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Primary Health Care (Carers)

I am pleased to have secured this debate with the Minister. As a newly elected MP, I went to a meeting of the all-party group on carers yesterday, one of the aims of which is promoting awareness in the House of the needs of carers. I am glad to have the chance to do that today. I congratulate the Minister on his role. He has responsibility for some of the key areas affecting all our communities. Carers are an important group in our society. We know from the 2001 census that at least 5.2 million people give unpaid care to family members and others. We also know from the census that more than a million carers care for more than 50 hours a week. Research into the health impact of caring at such levels is not yet extensive. However, a number of surveys and other research have pointed to the fact that caring has an impact on the carer's health, particularly at the heavier commitment levels, and that will be a major theme in my speech. I want to discuss the extent to which current practice in primary health care is supporting the needs of carers and suggest what the Government can do to ensure that that support is improved. Those working with primary health care teams find that many say that their workload prevents them from changing practice or taking on new tasks, but many general practitioners and primary health care teams are changing practice and taking on new tasks. I shall set out what I think can be done to move forward on these issues to improve the health and quality of life of carers. In 1999, the Government brought carers' issues to the fore when they published the national strategy for carers. Previously, the role of carers had been under-recognised and undervalued. The health and social care analyst, Melanie Henwood, summed that up in 1998 when she chose the title ““Ignored and Invisible?”” for the report on her research into carers' experience of the NHS. That was why it was particularly important that, in their national strategy, the Government identified the NHS as the single most important first point of contact for carers. The strategy identified some important roles for primary health care staff. First, they should identify patients who are carers and patients who have a carer; secondly, they should check carers' physical and emotional health wherever a suitable opportunity arises, and at least once a year; thirdly, they should inform carers routinely that they can ask for an assessment of their own needs; fourthly, they should ask patients who have carers whether they are happy for health information about them to be given to their carer; and fifthly, they should signpost carers to other sources of support such as support groups and the local carers' centre. That checklist for primary care was an important step forward, but, six years on, it is now time to look at the extent to which primary health care teams are following it. It is clear that we should do that if we want to build on the national strategy, both to protect carers' health and enable them to continue caring. From 2001 to the start of this year, I worked as an independent consultant with colleagues on research into carers' needs and issues for the national charity, the Princess Royal Trust for Carers. I do not feel the need to declare an interest, because that work ceased when I became a Member of Parliament. In 2002, I co-ordinated for the Princess Royal Trust for Carers the largest ever survey of carers in the UK. Three years on from the publication of the national strategy, that survey provided a snapshot of carers' needs and priorities. A second project, in 2003, focused more specifically on primary health care and the most effective ways to identify carers and get them using support services. Ministers with responsibility for social care, my right hon. Friend the Member for Redditch (Jacqui Smith) and later my hon. Friend the Member for South Thanet (Dr. Ladyman), spoke at the national launch of those reports. The reports from both projects, and a number of other surveys, have pointed to the fact that caring has an impact on the carer's health, particularly at the heavier levels of caring commitment. More than two thirds of the carers responding to the 2003 survey I mentioned felt that their own health had been affected by caring. That was in line with national findings. Symptoms reported to the general household survey by those caring for more than 50 hours a week included loss of sleep, reported by half the respondents, and physical strain, reported by almost a quarter, while one third felt depressed. It is becoming accepted that caring has an impact on carers' health. The effects of caring can cover a range of conditions including back pain or injury caused by lifting and handling, stress and mental health problems, poor immune responses, and hypertension and the associated risk of coronary heart disease. On mental health issues, it seems from a number of surveys and studies completed since the national strategy was published that carers at the heavier end of commitment, those living in the same household as the cared-for person and female carers are all at high risk of mental ill health. Further, a study from the United States of people giving care to patients with stroke and dementia found that their health was affected in ways that would accelerate the risk of age-related diseases. The study found that the stress that the carers experienced was prematurely ageing their immune systems. That is clearly a significant finding for carers. Understanding carers' health problems and needs and identifying what forms of support could alleviate the stresses on carers are therefore key areas for further research by the NHS. Maintaining and improving carers' health is correct in principle, because they are patients in their own right. For the NHS and social care agencies it is also a cost-effective way of maintaining the essential support that the carers give to the cared-for. The health of groups of patients such as those suffering from diabetes or heart disease is made a priority in the NHS through specific targets and incentives. Heavily committed carers should also be a target group for support and health improvement. The necessary first step in enabling new and more targeted work to take place with carers within a GP practice population is to step up the pace of the work on identifying carers. In the late 1990s that was seen as essential. The Government had issued national priorities guidance on it in 1998, asking GPs, primary health care teams and social services staff to identify carers by April 2000. However, that target date was deferred and no new date has been set. The good news is that the momentum of the work that started in the late 1990s carried on for a number of years, and much good practice has been developed. Now it is seen to be important that carers be identified in a more focused way. GPs and their teams see limited value in wholesale identification of carers, and often reject such an approach for workload reasons. Current good practice suggests that it is worth identifying carers who would benefit from being referred to other agencies for support and assessment of their needs. Carers with the highest level of caring commitment are likely to be in greatest need of support, and also need to have their own health monitored more frequently. In a GP practice population of 2,000 there are likely to be some 200 carers, of whom about 40 are caring for more than 50 hours per week, so the task of identifying the most heavily-committed carers is manageable. Also, a wealth of good practice, protocols, guides and training is available on how to identify carers most effectively. It was clear from the report of the research done in 2003, which I mentioned earlier, that the work being done by GPs and primary health care staff on identifying carers is patchy. Some GPs and their staff work on it enthusiastically while others say that they are too busy. That means that carers using the GP practices that do not do such work are denied access to the services and support that they could get if they were identified and referred by their GPs. It would help if this work by GPs were better recognised in GP contracts. In current contracts, out of a maximum of 1,050 points available for quality of service, having a protocol to identify and refer carers is worth only three points. That is not a significant incentive; a larger contractual element would now seem appropriate. Also, if the Government were to set a new target date by which primary care teams working with social services staff were to identify carers—perhaps starting with the most heavily committed carers—that would send out the message that the Government considered the task to be important. If GPs identified those carers, they could offer them a health check. Standard 6 of the national service framework for mental health explains that carers of a person on the care programme approach should have"““an assessment of their caring, physical and mental health needs, repeated on at least an annual basis””." A similar approach could be introduced for other heavily committed carers. In Salford, the carers' centre is working with local GPs to identify and refer carers for support. Staff at the centre told me about a recent case that exemplifies the way in which a carer's health can improve when they receive the right support. The carer presented at the GP's practice suffering from stress and depression. The doctor prescribed anti-depressants and referred the carer for counselling. At the first counselling session, the counsellor asked whether the carer knew about the carers' centre and whether she had received an assessment of her needs, and the answers to both questions were negative. The counsellor referred the carer to the centre, which arranged a carer's assessment. It identified the need for respite care and help with personal care for the person cared for. With that counselling and extra support, the carer has already been able to reduce her use of anti-depressants. The primary care worker from the carers' centre contacted the GP's practice and found that it had no policy for identifying and referring carers. The example of that patient showed the practice how it could benefit from working with the centre. The staff have now received training in supporting carers, and the practice is making referrals to the centre. GPs and primary care teams would be helped greatly in the task of identifying carers if the Government had a publicity and awareness-raising campaign to encourage carers to identify themselves to their GP. Friday 2 December is carers' rights day, and that would be a good target date for such a campaign. Finally, I want to talk about the idea of extending the concept behind the expert patients programme to create an expert carers programme. The expert patients programme has been one of the more innovative concepts in NHS thinking, and I urge the Minister to look at extending it to create an expert carers programme. The NHS, social services and others rely on carers' knowledge and experience in managing many illnesses and chronic conditions. From the parents caring for a teenager with a chronic eating disorder to the spouse, son or daughter caring for a person suffering from Alzheimer's, we can see that there is a role in health care for the expert carer. The Institute of Psychiatry at King's College is interested in developing an initiative on expert carers to help those with anorexia nervosa and other eating disorders. The self-management scheme for carers at the Long-term Medical Conditions Alliance could also provide a starting point for an expert carers programme. The suggestions that I have made to improve the support that primary health care gives to carers include more research by the NHS into the impact of caring on the carer's own health, particularly at the heavier end of caring commitment; ensuring that the work of identifying carers in a GP practice population attracts a larger contractual element in GP contracts; setting a new target date for identifying the most heavily committed carers; a Government-run publicity and awareness-raising campaign asking carers to identify themselves to their GPs; and developing an expert carers programme. I look forward to the Minister's response.