Social Care (Local Sufficiency) and Identification of Carers Bill

David Nuttall Excerpts

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

We are talking about a reporting duty. If local authorities, working with their health partners, do not report on social care provision, no one else will. Those of us interested in these matters ask questions, but we do not get very good information. Sending freedom of information requests to every social care authority in the country is not the best way for national organisations or Members of the House to get such information. We are asking for a picture of the market to be held in each local area. I am not suggesting a move in a direction in which the Government are not already going. The Government now expect local authorities to be what they call “market shaping”, taking action to drive the market. We are saying that they do not even have a picture of what exists now. Until we have such a picture, which is not just gathered by freedom of information requests, the expectation of the Department and the Government of local authorities is perhaps not reasonable. It is not a budgeting duty but a reporting duty.

I was dealing with sufficiency and the reporting duty and saying that organisations such as Age UK believe it is important that local authorities have a view of the sufficiency of their local care services. To expand on a point my hon. Friend the Member for Leicester West has made, the way local authorities are currently cutting back on what they pay in fees for social care beds and nursing home beds is actually creating market distortions, because some providers are simply moving to areas where there are more self-funders. In Greater Manchester, for example, all the nursing home providers might move to Trafford, which is a wealthier borough, and we would not have proper provision in Salford, part of which I represent. What is happening in the market could result in that kind of distortion, and that should be spotted.

[Mr David Nuttall (Bury North) (Con)]

I am grateful to the hon. Lady for giving way and, indeed, for bringing the matter before the House; she is making a valuable contribution. Does she not share my concern that there is a danger that imposing new duties to prepare the various assessments and reports that the Bill would require could actually take funding away from the provision of front-line services?

[Barbara Keeley]

I have run through some of the details. Front-line services have already been greatly reduced. In fact, local authorities are no longer primary providers, given that they are meeting the needs of a very small group of people.

Let me get back to the point about sufficiency. The all-party group on local government has recently conducted an inquiry into adult social care, supported by the local government information unit. We looked at the role of local government in shaping the local market for social care and took evidence from local authorities that are already acting on that. Interestingly, Nottinghamshire county council told us that it monitors and records occupancy and availability of care home beds for self-funders, which is unusual. Lancashire county council told us that it provides advice and information to all on mainstream services, and signposting to them, regardless of whether people would be eligible for council services, and it is one of the first authorities to do that. The inquiry found some examples of market-shaping activities by local authorities, but the final report was clear that that was only an emerging role for local authorities, and we could not find many examples.

Clause 3 therefore provides that local authorities should assess local care needs and existing social care provision, and if supply does not meet demand, as the hon. Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) have just touched on, the local authority would have a duty to consider the necessary steps to address the gaps. They would not have to take those steps; it is just that nothing will happen unless they have some idea of how it might happen. In their market-shaping role, for instance, they might try to encourage more nursing home providers of a particular type. That is similar to measures set out in the Childcare Act 2006, through which the Government sought to ensure sufficient local child care.

Clause 4 would ensure that NHS bodies had procedures in place to identify carers, promote their health and well-being and ensure that they received appropriate information and advice. I first sought to introduce such a measure in 2006 through a ten-minute rule Bill, and then again in 2007. I acknowledge that progress has been made, but there is still much to do. As we know, many carers do not recognise that they are carers; they see their caring role as part of being a wife, husband, son or daughter. Many are hidden, particularly at the start of caring.

I believe that a key focus in identifying carers should be concern for the health of those with the heaviest caring commitments. The 2001 census found that 10% of all UK carers were caring for more than 50 hours a week. Interestingly, figures published by the NHS Information Centre show that that figure had doubled, to 22%, by 2010. In Salford, the proportion of carers who provide full-time care has actually been at a higher level for some time. In 2001, around one in four carers in Salford provided care for more than 50 hours a week, and even at the time that was more than twice the national figure for carers with the heaviest commitment. I am almost certain that that is related to health inequalities and poor health.

Two wards in my constituency have very high levels of people caring for relatives with stroke disease, heart disease or cancer, which mean the heaviest commitments. We know that full-time care can take a toll on a carer’s health, so the health needs of carers must be recognised. We know that those caring for more than 50 hours a week are twice as likely to suffer ill health, and those caring for a person with dementia or stroke disease are even more at risk. Early identification and support for those carers means that they can maintain their health and manage and sustain their caring role better.

The Princess Royal Trust for Carers centre in Salford has a project to identify carers both within primary care and at the Salford Royal hospital. I want to take this opportunity to pay tribute to The Princess Royal Trust for Carers for its work in primary care over many years in centres such as the one at Salford. Its work has been done by a primary care worker, Julia Ellis, and the centre manager, Dawn O’Rooke. In fact, the previous Minister responsible for care services, the hon. Member for Sutton and Cheam, visited my constituency to hear about the trust’s project to identify carers within primary care. I extend an invitation to the new Minister to do the same.

Different local GP practices do the work of identifying carers differently. For example, practice nurses from the Limes medical centre carry out their identification work when making home visits to patients who seem to have a carer. They run through a series of questions with the patient and carer about who does certain tasks and then fill in a referral card for the practice to ensure that the health team knows about the carer so that they can be referred to sources of advice and support. The Dearden Avenue medical practice has a different approach. Its staff carried out a search on the practice’s computer. For all those patients over 70 who are not in residential care, a letter was sent to the next of kin asking if they were the patient’s carer. Of 149 letters sent, 90 were returned by carers. The carers centre could then send information about the care and support available to the carers, including having an assessment of their own needs.

I am pleased to know that GPs and primary health care teams in my constituency are tackling that work, but there is much more to do. The manager of the carers centre tells me that, having established a network of links within GP practices to identify carers, over 300 referrals a year are made to the centre by local GPs. However, we have some 20,000 carers in Salford, of whom around 5,000 will be caring for more than 50 hours a week. We need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them for advice and support.

Clause 5 would require local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. Young carers are the most hidden of all carers. The 2001 census recorded some 175,000 young carers, but more recent research by the BBC indicates the much higher number of 700,000, which is around 8% of secondary school pupils. Most young carers care for a parent, often a single parent. The care they give might involve much physical care or the difficult task of providing emotional support for a parent with a mental health problem or substance addiction.

The Carers Trust tells us that the identification of young carers remains a key issue, as many young carers seek help only in a crisis. As we have discussed in previous debates, many young carers find that their extra responsibilities lead to their failing to complete work for school, doing badly in exams and, worst of all, being bullied. Although teachers and social workers are the best people to identify and support young carers, there is a lack of professional awareness about their needs and concerns. Young carers report that they can feel stigmatised by teachers, and they might leave school or college prematurely without completing qualifications.

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[Barbara Keeley]

I am sure that it will. The difficulty with capturing this in the Bill, as in any legislation, is that it spreads across Departments. It is something for us to work on, and there is much to be done.

Young carers do not enjoy the same opportunities and outcomes as other children and young people. The Carers Trust tells us that young carers frequently experience worry, stress, anxiety, depression and feelings of loss and panic, as well as mental health problems and risk of self-harm. They fear for the condition of the person they care for, but they often have more fear of being taken into care. They feel angry and resentful because they have such responsibilities, yet they are not recognised. Most of all, they experience a lack of time for play, leisure and sport, and miss out on social time with their own age group. A serious consideration for all of us, given that we are talking about 8% of the secondary school population, is that a caring role also leads to missed educational opportunities, poor educational outcomes, and, later on, reduced employment opportunities. Over a quarter of young carers aged 11 to 16 miss school owing to caring, and that figure rises to 40% when the parent is mentally ill or misusing drugs or alcohol. Young adult carers are twice as likely as their peers not to be in education, employment or training. It is common for them to move into full-time caring after they finish compulsory education, particularly if they are receiving no support.

Clause 6 would place a duty on colleges of further and higher education to identify students who are carers and to have in place policies of support for them. When we included this proposal in the Bill, I did not realise that it was quite ground-breaking and new. A report in 2008 by Young Carers International for the Princess Royal Trust for Carers reported that there were 290,000 young adult carers in the UK. The figures move between 300,000 and 800,000; nobody really has any idea. The report said that apart from statistics that could be obtained from the census,

“Little is known about young adult carers aged 16-24 in the UK”

and:

“Information is sparse about the issues and challenges that they face due to being carers”.”

Young adult carers at university or college have to balance giving care with their academic studies and learning. Some do this by caring at a distance, returning home at weekends or holidays to provide care, but others have to balance care and study by continuing to live at home and travelling to their local university so that they can maintain their regular caring roles. The report told us that none of the young adult carers at university it surveyed was aware of any specific carer support being available at their university. Similarly, they were often unaware of local services for carers that might be able to support them because, sadly, those services have not reached out to university student populations. There is a mismatch in that regard.

That was the situation in 2008. It is interesting that only this year greater awareness of the needs of student carers seems to be developing. The Fair to Care campaign in Scotland is lobbying for the development of carers’ strategies in universities.

[Mr Nuttall]

What is the problem that the hon. Lady is seeking to address in this clause? Is it that she feels that student carers do not have access to information?

[Barbara Keeley]

The problem we are trying to address is that the people who are responsible for the welfare of these students and their progress through their courses do not recognise that caring will get in the way of what they can achieve at university, given all the potential difficulties—for example, a sudden deterioration of the cared-for person’s condition. Policies are often in place for parent carers with children and mature students, but there is a complete gap in what universities have considered for other carers.

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[Sir Tony Baldry]

I am clearly being uncharacteristically incapable of communicating what I am seeking to achieve. I do not in any way resile from the provisions in the Bill. The provisions that the hon. Member for Worsley and Eccles South has put forward are necessary and valuable. I am simply trying to find a constructive way to ensure that as many of those provisions as possible eventually arrive on the statute book.

The hon. Member for Aberavon has to recognise that the Government have a strategy for carers, which is set out very clearly on pages 34 and 35 of the White Paper on reforming care and support. It states:

“From April 2013 the NHS Commissioning Board and clinical commissioning groups will be responsible for working with local partners to ensure that carers are identified and supported.”

That existing strategy has a number of parts that we would all want to discuss with the Ministers and officials who have responsibility for this policy. For example, much of the hon. Lady’s Bill is rightly about how we help and support carers in the world of work. The White Paper states,

“we will produce and publish a road map setting out action to support carers to remain in the workforce.”

I am always a bit suspicious of phrases such as “road map”, because I am never sure what legislative force a road map has. We will want to discuss with Ministers, in fairly robust terms, how we can ensure that the Bill that the Government bring forward in due course meets the aspirations and needs of the millions of carers in this country, for whom all of us present in the Chamber are concerned.

[Mr Nuttall]

Will my hon. Friend give way?

[Sir Tony Baldry]

I give way to my hon. Friend, who is one of the pallbearers.

[Mr Nuttall]

I am most grateful to my hon. Friend for giving way. I hope to be helpful to him. Does he agree that rolling up the thrust of the private Member’s Bill into the Government Bill, which I think is the line that he is going down, would be entirely in line with the first recommendation of the Law Commission’s “Adult Social Care” report, which states that there should be a single statute in this area?

[Sir Tony Baldry]

Absolutely; having a robust single statute is in everybody’s interest. We need to understand that we are not abandoning, resiling from or giving up any of the provisions in the Bill, but saying, to use a rather boring lawyers’ term, that they are adjourned generally with liberty to restore. In other words, we want to make quite sure that we have the opportunity to have a series of meetings with the Minister and his officials, so that we can go through the details of what is proposed for the Government’s Bill and how many of the private Member’s Bill’s provisions we can incorporate in it. The Minister has given his undertaking that we will have those meetings, and I know it was given in good faith.

It is the Government’s clear intention and policy to support as many people as possible to be in work, and one challenge for carers is the difficulty of retaining employment. The Government, hon. Members and everyone else have common cause on that, so it is just a question of how to make effective policy.

Likewise, it is clearly crucial that carers are identified, that they know themselves to be carers and that the supporting machinery identifies them as such. The provision of respite care has helped. In the past, I have asked GPs, “Why don’t you identify patients in your practice who have carers?” They have said, “Well look, Tony, there’s not really much point, because there’s not much that we can do to help them. We can identify them, but how much further does that get us?” At least now, with the NHS being able to provide respite care, there is a real purpose to GPs’ doing that. We need to ensure that the system sends the right signals and provides the right support.

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[Alex Cunningham]

I very much agree with my hon. Friend. I have tremendous concerns, because a child who faces a detention might not turn up for it and end up getting deeper and deeper into trouble because of a lack of understanding among their teachers. That is all the more reason why we need the provisions in the Bill to ensure that young carers are identified and that responsibility is placed on schools to provide them with the necessary support.

[Mr Nuttall]

When that point about detentions was raised, did the schools Minister not make it clear that the detention would continue to have to be reasonable, that consideration would have to be given to all the circumstances and that teachers were well placed to understand the needs of an individual pupil?

[Alex Cunningham]

The then Minister did indeed say that a detention had to be reasonable, but a teacher who does not know that the young person is a carer cannot take that into consideration. That is all the more reason why we need such provision. It is also interesting to note that young carers aged between 16 and 18 years are twice as likely as their peers to not be in education, employment or training—a so-called NEET.

We are a long way from being perfect in the borough of Stockton-on-Tees—although we are very close to it on many issues—but I am proud to say that the borough council is very much leading the way on issues associated with young carers. The council has a young carers strategy, which has been in place since 2009. The aim is to ensure that services work together and share information to identify and support families to avoid young people becoming established in inappropriate caring roles, and to ensure that schools have in place procedures and policies that offer flexible and additional support to young carers, such as provision for personal tutors and access to the local young carers project. Stockton borough council and NHS Stockton-on-Tees are also developing a joint carers and young carers strategy, which will enable carers to be involved in planning care packages and designing local care services, and to fulfil their educational and employment potential.

Many other councils and health authorities are also doing innovative and exciting things to identify and support young carers—and carers generally—but many are not. They need the guidance in the Bill to fulfil the needs of one of the most vulnerable groups of young people in our society. We are all well aware of the immense challenges facing young carers, but we cannot help them if we cannot identify them. Again, that is why the Bill is so important to enable and ensure that support is provided.

As I set out at the start of my speech, the Government can send a signal to local authorities today—demonstrating that they believe that there has to be proper identification of young carers, universal protection for them and the right to quality services—by allowing the Bill to progress to Committee for further discussion and development. Even though the Government are developing their own legislation on carers, including young carers, in different Bills, they will disappoint a large community of people, along with their supporters, if they do not do so. Young carers give up a lot to be carers. They miss out on comforts and freedoms that the rest of us take for granted. They often give up their time and their social lives; indeed, they give up their childhoods. Their focus is on the loved ones they care for. That is why we have to remember to focus on them and move the Bill forward today.

[Mr David Nuttall (Bury North) (Con)]

I warmly congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on her success in coming third in the ballot for private Members’ Bills and on securing the slot this morning. As always, it is a great pleasure to follow the hon. Member for Stockton North (Alex Cunningham), who speaks with such authority on these issues. The hon. Lady’s interest in the matter is well known, and she should be congratulated on her determination in pursuing what is undoubtedly an extremely important issue.

Many private Members’ Bills cover only a narrow area or a specific point of law and are often technical in nature. Some of them are just one-clause Bills. This Bill is quite the opposite. No one could accuse the hon. Member for Worsley and Eccles South of lacking ambition, given the scope and depth of her wide-ranging Bill, which would affect millions of our fellow citizens.

An increasing number of families are involved in the care of another family member—often, but not exclusively, an older relative. In many cases, this can involve a younger person with a disability who requires care on either a temporary or a permanent basis. We are fortunate that the hon. Lady has succeeded in introducing her Bill, as it enables us to spend time today considering the plight of carers and highlighting the problems they face. We are also able to publicise some of the excellent help that is already available to carers. The debate also gives us an opportunity to highlight what the Government have done and are continuing to do for carers.

The Queen’s Speech at the beginning of this Session included a commitment to publish a draft care and support Bill. Some people might have been surprised, in the light of that announcement, that the hon. Lady’s Bill was introduced at all. It first saw the light of day on 20 June this year, when it received its First Reading. It was published the following month, on 10 July. Unfortunately for its promoter, the following day saw the publication of the Government’s own draft Care and Support Bill, which had been announced in the Queen’s Speech. I submit that this issue is so important, and has such huge ramifications for the public purse, that it should be the subject of a Government Bill. One of the problems with this private Member’s Bill is the lack of information on the likely cost of the measures it contains.

As I said earlier, caring for another person can take many forms. When I was a child, my family cared for my grandmother. Looking back, I do not recall the terms “carer” or “caring” being used that often. We simply said that grandma—or nana, if I am to be strictly accurate about the name we used—lived with us. I cannot remember how young I was when my mother’s mother came to live with us, but I cannot recall a time in my childhood when grandma was not around. Unfortunately, as she progressed through her 70s and 80s, she became increasingly afflicted by ill health, and undoubtedly needed caring for.

The catalyst for my grandmother leaving her own home and coming to live with us was her arthritis, especially in her knees. She found it difficult to walk and, particularly, to climb stairs. That disability meant that grandma had to sleep on a bed settee in the lounge. If truth be told, she would have had to sleep downstairs anyway, as we had only two real bedrooms—one for mum and dad, and one for my brother and me. Unfortunately, in addition to her arthritis, grandma also suffered from Parkinson’s disease and, in her final years, from Alzheimer’s. By that stage of her life, she was therefore heavily dependent on the rest of us to look after her. We might not have used the term, but we were her carers.

Other than having what in those days was an orange badge for the car—which enabled my dad to park near to where we were going so that grandma did not have far to walk—and attendance allowance or some other benefit to which we were entitled, I do not recall any other specific assistance or any group being around to help. It is a testament to how far we have developed as a society that there is now far more help available for those who need and want it.

There are many reasons that the provision of care has risen up the political agenda in recent years. There have been enormous advances in medicine and in man’s ability to conquer disease. New treatments and technological developments have united to increase life expectancy. Sadly, however, increased life expectancy does not always bring with it the ability to continue to live as we did when we were younger. It comes with a price.

Living to an advanced age after enjoying good health for many years does not guarantee that that good health will continue. Indeed, the opposite is often the case. Later-life conditions, as the human body effectively wears out, inevitably mean that many people become increasingly reliant on others to look after them. Changes in working practices mean that fewer families are able to take in an elderly relative as we did when I was a child. There are now many more women in the workplace, and far fewer families in which the wife stays at home. That means that, in many cases, care still takes place but at some distance, with a son or daughter travelling great distances each day to look after their elderly relative so that they can continue to live in their own home. We must never underestimate the enormous value of that care.

Statistics from the Department for Work and Pensions’ family resources survey for the United Kingdom for 2010-11 give us an idea of the scope and scale of the problem, and of the number of disabled people and carers in this country. The survey found that 4.8 million people were carers, which equates to about 8% of the total UK population. Of that number, 3.5 million were adults of working age, and 1.3 million were adults over the state pension age. There were also about 100,000 children acting as young carers. The distribution of carers, broken down by age group, has remained broadly stable over the past 10 years.

The survey also found that the prevalence of disability in the United Kingdom involved 19% of the population. That means that about one in five people in this country was classed as having some form of disability. Not surprisingly, the prevalence varied considerably between age groups, ranging from 6% among children through 15% among working-age adults to 45% among adults over the state pension age.

According to that same survey, some 27% of adults of working age worked full time, equating to about 1.5 million people, with another 10% working part time. It is interesting to note that the comparative figures for all adults of working age were 68% and 20%.

I note that in clause 8, to which we have not yet referred this morning, subsection (1) deals with interpretation and it helpfully defines some of the key terms in the Bill. The biggest key term of all, of course, is what constitutes “a carer”. For the purposes of the Bill, a carer is defined as having

“the same meaning as in section 1 of the Carers (Recognition and Services) Act 1995”,

so it may be useful at this juncture to remind hon. Members of precisely what that statutory definition of a carer is. Section 1 of the 1995 Act defines a carer as an individual who

“provides or intends to provide a substantial amount of care on a regular basis”—

not for just anyone, but for someone who is classed as “a relevant person”, and a relevant person is someone who has had their needs assessed by a local authority under section 47(1)(a) of the National Health Service and Community Care Act 1990.

It should be noted that this statutory definition is not the same definition as that used by many charities. For example, the Carers Trust defines a carer as

“someone of any age who provides unpaid support to family or friends who could not manage without this help.”

[Jacob Rees-Mogg (North East Somerset) (Con)]

Will my hon. Friend clarify whether the survey he mentioned used the legal definition or a broader definition of carers when it came up with the 8% figure?

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[Mr Nuttall]

My belief is—I stand to be corrected on it—that the survey used a wider definition rather than the strict statutory definition contained in section 1 of the 1995 Act.

[Jacob Rees-Mogg]

That is a helpful answer. Does my hon. Friend suggest, then, that this Bill will apply to a much smaller number of people than it would if it used the survey definition rather than the definition in the previous Act?

[Mr Nuttall]

That would appear to be the case. If the survey used the wider definition, which I believe it might have, it would indeed indicate that the number of people affected by the Bill would be fewer as a result of its using the statutory definition.

After the Carers Trust’s definition of a carer as

“someone of any age who provides unpaid support to family or friends who could not manage without this help”,

it goes on to state:

“This could be caring for a relative, partner or friend”—

we should note that this definition includes friends as well—

“who is ill, frail, disabled or has mental health or substance misuse problems.”

At this point, we come to what I submit are some of the problems with the interpretation of the Bill. What exactly constitutes a “substantial” amount of care? Who is to be the judge of whether care is substantial or not? One man’s definition of what is “substantial” may not be the same as another’s. Therein lies the first of a number of uncertainties in the Bill.

[Philip Davies]

I am looking at the 1995 Act, too. As my hon. Friend makes clear, it defines a carer as someone who

“provides or intends to provide a substantial amount of care”,

but it also includes the phrase, “on a regular basis”. Does my hon. Friend agree that while there might be a lot of debate about what constitutes “substantial”, there might be quite some debate, too, about what constitutes a “regular” basis of support?

[Mr Nuttall]

My hon. Friend is quite right that there are two legs to the definition. It is not just a question of whether it is “substantial” but of whether it is “regular”. It could be once a year. If someone visits their elderly granny once a year, that is regular, but it is not the same as going around morning, noon and night to look after an elderly mother who needs care almost constantly. I therefore think there are difficulties with the definition, and I submit that it needs clarification. The Bill is silent on that and I fear that the explanatory notes, which are excellent in many ways, as I shall explain later, are silent on it, too.

[Philip Davies]

On that point, does my hon. Friend agree that the wider definition is more helpful than the one set in statute? There might well be cases—I am sure we have all come across them; I have certainly come across them in my constituency—where people need some kind of care and help, yet the local authority, probably for financial reasons above all else, has decided that it is not going to give them the support they need. Many people are looking after relatives or friends who need care, but who have not passed the test of being assessed as such by a local authority.

[Mr Nuttall]

My hon. Friend touches on an important point. I fear—I am sure others will, too—that this Bill may unreasonably raise the expectations of that group of carers covered by the wider definition. They may think, “This is me; I’m a carer”, but would they be a carer under the much narrower definition in the Bill? As I say, there is a danger that many carers will feel that this debate is about them, when under the statutory definition in clause 8—it is clear, referring back to section 1 of the Carers (Recognition and Services) Act 1995—they may not be covered.

[Barbara Keeley]

It is important for the House to understand that this is a Second Reading debate, and that there will be plenty of opportunities in Committee to look further at interpretations and definitions and to alter those definitions if they are too narrow. First, I hope that the hon. Gentleman will not take up an awful lot more time as others are waiting to speak. Secondly, is he prepared to support the Bill on the basis that if any of the definitions in the interpretations clause were too narrow, they could be looked at further?

[Mr Nuttall]

I am grateful. I was dealing with the point about definitions in response to an intervention from my hon. Friend the Member for Shipley (Philip Davies), but it is part of my wider concerns about the Bill. The Bill’s general aims are entirely laudable. Who would not want to help those who provide care for others, particularly for those who need help, assistance and care? All of us can unite on that. I am fully behind the idea of providing what care we, as a society, can afford to provide for those who need it. However, I think that there is a genuine debate to be had about how much further we can go at present, and about whether the Bill is the right vehicle to provide such support or whether—and I think this is an important point—we should heed the substantial report from the Law Commission, which stated in its first and very clear recommendation that a single Act should replace all the existing legislation. I think that we should give further thought to what has been said this morning about the possibility of incorporating the provisions of this Bill in the draft social care Bill.

[Diana Johnson]

Does that mean that the hon. Gentleman does not support this Bill?

[Mr Nuttall]

As I have made very clear, I support the general aim that the country should continue to provide support, as it does already—

[Diana Johnson]

What about this Bill?

[Mr Nuttall]

I think that this Bill is too wide in its implementation, and not clear enough. I shall be dealing with each clause and explaining what the difficulties are, but we are not there yet. The hon. Lady is jumping the gun slightly.

The Bill has two general aims. The first is to place a duty on local authorities to ensure that there are sufficient social care services to support carers and those who are disabled.

[Philip Davies]

Before my hon. Friend continues his speech, may I urge him not to be distracted by the tactics of the hon. Member for Kingston upon Hull North (Diana Johnson), who is trying to do something that might be described as rather despicable? She is trying to argue that the fact that someone does not support a particular Bill means that that person is against the whole concept of the aim of the Bill or the subject area. Anyone who knows my hon. Friend will be aware that he is passionate about helping carers and people who need this kind of support. He should not be distracted by those who try to characterise his opposition to certain elements of a piece of legislation as opposition to the welfare of carers as a whole. I urge him to continue in his current vein.

[Mr Nuttall]

I am grateful to my hon. Friend. I feel that there is a danger that some of the content of the Bill may cause scarce resources to be diverted from front-line services to carers for the purpose of the production of assessments, surveys and strategies, rather than providing real, genuine help for those who need it most.

[Dr Francis]

If we take the hon. Gentleman at his word—and I do take him at his word: I believe that he is genuinely concerned about carers—it must be said that he has posed a series of very valid questions. Is it not time for him to allow the official Opposition to express their view, and, more important, to allow the Minister to respond to those questions? Should he not end his speech now?

[Mr Nuttall]

We are less than halfway through the time allocated for the debate, which did not begin until after 9.45 am. I do not think that there is much danger of our not being able to hear the views of Front Benchers. I entirely agree with the hon. Gentleman that there are plenty of things that we want to hear from those on the Opposition Front Bench. I am particularly interested to know why, if this measure is so important, the Labour party did not present it in the form of a Government Bill during the 13 years in which it had the opportunity to do so.

[Heidi Alexander (Lewisham East) (Lab)]

If the hon. Gentleman thinks that it is so important to hear from Front Benchers, does he also think that it is important to hear from those of us who want to make the case for carers in our constituencies, and who have expressed to you, Madam Deputy Speaker, our desire to speak in the debate? I wonder whether he will be allowing those of us on this side of the Chamber to make our contribution.

[Mr Nuttall]

Absolutely. I completely agree. We want to hear from as many Members as possible, including the hon. Lady.

[Jacob Rees-Mogg]

If my hon. Friend managed to go on for a further two hours and 25 minutes, his speech would be of such an heroic nature that he would deserve an award rather than criticism. However, I do not think that even he will manage that, so there is clearly enough time for others to speak.

[Mr Nuttall]

I am trying to be as generous as possible in taking interventions, many of which, I would point out very gently, have come from the other side of the Chamber. I shall move on and try to deal with matters as quickly as possible, but they are genuine matters of concern which I think need to be heard. After that, we can hear from other Members.

As I was saying before the various interventions, the Bill has two general aims. The first is to place a duty on local authorities to ensure that there are sufficient social care services to support carers and those who are disabled, and in particular to aid them to enter or remain in the labour market or undertake work-related education or training. The Bill also seeks to secure the early identification of carers by health bodies such as clinical commissioning groups and foundation trusts, schools, and further and higher education establishments.

As we have heard, clause 1 imposes a general duty on

“every local authority to take steps to ensure that, as far as reasonably practicable, a range and level of social care services are provided to meet the reasonable requirements of disabled people and carers who are ordinarily resident in their area.”

I was grateful to the hon. Member for Worsley and Eccles South for indicating that the definition of “reasonably practicable” was designed to be set down in future legislation, through delegated legislation. I am prepared to accept that assurance, but it does mean that we are effectively being asked to sign a blank piece of paper.

Clause 2 provides that in order to demonstrate that a local authority has discharged its general duty under clause 1,

“every local authority shall be under a specific duty to secure, so far as reasonably practicable, the provision of social care services sufficient to meet the reasonable requirements of all people aged 18 or over with a disability and carers who require such support to enable them to—

(a) take up, or remain in, work, or

(b) undertake education or training which could reasonably be expected to assist them to obtain work.”

In just those first two clauses, we see that the test of “reasonableness” is key; the idea crops up time and again. Perhaps it would have been helpful if we could have known at this juncture how that will be defined.

What we do have, however, is information from the Institute for Social and Economic Research at the university of Essex. Last year, it published a paper entitled “Trends in the Employment of Disabled People in Britain”, which was a detailed analysis of the series of general household surveys published between 1974 and 2005, and covered adults between the ages of 20 and 59. The report found that the prevalence of disability has gradually increased, stating that the proportion of working age adults who report a limiting long-standing illness

“rose from 14% in 1975 to 18% in 1996, before falling back again to 16% in 2004.”

It went on to state that

“disabled people are less likely to have a job than other people, even after taking account of other characteristics such as their age and educational background.”

The paper presented an important concept—the idea of the disability employment penalty—and undertook an analysis for the period between 1995 and 2005 of its impact. It stated that

“the ‘disability employment penalty’ has been calculated as the difference between the actual proportion of disabled people in work, and what the proportion would have been if those same people were not disabled, but all their other characteristics (gender, education and so on) remained the same. So the actual outcome for disabled people is compared with the hypothetical situation in which their disadvantage was switched off. For the straightforward model covering the last ten years of the period under analysis:

80% of non-disabled people in the age range covered were in work, averaged over the ten year period 1996-2005.

76% of disabled people would have been in work if their disability had no effect

48% of disabled people were actually in work.

So

4% (80-76) is a measure of how much disabled people were disadvantaged by their other observed characteristics (such as age and education).”

However, on the basis of this research,

“28% (76-48) is the true disability penalty.”

The author actually cautioned that that penalty figure might be an underestimate because the “limiting long-standing illness” definition

“is probably too broad (including many adults with only slight impairments), this is probably a smaller penalty than would be observed if a tight definition of disability were used, restricted to people with more serious impairments. Note too that the estimate of 28% is the average effect of a range of conditions, impairments and severities, all bundled into a single category labelled ‘limiting long-standing illness’. Previous analysis of a much more detailed disability survey has shown that the penalties affecting different types of disabled people range from 0 to 100%, and helps to show that they are not all facing the same experience.”

The paper also considered how the penalty had changed over time, finding that it had risen

“from 17 percentage points to about 28 percentage points”

between 2000 and 2004. It also found

“that people with severely disadvantaging sets of health conditions have been more, not less, affected by the trends.”

Under this Bill, local authorities would need to ask why disabled people are less likely to be in employment. The Office for National Statistics published the results of the first wave of its life opportunities survey in December 2011, using evidence gathered during the period from June 2009 to March 2011. It described the LOS as a major new national survey of disability in Britain that

“aims to measure people’s use of local facilities, including public transport and health services, and their participation in leisure activities and employment opportunities.

It also aims to find out why people don’t take part in work or leisure activities that they would like to, or why they may experience difficulties in using public services.”

The survey investigated the barriers and what it called the enablers to employment for three groups of adults aged 16 and over: the employed, who were in employment but were limited in the type or amount of paid work that they did by their impairment status; the unemployed, who were unemployed and seeking employment but were limited in the type or amount of paid work that they could do by their impairment status; and the economically inactive, who were neither in employment nor actively seeking work. The top barrier to employment opportunities for adults with an impairment in each group was their health condition, illness or impairment. The second top barrier for the employed was family responsibility, whereas for the unemployed it was the lack of job opportunities and for the economically inactive it was disability-related.

As for what the researchers called the “enablers”, most respondents did not indicate the most important factor at all. In so far as they did, the most often stated enabler was modified hours or days or reduced work hours. We know from the DWP family resources survey, to which I referred earlier, that the majority of carers balance their caring responsibilities with paid work. Those in full-time employment made up the largest group of carers in the United Kingdom, at 35%, and the next largest, at 24%, were those in retirement, followed by the economically inactive, at 21%, and those in part-time employment, at just 17%. Among the working-age population, 60% of carers worked full time whereas 27% worked part time, compared with 68% and 20% among all working-age adults.

A survey by the NHS information centre, published in December 2010 and entitled “Survey of Carers in Households 2009/10”, provides an insight into how caring responsibilities affect the employment and education of carers. That survey found that caring duties did not adversely impact on the employment of most people, although they did for a sizeable minority. All carers who were under 70, regardless of their personal status, were asked whether their ability to take up or stay in employment had been affected by the assistance they gave the main cared-for person. Although just over a quarter of that group, 26%, felt that their caring responsibilities had affected them in such a way, nearly three quarters, or 74%, did not feel that that was the case.

The survey also gave some further detail of the backgrounds of those whose employment was so affected. The groups who were most likely to say that their employment prospects had been affected by the care they provided were: those aged 35 to 44, who represented 34% of carers, and those aged 45 to 54, who represented 30%; those looking after the home or a family, who represented 46%, and those working part time, who represented just 35%; those who were caring for someone in the same household, who represented 38%; those providing care for 20 hours or more per week, who represented 40%; and those in bad or fair health, who represented 34% and 32% respectively.

As for the specific impacts, just over a third, or 35%, of working-age carers who were looking after the home or family had to leave employment altogether, compared with 10% on average, whereas 23% of carers who were working part time, or almost one in four, had reduced their employment hours compared with an average of 8%.

It is of course important to understand why carers are less likely to be in employment. The “Survey of Carers in Households 2009/10” stated that

“the intensity of care provision has an impact upon interest in taking up paid employment.”

Of those who were caring for less than 20 hours a week, 24% were interested in taking up paid employment in the near future, compared with only 11% of the high-intensity group of carers. Of those interested in returning to work, 51% indicated that they would like to work part time, while 38% wanted full-time work and 11% did not know. On the possible barriers to employment, saying, “I cannot work because of my caring responsibilities,” was the third most popular explanation for not working, with 37% of people choosing that response.

[Barbara Keeley]

The hon. Gentleman should be aware that many carers and disabled people, and their organisations, are following the debate. He has been speaking for more than 40 minutes and rambling around a lot of statistics, and it is now being said on social media that he and his colleagues are talking out a Bill of great value. He should know that people who are following what was a reasonable and proper debate on the Bill do not appreciate the tenor of what he is saying. He is destroying the debate.

[Mr Nuttall]

I have already made my support for carers absolutely clear. My hon. Friend the Member for Banbury (Sir Tony Baldry) has also secured a helpful undertaking from the Minister on ensuring that the Government engage with the Bill’s supporters about the subjects that it deals with in the context of the draft Care and Support Bill.

[Philip Davies]

Has my hon. Friend noted the irony that Labour Members who regularly troop through the Lobby to vote against Government programme motions, because they say that those motions allow insufficient time for debate and effective scrutiny, now take the view that this Bill should go through the House without any scrutiny whatsoever just because it happens to have their support? Our duty in this place is to scrutinise legislation, whether Labour Members like it or not.

[Mr Nuttall]

There is indeed such an irony. Legislation of all kinds should receive proper scrutiny.

[Jacob Rees-Mogg]

It is worth noting that if Labour Members were so committed to the Bill, they would have been able to get 100 Members here to support a closure motion. Alternatively, they could move a motion that would force an hon. Member to bring their speech to an end, but they have not asked to use either of those mechanisms.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Actually, the speech of the hon. Member for Bury North (Mr Nuttall) could be terminated only if the occupant of the Chair—myself—told him to resume his seat because of tedious repetition. Whatever hon. Members might think of his contribution, he has not got to that point. I would be grateful if we could allow the hon. Gentleman to continue his speech so that others may then participate.

[Mr Nuttall]

Thank you, Madam Deputy Speaker.

Let me make a further quick point about the statistics that I was citing. The largest single barrier to employment that was highlighted—by 63% of respondents—was a lack of suitable local job opportunities, so an area’s prevailing employment market is obviously pre-eminent when determining whether a carer or disabled person is able to get into the workplace.

Clauses 1 to 3 would impose a sufficiency duty. The explanatory notes state that the duty

“goes beyond the existing duties and focus of local authorities which are only on those for whom they have direct responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds. There are currently no duties on local authorities to assess or address supply of non-statutory services for individuals privately purchasing care, by encouraging the development of new services.”

The notes go on to say:

“This clause would ensure that local authorities build a complete and accurate picture of the services needed, provided and purchased in their area.”

It would have been helpful if this duty could have been road-tested somewhere on a trial basis. There could perhaps have been a pilot before the Bill was introduced.

Clause 1(2) states that in discharging the sufficiency duty a local authority must have regard to statutory guidance issued by the Secretary of State. It might be expected that such guidance would clarify the terms necessary to determine what amounts to compliance with this sufficiency duty. The explanatory notes helpfully suggest:

“Placing a strategic duty on local authorities to ensure adequate social care would mean local authorities need to assess the care available in their area looking at the supply and demand of care and the affordability, accessibility and quality of provision. They would also need to identify gaps in provision and how these will be addressed. Local authorities would work in partnership with local providers to assess how services could support disabled people and carers to work, where appropriate.”

I will skip a large part of my prepared notes because, as we have heard this morning, where there is a difference between this Bill and the Government’s Bill, the Minister will look at trying to ensure that that requirement is included in the Bill.

The explanatory notes do not tell us the likely cost for every local authority to undertake the assessments that the Bill requires, and that is one of its principal problems. We have no idea of the cost of carrying out an assessment of the social care needs of disabled people and carers in any given area, which is why I suggested that a pilot project might have given us some idea of the likely cost.

[Barbara Keeley]

So that we do not spend a great deal more time on this, will the hon. Gentleman accept that it is not part of the private Member’s Bill procedure in any way to run pilots? That is a matter for the Government. The Bill was introduced a short time ago and that was not possible. It is really not worth his spending a lot of time on that suggestion.

[Mr Nuttall]

I am grateful for that intervention. I appreciate that a pilot cannot be done in the same way that the Government could have done it, but as we have already heard this morning, there are many initiatives going on in local authorities throughout the country, and I am sure that it would have been possible for one local authority to have picked this up and trialled the Bill to at least give us some idea, or put some information before us this morning, of the likely cost, even if it was a matter of someone sitting down and trying to work it out for themselves. There will inevitably be a substantial cost.

[Dr Francis]

If the hon. Gentleman had listened carefully to what I said he would have heard that Carers UK has piloted something similar in Conservative Kensington and Chelsea and Labour Islington. There is good practice everywhere. What about the actual saving to the taxpayer from the tax take as a result of people going back into work? We are not talking about costs here, but about savings to the Exchequer.

--- Later in debate ---

[Mr Nuttall]

The hon. Gentleman is absolutely right. We all want as many people as possible to be able to return to the workplace, and what we are trying to do this morning is arrive at the best solution for achieving that common aim.

Clause 4 relates to the promotion of carers’ health. It would impose a duty on health bodies to:

“(a) promote and safeguard the health and well-being of carers;

(b) ensure that effective procedures exist to identify patients who are about to become carers;

(c) ensure that appropriate systems exist to ensure that carers receive appropriate information and advice”.

Although there are currently no legislative requirements for health bodies to promote the health and well-being of carers specifically, there are already statutory duties on health bodies to promote the health and well-being of people who use health and social care services and members of the public generally. The obvious question is this: what is the point of singling out carers? Surely they are included as a group within the existing legislative provisions.

[Barbara Keeley]

The reason for singling out carers is that they have responsibility for not only their own health, but that of the person they care for, and in many cases they do not take care of their own health and do not have time for doctors’ appointments. We are asking for health bodies to have a specific, extra concern for carers. Given that their whole day can be taken up with caring, that extra duty can sometimes be fulfilled by a GP offering them first or last appointments. The hon. Gentleman has now been speaking for more than 50 minutes. Second Reading is not meant for this sort of line-by-line review; that is meant to happen in Committee. He is pushing it to the point where it is being said outside this place that he is attempting to destroy the Bill and the debate.

[Mr Nuttall]

I am certainly not trying to destroy the Bill. I will stick to my point, because I think that we need to look at this—[Interruption.] [Hon. Members: “In Committee.”] It is an important part of the Bill. Existing legislation covers all members of the public, so I do not think that we need to single out a specific group.

[Philip Davies]

Opposition Members talk about these matters being considered in Committee. Given that the Government have published a draft Bill on this very subject, does my hon. Friend not agree that Opposition Members, if their overwhelming priority is to discuss these matters in Committee, will have an amazingly good opportunity to do so at length in relation to the draft Bill? That can be done without this Bill progressing any further.

[Mr Nuttall]

That is indeed the case. I am sure that it will be possible to consider all these matters in detail when we look at the draft Bill in Committee.

The NHS operating framework for 2012-13 already provides that carers must receive help and support from local NHS organisations. Primary care trusts are required to agree policies, plans and budgets to support carers with local authorities and carers’ organisations and make them available to local people. It states:

“Following a joint assessment of local needs, which should be published with plans, PCT clusters need to agree policies, plans and budgets with local authorities and voluntary groups to support carers, where possible using direct payments or personal budgets. For 2012/13 this means plans should be in line with the Carers Strategy and: be explicitly agreed and signed off by both local authorities and PCT clusters; identify the financial contribution made to support carers by both local authorities and PCT clusters and that any transfer of funds from the NHS to local authorities is through a section 256 agreement; identify how much of the total is being spent on carers’ breaks; identify an indicative number of breaks that should be available within that funding; and be published on the PCT or PCT cluster’s website by 30 September 2012 at the latest.”

So there is already a lot going on within the NHS. Let us not forget that the Department of Health is providing the NHS with £400 million over the four-year period from 2011-15 to support carers in taking breaks from their caring responsibilities. The Department has also funded the national carers strategy demonstrator sites programme, which is focused on three areas of support to improve carers’ health and well-being, carers’ breaks and health checks, with better NHS support. The new idea of national carers strategy demonstrator sites has been independently evaluated by the Centre for International Research on Care, Labour and Equalities at Leeds university, which has prepared an excellent report on how successful it has already been.

Clause 5 seeks to place a duty on a local authority to ensure that within 12 months of Royal Assent

“it takes all reasonable steps”—

again, we have no idea of what “reasonable” may amount to—

“to ensure that in relation to…any school within its area and under its control, and…any functions it discharges…there is in place a policy”

to identify and support young carers. However, the clause makes no mention of academy schools. Perhaps when the hon. Member for Worsley and Eccles South winds up she will be able to explain why academy schools would not be covered, because they are state schools that are independent of local authorities but still funded—

[Barbara Keeley]

To ensure that the hon. Gentleman does not mislead the House or any of the very large number of people who are watching him try to destroy this debate, let me point out that as the promoter of the Bill I do not have an opportunity to wind up. That is not how these debates work.

[Mr Nuttall]

That is absolutely right. I should have said that the hon. Lady might explain by way of intervention why these schools are not included, as she did not mention it in her opening speech.

There is already a lot of very good work going on in this area. In 2009, the Association of Directors of Adult Social Services and the Association of Directors of Children’s Services published a model local memorandum of understanding entitled “Working Together to support Young Carers”, which was aimed at providing staff in schools and other adults with a framework to develop support for young carers and their families.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I have been following very closely what the hon. Gentleman has been saying for the past hour. I have been able to do that because much of it is in the House of Commons research paper on the Bill. I sincerely hope that he is not just taking quotes verbatim from that. If he is, as he knows, he will be falling foul of Standing Order No. 42. Perhaps he can therefore assure me that in continuing his remarks I will not be able to read them first in this document.

[Mr Nuttall]

Thank you, Madam Deputy Speaker. I have indeed been helped by the Library’s document, which is extremely useful in analysing the Bill.

I will move on, if I may. As I understand it, there is nothing to prevent local authorities from carrying out the various actions proposed by the Bill, so it might be worth asking why they are not already going down that route.

[Jacob Rees-Mogg]

Is my hon. Friend referring to the general power that the Government’s Localism Act 2011 gave to local authorities, allowing them to carry out a much wider range of activities than was the case under the previous limitation whereby everything had to be identified by statute? Are parts of this Bill therefore unnecessary because of the abilities that local authorities already have?

[Mr Nuttall]

My hon. Friend is right that, under the Localism Act, local authorities now have a general freedom to do what they want without being given specific powers by central Government.

I pay tribute to the important and valuable work of various charities in this sector, for which they should be warmly commended. The Carers Trust charity’s website is a good source, packed with useful information. A particularly useful function enables anyone who is seeking help to find the location of their nearest centre simply by typing in their postcode. It covers the Princess Royal Trust for Carers network and the Crossroads care schemes.

[Barbara Keeley]

On a point of order, Madam Deputy Speaker. Is it not now the case that the hon. Gentleman is departing too far from the Bill’s content? I do not think that a discussion of the website of the Princess Royal Trust for Carers has anything to do with this Second Reading debate.

[Madam Deputy Speaker (Dawn Primarolo)]

This is a matter for the Chair. There is an argument that reference to the trust’s details is relevant to the Bill. The trust is also identified clearly in the House of Commons research paper.

Although this is not on a point of order, while I am on my feet I remind the hon. Member for Bury North (Mr Nuttall) that, in principle, it is not permitted to read a speech in the Chamber. It is permissible to refer to notes and read short extracts from documents, but I think that he is stretching that widely now. He is in order and I hope that he will stay in order. I am sure that he is about to conclude to allow others to speak.

[Mr Nuttall]

I am about to conclude, Madam Deputy Speaker. I was not going to go into the website in detail. I pay tribute to all those who help run the Bury carers centre and the Bury Crossroads group in my constituency. Their details can be accessed through the website. They provide enormous help for carers in need of help, advice and assistance in my constituency.

As I said at the outset, the hon. Member for Worsley and Eccles South should be commended for bringing this issue to centre stage. I am sure that every hon. and right hon. Member has nothing but praise for the army of carers in this country who look after loved ones. The Bill is a genuine attempt to improve the lot of carers, but I fear that there are dangers associated with it. We have to be careful how we use scarce resources; I do not want them to be diverted away from front-line services.

The consultation period on the Government’s draft Care and Support Bill is now open until 19 October. It is a substantial draft Bill, with 83 clauses and 8 schedules. I hope that the promoters of this private Member’s Bill will take advantage of the consultation to suggest how the draft Bill could be amended and improved. The Minister has also given an undertaking my hon. Friend the Member for Banbury. I will conclude now, because I want to hear from the Front-Bench representatives and other Members, so that this can be a good, wide-ranging debate.