty’s Revenue and Customs recently put out a press statement on the proposed changes, which told us that the Government’s plans for changing child benefit are legal. I have been in the House for a number of years and I am not familiar with Government Departments telling us that policy changes are legal. I can only imagine that it must reflect a measure of concern about the Government’s incompetence that Departments have taken to doing so. My concern, however, is not about the legality of the proposed changes, but that they are wrong and should not happen.

The CPAG has summarised the benefits of child allowances. They achieve horizontal distribution between families, from those without children to those with children, life-cycle redistribution—most people have children at some point and we want to help whenever families are most pressed—and intergenerational redistribution, and they place a value on all children. For those reasons and many others, the benefit should be kept in its universal form. The changes are grossly unfair and probably unworkable.

The ICAEW has branded the legislation seriously flawed in principle and in practice. It points to many problems and I will highlight a few. HMRC will be using the tax system to claw back from one individual a benefit paid to the other, which could be extremely difficult as families in similar situations will be treated differently. Despite the introduction of the taper, the changes could still lead to a huge disincentive for individuals to earn more. The worst aspect of the proposed changes is that a family with a single earner who has an income of more than £60,000 is significantly worse off through the withdrawal of the benefit, while two-earner couples with incomes of up to £50,000 each will not lose the benefit.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

My hon. Friend is making a great start to the debate. When meeting people in her constituency during the local elections, was my hon. Friend struck by how hard that unfair and unworkable aspect of the change is hitting them? One voter I met, who voted Conservative at the last election, said that he will never vote Conservative again because of the unfair nature of the changes. I spent a long time talking to him and he just could not believe that they were going to be introduced.

[Roberta Blackman-Woods]

My hon. Friend has made an excellent intervention. The unfairness of the changes goes to the heart of the debate. I suspect that as more and more people wake up to what will happen to their child benefit next January, we will see an even greater public outcry.

The changes disadvantage single parents, and partnerships where one person has decided to stay at home. With changed family circumstances, it may be very difficult to claw back payments or decide who should pay them. Taxpayers could be penalised for failing to submit information that they have no access to, particularly if the relationship breaks down. The extra administration involved could place huge burdens on HMRC at a time of budget restraint, and particularly at a time of cuts in staffing levels. We are therefore left with a number of questions.