Cost of Living: Public Well-being
Baroness Drake Excerpts(2 years, 1 month ago)
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Baroness Drake
That this House takes note of the impact of the cost of living on the public wellbeing.
Baroness Drake (Lab)
My Lords, the real and present danger of rising inflation is clearly and obviously undermining public well-being. It is common cause to want to increase growth, but the questions of how to, who benefits and who suffers on the journey plan are at the heart of the markets’ and the public’s failing confidence in the Government. The Government have frightened the ordinary people whose interests they were elected to protect.
The Government are now so deeply divided that chaos will of itself undermine market confidence in the UK. Borrowers faced paying the price for the market’s lack of confidence in the mini-Budget, and millions will now feel the cost of regaining it. The Prime Minister’s Budget undercut key institutions, came with no OBR forecast, lacked detail about costing, worked at cross-purposes with the Bank of England and led to dramatic shifts in the financial markets. Her approach invited no restraint and certainly did not consider public well-being.
Of course there are global pressures, but there is a unique UK government contribution. The chief executive of the Resolution Foundation called it
“the biggest unforced economic policy error of my lifetime … Lower taxes combined with a loss of market confidence mean rising interest rates, leading to higher mortgages and lower living standards.”
Rishi Sunak observed:
“We cannot make it worse. Inflation is the enemy that makes everybody poorer.”
Unfortunately, it was made worse—much worse.
On 23 September the fiscal Statement was delivered against the background of a rising cost of living, weak growth and rising interest rates. Kwasi Kwarteng said that it was
“a new approach for a new era … For too long in this country we have indulged in a fight over redistribution”,—[Official Report, Commons, 23/9/22; cols. 934-38.]
and that the new Government would “focus on growth”. That was a defining Statement. It conveyed the view that arguments over redistribution are an indulgence, that planning for the public well-being is separate from achieving economic growth and that the public benefits of growth would trickle down from the spending and investments of rich people and big corporations who are taxed less.
On trickle-down, oh so many authoritative sources reinforce the IMF view:
“We find that increasing the income share of the poor and the middle class actually increases growth while a rising income share of the top 20 percent results in lower growth—that is, when the rich get richer, benefits do not trickle down.”
Gross domestic product is an important measure of national performance. It indicates changes in the size and overall strength of the economy. There is growing recognition, however, of the limitations to the use of GDP because it fails to capture many things that society may value. There is a growing view that traditional economic measures should be complemented by well-being measures to inform policy and spending priorities. To lift from a Bank of England explanation:
“GDP doesn’t tell us anything about how evenly income is split across the population. Growth could mean everyone becoming better off or just the richest segment getting even richer.”
In 2018 the Treasury Green Book guidance on public sector appraisal and evaluation was revised to include references to well-being at all stages of policy development. I doubt that guidance got an airing in the preparation of the mini-Budget. The ONS has a well-being measurement framework consisting of 10 domains. I cannot cover them all but they include the economy, personal finances, where we live, health, personal well-being and the environment. As the FT reported, the ONS September figures confirm the stress that inflation, falling real wages and rising mortgage rates are placing on households, and the proportion in financial difficulty is increasing. One-fifth of Britons are being forced to borrow more to meet payments and half are unable to save at all. One-third have struggled to meet mortgage payments and we have not seen the full extent of the hikes in mortgage rates. Three-quarters—77%—of adults are worried about the rising cost of living. The experience of Step Change, the debt charity, aligns with these findings.
High inflation does not impact everyone equally. New Economics Foundation modelling shows that, on average, price increases have pushed up the cost by £2,300 a year of an essential basket of goods and services—the minimum income standard measured by Centre for Social Policy research. This rise for the poorest half of families is nine times larger than for the richest 5% as a proportion of income, and six times larger for middle-income families. Middle-income families are increasingly impacted. An additional 2.2 million people across 900,000 households will see their incomes fall below that standard in 2022, despite having average earnings from work of £33,000.
These findings and those of the IFS, the Resolution Foundation, the Legatum Institute, the Joseph Rowntree Foundation and many others confirm the importance of uprating universal credit and legacy benefits by inflation for the many stressed individuals and households. You do not get a clean slate by asserting that it is a new era; you have to carry the consequences of the impact on public well-being of the sustained cuts in social security benefits over the past 10 years and the compounding effect of future cuts. Asserting a clean slate is not enough.
Few things are more important for public well-being than a roof over your head, but mortgage rates are up, rents are rising, the stock of housing is stagnating and homelessness is rising. Adults in their 30s and 40s are now three times more likely to rent than 20 years ago. Household debt is rising. Household financial resilience is already in decline in the UK. Some households can weather the storm, but many others lack the resilience to do so. Employment benefits, social security benefits, private insurance, savings, affordable credit and fewer pre-existing debts strengthen financial resilience, but all those factors have been weakening. The majority of employers now pay only statutory sick pay of £90.33 a week, 11.5 million adults have less than about £100 in savings and 65% have no form of life or protection insurance.
Recent ONS findings on household financial resilience confirm that the proportion of households in financial difficulty is rising. Its opinions and lifestyle survey uses the affordability of an unexpected expense of £850 as a measure of financial vulnerability to identify those most at risk. More than one-third of adults reported that they could not afford such an expense. The groups more at risk and more likely to report that they could not afford an unexpected expense included adults on lower incomes, 40% of parents, 53% of adult renter households, disabled adults’ households, adults who were divorced or separated and adults in regions outside the south-west, south-east and London.
The Bank of England reported that credit card borrowing rose at its fastest pace in 17 years. When children live in stressed households, their physical and mental health suffers, as do their education and life chances. Increases in child poverty levels in England between 2015 and 2020 were associated with more than 10,000 additional children entering state care. Does the Minister agree with me that the volume of evidence on the stress of households now confirms the importance of uprating universal credit and legacy benefits by the rate of inflation?
Levelling up is a flagship policy that risks stalling. The phrase is disappearing from the Government’s lexicon. Rising inflation will reduce public investment and undermine the very prospects of private investors turbocharging regional growth. It will drive up regional inequalities in economic performance, life chances, health, income, education, children’s wellbeing and public services. If regional inequality is not at the heart of a growth plan, neither is wellbeing.
The Institute for Fiscal Studies observed:
“We’ll know we are on the way to levelling up when differences in health and life expectancy across the country start to drop. Sadly, that’s one measure of inequality that has clearly been moving in the wrong direction over the past decade.”
Female healthy life expectancy at birth in the most deprived areas was 19.3 years less than in the least deprived areas. For males it was 18.6 years less. ONS figures show that since early 2020, almost 400,000 people exited the jobs market with long-term health problems. The Government committed to addressing the wide inequalities in health outcomes between deprived and well-off areas, between white and BAME populations, and between north and south. So where is the promised White Paper on health disparities that was so integral to Boris Johnson’s declared mission to take “bold action” to address them? May I ask the Minister where is the White Paper? Has it been dropped?
The rising cost of living will drive more people into poverty, with serious consequences for health. New polling from the Royal College of Physicians shows that over two-thirds of people are more worried about their ability to stay warm and healthy at home this winter compared to last winter. A recent issue of highlights from the Lancet Public Health emphasises the relationship between changes in individual or household income and mental health and well-being.
The Money and Pensions Service reveals that three in 10 people—30%—report problems with mental health, up from 21%, particularly among the working-age population, linked to worse financial well-being. The Government’s health and social care Statement confirmed that the NHS backlog was rising and acknowledged that there is too much variation in social care across the country. They want to free up beds, with a focus on discharge to home or care home, to address the waiting list of 7 million. Following the scrapping of the health and social care levy, the funding increase for health and social care, based on forecasted receipts that would have been received from the repealed taxes—an estimated £13 billion per year—will now follow from general taxation. How will the Government replace the money that will no longer accrue from the health and social care levy: through raised taxes, more borrowing or public expenditure cuts elsewhere?
The levy was the answer to Boris Johnson’s promise to fix the social care crisis “once and for all”. Is it still the Government’s belief that the funding that will be taken from general taxation, instead of the hypothecated tax, will still fix the social care crisis once and for all, or has their view changed?
Given the stress on households, both economic and well-being measures must be brought into the evaluation of the decisions the Chancellor is currently considering. Market confidence needs to be restored but the public will want to understand the trade-offs the Government will now be making, and the implications for their national interest and their well-being, because currently they cannot—and they will want to know. I beg to move.
Baroness Drake (Lab)
My Lords, I thank the Minister for his reply. I have to acknowledge the humour he introduced at the beginning. He is quite right; one of the 10 domains of well-being that the ONS measures is governance—how decisions that affect ordinary people’s lives are made—so he was probably wise to bat that one away. I give him credit for fleetness of foot on that.
Given the instability in the Government, it is very difficult for him to give answers to questions with any confidence, and that clearly shows. It is not a reflection on his ability, but it is clear that at the moment any Minister for this Government cannot answer what are incredible challenges for most of the population. The Minister cannot tell us about the White Paper on inequalities, the Government’s confidence on dealing with the social care crisis or whether they are losing the political will on regional inequalities. Without meaning to be disrespectful, his inability to answer those questions in itself contributes to the evidence that this is a Government who cannot lead.
I thank all noble Lords who participated in today’s debate for making so many excellent contributions. They took different dimensions but brought it all so alive. In our normal daily lives, let alone in the statistics we have read—and I have read a lot over the last two weeks—we see the humanity and the challenges. We see our friends ringing up saying, “Oh my God, my son can’t afford the mortgage interest rate. What am I going to do? Am I going to have to go back to work and help him with the money?”. These are real human stories that people are experiencing. We live in extraordinary times. Our economy is under pressure, the public is frightened and the Government are in chaos, holding the confidence of neither the public nor the markets. I think it is a moment in our history as a country.
Those in our influencing institutions—those in the Bank of England and the Treasury, and our Parliaments and Ministers—must bear heavily the responsibilities that they have to discharge at this time. There really is a huge national interest here, above petty personal issues. For everyone, whether it is civil servants, parliamentarians or Ministers, this is the moment to recognise that they must do what is in the national interest. They must carry it heavily on their shoulders, though it may be a burden—because it should be—and deal with this cost of living crisis.
As my noble friend Lord Layard and the noble Lord, Lord O’Donnell, argued so persuasively, they must benchmark their decisions against the public well-being and show how they did it. For heaven’s sake, that is what the people of this country want to see and know. The confidence will not come back to our democratic institutions until we do that visibly. They need to see and know how we are looking after their national interest. We know that there are going to be more challenges, but I thank everyone who participated in today’s debate.
Queen’s Speech
Baroness Drake Excerpts(4 years, 10 months ago)
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Baroness Drake (Lab)
My Lords, what an act to follow.
The Queen’s Speech embraces policies directed at supporting working families, but I want to raise a growing systemic problem within our economy which the gracious Speech does not fully capture: the decline in household financial resilience—by which I mean the ability to cope financially when faced with a sudden fall in income or unavoidable rise in expenditure, and to reflect on a route to address it.
I recently chaired a steering group study into household financial resilience, under the governance of the Money and Pensions Service. Its membership ranged from the finance industry to Toynbee Hall, and was ably supported by Alan Woods, a retired senior civil servant from the DWP. The study examined findings from a wide range of respected sources through the lens of financial resilience, demonstrating the widespread nature of financial shocks and income volatility and indicating that low financial resilience is a substantial and widespread problem.
Growing evidence reveals that a single adverse event can push a household over the edge. Low financial resilience is not reserved to those on low incomes; it has travelled up the income scale. Each year some 4 million to 6 million working age people suffer a life event which can cause an income shock by reason of illness, job loss, relationship breakdown, death of a partner, or caring responsibilities. A further sizeable group experience other life events which disrupt household finances. Over 70% of those in regular work face significant volatility in monthly earnings. Some households are well placed to weather the storm, but many lack the resilience to do so.
A range of factors can increase financial resilience—such as access to employment benefits, state benefits, private insurance, savings, affordable credit, help from family and fewer pre-existing debts—but the evidence reveals that all those factors are weakening, shifting greater responsibility for resilience on to the individual, which many are ill-prepared to meet. The labour market is changing. Self-employment has risen to around 5 million, 60% of private sector employees work for SMEs, nearly 9 million in micro-businesses, and a growing number of workers lack standard employment protections. Fewer work for large businesses, which traditionally offered benefits that mitigated income shocks. Yes, more people have felt the benefits of employment, but there is a long-term decline in employer provision of occupational benefits, in both coverage and value, such as sick pay, redundancy pay and death benefits. Only 28% of employers provide more than the statutory sick pay of £94.25 a week.
Work is increasingly less secure and earnings less predictable. Means-tested benefits have fallen in real terms, help with housing and mortgage costs is restricted, 11.5 million adults have less than £100 in savings, and the FCA found that only 3% of adults had income protection and only 4% had mortgage protection insurance.
Owner occupation can boost resilience, but it has declined markedly among working age groups over the past 15 years. Low financial resilience matters because it can lead to problem debt, poor health, children’s loss of well-being and housing problems, and adverse effects on employers, utility providers, financial institutions and the economy.
I am not arguing specific policies but highlighting the evidence which demonstrates that falls in household financial resilience have been an unintended or unrecognised consequence of both socioeconomic and public policy changes. Addressing the problem requires a sound analytical basis, but current measuring of household resilience is insufficient to authoritatively inform policy. There is a compelling case for the Office for National Statistics to introduce a financial resilience index, which would: map the level of resilience in households and track changes over time, highlight segments where action is most needed, improve understanding of the underlying causes and drivers of low resilience, and provide a basis against which policies or actions could be tested.
I hope that the Minister will agree that, to improve the socioeconomic experiences of households, we need to measure and fully understand the problem of falling household financial resilience—and currently we do not.
Queen’s Speech
Baroness Drake Excerpts(5 years, 1 month ago)
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Baroness Drake (Lab)
My Lords, the Government may aspire to the uplands of the “greatest place on earth”, but social and economic headwinds may undermine that persuasive rhetoric. The growth in employment has been positive for households, but the labour market is softening and there is a growing body of evidence that household financial resilience is weakening. Many households are living on the edge. They are getting by, some comfortably so, but a single adverse event can push them over that edge. Low financial resilience is not reserved to those on low incomes; it has travelled up the income scale. Some are well placed to weather the storm of a sudden fall in income or unavoidable rise in expenditure, but others are not.
Each year, some 6 million working-age people face a life event likely to cause a substantial fall in income; a further 6 million face a sudden, unplanned expenditure need. These shocks arise for reasons such as illness, job loss, reduced hours, relationship breakdown, bereavement and new caring responsibilities. Low resilience has consequences for people, for welfare and health costs, for employers, and elsewhere in the economy. A range of factors increases resilience: access to employment benefits, state benefits, private insurance, savings, affordable credit, help from family and fewer pre-existing debts, but those factors are weakening, shifting more responsibility for financial resilience on to the individual, which many are ill prepared to take on.
Support from employer occupational benefits such as sick pay, redundancy pay and death-in-service payments is declining in coverage and value: only 28% of employers provide more than the basic statutory sick pay of £94.25 a week. State benefit rates have fallen in real terms; help with housing and mortgage costs has reduced. While it is true that more people are in work, one in six is self-employed, one in 12 has contracts with reduced employment protections and some 73% of people in regular jobs face significant fluctuations in monthly earnings. Fewer people work for large businesses, which traditionally offered benefits that mitigated income shocks. Now, 60% of private sector employees, more than 16 million people, work for small and medium-size enterprises and more than half, 8.8 million people, work for micro businesses.
On savings and insurance, the FCA found that 13% of adults have no cash savings whatever and that a further one in three has savings of only between £1 and £2,000, while 65% have no form of life or protection insurance.
Secure, regular work, with good employment benefits, is an important defence against low household financial resilience. Given the weight of the current evidence, moving away from a level playing field on employment standards, which the new Brexit allows, will not build the greatest place on earth but will push more families over the edge. Employment growth has been positive but as David Ramsden, a Deputy Governor of the Bank of England, observed, that businesses are increasing employment at the same time as they are reducing investment raises concerns over that resilience in the labour market. One explanation could be that businesses are substituting labour for capital, as hiring is easier to reverse than capital expenditure. A further explanation could be a shift away from capital-intensive, export-oriented businesses and into labour-intensive, domestically focused ones. Either way, neither is beneficial for financial resilience in households.
I welcome the pensions Bill. There is about £7.6 trillion of state, public and private pension entitlements in the UK pension system. The market and public policy supporting that system demand scrutiny and the Bill provides a further opportunity to do that. However, I am concerned it does not lock in that a pensions dashboard is for the public good, and that the best interests of pension savers are not to be traded off against the interests of financial providers. I am sure that this House will want to debate that issue with the Government at some length.
The Government could do much more to address the persisting gender pensions gap. Only about 36% of those eligible for auto-enrolment are women. Women’s ability to save is also constrained by income inequality throughout their lives. The highly regarded Fawcett Society has outlined the case for the introduction of a carers’ credit towards occupational pension saving, to ensure that those who take time out of paid work to care for children or adults would see their caring contribution recognised not only in the state pension system, where this is already the case, but also under the auto-enrolment system. Prior to the introduction of the flat-rate state pension in 2016, the principle of crediting carers applied to the state second-tier pension, S2P. That principle should not be lost but should continue to apply now that the second tier has transferred to private provision through auto-enrolment. I hope that the Bill will be the opportunity to push the Government on what progress they can offer to address this persistent gender pensions gap.
Lyme Disease
Baroness Drake Excerpts(9 years, 1 month ago)
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Baroness Drake (Lab)
My Lords, ticks are a tiny blood-sucking species which feed on animals including humans. They have been around a long time: they belong to the family of arthropods that began to evolve 500 million years ago. Despite this longevity, however, most of the UK population is still unaware of how nasty these little creatures can be.
Last month the London School of Hygiene and Tropical Medicine published its research into ticks to establish to what extent they carry the bacterial pathogen that causes Lyme disease. Its team of experts conducted research in south London parks, including Richmond Park, a nature reserve of some 2,360 acres. There they collected more than 1,100 ticks. A quarter of these were tested for the infectious pathogen and about 3% were found to be carriers. Their report, however, considers the potential risk to humans to be much more significant than the statistics might suggest, because almost all the infected ticks were found in open grassland in areas frequented by the huge number of visitors. According to a 2015 Ipsos MORI survey, Richmond Park receives 5.5 million visitors each year. It is no wonder that the London School of Hygiene has called upon the royal parks to encourage visitors to take preventive measures, by increasing public awareness.
However, this just is not happening—either in Richmond or elsewhere. I walk most days in Richmond Park and much work is done to keep it so beautiful. It has large herds of fallow and red deer, which are ideal tick hosts, but there is little information alerting people to the risks or suggesting what to look for, what to do and how to take sensible precautions, such as stay on paths, avoid dense vegetation, and cover arms and legs. I often see people and very young children with bare arms or legs walking through the dense ferns and long grass, and their parents are oblivious to the risk they face.
I suffered a tick bite, with its bullseye rash, a few weeks ago. My GP at the nearby Sheen Lane Surgery responded quickly and prescribed antibiotics. Other GPs may not be so alert, yet early diagnosis is key to preventing the disease progressing to more serious stages. Public Health England estimates that there are up to 3,000 new cases of Lyme disease in England and Wales each year. The British Society for Immunology confirms that cases have risen steadily, as they have in Europe. Apart from a rash, early symptoms can include fatigue, fever, and headache, y et there appears to be no consensus on the complexity of the disease or the many clinical outcomes that it can produce. The problem of observable clinical features is exacerbated by the difficulty in confirming a diagnosis. As Public Health England confirms, cases left unaddressed or belatedly treated with antibiotics can lead to very serious problems, such as Lyme arthritis, myocarditis, and meningitis.
Testing does not confirm the actual presence of the bacteria, simply the body’s immune reaction to having encountered that bacterium at some previous time. It takes several weeks for an infected person to produce the relevant antibodies, so an early test may produce a false negative result. Treatment by antibiotics can slow or stop the production of the key antibodies altogether. The charity Lyme Disease Action complains that many clinicians remain unaware of the extent of the limitations of laboratory investigations. Tests can help to confirm Lyme disease, but no blood test can completely rule it out. Yet some GPs treat test results as definitive.
The British Society for Immunology is right to call for the funding of further research to establish more accurate diagnostic tests. More research is also needed on the disease itself. No vaccine is available. Protecting against tick bites can help to prevent Lyme disease. Even if, like me, you take great precautions, you can still get bitten. This takes us back to the importance of greater public awareness and of information alerting people to the risk of tick bites, what to look for, what to do, and how to take sensible precautions.
NHS: Antiphospholipid Syndrome (APS)
Baroness Drake Excerpts(9 years, 8 months ago)
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Baroness Drake
To ask Her Majesty’s Government what actions they are taking to raise awareness of the autoimmune condition Antiphospholipid Syndrome (APS) amongst general practitioners and throughout the National Health Service.
Baroness Drake (Lab)
My Lords, I am keen to understand what the Government are doing to raise awareness of the autoimmune condition antiphospholipid syndrome—APS—among GPs and throughout the NHS, and to promote greater doctor recognition of the symptoms and earlier diagnosis.
APS, also referred to as Hughes syndrome, is an acquired autoimmune condition. The clinical features include thrombosis—venous, arterial and microvascular —and/or pregnancy complications and failure. It is important to recognise APS in the context of these problems and the need for appropriate treatment to reduce the risk of recurrence. In APS, the immune system produces abnormal antiphospholipid antibodies that target proteins attached to fat molecules called phospholipids, which makes the blood more likely to clot. There is currently no cure for APS but, if diagnosed, the risk of developing blood clots can be greatly reduced.
APS can affect people of all ages but it most usually affects adults aged 20 to 50, and affects more women than men. The exact prevalence of APS in the population is not known, but it is estimated that APS is present in around one in six of patients who have thrombosis or pregnancy loss, and present in 13.5% of strokes, 11% of heart attacks and 9.5% of DVTs. There is a need for a high-quality study of how common diagnosed APS is in the UK. Simple blood tests that identify APS, available in every district general hospital in the country, can often explain the underlying causes of strokes, heart attacks, pulmonary embolism and recurrent miscarriages. However, the condition is still poorly recognised in the UK. These simple blood tests can achieve earlier diagnosis and treatment for many patients, but there is an issue not only with testing, as some clinicians do not think of the diagnosis in the first place.
It is essential to raise awareness of APS among GPs and throughout the NHS. In my personal experience GPs and dentists, even if aware, are often not confident of treating patients who have it. This resonates with the findings of the charity the Hughes Syndrome Foundation, which ran a poll on the HealthUnlocked website. It found that 40% of GPs were aware of the condition but hardly any were confident in diagnosing or treating it. When the issue of making doctors more aware of APS was raised previously with the Department of Health, the response was that there are hundreds of different medical conditions and there is no particular reason why more attention should be drawn to this one—an opinion that I believe needs to be challenged.
There has been a significant increase in the level of research into APS, expanding the evidence base which continues to confirm that APS contributes significantly to the incidence of strokes, heart attacks, recurrent miscarriages and DVT. This is increasing awareness of the syndrome and the need for long-term treatment but, notwithstanding the growing body of evidence, while there are NICE guidelines for prevention and treatment of venous thrombosis there is none for APS.
The world of obstetrics has been one of the first to pick up on the syndrome. There are guidelines published by the Royal College of Obstetricians and Gynaecologists on the investigation of recurrent miscarriage, one of which is that women who have three consecutive miscarriages before the 10th week of gestation should be tested for APS. As a woman, one inevitably asks why it is necessary to suffer the deep distress of three failed pregnancies before blood tests are undertaken. Why can it not be done sooner? There are many other causes of miscarriage but that is not an argument against early testing of APS as, if its presence is confirmed, it is often treatable. The recognition and treatment of APL-positive pregnancies has undoubtedly delivered an improvement in pregnancy figures, but some hospitals do not include APL in their pregnancy screening. Yet APL-positive pregnancies increase the odds of stillbirth by between threefold and fivefold.
Guidelines on the Investigation and Management of Antiphospholipid Syndrome, published by the British Committee for Standards in Haematology, recommends that anyone under the age of 50 who has a stroke should be tested for APS. However, empirical research, again carried out by the Hughes Syndrome Foundation, found that not all the tests which look for APS are included in thrombophilia screens around the UK. The UK’s National Screening Committee’s guide to such screens states that the typical test includes lupus anticoagulant, but there is no mention of anticardiolipin or anti-beta-2 glycoprotein 1 tests. The Hughes foundation research reveals that not every hospital even tested for the lupus anticoagulant. If someone under 50 has a stroke, it is not certain that guidance will be followed or key tests carried out.
As clinical recognition has increased, so has the spectrum of signs and symptoms of APS to include features such as balance problems and gastrointestinal pains—symptoms which, when looked at holistically, can be indicative of APS. By not achieving greater awareness, pulmonary embolisms, strokes, heart attacks and miscarriages which are due to APS and often preventable will continue to occur, exposing individuals to risk and the NHS to much greater costs.
What action are the Government taking to raise awareness of antiphospholipid syndrome among general practitioners and throughout the NHS? What are they doing to promote greater doctor recognition and diagnosis of APS? What action are they taking to promote earlier and more routine blood testing to identify the condition? Will the Government promote APL testing in pregnancy screening throughout the NHS and review the policy whereby women have to have the distress of several miscarriages before they are tested for APS?
People with undiagnosed and untreated APS face being unwell over long periods, often for the want of simple blood tests. They can despair of ever finding a confirmed diagnosis or course of treatment, yet the treatment of APS can be life-changing. I conclude with a real-life clinical case study. Over a 30-year period Mrs A, now 50, suffered two DVTs, one pulmonary embolism, angina, transient ischaemic attacks, three miscarriages and, finally, a slight stroke. Eventually she was diagnosed with APS. I had my own journey, but eventually I met the wonderful doctors at Guy’s and St Thomas’ Hospital.
Children and Families Bill
Baroness Drake Excerpts(11 years ago)
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Baroness Massey of Darwen
My Lords, Amendment 267, in the names of myself and my noble friend Lady Drake, suggests changes to the statutory leave and pay of prospective adopters with whom looked-after children are placed, special guardians and family and friends carers. Insertions are suggested to sections of the Employment Rights Act 1996 and sections of the Social Security Contributions and Benefits Act 1992.
We had a lengthy discussion on support for family and friends carers in Committee on 26 October. I shall summarise a few points from that debate as a background to today’s considerations. An estimated 300,000 children are being raised by relatives and friends. Only an estimated 6% of children who are raised in family and friends care are looked after by the local authority and placed with approved foster carers. Children in kinship care do better in terms of attachment and achievement, but their carers are under severe strain—95% of family and friends carers say so. In the previous debate I called them heroes, and so they are. We are not really addressing the inequalities and unfairness that they face at the moment.
The Kinship Care Alliance attributes this strain to three major factors: kinship carers are not entitled to local authority financial or other support—financial support is discretionary; many kinship carers have to give up jobs to support the children and they have no right to specific services and benefits. Despite guidance to local authorities in 2011 which stated what support they should provide by September 2011, 30% of local authorities do not have a family and friends care policy. Financial costs include the immediate cost of a child coming to live with a carer, the costs of applying for a legal order to provide the child with security and permanence, loss of income and pension rights and, finally, the considerable costs of raising a child.
Children who live with family and friends care have experienced similar adversities to those in the care system or who are adopted, yet foster carers get a national minimum financial allowance and the Government are rightly improving adopters’ rights to a period of paid leave on a par with maternity leave. However, the 95% of family and friends carers who are raising children outside the care system are not entitled to anything in paid leave when they take on the care of children.
The Family Rights Group’s publication Understanding Family and Friends Care, reflecting the latest survey of family and friends carers in 2012, reported that only one in eight of the 327 respondents who answered the question about the effect that becoming a family and friends carer had had, said that they had continued to work as before, and one in nine that their partner had continued to work as before. Indeed, 38% had to give up their job to take on the care of the children—in London the figure was 46%. Overall, the picture which emerged was that carers were likely to have made sacrifices in the workplace in order to care for the kinship children. Very few just carried on working as before. Many decreased their working responsibilities and their income by reducing their hours or stopping work altogether—sometimes, I have to say, at the insistence of social workers.
Children who have been through trauma or tragedy, and who may have multiple needs, require time to settle in with their carers. The carers are often required to attend a number of meetings relating to the care and needs of the children, but the absence of any right to paid leave means that we are forcing many family and friends carers to give up work in order to do right by these children. We are pushing them into a life of dependency on benefits and into severe poverty. Some are grandparent carers who are unable to get back into employment when their grandchildren are older. Some are younger sibling carers who have few qualifications and only a few years in employment when they take on their younger brothers and sisters, but later find it difficult to re-enter the labour market. Research has shown that three-quarters of family and friends carer households face severe financial hardship. I hope that the Government will be able to address these urgent issues, and I beg to move.
Baroness Drake (Lab)
My Lords, I support Amendment 267, which would bring family and friends carers and special guardians in employment within scope for statutory entitlement to pay and leave when taking on the care of a child. The Bill extends the right that adoptive parents have to take ordinary and additional adoptive leave to approved adopters who have looked-after children placed with them. By contrast, the vast majority of family and friends carers who are raising children outside the looked-after system are not currently entitled to even a day of statutory paid leave when they take on the indefinite care of a child. Many have no entitlement beyond a few days’ unpaid emergency leave. That is a public policy that conveys that kinship carers have less value or make a lesser contribution than other carers of children, even though the children they care for often have complex needs. That cannot be right.
The amendment would extend the same employment rights to family and friends carers who have special guardianship orders, and to family and friends carers who take on the care of a child in certain defined circumstances. It would give the Secretary of State the authority to define those circumstances, and would extend the right to additional adoptive leave to family and friends carers and those with guardianship orders, again giving the Secretary of State the authority to define the prescribed circumstances.
There is a stark imbalance in the proposed employment leave entitlements for adoptive and prospective adoptive parents when compared to the lack of entitlements for kinship carers. That is unfair, irrational and inconsistent with the Government’s policy on the welfare and protection of children. It is unfair in that kinship carers voluntarily take on the responsibility, often in very difficult circumstances and at considerable cost to themselves, saving the taxpayer considerable amounts of money and achieving better outcomes for the child than if they had entered the care system. It is irrational in so far as the statutory rights to leave for parents, adopters or prospective adopters have been or are being improved, but no statutory rights are extended to the kinship carers of thousands of our most vulnerable children. It is inconsistent with current welfare policy in that the absence of a statutory right to leave, on taking care of the child, raises the barriers to carers’ continued workforce participation and increases the likelihood that they will become long-term unemployed and dependent on benefits. That undermines participation in the workforce as a route out of poverty for the children and the carer.
During the passage of the Welfare Reform Bill, the Government recognised that family and friends carers make a valuable contribution by caring for vulnerable children, and exempted those carers from work conditionality under the universal credit during the first 12 months of caring for a child. The Government have time-limited that exemption in the expectation that many carers should return to the labour market after a period of adjustment, so why not make provision for a statutory entitlement to leave and reduce the incidence of kinship carers leaving the labour force in the first place?
However, the problems that kinship carers face do not lie only in the requirements of the welfare system, they also suffer from the complete lack of recognition in employment law. The imbalance in their right is inconsistent with the protection of child welfare, in that kinship carers need to take leave to settle the children, who have often been through so much. This often comes after a long period of family crisis; the children can be traumatised and insecure, and they need to know that someone is there for them. That is precisely why social workers often want or require carers to take time out of work. There are also the practical requirements of making appointments with schools, solicitors and social workers, arranging legal orders and so on. Often, the children arrive unexpectedly in just the clothes they are wearing, but there is not even the most modest statutory provision allowing employed carers leave from their employment. Yet kinship care is the most common permanency option for children who cannot live with their birth parents. The same arguments apply to the extension of parental leave to kinship carers as were advanced for the introduction of adoption leave in the Employment Act 2002: the need for time for children to settle with and bond to carers and the advantages of enabling carers to remain in the labour market.
To scope the problem, an estimated 60,000 kinship carers have dropped out of the labour market to bring up children. The reasons for this include the needs of the child, but the fact that they are not entitled to time off increases the likelihood of their leaving the labour market, so contributing to the high proportion of kinship carers living in poverty. Family Rights Group research found that one-third were living on incomes below £350 a week. Grandparents Plus found that 73% of kinship carers were working before the children moved in, but that almost half of those who had been working left their jobs when the children arrived. Some 83% of those who gave up work say that they would have liked to have remained in work, while of those who gave up work just 13% are now back in work. Similarly, a Family Rights Group survey found that 38% of family and friends carers had left their job, lost their job or taken early retirement when they took on the care of the child.
The Bill presents the opportunity to extend parental leave entitlements to kinship carers who take on the indefinite care of a child, and to give them parity with prospective adopters. The majority of family and friends carers are not entitled to even one day of statutory paid leave. That cannot be fair. The arguments for providing a right to leave are equally compelling, whether looked at from the perspective of the carer or of the child.
Baroness Howe of Idlicote
My Lords, I have been reminded by the noble Baroness, Lady Massey, that we have had this discussion in the past. It struck everyone at the time how completely unfair this whole system was. Now that the noble Baroness, Lady Drake, has spelt out so many comparisons, it is, frankly, almost embarrassing to think about the disadvantage that kinship carers suffer when they take on this responsibility and often—most likely, I would say—produce much better results for those children, giving them a likely prospect of a far more fulfilled life than if they had gone into different forms of care.
In supporting what has been said, I would say to the Minister that I would love to hear that this area was going to be looked at hard and, as far as possible, a range of comparable systems would be considered for kinship carers, those coming into care and those who are to be adopted. If he could give us that assurance, or indeed tell us that a lot of this is already in process, that would be very helpful in settling our minds until Report, if nothing else.
Baroness Drake
“Kinship carers’ adjustment leave
(1) A qualifying employee who satisfies prescribed conditions may be absent from work at any time during an adjustment leave period.
(2) An adjustment leave period is a period calculated in accordance with regulations made by the Secretary of State.
(3) The regulations under subsection (2) above shall include provision for determining the extent of an employee’s entitlement to leave under this section but shall secure that where an employee is entitled to leave under this section he is entitled to at least four weeks’ leave, or for a longer period to be prescribed.
(4) An employee who exercises his rights under subsection (1)—
(a) is entitled, for such purposes and to such extent as may be prescribed, to the benefit of the terms and conditions of employment which would have applied if he had not been absent, (b) is bound, for such purposes and to such extent as may be prescribed, by any obligations arising under those terms and conditions (except in so far as they are inconsistent with subsection (1)), and(c) is entitled to return from leave to a job of a prescribed kind.(5) For the purposes of this section, an employee is a qualifying employee if he is a family and friends (kinship) carer looking after a child full-time because the parent(s) is unable to look after the child, in the first 12 months after the child moves in.”
Baroness Drake
My Lords, in moving Amendment 267A, I will speak also to Amendments 267B and 267C.
Amendment 267A proposes a new form of unpaid adjustment leave similar to parental leave—a modest entitlement of a one-off period of at least four weeks for a kinship carer during the first year after a child moves in. Often children arrive without notice and it may be unclear how long the child will be staying or whether it will be a long-term arrangement. However, the children have immediate and complex needs. Friends and kinship carers often lack parental responsibility when children first arrive because it takes time to arrange a legal order. Adjustment leave would meet kinship carers’ urgent need for time to adjust to the upheaval in the children’s lives, apply for a legal order, a residence or special guardianship order to secure the care of the child and attend numerous meetings, and would reduce the prospect of the carer being pushed out of their job as a consequence. The challenges they face were well articulated in the debate on the previous amendment.
Adjustment leave would be available for a kinship carer who can demonstrate that the children cannot live with their parent. A qualifying employee would have to meet prescribed conditions and the adjustment leave period would be calculated in accordance with regulations made by the Secretary of State. While they are seeking to secure the necessary legal orders, kinship carers may not fulfil the prescribed circumstances which the Secretary of State may have already, or may in the future, set for access to other statutory employment rights of leave. A modest period of unpaid adjustment leave would give such carers the urgently needed time to act to protect the child. At the moment they are given little or no support. The law recognises the need for an adjustment period for parents but gives no statutory recognition of any kind to kinship carers and no protection against the breaking of the employment contract when they take such urgent leave to care for the child.
The intent of Amendment 267B is to enable those with caring responsibilities—be they friends, family members or grandparents—for a child, a vulnerable adult or an elderly person to take up to two weeks’ leave per year unpaid in order to deal with pressing caring responsibilities. The amendment would give the Secretary of State the authority to define the prescribed conditions for qualifying employees and the period of leave, subject to an entitlement to two weeks’ leave in a given year. Parents of children are entitled to take up to four weeks’ parental leave a year, up to a total of 18 weeks, but many other carers do not have any statutory entitlement even to unpaid leave for a caring need, with the possible exception of a few days’ emergency leave.
Baroness Drake
I thank noble Lords who have spoken in this debate. I thank the Minister for his response, and I shall respond to some of his points. Obviously, it is welcome that the Government are looking at the issue of kinship carers and employment but, like my noble friend Lady Massey, I have to ask how long that will take. The issue is now pressing and urgent, and it is not a new one; the question of the lack of protection for this group of people was well aired during the Welfare Reform Bill.
I hear what the Minister says about scoping the project, but a lot of work was done by the noble Lord, Lord Freud, and the DWP team to identify this community and the challenges that it faces. Hopefully, that is banked and does not have to be repeated. The issue here is that, at the moment, maybe with the exception of getting a bit of emergency leave, the statutory provisions in this country do not protect individuals by giving them a statutory right to leave and an ability to keep their employment contract in place. It is welcome that the Government are going to return with a likely timetable before Report.
Most noble Lords here are familiar with the emergency leave provisions, but those do not address the kind of fundamental challenges that kinship carers face when they take on a child at very short notice, with all the complexity and problems that go with that, and subsequently become confirmed as the permanent long-term carer of that child. It is a little drop of a contribution and does not really start to tackle the fundamental challenges that many of them face. It still does not address the glaring imbalance between the support provided to prospective adopters, parents and surrogate parents when it comes to statutory protections. They are the Cinderellas and, consequently, so are the children they look after.
Flexible working proposals are clearly welcome. They are very important in allowing carers to balance their relationship with whoever they are caring for and to stay in work on an ongoing basis, but they do not of themselves provide the statutory right to leave, which is the essential issue for many people when they are either facing a pressing caring need or taking on a child in urgent circumstances. The flexible working arrangements do not necessarily address the immediate problem of the requirement for leave while allowing the employment contract to stay in place.
I hear what the noble Viscount says about grandparents. I have read the statutory provisions and the guidance—I must go and read them again. I worry that the phrase “reasonably relies” will have to be defined by case law. Therefore, there is a hurdle that grandparents have to first meet before they can say, “I will be the one that goes and helps the child. I am a person who that child reasonably relies upon for care in an emergency situation”. If the Government want grandparents to be supported and enabled to take emergency leave to provide that support for families, I struggle to see why one does not simply deal with it straightaway by a simple, modest little provision that would remove any ambiguity on that point.
The issue of statutory leave for kinship carers is not going to go away. So many people feel so strongly about it, and I am sure we will come back to it. I beg leave to withdraw my amendment.