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On two occasions I have introduced 10-minute Bills which would give health bodies a duty to identify carers and then require them to be referred to sources of help and support. Identification of carers should result from an holistic view of the patient and their family. Opposition Front Benchers have expressed a similar view—that we must move toward that more holistic approach. If the patient needs substantial care and support, GPs should be looking around and
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asking who is providing it and how they, as health care professionals, can support the person providing the care.

The need for GPs to identify patients who are carers and patients who have a carer was first stated by the Government nine years ago, in the first national carers strategy. The five-point checklist given to GPs in that strategy suggested, for example, that they check carers’ physical and emotional health at least once a year, that they tell them that they can have an assessment, and that they help them to find local support groups or carers’ centres. Clearly, that does happen—Members may be aware from their own surgeries of carers who know that such help is available—but even though my constituency has a wonderful carers centre, many of the people who come to me do not know about the help and care available to them.

The GP contracts established in 2004 appeared to offer an ideal opportunity to ensure that GPs undertook the work of identifying carers, but out of a maximum of 1,050 “points” available in the contracts for the quality of GP services, only three relate to identifying carers. In my view, that gives insufficient incentive to GPs to undertake what is becoming a vital task. I hope that the updated carers strategy and developments based on it in the months and years to come will ensure that we take on the vital task of identifying carers, making it something that GPs must commit to contractually, rather than just optional. Because the contractual reward is so small, many GPs simply have not bothered with it. We talk about personalisation, but as there is very much more for a family and a carer to take on board, knowing at the right point of diagnosis where all the care and support can be found is vital.

The “case for change” document asked which is more important: local flexibility or national consistency? It is crucial that we reach a consensus now on the balance between local decision making and ensuring a basic national entitlement to care. I believe that local decision making is important in many service areas, but, as other hon. Members have said, we have moved to a point where there are unacceptable differences between the level of social care services offered by local authorities and the continuing care services offered by various local NHS bodies.

Let me give an example of decisions on the eligibility of patients for continuing care, which can be crucial. A constituent of mine, Mrs. Reade, desperately wanted to care for her husband at home when he was diagnosed as terminally ill with an aggressive form of motor neurone disease. His final weeks of life ran across Christmas and new year. The Ashton, Leigh and Wigan primary care trust turned down the request for continuing care because there were so many delays in reaching a decision, mainly caused by staff absences during the holiday weeks. The absence of a social worker in the hospital proved crucial to things going wrong there. Sadly, the letter conveying this decision to Mrs. Reade, which was written in very difficult, technical language, arrived just days after her husband had died in hospital. We can and must do better than that.


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Because I have two local authorities in my constituency, there is different provision for those of my constituents with moderate and substantial need; the services vary, depending on which council area they live in. I hope that the CSCI review of eligibility criteria helps to iron out those differences.

Many speakers today have touched on the need to recognise that service development is being pursued at different rates. Telecare, which I see as vital, has been used to great effect in some regions of the UK, such as West Lothian, and in some authorities—Oldham has been mentioned—but other authorities are not pursuing the new technologies at the rate that they should. I am very pleased that the Department of Health has announced the piloting of telecare and the £31 million investment to ensure testing on a large scale, but following the pilot, it will not be acceptable if some areas are allowed to lag behind in providing services involving telecare. My belief is that we have to accept the principle that people are entitled to equal care wherever they live.

In conclusion, I commend the progress made by the Government in developing support for carers and greater choice and flexibility, in recognising the need to regulate and develop skills in the social care work force, and in the recent and earlier developments in telecare. As we set out on a path towards that new care and support system, which I am sure all hon. Members want, I hope that we can embrace the two developments that I have discussed. First, we must ensure that GPs and primary care staff identify carers, because there is no way that they will obtain the advice and support they need if the primary care people do not do that. Secondly, we must ensure that local decision making does not get in the way of offering decent minimum standards of both social care and continuing care.

5.15 pm

Jeremy Wright (Rugby and Kenilworth) (Con): I am pleased to follow the hon. Member for Worsley (Barbara Keeley), whose commitment to and enthusiasm for carers’ issues I recognise and entirely share. The debate has made yet clearer the scale of the challenge we face in constructing a social care system that is adequate and decent, and that covers to a good standard those whom it needs to cover. It is right that funding plays a large part in that, and we have talked a little about how that funding might be found. It has also been sensibly said that we first have to decide what kind of system we wish to fund, and I wish to discuss that initially.

I agree entirely with the hon. Lady and with others that it is too easy to talk only about the challenges that we face and not enough about the opportunities that the development of modern technology has presented to us—telecare is one of those. It is hugely encouraging and exciting that we can now examine ways of providing people with the reassurance that they and their families wish to have, while preserving their independence and their dignity, as the Minister mentioned, with a form of care that is not intrusive, but which works well for them. Those aspects of telecare give us some reason to be cheerful.

Of course, we face a number of problems and we cannot ignore them. Some operate at a very high level, being widespread and difficult to resolve, whereas
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others operate at a very small, personal level. I shall identify one such problem that will be familiar to all hon. Members who speak regularly to carers. In any system that involves people supplying care from social services departments or elsewhere, we should find a way of ensuring that as often as possible it is the same individual who turns up at a person’s door, because one difficulty we face is that often a different individual rings the doorbell each time. That means that it is difficult for a good relationship to be built up with the person who is being cared for. It also means that it is more difficult for anybody living at the house—perhaps a permanent, so-called, informal carer—to say, “If they’re five minutes late, I’ll leave the door open”, or “I feel happy to go out and have them in the house when I’m not there.” These minor, personal issues have a huge effect on the quality of care provided and on the overall experience.

It has been said—this point goes back to the macro level—that one of the major issues is the system’s complexity. There is no doubt that those who have not previously experienced it are befuddled by how someone goes about finding the care they need, and where they go for the help they want. As has been mentioned, one of the places people often end up looking for that help is the voluntary sector. It does tremendous work in this area, on which we should congratulate it, and I am sure that there are ways we can support the sector further. I heard what the Minister had to say about that, and it is encouraging.

We can perhaps be more imaginative still, by finding other ways of providing that assistance, support and guidance in other scenarios and circumstances with which people who use such things are familiar. We have spent a good deal of time in other debates in this House trying to think of ways of supporting the rural sub-post office network; we have tried to think of things that we can allow sub-postmasters and sub-postmistresses to do that will give them a ready supply of income. Providing this sort of advice on how to find the right social services and how to gain access to these networks is something that rural sub-postmasters and sub-postmistresses and, indeed urban sub-postmasters and sub-postmistresses, could do very effectively. That is because of the relationship of trust that they have already built up with the sort of people who are likely to be the main customers for social services, in addition to being regular customers in their local post offices. I hope that we can also explore that.

Much of the complexity and many of the problems arise from the relationship, or lack thereof, between the health care sector and the social services sector. The Minister described it as a Berlin wall, but in many ways it is more like the Grand canyon. There is a gap between health and social services into which too many people regrettably fall. To give just one example, there is the game of pass the parcel between health and social services when someone who is in receipt of social services support is admitted to hospital—perhaps a rehabilitation hospital for a short time to get them back on their feet.

That seems to be a signal to social services that the person should no longer have any action taken on their file, which is put into a drawer. The person is now a health service responsibility, and no further work will be done on that file unless or until the person comes
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back to the front door of social services. That is regrettable, if we are serious about the sort of joined-up working that phrases such as “multidisciplinary teams” suggest should already be happening. I hear that phrase all the time, but I do not see much evidence of it taking place. It is common ground that we need more joined-up thinking, but the problem applies to cases in which assessments have been made and when short stays in hospital break up what was previously a reasonably effective social services provision.

It is impossible to ignore the economics in the context of this debate. The problem arises from the dysfunctional relationship between health and social services over exactly what is classed as a health need and what is classed as social care need. I make no apologies—nor would the Minister expect me to do so—for raising again the issue of dementia. As the hon. Member for Kingswood (Roger Berry) made clear, dementia is a classic example of the problem. As those with dementia find it progressively more difficult to feed themselves and to deal with other care needs, those needs are assessed not as health needs but as social care needs, resulting in a contribution being necessary—where appropriate—from the individual or their family. They regard that as bitterly unfair, and I am sure that the House can understand why that is. People with dementia and their families are by no means the only ones in that position, so any system we develop must find a fair way to identify needs. It is accepted that some contribution will be needed in the appropriate cases, but we need a way of distinguishing which those cases are, without trying to pretend that what arises from a medical condition does not in fact do so. That is an issue that we must consider.

Dementia will have a much wider impact on the social care system—either the existing system or one that we will construct in the future. The Minister knows the figures: 700,000 people have dementia now, and that will rise to well over 1 million in less than 20 years. Those people will put extra pressure on the care home sector and on the care delivered in the community. The Minister knows, because we have had this conversation, of my strong view that we should have mandatory training for those who work in the care home sector who will inevitably deal more and more with people with dementia. That argument applies equally to those who provide social care to the two thirds of people with dementia who live in the community. The care providers must understand the condition and the symptoms it presents.

The hon. Member for Worsley mentioned what is sometimes referred to as “informal care”, which forms a substantial part of the care provided. I personally do not like the term, as it suggests care that is casual or sporadic, whereas in most cases it is neither. In fact, it involves people sacrificing their own lifestyles for the benefit of the lifestyle of another. People prepared to do that deserve the greatest possible consideration in any debate on the future of social care.

Nor can we ignore the economics of the issue. It is correct that we will face a huge funding shortfall if we continue to provide only the level of support that is currently provided. The hon. Member for South Thanet (Dr. Ladyman) was probably right to say that
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the current figures are an underestimate, but the Government predict a £6 billion shortfall over the next 20 years.

According to Carers UK’s last assessment, carers save the state some £87 billion through the work that they do. It does not take much more advanced mathematics than even I can manage to work out that if those carers, for whatever reason, were unable to do even 10 per cent. of what they now do, we could swiftly more than double the deficit. Of course we have to think about ways to solve the financial crisis facing social care, but if nothing else we should not make it worse. That means ensuring that whatever we do, we support carers in all that they provide to the system and make life as easy as we possibly can.

I want to focus briefly on a minor subset of the people whom the hon. Member for Worsley described. Some 1.5 million of the 6 million carers are over 60 years of age, and I suspect that that proportion will only increase over time. Those people face particular challenges. It seems remarkable, looking at the figures, that 8,000 carers are over 90. How those people manage is completely beyond me. It shows that a large number of people who have considerable problems of their own are carrying out the functions of a carer.

As I say, the phenomenon will only grow because families will become yet more far-flung as time passes. There will be less support from other members of the family and spouses will often be the carer. Given that those being cared for are predominantly elderly, their spouses will be, too, and, because of increasing life expectancy, a carer might be a son or daughter of pension age. We have to think about the particular requirements of those people, which are obvious in many ways. The more elderly are more likely to fall victim to illness, and we know already that carers are more vulnerable to illness. We know that the physical requirements of moving someone around get more difficult the older the carer gets.

Some of the problems that face all carers face older carers more dynamically. I shall focus on two of those. First, respite care has already been mentioned and it is crucial to all carers, but one tends to find that the older generation are less willing to ask for respite even though they are more in need of it. The second problem is the relationship between carers and social services departments. That seems to me to be a major structural problem.

Among carers of all ages, there is the constant refrain, “We are not listened to. We are not respected. We are patronised and talked down to and we know the people whom we care for much better than social services do.” There has to be a better relationship between carers and social services departments to ensure that carers remain keen and enthusiastic to do what they do against all the barriers to their doing so, which will always exist. Any programme to deal with social care must address that problem.

We need to talk about funding and social services departments but, as the hon. Member for Worsley said, we must never forget the substantial portion of care that is provided by those who do it voluntarily, and who do it very well.


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5.28 pm

Mr. David Kidney (Stafford) (Lab): I want to add my praise to the Minister for the policies and spending programmes that he has been responsible for introducing as he described. I also praise him for bringing the Government to the position that they are in, with the beginning of the consultation that we have debated today.

We are coming to the end of the welfare state mark 1, which was designed by William Beveridge. I have always been slightly curious about the life of William Beveridge because for all my childhood I lived in a house in Beveridge close in Stoke-on-Trent. I always wanted to know why the street was named after him. It is tremendously to the credit of our predecessors, the politicians of 1941, that, in the depth of a dangerous war when the survival of our democracy was in the balance, they appointed William Beveridge to design the state of Britain that we would hope for when the war was won. The welfare state that was then implemented by the 1945 Government—the national health service, social security and the philosophy of support for every citizen from cradle to grave—has stood us in good stead until now, but the faults and strains of 60 years of pressure have been well described.

We have reached the stage where we need to design the welfare state mark 2, which must take account of the complex health and social care needs of many more older people than it did in the past. As my hon. Friend the Minister said, that involves an adult care system for many people other than old people; it is for all those who are disabled, those with learning difficulties, those with autism and carers.

I am pleased that so many hon. Members mentioned young carers. Although we have been talking about adult care, youngsters often care for adult family members and we must ask to what extent the pressure is on them to provide that care because of failings in the social care system. As adults, we must ask what is our responsibility and why we deprive youngsters of their childhoods, as they take on those grown-up responsibilities of caring for adults.

I hope that, in the consultation, we will design a system that can cope with all the new pressures and demands and be affordable. The Government are right to start with a fairly open consultation, with not very many constraints and restrictions, because there are big questions to answer about what we want in the system, how much it will cost and precisely what the public are prepared to pay through their taxes and through their personal expenditure from their own pockets, as they contribute to the debate during the six months of consultation.

I want to spend the very short time that I have to contribute to the debate in describing an event that I jointly hosted at Stafford with Staffordshire university a few months ago, before the consultation began. We set ourselves the objective of contributing to the national debate, while anticipating changes in future national policy and starting immediately to implement them locally in Staffordshire. Our audience involved three Departments, the Association of British Insurers and other insurance representatives from the national scene. We had regional representation from the health, social care and voluntary sectors, as well as the main
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players from the local providers of health care, social care and voluntary services.

We came up with five things that we thought it important to adopt in the policy. First, a conceptual change is required to assist an ageing society. We thought that universal provision must be taken as a prerequisite if we live in a fair and equitable society. Alongside that, we need a speedy integration of health and social care. It is important to invest in prevention as a high priority, echoing the King’s Fund report “Paying the Price”. We recognise that a significant debate is required on the balance between state responsibility, individual responsibility and family responsibility.

The second thing was the future work force. We need a work force who are both flexible and fit for the future. Work force projection and planning require more sophistication for the future. Although we now see a slow movement from secondary to primary care health provision, the move of mental health services into primary care advances at a much slower pace.

The third thing that we talked about was financing and communicating systemic change. A viable, fair and equitable system will cost more than the present one, but insurance alternatives need to be explored. A pooled finance system might help, by utilising state and individual components, and pass the equity test.

The fourth thing was intergenerational support. How do we persuade young people to start to think about old age and to plan for later life? What are the incentives for them to do so? Although the dignity in care agenda has started work on valuing older people, much more is still to be done.

The fifth thing that we wanted to talk about was the future focus of the system. Prevention must become a key priority alongside incentivising the health agenda, not the illness agenda. Technology needs the development that many hon. Members have commented on already today. They are the five points that we wanted to project. We want to move on to develop our services locally, anticipating what we think will be the national decision.

Before concluding, I want to tell my hon. Friend the Minister that Staffordshire university was a great help to me. It has a centre for ageing and mental health, and it wants to contribute to the debate. I would offer its help, with its agreement, to my hon. Friend in any way that he wants, perhaps by hosting events, running panels to contribute to the debate and advising the Department of Health if it wants it. On the same basis, I want to offer my assistance, as a Member of Parliament, in the consultation, and suggest that other MPs want to do the same. We are a very good resource for collecting the views of our constituents, and for explaining to people that the consultation is taking place and how important it is. If necessary, we can host events ourselves to contribute to the debate over the next six months.


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