§ Order for Second Reading read.9.34 am
§ Mr. Tom Pendry (Stalybridge and Hyde)
I beg to move, That the Bill be read a Second time.
Although I am in my 30th year in the House, I have never before had the good fortune to win a high place in the private Members' ballot. It is not until one does so that one realises how many friends one has. In my case, most of them vanished almost overnight when I decided to introduce this measure—although not, happily, the right hon. and hon. Members in the Chamber today, who are, I am sure, as passionate as I am about the need to assist carers. That is not to say that other right hon. and hon. Members do not care, but their main concern when befriending me was clearly to steer me in another direction, which was their first choice.
The mountain of mail that one has to cope with from individuals and organisations is enormous. Perhaps the most ironic experience was having to deal with almost half a rain forest from those who wished me to introduce the Newspaper and Magazine Recycling Bill. That is a very worthy measure, however, and I wish my hon. Friend the Member for Bristol, North-West (Dr. Naysmith) every success in getting it through.
I am also grateful for the cross-party support I have received in launching the Bill. This is truly an all-party measure and if, as I hope, it gets on to the statute book, it will reflect a great deal of credit on the House. I give particular thanks to the sponsors who span the political divide. In addition to the usual stalwarts with an interest in this area, including my hon. Friends the Members for 1336 Halesowen and Rowley Regis (Mrs. Heal), for Loughborough (Mr. Reed), for Newcastle-under-Lyme (Mrs. Golding), for Bury, North (Mr. Chaytor), for Denton and Reddish (Mr. Bennett), for Wakefield (Mr. Hinchliffe) and for Scarborough and Whitby (Mr. Quinn), I also have support from three former Conservative Ministers—the right hon. Members for South-West Surrey (Mrs. Bottomley) and for Charnwood (Mr. Dorrell), both former Secretaries of State for Health, and the hon. Member for Broxbourne (Mrs. Roe). I also have the support of the Liberal Democrats in the form of the hon. Member for Taunton (Jackie Ballard). I am pleased to see my right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke), a great champion of carers, in his place—and, indeed, right hon. and hon. Members of all parties
I am particularly delighted that the Government have lent their support to the Bill. With that kind of support, and a fair wind, we might be able to celebrate a stunning victory for carers. It will, in my view, be a victory not only for carers but for parliamentary democracy, for the Bill is about freedom, choice and flexibility. It will give carers the help and support that they need to enable them to continue caring.
I chose the Carers and Disabled Children Bill because I, like most Members, have recognised over the years that the carers in our society should be given more choice and flexibility to allow them to carry out their caring role. I decided to see whether I could build on the provisions of the measure introduced by my hon. Friend the Member for Croydon, North (Mr. Wicks), who is now the Under-Secretary of State for Education and Employment—the Carers (Recognition and Services) Act 1995. I pay tribute to him for his dedication to carers in getting such an important measure on to the statute book. However, my Bill goes beyond the 1995 Act, in so far as it will help all kinds of informal carers—husbands and wives caring for their spouses, parents caring for their ill or disabled children, and adults caring for elderly patients, to name just a few. It will do that by allowing local authority social services departments to assess their need for support and help them in their caring role by giving them what they need in the form of services.
The 1995 Act was a great step forward when it was introduced. For the first time, local authorities formally took into account the carer's ability to care before arranging services for the cared-for person. But, as I said, this Bill goes beyond the 1995 Act in many important respects. In a nutshell, it gives carers enhanced rights to assessment of their own needs; it gives local authorities powers to provide services to carers in their own right; it builds on the freedom and the choice that direct payments give people by allowing carers direct payments for their services, and it ensures that parents, too, can receive direct payments for services to their disabled children.
Many of us, at some time in our life, will care for someone else. We give care willingly to our nearest and dearest because we love them. For some, this caring role will become a larger part of their life, taking up more of their time, because someone close has become ill or disabled. The care provided by carers is not provided on a formal basis by organised, paid professionals. Informal care delivered by family and close friends is provided on an unpaid basis. It is care that draws on feelings of love and duty.
1337 Caring is often very hard work, and can be emotionally draining. It takes many forms within a range of relationships. Although the circumstances that lead people to become carers may be different, many of the difficulties faced by carers are common. The impact on their lives of caring can be similar: distress at seeing a loved one in pain; emotional loss as the nature of the relationship changes; effects on other relationships; a sense of isolation and loneliness; and feelings of stress and depression.
In recent years, there has been a growing recognition of the importance of informal care and its effects on carers. I have known many carers over the years. In Stalybridge and Hyde alone, there are perhaps just under 9,000 carers—roughly one in eight of my constituents. I have been amazed by the amount of support that they have given to elderly, sick or disabled relatives. I have been struck by the fact that, even though they are providing substantial amounts of care, relatively small changes can improve the quality of their lives. I hope that my Bill will go some way towards doing that.
I do not believe that we can afford to ignore the needs of carers. There is a strong social and moral argument for supporting them, but there is a clear economic imperative as well. There are an estimated 5.7 million carers in the United Kingdom. The support that they provide for their elderly, sick and disabled relatives is estimated to be worth £34 billion a year. If we ensure that carers are able to care and are given the means to care in ways that preserve their health and well-being, we shall avoid the enormous costs that would be associated with any breakdown of caring.
My Bill is concerned with carers at the heavy end. In other words, it caters for those who provide regular and substantial care. An estimated 1.7 million carers provide that level of care, giving 20 hours or more a week in support to a disabled or ill person. Some 855,000 carers provide more than 50 hours of care a week.
Those carers are people like Sheila, who has cared for her daughter for 37 years. I do not want carers such as Sheila, who spoke movingly at the launch of my Bill on Tuesday, to be refused help because the person for whom she cares has refused a community care assessment. Caring for her daughter is enormously stressful, and she spoke on Tuesday about the many times when she had been desperate for support after nights of broken sleep, worry and constant care.
Sheila's daughter has epilepsy and mental health problems. Over the years, she has developed a deep mistrust of professionals. I want people such as Sheila to have their needs met in ways that give them more choice and flexibility. I am pleased that the Government have raised the profile of carers. The most significant development has been the publication of the national strategy for carers, which was launched by the Prime Minister on 10 June 1998. Incidentally, 10 June is my birthday, should anyone wish to make a note of it.
Next week, on Tuesday, we shall celebrate the first anniversary of the strategy's publication. At its launch, the Prime Minister stated that we must take our work to support carers further, and my Bill will do just that. Caring for carers is a vital element in caring for those who 1338 need care. What carers do should be properly recognised and supported. The Bill will take us one step further towards achieving that.
Those who have studied the Bill will know that it is longer than the average private Member's Bill. It is also complex. However, the right hon. and hon. Members who have read it know that the Bill will provide a legislative framework to bring about simple changes that will make a big difference to carers' lives. The Bill strikes the right balance between providing strong support and recognition for carers and respecting the individual rights of disabled people. I thank everyone who has given me advice and support on the Bill, including officials from the Department of Health and the Carers National Association.
I should like to set out in a little more detail how the Bill attempts to turn the principles that underlie it into practice. Clause 1 provides that a carer who is 16 or over has the right to an assessment from a local authority of his or her ability to provide, and continue to provide, care for the cared-for person.
§ Mr. Eric Forth (Bromley and Chislehurst)
I congratulate the hon. Gentleman not only on coming high up in the ballot, but on introducing a Bill of this kind. Before he begins his detailed discussion of the Bill, will he tell us what conversations he has had with local authorities or their organisations about the impact that the Bill will have on them? How do the local authorities see themselves fulfilling the obligations and duties that the Bill would lay on them?
§ Mr. Pendry
I thank the right hon. Gentleman for his constructive intervention. I have held discussions with local authorities—my own in particular—and with caring organisations. There is certainly a grey area, in that the authorities do not know exactly what the impact will be. However, they all seem confident that they can cope with the Bill. In addition, clause 9 contains a financial provision, which will provide a stop-gap by which we can assess the Bill's effects if, as I hope, it becomes an Act.
Clause 1 also provides that a carer should have a right to an assessment from a local authority if the carer provides or intends to provide a substantial amount of care on a regular basis for another individual aged 18 or over, and the carer asks the local authority to carry out an assessment of his or her ability to provide and continue to provide care. That would be particularly helpful where the cared-for person had refused an assessment for community care services or the delivery of community care services following assessment, as is the case with Sheila's daughter.
Clause 4(1) amends section 1 of the Carers (Recognition and Services) Act 1995 and enables local authorities to take into account, for the purposes of an assessment under clause 1, any carer's assessment previously carried out under the 1995 Act, where the information may be material. That assessment would enable the local authority to decide whether to provide services to the carer under clause 2. The local authority would have to consider the assessment and decide whether the carer had any needs in relation to the care that they provided for the person cared for. The authority would then decide whether or not it could provide services to meet those needs and whether or not to provide them. 1339 That decision would depend on whether the cared-for person had refused help from the local authority or whether it would be more appropriate for the service to be provided direct to carers to support them in their caring role or maintain their own health and well-being.
This is a very important change to the way in which social services departments may provide support. The aim of the Bill is to focus on enabling those who choose to care, and whose care is wanted by another person, to do so without detriment to their own health and well-being. The Bill is sensitive to the complexities of the relationship between the carer and the cared-for person.
Clause 2(3) states that some services, though provided to the carer, may be services that could be delivered to the cared-for person by way of community care services. If such services are delivered to the carer, they may not, except in prescribed circumstances, include anything of an intimate nature. There is a power to set out in regulations what is, or is not, a service of an intimate nature. Services that may only be delivered to the person cared for might include dressing, feeding, lifting, washing or bathing.
§ Mr. Philip Hammond (Runnymede and Weybridge)
Will the hon. Gentleman clarify whether the provision of services directly to the cared-for person could happen when that person had refused an assessment? Could the services be provided against the wish of the cared-for person?
§ Mr. Pendry
As I understand it, that could happen, but it would be done after discussion with the local authority.
The Bill does not offer the carers of adult users the right to determine the services to be delivered to users. Nor does it give local authorities the power to provide carers with services that are of an intimate or personal nature. However, the Bill recognises that users of services—cared-for people—and their carers are closely linked. The Bill ensures that local authorities can look at meeting carers' needs as well as meeting the needs of the person cared for.
The effect of clause 4(2) and (4) is that, where a local authority is deciding whether to provide a particular service to the carer under the Bill, or to the user under community care legislation, the authority must make it clear who is the recipient of that service. For example, it must make it clear who will be liable for any charges, or who may complain in relation to the service in question.
For many carers, a break from their caring role is a key issue. However, a short-term break does not mean the time that a carer needs to spend away from home for such tasks as buying the weekly shopping. A break that helps carers maintain their health and well-being is an opportunity to have a life of their own. In particular, it is the chance to spend time with family and friends—or indeed with the person for whom they are caring, but free from their usual caring responsibilities.
There are two important issues that dictate whether carers will enjoy a break: first, that there is flexibility in the timing of the break; and secondly, that the additional services provided to the user benefit the person for whom he or she is caring. For a carer to enjoy a break, it is particularly important that the person who is usually cared for is content with the type of additional support that is given.
1340 Clause 3 enables the Secretary of State or the National Assembly for Wales to make provision in regulations for local authorities to issue vouchers for short-term breaks. That scheme will offer carers and the people who are cared for flexibility in the timing of the carer's break, and choice in the services delivered to users while their carer is taking a break.
A typical situation would be that a carer was assessed by the local authority as needing regular breaks from his or her caring role. The local authority would need to assess the user's need for additional support to allow that carer to take a break. The cared-for person may choose to have vouchers rather than directly provided services. It is intended that the regulations will include provisions for vouchers—whether for money or for the delivery of a service for a period of time—to be redeemed by the voucher holders, at a time of their choosing, for services delivered by local authority approved providers.
The short-term break voucher scheme will introduce a simpler way of achieving more flexibility and choice in the delivery of short-term breaks than is currently available via direct payments. It is important to the users of social services and their carers that they have that choice and flexibility in the timing and nature of services delivered to meet their assessed needs.
It is especially important for carers—who give so much—that they are recognised as individuals in their own right. They must have more choice for themselves concerning the way in which they care, and more control over their lives. At present, disabled people may ask their local authority to assess their need for support to live independently in the community and, as an alternative to receiving services from the local authority, can have the money to purchase the support that they need.
§ Mrs. Llin Golding (Newcastle-under-Lyme)
Is my hon. Friend aware that, in my constituency, the local authority is already holding consultations with NCH Action for Children to set up respite care for disabled children, to provide information and to give outreach support? Does he agree that that would fit well with what he wants to provide through his Bill?
§ Mr. Pendry
I am grateful to my hon. Friend for drawing our attention to that excellent scheme. Local authorities take different approaches to these issues, but I am sure that they will all welcome the Bill.
Clause 6 would add a new section to the Children Act 1989 to extend the option of direct payments to parent carers to meet the needs of their disabled children, and to disabled children aged 16 and 17. The responsibilities of parent carers are often made more arduous by the difficulty of accessing mainstream services—for example, child care, including after-school clubs and leisure activities. When parent carers do not think that services are sufficiently tailored to meet the needs of their family, direct payments offer more choice in service delivery.
The clause adds a further section to the 1989 Act to enable the Secretary of State or the National Assembly for Wales to make provision in regulation for local authorities to issue short-term break vouchers to parent carers. The extension of the option of direct payments to 16 and 17-year-old disabled children may be helpful for 1341 young disabled people who want to become more independent; for example, because they want to go into further education or to move away from home.
Clause 7 enables local authorities to charge carers for the services they receive. There is some controversy about charging, and many organisations have approached me on that point.
§ Mr. Hammond
Would that clause provide for the means testing of any cash payments or vouchers that were provided?
§ Mr. Pendry
I was about to say that we need to examine that matter closely in Committee. I hope that my hon. Friend the Minister will be helpful in that regard. Carers look after friends or relatives who might otherwise be a cost to the state and a charge on the taxpayer. There is much feeling among those carers that they should be given a better deal. I understand that talks are taking place in the Department, so I hope that the Minister will be helpful.
Although it would not be possible for a private Member's Bill to try to change Government policy in these matters, I would welcome some response from my hon. Friend on charging for social and other services. I have talked to caring organisations and listened to their concerns and am convinced that we need to amend the measure when it goes into Committee. I hope for support from both sides of the House. I cannot quite see a smile on my hon. Friend's face, but he is a caring man and I am sure that he will listen to our case.
§ Mr. Paul Burstow (Sutton and Cheam)
I very much endorse the hon. Gentleman's remarks on the need for a comprehensive consideration of charging policies. I look forward to the Minister's comments on that point.
Does the hon. Gentleman share the concern of several organisations that the interaction of clauses 2 and 7—in relation to service provision and charging—could lead to a perverse outcome, whereby the carer is asked to pay for services for the disabled or elderly person? As a consequence, the carer's means rather than those of the cared-for person would be assessed.
§ Mr. Pendry
That issue has been raised with me. However, I am assured that that would not be the outcome. I accept that the matter causes concern, but we can iron out its ramifications in Committee.
§ Mr. David Maclean (Penrith and The Border)
I congratulate the hon. Gentleman on introducing the Bill. He has told us that it does not yet contain all the refinements that he wants; one understands that, given the processes of government, he may have had to dilute the measure slightly. I assure him that I am willing to put myself at his disposal, as I am certain is my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth). We have considerable experience of drafting amendments, which he may find useful.
Furthermore, the hon. Gentleman may be aware that, last year, during the proceedings on the Protection of Children Bill, the Minister expressed his gratitude to my right hon. Friend and I because we tabled some 1342 amendments to that measure, ensuring that it was satisfactory and efficient. We are willing to give that assistance again.
§ Mr. Pendry
I am grateful to the right hon. Gentleman, especially as he achieved something that I failed to do—he got a smile from the Minister.
The point is well taken; we need to reconsider the matter. However, following the introduction of the strategy outlined in "Caring about Carers", the Government have made a special grant of £140 million over three years, to ensure that local authorities provide a wider range of services to support carers. We must acknowledge the Government's generosity in that regard.
§ Mr. Hammond
According to the hon. Gentleman's figures, there are about 1.5 million carers providing substantial care. Will he confirm that the Government's generosity would deliver about £50 or £60 a year per carer?
§ The Minister of State, Department of Health (Mr. John Hutton)
I am extremely grateful to my hon. Friend for allowing me to intervene on his excellent speech, and I hope that he will forgive me for doing so. While he is reflecting on the question posed by the hon. Member for Runnymede and Weybridge (Mr. Hammond), he may want to remind the House of how much special and specific grant was ever made available by the Conservative Government to benefit carers.
§ Mr. Pendry
With my all-party hat on, I deliberately tried to avoid such remarks—although such comments are allowed from my hon. Friends on the Treasury Bench.
I hope that this important Bill will be allowed to go to Committee and that it will speed its way on to the statute book.
§ 10 am
§ Mr. Robert Syms (Poole)
I welcome the introduction of this Bill by the hon. Member for Stalybridge and Hyde (Mr. Pendry). He is well respected by hon. Members on both sides of the House and has made a good start in his contribution to a Bill that is important to many people.
Carers have a very difficult task. As Members of Parliament, we all meet people in our surgeries who are struggling to look after relatives or other people. Carers sometimes feel that the welfare state and the structure of society do not take their needs into account.
As the hon. Gentleman said, the efforts of carers are not always recognised and they are certainly not always rewarded. Many say to me, as they say to all hon. Members, "If I didn't care for my relative and he became a burden on the state, think what it would cost you." We are all very much aware that carers save the state a lot of money and it is better that relatives look after relatives and partners look after partners. Anything that we can do to facilitate that role would not only save us a considerable amount of money, but would make people's lives much easier.
1343 The problem is very much a case of the straw breaking the camel's back. A little help, respite, support and care can make the carer's whole task easier and ensure that everyone who is cared for has a better deal. As Conservative Members have already made clear, we shall consider the Bill constructively, if not uncritically. We shall have to consider the detail in many of its clauses. The offer of my right hon. Friend the Member for Penrith and The Border (Mr. Maclean) is helpful in the sense that he can crawl over a Bill, find snags and be helpful—when he wants to be. I am sure that he will do that.
Great Britain has an estimated 5.7 million carers. One in six—or 17 per cent.—of households contain a carer. That is a vast number of people, even it is aggregated out on a constituency basis. In the south-west, the area that I come from, 12 per cent. of the adult population are carers. The burden falls more on women than on men. I have met many women who look after their partners. They have terrible problems lifting their male partners and suffer from back and associated problems. In Britain, 58 per cent. of carers are women and only 42 per cent. are men. Although the latter figure is higher than I thought it would be, nevertheless the burden falls rather more on women. Nine out of 10 carers care for a relative. Those are pretty important statistics.
Many carers not only have to look after their loved one or partner, but 20 per cent. of them do so for more than 20 hours a week. In fact, 4 per cent. of carers have to provide care for more than 50 hours a week, which is a substantial amount of time. Those who live with the person for whom they care spend the most time on the task. Apart from that, carers try to lead ordinary lives. In addition to looking after a relative, they work, shop, catch the bus and have to deal with the problems of congestion and returning home. The burden on such people is substantial.
Representations make it clear that the Bill, particularly clause 1, gives a recognition to carers that perhaps did not exist in the past. The Bill is very much welcomed by most of the organisations that sent in comments. However, I hope that the hon. Member for Stalybridge and Hyde will not mind if I focus on some of the concerns raised, rather than on the positive points, of which the Bill has many.
The Carers National Association expressed its disappointment that, under clause 1, parent carers—parents who care for disabled children under the age of 18—will not be able to benefit from the Bill. They will not be able to receive services in their own right, because clause 1 refers explicitly to people who carefor another individual aged 18 or over".At present, parent carers and their disabled children can receive holistic family services under the Children Act 1989. However, carers say that the child is the focus of such services and, although that is right, it overlooks the need of parents. The Carers National Association does not believe that it is the Government's intention to exclude parent carers and hopes that the issue can be resolved either by amending the Bill or by strengthening the guidance in the Children Act.
Clause 2 makes provision for a local authority to provide any service that it believes will help the carer. That service might involve direct contact with the person cared for, but the Bill states that the service must never be intimate. However, the Carers National Association points out that the Bill does not define what is meant 1344 by an "intimate service". Although the Bill provides for regulations to define an intimate service, it does not state when or whether they will be published in draft form for consultation first. It is important that the definition is published.
Concern has also been expressed that carers will be charged for services, and such concern is inevitable. The Carers National Association is concerned that carers will be charged for services that would otherwise have been provided to the disabled person. The crucial words are in clause 2(3), which states:A service, although provided to the carer … may take the form of a service delivered to the person cared for".The problem is that there is a power to charge service recipients in section 17 of the Health and Social Services and Social Security Adjudications Act 1983. It gives local authorities the power to charge the person to whom the service is provided for non-residential, community care services.
Concern has also been expressed that clause 1 will give a local authority discretion to decide whether to provide a service. Many people believe that the burden should be on a local authority to explain why it is or is not providing a service. People who have been assessed and who expected some support would like a social services department at least to explain why it is not providing support if their application has been turned down. They would be a little more satisfied if they received an explanation.
§ Mr. Hammond
Is not the most likely explanation of a social services department's decision not to provide services simply the fact that it does not have the resources available? Are not people likely to find that an unsatisfactory explanation, as it reintroduces the concept of a lottery into the question of who does or does not receive care?
§ Mr. Syms
My hon. Friend makes an important point. I was about to come to that problem, because we have an assessment system that creates expectations. Although this is a private Member's Bill, I suspect that the Government may well smile on it, and there will be financial implications for local authorities. If people are not to be disappointed once the Bill is enacted, there will have to be planning and further resources to assist local authorities.
As I said earlier, it is a false economy not to do something for carers. If the straw breaks the camel's back, many more people will look to the state, so there will be much more expense. From the caring and financial points of view, it makes sense to focus on the problems of carers.
The Royal Association for Disability and Rehabilitation expressed concern about the potential problems arising from the direct payments provided for in clauses 5 and 6. Although RADAR has welcomed the introduction of direct payments for disabled people aged 16 and 17, it notes that there is a danger that a conflict could arise between the carer and the person to whom the care is being provided. It argues that it is crucial that there should be clear policy guidance about how such conflict would be resolved and that local authorities should uniformly apply the guidance.
The Council for Disabled Children and the Local Government Association seek clarification on how to ensure that a proper balance is reached between parents' 1345 and young people's wishes and feelings, which was the point raised by my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) in his intervention. Parents might need respite care for their own survival, but a young person might not wish to use available services.
Clause 7 deals with charging. The Carers National Association believes that the clause is the most problematic part of the Bill because it gives local authorities the power to charge carers for services provided to them. At present, only the user can be charged for services. The association is opposed, on principle, to charging for non-residential community care. Carers already devote their time and money to caring, so why should they pay for a service that helps them to continue caring? Many people will refuse services because of their inability to pay. That is a knotty problem.
I turn now to respite care. I served for several years on the Wessex regional health authority, and I remember being impressed by doctors and others at a seminar who talked about the benefits of respite care. As a nation, we have not made enough provision for that over the years. Respite care is important because of the burdens on carers and the long hours that they put in. Mencap is concerned that the Bill does not give carers a right to respite care and that no resources are allocated for it in addition to those that have already been announced.
We know that many social services departments are hard-pressed, and there will certainly be a great deal of pressure on them to provide respite care. We know also that there may be differences, which affect benefits, between respite care provided by the national health service and that provided by social services. When local respite care is provided by the NHS, it is judged to be hospitalisation, so many people find that they lose benefit when their loved one goes into respite care for a few days. That, too, is a knotty problem. There is sometimes an artificial division between social services and the national health service.
I broadly welcome the Bill. There are many matters that need to be sorted out in Committee, and I hope that that will be done, but many carers throughout the country will give the Bill a big cheer. The Government have a responsibility in this matter. After all, the hon. Member for Stalybridge and Hyde is to some extent following the strategy outlined by the Government. As the Bill proceeds, they have a responsibility to answer questions and look kindly on some of the Bill's resource implications.
It would be a great pity if, carers' expectations having been raised by the intoduction of a Bill that recognised their needs, life remained difficult for many local authority social services departments. We all know that, despite the funding discussed in yesterday's local government debate, many of those departments remain hard-pressed and have to juggle the serious demands made on them.
§ Mr. Tom Clarke (Coatbridge and Chryston)
I welcome the general tone of the speech made by the hon. Member for Poole (Mr. Syms). Some of his detailed points may have momentarily depressed my hon. Friend 1346 the Member for Stalybridge and Hyde (Mr. Pendry), who has much more experience of the House than I have. However, when I sought to pilot through the House what is now the Disabled Persons (Services, Consultation and Representation) Act 1986, such specific questions about my Bill remarkably vanished when, on the eve of Third Reading, Mrs. Thatcher said, "There isn't anything here that we can't deal with." I hope that my hon. Friend will feel comfortable with that assurance.
I regarded clause 8 of the 1986 Act as precious, and it was supported by my hon. Friend. I warmly congratulate him on his good luck in achieving a high place in the ballot, but more importantly on his good judgment in choosing such an important and relevant subject.
The Bill adds to the Carers (Recognition and Services) Act 1995, introduced by my hon. Friend the Member for Croydon, North (Mr. Wicks). I shall not make political points. I was shadow spokesman on community care for a number of years and led for the Opposition in proceedings on the Children Act 1989. Although we had difficulties in implementing the 1995 Act, there was a basis of agreement on both sides. What matters today is what mattered in previous years: the political will to see the Bill through the House and to recognise the will of Parliament.
Not only has my hon. Friend the Member for Stalybridge and Hyde achieved that in presenting his Bill for Second Reading, but he has under his belt a firm Government commitment in the money resolution. That is the response to the points made by the two Conservative Members who have temporarily left their seats. Not every private Member's Bill has that commitment. With that start, my hon. Friend will get a fair wind, and we want to support him in that spirit. I am glad that I seem to have given good news even to the hon. Member for Poole, for whom I have great respect.
My hon. Friend the Member for Stalybridge and Hyde is providing a focus on an idea whose time has come. We all know from our constituency experience of the problems of the many carers. My hon. Friend and the hon. Member for Poole mentioned that there are about 5.7 million carers. It is difficult to define the role of informal carers, but if those people—men and women, young and elderly—did not demonstrate the dedication that they do, the strains on the Treasury would be untenable. When my hon. Friend's Bill is enacted, as I hope it will be, his wise proposals will not save the Treasury money, but even so, we have a responsibility to carers and those for whom they care which my hon. Friend is admirably addressing.
I welcome my hon. Friend's specific proposals. The vouchers are workable and realistic. My local government experience leads me to think that they will be welcomed by local authorities, a point raised earlier by the hon. Member for Poole.
One of the Bill's most inviting features is the measure to make direct payments to 16 and 17-year-olds. When the Leader of the Opposition, the right hon. Member for Richmond, Yorks (Mr. Hague), was acting for the then Government and I was speaking for my party, there was no difference between us on the principle of direct payments. Local authorities were urging us to introduce them, and they were right. We had doubts about how many groups direct payments should cover and how they would work.
1347 We are in a stronger position today to assess the success of direct payments. I wonder whether my hon. Friend the Minister will have time to expand on the statement made by the Minister of State, Home Office, my right hon. Friend the Member for Brent, South (Mr. Boateng), on 8 February 1999 and whether the Government think that in time such payments could be extended further. We are concerned about the over-65s and those with learning difficulties. We who are involved with disability issues as members of the all-party group on disability have always accepted that many of the measures we want must be evolutionary in nature—they cannot be achieved overnight. The step forward represented by my hon. Friend's Bill is extremely welcome.
With the provisions on direct payments, my hon. Friend has addressed one of the most serious issues that I have encountered during my years travelling about the United Kingdom—including Scotland, although the Bill does not apply to Scotland. He will know that one of the greatest worries of parents of young people with learning disabilities and physical disabilities is what will happen to their offspring when they leave formal education. If the provision for 16 to 17-year-olds is implemented, the future of those young people will be much clearer; that will be far more reassuring to their parents than anything we have so far achieved. That is a wonderful step forward, which will be welcomed by the 19-plus groups throughout England and Wales and by parents. The impact on carers of the Bill, coupled with previous measures and the Government's positive approach, will be profound. The time is right.
We have all encountered in our constituencies people who have become more frail with age, dealing with offspring who have learning and physical disabilities, who have, over time, become bigger and heavier and more difficult to cope with. The hon. Member for Poole raised questions asked by several organisations, but I am sure that he acknowledges that they support the Bill none the less. My hon. Friend the Member for Stalybridge and Hyde can reply to those organisations, by saying that, if we do not deal with the stresses and strains imposed on carers in those circumstances—elderly people trying to cope with adult offspring—we will find, with increasing frequency, the relationship between carer and person cared for breaking down, ending in two people becoming institutionalised. If my hon. Friend's Bill prevents such occurrences, it will both be socially right and save local authorities, the NHS and the Treasury money that can be usefully spent elsewhere.
I congratulate the Library on preparing an excellent research paper, which, referring to the national strategy for carers report, states:Among carers who spend at least 20 hours a week caring—nearly half of them had been caring for more than five years—49 per cent. had not had a break since they began to care. Six out of 10 carers, who lived with the person they cared for, felt unable to leave that person unattended for as little as 2 hours.My heavens, that is real dedication. Are they not entitled to the support of the House as well as the sort of support that my hon. Friend's Bill offers? There is great demand for the services that carers supply. Even though they are often motivated by sheer love and affection, they need the sort of practical support that the Bill offers. We must address a variety of circumstances: carers help sick people, disabled people and people with mental illness. 1348 As a result, carers themselves often experience huge psychological and emotional stress. We all want to relieve that stress, as do local authorities, which have told us that that can be achieved by providing modern, up-to-date home care, day care and, above all, respite care. People who have not left for longer than two hours the person for whom they have cared for five years are entitled to a bit of help—enough time to enable them to do a bit of shopping and anything else they need to do to recharge their batteries.
My hon. Friend's Bill admirably addresses the social inequalities experienced by disabled people and their carers. Of great importance is the fact that it will help the many children who are carers for adult disabled people. The Library paper states:The report of a survey of young carers undertaken in 1997 and published in 1998 concluded that the needs of many young carers were still unknown and unmet. Only 11 per cent. of young carers in the survey had been assessed for services, and only 5 per cent. under the Carers Act. The report said that the position of young carers as a group appeared to have changed slightly for the better since 1995 but there was considerable scope for improvement.
§ Mrs. Rosemary McKenna (Cumbernauld and Kilsyth)
Does my right hon. Friend agree that the problem is the invisibility of such children? For many years, carers as a group were invisible, but child carers continue to be so. Education authorities and schools have a role to play in identifying children who bear such a huge burden.
§ Mr. Clarke
I agree. My hon. Friend speaks from great experience, as a former president of the Convention of Scottish Local Authorities and provost of Cumbernauld and Kilsyth. I am glad that she has raised the question of education and the role of education authorities.
I welcome the vision enshrined in the Bill. Many of the individual issues raised today will be dealt with in Committee, and an evolutionary approach will take us further still. Whatever questions are put to my hon. Friend the Member for Stalybridge and Hyde and the Carers National Association by those who have campaigned for many years—including Mencap, Lord Rix, and the National Centre for Independent Living, headed by that formidable woman, Jane Campbell—it is important to recognise that they have all welcomed the Bill. You, Mr. Deputy Speaker, would rightly rule me out of order if I referred to Scotland, because the Bill does not cover Scotland, but I am sure that my hon. Friend will acknowledge the views of the Carers National Association for Scotland, especially because his Bill will become a beacon for the rest of the UK and Europe.
The Bill is welcome. It gives a large number of people both rights and responsibilities, but I believe that they will welcome the challenge. People working in the field will always ask for more resources, and they are right to do so. The Government are in a strong position to respond.
Almost a year ago to the day, on 8 February 1999, the Minister of State, Home Office, my right hon. Friend the Member for Brent, South said in his excellent announcement on carers that the Government would provide £750 million to promote independence—the sort of independence that my hon. Friend the Member for 1349 Stalybridge and Hyde welcomes—and £375 million for vulnerable children. Given that fair wind, the excellent Bill introduced by my hon. Friend has every prospect of success. It deserves to succeed, and I am delighted to give it whatever support I can. I wish it well on its travels through the two Houses of Parliament. I believe that my hon. Friend strikes the right note and I wish his measure godspeed.
§ Mr. Paul Burstow (Sutton and Cheam)
I echo the concluding comments of the right hon. Member for Coatbridge and Chryston (Mr. Clarke). The Bill deserves to succeed on its own terms, but more importantly because of the people to whose quality of life it will make a substantial difference.
I congratulate the hon. Member for Stalybridge and Hyde (Mr. Pendry) on his initiative in choosing the topic as the basis for his private Member's Bill. On behalf of the Liberal Democrats, I wholeheartedly support the principles that underpin the measure. Although there are specific points of detail that may be the subject of closer consideration in Standing Committee, which I hope the Bill will reach, it marks a step change in the House's attitude to carers. For that, the hon. Gentleman deserves the thanks of a great many people outside the House, not least in my constituency where many carers provide many hours of support for loved ones and others.
At the outset, I shall refer briefly to my own experience in my constituency. When we discuss such matters, we bring to the debate our experience from our constituency surgeries, casework and face-to-face contacts, which we reflect on, evaluate and learn from. In my constituency we have a local carers forum and a local branch of the Carers National Association. We are lucky also to have a carers centre, which underpins all that is being done in Sutton and allows carers' voices properly to be heard by the local authority and other service providers.
I am repeatedly struck by the fact that carers feel undervalued and isolated at home. Last year, I had the opportunity of spending a day with Lilian, a carer in my constituency, who for the past three years has been caring for her husband. He has dementia, one of the cruellest conditions. A person with dementia is there physically, but not in any other practical sense.
I spoke at length to that constituent, who is intensively involved in providing care and support for her husband. What came across most powerfully was her desire to have a life outside that caring role, without feeling guilty. If the Bill enables people like Lilian to get more support for their needs, in addition to support for the person for whom they are caring, their lives will be substantially improved. They will be able to shoulder the burden of care—although they do not see it as a burden—for far longer.
The Bill builds on the existing community care and carers recognition legislative framework. The hon. Member for Stalybridge and Hyde also referred to clauses that amend child legislation. It marks a step change by giving carers a clear right to an assessment even when, as we have heard, the disabled or elderly person who is being cared for chooses not to take up the right, under the community care legislation, to an assessment of his or her care needs.
1350 The hon. Gentleman described the main features of his Bill, so I shall not repeat them as other hon. Members want to contribute to the debate. The Bill makes an important distinction between the rights of the carer and the rights of the person cared for. It extends direct service provision to carers. For the first time, local authorities will have the power to provide services for carers.
The introduction of vouchers may cause concern in other contexts, but in this case would be a powerful tool for giving users control and allowing carers to shape the services provided for them and for those in their care. That is particularly relevant in respect of short-term respite breaks.
With the best will in the world, large organisations such as local authorities cannot always tailor their services to meet individual needs. They cannot always provide a slot for a respite break when it is most needed. Although voucher schemes will have some logistical impact on the ability of local authorities to deliver, they are vital to allow carers and those for whom they care to choose when, where and how respite is taken. That is crucial to the dignity of carers and a recognition of their value.
Another important advance that the Bill would bring about is the extension of the scope of direct payments to carers and to young disabled people of 16 and over. Estimates of the number of heavily involved carers range from 1.75 million to 2 million. Even by the criterion of 20 hours of care a week, 1.7 million carers are potential beneficiaries of the measure. Of those, it is estimated that 1.2 million provide physical and/or personal care for elderly people.
There is no doubt that those figures represent an under-reporting of the true number of people who undertake caring responsibilities. There are far too many hidden carers in this country, especially younger carers, perhaps caring for their parents, who are not picked up in the general home surveys. We need to do more to make sure that we uncover not just the statistics, but the people.
In my borough the statistics reveal that there are 20,000 carers, but far fewer than 10,000 of them are identified as being in receipt of services or as having been assessed. Much more needs to be done to turn the statistics into the names and addresses of people who could benefit from the proposed services. The Bill does a great deal, but it does not address that issue, which is fundamental to developing services for carers.
Clause 1, which provides new rights of access, is welcome. One or two concerns have been raised and need to be dealt with in Standing Committee or in the Minister's response. We hope that there will be scope for amendments to add, for example, parent carers of adult children. It would be interesting to know why they were not included in the scope of the Bill. Another way of addressing that omission, without recourse to primary legislation, would be through new guidance to local authorities under the existing legislation on children.
Clause 2 gives local authorities powers to provide services for carers which are incidental to the care of the disabled or elderly person. Carers need services in their own right. They may need counselling—for example, to provide them with strategies for coping with a person in the early stages of dementia. They need training—perhaps for lifting. Many, though not all, need support groups. Such services require funding. There is anxiety about the precise wording of the clause because it appears that some 1351 of the provision for services that is provided directly to the disabled or elderly person could be given to the carer instead. Clearly, the devil will be in the detail of the regulations. It is vital that giving support to carers does not mean that the disabled or elderly person becomes more dependent on the carer. It is important to maintain a dual focus on the needs of the carer and the person who is cared for. We should not undermine the sense of independence that we wish to give the elderly or disabled person.
The hon. Member for Stalybridge and Hyde referred to intimate services and said that the regulations would define them. We would welcome the opportunity in Committee to explore the potential definitions. The earlier we see draft regulations, the better for hon. Members and for the many organisations that represent disabled people, elderly people and carers. Intimate services are crucial for someone who suffers from dementia. Inadequate services for dealing with incontinence are a key trigger for going into residential care. I would be interested to learn more about what will be included in and excluded from the definition of intimate care. Carers need support to undertake tasks that often lead them to give up their caring role when they may not wish to do that.
Anxiety exists about the charging powers in clauses 4 and 7 and their relationship to clause 2. Clause 2(3) states:A service, although provided to the carer … may take the form of a service delivered to the person being cared for".We need further clarification. It would be wrong if local authorities could assess the carer's means and charge the carer for the care package, rather than the current position whereby the local authority assesses the disabled person's means. Some disabled people, because of their means, do not have to pay for services, or they pay a lower rate. The local authority should not be able to use the new power to switch the financial burden to the carer.
The hon. Member for Stalybridge and Hyde gave me some welcome assurances. The anxiety is genuine, and the issue has been raised by various organisations. The Minister's body language suggested that we should not be concerned. I hope that he will clarify how the relationship between the two charging policies will work.
§ Mr. Hammond
I have another problem with clause 2(3). My reading of it suggests that it will be difficult for services that do not include intimate services to provide any real respite for the carer. Perhaps the hon. Gentleman has considered that problem.
§ Mr. Burstow
The hon. Gentleman is right to make that point. The Carers National Association and others have expressed anxiety about what the definition will cover. We will have to explore that in some detail in Committee.
Anxiety has been expressed about extending the principle of charging. I hope that the Minister can give us some idea of the time scale that the Department has set in which to publish its new policy statements and frameworks for charging. Many local authorities are waiting for that and are almost paralysed; they will not recast their charging policies, despite the pressure to do so, because of budgetary constraints. Charges are a disincentive to taking up services—the assessment or the service itself. Clarity about the Government's view of the 1352 way in which the Bill, and the charging regime that it might introduce, will complement existing charging policies would be helpful.
Clauses 5 and 6 are welcome because they extend the principle of direct payments. More control for the service user is vital because it provides choice and a sense of independence. The clauses achieve the necessary balance between the rights, needs and wishes of the carer and those of the disabled or elderly person. It is vital that we do not further institutionalise the disabled or elderly person by giving a disproportionate amount of power to the carer.
Clause 9 is perhaps the nub of the Bill. It deals with the way in which the measure will be financed. A money clause is welcome, and I applaud the Government for supporting the Bill by including that provision. The Bill will have cost consequences. If it does not, it will not deliver anything. The Government are realistic in including such a provision. When the Carers (Recognition and Services) Act 1995 was considered, the Association of Directors of Social Services estimated that its implementation would cost a modest £40 million. I have seen no assessments of its actual cost, but because no additional funds were provided at the outset, assessment of needs has been extremely slow.
Funding is essential to implementation. The social services inspectorate stated in a report:We did not find that assessments and reviews for carers were routinely part of social services practice. Many staff were … unclear about entitlement … Explicit carers' assessments were rare although staff would often claim to have carried out some form of implicit—and unrecorded—assessment.Carers' assessments are different from taking carers' views into account. Most local authorities claim that they do that. It is crucial that the assessments are properly funded and that plans of action to support the carers are put in place. The carers' grant that has been mentioned is an important foundation to underpin the development of services for carers. We might quibble about current funding through the carer's grant, but it is a useful way of channelling resources to develop that aspect of the service. In the long run, we believe that specific grants should be included in the general revenue support grant so that local authorities retain some discretion about the way in which they provide services.
Flexibility is the key to developing services for carers and disabled people. Sitters' services and care attendance schemes are more acceptable to many people. However, sitters' services are not widely available—surveys have revealed a patchwork quilt of provision. I am fortunate that there is an organisation called Voluntary Sitters in my borough. It provides the sort of short-term support to which the right hon. Member for Coatbridge and Chryston referred. Carers are often not prepared to go away even for two hours. Sitters' services provide crucial support, which enables people to get their hair cut, do some shopping and live their own lives for a short time. That can make so much difference to the quality of their lives. A massive expansion of such services is required, but the infrastructure for that does not yet exist. The voluntary sector and the public sector need to do more. The carer's grant is welcome if it primes the pump for those services.
Resources are everything. My local authority has received a 2.8 per cent. increase in its standard spending assessment for social services. That is well below the 1353 national average. Consequently, it has to consider charges for day care services for people with learning disabilities to bring it into line with neighbouring authorities. I attended a carers forum in my borough before Christmas, and the matter was debated there. I met parent carers of adults with learning disabilities. They expressed their anger at being told that they have to pay charges after having cared for and supported their loved ones informally for years. That is outrageous. That is not a criticism of the local authority, which has to make those hard choices, but it is absolutely the reason why local authorities such as Sutton and many others need the Government to provide the framework that they promised in the social services White Paper in 1998. That framework is still not with us today.
The principle that the Bill establishes above all else—and it is absolutely vital—is the separation of the rights of the carer from those of the disabled or elderly person. Access to assessment, services and direct payments would no longer be matters in which the disabled or elderly person and the carer would be fettered. That can be a problem in some relationships and the Bill would facilitate its removal. That is welcome, but the principle should also apply to the benefits system and the carer should be able to gain access to invalid care allowance without having to show that the cared-for person is in receipt of attendance allowance. Currently, ICA is paid only to carers who support a cared-for person who is in receipt of attendance allowance, the middle or higher rates of disability living allowance or constant attendance allowance. The gateway to ICA is through the take-up of benefits of the cared-for person.
Although we know that more than 1.7 million people each provide more than 20 hours of care a week, only 400,000 carers are in receipt of ICA, which is a small benefit and small recognition of and support for their caring role. It does not include people of pensionable age, but they incur additional costs as carers. Indeed, they are excluded, as are people who earn only £50 a week. There are other effects as people who provide a great deal of care do not receive the recognition they need. For example, carers will receive the state second pension only if they have a record of entitlement to ICA, but many heavily involved carers will never have such a record and so will never receive that benefit.
We wholeheartedly support the principles enshrined in the Bill and give it our full support. We hope that it will complete all its stages and look forward to exploring the detailed questions in Committee.
§ Mr. Huw Edwards (Monmouth)
I am pleased to be called to speak. I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on both finishing so high in the private Member's Bill ballot and on introducing this Bill, which is certainly one I would have liked to introduce myself. A year or so ago, I introduced a ten-minute Bill that would have given people a right to respite care, which I shall discuss in more detail later.
The national carers strategy does the Government great credit. We have waited a long time for it. I have tried to tell my constituents and carers' groups about the strategy, but even now there is a fair degree of scepticism. Carers 1354 have had their hopes raised on many occasions and it has taken them a long time to accept that legislative changes will affect their lives in due course. Why did it take until the last few years of the 20th century for us to introduce rights for carers? Does not that reflect the history of our social services—which has been so different from that of the national health service, in which we enshrined the principles of universality and comprehensive care more than half a century ago? Changes in social care have been piecemeal, and different groups—children, people with physical or learning disabilities and those with mental health problems—developed rights at different times. By the 1990s, carers, too, were developing rights.
The Bill draws on the work of the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Croydon, North (Mr. Wicks), and I am glad that it has all-party support. My interest is of long standing. When I was 18, during what young people now call the gap year, I worked for Lambeth social services in a low-level clerical job. I provided carers or disabled people with holidays, which were then called recuperative holidays; they went to Margate for a week. That job gave me a great personal insight into the role and lives of carers.
I later had the privilege of working for Mencap, learning more about the role of carers who looked after people with learning disabilities. For most of my professional career I was a university lecturer in social policy with an academic interest in and commitment to the education of people who go into a career in the social services.
In 1998, I introduced a ten-minute Bill—the Disabled Persons and Carers (Short Term Breaks) Bill—on behalf of Mencap, with the support of other voluntary organisations such as the Carers National Association. I am pleased that some of its principles have been incorporated into this Bill, although it does not go as far as my ten-minute Bill. If I am involved in Committee, I hope that we can make further representations to the Government.
It is estimated that there are about 9,000 or 10,000 carers in Monmouthshire. Last summer, I had the great privilege of bringing a couple of them to the annual garden party at Buckingham palace. We were allowed to invite party supporters, but I thought that the carers in my constituency were more important. I understand that 9,000 people attended the garden party; I could have filled it with the carers of Monmouthshire alone. That thought had a profound impact on me.
To its credit, the Bill enshrines the right of carers to ask for an assessment of their needs. Some carers in my constituency will still be sceptical about that, because they know what it is like to go through assessment after assessment after assessment and not receive the services that they are assessed as needing to help the person for whom they care. That point needs to be considered very seriously.
Clause 2 enshrines the important principle of giving local authorities powers to provide direct to carers services such as counselling and information as well as physical help, training and advice on lifting, to which other hon. Members have referred. On services, it says:The local authority must consider the assessment and decide1355 whether any service will help the carer to provide for the disabled person. But there is a danger there. What will the local authority consider people to be in need of? What is considered worthy in one area may not be considered worthy in the area next door.
We return to the fact that we have never enshrined universality in our social care sector as we enshrined it in the provision of health care services. Territorial injustice has always been a problem in our social services. Services might be provided in one area, although similar needs might not be met in another, for whatever reason—perhaps political priority.
Hon. Members have referred to the work of young carers. I have had a little contact with them and attended one or two conferences. I have been struck by the fact that some young carers do not look after people with clear physical disabilities, but parents in their 20s and 30s who may have drug, alcohol or mental health problems. They care for them in intolerable circumstances and often with little support.
I am pleased that the Bill applies to Wales. There was concern when the national carers strategy was published because it related only to England. It was the duty of myself and other Welsh Members to make it clear that we needed a similar strategy in Wales. There are 300,000 carers in Wales, 50,000 of whom provide care for more than 50 hours a week. There are 2,500 young carers aged under 18. The National Assembly for Wales, and particularly the Health and Social Services Secretary, Jane Hutt, should be given credit for having allocated £9 million over three years for the strategy. I hope that the amount can be increased as a result of the Bill.
Monmouthshire has developed a carers strategy. It is probably behind the times compared with some other authorities, but I am glad to have been at its launch. A newsletter was recently published and sent to all carers; there is support for carers through organisations such as Crossroads; there has been a carers week; and the need for a carers' centre has been recognised. However, there are problems. In an area of 300 sq miles, with market towns in the four corners of the constituency, where should the carers' centre be? Clearly, four or five centres would be better because carers will have transport problems if there is only one. Many carers are unable to get around because of the problems involved in caring for others. We need carers' centres in a number of areas.
I welcome clause 3, which reflects the ten-minute Bill that I introduced the year before last. According to Mencap, which helped me with my Bill, 100,000 people with severe learning disabilities and their carers are not receiving respite care. Only 32 per cent. know about respite care, and almost one in five carers who apply for it are refused it by a local authority or health authority. When the Bill is enacted, I hope that those will become statistics of the past.
In recent weeks and months I have met groups of carers in my constituency. They have stressed the value that they place on respite care. It provides opportunities to meet new people, for personal development, to be independent and to enjoy a new environment. Short-term breaks and respite care have the same attractions for people with disabilities as for the rest of us. The carers whom I have met say that they need short-term breaks to allow them to lead a more ordinary life. They need to recharge their 1356 batteries by going away for a few days, or even a few hours. They need to spend time with their partners or families, to see friends, to catch up with the housework, to go shopping or simply to sleep. According to Mencap's research, four out of 10 carers had not been out for an evening in the past six months.
We are talking about people who are socially excluded. They cannot enjoy the expectations of life that the majority of us take for granted. One mother wrote to me:I am very grateful for the 3 hours per week respite that we have through our Mencap Family Carer, but I am conscious of how fortunate we are compared to most others.That comes from someone receiving just three hours respite a week.
A short-term break could mean a break in the carer's own home—a sitting service. It can be inexpensive, but the value of such a small investment can be immense. I did not consider introducing a voucher scheme in my Bill, but it will be welcome, notwithstanding the reservations that people have had about such schemes for other services such as pre-school provision.
Respite care can also be cost-effective. Research by Dr. Peter Frost of the university of Brighton has shown that by supporting carers we can maintain their health, thereby reducing the cost of hospitalisation and breakdown. Respite care can also help carers to return to work, reducing the cost of benefit and increasing the revenue from national insurance and taxation. If carers could not or did not care, the responsibility would fall even further on the state. Employed carers would be paid, receiving time off and annual leave, whereas care is currently provided for nothing by the vast army of carers.
I wish my hon. Friend every success with the Bill. If I can be of help on the Committee, I shall be happy to serve. It is a great achievement that we have a national carers strategy under this Labour Government. The Bill will put part of that into action.
§ 11.4 am
§ Mr. Stephen O'Brien (Eddisbury)
I add my congratulations to the hon. Member for Stalybridge and Hyde (Mr. Pendry) on introducing this welcome Bill. I also congratulate him on coming so high in the ballot. I was also on the list, but much lower down than him, so my congratulations are particularly personal.
All my Conservative colleagues join me in welcoming the Bill. Its objectives are wholly commendable and it is consistent with what has been trailed for some time. However, I am disappointed that the Government have not given the Bill sufficient priority and found time for it in their legislative programme, leaving it instead to take up valuable private Member's time. I declare my personal interest: in the light of the Prime Minister's comments on Tuesday to the National Farmers Union, I hope that the Government will consider supporting my Food Labelling Bill, which is due for its Second Reading on 3 March.
The Bill we are considering today extends beyond the family, but its underlying principles are rooted in a sense of family; it is fully consonant with a commitment to the family and the recognition of carers who make provision for their loved ones within the family. I have seen that in my life. My mother and my wife are both nurses who have been concerned with caring for the terminally ill. My 1357 family has lived in a nursing home for the terminally ill that offered respite breaks. Those caring for their relatives could arrange to have them sent to the home under the supervision of my mother for a month while they went on holiday or otherwise caught up with their lives. That was a valuable service. However, it was a private sector service restricted to those who had sufficient means. The welcome aspect of the Bill is that it provides an opportunity for a greater extension of those services and provisions.
The focus must be on resources. The right hon. Member for Coatbridge and Chryston (Mr. Clarke) and the hon. Member for Sutton and Cheam (Mr. Burstow) talked about that in detail. There are two basic issues. The first is the resources at local authority level for those who are already receiving some support. I recently had a case at my surgery involving the devoted and caring parents of a 26-year-old who was severely mentally retarded. They gave him the most amazing care. Their situation had been assessed and they had been awarded 83 days per annum respite care for the previous two years. That was welcome and clearly necessary because both parents were beginning to get on in years.
However, all of a sudden, because of a limitation of resources, the 83 days were reduced by letter to 51 days. That is still not bad, but that is not the point. The parents needs had not changed. They still needed those 83 days to recharge their batteries so that they could provide proper care the rest of the time, which is clearly exhausting. It is also important for carers to know that they have a set amount of time when they will be released from their burden so that they can plan and set targets and goals. The Bill is a welcome move forward in looking carefully at the needs of carers.
Assessments produce certain expectations, and if services are reduced or denied due to a stretching of resources, serious difficulties may arise. If the Bill becomes law, its detailed provisions will have to be worked out with care and consideration. It will be important to make sure that there are adequate resources, so that once an assessment has been made, and provided that the needs have not changed, there are no arbitrary variations in the support that is provided purely because of annual financial considerations.
Another, perhaps more important, aspect of the Bill is the need for resources to provide the services in clause 2, which have been mentioned in previous speeches. Subsection (2) states:The services referred to are any services which … may take the form of physical help or other forms of support.As my hon. Friend the Member for Poole (Mr. Syms) said, one of the most significant aspects of caring involves lifting and turning the patient. The professionalism and ability of carers to turn patients and help them to avoid bedsores is often regarded as a test of the effectiveness of the care provided. A commitment to training is absolutely crucial, and may be a more effective use of resources. Training is important not only for lifting, but for the regime of turning patients if they are bedridden or seated for long periods of time.
I am interested in how the Bill would operate in terms of resources. The explanatory notes mention training, so perhaps the Minister will say something about that in his 1358 response to the debate. I am also concerned about charging, which is covered by clause 7. Although I understand the framework that is set out, one of the benefits of the Bill will be to encourage carers to feel that their good work has been recognised. However, the charging regime in clause 7 may result in people refusing services because of their inability to pay or their concern about the level of the charges. It is important that the good intentions of the Bill can be translated into action—and that will require resources. It would be useful to examine how the charging provision will operate in practice, so that it does not become a deterrent. I look forward to hearing more about that.
Finally, in respect of the financial provisions in clause 9, I am unclear about what the Government envisage and the extent to which they are working with local authorities to ensure that there are adequate resources. I hope that the Minister will clarify that in his response to the debate.
I welcome this important and necessary Bill, which, at last, fully recognises the significant role of carers in society. My hon. Friends and I are happy to support it.
§ Mr. John Heppell (Nottingham, East)
I shall not spend long discussing the details of the Bill as it is important to look at the bigger picture. I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) and many others, including my right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke), the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Croydon, North (Mr. Wicks), and my hon. Friend the Member for Monmouth (Mr. Edwards) on their work in this field. I could continue mentioning right hon. and hon. Members, but the real congratulations should also go to some of the people who have been campaigning to make carers a big issue.
I see the Bill not as the first step, but as part of a strategy that has suddenly gained pace. I should also congratulate the Minister and the Government on their role, to which I shall turn later in my speech.
The hon. Member for Sutton and Cheam (Mr. Burstow) and my hon. Friend the Member for Monmouth spoke from personal experience. I consider myself fortunate in that I have never had long-term responsibility for caring for someone. We can attend forums and talk to constituents, but we can never understand what it is to be a carer unless we have experience of caring.
My right hon. Friend the Member for Coatbridge and Chryston always used to tell people, "At some stage in your life, it is likely that you will suffer some disability and find out what it is like to be disabled." It is also likely that at some point in their lives, most people will be a carer. Recent studies show that, in a typical lifespan, six out of 10 people are likely to undertake heavy caring duties and that the chances of becoming a carer increase with age. Even those whose attitude is, "I'm looking after No. 1" should remember that at some time in the future they may need the provisions that we are making today.
The common-sense argument for the proposed changes in the Bill and the overall strategy are overwhelming. It is obvious that we need to do something to help carers. I have heard many debates about who should be responsible for community care and whether social services should take more of the burden off the national health service. In reality, 1359 the majority of community care is undertaken not by the national health service or social services, but by ordinary carers who are devoted to members of their families. Those carers save the Government some £34 billion. That is an awfully big resource, and a resource that we cannot afford to ignore. If we do, carers will burn out and cease to be able to act as carers. They may become ill themselves, which means that the burden—not just in relation to the person being cared for but in relation to the carer—falls on the state. We end up providing a higher level of service because we could not provide the necessary support in the first place. I welcome this Bill because it provides that support.
I said that I had no personal experience of being a carer, but I do have one small experience about which I wish to tell the House, as it left a lasting impression. My wife used to work for social services in a residential home for people with disabilities. The home took the residents for a weekend trip, and wanted volunteers to assist. My wife kindly volunteered me for a weekend at Butlins in Skegness. People might agree that there may be grounds for divorce in that, but it turned out that Skegness—although it is always fairly bracing—was quite sunny. We had a pleasant weekend, and the company was excellent. I had a good time, and it was fulfilling and rewarding.
I was a second-class carer, as the residential workers carried out any unpleasant tasks. My tasks were menial, but what stays in my mind was how exhausted I was at the end of the night and at the end of the weekend. That made me think—what if I had been caring not for a weekend, but for a week, a month, a year or a lifetime? That is the reality for many carers. We must make sure that we provide support for those lifetimes.
In some respects, the Bill is just a step forward. My hon. Friend the Member for Croydon, North proposed the Carers (Recognition and Services) Act 1995 under the previous Tory Administration, and that was a step forward, but it did not deliver in all respects. The proposals were not taken up, and carers recognised that. I was pleased to see the fresh impetus that was given to the matter by the incoming Government.
It was no surprise that one of the first groups that the Prime Minister invited to No. 10 Downing street was carers, and it was significant for them to receive that level of support from someone so senior. There was an immediate recognition by the Government that something needed to be done quickly. As a result, the Deputy Prime Minister launched the national strategy for carers in February last year, and the proposals in the Bill are in the strategy document. I am pleased that my hon. Friend the Member for Stalybridge and Hyde decided that we must implement the proposals: it is a question not just of fine words but of producing concrete proposals on which people can work.
I want to congratulate those in local government and the health service, who have been putting the local plans together. We heard from my right hon. Friend the Member for Coatbridge and Chryston that £750 million had been put aside to help develop people's independence, and that £375 million has been put aside for children's initiatives. The initiatives under the national strategy are significant, with £20 million going in this year, £50 million next year and £70 million the year after that.
Local organisations have asked me what is to happen after the three years. We know that money is there now, but I was asked to lobby for the money to remain and, if 1360 possible, to be increased in the future. I can tell my hon. Friend the Minister that I am lobbying now: I want that money to remain and to increase after the three years. We need to ensure that the necessary resources exist.
I want to congratulate local organisations working within the national strategy who have spent money locally. We often talk about partnership—it is a buzzword—but I see real partnership in the work in Nottinghamshire between local authorities, health authorities and voluntary organisations which are putting together plans to ensure that people can have respite care. They are producing practical plans that aid people, and the Bill will help to make that more possible.
The Bill builds on what has gone before, but it introduces something which is sadly lacking and much needed—flexibility. The Bill recognises that there is a diversity of carers. The majority are women, but almost as many men are carers also. That fact has not come to the fore. Carers range from the very elderly to young children, and we need plans and proposals for those young children.
The Bill recognises that there is not a stereotypical carer, and that what might be appropriate help for one carer is not appropriate help for another. We must have the flexibility to allow local authorities, carers' organisations and carers themselves to develop the plans that suit them as individuals—not what is foisted on them by the state or by any organisation. Let us give them what they want, because in many respects they are giving us what we want.
§ Mr. Lawrie Quinn (Scarborough and Whitby)
This morning, we have heard many congratulations. I, too, wish to congratulate all the organisations mentioned by my hon. Friend the Member for Nottingham, East (Mr. Heppell).
It would be remiss of me not to congratulate my hon. and very good Friend the Member for Stalybridge and Hyde (Mr. Pendry), not only on his good fortune in being selected in the private Members' Bill ballot but on introducing a Bill that is important to the people of Scarborough and Whitby. My hon. Friend has been very kind to me over many years. I would go so far as to suggest that he has been a sort of mentor to me in terms of learning about Parliament and the business of being a parliamentarian. I am honoured that he approached me to sponsor his Bill.
Scarborough and Whitby is a large part of the county of North Yorkshire. Until fairly recently—1974, in fact—it was part of a large, rural and mixed local government area. Following the 1974 reform, the previous Government saw fit to separate the City of York from the county of North Yorkshire, making it a unitary authority. I am glad to say that, in the important matter of carers, there is continued partnership between the new county of North Yorkshire and the new unitary authority of the city of York.
For all the statistics about which we have heard, the true figures are invisible because they have not been properly collected. In doing research for this debate, I tried to find statistics for my area. The most recent figures that I could find were compiled in 1994—they are very dated figures—when the Policy Studies Institute concluded that the work done by carers nationally amounted to the equivalent of £30 billion.
1361 That staggering figure is more than the combined budgets of central and local government for health and social services. It suggests that in North Yorkshire and the City of York, with about 73,000 carers, the care and public service amount to the equivalent of about £400 million a year. If we brought the figures up to date, it would not be beyond any mathematician to show that nearly £500 million of work is being done in that area alone.
People do that work for love and out of a sense of duty and care for their immediate family. They have real dedication and commitment. I want to bring in a personal dimension. My hon. Friend the Member for Nottingham, East mentioned the fact that one in six households has a caring responsibility. That means that it is likely that one in six hon. Members has such a responsibility. I am not a carer, but I am one of those people who have to care for a carer. I have not heard that phrase this morning, but it is an important factor.
Many hon. Members have spoken of how the commitment and dedication to loved ones can burn out lives. Recent figures suggest that only about 18 per cent. of carers get access to respite care or even to assessments from local authorities. There is a huge hidden problem: it is the classic iceberg syndrome. Damage is being done not only to individuals but to the fabric of society. I can see that in the small villages and hamlets of rural North Yorkshire.
There is a terrible loss of potential. Carers lose the opportunity to play the fullest part in everyday life. The Bill gives them flexibility in determining the assistance that they can buy in to the home. I know, from my personal experience of trying to persuade my wife to take time off from her responsibilities for caring for her mother, and from people who visit me in my constituency surgery, that that is crucial.
Six months ago, a distraught family came to my Whitby surgery. They had thought that they could define the service that they needed to suit their circumstances in one of the most remote villages in my constituency, but when they tried to buy in the individuals whom they wanted to support their loved one, they were caught up in bureaucracy and red tape and the notion that the social services department knows better, when in fact the loved one would have been more comfortable with the specification that they had defined.
The Bill gives the carer the opportunity and the resources to define the support that they need. I am extremely pleased that, by virtue of clause 9, the Government and the Treasury have shown that they are willing to make the finances available for that.
I think back to the days before I was a Member of Parliament, and to a previous Administration and the debates that we had on the fine Bill introduced by my hon. Friend the Member for Croydon, North (Mr. Wicks). The difficulties always came down to the fact that the resources were not there. Resources are the crucial element. The all-party support this morning is tremendous. This is not a partisan issue.
Before entering Parliament, I was an engineer. In my maiden speech, I said that throughout my career I had been involved in solving problems, not creating them. It 1362 is a great pleasure to be involved in legislation that continues that process. Many hon. Members have referred to the groundswell of opinion in favour of a policy whose time has come, and it is deeply regrettable that the financial resources were not there before.
When the Bill was published, I got hold of copy early and did the proper thing in trying to consult my colleagues in local government. I was referred to Mr. Andrew Cousins of the Association of Directors of Social Services. I did not know it this time last week, but he is the director of social services in Gloucestershire. I was unable to speak to him because, sadly, the past week has been taken up for him by the tragic and regrettable events of last Friday night in the surgery of the hon. Member for Cheltenham (Mr. Jones). I can imagine the tension and frustration of some carers who have come to my surgeries and I can understand how they can sometimes be on the point of boiling over.
I have also witnessed the problems of carers when the loved one is no longer there and the caring responsibility has gone. The carer's purpose in life has gone, and that is a big problem, especially in remoter areas where people can feel isolated and detached.
I pay great tribute to Scarborough and Ryedale carers resource centre, which is based in Pickering and does a tremendous job. It forms a network for the many carers in the area and ensures that carers receive key advice. However, as I have said, some 80 per cent. of carers in my constituency do not recognise that they are carers. My estimate is that at least 12,000 people in Scarborough and Whitby are in that situation—and they make up a large part of the social fabric of my constituency. If they are supported, it is through the partnership of North Yorkshire county council and City of York council, but at the point of delivery the support is provided by the voluntary sector and the mutual support of other carers.
The Bill offers us the opportunity properly to support those performing a caring role in our society. It is essential that the Bill is given a fair wind and, like my hon. Friend the Member for Monmouth (Mr. Edwards), I wish to offer my services to assist the progress of the Bill. I do so both for personal reasons and to speak up for my constituents and the many people in rural communities such as those in North Yorkshire. We have an important opportunity in this Bill to solve a problem—to melt the iceberg—and ease carers' burden of responsibility. I hope that when my hon. Friend the Minister winds up he will be able to answer one simple question for the people of Scarborough and Whitby, and those who work in the resource centre I mentioned earlier: who cares for the carers?
§ Mrs. Sylvia Heal (Halesowen and Rowley Regis)
In the knowledge that I am repeating what has already been said, I wish to add my personal congratulations to my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on coming first in the ballot and on his excellent good sense and judgment in choosing this issue for his Bill. I am delighted to be able to contribute to the debate, having worked for so many years on carers' issues. It gives me particular pleasure because I was also involved in the development of the Carers (Recognition and Services) Act 1995, which was sponsored by my hon. Friend the Member for Croydon, North (Mr. Wicks), when I was working for the Carers National Association.
1363 The Bill is welcomed by carers and disability organisations, as well as the many carers who are likely to benefit from it. However, many people will not immediately recognise how the Bill could improve the quality of their lives, simply because they do not recognises that they are carers.
Over the past 20 years, great steps have been taken in recognising the situation of people who care for relatives or friends at home. Carers have been recognised in policy statements, but have not always had their needs met with appropriate services and support. Like my hon. Friend the Member for Scarborough and Whitby (Mr. Quinn), I recall a carer saying, "Who cares for the carer?" This Bill will go a long way to providing some of the care and support that they need. It makes good moral and social, as well as economic, sense to support carers.
We have heard estimates that one in eight people in Britain are carers, which is some 6 million people. Of those, we estimate that 1.7 million could benefit from the Bill. Those figures are likely to be underestimates, because many people who care for members of their family are unknown to the statutory services and would not label themselves as carers.
Carers' needs are diverse. Their first concern is always the well-being of the person for whom they care. However, emotional support, relief from isolation, receipt of reliable services, information and recognition of their role are all important in supporting carers. From experience, including the knowledge and understanding I have gained from carers in my constituency, I know that this Bill provides the right legislative framework to provide the right support for carers. That is something for which carers have been fighting for many years, and it gives me great pleasure to be able to contribute to the process.
I also feel positive that the Bill takes forward the national strategy for carers, which was first announced by the Prime Minister in June 1998. I agree wholeheartedly with the Prime Minister that we "must do more" for carers. The Bill shows that that strategy is not simply a document gathering dust on a shelf and it is not simply a pile of words and aspirations. The Bill shows that we have a real commitment to turn those pledges into practice and to ensure that the strategy makes a real difference to carers' lives.
The Carers (Recognition and Services) Act 1995 was a good piece of legislation, but it has had its difficulties. Therefore, I am delighted that we are being given an opportunity to iron out those difficulties. The sorry evidence from the Carers National Association is that carers have been refused their own assessments, either because the person they care for refuses an assessment or has already been assessed. I welcome the fact, therefore, that the Bill will give carers a right to an assessment of their own needs even though the person for whom they are caring refuses an assessment.
My hon. Friend the Member for Stalybridge and Hyde has already referred to Sheila, the carer from Cardiff who joined us last Tuesday. She made a great impression on all those who heard her story of everyday life. Her daughter, who has mental health problems, refused an assessment, and that may have been based on her loss of trust in the professionals who were working with her. The consequences for Sheila include nights of broken sleep, worries about the next episode, the loss of a career she 1364 loved and had trained for, and the strain of constant care. All of that has taken its toll on Sheila's health. Had Sheila had the benefit of the Bill, she would have been able to fight for something for herself.
Having worked on the development and implementation of the Carers (Recognition and Services) Act 1995, I know the importance and value of ensuring that groups of carers are not forgotten. I noted from the copy of the Bill that the new rights to assessments only cover adults over the age of 16 who care for adults. Surely it is not the intention of the Bill to exclude parent carers from that provision and I note that parent carers are included elsewhere in the Bill. I would certainly welcome further clarification on the thinking behind the drafting of the relevant clause. I know that that would be warmly welcomed by parents of disabled children and the organisations representing them, such as Contact A Family.
Secondly, I welcome the new rights that carers will be given to receive services. People like Harold and Daphne would be delighted to know that. Harold is extremely proud of the fact that he has been married to Daphne for the past 59 years. For the past 10, Harold has been quite severely physically disabled, and Daphne provides round-the-clock care. Harold gets extremely annoyed that Daphne, as his carer, cannot receive the simple services that would help her to care for him. They do not want personal care from an "outsider", as they call it, feeling that that would mean too much disruption. They want help with the housework and the gardening, and they cannot get it. It causes Daphne a lot of distress, on top of the caring that she already provides. It also means that she cannot spend quality time with her husband, something that they both miss. I hope that the Bill will give Daphne access to the help that she needs.
Thirdly, I welcome the proposed direct payments and voucher schemes. Again, I have heard many stories about how difficult it can be to have a service arranged. Carers have always said that they want flexibility and choice; they want more control over their lives, rather than someone controlling them. We have seen what a huge difference direct payments have made to disabled people's lives, and I am delighted that such flexibility is being extended to carers.
The Council for Disabled Children and Contact A Family welcome the proposal and see how it could be helpful. But they, too, have some concerns and hope that when practicable, there will be consultation with parents.
As someone who has campaigned for greater awareness of the contribution by young carers and for support for them, I am particularly pleased that direct payments will be available to young carers aged 16 and 17. While I do not wish any young person to have inappropriate caring responsibilities, I realise that many children and young people cope with considerable caring and household responsibilities to an extent that would daunt many adults.
The provisions in the Bill concerning payments for 16 and 17-year-old carers are clearly drawn, with safeguards in mind, to ensure that services are safe and that the young carer can manage the process. Local authorities, when considering offering direct payments to both groups of young people will, I am sure, take into account the principle enshrined in the Children Act 1989 that the child's welfare is paramount.
I believe that vouchers will also give far more flexibility to carers. I was struck by the case of Evelyn, who cares for her elderly father. She received the 1365 horrifying news that her daughter had been diagnosed with cancer and was severely ill. She desperately needed to be with her daughter, but could not go because it did not fit in with her time allocated for breaks. In the end, Evelyn did get time off, but it was a long, hard fight. She should not have had to fight. Again, the stress took its toll on Evelyn and, no doubt, on her daughter. Vouchers might have given Evelyn the freedom to organise her breaks differently, which is why I warmly welcome the provision.
When we talk about breaks, I emphasise that we are talking about relatively short periods of time off from caring to do the things that most of us take for granted, such as going shopping, getting a haircut, seeing a film, reading the newspaper and having a bath or shower without being interrupted. One parent carer said, "Getting a haircut makes me feel human. It's the only thing I ask for." Such breaks are vital for carers to maintain their own health and well-being.
I would also like to raise the issue of charging for non-residential care services. I agree with my hon. Friend the Member for Stalybridge and Hyde that this is an extremely sensitive area for carers and I, too, would welcome the Minister's views on it. I know that carers—and I include myself as an individual—would also welcome the Minister's assurances that it is not his intention to charge carers for what are essentially users' services.
My final point regards funding. I was delighted to see the financial provision in clause 9, which enables the Government to put funding behind the measure. After the Bill was published, I spoke to the two social service departments covered by my constituency—Dudley and Sandwell. Both asked the same question, which the Minister will not be surprised to hear, about whether resources will be put behind the Bill should it become law. Of course I realise that the next round of the comprehensive spending review is under way and that the Minister will not be able to make any specific comments about funding. However, will he consider local authorities' views about funding in his discussions on the comprehensive spending review? I do not want to see such a broadly positive piece of legislation hit by the same difficulties as the 1995 Act.
§ Mr. Hammond
My interpretation of clause 9 is that it refers only to additional moneys that need to be paid out under other Acts of Parliament as a result of this measure, not to moneys paid out as a direct result of its provisions. Is that the hon. Lady's understanding as well?
§ Mrs. Heal
I am taking the liberty of using my opportunity of speaking in the debate, with the Minister present, to ensure that all aspects of the funding for this and other parts of the Bill are noted. I acknowledge that, according to the Carers National Association, one year after the 1995 Act was implemented, three quarters of authorities said that lack of funding had restricted their ability to implement the legislation. When carers have been refused assessments, they are sometimes told that there is no money so it is not worth asking. I repeat that I do not want to see that happen here.
Both the authorities in my constituency, Sandwell and Dudley, welcomed the Bill's principles, but referred to the need for adequate financial resources to follow the 1366 implementation. They will have to provide extra social work time for assessments and they are aware that they must develop effective local publicity to encourage the relevant carers to come forward for assessment.
On the whole, the Bill has my personal backing and that of carers in my constituency. Various organisations throughout the country have welcomed it. It provides what carers have pressed for, and I am delighted to lend my support to it.
I shall refer just once more to Sheila. On Tuesday, she asked us to "work our magic" for carers. I sincerely hope that the Bill will let us do that.
§ Charlotte Atkins (Staffordshire, Moorlands)
I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on introducing a Bill that will bring support and relief to a host of carers, some of whom are in desperate situations.
I have recently learned of the case of a 78-year-old man who has looked after his 75-year-old wife for 12 years. She is housebound and requires 24-hour care. She is totally dependent and cannot be left. Carers go to the house each morning and evening to help to wash, dress and feed her, but the man is otherwise on his own, day in and day out.
In recent years, respite care has been made available for two weeks out of six. That demonstrates the huge burden that that man must carry. The respite care should provide a welcome release from his relentless caring duties. Instead, it has become a cause of distress and anxiety. Rather than reducing his mental anguish, it has increased it.
When that man's wife returns from the national health service hospital where she spends two weeks in every six, she comes home covered in bruises and, sometimes, sores. He has photographic evidence of that, spanning four years. It is evidence of, at best, neglect, or, at worst, abuse.
Why has that man not acted on that evidence? The simple answer is fear. He has a fear of losing his only break from caring. He has a fear that he would be left with the full, unrelenting burden of caring without support. He has virtually no one to turn to. He believed that the respite care his wife received was the only care available. His general practitioner reinforced his isolation because he, the doctor, had a vested financial interest in seeing the NHS bed filled.
There was no flexibility in the arrangements, and no choice. The man was locked into an NHS hospital care package that he knew was providing inadequate care. He felt trapped by the system, and as if he had no alternative. There was no recognition of his needs as a carer. A "take it or leave it" mentality existed. I believe that the Bill will ensure that his needs are assessed so that he can choose a more flexible care package, possibly bringing care into his home for extended periods.
In his daughter's words, the only recognition that that man received was the acknowledgement that the service that he provided would be more expensive if provided by the state. He was seen as a service, not as a person. The Bill should change all that. That man's needs must be assessed and provided for. He has provided unstinting, dedication to his wife for 12 years, and it time that his needs were recognised.
§ 12.2 pm
§ Mr. Andrew Dismore (Hendon)
I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on securing a high place in the private Members' ballot and on selecting such an important Bill. The work of carers has often been under-acknolwedged both in the House and in the country.
My hon. Friends the Members for Nottingham, East (Mr. Heppell) and for Halesowen and Rowley Regis (Mrs. Heal) both mentioned the national strategy for carers, which the Government published recently in a document entitled "Caring about Carers". The starting point for our debate must be what the Prime Minister said about carers in the foreword to that document. He said:Carers devote large parts of their own lives to the lives of other—not as part of a job, but voluntarily. And often in addition to working themselves. For the sick, the frail, the vulnerable and the elderly, carers provide help and support in ways which might otherwise not be available. By their effort, their patience, their knowledge, their understanding, their companionship, their determination and their compassion, carers very often transform the lives of the people they're caring for—even if the difficulties they're grappling with still remain. Carers are among the unsung heroes of British life.I very much agree with all that my right hon. Friend said. His words inform both the background to the Bill and Government's whole approach to caring, as set out in the national strategy and other Government documents.
The explanatory notes provide some background on the number of carers. They state:Great Britain has an estimated 5.7 million carers and one in six households—17 per cent.—contains a carer. Of the estimated 5.7 million carers, 1.7 million devote at least 20 hours a week to caring. Of those, 855,000 care for 50 hours or more. Most caring is based on close personal relationships.
§ Mr. Quinn
My hon. Friend used the word "estimated". Is that not the central problem? Does he welcome the fact that, in the 2001 census, for the first time there will be questions to try to define and quantify the carers in our society? That will enable us better to service their needs, because an abstract concept such as "estimate" does not get a reaction from the Treasury—the Treasury wants hard figures.
§ Mr. Dismore
My hon. Friend makes an extremely valuable point. The purpose of the census question is not merely the compilation of numbers. He is correct to point out that we need a much more accurate picture not only of the total number of carers, but of where they are throughout the country. I suspect that the distribution of carers is not even; it may be greater in those areas in which there is a large pensioner population. For example, the Burnt Oak ward of my constituency has a high proportion of pensioners.
We do not merely want to find out where carers are; such a census question would also help the carers to argue their case. I am reminded of the story of Emily Wilding Davison—of which I am sure you are aware, Mr. Deputy Speaker. When the 1911 census took place, women did not have the right to vote, so Miss Davison hid herself in the broom cupboard behind the Chapel downstairs and was thus able to put the House of Commons as her address on the census form. She made an important political point on behalf of women fighting for the right to vote.
1368 I hope that carers do not have to hide in the broom cupboard during one of their periods of respite to make political points; we are in the Chamber to make those points on their behalf. Nevertheless, the fact that the census will show how many carers there are and where they are will strengthen their arguments for a fair share of our national resources.
A large proportion of people in potential need of care live in parts of my constituency. A survey conducted by my local authority shows that throughout the London borough of Barnet there are about 30,000 carers. However, I suspect that, for the same reasons that were given by other hon. Members, the true number is much higher than that; strictly pro rata, there would be about 10,000 carers in my constituency. The true figure is probably somewhat higher than that.
The terms of reference of the national strategy for carers are most important because they also inform the background to the Bill. The terms of reference were:To draw together existing work within Government that impacts on carers; to take account of the emerging findings of the Royal Commission on Long-Term Care; to gather examples of best practice in providing help for carers at local level, to assess whether any key needs of carers have been overlooked; to clarify the Government's objectives for carers; to set out an integrated strategy for future action by Government.My local authority took that to heart. During 1999, while the strategy was being developed, we formed a carers' steering group, with representation across the board. It included representatives not only from Barnet council, but from Barnet health authority, the local NHS trusts—especially Barnet Healthcare NHS trust, which provides primary care—carers, the voluntary associations supporting carers, and primary care groups. We built up a partnership, using the ideas about joint working that the Government are so keen to promote. The group used as its framework the King's Fund "Carers Compass" that sets out the main areas that carers have regarded as important to them. The Bill's terms, especially those about assessment, will draw out some of those themes.
Through its joint discussions, the group developed a series of issues that carers thought were important. The first was the issue of information. My research in reading up on the Bill has made it clear that carers find it very difficult to access the information that they need. At a basic level, that includes information and advice about the health or condition of the person for whom they are caring. The condition of the people cared for may be complex medically and carers may not know whether what they are doing is of benefit. Sometimes, out of ignorance, careers may do things that act against the benefit of the people for whom they care. Carers, therefore, need information on how to cope with those conditions, and information about the services and benefits available to them is absolutely vital.
We are all aware that the information provided by the Department of Social Security on the take-up of benefits shows how few people, who could qualify for the benefits, either know about them or claim them. In the assessment procedure that the Bill will require of local authorities, I hope that they will take on board the need to advise carers of the benefits available to them and help them to take up those benefits through the DSS. There is no doubt that research continues to show that carers have great difficulty in obtaining the information that they need.
1369 Carers want their own health needs to be recognised. They need to be satisfied that high-quality services are available to them and—equally, if not more importantly—to the people for whom they are caring. The object of the assessment is to enable local authorities to plug the gap if carers need to take time off. Careers need to have confidence in the standard and reliability of services. They want to be assured of the quality of the services provided to the person for whom they are caring both at present and for the future, such as in the event of a carer being ill and having to take time off. They need to be empowered, in some instances, to make use of the alternatives to their own care, and that is what the Bill tries to achieve.
Much has been said about the need of carers to have time off. I was very moved by the graphic examples given by hon. Friend the Member for Halesowen and Rowley Regis, who spoke in great depth about the problems facing her constituents. Carers need the freedom to have a life of their own and to spend time with their family and friends. Sometimes, their family is not just the person for whom they care. There is a risk that carers will become isolated, so they need to be able to spend time with their extended family and relations. They need to spend time free of the person for whom they care. That may sound a little harsh and callous, but if that relationship is to be strengthened and the bond maintained, they must sometimes be freed of their usual caring responsibilities.
The problem also cuts across the employment world. Carers often remain in employment, which is important if they are to maintain their independence. Such activity reduces the likelihood of carers becoming socially isolated and, ultimately, may result in them being able to continue caring for much longer than they would otherwise have been able to do.
We need to think about the emotional support that carers require. That may often best be met through family and friends or, in more organised ways, through support groups. I know that there are support networks in my constituency. Skilled help at particular times—for example, at the start of caring or when the condition of the person being cared for changes—can considerably assist the carer. Recent research by the personnel social services research unit in preparing its report on the evaluation of care for elderly people suggests that a carer's employment may result in an increased ability to continue to care.
Training and support care are also needed. Carers need to be sure of their financial security, and not just through the state benefits that they receive while they are caring. People in their 40s or 50s may suddenly find that they have to care for an elderly parent. If they are not able to continue work, they become worried about their own futures.
The Bill deals with assessment of present needs, but I am concerned about the problem of the future of carers when they become pensioners and their need for financial security. I mention at this point the important state second pension provisions that are being discussed in the Standing Committee on the Child Support, Pensions and Social Security Bill, on which I am pleased to serve.
Carers have a need to be heard and want their views to be taken into account and their contribution recognised. Those who care for another person need to be recognised 1370 much more widely in society. Carers value involvement in discussions about the help provided to them and the person for whom they are caring, as well as the practical help that the Bill aims to provide. Carers have a voice not only, as my hon. Friend the Member for Scarborough and Whitby (Mr. Quinn) said, as a political force in organisations such as the Carers National Association, but as individuals, and we must be careful to recognise them as such.
§ Mr. Quinn
Has my hon. Friend, when meeting carers in his surgery, encountered, as I have, the problem that they do not realise that they are in that role? Does he agree that providers of primary care services, such as GPs, need to have a better identification process and should tell those who take on these onerous responsibilities that they are indeed carers and direct them to the support networks to which he is alluding?
§ Mr. Dismore
My hon. Friend makes a valuable point. An hon. Member referred earlier to the problems of occasionally caring for a relative who is sick only for at week or two at a time. I know that dealing with family illness can be a demanding task, and the thought of continuing such care for a long period is daunting. I suspect that some carers often think that the situation will last for only a week or two and do not identify themselves as playing a caring role. Unfortunately, illnesses progress and carers may unwittingly slip into a full-time caring role. They add an extra hour here and an extra day there, and before they know it they are spending 50 or more hours a week caring for a sick relative or friend. My hon. Friend is right to point out that many people do not see themselves as carers.
We have to be careful, however, not to stigmatise people or treat them as a group without considering their individual needs. The carers national strategy deals with that point. It says that local authority servicesmust aim to understand carers' needs—individually and as a group. The Government believes that all services used by carers should involve them in service planning. Carers' organisations and representatives can help service providers by providing a forum in which consultation of carers about service provision can take place. Services which have one-to-one dealings with individual carers, and with the people for whom they care, need to make sure that the carer is involved and consulted about the services which he or she needs.The London borough of Barnet's local strategy did not aim only to bring together the partnership group, which I mentioned earlier, to try to identify what it thought were the issues—in its second stage it conducted an important survey of individual carers' views and needs. Individual assessment is intended to allow service providers to judge the state of carers' health, their needs and wishes and their ability to continue to care, if that is what they want to do, or to bring informal caring to an end, if that seems right for the carer and the person being cared for. That is an important feature of the assessments that will, if the Bill is passed, be carried out under clause 1. When an assessment is carried out at the request of the carer, the local authority might tell certain carers that it is perhaps time that they started to consider "professionalising" the care that they provide, because they are getting older and might soon start to need care themselves if they do not get some assistance.
The Bill builds on the principles of empowering service users and carers and promoting independence and choice. The London borough of Barnet has an agreed carers 1371 strategy that promotes those principles and establishes a clear direction for the development of services for carers. The Bill will allow the range of services, both direct and indirect, to be expanded so as better to meet the needs of local carers.
We have focused on clause 1 and the assessments, but they are not the sole issue: once the assessment has been carried out, the answer to what happens next is set out in clause 2. I want that clause to be strengthened. It states that the local authoritymust consider the assessment and decide … whether the carer has needs in relation to the care which he provides or intends to provide … whether they could be satisfied … by services which the local authority may provide; and … if they could … whether or not to provide those services".However, the local authority does not necessarily have to provide those services. We might need to address that lacuna in Committee.
The services mentioned in the clause cantake the form of physical help or other forms of support.However, like the hon. Member for Sutton and Cheam (Mr. Burstow), I am concerned about distinguishing between intimate services and other sorts of services. I discussed the matter with representatives of my local authority's social services department, who think that that issue needs to be clarified. They believe the answer probably lies in the fact that "care needs" will be for services provided to the person cared for, not to the carer. They told me that clause 2 was "somewhat confusing", adding:If it was decided that a service user had intimate care needs (including for example dressing, feeding, lifting, washing or bathing) it is self evident that this would be provided as part of their own care package and not that of the carer.I am not sure that the Bill makes that self-evident, so I hope that the issue is addressed in Committee, either by amending the clause, or by defining more clearly in clause 10—the interpretation clause—what the phrase "of an intimate nature" means.
§ Mr. Hammond
Is not the point that, in the circumstances envisaged by the Bill, there may be no care assessment for the person who would otherwise be receiving care?
§ Mr. Dismore
I am grateful to the hon. Gentleman, because he has put more succinctly the point that I was trying to make at too great a length and in a rather confused way. It may well be that the assessment conducted under clause 1 will throw up such issues, and prompt an assessment of the person being cared for under wider community care provisions. That lacuna needs to be clarified, perhaps by the insertion of a new clause providing that, if the clause 1 assessment raises the need for a further assessment of the person being cared for, the local authority should be under a duty to carry out such an assessment. In addition to that, I repeat that "intimate care" needs to be better defined.
We must consider the sort of needs that carers have and the services that they require. We in Barnet brought together voluntary organisations, the local authority and local health workers in one group. After that exercise had identified an overall strategy, a survey of carers was undertaken to identify their needs.
1372 Top of the list was respite care, which came as no surprise. The term "respite care" was used in the information that came from my local authority, and it is sometimes used by carers, but what is meant is a break, short or long. The term "respite care" can be demeaning and stigmatise carers. It implies that care is an onerous task—which it is—and that it is unpleasant and not properly recognised, whereas carers are, by definition, caring people and often take great pleasure in looking after the person for whom they are caring.
What sort of breaks are envisaged? A short stay in a residential care home by the person being cared for could enable the carer to have a holiday. Time spent in a day centre by the person being cared for could allow the carer to carry out day-to-day tasks such as shopping. A night sitting service could allow the carer to get a full night's sleep, which is particularly important for carers who also have employment commitments.
Someone to take the person being cared for on an outing would give the carer time to himself or herself at home. A Sunday sitting service would enable the carer to go to church or visit family and friends at the weekend, and an evening sitting service would allow the carer to take adult education classes, or simply to have a meal out or an evening out at the cinema or theatre. Daytime sitting would allow domestic tasks to be carried out. Another sort of break would be a holiday for the carer and the person being cared for together.
We must make sure that the breaks offered are fulfilling for both the person needing care and the carer. Going to the dentist should not be regarded as a break for the carer, even if a broken tooth is being attended to. In planning a short break, adequate preparation must be made for both the person being cared for and the carer.
§ Mr. Hammond
I listened to the catalogue of opportunities that the hon. Gentleman outlined. Will he take care not to raise expectations too high? At the risk of incurring the Minister's wrath, I say again that in 2001–02, the ring-fenced grant will be worth £70 million. By my calculation, that allows about £50 per carer who gives more than 50 hours care a week. That will not provide much from the catalogue that the hon. Gentleman outlined.
§ Mr. Dismore
I am grateful to the hon. Gentleman for that intervention. I intended to make that point at the end of my speech. It will come as no surprise to my hon. Friend the Minister that local authorities are concerned about the potential financial implications. We must be careful not to raise expectations, but the hon. Gentleman should recognise that much good work is being done.
Through the partnership approach, my local authority has put forward a comprehensive three-year plan to start identifying the problems and the ways in which needs can be met by both the voluntary sector and the statutory agencies. It is well on the way to providing many of the services required.
As was convincingly argued earlier, many of the services that we are proposing will prove cheaper to the public purse. As my hon. Friend the Member for Stalybridge and Hyde said when he introduced the Bill, not only would it improve the service for carers and for the people being cared for, but it would benefit the Treasury.
§ Mr. Heppell
We should bear in mind that we are not starting from base zero. The idea that local authorities do 1373 not provide any of those services at present is nonsense. I recently received a letter from the Carers Federation, Nottingham and Nottinghamshire, which praised the local authority for the initiatives that had already been taken. We should not assume that we are starting from nothing and that only the carer's grant will improve the services that we are considering. Many people enjoy residential respite services, breaks at home and day-care services. We are considering expanding those services, not starting afresh.
§ Mr. Deputy Speaker (Sir Alan Haselhurst)
Order. The hon. Gentleman is making another speech. Interventions must be short.
§ Mr. Dismore
I am grateful to my hon. Friend for his intervention. The Opposition tend to focus on the money that central Government provide and neglect what is happening locally through social security budgets, through other agencies and through the voluntary sector.
My hon. Friend is right to say that it is worth restating not only what happens locally, but nationally. Paragraph 24 of the national carers strategy sets out the resources that the Government are starting to provide. It states:The Government has already announced the allocation of £750 million over the next three years to promote independence through prevention of illness, disability or disease, and through rehabilitation, and carers and the people they care for will benefit from this.That is the overall picture. The document continues:On top of that, we are making available a new special grant—ringfenced funding—to local authorities for the enhancement of services to allow carers to take a break from caring. The grant will total £140 million for England over the next three years—£20 million in 1999/00, £50 million in 2000/01, £70 million in 2001/2002.The hon. Member for Runnymede and Weybridge (Mr. Hammond) referred to the final figure.
I am sure that carers and those they care for, who are also electors, will realise that by 2001–02 we are likely to be approaching or on the other side of a general election. The hon. Member for Runnymede and Weybridge referred to the Government's actions after 2001–02. I assume that he believes that the Conservative party will not win a general election, and is asking for our forward plans after the comprehensive spending review in the summer. The hon. Gentleman made no commitment about the money that the Opposition would be likely to devote to caring.
§ Mr. Heppell
In the second year of the carer's grant, 95 per cent. of the grant will be spent on breaks, as opposed to 75 per cent. in the first year. That is another example of expansion within existing financial provision.
§ Mr. Dismore
I am grateful to my hon. Friend. He mentioned the money that is available, and I hope that that will not be the end of the story. As people become more aware of the challenges and problems that carers experience, there may be an expansion of provision in the voluntary sector, and people who are not paid will provide short breaks through, for example, evening sitting services. In addition to the money, which is vital, there will be added value as the debate progresses and improvements in voluntary services.
1374 Before I took a series of interventions, I referred to the needs that carers identified in response to the survey that my local authority conducted. We have dealt comprehensively with short breaks, but the survey identified the need for more help with transport. Unreliable transport is a problem for carers, who need to be able to plan their day. If they do not know at what time transport to the day centre will turn up, it is difficult for them to undertake any activities that they had in mind as part of the break. A range of transport services is more likely to meet the diverse needs of carers.
As my hon. Friend the Member for Halesowen and Rowley Regis mentioned earlier, carers need help with practical matters such as shopping, cleaning and gardening. I hope that such activities will be identified as part of the assessment to which clause 1 refers. They need a holiday and a break from the caring environment, even if that is a brief trip to the constituency of my hon. Friend the Member for Scarborough and Whitby. May I promote my birthplace, Bridlington, which is a far better seaside resort than Scarborough for a day out or a week's holiday? It could provide carers with a welcome break from the caring environment.
Carers need training not only in lifting—although obviously it is important that they do not injure themselves when moving people with disabilities—and rather personal tasks such as incontinence management, but in dealing with stress, which sometimes gets a bad name in the House and among the wider public. In my previous life as a lawyer, I often had to advise clients who were suffering from stress on how to pursue claims. I found generally that people tend to pooh-pooh stress; they think that it is part of everyday life. Of course it is: making a speech in the House can be very stressful for many of us.
§ Mr. Dismore
I am sure that making a speech is not stressful for the right hon. Gentleman; he is an experienced parliamentarian.
§ Mr. Dismore
The right hon. Gentleman loves making speeches, but it can be stressful for many of our colleagues. Making a speech is a one-off—we can prepare and we know it is coming—but carers face different problems. They may have to experience stress day in, day out, or the relative they are looking after may cause them a lot of stress.
§ Mr. Dismore
My hon. Friend makes an interesting analogy. The Bill is about spreading the load, which is why training is important. I am pleased that that features in the national strategy for carers, which says on page 60:Training can empower carers—by giving them new confidence".The document deals with all sorts of matters on which people need training. I would not be wasting the House's time by describing them, but I want to make a little 1375 progress and return to the point I was making about stress. Participants in a course called "Looking After Your Stress", who valued the contacts and friendships that they had made, reported decreasing stress levels. If stress management can be taught to carers, it will make their lives a lot easier and a lot better and enable them to continue caring for a lot longer.
Carers need greater flexibility and choice in how services are delivered and the Bill goes a long way to providing that through the arrangements for vouchers or direct payment. I am particularly struck by the fact that people like to be in control of their own lives wherever possible—I had not thought about that issue until I started to research carers for the debate—and can often provide far better services that are tailored to their needs if they have the money to do so. Inevitably, there is an off-the-peg element if services are provided by a statutory agency—people get what is on offer whether it fits or not.
I know that local authorities—mine is one of them—are doing their best to tailor off-the-peg services to carers' needs, but there is inevitably a degree of coping with a services straitjacket. If we can empower carers to buy their own services as and when they need them—through either vouchers or direct payment—that will be an extremely welcome development. Indeed, carers may get more for their money in the absence of all the overheads that go with providing a statutory service.
Carers need a listening ear and someone to talk to; that is part of trying to deal with stress. I was pleased to be invited to open a good neighbours service on the Grahame Park estate in my constituency— neighbours try to help others out. On many big housing estates such as Grahame Park there is great isolation. The nature of housing estates tends to make people lock themselves into their homes at night rather than engaging with their neighbours. That isolation is part of the problem for carers. Developing befriending and good neighbour services is a way of trying to break down that isolation.
The strategy also refers to the need for better information and advice—which I have already dealt with—financial advice and carer-friendly employment practices. I do not want to run the risk of straying out of order by talking about all the wonderful family friendly employment policies that the Government are introducing, but we should recognise that the needs go beyond simply looking after children. The family includes elderly relatives, who may have difficulty looking after themselves, and relatives with disabilities. The family is more than just parents and children. I hope that as our family friendly employment policies develop, they will take carers' needs into consideration.
We need more help and advice from GPs. Part of the problem with the GP service in my area is that primary care provision is overstretched and GPs do not have the time that they need to talk to carers about some of the issues that we have discussed. If GPs had a little more time to talk to carers, they might find that their work load reduced, because if carers have more information about the condition of the person they are caring for, they may be able to provide basic care instead of having to call on the GP or the health service. It is in the interests of GPs to try to spend a little more time with carers and discuss their needs.
§ Mr. Edwards
Does my hon. Friend agree that GP surgeries can play an additional role by supporting carers 1376 organisations financially? One of the GP surgeries in Chepstow in my constituency has put a significant amount of money into the local Crossroads scheme.
§ Mr. Dismore
That is an interesting suggestion. I should like to know more about it. Perhaps that example of good practice could be fed into the debate as it develops. I am sure that my hon. Friend the Minister would also like to take it on board.
Charging is a thorny issue. In its briefing on the Bill, my local authority mentioned the concerns that have been raised about charging carers for the services that they receive. Barnet charges service users and the level of support that it provides is determined to some extent by the costs that can be reclaimed. The same principle applies to carers when they become service users. The council will not be able to provide a service to carers unless at least some of the cost is reclaimed. We have to examine the local criteria and protocols that need to be established to clarify charging policies and practices. I am concerned that carers will be charged for some services, but that is inevitable. The charges should levied at a reasonable level. That picks up on a point made earlier by the hon. Member for Runnymede and Weybridge. If modest charging makes more money available, more services ultimately can be provided.
§ Mr. Forth
Does the hon. Gentleman share my worry that neither clause 7 nor the explanatory notes say anything about charging, other than the comment in the explanatory notes that clause 7 enables local authorities to charge carers for the services that they receive? Would the hon. Gentleman have expected at least a word such as "reasonable" or some other provision that would give us some reassurance that the charges will be levied at a level that carers can accommodate?
§ Mr. Dismore
I am grateful to the right hon. Gentleman for that intervention, because he makes a valid point. Unfortunately, clause 7 amends other Acts. I do not know section 17 of the Health and Social Services and Social Security Adjudications Act 1983—which provides for charges—well enough to say whether it specifies that charges have to be reasonable or assessed against the means of the carer or service user. Clause 7 simply tacks on a new paragraph (0 to section 17(2) of that Act. The right hon. Gentleman makes a telling point.
I was stressing my hope that when charges are levied—and that is inevitable—they are reasonable and affordable. Otherwise, all the Bill's provisions—the assessment procedure and the services provided by the Government under clause 2—will not be implemented. Perhaps my hon. Friend the Minister will address that point in his reply to the debate.
The debate so far has focused on the problems faced by adult carers. However, the Bill also considers the position of young carers. I was staggered to read in the national carers strategy that research currently available suggests that there are between 20,000 and 50,000 young carers—children who look after their parents or elderly relatives. Many of them receive no support from statutory or voluntary services. To return to the point made my by hon. Friend the Member for Scarborough and Whitby, I suspect that that is because their circumstances are not known. They may come to light only if the child is having difficulties at school, such as underperforming or even not 1377 turning up, and the school or education authority decides to investigate. Only then may it become apparent that the child is undertaking onerous caring duties.
The national carers strategy identifies some of the problems that we should be looking out for in this respect. I am pleased that the Bill makes it clear that it is essential that assessments are also made available to young people.
§ Mr. Hammond
I may have misunderstood the Bill's provisions. I share the hon. Gentleman's concerns about young carers, but my understanding is that clause 1 specifically does not apply to young carers. I am sure that the needs of young carers can be addressed under the Children Act 1989, but it seems to me that the Bill makes no additional provision for them.
§ Mr. Dismore
That depends on how one defines young carers. The Bill provides additional facilities for carers aged 16 and over. Perhaps we should consider in Committee whether 16 is the right cut-off point. There may be a case for including even younger carers, perhaps by tabling a new clause. Carers under 16 may not be in a position to ask the authorities for an assessment of their needs simply because they are not used to dealing with statutory authorities. The Bill could make arrangements for their school or GP to suggest to the local authority that such an assessment was necessary.
I mentioned earlier that such children may have problems at school—perhaps with doing their homework and getting qualifications. They also risk becoming isolated from others of the same age and from the rest of their family. They may lack time for play, sport and other leisure activities that help their development. They may face conflict between the needs of the person who they are helping and their own needs, which can often lead to feelings of guilt and resentment. They may believe that there is nobody out there looking out for them and feel that the professionals do not listen to them because they are children.
The overall lack of recognition and praise for the contribution of carers also applies to children, who may feel isolated and different and that nobody understands their experience. All that may cause problems for them as they grow up, in terms of finding work, moving into their own homes and establishing relationships. That is particularly important in respect of young carers from ethnic minority groups, where families are more tightly knit and family relationships often impose greater obligations.
I want to refer to adult carers looking after young children, and I am pleased to see that the Bill deals with them. Clause 6 extends direct payments to those caring for disabled children and parents of disabled children. The Government have made great strides in helping those who look after disabled children through their social security reforms, particularly in terms of mobility allowance for severely disabled very young children. Clause 6 develops that by providing more direct financial aid to parents of disabled children.
Disabled children will receive help to enable them to make the transition from childhood to adulthood by giving them the responsibility to look after their own resources. Equally, the provision of vouchers or direct cash 1378 payments to the parents of disabled children empowers them—a point made forcefully by my hon. Friend the Member for Stalybridge and Hyde. He said that the direct payment arrangements would help parents to make the decisions that they want to make on behalf of their children, rather than the parents being told what decisions to make because the facilities are available only in kind rather than in cash. I am pleased that we are addressing that.
The Bill does not place any burdens on the voluntary sector that it does not wish to undertake, but it allows the voluntary sector—and the business community—to expand the range of services that it provides and to market those services directly to service users and carers. That will provide a helpful stimulus to business and the voluntary sector, and an important supplement to the statutory agencies. I am pleased to support the Bill.
§ Dr. Desmond Turner (Brighton, Kemptown)
I wish to join the list of those congratulating my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on introducing the Bill, which not only has cross-party support but has the support of an all-important double act—the right hon. Members for Penrith and The Border (Mr. Maclean) and for Bromley and Chislehurst (Mr. Forth)—which means that it might actually make it to the statute book.
The Bill is a critical step forward for carers. It is only in the past four years that they have come to be recognised by Parliament as an entity whose needs we must consider in legislation. For years, they have been making the most vital contribution to society imaginable. Now, carers will have a statutory right to have their needs recognised by social services authorities.
§ Mr. Hammond
The hon. Gentleman is right that the Bill recognises for the first time the statutory rights of carers but he is wrong to say that carers have not been recognised as such in legislation. I will seek to show later that carers have been recognised in legislation going back to 1981, and that the Bill is part of that growing recognition.
§ Dr. Turner
I accept the chiding from the hon. Gentleman, but this is the first time that carers have had a statutory right. That is important.
Before I came to this place, I was heavily involved in the implementation of community care legislation as a county councillor and a leading member of a social services. We recognised from the outset that if the assessment procedure did not involve the carers, it would be incomplete from the point of view of both carer and cared for, but such involvement was not the universal practice of social services departments.
There is an enormous variation in the services provided in different areas, from almost none to rather a lot. The Bill will not dictate a uniform pattern of care support services—that would probably discourage innovative authorities—but will effectively force all local authorities to examine rigorously what they do to support carers, so they will all come up with at least a range of core services that all carers need.
My hon. Friend the Member for Hendon (Mr. Dismore) has spoken of all the services that carers might need. If the Bill does nothing other than make social services 1379 departments take carers seriously and provide for them properly, it will have been worth while; but I think that it goes much further.
We need to sustain the carer. It cannot be said too often how important carers' work is. We can make rough calculations of the value of their contribution. It has been said today that it would cost £34 billion to substitute for it, and I suspect that that is an underestimate. The sum involved if all 5.7 million carers stopped caring would wipe out our entire national health service and social services budgets. Their input is enormously valuable, and they do it for love. They are people whom we must treasure above all others.
The carer's life is not fun. My hon. Friend the Member for Nottingham, East (Mr. Heppell) rightly said that we should all realise that any of us at any time could be pitchforked into a situation in which we feel morally obliged to be a carer, and we should certainly think about that, but few of us know what the restrictions and the lack of opportunity to socialise or have a career are like. All the things that we take for granted, even within the strictures of life in this place, are taken away; our lives are far less rigorously determined than those of carers.
I had no more than a small taste of that when I had to care for my daughter for three weeks when she was horrifyingly injured in a motor accident in the Dominican Republic, where hospitals do not have nursing staff in the sense that ours have, and families have to do all the caring. She was totally immobilised and I learned what caring was about.
At its last annual general meeting, my local branch of Care for Carers in East Sussex put out a challenge to all the politicians present to take the place of a carer for just a day. That was long enough to impress on me what was truly involved. I had the privilege of substituting for the parental care of a young teenage girl with spina bifida and severe learning difficulties. At the end of the day, I was shattered: it was incredibly demanding. One had to be so sensitive in every respect. To do the job properly, people would have to be highly trained and highly sensitive.
In such a situation, the carer cannot relax for a moment. I was a carer for only a few hours, but the caring parent—a single parent with other children to worry about—did it every day of her life except for an occasional respite break when her daughter had residential care for a few days. My hon. Friend the Member for Hendon raised the issue of what such care is called, but carers do not give a damn whether it is called respite care or a short break—they just want it to be provided. That is what matters more than worries about politically correct language.
What support do we give carers? It is highly variable, but most of them certainly have little financial support. The hon. Member for Sutton and Cheam (Mr. Burstow) rightly emphasised the difficulties that carers have with the benefit system. He pointed out that few carers receive invalid care allowance—some 400,000 out of 5.7 million. Why is that? Carers are not rich—in fact, by definition they are nearly all poor. The reason is that they are nearly all on income support and it is no use claiming invalid care allowance, because it is simply taken off their income support, pound for pound. They would not be better off if they claimed, so they do not claim. That is the experience of many of my constituents.
The future changes under the national carers charter will change the position and it will become worth while for carers to claim invalid care allowance because it will 1380 qualify them for the second state pension. That is welcome, but given the onerous burden placed on carers, they should receive a weekly income over and above income support. They have to live permanently on income support, which is not designed to sustain people indefinitely. It does not provide, for example, for replacing shoes as they are worn out. It is a basic subsistence income, and carers are entitled to more than that, given the enormous contribution that they make and the saving to the Exchequer of not paying for someone else to provide care. I hope that my hon. Friend the Minister will bring my remarks to the attention of his colleagues in the Department of Social Security, because carers should be more generously treated by the benefit system.
I would like to turn to the important issue of resources which, in the context of the Bill, cannot be taken in isolation: it must relate to the whole community care support system and its financing. That is under acute pressure, and has been since the introduction of the National Health Service and Community Care Act 1990. The system was etched on my mind, as I was one of those at the coal face who had to implement the legislation. Under that system, the assessment had to fit the money available. We had this wonderful structure called eligibility criteria. The 1990 Act provided that eligibility criteria should match the resources available so the net goes up and down, according to the money available. That means that the resources available to provide for carers are concomitantly varied.
I take issue with one of the statements in the explanatory notes to the Bill which were written by the Department of Health. On the Bill's financial effects, the notes state:The only additional costs that are likely to arise in implementing this Bill will be those relating to the carer's right to an assessment in circumstances where the person cared for has refused an assessment … These additional costs are expected to be contained within the existing local authority allocation.If we are to deliver recognisably increased support for carers, as the Bill quite rightly implies, there will be additional costs. They cannot be contained within the existing local authority allocations.
§ Mr. Hammond
Is not the hon. Gentleman saying that the procedures under clause 2 will inevitably be subject to precisely the same eligibility criteria to which he referred in relation to other social services provision?
§ Dr. Turner
I thank the hon. Gentleman for that intervention. He is basically right: everything in the Bill and the 1990 Act is subject to eligibility criteria and matching to resources. There is no way of arguing around that. However, we can argue about how much resource we put in and how much its intelligent use can save in the long term.
My point to the Minister—which relates to the issue raised by my wise and right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke)—is that sustaining carers will make care arrangements more sustainable. Sustaining carers for more years than they might otherwise be able to keep going without adequate care and support may save the domiciliary care arrangement from breakdown. Because when it finally does break down, either because the carer becomes unable to continue caring, or the cared-for person gets beyond the capacity of the carer 1381 to care for him or her and has to take up an institutional placement, the social services costs will increase considerably. There is virtue in putting more money into carers. I hypothesise that spending, say, £1 billion on carers would not mean an extra £1 billion in global spending because we would save in other ways—although the complexities involved make it difficult to prove that argument.
Money has already been put into the carers charter, but more is needed. The only figures that I can cite are those for Brighton and Hove, my own authority, which invests roughly £4.8 million in support for carers. That all-embracing figure covers day centres where carers are involved, and so on. In addition, the carer special grant is £128,000 for the coming financial year. In effect, the authority can increase by one third the amount that it spends on residential respite care, but there will be no significant increase for existing clients because more carers are receiving respite care. This means that no one is receiving the desirable amount of respite care. To achieve the care that highly stressed carers require, we should need a lot more money. I do not envy the Minister his task of pleading for carers in the next comprehensive spending review. A significant sum is needed both for carers and for community care as a whole.
This debate must be related to the Government's response to the forthcoming royal commission on continuing care. I share the view of directors of social services and others involved in social care that the current system, which resulted from the Community Care (Residential Accommodation) Act 1992, will not be sustainable. We must consider whether we should separate social care from nursing care, and that question has considerable implications for Government spending and for the charging of individuals who give or receive care. I do not expect the Minister to address those complex issues today. They are too big, and I am straying beyond the context of the Bill. However, the Bill must be related to the global picture.
I do not wish to be negative: I am merely seeking to be realistic about the complexities of a situation to which the Bill makes a valuable contribution. I repeat my appreciation of the fact that my hon. Friend the Member for Stalybridge and Hyde has chosen a Bill that is necessary if we are to give impetus to the national carers strategy. Carers will welcome it with open arms, particularly if local authorities are given the resources to make it work.
§ Mr. Steve McCabe (Birmingham, Hall Green)
I apologise, Mr. Deputy Speaker, for not being in the Chamber at the start of the debate. I was in the building, but I had to deal with a pressing constituency matter. I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on introducing the Bill.
Although the practical content of the measure is vital, what is even more important is that it offers us an opportunity to make a cultural or psychological shift in our attitude to carers and to people with disabilities. As a former social worker, with some experience in the field, I have no desire to bash the social work profession—plenty of people have been doing that for many years. 1382 However, it is important to realise that, although we constantly talk about enabling and empowering people, the professionalisation of caring has had the opposite effect.
We have emphasised the needs of professionals, organisations and services and have taken the focus away—not intentionally—from the needs of the carers and those who need assistance. One of the effects of the measure will be to shift that focus back where it should be—on the needs of those doing the caring and those in need of services.
One obvious example of that is the voucher scheme. It is ludicrous that people can be caring night and day, all week, and cannot ask their local authority for a break at a time of their choice. When they ask for a break, the local authority replies, "Well, you can have one at this time, in that month." That is nonsense; the priority is given to those who organise the service, not to those who need it.
The vouchers would make a significant change by putting the focus where it should rightly be—on giving respite and relief to a person who is exhausted. When a person is reaching breaking point, it is of no use to be told, "In three or four weeks, you might have a weekend off." The whole point of respite is that people should be able to decide when they need a break and should be able to have access to relief.
The direct payments scheme is welcome. It is a massive step forward in our approach to caring. In our attempts to provide higher standards of care and better quality services, we have over-professionalised some aspects of caring. In many cases, we have created a crude, paternalistic service.
I used to have the unhappy task of telling people what the local state was prepared to offer them and what it thought was appropriate for them. Perhaps I was not a particularly good social worker—although I was not alone in that—but I did not listen to what people said they needed. The brief was to tell them what was available and what they could have. That paternalistic approach has damaged the relationship between social workers and the people who need help and support. Over time, that has ground down carers and produced the feeling that people do not listen and do not care. Carers are merely talking to a local machine that is churning out the available services.
Direct payments are the way forward. They are the greatest gift that the Bill offers, because it recognises that people know what they need to make the quality of their lives better. They know how often and what type of services they require, and, by providing resources, the Bill will enable them to select them in the form that they want. That is one of its greatest strengths.
My hon. Friend the Member for Brighton, Kemptown (Dr. Turner) also referred to resources. They are critical and I hope that the Minister will be able to offer us some reassurances about clause 9. I do not suggest that he should tell us exactly how much money will be available.
§ Mr. Hammond
One of the hon. Gentleman's colleagues drew attention to the explanatory memorandum which suggests that, apart from the administrative costs of assessment, the Bill is unlikely to 1383 give rise to additional costs. Does the hon. Gentleman take that to mean that additional sums will not arise under the provisions of clause 9?
§ Mr. McCabe
I said that we had lost our focus when we organised and professionalised these services, so I think that quite a lot of money is wasted in the existing administration of them. That money does not directly benefit the carer or the person who needs the services; it is lost in the local state machine. Although I do not attempt to deny that costs are attached to direct payments, it strikes me that there could be a shift of resources. If we were to put less emphasis on the local state bureaucracy and the local social worker's role and more emphasis on what individuals need, there may be scope for a transfer of resources. Nevertheless, money must be made available if direct payments are to be introduced, and I hope that the Minister will say a little more about the availability of resources.
Local authorities are generally resistant to direct payments for two reasons. They see them as expensive and as something that will lead to the loss of their power. When services are directly provided by the local state, it has immense control and power and it builds up a self-perpetuating bureaucracy. People are always needed to perform extra tasks or to do extra paperwork and administration. Local authorities are reluctant to have direct payments because they see them as a threat to their existing power and control.
We have all become obsessed with the notion of professionalised caring. There was a time when many of the services provided today would not have come under a professionalised umbrella. I do not attack the idea of higher standards or deny that people should have better training; that is obviously desirable. Many inquiries have made the case for that. However, some services may not have benefited from being over-professionalised. One example is counselling, which is a massive operation these days. People have to undergo lengthy training and to have qualifications—this diploma or that. However, 20 years ago counselling was a reciprocal arrangement; people assisted each other. It did not require such apparatus, and people got as much benefit from it as they do today.
There was a time when local authorities provided home helps, who did basic domestic chores such as cleaning and shopping. We have created home care services, which are good for people who need intensive support, but the development of those services and the professionalisation of the work mean that it is almost impossible to get a local authority home help. The notion of home helps has died. If we ask people, we find that they want someone to come and provide a little help at a set time of day, because that would make a difference to how they cope.
§ Mr. Heppell
Is not that why it is so important that the carers national strategy introduces a requirement for local authorities to survey carers to find out exactly what they want? If we ask them what their needs are, rather than try to second-guess them, there is a good chance that we will meet those needs.
§ Mr. McCabe
I totally agree that we should ask people what they want rather than try to second-guess their needs. However, we also need a culture and framework in which we respond by doing what they ask, rather than being 1384 locked into the mindset that services must be organised and provided in a certain way and people must be told what services they can have. That is the current mindset, and direct payments could change it, but we must get away from the over-professionalised notion of how services should be delivered.
Returning to the example of home helps, it is ironic that in creating more professionalised services, we have made them less available to people. Many need services at the weekend and late in the evening, but it is almost impossible for most local authorities to provide home care at those times without exorbitant costs. That results in the absurd situation of people being told when they must go to bed and what day of the week and what time they can have a bath. That is a direct consequence of the way in which we organise services because we employ people who prefer to work nine to five, and those are not necessarily the hours when people are most in need of the services.
§ Mr. Gareth R. Thomas (Harrow, West)
On the over-professionalisation of services, will my hon. Friend take this opportunity to praise the Carers National Association and, more importantly, centres such as the Harrow carers centre in my constituency, which have lobbied social services and other statutory authorities that provide care for the flexible services about which he is talking?
§ Mr. McCabe
Yes. A number of organisations have done wonderful work. As I said at the outset, I am not attacking local authorities or condemning social workers, but we have inadvertently organised services so that they are of least benefit to the people who are most in need of them.
§ Mr. Dismore
I am concerned that we do not set professional services against non-professional services. Is not the real issue the need to build a proper partnership between statutory agencies such as health authorities and local authorities, the voluntary sector and individuals to make sure that we have a properly co-ordinated service that plugs all the gaps and takes account of the criticisms that my hon. Friend has been making?
§ Mr. McCabe
I repeat, I am not knocking professionals or condemning local authorities and social workers. I merely suggest that we have created a structure, a mindset, a framework that over-professionalises certain aspects of the work and certain tasks. The way to address that is both to listen to carers and their organisations and to create the partnerships that will ensure that flexible care and support are provided at the times people need them.
Acting as a brake on the success of current direct payments is the fact that they can create difficulties for the recipient, because that individual becomes, in effect, an employer and faces all the red tape and bureaucratic inconvenience that that implies. When considering the implementation of the Bill, will the Minister look at ways in which we can relieve some of the pressure on individuals who have direct payments, so that they do not become locked into interminable employer obligations? Although they might have ulterior motives, some local authorities have argued that one reason that direct payment is used to a lesser extent than we might have hoped is that people find 1385 quite daunting the number of potential risks to which they become exposed in the role of employer. Is there any way to ease that problem?
Earlier, we heard about a scheme in Harrow; there is a similar scheme in my constituency, where there is not-for-profit home help agency. People contract with it to obtain the services they want at the time they want them, but the legal and employment framework is handled by the agency. It strikes me that such a system might offer an answer: it organises and controls services and, by localising them, makes them more intimate and more responsive to individual needs; it also relieves the individual of some of the unnecessary burdens and pressures that go with being an employer. We should consider such schemes. Otherwise, in trying to empower individuals, we might hamper them with unnecessary burdens that stifle them and prevent us achieving our goal.
§ Mrs. Heal
Does my hon. Friend agree that it is important to take note of some of the complexities of direct payments, even though such problems may be different in respect of payments made to carers rather than to those cared for? I have no doubt that those hon. Members who are fortunate enough to serve on the Committee will address those problems. I am sure my hon. Friend agrees that the Bill offers carers a wide spectrum of choices, which will enable escape from the strictures of limited choice. The combination of direct payments, vouchers and local authority provision will offer a range of possible services that carers and the people for whom they care want.
§ Mr. McCabe
I agree, which is why the Bill is so wonderful. It will unlock people's potential and enable them to escape from the terrible environment into which we have inadvertently put them: that of being nothing more than the recipients of services. The Bill will give people the chance to open up their lives and gain greater control over them. That is what the Bill is all about.
The Bill offers a great opportunity for a culture shift. It allows us to change our approach to carers and those who are in need of services. The voucher system enables carers to have a break when they need it, rather than when someone tells them that they are entitled to one. Direct payments are the key to giving people control over their lives. We must work in partnership with others to give carers such control. That is the central element of the Bill.
§ Mr. Philip Hammond (Runnymede and Weybridge)
I congratulate the hon. Member for Stalybridge and Hyde (Mr. Pendry) on his choice of subject for his private Member's Bill. He spoke of winning friends, and I assure him that he will have won many through his contribution today.
I congratulate other hon. Members who have spoken. Many have displayed a depth of experience and knowledge that has made the debate interesting and worth while. I am pleased to see the Minister of State, Home Office, the right hon. Member for Brent, South (Mr. Boateng) on the Treasury Bench for the winding-up speeches, as he has been a major contributor to the Government's strategy for dealing with carers.
1386 The Government rightly recognise the position and role of carers in our society. Many hon. Members referred to the large number of carers—almost 6 million by most estimates, although inevitably the figure will always remain an estimate. The essential feature of those carers is that their care is voluntary. They do it out of love and a sense of duty and obligation. In that way they contribute to our society some £30 billion worth of care.
We as a society have not only a moral obligation to support carers in what they do, but an economic imperative. The care that is provided informally in our society underwrites our national health service and underpins our social care system. The great silent army delivers care that would simply be unaffordable if it had to be provided through the formal system.
It is right and proper that the Bill focuses on the needs of voluntary carers, and in doing so underpins family and community values. We support and encourage that trend.
The starting point in the discussion about care and carers must be that care is rooted in the family, with the state and the statutory bodies providing support and encouragement for that care—not the other way round, starting from the assumption that the state has an obligation to provide all the care needs of every individual. The hon. Member for Birmingham, Hall Green (Mr. McCabe) developed that point admirably in his speech.
The Government have outlined a national strategy for carers, with which we are broadly in agreement. The right hon. Member for Coatbridge and Chryston (Mr. Clarke) described the development of policy towards carers as evolutionary. That was an inspired use of language.
I shall try to put the Bill in the context of the evolution of Government policy across Governments of both parties towards the needs and recognition of carers, and show that the Bill is part of a continuum. It is not a sudden departure or a step change, but, as the hon. Member for Stalybridge and Hyde said, it builds on what has gone before.
In their national strategy for carers, the Government have repackaged the various strands of Government policy that deal with carers. In the mood of a Friday debate, perhaps I can say that they have rather better packaged those separate strands to present a coherent whole. However, the Bill is essentially a continuation of what has gone before. That is emphasised by the fact that my right hon. Friends the Members for South-West Surrey (Mrs. Bottomley) and for Charnwood (Mr. Dorrell) are co-sponsors of the Bill.
The Government's national strategy for carers makes a welcome statement about recognising and supporting carers, and identifying the needs of carers as distinct from the needs of those cared for. Balance is essential. We must find a way to support carers without eroding the essentially voluntary nature of what they do, which is rooted in obligations of love and duty. Those are important, if unfashionable sentiments.
The hon. Member for Monmouth (Mr. Edwards) commented on the speed—or lack of it—with which the need for separate services for carers had been acknowledged. I have discussed that with my right hon. Friends the Members for South-West Surrey and for Charnwood. The answer may have something to do with Government's anxiety to develop a system of supporting carers without undermining the essentially voluntary 1387 nature of what they do. I am happy to acknowledge that the Government are sensitive to the voluntary nature of caring. Their national strategy does not try to bureaucratise the sector, but supports voluntaryism. On that basis, we are happy to support the Government.
At the risk of undermining the consensus that often breaks out in Friday debates, it jars slightly that a measure which is central to the Government's strategy for carers is presented as a private Member's Bill. The Prime Minister has protested the importance that the Government place on carers' needs. Without the Bill, there would be a gaping hole in the national strategy for carers. While it is to the credit of the hon. Member for Stalybridge and Hyde that he has promoted the Bill, it reflects no credit on the Government that they were unable to find Government time in which to introduce the Bill. It is purely by chance that the hon. Member for Stalybridge and Hyde stepped into the breach. Without him, legislation would not reach the statute book so quickly.
§ Mrs. Heal
The hon. Gentleman claims that it is to the Government's discredit that the subject has been left to a private Member's Bill. Does he agree that it was to the discredit of the previous Government, who were in office for 18 years, that they did not even develop a national strategy for carers?
§ Mr. Hammond
I shall attempt to show that the strategy for carers has been developing over the past 20 years. The Government have rightly made great play of the emphasis that they place on dealing with carers' needs. On reflection, perhaps the hon. Lady will agree that it is disappointing that such a Bill was not introduced in Government time.
There is a broad base of support for the Bill and the Government's strategy for carers. We shall not be entirely uncritical, and I shall focus especially on resources and expectations. I do not belittle the Government's actions, but in the third year of their three-year programme of ring-fenced grants, the additional money available to provide respite care is £70 million. There are 6 million carers in total, 1.5 million provide more than 20 hours of care a week, and almost 1 million provide more than 50 hours of care a week. It is important to keep expectations in check, because elementary arithmetic makes it clear that relatively small amounts of money will be available per carer for additional services. I am in no way belittling what has been done, but it is important that we do not let the rhetoric run away with us.
There has been a lack of recognition of family and informal care from the inception of the modern welfare state, in marked contrast with other European countries where the obligations of family care are enshrined in law. Many hon. Members would find some examples quite oppressive if they applied here. However, over the past 20 years there has been growing awareness and recognition of the needs and the role of carers. That has been reflected in Government publications and legislation, although I readily acknowledge that until recently the focus was clearly on the cared for with the carer an ancillary part of the equation.
1388 The 1981 White Paper, "Growing Older", was the first Government publication explicitly to recognise the concept of the carer and the problems that carers face. In 1988, the Griffiths report—the precursor to the National Health Service and Community Care Act 1990—acknowledged that family, friends, neighbours and the community provided the great bulk of care and that that would continue into the future. It set out the principle that public provision should support and strengthen that voluntary care, not replace it. The guidance for the 1990 Act specifically recognised the need to take account of the preferences and needs of carers. The 1989 White Paper, "Caring for People", set out six objectives, of which one was ensuring that service providers offered practical support for carers.
In 1985, 1990 and 1995, the previous Government commissioned special surveys as part of the general household survey to establish the exact extent of the provision of informal care. Every speaker has recognised that provision is crucial to the debate. The trend of recognising carers continued with the Disabled Persons (Services, Consultation and Representation) Act 1986 and the Carers (Recognition and Services) Act 1995, which explicitly recognised the role of carers and gave a right to assessment of the carer's ability to care, although always in the context of the cared-for person.
§ Mr. Burstow
The 1995 Act was introduced as a private Member's Bill. What additional funds were earmarked by the Conservative Government to enable the legislation to be implemented?
§ Mr. Hammond
The hon. Gentleman makes his point. The then Government suggested that additional funds would not be required and that those matters could be dealt with by existing local authority allocations. He will find precisely the same wording in the explanatory memorandum for the Bill, which has been prepared by the Department of Health.
To bring us up to date, the new Government—to their credit—have rightly recognised the role of carers and the evolution of that recognition over the past 20 years. I hope that the Minister will not pretend that all that began on 1 May 1997. The Government have set out the key elements of their strategy for carers. Some are already being dealt with by other legislation or regulation, some remain to be dealt with and two are dealt with by the Bill: the provision of respite care, for which a ring-fenced grant has already been announced and implemented, and legislation to enable local authorities to address the needs of carers directly.
It is common sense that we should be able to address the needs of carers directly where that represents the least costly and most effective way of meeting the objective of ensuring the proper continuation of informal care for a person who needs it. The dual objectives of the Bill and the strategy are to support carers in carrying out their caring more efficiently and effectively and to maintain their health and well-being to ensure that they do not, in turn, need care.
We broadly support the Bill, but I have many questions and observations, some of which could be dealt with by the hon. Member for Stalybridge and Hyde and others which could more appropriately be dealt with by the Minister. Clause 1 is rightly directed at informal carers 1389 only. It enshrines the right of a carer to have their own assessment. That is important, because across our social service system the assessment provides the gateway to resources and services. The Bill says only thatthe local authority must carry out such an assessment if it is satisfied that the person cared for is someone for whom it may provide or arrange for the provision of community care services.The Bill envisages a situation in which the cared-for person has refused an assessment. How will it be possible for a local authority to decide whether the person cared for is someone for whom it may provide services under the appropriate legislation without carrying out an assessment? There will inevitably be an assessment of the cared-for person, maybe at arm's length, even against their express wishes. The Minister should consider how that will work.
Clause 1(4) and (5) give the Secretary of State power of directions, but within those directions there will be local discretion on the form of assessment. Does the Minister envisage the directions substantially constraining that local discretion, perhaps imposing a national assessment tool to ensure uniformity in assessment? It would be useful if he could tell us his current thinking on that.
Clause 2 creates a power for local authorities to provide services and direct payments to carers. As others have pointed out, subsection (1)(c) requires that after the local authority has assessed needs, established that there are some and defined that it could satisfy them, it must decide whether it will provide such services. The hon. Member for Stalybridge and Hyde suggested that that would simply be a question of a local authority deciding whether it was preferable to provide the services to the carer or to the person cared for. Because of the resource constraints, local authorities will have to decide whether they can afford to provide care at all. We need to ask on what basis local authorities will ration the available care. Local authority social services departments are under tremendous financial pressure. The Government have introduced a ring-fenced grant for respite care, but other services that local authorities have historically provided are being squeezed by other priorities and by the Government's focus—appropriate though it is—on education.
There will be a limited amount of money available to a local authority for providing services under clause 2. There must be a real danger that as different authorities adopt different approaches to prioritisation we shall drop into a system of postcode care. Individuals with similar needs may find that they receive very different treatment from one authority to another. I know from Ministers' comments about the national health service that they are anxious to avoid that. I would be interested to hear how the Minister plans to prevent such differences occurring in the provision of care by local authorities under clause 2 of the Bill.
There will be a great danger of bitter disappointment following the general feeling of goodwill surrounding the Bill if people discover that the help that they thought they would get as a result of the Bill is no longer available due to financial constraints.
I have a specific question for the Minister in relation to clause 2(3)(b) which relates to the provision of intimate care. In response to my intervention, the hon. Member for 1390 Stalybridge and Hyde expressed the view that clause 2 would permit the provision of care by an outside carer against the wishes of the person being cared for. I find that somewhat disturbing and I would be grateful if the Minister would clarify the position.
I can see the argument for limiting the provision of intimate care in terms of the protection of the person being cared for, but as I said earlier in an intervention on the speech by the hon. Member for Hendon (Mr. Dismore), I cannot see how realistic respite care can be provided if it does not include intimate care. It might allow for the odd break of an hour or two for shopping, but clearly it would not allow the carer to go away for a weekend or longer. The provision clearly requires clarification.
Clause 3 takes further the idea of providing respite care, which is extremely important to carers, by giving powers to the Secretary of State to introduce a voucher system. I believe that it is an excellent idea to create a currency that would empower people. Many right hon. and hon. Members have used the term "empowerment" this morning. Vouchers have the benefit of flexibility. Indeed, if this were not a private Member's Bill and today was not a Friday, I might be tempted to trawl through old copies of Hansard to find out what Ministers and Labour Back Benchers have said in the past about the concept of vouchers. However, I am always delighted to witness Ministers, policy makers and Government Back Benchers on the road to Damascus.
Clause 3(3)(a) allows vouchers to be expressed in terms of money or service time. Perhaps the Minister could let us know whether his current thinking is that vouchers will be expressed in terms of service time or money. If they are to be expressed in terms of money, that will raise the vexed question of whether topping up the value of the voucher will be allowed. As, by virtue of clause 7, the vouchers or cash payments will be means tested according to the means of the carer, will the vouchers be issued in a way that makes them personal to the carer, or will they be transferable so that carers will be able to exchange vouchers? Will they be tradeable, so that someone who has been assessed as needing a break and given a voucher will be able to exchange that voucher for money? I would be grateful if the Minister would clarify that.
The vouchers may be issued either to the carer or to the cared-for person, but the Bill is silent as to how that dilemma will be resolved. There is considerable potential for conflict between carers and the cared-for person because the vouchers are currency, and they give power—the power of decision-making to the person in receipt of them. This will not be an issue in most cases, but at the margin hard decisions will have to be made. How does the Minister expect those decisions to be taken?
Clause 3(3)(d) specifies that there will be a maximum period during which the voucher is valid. Can the Minister confirm that this will not be a period limited to the issuing authority's financial year, but that authorities will be able to carry over some of money from the ring-fenced grant from one year to the next to represent the uncashed value of open vouchers? That will be important if people wish to have full flexibility in planning their use of the vouchers.
Clause 6 deals with direct payments or vouchers to parents of disabled children and to disabled children aged 16 and 17. Will the Minister confirm that where direct 1391 payments are made to the parents of disabled children, those will always be non-taxable? Will he consider and give guidance on the circumstances in which he expects direct payments to 16 and 17-year-olds to be made?
Hon. Members have emphasised the virtue of such a proposal in terms of the additional independence that it will give to those young people. However, I must voice concerns. These people are children under the age of full adulthood. The measure may create considerable tensions in the parent-child relationship and may undermine parental responsibility. In terms of further and higher education, the benefits are clear, but can the Minister tell us how he hopes this will be dealt with by local authorities without undermining the parental responsibility of those looking after disabled children?
I did not think earlier that I would have to constrain my remarks because of time, but events have taken a different turn. I ask the Minister to confirm that clause 7, which applies the charging mechanism, also applies the means-test which operates in other social services provision.
On clause 9, what is the Government's assessment of additional demand that will be created by the provisions of the Bill? The explanatory memorandum suggests that there will be no additional financial implications. Frankly, I find that difficult to believe. As the hon. Member for Sutton and Cheam (Mr. Burstow) said, if there are no financial implications of the Bill, it will not have succeeded in its purpose.
Overall, we feel that the Bill is an important contribution in terms of taking the agenda of carers and their needs forward. We believe that there are some dangers which I have sought to highlight and which we can deal with adequately in Committee. We will enter the Committee in a constructive mood, seeking to engage with the hon. Member for Stalybridge and Hyde and with the Government in resolving some of those questions to ensure that when the Bill reaches the statute book, it is a robust, durable and effective measure.
§ 2.4 pm
§ The Minister of State, Department of Health (Mr. John Hutton)
We have had a well-informed and constructive debate on an important piece of legislation. In the House, as elsewhere, there is no substitute for common sense gained from practical front-line experience. We have heard from several hon. Members who have that experience in substantial measure: in particular, my hon. Friends the Members for Halesowen and Rowley Regis (Mrs. Heal), for Birmingham, Hall Green (Mr. McCabe) and for Brighton, Kemptown (Dr. Turner), and my right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke).
My hon. Friend the Member for Halesowen and Rowley Regis said that it is possible to make a strong moral, social and economic case for the Bill. I agree strongly on all three factors. It is perfectly possible to quantify the benefits in financial terms, but not in human terms. We cannot quantify the practical difference that the Bill can make to the lives of both carers and cared for.
My hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) has done the House a huge service, and I warmly congratulate him. He described the Bill as a stunning victory for carers. He was entirely accurate. This is a breakthrough, and I hope that it is the beginning of a 1392 new culture and a new approach in social services and other agencies and that the important contribution of carers will be more properly recognised.
Notwithstanding what the hon. Member for Runnymede and Weybridge (Mr. Hammond) said about the history of the evolution of social care policy, we have made a significant difference in the past two or three years. It is important to consolidate and develop that change and to take the next steps forward.
My hon. Friend the Member for Stalybridge and Hyde made the point well that this is not the end of the story. We could usefully describe the Bill as the turning of a new page in that story. There is much still to do in ensuring that we continue to sustain the momentum that the Bill has created. There is no doubt that it is a landmark piece of legislation. We all have a responsibility to maintain that progress into the future.
My hon. Friend the Member for Scarborough and Whitby (Mr. Quinn) made an excellent speech, not only drawing on his own experience but asking the important question about who will care for the carers. From what everyone has said, there is no doubt that the answer is that we must assume the primary responsibility in the legislative framework and in the resources that we allocate to agencies to ensure that they can provide that service.
I agree with the hon. Member for Runnymede and Weybridge that we must strike the right balance, assuming the appropriate range of responsibilities in the public, voluntary and independent sectors while allowing the family to make the appropriate contribution. We want to reflect that in the legislation that we develop, and the Bill certainly achieves that. We have a responsibility as a society to care for the carers, and the Bill is an important reflection of that.
I have only a short time to respond to 15 Back-Bench speeches and offer my own thoughts on the Bill, so I hope that hon. Members will forgive me if I do not refer in great detail to their speeches. I will try to refer briefly to some of the points that have been made.
The hon. Member for Poole (Mr. Syms) asked about parent carers. I think that there has been a genuine misunderstanding about the Bill's implications for parent carers, and I hope soon to dispel that. It has always been our intention to consult widely, involving all the interested parties, on guidance and regulations under the Bill.
My right hon. Friend the Member for Coatbridge and Chryston and my hon. Friend the Member for Hall Green referred in their excellent contributions to the important changes that the Bill will introduce into the direct payments legislation. The Government have no doubt about the importance of direct payments in promoting choice, flexibility and independence. The direct payments scheme, properly operated by local authorities, will have the effect of transferring power from institutions to individuals, and that is entirely consistent with the points that all hon. Members have made in the debate about the importance of empowering individuals, be they carers or people with a disability, to exert greater control and flexibility over the decisions that affect their lives.
My hon. Friend the Member for Hall Green spoke from his considerable experience as a social worker about some of the inflexibilities that are an almost inevitable feature of large public sector organisations. Not for the first time, I hear the criticism he has made, but the challenge of direct payments for local authorities is to ensure that when 1393 services are provided directly by local authorities they are as flexible and as tailored to the needs of service users as those provided through direct payments. That is a big challenge, but it is the future and local authorities must put themselves in a position to achieve it.
The Bill will introduce some significant changes to the direct payments framework—I congratulate my hon. Friend the Member for Stalybridge and Hyde specifically on that—which will encourage greater choice, control and flexibility in the provision of services. That is much to the good.
The hon. Member for Sutton and Cheam (Mr. Burstow) raised several interesting questions. I reassure him that the Bill will not compromise or undermine the relationship between carers and those being cared for. Several hon. Members have pointed out, and I accept, that the Bill covers some complex areas and raises some problems, especially in relation to services of an intimate and personal nature. The hon. Member for Runnymede and Weybridge also expressed his views on that point.
I do not pretend that there is an easy solution, but we intend—once the Bill is enacted—to consult as widely as possible on how we can make the necessary regulations effective. It is appropriate to resolve the problems through regulations, instead of locking us into a fixed formula in the Bill that might be difficult to change in future years. My hon. Friend the Member for Stalybridge and Hyde has tried hard to get the balance right in his Bill, and we support the current drafting because it has succeeded in doing just that.
§ Mr. Burstow
When the Bill is in Committee, will it be possible to have early drafts of those definitions?
§ Mr. Hutton
As always, we will do our best to support the work of the Committee, but I cannot give any absolute assurances.
The hon. Member for Sutton and Cheam expressed concerns about whether under clause 2(3) of the Bill the income or assets of the carer, or of the cared-for person, would be taken into account when assessing liability for charging. The answer is in clause 4(4), which makes it clear that that decision will be made by the local authority providing the services. I suspect that we will also need to issue guidance on that point, so that the clause is interpreted consistently.
The hon. Member for Eddisbury (Mr. O'Brien) made a strong case, as did others, for more resources for local authority social services departments. I am not clear whether he has spoken to the new shadow Chancellor, but perhaps we can look forward to some more policy U-turns. It is refreshing to hear Conservative Members raise those issues, but it must be said that it has taken them some time to get to that position. I recall that in the previous Parliament there was a deafening silence from the Conservatives on such issues.
My hon. Friend the Member for Nottingham, East (Mr. Heppell) who, sadly, is no longer in his place, was right to say that the Bill is part of a wider strategy. I, too, am sure that there is more that we need to do.
1394 May I correct a mistake made by my hon. Friend the Member for Kemptown when he was describing the allocation of the carers' grant to his local authority? He quoted this year's figure of £128,000, when Brighton and Hove council will receive £313,000 next year.
§ Mr. Maclean
I am very grateful to the Minister for giving way in his customary courteous manner. He will be aware that the Carers National Association, Mencap and the Royal Association for Disability and Rehabilitation have some small concerns about certain parts of the Bill. Although I generally support the Bill and wish it well, I hope that the Minister will have as open a mind as possible in Committee or perhaps on Report so that we can explore the individual concerns and amendments in due course. The Minister may then be minded to accept some of them, which may reassure those of us who have read carefully the briefings of Mencap, RADAR and the Carers National Association.
§ Mr. Hutton
The Government certainly have an open mind about these issues, as we display when they come before the House. But this is a private Member's Bill—my hon. Friend the Member for Stalybridge and Hyde has control of it, while we express our views. However, I assure the right hon. Member for Penrith and The Border (Mr. Maclean) that we have an open mind about these issues.
It is our view, and I shall not pretend otherwise, that the Bill adequately meets all the objectives that we would like it to achieve. There is one issue that has been mentioned in the debate to which I would like to turn my attention. A number of right hon. and hon. Members have expressed concerns about parent carers, and I should like to reassure them that support for parent carers under the Children Act 1989 has been available since the Act was implemented. The Carers (Recognition and Services) Act 1995 already provides parent carers with a right to an assessment of their need. That is of course why we do not need to refer specifically to parent carers in clause 1 to 4. We have examined the issues carefully, and we believe that the Bill is drafted perfectly properly. I reassure hon. Members who voiced their concerns that there has been no oversight; we have looked at the matter very carefully—and I know that my hon. Friend has too—to ensure that the drafting of the Bill is adequate and comprehensive.
§ Mr. Hutton
I am afraid not, because I have a lot to deal with.
The Bill will go significantly further than the 1995 Act, which was introduced and piloted through the House by my hon. Friend the Member for Croydon, North (Mr. Wicks). It will give effect to the Government's carers national strategy commitment by enabling local authority social services departments to supply certain services direct to carers following assessment, either because the user has refused help from the local authority, or because it is more appropriate for the service to be provided direct to the carers to support them in their caring role and to maintain their own health and well-being.
In addition to offering greater support to carers, the Bill offers more opportunities for carers and the people they care for—including parent carers of disabled children, 1395 young carers and disabled children aged 16 and 17—to have flexibility in the timing and choice of the way in which services are delivered to meet their assessed needs.
The carers national strategy is aimed at empowering carers to make more choices for themselves and to have more control over their lives. They want their positive contribution to society to be valued and acknowledged. The Bill achieves that by giving local authorities the power to provide services direct to carers to support them in their caring role and by extending direct payments to carers to meet their own assessed needs.
The Community Care (Direct Payments) Act 1996 came into force on 1 April 1997. The Act gives local authorities the power to offer people cash payments as an alternative to providing social care services, so they may purchase the relevant services themselves. The Act was widely welcomed by disabled people. The extension of direct payments to carers to meet their own assessed needs, and to parent carers, has also been welcomed by carers organisations and voluntary organisations for children.
Direct payments offer more choice and flexibility in the timing of services and the way in which they are delivered, but of course people must use their direct payments to meet their assessed need for social services support.
Some parents will grasp the opportunity of receiving payments instead of services. They may choose to employ a personal assistant for their child instead of receiving a regular series of short-term breaks. Such an assistant could help the disabled youngster to enjoy mainstream leisure facilities or after-school clubs, which would achieve the Government's objective of social inclusion.
Parent carers like to be as independent as possible in making arrangements for the care of their disabled children. The Bill will help them to achieve a far greater level of independence than they have experienced before. However, direct payments for parent carers raise various questions, including promoting the welfare of the disabled child, which need to be carefully considered, as the hon. Member for Sutton and Cheam said.
Direct payments will be provided within the framework of part III of the Children Act 1989, which requires that local authorities provide a range of services to promote and safeguard the welfare of children. By amending the Children Act, the Bill will ensure that the legislative framework to promote and safeguard the welfare of children will still apply when parents choose the option of direct payments. Local authorities will have to review direct payments as the needs of children and families change over time, just as they do when families receive services directly from the local authority.
There is also the consideration that children could be put at risk if parents used their direct payment to engage unsuitable people to help them care for their child. That is an issue for both parent carers of disabled children and disabled parents seeking people to support them in their parenting role. The Department of Health will help parents to take the steps necessary to satisfy themselves that a person offering to help with the care of their child is a suitable person. In addition, the Government intend to legislate to ensure that local authorities have the power to undertake criminal record checks on behalf of parents—if the parent wishes it—as soon as possible.
1396 The extension of direct payments to 16 and 17-year-old disabled children and young people will offer them additional flexibility to meet their own developmental needs. The extension of direct payments to that group of young people follows strong representations to the Government's recent review of direct payments from groups, such as RADAR, that represent disabled young people.
Particular issues also surround the power to make direct payments to 16 and 17-year-old young carers. The Government do not want to burden any children with inappropriate caring responsibilities. Local authorities will offer direct payments to 16 and 17-year-old young carers only after giving full consideration to the interests of the child.
I stress that advocacy and support will be important to young people who are thinking about or receiving direct payments. The concept of independent advocacy is familiar to local authority social services departments. Advocacy and support services relevant to direct payment schemes already exist in the many authorities with good direct payment schemes. These may need to be adapted for young people, but local authorities have experience of the types of services that would be appropriate, and the Government are committed to ensuring that best practice in the use of direct payments is disseminated among all local authorities.
The carers national strategy also identified voucher schemes as a way of giving users and carers more flexibility in the timing and choice of the ways in which additional services were delivered. The Bill will meet the carers national strategy commitment to offer vouchers for short-term breaks. After an assessment of a carer or parent carer results in a decision that the carer needs breaks from caring responsibilities, the cared-for person will be assessed for the type of additional support that he or she needs if the carer is to take a break. Vouchers may be exchanged—at the time of choosing of the carer or cared-for person—for the services the user has been assessed as needing while the carer takes a break.
The hon. Member for Runnymede and Weybridge asked me about 20 specific questions about the Bill. We shall try to address those issues in Committee. In particular, the hon. Gentleman asked whether the face of the vouchers would show a money value or an assessment of service need. The Bill addresses that point, as he will find if he reads it carefully.
§ Mr. Hutton
The hon. Gentleman is quite right. The Bill says that it could be either. However, he asked whether the value could be expressed as either, and the obvious answer is yes.
In relation to the implementation of the measure, we intend to issue local authorities with appropriate help in the form of guidance as to the use of the new powers.
The issue of charging and resources was raised constantly. My hon. Friend the Member for Stalybridge and Hyde and other hon. Members asked me to comment on the Government's position on charging for non-residential care, including services to carers. It is for each local authority to decide whether to make charges for non-residential services and, if so, how much to charge. The existing legislation requires any such charge 1397 to be reasonable—that is the issue raised by my hon. Friend the Member for Hendon (Mr. Dismore). Our view is that it is reasonable to recover a charge, if that can be done without causing hardship to the service user.
In our White Paper, "Modernising Social Services", we recognised that the scale of variation in discretionary charges is unacceptable. We are considering the recommendations in the royal commission's report, and we shall consider carefully the Audit Commission's review of local authority charging when it is published in April. We shall then consider how the system could be improved in the light of the royal commission's report and that forthcoming study. We hope to announce our conclusions later this year.
We shall of course work with the voluntary sector—including carers' organisations, such as the Carers National Association, to ensure that users of services and carers can be fully involved in that process of consultation. I shall ensure that the views of carers are fully taken into account—as I think my hon. Friend the Member for Stalybridge and Hyde asked me to do.
Our aim is to move as far as possible towards greater consistency and fairness in charging. That commitment includes being fair to carers and to other people who receive community care services. However, we need a consistent approach, not one that might treat one group of people who use those services differently from another.
Resources have been referred to repeatedly. I want to correct one misunderstanding. There have been many references to the carers special grant—the £140 million of new resources over the three years of the spending review. The point has been well made by some hon. Members that that is only part of the resources package available to local authorities to support carers and to 1398 provide respite services. It is on top of the substantial increases in social services spending that are currently under way.
The hon. Member for Sutton and Cheam is always talking about reductions in spending in social services departments. The Government are raising spending on social services by almost £500 million this year. In addition to that general lift in the resources package, there are the specific grants to which my right hon. Friend the Member for Coatbridge and Chryston referred to—£750 million of new partnership money and £375 million of children's special grant. Those amounts form part of the wider resource envelope against which we should judge the Government's record on resourcing carers' services.
I do not speak in a partisan sense—this is not the time to do that, although it may be the place—when I point out that the Government are taking a significant step forward in the way in which we are resourcing social services and social care. That is reflected by the £2.8 billion increase in social services over this spending round and by the additional grants that we are making.
The Government value carers and will continue to support them in their caring role. We strongly support the measures in the Bill. The Bill helps carers by empowering them to make more choices for themselves and to have more control over their lives.
Once again, I congratulate my hon. Friend the Member for Stalybridge and Hyde on promoting the Bill. It is an important step forward, both for carers and for people with disabilities. I hope that the House will give it the strongest possible support.
Question put and agreed to.
Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).