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Mr. Edwards: Does my hon. Friend agree that GP surgeries can play an additional role by supporting carers
organisations financially? One of the GP surgeries in Chepstow in my constituency has put a significant amount of money into the local Crossroads scheme.
Mr. Dismore: That is an interesting suggestion. I should like to know more about it. Perhaps that example of good practice could be fed into the debate as it develops. I am sure that my hon. Friend the Minister would also like to take it on board.
Charging is a thorny issue. In its briefing on the Bill, my local authority mentioned the concerns that have been raised about charging carers for the services that they receive. Barnet charges service users and the level of support that it provides is determined to some extent by the costs that can be reclaimed. The same principle applies to carers when they become service users. The council will not be able to provide a service to carers unless at least some of the cost is reclaimed. We have to examine the local criteria and protocols that need to be established to clarify charging policies and practices. I am concerned that carers will be charged for some services, but that is inevitable. The charges should levied at a reasonable level. That picks up on a point made earlier by the hon. Member for Runnymede and Weybridge. If modest charging makes more money available, more services ultimately can be provided.
Mr. Forth:
Does the hon. Gentleman share my worry that neither clause 7 nor the explanatory notes say anything about charging, other than the comment in the explanatory notes that clause 7 enables local authorities to charge carers for the services that they receive? Would the hon. Gentleman have expected at least a word such as "reasonable" or some other provision that would give us some reassurance that the charges will be levied at a level that carers can accommodate?
Mr. Dismore:
I am grateful to the right hon. Gentleman for that intervention, because he makes a valid point. Unfortunately, clause 7 amends other Acts. I do not know section 17 of the Health and Social Services and Social Security Adjudications Act 1983--which provides for charges--well enough to say whether it specifies that charges have to be reasonable or assessed against the means of the carer or service user. Clause 7 simply tacks on a new paragraph (f) to section 17(2) of that Act. The right hon. Gentleman makes a telling point.
I was stressing my hope that when charges are levied--and that is inevitable--they are reasonable and affordable. Otherwise, all the Bill's provisions--the assessment procedure and the services provided by the Government under clause 2--will not be implemented. Perhaps my hon. Friend the Minister will address that point in his reply to the debate.
The debate so far has focused on the problems faced by adult carers. However, the Bill also considers the position of young carers. I was staggered to read in the national carers strategy that research currently available suggests that there are between 20,000 and 50,000 young carers--children who look after their parents or elderly relatives. Many of them receive no support from statutory or voluntary services. To return to the point made my by hon. Friend the Member for Scarborough and Whitby, I suspect that that is because their circumstances are not known. They may come to light only if the child is having difficulties at school, such as underperforming or even not
turning up, and the school or education authority decides to investigate. Only then may it become apparent that the child is undertaking onerous caring duties.
The national carers strategy identifies some of the problems that we should be looking out for in this respect. I am pleased that the Bill makes it clear that it is essential that assessments are also made available to young people.
Mr. Hammond:
I may have misunderstood the Bill's provisions. I share the hon. Gentleman's concerns about young carers, but my understanding is that clause 1 specifically does not apply to young carers. I am sure that the needs of young carers can be addressed under the Children Act 1989, but it seems to me that the Bill makes no additional provision for them.
Mr. Dismore:
That depends on how one defines young carers. The Bill provides additional facilities for carers aged 16 and over. Perhaps we should consider in Committee whether 16 is the right cut-off point. There may be a case for including even younger carers, perhaps by tabling a new clause. Carers under 16 may not be in a position to ask the authorities for an assessment of their needs simply because they are not used to dealing with statutory authorities. The Bill could make arrangements for their school or GP to suggest to the local authority that such an assessment was necessary.
I mentioned earlier that such children may have problems at school--perhaps with doing their homework and getting qualifications. They also risk becoming isolated from others of the same age and from the rest of their family. They may lack time for play, sport and other leisure activities that help their development. They may face conflict between the needs of the person who they are helping and their own needs, which can often lead to feelings of guilt and resentment. They may believe that there is nobody out there looking out for them and feel that the professionals do not listen to them because they are children.
The overall lack of recognition and praise for the contribution of carers also applies to children, who may feel isolated and different and that nobody understands their experience. All that may cause problems for them as they grow up, in terms of finding work, moving into their own homes and establishing relationships. That is particularly important in respect of young carers from ethnic minority groups, where families are more tightly knit and family relationships often impose greater obligations.
I want to refer to adult carers looking after young children, and I am pleased to see that the Bill deals with them. Clause 6 extends direct payments to those caring for disabled children and parents of disabled children. The Government have made great strides in helping those who look after disabled children through their social security reforms, particularly in terms of mobility allowance for severely disabled very young children. Clause 6 develops that by providing more direct financial aid to parents of disabled children.
Disabled children will receive help to enable them to make the transition from childhood to adulthood by giving them the responsibility to look after their own resources. Equally, the provision of vouchers or direct cash
payments to the parents of disabled children empowers them--a point made forcefully by my hon. Friend the Member for Stalybridge and Hyde. He said that the direct payment arrangements would help parents to make the decisions that they want to make on behalf of their children, rather than the parents being told what decisions to make because the facilities are available only in kind rather than in cash. I am pleased that we are addressing that.
Dr. Desmond Turner (Brighton, Kemptown):
I wish to join the list of those congratulating my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on introducing the Bill, which not only has cross-party support but has the support of an all-important double act--the right hon. Members for Penrith and The Border (Mr. Maclean) and for Bromley and Chislehurst (Mr. Forth)--which means that it might actually make it to the statute book.
The Bill is a critical step forward for carers. It is only in the past four years that they have come to be recognised by Parliament as an entity whose needs we must consider in legislation. For years, they have been making the most vital contribution to society imaginable. Now, carers will have a statutory right to have their needs recognised by social services authorities.
Mr. Hammond:
The hon. Gentleman is right that the Bill recognises for the first time the statutory rights of carers but he is wrong to say that carers have not been recognised as such in legislation. I will seek to show later that carers have been recognised in legislation going back to 1981, and that the Bill is part of that growing recognition.
Dr. Turner:
I accept the chiding from the hon. Gentleman, but this is the first time that carers have had a statutory right. That is important.
Before I came to this place, I was heavily involved in the implementation of community care legislation as a county councillor and a leading member of a social services. We recognised from the outset that if the assessment procedure did not involve the carers, it would be incomplete from the point of view of both carer and cared for, but such involvement was not the universal practice of social services departments.
There is an enormous variation in the services provided in different areas, from almost none to rather a lot. The Bill will not dictate a uniform pattern of care support services--that would probably discourage innovative authorities--but will effectively force all local authorities to examine rigorously what they do to support carers, so they will all come up with at least a range of core services that all carers need.
My hon. Friend the Member for Hendon (Mr. Dismore) has spoken of all the services that carers might need. If the Bill does nothing other than make social services
departments take carers seriously and provide for them properly, it will have been worth while; but I think that it goes much further.
We need to sustain the carer. It cannot be said too often how important carers' work is. We can make rough calculations of the value of their contribution. It has been said today that it would cost £34 billion to substitute for it, and I suspect that that is an underestimate. The sum involved if all 5.7 million carers stopped caring would wipe out our entire national health service and social services budgets. Their input is enormously valuable, and they do it for love. They are people whom we must treasure above all others.
The carer's life is not fun. My hon. Friend the Member for Nottingham, East (Mr. Heppell) rightly said that we should all realise that any of us at any time could be pitchforked into a situation in which we feel morally obliged to be a carer, and we should certainly think about that, but few of us know what the restrictions and the lack of opportunity to socialise or have a career are like. All the things that we take for granted, even within the strictures of life in this place, are taken away; our lives are far less rigorously determined than those of carers.
I had no more than a small taste of that when I had to care for my daughter for three weeks when she was horrifyingly injured in a motor accident in the Dominican Republic, where hospitals do not have nursing staff in the sense that ours have, and families have to do all the caring. She was totally immobilised and I learned what caring was about.
At its last annual general meeting, my local branch of Care for Carers in East Sussex put out a challenge to all the politicians present to take the place of a carer for just a day. That was long enough to impress on me what was truly involved. I had the privilege of substituting for the parental care of a young teenage girl with spina bifida and severe learning difficulties. At the end of the day, I was shattered: it was incredibly demanding. One had to be so sensitive in every respect. To do the job properly, people would have to be highly trained and highly sensitive.
In such a situation, the carer cannot relax for a moment. I was a carer for only a few hours, but the caring parent--a single parent with other children to worry about--did it every day of her life except for an occasional respite break when her daughter had residential care for a few days. My hon. Friend the Member for Hendon raised the issue of what such care is called, but carers do not give a damn whether it is called respite care or a short break--they just want it to be provided. That is what matters more than worries about politically correct language.
What support do we give carers? It is highly variable, but most of them certainly have little financial support. The hon. Member for Sutton and Cheam (Mr. Burstow) rightly emphasised the difficulties that carers have with the benefit system. He pointed out that few carers receive invalid care allowance--some 400,000 out of 5.7 million. Why is that? Carers are not rich--in fact, by definition they are nearly all poor. The reason is that they are nearly all on income support and it is no use claiming invalid care allowance, because it is simply taken off their income support, pound for pound. They would not be better off if they claimed, so they do not claim. That is the experience of many of my constituents.
The future changes under the national carers charter will change the position and it will become worth while for carers to claim invalid care allowance because it will
qualify them for the second state pension. That is welcome, but given the onerous burden placed on carers, they should receive a weekly income over and above income support. They have to live permanently on income support, which is not designed to sustain people indefinitely. It does not provide, for example, for replacing shoes as they are worn out. It is a basic subsistence income, and carers are entitled to more than that, given the enormous contribution that they make and the saving to the Exchequer of not paying for someone else to provide care. I hope that my hon. Friend the Minister will bring my remarks to the attention of his colleagues in the Department of Social Security, because carers should be more generously treated by the benefit system.
I would like to turn to the important issue of resources which, in the context of the Bill, cannot be taken in isolation: it must relate to the whole community care support system and its financing. That is under acute pressure, and has been since the introduction of the National Health Service and Community Care Act 1990. The system was etched on my mind, as I was one of those at the coal face who had to implement the legislation. Under that system, the assessment had to fit the money available. We had this wonderful structure called eligibility criteria. The 1990 Act provided that eligibility criteria should match the resources available so the net goes up and down, according to the money available. That means that the resources available to provide for carers are concomitantly varied.
I take issue with one of the statements in the explanatory notes to the Bill which were written by the Department of Health. On the Bill's financial effects, the notes state:
"The only additional costs that are likely to arise in implementing this Bill will be those relating to the carer's right to an assessment in circumstances where the person cared for has refused an assessment . . . These additional costs are expected to be contained within the existing local authority allocation."
If we are to deliver recognisably increased support for carers, as the Bill quite rightly implies, there will be additional costs. They cannot be contained within the existing local authority allocations.
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