HL Deb 08 February 1999 vol 597 cc27-39

4.13 p.m.

Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)

My Lords, with the leave of the House, I shall now repeat the Statement being made in another place by my honourable friend Mr. Paul Boateng. The Statement is as follows

"With permission, Madam Speaker, I would like to make a Statement about the publication today of the Government's National Strategy for Carers.

"The Prime Minister announced plans for a National Strategy for Carers, which he asked me to lead, on 10th June 1998.

"The Government believe, as the Prime Minister himself said last June. that carers play a vital role in the community and also in supporting families. Without them, the NHS and social services could never hope to provide that which they contribute to the care of the sick and vulnerable. The Government are determined to see that carers get the support they need.

"The Prime Minister said that the national strategy should bring together existing initiatives into a single package for the first time. We have done more than this. As I shall explain, we are today announcing a substantial new policy package for carers.

"The work on the National Strategy for Carers has involved a large number of organisations: not only Government departments, people from the National Health Service and local authorities, but also individual carers, representatives of carers' organisations, and of more specialised voluntary organisations which help, for example, people with mental health problems. We are grateful to all of those who joined working groups and to those who attended a major consultative conference on the strategy held last November.

"The policies of a large number of Government departments impact on carers. The document published today involves all of them. We held for the very first time two meetings of a Ministerial Group specifically established to consider carers issues.

"People who provide care for their relatives or friends who are disabled, vulnerable or frail can devote large parts of their own lives to looking after others. Many of them are also in paid work. The majority of carers are women. All of them need some help and support. Our National Strategy for Carers describes what we have been doing. It describes what we are going to do. Carers will have better information. They will be better supported. They will be cared for better themselves.

"Two-thirds of carers of working age are in paid employment. For many of them, combining work with caring can be difficult. The Government's family-friendly employment strategy will help them. We will give carers the right to time off to deal with a family emergency. A carer might need, for example, time to take his or her elderly parent to hospital following a fall. The Second Reading of the necessary legislation, the Employment Relations Bill, is scheduled for tomorrow.

"We have also considered those carers who cannot combine paid work with caring. For those of working age, many of them would like to do so. Even more would like to be able to return to work when their caring responsibilities come to an end. We will consider the scope for extending the New Deal to help carers to return to work. We will publicise the benefits—to employers, as well as to carers—of flexible, carer-friendly employment policies. We will consider our own position as a major employer and make sure that we set the highest standards for carers working in the public sector.

"Carers also need support from the statutory services. This does not just mean social services. All services need to provide carers with information and to involve them in the planning of services. Only in this way can services be more responsive to carers' needs.

"The National Health Service has an important role here. First, it must help carers to maintain their own health. Half of all carers in a recent study said they had suffered from a physical injury since they began to care. Half said that they had been treated for stress-related illnesses. The Government's National Priorities Guidance to health and local authorities will require those authorities to help carers to maintain their health and emotional wellbeing.

"The National Health Service must also provide information to help carers to care. They need to know about the health needs, treatment and medication of the person they are caring for. Of course this can only be done with the consent of the patient. But sometimes doctors do not ask whether the patient agrees. We believe that doctors should always do so.

"We have already announced an extra £750 million for local authorities over the next three years to help them promote independence, especially through greater partnership with the health service over prevention and rehabilitation. People who need care, and their carers, will benefit from this.

"We are providing additional funding, from within the Comprehensive Spending Review plans, of £140 million for England over the next three years specifically to help carers. This will be a new ringfenced special grant. It will go to local authorities to extend the range of services they provide to give carers a break from their caring responsibilities. The research evidence shows that carers who have a break are better able to cope and that their own health suffers less. The new special grant will total £20 million in 1999–2000, £50 million in 2000–2001, and £70 million in 2001–2002.

"We also intend, when parliamentary time allows, to introduce new legislation to extend the powers which local authorities have to address carers' needs directly. At the moment, the focus of most of the legislation is on the person needing care. We want carers to have more control over the form and timing of the services which they need. This is especially true of services. designed to give them a break from caring.

"The national carers' strategy will also help some specific groups of carers. First, we are announcing today that there will be a reduction in council tax for some disabled people. People who live in accommodation which is valued at band A and which has an extra room, which they need because of their disability, or enough floor space to allow them to move around in a wheelchair, will receive a reduction in council tax similar to that which is given now for the other bands. This change will be made from 1st April 2000.

"Secondly, we have particular concerns about young carers. The Government are taking extensive action to offer new help to children and young people. We are placing particular emphasis on supporting the most disadvantaged children and their families. Children who have to provide personal care to a parent may not realise that they are carers. But their attendance at school can suffer. They can also have difficulty doing their homework. Often they have no time for leisure, for play, or to meet their friends. The Government will promote awareness of the needs of young carers. We will encourage schools to make sure there is someone to support them. This need not be a teacher—it could be someone else with the right skills and time 1:0 develop special expertise. Children who are carers may need help to contact professionals in the health service, the social services, or a local project worker specifically for young carers.

"There is also a group of children who need more care themselves than other children of the same age. Their parents are particularly in need of help and support. They may feel unable to spend enough time with the rest of their family. We are increasing the help and support that we provide to parents with a disabled child. We have already announced new objectives for children's services, which require local and health authorities to work together to meet the needs of disabled children. Social services will get an extra £375 million to help them to meet the needs of vulnerable children. We are also introducing new children's nursing teams, in memory of Diana, Princess of Wales, to support those children who have life-threatening health problems. These will cost £2 million a year initially, and we are establishing 10 teams around the country.

"Many carers need help and support in the neighbourhoods where they live. In general, we believe that this is best provided by voluntary organisations. Carers' centres are one example. These already exist in a number of areas. We want to make sure that all carers have access to a support service near to where they live. The national strategy report also describes how we intend to make sure that carers get a high quality service from such carers' centres.

"The National Strategy for Carers contains a great deal of information about carers and their needs. But in some cases we lack information. This is why we will be introducing a new question about carers in the 2001 census. The results of this new question will tell us, for example, how many carers there are in each local authority area. The information will allow local authorities to plan much better how to provide services for carers to meet their needs.

"The Government believe that what carers do should be properly recognised and properly supported. We—the Government and the whole country—should take pride in carers. The Government are determined to make sure that carers can feel proud of what they do and of a society which recognises the debt of gratitude that we owe them for doing it."

My Lords, that concludes the Statement

4.23 p.m.

Earl Howe

My Lords, the House will be particularly grateful to the Minister for repeating the Statement, which contains much that we can welcome. The proposals highlight a very sizeable group of people in our society whose daily work is as vital as it is unsung. We are at one with the Government in their wish to give them the recognition or their efforts that they deserve. We hear much nowadays about the supposed breakdown of family life and of the disappearance of the sense of duty and the sense of responsibility accompanying it. However, it is the carers in our society who, thankfully, belie that rather depressing image. They are people who voluntarily shoulder a heavy burden of responsibility and often, in the process, a heavy emotional burden, sometimes from a young age and sometimes for a period of many years' duration. As the Statement says, if we did not have such people, it would be hard to imagine how the NHS and the social services would be able to fill the gap anything Ike adequately.

We welcome the additional funding that has been earmarked and ring-fenced to enable carers to take breaks from their responsibilities. However, I have two questions for the Minister in that respect. First, can the noble Baroness say how much of that money is newly announced money; and, secondly, can she tell us what kinds of respite care the Government envisage? As the Minister will know, the availability around the country of regular respite care for the elderly is very variable and often involves the elderly person having to be moved out rather than someone coming to the house from outside to take the carer's place. Can the Minister confirm that it is the latter type of arrangement that the Government wish to encourage? Can she also say what emphasis the Government are placing on involving the voluntary sector in these initiatives? I mention that particularly because of the reduction in funding to voluntary groups which has been forced upon local authorities by changes in the distribution of local government grants. Indeed, in some areas, the changes have led to cuts in social services. Therefore, one cannot help feeling that this announcement, at least in part, is a case of the Government giving with one hand and taking away with the other.

The Statement rightly calls attention to the need for better information about the services currently available to carers, as well as those which are proposed. Is there anything more the Minister can tell us as regards the Government's ideas on the matter? One extremely important aspect is the need to raise awareness of training opportunities for carers, especially in terms of first aid and health and safety. Does the Minister agree with that and, if so, can she say what sorts of opportunity for training the Government would like to see provided?

We welcome moves to augment the pension entitlement of carers. But, again, I am afraid that it is a case of the Government giving with one hand and taking away with the other. As the Minister will know, it is the Chancellor of the Exchequer's targeting of pension funds and the poorest small savers which is set to yield very substantial inflows into the Treasury in the years ahead. I welcome further details of the Government's pension proposals. However, does the Minister agree that the carers of today are equally deserving of the benevolence of the Chancellor of the Exchequer? Will she seed the thought in the mind of her right honourable friend of the merits of a transferable tax allowance for single-earner married couples to ease the burden on such couples where one partner gives up work to take on the responsibilities of a carer?

The extent to which these proposals have a real impact on the lives of carers depends, critically, on the way in which they are developed at local level. Can the Minister tell us what specific initiatives the Government wish to see taken by local authorities? Equally, can she say what concrete proposals the Government have to encourage carer-friendly employment policies both in the public sector and in the private sector, as opposed to the inevitably more generalised approach adopted in the Employment Relations Bill? Given the structure of the Government's New Deal, can the Minister say what provision is to be made by the Government for carers who are either unable or unwilling to return to work because of caring commitments?

As I indicated earlier, we welcome these initiatives and look forward to following their implementation in practice over the months and years ahead.

4.28 p.m.

Lord Clement-Jones

My Lords, I join the noble Earl in thanking the Minister for repeating the Statement. In many ways, the strategy document is a very impressive one. From these Benches, I pay tribute to the something like 6 million carers who, I believe, save the state around £34 billion—a very large figure—in terms of the work that they do in looking after friends and relatives. Such caring would otherwise have to be paid for by the state. We are certainly very conscious on these Benches of the work that they do and also of the voluntary organisations which represent them so effectively. A number have been mentioned today and also feature in the document.

We welcome the commendable and notable speed with which the strategy has been put together since last June. The carers' strategy contains many important practical elements but the financial aspects of the package are somewhat modest. We should not become carried away by the proposals. We welcome the respite care proposals and also the brochure which accompanies the strategy paper. Can the Minister confirm that the Government will consider more generous measures in future? If one calculates the amount per carer of the financial package for this coming year, the amount is about 15p per week. Will the Government therefore consider more generous measures in future?

My next point was mentioned by the noble Earl. The Government have acknowledged that social services' budgets will be about £100 million short this year. We know that the carer assessments are not up to scratch and only about two out of 10 carers have so far been assessed by their local authorities. What impact will the lack of resources for local government have on those assessments? As regards retirement, we welcome the announcements about second pensions. We look forward to hearing further details in due course. Today's carers are of key importance. What consideration are the Government giving to providing benefits beyond retirement age to today's carers?

We also welcome the consideration that is being given to extending the New Deal to carers returning to work. When will that decision be made? We welcome the Government's commitment to carer-friendly employment policies and their commitment to monitor those policies. However, monitoring by itself is not enough. That needs to be benchmarked against best practice by other major employers and other government institutions. We welcome the statement about national priorities guidance and in particular the requirement on health and local authorities taking account of carers' needs. But what consultation requirements as regards health improvement programmes will be built into legislation?

The Government make strong and welcome statements in the strategy document about information for carers. I welcome the references to the StartHere project. That may play an important role in providing information for carers and health professionals. Will the Department of Health consider bringing forward the evaluation of that project to a date earlier than April 2000?

The Government have naturally raised expectations through this strategy. We welcome many of the proposals. However, the strategy is not so much a revolution as modest evolution towards proper consideration of the needs of carers. We welcome it but we look forward to hearing of more extensive proposals on the financial aspects.

4.33 p.m.

Baroness Hayman

My Lords, I am grateful to the noble Earl and the noble Lord for their support of the thrust of government policy and also for their generous recognition of the enormous role that carers play in the fabric of society and communities in this country, and the individual and communal support that they provide to many of our fellow citizens.

First, I shall mention funding and resources. The noble Lord, Lord Clement-Jones, said that the proposals were modest. I urge noble Lords not to look simply at the £140 million special grant, but to recognise that, for example, £750 million will be allocated to local authorities over the next three years to help them to promote independence by concentrating on prevention and rehabilitation. That will be important for people who need care and for their carers. I refer also to today's council tax announcement. Those measures will all be helpful.

The £140 million special grant is new money in the sense that it is ring-fenced. It is part of the £3 billion extra money for personal social services that will be made available, During the CSR period. It will be distributed in the yearly tranches to which I referred in the Statement. The noble Earl, Lord Howe, asked exactly what the money would be allocated for, the role of the voluntary sector and about getting away from some of the rigidities as regards the models of service and breaks that have been offered in the past. The measure is aimed at widening the scope of the provision that is available and encouraging innovation based on the articulated needs of people in different local authority areas.

One of the conditions of receiving respite care grant is consultation with local carers and the voluntary services about the kind of services which should be provided. I believe that the search for diversity will result in a greater focus on home based services and flexible services that may allow people to spend a period out of their own homes rather than the person needing care having to leave his or her home in order for the carer to have a break. Often the carer knows that that is not acceptable to the person receiving the care and therefore the carer does not get a break. We shall seek to provide respite in a more acceptable way. That is the philosophy that the Diana nursing teams will seek to follow. For example, we seek to allow parents the opportunity to attend parents' evenings for their other children, secure in the knowledge that someone whom they trust is looking after the child who needs care in their own home. I believe there are much more flexible ways in which we can provide that kind of help.

I accept the need for training of carers which was mentioned. This links in with the point about identification. If a general practitioner knows only about a patient and not about his or her family circumstances, and does not know therefore that the patient's carer needs advice or training, for example, on lifting, that advice or training will not be made available. I hope that the clear lead in the national priorities guidance will make people focus on that point. I believe that in the past some of the discharge arrangements have not focused on assessing carers' needs as well as the need for adaptations in the home; for example, when someone is discharged from hospital. We need to adopt a different philosophy that encompasses the needs of carers.

I was asked about the New Deal. We shall certainly consider the best ways of assisting carers to return to work. I am afraid that I have lost my place in my brief and I shall have to write to the noble Lord on that point. Carer-friendly employment policies will need to become an integral part of our policies to encourage family friendly employment. Our strategy is to promote good practice in that regard. I am grateful to the noble Lord, Lord Clement-Jones, for welcoming the respite breaks publication which accompanies the report. That document shows how this measure can be provided.

As to pensions, we should not undervalue the importance of the new entitlement to a second pension. In the nature of pension provisions, it takes time to build up. Carers are particularly vulnerable as regards not building up a pension entitlement because of the interruption of their employment during times of caring. That can be exacerbated for women who become carers after a period of interrupted employment bit the purpose of being at home to look after children. In the long term, it is very important that we ensure that the thousands of carers who have to take a break from employment benefit from these proposals.

In the short term, from April 1999 the Government will introduce a minimum income guarantee for the poorest carers, who will receive a minimum of £75 a week through income support. Very clearly, in all areas of health policy, social security and taxation, our duty is to provide support to the very poorest.

I take the point that the £140 million of the special carers grant will not solve all the problems or provide a vast array of services for every carer in the country. We want the grant to stimulate more conceited action by local authorities, working closely with the health service, to systematically identify the needs of carers in the locality; to draw up plans to meet those needs; to ensure that the provisions offer much greater diversity and flexibility than the existing provisions; and to systematically involve carers and carers' organisations in their planning and implementation. If we put in place that framework, we will have done an enormous amount on which to build.

4.42 p.m.

Lord Taylor of Gryfe

My Lords, I declare an interest. For many years I have been associated wilh a voluntary organisation operating in this field, Scottish Action on Dementia—SAD—which is an appropriate name. I congratulate the Minister and the Government on this very important and belated recognition of the debt we owe to carers in our society.

Recognising that health will be devolved in May of this year, I would ask the Minister whether similar legislation is anticipated for the provisions made in this Statement to apply in Scotland. That is terribly important.

I congratulate the Minister on her recognition of the role of the voluntary services. In the organisation to which I referred, we have a network of community groups in towns and villages in Scotland who perform voluntary services. They will be encouraged by the Statement. That is important because many of them lose heart when voluntary work goes unrecognised.

We have established in Stirling University a chair for carers, for training people to care. That is why I was glad to hear the reference to training. I hope that that outpost, which is difficult to maintain and finance, will continue to be recognised as a national training centre, not necessarily as a Scottish operation. Can the Minister give me some encouragement that the important principles in this valuable Statement will be extended to Scotland, despite the activities of devolution in the year ahead?

Baroness Hayman

My Lords, I am grateful to my noble friend for his comments. I am interested to hear about the work of Stirling University. I would be deeply disappointed if devolution meant an end to learning from each other in these areas. I am sure that we have much to learn from that centre. I shall ensure that we investigate ways in which the practices developed there can be spread.

The noble Lord will be reassured to know that in Scotland the commitments are being taken forward by an action plan to modernise community care, published in October. A key element of the plan is to provide £5 million additional money for respite, homecare and other services. The thrust of the policy described for England and Wales is very definitely being taken forward within Scotland.

Baroness Pitkeathley

My Lords, perhaps I may—

Baroness Ludford

My Lords, I was about to give way to the noble Baroness, Lady Pitkeathley, in recognition of her valuable role. I am honoured to be the ward councillor representing the Carers National Association in my ward of Clerkenwell, Islington.

This is definitely a solid step forward in the recognition of the vital contribution of carers but, as my noble friend Lord Clement-Jones said, it obviously will not solve all the problems. The Minister has stressed that the ringfenced £140 million is just one aspect of the increased funding. Unfortunately, the reality on the ground is that many local authorities are having to make severe cuts in social services. The additional funding is £20 million in 1999–2000. My local authority is having to cut £15 million from its budget, of which several million is for social services. Welfare advice agencies are also being cut. That will affect the advice given for claiming minimum income support.

Will the Minister keep up her efforts for greater funding? The reality on the ground, as experienced by carers, is that this is a mixed bag because of general cuts in social services. When the new legislation to extend the powers of local authorities to address carers' needs is introduced, will the Minister ensure that the money to implement those powers is available; otherwise, instead of greater hope for carers, it could lead to some disillusionment?

Baroness Hayman

My Lords, I note what the noble Baroness says. Of course it is very important. Resources are essential—and everyone wants to see greater resources—but an issue like the new legislation, which establishes the principle that carers will be entitled to help in their own right, is a very important one. It is very significant for individuals and organisations working in this field.

It is tremendously important to recognise that sometimes we can do things by having more flexibility without spending extra money. For example, it might be better for a carer who wants to go out for three hours to attend evening classes to receive money for a taxi home. That avoids the need for someone to be in the home for four hours because of a longer journey time. At the moment, a local authority can only provide the service to the people who need it, not to the carer—so we are not always talking about extra money.

The £140 million will be ring-fenced. In the package we are bringing together—on the housing front; on the proposals for family friendly policies; in recognising the needs of carers who are in employment; and particularly in the proposals for young carers in respect of their educational needs—we recognise the burdens that carers carry. This is a tremendously important area, not necessarily hugely expensive, but one that can make an awful lot of difference to their lives.

Lord Rix

My Lords, as the person who introduced the Disabled Persons and Carers (Short-Term Breaks) Bill into your Lordships' House during the term of the previous government, which was supported by all sides of the House, including of course the current Government, I have three brief questions. First, will the legislation to be introduced place a statutory obligation on local authorities to ensure that carers' needs are assessed and that assessment takes account of both the needs of the disabled person and the carer in regard to respite care and short-term breaks? The Minister may notice that I am holding in my hand a booklet published this month by MENCAP and entitled Fully Charged: How Local Authority Charging Is Harming People With A Learning Disability. That leads me to my next question. Is the Minister aware that a number of local authorities charge for respite care for children with learning and other disabilities? Therefore, will the new funding put a stop to this practice and enable parents to make full use of the breaks which are to be offered to them?

Baroness Hayman

My Lords, our approach, which is different from that taken by the Bill with which the noble Lord was associated, is very much one of supporting the principles that exist in community care and children's legislation. Our approach will mean that proper attention will be paid to carers' needs so that services can be provided directly to both the carer and the person for whom he or she is caring. The noble Lord asked about charging and referred to what is going on in some areas. We shall have to look at that in some detail when we see what specific schemes are introduced under the grant proposals. I hope that we will be able to provide a great deal of what the noble Lord is looking for in terms of more flexible support for carers and the people they care for, often in their own homes, and a greater availability of respite care. Perhaps I may write to the noble Lord on some of the detail.

Lord Renton

My Lords, I declare an interest. I have a very severely handicapped daughter—she is mentally and physically handicapped—and like the noble Lord, Lord Rix, I was chairman of MENCAP. I have not yet had the advantage of seeing the Statement. When I heard it, I welcomed it. If I may say so, the noble Baroness, Lady Hayman, deserves credit for the very caring way in which she deals with these matters when they come before your Lordships.

I do not know how far the Statement goes in providing for those cases where the family can no longer provide care. That arises when the parents are either too old or die—or one of them dies—or when the child is so severely handicapped that he or she could not be looked after at home. If the Statement does not go that far, I wonder whether, before long, the Government will issue a statement about the help that can be given to village communities, which have a great advantage, and to those living in the community who are not so severely disabled that they could live in a small home and perhaps go out to work. Those are the two most important ways of looking after handicapped or disabled people when they can no longer be looked after at home.

Baroness Hayman

My Lords, I am grateful to the noble Lord, Lord Renton. I know of his long-standing concern in this area. The issue of village communities has been discussed! in your Lordships' House before. I know that my honourable friend John Hutton, who has responsibility for this area, met representatives of the movement to encourage village communities. He is well aware of the feeling that a range of provision needs to he available to people with learning disabilities. I recognise that in some areas there is a feeling that this is the most appropriate form of provision. I recognise the anxiety that parents often feel about their ability to cope in the future as handicapped children grow older and about what will happen to them when they are not there and able to cope. It is part of the long-term planning responsibilities of social services departments to ensure that provision is available after the caring is no longer done by the carer. There is a responsibility for doing that planning—not imposing sudden change, which can be very disruptive, but involving carers in discussing long-term plans before they are needed.

Baroness Pitkeathley

My Lords, I am sure that my noble friend will understand what a happy day this is for me. As she said, the Statement and initiative will not solve every problem of every carer but in my view it ranks with the introduction of the invalid care allowance and with the passing of the Carers Act in the history of the carers' movement. Perhaps I may he permitted to add my congratulations to all those who have been involved and also my thanks to Members of your Lordships' House on all sides who have always been so supportive of the carers' issue.

Does my noble friend agree that this marks the passage of carers from the margins to the mainstream of social and health policy? Does she further agree that how we monitor and evaluate the allocation of specific sums of money to local authorities is important in ensuring the best possible value for carers and ensuring that the needs of all groups of carers, including not just young carers and parent carers but the needs of carers from minority ethnic communities, are not overlooked?

Baroness Hayman

My Lords, I am delighted that my noble friend has had a chance to speak on this subject. It would have been deeply ironic had she not, given her immense personal contribution to the cause of carers in this country. She demonstrated some of the vision that has made her such an effective campaigner by focusing not on "this sum of money" or "that sum of money" but on how we transform the way in which we think about carers and how we integrate their needs into the planning of health and social services. I very much take her point that we need to monitor and evaluate. Whatever money we spend, we want to ensure that it is spent effectively. The Statement refers in particular to the needs of young carers, but my noble friend is right to remind us that carers and the people for whom they care are a diverse group. They may include short-term carers and long-term carers; there may be people who have a physical disability or a mental illness; and there may be people with very specific needs because of the ethnic group from which they come or for a variety of other reasons. That is one of the reasons why it is important that we push down to local level the responsibility for ensuring that local plans are sensitive to the needs of local communities.

Lord Pearson of Rannoch

My Lords, I, too, should declare an interest as the honorary president of the National Society for Mentally Handicapped People in Residential Care, and also as the father of a mentally handicapped child. I should like to join other noble Lords in congratulating the Government on this initiative and in welcoming these papers. I particularly welcome the answer that the Minister gave to my noble friend Lord Renton.

As there are a few minutes left on the clock, I thought it might be in order to underline the seriousness of the situation which affects particularly mentally handicapped people; that is, people with leaning disabilities and severe learning disabilities in this country, of whom there are about 156,000, a large proportion of whom still live with their families. The problem is well set out on page 18. We see that 27 per cent. of all carers are already over 65. Therefore, the problem, exacerbated as it is by "the bulge" and other factors, is getting worse. The noble Baroness suggested leaving this problem to social services at local level. But in order to encourage village communities in the way my noble friend suggested I fear the Government will have to put a little pressure on those social services at local level. Encouraging village communities is one option that is available in future. There is already acknowledged to be a shortage of 25, 000 residential beds for mentally handicapped people, and that number is still rising. Therefore, my only question to the Minister is: will she please feel able to exert a little pressure from the centre at local level, because the whole concept of village communities is, I am afraid, still resisted at local level and does not fit with the Government's laudable intentions of choice and opportunity for this very vulnerable section of society?

Baroness Hayman

My Lords, I note with care what the noble Lord says on this issue. As ever, we must strike the right balance between national policy and local sensitivity to local needs. If I inadvertently gave the impression that the responsibility lay solely with social services at local level, that is not correct. The national priorities guidance spells out clearly the shared priority between health and social services in this area. The carers strategy goes sufficiently wide to show a recognition that there are many other areas of government which also need to be brought in if we are to provide the range of services and facilities that are needed by carers and their dependants.