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House of Commons
Friday 7 September 2012
The House met at half-past Nine o’clock
Prayers
The Chairman of Ways and Means took the Chair as Deputy Speaker (Standing Order No. 3).
Mr David Nuttall (Bury North) (Con): I beg to move, that the House sit in private.
Question put forthwith (Standing Order No. 163).
The House divided:
Ayes 0, Noes 46.
[9.34 am
AYES
Tellers for the Ayes:
Philip Davies and
Mr David Nuttall
NOES
Alexander, Heidi
Baldry, Sir Tony
Barker, Gregory
Benyon, Richard
Bone, Mr Peter
Bottomley, Sir Peter
Bradley, Karen
Brown, rh Mr Nicholas
Bryant, Chris
Burns, rh Mr Simon
Cunningham, Alex
Dakin, Nic
David, Wayne
Fitzpatrick, Jim
Francis, Dr Hywel
Gauke, Mr David
Grant, Mrs Helen
Greatrex, Tom
Hamilton, Mr David
Hammond, Stephen
Hancock, Matthew
Hanson, rh Mr David
Hodgson, Mrs Sharon
Hollobone, Mr Philip
Hurd, Mr Nick
Irranca-Davies, Huw
Johnson, Diana
Keeley, Barbara
Kendall, Liz
Lamb, Norman
Lewis, Brandon
Malhotra, Seema
McCarthy, Kerry
Munn, Meg
Murray, Ian
Ottaway, Richard
Pincher, Christopher
Randall, rh Mr John
Rees-Mogg, Jacob
Sandys, Laura
Truss, Elizabeth
Umunna, Mr Chuka
Vara, Mr Shailesh
Webb, Steve
Weir, Mr Mike
Wright, Jeremy
Tellers for the Noes:
Greg Hands and
Mr David Evennett
Question accordingly negatived.
7 Sep 2012 : Column 498
Social Care (Local Sufficiency) and Identification of Carers Bill
9.48 pm
Barbara Keeley (Worsley and Eccles South) (Lab): I beg to move, That the Bill be now read a Second time.
I welcome the Minister to his new role and to his first debate, I think, in the main Chamber as Minister responsible for care services. After being drawn third in the ballot for private Members’ Bills, I knew that I wanted to introduce a Bill to improve quality of life for carers. I have been able to introduce a ten-minute rule Bill on the identification of and support for carers three times in the past, in 2006, 2007 and 2010. A number of the sponsors of this Bill also supported the earlier Bills. I particularly highlight the support of the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who both supported each of those three Bills. I also want to highlight the support of the former Minister for social care, the hon. Member for Sutton and Cheam (Paul Burstow), who supported my Bills in 2006 and 2007. I thank the former Minister for his work on this Bill and for meeting me and the Bill’s sponsors to discuss the issues.
The issues addressed by this Bill are of great importance to carers and the people for whom they care. The Bill is supported by 28 national organisations and I shall mention some of them now: Age UK, the Alzheimer’s Society, the Carers Trust, Carers UK, Independent Age, Leonard Cheshire Disability, Marie Curie Cancer Care, Parkinson’s UK, the Royal National Institute of Blind People and the National Union of Students. In addition, 57 local organisations and three NHS bodies support the Bill, as well as more than 2,000 individual carers.
Clauses 4 to 6 focus on the identification of carers. I will talk about them later, but first I shall speak to clauses 1 to 3, which address the sufficiency of social care. We know that demographic pressures are increasing the demand for care services, which is often described as the care crisis. I, like other hon. Members, have argued many times that we need to close the funding gap for social care. The provision of sufficient social care is complex. As Andrew Dilnot says in the report of his commission on the funding of care and support:
“It is a matter for celebration that people are living longer. For many, these are extra years of good health and quality of life. For others whose care needs grow, we see much fear and uncertainty. Caring for and supporting each other should be something to celebrate. In the life and work of individuals and carers we can see dignity and independence made possible, and much that is good about our communities and society.”
We should indeed celebrate the fact that we are living longer and that more than 5 million carers are willing to provide care and support to a family member or friend, but we should also ensure that we support those carers and acknowledge that they have a right to work, and to have a social life and leisure, alongside their caring commitments. The Government frequently express that as their aspiration in carer strategy documents, but it is not what happens in many parts of the country.
A lack of identification of carers and of appropriate support for them has costs for not only the individual but our economy. Carers UK estimates that 1 million
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carers have given up work or reduced their working hours so that they can care. Its 2011 survey found that 31% of working age carers gave up work or reduced their working hours to care because support services were insufficiently flexible, because the person for whom they cared did not qualify for support, because there were no suitable services in the area, or because the services were too expensive or not reliable enough.
There are many case studies showing the great impact that giving up work to care has had on carers’ lives. Salford carers centre told me of carers who, after seeing no way of avoiding giving up the work that they loved in order to care, felt “desperate” or
“upset at being pushed into a corner”.
Carers UK cites the example of Susan who cares for her adult son, Tom, who has severe autism. Tom needs a lot of care, including constant supervision, because he regularly has fits. He has no sense of danger and does not eat unless prompted. Susan used to be head of English at her local school, but she was forced—she had no alternative—to give up her job to care for Tom because his college holidays did not fit the school holidays, and it was impossible to find suitable replacement care for him. Susan would like to work but, without appropriate care services, she can fit in only 12 days of supply teaching each year around caring for Tom.
Age UK told me about Christine who cares for her mother, Margaret. After Christine’s father died, and owing to her mother’s mobility problems, Christine offered her mother the chance to live with her. She intended to carry on working, but her mother’s mobility deteriorated, and the strain of caring and also working in a demanding job led to the total collapse of her health. After giving up work and using all her savings, Christine found that she had to go on benefits, which wounded her pride and played on her health. Employers for Carers, a business forum of 55 employers representing nearly 1 million employees, supports the Bill as a measure that is important for our country’s future economic productivity.
Diana Johnson (Kingston upon Hull North) (Lab): Given the country’s economic circumstances, we all recognise the importance of keeping people in jobs whenever possible and of creating jobs as part of an attempt to grow the economy. Does my hon. Friend agree that the Bill would go some way towards helping that to happen?
Barbara Keeley: Absolutely; I thank my hon. Friend for that point.
The Bill is also supported by British Gas, BT, Bright Horizons and PricewaterhouseCoopers because they believe that its measures are important. Caroline Waters OBE, the director of people and policy at BT and the chair of Employers for Carers, says:
“We are seeing the mounting costs, not just to families but to business of a care system that often cannot support carers trying to juggle work with care. Stimulating the care market can deliver an economic triple win—better services for families, the infrastructure to help employers retain skilled staff and a real boost to economic growth. The debate started 20 years ago with childcare and there is now a pressing need to bring the same focus and progress to
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care for older and disabled people. This Bill would start this important process by placing a duty on local authorities to ensure a supply of care as is already the case for childcare.”
Members of the Employers for Carers forum increasingly report staff leaving work at short notice to take on caring responsibilities. The peak age for caring is between 45 and 65, and that age frequently coincides with the peak of an employee’s skills, knowledge and experience. Losing such employees can lead to large retraining costs on top of recruitment costs.
A recent report by Dr Linda Pickard of the London School of Economics shows that carers giving up work to care costs about £1.3 billion a year in lost tax revenue and benefits. Also on costs to the economy, a recent report by Carers UK suggests that the failure to address the funding of adequate care provision, as other countries have done, means that we are missing out on jobs and growth.
Seema Malhotra (Feltham and Heston) (Lab/Co-op): Does my hon. Friend agree that it is vital that we support carers of working age who are reducing their work hours and days because of the disproportionate impact it has on their pension savings and entitlements? The prospect of becoming a poor pensioner is not the right reward for those who give so much to families and our communities.
Barbara Keeley: Sadly, that is the case. We know that the care sector is underpaid, but that is nothing compared with the financial impact of giving up work to take on a caring commitment.
Roberta Blackman-Woods (City of Durham) (Lab): I was interested in my hon. Friend’s points about employers. Does she agree that it is in employers’ interests to learn more about the needs of carers, and to support them better, so that they do not lose valuable, well-trained staff and have to recruit new ones?
Barbara Keeley: I very much agree, and I am sure that that is why the Bill has received such strong support from Employers for Carers.
Other countries have put in place development strategies for home care. In France, the first phase of its development strategy for the home care sector led to a growth of 100,000 jobs year on year. However, even after the worldwide recession, such strategies have led to 50,000 more jobs there each year.
There is a real need for care and support services to enable carers and disabled people to work, but the social care picture in England is one of growing need, shrinking provision, and totally inadequate information and advice about what is available. I have discussed the cuts to social care budgets during previous debates on social care funding.
Dr Hywel Francis (Aberavon) (Lab): My hon. Friend makes a powerful case. Is she aware of good practice in Scotland and Wales that England should be following?
Barbara Keeley: I have not followed that as closely as I might have done, so I hope that we will hear from my hon. Friend later about the practice in Wales. However, we have much to learn from other countries.
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It is important that we bear in mind the shrinking provision of social care because we know that demand is growing. Since 2010, local councils’ adult social care budgets have been cut by more than £1 billion, and a further £1 billion of cuts is expected. The number of vulnerable older and disabled people who have their home care services fully paid for by their local authority has fallen by 11% over the past two years. According to a survey by the Care and Support Alliance, services have been cut to 24% of disabled adults. Research by Age UK shows that cuts to council budgets mean increased fees for services—in fact, service fees have increased by 13% over two years. Almost half of all local councils are charging more, or making new charges, for home help or day care. One in six councils has reduced personal budgets for care packages, and almost half of all councils have frozen the rates that they pay for residential care. In addition, the fees for both residential care and nursing home care have increased by 5% on average during the past year.
Those are important statistics, but sadly they are not routinely gathered so that they can be scrutinised by, for example, the Health Committee. They were mainly gathered through freedom of information requests by my hon. Friend the Member for Leicester West (Liz Kendall) and various organisations. Local authorities do not have a full picture of local care provision, particularly that needed by the 80% of care users who are self-funding. Those self-funders—people whose assets exceed the means test for local authority support—spend £5.5 billion a year on care, with top-ups to statutory services costing them another £1.15 billion. It is vital that we have a better and more complete picture of social care provision, including that very large amount for self-funders.
Clauses 1 and 2 introduce a strategic duty on local authorities in England to ensure that sufficient social care services exist in their local area to meet the care needs of disabled people and carers. They seek to move towards local authorities having a total and accurate picture of what is purchased and provided in their area. Existing duties on local authorities relate only to those for whom the local authority has a statutory responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds.
It might be argued that the Government’s draft Care and Support Bill introduces a duty on local authorities to establish and maintain the provision of information and advice relating to care and support for adults and carers. The draft Bill says that a local authority must promote the efficient and effective operation in its area of a market in services for meeting care and support needs. However, that duty does not cover an assessment of local sufficiency, and it is that picture that can truly help carers and disabled people, particularly in terms of working, as we have just discussed.
Andrew Dilnot, in his 2011 report, set out the need to place duties on local authorities to provide information, advice and assistance services in their area, and to stimulate and shape the market for services. Moving to embrace a duty to develop a full picture of care and support services, and to assess the sufficiency of those services, will assist local authorities in developing their role as market shapers.
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Clause 2 includes a duty to promote sufficiency of the supply of care, which, as we have discussed, would bring a new focus on the importance of social care in promoting and enabling work for disabled people and unpaid family carers. Carers UK has analysed local authority joint strategic needs assessments, which is really the only assessment that we have, but this analysis has shown that the majority of those assessments do not link care provision with work, so clause 2 would link well with Government strategies around work for carers and people with disabilities.
Kerry McCarthy (Bristol East) (Lab): A couple of weeks ago in my constituency, I met a group of young adult carers aged from 18 to 24 who, for the most part, look after disabled parents, but sometimes siblings as well. They have particular needs because they are at the stage when they want to get on with their careers and perhaps go to university, and they have to make the choice between that and putting their life on hold to care. Does my hon. Friend agree that we need particularly to look at the needs of that group, who do not fall into the same category as other adult carers?
Barbara Keeley: I do, and I will come on to the issue of student carers. The Bill explores student carers for the first time. I do not know why the issue has not been discussed more in the House, but it is vital that we, as constituency Members, take note of it.
Joint strategic needs assessments done at local level do not link care provision with work, and that is why the clause is important. The Department of Health has an upcoming event on developing care markets, the invitation to which we received yesterday. It says:
“the ability to choose from a variety of high-quality services should be available to all people in a local area, regardless of who pays for their care.”
Age UK, in its support for my Bill, commented on that Government aim to give people who need care and support a greater choice. It said:
“this cannot become a reality unless local care markets work effectively to provide people, including those with specialised needs, with appropriate services. Whilst we welcome proposed duties in the draft Care and Support Bill that would require local authorities to take steps to ensure that appropriate services are available this falls a long way short of a requirement to ensure sufficiency. We will certainly be advocating for a Bill or subsequent regulations that will include more specific duties on local authorities.”
Philip Davies (Shipley) (Con): I congratulate the hon. Lady on introducing the Bill and bringing the plight of carers to the House. We all owe carers a big debt of gratitude. The Bill is littered with phrases such as “practical steps”, “reasonable steps” and “sufficiency”. What does she consider sufficient and reasonable, because the Bill does not make that clear, and how much would those steps cost?
Barbara Keeley:
I will come on to the sufficiency measures, which are similar to a provision in the Childcare Act 2006, which placed a duty on local authorities to report on the sufficiency of child care in their area. The key thing is to ensure, first, that local authorities have a good enough picture. At the moment, the only picture they have is of what they are commissioning and providing, and, as I said, 80% of people who need care are self-funding,
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and their needs and whether they are being met are not looked at all. We therefore have a huge gap in information on the needs of those people and whether they are being met. There might be a need for nursing home beds for people with certain categories of dementia, and unless they were paying for them, local authorities would have no idea whether those existed. That information does not exist for all the people living in an area who needed that provision. As I said, health bodies and local authorities do joint strategic needs assessments, but they are not taking account of the fact that that can help people to work. We are trying to ensure that, as with child care, there is such provision, so it is similar to that measure.
The Bill does not go into detail because that is usually done in regulations which would be decided after the Bill had been passed. These are matters that can be debated and decided in Committee. However, in placing new duties on local authorities we are aware that we want regulation to be as light touch and low cost as possible. That is why some of the language is hedged around with phrases such as “reasonable steps”. We do not want to put expectations on local authorities that they cannot meet in the present environment.
Philip Davies: That was a helpful response. To get to the nub of the issue, does the hon. Lady believe that the House should pass legislation to provide certain duties, at whatever cost, which should be met, or does she accept that only a certain amount of money can be afforded and that the question then is how best that can be allocated?
Barbara Keeley: We are talking about a reporting duty. If local authorities, working with their health partners, do not report on social care provision, no one else will. Those of us interested in these matters ask questions, but we do not get very good information. Sending freedom of information requests to every social care authority in the country is not the best way for national organisations or Members of the House to get such information. We are asking for a picture of the market to be held in each local area. I am not suggesting a move in a direction in which the Government are not already going. The Government now expect local authorities to be what they call “market shaping”, taking action to drive the market. We are saying that they do not even have a picture of what exists now. Until we have such a picture, which is not just gathered by freedom of information requests, the expectation of the Department and the Government of local authorities is perhaps not reasonable. It is not a budgeting duty but a reporting duty.
I was dealing with sufficiency and the reporting duty and saying that organisations such as Age UK believe it is important that local authorities have a view of the sufficiency of their local care services. To expand on a point my hon. Friend the Member for Leicester West has made, the way local authorities are currently cutting back on what they pay in fees for social care beds and nursing home beds is actually creating market distortions, because some providers are simply moving to areas where there are more self-funders. In Greater Manchester, for example, all the nursing home providers might move to Trafford, which is a wealthier borough, and we would
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not have proper provision in Salford, part of which I represent. What is happening in the market could result in that kind of distortion, and that should be spotted.
Mr David Nuttall (Bury North) (Con): I am grateful to the hon. Lady for giving way and, indeed, for bringing the matter before the House; she is making a valuable contribution. Does she not share my concern that there is a danger that imposing new duties to prepare the various assessments and reports that the Bill would require could actually take funding away from the provision of front-line services?
Barbara Keeley: I have run through some of the details. Front-line services have already been greatly reduced. In fact, local authorities are no longer primary providers, given that they are meeting the needs of a very small group of people.
Let me get back to the point about sufficiency. The all-party group on local government has recently conducted an inquiry into adult social care, supported by the local government information unit. We looked at the role of local government in shaping the local market for social care and took evidence from local authorities that are already acting on that. Interestingly, Nottinghamshire county council told us that it monitors and records occupancy and availability of care home beds for self-funders, which is unusual. Lancashire county council told us that it provides advice and information to all on mainstream services, and signposting to them, regardless of whether people would be eligible for council services, and it is one of the first authorities to do that. The inquiry found some examples of market-shaping activities by local authorities, but the final report was clear that that was only an emerging role for local authorities, and we could not find many examples.
Clause 3 therefore provides that local authorities should assess local care needs and existing social care provision, and if supply does not meet demand, as the hon. Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) have just touched on, the local authority would have a duty to consider the necessary steps to address the gaps. They would not have to take those steps; it is just that nothing will happen unless they have some idea of how it might happen. In their market-shaping role, for instance, they might try to encourage more nursing home providers of a particular type. That is similar to measures set out in the Childcare Act 2006, through which the Government sought to ensure sufficient local child care.
Clause 4 would ensure that NHS bodies had procedures in place to identify carers, promote their health and well-being and ensure that they received appropriate information and advice. I first sought to introduce such a measure in 2006 through a ten-minute rule Bill, and then again in 2007. I acknowledge that progress has been made, but there is still much to do. As we know, many carers do not recognise that they are carers; they see their caring role as part of being a wife, husband, son or daughter. Many are hidden, particularly at the start of caring.
I believe that a key focus in identifying carers should be concern for the health of those with the heaviest caring commitments. The 2001 census found that 10% of all UK carers were caring for more than 50 hours a week. Interestingly, figures published by the NHS
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Information Centre show that that figure had doubled, to 22%, by 2010. In Salford, the proportion of carers who provide full-time care has actually been at a higher level for some time. In 2001, around one in four carers in Salford provided care for more than 50 hours a week, and even at the time that was more than twice the national figure for carers with the heaviest commitment. I am almost certain that that is related to health inequalities and poor health.
Two wards in my constituency have very high levels of people caring for relatives with stroke disease, heart disease or cancer, which mean the heaviest commitments. We know that full-time care can take a toll on a carer’s health, so the health needs of carers must be recognised. We know that those caring for more than 50 hours a week are twice as likely to suffer ill health, and those caring for a person with dementia or stroke disease are even more at risk. Early identification and support for those carers means that they can maintain their health and manage and sustain their caring role better.
The Princess Royal Trust for Carers centre in Salford has a project to identify carers both within primary care and at the Salford Royal hospital. I want to take this opportunity to pay tribute to The Princess Royal Trust for Carers for its work in primary care over many years in centres such as the one at Salford. Its work has been done by a primary care worker, Julia Ellis, and the centre manager, Dawn O’Rooke. In fact, the previous Minister responsible for care services, the hon. Member for Sutton and Cheam, visited my constituency to hear about the trust’s project to identify carers within primary care. I extend an invitation to the new Minister to do the same.
Different local GP practices do the work of identifying carers differently. For example, practice nurses from the Limes medical centre carry out their identification work when making home visits to patients who seem to have a carer. They run through a series of questions with the patient and carer about who does certain tasks and then fill in a referral card for the practice to ensure that the health team knows about the carer so that they can be referred to sources of advice and support. The Dearden Avenue medical practice has a different approach. Its staff carried out a search on the practice’s computer. For all those patients over 70 who are not in residential care, a letter was sent to the next of kin asking if they were the patient’s carer. Of 149 letters sent, 90 were returned by carers. The carers centre could then send information about the care and support available to the carers, including having an assessment of their own needs.
I am pleased to know that GPs and primary health care teams in my constituency are tackling that work, but there is much more to do. The manager of the carers centre tells me that, having established a network of links within GP practices to identify carers, over 300 referrals a year are made to the centre by local GPs. However, we have some 20,000 carers in Salford, of whom around 5,000 will be caring for more than 50 hours a week. We need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them for advice and support.
Clause 5 would require local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. Young carers are the most hidden of all carers. The
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2001 census recorded some 175,000 young carers, but more recent research by the BBC indicates the much higher number of 700,000, which is around 8% of secondary school pupils. Most young carers care for a parent, often a single parent. The care they give might involve much physical care or the difficult task of providing emotional support for a parent with a mental health problem or substance addiction.
The Carers Trust tells us that the identification of young carers remains a key issue, as many young carers seek help only in a crisis. As we have discussed in previous debates, many young carers find that their extra responsibilities lead to their failing to complete work for school, doing badly in exams and, worst of all, being bullied. Although teachers and social workers are the best people to identify and support young carers, there is a lack of professional awareness about their needs and concerns. Young carers report that they can feel stigmatised by teachers, and they might leave school or college prematurely without completing qualifications.
Roberta Blackman-Woods: My hon. Friend makes a wonderful point about the need to support young carers more. I have been a school governor for more than 20 years but have never heard the governing body talk about the needs of young carers. That needs to be addressed and more information needs to be given to governors and head teachers.
Barbara Keeley: My hon. Friend is absolutely right. Indeed, the carers centre in Salford has a young carers project that has developed to the point of having a presence in all but one of the secondary schools in Salford. It has also started a more limited level of work in primary schools. It is vital, because it is identifying young carers and spreading awareness among teachers and pupils about the role of young carers. It is only that work with other pupils that will stop them bullying and picking on young carers.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab): Further to that point, does my hon. Friend agree that it is vital that all professionals who come into contact with young carers get together and communicate more, especially with regard to young people who are trying to stay under the radar and doing everything possible not to be identified as carers? The one person in their lives who could probably identify them as carers is the GP, because the GP would know the needs of the parent they are no doubt caring for.
Barbara Keeley: Very much so. It sometimes involves social workers and very often teachers. Teachers need this awareness because young carers may fail to turn up at school, not do their work on time, and not be there for exams. It is often said by young carers’ organisations and projects that GPs and health professionals ignore young carers. A 10 or 11-year-old is expected to care for someone with perhaps an alcohol problem or a mental health problem, and yet the GP or doctor involved in that situation simply ignores them, treating them as if they were not there.
Diana Johnson:
Given what my hon. Friend is saying about young carers, there appear to be similarities with looked-after children. Measures have been put in place in schools to ensure that looked-after children are given
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the support they need in difficult circumstances. Could we transfer those measures to children who are caring for siblings or parents?
Barbara Keeley: I am sure that there are similarities. This field of work is opening up, but much more needs to be done.
It is interesting to talk to organisations such as the Carers Trust and the Children’s Society, which run the young carers projects, about identification, which my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) mentioned. Young carers are already eligible for assessment under carers legislation and as “children in need” under the Children Act 2004, but very few of them are identified or ever assessed for support. In supporting the Bill, the Carers Trust says that
“clear duties on local authorities and further and higher education institutions to identify and support young carers will help ensure that inappropriate caring is prevented or reduced so that young carers can enjoy the same opportunities and outcomes as other children and young people.”
Dr Francis: Does my hon. Friend agree that as the Bill progresses it will be important for the Minister to look at the excellent work that Crossroads Care did in the recent past in supporting young carers through projects of the kind that she has described?
Barbara Keeley: I am sure that it will. The difficulty with capturing this in the Bill, as in any legislation, is that it spreads across Departments. It is something for us to work on, and there is much to be done.
Young carers do not enjoy the same opportunities and outcomes as other children and young people. The Carers Trust tells us that young carers frequently experience worry, stress, anxiety, depression and feelings of loss and panic, as well as mental health problems and risk of self-harm. They fear for the condition of the person they care for, but they often have more fear of being taken into care. They feel angry and resentful because they have such responsibilities, yet they are not recognised. Most of all, they experience a lack of time for play, leisure and sport, and miss out on social time with their own age group. A serious consideration for all of us, given that we are talking about 8% of the secondary school population, is that a caring role also leads to missed educational opportunities, poor educational outcomes, and, later on, reduced employment opportunities. Over a quarter of young carers aged 11 to 16 miss school owing to caring, and that figure rises to 40% when the parent is mentally ill or misusing drugs or alcohol. Young adult carers are twice as likely as their peers not to be in education, employment or training. It is common for them to move into full-time caring after they finish compulsory education, particularly if they are receiving no support.
Clause 6 would place a duty on colleges of further and higher education to identify students who are carers and to have in place policies of support for them. When we included this proposal in the Bill, I did not realise that it was quite ground-breaking and new. A report in 2008 by Young Carers International for the Princess Royal Trust for Carers reported that there were 290,000
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young adult carers in the UK. The figures move between 300,000 and 800,000; nobody really has any idea. The report said that apart from statistics that could be obtained from the census,
“Little is known about young adult carers aged 16-24 in the UK”
“Information is sparse about the issues and challenges that they face due to being carers”.”
Young adult carers at university or college have to balance giving care with their academic studies and learning. Some do this by caring at a distance, returning home at weekends or holidays to provide care, but others have to balance care and study by continuing to live at home and travelling to their local university so that they can maintain their regular caring roles. The report told us that none of the young adult carers at university it surveyed was aware of any specific carer support being available at their university. Similarly, they were often unaware of local services for carers that might be able to support them because, sadly, those services have not reached out to university student populations. There is a mismatch in that regard.
That was the situation in 2008. It is interesting that only this year greater awareness of the needs of student carers seems to be developing. The Fair to Care campaign in Scotland is lobbying for the development of carers’ strategies in universities.
Mr Nuttall: What is the problem that the hon. Lady is seeking to address in this clause? Is it that she feels that student carers do not have access to information?
Barbara Keeley: The problem we are trying to address is that the people who are responsible for the welfare of these students and their progress through their courses do not recognise that caring will get in the way of what they can achieve at university, given all the potential difficulties—for example, a sudden deterioration of the cared-for person’s condition. Policies are often in place for parent carers with children and mature students, but there is a complete gap in what universities have considered for other carers.
Mrs Hodgson: I hope that the Bill will deal with a situation that I fear my daughter’s best friend will otherwise fall foul of. They have both just done their GCSEs, they are both as able and bright as each other, and they both want to go on to university. My daughter plans to go away to university while her friend is considering staying in the local area, for the reasons my hon. Friend has highlighted. I worry that without the Bill her aspirations may never be fulfilled, because if she does not get the support it suggests she might start at university but then find that she is unable to continue. That would be so sad, because at 16 the two friends are as bright as each other.
Barbara Keeley: I agree; that is a very good point.
Philip Davies:
I wonder whether the hon. Lady is being unfair to universities by saying that there is a gap in the provision of information for student carers. I do not doubt that she knows more about the subject than I do, but my local university, Bradford, has a very extensive policy on student carers, with lots of information about
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what help could be provided. In saying that there is a gap, does she think that he might be doing a disservice to universities such as Bradford, which are clearly doing an awful lot to help student carers?
Barbara Keeley: I am very glad to hear that Bradford does that. Professor Luke Clements of Cardiff university, who helped to draft the Bill, says that it depends on having the right sort of vice-chancellor with go-ahead policies. It is not only I who believe that there are gaps; so does the National Union of Students, which understands these things. Particularly in Scotland, the websites of people who are standing for representative positions in the NUS show that they are all campaigning on Fair to Care and asking universities to have a carers strategy. It must therefore be the case that lots of universities, including those in Scotland, do not have a carers strategy. We are asking that a policy be put in place to recognise carers’ needs and tell them where to go for support. I am glad that the Bill would remedy the situation whereby perhaps hundreds of thousands of student carers are left to struggle alone with the difficult demands of juggling their caring responsibilities alongside studying.
The Bill deals with vital issues for carers and for disabled people. I thank Professor Luke Clements and Carers UK for their help in drafting the Bill. Emily Holzhausen and Chloe Wright of Carers UK have provided much extra support in preparing for today’s debate, and I thank them for that. I also thank Kate Emms of the Public Bill Office for her sound advice and help. I thank all the co-sponsors of the Bill for their support for the measures it contains. It has been good to know, as we have worked on this, that the issues involved in social care and the need to identify carers, young carers and student carers generate such great cross-party support.
The provisions in the Bill should be taken forward, and I hope that we will get the chance to discuss and, if necessary, modify them in Committee. Five million carers, including young carers and student carers, depend on our progress on measures that will help them, and I hope that we do not let them down.
10.29 am
Sir Tony Baldry (Banbury) (Con): The Government published their White Paper, “Caring for our future: reforming care and support”, just before the summer recess, and I think we would all agree with its statement:
“Carers make a vital contribution to promoting the wellbeing and independence of the people they care for…The support provided by millions of carers is testament to the strength of our society and our communities. However, we also recognise that caring brings challenges. Providing better support to carers is therefore crucial to ensure that they can maintain their own health and wellbeing, care effectively and have a life of their own alongside caring.”
Earlier this year, various all-party groups, including the all-party group on social care, which is chaired by the hon. Member for Worsley and Eccles South (Barbara Keeley), who has so ably introduced this Bill, and the all-party group for carers, which I co-chair, met to consider the measures needed to do exactly what the Government say they want to do in their White Paper, namely provide better support for carers, so that they can
“care effectively and have a life of their own alongside caring.”
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The hon. Lady was fortunate enough to come reasonably high in the ballot for private Members’ Bills and, with the help of a number of carer organisations, such as Carers UK, drafted a Bill that addresses the challenge of how we can give effective support to carers.
The Government then published their much-awaited White Paper on social care, which was widely welcomed. I am delighted to say that, for the first time, it makes substantial commitments to carers, which I will come to in a moment. Unfortunately, but perhaps understandably, most of the press commentary on the White Paper centred on what the cost of residential social care would be. The new policy and the contribution to the support of carers were not necessarily highlighted sufficiently, but they are included in the White Paper.
The hon. Lady and those involved in promoting the Bill examined the measures in the White Paper and considered what other measures would be of further benefit to carers. A number of the Bill’s provisions are, therefore, not included in the White Paper, but I acknowledge that there is some overlap. For example, clause 1, which would introduce a duty to ensure sufficient social care support, is probably covered by the provisions in the draft Care and Support Bill.
I am anxious to find a way forward whereby we do not wake up tomorrow morning to headlines stating that the Government have killed off a Bill that would give more support to carers. We need to find a grown-up way to do this. My hon. Friends the Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) are present, and I suspect that these sextons on duty—these pallbearers of private Members’ Bills—will make lengthy contributions that may well not enhance the nation’s understanding of the problems faced by carers.
Before we make any further progress, I therefore want to make a request to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), who I am delighted to see taking responsibility for this issue at the Dispatch Box for the first time. The White Paper contains a welcome chunk of policy on carers, but people involved with carers feel that some areas could be further enhanced. All I want my hon. Friend to do is give a clear undertaking that, between now and the eventual Second Reading and debate of the Government’s Bill on social care, he would be willing to have meetings with the relevant all-party groups to discuss how provisions relating to carers could be further enhanced.
I fully accept—the interventions on the hon. Member for Worsley and Eccles South demonstrated this—that there are tensions in relation to how one balances duties on various organisations and partners in ways that are reasonable to their costs, and to some of the changing patterns resulting from the fact that local governments are now seen more as enablers than deliverers. I want my hon. Friend to give an undertaking that he would be willing to have discussions with those of us who are concerned about carers policy, to try to ensure that, when the Government’s Bill on social care is presented to the House, those parts relating to carers are as robust and as resilient as possible.
I hope that my hon. Friend is willing to give that undertaking. Given that he has only taken up his brief this week and has probably yet to read the briefing for incoming Ministers in his red box, I would fully understand
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it if he felt unable to respond in detail today and say, “Well, I can accept those bits of the Bill, but not those bits.” That would be difficult. It would be disappointing, however, if there were any scintilla of a suggestion that the Government want to “kill off” this Bill because they do not want it to pass. I hope that my hon. Friend will see this as an opportunity to have a constructive debate on policy on carers and their needs, and trumpet his willingness to engage with us to make sure that those parts of the Government’s new Bill relating to carers are as good as possible.
The Minister of State, Department of Health (Norman Lamb): I am grateful to my hon. Friend for his comments, and I am happy to give, straight away, the undertaking that he seeks. I will engage fully with the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the Bill’s promoter, and with the relevant all-party groups. It is important that we get this right and that we do not let down those people with caring responsibilities. I am very happy to give a firm commitment to engage fully between now and when the Government’s Bill is presented to this place.
Sir Tony Baldry: I am grateful to my hon. Friend for that undertaking. I would understand if the Government did not want the Bill under discussion to progress, but that must be balanced against his undertaking.
Dr Francis: I welcome the new Minister’s statement. Does the hon. Member for Banbury (Sir Tony Baldry) agree that the Minister should also be invited to engage with the national carer organisations and with the Health Ministers of the devolved Administrations, particularly because, as a good Liberal, he is an enthusiastic supporter of democratic devolution?
Sir Tony Baldry: We all know the organisations and bodies that are concerned about carers policy. I heard my hon. Friend the Minister say clearly that he was willing to engage with us and others to make sure that, when the Bill on social care is presented to the House, those parts of it that deal with carers are as robust as possible. For the first time, we are at last acknowledging that a large number of people in this country are carers and that there need to be robust policies in relation to them.
Dame Joan Ruddock (Lewisham, Deptford) (Lab): Will the hon. Gentleman give way?
Sir Tony Baldry: Before I give way to the right hon. Lady, I want to say that I hope that the Government’s Bill will codify all the existing legislation relating to carers. Over the years, a whole number of private Members’ Bills, one of which was introduced by the hon. Member for Aberavon (Dr Francis), have enhanced the role of carers. It is confusing and difficult for people to find their way around different bits of legislation, so it would be good if all of the legislation relating to carers were collected in one piece of legislation.
Norman Lamb: I am grateful to my hon. Friend for allowing me to intervene again.
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It is the Government’s ambition to codify all the provisions relating to carers and care and support in one Act of Parliament. A big problem, as he rightly identifies, is that the law has developed in a haphazard way. Getting it all into one Act of Parliament, written in plain English, would be of real benefit to carers and others in the sector.
Sir Tony Baldry: I am genuinely delighted to hear my hon. Friend say that. It is really good news. If we continue on that basis, we will make substantial progress.
Dame Joan Ruddock: I wanted to intervene to say that I was surprised that the hon. Gentleman was satisfied with the Minister. I say to the Minister that it would be a miracle if one could get every piece of legislation into one consolidated Act; it just does not work in that way.
I say to the hon. Gentleman that it would be a great shame if the Bill were talked out today, after all the work, all the effort, all the support in the country and all the Members who have come here today to support it. The place to deal with the issues that the Government may or may not want is in Committee. A vote in favour of Second Reading today would send an important message on all the matters that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has spoken about so ably this morning.
Sir Tony Baldry: Having been a Minister in the last Government and as a grown-up and senior Member of this House, the right hon. Lady has a clear understanding of how legislation works and evolves. A large number of private Members’ Bills during the 13 years of the last Government did not make progress in the form in which they were drafted. The point is not that the Bill must pass today in this form, but that it contains a number of provisions, some of which are not in the White Paper.
The grown-up and responsible undertaking that I have received from the Minister is that he will have intelligent discussions with all of us who are concerned about carers policy over the next few months to see whether we can get some of these provisions into the Government Bill when it is brought forward. If not, all of us will want to hear good reasons why, given that some of the work in the private Member’s Bill builds on previous legislation, for example on child care, where there are clear precedents for what we are seeking to achieve.
Barbara Keeley: It is not without precedent for Conservative or Labour Governments to accept private Members’ Bills relating to carers. I think that I am right in saying that of the three pieces of legislation brought forward by Labour MPs, one was brought forward with the agreement of a Conservative Government and the other two with the agreement of a Labour Government. For all the pious aspirations in the carers strategy documents that are rolled out by Governments, it is the concrete rights and measures in those private Members’ Bills that have made the difference, as I said in my speech. It is important to recognise that sometimes a specific measure is needed, rather than a lot of consolidation and aspiration, which make no difference to carers on the ground.
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Sir Tony Baldry: The hon. Lady has raised two important points and I will deal with them both, because I do not want there to be a scintilla of misunderstanding.
The private Members’ Bills brought forward by the right hon. Member for Torfaen (Paul Murphy), the hon. Member for Aberavon, Lord Pendry and others were valuable contributions. The difference with this private Member’s Bill is that since the hon. Lady and those who are proud to sponsor it brought it forward, the Government have published a substantial White Paper covering this policy area. We are dealing with a policy that the Government are still consulting on and thinking about across Whitehall and with other organisations.
It is in all our interests that effective carers legislation is, as far as is possible, contained in one piece of legislation, namely the Government Bill. I am not for one minute suggesting that codifying existing carers’ rights is sufficient. I am saying that if and when the Government bring forward the Bill on social care, I hope that a large part of it will deal specifically with carers, and that within that part there will be a codification of existing carers legislation, which the Minister has acknowledged there will be.
Dr Francis: May I clarify what happened with my Bill? It was part of the wider strategy of the Labour Government to advance equalities legislation. It is therefore slightly disingenuous of the hon. Gentleman to suggest that my Bill was somehow separate from the wider advances that were made. Similarly, he should be saying, as the joint chair of the all-party parliamentary group on carers, that he supports this Bill, irrespective of the wider advance in social care legislation under this Government, whenever it comes.
Sir Tony Baldry: I am clearly being uncharacteristically incapable of communicating what I am seeking to achieve. I do not in any way resile from the provisions in the Bill. The provisions that the hon. Member for Worsley and Eccles South has put forward are necessary and valuable. I am simply trying to find a constructive way to ensure that as many of those provisions as possible eventually arrive on the statute book.
The hon. Member for Aberavon has to recognise that the Government have a strategy for carers, which is set out very clearly on pages 34 and 35 of the White Paper on reforming care and support. It states:
“From April 2013 the NHS Commissioning Board and clinical commissioning groups will be responsible for working with local partners to ensure that carers are identified and supported.”
That existing strategy has a number of parts that we would all want to discuss with the Ministers and officials who have responsibility for this policy. For example, much of the hon. Lady’s Bill is rightly about how we help and support carers in the world of work. The White Paper states,
“we will produce and publish a road map setting out action to support carers to remain in the workforce.”
I am always a bit suspicious of phrases such as “road map”, because I am never sure what legislative force a road map has. We will want to discuss with Ministers, in fairly robust terms, how we can ensure that the Bill that the Government bring forward in due course meets the
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aspirations and needs of the millions of carers in this country, for whom all of us present in the Chamber are concerned.
Mr Nuttall: Will my hon. Friend give way?
Sir Tony Baldry: I give way to my hon. Friend, who is one of the pallbearers.
Mr Nuttall: I am most grateful to my hon. Friend for giving way. I hope to be helpful to him. Does he agree that rolling up the thrust of the private Member’s Bill into the Government Bill, which I think is the line that he is going down, would be entirely in line with the first recommendation of the Law Commission’s “Adult Social Care” report, which states that there should be a single statute in this area?
Sir Tony Baldry: Absolutely; having a robust single statute is in everybody’s interest. We need to understand that we are not abandoning, resiling from or giving up any of the provisions in the Bill, but saying, to use a rather boring lawyers’ term, that they are adjourned generally with liberty to restore. In other words, we want to make quite sure that we have the opportunity to have a series of meetings with the Minister and his officials, so that we can go through the details of what is proposed for the Government’s Bill and how many of the private Member’s Bill’s provisions we can incorporate in it. The Minister has given his undertaking that we will have those meetings, and I know it was given in good faith.
It is the Government’s clear intention and policy to support as many people as possible to be in work, and one challenge for carers is the difficulty of retaining employment. The Government, hon. Members and everyone else have common cause on that, so it is just a question of how to make effective policy.
Likewise, it is clearly crucial that carers are identified, that they know themselves to be carers and that the supporting machinery identifies them as such. The provision of respite care has helped. In the past, I have asked GPs, “Why don’t you identify patients in your practice who have carers?” They have said, “Well look, Tony, there’s not really much point, because there’s not much that we can do to help them. We can identify them, but how much further does that get us?” At least now, with the NHS being able to provide respite care, there is a real purpose to GPs’ doing that. We need to ensure that the system sends the right signals and provides the right support.
Diana Johnson: I listened carefully to what the hon. Gentleman said about employment. The Bill contains provisions to do with young carers’ education and colleges of further education. I am concerned that the Department for Education’s direction of travel is not towards providing regulation on those matters to schools, colleges and universities. The Department for Business, Innovation and Skills, which holds the universities portfolio, should also be involved in that. The Minister has given an undertaking from the Department of Health’s side, but other Departments are also involved. I am not convinced at the moment that the Bill’s provisions will find their way into the Care and Support Bill. I would like this private Member’s Bill to go forward, because it contains additional measures that we want in place.
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Sir Tony Baldry: It is very rare that an area of public policy, particularly on something as important as carers, can be dealt with by just one Department. I have absolutely no doubt that the Government’s White Paper on social care is the subject of an enormous amount of interdepartmental discussion. One task of the various all-party groups is to highlight to the Department of Health the issues that relate to other Departments, so that it can negotiate with those Departments before bringing forward its Bill. There will be cost implications in different areas, and I am sure there will be a robust debate about money on Second Reading of the Care and Support Bill. We have not yet come to that.
I say to the hon. Lady that the White Paper was published only shortly before the summer Adjournment. There has been little opportunity for any of us to interrogate Ministers in other Departments about policy areas such as those that she rightly identifies. Of course, a number of Ministers, like the one who is here today, have only just taken on new ministerial briefs. I believe that at Minister of State and Parliamentary Under-Secretary of State level, only 11 Ministers will be opening the same red boxes this weekend as they did last weekend. Those of us who have been Ministers know that it takes two or three weeks just to absorb the briefing for incoming Ministers, so we should not be impatient. What is important is to ensure that those of us who are in all-party groups relating to carers, or who are concerned about carers policy, can support the Government’s social care Bill on Second Reading.
Philip Davies: Will my hon. Friend give way?
Sir Tony Baldry: I give way to the other sexton.
Philip Davies: I am grateful. I have been trying to decode what my hon. Friend said about me and my hon. Friend the Member for Bury North (Mr Nuttall). I do not know whether he was trying to be insulting, but in his characteristically charming way, or whether he was merely saying that we take a close interest in each private Member’s Bill, which I would say was a compliment, even though perhaps a rather ham-fisted one.
Is my hon. Friend trying to say that if we get the undertakings that I am sure we would all like from the Minister today—he has already made some—it would be helpful if the hon. Member for Worsley and Eccles South (Barbara Keeley) were to withdraw her Bill?
Sir Tony Baldry: We all have to be grown-up about this. The hon. Member for Worsley and Eccles South has come up in the ballot, and it is a matter for her how she deals with the Bill. She is perfectly entitled to take it forward. I am just concerned to ensure that there is no scintilla of a suggestion that we will get ourselves into a hole. I was in the House when Nick Scott was the Minister responsible for the disabled. We got ourselves into a terrible hole over a private Member’s Bill by giving the impression that we were not interested in policy relating to the disabled, which of course was totally untrue. I do not want there to be any suggestion of that happening in relation to carers. I hope that we have now found a constructive way forward.
Roberta Blackman-Woods: Will the hon. Gentleman give way?
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Sir Tony Baldry: I had not intended to take so much time, so I will conclude after giving way to the hon. Lady.
Roberta Blackman-Woods: I am grateful to the hon. Gentleman for giving way when he was about to conclude. I am having some trouble following Government Members’ logic. Surely it would help if we could get into legislation the measures to support carers that we all want to see. We should give a strong message that the House supports the Bill.
Sir Tony Baldry: Let me have one last crack at this; then I will sit down. I believe everyone in the Chamber agrees that supporting carers is incredibly important. One privilege of being an MP is that people invite us into their homes and open up to us about their problems. I suspect that we have all been to many a house where an elderly wife looks after an elderly husband, or the other way around, who has early or age-related dementia. Given our tendency to live longer, the costs of nursing home care and sometimes the difficulties of local authority budgets, the reality is that more and more people with Alzheimer’s or other age-related dementias are having to stay at home longer and be cared for by loved ones.
We also go into homes like the one that I visited recently, where I found a mother looking after her daughter who had severe learning difficulties and was effectively bedridden. That mother has looked after her daughter lovingly for much of her life. As we know, the challenges and strains of such a situation often lead to the break-up of other relationships, with all the consequences that brings.
There are also many young carers, who are often the hardest group to reach and the most overlooked. People are not always conscious that there are young carers. When we go into their homes, it is sometimes unclear who is the parent and who is the carer, and how the parent can take parental responsibilities for the child while the child takes caring responsibilities for the adult. The swings in that situation can be extraordinarily difficult.
What is almost unique about this Bill is that since the hon. Member for Worsley and Eccles South came high in the ballot and brought forward her Bill on carers, which was fantastic, the Government have produced a substantial White Paper covering exactly that policy area. Part of the Bill overlaps with the White Paper and part does not, but the Minister has given the undertaking that he is willing to engage with us on the bits that are not yet established as Government policy in the White Paper, to see whether it is possible for them to become Government policy before the Care and Support Bill receives its Second Reading. I would rather have an undertaking to engage in constructive debate and discussion about trying to get those provisions into the Bill, than run the vagaries of whether the Bill gets a Second Reading today—of course, how we proceed is entirely a matter for the hon. Lady—and whether, when we get to the rather boring part, Report and Third Reading, the Bill fails to make sufficient progress because the Government do not want it to proceed.
I hope that all sides of the House will recognise the importance of supporting carers and getting the policy right. The Government have acknowledged the importance of carers in the White Paper, and we must all engage in
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further work. We would have had to do that anyway in Committee, but instead we will work with the Minister and his officials. We must ensure that all hon. Members can support the Bill, so that when it is published it does justice to the need to support millions of carers throughout the country about whom we are concerned.
11.1 am
Dr Hywel Francis (Aberavon) (Lab): It is a pleasure to follow the hon. Member for Banbury (Sir Tony Baldry) who has made an eloquent case—I say this as an act of generosity—for the Bill. I must declare an interest as I am the honorary vice-president of Carers UK, and patron of a number of carers organisations in my constituency.
I warmly congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on introducing this vital Bill, and on all the hard work she has done on behalf of carers since she joined the House in 2005 and became an active member of the then new all-party group on carers.
As has been indicated, I have a strong interest in the Bill. As past carers, my wife and I know some of the great challenges that are experienced by carers, and the desperate need for recognition, identification and support, especially for those who wish to work or return to education and training. The Carers (Equal Opportunities) Act 2004, which had been my own Bill, introduced an important dimension to carer support services, not least by helping carers who wished to work or access education, training or leisure activities. Then and now, right hon. and hon. Members speak for all our constituents when we seek justice for carers and their families. Indeed, we are part of a great disability and carers movement throughout the country, although sadly we recently lost two of its mighty champions—Lord Ashley of Stoke and Lord Morris of Manchester. They supported the 2004 Act and campaigned successfully for the advancement of the rights of disabled people and their carers. I am sure that they would be proud to support the legislation proposed today as a discrete private Member’s Bill.
The 2004 Act covered England and Wales, but this Bill applies only to England. It is nevertheless instructive to outline briefly what has happened in both countries and in Scotland since 2004. A measure to identify carers was included in the original drafts of the Carers (Equal Opportunities) Bill. It was dropped in Committee when the UK Minister and the Welsh Government agreed to consider alternative measures via guidance, or other measures. In England, no further steps were taken beyond the inclusion of guidance to ensure that carers are indentified. The Welsh Assembly Government, however, saw carers as a key issue and used their first primary legislation-making powers under the Wales measure to bring forward legislation on carers. That led to the successful and ground-breaking Carers Strategies (Wales) Measure 2010, and I congratulate the Welsh Minister responsible for carers, Mrs Gwenda Thomas, on her visionary work. I also congratulate the Welsh Affairs Committee, which I previously chaired, on its early scrutiny work of the legislative competence order on carers which, in a way, led directly to the Welsh measure.
England is now lagging firmly behind in legislation to identify carers, and it is therefore incumbent on hon. Members to rectify that situation today. When the
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opportunity to frame new legislation arose, Carers Wales argued strongly for the Welsh Government to place a duty on NHS bodies to identify carers. As I said, such a provision was in the original text of my 2004 Bill, although it was omitted in the Act.
The rationale of Carers Wales was that although most carers have no relationship with social services, all will have contact with the national health service, even if only through their GPs. A compelling part of the evidence base was the Welsh Government statistics showing that the number of people, including disabled children, with long-term conditions, frailty or disabilities who receive services from social services, made up a tiny proportion of those identified as disabled in the 2001 census. Furthermore, the number of carer assessments carried out by local authorities were, sadly, a tiny percentage of those listed as carers in the census.
Carers Wales demonstrated that the duty to identify carers would be the most effective way of getting information and, indirectly, support for the greatest number of carers. In Wales we are on track to achieve that goal, and it is something that the Bill also aims to achieve. That is why we should support its progress today.
Practice on the ground in other areas shows that we are not entirely without hope that such a measure can be achieved in England. Carers UK is funded in Kensington and Chelsea by the royal borough, and part of its work is to provide advice surgeries in three key GP practices. As a result of several different methods of identification, many families have found the support they need, much of which comes from outside social services. Those individual carers would not otherwise have been identified.
Elsewhere in England, Carers UK has a link worker in Islington whose task is to identify carers in a hospital setting. Again, evidence suggests that carers are not receiving advice and information at the right time to make the correct decisions for them and their families. The Bill we are discussing wishes to achieve good practice universally across the whole of England.
My county borough of Neath Port Talbot has the highest proportion of carers of any county borough in the United Kingdom—20,067 according to estimates from 2011, which is an 8% increase on 2001. That care is valued at £461.9 million per year, which is a 34% increase on 2007. That indicates to all hon. Members the growing challenge before us; it will not go away and it requires identification and quantification.
As I said, it is instructive to look briefly at Scotland. To Scotland’s credit, it has had legislation since the Community Care and Health (Scotland) Act 2002 took effect. The first drafts of my 2004 Act were based on experience in respect of those provisions, as was the measure introduced in Wales. NHS bodies in Scotland have a legal requirement to develop a carers information strategy, which includes, for example, the provision of training for carers on carers’ issues in the work force, especially for those on the front-line. There is much for the Minister to learn from the devolved Administrations of Wales, Scotland and—dare I say it?—Northern Ireland.
The Bill is a modest and yet revolutionary proposal, with widespread cross-party support in the House.
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Barbara Keeley: I value my hon. Friend’s support given his knowledge of passing previous measures. May I take this opportunity to say that I intend to press the Bill to a Division and have no intention of withdrawing as it was suggested earlier I should do? As I said in the conclusion to my speech, the measures are needed by carers of all ages. That is why I introduced the Bill and I am grateful for his support.
Dr Francis: As a vice-chair of the all-party parliamentary group on carers, I warmly welcome my hon. Friend’s intervention. I am sure the group endorses her decision.
As I said, the Bill has massive support throughout the country. There is considerable support from employers, but—this has not been said—there has also been considerable support historically, as there is currently, from trade unions, and particularly the Union of Shop, Distributive and Allied Workers, which has always campaigned for carers. I warmly welcome the endorsement of the Bill by Caroline Waters OBE, director of people and policy for BT group and chair of Employers for Carers. Furthermore, the Association of Directors of Social Services and many individual directors of social services have endorsed the Bill.
A number of hon. Members have spoken of the importance of young carers and supporting young people going through university. I commend the work of the Open university, which has identified carers as a target group to support. I am very pleased with the work done by my good friend Rob Humphreys, the excellent director of the Open university in Wales, who is organising a conference on carers and higher education, which will take place later this year.
The Prime Minister only this week spoke of the importance of all Government Departments focusing on regenerating the economy. What better way to achieve that than by identifying our valued, unpaid carers so as to assist them back to work or into training, or by supporting our young carers in their studies? He could do so today by supporting this admirable Bill.
11.13 am
Laura Sandys (South Thanet) (Con): It gives me great pleasure to follow the hon. Member for Aberavon (Dr Francis), in particular because of his history; he has been involved in the carers agenda for many years. I am pleased to be a sponsor of the Bill. The hon. Member for Worsley and Eccles South (Barbara Keeley), who introduced it, has a huge track record on social care and carers.
The issue of carers not only impacts the constituents of every Member of Parliament; there is probably not one MP who does not have a friend, a friend of a friend, a cousin or other family member who is caring or very close to somebody who is. Carers permeate every part of society, and every socio-economic and age group. For that reason, it is crucial that carers legislation and policy are taken extremely seriously.
I am pleased that the Government have taken the initiative to develop a White Paper that, for the first time in many years, deals with the gritty, extremely complicated—it does not lack pain—policy on long-term social care. We are facing a big problem in this country
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and globally. Carers are very much at the heart of how the policy needs to develop and evolve. In many ways, they are front-line troops.
The legislation and media coverage is all about care homes—the scandals involve the institutional support for people who are not well—but the important thing is what happens behind closed doors, and we need to address the quantity of people who need care and support. Those people are in some ways hidden from the system. They are invisible to the authorities, but they need both recognition—they need to know that we know and respect them—and practical support. We need policies to ensure that they are given the support they need and deserve because of the sacrifice that they are making.
Support for carers is a crucial long-term health care policy, but it hit me personally and changed my life. I was 17 when my father had a massive stroke and it changed our life dramatically. I was going to go to university, but I went out to work as a dispatch rider. My mother’s life changed dramatically. I did not go to university—I helped her to care for my father. Over the five-year period that it took for my father ultimately to die, my mother probably aged by about 15 years. That is the example of my life, but those things are happening around the country. People who are frail and have health problems find the moral responsibility of caring both physically and sometimes financially extremely difficult.
My experience changed my life and certainly my education, but it also taught me of the extraordinary self-sacrifice around the country. The issue of young carers is very important. I have done a lot of work in my constituency with them. The Bill needs to ensure that local authorities and all institutions around young people look to identify those who take responsibilities way beyond their years. I go regularly to a young carers group. The young children in the group look and behave as though they are older than their age. That is fantastic—they are maturing and taking extraordinary responsibilities—but caring changes how they grow up, including their access to a social life. They age before their time.
I make the situation clear to my local schools, but I am very lucky because they have taken a lot of personal responsibility to identify those young people. I appreciate, however, having listened to other Members, that some schools and even some people in social services do not understand the dynamic of these households and the additional responsibilities being put on these children.
Identification is extremely important for another slightly more controversial reason. A teacher in my area said to me, “Although the parents of some of these children have been ill, they are no longer ill but have become dependent on the child delivering care services to them.” There are all sorts of issues within this pathway of being a young carer that need to be identified so that support can be provided. We need to ensure that schools, social services and the institutions around these young people understand the issues, and we need to ensure that clear action is taken to alleviate the situation of children providing support to parents who have entered into this relationship of dependency.
Dr Francis: The hon. Lady talks about lessons and is making a powerful case, but however much we sympathise with carers, surely the real lesson is that there is no substitute for legislation.
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Laura Sandys: Legislation is important and is part of what the Government are doing to get a grip on the situation. The forthcoming social care Bill is extremely welcome and it is important that these measures be considered and incorporated in it. I do not question the importance of legislation.
Humanity is also important, however, and that is about education, understanding and people being able to identify the problems in front of them. On the long-term care issue, let us consider the system operating in Torbay. That did not need legislation. It needed common sense and an understanding of how to integrate the provision of care. It needed agencies to talk to each other and to think about how to deliver service to individuals and families, rather than thinking of themselves as institutions.
Diana Johnson: I am listening carefully to what the hon. Lady says. She points to examples of good practice, but those often require a champion who sees young carers as an important issue that needs to be addressed. Unfortunately, however, not all head teachers, heads of colleges or vice-chancellors take the same view about young carers or student carers, so having legislation to underpin what is required of those institutions is important, as too are champions.
Laura Sandys: I do not dispute the need to ensure that everybody within these institutions has a responsibility towards carers. There is no question about that. They also have responsibility for the welfare of children. They have to understand that this is bigger than just the responsibility of carers. It also involves attainment at school and young people’s mental health. It is interesting and a bit concerning that some teachers do not even know that there is such a thing as a child carer. I find that remarkable, but solving that problem does not require legislation; it requires the education of the educators. This private Member’s Bill is part of the way to ensure that we start to normalise what is required from these organisations and institutions.
We have an opportunity here. Perhaps we, as the Bill’s sponsors, should be making representations to the Select Committee on Health, which will be doing the pre-legislative scrutiny of the forthcoming social care Bill. We should ensure that the Committee appreciates the importance of the measures in the private Member’s Bill and puts in its report provisions to ensure that the Government respond not only to this debate and the private Member’s Bill but to the Select Committee’s report.
There is also an opportunity, in this legislation and the wider general practice of local authorities, in respect of the health and wellbeing boards. Health and wellbeing boards and the doctors’ commissioning units need to be focused not just on the patient who walks in the door but on the person looking after that patient. I am sure that many of us in the Chamber—and, I hope, beyond—always, as I do, say to the doctor, “You look at the patient, but do you always ask, ‘How is the carer? How well is that carer?’” Sometimes the carer will be less well than the so-called patient, but they will not present to doctors. It is crucial that doctors take the initiative and understand that if the carer ends up in hospital, we end up with two people in crisis, not just one. I would welcome clear statements from the Secretary of State and the Minister that GP commissioning and what I
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call practices of humanity need to be drilled through the health service in order to address these problems, which will present themselves and which will cost everybody in money and suffering.
I am very supportive of the provisions in the Bill, and I urge the Government to consider them as part of their overall legislation. The hon. Member for Worsley and Eccles South is a member of the Health Committee and I am sure she will be a great advocate, but it would be useful if proponents of this legislation were also to put in a submission to the Committee. I hope that this Bill will be encapsulated in the forthcoming Government Bill.
11.27 am
Alex Cunningham (Stockton North) (Lab): I am delighted to speak in the debate and to follow the hon. Member for South Thanet (Laura Sandys), who made an eloquent speech, illustrated in particular by her mention that we are all affected—we all know somebody who is a carer and who probably has a tough life because of it.
The Bill is long overdue and I hope that the Government will allow it to reach the Committee stage for further discussion and development. For too long, we have taken carers for granted. We underestimate their invaluable contribution to the well-being of their families and communities—not to mention the economy. We fail to support carers, including children and young people, who often themselves suffer ill-health, and neglect the needs of carers who want to work outside their home. That is why the Bill is so important. It will go far in meeting carers’ needs, without placing huge additional financial burdens on local authorities already struggling to cope with the deep cuts they are having to implement.
I want to talk in particular about young carers—those under the age of 18 who undertake significant and, I would argue, often inappropriate caring responsibilities for their parents, grandparents or siblings. Let us be clear: they are children. Indeed, the average age of a young carer is a mere 12 years—12-year-olds whose only concerns should be enjoying their youth and playing with their friends. Instead, very often they simply lose their childhoods as they care for disabled parents, parents who may be drug dependent, and parents whom they love deeply. No one wants to get too graphic about the things children do for their parents, but among other things they feed them, get them to the toilet, help bath them and help them get dressed.
To take on that level of care for a loved one is remarkable. Carers provide constant support, comfort and companionship. As my hon. Friend the Member for Darlington (Jenny Chapman) once said, “They make the good days good and the hard days better.” We know how young carers are passionate about supporting their families. The majority of young carers want to care and few ask to stop caring altogether, but they also need to be supported. Many young carers, however, struggle through the education system without being recognised as young carers. Their needs and those of the people for whom they are caring are often identified only during a crisis.
The Bill would create a strategic duty on local authorities to ensure that schools are proactive in identifying young carers as soon as possible, with a similar duty on further and higher education bodies. The earlier young carers
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are identified, the more support can be made available to them and the person for whom they care. Many young carers go without being identified, and a key reason that young people drop out of university and college, as others have said, is that they are caring for someone, often a parent.
Let us not underestimate the scale of the problem. Recent surveys have pointed to a hidden army of UK young carers, with four times as many young carers in the UK as are officially recognised. The 2001 census identified only 175,000 young carers, 13,000 of whom care for more than 50 hours a week, but a survey of schoolchildren has indicated that there are about 700,000 young carers in the UK—an astounding figure. Even that does not tell the whole picture. In the UK almost 3 million children under the age of 16—equivalent to 23% of all children—live in households in which one family member is hampered in daily activities by a chronic physical or mental health problem, illness or disability, meaning that countless young people have caring responsibilities, including administering medication, washing, cooking and cleaning.
We have some great support for young carers in my constituency, and my wife Evaline is a volunteer director of the Eastern Ravens Trust, a local children’s charity that has been working for more than 50 years to support children and young people from the Stockton borough area who are experiencing social isolation. One scheme is the young carers project, which provides young carers with the opportunity to meet and socialise with other carers, letting them simply have fun and blow off steam. I love spending time with them and was delighted to see them in this very Chamber not long after I was elected.
The project has also received a grant from the Princess Royal Trust for Carers to focus on identifying those young carers in households with substance-misusing parents who need support to help them be children as well as carers. The grant has made it easier to identify and help some of the most vulnerable carers in our area. The steering group, Young Carers Aloud, also aims to raise awareness of young carers and their issues in Stockton and has devised a young carers card that it hopes can be used discreetly in schools to let teachers and staff know who young carers are, ensuring that they get the support they need. Often, those young carers do not want their peers to know about their personal situations.
The Bill will enable such work to be performed all over the country. Young carers I meet tell me that they often feel isolated at school, and that they are a frequent target for bullies, as other Members have said. They have difficulties concentrating in lessons, worrying about their parents or family member—“Are they at home?”, “Are they okay?”, “Have they had an accident?”, “Have they lost their memory today?” Young carers are often unable to complete their homework as they simply do not have enough time due to their caring responsibilities. As a result, such young people, because no one knows about their situation, are often punished—they might be given a detention after school, which means that they cannot be present for family members who rely on them.
Examples of young carers in my constituency include someone whom I will call Susan. She is only 12 years old, yet she is the primary carer of her disabled mum.
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She used to be quiet and shy, but since accessing support at the Eastern Ravens Trust she has blossomed into a confident, lovely girl. Another carer is Peter—again, not his real name—who, despite being only 14, has been supported by the Eastern Ravens Trust for over four years. Peter himself suffers from learning difficulties and epilepsy, and yet he is the primary carer for his disabled mum, who also has mental health issues.
Schools in my constituency try to help young people whom they know to be carers, but throughout the country there is a tremendous lack of support for young carers, who can feel stigmatised by teachers and peers lacking understanding of their situation and leave school or college prematurely, without completing qualifications.
Diana Johnson: I am interested in what my hon. Friend says about detentions. Was he as disappointed as I was when the Government introduced measures in the Education Act 2011 that removed the requirement that 24 hours’ notice be given when a child is given a detention? A number of representations were made about how that could affect young carers who had to return home speedily to look after the person they were caring for. Does that not show that other Departments are not as aware as they should be of issues affecting young carers?
Alex Cunningham: I very much agree with my hon. Friend. I have tremendous concerns, because a child who faces a detention might not turn up for it and end up getting deeper and deeper into trouble because of a lack of understanding among their teachers. That is all the more reason why we need the provisions in the Bill to ensure that young carers are identified and that responsibility is placed on schools to provide them with the necessary support.
Mr Nuttall: When that point about detentions was raised, did the schools Minister not make it clear that the detention would continue to have to be reasonable, that consideration would have to be given to all the circumstances and that teachers were well placed to understand the needs of an individual pupil?
Alex Cunningham: The then Minister did indeed say that a detention had to be reasonable, but a teacher who does not know that the young person is a carer cannot take that into consideration. That is all the more reason why we need such provision. It is also interesting to note that young carers aged between 16 and 18 years are twice as likely as their peers to not be in education, employment or training—a so-called NEET.
We are a long way from being perfect in the borough of Stockton-on-Tees—although we are very close to it on many issues—but I am proud to say that the borough council is very much leading the way on issues associated with young carers. The council has a young carers strategy, which has been in place since 2009. The aim is to ensure that services work together and share information to identify and support families to avoid young people becoming established in inappropriate caring roles, and to ensure that schools have in place procedures and policies that offer flexible and additional support to young carers, such as provision for personal tutors and access to the local young carers project. Stockton borough
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council and NHS Stockton-on-Tees are also developing a joint carers and young carers strategy, which will enable carers to be involved in planning care packages and designing local care services, and to fulfil their educational and employment potential.
Many other councils and health authorities are also doing innovative and exciting things to identify and support young carers—and carers generally—but many are not. They need the guidance in the Bill to fulfil the needs of one of the most vulnerable groups of young people in our society. We are all well aware of the immense challenges facing young carers, but we cannot help them if we cannot identify them. Again, that is why the Bill is so important to enable and ensure that support is provided.
As I set out at the start of my speech, the Government can send a signal to local authorities today—demonstrating that they believe that there has to be proper identification of young carers, universal protection for them and the right to quality services—by allowing the Bill to progress to Committee for further discussion and development. Even though the Government are developing their own legislation on carers, including young carers, in different Bills, they will disappoint a large community of people, along with their supporters, if they do not do so. Young carers give up a lot to be carers. They miss out on comforts and freedoms that the rest of us take for granted. They often give up their time and their social lives; indeed, they give up their childhoods. Their focus is on the loved ones they care for. That is why we have to remember to focus on them and move the Bill forward today.
11.38 am
Mr David Nuttall (Bury North) (Con): I warmly congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on her success in coming third in the ballot for private Members’ Bills and on securing the slot this morning. As always, it is a great pleasure to follow the hon. Member for Stockton North (Alex Cunningham), who speaks with such authority on these issues. The hon. Lady’s interest in the matter is well known, and she should be congratulated on her determination in pursuing what is undoubtedly an extremely important issue.
Many private Members’ Bills cover only a narrow area or a specific point of law and are often technical in nature. Some of them are just one-clause Bills. This Bill is quite the opposite. No one could accuse the hon. Member for Worsley and Eccles South of lacking ambition, given the scope and depth of her wide-ranging Bill, which would affect millions of our fellow citizens.
An increasing number of families are involved in the care of another family member—often, but not exclusively, an older relative. In many cases, this can involve a younger person with a disability who requires care on either a temporary or a permanent basis. We are fortunate that the hon. Lady has succeeded in introducing her Bill, as it enables us to spend time today considering the plight of carers and highlighting the problems they face. We are also able to publicise some of the excellent help that is already available to carers. The debate also gives us an opportunity to highlight what the Government have done and are continuing to do for carers.
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The Queen’s Speech at the beginning of this Session included a commitment to publish a draft care and support Bill. Some people might have been surprised, in the light of that announcement, that the hon. Lady’s Bill was introduced at all. It first saw the light of day on 20 June this year, when it received its First Reading. It was published the following month, on 10 July. Unfortunately for its promoter, the following day saw the publication of the Government’s own draft Care and Support Bill, which had been announced in the Queen’s Speech. I submit that this issue is so important, and has such huge ramifications for the public purse, that it should be the subject of a Government Bill. One of the problems with this private Member’s Bill is the lack of information on the likely cost of the measures it contains.
As I said earlier, caring for another person can take many forms. When I was a child, my family cared for my grandmother. Looking back, I do not recall the terms “carer” or “caring” being used that often. We simply said that grandma—or nana, if I am to be strictly accurate about the name we used—lived with us. I cannot remember how young I was when my mother’s mother came to live with us, but I cannot recall a time in my childhood when grandma was not around. Unfortunately, as she progressed through her 70s and 80s, she became increasingly afflicted by ill health, and undoubtedly needed caring for.
The catalyst for my grandmother leaving her own home and coming to live with us was her arthritis, especially in her knees. She found it difficult to walk and, particularly, to climb stairs. That disability meant that grandma had to sleep on a bed settee in the lounge. If truth be told, she would have had to sleep downstairs anyway, as we had only two real bedrooms—one for mum and dad, and one for my brother and me. Unfortunately, in addition to her arthritis, grandma also suffered from Parkinson’s disease and, in her final years, from Alzheimer’s. By that stage of her life, she was therefore heavily dependent on the rest of us to look after her. We might not have used the term, but we were her carers.
Other than having what in those days was an orange badge for the car—which enabled my dad to park near to where we were going so that grandma did not have far to walk—and attendance allowance or some other benefit to which we were entitled, I do not recall any other specific assistance or any group being around to help. It is a testament to how far we have developed as a society that there is now far more help available for those who need and want it.
There are many reasons that the provision of care has risen up the political agenda in recent years. There have been enormous advances in medicine and in man’s ability to conquer disease. New treatments and technological developments have united to increase life expectancy. Sadly, however, increased life expectancy does not always bring with it the ability to continue to live as we did when we were younger. It comes with a price.
Living to an advanced age after enjoying good health for many years does not guarantee that that good health will continue. Indeed, the opposite is often the case. Later-life conditions, as the human body effectively wears out, inevitably mean that many people become increasingly reliant on others to look after them. Changes in working practices mean that fewer families are able
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to take in an elderly relative as we did when I was a child. There are now many more women in the workplace, and far fewer families in which the wife stays at home. That means that, in many cases, care still takes place but at some distance, with a son or daughter travelling great distances each day to look after their elderly relative so that they can continue to live in their own home. We must never underestimate the enormous value of that care.
Statistics from the Department for Work and Pensions’ family resources survey for the United Kingdom for 2010-11 give us an idea of the scope and scale of the problem, and of the number of disabled people and carers in this country. The survey found that 4.8 million people were carers, which equates to about 8% of the total UK population. Of that number, 3.5 million were adults of working age, and 1.3 million were adults over the state pension age. There were also about 100,000 children acting as young carers. The distribution of carers, broken down by age group, has remained broadly stable over the past 10 years.
The survey also found that the prevalence of disability in the United Kingdom involved 19% of the population. That means that about one in five people in this country was classed as having some form of disability. Not surprisingly, the prevalence varied considerably between age groups, ranging from 6% among children through 15% among working-age adults to 45% among adults over the state pension age.
According to that same survey, some 27% of adults of working age worked full time, equating to about 1.5 million people, with another 10% working part time. It is interesting to note that the comparative figures for all adults of working age were 68% and 20%.
I note that in clause 8, to which we have not yet referred this morning, subsection (1) deals with interpretation and it helpfully defines some of the key terms in the Bill. The biggest key term of all, of course, is what constitutes “a carer”. For the purposes of the Bill, a carer is defined as having
“the same meaning as in section 1 of the Carers (Recognition and Services) Act 1995”,
so it may be useful at this juncture to remind hon. Members of precisely what that statutory definition of a carer is. Section 1 of the 1995 Act defines a carer as an individual who
“provides or intends to provide a substantial amount of care on a regular basis”—
not for just anyone, but for someone who is classed as “a relevant person”, and a relevant person is someone who has had their needs assessed by a local authority under section 47(1)(a) of the National Health Service and Community Care Act 1990.
It should be noted that this statutory definition is not the same definition as that used by many charities. For example, the Carers Trust defines a carer as
“someone of any age who provides unpaid support to family or friends who could not manage without this help.”
Jacob Rees-Mogg (North East Somerset) (Con): Will my hon. Friend clarify whether the survey he mentioned used the legal definition or a broader definition of carers when it came up with the 8% figure?
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Mr Nuttall: My belief is—I stand to be corrected on it—that the survey used a wider definition rather than the strict statutory definition contained in section 1 of the 1995 Act.
Jacob Rees-Mogg: That is a helpful answer. Does my hon. Friend suggest, then, that this Bill will apply to a much smaller number of people than it would if it used the survey definition rather than the definition in the previous Act?
Mr Nuttall: That would appear to be the case. If the survey used the wider definition, which I believe it might have, it would indeed indicate that the number of people affected by the Bill would be fewer as a result of its using the statutory definition.
After the Carers Trust’s definition of a carer as
“someone of any age who provides unpaid support to family or friends who could not manage without this help”,
“This could be caring for a relative, partner or friend”—
we should note that this definition includes friends as well—
“who is ill, frail, disabled or has mental health or substance misuse problems.”
At this point, we come to what I submit are some of the problems with the interpretation of the Bill. What exactly constitutes a “substantial” amount of care? Who is to be the judge of whether care is substantial or not? One man’s definition of what is “substantial” may not be the same as another’s. Therein lies the first of a number of uncertainties in the Bill.
Philip Davies: I am looking at the 1995 Act, too. As my hon. Friend makes clear, it defines a carer as someone who
“provides or intends to provide a substantial amount of care”,
but it also includes the phrase, “on a regular basis”. Does my hon. Friend agree that while there might be a lot of debate about what constitutes “substantial”, there might be quite some debate, too, about what constitutes a “regular” basis of support?
Mr Nuttall: My hon. Friend is quite right that there are two legs to the definition. It is not just a question of whether it is “substantial” but of whether it is “regular”. It could be once a year. If someone visits their elderly granny once a year, that is regular, but it is not the same as going around morning, noon and night to look after an elderly mother who needs care almost constantly. I therefore think there are difficulties with the definition, and I submit that it needs clarification. The Bill is silent on that and I fear that the explanatory notes, which are excellent in many ways, as I shall explain later, are silent on it, too.
Philip Davies:
On that point, does my hon. Friend agree that the wider definition is more helpful than the one set in statute? There might well be cases—I am sure we have all come across them; I have certainly come across them in my constituency—where people need some kind of care and help, yet the local authority, probably for financial reasons above all else, has decided that it is not going to give them the support they need.
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Many people are looking after relatives or friends who need care, but who have not passed the test of being assessed as such by a local authority.
Mr Nuttall: My hon. Friend touches on an important point. I fear—I am sure others will, too—that this Bill may unreasonably raise the expectations of that group of carers covered by the wider definition. They may think, “This is me; I’m a carer”, but would they be a carer under the much narrower definition in the Bill? As I say, there is a danger that many carers will feel that this debate is about them, when under the statutory definition in clause 8—it is clear, referring back to section 1 of the Carers (Recognition and Services) Act 1995—they may not be covered.
Barbara Keeley: It is important for the House to understand that this is a Second Reading debate, and that there will be plenty of opportunities in Committee to look further at interpretations and definitions and to alter those definitions if they are too narrow. First, I hope that the hon. Gentleman will not take up an awful lot more time as others are waiting to speak. Secondly, is he prepared to support the Bill on the basis that if any of the definitions in the interpretations clause were too narrow, they could be looked at further?
Mr Nuttall: I am grateful. I was dealing with the point about definitions in response to an intervention from my hon. Friend the Member for Shipley (Philip Davies), but it is part of my wider concerns about the Bill. The Bill’s general aims are entirely laudable. Who would not want to help those who provide care for others, particularly for those who need help, assistance and care? All of us can unite on that. I am fully behind the idea of providing what care we, as a society, can afford to provide for those who need it. However, I think that there is a genuine debate to be had about how much further we can go at present, and about whether the Bill is the right vehicle to provide such support or whether—and I think this is an important point—we should heed the substantial report from the Law Commission, which stated in its first and very clear recommendation that a single Act should replace all the existing legislation. I think that we should give further thought to what has been said this morning about the possibility of incorporating the provisions of this Bill in the draft social care Bill.
Diana Johnson: Does that mean that the hon. Gentleman does not support this Bill?
Mr Nuttall: As I have made very clear, I support the general aim that the country should continue to provide support, as it does already—
Diana Johnson: What about this Bill?
Mr Nuttall: I think that this Bill is too wide in its implementation, and not clear enough. I shall be dealing with each clause and explaining what the difficulties are, but we are not there yet. The hon. Lady is jumping the gun slightly.
The Bill has two general aims. The first is to place a duty on local authorities to ensure that there are sufficient social care services to support carers and those who are disabled.
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Philip Davies: Before my hon. Friend continues his speech, may I urge him not to be distracted by the tactics of the hon. Member for Kingston upon Hull North (Diana Johnson), who is trying to do something that might be described as rather despicable? She is trying to argue that the fact that someone does not support a particular Bill means that that person is against the whole concept of the aim of the Bill or the subject area. Anyone who knows my hon. Friend will be aware that he is passionate about helping carers and people who need this kind of support. He should not be distracted by those who try to characterise his opposition to certain elements of a piece of legislation as opposition to the welfare of carers as a whole. I urge him to continue in his current vein.
Mr Nuttall: I am grateful to my hon. Friend. I feel that there is a danger that some of the content of the Bill may cause scarce resources to be diverted from front-line services to carers for the purpose of the production of assessments, surveys and strategies, rather than providing real, genuine help for those who need it most.
Dr Francis: If we take the hon. Gentleman at his word—and I do take him at his word: I believe that he is genuinely concerned about carers—it must be said that he has posed a series of very valid questions. Is it not time for him to allow the official Opposition to express their view, and, more important, to allow the Minister to respond to those questions? Should he not end his speech now?
Mr Nuttall: We are less than halfway through the time allocated for the debate, which did not begin until after 9.45 am. I do not think that there is much danger of our not being able to hear the views of Front Benchers. I entirely agree with the hon. Gentleman that there are plenty of things that we want to hear from those on the Opposition Front Bench. I am particularly interested to know why, if this measure is so important, the Labour party did not present it in the form of a Government Bill during the 13 years in which it had the opportunity to do so.
Heidi Alexander (Lewisham East) (Lab): If the hon. Gentleman thinks that it is so important to hear from Front Benchers, does he also think that it is important to hear from those of us who want to make the case for carers in our constituencies, and who have expressed to you, Madam Deputy Speaker, our desire to speak in the debate? I wonder whether he will be allowing those of us on this side of the Chamber to make our contribution.
Mr Nuttall: Absolutely. I completely agree. We want to hear from as many Members as possible, including the hon. Lady.
Jacob Rees-Mogg: If my hon. Friend managed to go on for a further two hours and 25 minutes, his speech would be of such an heroic nature that he would deserve an award rather than criticism. However, I do not think that even he will manage that, so there is clearly enough time for others to speak.
Mr Nuttall:
I am trying to be as generous as possible in taking interventions, many of which, I would point out very gently, have come from the other side of the
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Chamber. I shall move on and try to deal with matters as quickly as possible, but they are genuine matters of concern which I think need to be heard. After that, we can hear from other Members.
As I was saying before the various interventions, the Bill has two general aims. The first is to place a duty on local authorities to ensure that there are sufficient social care services to support carers and those who are disabled, and in particular to aid them to enter or remain in the labour market or undertake work-related education or training. The Bill also seeks to secure the early identification of carers by health bodies such as clinical commissioning groups and foundation trusts, schools, and further and higher education establishments.
As we have heard, clause 1 imposes a general duty on
“every local authority to take steps to ensure that, as far as reasonably practicable, a range and level of social care services are provided to meet the reasonable requirements of disabled people and carers who are ordinarily resident in their area.”
I was grateful to the hon. Member for Worsley and Eccles South for indicating that the definition of “reasonably practicable” was designed to be set down in future legislation, through delegated legislation. I am prepared to accept that assurance, but it does mean that we are effectively being asked to sign a blank piece of paper.
Clause 2 provides that in order to demonstrate that a local authority has discharged its general duty under clause 1,
“every local authority shall be under a specific duty to secure, so far as reasonably practicable, the provision of social care services sufficient to meet the reasonable requirements of all people aged 18 or over with a disability and carers who require such support to enable them to—
(a) take up, or remain in, work, or
(b) undertake education or training which could reasonably be expected to assist them to obtain work.”
In just those first two clauses, we see that the test of “reasonableness” is key; the idea crops up time and again. Perhaps it would have been helpful if we could have known at this juncture how that will be defined.
What we do have, however, is information from the Institute for Social and Economic Research at the university of Essex. Last year, it published a paper entitled “Trends in the Employment of Disabled People in Britain”, which was a detailed analysis of the series of general household surveys published between 1974 and 2005, and covered adults between the ages of 20 and 59. The report found that the prevalence of disability has gradually increased, stating that the proportion of working age adults who report a limiting long-standing illness
“rose from 14% in 1975 to 18% in 1996, before falling back again to 16% in 2004.”
“disabled people are less likely to have a job than other people, even after taking account of other characteristics such as their age and educational background.”
The paper presented an important concept—the idea of the disability employment penalty—and undertook an analysis for the period between 1995 and 2005 of its impact. It stated that
“the ‘disability employment penalty’ has been calculated as the difference between the actual proportion of disabled people in work, and what the proportion would have been if those same people were not disabled, but all their other characteristics (gender,
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education and so on) remained the same. So the actual outcome for disabled people is compared with the hypothetical situation in which their disadvantage was switched off. For the straightforward model covering the last ten years of the period under analysis:
80% of non-disabled people in the age range covered were in work, averaged over the ten year period 1996-2005.
76% of disabled people would have been in work if their disability had no effect
48% of disabled people were actually in work.
So
4% (80-76) is a measure of how much disabled people were disadvantaged by their other observed characteristics (such as age and education).”
However, on the basis of this research,
“28% (76-48) is the true disability penalty.”
The author actually cautioned that that penalty figure might be an underestimate because the “limiting long-standing illness” definition
“is probably too broad (including many adults with only slight impairments), this is probably a smaller penalty than would be observed if a tight definition of disability were used, restricted to people with more serious impairments. Note too that the estimate of 28% is the average effect of a range of conditions, impairments and severities, all bundled into a single category labelled ‘limiting long-standing illness’. Previous analysis of a much more detailed disability survey has shown that the penalties affecting different types of disabled people range from 0 to 100%, and helps to show that they are not all facing the same experience.”
The paper also considered how the penalty had changed over time, finding that it had risen
“from 17 percentage points to about 28 percentage points”
between 2000 and 2004. It also found
“that people with severely disadvantaging sets of health conditions have been more, not less, affected by the trends.”
Under this Bill, local authorities would need to ask why disabled people are less likely to be in employment. The Office for National Statistics published the results of the first wave of its life opportunities survey in December 2011, using evidence gathered during the period from June 2009 to March 2011. It described the LOS as a major new national survey of disability in Britain that
“aims to measure people’s use of local facilities, including public transport and health services, and their participation in leisure activities and employment opportunities.
It also aims to find out why people don’t take part in work or leisure activities that they would like to, or why they may experience difficulties in using public services.”
The survey investigated the barriers and what it called the enablers to employment for three groups of adults aged 16 and over: the employed, who were in employment but were limited in the type or amount of paid work that they did by their impairment status; the unemployed, who were unemployed and seeking employment but were limited in the type or amount of paid work that they could do by their impairment status; and the economically inactive, who were neither in employment nor actively seeking work. The top barrier to employment opportunities for adults with an impairment in each group was their health condition, illness or impairment. The second top barrier for the employed was family responsibility, whereas for the unemployed it was the lack of job opportunities and for the economically inactive it was disability-related.
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As for what the researchers called the “enablers”, most respondents did not indicate the most important factor at all. In so far as they did, the most often stated enabler was modified hours or days or reduced work hours. We know from the DWP family resources survey, to which I referred earlier, that the majority of carers balance their caring responsibilities with paid work. Those in full-time employment made up the largest group of carers in the United Kingdom, at 35%, and the next largest, at 24%, were those in retirement, followed by the economically inactive, at 21%, and those in part-time employment, at just 17%. Among the working-age population, 60% of carers worked full time whereas 27% worked part time, compared with 68% and 20% among all working-age adults.
A survey by the NHS information centre, published in December 2010 and entitled “Survey of Carers in Households 2009/10”, provides an insight into how caring responsibilities affect the employment and education of carers. That survey found that caring duties did not adversely impact on the employment of most people, although they did for a sizeable minority. All carers who were under 70, regardless of their personal status, were asked whether their ability to take up or stay in employment had been affected by the assistance they gave the main cared-for person. Although just over a quarter of that group, 26%, felt that their caring responsibilities had affected them in such a way, nearly three quarters, or 74%, did not feel that that was the case.
The survey also gave some further detail of the backgrounds of those whose employment was so affected. The groups who were most likely to say that their employment prospects had been affected by the care they provided were: those aged 35 to 44, who represented 34% of carers, and those aged 45 to 54, who represented 30%; those looking after the home or a family, who represented 46%, and those working part time, who represented just 35%; those who were caring for someone in the same household, who represented 38%; those providing care for 20 hours or more per week, who represented 40%; and those in bad or fair health, who represented 34% and 32% respectively.
As for the specific impacts, just over a third, or 35%, of working-age carers who were looking after the home or family had to leave employment altogether, compared with 10% on average, whereas 23% of carers who were working part time, or almost one in four, had reduced their employment hours compared with an average of 8%.
It is of course important to understand why carers are less likely to be in employment. The “Survey of Carers in Households 2009/10” stated that
“the intensity of care provision has an impact upon interest in taking up paid employment.”
Of those who were caring for less than 20 hours a week, 24% were interested in taking up paid employment in the near future, compared with only 11% of the high-intensity group of carers. Of those interested in returning to work, 51% indicated that they would like to work part time, while 38% wanted full-time work and 11% did not know. On the possible barriers to employment, saying, “I cannot work because of my caring responsibilities,” was the third most popular explanation for not working, with 37% of people choosing that response.
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Barbara Keeley: The hon. Gentleman should be aware that many carers and disabled people, and their organisations, are following the debate. He has been speaking for more than 40 minutes and rambling around a lot of statistics, and it is now being said on social media that he and his colleagues are talking out a Bill of great value. He should know that people who are following what was a reasonable and proper debate on the Bill do not appreciate the tenor of what he is saying. He is destroying the debate.
Mr Nuttall: I have already made my support for carers absolutely clear. My hon. Friend the Member for Banbury (Sir Tony Baldry) has also secured a helpful undertaking from the Minister on ensuring that the Government engage with the Bill’s supporters about the subjects that it deals with in the context of the draft Care and Support Bill.
Philip Davies: Has my hon. Friend noted the irony that Labour Members who regularly troop through the Lobby to vote against Government programme motions, because they say that those motions allow insufficient time for debate and effective scrutiny, now take the view that this Bill should go through the House without any scrutiny whatsoever just because it happens to have their support? Our duty in this place is to scrutinise legislation, whether Labour Members like it or not.
Mr Nuttall: There is indeed such an irony. Legislation of all kinds should receive proper scrutiny.
Jacob Rees-Mogg: It is worth noting that if Labour Members were so committed to the Bill, they would have been able to get 100 Members here to support a closure motion. Alternatively, they could move a motion that would force an hon. Member to bring their speech to an end, but they have not asked to use either of those mechanisms.
Madam Deputy Speaker (Dawn Primarolo): Order. Actually, the speech of the hon. Member for Bury North (Mr Nuttall) could be terminated only if the occupant of the Chair—myself—told him to resume his seat because of tedious repetition. Whatever hon. Members might think of his contribution, he has not got to that point. I would be grateful if we could allow the hon. Gentleman to continue his speech so that others may then participate.
Mr Nuttall: Thank you, Madam Deputy Speaker.
Let me make a further quick point about the statistics that I was citing. The largest single barrier to employment that was highlighted—by 63% of respondents—was a lack of suitable local job opportunities, so an area’s prevailing employment market is obviously pre-eminent when determining whether a carer or disabled person is able to get into the workplace.
Clauses 1 to 3 would impose a sufficiency duty. The explanatory notes state that the duty
“goes beyond the existing duties and focus of local authorities which are only on those for whom they have direct responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds. There are currently no duties on local authorities to assess or address supply of non-statutory services for individuals privately purchasing care, by encouraging the development of new services.”
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“This clause would ensure that local authorities build a complete and accurate picture of the services needed, provided and purchased in their area.”
It would have been helpful if this duty could have been road-tested somewhere on a trial basis. There could perhaps have been a pilot before the Bill was introduced.
Clause 1(2) states that in discharging the sufficiency duty a local authority must have regard to statutory guidance issued by the Secretary of State. It might be expected that such guidance would clarify the terms necessary to determine what amounts to compliance with this sufficiency duty. The explanatory notes helpfully suggest:
“Placing a strategic duty on local authorities to ensure adequate social care would mean local authorities need to assess the care available in their area looking at the supply and demand of care and the affordability, accessibility and quality of provision. They would also need to identify gaps in provision and how these will be addressed. Local authorities would work in partnership with local providers to assess how services could support disabled people and carers to work, where appropriate.”
I will skip a large part of my prepared notes because, as we have heard this morning, where there is a difference between this Bill and the Government’s Bill, the Minister will look at trying to ensure that that requirement is included in the Bill.
The explanatory notes do not tell us the likely cost for every local authority to undertake the assessments that the Bill requires, and that is one of its principal problems. We have no idea of the cost of carrying out an assessment of the social care needs of disabled people and carers in any given area, which is why I suggested that a pilot project might have given us some idea of the likely cost.
Barbara Keeley: So that we do not spend a great deal more time on this, will the hon. Gentleman accept that it is not part of the private Member’s Bill procedure in any way to run pilots? That is a matter for the Government. The Bill was introduced a short time ago and that was not possible. It is really not worth his spending a lot of time on that suggestion.
Mr Nuttall: I am grateful for that intervention. I appreciate that a pilot cannot be done in the same way that the Government could have done it, but as we have already heard this morning, there are many initiatives going on in local authorities throughout the country, and I am sure that it would have been possible for one local authority to have picked this up and trialled the Bill to at least give us some idea, or put some information before us this morning, of the likely cost, even if it was a matter of someone sitting down and trying to work it out for themselves. There will inevitably be a substantial cost.
Dr Francis: If the hon. Gentleman had listened carefully to what I said he would have heard that Carers UK has piloted something similar in Conservative Kensington and Chelsea and Labour Islington. There is good practice everywhere. What about the actual saving to the taxpayer from the tax take as a result of people going back into work? We are not talking about costs here, but about savings to the Exchequer.
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Mr Nuttall: The hon. Gentleman is absolutely right. We all want as many people as possible to be able to return to the workplace, and what we are trying to do this morning is arrive at the best solution for achieving that common aim.
Clause 4 relates to the promotion of carers’ health. It would impose a duty on health bodies to:
“(a) promote and safeguard the health and well-being of carers;
(b) ensure that effective procedures exist to identify patients who are about to become carers;
(c) ensure that appropriate systems exist to ensure that carers receive appropriate information and advice”.
Although there are currently no legislative requirements for health bodies to promote the health and well-being of carers specifically, there are already statutory duties on health bodies to promote the health and well-being of people who use health and social care services and members of the public generally. The obvious question is this: what is the point of singling out carers? Surely they are included as a group within the existing legislative provisions.
Barbara Keeley: The reason for singling out carers is that they have responsibility for not only their own health, but that of the person they care for, and in many cases they do not take care of their own health and do not have time for doctors’ appointments. We are asking for health bodies to have a specific, extra concern for carers. Given that their whole day can be taken up with caring, that extra duty can sometimes be fulfilled by a GP offering them first or last appointments. The hon. Gentleman has now been speaking for more than 50 minutes. Second Reading is not meant for this sort of line-by-line review; that is meant to happen in Committee. He is pushing it to the point where it is being said outside this place that he is attempting to destroy the Bill and the debate.
Mr Nuttall: I am certainly not trying to destroy the Bill. I will stick to my point, because I think that we need to look at this—[Interruption.] [Hon. Members: “In Committee.”] It is an important part of the Bill. Existing legislation covers all members of the public, so I do not think that we need to single out a specific group.
Philip Davies: Opposition Members talk about these matters being considered in Committee. Given that the Government have published a draft Bill on this very subject, does my hon. Friend not agree that Opposition Members, if their overwhelming priority is to discuss these matters in Committee, will have an amazingly good opportunity to do so at length in relation to the draft Bill? That can be done without this Bill progressing any further.
Mr Nuttall: That is indeed the case. I am sure that it will be possible to consider all these matters in detail when we look at the draft Bill in Committee.
The NHS operating framework for 2012-13 already provides that carers must receive help and support from local NHS organisations. Primary care trusts are required
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to agree policies, plans and budgets to support carers with local authorities and carers’ organisations and make them available to local people. It states: