Barbara Keeley (Worsley, Labour)

I beg to move,

That leave be given to bring in a Bill to require that general practitioners or Primary Health Care teams identify certain patients who are carers or who have a carer;
to require identified carers to be referred to sources of advocacy, help and support;
to require that carers' needs are taken into account in relation to the allocation of appointments, procedures for issuing prescriptions, and waiting room arrangements;
to make provision for routinely checking the physical and emotional health of carers;
and for connected purposes.

Although there are 5.2 million carers, I want to focus on those who have the heaviest commitment, where caring can have an impact on the health of the carer. One million carers care for more than 50 hours a week, which is more than a full-time job. Research shows that such caring commitments often result in poor health for the carer. A Carers UK report, based on the 2001 census, showed that one in five of those caring for more than 50 hours a week were not in good health, and that figure worsened to one in four carers in some areas of the country. Areas with the worst figures for poor health among carers also tend to have high levels of disability and illness, often linked to the heritage of industrial disease. Those include my local authority areas of Salford and Wigan and many former industrial and mining areas nationwide.

The report noted that older carers are often likely to be suffering poor health, and caring will have a further impact on the carer's health. An American study of carers of patients with stroke disease or dementia found that caring did have an impact on their health. Stress from caring affected the carer's immune system in ways that accelerated the risk of age-related diseases. The stress of caring does not just affect older carers—the Carers UK report found that carers in younger age groups, from 16 years upwards, were significantly more likely to suffer ill-health than non-carers of the same age.

The fact that carers' health suffers through caring is well known to the charities who work to support carers. The Princess Royal Trust for Carers has some 60 centres in its network, which work with primary health care teams to help them to identify and support carers. The trust also has more than 30 projects working directly with primary care. The first projects were established in the early 1990s and that work led to the trust publishing a good practice guide for support workers and GP practices in 1999.

In the same year, the Government's national strategy for carers noted that the NHS was

"the single most important point of contact"

for many carers. The Government highlighted in the strategy the fact that GPs and primary health care teams had a key role that they should be performing with carers within their practice population.

The strategy included a five-point checklist for primary care to use with carers. The checklist covered GPs identifying carers, making checks on their physical and emotional health, telling carers that they can ask for a social services assessment of their own needs, routinely asking patients about sharing information about their health with their carer and being aware of local carers' support groups and telling carers about those groups.

The national strategy gave that checklist to GPs as good practice for their work with carers. The emphasis on identifying carers within primary care was important because carers play such a vital role in health and social care. They are increasingly being recognised by NHS staff as partners in care. While a proportion of GPs and primary health care teams do work to identify the carers within their practice population, research on the extent of the work being done shows that this is patchy. Some GPs say that they are too busy to undertake the work. My Bill would require that primary care trusts and local health boards ensure that effective procedures exist within primary care to identify carers.

Current good practice suggests that it is worth GPs identifying certain carers so that they can be referred to other agencies for support and for assessment of their needs. In a GP practice population of 2,000, there are likely to be some 200 carers, of whom about 40 will be caring for 50 hours or more per week. The task of identifying the 40 carers with the heaviest commitments does seem manageable.

The Princess Royal Trust for Carers centre in Salford has a primary care liaison worker called Julia Ellis. Julia told me how two primary care practices in my constituency were successfully identifying and referring carers to her centre. Practice nurses from the Limes medical practice in Walkden carry out that work when making home visits to a patient who seems to have a carer. The nurses run through a series of questions with the patient and carer about who does certain tasks for the patient. The nurses then fill in a referral card for the practice to ensure that the primary health care team know about the carer, and they also ensure that the carer is referred to sources of advice and support.

The Dearden avenue medical practice in my constituency has a different approach. Its staff carried out a search on the practice's computer system. For all those patients over 70 who were not in residential care homes, a letter was sent to the next of kin asking if they were the patient's carer. Out of 149 letters sent, 90 were returned from carers. That excellent response rate enabled follow-up information to be sent, telling the carer about support and information available, including having an assessment of their own needs at Salford carers centre.

I pay tribute to the Princess Royal Trust for Carers for its work in primary care for many years in centres such as the one at Salford, and to Carers UK for their campaigns to highlight carers' issues and needs. Although I was pleased to find that GPs and primary health care teams in my constituency are tackling the work of identifying and referring carers, there is much more to be done.

Since I became an MP, a number of constituents who are carers have asked for help with urgent problems with health services. I have found that those constituents tend not to think of themselves as carers; nor have they been identified as such by their GPs. They do not know that there is a carers centre in Salford and a carers support group in Wigan and Leigh, both of which can offer them advice and help. It seems that we have a long way to go before it is routine for carers to be identified and offered the help and support that they need.

Carers are not yet routinely identified and referred for advice and support; nor are they helped to plan alternative care if their own health fails. Last year, Carers UK reported on the experiences of more than 1,000 carers who had to find alternative ways to manage their caring responsibilities during an emergency or health crisis. Some of those carers had life-threatening conditions themselves, but they still had a battle to find information and support.

Carers with substantial caring commitments need to have regular checks on their own physical and emotional health. My Bill would require that carers are offered consultations and health checks and that that is done routinely for carers whose health is at risk because of caring. Carers also need to have regular reviews of how they are coping with their caring commitment in case their own health deteriorates or they stop being able to cope. They also need information on what alternative care is available, and my Bill would enable carers to be referred for such advice.

Research has shown that carers can find it difficult to make an appointment with a GP for their own health needs, as they are more restricted in the times that they can attend and must often make alternative care arrangements. Similarly, it is difficult for them to get out of the house to pick up prescriptions. When attending an appointment with the person who is cared for, the waiting room arrangements can be a barrier for carers, particularly if the cared-for person is an autistic child, chronically or terminally ill, or suffering from dementia. Having to wait to see a GP is annoying for many people, but carers in the situations that I have described find that a wait may be impossible. My Bill would require that primary care services take carers' needs into account in making medical appointments, issuing prescriptions and making suitable arrangements in the waiting room.

The recent White Paper, "Our health, our care, our say", offered a new deal for carers and an updated and extended national strategy. The new strategy will promote

"the health and well-being of carers, including the particular needs of younger carers."

I hope that Ministers will study my Bill, as a key step in offering that new deal to carers. I thank Carers UK and Luke Clements for helping me to draft the Bill and the House for giving me the opportunity to present it today.

Question put and agreed to.

Bill ordered to be brought in by Barbara Keeley, Dr. Hywel Francis, Meg Hillier, Alison Seabeck, Ed Balls, Tony Baldry, Mrs. Nadine Dorries, Mr. Paul Burstow, Lady Hermon, Helen Goodman, Lynda Waltho and Ms Diana R. Johnson.