Welfare Reform and Work Bill

Debate between Baroness Hollins and Baroness Pitkeathley

Monday 14th December 2015 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, Amendment 64 concerns those people who are kept out of the workforce as a result of their caring role. Every year, 2.1 million people take on an unpaid caring role and nearly 2.1 million people find their caring role comes to an end. While not of all of those whose caring role finishes have given up work to care or may be of working age, a considerable number of them are in that situation. Indeed, Carers UK research shows that 2.3 million people have given up work at some point to care, unpaid, for loved ones.

People give up work to become a carer for all kinds of reasons. It may be simply through personal choice or because there are some unreliable services out there that provide substitute care. Others feel forced to leave through a lack of carer-friendly employment practices such as flexible working and paid care leave.

The Government do not currently collect information about the number of working-age carers who remain out of work after their caring role ends. However, evidence from Carers UK’s Caring and Family Finances inquiry indicated that former carers who are of working age remain significantly less likely to be in work than non-carers of working age.

Leaving work to care puts pressure on the day-to-day finances of carers and their families, but it can also have far-reaching consequences for their long-term financial independence as they struggle to return to work after a caring role. Former carers out of work report high reductions in their income as a result of the legacy of caring, with over 80% saying that their income was more than £10,000 a year less than it would have been if they had not been carers.

The end of caring responsibilities can cause complete disruption to family finances, but the wider economic impact is also vast. Research from Age UK and Carers UK indicates that £5.3 billion has been wiped from the economy in lost earnings because of people who have dropped out of the workforce due to caring. Providing the right amount of support to enable carers to return to work is essential, not only for their health, well-being and finances but for the wider economy.

Our ageing population and the fact that more people are living with long-term conditions means that the demand for care will rise. Measures therefore need to be in place for those who choose to give up work to be able to return. A requirement to report on the support available to former carers and the number of former carers in employment would ensure that this often-hidden group would be given the tailored support they need. Does the Minister acknowledge that more needs to be done to help former carers back into employment and will he undertake a review of the support currently available to former carers? Does he agree that helping former carers back to work benefits both the carer’s own personal health and finances and the economy as a whole?

[Baroness Hollins]

My Lords, I will speak to Amendment 67, in support of my noble friend Lady Campbell. Given the Government’s ambitious commitment to halve the disability employment gap, it seems logical and common sense to require the Secretary of State to report on progress, but such a report would need to be broken down by disability or impairment. For example, the Spinal Injuries Association draws attention to a number of issues that prevent people with new spinal cord injuries returning to work. I shall mention just two of those. The first is the need to have the right care and support package in place that is flexible enough to enable a person to work. The second is the need for accessible transport to and from work.

The employment rate for people with learning disabilities, mental illness and autism remains stubbornly low, which highlights the very real structural and attitudinal barriers that exist for them. Worryingly, the Health & Social Care Information Centre reports that the percentage of people with learning disabilities in paid work has dropped from 7.1% to 6% in the past few years. To be frank, the current government employment schemes have failed people with learning disabilities. The National Development Team for Inclusion has done some thorough research into the cost-effectiveness of employment support for people with mental health problems and learning disabilities. It shows that much of the current public spending in this area is being wasted, as it goes on non-evidence-based models that are more expensive and have poorer outcomes than the approaches that do work. If scaled up, effective interventions could be expected to support up to three times as many people in retaining paid work. This would save considerable sums in traditional care services.

A major obstacle for people with learning disabilities to getting into work is the lack of aspiration, for themselves if they have grown up not having any expectation of working, and of their families, their supporters and the professionals who advise them. The two approaches found by the NDTi to be effective were individual placement support and supported employment. I declare an interest here as I have published a book for employers which tells the story of Gary Butler and his work at St George’s, University of London, where he is employed to teach medical students how to communicate with people with learning disabilities. It is interesting because it is a job which only those with learning disabilities can do. The normal image of work that is suitable for such people is traditionally along the lines of collecting trolleys at Sainsbury’s and so on, but there are jobs which are particularly suited to people’s own needs and interests. St George’s has been employing two people with learning disabilities as trainers for 23 years. It is something that I initiated after having seen a similar kind of scheme in Boston.

With the right support, people with learning disabilities and those with mental illness make valued employees who are more likely to stay in work with lower sickness rates than non-disabled people, and there is research evidence for this. I hope that the Minister will recognise the value of a detailed report so as to understand any remaining barriers to halving the disability employment gap and, as my noble friend said, to get behind the figures.

Health and Social Care Bill

Debate between Baroness Hollins and Baroness Pitkeathley

Tuesday 13th March 2012 Lords Chamber

[Baroness Hollins]

My Lords, I support the amendment. I note that one of the reasons given for not considering statutory regulation for this group is that there is a very high turnover of staff in this grade. This seems to me to be a symptom of an unsatisfactory situation and perhaps points to the poor job satisfaction and lack of prospects for healthcare workers. My noble friend has pointed to the problems with skill mix. I think that she was really talking about skill mix across the whole range of mental and physical healthcare settings and not just physical healthcare. Within that, she would have included people with learning disabilities.

It seems to me that there must be some minimum requirements for training and supervision. I know that the Government suggest that it is the responsibility of the employer, and perhaps also of the commissioner, to ensure that the service which is provided reaches minimum standards. Perhaps that requires that, in order for commissioners to contract with an employer, a service has to have been appropriately accredited. A service which has been accredited has of course been accredited for the whole service, not just for the work of individual staff, who are subject to their own regulatory authority.

This morning, I revisited the Royal College of Psychiatrists’ accreditation standards for adult in-patient wards for people with learning disabilities—I should remind noble Lords that I am a past president of the Royal College of Psychiatrists and a psychiatrist myself. The college’s general standards very helpfully include attending to recruitment and retention of staff, training, supervision, management of complaints and so on. It is helpful to think about the relationship between the necessary accreditation of services and the need to attend to the training and aspirations of all those staff who work in such services: retention and job satisfaction are key to this.

[Baroness Pitkeathley]

My Lords, I join with others in paying tribute to the noble Baroness, Lady Emerton, for her tenacity and commitment in keeping the issue of healthcare assistants before your Lordships’ House. She may not be my noble friend in the political sense, but she has been my friend in the professional sense for many years.

I am sorry, therefore, to disagree with her on this particular issue. Indeed, it seems that I am a lone voice disagreeing with her. I certainly want to emphasise that I do not disagree about the problem with regard to healthcare assistants which has been so thoroughly and persuasively set out by her and other noble Lords. But the Council for Healthcare Regulatory Excellence, the organisation which I chair, disagrees with her, as she knows, about statutory regulation being the solution to these problems. The CHRE has had the opportunity of speaking to many of your Lordships in two seminars organised by the Minister, so I do not need to take up time here repeating the arguments. I will say only that mechanisms already exist to deal with the difficulties which your Lordships have set out. These include ensuring that those supervising healthcare assistants take their supervisory responsibilities seriously. The Nursing and Midwifery Council is providing strong direction on this with its codes. Employers are required to ensure safe systems of work, which include giving support to healthcare professionals in delegating and supervising effectively. There is also the vetting and barring scheme, whose aim is to prevent unsuitable people from entering or remaining in the workforce.

Add to this the expense and relative slowness of statutory regulation and it seems to add up to a case showing that the increased public protection that we are all seeking can be achieved by applying existing mechanisms more firmly. We should consider other ways of making this large group of workers, low paid as they are and with a 30 per cent turnover, as we have been reminded every year, feel more acknowledged and valued. There may well be a role for a professional association with a voluntary register, but principally we must use existing processes effectively before we embark on statutory regulation.

With regard to voluntary registers, which have been mentioned so much this morning, or accredited registers, as proposed by the Bill, much work has already been done by the CHRE. We are using the term “assured registration” to distinguish it from the old notion of voluntary registers and to describe the process of organisations assuring the individuals on their register and then the CHRE accrediting the organisations and their registers, thus creating accredited registers. I remind your Lordships that the whole purpose of such a scheme is to enhance consumer protection. The standards to be met by organisations which hold accredited voluntary registers will include standards of competence, education and training, registration of complaints and information provision. I certainly do not want to argue that this is the same as statutory regulation, but for many professions it offers further safeguards for patients and public, and that is what we are all seeking.