| Previous Section | Home Page |
Column 432
I repeat that, although a caring relationship is based on affection and love, one cannot be too romantic about it. Just as, in the horrible jargon, the "user"--the person being cared for--should have a right to an assessment with the social worker at which the carer is not present, so there should be a right for the carer to be able to sit down with the social worker and explain the position.Mr. Alan Duncan (Rutland and Melton): We have heard a great deal from the hon. Gentleman about assessments and needs. I believe that hon. Members on both sides of the House would be happy to agree with all that. However, before he finishes speaking about new clause 1, will he clarify exactly what it is likely to mean in practical terms as regards the arrangement between the carer and the person cared for?
10.15 am
Mr. Wicks: I shall mention that in my concluding remarks, but obviously it is vital. It would not impress the carers of Britain--or, indeed, the hon. Gentleman--to have an assessment that did not lead to practical support.
Good practice is vital. I shall give a practical illustration of the way in which the assessment of carers' needs becomes important. When a social services department assesses the needs of the person being cared for--let us say, an elderly relative--the elderly relative, perhaps with senile dementia or with other major handicaps, may well not say to social services, "I want respite care. I think that it would be good for my daughter to give her a break," so that someone else can look after her for two weeks in a nursing home. However, when the carer has the discussion with the social worker, she or he may well say, "I am going crazy here. I am pulling my hair out. I am about to have a breakdown. I must have a break."
If the Bill works in practice as I intend it to, it would enable the social services department to say, "Although the elderly person did not mention respite care, the carer is crying out for it, and among the services that we provide, albeit to the cared-for person, respite care will be there regularly." That is an illustration of the way in which I hope that the legislation will work.
Dr. Norman A. Godman (Greenock and Port Glasgow): May I draw to the attention of my hon. Friend the fact that the present practice in the Strathclyde region of Scotland is that the carer must agree to the assessment made by the appropriate social worker?
My hon. Friend's admirable Bill comes at an awkward moment for social work departments in Scotland because of the reorganisation of local government. Those new social work departments, under the new authorities, will need the type of guidelines that he spoke about a minute ago.
Mr. Wicks: Indeed. I am grateful to my hon. Friend, because he reminds us that although, in making out the case for new legislation and for policy development, we must talk about bad practice and about neglect, in many parts of our countries there is much good practice. We need to draw on that good practice if the guidance issued by the Department of Health is to be the guidance that is required. I recognise the good practice in my hon. Friend's region and in many parts of the country. I repeat that, throughout Great Britain, only a minority of carers--fewer than one in five --receive a separate assessment of their needs. However, we need to draw on that good practice.
Column 433
I recognise that the reorganisation in Scotland poses difficulties, but, more positively, new departments and new councils may well be able to look afresh at their priorities and take that one into account. Although it might be awkward for councils, it would be even more awkward for carers if the implementation of the Bill were delayed, as my hon. Friend would be the first to recognise. I shall say more about the services that might flow from the measure, because it would be frustrating indeed if we simply introduced an assessment that did not lead to positive change and more service support for carers, and indeed the person being cared for. One needs an assessment of needs, because people's needs vary enormously. I do not want social services to visit a home offering a pre-ordained package of care. I want those people to listen and learn from the person who best knows what care is required--the carer. The services and support required vary--home help might be required or it might be help with bathing or putting an often large and heavy person to bed in the evening or getting him or her up in the morning. My talks with carers in different parts of the country suggest that often it is the need for respite care that people stress. We all need a break from time to time. We have just returned from an Easter recess. While I spent most of mine preparing my notes for this morning, other hon. Gentlemen no doubt had a break.Ms Rachel Squire (Dunfermline, West): Hon. Ladies did not.
Mr. Wicks: Hon. Ladies did not, because a woman's work is never done, which is one of the Bill's themes. We are trying to correct that, and I am grateful to my hon. Friend for reminding me of that. We all need a break. When we talk to carers, as many hon. Members have done recently, we are struck by the fact that some carers never get a break. Such people wish that, if only for one evening a week, they could be free of their caring tasks. They wish that someone could come in to look after their elderly relatives or their children with disabilities, so that they could go out with their husband, wife or partner, get away from it all and have a break. That is a modest demand, but some carers never have an evening off and never have a holiday. If only there were respite care so that the person could be cared for--perhaps still in his or her own home or a nursing home- -and so that the carer and his or her partner could take that break. That would make a difference. I hope that such practical support will flow from the recognition of carers' needs. At present, that tends not to happen.
One carer in Croydon told me that she almost cracked up--to use her phrase- -at one stage. She told me that no one ever mentioned respite care. She said that the social worker once said to her, "You have done a great job-- keep up the good work." As the carer said to me, that sort of statement denies someone the right to ask.
I shall now outline the Bill's implications in Scotland. Colleagues will have recognised that the amendments also apply to Scotland. Given the legislative background and the fact that there are different laws in Scotland, the Bill will apply there in different ways. There are 700,000 carers in Scotland. I had the opportunity of meeting a few of them in Edinburgh only recently. Obviously, we are determined that the policy intentions should apply to Scotland.
Column 434
The amendments enable the legislation to cover most carers in Scotland; certainly the provisions are the same for those adults caring for elderly relatives and for young carers. I am advised, although I am not an expert on Scottish legislation--colleagues might be--Mr. Wicks: Yes, the Under-Secretary of State for Scotland, the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton), is an expert. When I refer to colleagues, I include the Minister. I am advised that we need to implement the policy intentions as they affect adult carers-- normally parents looking after disabled children--in slightly different ways in Scotland. We have had positive discussions with the Scottish Office. I know that the Minister of State, Lord Fraser, would allow me to quote from his letter to me of 11 April in which he set out his policy intentions. On parent carers, he said that he agreed with the principles underlying the proposal of the Under-Secretary of State for Health,
"but if we are to secure corresponding provision in Scotland for assessment of the needs of adult carers for disabled children, this will have to be done in some other way. We will be prepared to instruct an appropriate amendment to the Children (Scotland) Bill in the course of its passage through Parliament. This would provide for the same intention as that reflected for England and Wales in subsection (2) of the new clause proposed for amendment to the Carers (Recognition and Services) Bill. I trust you will find this acceptable."
Colleagues may have a view on whether it might have been possible to have exactly the same legislative arrangements for our countries so that Scotland was entirely in line, in its legislation, with England and Wales. I have no judgment or expertise on that. My concern was not with legislative niceties, but with the carers themselves. Carers in Scotland are, in many ways, the same as carers in England, Wales and Northern Ireland. I am confident that, with new clause 2, which looks after most of the carers of Scotland, and with a clear statement from the Minister, the policy intentions behind the Bill will also apply to Scotland.
Dr. Godman: I am pleased to hear that Lord Fraser is offering support, because clause 20 of the Children (Scotland) Bill places a specific duty on local authorities to minimise the difficulties faced by children with disabilities. That Bill contains a provision to provide that sort of service to disabled children.
Mr. Wicks: I am grateful to my hon. Friend for making that point. As the Bill proceeds, no doubt there will be an opportunity for Scottish colleagues to ensure--although I do not think that they need to do so--that the policy intention is included in the Bill, but to have some discussions on the subject of children in Scotland. I apologise to the Committee for taking a long time to describe the provisions under this group of amendments. We are dealing with the heart of the Bill and I have been given the opportunity to outline the overall policy intentions. While it is up to the Committee and its Chairman, and not me, I suspect that we shall make faster progress later.
Lady Olga Maitland (Sutton and Cheam): I support the hon. Member for Croydon, North-West (Mr. Wicks) in his introduction of new clause 1. I agree with him that the Bill should deal with family care in the round. It struck
Column 435
me as unusual and strange that the Bill should have been initially constructed without reference to children. It is logical and plain common sense to include within the Bill's provisions, certainly in the new clause, the cares and concerns of children.I have met many parents of children who have been severely disabled. I have sat with them in their homes and met them at various centres. I am deeply aware of the frantic work they do. They are almost Cinderellas in the sense that people take their love for their children for granted. It is also taken for granted that parents will care for their children unstintingly and with 24-hour energy--almost beyond the strength of any man--and still come up smiling, but parents are carers and need a tremendous amount of support.
Children who are severely disabled, who display aggressive and challenging behaviour, who are wakeful and who do not sleep or conform to any normal pattern of behaviour, can drive their parental carers to distraction. Some children never sleep, which means that parents have to get up throughout the night. The father then has to go to work the next day when he is weary and exhausted. It is important that those parents, as carers, should be included within the terms of the Bill, and should have their needs assessed. If the carers break down, the whole system breaks down. Parents are naturally determined to hang on because they love their children so much, but many do not realise that they could seek help. We must provide parents with the assistance that they need. As the hon. Member for Croydon, North-West said, the provision of respite care is essential not just to relieve tension but to enable parents to forge their own personal relationships. They must keep their families together and they can do that successfully only if they have some privacy. We must provide parents with that kind of support. 10.30 am
Parents often have other able-bodied children who can suffer dreadfully when parental attention is concentrated on a disabled child. Those able- bodied children have needs and concerns and the resulting rivalry among siblings must also be taken into account. We must examine that issue in the broader context of this Bill; we should not simply say that it comes within the orbit of different legislation, such as the Children Act 1989 and so on. That is rather like sifting through the laundry and saying that one can have the socks but not the vest.
I wish to draw to the Committee's attention to the case of a mother who has had a very trying time looking after her 16-year-old son, Stephen, who is profoundly mentally handicapped. That mother has the additional burden of caring for an elderly mother-in-law who suffers from senile dementia. One can only imagine what it must be like in that household. That mother receives voluntary assistance, but no statutory help. Her child can perform basic tasks for himself, but, although though he is 16, he has the mental capacity of a four-year-old. He therefore needs constant supervision in performing daily tasks, such as getting up in the morning, getting dressed, going to the bathroom and cleaning his teeth. Those routine activities that able-bodied people take for granted place enormous stress and strain on that mother, who is also caring for another invalid relative.
Column 436
That mother is also concerned about another issue that was not raised by the hon. Member for Croydon, North-West but that I believe should also be taken into account. Parents are deeply anxious about what will happen to their disabled children when they reach the age of 19 and are therefore no longer eligible to receive immediate care. What will become of those children, and where will they go to engage in daytime activities? Even more worrying is the question of what will happen to those children when their parents die.The mother to whom I have referred says that she spends a lot of time worrying because she can see that her son Stephen faces a bleak future. At the moment, that young man is conditioned to life within an established routine and pattern within the home. When his mother dies, he will be uprooted from his home, and his mother is extremely anxious about what will happen to him after that.
We must try to reassure parents in that situation that their children will not be thrown on to the streets. We must establish a proper care plan, which may be discussed with parents while their children are young--it should not be left until the children concerned are in their 20s--because that is when parents begin to worry and fear for their children's future. We must take those factors into account.
I also draw attention to the plight of parents of teenagers who develop schizophrenia. The illness is a curse--I can think of no stronger word to describe it. I am filled with admiration for Marjorie Wallace, who is the founder and director of Schizophrenia--A National Emergency, the charity which helps the victims of schizophrenia. She has done some heroic work in highlighting the problems of schizophrenia, which had previously been the skeleton in the family closet.
One has only to talk to a parent whose child has developed schizophrenia to know what the phrase "hell on earth" means. The illness places a terrifying strain on parents, partly because it takes a long time to diagnose properly. The parents of a child who stays up all night playing loud music and then sleeps during the day may eventually take that child to receive professional help only to be told that their child is experiencing adolescent behavioural problems. Therefore, it may be some time before the child receives the appropriate drug treatment.
Another problem is that children with schizophrenia may suddenly refuse to take their medication and erupt into dangerous violence. Parents need a tremendous amount of support from their general practitioners and social services. In a time of crisis, they must be able to have their children sectioned if that proves necessary. Violent teenagers are very powerful and they can cause a great deal of harm. I have talked to parents who are terrified of their children but, because they love them so much, wish to care for them at home. A unique feature of the illness is that children afflicted with it can become suicidal. Therefore, parents are fearful for their children's safety and cannot turn their backs on them for even a moment. Children with schizophrenia may also do themselves tremendous harm. They are able to ignore the feeling of pain and so may deliberately place their hands on a hot stove top and injure themselves. The illness places a terrifying strain on parents and we must be aware that they need special attention, vigilance and support. Therefore, the new clause is an essential part of the Bill.
Column 437
The issue of children who are carers is equally important. It is a twilight world and, as the hon. Member for Croydon, North-West said, it is difficult to know how many child carers there are. There may be 10,000 or 40,000--I have a feeling that the figure is probably closer to the latter. I believe that we must train teachers to ask questions and seek information about children's life styles if they become aware that children are not performing normally at school. If children do not do their homework, if they look tired and anxious and are fidgety, with poor concentration spans, teachers should not accept simple explanations. They should visit the family concerned or they should alert social services. Teachers must be alert to the fact that those children could be carers. As the hon. Gentleman said, a child who is a carer may be too embarrassed to tell his friends that, instead of running home to feed the dog, he is going home to look after mum.In my surgery I recently dealt with the case of a young woman--she is now 19 or 20--who has looked after both her parents for much of her life. Her parents, who are now in their 40s, suffer from crippling arthritis. Throughout her childhood, the daughter rushed home from school to ensure that her parents took the right tablets. She always worried about them a great deal. Now she has left home because she has married and become a mother herself, with two tiny children adding to her burdens--but she still rushes to her parents, worrying about them. I am full of admiration for the lifelong commitment of this young girl. I regret to say that Sutton social services, although up to speed in many other areas, has not yet understood that enabling that girl to live close to her parents so that she can look after them will prevent them from becoming a heavy burden on resources.
It is essential to bear in mind the needs of young carers. I heard only yesterday of the case of a father who recently suffered a stroke. To his mortification, the only person at home to whom he can turn is his 15-year- old daughter. This young girl has to deal with all the most personal aspects of his life, including going to the toilet. Frankly, only an adult capable of more objectivity should be put in such a position. It becomes a deeply stressful relationship: the father is humiliated and embarrassed by what the girl has to do for him, and she is not getting the support that she clearly deserves.
Far too many such cases come to light by accident. People are suffering silently at home instead of being given the attention that they require. I very much doubt whether this girl's case would ever have come to light under the provisions of the Children Act. I feel sure, however, that this Bill would scoop her up and provide her with the support that she so desperately needs. That is another reason why I hope that the clause will stand part of the Bill.
Social services departments are the key to the whole Bill, so I shall discuss their role. I have held long conversations with the social services department in Sutton on this subject. To its credit, it already assesses carers on a voluntary basis; but those people are brought to the attention of social services by the circumstances of those for whom they are caring. At present, social services makes its assessments quite speedily. If someone needs immediate help, he or she can be given it in a matter of hours--although usually it would take up to a couple of
Column 438
weeks. That in itself is a vast improvement on what happens to children who are given education statements, a process that can take six months or more.We all appreciate that those assessments must be carefully planned and carried out. I agree with the hon. Member for Croydon, North-West that a clipboard approach is wrong. Assessments should be done privately in carers' homes, preferably outside the hearing of the cared-for person. That is essential, because, owing to the nature of their problems, cared-for people can become very introspective and can take it for granted that the only person who can possibly look after them is their spouse, mother or daughter. They can become quite frantic if they hear conversations in which it is suggested that they might be given respite care or a temporary sitter. All that calls for a great deal of tact and flexibility.
Respite care should come high on any list. It is important to take into account the feelings of carers as well as the feelings of the people who are cared for. I know of a number of cases when the cared-for person has blackmailed his nearest and dearest, saying in effect, "You cannot possibly suggest that I be looked after by anyone else." For instance, I knew a wonderful elderly lady who used to look after her father, who was in his 90s. I am sorry to say that in the end she died before her father because she was so worn out. He would not accept any respite care or any alternative help. Firmness is called for in such cases.
10.45 am
Next there is the problem of the benchmark: at what point should help be given, and on what scale? On the answer to that question, many other things will depend. If an assessor examines only the condition of the cared-for person and prescribes services in that context, he is missing the point. Assessors should also scrutinise the condition and health of the carer, because if the carer is not fit and well the whole show will fall apart. The carer may be physically mobile and able to get out to the shops and perform basic tasks, but may also be rather fragile. Meanwhile, the cared- for person, although perhaps in a wheelchair, may be physically quite robust, while still needing help. We need to be careful not to be blinded by the physical condition of the disabled person, who may be fairly well, while forgetting that the carer may be getting ever frailer.
It would also be very cruel if a marvellous assessment plan for a carer were drawn up, but there were not enough resources to back it up. I therefore urge the Minister to tell us whether he will be putting more resources into this important sector, and whether they will be ring-fenced. I realise that that is rather a challenging request, but I am worried by the fact that some local authorities do not share my idea of correct priorities. I believe that any local authority's top priority should be its social services--I have no doubt about that. Sutton, a Liberal Democrat- controlled borough, has cut social services spending by 1.6 per cent., yet it has employed a play development officer and a dance development officer, and it is spending £40,000 keeping a public library open on Sunday afternoons. Those items of expenditure do not carry anything like as much importance as social services, in particular its task of caring for carers and people with disabilities alike. We therefore need to ensure that money cannot be devoted to other less important sectors--hence the need for ring fencing.
Column 439
Resourcing needs to be carefully thought through. The guestimate for my constituency is that about 19,000 carers are to be found there, of whom 1,300 have been identified, helped and funded. As a result of the Bill, many more carers will come to light, so we shall need the resources to give them the back-up they need. It is therefore essential to think that through carefully and not to repeat what happened with the Child Support Agency, which was an excellent idea originally but which stumbled on many rocks along the way. I conclude that that was due to a lack of forethought. In this sector, which affects so many people's lives, it would be a cruel trick if we merely identified the need but did not come up with the resources to meet it.I give a warm welcome to the ideas expressed by the hon. Member for Croydon, North-West, and I hope to have an opportunity later to make further contributions.
Ms Rachel Squire: I, too, am delighted to have the opportunity to speak in support of the Bill, and in support also of new clauses 1 and 2 and the amendments. I congratulate the Minister, the hon. Member for Battersea (Mr. Bowis), and the Government generally for supporting the Bill and for ensuring its passage through the House of Commons. It is a refreshing and welcome change for right hon. and hon. Members on both sides of the Chamber to speak with one voice, and to make that voice heard to the benefit of 6.8 million carers. I, too, praise the work of the voluntary sector, and most notably the Carers National Association, for all the work that it has done for and with carers and for providing invaluable advice and assistance to all hon. Members on both sides of the Chamber and those in another place who have taken an interest in carers and community care.
I am not in a position to name all the individuals who have been involved with the Bill. My hon. Friend the Member for Croydon, North-West (Mr. Wicks) has mentioned some of them. It would take too long to try to name all those who have been responsible for putting the Bill on the statutory road. It would be remiss of me, however, not to praise my hon. Friend the Member for Croydon, North-West. I trust that it will come as not too much of a shock to him for me to pay tribute to the tremendous work that he has done. I am aware that sometimes over the past few weeks I have tended to behave more at times like a nippy sweetie, to use a good Scottish expression.
Mr. David Hinchliffe (Wakefield): A what?
Ms Squire: I shall explain the meaning of the term later. I was tending to behave in that way rather than as a supportive colleague. I was constantly demanding to know what was happening and what was going on. We would not be here today, however, if it had not been for my hon. Friend's commitment, expertise and hard work. That he chose to introduce the Bill among many hundreds of other legislative possibilities speaks clearly of his commitment to carers. No one could have spoken more eloquently of their need than my hon. Friend.
The Bill enables carers to make their voice heard. It recognises carers as individuals with their own identity and needs. It recognises also that carers' needs are not always identical to those of the people for whom they are
Column 440
caring. It recognises too that the United Kingdom's 6.8 million carers are individual men and women, including young people, and not an amorphous identical mass.There may be some who ask why we need the Bill, why carers need their own assessment and why their voice is not already heard. Like other hon. Members, I shall give a few examples of why the Bill is so necessary.
Carers are too often the last to ask for help for themselves. All too often they see the responsibility of caring for someone as a pressure, trauma and stress that they should be able to deal with whatever the circumstances. I agree with the comments by the hon. Member for Sutton and Cheam (Lady Olga Maitland) about some of the pressures facing parent carers, especially as they remain carers when their children become adults.
I still remember vividly, when I was a social worker in Birmingham, meeting an elderly couple. The woman was in tears and her husband was shaking with emotion. They had come to ask whether the social services department could arrange a week's holiday for their son. Their son was in his 30s and had learning difficulties. It emerged that they had never had a day's break from caring for him since he had been born.
The elderly couple were physically exhausted. Their tears and upset were more than anything due to feeling guilty about coming to ask for one week's holiday. They somehow felt that they were failing in their responsibility as parent carers to ask for one week's break. Although it is now 17 years later, and five years after the enactment of the National Health Service and Community Care Bill, we would be wrong to think that there were not still hundreds of thousands of carers in our communities in similar positions, not asking for help themselves because they feel that they should cope. They seem to take the view that to ask for help would be a failure on their part.
The Bill will tell all carers that they have rights, too. I hope that it will ensure that the majority of carers will have an assessment of need. The report published by Scope earlier this year on the experience of long- term care by parents with disabled children and families has already been mentioned. The survey revealed that only 13 per cent. of carers had received an assessment of need. The Carers National Association survey 1994 survey revealed that 80 per cent. of carers felt that community care reforms had made no difference to their lives. It has already been stated how frequently carers miss out because they are seen as a lower priority when there is a conflict between demands and insufficient resources. We would all like to think that we already support carers, and that if we have not been carers ourselves, we have friends, relatives or neighbours who have been or who are.
Yet another example which sticks in my mind of how the present system is failing carers--it has already been touched upon by my hon. Friends--is that of Sadie Taylor, a woman from Lanarkshire who spent seven months caring for her terminally ill husband. I asked Sadie what sort of support she received from the health board and the social work department. She told me that generally it had been very good. She added, "Rachel, what I most needed at times was for someone to ring to ask me how I felt." That point has been made by my hon. Friend the Member for Croydon, North-West.
Column 441
Sadie's experience reflects another concern, which is that in the development of community care there can too often be a false division drawn between health and social care. If we needed care, we would all choose to receive that care in our own homes rather than in a residential or nursing home, or a hospital. The Bill recognises, however, that our needs can have tragic results on the health of the carer. That is nowhere more clearly demonstrated than bythe demands made on a carer by someone who has reached the severe stages of dementia or Alzheimer's disease.In my constituency, I shall never forget hearing of a woman who had been caring for her husband, who had Alzheimer's disease. He had become so frail and restless that when they went to bed at night she tied her pinkie--her little finger--to his to ensure that she was woken up when he started to try to wander round the house. The neighbours went to investigate one day when they had not seen either the husband or the wife. They found the husband still alive but his wife was dead. The general practitioner diagnosed that her death was due to exhaustion.
There are many carers who are close to exhaustion. It is to be hoped that they are receiving much support. The Bill recognises, however, that it is never easy for a carer to look after his or her own health. Time and again carers say, "I can't afford to be ill." I said at the start that the purpose of the Bill is to recognise carers as individuals; indeed, to recognise that any six carers will have six different sets of needs. Again, as has already been said, we must develop not a set fixed agenda of services, but a pick-and-mix range of care and support. The amendments that I have tabled to new clauses 1 and 2, on communication difficulties, are one small example of that.
11 am
None of us could ever anticipate every possible need or requirement, for in community care we are dealing with millions of unique individuals. My amendments, though, ask the Government and my hon. Friend the Member for Croydon, North-West to recognise the need to address the communication requirements of deaf and disabled carers, who, when they are being assessed for services to enhance their ability to provide care, may require particular communication assistance. For example, it may be vital that an interpreter fluent in sign language is available during the assessment of care, or for there to be technical communication aids.
Although section 8(2) of the Disabled Persons (Services, Consultation and Representation) Act 1986, requires a local authority to provide communication services when assessing the abilities of a deaf carer, I understand that that part of the Act has never been fully implemented. I do hope that my hon. Friend and the Minister will address those concerns in the implementation of the proposed legislation.
Another area on which I would like to touch is the overall value of the care that is provided by carers. Although we have talked about the 6.8 million carers in the United Kingdom, the Bill is of immediate priority to the 1.5 million full-time carers who care for someone for more than 20 hours a week. We recognise that no accurate value can be placed on the community care that they provide, but it is estimated at more than £30 billion a year.
Caring for someone can create financial hardship as well as emotional, physical and psychological stress. For instance, many carers have to give up work. A survey by
Column 442
Caring Costs found that 53 per cent. of carers had given up work to care for a relative or someone at home. Such carers lose out on national insurance credits and pension entitlements. Caring at home costs a lot. It runs up fuel bills. It may involve special dietary requirements and medical supplies. Again, I came across one family in my constituency who for a period had to spend £49 a week just on bandages and other essential medical supplies. That is a lot of money for anybody's income.Not only are carers unable to save money, but they often draw on their savings to subsidise the extra costs of disability. A Department of Social Security report four years ago found that two thirds of carers reported that caring had had an adverse effect on their standard of living. Yet only 0.5 per cent. of the social security budget goes on direct financial support to carers in their own right. I know that the Government have demonstrated their recognition of the financial penalties that carers may incur, most recently in the passage of the Jobseekers Bill, when they agreed to change the rules in favour of ex-carers by looking at their contribution record prior to caring when it came to an assessment for the benefit.
I ask the Government to give an assurance that they will give serious consideration to the confusing complexity of benefits to carers, and in particular to look at three areas. First, people who give up work to care may not be covered by mortgage insurance protection by voluntarily giving up employment, and could be hit drastically by the Government's plans to limit help with mortgage interest for people on income support. Secondly, I ask for assurances about the impact that incapacity benefit will have on carers, either on the person for whom they are caring or, indeed, the carers themselves, because the majority of carers are in the age range 45 to 65. Their own health may be becoming frail. I think that we are all aware of the increasing number of carers in their 60s or 70s who care for people in their 80s and 90s.
The third area about which I am particularly concerned, in terms of the financial pressures on carers, is the additional personal tax allowance. As hon. Members know, it is £1,720 per annum and is given to married men whose wives are permanently disabled and who also have a child or children to care for. The Treasury estimates that around 10,000 married men carers currently benefit from that allowance, yet it is not available to married women in a similar position. The Treasury admits that the allowance is both anachronistic and an anomaly. Even the Inland Revenue admits that it is unfair. Yet rather than extend that allowance to the 8,000 or 9,000 women who might be entitled to it if the rules were changed, it appears that the Treasury is threatening to abolish the entire provision for the men who currently receive it, as well as deny it to those women. Although the Bill does not deal with financial support for carers, I ask the Government to tackle that discrimination in the additional personal allowance. The cost of doing so has been estimated at just over £2 million, a relatively small price to pay. It would help carers to remain in work and not have to draw on state benefit. We have heard a lot--we will hear a lot--in today's debate about how carers are valued and should be praised for their tireless devotion, but sometimes praise is not enough. People are poor because they care. They are financially penalised because they care. Carers deserve a better deal. I hope that the Minister will use his influence to
Column 443
that end and that we can look forward to the Chancellor, in his November Budget, extending the additional personal allowance to married women who are carers.I make particular mention of my concerns in Scotland, as an hon. Member who represents a Scottish constituency. As has already been said, there are approximately 700,000 carers in Scotland--one in seven of the population. I am delighted that the Bill applies to Scotland, but I share my hon. Friend's concerns that it will leave carers of disabled children in Scotland in a worse position than carers in England and Wales. New clause 1 applies to England and Wales and allows a carer to ask for an assessment of his or her needs, whether caring for a disabled adult or for a disabled child. In Scotland, the amendments relate only to the community care assessment procedure for disabled adults, so the carer of a disabled child would not have the right to request an assessment of his or her needs.
It has been suggested that amendments to the Children (Scotland) Bill will be tabled to bring the position in Scotland in line with what is proposed for England and Wales, and I appreciate that. I hope that today the Minister will make a further commitment to table amendments to that Bill, incorporating the Chronically Sick and Disabled Persons Act 1972 in the new disabled child's assessment.
The Parliamentary Under-Secretary of State for Scotland (Lord James Douglas-Hamilton): Amendments will be tabled, although I cannot guarantee that it will be done on Report; the proposal may be made in a Lords amendment, but the House of Commons will consider it. Our purpose is to achieve maximum consistency with the reforms south of the border.
Ms Squire: I thank my hon. Friend for that assurance, which will be welcomed by all hon. Members. The position of young carers is also relevant to the Children (Scotland) Bill, and we must ensure that the same provision is made for them in Scotland, as in England and Wales.
I must praise the current support for carers in many parts of the country, which is provided by voluntary associations, local authorities, health authorities and health boards. Like my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman), I am well aware of the efforts that many Scottish local authorities have made, particularly Strathclyde and Lothian regions and my local council, Fife region.
I share my hon. Friend's concern about the disruption to services and co- operation that local government reorganisation may cause. Only this week, however, I received a copy of a specific strategy for carers from Fife region. That strategy was drawn up after extensive consultation with carers, and with the voluntary sector and the health board. It states that carers' needs should be assessed, and that a care plan should be devised in conjunction with them. I hope that, by the end of today's debate, that commitment will look like becoming a reality for carers from Brixton to Belfast, from Cardiff to Croydon and from Thurso to Tredegar.
Column 444
Let me finish by quoting the words of a carer from Fife who wrote to me about her experience. Her words clearly support the Bill. She wrote:"During one crisis in my caring I turned to my church minister because I felt I had failed in my own expectations of myself and he asked me quietly, `Who do you think you are--God'!
The majority of us want to do the job well. It is for people we are committed to and love, but we cannot begin to do that until we come to terms with ourselves and others' expectations of us, their understanding and recognition of our limitations. If there is one thing that has become clear to me it is the fact that `No man is an island'.
We all need help, some of us more than others.
So all you people out there--meet us half way, don't just write about us-- help us."
Mr. Peter Thurnham (Bolton, North-East): I congratulate the hon. Member for Croydon, North-West (Mr. Wicks) on his success in securing not only a Second Reading but a Committee stage for his Bill. I must admit that I was somewhat alarmed when I looked at the amendment paper and found that clauses 1, 2 and 3 were to be deleted; I wondered what would be left of the Bill. The hon. Gentleman, however, has been able to resubstantiate it by means of the new clauses. I also congratulate him on securing Government support: that is, of course, an important part of putting a private Member's Bill on the statute book.
The Bill itself is important. We are dealing with a huge army of carers, numbering some 7 million; I believe that 1.5 million are full time. The hon. Member for Dunfermline, West (Ms Squire) estimated the value of the unpaid services provided by those carers at some £30 billion--I hope that she will forgive me if I do not refer to her as my hon. Friend; Friday seems to be a very friendly day. Perhaps it is part of the spirit of the new Labour party for Labour Members to call Ministers their hon. Friends, but I do not think we need continue the practice throughout the debate.
11.15 am
Earlier, the value of care was estimated at £20 billion, but it may be impossible to put a value on the love that is part of the whole business of caring in the home. It is also difficult because so many different figures are used. The other day I met private care workers at Longsight Lodge, a sheltered home for old people in my constituency. They were paid £3.50 an hour. Voluntary services and private companies such as the Red Rose organisation in Lancashire charge £4.45 an hour for their care workers.
I was surprised to see an advertisement in the Bolton Evening News recently. Bolton council was advertising for care workers aged 18 or more, offering £4.21 an hour. That priced their services well above those provided by the voluntary sector. I wondered why a council that should consider itself to have an enabling role should take on the role of provider, at a cost substantially greater than that in the private sector. I feel that my hon. Friend the Minister should look into the question of costs and accounts. Indeed, I believe that my right hon. Friend the Chief Secretary to the Treasury has forwarded a letter from me to my hon. Friend about cost, asking whether local authorities are contracting out enough care work to the voluntary sector.
I believe that the position should be monitored, but I have found it difficult to obtain figures showing whether that is being done and whether- -as is required by the
Column 445
community care legislation--85 per cent. of care is being put out to the voluntary and independent sectors. My hon. Friend the Minister should ensure that we are given better value for money, given the substantial sums that the Government are spending on community care.The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): I am delighted to learn that my right hon. Friend the ChiefSecretary to the Treasury is seeking my advice. The 85 per cent. requirement is indeed being monitored: that is one of the purposes of the audit that takes place before the figures come to the Department. Once they have been properly audited, we shall have the full picture.
Mr. Thurnham: I had hoped to be able to elicit the information by means of a parliamentary question, but sofar that has proved rather difficult. I wrote to my right hon. Friend the Chief Secretary the other day; he wrote back, saying:
"what you say about Bolton does look worrying. If local authorities are ignoring opportunities to reduce costs through sensible outsourcing, it certainly casts a fresh light on the allegation that they are unable to manage their responsibilities within existing financing constraints."
There is certainly a great need for carers. The first of the four categories listed by the hon. Member for Croydon, North-West was that of adult carers looking after adults in need of care, but he also raised the important question of looking after disabled children, of which I have had personal experience. The figures suggest that there are some 350,000 disabled children living at home, while an estimated 5,000 more are so severely disabled that their families have been unable to cope with them, so they are receiving residential care. We should do all that we can to provide loving family homes for those children. The extent to which care services are available to help foster families and adoptive families are important, and show the value of the Bill. Respite care, which has been mentioned, is one of the important factors in determining whether a family is able to foster or adopt children.
I was delighted by the opening of Grosvenor house in my constituency. It was formerly a children's home but is now a respite care home for people suffering from mental and other disabilities. The Duke of Westminster was kind enough to lend his name to the new building, which was established as a result of the efforts of Bolton handicap action group, which I helped to form in 1987. I was appalled at the number of people whom I met who were struggling to look after mentally handicapped "children" who are now adults and plainly in need of considerable care. Those people said that they could not manage without more help. We brought them together and formed the action group, which has certainly had an impact on the local authority in pressing for much better services.
I think immediately of constituents with difficulties who have met me on a number of occasions. They include people such as Mary Cummings and her husband, the parents of David Cummings who needs a great deal of care, and Nora Hargreaves and her son Paul. Paul is severely disabled and his mother wanted to go away for a few days because her doctor said that she could not manage to look after her son any more. She thought that if she had a break she might be able to continue to look after him. The local authority said that it would take Paul for a short spell of respite care but then said, "We are
Column 446
sorry. He is too disabled and we cannot take him in." That 65-year-old lady was looking after her son yet the council said that he was too difficult to look after.Another difficult case is that of Daniel Heaton, a youngster in my constituency who is reaching the end of his time at school as an autistic child. His parents are concerned about the extent of care that he will need when he leaves school and the amount of help that they will be able to have. Their love for that child is apparent. They do not want him to have to leave home but they know that they will need considerable help to look after him and find sufficient day services properly to occupy his time.
The work carried out by Contact a Family has already been mentioned. I endorse its good work and that of its director Harry Marsh. I have had contact with the organisation over many years both nationally and through the work that it does locally in Pendlebury children's hospital in Manchester.
I do not intend to speak for long because I want to leave time for us to reach my own Bill. Fridays can be difficult and I should not like my Bill to fall to the vagary of being talked out, nor do I want to be a spectacular own-goal scorer in that respect.
I was interested in the comment by my hon. Friend the Member for Stratford- on-Avon (Mr. Howarth) about children with special educational needs and his question about whether, during statementing, some account should be taken of their need for care. I am concerned about the statementing process in Bolton. The Audit Commission has highlighted the long delays. I understand that fewer than 9 per cent. of the statementing cases in Bolton have been completed within the statutory six-month period. That is an example of how the bureaucratic process can be impossibly slow and cumbersome in dealing with what are often the urgent needs of parents. My hon. Friend raised a wise point and perhaps the Minister will be able to consider it further.
I wish the hon. Member for Croydon, North-West all success in the passage of his Bill. I shall watch it proceed with great interest both for its own importance and as an example of how my Bill will follow his.
| Next Section
| Home Page |