Carers

Debate between Tony Baldry and Barbara Keeley

Thursday 20th June 2013 Commons Chamber

[Sir Tony Baldry]

That is an extremely good point. These things are organic. A few years ago big employers such as Sainsbury’s would not necessarily have been involved in that way. Having been involved in carers policy over the years, what I find encouraging is that each year a further step is achieved.

[Barbara Keeley]

I had not intended to make this point earlier, but I will make it now because so much has been said about employers. The Independent Parliamentary Standards Authority does not allow MPs’ staff to take compassionate leave; it allows MPs to give only sick leave or maternity leave, as I discovered late last year. Given all the good work that has been done with employers, that is an issue the whole House should take forward.

[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

Social Care (Local Sufficiency) and Identification of Carers Bill

Debate between Tony Baldry and Barbara Keeley

Friday 7th September 2012 Commons Chamber

[Sir Tony Baldry]

Having been a Minister in the last Government and as a grown-up and senior Member of this House, the right hon. Lady has a clear understanding of how legislation works and evolves. A large number of private Members’ Bills during the 13 years of the last Government did not make progress in the form in which they were drafted. The point is not that the Bill must pass today in this form, but that it contains a number of provisions, some of which are not in the White Paper.

The grown-up and responsible undertaking that I have received from the Minister is that he will have intelligent discussions with all of us who are concerned about carers policy over the next few months to see whether we can get some of these provisions into the Government Bill when it is brought forward. If not, all of us will want to hear good reasons why, given that some of the work in the private Member’s Bill builds on previous legislation, for example on child care, where there are clear precedents for what we are seeking to achieve.

[Barbara Keeley]

It is not without precedent for Conservative or Labour Governments to accept private Members’ Bills relating to carers. I think that I am right in saying that of the three pieces of legislation brought forward by Labour MPs, one was brought forward with the agreement of a Conservative Government and the other two with the agreement of a Labour Government. For all the pious aspirations in the carers strategy documents that are rolled out by Governments, it is the concrete rights and measures in those private Members’ Bills that have made the difference, as I said in my speech. It is important to recognise that sometimes a specific measure is needed, rather than a lot of consolidation and aspiration, which make no difference to carers on the ground.

Adult Social Care

Debate between Tony Baldry and Barbara Keeley

Thursday 8th March 2012 Commons Chamber

[Tony Baldry (Banbury) (Con)]

I am grateful for the opportunity to contribute to this debate, not least as co-chair with Baroness Pitkeathley of the all-party group on carers. The first point I want to make is about the phrase “adult social care”. One of the difficulties in this area is that if we are not careful we develop a secret garden of policy and we all start to descend into shorthand—referring to Dilnot as though everyone understands the five paragraphs that follow from that. I thought that the shadow Secretary of State for Health made a good point when he said that, for many people, this is all about being afraid of getting old. I think that this should be about not adult social care but care of the elderly.

When the Law Commission was asked to define social care, the best that it could come up with was the phrase

“promote or contribute to the well-being of the individual.”

That was pretty otiose. We should focus on care for the elderly because we will need to enlist in our constituencies many more people to get involved in this, not least local councillors, with the introduction of health and wellbeing boards. I do not know about other hon. Members but, although I think that the provisions in the Health and Social Care Bill on integration are really good news—I will come on to that in a second—I do not sense that county councillors and others have yet woken up to the fact that shortly they will be part of the boards and will be involved in delivering integrated care. Part of the reason for that is that this has been a bit of a secret garden of policy. One of the things that Ministers will have to do in the near future is go out and talk to, in two-tier authorities such as mine, county councillors, but in others those councillors who are responsible for running social services, to get across the fact that the whole way in which services are delivered will fundamentally change.

About half the speeches this afternoon have been what I would describe as old-fashioned speeches to Ministers, saying, “Please can we have some more money?” The truth of the matter, as we all know, is that there is no more money. It is actually more challenging than that. We have the Nicholson challenge of 4% efficiency savings in the NHS over four years. We will make this work only if we completely rethink the way in which we deliver services. We all know of far too many people who are in hospital but could be moved elsewhere if intermediate beds were available. That would mean they could be moved out of acute beds, such as those at the John Radcliffe hospital or the Horton general hospital in Banbury, but that would require someone working out how to provide more community facilities and intermediate beds and how they would be paid for, and that will require a lot of rethinking by county councillors and GP commissioning bodies working together.

We have to start to put this in a language that everyone understands. When the White Paper is published in the “spring”—that leaves only April—there is a danger that we will all get fixated on Dilnot and the cap. It seems to me that that is just one part of the whole equation for improving care for the elderly and, increasingly, elderly people suffering from dementia. The figures on dementia are really pretty scary. Among the many organisations that produced briefings for today’s debate is the Alzheimer’s Society, which reports—I had forgotten this—that there are now nearly 750,000 people in the UK with dementia, and that figure is set to rise to over 1 million by 2021, when many of us expect still to be in the House.

Dementia costs the UK economy £20 billion a year. When I was first elected to the House, most Christmases I would visit the homes for the elderly in my constituency. The residents then were mostly spry widows in their 70s, but now all the homes are almost totally full of people suffering from dementia or age-related dementia. This is about how we care for the elderly and, increasingly, elderly people with dementia, many of whom are having to stay at home longer. Indeed, the Alzheimer’s Society says that more than half of the people suffering from dementia have not yet been diagnosed as such because their families or those are caring for them are probably disguising the fact.

[Barbara Keeley]

I do not know whether the hon. Gentleman thought that my speech was one of the old-fashioned ones asking for more resources, but he probably did. However, I gave three examples of cuts to services for people with long-term conditions: the support services for people with dementia that Age Concern was running; a community matron service; and active case management for people with long-term conditions. It is inexcusable for those to be cut. If the Nicholson efficiency reforms are causing those services to be cut there is no way forward, because those are the supports in the community that will keep people out of hospital. It seems crazy. I now have three examples, whereas at Christmas I had only one. I am distressed to think that those services are being cut, because they are the way to support those people in the community.

[Tony Baldry]

One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.

Social Care Funding

Debate between Tony Baldry and Barbara Keeley

Thursday 10th November 2011 Westminster Hall

[Tony Baldry]

That is a helpful update for the House, and I am grateful to the Minister.

[Barbara Keeley]

Does the hon. Gentleman share my concern—this may be the theme that he is developing—that there is a conflict between localism, the removal of ring-fencing and ensuring that a local authority delivers adequate social care? I find it hard to see, when exhortations are clearly not working with local authorities, how we can ensure that some authorities do not just cut their social care budgets to the bone and give people inadequate services. It is quite clear, with £1 billion in cuts this year, that they are not doing as the Minister would like.

[Tony Baldry]

I see the situation rather differently from the hon. Lady. Local authorities such as Oxfordshire are committed to delivering good-quality social care for elderly people. The challenge for them is to ensure that the increasing number of elderly people, often with increasing needs, receive appropriate care, whether at home or in residential care. A tight budget presents them with a significant challenge, but it is a challenge to which they are committed.

I appreciate that the hon. Lady comes from a unitary authority, but for two-tier authorities in shire counties such as mine, social care is now their most significant contribution. Increasingly, schools and education are running themselves, so authorities are going to be judged on the quality and the way in which they deliver social care.

[Tony Baldry]

I am not entirely sure where the hon. Gentleman is going with that point, so if the House will excuse me, I will not follow him down that particular line.

I do not think there is any lack of local accountability as far as the national health service is concerned. The Oxfordshire joint health overview and scrutiny committee is meeting today and will consider, for example, possible service changes at Horton general hospital in my constituency. The committee will, I am sure, vigorously interrogate the senior management from the Oxford University Hospitals NHS Trust and from the Oxfordshire and Buckinghamshire PCT cluster.

In the debate on social care, we must not underestimate the burden or the toll on carers of the task of looking after elderly people with age-related difficulties. Carers UK has found that carers providing significant amounts of care are twice as likely to suffer from ill health as non-carers. In 2008, a survey of heavy-end carers showed that more than half of those caring were in debt, and nearly three quarters were struggling to pay household bills. A large number of carers, about 1 million, have given up work or reduced their working hours because of caring. The peak age for carers is between 45 and 65, which is often the age at which they would be at the peak of their training, skills and career experience. That can be a cost not only to the carer, but to businesses and employers as they lose key people who have to care for relatives.

We have seen some excellent organisations such as Employers for Carers, which was set up by Carers UK and seeks to bring together numerous employers, generally larger ones, to promote flexibility and workplace support for employees juggling work and care, but that is not always possible for small and medium-sized employers. There is also a cost to the NHS. Sometimes, if we are not careful, there is a trade-off between the quality of social care, the provision of sufficient beds in nursing homes and residential care homes, and the need to prevent delayed discharges and bed blocking in hospitals. We had a debate on that not long ago, to which I contributed. In Oxfordshire, we are grappling with the issue of delayed discharges. If we are not careful, the cost to the NHS of delayed discharges will be significant, particularly at a time when more and more hospital treatments can be offered as elective day treatments. Generally, people are spending less time in hospitals, so delayed discharges add particular cost to the NHS.

[Barbara Keeley]

I thank the hon. Gentleman for giving way again; he is being very generous with his time. Does he have any thoughts on the point that I made earlier about the Dilnot commission and the £35,000 that must be paid out by the individual in the shared-costs model, which does not recognise informal care? He is making the point that people are giving up work to become carers, which has a huge financial cost. They may be struggling to pay bills but, even so, when their loved one goes into a care home, they will still have to pay £35,000. There is no recognition of everything that they have done that has helped the state save money. Does he agree that that is not fair?

[Tony Baldry]

We all have to recognise that there is only so much, on a cross-party basis, that Ministers will be able to do in the White Paper, which I hope will come out next spring. If the White Paper contains a sustainable funding process for residential care, we will all consider that to be a substantial step forward. We must not forget, however, that a number of issues will still be relevant to carers, particularly because, in order to maintain costs and keep them down, most local authorities are trying to keep people at home for as long as possible. For example, in my constituency and in those of many of the other Members who are present, it was previously the case that frail, elderly, but mentally alert people lived at home, but that has become increasingly true of people with age-related illnesses such as dementia or Parkinson’s, and it will continue, because however much the funding for residential care is increased, there will still be that population at home.

Another point that I want to reinforce to the Minister—I am sure that he will take it on board—is that a number of organisations concerned with social care are in consensus in supporting the recommendations from the Dilnot commission, particularly the recommendation on protecting families from catastrophic care costs by capping lifetime care bills because, at present, families coping with long-term conditions can face bills of tens or hundreds of thousands of pounds to pay for home and residential care. There are fears of unaffordable bills forcing families to provide round-the-clock care, and two thirds of carers end up spending their own income to pay for the care of the person for whom they care.

Those of us on the all-party group on carers welcome the Dilnot commission’s clear recognition of the need for additional resources for social care, to overcome an historic shortfall and to recognise the growing demand. We need a new national system of eligibility and portable assessments to create a more standardised system across England and to remove some of the uncertainty that families face as they deal with different systems in different council areas. We also need a new awareness, advice, information and advocacy strategy, to help families plan for care and access private, state and voluntary sector support. I think that there is strong consensus on those points, and I hope that the Government will adopt the proposals in the forthcoming social care White Paper.

Caring Responsibilities

Debate between Tony Baldry and Barbara Keeley

Wednesday 15th June 2011 Westminster Hall

[Tony Baldry]

I am sorry, but I will not give way any more because these exchanges demonstrate why I need to read into the record for future debates the three paragraphs that I mentioned earlier. We would all love to have lots more money that we could spend, but alas that is not the case.

With regard to this particular debate, it seems to me that there is a lot more that can be done to help and support carers without necessarily spending a huge amount of extra money. The first thing that we ought to do, or at least we ought to make a much greater effort to do, is to identify which people are carers and to encourage carers to see themselves as carers. Local authorities provide considerable services for carers, but of course they can only provide those services if people identify themselves as carers.

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

Will the hon. Gentleman give way?

[Tony Baldry]

I will not give way, as I just want to make a little more progress.

I was quite interested in a note from Sainsbury’s. Sainsbury’s has been pursuing an initiative in Torbay to help to identify “hidden” carers. It was working with the Torbay Care Trust and it sought to identify customers in its supermarkets who might have caring responsibilities. Staff talked to customers and if it seemed that a customer might be a carer, they were asked if they were in fact a carer. If the customer said, “Yes”, they were then directed to a trained member of the Torbay Care Trust. In a very short period, that initiative led—in just one supermarket—to 140 new people signing up with the Torbay carers’ register.

Sainsbury’s is going to expand that initiative to other stores across the country. I suspect that huge numbers of people who act as carers do not know that that is what they are, for example, husbands and wives who look after loved ones, and young people who look after parents. We should be working as hard as possible to help people to recognise that they are carers. Considerable help and support are available for people who know they are carers. In carers week, one can see that a range of organisations have come together—

[Barbara Keeley]

Will the hon. Gentleman give way?

[Tony Baldry]

I will give way to the hon. Lady in a moment.

A range of organisations that provide advice and support have come together, including Age UK, Carers UK, Counsel and Care, Crossroads Care, Dementia UK, Macmillan Cancer Support, the Multiple Sclerosis Society, Parkinson’s UK and the Princess Royal Trust for Carers, but they obviously cannot give advice unless people actually recognise that they are carers.

[Barbara Keeley]

I agree that identifying and supporting carers is important. Will the hon. Gentleman therefore communicate to the Minister with responsibility for care services that he should support my Carers (Identification and Support) Bill, which the Government have indicated they would not support? The Bill would provide a basis for the proper identification of carers by NHS bodies, local authority bodies and schools. It is more appropriate that public bodies help to identify carers, rather than the task being left entirely to supermarkets such as Sainsbury’s.

[Tony Baldry]

I do not dissent from that, and in a second I will come on to the Law Commission’s report. It is important that we recognise carers, and if statutory bodies can help to identify them, that too is important.

We are fortunate this afternoon to have the Under-Secretary of State for Health present, and I wish to make a couple of points about carers and health. Often nowadays, when a person being cared for goes to see their GP or a specialist, the carer is treated as if they were invisible. The concept of patient confidentiality is being used as a mechanism for denying the person who is being cared for the support of their carer, whether it is children taking their aged parents to see the doctor, or a husband taking his wife or vice versa. Often, the carer is able to provide counsel and care for the person they are caring for, and they should not be seen by the GP or the health service as invisible. The NHS, GPs and the Royal College of General Practitioners need to work out a protocol for how the NHS deals with carers. There obviously have to be some balances concerning patient confidentiality, but it must be possible to work out how the NHS should deal with and respond to carers.

Carers are most concerned about the people they are caring for needing access to the NHS in the evenings and at weekends, when there are out-of-hours systems in place. The out-of-hours GP system was, as it happens, brought in by the previous Government, and it is of variable quality across the country. I think that the Minister will find that one of the growing pressures on the NHS is the number of people who self-refer to accident and emergency departments in the evenings and at weekends, because they can at least be confident of being seen, even if they do not need A and E treatment. They cannot be turned away at the door because the NHS has a duty of care when they turn up. It might be sensible to have primary care triage in A and E departments. We have a Darzi centre in Banbury, but I see no reason why one should not have primary care triage at the door of A and E so that people who do not require A and E services can be confident of accessing primary care without having to hang on on various helplines, or talk to distant voices in which they have no confidence. That would give much greater confidence to carers and to those for whom they were caring, and would significantly reduce the cost to the NHS of the significant number of inappropriate treatments and admission at weekends and in the evenings.

Another responsibility of the Department of Health are carers’ breaks, about which many carers are very concerned. One of the longest running campaigns of the all-party group on carers over the years has been on carers’ breaks. There are supposedly significant amounts of money in the system—some £400 million—for carers’ breaks but, as is the case with so much money, it is not ring-fenced. Some PCTs have been extremely good about that, but we will need to watch where the money goes, particularly as we transfer to GP commissioning. Can we develop systems of best practice? It is not just a question of talking about carers’ breaks; we also need to ensure that systems are in place.

Public Sector Funding

Debate between Tony Baldry and Barbara Keeley

Wednesday 23rd March 2011 Westminster Hall

[Tony Baldry (Banbury) (Con)]

I think, Mr Amess, that coming in, making an intervention and disappearing is known as doing a Spink, is it not?

It is a great pleasure to follow the very thoughtful speech made by the hon. Member for Worsley and Eccles South (Barbara Keeley). She and I are involved as officers of the all-party group on carers. I think there is no one in this Chamber who does not support the work of volunteers and we would all like to see the maximum amount of volunteering. We all have to accept, however, that we start from a position of having to manage an enormous budget deficit. Each and every day, the Government have to spend £120 million, just on interest, to service the deficit. I did a calculation the other day. I added up all the money that the Government give to my constituency through the local district council, the money it gives in grants to Cherwell district council, Oxfordshire county council, the Oxfordshire primary care trust and Thames Valley police for the whole of Oxfordshire, Berkshire and Buckinghamshire. The total equates to just 11 days’ interest on the budget deficit. We all have to put this in some sort of context.

I want to make some general comments about local government. I have come to the conclusion that the way it operates will have to change radically and fundamentally, and I shall give the House examples of that. We have had a system under which we all pay our taxes, the taxes go to the Treasury, the Treasury allocates money to local government, and local governments, from their largesse, allocate money to voluntary groups in their area, as they see fit. Voluntary groups have very much been rentiers, dependent on the largesse of local government and what it has chosen to give them. That needs to change considerably.

First, there needs to be a commitment by local government to allow much greater community scrutiny. May I give the House an example of why that is the case? On Saturday, I met with campaigners in Deddington in my constituency who want to retain their library. As we discussed the situation, it became apparent that we have in Oxfordshire a public library service, but also a schools library service, which is operated completely separately. That prompts the question, why do we need two services? What happens with back office costs? As we discussed the matter further and began talking about the mobile library, we realised that it was going to villages to which, at the same time, the GP surgery—in the village that has the library—sends transport to collect people to come into the surgery.

As the discussion continued, it struck me that, under that system, the risk is that the greatest cuts will be made at the front end—that is, at the service end—yet no one has had an opportunity to understand the full central costs of running the services. The local authority has not been subjected to complete scrutiny so that people may make proper value judgments about whether it is ensuring that any spending reductions it has to make are fairly distributed between it and the services that it might hitherto have supported.

There is a danger that local authorities will simply retrench to their statutory obligations and duties, and say, “If we don’t have a statutory duty to do this, we won’t do it.” However, as we all know, the reality is that, for a long time, part of the fabric of society has been local authorities funding all sorts of organisations and operations that are not necessarily part of their statutory obligations.

There needs to be a new obligation on local authorities to subject themselves to much greater community scrutiny, and that would happen in part if they had to put all their expenditure online and be much more transparent about how they spend their money. Transparency is one thing, but we also need to ensure that they subject themselves to much greater scrutiny so that people can ask questions about how money is spent.

[Barbara Keeley]

The hon. Gentleman is talking about local authorities retrenching and cutting back on support for the voluntary sector, but I have just outlined an example of the Government doing that. Does the same duty fall on the Government when they start retrenching and substantially cutting grants to charities?

[Tony Baldry]

The hon. Lady is already able to scrutinise Government decisions—that is exactly what she is doing today in this Chamber. She will have the benefit of a response from my hon. Friend the Minister, whom I am sure will answer her questions about TimeBank, which is an excellent charity and an excellent initiative, in his winding-up speech. Local government needs to take a new approach to scrutiny.

My second point is about engagement. My constituency happens to have been confronted with a threat to the local general hospital. Over time, that has constructively resulted in much greater engagement between local authorities, the primary care trust and various campaigning groups, which has been incredibly successful. As a consequence, we have managed to keep the local hospital as a general hospital.

It strikes me that that is a new, organic pattern of engagement between the local authority and, importantly, its officers, and members of the voluntary and community sectors. There are no rigid demarcations as to who is accountable or who is elected. It involves people coming together constructively to try to work out what is in the best interests of the community as a whole. We need the local government, its officers and elected members to be involved in much more of that sort of broader community engagement so that there can be an ongoing discussion with the community.

My last point is that there needs to be much greater commitment on the part of local government and central Government to put opportunities to tender out to social enterprises and voluntary organisations, and they need to be much clearer about how that should happen. The last example from my constituency is a new social enterprise in Banbury that was set up by people who had been working for many years with offenders at Bullingdon prison who were addicted to or had a dependency on drug or substance abuse. They have been doing excellent work involving ex-offenders in therapy. They have a good, reputable board of trustees, including some eminent doctors and others, and are doing a great deal of work with people who voluntarily self-refer. However, they could do a great deal more in the rehabilitation revolution by offering their services to people who may recently have come out of custody or may be in danger of going into custody—for example, there could be referrals from the courts.

The difficulty is that there is a disconnect in the rehabilitation revolution between how such groups get referrals, who buys the services and how they buy services. If government collectively wants social enterprises to develop, there needs to be a much clearer indication of where, within the machinery of central Government and local government, organisations can buy services. Otherwise, it will be extremely difficult for social enterprises to grow because they will have no idea how they might be able to maintain a sustainable income.

We are in incredibly challenging times because of the need to tackle the budget deficit, but we also have an opportunity to rethink much of what we do and how we approach central Government and local government. In the past, there has been a completely top-down, paternalistic, dirigiste system in which a citizens advice bureau at the bottom of the pile is lucky if it gets a grant each year from the district council. We should turn that on its head. There should be a bottom-up, community-driven process of priorities so that people in Deddington or Adderbury who are concerned about their library can drive the agenda, rather than it being imposed on them from the top. We should see this as an opportunity for real change.