My Lords, Amendment 219 in this group is in my name and I thank the noble Baronesses, Lady Pitkeathley, Lady Watkins of Tavistock and Lady Meacher, for also signing it. Just before I speak to that amendment, can I say that I also support the other amendments in this group so helpfully introduced just now by the noble Baroness, Lady Wheeler? I find her clarification of the difference between care workers and unpaid carers particularly helpful and vital in this debate because unpaid carers are invisible.
My amendment deals with unpaid carers. I am very grateful for the briefing from Carers UK which estimates —as we heard from the noble Baroness, Lady Wheeler—that there are as many as 13.6 million unpaid carers in the UK and, shockingly, over 1.4 million people providing over 50 hours of unpaid care a week. My brother looked after my mother for eight years, probably for 40 to 50 hours a week for most of that time. It meant that he just could not work at all. He is not alone.
I am sure we all know someone who is an unpaid carer. Even if they want to fulfil this role for their loved ones, society and the Government need to recognise the difficulties this gives the carers. The census in 2011 showed that carers are more than twice as likely to be in poor health than those who do not have a caring role—and they need support too, especially if they are isolated at home with the person they are caring for, whether that is day services or short in-patient respite care. Some 72% of carers have not had any breaks from caring during the pandemic and, as a result, are exhausted and worn out.
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One of the aims of this Bill is to drive closer integration between health and social care. However, while one half of the system—social care—recognises carers legally as an equal part, the other—the NHS—does not. Many councils, local authorities and other caring institutions are doing their bit in the social care system to try to provide support for unpaid carers but, for effective integration across the system, both the NHS and social care need to have a statutory duty to have regard to carers and to promote their well-being.
In practice, the amendment would mean that NHS bodies must identify unpaid carers who come into contact with NHS services and ensure that their health and well-being are considered when decisions are made concerning the health and care of the person or people who they are caring for. This is a strategic provision that sets out an absolutely fundamental principle. It does not confer any rights on an individual carer; in other words, the NHS would have a duty to “think carer” and it would help to avoid situations where carers had been omitted—for example in discussions about hospital discharge guidance, and in ensuring proper “carer proofing”.
While unpaid carers provide the bulk of care, and are often relied upon, they are not systematically identified, supported or included in the NHS. We know that there
is good practice in certain areas, but it is neither systematic nor systemic throughout the NHS. This lack of recognition and support for carers hinders evaluation and measurements of effectiveness. Closer integration between health and social care means that we now have the opportunity to manage this. We need invisible unpaid carers to become visible, so that everyone in the NHS “thinks carer” in everything they do with the person who they are caring for. By so doing, it will help the carer to fulfil their role. That is what my amendment seeks to do.