In the unavoidable absence of the noble Baroness, Lady Finlay, and at her request, I shall move Amendment 6 and speak to Amendments 8 and 9 tabled in her name and mine, and speak to my Amendments 46, 47, 48 and 58.
The first group of amendments concerns parent carers. The Care Bill is drafted to apply only to adult carers of adults. This means that the new rights for carers included in the Bill will not apply to adults caring for disabled children or to children caring for disabled adults. The Government have committed to address this disparity for young carers by bringing forward very welcome changes in how they will join up this Bill and the Children and Families Bill to meet the needs of young carers and their families. This is extremely welcome, but it will leave parents of disabled children as the only group of carers whose rights to assessments and support will be left behind.
Carers UK and other carers organisations have been deeply disappointed that parent carers’ rights are not being given the same recognition as other carers’ rights and that the legislative technicality of their rights falling under the remit of children’s rather than adults’ legislation risks them being left with inferior rights. These amendments include parent carers in three key places in the Bill in order to probe the Government’s intentions regarding parents of disabled children and how they intend to address the disparity with the rights of parent carers. The Government have put forward an approach which joins up the Care Bill and the Children and Families Bill for young carers—which is very much to be welcomed and on which the Government are to be congratulated—and these amendments call for them to do the same for parents
of disabled children. If nothing is done about this, parents of disabled children will be left with lesser and inconsistent rights to assessment and support. The rights of certain groups of carers will be left at different levels in different pieces of legislation, which will be confusing for many people, and parents of disabled children, who already have difficulty accessing support, will find it even harder to participate in work and their community in any way at all.
In this Bill, the Government are improving the rights of carers for adults by removing the need to provide regular and substantial care in order to receive an assessment, removing the need to request an assessment of their needs, placing a duty on local authorities to provide services to the carer following assessment when they meet the eligibility criteria, and introducing a new well-being principle. All this is very welcome, but parents of disabled children also need support. They have often struggled to establish rights as individuals on a par with other carers, and they are at particular risk of having their own rights overlooked as individuals. Too often, they are seen only as parents and their needs as carers are not identified or supported. This was summed up for me this weekend in a conversation I had with a parent carer known to me. He and his wife have been caring for their 30 year-old, very disabled son who is physically and mentally disabled. They have been caring for him for more than 30 years and have had the usual struggle in trying to find any support. When trying to access respite care when the wife, who has diabetes, was severely ill, they were told, “But you’re not carers. These rights don’t apply to you. You’re only parents”. They are not only parents. Normal parents do not have to look after their child and do everything for him for 30 years.
It is three times more costly to bring up a disabled child than a non-disabled child. Parent carers are more likely to be reliant on income-based state support, and 34% of sick or disabled children live in households where there is no adult in paid work. They are also more likely to suffer relationship breakdown and divorce, and they are three times more likely to suffer ill health and heath breakdown than parents of non-disabled children. They are also commonly very isolated and unable to get support that fits the whole family.
The Law Commission, I remind the House, recommended that existing duties to assess parent carers should be amended to make them consistent with the adult social care statute. The Government, I am afraid, have so far failed to act on this recommendation. I tabled similar amendments during the Committee stage of the Care Bill and the Minister responded. However, the Government’s response did not address the disparity that will arise for parent carers, who will have lesser rights to an assessment of their need for support and will not have the same rights to support services as other carers.
These amendments try to address that. In brief, they include parent carers in the well-being clause. The intention of the first amendment is to include the parents of disabled children in the duty placed on local authorities by Clause 1 to promote the well-being of individuals. They also want to prevent parent carers’ need for support arising in the first place. Too often
parent carers reach crisis point, leading to high-cost interventions. In addition to the negative impact on outcomes for the whole family caused by mental or physical breakdown in the parent, relationship breakdown and unemployment, there are also substantial costs to local authorities, commissioners and indeed to the economy. The costs of mental ill health, as we all know, are rocketing. The cost of family breakdown is estimated to range from £20 billion to £40 billion every year.
The other amendment includes parent carers in the duty to make the assessment. The Bill is making it easier for adults to receive a carer’s assessment by creating an automatic right to one and removing the requirement that they provide regular and substantial care. When I see that in legislation I want to stand up and cheer. That is a great development. However, unless similar changes are brought forward for the parents of disabled children, they will still need to request a carer’s assessment from their local authority and do not have a right to one unless they are providing regular and substantial care. This disparity means that parent carers will be the only carers to have these additional barriers to support in front of them. This amendment seeks to include parents of disabled children in the duty on local authorities in the Care Bill to assess carers, which creates a lower bar to assessment than the current legislation.
I hope that the Minister will look favourably on these amendments. Will the Government give assurances that parents of disabled children will not be left with lesser rights? How will the Government ensure parity of rights for parents of disabled children and how will the Government act to join together the Care Bill and the Children and Families Bill—being considered in the Moses Room as we speak—to ensure that the families of disabled children are able to access support? Will the Minister commit to working with the Children’s Minister to ensure that the rights of parent carers are not left behind? Will the Minister assure me that, having worked so effectively with the Department for Education to strengthen the rights for young carers, he will do so again to strengthen the rights of families with disabled children?
My Amendments 46 to 48 and 58 are about charging for carers’ services. They are supported by Carers UK and the Carers Trust. The current law includes the power to charge for meeting the needs of carers but very few local authorities use this power. As well as continuing to give local authorities the power to charge carers, the Bill includes a power to charge carers for arranging services for them. Local authority adult and social care budgets are under ever-increasing pressure and we must be concerned that carers may be looked to as a source of revenue. Carers already contribute a huge amount, often at great personal cost, as caring has a negative impact on their finances, health and well-being, and opportunities to engage in work and education. I make no apology for repeating the figure that I have quoted many times in your Lordships’ House—Carers UK has calculated that the contribution of carers is worth £119 billion a year in savings to the Exchequer. Charging a carer for support to meet their needs, often in order to help them continue in caring, risks being counterproductive by preventing carers
accessing services and may even discourage carers seeking support. As a result, the adoption of charging policies would result in additional costs to local authorities.
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Carers and the person or people they are looking after—we should remember that many carers look after more than one person—may not have the same income. In many cases, carers have had to give up work or live on a reduced income as a direct result of their caring responsibilities. They may not have access to the same income that enables the person they care for to self-fund their care and support. The cost of supporting individual carers is frequently minimal but the financial benefit to local authorities can be significant. The Government have identified that carers are the first line of prevention, and that properly identifying and supporting carers will prevent escalation of demand on statutory services. The Government’s own impact assessment of the Care Bill set out evidence on the cost-effectiveness of supporting carers: for example, by preventing or delaying hospital or residential care admission; by sustaining the caring role; by improving the health and well-being of carers; and by assisting carers to remain in or return to work.
A number of local authorities have individually examined the value of their care and support services and have concluded that supporting carers is very cost effective. Surrey County Council, for example, did a cost-modelling exercise which concluded that supporting carers helps prevent breakdown of caring situations, provides help in a manner that many families appreciate and avoids far greater costs for the provision of more expensive and intrusive care packages. This was also the conclusion of Herefordshire County Council, which recently reversed its decision to charge for carer services. It found that charging would risk increased pressure on social care budgets and that no additional income would be raised by the council because of carers’ low income. No advantage could be gained because of the negative effects of charging. I should declare an interest as patron of Herefordshire Carers Support, but I am sure that that had nothing at all to do with the decision not to charge carers.
I must also mention carers and the care account. Unlike for older and disabled people, the cost of services for carers will not accrue towards a care account. This means that, unlike disabled or older people, any services which carers pay for themselves, or which they are given through public services if they are deemed eligible, will not count towards the care account. In the care account model, any unpaid support that a carer provides for eligible needs will reduce the amount that the public will have had to contribute towards the capped-costs model. In other words, a carer’s contribution is counted several times over, yet they themselves may have to make increasing financial contributions which would not go towards their own care account for the future. There is nothing in the capped-costs model which recognises the contribution of carers and many carers will feel that it is unfair that they provide unpaid care and must pay for support which enables them to continue to do so. By any judgment, that is unfair.
The simplest way to resolve the issue of the care account not applying to carers is to remove charging for carer services completely. A care account for carers would be a hugely complex exercise in any case, and it would arguably be easier at this stage simply to protect carers from being charged for services. What is the Government’s rationale for leaving carers out of the care account? Do the Government agree that it would be far easier and more equitable if the Government removed charging for carers altogether?
Finally, I turn to Amendment 48; I apologise for delaying the House with all these amendments, but I might as well speak to them while I am on my feet. Amendment 48 is about services of an intimate nature which can only be provided to the disabled person. We considered this in Committee. There is no clarity in the Bill about what a disabled person’s service is and what a carer’s service is, which will lead to confused decision-making and carers being increasingly, or wrongly, charged for services. Under the current legislation—the Carers and Disabled Children Act 2000, which I had the honour of taking through your Lordships’ House—services provided to the disabled person in order to meet the needs of the carer cannot include services for the disabled person that are of an “intimate nature”. This ensures that disabled people keep control of their own services while protecting carers from being charged for services. This is a vital protection which is critical for carers. This amendment seeks to reintroduce this wording into the Bill with several clear purposes. The first is to ensure that disabled people will keep control of personal services. The second is to ensure that decision-making is made clearer for front-line professionals. The third is to protect carers from increasingly being charged for services.
Currently, the Carers and Disabled Children Act 2000 specifies that services provided to the disabled person in order to meet the needs of the carer cannot include services “of an intimate nature”. The Bill, as we know, introduces new rights to assessment for carers; new duties to provide services to carers following assessment; and the power to charge for services to carers that are provided to them and to charge for arranging these services. Disabled people can be charged for services provided them, including if the services meet the needs of carers, but currently there is no definition of whom a service belongs to. This was a recommendation in the Joint Committee’s report when we scrutinised the draft care and support Bill: that the Government protect carers from being wrongly charged by including the wording at Clause 14.
This wording is very welcome because it prevents wrongful charging, but the Bill still leaves wide open the issue of how a practitioner decides to whom the service is provided and thus potentially charged. The new wording of the Bill opens up the possibility, I fear, that intimate care services for a disabled person could be provided to the carer and a whole new scale of charging developed. I do not believe that that was the Government’s intention when they changed the wording of the Bill, so that the definition of intimate care should be retained, with more detailed guidance to assist local authorities and carer centres in using the legislation. The reason this clarification matters even further is because of what I referred to earlier about
the care account. There will be negative consequences if further clarity is not provided so I very much hope that the Minister will accept this and my other amendments and I beg to move.