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It was expected that where current services met needs last year they would be enhanced by the additional money, and that where more diversity was needed authorities would plan for the provision of further services. A carers plan would help to specify how those new services were being developed. Another key benefit of a carers plan is that it would help to solve a problem that many of us recognise--the lottery in the provision of carers services. Access to certain services is much greater in some local authorities than others, and the requirement to publish a carers plan would increase local authorities' accountability and reduce the sense of there being a lottery in provision.
Carers have a difficult time accessing their rights and receiving information about services. A carers plan would help to solve that problem. Research carried out by the Carers National Association in 1997 found that only 18 per cent. of carers providing substantial amounts of care had received an assessment of their needs. In 1994, the Carers National Association found that only 32 per cent. of carers had received a copy of the disabled persons care plan. In 1997, it found that some 85 per cent. of carers had received feedback since their assessment, but only 56 per cent. had received it in writing. However, more recent research carried out in 1998 found that 72 per cent. of carers had not received a copy of the hospital discharge plan that they
The problem of access to services was highlighted by the excellent social services inspectorate report that was published in November 1998, entitled "A Matter of Chance for Carers". It stated in its opening paragraph:
Now that local authorities have to count the number of carers who are being assessed, they are becoming more conscious of offering assessments, ensuring that the right policies are in place and recording the right information. Of course, collecting statistics cannot guarantee that carers are given good assessments, but it is a step in the right direction. The publication of such information in a carers plan would clearly increase the accountability of those who are supposed to be providing services to carers.
A carers plan would also complement the Government's fair access to care initiative, which I understand has not yet been published. The Carers National Association very much hopes that it will further reduce the lottery of care.
The Government's concern about the range of eligibility criteria for services was flagged up as early as the 1997 social services White Paper. Again, a carers plan would help to complement efforts to standardise the eligibility criteria and make them fairer. Authorities tend to draw up eligibility criteria for social services based on the degree of risk to the disabled or elderly person. They use those criteria to determine, for example, whether an elderly woman with particular needs would have access to certain services.
Eligibility criteria also seem to exist for carers who try to exercise their right to assessment. Some carers have been told by social workers, "You're not in crisis yet, so you don't need an assessment." That goes against good practice and against the wording of the Carers (Recognition and Services) Act 1995 introduced by the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Croydon, North (Mr. Wicks), which clearly states that carers have a right to request an assessment if they are providing regular and substantial care. The law does not require them to be in crisis for that to happen. What some carers are being told also goes against the Government's prevention agenda and is clearly against basic common sense.
A carers plan would facilitate the publication of such eligibility criteria and would help to hold local authorities to account. It would also complement efforts to break down the health and social care divide--an issue that concerns many hon. Members. It is a key issue for carers, who feel strongly about it. Research carried out by the Carers National Association in 1998 revealed that the first priority for the vast majority of carers was that health and social services should work closely together. Many respondents mentioned the problems of policy and service fragmentation and said that the need to break down the Berlin wall between health and social services was affecting the care that they were able to access. They commented on the experience of being batted between the NHS and social services. One carer said:
When the NHS and social services fail to agree to provide services, or fail to provide joined-up services, those who suffer are the disabled, the ill or the elderly. Carers are too often left to cope with unacceptable levels of caring responsibility.
Mr. Barron: My hon. Friend has gone into great detail about the current situation and he obviously believes that the carers plan is a major issue. However, in relation to a previous group of amendments, my hon. Friend the Minister said that the Government were considering strengthening guidelines to local authorities. Which is the best mechanism? Is it a carers plan that goes into great detail, or is it stronger central guidance to local authorities so that we no longer have the situation in which some people are more equal than others when it comes to accessing care from the local authority?
Mr. Thomas: I do not think it is a matter of having one or the other. We need stronger central guidance and a carers plan to throw a spotlight on how local authorities are responding to that guidance.
The challenge of having to produce a carers plan for public consumption would help to identify problems and make sure that the partnership grant, which is part of the modernising social services grant that will be provided by the Department of Health to local authorities in England over the next three years, is properly spent. I understand that the partnership grant is designed to encourage closer and more joined-up working.
We also have legislation to back up the notion of more creative joint working. The Health Act 1999 introduced a new way of closer working whereby there are clear benefits to be gained, including integrated services, pooled budgets and lead commissioning, and local authorities and health authorities can transfer their commissioning responsibility to each other. A carers plan would help to reveal just how successful local authorities and health authorities have been in responding to the Health Act 1999.
The Carers National Association believes that monitoring is extremely important as it is likely that areas that have better joint working relationships are more likely to be able to bid for budget flexibilities. A carers plan would clearly provide an important source of monitoring, which the Carers National Association has identified as particularly important.
The association asked what would happen in areas where there were poor joint working relationships. A carers plan would help to expose those poor relationships, and enable the social services inspectorate to take appropriate action.
As part of my research for this debate, I consulted the Alzheimer's Disease Society. I was told that about 5,000 people with dementia live in the Brent and Harrow health authority area, which means that there are at least two or three times that number of carers. Clearly, a carers plan would be of great benefit to people with dementia.
The society stressed that the amount of informal care provided by friends, volunteers and family is substantial. Two thirds of people with dementia continue to live in their own homes. A significant minority live alone, but most are cared for by family members, many of whom are elderly themselves. The society said that the shift in the 1980s from residential care to community care increased the burden on family carers. By providing more information, a carers plan would help to relieve some of that burden.
The Alzheimer's Disease Society made it clear that a partnership between carers, people with dementia and the staff who work with them is vital to the development of sustainable long-term care. A carers plan would show whether such a partnership was in place. If that partnership were not in place and working properly, a carers plan would help ensure proper accountability to carers and provide information about where they could turn for help.
The society told me that carers need practical support, which may take the form of financial help, respite care, training or information. A carers plan would help identify how much support carers need, and where they could find it. Recent research showed that a carer's ability to cope was the most significant factor in the shift from home care to institutional care, but that inadequate training and support for carers was widespread. A carers plan would help to show where such training and support was available.
The Government recognise the separate needs of carers, but many carers remain unaware of the support available. A carers plan would help them find out where the support that they need can be found. Respite--the provision of a break from caring--is one of the most frequent of carers' requests, as the House will know. It tends to be provided with the explicit aim of avoiding institutional care, so it is ironic that short-stay institutional care remains the most easily accessible form of respite provision for people with severe dementia or behavioural disturbances.
However, that form of respite is sometimes not the most effective or desirable form of support. Flexible, community-based models of respite include family support schemes and sitting services schemes. They extend the range of respite opportunities available and may enable a carer to continue to care for a person with dementia for a longer period.
Such alternatives are needed, and a carers plan would help people to know where those new forms of respite could be found. Some local authorities would be shown to be relatively advanced in the provision of that support compared with their neighbours. That might encourage those neighbouring authorities to increase support provision in their areas. High-quality respite care could also help to reduce levels of abuse and maltreatment of elderly people, according to the Alzheimer's Disease Society.