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Mr. Quinn: Has my hon. Friend, when meeting carers in his surgery, encountered, as I have, the problem that they do not realise that they are in that role? Does he agree that providers of primary care services, such as GPs, need to have a better identification process and should tell those who take on these onerous responsibilities that they are indeed carers and direct them to the support networks to which he is alluding?

Mr. Dismore: My hon. Friend makes a valuable point. An hon. Member referred earlier to the problems of occasionally caring for a relative who is sick only for at week or two at a time. I know that dealing with family illness can be a demanding task, and the thought of continuing such care for a long period is daunting. I suspect that some carers often think that the situation will last for only a week or two and do not identify themselves as playing a caring role. Unfortunately, illnesses progress and carers may unwittingly slip into a full-time caring role. They add an extra hour here and an extra day there, and before they know it they are spending 50 or more hours a week caring for a sick relative or friend. My hon. Friend is right to point out that many people do not see themselves as carers.

We have to be careful, however, not to stigmatise people or treat them as a group without considering their individual needs. The carers national strategy deals with that point. It says that local authority services

"must aim to understand carers' needs--individually and as a group. The Government believes that all services used by carers should involve them in service planning. Carers' organisations and representatives can help service providers by providing a forum in which consultation of carers about service provision can take place. Services which have one-to-one dealings with individual carers, and with the people for whom they care, need to make sure that the carer is involved and consulted about the services which he or she needs."

The London borough of Barnet's local strategy did not aim only to bring together the partnership group, which I mentioned earlier, to try to identify what it thought were the issues--in its second stage it conducted an important survey of individual carers' views and needs. Individual assessment is intended to allow service providers to judge the state of carers' health, their needs and wishes and their ability to continue to care, if that is what they want to do, or to bring informal caring to an end, if that seems right for the carer and the person being cared for. That is an important feature of the assessments that will, if the Bill is passed, be carried out under clause 1. When an assessment is carried out at the request of the carer, the local authority might tell certain carers that it is perhaps time that they started to consider "professionalising" the care that they provide, because they are getting older and might soon start to need care themselves if they do not get some assistance.

The Bill builds on the principles of empowering service users and carers and promoting independence and choice. The London borough of Barnet has an agreed carers

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strategy that promotes those principles and establishes a clear direction for the development of services for carers. The Bill will allow the range of services, both direct and indirect, to be expanded so as better to meet the needs of local carers.

We have focused on clause 1 and the assessments, but they are not the sole issue: once the assessment has been carried out, the answer to what happens next is set out in clause 2. I want that clause to be strengthened. It states that the local authority

"must consider the assessment and decide . . . whether the carer has needs in relation to the care which he provides or intends to provide . . . whether they could be satisfied . . . by services which the local authority may provide; and . . . if they could . . . whether or not to provide those services".

However, the local authority does not necessarily have to provide those services. We might need to address that lacuna in Committee.

The services mentioned in the clause can

"take the form of physical help or other forms of support."

However, like the hon. Member for Sutton and Cheam (Mr. Burstow), I am concerned about distinguishing between intimate services and other sorts of services. I discussed the matter with representatives of my local authority's social services department, who think that that issue needs to be clarified. They believe the answer probably lies in the fact that "care needs" will be for services provided to the person cared for, not to the carer. They told me that clause 2 was "somewhat confusing", adding:

"If it was decided that a service user had intimate care needs (including for example dressing, feeding, lifting, washing or bathing) it is self evident that this would be provided as part of their own care package and not that of the carer."

I am not sure that the Bill makes that self-evident, so I hope that the issue is addressed in Committee, either by amending the clause, or by defining more clearly in clause 10--the interpretation clause--what the phrase "of an intimate nature" means.

Mr. Hammond: Is not the point that, in the circumstances envisaged by the Bill, there may be no care assessment for the person who would otherwise be receiving care?

Mr. Dismore: I am grateful to the hon. Gentleman, because he has put more succinctly the point that I was trying to make at too great a length and in a rather confused way. It may well be that the assessment conducted under clause 1 will throw up such issues, and prompt an assessment of the person being cared for under wider community care provisions. That lacuna needs to be clarified, perhaps by the insertion of a new clause providing that, if the clause 1 assessment raises the need for a further assessment of the person being cared for, the local authority should be under a duty to carry out such an assessment. In addition to that, I repeat that "intimate care" needs to be better defined.

We must consider the sort of needs that carers have and the services that they require. We in Barnet brought together voluntary organisations, the local authority and local health workers in one group. After that exercise had identified an overall strategy, a survey of carers was undertaken to identify their needs.

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Top of the list was respite care, which came as no surprise. The term "respite care" was used in the information that came from my local authority, and it is sometimes used by carers, but what is meant is a break, short or long. The term "respite care" can be demeaning and stigmatise carers. It implies that care is an onerous task--which it is--and that it is unpleasant and not properly recognised, whereas carers are, by definition, caring people and often take great pleasure in looking after the person for whom they are caring.

What sort of breaks are envisaged? A short stay in a residential care home by the person being cared for could enable the carer to have a holiday. Time spent in a day centre by the person being cared for could allow the carer to carry out day-to-day tasks such as shopping. A night sitting service could allow the carer to get a full night's sleep, which is particularly important for carers who also have employment commitments.

Someone to take the person being cared for on an outing would give the carer time to himself or herself at home. A Sunday sitting service would enable the carer to go to church or visit family and friends at the weekend, and an evening sitting service would allow the carer to take adult education classes, or simply to have a meal out or an evening out at the cinema or theatre. Daytime sitting would allow domestic tasks to be carried out. Another sort of break would be a holiday for the carer and the person being cared for together.

We must make sure that the breaks offered are fulfilling for both the person needing care and the carer. Going to the dentist should not be regarded as a break for the carer, even if a broken tooth is being attended to. In planning a short break, adequate preparation must be made for both the person being cared for and the carer.

Mr. Hammond: I listened to the catalogue of opportunities that the hon. Gentleman outlined. Will he take care not to raise expectations too high? At the risk of incurring the Minister's wrath, I say again that in 2001-02, the ring-fenced grant will be worth £70 million. By my calculation, that allows about £50 per carer who gives more than 50 hours care a week. That will not provide much from the catalogue that the hon. Gentleman outlined.

Mr. Dismore: I am grateful to the hon. Gentleman for that intervention. I intended to make that point at the end of my speech. It will come as no surprise to my hon. Friend the Minister that local authorities are concerned about the potential financial implications. We must be careful not to raise expectations, but the hon. Gentleman should recognise that much good work is being done.

Through the partnership approach, my local authority has put forward a comprehensive three-year plan to start identifying the problems and the ways in which needs can be met by both the voluntary sector and the statutory agencies. It is well on the way to providing many of the services required.

As was convincingly argued earlier, many of the services that we are proposing will prove cheaper to the public purse. As my hon. Friend the Member for Stalybridge and Hyde said when he introduced the Bill, not only would it improve the service for carers and for the people being cared for, but it would benefit the Treasury.

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