Only a few days to go: We’re raising £25,000 to keep TheyWorkForYou running and make sure people across the UK can hold their elected representatives to account.Donate to our crowdfunder
I beg to move,
That this House, noting that there are an estimated 5·5 million people from the age of seven to 70 years caring for disabled and elderly relatives at home, often for many years, pays the warmest possible tribute to those carers; and, further noting the research which shows that carers themselves suffer disproportionately from mental and physical illness, social isolation and poverty, calls upon the Government to take urgent action to improve their position, especially in view of the undoubted savings to public funds which flow from their commitment, and in particular to ensure that, in line with its stated policies on care in the community: (i) adequate respite care, both at home and in short-stay facilities, be assured by a considerable improvement in the level of support given to statutory and voluntary agencies, (ii) a flexible system of cash and other appropriate support services, such as home helps and home nursing, be available at times when the carer needs them and (iii) the invalid care allowance is made available to married women carers as recommended by the Select Committee.
Community care policies have been advocated now for a decade on the basis that it is much better for those who need support because of physical or mental infirmity to be cared for outside large institutions. It is now becoming increasingly recognised, however, that that policy has merely shifted the burden of care from the trained and supportive to the untrained and isolated in the form of the family. What started off as a policy of keeping dependent people out of institutions has backfired to the point where it has created more mentally and physicaly ill people—this time those who are supposed to be the carers.
At present, carers save the state over £5,000 million. That would be the cost to the state if it had to provide alternative institutional care. One would think that the state would aim to put back some of that money to support them in their invaluable role. Instead, the Government have been offloading responsibility on to their shoulders without even a sideways look at how they should be helping.
At present 5·5 million men and women are caring for an elderly or disabled friend or relative who could not live safely or comfortably without their help. They include about 1·25 million people who are caring for someone who is severely or extremely severely handicapped. I understand that as many as 100,000 of them have been caring for more than 10 years, and that thousands have been caring for as many as 30 years or more. Those figures give the lie to the myth that we are no longer a caring nation.
Today, far more people than ever before are making a major contribution to the physical and mental health of a family member, but they can maintain that role only if they have support. The Opposition have tabled this motion because of the absence of that support in far too many cases.
About two out of three carers are in poor physical or mental health at any one time. Recent surveys have shown that nearly half are at serious risk of mental illness. Nearly seven in 10 suffer physical injury as a result of their caring duties, because there is a great deal of single-handed lifting involved, unlike in hospitals where nurses are ordered to lift only in pairs or using the appropriate hoists. The position is made worse for carers when a back injury cannot be rested or a hernia repaired because there is no one to take over their caring duties while they are in hospital.
Carers suffer emotional and psychological stress from social isolation, when other family members flatly refuse to help, or when statutory services simply fail to materialise in support. The complete submersion of one's own needs and preferences in those of another and feeling wholly out of control of one's life are major causes of depression in carers. They suffer financial penalty because disability and frailty nearly always lead to reduced income and increased outgoings. The Government should not be so mealy-mouthed about that by altering the word "poverty", which we use, to "disadvantage" in their amendment. Carers suffer "poverty"—and we use that word advisedly.
Many entitlements to benefit are lost as soon as a disabled person moves in with a family member. An elderly disabled parent can no longer claim supplementary pension and will lose heating and diet allowances. Most important, carers' problems are often multiple, not of one type alone. Physical injuries, psychological stress, and financial hardship are often compounded. In addition, many carers have duties towards not only one single disabled, or extremely disabled, person, but to two, or even three. I could give many examples, but I shall cite one.
A woman of 50, whom I know, cares for her husband who is 20 years older than she is and is suffering from dementia. Her parents, who are in their 90s, and her mother's sister live with them. Both her mother and her mother's sister are physically frail, and her mother is also blind. She receives assistance only from a district nurse who comes once a week to give her mother a blanket bath. Such cases are typical. There is nothing exceptional about them.
All the evidence shows that the more handicapped and dependent a relative is, the less support a carer will receive from formal and informal agencies. That makes the cumulative burden all the harder to bear. The more disabled a relative, the fewer the people who are prepared to give the necessary assistance. It is because volunteers and neighbours are of little help when a disability becomes advanced, which is when help is needed, that statutory support is urgently required.
Above all, the debate centres on the unrecognised needs of women. More than one in eight women is a carer, and four out of five carers are women. Their position is much worse than that of their male counterparts because they are much more likely to have to give up their jobs. They have less money, experience more stress, and are less likely to receive support services. To add insult to injury, married and cohabiting women are denied invalid care allowance, which is the sole benefit paid to people who are prevented from undertaking full-time work because they are carers.
The problem will not go away. As the numbers of elderly people increase—that section of the population will grow fastest towards the end of the century—an increasing number of people will need assistance if they are to continue to lead independent, fulfilled lives. Our intention today is to make it clear that carers cannot and must not be expected to bear the full weight of the Government's community care policies unseen, unpaid and undervalued. That is the central theme of the debate.
I take this opportunity to pay the warmest tribute to the Association of Carers for its dedicated and tireless campaign to bring this vital issue to the attention of the nation.
At present, the position of carers is worsening. The Social Security Bill will leave carers entitled to long-term supplementary benefit worse off by £6·90 a week. In addition, they will have to pay the first 20 per cent. of their rates from that reduced income. The Government have refused to move on the European Advocate General's recommendation on the Drake case, made a week ago. They have talked of the money being spent on services instead of on invalid care allowance. The truth is that the allowance is not being paid and the services are not being provided. The Government failed to support the carers' clause in its original form in the private Member's Bill introduced by my hon. Friend the Member for Monklands, West (Mr. Clarke). Therefore, they have denied carers the right to be assessed for their ability to care or to continue caring, and that is extremely important to carers.
Even the Government's helping-the-community-tocare programme—I pass over its tiny £10·5 million budget—has been a wasted opportunity for carers, because almost none of the funding has been directed towards increasing statutory services to carers as a right.
Our motion calls on the Government to provide some real, substantial increase in support for carers in ways which they want. First, carers—who have often given up full-time work to undertake their caring role—want an income independent of those whom they look after. Following the clear prompting—I know that this is a recommendation—of the European Court, we in the Labour party believe that the Government have an undeniable duty to pay invalid care allowance to married and cohabitating women. I have received legal and counsel's opinion that if, in June, the European Court decide that the Government are discriminating against women, and if they do not pay invalid care allowance to every eligible woman, regardless of whether she has claimed it, backdated to December 1984, they will be acting unlawfully.
I believe that if a Labour Government had been in power for seven years, they would have paid the invalid care allowance to married women without waiting for a decision by the European Court. We do not believe in discrimination in social security matters. A British Government should not need external prompting.
It is no good the Government making noises about spending money on services. The fact is that invalid care allowance is an income replacement benefit. The Government have no more right to offer invalid care allowance or services to carers than they have to offer a state retirement pension or home helps and day centres to elderly people. Carers are entitled to income and to services. It is false economy not to provide this balance of aid. In the absence of both, many carers are forced to give up a role that they would otherwise maintain. The alternative, institutional care, is a far greater cost to the state.
Carers want access to respite care, both in the home and in a residential setting, which is of a quality acceptable to the carer and the dependant. Such evidence as we have shows that respite care is patchy. I am aware that some local authorities provide excellent respite care, but they are few in number and mainly Labour authorities. More Tory authorities should provide such care. The existing respite care, however, is patchy, inflexible, inappropriate and often directed at the dependant rather than the carer. All too often, carers are placed in an intolerable position when the person they care for refuses to go into respite care, or states that they do not need it because they have a daughter to look after them.
I know that it is invidious to pick out the name of a voluntary organisation, because there are so many performing an important role, but I think it is fair to pay tribute to the work of Crossroads and other care attendant schemes which seek to offer a multi-purpose, paid worker, round the clock, every day of the week. It is only such schemes which enable carers either to continue at work or to take time out from caring to meet their own needs. That is the right model for respite care. All the tasks of the carer need to be covered; otherwise breaks for more than a few hours from caring would be impossible.
Does the hon. Gentleman accept that an important aspect in attempting to maximise the provision for respite care is flexibility? Respite care should be available at short notice as a support service within the home or a place suitably near to the home. In case of illness or emergency, respite care should be available immediately.
The hon. Gentleman must be telepathic, as I was about to make that exact point. It is crucial that respite care is flexible enough to cover emergencies and unforeseen circumstances, as well as set and specific periods of care. That would enable the needs to be met.
Carers need advice and access to information. Many carers feel isolated. They do not know what, if any, services are available within the local community. At present, the vast majority of carers receive neither training nor support. There should be medical assessment of both the carer and the dependant. It is impossible to know what sort of services would be most suitable if neither the clinical condition of the dependant nor the medical capability of the carer has been checked. There should be a continuous back-up service and reviews so that help can not only be provided at times of crisis, but adjusted to match changing circumstances.
The Government in their amendment complacently talk about
continuing improvement in the level of support given to statutory and voluntary agencies".
For millions of carers and dependants that is a cruel joke. The lie is proven by the pathetically low community care expenditure, the continued rate support grant cuts and the drastic cuts in the voluntary sector budget due to the Government's abolition of the GLC and the metropolitan counties.
The Government are proposing a so-called social fund in the Social Security Bill. That fund will undermine community care policy and force many thousands of people into institutions. The Government have rejected the invalid care allowance for married women and revealed their true attitude to carers. On 28 January, the Minister for Health dismissed my plea for increased income support for carers on the ground that it would mean
a great big nanny state".—[Official Report, 28 January 1986; Vol. 90, c. 779.]
We reject that nauseating disregard for those who have given unremitting care and support to the disabled and the elderly year upon year, without complaint and without any allowances. By contrast to that disregard, the Labour party pledges to extend the invalid care allowance to married and cohabiting women. We do not accept the Government's feeble excuse that they cannot afford the meagre benefit of £23 a week for 96,000 women, when the same Government can find the money to pay private nursing homes £250 a week to look after elderly people.
We will appoint a carers' liaison officer to each social services department to identify carers in its area and to assess how best to meet their needs. We will seek to provide respite care and a flexible system of support services for carers. It will take time, and the services will have to be phased in as our economy recovers. However, we acknowledge the objective and will not shirk that responsibility.
We do not accept the present position, whereby carers are presented with the stark choice of looking after a dependant with minimal support and at great, sometimes crippling, cost to themselves or of putting their relative into permanent residential accommodation. The vast majority of carers are devoted to looking after and keeping their relatives at home. To do so they need financial, social and practical support. If the Government will not provide that, we will.
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
`noting that there are a substantial number of people from the age of seven to 70 years caring for disabled and elderly relatives at home, often for many years, pays the warmest possible tribute to these carers; and, further noting the research which shows that carers themselves often suffer from mental and physical illness, social isolation and disadvantage, recognises the action already taken by the Government to improve their position, especially in view of the undoubted savings to public funds which flow from their commitment; and in particular welcomes the Government's intentions, in line with its stated policies on care in the community and the availability of resources, that: (a) adequate respite care, both at home and in short-stay facilities, be assured by continuing improvement in the level of support given to statutory and voluntary agencies, (b) a flexible system of appropriate support such as home helps and home nursing be available at times when the carer needs them and (c) any judgment which may be made by the European Court relating to the invalid care allowance introduced by the Labour Government in 1976, be carefully considered by the Government and made the subject of a report to the House.'.
This debate gives the House and myself a chance to pay a warm tribute to the role of informal carers. I certainly welcome that part of the speech of the hon. Member for Oldham, West (Mr. Meacher), which was otherwise
characterised by pessimistic and exaggerated descriptions of these matters. I hope that his tribute to informal carers is echoed in all quarters of the House.
Last week The Sunday Times graphically described the pressures that a heavily dependent person represents to a family. The article explained that, even when practical help is provided to such a family, that help puts pressures on the family. I doubt whether there is any way of avoiding such pressures on informal carers, but without doubt all those concerned—the professionals, the voluntary agencies and the informal carers—who support such families need to work together to minimise the pressures upon carers.
The key significance of informal carers has, as the hon. Gentleman said, recently been referred to in our debates on the Disabled Persons (Services, Consultation and Representation) Bill, introduced by the hon. Member for Monklands, West (Mr. Clarke). I do not wish to add anything to what I said about that Bill on the Floor of the House and in Committee. I am glad that the Bill is making progress.
The hon. Member for Oldham, West made much of the invalid care allowance and married women. The Government have made their position perfectly clear. The cost of extending invalid care allowance to married women is estimated to be £100 million a year extra, net of savings on other benefits. Even if the resources were available, this should be seen in the context of priorities for social security spending as a whole. The present invalid care allowance arrangements were introduced by the Labour Government of 1976. I do not think that shone through the speech of the hon. Gentleman. This discriminatory legislation, which the hon. Gentleman derided, was introduced by the Labour Government. I am not sure whether he was a member of that Labour Government, but he was certainly a supporter of that Government. The judgment of the European Court as to whether the arrangements that were so introduced contravene the Community's directive on equal treatment is not expected until June. However, I repeat the assurance that it will be carefully considered by the Government and made the subject of a report to the House, as stated in the amendment.
Opposition Members are always keen to add to their list of promises to spend more and more. Indeed, I noticed that the hon. Member for Oldham, West was at it again today. I want to contrast their promises with the performance and record of this Government. For example, we have increased spending on benefits for the long-term sick and disabled by more than 50 per cent. in real terms. In cash terms, we have more than doubled the mobility allowance and taken it out of tax. We have ended some of the discrimination against women, which we inherited from the Labour Government, by abolishing the household duties test and introducing a new severe disablement allowance. We have also ended the invalidity trap—a move that helps 55,000 sick and disabled people.
Of course, there is no hon. Member who would not give high priority to support for the disabled and those who care for them, but we serve them ill if, as the hon. Member for Oldham, West has done, we make promises that it is beyond this country's capacity to fulfil.
Perhaps I can explain the canard of £24 billion that Ministers keep mentioning. Apparently, £2·5 billion of that sum is for equalising the retirement age at 60. Neither I nor anyone else in the Labour party has given that commitment. It simply shows what a total fabrication that total of £24 billion is. The Minister has mentioned the £100 million that the ICA would cost. My point was that there would be a net saving if more people were kept in the community instead of being put into private nursing or rest homes at a cost of £250 a week or more and at the expense of supplementary benefit.
In effect, the hon. Gentleman is not promising to spend any more money. That contrasts with the attitude of some of his hon. Friends, who always want to know what extra money the Government intend to spend.
As the hon. Gentleman is in a mood to discard promises, perhaps he will turn his mind to the £4·5 billion commitment that he made last April, when he said that a Labour Government would pay a disablement costs allowance of nearly £60 a week on top of the existing attendance allowance. Does he stand by that commitment today, or does he wish to withdraw it? Disabled people and their carers have a right to know which of Labour's promises can be believed. Frankly, I think that they would be very unwise to bank on any of them being implemented.
As I have said, the Government fully recognise what families, friends and neighbours do in providing support within the community for the disabled and elderly frail. Real progress is being made, particularly in the provision of support for informal carers of heavily dependent people living at home. But that progress represents only part of the improvements made over the past six years in the health and social services generally.
Expenditure on the NHS has increased by about 24 per cent. in real terms between 1978–79 and 1986–87. In 1984, there were nearly 3,000 more GPs than in 1976, and as a result the average list size has been reduced. That is particularly important as the number of elderly people who require greater medical care is increasing. More than 3 million extra out-patient cases were dealt with last year compared with the year before we came to power. Community psychiatric nurses have increased in number. Indeed, the increase has been significant, as the number has more than doubled. Many more examples could be given, but I have quoted enough to show that on a range of measures significant improvements in the services available to patients have been made.
Progress has equally been made in the social services. We introduced the social services inspectorate in April 1985 to help to improve the quality and efficiency of services. The number of social workers has risen by 25 per cent., from 12,481 in 1978 to more than 15,600 in 1984. In the same period there was a 13 per cent. increase in the number of home helps, and we all know how important they can be. Expenditure by social services departments increased in real terms by 19 per cent. between 1978–79 and 1984–85. Those increases in resources have been matched by the action that we have taken to encourage collaboration between the different statutory services.
We have placed emphasis on the key enabling role of social services departments in mobilising all the sources of support available in the community. We have widened the membership of joint consultative committees to include representatives of the voluntary sector and of family practitioner committees. We continue to seek improvements in services that provide support to those in the community who need it, with the recent publication of the consultation document on primary care.
We estimate that there are 12,600 disabled people in the Barnsley area, which represents 7 per cent. of the population. Moreover, 7,000 of them are severely disabled and require constant care and attention night and day. The carers should clearly receive more financial recognition. In industrial towns, the number of disabled people is higher than average because of coal mines, factories, and so on. Local authorities in those areas would like to develop a much more comprehensive care and attendance service. What plans does the Minister have to assist local authorities to achieve that objective?
I have already said that no hon. Member would fail to give high priority to the extension and improvement of services for the disabled, but such matters must be seen within the context of the availability of resources. Indeed, that is mentioned in our amendment.
I am talking about real improvements. I know that the hon. Member for Oldham, West may wish to concentrate on other areas. However, the imaginative proposals in the report of the review of the role of community nursing services, chaired by Mrs. Julia Cumberlege, which is now out for consultation, illustrate further ways in which services might be changed to meet better the needs of users, including informal carers. The crucial role of informal carers—families, friends and neighbours—who care for heavily dependent people living in the community should be much more widely recognised. They certainly need advice and information about how to cope, sometimes emotionally and often with practical problems.
Practical assistance can greatly help. I refer, for example, to the provision of bath hoists. We have already heard about the difficulties faced by elderly carers who have to do a lot of lifting. Moreover, the availability of some form of respite care can make all the difference. Being treated as a valued member of the team by those paid professionals helping to support the dependent person can also make all the difference. It was because the Government recognised that too often informal carers were ignored rather than supported by those providing health and social services that, during the past few years, considerable emphasis has been placed on the role of informal carers.
Is the Minister aware that in constituencies such as mine, where Winterton hospital cares for many psycho-geriatric patients, patients are gradually being released into the community? Is he further aware that that is causing tremendous problems for the families looking after them informally? The worst thing that could happen would be for the services provided by local authorities to be cut.
I agree that the arrangements which are being made for people to move back into the community must be carefully considered and co-ordinated by all concerned. Generally speaking, the policies—they are not just this Government's policies, but they have been considered desirable for many years, as the hon. Gentleman recognised—are being pursued.
The DHSS has taken a variety of steps, some of them modest, which together add up to a significant programme of action. In 1983 and 1984, the Department's social work service ran a major national project to draw attention to the needs of informal carers and to encourage policy makers, managers and front-line workers to consider how support for a dependent person's informal carer could be made an integral part of the range of services needed for effective community care.
To continue the policy development beginning with that social work service project, several elements of the helping the community to care programme are specifically concerned with support for informal carers. The King's Fund is undertaking two projects. One is aimed at improving the quality and availability of information and training of use to informal carers about what services might be of help or about how to cope. The other, in cooperation with Age Concern, is to provide information and training directed at general practitioners and community nurses so that they are better equipped to advise carers of elderly people suffering from incontinence. A third element of the helping the community to care programme is the development of three demonstration districts—in east Sussex, Stockport and Sandwell—of voluntary sector services to support informal carers.
We have heard about the importance of respite care. It is right for dependent people to be cared for in their homes as far as possible, and I recognise the need for respite care in the interests of the dependent person and of his family or friends who support him. Respite care, as the hon. Member for Caernarfon (Mr. Wigley) said, is especially valuable when unplanned events or emergencies mean that the informal carer must give up his responsibilities for a time. Like many hon. Members, I know from personal contacts how valuable such respite care can be. I wonder whether full advantage is being taken of the variety of types of respite care provided through the voluntary organisations. This is being investigated in the demonstration districts that I mentioned, and there may be scope for advance in that area.
It is clear that there are hundreds of thousands of informal carers, but there has so far been no systematic information about their circumstances and numbers. The hon. Member for Oldham, West gave figures of 5·5 million carers and £5·3 billion. The latter, which is the amount alleged to have been saved as a result of existing policies, is a fanciful calculation.
Two major national surveys by the Office of Population Censuses and Surveys will provide hard information. The general household survey has, for the first time, explicitly asked people whether they care for a dependent person, and those results should begin to be available at the end of the year. The major national survey of disabled people includes questions about who cares for the disabled person, and it will provide information early in 1988 about the services that families with a dependent disabled person receive. The information from those two surveys will enable planning for community care to take better account of the needs of informal carers.
The comprehensive statistical information that will be provided by the OPCS surveys will be complemented by a programme of research being undertaken by the social policy research unit of the University of York, funded by the DHSS.
The initial social work service project is being followed up with two national seminars—one in London last month and the other to be held soon in Leeds—about support for informal carers specifically directed at those concerned with community nursing services.
For several years, the Department has supported national voluntary organisations directly or indirectly interested in informal carers through its general scheme of section 64 grants. The major national voluntary organisations concerned with the needs of client groups of dependent people, such as Age Concern, MENCAP and MIND, receive grants under the scheme and take an interest in informal carers as significant contributors to the well-being of the client group concerned. Other national voluntary organisations more directly concerned with the needs of informal carers also receive grants from the Department.
The hon. Member for Oldham, West mentioned the valuable work done by the Association of Carers. He will know that it receives a grant from the DHSS, as do Crossroads Care Attendant Scheme, Contact a Family, the National Association of Carers and their Elderly Dependants and other similar voluntary organisations at national and local level, all of which make significant contributions that are supported actively in the constituencies by hon. Members on both sides of the House.
Meals on wheels is an extremely valuable service and an excellent example of productive collaboration between a social service department and a voluntary organisation—the Women's Royal Voluntary Service. The WRVS is already doing much, and I pay tribute to its work, which I hope will expand and develop in the months ahead. Many people, especially elderly people, depend upon the delivery of a meal to the door by the meals on wheels service. More that 28 million meals are provided every year, often by the dedicated members of the WRVS. As part of our search to improve the value of services, we have commissioned several research projects from the WRVS to test the feasibility and acceptability of offering alternatives to the traditional cooked meal delivery service, such as escorted shopping trips. We have asked the personal social services research unit at the University of Kent to carry out a study of the present position. We hope to set up a seminar to consider the subject, especially the different options for future development, early in 1987.
There is greater scope—I am buttressed in that belief by the conversations that I have had with Dame Barbara Shenfield, the leader of the WRVS—that we can do more. I hope that we can obtain better co-operation between the statutory agencies and the voluntary workers. We have made substantial progress in providing community care through, for example, joint finance.
It has increased to £670 million since then. Of course, the hon. Gentleman always wishes to denigrate what we have done, because the Labour Government did so little when they were responsible. We have also made considerable progress in taking long-stay children out of large mental handicap hospitals and putting them into better provision in the community, including small NHS units for children who need health care. More than 2,400 children were in such hospitals at the end of 1980. At the end of 1984, there were fewer than 700, including those children in short-term care. Our latest estimates show that the numbers are now much lower.
We are committed to providing efficient and effective services for those who need them. For too long, the central key role played by families, friends and neighbours in community care has been ignored. Of course, it is not true to say that nothing more needs to be done by statutory and voluntary service providers before adequate support is provided for all informal carers. We have recognised their key importance and brought it to the notice of those planning and providing services locally. We are developing and exploring new and better ways of providing support. We are undertaking the research to provide solid evidence for future planning. I believe that that is a record of progress, and it lays the foundations for significant further progress over the next few years. I commend the amendment to the House.
The Minister for Health has just proved that he is incapable, not only of taking care of carers, but of making a decent speech on the issue. He accused my hon. Friend the Member for Oldham, West (Mr. Meacher) of being pessimistic, but my hon. Friend was reflecting the deep and profound pessimism of carers. The right hon. Gentleman should ask his hon. Friend the Minister for Social Security, who has responsibility for the disabled, what was said to him by the deputation of carers I took to see him a few months ago. The carers were profoundly pessimistic, as my hon. Friend the Member for Oldham, West explained. That was the reason for my hon. Friend's pessimism. He was reflecting the reality of the situation.
The right hon. Gentleman referred to an article in The Sunday Times. I cannot see how any Minister could read such an appalling and tragic article and refuse to do anything positive and constructive for carers. It beggars belief that the Minister could use the example of an article in The Sunday Times and make the bromide speech that he made today. The right hon. Gentleman said he wa glad that the Bill introduced by my hon. Friend the Member for Monklands, West (Mr. Clarke) was making progress, but he surgically removed from the Bill the provision relating to carers.
The right hon. Gentleman said that the figures cited by my hon. Friend the Member for Oldham, West were fanciful. The right hon. Gentleman does not know the real figures, so he attacked my hon. Friend. The right hon. Gentleman has not taken the trouble to find out what they are. He said that the figures would emerge in 1988, but carers cannot wait until then. The Conservative party has been in power for seven years and Ministers for Health have had sufficient time to ascertain the position. The Minister said that he recognised the importance of carers, but he still made a wordy speech which offered no real progress. He has not satisfied the House on all those issues. In fact, I am sorry to say that he made a bad speech. His speech disappointed me, because I had hoped that hon. Members on both sides of the House would agree on this issue.
The debate is not about compassion; it is about justice. People have become carers because they love the people for whom they care and because they have compassion for them. It is unjust for society and it is wrong for the Government to expect those people to become virtual slaves in caring for disabled people. Severe disability damages people's lives. It is wrong that a disability should damage the lives of those caring for disabled people. In fact, it devastates their lives, yet that occurs all too often. It is unjust, unfair and intolerable.
The Government's amendment seems similar to the early-day motion which was supported by hon. Members on both sides of the House, but there are some significant differences. The early-day motion asked the Government
to ensure that … adequate respite care … a considerable improvement in the level of support … a flexible system of cash and other … services, such as home helps and home nursing"—
the invalid care allowance is made available to married women".
The amendment pays warm tribute to carers. We can all say that we pay tribute to carers. However, the amendment uses the phrase
in line with its stated policies … and the availability of resources".
We all know that that is shorthand for saying that funding will not be provided and that the money is not available. That is what the Government are saying. The Minister's fine words mean Only that, because of a lack of resources, the carers will not receive the money.
The amendment refers to the European Court judgment and says that the Government will carefully consider it. That is not good enough. We do not want the judgment just to be carefully considered by the Government. We want it to be accepted by them. There is a great difference between considering and accepting.
It is impossible to overstate the importance of the issue to women. There are some men carers but basically it is a women's issue. A few months ago, in the presence of my wife, I attended a meeting of carers at county hall across the river. I went as their friend. In the 20 years that I have been a Member of Parliament I have never had such a rough ride. Those women carers, of many creeds and kinds—some black, some brown and some white—were unanimous in their bitterness at being exploited. When I tried to explain that, along with many hon. Members, I was campaigning for carers, they were vindictive. They said that it did not matter what we were trying to do. The only thing they cared about was what we were doing and what we had accomplished. I could not say that we had accomplished anything. I have never known women who felt so bitter. They are treated badly. They feel that they are abused by authority. A loving task to them has become a prison sentence, where no adequate support is provided.
Some of the country's 1·25 million carers are driven to despair, are in ill health and in need of care. Some carers are prisoners of their own conscience. Cash is the most important requirement. It has been estimated, as my hon. Friend the Member for Oldham, West said, that more than £5 billion is saved every year. I pay a warm tribute to Judith Oliver of the Association of Carers for the marvellous work that she and her colleagues have done and to Pat Osborne of the Crossroads association for the wonderful work that that group has done. Those associations are demanding cash, and rightly so, because cash is crucial.
Back-up services are also being demanded. There is no round-the-clock nursing help and carers are neglected, especially at weekends. There is little respite provision. Above all, carers need a break. They cannot stand the eternal grind 24 hours a day, seven days a week, 365 days a year. Yet often, when they contact the emergency services, they find that they get little help. Carers are not given adequate training. They are given a rough deal. As my hon. Friend the Member for Oldham, West rightly emphasised, the more disabled a person is, the more difficult it is to get help. Carers are taken for granted by national Government, local authorities and the public.
I have no doubt that the main reason why carers are shabbily treated is that they are women. This is a women's issue. If most men were carers, responses and attitudes would be very different. People look down on women. The Government look down on women. Women are shabbily treated, and women carers are the most shabbily treated of all. That is the main reason why the Government pay scant regard to them. I hope that the Government will pay due regard to this debate, because carers can easily sink and become submerged non-persons unless we can help them. There is a strong feeling among carers that they want not just cash but recognition and a sense of identity. That is what they require.
I suggest that we should provide for carers a genuine new deal, which includes eight points. First, we should give carers an honoured place in society. Secondly, we should recognise their wonderful value and make civilised and adequate provision for them. Thirdly, there should be adequate Government recognition of the serious problems hidden behind the sad curtains and the lonely wheelchairs. Fourthly, there should be an end to discrimination against married women and co-habitees. They should be paid the invalid care allowance now rather than have to wait until the Government are dragged kicking and screaming by the European Court to undertake reform. Fifthly, there should be a careful assessment of the role, capacity and functions of all carers and the burdens that they relieve. Sixthly, home helps and nursing helps should be made available when needed and for as long as required. Seventhly, the provision of expert care is needed so that carers can have a break, rather than a breakdown. Eighthly, there should be planned provision of information and advice about benefits, services and options.
Carers are exploited because they care and are dutiful, because they love their dependent relatives, because they want to help and because they are women. It is time that we ended this scandal and gave them justice.
I feel somewhat upstaged by the speeches of the hon. Member for Oldham, West (Mr. Meacher) and of my right hon. Friend the Minister for Health. Those who follow the Order Paper may recall that on 10 February I tabled a not dissimilar private Member's motion. On listening to the opening speeches in this debate, particularly that of the hon. Member for Oldham, West, I could not help but feel that if I rather than the hon. Gentleman had opened the debate—I say this in due modesty—I might have created a better atmosphere for the debate. Above all, this is a subject on which we should try to strike a consensus. I shall not, therefore, reply to some of the more partisan of the hon. Gentleman's points or take up some points raised by the right hon. Member for Stoke-on-Trent, South (Mr. Ashley).
I start with the proposition that many more dependent people are cared for at home than are cared for in the ordinary hospitals, institutions and rest homes of all the statutory, charitable and private groups combined. That is our point of departure. To set it out in a little more detail, I shall give the House a round up of the facts, some of which have been mentioned.
More than 1·25 million people are caring for a relative or friend who is severely or very severely disabled due to illness, accident or the infirmities of old age. About 100,000 of those carers have been doing so for 10 years or more and some have been doing so for more than 30 years. More than 5·5 million people are supporting a person who because of age, illness or disability could not live safely or comfortably without the help of the carer. More women now care for an elderly or disabled relative than care for a child under 16. That fact, which has not yet come up, is one of the most penetrating facts to grasp in the debate. As the right hon. Member for Stoke-on-Trent, South said, four out of five carers are women.
Recently published reports confirm that there is an inverse ratio of support for carers—the more handicapped the dependent relative, the less support is made available. Research in Yorkshire has shown that the more disabled the relative, the fewer the people able to undertake the care because it is too difficult and onerous. That means that volunteers and neighbours find it increasingly difficult to give meaningful help as the disability becomes more advanced and severe.
If 1 per cent. of those caring just for the elderly suddenly gave up, our health and social services would find their budgets being increased immediately by 20 per cent.
That is an interesting point. The social services department in Barnsley estimates that its budget would probably increase by twice as much again. I notice that the hon. Members for Eastleigh (Sir D. Price), for Renfrew, West and Inverclyde (Mrs. McCurley), for Cheltenham (Mr. Irvine) and for Mid-Kent (Mr. Rowe) and 43 other colleagues have signed early-day motion 299. I have been listening intently to the hon. Member for Eastleigih, and I hope that he will join us in the Division Lobby.
If the hon. Gentleman had listened, he would have heard me say that I wanted the debate to achieve a consensus. I was referring to a major point. The hon. Gentleman can keep his party points for his party's committees.
It is estimated that those caring for the elderly at home save the statutory services £5·3 billion a year. It is important to take on board also the fact that the cost of a bed in a residential establishment is between £140 and £500 a week. By contrast, the maximum rate of attendance allowance available only to the most severely disabled living at home is £30·60. The invalid care allowance is only £23 a week.
That puts the role of the carer and the scope of the problem within statistical dimensions. The problem is severe. It covers age spectrum. It is important to remember that many carers are themselves elderly people.
No, I have given way once already, and I am trying obediently to be brief.
It is generally acknowledged that there are a number of hon. Members who have personal experience of caring. They will be with me when I say that the reality of caring for someone whom one loves is so private and intimate that even in a debate like this the House will not expect us to share our personal experiences. I certainly do not intend to do so. Suffice it to say that most carers have consciously chosen to look after their dependent relatives at home because they love them. They do not, therefore, want to hand the job over to anyone else.
Caring for someone who is heavily dependent is continuous, tiring, stressful, and restrictive. It can impose serious strains on other relationships within the family. Many of us have constituents with a severely disabled child and have seen how this can have repercussions on other children in the family who are not disabled. Outside help at key times on both a regular and a one-off basis can make the difference between total breakdown and a successful and loving partnership between the carer and the cared for.
That leads me on to consider—and this is what future discussion should be about—the different forms of support that are needed. In the interests of brevity I shall try to go straight to the heart of the matter. I invite the House to consider the various ideas put forward by the Association of Carers. Time prevents my going through them, but I would mention one point which comes in its submission to hon. Members:
It does appear at the moment that the presence of a carer is often seen by statutory services to obviate the need for supportive services, whereas carers are almost invariably in need of help in the very onerous tasks which they have opted to undertake out of love.
I think that this is true.
I should like to draw the attention of the House to the report of the Select Committee on Social Services and the 101 recommendations that we made. Let me emphasise that we made them on an agreed basis, across the party spectrum, which is the spirit that I wish to introduce, and maintain, in this debate. I hope that when replying to the debate my right hon. Friend will declare the Government's support for those measures.
Each of us who takes part in this debate will have his own suggestions for improvement. We have already heard a number from the right hon. Member for Stoke-on-Trent, South. I should like to suggest a few briefly, in encapsulated form.
We need more back-up in the home. This means more home helps and more meals on wheels. I pay tribute to the progress which has been made, but we have only 50,000 home helps in England, and that is not enough. There is uneven provision between men and women. In support of that I quote from a recent report of the Equal Opportunities Commission:
Evidence presented in our report shows that nearly 60 per cent. of male carers studied received home helps compared with only 34 per cent. of female carers, and 28 per cent. of men had the support of the meals on wheels service compared with 16 per cent. of the women. It seems services which provide direct help with the daily domestic routine are more likely to be provided if the carer is a man. So the work and health of women carers is affected to a greater degree.
We would like to see progress made in this area, not only for its own sake, but because this is an inequality which I find unacceptable.
We need more medical support in the home. My right hon. Friend referred to the primary care report which has just come out. We have to build on that. We must support the general practitioner service, which is the linch pin. We ought to extend the role of the community nurse, the community physiotherapist and the occupational therapist. In my part of the world they are extremely helpful to the handicapped.
We need an extension of the care assistant or care attendant. I call in aid the development of the care attendance service in Hampshire. On the hospital side, we need to have relief on call, what in our report we refer to as the "revolving door". If a chance is taken in putting people back into the community and the carers run into difficulties, they can by this means get those people back into hospital. This may have to be done at awkward times—which is when it nearly always happens—and not during the conventional surgery hours.
There is a need for the carer to have time off from caring. Age Concern once described the life of a carer of someone with dementia as the 36-hour day. Earlier, I heard people talking about problems of overtime. If one is caring for someone who is severely disabled, there is no question of normal working hours or overtime; it is a total commitment. So the need for relief is often urgent.
What happens when the carer runs out of steam? We all get these tragedies in our surgeries—a mother and father, now old-age pensioners, who, having looked after a severely disabled child who is now aged 40 or 45, can no longer provide the necessary care because they have literally run out of steam.
I support all the pleas to my right hon. Friend to get the invalid care allowance right. I have raised the issue, as have many right hon. and hon. Members. There is no longer any justification for not extending it to married women. As I said in a letter to The Times a few months ago, I very much hope that my right hon. Friends will be able to do it gracefully before they are compelled to do it by the European Court.
I hope that I have said enough to demonstrate the importance of carers to our nation. We need them. We cannot get on without them. I hope, too, that I have demonstrated that carers need more back-up, and more support, especially professional support, if they are to fulfil their role as carers and still have some personal life of their own.
I beg the House not to treat carers as if they were an object of pity or compassion. They do their caring willingly, as part of their role in life, out of love.
The hon. Member for Eastleigh (Sir D. Price) has spoken with considerable knowledge and a good track record in putting forward his point of view. He has set up an interesting agenda of proposals which will probably find cross-party support in this Chamber. Above and beyond the debate tonight, there is plenty there for which we can gather a consensus. But such is the nature of these debates that this evening at 7 o'clock we shall have to decide which way to vote on the motion. I can find nothing in the motion with which to disagree, and I am glad that it is before us for debate.
I might perhaps enter a number of caveats and additional points, but some of these have already been touched on and, because I know that other Members want to take part in the debate, I shall try not to detain the House.
The first of my three caveats is a plea for a proper balance in dealing with carers between the voluntary sector and the statutory sector. I know from my experience as president of the Liverpool old people's hostels association and from discussions with the Merseyside council for voluntary service and Liverpool young persons advisory service that they are very stretched for funds. They believe also that they are having to deal with a local authority which almost seems philosophically opposed to the spirit of voluntarism, and that can make life difficult for the voluntary organisations. If adequate support is to be given to those who care and who do the caring work, resources and support must be provided for voluntary organisations. Although I am glad to see a reference in the motion to increased support for voluntary organisations and agencies, I should like the Government to look at ways in which their position might be better protected.
Another caveat concerns the division of responsibility between health and social services departments. Often they are hopelessly unco-ordinated. To rectify this, I would like to see the health and social services provision for adults amalgamated under directly elected regional government. I would also like to see the social services provision for children integrated into a family courts system.
My third caveat is about flexibility, of which there needs to be more if we are to give more help to carers—a point on which the hon. Member for Eastleigh touched. Flexibility in the provision of care requires the breaking down of the entrenched intransigence of some groups of people, regrettably some of them trade unionists who defend working practices and insist that care may be provided only at certain times—for example, not at weekends. I hope that the Opposition Front Bench will use its considerable influence with the trade unions to ensure that some of this inflexibility is broken down.
In addition, we should like to see a charter for carers that would establish their inalienable right to an income that is independent of their dependants. Secondly, there should be access to information, which is often denied by the professional to the carer. Thirdly, as other hon. Members have said, there must be respite care, which is so important. Fourthly, there must be increased governmental encouragement and support for organisations such as the Association of Carers, with opportunities for more training to be provided under their aegis.
Enhanced nursery provision would enable women to have more flexibility in caring for children or relatives and would increase opportunities for women generally. Our record is not good. In France, 90 per cent. of three-year-olds attend nursery. In West Germany, the figure is 70 per cent. Here, it is only 2·8 per cent. My city of Liverpool intended to open six new nursery classes in 1985–86, but the Secretary of State withheld his approval. The authority will again seek approval for 1986–87. I hope that this time the Secretary of State will give the go-ahead.
These are the caveats and addenda that I would enter, while supporting the Opposition motion. Like the Government in their amendment, we commend the estimated 5·5 million people who are supporting disabled or elderly relatives at home. We have all been sent details of how many it is estimated are in our constituencies. I am told that there are 9,500 carers in my constituency. However, we repudiate the Government's contention that they are giving adequate support to the carers. Like the right hon. Member for Stoke-on-Trent, South (Mr. Ashley), I feel that the Social Security Bill, which should have been a golden opportunity, makes no specific provision for carers, and some will be up to £6·90 a week worse off because of the changes being made to long-term supplementary benefit.
What thanks is that to people who have sacrificed so much for the good of others? What sort of thanks is that to those who save the state millions of pounds? If just 10 per cent. of those who are cared for at home had to be looked after in residential institutions, the public cost would be over £1 billion a year. In comparison, the cost of extending invalid care allowance to married women—a move for which there is all-party agreement, and which would be of real help to the carers—would be less than one tenth of that £1 billion a year, at approximately £85 million a year.
The key to the Government's intentions comes in that immortal phrase used by the Minister for Health, "the availability of resources". If a Government can find, as this Government did a few weeks ago, £1 billion to give away in tax reductions, and can look next year to a further £4 billion for cuts in taxes, why can it not find greater resources to support the carers? That is the touchstone on which the Government's sincerity should be judged. By that touchstone, we shall vote against them tonight.
I am fast reaching the stage when I find it hard to take seriously the views expressed by the Labour party, because its answer to all difficulties is the profligate application of a cheque book—somebody else's. I have been closely involved in caring for carers for many years. It is no news that their difficulties are not only financial. There has been a certain amount of rivalry over voluntary organisations, and I speak on behalf of the National Council of Carers and their Elderly Dependants, now reaching its 21st birthday and so well in advance of many others who have more recently joined the debate on the needs of carers.
The council was founded at a time when nearly all the caring for elderly relatives was done by unmarried women—the single daughter staying at home looking after the elderly relatives. The invalid care allowance, which was introduced in 1976, was brought into existence largely under the pressure of organisations such as the council.
I share the views of those who hope that the Government will find it within their power to find the £100 million necessary to pay the invalid care allowance to married women. I am content for that to wait for the fully considered judgment from the European Court, and until it has been considered by the Government and they have made it the subject of a report to the House. However, having been through all those necessary steps, I have every confidence that the Government will do the right thing by the many married women caring for dependants. I pay tribute to the Government for the steps that they have already taken in extending the invalid care allowance to non-relatives and doubling the amount of part-time earnings that can be allowed before entitlement to the allowance is affected.
I wish to speak particularly about the carers of the elderly. It is easy to throw all carers into the same discussion, as they have many aspects in common, but they also have distinguishing features. For example, there is no doubt that elderly parents will be very much a growing part of our community as the number of residents over 85 doubles in the next century. Increasingly, elderly people will be looking after the very elderly.
Many contributors have said that it is too easy to take carers for granted, and to assume that all is well for them until they reach breaking point. I hope that the debate will highlight some of their needs and the ways that they can be given help before they reach that breaking point.
We have spent too little time concentrating on some of the good practices that have been established throughout the country. In my constituency, I have been consistently impressed by pioneering projects and ideas about meeting the needs of the elderly and carers. It has become fashionable to say that we always want more without looking carefully at what is being achieved, learning from our successes and then trying to spread good practices to other areas.
In my constituency I have visited many projects for sheltered housing, cluster housing, good neighbour schemes and, above all, schemes using telecommunications systems to keep in touch with dependants. The recent census returns showed a doubling of the number of people living on their own. People are increasingly reluctant to live with their relatives, whether semi-dependent or independent. Using telecommunications networks is the way to ensure that the welfare of the elderly is provided for without their losing privacy.
It is too easy to say that we need more resources for health care, but we have had a 24 per cent. increase in real terms in spending on the Health Service. Above all, I applaud the 63,000 more midwives and nurses since 1979. I hope that we shall be able to discuss the role of nurses in the light of the report by Julia Cumberlege. Nurses are independent professionals who should have increasing scope for practising on their own, and are particularly important in meeting the needs of dependants.
During the autumn, I was fortunate enough to spend a morning in my constituency with a district nurse and a health visitor and I was constantly impressed by the new practices, developments and schemes available for the elderly. It is more fashionable to say that we do not have enough, and in many areas there is room for improvement, but when one goes out on the twilight scheme, which offers help to put dependants to bed in the evenings, and many other schemes, one realises the recent remarkable achievements.
I should like to share with the House my pride in the new geriatric hospital in my constituency, which has cost 1·2 million to build. For too long, health care has too easily concentrated on the dramatic, exciting and acute operations rather than on the less exciting Cinderella services for the mentally ill, the mentally handicapped and the elderly. It is too easy not to recognise the great redirection of resources, not always met with favour by the power leaders in the NHS, but making an enormous difference for those in need of health care.
Much mention has been made in the debate about the role of voluntary organisations. These organisations do the best work and the work which we can be most proud of in our country. Many voluntary organisations have not been mentioned—for example, the Alzheimers Disease Society and the Red Cross. Many voluntary organisations organise schemes and work together with statutory authorities.
We have not so far in the debate mentioned the needs of former carers. Reference has been made to those people who give up five, 10, 15 or 20 years of their lives to care for a young or an old dependent relative. That may result in the carer becoming extremely isolated as the dependent relative's needs take up all the carer's time and attention. When that relative dies, the carer can be quite bereft and take some time before he is ready to return to employment. I hope that the Minister will consider whether it is possible in the provision of benefits to give that carer longer after the death of the dependent relative before the relevant benefits are lost. As a member of the National Council of Carers and their Elderly Dependants said, "Carers cannot walk from the graveside straight to the jobcentre."
Carers have financial needs and there are extra burdens to caring quite apart from the loss of earnings. I am confident that, with due consideration and careful planning, the Government will find their way to keep in line with the rulings of the European Court. Carers also have practical needs—relief and respite care, day arid night sitting services, day centres, lunch clubs, recreation and leisure facilities. It is vital that there should be joint planning and careful surveys of the needs in specific areas. It is also vital that there are mechanisms for offering information and advice to carers.
There is, above all, one area which is so easily undervalued by those who see everything in basic financial terms which requires consideration—the emotional needs of carers. Carers are isolated and unacknowledged. Their status needs to be raised in the eyes of us all, and local authorities, voluntary organisations and professional bodies at every level must be aware of carers. I hope that the tributes paid in the debate to the commitment of informal carers will lead to a greater appreciation and understanding of those unsung heroes throughout the country.
I am acutely aware of the shortage of time and I will therefore speak for no more than five or six minutes, not because this serious debate does not deserve more of my time, but because many of my colleagues wish to speak.
Most hon. Members are aware of the problems in our constituencies and know of the many thousands of people who are affected by the lack of resources for caring for loved ones, neighbours or families. Some 12,000 people are affected in my constituency and at least 1,200 of them are severely handicapped and have, as already mentioned, extra problems which are difficult to resolve immediately unless more resources are available. A special kind of person is required to deal with such cases.
I believe that the main argument relates to resources. The hon. Member for Surrey, South-West (Mrs. Bottomley) said that it was all very well for Opposition Members to talk about providing more money but that that money always comes from someone else's cheque book. I do not know who these aliens are, these "someone elses", these people who do not appear to belong to our society. The hon. Lady seemed to imply that they were removed from reality. I do not believe that many people would object to helping the people who help others. The cheque book mentality is not a good argument for inaction.
Sheffield has done a great deal of work to help carers. On many occasions the district council in Sheffield has told me that there are three aspects about carers, and they have been outlined already in the debate. The first is that practical help and flexibility are required. At present there are services in Sheffield which do the best that they can. However, local authorities generally find it difficult to give the support at the right time in the right place. There was a story of one local authority which could not provide services early in the morning, late at night or at the weekend because it could not afford it, yet it could afford to offer places in homes which could cost much more. We must locate the resources in the right places. Flexibility in that area is vital.
Sheffield is trying through experimental areas such as the scheme at Ecclesfield to provide such flexibility and Sheffield hopes to introduce further changes to help the carers who are caring for 24 hours a day. It is a fact of life that, without additional staff, it will cost almost £175,000 in premium rate payments to fund that experimental project. Such a sum is not easy for local authorities to come by.
Secondly, local authorities have the problem of finding enough cash for adaptions. It is vital that carers should have such adaptions in their homes. In Sheffield, in 1985–86, expenditure on adaptions was £1middot;2 million. There have been many debates over the past year or two about public expenditure. It is obvious that, in relation to revenue, that money will not be forthcoming and therefore we will have problems in sustaining programmes which we believe to be essential for adaptions.
My third point relates to respite care. Occasionally people want a break, particularly those who care for the severely handicapped. They need time to restore morale and recover physically and emotionally from such caring. I know that some of the carers in my constituency will not ask for such a respite service, but I believe that such a provision should at least be available in a civilised society. It is impossible to continue day and night caring without some respite.
There is an early-day motion which is more or less in line with the motion we are debating. The hon. Member for Sheffield, Hallam (Sir J. Osborn) signed that early-day motion and I hope that he will be voting with the Opposition tonight. Most of my colleagues have said that the needs of carers are desperate. Their needs are not being shouted about because they exist behind closed doors and caring is done in a quiet and sincere manner. That does not mean that the need is not great. The need is present and the House and the rest of society have a responsibility to fulfill our commitment to carers.
As I was one of the proposers on behalf of the parliamentary panel for the personal social services which put forward the early-day motion which has been adopted by the Opposition as their motion tonight, some explanation as to why I intend to support the Government may be required. However, that is not too difficult to explain. The Opposition carefully chose the motion to scourge the Government's record and in a way which paid no heed, for example, to the galloping inflation which pauperised many of the people who now need help from the state because their savings were stripped by out-of-control public expenditure which made it impossible to make sensible provision for their later years.
I will be supporting the Government. However, I should like to make it clear that we are discussing a major problem. There is a huge bulge in the number of elderly people needing to be cared for. We must plan for that bulge just as carefully as we plan for any bulge in school or university populations.
We are sadly very much a behind-closed-doors society. It is the dream of most of us to rush back from our day's work, slam our front door in the face of the world, and stay at home with perhaps a small number of friends or by ourselves. That is running away from the thought of any commitment to others. We must ask ourselves whether that really is the way forward for our society. If it is, it will be the end of the willingness to care. It has been well pointed out that in the enormous increase in the number of step-families there will be a huge increase in the number of kin but perhaps a considerable falling off in the commitment of those kin to individuals within that relationship.
As we have heard today, carers have a range of needs, but one of the things that they need most is a 24-hour response. For reasons which I entirely understand, carers, having committed themselves to looking after their loved ones, are too reluctant to accept help from volunteers. They see it as a job in which they have developed considerable skill and they are reluctant to share it with volunteers. They need help in coming to terms with what has been demonstrated to be a remarkable source of help.
Secondly, we need more part-timers. I could not agree more with the hon. Member for Liverpool, Mossley Hill (Mr. Alton) when he says that the trade unions should be encouraged in every possible way to make it possible for people to respond outside the ordinary working day.
Thirdly, organisations such as Crossroads need support. It is enormously important that organisations which are not yet big enough to have formed major fundraising arms should be given a great deal more help with their headquarters' costs than organisations which have grown used to raising their own money. That is important. The delay which accompanied the grant to the headquarters of the Association of Carers made its life difficult. Therefore, we ask for both speed and rather more understanding of the needs of the headquarters of such organisations.
To provide care through the local authority bureaucracy is expensive, not because local authorities are unduly costly—some are, some are not—but because it is difficult for them to provide care cheaply. Liaison officers will be enormously costly, however worthy they may be. There have been examples of women meeting together and forming their own co-operative to provide care and that is a major way forward for helping carers to find the sort of 24-hour response that they need.
With the huge growth in demand, there is a need for new sources of funds. Ever since the war we have had a society which has put an enormous premium on people spending their money on their house. That is their principal form of saving. That is the most immobile form of saving and the most emotionally tied-up form of saving. It leads to poverty because people cannot bring themselves to trade down-market to free funds. They find it enormously difficult to shake off the emotional ties of their home and so they remain isolated from other people who might be more able to provide them with help. As a society we need to look seriously at ways of helping people in such a situation to release the funds which are tied up in their home. Some schemes are already available, but we need to look at the matter much more coherently and consistently than we have done.
I commend the Government for carrying out research into the best way of allocating what will always be, by definition, inadequate resources. However, their research and the findings which will come from it will cry out for more resources. What we are doing is, perfectly properly, postponing for a moment the spending of money so that we know exactly how best to spend it. But the money will have to be found. As our society begins to grow even faster—it has had several years of consistent growth—each of us should ask whether we would not prefer to spend some of our new prosperity on this neglected source of help.
I am delighted to follow the hon. Member for Mid-Kent (Mr. Rowe). I am vice-chairman of the social services support group in the House of Commons and it is my intention to vote for the motion before us. The words of the motion are identical to those of early-day motion 299 for which the hon. Gentleman and I acted as sponsors a few weeks ago and which 147 hon. Members have signed. If it was right to sign the motion then, by what token is it not right to vote for it today?
Indeed, I am a little surprised that the Government have not found a way of adopting the motion. I realise that the last part relating to the invalid care allowance is rather difficult at this time, but, as was said in another place recently—some hon. Members were there—the sooner the nettle is grasped the better. The Government will have to grasp it.
Many of the points in the motion appeal to hon. Members on both sides of the House, across party divides. The sort of divisions that have arisen tonight are unnecessary. We should be finding a way forward. The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) put forward a specific eight-point plan. The hon. Member for Eastleigh (Sir D. Price) put forward an action programme, as did the hon. Member for Liverpool, Mossley Hill (Mr. Alton). People have been looking for specific steps to try to reach the common objectives that we all share.
We can argue about what resources are needed and how they should be funded, but everybody acknowledges that ideally greater resources are needed and that they should be directed to the right places. The Minister said that no details of the numbers and circumstances of carers are available. He referred to the general household survey later this year and the national survey of disabled people in 1988. Those two surveys, which are all very well, will give us global statistics, but they will not give us detailed local figures. They may show what resources are needed, but the question that then arises is where to allocate those resources, to whom and to answer what needs.
In Committee on the Disabled Persons (Services, Consultation and Representation) Bill, the Minister said:
It would not be right to put a statutory obligation upon local authorities to assess carers' needs."—[Official Report, Standing Committee C, 5 February 1986; c. 68.]
It is necessary to assess carers' needs. New clause 10, eventually brought forward by the Government, contains the words:
the local authority shall … have regard to the ability of that other person"—
to continue to provide such care on a regular basis."—[Official Report, 11 April 1986; Vol. 95, c. 523.]
If the local authority is to have regard to the ability of the carer, what is the difference between that and trying to quantify that regard in terms of an assessment of what is necessary to provide the support services? We are in danger of playing with words here, when in our heart of hearts we all know that we need to be able to quantify and specify the requirements in detail in order to ensure that resources are available to meet those needs.
The Minister made the point that promises should not go beyond the country's capacity to fulfil them. I was a little disturbed last night when in another place it was suggested that the pressure to pay the invalid care allowance—we all hope that the Government will be forced by the build up of pressure to do that—could restrict the money available for other purposes to help disabled people. I realise that all Governments have a limited pot of gold from which to obtain resources, but there is a general mood, not only in the House, but in the countries of these islands, that we require a shift of resources in the direction of those needing care.
One reason for that is that we have not done enough in the past. That is not a party political point. Many people who provide care have not been supported enough, in the past and they need more in the future.
Secondly, there is the bulge in the elderly population, which the hon. Member for Mid-Kent mentioned. The increasing elderly senile population will have an enormous impact over the next 20 years. We have seen that happening over the past decade, and the momentum is growing. The pressure is there. We are not yet getting our act together to meet that need. Therefore, we must get the resources together to ensure that we are not caught out.
The position of the elderly and mentally infirm is very serious. They have requirements that carers cannot hope to contain within the community unless they get the range of support services that other hon. Members have detailed. I shall not repeat them now.
As the hon. Member for Surrey, South-West (Mrs. Bottomley) said, we need a survey of needs in particular localities. That comes back to the question of specific assessment. We cannot get away from it. Therefore, I hope that the Minister can give an assurance that when the Disabled Persons (Services, Consultation and Representation) Bill, which is critical to what we are discussing tonight, passes through another place, as I expect it will, probably unamended, the Government will find the necessary resources to ensure that it is implemented at an early date. I realise that the local authority clauses cannot be implemented in this financial year because of the constraints on local authorities. However, I hope that the Government will give a firm undertaking that the resources will be available to meet the needs of carers from the beginning of the next financial year onwards. I hope that will be a token of the Government's determination to do what is necessary to help carers.
There seems to have been a little fuss from the Opposition about the fact that some Conservative Members supported an early-day motion which approximates to their motion this evening. I believe that there was no harm in supporting the idea, but a little realism has been injected by the Government in the amendment.
I should like to speak about the elderly in Scotland. What we have been talking about tonight came home visibly to me when I recently visited Killallan house, in Houston, in my constituency, where a 97–year-old was celebrating her birthday and her 77–year-old son and daughter were visiting her. They were the fortunate ones. Most people in that position are still at home without help.
The problem of elderly carers with even more elderly parents or dependants is becoming more acute. Those in the greatest need are now those who are either unable or unwilling to articulate their problem because they do not want to be a burden on society. Many of them come from a generation which believes that love and duty are not bound up with money. Sometimes I believe that the Opposition do not understand that, no matter how little people are paid, they are still willing to do the work.
There is the problem of the elderly looking after the aged. However, for many younger carers there is the problem of loss of income combined with the high cost of the much needed services such as additional laundry, additional heating and lighting, aids for incontinence and special diets.
There are roughly 125,000 carers in Scotland. They are mostly women who undoubtedly have had a poorer deal than men. Their job will never get better or easier. Age, decline and ultimate loss are the end products of their hard work. It is estimated that the savings to the Scottish budget through the hard and unpaid work of carers is about £660 million per annum.
However, the Government have demonstrated their concern in Scotland. They have provided additional resources for keeping people within their own homes, with carers in mind. The emphasis is undoubtedly on care in the community and the SHAPE priorities and SHARE allocation of the Health Service shows that clearly. Additional funds have been provided and recently the Minister responsible for health in Scotland gave an additional £250,000 to help the elderly in their homes.
We are very responsive in Scotland to voluntary bodies such as Age Concern when they suggest projects. One project did a survey of dementia sufferers and their carers in Glasgow. We responded very swiftly and provided additional finance.
The benefits which are available must be taken up. It is important for those who are entitled to benefits to ensure that they get what they deserve. Admittedly, at present the benefit system is a tangled forest and there are many outstanding inequities, but we are steering a path through it. Age, sex and marital status can exclude one from benefits and we are well aware that married women are excluded from the invalid care allowance. That must ultimately change. Also, divorced women are not eligible if they are receiving maintenance. That seems unduly harsh.
I hope that the Government are willing to continue to move towards a more equitable position, not through the force of the courts but by humane evolution of the system. Of course, the cost implications are huge and we cannot do it overnight. However, it is important that we aim to get things right now. In the next decade the number of over-75s will increase by 33 per cent. That is a worrying figure for a society whose resources are created by fewer and fewer people. Seventeen per cent. of the Scottish population is now of pensionable age. The number will increase slightly between now and 2011, but the number of over-75s will have increased by 19 per cent. and the over-85s by 80 per cent.
It is interesting that 35 per cent. of all Scottish households have an old-age pensioner, but 31 per cent. of our pensioners live on their own. Therefore, additional resources need to be put into the system. Of the female carers in Scotland, 42 per cent. are more than 60 years old and 70 per cent. are more than 50 years old. The average age of a carer in Scotland is 61. That is a time in life when one needs a little help for oneself and should not be in a position where one has to use mental and physical energy to such a great extent. Those people do it willingly, voluntarily and out of love.
I add my congratulations to those which have already been given to the voluntary services for their help. The National Council for Carers and their Elderly Dependants is grateful to my hon. Friend the Member for Surrey, South-West (Mrs. Bottomley) for all the help that she gives it. Without that body the services would be under a severe constraint. My contact with the council has been quite frequent recently and I have found it a magnificent body.
Many other agencies are helping to keep carers happy and to prepare the elderly for old age. I must mention the Women's Royal Voluntary Service because it is the true embodiment of a voluntary organisation. It husbands its resources very well and it is involved in direct care with very little administration. Many of the voluntary organisations would do well to take the WRVS as their example. I also congratulate Age Concern, Crossroads and the other remarkable voluntary bodies.
The Government are showing greater willingness to participate in research and in funding this very important area. I hope that we can continue to help before it is too late.
We in the House and people outside are now about to book holidays, if they are not already booked. We are saying that we will put our household pets in places where they will be looked after or we will get friends to look after them. A carer of people is not in that happy position. A carer cannot do that. Why should carers be in that position?
We blithely take such people for granted. The Minister took them for granted when he said that the resources were not available. He said that the resources were not available in the social services departments. There is much understanding among hon. Members about the need to help carers. We must together try to find the money to achieve our objective. We can do it. Local authorities have capital expenditure tied up. For heaven's sake, let them release that capital expenditure and let it be spent on things that it should be spent on such as caring for the carers.
I am pleased that there is consensus about what needs to be done, but there is no consensus about the availability of cash. That is where the rub lies. There are 1¼ million people in this country who are looking after severely disabled relatives. Although they may be looking after their severely disabled relatives by choice, that is no reason for exploiting them, yet they are being exploited.
The hon. Member for Surrey, South-West (Mrs. Bottomley) said that it is all right if one signs cheques using somebody else's cheque book, but who is signing the cheque for £120 a week that goes to many owners of private nursing homes? This gives rise to the kind of headline that appeared earlier this week in the Liverpool Echo, which, together with the "World in Action" team, has done a great service by pointing out that many of the cheques for £120 a week are wasted because that money is swelling the profits of the owners of private residential nursing homes who are not providing proper food and conditions for the people in their care. I have already put down three parliamentary questions about residential homes, including Millvale House in my constituency.
I hope that the Minister for Social Security will agree to hold an independent inquiry into this matter. If the Government really care for those who are in private nursing homes, they should inquire into the cost of caring for people in those homes. They should provide more help for the real carers—relatives who provide care, not for profit, but for love.
The desperate urgency of the case for carers is obvious to the carers themselves and to anyone who knows a carer. At the very least, caring for an elderly or a disabled person can mean the loss of social life, job prospects and income, but for many carers it also means emotional and physical breakdown, exhaustion and isolation.
I want to mention the circumstances of one woman to whom I talked in her own home last week. For many years Mary looked after her elderly mother until she died at the age of 84 after a long, depressive illness. Three years later, when Mary was only 48, her husband suffered a massive stroke which left him with pre-senile dementia. It was then that, in practice, Mary lost the husband whom she loved dearly.
It is 12 years since Mary's husband had his stroke, years which have seen her life devastated. She has become totally isolated. She had to give up her job to look after him—a job she desperately misses, not only for the money, but because she enjoyed her work. She has lost contact with her friends. She cannot go out to see them because she has to stay in to look after her husband. When she last invited friends to her home her husband stripped off in front of them, so she feels that she can no longer invite them to her home. Her relationships with her children and the rest of her family have also broken down. Her children find that it is less easy to travel to see her, because they have small children, and she cannot travel to see them because she has to look after her husband.
Mary always gets up before her husband to have her breakfast, because as soon as he is awake she is too busy responding to his demands to find time to eat. She finds it impossible to eat at the same table as her husband, anyway, because he stuffs his food into his mouth so forcibly that he nearly always vomits over his food. He is doubly incontinent. She finds faeces smeared everywhere in the house—up the banisters and up the walls. She feels under strain 24 hours a day. On the morning that I met her she had awoken to find that her husband had disappeared. She spent anxious hours searching for him, with the help of the police.
In those 12 years of caring for her husband, the strain and isolation have broken both her physical and her mental health, but because her husband is doubly incontinent she finds it difficult to get respite care, even in an emergency. She had to be taken into hospital for a cancer operation, but even then she could not get respite care. Mary is one of the many carers whose caring has broken her. Because of the struggle and the strain, these carers feel as though they no longer have the capacity to care, yet they have no choice but to continue.
Mary has never been assessed as to her capacity to care. She has never been offered day or night sitting services, or a home help. She says that she cannot stand it any more. She wants to get her husband into residential care, but she will have to go on looking after him because of the low level of services where she lives.
Mary's case is heartbreaking in the extreme, but it is not unusual. It is relatively typical of the pattern of caring. It is not just part of her life; it is a series of caring roles that have taken over her life. They take up the 24 hours of the day, the seven days of the week, and the 52 weeks of the year. As both she and her husband are not earning, she has financial problems. Her case is also typical of the social isolation that is caused, of the breakdown of family relationships and of mental strain. Carers are six times more likely than anybody else to suffer a mental breakdown.
Mary lives in the London borough of Merton. It is a Conservative-controlled borough that takes pride in its low level of spending on social services. That means that it takes pride in an appallingly low level of services. Although there are carers in all parts of the country, the services that are available to support them in their role differ drastically. According to the Minister, there is a network of professional carers and the only problem is coordination, but whether one gets any help at all depends not upon one's needs but upon where one lives. There is no respite care for those looking after younger, physically disabled people if one is a carer in Conservative Kent or Conservative Richmond. In neither of those counties, unfortunately, is there one of the excellent Crossroads care attendance schemes.
I stand by the fact that no respite care is provided by the county of Kent for those looking after younger, physically disabled people. Many counties under Tory control provide less than half the number of home helps that are set down in the Government's minimum guideline.
The hon. Member for Eastleigh (Sir D. Price) referred to the need for more home helps. Is he unaware of the fact that councils that are under Tory control are cutting back on home helps and that the increase in the home help service that the Minster praised is because Labour-controlled councils, in the teeth of Government opposition, have tried to increase their provision? The Liberal-controlled Isle of Wight is such a care less council that it provides less than one third of the Government's minimum guideline for home helps.
It is an irony that the Government praise as responsible and exemplary those Liberal and Tory councils which leave carers to crack up behind closed doors. The Government condemn Labour councils which try to improve services in order to ease the burden on carers. The Government brand them as irresponsible and profligate. What an irony that the Government are discouraging councils which are trying to improve and increase services. The statement in the Government's amendment to our motion, that they intend to continue to improve the level of support for statutory agencies, is not true. In fact, last year council social services spending increased by only 0·5 per cent. because of Government restrictions, although the Department of the Environment acknowledges that a 2·5 per cent. increase is needed just to maintain existing services for the growing number of elderly people.
Nor is it true, as the Government say in their amendment, that they are continuing to improve the level of support to voluntary agencies. As a result of local government spending restrictions, voluntary organisations have seen their council grants cut by over a quarter. Instead, the Government have spawned a chaotic range of schemes for voluntary organisations, many of which involve services being provided by short-term Manpower Services Commission trainees on as little as 1·70 an hour. Carers deserve better than a disjointed service by an ever-changing stream of conscripts from the dole queue.
Instead of mealy-mouthed platitudes, the Government should embark upon a national strategy for ensuring comprehensive provision of services at local level. The Minister said nothing about that in his speech. He referred only to seminars. The Government should be taking the initiative to recognise the growing needs of a growing army of carers.
As well as the financial measures which my hon. Friend the Member for Oldham, West (Mr. Meacher) outlined, the Government should encourage the development of local services which ensure that there is early identification of carers and an assessment of their capacity to care. The Government should also provide sufficient residential provision to ensure that nobody has to care when that is beyond her or his capacity. Not all carers want to be voluntary carers. Some of them are conscripted into caring because there is no alternative. Carers need information and advice about help. They need the continuing backup of key workers to help them to fight their way through the maze of different agencies with which they have to deal. Obviously, we would like to see care attendant schemes in all parts of the country. The Government must encourage and co-ordinate group practice and make sure that the resources are there to back it up.
Forty seven Conservative Back Benchers have already signalled their support for this motion by signing early-day motion 299, which stands in the name of my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). That motion is identical to the motion that we are debating. The Government amendment totally contradicts early-day motion 299, and Conservatives who signed that motion must vote for this motion and against the Government. If they do not, they will be revealing themselves as dishonest and as hypocrites, and carers in their constituencies will be saddened to know that the support they thought they had from their Members of Parliament is worthless because they were not prepared to defend the interests of those carers whom they said they represented.
The one thing on which all hon. Members are united is the importance of the subject that we have been debating for over two hours. In some ways, the time has been too short for such an important subject. In the past, the people about whom we have been talking have had inadequate recognition, perhaps from hon. Members on both sides of the House. Such people are worthy not only of the admiration that has been expressed by every hon. Member who has spoken, but of the support of the whole community for what they do.
Apart from the occasional rude remarks that have been made about the Government and the odd sour note that has crept in, I found the debate immensely encouraging. I suspect that five, or certainly 10, years ago such a debate would not have taken place, because nobody would have thought the subject warranted even two or three hours of the time of the House. That is a sign of a great and welcome increase in public and political awareness of the problems of carers.
I have no doubt that part of the trigger for today's debate was the Advocate General's opinion, issued on Tuesday of last week. However, that would not have triggered off the debate if there had not been a fundamental interest in the subject. That interest represents an important gain for our political discussion and for a solution to the problems of the disabled and those associated with them. I am happy to acknowledge that, because I can claim something that was implicit in the speech of my right hon. Friend the Minister for Health who opened the debate. While the Government can in no sense claim, nor would we seek to claim, that it is primarily our own achievement, we have contributed to that awareness by the policies and initiatives that we have taken in the past four or five years.
When the first results of the DHSS social work service—now the social services inspectorate—project on informal carers were discussed at a major seminar at Friend's House in London, I was in the job now carried out by my hon. Friend the Member for Wycombe (Mr. Whitney). I remember making the opening speech at that conference which had been instituted to discuss the project. Those taking part included representatives from local authorities, health authorities, voluntary organisations and others. The conference sought to bring to their attention the need to think more about the problems of carers. A good deal has stemmed from that work, carried out only three or four years ago, and it is being built upon.
I know that the Opposition regard £10·5 million as a piffling sum, but we are contributing with our helping the community to care programme. That programme has its bits and pieces. Some are large, others are small, but they are all important in their way in developing further the recognition and awareness of this problem. Pilot projects are taking place in three local authority areas.
The hon. Member for Liverpool, Mossley Hill (Mr. Alton) spoke about the information and advice available to carers. The King's Fund work seeks to improve that information and advice. I know that people have occasionally rubbished such things and asked "What is information and advice?" In my experience both in this area and in a narrower way in social security, the improvement of information and advice fulfils a major need and ensures that people know where to go to get the help either in cash or in care that they need. I make no apology for those projects, because they play an important part in what we are all seeking to do.
My right hon. Friend touched on the development of joint finance and joint planning. I should like to join in the tributes that have been paid to many of the voluntary organisations. There has been a significant expansion of the amount of support given to those voluntary organisations by the Government to enable them to expand their work, to which the hon. Member for Oldham, West (Mr. Meacher) rightly paid tribute.
I have looked up the amount of grant aid paid to a number of those organisations, and it confirms my own recollection of what has taken place during the time that I have been in the Department. Broadly speaking, Crossroads and the Associations of Carers are getting three time the amount of grant aid now that they were getting just a few years ago. The Association of Carers was not receiving any grant aid when this Government took office, because at that time the association did not exist. We have not contributed to the association as much as it would like, but we have contributed significantly to the development of its important work. I hope that we shall be able to continue to do so and to develop financing methods that will assist still further its steady development and give it the greater security that it would undoubtedly like.
I should like to pay tribute to the hon. Member who made the most thoughtful speech in the debate—I hope that I am not offending any other hon. Member by saying that—my hon. Friend the Member for Eastleigh (Sir D. Price), who has considerable knowledge and a long involvement in these matters. It gave the debate the balance that it had previously lacked, because of some of the words uttered by the hon. Member for Oldham, West. I was struck by the point that I think my hon. Friend the Member for Eastleigh took from Judith Oliver of the Association of Carers about the tendency for local authorities and other service providers sometimes to assume too easily that if there is a carer there is no need for services. However, very often the opposite is true. Governments cannot change those attitudes by diktat from the centre, but they can help to change them over a period, and this Government have already contributed to that aim.
Much of the debate has focused on the argument about the invalid care allowance. I acknowledge the strength of feeling and the interest that exists on both sides of the House about that matter. We have heard quoted some huge figures of carers. Whether or not we quarrel with the size of those figures or the sums involved, the House should at least not run away with the idea that the extension of invalid care allowance to married women is a solution to the sort of problem that we are debating. At most, 70,000 of those millions of carers, about whom the hon. Member for Oldham, West spoke, would stand to gain. They would certainly not see this as a solution to their problems or as an alternative to the sort of services that have been spoken about so tellingly in the debate. For example, it must be recognised that an elderly carer would not gain at all from the extension of the invalid care allowance because, as part of her husband's pension, she already receives exactly the same amount of money that she would receive by way of invalid care allowance. If she were to receive invalid care allowance, the husband's benefit would be cut by a corresponding amount.
I ask people not to exaggerate the extent to which invalid care allowance presents a solution to this important issue, nor to exaggerate what would be achieved by what they are urging the Government to do. As the amendment says, we shall consider and report to the House on any judgment that the European Court may make in due course. Both the motion and the amendment in their different ways show the dilemma posed by many different needs. What they have in common is that they unequivocally recognise the needs of carers and the progress that has been made. However, much more needs to be done. The amendment invites the House to proceed in a considered and responsible way.
|Division No. 167]||[7.00 pm|
|Abse, Leo||Callaghan, Rt Hon J.|
|Alton, David||Callaghan, Jim (Heyw'd & M)|
|Anderson, Donald||Campbell-Savours, Dale|
|Archer, Rt Hon Peter||Canavan, Dennis|
|Ashdown, Paddy||Carlile, Alexander (Montg'y)|
|Ashley, Rt Hon Jack||Carter-Jones, Lewis|
|Atkinson, N. (Tottenham)||Cartwright, John|
|Banks, Tony (Newham NW)||Clark, Dr David (S Shields)|
|Barnett, Guy||Clay, Robert|
|Barron, Kevin||Clelland, David Gordon|
|Beckett, Mrs Margaret||Clwyd, Mrs Ann|
|Bell, Stuart||Coleman, Donald|
|Benn, Rt Hon Tony||Conlan, Bernard|
|Bermingham, Gerald||Cook, Frank (Stockton North)|
|Bidwell, Sydney||Corbett, Robin|
|Blair, Anthony||Corbyn, Jeremy|
|Boothroyd, Miss Betty||Cox, Thomas (Tooting)|
|Boyes, Roland||Craigen, J. M.|
|Bray, Dr Jeremy||Crowther, Stan|
|Brown, Gordon (D'f'mline E)||Davies, Rt Hon Denzil (L'lli)|
|Brown, N. (N'c'tle-u-Tyne E)||Davis, Terry (B'ham, H'ge H'l)|
|Brown, Ron (E'burgh, Leith)||Deakins, Eric|
|Buchan, Norman||Dixon, Donald|
|Caborn, Richard||Dobson, Frank|
|Dormand, Jack||Martin, Michael|
|Dubs, Alfred||Mason, Rt Hon Roy|
|Duffy, A. E. P.||Maynard, Miss Joan|
|Dunwoody, Hon Mrs G.||Meacher, Michael|
|Eadie, Alex||Michie, William|
|Eastham, Ken||Mikardo, Ian|
|Edwards, Bob (W'h'mpt'n SE)||Millan, Rt Hon Bruce|
|Ewing, Harry||Miller, Dr M. S. (E Kilbride)|
|Faulds, Andrew||Morris, Rt Hon A. (W'shawe)|
|Field, Frank (Birkenhead)||Morris, Rt Hon J. (Aberavon)|
|Fields, T. (L'pool Broad Gn)||Nellist, David|
|Flannery, Martin||Oakes, Rt Hon Gordon|
|Foot, Rt Hon Michael||O'Brien, William|
|Forrester, John||O'Neill, Martin|
|Foster, Derek||Orme, Rt Hon Stanley|
|Foulkes, George||Owen, Rt Hon Dr David|
|Fraser, J. (Norwood)||Park, George|
|Freeson, Rt Hon Reginald||Parry, Robert|
|Freud, Clement||Pavitt, Laurie|
|George, Bruce||Pendry, Tom|
|Gilbert, Rt Hon Dr John||Pike, Peter|
|Godman, Dr Norman||Prescott, John|
|Golding, John||Radice, Giles|
|Gould, Bryan||Randall, Stuart|
|Hamilton, James (M'well N)||Raynsford, Nick|
|Hamilton, W. W. (Fife Central)||Rees, Rt Hon M. (Leeds S)|
|Hardy, Peter||Richardson, Ms Jo|
|Harman, Ms Harriet||Roberts, Ernest (Hackney N)|
|Harrison, Rt Hon Walter||Robertson, George|
|Hart, Rt Hon Dame Judith||Robinson, G. (Coventry NW)|
|Haynes, Frank||Rogers, Allan|
|Heffer, Eric S.||Rooker, J. W.|
|Hogg, N. (C'nauld & Kilsyth)||Ross, Ernest (Dundee W)|
|Holland, Stuart (Vauxhall)||Ryman, John|
|Home Robertson, John||Sedgemore, Brian|
|Howells, Geraint||Sheldon, Rt Hon R.|
|Hoyle, Douglas||Shore, Rt Hon Peter|
|Hughes, Dr Mark (Durham)||Short, Ms Clare (Ladywood)|
|Hughes, Robert (Aberdeen N)||Silkin, Rt Hon J.|
|Hughes, Roy (Newport East)||Skinner, Dennis|
|Janner, Hon Greville||Smith, C.(Isl'ton S & F'bury)|
|Jenkins, Rt Hon Roy (Hillh'd)||Smith, Rt Hon J. (M'ds E)|
|John, Brynmor||Snape, Peter|
|Kilroy-Silk, Robert||Soley, Clive|
|Kinnock, Rt Hon Neil||Spearing, Nigel|
|Lambie, David||Stewart, Rt Hon D. (W Isles)|
|Lamond, James||Straw, Jack|
|Leadbitter, Ted||Thomas, Dafydd (Merioneth)|
|Leighton, Ronald||Thompson, J. (Wansbeck)|
|Lewis, Terence (Worsley)||Tinn, James|
|Litherland, Robert||Torney, Tom|
|Livsey, Richard||Wareing, Robert|
|Lloyd, Tony (Stretford)||Weetch, Ken|
|Lofthouse, Geoffrey||Wigley, Dafydd|
|McCartney, Hugh||Williams, Rt Hon A.|
|McKay, Allen (Penistone)||Wilson, Gordon|
|McKelvey, William||Woodall, Alec|
|MacKenzie, Rt Hon Gregor||Wrigglesworth, Ian|
|McTaggart, Robert||Young, David (Bolton SE)|
|Madden, Max||Tellers for the Ayes:|
|Marek, Dr John||Mr. Ray Powell and|
|Marshall, David (Shettleston)||Mr. Mark Fisher.|
|Aitken, Jonathan||Biggs-Davison, Sir John|
|Alexander, Richard||Blaker, Rt Hon Sir Peter|
|Alison, Rt Hon Michael||Body, Sir Richard|
|Amery, Rt Hon Julian||Boscawen, Hon Robert|
|Amess, David||Bottomley, Peter|
|Ancram, Michael||Bottomley, Mrs Virginia|
|Ashby, David||Bowden, Gerald (Dulwich)|
|Aspinwall, Jack||Boyson, Dr Rhodes|
|Atkinson, David (B'm'th E)||Braine, Rt Hon Sir Bernard|
|Baker, Nicholas (Dorset N)||Brandon-Bravo, Martin|
|Baldry, Tony||Bright, Graham|
|Bellingham, Henry||Brinton, Tim|
|Bendall, Vivian||Brittan, Rt Hon Leon|
|Benyon, William||Brooke, Hon Peter|
|Biffen, Rt Hon John||Brown, M. (Brigg & Cl'thpes)|
|Bruinvels, Peter||Howell, Rt Hon D. (G'ldford)|
|Bryan, Sir Paul||Howell, Ralph (Norfolk, N)|
|Buck, Sir Antony||Hunt, David (Wirral W)|
|Budgen, Nick||Hurd, Rt Hon Douglas|
|Bulmer, Esmond||Irving, Charles|
|Butcher, John||Jackson, Robert|
|Butterfill, John||Jessel, Toby|
|Carlisle, John (Luton N)||Jones, Gwilym (Cardiff N)|
|Carlisle, Kenneth (Lincoln)||Joseph, Rt Hon Sir Keith|
|Carlisle, Rt Hon M. (W'ton S)||Kellett-Bowman, Mrs Elaine|
|Carttiss, Michael||Kershaw, Sir Anthony|
|Cash, William||Key, Robert|
|Chalker, Mrs Lynda||King, Rt Hon Tom|
|Channon, Rt Hon Paul||Latham, Michael|
|Chapman, Sydney||Lawrence, Ivan|
|Chope, Christopher||Leigh, Edward (Gainsbor'gh)|
|Churchill, W. S.||Lennox-Boyd, Hon Mark|
|Clark, Dr Michael (Rochford)||Lester, Jim|
|Clark, Sir W. (Croydon S)||Lewis, Sir Kenneth (Stamf'd)|
|Clarke, Rt Hon K. (Rushcliffe)||Lightbown, David|
|Clegg, Sir Walter||Lloyd, Ian (Havant)|
|Colvin, Michael||Lord, Michael|
|Cope, John||Luce, Rt Hon Richard|
|Cormack, Patrick||Lyell, Nicholas|
|Couchman, James||McCrindle, Robert|
|Cranborne, Viscount||McCurley, Mrs Anna|
|Critchley, Julian||MacGregor, Rt Hon John|
|Crouch, David||MacKay, Andrew (Berkshire)|
|Dickens, Geoffrey||MacKay, John (Argyll & Bute)|
|Dorrell, Stephen||Maclean, David John|
|Dover, Den||McNair-Wilson, M. (N'bury)|
|du Cann, Rt Hon Sir Edward||McNair-Wilson, P. (New F'st)|
|Dunn, Robert||Major, John|
|Eggar, Tim||Malins, Humfrey|
|Emery, Sir Peter||Malone, Gerald|
|Evennett, David||Maples, John|
|Eyre, Sir Reginald||Marland, Paul|
|Farr, Sir John||Marlow, Antony|
|Finsberg, Sir Geoffrey||Marshall, Michael (Arundel)|
|Fletcher, Alexander||Mates, Michael|
|Fookes, Miss Janet||Mather, Carol|
|Forman, Nigel||Maude, Hon Francis|
|Forsyth, Michael (Stirling)||Mawhinney, Dr Brian|
|Forth, Eric||Maxwell-Hyslop, Robin|
|Franks, Cecil||Mayhew, Sir Patrick|
|Freeman, Roger||Mellor, David|
|Gardiner, George (Reigate)||Merchant, Piers|
|Garel-Jones, Tristan||Meyer, Sir Anthony|
|Gilmour, Rt Hon Sir Ian||Miller, Hal (B'grove)|
|Glyn, Dr Alan||Mills, Iain (Meriden)|
|Goodhart, Sir Philip||Miscampbell, Norman|
|Goodlad, Alastair||Mitchell, David (Hants NW)|
|Gorst, John||Monro, Sir Hector|
|Gow, Ian||Montgomery, Sir Fergus|
|Grant, Sir Anthony||Morris, M. (N'hampton S)|
|Griffiths, Sir Eldon||Morrison, Hon C. (Devizes)|
|Ground, Patrick||Moynihan, Hon C.|
|Grylls, Michael||Mudd, David|
|Gummer, Rt Hon John S||Murphy, Christopher|
|Hamilton, Hon A. (Epsom)||Neale, Gerrard|
|Hamilton, Neil (Tatton)||Needham, Richard|
|Hampson, Dr Keith||Neubert, Michael|
|Hargreaves, Kenneth||Newton, Tony|
|Harris, David||Nicholls, Patrick|
|Harvey, Robert||Norris, Steven|
|Haselhurst, Alan||Onslow, Cranley|
|Havers, Rt Hon Sir Michael||Oppenheim, Phillip|
|Hayes, J.||Oppenheim, Rt Hon Mrs S.|
|Hayhoe, Rt Hon Barney||Osborn, Sir John|
|Heathcoat-Amory, David||Ottaway, Richard|
|Henderson, Barry||Page, Sir John (Harrow W)|
|Higgins, Rt Hon Terence L.||Page, Richard (Herts SW)|
|Hind, Kenneth||Parkinson, Rt Hon Cecil|
|Hirst, Michael||Patten, J. (Oxf W & Abgdn)|
|Hogg, Hon Douglas (Gr'th'm)||Pawsey, James|
|Holland, Sir Philip (Gedling)||Pollock, Alexander|
|Hordern, Sir Peter||Portillo, Michael|
|Howard, Michael||Powell, William (Corby)|
|Howarth, Alan (Stratf'd-on-A)||Powley, John|
|Howarth, Gerald (Cannock)||Prentice, Rt Hon Reg|
|Price, Sir David||Stradling Thomas, Sir John|
|Proctor, K. Harvey||Sumberg, David|
|Pym, Rt Hon Francis||Tapsell, Sir Peter|
|Raffan, Keith||Taylor, John (Solihull)|
|Raison, Rt Hon Timothy||Taylor, Teddy (S'end E)|
|Rathbone, Tim||Temple-Morris, Peter|
|Rees, Rt Hon Peter (Dover)||Terlezki, Stefan|
|Rhodes James, Robert||Thompson, Donald (Calder V)|
|Rhys Williams, Sir Brandon||Thompson, Patrick (N'ich N)|
|Ridley, Rt Hon Nicholas||Thorne, Neil (Ilford S)|
|Ridsdale, Sir Julian||Thornton, Malcolm|
|Rippon, Rt Hon Geoffrey||Thurnham, Peter|
|Roberts, Wyn (Conwy)||Townsend, Cyril D. (B'heath)|
|Roe, Mrs Marion||Trippier, David|
|Rost, Peter||Twinn, Dr Ian|
|Rowe, Andrew||van Straubenzee, Sir W.|
|Rumbold, Mrs Angela||Vaughan, Sir Gerard|
|Ryder, Richard||Waddington, David|
|Sackville, Hon Thomas||Wakeham, Rt Hon John|
|Sainsbury, Hon Timothy||Waldegrave, Hon William|
|St. John-Stevas, Rt Hon N.||Walden, George|
|Sayeed, Jonathan||Waller, Gary|
|Shaw, Giles (Pudsey)||Walters, Dennis|
|Shaw, Sir Michael (Scarb')||Ward, John|
|Shelton, William (Streatham)||Wardle, C. (Bexhill)|
|Shepherd, Colin (Hereford)||Warren, Kenneth|
|Shepherd, Richard (Aldridge)||Watts, John|
|Shersby, Michael||Wells, Bowen (Hertford)|
|Skeet, Sir Trevor||Wells, Sir John (Maidstone)|
|Soames, Hon Nicholas||Wheeler, John|
|Speed, Keith||Whitfield, John|
|Speller, Tony||Whitney, Raymond|
|Spencer, Derek||Wilkinson, John|
|Spicer, Jim (Dorset W)||Winterton, Mrs Ann|
|Spicer, Michael (S Worcs)||Wolfson, Mark|
|Squire, Robin||Wood, Timothy|
|Stanbrook, Ivor||Woodcock, Michael|
|Stanley, Rt Hon John||Yeo, Tim|
|Stern, Michael||Young, Sir George (Acton)|
|Stevens, Lewis (Nuneaton)|
|Stewart, Allan (Eastwood)||Tellers for the Noes:|
|Stewart, Andrew (Sherwood)||Mr. Tony Durant and|
|Stokes, John||Mr. Peter Lloyd.|
That this House, noting that there are a substantial number of people from the age of seven to 70 years caring for disabled and elderly relatives at home, often for many years, pays the warmest possible tribute to these carers; and further noting the research which shows that carers themselves often suffer from mental and physical illness, social isolation and disadvantage, recognises the action already taken by the Government to improve their position, especially in view of the undoubted savings to public funds which flow from their commitment; and in particular welcomes the Government's intentions, in line with its stated policies on care in the community and the availability of resources, that: (a) adequate respite care, both at home and in short-stay facilities, be assured by continuing improvement in the level of support given to statutory and voluntary agencies, (b) a flexible system of appropriate support such as home helps and home nursing be available at times when the carer needs them and (c) any judgement which may be made by the European Court relating to the invalid care allowance introduced by the Labour Government in 1976, be carefully considered by the Government and made the subject of a report to the House.