Carers

Sarah Newton Excerpts

Thursday 20th June 2013 Commons Chamber

[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.

[Paul Burstow]

My hon. Friend is making an important point about the patchy quality of domiciliary care. There are good examples, such as in Wiltshire, where the service has been remodelled to focus on outcomes. However, there is an issue about whether the Government have the necessary powers to ensure that where poor commissioning practice is allowing contracting by the minute, which is resulting in sub-standard care to an individual, they can ensure good quality commissioning practice in the future. The Joint Committee on the draft Care and Support Bill has recommended a change in the law and the Government are doubtful of its need. Does she agree that the Government need to keep thinking about that and perhaps come back with an amendment?

[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—

[Sarah Newton]

I was just about to come to that.

[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.

[Sarah Newton]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. When the hon. Lady addresses that point, will she also pay attention to the fact that there are other Members who wish to speak and that she has been speaking for nearly 18 minutes?

--- Later in debate ---

[Sarah Newton]

I am grateful for your advice, Madam Deputy Speaker, and I am sorry. It is just that I am so passionate about this subject that I have lost track of time.

I am pleased that the Minister remembers that experience—this was the final point I was coming to—and has agreed to meet Tracey Roose from Age UK and Ian Jones from Volunteer Cornwall quite soon to take forward what he experienced first hand in Cornwall with some more ideas. Changing Lives is a fantastic example of how volunteers can work with GPs to ensure that people have access to all the care and support that they need to live happy, fulfilled lives in their communities. The pilot in Cornwall has had some quite dramatic results, not only in terms of carers feeling better supported and the vulnerable, frail older people concerned having a better quality of life, but in huge savings for the NHS, with 30% fewer unplanned admissions in our acute trust.

These are all the things that we instinctively and intuitively know—that if people get good advice, the help and support they need and opportunities to play their part in society, they can live independent lives at home. The Government can be proud of much of what they are doing, but given the concerns of carers we have heard throughout the week there is clearly still much more to do. I for one look forward to supporting the Government’s efforts to make this a proud country and a great place to grow old and care for people.