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4.14 p.m.

Baroness Nicol: My Lords, I am sorry that my noble friend Lord Ashley was unable to stay until the end of what is proving to be a most interesting debate. I want to concentrate my few minutes emphasising the value of, and the pressures on, carers—all carers, but in particular those who care for a relative, a friend, or in many cases a child, from love or a sense of duty, and who are in that position for 24 hours a day.

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It is estimated that some 6 million women and men in the United Kingdom act as full-time or part-time carers for those in need of support. Many of them struggle in difficult situations without help and even without recognition. About 1 million of our fellow citizens are caring full-time for a disabled elderly or mentally ill person. The National Federation of Women's Institutes estimates that one in three carers do not receive any support. Some may be helped by local services, but whether they receive support or not many have to carry the burden of responsibility of caring for someone who cannot manage alone for 24 hours a day, seven days a week, with all the ongoing strain involved.

All too often the carer has had to abandon any attempt to follow his or her career and is unable to maintain any separate personal life. Even when some outside work can be undertaken it is part-time and therefore mostly low paid. So financial problems are added to an already stressful situation. It is not unusual to find that when a carer is finally released from his or her responsibility, re-entry into the job market is difficult, and the loss of job and pension prospects can never be recovered. Yet carers save the taxpayer billions of pounds. It has been estimated that if they all had to be paid the going rate of £5.80 per hour the average annual cost would be of the order of £30 billion. It therefore makes good economic sense as well as good social sense to make sure that the support services are good enough to keep the carers going.

Perhaps the most desired and the most immediate relief is that mentioned by the noble Lord, Lord Jenkin of Roding: respite care. I think he has been alone in mentioning it. To be given a break from the daily pressure can be a life-saver. Some voluntary organisations and local support organisations do a splendid job in providing respite care for carers, but there is not nearly enough and, geographically, it is patchy. It is not unusual for a carer to find that there is no one within the kind of reach that makes it easy to come and go.

My party has produced a consultation paper called Making Carers Count. It gives valuable information on the background to the problems of carers and makes many useful suggestions for improvement. There is not time to read all of them, particularly as I have a question to put to the Minister. I wish, however, to mention one or two. We suggest that local charters for carers should set out clearly the services available in the area. It is surprising how little some carers know about what is available to them. We need a charter in which carers can find all the information they need. I understand that a scheme in Leeds has been very successful.

All carers should have an opportunity for separate assessment of their needs. That will obviously require visits from the professionals but it is important that carers should know exactly what they are up against and what is available to them.

Carers should have access to flexible and affordable respite care. That is always available if you can pay for it, but it is not an option which is open to many people, particularly if the problem has gone on for any length of time. As the noble Lord, Lord Jenkin, who has now abandoned us, said, it should be done by way of

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partnerships involving local authorities, the private sector and voluntary organisations. This is something the Labour Party supports.

The noble Baronesses, Lady Seccombe and Lady Macleod, mentioned young carers. They should have particular attention paid to their needs. In some cases they should be identified as "children in need" under the Children Act, and be supported as such. There are obvious difficulties for young carers who have not the mental experience to cope with many situations they find themselves in. But many of them battle on regardless.

I would be grateful to hear that the Government have identified the area of concern of carers generally and that they will encourage actively some solutions. We all want care in the community to work. Carers are the essential ingredient in any plan and should have all the help we can give them.

I wish to put to the Minister one question. The matter has been worrying me since I heard about it. An elderly couple, one of whom has had to go into a private nursing home, have had to pay part of the fees. Is it the case, when their savings run out, that the family home has to be sold to meet the costs of the private nursing home and that only when that sum has been reduced to about £8,000 is other help forthcoming? That creates an enormous anxiety for elderly couples. I hope that the Minister can lay it to rest.

4.20 p.m.

Lord Thurlow: My Lords, the subject of the debate finds us all in the same boat. It is not a partisan matter. If at some future date we have a change of government they will have the same problems, including that of financial constraints, on their plate. The debate has illustrated the enormous breadth of problems. None in your Lordships' House would question the broad policy objectives of community care that the Government introduced when they decided to implement the Griffiths Report. That was a revolution, and all revolutions cause problems, especially over timing. I am one of those who regrets that the implementation was not done over a longer timespan. The Government delayed introduction for over a year, when it was manifestly impossible for local authorities to take on their responsibilities. I am sorry that the delay was not longer, but that is history.

I shall confine my remarks to two aspects of the subject. The first relates to monitoring and the other to the revolving door syndrome issue to which the noble Baroness, Lady Robson, referred during the debate on the Address. The noble Lord, Lord Brimelow, questioned whether the Department of Health knows what is going on. I should not be surprised were the answer to be that it cannot know everything that is going on because it is part and parcel of the system of delegated responsibility that statistics, and so on, are fragmented. Nevertheless, the NHS, as it acknowledges, is responsible. It has the final and continuing responsibility for medical treatment and medical care. It cannot delegate that beyond a certain point. It is a fundamental responsibility.

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I should like to refer, as evidence of the problem, to what happened some time ago now when a commercial residential nursing home in, I think, Oxford, had a case of homicide which has received a great deal of publicity. Before the implementation of Griffiths the home had catered mainly for homeless people and not sick people. At that time the home was staffed by a young volunteer who was making a social contribution before going up to Oxford. He was on duty by himself for 24 hours with 10 or 11 residents. A schizophrenic patient had been introduced to the home after those responsible for that commercial project became aware that there was a slice of cake to be had from operating in the mentally ill field. During the night that unfortunate schizophrenic patient stabbed the young volunteer who, incidentally, had received no specialised training in looking after the mentally ill.

I have no doubt that in that case corrective action was taken. The point is that that was a residential home responsible for providing difficult care for the mentally ill. It ignored the Department of Health's guidelines on staffing and training. When confronted with the fact that it was ignoring the guidelines, it said calmly that the guidelines were not legally mandatory. I should like the Minister to ensure that in future the guidelines are given greater legal mandatory force. I hope that that will be one of the objects of the legislation to which we look forward.

On the revolving door syndrome, the public perception is—rightly or wrongly—that with the run down of the big mental hospitals and the reduction in the number of acute beds, there is no longer an assurance that those requiring treatment after discharge can always obtain it. I am a parent who has benefited from the past arrangements with big hospitals under which our schizophrenic son could always go back through the revolving door, and I am greatly concerned that there is no longer an absolute assurance that a bed will be available wherever and whenever it is wanted. We should be pleased to have the maximum transparency in this area.

4.28 p.m.

Baroness Gardner of Parkes: My Lords, this has been a most interesting debate, but the only distinction too many speakers have drawn between the NHS and community care is that one pays for one and not for the other. That is a false distinction as the NHS has not been entirely free since 1950 when the Labour Government introduced the first charges for the NHS. People tend to think of the NHS as a hospital service, and that is free, but there are many other aspects of the health service for which patients are means tested and for which charges are made. Priority cases, of course, are still treated free. That point needs to be put to make it clear that that is not the only distinction. There are much greater distinctions to be drawn between the NHS and community care.

Baroness Jay of Paddington: My Lords, I apologise for interrupting the noble Baroness, but surely what we

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are discussing this afternoon is continuing care, and the distinction there is between the free continuing care in the health service and means-tested social services.

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