Social Care (Local Sufficiency) and Identification of Carers Bill

Roberta Blackman-Woods Excerpts

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

Sadly, that is the case. We know that the care sector is underpaid, but that is nothing compared with the financial impact of giving up work to take on a caring commitment.

[Roberta Blackman-Woods (City of Durham) (Lab)]

I was interested in my hon. Friend’s points about employers. Does she agree that it is in employers’ interests to learn more about the needs of carers, and to support them better, so that they do not lose valuable, well-trained staff and have to recruit new ones?

[Barbara Keeley]

I very much agree, and I am sure that that is why the Bill has received such strong support from Employers for Carers.

Other countries have put in place development strategies for home care. In France, the first phase of its development strategy for the home care sector led to a growth of 100,000 jobs year on year. However, even after the worldwide recession, such strategies have led to 50,000 more jobs there each year.

There is a real need for care and support services to enable carers and disabled people to work, but the social care picture in England is one of growing need, shrinking provision, and totally inadequate information and advice about what is available. I have discussed the cuts to social care budgets during previous debates on social care funding.

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[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.

[Roberta Blackman-Woods]

My hon. Friend makes a wonderful point about the need to support young carers more. I have been a school governor for more than 20 years but have never heard the governing body talk about the needs of young carers. That needs to be addressed and more information needs to be given to governors and head teachers.

[Barbara Keeley]

My hon. Friend is absolutely right. Indeed, the carers centre in Salford has a young carers project that has developed to the point of having a presence in all but one of the secondary schools in Salford. It has also started a more limited level of work in primary schools. It is vital, because it is identifying young carers and spreading awareness among teachers and pupils about the role of young carers. It is only that work with other pupils that will stop them bullying and picking on young carers.

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[Sir Tony Baldry]

We all have to be grown-up about this. The hon. Member for Worsley and Eccles South has come up in the ballot, and it is a matter for her how she deals with the Bill. She is perfectly entitled to take it forward. I am just concerned to ensure that there is no scintilla of a suggestion that we will get ourselves into a hole. I was in the House when Nick Scott was the Minister responsible for the disabled. We got ourselves into a terrible hole over a private Member’s Bill by giving the impression that we were not interested in policy relating to the disabled, which of course was totally untrue. I do not want there to be any suggestion of that happening in relation to carers. I hope that we have now found a constructive way forward.

[Roberta Blackman-Woods]

Will the hon. Gentleman give way?

[Sir Tony Baldry]

I had not intended to take so much time, so I will conclude after giving way to the hon. Lady.

[Roberta Blackman-Woods]

I am grateful to the hon. Gentleman for giving way when he was about to conclude. I am having some trouble following Government Members’ logic. Surely it would help if we could get into legislation the measures to support carers that we all want to see. We should give a strong message that the House supports the Bill.

[Sir Tony Baldry]

Let me have one last crack at this; then I will sit down. I believe everyone in the Chamber agrees that supporting carers is incredibly important. One privilege of being an MP is that people invite us into their homes and open up to us about their problems. I suspect that we have all been to many a house where an elderly wife looks after an elderly husband, or the other way around, who has early or age-related dementia. Given our tendency to live longer, the costs of nursing home care and sometimes the difficulties of local authority budgets, the reality is that more and more people with Alzheimer’s or other age-related dementias are having to stay at home longer and be cared for by loved ones.

We also go into homes like the one that I visited recently, where I found a mother looking after her daughter who had severe learning difficulties and was effectively bedridden. That mother has looked after her daughter lovingly for much of her life. As we know, the challenges and strains of such a situation often lead to the break-up of other relationships, with all the consequences that brings.

There are also many young carers, who are often the hardest group to reach and the most overlooked. People are not always conscious that there are young carers. When we go into their homes, it is sometimes unclear who is the parent and who is the carer, and how the parent can take parental responsibilities for the child while the child takes caring responsibilities for the adult. The swings in that situation can be extraordinarily difficult.

What is almost unique about this Bill is that since the hon. Member for Worsley and Eccles South came high in the ballot and brought forward her Bill on carers, which was fantastic, the Government have produced a substantial White Paper covering exactly that policy area. Part of the Bill overlaps with the White Paper and part does not, but the Minister has given the undertaking that he is willing to engage with us on the bits that are not yet established as Government policy in the White Paper, to see whether it is possible for them to become Government policy before the Care and Support Bill receives its Second Reading. I would rather have an undertaking to engage in constructive debate and discussion about trying to get those provisions into the Bill, than run the vagaries of whether the Bill gets a Second Reading today—of course, how we proceed is entirely a matter for the hon. Lady—and whether, when we get to the rather boring part, Report and Third Reading, the Bill fails to make sufficient progress because the Government do not want it to proceed.

I hope that all sides of the House will recognise the importance of supporting carers and getting the policy right. The Government have acknowledged the importance of carers in the White Paper, and we must all engage in further work. We would have had to do that anyway in Committee, but instead we will work with the Minister and his officials. We must ensure that all hon. Members can support the Bill, so that when it is published it does justice to the need to support millions of carers throughout the country about whom we are concerned.

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am pleased to have to opportunity to speak in the debate and proud to be a co-sponsor of the excellent Bill introduced by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). Quite simply, regardless of whether it proceeds today—it was sad to hear from the Minister that it will not—the Bill is about recognising the huge contribution that carers make to our society, the billions of pounds they save the Exchequer and, most importantly, the human cost that incurs: poverty, isolation, mental and physical exhaustion—the list is endless.

Provision for carers is patchy, but the most frustrating thing for me is the fact that, where there is support out there, in many cases carers are unable to access it. Perhaps they do not know about it, or perhaps they fear reaching out for help in case they are taken away from the person they are caring for. For far too many carers help comes only when they reach a crisis point, which can ultimately end in tragedy, as we know. That is what the Bill seeks to address and why it is so important.

In my constituency there is a fantastic organisation called Sunderland Carers, which provides the kind of support that all carers need, and I have met the group on a number of occasions to discuss what needs to be done to support the hidden army of carers. They completely support the Bill, and I am grateful to them, and in particular to Kevin Devine, for providing me with two case studies that I will use to illustrate the impact that the Bill could have.

[Roberta Blackman-Woods]

I, too, do a lot of work with a carers’ support group in my constituency, Durham and Chester-le-Street Carers Support. Does my hon. Friend agree that such organisations would be greatly assisted by the measures set out in the Bill, because they would help them develop the range of support services that they and we want to see provided in their communities, and they really need additional help to give the support they want to give?

[Mrs Hodgson]

I totally agree. Those organisations are out there doing good work, but often they still need guidance, and legislation can often be at the root of that and can really help to ensure that they are funded, rather than having to scrabble around for money left, right and centre.

[Mrs Hodgson]

That is exactly the point. We know that provision is patchy across the country. Where it is good, it is very good; but where there are gaps, that can lead to tragedy, which none of us wants to see ever again.

The first of the two cases I want to highlight is that of a middle-aged male carer who gave up his full-time job to look after his wife, who has multiple sclerosis. He encountered many health professionals because of his wife’s illness, but his caring role was never acknowledged; it was always about her needs, and rightly so. Because of the lack of recognition from professionals, he struggled on his own for three years without any real support, never realising that he should have had it. By chance he saw an advert inviting people to take part in Sunderland Carers’ “Caring with Confidence” programme, which was a major turning point in his life. He was able to access practical support such as getting adaptations for his home to make the physical aspect of caring for his wife easier. Lifting and carrying someone can have serious implications for a carer’s own health. People have to be trained in how to lift people in a caring environment; it cannot be done automatically without potentially causing injuries. He could access short break services that gave him brief respite from his 24/7 caring role. This allowed him to take a holiday with his wife, with the extra support regarding the physical aspect of caring for her that made it a genuine holiday for both of them as a couple. He also gained a lot of support from meeting other carers, combating the isolation that he was feeling.

Finding Sunderland Carers changed that man’s life in almost as dramatic a way as becoming a carer had in the first place. However, we should be concerned about the fact that he could still be struggling out there on his own had he not seen the advert. All the professionals he saw could have signposted him towards that support but, for whatever reason, they did not. Whether it was because they did not know about the support available or did not think it was their job to tell him about it, I do not know. They could have helped him before he was forced to quit his job, which as well as cutting his social ties meant that the couple were in effect living on the breadline. That is why this Bill is so important.

A vital part of the Bill is about the identification of school-age and young adult carers. Caring can be tough at any stage of life, but for a child or a young person it not only impacts on their ability to enjoy the same kind of childhood as their peers but can define how the rest of their life will pan out. The figures are stark. Research by the BBC in 2010 suggested that there were as many as 700,000 young carers in the UK—about one in 12 of secondary school pupils. Further research says that there are almost 300,000 aged between 16 and 24, more than 61,000 of whom are 16 or 17, with one in five providing more than 20 hours a week of care. As I mentioned earlier, one of those 16-year-olds is my daughter’s best friend, so I have first-hand knowledge of the impact that this can have on a young person’s life. There are more than 220,000 young people aged between 18 and 24, and carers make up more than one in 20 people in that age group. That means that one in 20 of the 18 to 24-year-olds we come across is a young carer.

The situations that these young people are placed in and the demands that are made on them will vary greatly, but I want to give one example, again given to me by Sunderland Carers, to show the impact of caring on children’s lives and how much receiving the right support can help them. The example is that of two children who went to live with their grandparents at a young age because their mother was unable to care for them. The arrangement worked very well for a number of years. The children were thriving at school, had plenty of friends and took part in a number of other activities. But as time passed their grandparents grew older and their health and mobility suffered. They did not ask for help because they feared losing custody of their grandchildren. The children could not get out and about due to lack of transport, and this left the grandparents struggling to entertain them. As things progressed, the grandparents struggled to get the children to school, especially in poor winter weather conditions, because the grandfather relied on a mobility scooter, and occasionally he could not get them there at all. This affected their attendance, and even when they were at school they were often distracted because they were so worried about their grandparents’ health.

Thankfully, the school eventually recognised the children as being young carers and was able to get the family the support that they needed. A common assessment framework was put in place and a team was developed around the family. The children were then able to take part in activities that allowed them to get out and have a normal childhood and meet other young carers. Also, while they were out, the grandparents were able to get some much-needed rest, which meant they had more energy when the children were at home. The school transport problem was resolved, and now the children have a 100% attendance record. I have no doubt that they will still face challenges as they grow up, but now they have been identified as carers they should get the right support to help them to cope, and eventually to get qualifications and careers and to develop normal, fulfilling adult lives.

[Roberta Blackman-Woods]

In the case that my hon. Friend describes, it is good that the school managed to identify that there was a problem, but that does not always happen. What is so important about the Bill is that schools, colleges and universities will now have to proactively go out there to find the young carers and then think about how they are going to be supported. That is very much needed.

[Mrs Hodgson]

Exactly. Unfortunately, as my hon. Friend has said, many children are under the radar—some in even worse situations—and they will not be as lucky as those who have been identified. That is true of all school-age children, but it is arguably more true of young adults in further and higher education, who have less time with tutors or teachers who would be able to spot the obvious signs. That is what clauses 5 and 6 seek to address, which is why the Bill is so important and should be considered seriously. I hope the Minister will do that.

Teachers and educational institutions are not alone in their ability to identify young and young adult carers. I served on the Children, Schools and Families Committee in 2008 when we considered the issue of young carers, specifically children who are under the radar. I asked why GPs in particular were not more proactive in identifying such children, because it is a common-sense deduction that a parent with certain health conditions who is not receiving support from professionals or a spouse is probably relying on their children. The answer from Dr Jo Aldridge of Loughborough university was that GPs—and, for that matter, psychiatrists treating those with mental health issues—generally did not see such things as part of their job description. Clause 4 would take the long overdue step of making it part of their job description, which would be of particular benefit to young and young adult carers, as well as to all other unidentified carers. That is why the Bill is so important.

In conclusion, we want and need carers to provide care, because it saves the Government billions. Carers, by and large, want to continue to provide care, because they love the individual they are caring for, but the Government need to support them in doing so. Ignoring the needs of carers is simply not sustainable, because it leads inevitably to crisis; to a loss of expertise from the work force and of income tax for the Treasury; to, most importantly, children and young adults missing out on the opportunities available to them; and to poor educational outcomes, so it harms the life chances of those children who just want to look after their loved ones. That cannot be right, which is why the Bill is so important. I know that it will not progress today—the Minister has said as much—but I hope that he will pick up on the key measures that we have highlighted that are not in the draft Care and Support Bill and incorporate them into it, so that we can help carers of all ages with the best possible legislation.