CARERS' PLAN

HC Deb 05 May 2000 vol 349 cc409-26

'.—Every local authority shall prepare a Carers' Plan setting out how it proposes to provide services to carers assessed under section 1.'.—[Mr. Gareth R. Thomas.]

Brought up, and read the First time.

Mr. Gareth R. Thomas

I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker

With this it will be convenient to discuss the following amendments: No. 10, in clause 2, page 2, line 3, after "decide", insert— 'in consultation with the carer'. No. 11, in page 2, line 8, leave out "whether or not" and insert "how".

No. 13, page 2, line 12, leave out— 'in the local authority's view'. No. 14, page 2, line 16, after 'service', insert 'or other assistance'.

Mr. Thomas

Every local authority is already required by law to publish a community care plan, under the National Health Service and Community Care Act 1990. It is supposed to be good practice to include support for carers in that care plan, and local authorities are already under a legal obligation to consult carers on the plan. However, one of the problems with the community care plan documents that are produced by local authorities is that they are large and very general. For many carers, they are inaccessible.

The new clause proposes that every local authority should be under a statutory requirement to prepare a specific carers plan about how it proposes to provide services to carers. There are several clear advantages to that. Carers plans would provide much greater transparency for carers who wish to know more about how local authorities will take forward their new rights under the Bill. They would also allow greater accountability. The majority of local authorities are clear about how policy and practice should be executed in terms of the provision of services for carers, but the experience of the first year of operation of the carers grant demonstrated, according to research by the Carers National Association, that some local authorities do not always follow statutory guidance sufficiently closely.

One in 10 local authorities intended originally to spend less than 25 per cent. of the carers grant on services that provided carers with a break, even when the grant order specified that at least 75 per cent. of the grant moneys had to be spent on carers' breaks. To deal with that problem, this year's grant conditions specify that the local authority has to fill in a pro forma giving its clear intentions for spending the grant, so we are already close to local authorities having to produce a separate carers plan. The Carers National Association believes that the pro forma will help to standardise the information collected on the carers grant and ensure better accountability for carers, who will be able to see whether the new money is being spent on breaks rather than existing services.

A carers plan drawn up in consultation and partnership with carers would offer new weapons to help carers shape the way in which services are delivered to them. It could also help to foster better sharing of good practice. For example, carers plans could be linked to the Department of Health's new carers internet site, at www.carers.gov.uk, which is a welcome innovation.

All English local authorities were required to produce a carers plan in 1999 on how break services for carers would be developed. Social services inspectorate care regions report that most authorities have engaged well with carers and their representative organisations. I understand that the social services inspectorate care regions will follow up with local authorities how they continue to perform against last year's plans. If local authorities produced carers plans last year, there is no reason why they should not be required by the Bill to account to carers and local residents for how they are providing services to carers every year. There is considerable support for the work that carers do and considerable concern about the support they get. The publication of carers plans by local authorities would help to ensure that carers services receive the proper focus that they require from local authorities.

Last year, the Government announced some £20 million in 1999–2000 for the carers special grant. This year some £50 million will be allocated and, for 2001–02, the figure will be some £70 million pounds. If taxpayers' money is to be allocated for additional carers services, a carers plan would help to ensure that the money was properly accounted for. One of the conditions of the carers special grant was that local authorities reviewed, with other agencies, their provision of services to give carers a break from caring. Local authorities were required, in the first year of the grant, to involve and consult carers and their organisations on the appropriateness of existing provision and the possibility of greater diversity. Local authorities are therefore used to preparing carers plans and consulting with carers. I contend that they should be required to do so every year.

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It was expected that where current services met needs last year they would be enhanced by the additional money, and that where more diversity was needed authorities would plan for the provision of further services. A carers plan would help to specify how those new services were being developed. Another key benefit of a carers plan is that it would help to solve a problem that many of us recognise—the lottery in the provision of carers services. Access to certain services is much greater in some local authorities than others, and the requirement to publish a carers plan would increase local authorities' accountability and reduce the sense of there being a lottery in provision.

Carers have a difficult time accessing their rights and receiving information about services. A carers plan would help to solve that problem. Research carried out by the Carers National Association in 1997 found that only 18 per cent. of carers providing substantial amounts of care had received an assessment of their needs. In 1994, the Carers National Association found that only 32 per cent. of carers had received a copy of the disabled persons care plan. In 1997, it found that some 85 per cent. of carers had received feedback since their assessment, but only 56 per cent. had received it in writing. However, more recent research carried out in 1998 found that 72 per cent. of carers had not received a copy of the hospital discharge plan that they needed. All that suggests that implementation of policy in some areas still needs further work and the spotlight provided by a carers plan would help to encourage local authorities further to develop and implement policy laid down by the Department of Health.

The problem of access to services was highlighted by the excellent social services inspectorate report that was published in November 1998, entitled "A Matter of Chance for Carers". It stated in its opening paragraph: The quality and type of support that carers receive remain a matter of chance. Support depends far more on where carers live and who they are in contact with within social services than what they need. Some carers are offered very sensitive practical and emotional support, but others receive no information about what might be available and they are not assessed. A carers plan would clearly help to tackle the problem of lack of access to information. A requirement to publish a carers plan would also be a useful tool in Government efforts to reduce the lottery of care and would complement the development of new performance assessment frameworks.

Now that local authorities have to count the number of carers who are being assessed, they are becoming more conscious of offering assessments, ensuring that the right policies are in place and recording the right information. Of course, collecting statistics cannot guarantee that carers are given good assessments, but it is a step in the right direction. The publication of such information in a carers plan would clearly increase the accountability of those who are supposed to be providing services to carers.

A carers plan would also complement the Government's fair access to care initiative, which I understand has not yet been published. The Carers National Association very much hopes that it will further reduce the lottery of care.

The Government's concern about the range of eligibility criteria for services was flagged up as early as the 1997 social services White Paper. Again, a carers plan would help to complement efforts to standardise the eligibility criteria and make them fairer. Authorities tend to draw up eligibility criteria for social services based on the degree of risk to the disabled or elderly person. They use those criteria to determine, for example, whether an elderly woman with particular needs would have access to certain services.

Eligibility criteria also seem to exist for carers who try to exercise their right to assessment. Some carers have been told by social workers, "You're not in crisis yet, so you don't need an assessment." That goes against good practice and against the wording of the Carers (Recognition and Services) Act 1995 introduced by the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Croydon, North (Mr. Wicks), which clearly states that carers have a right to request an assessment if they are providing regular and substantial care. The law does not require them to be in crisis for that to happen. What some carers are being told also goes against the Government's prevention agenda and is clearly against basic common sense.

A carers plan would facilitate the publication of such eligibility criteria and would help to hold local authorities to account. It would also complement efforts to break down the health and social care divide—an issue that concerns many hon. Members. It is a key issue for carers, who feel strongly about it. Research carried out by the Carers National Association in 1998 revealed that the first priority for the vast majority of carers was that health and social services should work closely together. Many respondents mentioned the problems of policy and service fragmentation and said that the need to break down the Berlin wall between health and social services was affecting the care that they were able to access. They commented on the experience of being batted between the NHS and social services. One carer said: social services should get together with the NHS to provide a joint package instead of arguing with them about who pays. Clearly a carers plan would help to complement efforts to provide that joint package.

When the NHS and social services fail to agree to provide services, or fail to provide joined-up services, those who suffer are the disabled, the ill or the elderly. Carers are too often left to cope with unacceptable levels of caring responsibility.

Mr. Barron

My hon. Friend has gone into great detail about the current situation and he obviously believes that the carers plan is a major issue. However, in relation to a previous group of amendments, my hon. Friend the Minister said that the Government were considering strengthening guidelines to local authorities. Which is the best mechanism? Is it a carers plan that goes into great detail, or is it stronger central guidance to local authorities so that we no longer have the situation in which some people are more equal than others when it comes to accessing care from the local authority?

Mr. Thomas

I do not think it is a matter of having one or the other. We need stronger central guidance and a carers plan to throw a spotlight on how local authorities are responding to that guidance.

The challenge of having to produce a carers plan for public consumption would help to identify problems and make sure that the partnership grant, which is part of the modernising social services grant that will be provided by the Department of Health to local authorities in England over the next three years, is properly spent. I understand that the partnership grant is designed to encourage closer and more joined-up working.

We also have legislation to back up the notion of more creative joint working. The Health Act 1999 introduced a new way of closer working whereby there are clear benefits to be gained, including integrated services, pooled budgets and lead commissioning, and local authorities and health authorities can transfer their commissioning responsibility to each other. A carers plan would help to reveal just how successful local authorities and health authorities have been in responding to the Health Act 1999.

The Carers National Association believes that monitoring is extremely important as it is likely that areas that have better joint working relationships are more likely to be able to bid for budget flexibilities. A carers plan would clearly provide an important source of monitoring, which the Carers National Association has identified as particularly important.

The association asked what would happen in areas where there were poor joint working relationships. A carers plan would help to expose those poor relationships, and enable the social services inspectorate to take appropriate action.

As part of my research for this debate, I consulted the Alzheimer's Disease Society. I was told that about 5,000 people with dementia live in the Brent and Harrow health authority area, which means that there are at least two or three times that number of carers. Clearly, a carers plan would be of great benefit to people with dementia.

The society stressed that the amount of informal care provided by friends, volunteers and family is substantial. Two thirds of people with dementia continue to live in their own homes. A significant minority live alone, but most are cared for by family members, many of whom are elderly themselves. The society said that the shift in the 1980s from residential care to community care increased the burden on family carers. By providing more information, a carers plan would help to relieve some of that burden.

The Alzheimer's Disease Society made it clear that a partnership between carers, people with dementia and the staff who work with them is vital to the development of sustainable long-term care. A carers plan would show whether such a partnership was in place. If that partnership were not in place and working properly, a carers plan would help ensure proper accountability to carers and provide information about where they could turn for help.

The society told me that carers need practical support, which may take the form of financial help, respite care, training or information. A carers plan would help identify how much support carers need, and where they could find it. Recent research showed that a carer's ability to cope was the most significant factor in the shift from home care to institutional care, but that inadequate training and support for carers was widespread. A carers plan would help to show where such training and support was available.

The Government recognise the separate needs of carers, but many carers remain unaware of the support available. A carers plan would help them find out where the support that they need can be found. Respite—the provision of a break from caring—is one of the most frequent of carers' requests, as the House will know. It tends to be provided with the explicit aim of avoiding institutional care, so it is ironic that short-stay institutional care remains the most easily accessible form of respite provision for people with severe dementia or behavioural disturbances.

However, that form of respite is sometimes not the most effective or desirable form of support. Flexible, community-based models of respite include family support schemes and sitting services schemes. They extend the range of respite opportunities available and may enable a carer to continue to care for a person with dementia for a longer period.

Such alternatives are needed, and a carers plan would help people to know where those new forms of respite could be found. Some local authorities would be shown to be relatively advanced in the provision of that support compared with their neighbours. That might encourage those neighbouring authorities to increase support provision in their areas. High-quality respite care could also help to reduce levels of abuse and maltreatment of elderly people, according to the Alzheimer's Disease Society.

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Carers report that they suffer less stress and anxiety and are better able to cope with their caring role if they have access to good information and support. A carers plan identifying the range of support available to carers could only be of benefit.

The voluntary sector is highly successful in providing information. The better carers are educated, the better they are able to cope with the changing nature of the disease. Carers have said that the early provision of support and training for family members and friends not only improves the quality of care for the person with dementia, but relieves some of the anxieties of carers. Access to the early provision of support and training would be facilitated by the publication of a carers plan.

Early support would also help carers understand their own emotional responses and need for support. It is worth noting that when a person with dementia moves into residential provision, carers often continue to provide care, albeit in a different role. Moreover, many carers continue to share their experiences with others, offering support and advice for many years after their own caring responsibilities have ended. A carers plan would enable former carers with experience of the health and social care system to contribute to discussions about the type of services that carers should be given. Former carers would also help to hold local authorities to account over the support that they give to carers.

Many carers suffer financial hardship, which often compounds their emotional and social problems and can lead to a deterioration in their mental and physical health. Information about the support available to carers through the benefit system could be properly identified in a carers plan, and would therefore be of immense benefit. I hope that the Government's changes and improvements to the benefits system will include increased support for carers. A carers plan would inform carers about those changes.

Carers are often less able to participate in social activities. They provide most of the care given to people with dementia, and it is essential that they are not penalised as a result. Again, access to information about the benefits available from the Department of Social Security and through the tax system would be part of a carers plan.

Mr. Burstow

I have listened to the hon. Gentleman's speech closely, and I agree with much of what he has said about the idea of a carers plan. However, he seems to be describing two very different purposes for the plan: one purpose seems to be to inform carers about their rights and the services available to them, but the second purpose seems to be that it should act as a planning document and a tool for making local authorities—the service providers—more accountable. Does the hon. Gentleman agree that those purposes do not fit well together?

Mr. Thomas

I do not agree. I believe that the two purposes fit well together. A carers plan would be an opportunity to provide information to carers and, by highlighting what was available for them, it would be a useful document in terms of holding local authorities accountable. In addition, a carers plan would help to inform the planning and delivery of services.

Carers also tend to forgo employment opportunities. As a result, they are often unable to contribute to pension schemes, and they can find it harder to return to employment when their caring role has ended. Information about returning to employment could be included in the plan.

Information for carers would be one of the most profound benefits of a carers plan. I have already flagged up the Department of Health's excellent carers website, which was launched on 8 February. That will provide Departments with the opportunity to put on the internet details of the services and benefits affecting carers that they provide. I think that carers plans, particularly those of the highest quality, should be linked in to such a website, making it easier for carers who have access to the internet to get information about what services the Government are providing.

Carers plans must properly reflect the needs of black and ethnic minority carers. I understand that the Department of Health has forged strong links with national and London black carers forums. I contend that carers plans would enable local authorities properly to identify what support they are providing to those groups of carers.

In the course of my preparation, I consulted the Parkinson's Disease Society. People caring for someone with Parkinson's disease might want specific information in a carers plan, such as where specialist clinics are available in the health service. They might want to see evidence of work by the local authority and the health authority that shows that efforts are being made to increase awareness of the disease among other professionals in the area, through better education and training. They might also want access to information on drugs given in everyday language. The carers plan could help to indicate where such information would be available. Carers might also want to know how to get access to information about new therapy changes and new support for carers at crucial times. Again, a carers plan could help to identify where such support was available locally.

The Parkinson's Disease Society is campaigning hard to achieve the target of having some 240 Parkinson's disease nurse specialists. At present, there are 75 in post, and they provide particular support to patients and carers across the United Kingdom. A carers plan could help to identify which local authorities have access to such nurse specialists, and could help to encourage other local authorities to put pressure on the health authorities with which they are in partnership to make funding available for more Parkinson's disease nurse specialists.

The Parkinson's Disease Society has made it clear that respite care is extremely important, and that it wants an increase in the provision of high-quality respite care services. A carers plan could help to show which local authorities were expanding their respite care services for those with Parkinson's. The society has said that the provision of emergency respite care is also crucial, so that a crisis affecting the carer does not result in the patient being placed in a residential setting. In an emergency, carers want immediate access to information on getting respite care as soon as possible. A carers plan might help to ensure that local authorities provide such information.

I flag up again the important issues of helping carers stay in touch with, or return to, the world of work. Thanks to Ministers in other Departments, carers now benefit from ONE, the single gateway, which brings together the Employment Service, the Benefits Agency and other welfare providers at a single point of contact. A carers plan would help to identify that single point of contact. The ONE service is a significant change in the service that clients currently get from the benefits system. The Government have said that they want carers and people with disabilities to hear about the help on offer, to allow them to make informed choices about whether to utilise the ONE service to enhance their employability in the short or longer term. Clearly, no client would be forced to look for work or to take any step following a persona] advice meeting, but carers need to know where they can get access to such a service if they want to, and a carers plan would help in that respect.

My hon. Friend the Minister said in Committee that the Government would publish a new quality Green Paper on social services later in the year which will outline ways of providing better guidance to local authorities… that is the point that my hon. Friend the Member for Rother Valley (Mr. Barron) made in an earlier intervention— in relation to cost-effective quality social care interventions. He also said that the Secretary of State for Health had floated the possibility of a new social care institute of excellence…—[Official Report, Standing Committee C, 8 March 2000; c. 9.]

What better task for a new social care institute of excellence to begin with than looking at the carers plans produced by local authorities. What better way of showing carers the new guidance, through local authorities, than the publication of a carers plan.

My hon. Friend the Member for Halesowen and Rowley Regis (Mrs. Heal) spoke in the same debate about carers of people who are mentally ill. A carers plan could make a powerful contribution to identifying the support available to carers.

Mr. Hutton

I am reluctant to intervene on my hon. Friend while he is making his speech. However, the national health service framework for mental health, which was published in September last year, makes it clear that it is the responsibility of local authorities to provide a written care plan for those looking after people with mental health problems. That is also a sign that the Government are trying to ensure that carers feature prominently in service improvement right across the range.

Mr. Thomas

I am grateful to my hon. Friend for that intervention. I think that a carers plan can only help to make it clear where people can go to get access to information about assessments.

Amendment No. 10, in my name, suggests inserting the words in consultation with the carer after "decide". This a probing amendment, which simply reinforces the obvious point that services for carers should be provided in consultation with them. We are not interested in recreating big brother; we are not saying that the local authority always knows best. The amendment would reinforce the point that services should not be provided on the basis of somebody remote from the carer deciding what is best, but in consultation with the carer.

I hope that in my few words I have explained properly to the House how a carers plan provision could benefit the Bill.

Mr. Forth

In spite of the eloquence of the hon. Member for Harrow, West (Mr. Thomas), to which I pay willing tribute, I confess that he has not carried me very far with him. I am worried about the extent to which the hon. Gentleman believes that the act or preparation of planning would resolve so many questions.

I confess at the outset that I have an instinctive unease about planning per se. I am now old enough to remember the national plan back in 1964, when George Brown told us that it would be the salvation of the nation. That did not last long, and I am surprised to hear that new Labour—to which, no doubt, the hon. Gentleman would want to attach himself—still holds that rather naive belief in the benefits of planning.

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Setting that general objection to one side, I remain unclear, despite the pains that the hon. Gentleman took to explain his objectives following the intervention by the hon. Member for Sutton and Cheam (Mr. Burstow), about quite what he thinks the planning process would do. His ideas seemed to encompass the provision of information, which is not what I would regard as the normal objective of planning. On the other hand, they seemed to be about reassuring carers, which plans might or might not do. Thirdly, they seemed to be about setting out transparently the objectives of authorities and the way in which they proposed to meet the Bill's requirements.

The third of those objectives is the most legitimate and useful, but the hon. Gentleman's new clause does not make it explicit. In fact, it says very little, and it does not properly elucidate or pin down the many objectives that he set out. If we were to support the new clause—I would find great difficulty in doing so—I cannot see that it would add anything to the Bill's objectives or the proper provision of services to carers. It is too general, and would have to have been much more specific to be of any use.

Is the hon. Gentleman trying to reassure carers? Is he trying to reassure the Government by meeting the objectives either of their guidelines or regulations? I could see some point in that, but I am not sure that that was his objective. He hinted that the new clause would facilitate effective co-operation between the authority and, say, local health service bodies. There might be some point to that, but there was a lack of focus in what the hon. Gentleman said and in the simple wording of his new clause.

Responsibility for preparing the plan would clearly lie with the authority—at least, I think that that is clear. We need not question who in the authority would have to do that, but there is the time-honoured question of cost. The hon. Gentleman, understandably, did not deal with that, but we all know that planning carries costs. We must ask whether we believe that sufficient additional benefit—added value, in the ghastly modern jargon—would arise to justify the cost. Would not the money be better spent more directly on providing the services that are the Bill's objective? Unless we have a more accurate idea of the cost of the process suggested in the new clause, it is difficult to judge those points. Unless I were to be much more persuaded of the benefits, my feeling would be that the cost would be an unacceptable additional administrative burden on the local authority.

Mr. Barry Gardiner (Brent, North)

I have listened carefully to the right hon. Gentleman and I sense a certain inconsistency in his argument. On the one hand, he says that the costs of preparing the plan are too great; that we must know what we are doing; and that it might be better to spend the money directly. On the other, he has suggested that we must know what we would be spending the money on but, in order to know that, the plan would have to have been prepared. There is a certain circularity in the right hon. Gentleman's arguments.

Mr. Forth

I see what the hon. Gentleman is driving at, but spending the money and preparing the plan would occur anyway. That would not be additional, as that process already happens. The new clause suggests a burdensome additional administrative and bureaucratic process, which would cost even more. Plans do not come free, as anyone with even limited local authority experience will know. Whatever additional benefits may accrue from the process suggested by the hon. Member for Harrow, West—I have my doubts about them—I suspect that the costs will not be justified. The risk is that that additional cost would come from moneys that could be more directly used to fulfil the purposes of the Bill.

Mr. Gareth R. Thomas

May I take the right hon. Gentleman back a year? The requirement that went with additional money provided through the carers special grant was that each English local authority had to produce a carers plan. The vast majority did so, increasing the partnership with health authorities and increasing services. If they could do that last year, surely they could do it in future.

Mr. Forth

That puzzles me even more. Back when the hon. Gentleman opened his remarks on the new clause, he set out in detail what already happened, and then seemed to want more, or the same again, or a reiteration of what we do, or some such thing. For that reason, the entire new clause seems otiose. He has just reinforced my doubts by telling us that all this is more or less done already.

Mr. Thomas

The carers plan was produced because a specific requirement for it was linked to the money from the Government for the carers special grant. That was a one-off requirement. Unless my new clause is successful. there will be no reason why local authorities will have to produce a carers plan in future. I contend simply that if it was successful last year, we should roll on that success to future years.

Mr. Forth

That intervention raises several further questions. First, if the process was successful, authorities would presumably—at least, possibly—want to follow it again. Secondly, the extent to which the process was deemed to be a success would in itself affect whether it should be repeated. It is implicit in the way in which the Bill's ethos has been debated at every stage that we all assume a large amount of good will on the part of the Government and the local authorities.

Mr. Hutton

As a condition of this year's use of the carers grant, local authorities will be required to provide an updated version of their original plans. The planning obligation still features as part of the special grant regime.

Mr. Forth

That enables me to curtail my remarks, the House will he happy to hear. That seems to lay the whole matter to rest. I shall move quickly on to my concluding remarks, which relate to what the Minister has said.

I assume that, as there is a requirement for a plan, there is also a requirement to ensure the plans are satisfactorily and usefully drawn up. While the hon. Member for Harrow, West was speaking, it occurred to me that there was no provision in his remarks for any quality assurance. The process seemed unsatisfactorily loose, and I should like to hear from the Minister—following his extremely helpful intervention—an assurance that the process was satisfactorily carried out last year, and that mechanisms are in place, involving his officials or guidelines and the authorities who draw up the plans, to establish that the plans have a proper use and do much, if not all, of what the hon. Member for Harrow, West wanted. Can the Minister assure us that they would provide added value to the support and assistance that would be given to carers by the Bill? That is the main outstanding question.

Mr. Barron

I do not wish to speak for long. The Minister's recent intervention on the right hon. Member for Bromley and Chislehurst (Mr. Forth) goes some way to meeting my concerns. I am grateful to my hon. Friend the Member for Harrow, West (Mr. Thomas) for raising the matter, but I would find it difficult to support him. His speech was extremely well researched, and he made good points on several issues, particularly on hospital discharge and how carers, or people in the primary health care sector, gain information on the issues. Occasionally, they do not receive a service that is as good as today's information technology could provide. We should consider that issue.

Although I agree with many of the arguments made by my hon. Friend the Member for Harrow, West, I point out that, in the 1980s, my family had to deal with someone who had Alzheimer's disease, when there was little medical analysis of her condition. We cared for her within the family for many years; it was only at her death that she was found to have the disease. I do not criticise anyone involved, but the support services from the local authority and the health authority were pretty poor. Needs were not well met. That has changed, even though it is not enough to satisfy all individuals and organisations—I accept that entirely. However, matters have improved. During the past two decades, care for such people has become much better.

One of the points on which I disagree with my hon. Friend is that new clause 2 would give responsibility for drawing up the carers plan to the local authority. I am not attacking local authorities. I am a great believer in local democracy and in decisions on people's lives being taken as locally as possible. When we draw up legislation in this place, we do not know all the answers to people's needs. We may think that we do, but often we do not—as we find out later.

The important point is that the matter goes much wider than local authorities. The health authority has a large role in helping carers and people with disabilities to manage their lives in general. To suggest—as the new clause does—that local authorities should carry out that task on their own is not a good way forward.

I am sure that my hon. Friend the Minister will tell us—as he observed in his intervention—that there are other ways to handle the matter. Although I am sympathetic to care plans—as we all should be—because they give people rights, they also raise expectations. At present, there are different levels of care in local authorities and in health authorities. My fear is that, if we ask authorities to produce local care plans, those differences could be compounded and justified. In order to assist carers, what we should be doing is ensuring that best practice is observed throughout the system; we should improve matters for people and those being cared for as much as we can. To ask local authorities to draw up and justify care plans under the current system is probably not the best way to do that. We need improvements throughout the country rather than merely justifying the current system—as I suspect would be the effect of new clause 2.

Mr. Owen Paterson (North Shropshire)

There seem to be two contrasting aims in new clause 2, as it was elaborated on by the hon. Member for Harrow, West (Mr. Thomas). If there is a disparity between the services provided by local authorities, there may well be justification for a document that analyses that disparity, so that those offering a service that is less good can improve it. However, it is easy to list a load of problems, establish an institutional reform and sweep everything into that dustbin. The hon. Gentleman outlined many problems in some detail and stated that the carers plan would resolve them. That would be our Aladdin's cave.

The problem is that a document that describes the differences between local authorities will be an extremely broad one and thus it will inevitably be bland. That will not help the people who need it. We all hear of traumatic cases—those are the people we should be thinking about. If the carers plan is to be really effective, it will have to consider almost every individual case.

Carers are being treated as a homogenous lump, but every carer is dealing with an individual problem. Many are in families, where, for example, an isolated elderly person has Alzheimer's. They have to cope with the whole range of disabilities—physical and mental—or with different physical surroundings. Some people may be in blocks of flats with wardens; others—as in my constituency—may be in isolated cottages in the countryside. Some people are caring for children. I know of one especially traumatic case involving a quadriplegic child who is completely mentally and physically disabled and will need care for her whole life.

As the hon. Member for Rother Valley (Mr. Barron) pointed out, to help such people effectively, we need an individual plan for every case. That is an ambitious project. It would obviously need a large number of staff and skilled people and large resources. It might be prohibitively expensive.

There might be merit in drawing up carers plans for individual cases, but I am not sure that the hon. Member for Harrow, West has really thought the matter through. There is a contrast between an effective plan that would help those individuals and a broad, bland document that compared disparities between the services delivered by local authorities.

I shall be interested to hear how the Minister intends to resolve the matter. It would be easy to establish a carers plan and say that all the problems outlined by the hon. Member for Harrow, West will go away—but they will not. To be effective, we need to focus much more on the detail, but to do that will be extremely expensive and time-consuming.

11.15 am

Mr. Pendry

Before I respond to the debate, I thank all those who spoke of my incapacity to undertake my proper role of speaking longer than my hon. Friend the Minister, who spoke earlier on my behalf. When he pointed out that I had left my sick bed to be in the Chamber, Members sitting close to me scattered. Only my hon. Friend the Member for Denton and Reddish (Mr. Bennett) was either brave or foolhardy enough to remain within reach.

Any of my hon. Friends who believe that the right hon. Member for Bromley and Chislehurst (Mr. Forth) does not have a big heart and that he does not care about people should read Hansard on Monday. I am grateful for what he said.

My hon. Friend the Member for Harrow, West (Mr. Thomas) introduced the new clause thoughtfully and well. I greatly appreciate the efforts that he put into the new clause and the amendments. I shall deal with the amendments as a group, because they cover the responsibilities of local councils to decide which services they provide to carers and how. It is right to put carers in that position. I understand why hon. Members have tabled amendments. Like all of us, they want carers to receive the services they need—we are all agreed on that. However, as has been pointed out, all the new provisions are either unnecessary or would reduce a local council's ability to make effective decisions based on its own eligibility criteria and on the professional judgment of its assessing staff.

In relation to community care, we must also be very careful not to put carers in a position that is preferable to that of the people for whom they care. We do not want to give the impression of discriminating against service users in favour of carers. We do not want to impose a duty on local councils to provide services to carers—we simply want to empower them to do so. Amendment No. 10 would reinforce what is already clearly understood to be a fundamental principle of good practice in both service users and carers assessments. In the latter case, practitioners are left in no doubt about their responsibilities to hold consultations with carers. Under the Carers (Recognition and Services) Act 1995, the policy and practice guide on the content of a carer's assessment includes such matters as the carer's perception of the situation, the nature of their relationship with the user, the tasks undertaken and the consequent impact on the carer and the tasks with which they would like help.

My hon. Friend the Minister has already made a helpful intervention on that point. I am sure that he will want to say more. However, I know that he is adamant that similar unequivocal guidance will be issued if the Bill receives Royal Assent. I therefore ask my hon. Friend the Member for Harrow, West to be reassured and to withdraw the amendment.

Amendment No. 13 similarly seeks to remove the local authority's ability to judge whether particular services will help a carer. As I have said, good practice dictates that such a decision will follow discussions with carers, very much taking their views into account. It must also be made within the parameters of the council's eligibility criteria, which will prioritise within the council's resources the support of those with the greatest needs. If the final arbiter of the appropriateness of a service were not the local authority, whose view would matter? If the decision fell to carers, they would once again be in a better position than the service user, and that can be seen only as discriminatory. I therefore ask my hon. Friend the Member for Hendon (Mr. Dismore) not to press his amendment.

Amendment No. 11 would impose a statutory duty on local authorities, rather than create a power to provide services to a carer following an assessment of need. I would not want—I am sure that no hon. Member would—carers to be put in the position where the people for whom they care have no such right. I therefore urge my hon. Friend the Member for Halesowen and Rowley Regis (Mrs. Heal) not to press her amendment.

On amendment No. 14, the Bill enables local councils to offer carers support in order to meet their assessed needs as carers or to maintain their health and well-being. That support or assistance is expressed as the delivery of a service. The term is generic and includes assistance in the form of, say, a direct payment, which would enable a carer to purchase the services to meet the assessed need. On the basis of that explanation, I urge my hon. Friend the Member for Erith and Thamesmead (Mr. Austin) not to press his amendment.

I understand that the purpose of new clause 2 is to ensure that the legislation is properly considered and that councils give thought to the provision of services and also support carers as they carry out their caring role. I understand from my hon. Friend the Minister that the Department of Health would expect such an exercise to be conducted as part of the on-going planning and priority-setting work of social services departments. I am sure that my hon. Friend will wish to say more about that, but for those reasons I ask my hon. Friend the Member for Harrow, West to withdraw the new clause.

Mr. Hutton

I shall try to be brief. I certainly lend my support to my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) in his unwillingness to accept the group of amendments and the new clause, and I endorse all the arguments and his reasons for doing so.

Like my hon. Friend, the Government are committed to striking the right balance. We want to empower carers—of course we do. That is precisely the thrust behind the national carers strategy and, in fact, the main thrust of my hon. Friend's Bill. Several references have been made, including by my hon. Friend the Member for Harrow, West (Mr. Thomas), to the practical ways in which the Government are expressing their support for that commitment. They include the special carers grants that total £140 million, which will be made available over the next three years to provide carers with additional-break services. Several hon. Members have referred to the conditions that relate to the use of that grant, about which I shall say one or two words in a second.

It is important that we strike the right balance, as my hon. Friends have said. While empowering carers, we must be careful to ensure that there is no diminution of the rights of those who receive support from carers. We cannot allow the needs of those who are cared for to be recognised any less or their statutory rights to appear in any way less favourable than those of carers. We must have consistency and fair treatment between carers and those being cared for. For the reasons that my hon. Friend the Member for Stalybridge and Hyde has expressed, amendment No. 11 would make it harder for us to maintain such a level playing field.

The Government are committed to promoting the independence of disabled people. We have set up the Disability Rights Commission, for example, and are hoping under the Bill to extend the direct payments scheme. The best way of supporting carers is often to support the service user as flexibly as possible. I know that my hon. Friend the Member for Stalybridge and Hyde has been only too mindful of the need to strike a balance between the interests of service users and of carers.

The Government want councils to have the flexibility to support carers in ways that best meet their needs without compromising the rights of service users. We therefore welcome the approach of my hon. Friend in giving local authorities a duty to assess on request, but a power to provide services that they deem appropriate under their eligibility criteria. Such important eligibility criteria for carer services do not exist at the moment, but we will ensure—I am sure that the House will want us to do so—that policy and practice guidance on the Bill, when it is enacted, will support councils in developing them.

Other work to support that important process is in fact already under way. An equitable approach to meeting the needs of service users and carers is a key plank of the Government's policy. Over the coming months, as my hon. Friend the Member for Harrow, West said, policy and practice guidance on a new initiative to ensure consistency in social services eligibility criteria will go out for consultation among local authorities and others. When the comments received have been duly considered, guidance will go to councils on how best to ensure greater consistency and transparency in implementing future eligibility criteria. I say to my hon. Friends the Members for Harrow, West and for Rother Valley (Mr. Barron), who has an interest in the matter, that such guidance will have statutory effect under the Local Authority Social Services Act 1970.

If the Bill receives Royal Assent, the Department of Health, as my hon. Friend the Member for Stalybridge and Hyde has pointed out, will make good use of the opportunity to revise and strengthen the guidance for practitioners who conduct carer assessments. As my hon. Friend rightly said, the full participation of carers will form a crucial part of that guidance. So, for the reasons that he has made clear, amendment No. 10 is not necessary. We shall also seek to address the fact that there has never been a simple, carer-friendly guide on carers rights, which we shall put right, too.

On new clause 2, I find myself in the rather odd position of agreeing with the right hon. Member for Bromley and Chislehurst (Mr. Forth). We shall have to keep that between the two of us. We need to be careful not to add unnecessarily to local authority planning obligations. In fact, I think the opposite; we should be looking to simplify the planning requirements that we place on local authorities.

As my hon. Friend the Member for Rother Valley rightly pointed out, we should be encouraging greater co-operation between health authorities and local authorities. If we approach the issue of carer services from the perspective that I am afraid underlines the new clause, responsibility will fall entirely on local authorities. I understand why my hon. Friend the Member for Harrow, West has phrased the new clause in such a way, because the Bill is about local authorities, but to place the planning responsibility for improving carer services solely on councils would be to misunderstand the nature and purpose of this entire area of social policy. We must ensure that we encourage greater partnership between health and local authorities in improving the way in which all local authority services for carers are delivered.

My hon. Friend, who obviously takes a very close interest in such issues, will want to know that there is much work under way to improve the planning process in the area. He will be aware, although he did not refer to it in his speech, that we are trying to encourage health and local authorities to develop new joint implementation plans locally in a number of key areas which will benefit and interest carers, including learning disability, mental health and services for older people. In all such areas, a significant amount of work is under way. My hon. Friend also rightly referred to the way in which we are intending to ensure that we raise the quality and level of social services performance through, for example, the development of our new performance assessment framework, which will be of particular benefit to carers.

My hon. Friend the Member for Stalybridge and Hyde was right to say that, if the Bill receives Royal Assent, the Government intend that planning for carer services should become part of the mainstream of planning and priority setting in social services. Local authorities are, of course, already preparing plans under section 46 of the National Health Service and Community Care Act 1990. Those plans are an important source of information for non-statutory bodies and, of course, the public—I know that my hon. Friend the Member for Harrow, West is interested in empowering members of the public—on how an authority intends to implement its community care responsibilities. Local authorities are required by the 1990 Act to consult widely on those plans. Statutory directions that emphasise the need for authorities to consult all those involved in community care, including representatives of independent-sector providers, other agencies, such as health and housing authorities, and representatives of both user and carer groups, have been issued.

11.30 am

The guidance on preparing plans helps to ensure that local councils adopt a long-term strategic outlook to community care planning. It encourages better joint planning between local health and housing authorities and full involvement of relevant local agencies in the successful delivery of high-quality care. The guidance is also designed to provide stronger partnerships between all agencies involved in the delivery of community care and with users and carers themselves. It is consciously generic so as to provide a firm foundation to underpin the many other programmes and plans that local authorities prepare. In addition, there are the plans that local councils are revising and reviewing as a condition of receiving the three special grants to promote independence. They do that through breaking down barriers between health and social services, encouraging early intervention to prevent crises, and supporting carers who wish to continue to care.

As I said in an intervention on the right hon. Member for Bromley and Chislehurst, the revised plans for the spending of the carers special grant for this financial year must be sent to the Department of Health by the end of May. The right hon. Gentleman was concerned whether we were satisfied about the adequacy of those plans and the arrangements for making sure that the money is spent in the way that we intend. I assure him that we are satisfied in all those respects. We take a very close interest in ensuring that the money that Parliament provides to support carers services is spent on carers services, and not anywhere else.

This has been a helpful debate in that a number of centrally important issues on the development of carer services have been aired. For all of the reasons that my hon. Friend the Member for Stalybridge and Hyde spelled out, and given the extra assurance that I have been able to give about aspects of how the Government intend to implement the Bill and to develop services in the future, I hope that my hon. Friend the Member for Harrow, West will not press the new clause to a vote.

Mrs. Heal

rose—

Mr. Deputy Speaker

Order. May I say to the hon. Lady that it makes for orderly debate if Members seeking to speak to an amendment that they have tabled or to make a contribution to a group of amendments speak when they are given the opportunity to do so earlier in the debate? We have now had a reply from the promoter of the Bill and the Minister. There is no automatic right to speak a second time, so any remarks made now might not be answered.

Mrs. Heal

Thank you, Mr. Deputy Speaker. I certainly thank you for your indulgence and I apologise for being remiss in not catching your eye earlier.

Mr. Deputy Speaker

Order. I should perhaps also say that I had received an—indirect it is true—message from the hon. Lady that she did not intend to speak. That is why we find ourselves in this situation.

Mrs. Heal

Thank you very much, Mr. Deputy Speaker, for giving me this opportunity to speak. I will restrict my remarks, having heard the comments already made.

I tabled amendment No. 11, which would leave out "whether or not" and insert "how" on page 2, line 8. It relates to local authorities and assessments. It is important for us to stop and consider the position in which many carers finds themselves. The amendment is about implementation of the clause. It would ensure that uncertainty for carers is removed. Clause 2(b) already refers to whether a local authority could be satisfied (wholly or partly) by services which the local authority may provide. My amendment would make the local authority address the question of how those services will be provided. The Bill already makes sufficient reference to give the authority discretion if that is so required when the assessment has been completed.

Uncertainly and lack of information have existed for far too long for carers. They are unsure whether they are entitled to services and, if so, what those services will be and, more important, how and when they will be delivered. The "how" is important, because how the services are delivered may enable many carers to live some of their lives and may provide them with some quality of life in addition to the care that they offer to a disabled person. They may have the opportunity to take a break themselves or to continue working. Therefore, how and when services are provided is a crucial issue.

I craved your indulgence, Mr. Deputy Speaker, in allowing me to speak to the amendment. I hope that it still may be considered or that, at least, my remarks on it will be considered by the Minister.

Mr. Andrew Dismore (Hendon)

I apologise to you, Mr. Deputy Speaker, for not rising earlier. I had expected to follow my hon. Friend the Member for Halesowen and Rowley Regis (Mrs. Heal).

I shall make a couple of brief points about the amendments and in particular amendment No. 14. I want to follow up a point made by the Carers National Association about the definition of services for carers. It is concerned particularly about transport for disabled people to and from day centres and it fears that the way that the Bill is currently drawn could mean that that becomes defined as a carer service, because it would help a carer to care and would provide respite time while the person being cared for is at the day centre.

The association says that the clause's wording is problematic because it introduces the possibility that carers could be charged for services that were previously considered to belong to the user. I shall amplify that point when we come to my amendment to clause 7.

On Second Reading, an indication was given that the issue would be considered at a later stage, perhaps on Report. As far as I can tell, it has not been addressed, so I hope that my hon. Friends the Member for Stalybridge and Hyde (Mr. Pendry) and the Minister, who unfortunately have already replied to the debate, will bear my points in mind as the Bill progresses, I hope, to its later stages.

Mr. Gareth R. Thomas

I want to respond briefly to what has been a useful debate. I fear that I have perhaps not carried the House with me on the new clause. I have ranged against me my hon. Friend the Members for Rother Valley (Mr. Barron) and for Stalybridge and Hyde (Mr. Pendry) as well as my hon. Friend the Minister, not to mention the perceived alliance with the right hon. Member for Bromley and Chislehurst (Mr. Forth).

I am grateful to my hon. Friend the Minister for his assurances and very much welcome the fact that a carers plan will be required because of the special grant moneys that will be available next year. Therefore, I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.