Westminster Hall
Wednesday 6 June 2007
[John Bercow in the Chair]
National Carers Strategy
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Roy.]
9.30 am
Barbara Keeley (Worsley) (Lab): I am pleased to have secured this debate in the run-up to carers week, which as I am sure everybody knows takes place this year from 11 to 17 June. I am this year’s carers week parliamentary champion. Carers week plays a vital part in raising awareness of the key role of carers in our society and helps to highlight the challenges that they face. I am sure that we shall explore many of those challenges this morning.
Every debate on carers notes that there are about 6 million carers in the UK, which means that every constituency contains thousands of people who are caring for a friend or relative who is sick or disabled. In my Worsley constituency, there are 10,000 unpaid carers, including 2,300 who care for more than 50 hours a week. My constituency contains wards that have much higher than average levels of cancer, stroke and coronary heart disease. In such wards, the heavier level of caring commitment means that one in three carers cares for more than 50 hours a week compared with the national average of one in five.
Research has shown that carers who care at the heavier end of caring commitment suffer impacts to their health as a result. I understand that that is particularly the case for those who care for people with stroke disease or Alzheimer’s. We must require general practitioners and their primary care teams to identify all those carers whose caring commitment puts their own health at risk.
Dr. Ian Gibson (Norwich, North) (Lab): I am extremely interested to hear this discussion about carers’ health. Has a systematic study been done in this country, supported by, for example, the Economic and Social Research Council, on the types of illnesses and problems that carers have? My experience is that depression is a major factor. Does my hon. Friend agree that, given that the Mental Health Bill is just around the corner—we hope—we will seriously have to address that feature politically and give resources to it?
Barbara Keeley: I certainly do agree. As I understand it—the Minister may be able to help us with this later—not much systematic study has been done on the health impacts of caring. I know of just one such study, which I believe was done in the United States. It showed the impacts of caring in respect of stroke disease and Alzheimer’s.
I was just making the point that, in any case, it is necessary for GPs to identify people with heavy caring commitments. That step is basic common sense, because the unpaid care provided by those carers is a vital cornerstone of our health and social care system. I should remind the Minister that I recently
reintroduced a ten-minute Bill that would require health bodies to identify carers and then refer them to sources of help and support. Following on from the suggestion of my hon. Friend the Member for Norwich, North (Dr. Gibson), it would also enable those practitioners to keep an eye on the health of the most committed carers.
I hope that the provisions outlined in my Bill can be considered as part of the review. In 1999, this Government launched the first national carers strategy. We all now acknowledge that that was an important step forward for carers and their organisations. At that time, the Government gave GPs a five-point checklist for use with carers, which included the fact that GPs should identify patients who are carers or who have a carer. Eight years on, the slightly disturbing thing is that research shows the inconsistent and patchy nature of the work being done by GPs to identify carers within their practice population. If we accept that we know about only a small proportion of the total number of carers, we will see that this is an important issue. It is important because we, as Members of Parliament, know that if carers are not identified, they will struggle to get the support that they need and should receive.
This example of identifying carers, and the involvement of GPs in that, goes to the heart of a key issue that should be addressed in the review. In 1999, the Government strategy outlined a variety of good practice that was considered essential to deliver much-needed support to carers. Most of us know from our own contact with carers and carers’ groups that if, in reality, local authorities or primary care trusts fail to deliver that support, carers just have to manage, and it is their health and quality of life that then suffers.
David Lepper (Brighton, Pavilion) (Lab/Co-op): I congratulate my hon. Friend on securing the debate. Does she agree that schools and education authorities also have a role to play, particularly in relation to young carers and their needs? I am pleased that my constituency has a young carers support group, but I am aware that many parts of the country do not have such things. Will she include the need to identify and provide support to young carers among the measures that she would like the Government to consider?
Barbara Keeley: Very much so. As is often the case in these debates, I shall come in a moment to the point that has been raised.
Much has been achieved for carers in the past 10 years: legislation has been introduced in private Members’ Bills recognising carers’ rights; more than £1 billion has been invested in short breaks; and there has been a greater awareness of the contribution that carers make to society.
David Taylor (North-West Leicestershire) (Lab/Co-op): My hon. Friend mentioned the role of private Members’ legislation. The Carers (Equal Opportunities) Act 2004—it is now an Act—which was introduced by my hon. Friend the Member for Aberavon (Dr. Francis), played a huge part in all this. Would it not send the right message to carers if mainstream Government legislation were introduced as part of the next Queen’s Speech to tackle the carers strategy issues that are being raised by so many throughout the country?
Barbara Keeley: I agree with that. I was just going to say that the extra £340 million to help disabled children and their families that was announced on 24 May was a welcome development in the view of most Members of this House. As we shall probably hear this morning, many carers’ groups are coming to their Members of Parliament with concerns about short-term funding and lottery funding. Such issues will not go away until much of the money is mainstream. The issues that carers have, and deal with, are continuous, so the funding cannot be short-term. That is a key issue.
We must accept that we are moving in the right direction and that legislation such as the Carers (Equal Opportunities) Act 2004 means that carers’ wishes to work or study must be taken into account. Importantly, the right to request flexible working was enshrined in the Work and Families Act 2006. Those are important milestones. Most recently, the Pensions Bill contains the first real recognition that caring work is on a par with paid employment and should be recognised as such in terms of credits towards the state pension. Such steps are important.
Like many hon. Members present, I feel that there is still a long way to go before carers are fully supported and fully recognised. It is clear from survey after survey that carers can suffer ill health and financial strain through their caring. I have mentioned the impact that caring can have on the health of carers, although we do not know enough about that. We do know from surveys that carers are more likely to be in low-paid jobs or careers, or not in employment at all.
Carers UK recently found that 72 per cent. of carers are worse off financially as a result of caring and that the longer someone is a carer, the more likely they are to be on a low income. It is time for a review of the income that carers receive.
Dr. Gibson: What happened to the minimum wage in respect of carers?
Barbara Keeley: Again, the Minister may help us with that later. Many carers are now raising an issue with their MPs: what is the equation between their financial situation and the minimum wage? The issue is important.
David Taylor: Of course, the minimum wage issue is a real concern, as is the issue of the carer’s allowance, which is less than £50 a week for a minimum of 35 hours’ care at £1.40 an hour. There seems to be quite a void. However, one source of real angst among many elderly carers is the cessation of carer’s allowance at the point of retirement for so many people. Is that not something that could be tackled, bearing in mind that the value to the economy of carers is approaching £60 billion a year? I should have thought that a sliver of that money would help redress the anomaly.
Barbara Keeley:
Yes, indeed. We ought to consider carers’ income as a whole: income that they can gain from work, benefits, tax credits and pensions. I am sure that that is a possible step for the review. The whole issue needs to be considered. We know that carers’ numbers must continue to grow as the population ages, and that people with disabilities and serious illnesses
are living longer and are more likely, because of our model of health and social care, to want to live at home.
Carers still feel that they face significant barriers in important areas. Interestingly, a recent Carers UK survey showed that carers’ key priority is still the need to feel recognised and valued for their role by professionals and society generally. Importantly, one in five carers made it their top priority. Maintaining health and well-being is important to one in 10 carers, as is the availability of respite breaks. However, there is still a feeling about the need for recognition, and the income, benefits, tax credits and pension issue is part of the issue.
Recognition is important to carers whenever they access services and deal with professionals. There is a need to understand the role that they fulfil and to treat it with respect. The review seriously must consider the way in which we can change attitudes and develop understanding about carers, particularly among the professionals whom they have to deal with.
On Monday I met a group of carers from south Warwickshire who raised the issue that health and social care professionals do not always work with them to develop the best solution for the carer and cared-for person. One carer mentioned that the person whom she cared for would not use external respite care, but that the social worker would not help her to find alternative home-based respite care. The carer and I felt that she was not being treated as a partner in care as we would expect.
Hon. Members have already referred to the fact that of all the strategies for carers deserving attention in the review, appraising the reason why 175,000 children are young carers is one of the most compelling. For the Princess Royal Trust for Carers, what is needed most is to reduce the numbers of young carers. To do so, adult and children’s services must work together to ensure that parents with a disability or illness receive the proper support that they need. Resources to provide such support are too scarce and services are not set up to work together.
I also talked this week to two young carers who told me about the impact that caring had had on their lives and education. Both young people had missed out at school and they had had little or no time for leisure. One of them told me that for six years, she had rarely left her home apart from to go to school or college.
My Bill would place duties on social services authorities to consider the support services that are needed to sustain the parenting role in families in which a parent has a disability or a serious illness. If the adult relies on the care of their child, that is the point to offer support services. Doing so would ensure that the health, education and well-being of the child or young person were not impaired by caring responsibilities at an inappropriately young age. The two young carers whom I met had definitely missed out on their education and leisure time, but importantly, they told me that other young carers at school were not receiving any support as they would not discuss their home situation with anybody. Young carers can feel, they told me, that they will be misunderstood by staff at school. They would definitely be bullied by other children because their home lives were different.
Mr. Stephen O'Brien (Eddisbury) (Con): The hon. Lady makes an excellent point. Is she also aware of the evidence that one reason why child carers do not mention that they are carers—part of the number of hidden carers—is the fear that families may get broken up, which would lead to something that they do not want?
Barbara Keeley: Yes, indeed. There is a panoply of reasons: being bullied and misunderstood, and, possibly, fear of the family being broken up.
My ten-minute Bill would require that schools and local authority children’s services have policies in place to support young carers. It is a difficult and complex issue, but such measures are needed. The importance of the situation was underlined by the tragic suicide of Deanne Asmoah, who could no longer cope with the responsibility of caring for her terminally ill mother.
The carers strategy review must consider the way in which we can improve carers’ health, well-being and life chances. The recent survey by Carers UK discovered that many carers find it difficult to pursue study, leisure activities or just a social life, and it is important that we meet those needs if carers are to feel supported and valued.
A key consideration is that carers groups are calling for new equalities legislation to cover them. Carers have gained their rights mainly through the legislation that three Labour Members have introduced in the past 10 years. Trevor Phillips is keen that the new Commission for Equality and Human Rights starts to study the issue of rights for carers, and that interest is welcome.
A cross-governmental approach is needed on carers issues, because the needs of carers do not fall neatly into one Department. Caring can affect a carer’s health, financial situation, social life and education, and it is essential that the Government appoint a Minister to act as carers’ champion throughout the Government, as the Welsh Assembly Government have already done.
Carers’ organisations feel that the original national carers strategy of 1999 had too short an outlook—only three to four years. Immediate changes, medium-term commitments and long-term vision are needed, and the national carers strategy must be a strategy for the future, looking beyond the next 10 years. As the numbers of carers increase, we must have reliable and comprehensive policies in place to cope with it and to continue to support existing carers.
A key issue in the short term is to ensure that questions about caring are included in the 2011 census. The 2001 census provided crucial evidence about caring, which has been vital for decision makers and policy makers, but there is a risk that those questions will not be included in the next census, which would be a backward step.
I commend the work in my constituency’s local authority area, Salford, to improve support and services for carers. In 1998, before the national strategy was introduced, Salford developed its own strategy, which was produced by carers for carers. The Salford Carers Forum oversees the strategy, which was updated in 2002.
Over the past nine years, my local area has developed a great deal of good practice, which is encouraging. There has been a Princess Royal Trust for Carers centre in Salford for eight years, and it employs 10 members of staff who provide support, advice and information. Encouragingly, there is also a young carers group, which many areas do not have.
Since 1999, we have had an “aspirational project” to give carers of people with autism and Asperger’s in Salford a break, and the Manchester Jewish Federation carers advice service offers services to Salford carers. The Princess Royal Trust for Carers centre has a GP liaison service working with primary care services throughout Salford. The centre finds such work a struggle, because for an organisation of its size, it is difficult to map the whole NHS; however, it does its very best.
The excellent Salford Crossroads organisation last year provided more than 20,000 respite care hours to help more than 200 carers in Salford. All that work is greatly appreciated, and Salford Crossroads was recently awarded “excellent” status by the Commission for Social Care inspection. There are high standards of service in the voluntary sector.
The local authority is developing a carers strategy action plan. It has targets for the next three years, and it will be linked to the outcomes that the White Paper “Our Health, Our Care, Our Say” identified. I am pleased that carers in Salford are directly engaged in identifying priorities. Indeed, last month there was a workshop where carers could meet professionals to identify their needs.
In my local area, the experience of local carers helps to form the basis of our local action plan. That is not true of every part of the country. Local carers have already made some suggestions to improve, in small ways, the support that is available to them. They include developing small libraries at carers centres, services that loan wheelchairs, commodes and other equipment, and even a small gym and computers at local carers centres. I understand that my hon. Friend the Minister will consult carers at a meeting in Manchester on 29 June, and I hope that he picks up on the ideas that are coming forward and gathers many more from carers when he is there.
It is a measure of the challenges that we face locally that more than 22,000 people in Salford identified themselves as carers in the census, but that only a comparatively small number of carers are known to carers support groups. Although many other issues are important to carers, central to the national carers strategy review must be the provision of an effective framework both in GPs’ surgeries to identify carers, and in schools to identify young carers. It would make carers aware of the support that local organisations work so hard to deliver. We have some excellent services and support there, but it needs to be backed by the aspects in the review on which I have touched. Key among those will be the review of carers’ income and looking at the structure of the funding sources for the services on which they rely.
The strategy review is important to carers. To get it right, we need to put carers at the very heart of the consultation, and that is what is happening. I welcome the review and look forward to seeing how carers will help to shape it to meet their needs, now and in the future.
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