Motion made, and Question proposed, That the sitting be now adjourned.-(James Duddridge.)
Mr Joe Benton (in the Chair): Before I call the Minister, I want to explain, chiefly for the benefit of new Members who are attending Westminster Hall for the first time, that the procedure for this debate will be that I will call the Minister, after which I will call individual Back Benchers. I hope that we can begin the winding-up speeches from the Opposition spokesman and the Minister at about 5 pm.
The Minister of State, Department of Health (Mr Paul Burstow): It is a great pleasure to open the debate and to do so as a Minister. I look forward to working with the hon. Member for Worsley and Eccles South (Barbara Keeley) in her new role as an Opposition spokesperson on health. I forgot to welcome her to her role at Question Time the other day, so I put that right now.
We are here to debate a very important issue for our society: how we offer proper support for the nearly 5 million adults in England who spend a significant proportion of their life providing unpaid support to family members or friends. Among those 5 million adults, there is real diversity with respect to the amount of care they provide, how long they provide it for, and when they provide it during their lives.
For instance, the biggest group of carers is made up of older people in their 60s or 70s, or even their 80s. Typically, they are looking after a husband or wife who is in declining health, although they themselves might be in poor or frail health. They are often devoted to their husband or wife, yet they are deeply concerned about what the future holds. The existence of that group reinforces the need for better identification of carers, for better ongoing support to ensure that they stay healthy and well, and for better integration of services across health and social care to ensure that those carers are fully involved in the treatment and ongoing care of their spouse.
Next, there are carers of my generation-people in their 40s or 50s-who find themselves caring for a parent or partner for several years, or perhaps longer. Those people need real flexibility and control to ensure that they can balance their caring duties with their work responsibilities and bringing up their own families. They are the "sandwich generation" that is often talked about.
There are also significant numbers of lifelong carers, who might have a son or daughter with a physical disability or a learning disability. They can become carers in their 20s. They have a lifelong commitment to support a loved one, which means that we are looking for support that can help them to lead a life outside
caring, and to have a career, a marriage, friendship and hobbies-all the things that the recent carers week survey told us that so many of them do without.
Let us not forget about young carers. Officially, there are 175,000 of them, but I think that we all know that that figure is just the tip of the iceberg and that there are significantly more. Young carers are children who do not have a recognisable childhood because of their caring responsibilities. They do amazing things to support parents, brothers or sisters, but they need considerable support themselves. They need tailored and integrated support, with schools, social services and community groups working together to ensure that they have the same opportunities as other young people: a good education; good health; training opportunities; a social life; and, yes, the ability just to be children and have fun, which is what childhood should be about.
I am making the point that the policies that we introduce and the support that we offer must reflect that kaleidoscope of carers' backgrounds, experiences and needs. Although many carers enjoy their caring responsibilities, I have no doubt that hon. Members in the Chamber have met carers in their constituencies who are at the end of their tether. Those carers feel undervalued and overlooked, and frustrated that the care and support available is not tailored to fit their families' needs. Sometimes they feel a whole host of emotions: anger that such a thing could have happened to their family; grief at a life forgone out of love and duty; and guilt for feeling that they need a break, a breather and a bit of time to themselves.
That is why mainstream statutory services can make a massive difference. A comparison of the findings of the personal social services survey by the Department of Health, which was published yesterday, with the findings of the recent Carers UK survey entitled "No life of my own" reflects that point. The Department of Health survey of 35,000 carers, all of whom were in contact with statutory services, found that only 13% reported having no time to do anything that they valued or enjoyed. In contrast, the Carers UK survey of more than 3,000 carers who may have had little contact with the NHS or social services reported that 76% of respondents did not have a life outside their caring role.
What does that tell us? I think that it suggests that when carers have contact with services-whether in the voluntary sector, the local authority sector or the private sector-they are more likely to have a positive experience. That makes it all the more important that such services work harder for carers.
There are four points that I want to emphasise today. First, we must identify more carers so that we can put them in contact with the services that can help them. Many people simply do not identify themselves as a carer and hence do not come forward to get the help to which they are entitled. This is an area in which GPs can play a role, which was reinforced to me recently when I visited an excellent GP centre in Lambeth.
Just a few days ago, I attended a round-table event organised by the Afiya Trust at which a number of speakers told me about the specific challenges faced by certain ethnic groups. On that point, I intend to look at how we can break down some of the barriers that exist and ensure that we get culturally sensitive support to those who need it.
Secondly, we must ensure that there is effective integration across the whole system. We need joined-up planning, joined-up commissioning and joined-up delivery for carers and the people for whom they care. Public services need to talk to each other, but not just to each other-they also need to talk to the voluntary sector. They must respond to the whole picture of a family's circumstances, rather than just considering their own specific area of expertise. We need one system pulling together, rather than different systems pulling apart.
Better integration across health and social care is particularly vital. Such integration has been talked about for years-I have attended debate after debate about it. If we want to make progress for carers, councils and health authorities will have to make such integration happen on the ground, along with their partners in the third and independent sectors.
Thirdly, we must make personalisation a reality for everyone and ensure that packages of support genuinely fit around a family's needs and the way in which they want to live their lives. We plan to do that by encouraging the far wider use of direct payments, which is already a very popular way of giving carers more flexibility and control. The Government have made a clear commitment in the coalition programme that we will encourage more local authorities to offer direct payments. We will also challenge local authorities to provide those payments, and we will encourage others to hold local authorities to account so that they provide them.
One thing that we will not do, however, is to make promises that we cannot keep, which was what the previous Government did when they promised £150 million for breaks for carers. Thanks to the Princess Royal Trust for Carers, it is now well documented that primary care trusts siphoned off that money to spend on other things. Speaking from my personal experience, I can say that getting information from PCTs about how they were spending that money was like pulling teeth. Despite the fact that inquiries and freedom of information requests were made, some PCTs conspicuously failed to answer the local population that they exist to serve.
Let me be clear that local NHS commissioners should have full autonomy and control over how they spend the money that is allocated to them. Therefore, if we are putting money into the baseline, a Minister cannot claim credit by saying that they are going to spend the money on x when they know perfectly well that they cannot guarantee that.
I stress, however, that if we agree to loosen Whitehall's grip, it is important that there is much greater local accountability. As part of a series of far-reaching reforms, we will set out shortly a programme for much greater transparency and accountability for the NHS at local level. Hon. Members and their constituents will be able to hold their local health services to account for how they spend taxpayers' money. As a starting point, strategic health authorities have already reviewed how PCTs actually go about prioritising support for carers. We will publish the results of that audit and they will be put in the House of Commons Library in the near future.
I am afraid that I have to inject a dose of realism into this debate, as we also have to deal with the repercussions of the financial legacy that the Government inherited. As the recent Budget made clear, the Government will
need to make significant cost savings to help the country to reduce the deficit. There will be a premium on efficiency and on ensuring that every penny of taxpayers' money counts, reaches the front line and makes a difference to carers' lives.
That may involve difficult judgment calls. For example, I have just made the decision to terminate the caring with confidence training programme on the grounds that it was not delivering value for money or giving carers training where it mattered. We will be providing the training materials from that programme free of charge to carers' centres and others so they can carry on, with local partners, delivering training for the benefit of carers who need it. Having cancelled that programme, we can now ensure that the money does much more to benefit carers on the ground. We will shortly roll out a training programme to raise GPs' awareness of their role in, and contribution to, supporting carers.
Better support is not necessarily about spending more money; it is about spending more wisely, which is what we intend to do. At the same time, the state should not over-reach itself. There are limits to what the Government and statutory services can do on carers' behalf. As demography and patterns of disease remould our society, the wider community has a responsibility to adapt to those changes. That involves a big role for charities and voluntary groups, which can do much to stimulate grassroots response to many of the day-to-day issues that carers face. As a Member of Parliament for 13 years, I come to this debate not because of my personal experience in a caring role but because I have been taught and shown the issues confronting carers by my own carers' centre in the London borough of Sutton.
Whether we call it active communities, social capital or the big society, we need to reignite the latent sense of collective responsibility that leads people to look out for each other and make the small gestures that can help in a big way. Employers also have a big role to play in making it easier for carers to stay in work. We pledge to extend the right to request flexible working to all employees, but a right to request is not a right to have. I am conscious that change depends on whether organisations across the private and public sectors grasp the economic arguments about what making such a commitment will deliver. We will be making those arguments strongly in the coming weeks and months, and I hope that all hon. Members in the Chamber will make the case when talking to employers and employers' organisations in their constituencies. We must also make staff much more aware of the opportunity to ask for a break. The right to request was introduced four years ago, yet recent research indicates that half of those entitled to it did not even know that they had that right.
In conclusion, carers are and will remain a vital thread holding our society together. We pick at that thread at our peril. We will use this summer to develop a fresh, new carers strategy. We will build on what went before and acknowledge what the last Government did, but ensure that what we have is deliverable and affordable, and that it addresses carers' concerns. I hope that today's debate will play its part in shaping that refreshed strategy, and I look forward to hearing hon. Members' contributions.
Mr Joe Benton (in the Chair): Order. Before I call the next speaker, I refer again to the fact that 10 Members have so far indicated that they want to speak. As Members know, the debate will finish promptly at 5.30 pm. Obviously, I will do my best to accommodate everybody, but that is not a matter for me. However, I ask hon. Members to bear that in mind so that everyone can speak.
Kate Green (Stretford and Urmston) (Lab): I am pleased to have the opportunity to speak in this debate, not least because it is an important chance for us to pay tribute to the tremendous contribution made by carers across the country. I pay tribute particularly to the carers in my constituency.
As the Minister rightly said, many people do not even identify themselves as playing a caring role, yet they make a substantial contribution to supporting family members. That, of course, saves the public purse an enormous amount of money, but it frequently puts such individuals and their families under great pressure and stress.
I want to highlight the importance of providing carers with the financial support needed to participate fully in a life beyond care. That is at the heart of all the other forms of engagement and support rightly identified by the Minister, such as service support and measures enabling carers to get out into the community and, if they want to and can, to take up paid work.
I am concerned that carers are facing a raw deal financially. Many carers are placed in a position of relative poverty as a result of their caring role. I am concerned that recent announcements and the effect of the spending cuts that are still expected could put them in a yet more difficult position.
I am particularly anxious that, in the medium term, linking the value of safety net benefits to the consumer prices index will depress the value of carers' income. I think that we would all agree that carer's allowance is far from generous. Many other benefits important to families that include carers will be hit by the same constraint. The financial resources available to carers are a concern. Clearly, adequate financial resources are a prerequisite of every form of social participation: for example, the ability to take time out to go to the cinema, to go swimming or even just to have the pleasure of a cup of coffee in the town centre down the road.
The second issue about which carers have expressed concerns to me, not because it directly affects them individually but because of its effect on the people for whom they care, is the Government's intention to test eligibility for disability living allowance. Carers recognise that their entitlement to carer's allowance is affected in many cases by the assessment made of the individual for whom they care and whether that person is entitled to DLA.
I alert the Minister to the difficulties already arising in the processes for testing people for the new employment and support allowance. If testing is to be widened significantly, it is important that those problems are not replicated and that people's eligibility for benefits to which they are entitled can be confirmed quickly. It is extremely retrograde to run people through medical tests for a disability living allowance intended not specifically
to meet medical needs but to support much wider social participation needs. This is about meeting the extra costs that come with disability and long-term ill health. Medical assessments do not get to the nub of those problems.
Another of the Government's financial announcements affecting carers that is causing concern is the decision not to continue with the savings gateway. Caring eats into savings, leaving families with little to fall back on. The savings gateway has been a success story, enabling people to set aside modest amounts in the knowledge that their saving plan would be supplemented and supported by Government investment. Many carers are disappointed that it will not continue.
I am sure that my hon. Friends and other hon. Members will also want to speak about the impact on the wider service network available to carers and concerns about the implementation of public service cuts. The cuts must be made in a way that protects carers and ensures that their needs continue to be met. I highlight particularly the concerns in my constituency about the tremendous time lag in assessing family members' needs that frequently leaves carers without any support at all. Often, in due course, that support is put in place, but it is quite unacceptable that assessments should take weeks, months or, in some cases, even years. In the meantime, carers are put under great pressure to manage as best they can.
Other hon. Members will also want to draw attention to the opportunities for carers to participate more fully in paid work. I was pleased that the Minister referred to the need to ensure that people are aware of their right to request flexible working and acknowledged that we have a significant job to do with regard to employers. I certainly accept his challenge to ensure that the employers in my constituency are well aware of the issue. There is a particular imperative on the public sector to lead the way and to show that it can be the sort of employer that exemplifies the highest of standards in this field.
Of course, the real problem for carers entering paid work is the massive financial disincentive that they face as soon as they earn only a modest amount of money and the cliff-edge threshold that comes in as soon as they are on earnings of more than £97 a week. I think that we can all agree that that is a modest sum-for a large number of carers, work simply does not pay. We cannot afford the carer's allowance to become the new equivalent of the much criticised dumping ground that, in effect, incapacity benefit became, when it was used as a way of massaging people out of the workplace on to some other form of inadequate benefit. It is important that carers can make work pay through a more generous disregard of earnings and a more gradual withdrawal rate as they move into paid work.
Everyone understands the financial pressures on public expenditure, but it is absolutely wrong that carers, who contribute so much and who are among the poorest, should take the biggest hit. They are being hit by the triple whammy of poor benefits, a difficulty in making work pay and a worry about the future investment in the services on which they rely. Those factors cumulatively add up to a severe limitation on the ability of carers to participate in the activities outside caring that so many of them desire to undertake. I very much hope that the public spending round of the comprehensive spending
review will provide more generosity towards that vital group of people than the Budget has given us cause to hope for so far.
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