House of Commons Hansard Debates for 21 Apr 1995

Ms Liz Lynne (Rochdale): I am pleased to support the hon. Member for Croydon, North-West (Mr. Wicks), and I congratulate him on getting his Bill this far. I also congratulate the Minister on his work in supporting the Bill. I am pleased that young carers--those under the age of 18--will be included, because they have a difficult time. Many children are under a great deal of stress and often have to suppress their own needs because of the needs of the parents for whom they are caring. They could have many problems in later years because of the build-up of that stress and the fact that they did not have a proper childhood because they did not get the back -up they needed.

It is estimated that there are 40,000 young carers, and they have many different problems. The Carers National Association has spoken about several young carers and I shall mention the problems of one of them. Jenny is aged 14 and her father has Alzheimer's disease. She helps her mother care for him. He is often confined to a wheelchair and has difficulty eating, sleeping, speaking, bathing and dressing himself. Jenny also looks after her younger brother. Her mother works at night, leaving Jenny in sole charge of her brother and father. Jenny's school friends

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are unsympathetic because they think she is making it up, as her father looks normal. She gets very tired, and her school work has started to suffer.

That is just one case, but I know of many more cases of, children similar to Jenny who suffer because their school friends do not understand. Quite often, the adults do not understand, either, and in some cases that applies to the teachers. We heard of a young child who was not able to do his homework. The teacher did not recognise that the reason for that was that he had to care for a relative. Many young people fear being taken into care, and the parent for whom they are caring often feels that the child might be taken into care if that is reported to social services. I certainly hope that, when the Bill is passed, that fear will be addressed. I am sure that it will help parents and their young carers to come forward. The Bill gives many new opportunities to local authorities but, as the hon. Member for Sutton and Cheam (Lady Olga Maitland) said, the money for community care has to be found and the Government must provide it to make sure that the Bill's provisions can be paid for. Not only young carers but all carers will be helped by the Bill. For many years, carers have been largely ignored by everyone and had to get on with their daily lives while caring for relatives or friends. Their contribution is enormous but it is not properly recognised. They have helped the public purse because, without them, the cost to the Treasury would be immense. Those 6.8 million carers make a contribution to the country and that is why I plead for more money for community care.

Carers suffer many diverse problems and must be assessed individually. For example, those looking after elderly people suffer many problems. I shall quote another example given to me by the Carers National Association. A Mrs. Smith gave up her job to care for her 84-year-old aunt, who is in the early stages of dementia and is incontinent, and for her 86-year-old mother, who has arthritis and is underweight and very frail. The aunt lives in Enfield and the mother in South Woodford. She travels to and from her aunt and mother caring for them. The aunt was discharged following a lengthy spell in various hospitals. Mrs. Smith fully explained her caring responsibilities and the intolerable stress she was under, but no domiciliary services were arranged. She asked for respite care but it was flatly refused. Under the Bill, Mrs. Smith would have the right to an assessment of her ability to continue caring following assessments of both her relatives. Those are but two of many examples.

The Alzheimer's Disease Society has said that 66 per cent. of carers have been caring for more than three and a half years. Half of all carers spend approximately 80 hours a week on their caring responsibilities for a relative or friend suffering from dementia. A year-long study of 100 selected carers, by the Alzheimer's Disease Society, was issued in April 1994, and showed that 59 of those carers had not received an assessment. Only 13 had received a separate community care assessment, and 61 had not been offered a regular review of care. I was going to say that that is incredible, but it has been happening for some years. Let us hope that the Bill and the clauses that we are debating will address that matter once they have been passed into law.

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Carers need respite care, day care facilities, sitting services and--above all--a holiday, as they have been caring for year after year with no help whatsoever. If their needs were better assessed--which they can be under the Bill by a local authority-- services could be provided.

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A few years ago, one of my constituents came to see me--this took place before I was elected as a Member. I was at the time working with the parents of children with learning disabilities in my constituency, and we set up a parents' group on statementing. A man whose son was suffering from learning disabilities--several friends of mine have children with such problems--came to see me. He and his wife had been caring for their child without complaint for many years. The man was thought of as very strong, and he had always said, "I can cope; I can manage." That is what most carers do.

My constituent saw me that day and asked whether I could do anything to help him, as he felt that he was on the verge of a nervous breakdown. He said that he could not handle it any more, and that he did not think his wife could, either--although she would not admit to that. Respite care for such people is so cost-effective. If they do not get that break, they will have a breakdown or something else will happen to them, and they will be unable to care for their child or relative. In the end, that child or relative will have to be taken into care.

No matter how welcome the Bill is, it is a modest measure, because it does not address the underfunding of care in the community. I am grateful to the Minister for going this far, but the Bill does not address several points with which carers have problems, such as the need to introduce a carer's benefit.

In considering the new clause, we must consider also the financial problems of carers. It is estimated that 26 per cent. of all carers, and 40 per cent. of older carers, are living in actual poverty. There are enormous financial costs for those carers, and unless money can be found for community care, I do not think that those carers will benefit from the Bill.

Carers must give up work to meet their commitment, and many middle-aged carers who then find that they need to return to work cannot get a job. We must address all those issues, and I hope that the Minister will look at them. We must address the problems with incapacity benefit, and I am sure that the Minister will put pressure on his Government colleagues on that matter, as there are knock-on effects from cuts in incapacity benefit.

I am grateful, as the hon. Member for Dunfermline, West (Ms Squire) was, that the Government have accepted some measures in the Jobseekers Bill, although I wish that they had gone further and allowed a national insurance holiday for employers who take on a carer who has been caring for a number of years. I hope that the Government will do that in future. I very much welcome the Bill, and I also welcome the fact that it has all-party support, but the Minister must take the other needs of carers on board. Finally, I must say again that I am grateful to the hon. Member for Croydon, North-West for introducing this excellent Bill.

Mr. Piers Merchant (Beckenham): I give my strong support to the cause. People might wonder why we are having this debate, as it appears that we all agree on the basic principles of the Bill, but there is a good reason why

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the matter should be aired--even if it is only briefly. So many people are affected by the implications of caring, and of the legal framework in which it operates at present and will operate in the future, that it is only right that the concerns are aired and that the efforts made to address the problems are discussed.

I congratulate the hon. Member for Croydon, North-West (Mr. Wicks)--he is a neighbour of mine--on the zeal with which he has approached the subject, and on the efforts and energy which he has put in to bring the Bill before the House and to get it to this stage. I listened with interest to the brief Second Reading debate. I would have liked to speak in that debate, but I am at least getting an opportunity to make a brief speech now.

Like my hon. Friend the Member for Bolton, North-East (Mr. Thurnham), I was somewhat alarmed when I first looked at the amendment paper and saw that the amendments in the name of the Bill's promoter, the hon. Member for Croydon, North-West, appeared to hack the Bill into nothing by removing clause after clause. I moved on, however, to look at the new clauses and saw that the Bill was being recast in a way that made it technically more effective in terms of its practical operation. I congratulate the hon. Gentleman on his flexibility and wisdom in taking advice on that technical area to ensure that what is enshrined in the legislation works. That is what matters.

The new clauses will make the Bill effective and will bring support to the 6.8 million unsung heroes--an amazing figure, which includes 10,000 to 40,000 children--who act as carers. They give tremendous care and support with love and devotion. The value of that support is inestimable, and it is impossible to put a figure on it because there is no alternative way of providing the quality and nature of that care.

It is possible to cost the savings on a more practical level, but it is very difficult to reach an accurate figure. The amount saved has been estimated at £30 billion, and those resources would have to be found to provide even a minimal alternative system to give just the practical elements of care.

It is wrong to talk too much in terms of costs and alternatives, because, in reality, there is no alternative. Care must be provided by those who have a direct connection with or emotional attachment to the person who needs care. That is why carers play such a valuable and inestimable role, and why they deserve every support to enable them to carry out that function effectively.

We have all learnt about this problem from our experiences with our families. I dare say that there is hardly a family in this country that has not--for one reason or another--experienced the need to provide care and support for a relative. My experience is probably typical. I first came across the problem as a child when a great-uncle was taken ill and went blind. He had led an active life, but he suddenly changed from being the person who more or less ran the household into someone in need of permanent care and attention, and he took to his bed. Not only was the household robbed of his support, effort and work, but he needed round-the-clock care. The care was provided by his wife, my great-aunt. They were a fairly elderly couple. My aunt had to provide care for some eight or nine years. It completely wore her out, and at the end of that period she died, principally as a result, I have no doubt, of the strain that she had been put under in the last years of her life. It is perhaps ironic that,

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as often happens in such circumstances, her husband lived on for many years. He was taken abroad by his daughter, who lived many thousands of miles away. She was able then to perform the role of carer. She was a qualified nurse and, of course, she was much younger than the mother, so it was perhaps a little easier for her. She was able to see him through many further years of life.

The example illustrates the pressure that carers are put under. They are people who are not trained, and perhaps did not anticipate playing such a role. They are suddenly landed with that responsibility, often during the latter years of their life, and the strain can be tremendous. Often, they are the sort of people who do not ask for help yet need help on a regular basis.

My grandmother required support in her declining years. Now my father, who is an elderly man not in the best of health--although I am glad to say that he is recovering--needs the support of my mother. In all those cases in my family, I have seen the need for family members to become carers. In all cases, there was no support from outside, but support would have been helpful--not so much for the people who needed the care as for the carers, when under stress or difficulty or when facing new challenges. They needed to be given advice and respite care or simply to be supported so that they could carry out the function that they wanted to fulfil more effectively. Perhaps I should add--this is no great revelation--that in all the cases that I have described from my personal experience in my family, the people cared for most strongly want the support of their closest relative. They do not want support from outside. They do not want a stranger providing for them. That is not lack of gratitude. It is a perfectly normal human reaction, particularly if people are sick and require support. They do not want to start building up a relationship with someone from outside. They do not want the "authorities" to become involved unless it is absolutely necessary. They far prefer to receive support in the comfort of their own home from people they know. That is the real value of carers.

I have spoken from a rather narrow perspective, but there is also a huge national and social problem. It has been brought into sharp highlight recently by the Carers National Association, particularly Jill Pitkeathley. At the beginning of this Parliament, I attended a meeting held near this place addressed by my right hon. Friend the Secretary of State for Health, who has had experience of the problem in her previous existence in social work. It was the first time that I had ever heard carers' problems discussed at length at a political level rather than at a personal level or in individual cases. Since then, I have been contacted by a number of campaigners in my constituency. As a result, I recently attended a meeting of the all-party disablement group, at which representatives of the Carers National Association went into further details. I subsequently attended a lobbying meeting. All that has helped me to grasp the extent of the problem --not only the depth of individuals' difficulties but the breadth of the problem throughout the country. I call it a problem not because there is anything wrong with the system of caring that carers provide but because there are clear gaps in the support that the people who provide the valuable service require.

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I was particularly struck by the difficulties faced by young carers. I have not previously come across young carers in any personal capacity. I learned of the difficulties that they experience. Some harrowing experiences have been described today. Young children suddenly have to grow up because they have an additional burden of responsibility. That makes one realise how important it is to deal with the problems that have become associated with caring.

Of course, not all examples are the worst. Nevertheless, it is important to tailor legislation and support from outside to provide means of help for those worst cases. Only in that way can we hope to pass legislation that is in any sense adequate. The most important thing that is required is simple recognition. In so far as the Bill provides that, it performs a vital service. It says in sharp headlines within this place and, I hope, in law that carers exist across the country in large numbers and need the recognition of the law and the system to carry out their functions properly. The Bill introduces--the clauses in this group specifically do so --a requirement for carers to be assessed. That is important. We have heard today, and I have given examples, of carers ending up as the people most in need of care. To prevent that, a proper assessment needs to be made at an early stage so that it can be judged whether they can cope and to what extent they need support in doing so. The new clauses enable local authorities to give support. The Bill does not go as far as I would like--I am sure that the hon. Member for Croydon, North-West agrees with me--but it is important to see it as a first stage. So long as authority and power are given to local authorities to provide support, that can be followed up later with greater pressure, both legally and in other ways, to ensure that support is forthcoming.

I make no apologies for mentioning again a most important element of the new clauses that we are discussing and of the Bill--the provision of respite care. If I were asked what single most important contribution could be made, I would say that it was the provision of respite care to enable carers to continue without becoming completely drained of all energy, and to have the opportunity to recharge their batteries.

We often talk of care as something provided for and by the elderly. That is indeed the case in the majority of examples; but we should not allow the debate to pass without remembering that young people both give and need support. I make special mention of the increasing number of people who, sadly, suffer as a result of the ravages of HIV. Often, the people who suffer from the advanced complications that HIV creates are those most in need of support because of the nature of the illness. They find it most difficult to adjust to receiving support because generally they are young people who have been active until recently and because, sadly, there is still stigma attached to the illness, so provision is not easily forthcoming. I hope that HIV sufferers will be specifically considered when the Bill is implemented.

The Bill plays an important part in building on the care in the community system--a system which I strongly support and which has already shown itself to be effective and helpful. I am surprised that such a major reform has been introduced without more difficulties than have been

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presented. I do not disguise the fact that there have been difficulties and that difficulties remain, but in general the system has come on stream surprisingly successfully. If it is to work properly, it is important to include carers' needs as a central part of the provision of care in the community. The new clauses will achieve that. They will do more than is done now and will establish a deep official link between caring and care in the community, which I am glad to see.

I am also glad that the Government, through the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Mr. Bowis), have constantly shown support for the thrust of the Bill and its practical implications. By creating a carer's right to be assessed and making it an essential first point, when it is requested, we will greatly strengthen the position of carers and greatly improve the quality of care in the community.

I must draw hon. Members' attention to two aspects of the problems facing carers. The Carers National Association carried out a survey that showed that 47 per cent. of members had experienced financial difficulty since becoming a carer, 65 per cent. said their own health had suffered, 20 per cent. had never had a break and 33 per cent. got no help or support. That is a powerful sign of the amount of support that is needed and it builds on the personal examples that we have heard.

The British Medical Association's report "Taking Care of the Carers" estimated the value of carers at between £33 billion and £39 billion. Both those factual investigations add further clarity to the need to support carers. The Bill will provide for that support, which is why I strongly support the new clauses and the Bill. Of course, it will not make everything perfect and more will need to be done, but the essential thing is that it will provide greater recognition for carers, which will bring them greater support. For that reason, the Bill is a most important stepping stone.

Dr. Godman: I shall be brief, and I must first compliment my hon. Friend the Member for Croydon, North-West (Mr. Wicks).

In my brief intervention, I want to fire a couple of questions across the bows of the Under-Secretary of State for Scotland, the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton). I will not call him my hon. Friend, but he is a fair-minded adversary. He and I have campaigned--if he will forgive the immodesty--to reform child care law in Scotland, and some of my questions will be directed to that issue.

As we know, there are about 700,000 carers in Scotland, with about 16,000 in my area of Inverclyde. I promised members of the Inverclyde Elderly Forum and the local branch of the Alzheimer's Society of Scotland that I would be here today.

I must against stress that, in Strathclyde, present guidelines and practices focus on a needs-led assessment of the person requiring care. The carer has to be involved in the assessment at all stages. Indeed, before it is concluded, the carer is asked if he or she agrees with it.

Shortly before she resigned from the social work department, my wife carried out such an assessment in a hospital. Many are carried out in hospitals, although ideally they should be carried out in a person's home. My wife and the daughter of the person needing care agreed that the very elderly and frail lady concerned should be returned to the daughter's home. As a social worker, my

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wife was able to ensure that the carer received certain assistance. As the Minister knows, my wife became a regional councillor, which forced her resignation.

Needs-led assessment is a long-established practice in Strathclyde and takes into account the needs of the carer, but the Bill will strengthen such assessments, which is why I welcome it. The Bill will also iron out some of the inconsistencies in Scotland.

My questions to the Under-Secretary of State for Scotland have largely been answered by his honourable assurance that clause 20 of the Children (Scotland) Bill will be amended, but new clause 2 mentions "disabled children". Is it likely that clause 20 will have to be amended in this or the other place to take that into account? Clause 20(1)(a) of that Bill says that the services provided by a local authority shall be designed

"to minimise the effect, on such disabled children as are within the authority's area, of those children's disabilities".

Clause 20(1)(b) continues:

"to give those children the opportunity to lead lives which are as normal as possible."

I should have thought that one of the objects of my hon. Friend's laudable Bill is to ensure that the carers of such children are given assistance by local authorities, so there is much compatibility between it and clauses 19 and 20 of the Children (Scotland) Bill. If the Under-Secretary of State for Scotland cannot answer now, perhaps he will be good enough to write to me and place a copy of his letter in the Library. How has the Scottish Office publicised the rights of carers to a needs-led assessment of their needs? That is an important and serious question. Many elderly people are unaware of their rights, for example, to certain social security payments. There is a genuine ignorance of their rights. It is essential that elderly carers in particular are alerted to the rights that they will be given under the Bill --I am convinced that my hon. Friend's Bill will become an Act of Parliament.

Will the Under-Secretary of State for Scotland also say whether section 12A(4) of the Social Work (Scotland) Act 1968 needs to be amended where the provision of services required by a disabled person is concerned?

Following the comments by the hon. Member for Bolton, North-East (Mr. Thurnham), I believe that the working party that is examining the ownership and management of private residential homes for the elderly is to publish its report in the autumn. Can the Minister confirm that, because eventually many people who care for elderly relatives cannot do so adequately and, often on the recommendation of a social worker, they are encouraged to allow the person to take up residence in a private residential home for the elderly?

As the Minister knows, there is serious disquiet about the ownership and management of some such homes. At the fatal accident inquiry into the Glencova home in Glasgow, the sheriff described the elderly people in the home as being treated like livestock, for money. So there is real concern when carers cannot look after elderly people, who then must go into a home. Many homes are excellently run and well managed by professionally qualified individuals, but there remain many questions concerning some homes.

This wholly admirable measure will be introduced in Scotland at a time when the social work departments are to disappear, along with regional councils. That does not

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mean that the essential and important services provided by the social work departments are to disappear also; the new councils will take on that important role and significant functions. At the last moment, Lord Fraser introduced an amendment to the Local Government (Scotland) Bill, which stipulates that the new councils must appoint a senior social work officer with prescribed social work qualifications. So I hope that social workers will be re-employed in the new councils and take their skills, experience and knowledge to their new employment.

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The Minister knows of my concern that many of those who will shape the policies, procedures and practices of social work departments have no experience as administrators in the regional councils. In the recent election in Scotland, the overwhelming majority of successful candidates elected to the new authorities are district councillors. In Inverclyde, four of the 20 new councillors are regional councillors and of the 82 in the new Glasgow authority, fewer than 20 of the successful candidates are regional councillors. So the majority of councillors have no experience of the implementation of social work policies, procedures and practices. That holds true for education and other functions as well. If the Minister is to issue guidelines, they must be issued to councillors as well as to chief social work officers and their staff.

The measure is wholly admirable, and will bring relief to many of my constituents. I meet many carers as I go about my work, as does any hon. Member, and I know the remarkable, selfless, devoted attention they give their loved ones who are infirm or suffer from disabilities. It behoves us to protect the carers, as well as seeking to protect those who need care. I welcome this measure and hope that, at some point, the Minister will answer the few concerns that I have voiced today.

Mr. Duncan: Thank you, Mr. Morris, for allowing me a few moments to make some observations on the new clause, which I am happy to support and which goes to the nub of the Bill introduced by the hon. Member for Croydon, North-West (Mr. Wicks).

As the hon. Member for Greenock and Port Glasgow (Dr. Godman) said, carers' self-sacrifice is inestimable. Amidst the many criticisms which some hon. Members on this side of the House receive from constituents in the current climate, the "thank you" that sticks most in my mind was when a couple came up to me and said, "Thank you, you have changed our lives." I was taken aback but then recalled that, a year earlier, the couple had come to see me at my constituency surgery. They were very unhappy and about to divorce. The man could not get a job and they looked bedraggled because they had been caring for their Down's syndrome child and desperately needed respite care. A year later, having received that care and been able to put the child into a home for long periods, their whole lives had been transformed. That is the sort of case that the Bill will deal with. At present, we appear to have too sharp a segregation between private care in the family home and the care provided by the social services. The Bill will better link the two, so that the resources of social services are used more productively to assist those trying to keep a family together and provide care within the household setting.

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May I inject a note of caution? As I suggested in my intervention to the speech by the hon. Member for Croydon, North-West (Mr. Wicks) early this morning, the Bill is essentially a statement of intent rather than a legal document of practice. It is more difficult to legislate for intent and what one wishes to happen than to lay down a set of rules that must be met. At times, it will be difficult to assess whether the law has been adhered to or been broken because, by and large, it is a gesture, albeit a worthy gesture, rather than a detailed set of requirements.

So my note of caution is simply that we must be careful about exactly how the Bill will translate in practice, if it is enacted, as I hope it will be. I would not like it to become a first step towards the universal provision of, for example, a minimum allowance for all carers in all circumstances. Rather, it should become exactly what hon. Members on both sides of the House have said: a means to ensure that discretionary decisions can sensibly be taken to alleviate some of the real burdens carried by those who care almost full time, day and night, for a loved one in their own households.

I support the Bill, with the proviso that it should not be the first step to a massive extension of universal care in all circumstances. It should be an important empowering measure to enable social services to alleviate the burden on those who, in a private setting, currently take on all the responsibility and face too heavy a burden in doing so. In that spirit, I hope that the hon. Member for Croydon, North-West accepts the support that I give the Bill. I hope that, once enacted, it will not be abused by calls that are too loud for too massive a subsequent provision.

Mr. Alan Howarth: I am extremely pleased to be a sponsor of the Bill introduced by the hon. Member for Croydon, North-West (Mr. Wicks). I congratulate him not only on introducing the Bill but on how he has negotiated the developing substance of the Bill and on how he spoke today. He paid tribute to the Carers National Association and other organisations, and I readily join him in those tributes. However, he was a little too modest, because his work, from the time before he was in the House and throughout the period during which he has been a Member, means that he has a depth of knowledge and commitment in this area. The Bill is an admirable expression of that.

I also congratulate and thank the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Mr. Bowis). His speech on Second Reading was both characteristic of him and heartening. He spoke on behalf of the Government and, evidently, on his own behalf, with humanity and warmth.

The Bill articulates and fills out the legislative provisions of the National Health Service and Community Care Act 1990 and the Children Act 1989. Although the guidance issued by the Government in amplification of those measures has made it clear that Ministers expect assessments to be made of the needs of carers, none the less the requirement is not adequately specified in the legislation currently on the statute book. This measure is a timely and necessary amplification of existing legislation.

I am pleased that the hon. Member for Croydon, North-West chose to incorporate the word "recognition" in the title of the Bill. The colossal contribution that carers make to the well-being of our society and the lives of

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those for whom they care deserves to be recognised. Carers give what they give willingly and lovingly and undertake immensely demanding responsibilities, which are all too often also immensely exhausting.

I have been reminded of that truth with special vividness in several meetings and conversations that I have had in my constituency recently, in which I have again been made aware of the sheer goodness of carers. I have also noted again what are all too often the inadequacies of the support that we give them.

I have not sought the permission of the people concerned to name them, so I will not. I shall only say that Mrs. K, my constituent, who is 81, cares for her husband, who has diabetes, who has lost both legs and who has Parkinson's disease. Fortunately, they receive significant respite, because he spends one week in three at a community hospital, but the burden that his wife carries in the other two weeks is enormous. Mrs. K contacted me because she was, understandably, deeply worried about the increase in the charges that they were expected to pay for the support that they receive from the social services department. They have been receiving 13 hours of help a week. Previously, they were being charged £7 a week. Suddenly, early this year, they were given to understand that they would be charged £7 an hour and that the cost to them would increase to £91 a week.

Let me also mention Mr. and Mrs. D, who have two adopted sons, one of whom is autistic and the other of whom has Down's syndrome. They are struggling to keep their heads above water. The building society is struggling not to repossess their home, but they are in deep financial difficulty and just at this moment they have been told that they are to lose the six hours a week of respite help that they have been receiving. That is wrong in itself and it is enormously short-sighted. We should not only honour our carers, but give them a sensible and decent amount of support.

I shall name another person, by whom I was deeply impressed, as were other hon. Members. That person is Patricia Mighty, who came to give evidence to the informal Select Committee on the family, chaired by the hon. Member for Hammersmith (Mr. Soley), last year. The hon. Member for Croydon, North-West and my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) also served on that committee. I am sure that they would endorse what I say.

When Patricia Mighty came, accompanied by Francine Bates of the Carers National Association, she moved us all to admiration for the work that she was doing in looking after a father with multiple disabilities, a mother developing cancer and a 12-year-old son, while holding down a job as a part -time helper in an old people's home. It is an heroic performance. However, although we were moved to immense admiration for her, we were also moved to an intensified disquiet and shame about the inadequacy of public support for a person in the position in which Patricia Mighty finds herself.

I am glad that we have heard no suggestions in today's proceedings of the type that one sometimes hears, to the effect that there is too great a tendency for people in this day and age to dump their responsibilities on the state. That is precisely what the 6.8 million carers in this country are not doing. They willingly shoulder responsibilities that they believe to be natural and appropriate, but they also need help.

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The measure confers a new right on carers: a right to request an assessment. Sometimes we hear that there is an excessive emphasis on rights as opposed to responsibilities. Those carers take responsibility and we, their fellow members of society, have a responsibility towards them, and in many respects we express that responsibility by public provision.

The Bill provides, therefore, that carers may be assessed for their needs, to be part of the formal assessment of the services that it may be appropriate to provide. However, it is worth emphasising, as I understand new clause 1, that the disabled person remains very much at the heart of provision and that the assessment that may be made of the carer's needs is an assessment made in the context of the assessment of the needs of the disabled person. It may be worth emphasising that, to offer reassurance to disabled people who fear that, in the emphasis that we wish to give to recognition and support for carers, they themselves may somehow be marginalised or their interests made subordinate.

I do not believe that many people have that fear. Nevertheless, we all know that, although the caring relationship is time and again a caring relationship of love, it can also be fraught with mutual stress and strain, and it may be worth offering that consideration by way of balance and reassurance.

12.15 pm

I am especially pleased that, in the development of the content of the Bill, due focus has been put on the needs of young carers. The reality of their predicament is too little recognised; their needs are too little understood. They experience a type of premature adulthood, and it is a bitter irony that they and their families should, not infrequently, live in fear of the young carer being taken into care. As a result of the Bill, their needs will be better focused and, I hope, will be met in future with better understanding.

It is good that subsection (2) of new clause 1 is targeted at the needs of carers of disabled children. The psychological shock for parents and other members of the family on identification of the disability of a child can be very great. Sadly, the experience thereafter is almost always that of an immense struggle, everything being uphill work, with families--especially parents--struggling to secure the provision that is appropriate and having to deal with agencies that are all too often defensive and fragmented. I hope that the measure will help us to achieve greater coherence and co- ordination of provision in support of parents who are carers of disabled children. Whether it is in educational statements, which we mentioned earlier, or in providing transport or aids and equipment, we need to take a more coherent total approach to what is needed to support such families.

I do not suppose that those people's lives will be instantly transformed as a consequence of the Bill reaching the statute book, but if it now becomes part of our official policy to recognise and support their needs, and to provide a formal assessment of their needs, that is an important civilising advance of principle. It is right that we take those steps. We are, after all, a society that is affluent, and if we are to be a decent society, that is what we should do.

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To take a carer's needs into account will enable a more cost-effective use of resources to be achieved because expenditure on carers, assuming that it is on sensibly designed and well- monitored policies, is investment. On any rational cost-benefit analysis, we should provide adequate levels of support for our carers. I congratulate my right hon. and hon. Friends who are Ministers at the Department of Health, as I suspect that they will have undertaken a dialogue with the Treasury, which may not always have been straightforward or easy. I do not find occasion to praise the Treasury as often as I would wish, so let me congratulate Treasury Ministers on their recognition, at least in this sector, that it is necessary to spend money in order to save money, and that support for carers is an investment.

The best research of which we are aware suggests that the work of unpaid carers saves the Exchequer about £34 billion a year. It would be improvident not to provide by way of public expenditure enough funding to keep the carers on the road. It has been well calculated that, if 10 per cent. of the 6.8 million carers were to buckle under the strain and drop out, the result would be an additional £2 billion charge on public expenditure. Carers are willing donkeys, but we should not drive them until they drop. The cost of failing to support them adequately will be huge.

Let us consider the typical costs of local authority residential care. The cost of care for a younger physically disabled person is £498 a week, for a mentally handicapped person, £296 a week, for an elderly person, £178 a week and for a mentally ill person, £167 a week. It will certainly be cheaper to fund adequately support for carers. It has been convincingly computed that the average value of unpaid care for a week for people with severe disabilities is £205. It would be short-sighted fiscally not to provide sufficient support to enable carers to continue performing their role.

It is also short-sighted if the terms and extent of our support are insufficient to enable carers, where they can reasonably do so, to be in work. The hon. Member for Dunfermline, West (Ms Squire), in the course of her sensitive and thoughtful speech, observed that 53 per cent. of carers had given up work in order to care. I have noted that only 20 per cent. of all carers work part-time. As a result, we are losing the benefit not only of the tax payments and national insurance contributions that those people would contribute to the Exchequer, but of the broader contribution that they might make through their employment to the overall performance of the economy. Of course, I recognise that we could quickly find ourselves spending a lot on additional support for carers. I recognise the problem that any responsible Government face in finding sufficient resources in the short term, but we are not talking about lavishing resources on anyone. We are not talking about lavishing resources on all the 6.8 million carers, who include large numbers of carers who might more appropriately be termed informal helpers. We are talking of between 1.5 million and 2 million carers who are at the heavy end of caring--those who care more than 20 hours a week and provide physical as well as personal care.

What such people typically ask for by way of additional support is characteristically modest--often not more than four hours' relief a week, so that they can get away and have a break. I should like them to receive more help than that; I should like them to receive more additional help in

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terms of respite care, sitting help, day care and holidays. But it is critical that we support those 1.5 million to 2 million people--who make only modest requests--to enable them to maintain their care, not just because it is the decent thing to do, but because hard -headed calculation shows that that is what we need to do.

We need to take care to ensure that the various Government policies work consistently towards the end of supporting carers.

Among the implications of the Bill and new clause 1, which now forms the Bill's heart, is the implication that we should review invalid care allowance. The conditions of eligibility for invalid care allowance remain very restrictive. I find that people are often surprised when I remind them that someone qualifies for that benefit only if he or she cares for a person for more than 35 hours. If he or she happens to care for two people for 20 hours each, he or she does not qualify. Someone qualifies for the allowance only if the person being cared for is in receipt of attendance allowance or disability living allowance and only if the carer is earning less than £50 a week and is under retirement age. Other benefits such as income support are deducted, pound for pound, in relation to invalid care allowance.

It is a benefit that few people obtain. Only 20 per cent. of full-time carers receive invalid care allowance and that allowance is modest. It is less than £35 a week, which represents only 11 per cent. of national average earnings and is only little more than three quarters of the adult rate of income support. It is not enough, and the Social Security Advisory Committee has urged the Government to make the benefit more generous.

I understand how difficult it is for my right hon. Friend the Secretary of State for Social Security to respond as positively as he would wish to everyone pleading for an increase in a specific benefit, but invalid care allowance represents only half of 1 per cent. of the social security budget, so it would not put us on the road to fiscal ruin if my right hon. Friend could find the margin to do a little more. That is an illustration of where we need to ensure coherence in our policy. If invalid care allowance is insufficient to provide an adequate level of help and to support sufficient numbers of people, fewer carers will be able to carry on providing the cost-effective support that they do provide.

Other hon. Members who have spoken in the debate have mentioned the importance of at least monitoring carefully the impact of incapacity benefit. The tougher eligibility rules for incapacity benefit as compared to invalidity benefit may mean that not only those who are cared for, but some carers, may lose benefit. That could have perverse results for the public purse.

I echo the plea made for careful consideration of the policy that the Government may introduce to withdraw income support for mortgage interest payments. Carers are likely to be rather poor candidates for private mortgage protection insurance. Typically, those households are poor. Carers suffer as a result of loss of earnings and damage to their careers, pension provision is often less substantial and they have fewer opportunities to save. They also face higher domestic costs. It would be wrong to compound their poverty and insecurity with the threat of repossessing their homes.

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It is likely that private insurers would not offer cover to carers, whom they would term "voluntarily unemployed". I do not think that my right hon. and hon. Friends would contemplate leaving carers without a safety net, whether it is provided by the state or by private insurance. If carers feel that they cannot shoulder the risk in the face of that insecurity, the added costs involved in care provision will fall on the state. The Government have recognised that private insurance mortgage protection may be unsuitable for the elderly and for some other groups. I hope that they will accept that carers should be included in that latter category.

I echo the plea that has been made to the Government to consider extending the employers' national insurance contribution holiday to people who have received invalid care allowance. As recipients of ICA, they are not required to sign on and it would be very unfair to penalise them subsequently as a result of a proposal that is intended to help them. Some 64 per cent. of former carers, and 76 per cent. of those aged over 50, are not in work one year after ceasing their caring responsibilities. I am sure that, in the spirit of the legislation, we shall look for better ways of helping them to rebuild their lives and return to society when they have completed their caring responsibilities.

I was glad also that the hon. Member for Dunfermline, West referred to the additional personal tax allowance.

I recognise that we can only gradually build up support for carers, whether it is through local authority service provision or through the benefit system. The Bill, and new clause 1, which is at the heart of it, establish the principle that we should provide that support with new clarity and force. In this area, as in others, generosity will reap rewards in terms of humanity, social cohesion and our self-respect as a society, as well as economically and politically. I congratulate the hon. Member for Croydon, North-West, as well as my right hon. and hon. Friends on their support for the policies embodied in the Bill.

12.30 pm

Mr. David Hinchliffe (Wakefield): The Carers (Recognition and Services) Bill represents the culmination of a lot of effort by many people and many important organisations that have worked for many years to reach this point. As I did not have the opportunity to speak on Second Reading, although I was present in the Chamber for that brief debate, it is important to pay tribute to a number of important individuals and organisations connected with the measure. Obviously, I must start by paying tribute to my hon. Friend the Member for Croydon, North-West (Mr. Wicks) for his immense efforts on behalf of carers and for piloting the legislation to this stage of the parliamentary process. During my time in Parliament, I have seen a number of hon. Members make their names on issues with which they have had no personal affinity simply through the luck of the private Members' Bills ballot.

In this instance, it is important to emphasise that for many years my hon. Friend has had a deep personal commitment to the issues that are addressed in the legislation. It is highly appropriate that he should receive the plaudits for piloting this important measure through the House and into law. He has been a passionate campaigner on the issues addressed in the legislation and I pay a sincere tribute to him for his efforts in that regard.

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It is also appropriate for me to refer to-- according to her own description--the "nippy sweetie", my hon. Friend the Member for Dunfermline, West (Ms Squire), who has prodded me on many occasions, almost physically at times, about Labour's policy in respect of carers. She has been very dynamic in her support of the legislation. Together with other hon. Members, I must single out the Carers National Association for special tribute. I have been aware of that organisation since the 1970s, when it operated under a different title and was concerned with single women and their elderly dependants. It is marvellous to see the efforts of so many people who have been directly connected with caring culminate in today's legislation.

I do not wish to embarrass anyone any further, but I think that it is important to place on record my personal appreciation of the contributions of Jill Pitkeathley and Francine Bates. I should also mention a former colleague, Sylvia Heal, who has been particularly active in the Carers National Association campaign on behalf of young carers, which has resulted in a major shift in opinion on how we can assist that group. Sylvia is a classic example of howformer Members of Parliament can lead more useful lives than they can by just sitting on the boards of privatised former public companies. She has done a marvellous job, as have her colleagues in the Carers National Association.

There are a number of local carers groups in my constituency who never stop reminding me of their needs and concerns. In some cases, they have travelled down 200 miles, while campaigning, to the House of Commons in support of this and other measures that affect them. I should also mention a number of other organisations that have offered me assistance with policy issues relating to carers. There are too many to mention, but I must refer to the Alzheimer's Disease Society, the Caring Costs campaign, Scope, Contact a Family and many others, including Age Concern. They have all been helpful and have worked to bring to public attention issues relating to carers and their needs.

Last, but not least, I pay tribute to the Minister. Earlier this week, he nearly had to render first aid to me at the Dispatch Box; possibly he was in a caring mode himself at the time--

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