HC Deb 01 March 2000 vol 345 cc66-74WH 12.30 pm
Mr. Jeff Ennis (Barnsley, East and Mexborough)

I am delighted to draw attention to the report that was published recently by Barnsley council's social affairs and health scrutiny commission, entitled "Care for Carers". That commission is chaired by my good friend, Councillor Len Picken, who is a carer himself. The report identifies many of the problems associated with carers that the Government must tackle. Last year, the Government produced a comprehensive and worthy report, entitled "Caring about Carers", a copy of which I have in front of me. It identified some of the problems, many of which the Government are addressing.

To set the scrutiny commission's report in context, it is important to remind hon. Members of some of the characteristics of my Barnsley constituency, which is in South Yorkshire. It is one of the most socially and economically deprived constituencies in the United Kingdom. One in three households has at least one disabled person—a legacy of the former mining industry. It is not surprising that South Yorkshire was recently granted objective 1 status by the European Union, given that, according to a recent estimate, the gross domestic product per capita is approximately 62 per cent. of the European average.

The former pit villages that make up the vast majority of my constituency are renowned for their close-knit community spirit. That is exemplified by the number of carers who provide help and support that might not otherwise be available. However, there are several reasons why it is not always possible to be precise about the number of carers. Many of those who carry out caring tasks do not see themselves as carers, and would not wish to be referred to as such. They see their role as one that any family member would fulfil for a sick or disabled relative.

Despite such difficulties, it is to some extent possible to quantify the number of carers. There are some 5.7 million carers in the United Kingdom who look after people who are frail, ill, disabled or unable to cope. In other words, almost one in eight people is a carer. Of those, some 1.7 million devote at least 20 hours a week to caring. Currently, three fifths of all carers receive no regular visitor support services. In Barnsley, there may be as many as 26,591 people acting as carers, 7,091 of whom devote more than 20 hours per week to the task. That estimate contrasts sharply with the carers' register, which is compiled by the carers' advice line. Despite a major effort to contact carers, only 2,500 are registered in Barnsley. More than 110,000 registration forms were sent out recently, but only 1,000 were returned.

The Government are keen to improve the information that they hold on carers, and intend to trial a new question for use in the 2001 census. It will focus on the provision of personal care and inquire about the number of hours of care provided per week. I fully support this initiative to identify the carer situation more accurately.

The difficulty of being sure about the number of adult carers pales into insignificance when compared with the difficulty of obtaining accurate information about the number of young carers. It has been estimated that in the United Kingdom there are some 51,000 young carers. Best estimates suggest that in Barnsley, 90 year 7 pupils care for a younger child every day or most days, 58 year 7 pupils care for an older relative every day or most days, 104 year 10 pupils care for a younger child every day or most days and 32 year 10 pupils care for an older relative every day or most days.

The impact of being a young carer can be severe. A recent national survey showed that many young carers suffer from depression, social problems and physical difficulties. It also showed that 70 per cent. of former young carers suffer long-term psychological effects, 28 per cent. have suffered health problems such as bad backs as a direct consequence of lifting the person for whom they are caring and 70 per cent. felt that their education had been affected, leading to poor exam results.

As many as 71 per cent. of young carers have been bullied because other children think that they are odd, 51 per cent. have been physically hit or grabbed, 79 per cent. have been called names and 20 per cent. have missed school as a result of being bullied. Most worrying is the fact that 33 per cent. of young carers have not seen their teachers about tackling the bullying.

When the commission took evidence relating to young carers it found that it was extremely difficult to establish the number. Hon. Members welcomed the new project being undertaken in partnership with education services to identify young carers and find ways to build up relationships to support them. As a result of that evidence, the director of education in Barnsley has been asked to liaise with all schools to raise the profile of young carers and highlight the social, psychological and educational consequences of being carers. He has also been asked to encourage all schools to incorporate specific references to young carers in their anti-bullying policies.

A common theme that emerged from the evidence-gathering session with carers' representatives was the difficulty of gaining access to the right information and support at the right time and in the right manner. A number of witnesses highlighted the need for a single point of entry to services and information. Any review of information requirements should include a feasibility study into the establishment of a carers' centre in Barnsley.

I am sure that the Government are fully committed to the principle of establishing carers' centres, particularly with the assistance of the voluntary sector and where carers are involved in the management. Carers' centres not only provide information, advice and support mechanisms but can also act as one-stop shops and help to give carers a break from their caring responsibilities.

The commission also heard evidence from witnesses who felt that existing support to carers was too focused on office hours. Many informal carers provide care 24 hours a day every day of the year. They may need support and information outside normal office hours. If they cannot get such help, they may feel let down or even scared. The focus of services in Barnsley should therefore be reviewed to assess support and information options outside normal office hours.

I know that the Government intend carers to access support and information on a 24-hour basis via the new NHS Direct telephone service, which has been available in South Yorkshire since last December. The new NHS Direct service has been well received by my constituents, and is much appreciated. However, the Government need to monitor closely the future take-up of the service by carers, especially in out-of-office hours. I hope that NHS Direct will introduce mechanisms to achieve such close monitoring and scrutiny. If NHS Direct does not have the desired effect, serious consideration should be given to establising a 24-hour national carers' helpline, perhaps in collaboration with the voluntary sector. The Government already fund a helpline run by the Carers National Association, which operates during normal office hours.

It was clear from evidence given to the commission that carers are beginning to feel involved and that their concerns are being heard. In written evidence submitted by the Alzheimer's Society, concerns were expressed about the limited number of carers attending meetings of carers' forums. Those forums appear mainly to be attracting carers' representatives. Although I do not want to detract from that important work, such concerns raise questions about how representative the forums are, and whether the council is receiving the full range of carers' opinions. There was a feeling that social services should review, in partnership with carers and carers' organisations, the way in which carers are involved and consulted. The commission made a number of positive suggestions on the issue, including giving consideration to agreeing and establishing carers compacts, which would clearly set out the relationships between carers, carers' organisations, council officers and elected members. Like tenant compacts, they should be seen as a way of increasing local democracy and strengthening and sustaining local communities.

The scrutiny commission strongly believes that communication is one of the main underlying issues. A training programe for front-line staff, which is drawn up in conjunction with and attended by carers and carers groups, would go a long way towwards resolving such issues. Witnesses who gave evidence to the commission felt that the conditions of many carers and those for whom they care could be improved by providing a greater amount of training for the carer. Although it is recognised that formal carers, whether paid or voluntary, require training in many areas such as lifting, handling and moving, as well as the use of specialist equipment, often the same level of training is not often provided to the informal carer. The consequences of a lack of adequate training can be health problems for the carer, and may eventually lead to the need for more expensive support services. The commission feels that it is important and sensible to review the level of training given, especially to informal carers.

The Government's strategy for carers comprises three key approaches, which tie in closely with many of the recommendations made by the scrutiny commission. First, carers should receive improved information so that they can become real partners in the provision of care, and access wider and better sources of information about the help and services available. Secondly, support should be given to carers by the communities in which they live, in terms of the planning and provision of services used by carers, and those used by the people for whom they care. Policies should be developed in the workplace to assist in combining employment with caring. The Government are already taking action on family friendly employment by offering employees unpaid leave for family emergencies, which is a step in the right direction. Thirdly, carers should be able to make real choices about the way in which they run their lives, so that they can maintain their own health and exercise independence and so that their role can be more fully recognised by policy makers and the statutory services. I commend Barnsley council's scrutiny commission report on caring for carers to the Minister for his consideration.

I congratulate Barnsley metropolitan borough council on being one of the first councils in the country, about a year ago, to modernise its structure to the new Cabinet-style model of local government, which the Government are trying to promote nationally. The scrutiny commission's report on carers highlights one of the many benefits to be gained by local councils in modernising for the benefit of the local council tax payer.

In conclusion, I believe that the Government recognise and support the major role that carers play in our society. In future, all organisations that are involved with caring must focus on not only the person being cared for, but the carer.

12.45 pm
The Minister of State, Department of Health (Mr. John Hutton)

I congratulate my hon. Friend the Member for Barnsley, East and Mexborough (Mr. Ennis) on choosing this subject for debate, and on his constructive and thoughtful comments. I am delighted that Barnsley council has responded so positively to the issues raised by the social services inspectorate's report "A Matter of Chance for Carers". I also welcome the fact that Barnsley's scrutiny commission has sought directly to involve carers in discussing current service provision and the best ways to develop services in future. Those are positive developments.

Such a framework is exactly what a best value authority should be developing in planning carer services. It is also exactly the kind of process that is encouraged by the national carers strategy, which stressed that such consultation with carers should form an integral part of each local authority's strategy for spending their carers special grant. The good news for carers in Barnsley is that the carers special grant for 2000-01 will be £234,000, which is more than double the amount of last year's grant. That new money for Barnsley will be spent on providing respite breaks for carers, which is a crucial service that carers value highly.

Another piece of good news for Barnsley is that it has been successful in bidding for Invest to Save money. Invest to Save is a Treasury-led scheme to promote new projects that bring together two or more public service bodies to deliver services in an innovative and more efficient manner. At £550,000, Barnsley's was the fourth largest single allocation of money to a local authority this year, and, at £918,000 over two years, was the second largest single allocation to a local authority. The Barnsley scheme focuses on developing a single information system for health and social care, allowing for integrated services in mental health, learning disability, children's services, physical disability and elderly care. The result will be services that are more convenient for service users and their carers, and more effectively provided by integrated teams of national health service and local authority staff. That is excellent and positive news.

On a national level, the Government have taken several steps to address the "lottery of location" that was described in "A Matter of Chance for Carers". I do not have time this morning to explain what has been achieved in relation to all 78 commitments that the Government made in the national carers strategy. I will therefore confine myself to the issues that my hon. Friend raised and talk more widely about how we see matters developing in future.

Most importantly, I congratulate Barnsley council on its attempts to reach out to carers. Nationally, some 29 per cent. of heavily involved carers are receiving some form of social services help. Many carers do not approach services at all until they are in crisis. That underlines the importance of a good awareness-raising strategy based on better information for carers and a prevention strategy that helps carers to think ahead.

Some 40 per cent. of heavily involved carers change each year because of death, the change of the carer or admission to a residential care facility. In Barnsley, that would mean that about 2,800 carers each year may need a local authority assessment. Improving the quality of information about what carers want is therefore the key to making services responsive in the right way at the right time. That underpins the approach that has been taken in Barnsley.

It is for that reason that the Government have developed the referrals, assessments and packages of care project, known as RAP, to provide for the first time a coherent set of national statistics on adult community care. The first indications are that the number of assessments of carers—in terms of the Carers (Recognition and Services) Act 1995—between 1 January and 31 March 1999 was approximately 60,000 for England. The second dress rehearsal of RAP is running from 1 April 1999 to 31 March 2000. We are confident that it will yield a greatly improved level of response and that the impact of the national carers strategy will be to increase the number of carers' assessments undertaken by local authorities.

The new Carers and Disabled Children Bill will give carers new rights to assessments, even when a service user refuses one. This, and the new power for local authorities to provide carers with certain services in their own right, will give further prominence to carers' assessments. Alongside the additional resources for breaks, to which I have referred, and the greater awareness of carers through the national strategy, the Bill is also likely to increase the number of carers who come forward for assessment. I am sure that my hon. Friend the Member for Barnsley, East and Mexborough will agree that those are positive developments.

The carers special grant to local authorities across England will provide £140 million over three years to help more carers to benefit from flexible breaks. Barnsley's carers plan for spending the special grant shows the effectiveness of this policy. Carers have been consulted at all stages of the development of the plan. They want the traditional services to continue; they also want greater flexibility and simpler access to breaks, hence Barnsley's new voucher scheme to maximise carers' choices. That is an excellent innovation. Those are just the kind of flexible schemes that local authorities should be developing. The new Carers and Disabled Children Bill—sponsored by my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry)—will give local authorities additional powers to develop schemes that allow carers and service users to have a choice between providers, as well as flexibility in relation to the timing and type of breaks.

My hon. Friend the Member for Barnsley, East and Mexborough spoke eloquently about the problems faced by young carers in Barnsley. The Government also want to ensure that young carers, like all children, have an education and enjoy good health and leisure time. Barnsley is right to focus on schools as the places in which to address the problems of young carers. The social inclusion pupil support guidance on pupil attendance published by the Department for Education and Employment in July 1999 included, for the first time, guidance on supporting young carers. It also suggests ways of linking to social services and local voluntary organisations.

In addition, learning mentors are being piloted through the excellence in cities initiative in six areas, to provide one-to-one support for children with problems at school, including young carers, and to help them to access external support. The Department of Health is also fully involved with proposals in the new youth support service, which will aim to provide a single point of contact for young people to get advice on social services, benefits, housing, careers and so on, and to put them in contact with relevant profesionals such as health and social workers.

Under the national healthy school standard, which is part of the healthy schools programme—a joint initiative by the Department for Education and Employment and the Department of Health—there are criteria against which school achievements will be assessed. One of those will be that pupils' views should be reflected in school activities, including pupils with special educational needs and health conditions, as well as disaffected pupils, young carers and teenage parents.

The Government are also committed to ensuring that local authorities recognise the need to sustain and enhance the number of young carers' projects. From the second year of the carers special grant, local authorities will be able to spend allocations on both adult and children's services. That will enable them to help carers of all ages and to fund projects focused on young carers' needs. I hope that young carers in the constituency of my hon. Friend the Member for Barnsley, East and Mexborough will be able to benefit from that.

The Government intend to strengthen children's services planning by making it a corporate responsibility of local authorities and the Department of Health. Plans will be required to demonstrate coherence across all relevant local plans and to address national and local objectives. The quality protects programme relates to young carers and to the support of families caring for disabled children. Its contribution will be crucial.

Officials from the Department of Health will meet carers' and children's organisations later this month to discuss further support for young carers' projects nationally. Child and mental health services funding will also be provided with £90 million between 1999 and 2002, some of which will have an impact on young carers' access to counselling services. I can tell my hon. Friend the Member for Barnsley, East and Mexborough that, last year, £105,000 was made available to support service enhancements in Barnsley and a further £105,000 will be provided in the coming financial year.

My hon. Friend referred to the need for carers to receive information about local services. The Carers' helplines offer crucial advice and support. Carers National Association's helpline, which is funded through grants from the Department, deals with 10,000 calls a year. Local helplines, through carers' centres, also provide a range of emotional support and information. Furthermore, 24-hour access to help and advice is currently available from several different sources, including the Samaritans, which provides emotional support for carers. For information on the national health service and related services, there is NHS Direct, to which my hon. Friend referred. It receives 100,000 calls per month.

There is also NHS Direct on-line and the new carers' website, which is available 24 hours a day for those carers with access to such technology. NHS Direct could refer on to local provision by social services emergency teams and ambulance services, as appropriate; otherwise, most information needs can be met during office hours. In fact, the experience of 24-hour carers' helplines throughout England has revealed that little use has been made of them at night and they have, therefore, reverted to office hours or extended office hours. We shall review the whole issue most carefully in future.

I am grateful to my hon. Friend for suggesting that NHS Direct might seek to record contacts from carers to ensure that they are using the service. I understand that there may be some room for manoeuvre in the future as NHS Direct develops. At present, however, although NHS Direct offers an excellent service to carers, the questioning of callers to ascertain their exact caring status may not always be possible. I agree with my hon. Friend that we must continue to explore innovative ways in which to involve carers in planning and developing their services. Carers' centres have an important role to play, but we must make use of new technology. Carers' satisfaction surveys will provide useful information in identifying the strengths and weaknesses of those services.

I could say much more about what the Government are doing to promote services for carers as I could about what is happening in Barnsley, but what is enormously encouraging is that there is a clear willingness in my hon. Friend's constituency to engage with carers' organisations and carers themselves to review the current range of services that are provided and to use in imaginative ways the new and additional resources that the Government are making available to support local authorities. That is a positive step forward and I congratulate the council, as I do my hon. Friend on the support that he provides to it.

My hon. Friend began his speech by drawing attention to the high levels of deprivation in his constituency and the implications that that has for those who care for people with disabilities. In areas such as Barnsley and in my constituency, too, which has a similar profile, it is incumbent on us in government, local authorities and the national health service to continue to explore ways in which to develop services, to put carers at the forefront of our concerns and ensure that our services are responsive to their needs. With the continuing support of the Government and that of my hon. Friend, I am sure that, over the next few years, we shall make significant progress, put carers firmly on the map at the top of our list of priorities and improve services and the range of support.