Carers

Steve McCabe Excerpts

Thursday 20th June 2013 Commons Chamber

[Paul Burstow]

The hon. Lady is absolutely right to say public sector employers should be—and could be, and must be—exemplars in this. Indeed, it would be great if the NHS itself was an exemplar in this area, yet as I will come on to say, I think in too many ways institutionally the NHS is rather biased against carers, and certainly blind to their needs in too many cases.

There is an economic reason why we need to do more in this area. It is estimated that as many as 50% of those involved in personal and household services operate in the grey economy. This represents a further missed opportunity in terms of job creation and lost revenue to the Exchequer. Looking across the channel to France where work began almost a decade ago to address a number of these issues, market development for homecare services has led to the creation of an additional 2 million jobs, with the industry becoming one of the biggest growth sectors in that economy.

There are clearly lessons to be learnt in how to support and strengthen carers’ ability to care in a way that supports the wider UK economy. I hope the Minister will be able to tell us when the “task and finish group” recommendations will be published.

Moving on, one of the most practical ways to support carers is to provide them with breaks from caring. That can help reduce the stress and the often constant demands that caring involves, and allow them to have the time to improve their own physical and mental health.

In recognition of the value of carers breaks, the Government committed in the 2010 spending review to spend £400 million over four years on breaks for carers living in England. As the Minister at the time, I was convinced of the importance of giving carers a break and knew that it would make a huge difference to their lives. I therefore regret that the evidence suggests that that has not happened. Monitoring by the Carers Trust for the year 2011-12 found that action on the ground had often been slow or non-existent. Despite clear reporting requirements, in many areas it was impossible to track how money had been spent, and in a small minority of cases nothing at all had been spent on services for carers. Some fantastic work has been done, but progress has remained appallingly slow. To be fair, this problem has dogged not just the coalition Government, but successive Governments.

I ask this question: what is the common factor? The common factor is the institution we are using to direct the money, which is the NHS. It does not see carers as significantly important contributors to it, and therefore it does not see this money as worth spending on them. That has to change.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I acknowledge the right hon. Gentleman’s efforts when in government, and I agree that this issue has dogged successive Governments. I wonder whether we have reached the stage where we have to give some clear statutory rights to carers in respect of respite care, because whatever organisation has the budget, it does not seem able to recognise that this is an essential need if a person is going to continue to be a carer. Would the right hon. Gentleman entertain that approach?

[Paul Burstow]

To be honest, in this area the NHS is probably drinking in the last-chance saloon. If we do not see progress, legislation may be necessary. There is another way in which the money could, and should in future, be earmarked for this purpose. There have been transfers from the NHS to local authorities for the support of social care more generally, and in some local authority areas that has happened with the carers break money as well; it has been transferred. It has not happened everywhere, however, and I think it should now become mandatory, so this money gets spent for the purpose the Government said in their spending review it was for. That is a perfectly reasonable thing to expect, and the Government need to reflect on three years of this money not getting where it needed to be, after a number of years of that under the last Government as well.

A survey by Carers UK found that in one in five cases where a person who was receiving care from family or friends was admitted to hospital as an emergency, that could have been prevented if the carer had received more respite care and support. This makes big differences financially to the NHS. It uses resources better, and that is why it beggars belief that the NHS has not yet made sufficient progress, with its partners in local government, to improve access to breaks for carers.

Under the health service reforms, with clinical commissioning groups taking the lead, there have been some examples of improvement, such as in Huntingdon, where there is an interesting carers breaks project led by GPs. Partnered with Crossroads Care, they identify carers by meeting them socially, and prescribe breaks. Carers who are met in that way tell me they have for the first time had the experience of having raised their needs as carers and seen that translated into tangible action that made a difference for them. We need to see more of that. It is a vital lifeline.

As has already been said, there are huge issues to do with identification of carers. Research by Macmillan has found that while over 70% of carers came into contact with GPs, doctors and nursing staff, only 11% of all carers reported that they had been identified as a carer by a health professional. We as a Government talk about making every contact count, and we should do so when it comes to identifying carers. I hope the Minister can look afresh at what we can do to challenge NHS England to fulfil its obligations. I hope the National Audit Office will take a look at how successive Governments have attempted to engage the NHS with the carers agenda.

I want to finish by talking briefly about the Care Bill. It is no small thing that this is the first ever Government Bill to provide for carers’ rights. Until now, the cause of carers has been advanced by private Members’ Bills. Let me place on the record my appreciation for the work of the late Malcolm Wicks, whose Carers (Recognition and Services) Act 1995 was a landmark in the rights of carers and a fitting legacy for such a thoughtful and generous Member of this House. For the first time, the Care Bill enshrines in legislation carers’ rights to an assessment of their needs and, importantly, establishes a duty to meet those needs which are eligible. It also establishes clearly the need to consult and involve carers in decisions about the care of those they care for.

Although the Care Bill is hugely welcome, inevitably there are gaps and unintended consequences that must be addressed if all carers are to get the support they are entitled to. Following the Government’s welcome announcement last week of their intention to amend the Children and Families Bill to ensure that the rights of young carers are as strong as those proposed for adult carers, we must see the necessary changes to it and the Care Bill, and ensure that the rights of parent carers of disabled children, which have so far been neglected in both Bills, are not allowed to fall through the cracks.

I look forward to colleagues’ contributions and hearing them draw on their experience of engaging with carers in their constituencies. I know from talking and listening to carers, and from tweeting about carers’ issues, the genuine and palpable outrage they feel because all too often they are overlooked and under-supported. We need to change that. The Government are making good progress, but more still needs to be done.

--- Later in debate ---

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I congratulate the Members who helped to secure today’s debate.

During the debate on the Queen’s Speech, I referred to the experiences of two carers in my constituency. One was Lynne Hanslow, who cares for her 96-year-old father, keeping him out of residential care. All that she asks for is a fortnight’s respite break each year, but this year, despite having given the council four months’ notice, she was denied that break and was abused by a local authority employee when she complained about her treatment. Not surprisingly, Ms Hanslow ended up having to go to her GP. A carer had been made ill by neglect and worry.

I have spoken to the council’s director of adult services, but so far Ms Hanslow has not received the full apology that she deserves, along with a promise that that will not happen again. I believe that the council’s chief executive should make the apology, thus sending the signal that he means to take the needs of carers seriously and will not stand for his staff treating them with contempt. Ms Hanslow’s experience is one of the reasons for my conclusion that statutory respite care should become a legal, enforceable right for carers. We have tried the other approaches for too long.

I also mentioned the case of Margaret McGarry. She cares for her frail elderly mother, who suffers from dementia. Her direct payments have been suspended, apparently in retaliation for her having had the temerity to go to a solicitor because she felt that the local authority was being unreasonable in terms of the flawed level of support that it was prepared to provide. There should be a much simpler independent review process for carers like Margaret McGarry who are treated in such an appalling way. The current system seems almost to be weighted in favour of officials and bureaucrats, at the expense of carers. I wonder whether the time has come for local authorities to create carers champions to look out for carers’ interests. I have come to the conclusion that local authority complaints procedures in much of the NHS these days are not about problem solving at all. They are about process. They are almost a game to create an illusion of accountability. I think we need a champion who will listen to carers’ concerns.

[Paul Burstow]

I think it is worse than that. The balance of power is entirely wrong. It is too much on the side of the local authority to which the individual is complaining. That is why we need advocacy, but it is also why we need to look at the case made in the Joint Committee report on the draft Care and Support Bill for the need for a tribunal service, to start to address these matters in a more impartial way, detached from the local authority. How can a local authority investigate itself?

[Steve McCabe]

I certainly agree with that, although I would be reluctant for us to have a complex system that the carer has more difficulty accessing. I take on board the right hon. Gentleman’s point, however.

In arguing for a champion, I am looking for someone like a councillor, with sufficient clout to intervene and right wrongs and cut through the madness and bureaucracy that all too often ends up punishing, rather than protecting, the carer. That does not mean we should not also have further review and appeal processes, but I want us to have something simple that people can make use of and that will make a difference.

A champion might also do more to make sure the voices of ordinary carers are heard. I am thinking about the hidden carers that so many Members have mentioned—the people who are too busy caring to have time to attend the consultation sessions, which are organised to suit the convenience and working hours of the NHS and local authority officials, so these people are never heard.

[Norman Lamb]

I totally agree with what the hon. Gentleman says about giving a voice to carers, who sometimes are treated appallingly, not only by providers of care, but by some of the statutory services and local authorities. With providers, we have introduced, through the NHS Choices website, the ability for people, in TripAdvisor style, to speak out and have their say about poor standards of care, and we may need to do something similar for local authorities, because there should be no hiding place when people are let down in that way.

[Steve McCabe]

I welcome what the Minister says. I am able to identify these people in my constituency, and I do not understand why it is so hard for the caring organisations to identify them.

I wonder why we do not say that at the point when an individual qualifies for attendance allowance the local authority should be notified and instructed to commence consultations with the person and their carer, with a view to establishing a long-term care plan and review strategy. That could reduce the occurrence of crisis care episodes, and the authority could simultaneously start to develop a support plan for the carer, so the needs of the carer are at the centre of the care plan.

[Paul Burstow]

The hon. Gentleman’s point about attendance allowance is interesting and important. He may know that this week the Strategic Society Centre think-tank published an interesting report setting out how this area might be reformed in a way that provides just what he has described: a front door into the social care system. Does he share my surprise that we have a system that does not talk to social care at least in part because it is entirely paper-based? It is not electronic, and perhaps the Department for Work and Pensions needs to consider putting it on that basis, so the information can be shared more freely.

[Steve McCabe]

I think I probably would agree with that, although the right hon. Gentleman must recognise that the Government are moving increasingly towards systems that do not allow for face-to-face exchange. I understand that that is one of the major disputes about what is happening in the DWP. I think it would make classic sense, however. All of us hear enough about joined-up government, and this is one area where a bit of joined-up government could save money and provide a much better service.

[Barbara Keeley]

I was at an event the other day—as was the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall)—at which somebody from the DWP was talking about this issue. They said they had tried a project to get their data to talk to the local authority’s data, but had given up because the local authorities all used different forms. That seemed to me to be appalling. The Minister might like to think about whether there could be guidance for local authorities. If local authority forms are all that is stopping this vital sharing of data, it is about time we dealt with that.

[Steve McCabe]

One of the penalties of having been a Member of this House for quite a long time is that we get fed up with hearing such excuses. We know fine well they are nonsense; if we want it to happen, we can make it happen. That is the approach we should take.

My hon. Friend the Member for Corby (Andy Sawford) talked about older carers and carers who have been caring for older relatives, and I want to touch on one particular aspect of that. What will happen under the Government’s deferred payment equity release plans to surviving spouses who are carers, or elderly children caring for even older parents—it is not uncommon these days for a 70-year-old to be the carer for somebody who is 95 or 96, for instance? What rights will they have? In such situations, when the person who is being cared for enters residential care, what will happen to a carer whose name is not on the deeds of the house, although it may be their family home and they may well have lived there since marriage, or even childhood?

We must ensure that these carers do not end up homeless, destitute individuals with no pot of money to support them when they end up needing care themselves. I am not sure that the deferred payment scheme as currently structured takes account of the risk for those carers, and it would be the cruellest of rewards if, after a lifetime of care, we left them in this predicament.

[Norman Lamb]

At present, when someone goes into a care home and they have to sell the home to pay for care, the position of the carer could be very precarious, but the arrangements for the right to defer payment potentially provide greater stability for the carer. The hon. Gentleman raises an important point, however, and I will be happy to write to him directly about it.

[Steve McCabe]

I am grateful to hear that the Minister will look at the issue. I acknowledge that the current system is far from perfect, but interest-related deferred payments could mean more of the pot being consumed, and therefore less for the remaining carer.