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Mr. Hammond: My interpretation of clause 9 is that it refers only to additional moneys that need to be paid out under other Acts of Parliament as a result of this measure, not to moneys paid out as a direct result of its provisions. Is that the hon. Lady's understanding as well?
Mrs. Heal: I am taking the liberty of using my opportunity of speaking in the debate, with the Minister present, to ensure that all aspects of the funding for this and other parts of the Bill are noted. I acknowledge that, according to the Carers National Association, one year after the 1995 Act was implemented, three quarters of authorities said that lack of funding had restricted their ability to implement the legislation. When carers have been refused assessments, they are sometimes told that there is no money so it is not worth asking. I repeat that I do not want to see that happen here.
Both the authorities in my constituency, Sandwell and Dudley, welcomed the Bill's principles, but referred to the need for adequate financial resources to follow the
implementation. They will have to provide extra social work time for assessments and they are aware that they must develop effective local publicity to encourage the relevant carers to come forward for assessment.
On the whole, the Bill has my personal backing and that of carers in my constituency. Various organisations throughout the country have welcomed it. It provides what carers have pressed for, and I am delighted to lend my support to it.
Charlotte Atkins (Staffordshire, Moorlands):
I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on introducing a Bill that will bring support and relief to a host of carers, some of whom are in desperate situations.
I have recently learned of the case of a 78-year-old man who has looked after his 75-year-old wife for 12 years. She is housebound and requires 24-hour care. She is totally dependent and cannot be left. Carers go to the house each morning and evening to help to wash, dress and feed her, but the man is otherwise on his own, day in and day out.
In recent years, respite care has been made available for two weeks out of six. That demonstrates the huge burden that that man must carry. The respite care should provide a welcome release from his relentless caring duties. Instead, it has become a cause of distress and anxiety. Rather than reducing his mental anguish, it has increased it.
When that man's wife returns from the national health service hospital where she spends two weeks in every six, she comes home covered in bruises and, sometimes, sores. He has photographic evidence of that, spanning four years. It is evidence of, at best, neglect, or, at worst, abuse.
Why has that man not acted on that evidence? The simple answer is fear. He has a fear of losing his only break from caring. He has a fear that he would be left with the full, unrelenting burden of caring without support. He has virtually no one to turn to. He believed that the respite care his wife received was the only care available. His general practitioner reinforced his isolation because he, the doctor, had a vested financial interest in seeing the NHS bed filled.
There was no flexibility in the arrangements, and no choice. The man was locked into an NHS hospital care package that he knew was providing inadequate care. He felt trapped by the system, and as if he had no alternative. There was no recognition of his needs as a carer. A "take it or leave it" mentality existed. I believe that the Bill will ensure that his needs are assessed so that he can choose a more flexible care package, possibly bringing care into his home for extended periods.
Mr. Andrew Dismore (Hendon):
I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on securing a high place in the private Members' ballot and on selecting such an important Bill. The work of carers has often been under-acknolwedged both in the House and in the country.
My hon. Friends the Members for Nottingham, East (Mr. Heppell) and for Halesowen and Rowley Regis (Mrs. Heal) both mentioned the national strategy for carers, which the Government published recently in a document entitled "Caring about Carers". The starting point for our debate must be what the Prime Minister said about carers in the foreword to that document. He said:
The explanatory notes provide some background on the number of carers. They state:
Mr. Dismore:
My hon. Friend makes an extremely valuable point. The purpose of the census question is not merely the compilation of numbers. He is correct to point out that we need a much more accurate picture not only of the total number of carers, but of where they are throughout the country. I suspect that the distribution of carers is not even; it may be greater in those areas in which there is a large pensioner population. For example, the Burnt Oak ward of my constituency has a high proportion of pensioners.
We do not merely want to find out where carers are; such a census question would also help the carers to argue their case. I am reminded of the story of Emily Wilding Davison--of which I am sure you are aware, Mr. Deputy Speaker. When the 1911 census took place, women did not have the right to vote, so Miss Davison hid herself in the broom cupboard behind the Chapel downstairs and was thus able to put the House of Commons as her address on the census form. She made an important political point on behalf of women fighting for the right to vote.
I hope that carers do not have to hide in the broom cupboard during one of their periods of respite to make political points; we are in the Chamber to make those points on their behalf. Nevertheless, the fact that the census will show how many carers there are and where they are will strengthen their arguments for a fair share of our national resources.
A large proportion of people in potential need of care live in parts of my constituency. A survey conducted by my local authority shows that throughout the London borough of Barnet there are about 30,000 carers. However, I suspect that, for the same reasons that were given by other hon. Members, the true number is much higher than that; strictly pro rata, there would be about 10,000 carers in my constituency. The true figure is probably somewhat higher than that.
The terms of reference of the national strategy for carers are most important because they also inform the background to the Bill. The terms of reference were:
Through its joint discussions, the group developed a series of issues that carers thought were important. The first was the issue of information. My research in reading up on the Bill has made it clear that carers find it very difficult to access the information that they need. At a basic level, that includes information and advice about the health or condition of the person for whom they are caring. The condition of the people cared for may be complex medically and carers may not know whether what they are doing is of benefit. Sometimes, out of ignorance, careers may do things that act against the benefit of the people for whom they care. Carers, therefore, need information on how to cope with those conditions, and information about the services and benefits available to them is absolutely vital.
We are all aware that the information provided by the Department of Social Security on the take-up of benefits shows how few people, who could qualify for the benefits, either know about them or claim them. In the assessment procedure that the Bill will require of local authorities, I hope that they will take on board the need to advise carers of the benefits available to them and help them to take up those benefits through the DSS. There is no doubt that research continues to show that carers have great difficulty in obtaining the information that they need.
Carers want their own health needs to be recognised. They need to be satisfied that high-quality services are available to them and--equally, if not more importantly--to the people for whom they are caring. The object of the assessment is to enable local authorities to plug the gap if carers need to take time off. Careers need to have confidence in the standard and reliability of services. They want to be assured of the quality of the services provided to the person for whom they are caring both at present and for the future, such as in the event of a carer being ill and having to take time off. They need to be empowered, in some instances, to make use of the alternatives to their own care, and that is what the Bill tries to achieve.
Much has been said about the need of carers to have time off. I was very moved by the graphic examples given by hon. Friend the Member for Halesowen and Rowley Regis, who spoke in great depth about the problems facing her constituents. Carers need the freedom to have a life of their own and to spend time with their family and friends. Sometimes, their family is not just the person for whom they care. There is a risk that carers will become isolated, so they need to be able to spend time with their extended family and relations. They need to spend time free of the person for whom they care. That may sound a little harsh and callous, but if that relationship is to be strengthened and the bond maintained, they must sometimes be freed of their usual caring responsibilities.
The problem also cuts across the employment world. Carers often remain in employment, which is important if they are to maintain their independence. Such activity reduces the likelihood of carers becoming socially isolated and, ultimately, may result in them being able to continue caring for much longer than they would otherwise have been able to do.
We need to think about the emotional support that carers require. That may often best be met through family and friends or, in more organised ways, through support groups. I know that there are support networks in my constituency. Skilled help at particular times--for example, at the start of caring or when the condition of the person being cared for changes--can considerably assist the carer. Recent research by the personnel social services research unit in preparing its report on the evaluation of care for elderly people suggests that a carer's employment may result in an increased ability to continue to care.
Training and support care are also needed. Carers need to be sure of their financial security, and not just through the state benefits that they receive while they are caring. People in their 40s or 50s may suddenly find that they have to care for an elderly parent. If they are not able to continue work, they become worried about their own futures.
The Bill deals with assessment of present needs, but I am concerned about the problem of the future of carers when they become pensioners and their need for financial security. I mention at this point the important state second pension provisions that are being discussed in the Standing Committee on the Child Support, Pensions and Social Security Bill, on which I am pleased to serve.
"Carers devote large parts of their own lives to the lives of other--not as part of a job, but voluntarily. And often in addition to working themselves. For the sick, the frail, the vulnerable and the elderly, carers provide help and support in ways which might otherwise not be available. By their effort, their patience, their knowledge, their understanding, their companionship, their determination and their compassion, carers very often transform the lives of the people they're caring for--even if the difficulties they're grappling with still remain. Carers are among the unsung heroes of British life."
I very much agree with all that my right hon. Friend said. His words inform both the background to the Bill and Government's whole approach to caring, as set out in the national strategy and other Government documents.
"Great Britain has an estimated 5.7 million carers and one in six households--17 per cent.--contains a carer. Of the estimated 5.7 million carers, 1.7 million devote at least 20 hours a week to caring. Of those, 855,000 care for 50 hours or more. Most caring is based on close personal relationships."
Mr. Quinn:
My hon. Friend used the word "estimated". Is that not the central problem? Does he welcome the fact that, in the 2001 census, for the first time there will be questions to try to define and quantify the carers in our society? That will enable us better to service their needs, because an abstract concept such as "estimate" does not get a reaction from the Treasury--the Treasury wants hard figures.
"To draw together existing work within Government that impacts on carers; to take account of the emerging findings of the Royal Commission on Long-Term Care; to gather examples of best practice in providing help for carers at local level, to assess whether any key needs of carers have been overlooked; to clarify the Government's objectives for carers; to set out an integrated strategy for future action by Government."
My local authority took that to heart. During 1999, while the strategy was being developed, we formed a carers' steering group, with representation across the board. It included representatives not only from Barnet council, but from Barnet health authority, the local NHS trusts--especially Barnet Healthcare NHS trust, which provides primary care--carers, the voluntary associations supporting carers, and primary care groups. We built up a partnership, using the ideas about joint working that the Government are so keen to promote. The group used as its framework the King's Fund "Carers Compass" that sets out the main areas that carers have regarded as important to them. The Bill's terms, especially those about assessment, will draw out some of those themes.
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