Care Bill [Lords]

Tony Baldry Excerpts

Monday 16th December 2013 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

I think that the whole House would agree with the right hon. Member for Salford and Eccles (Hazel Blears) that we must all try to ensure that our constituencies and communities are, so far as is humanly possible, dementia-friendly. I welcome the opportunity to contribute to the debate, not least in my capacity as the Commons chair of the all-party group on carers. I trust that the House will understand that that is why I intend to focus my comments specifically on carers’ needs. Other parliamentary colleagues will talk in detail about other aspects of the Bill, such as the national eligibility threshold, personal budgets and other important issues relating to the social care system. They are all important, but in the time available to me I want to focus on the needs of carers. I may well not be able to say all that I would like to say in the time available, and in those circumstances I will put the full text of the speech on my website, www.tonybaldry.co.uk—even those of us who have been in this place for 30 years can keep up with new technology.

I welcome the Care Bill and the fact that it contains significant new rights for carers, including stronger rights for an assessment of their needs and a clearer entitlement to services for carers and those for whom carers care as a result of any such assessment. I also welcome the fact that as well as introducing new rights for carers the Bill consolidates their existing rights. Over the years, a number of Bills have enhanced carers’ rights. All the recent ones have been private Members’ Bills, taken through the House with the support of organisations such as Carers UK and the all-party group on carers, so I welcome the fact that this Bill consolidates carers’ rights in a single piece of legislation. Clause 1 sets out the well-being principle, which is a hugely welcome overarching duty that will place individual well-being at the heart of the new reformed social care system.

The Bill has, of course, already enjoyed detailed consideration and scrutiny in the other place. It is to the Government’s credit that they have already introduced a number of further concessions, not least those for young carers, following the hard work of parliamentarians and the National Young Carers Coalition. Good progress has of course been made to enhance the rights of young carers through an amendment to the Children and Families Bill, which delivers four key improvements for young carers: the simplification of the legislation on young carers’ assessments; the extension of the right to an assessment of needs for support to young carers under the age of 18 regardless of whom they care for; the fact that it has been made clear to local authorities that they must carry out an assessment of a young carer’s needs for support on request or on the appearance of need; and the provision of appropriate links between legislation for children and for adults to enable local authorities to align the assessment of a young carer with an assessment of an adult they care for. The amendment works closely with the provisions in the Care Bill that focus on a whole-family approach to support, and that is all welcome progress.

There are three further issues, however, that I hope Ministers will consider as the Bill makes progress. First, it places new duties on local authorities to provide information and advice services, which are very welcome and will enable carers to access vital information and advice earlier. As part of the enhanced right for carers, the Bill places a new duty on local authorities to undertake a carer’s assessment for all carers. It is also good news that under clause 2 local authorities must have regard to the importance of identifying carers in their populations with unmet needs with the aim of early intervention and prevention of future needs, but the clause does not mention the NHS. Neither the Care Bill nor the health and social care legislation places any responsibility on the NHS to identify carers.

Ministers might say that there is a co-operation clause, clause 6, that requires health bodies to co-operate with local authorities on all clauses in the Bill, including the that on identifying carers, but the way that clause is drafted gives rise to serious concerns that the onus will remain on local authorities. That could well mean that carers will receive very little help from health bodies in certain parts of the country. It is a matter of common sense that for many carers their point of contact with the wider world and the person with whom they will discuss their wider caring responsibilities will be health professionals, such as their GP.

Macmillan Cancer Support estimates that there are nearly 1 million carers of people with cancer in England, half of whom are not receiving any support as carers, notwithstanding the substantial impact on their lives. It is a matter of common sense that carers of people with cancer come into contact mainly with health professionals who are simply not identifying them as carers, which as a consequence means that only 5% of the nearly 1 million people caring for people with cancer receive a carer’s assessment. Half of carers of people with cancer are not receiving any support in return for giving an average of almost 15 hours of care each week. As the number of cancer patients is likely to double from 2 million to 4 million over the next 15 years or so, so too will the number of carers.

Part of the reason why carers of people with illnesses such as cancer are not receiving any support is that three in five people providing unpaid care to loved ones with cancer do not consider themselves to be a carer. They thus lack awareness of carers’ rights, such as the local authority carer’s assessment, which is crucially important because it is the gateway for carers to get statutory support. There needs to be an explicit requirement in the Bill for health bodies to identify carers with unmet needs, with the aim of early intervention and support. Neither the Care Bill nor the Health and Social Care Act 2012 sets out any responsibility for the NHS to identify carers, which is surprising, given that this was something the Government specifically called for in their care and support White Paper, where they outlined the requirement for

“NHS organisations to work with their local authority partners . . . to agree plans and budgets for identifying and supporting carers.”

The first point that I therefore wish to impress on the Minister is that the Bill should specify that local authorities need to work with health bodies in order adequately to identify carers with unmet needs and provide sufficient services for them, and that there should be a duty on the NHS to identify carers. GPs need to see support for carers of their patients as also being part of their job, because in supporting the patient’s carer, GPs are also supporting the patient. There is, I suspect, a need for a national framework, or guidance, on how the NHS can better identify and support carers.

The second point that I wish to raise is a difficult one. The Government are introducing new and much appreciated rights for carers of adults through the Care Bill, and for young carers in the Children and Families Bill, but parents of disabled children under 18 are not included in either Bill. It is worth reminding ourselves of the recommendations of the Law Commission to strengthen the rights of parent carers in line with other carers, and to consolidate these rights in new legislation.

I appreciate that at a time when we are enhancing and hopefully improving special educational needs in the Children and Families Bill, the question arises whether every parent whose child receives a statement of special educational needs should be considered a parent carer, and I suspect that Ministers would probably respond that in straitened financial circumstances it simply is not possible to give financial support to a child with special educational needs through that system, and at the same time give financial support to their parents as parent carers.

On the other hand, I hope Ministers and the House will appreciate, as I am sure we all do, that for a parent of a seriously and severely disabled child, or a child with serious and severe learning difficulties, those responsibilities as a parent and as a carer can completely take over their life, with little respite. I hope that there will be an opportunity in the Public Bill Committee to consider whether it is possible to give targeted support to parent carers whom, as a matter of common sense, I think we would all recognise merit consideration as carers.

My third point is that the Bill perhaps needs greater clarity to ensure that carers are not wrongly charged for services provided to the person they care for. I know that ministerial colleagues have said that this is not their intention, but I suggest that that is not yet clear enough. Social workers and carer support workers will in due course have to use this legislation to decide on the one hand what is a carer’s service, and on the other what is a service for an older and disabled person. I suggest that this needs to be defined with greater clarity so as to prevent confusion or disputes. I would suggest that we should remove from local authorities any ability to charge for carers’ services. Not surprisingly, many carers are shocked to find, given the support and contribution they are making to caring for a loved one and the amount they are saving the state with the care they provide, that they are being charged for carers’ services.

I hope that during the passage of the Bill through the Commons, the Government will give consideration to these three points relating to carers, but I re-emphasise that overall the all-party group on carers very much welcomes the significant new rights for carers in the Bill, including stronger rights to an assessment of their needs and a much clearer entitlement to services for them and those they care for as a result of such a carer’s assessment.