Social Care Funding (EAC Report)
Baroness Kingsmill Excerpts(3 years, 10 months ago)
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Baroness Kingsmill (Lab) [V]
My Lords, I am delighted that we have at last got this debate, and I share the frustration of the noble Lord, Lord Forsyth, at the time it has taken. He has been an indefatigable leader and chairman of the Economic Affairs Committee in the time that I have served on it, and I am most grateful to him and my colleagues on it for all the work and energy that have gone into not only this report but others, where we have tried to be practical and helpful and to make achievable suggestions for policy change.
I am also grateful for the passion with which the noble Lord, Lord Forsyth, has dealt with this and spoken about it today. My passion is somewhat dimmed by defeat, in a way, because it feels as if this is something that I have been banging on about for ages and we are still not really getting anywhere—but I am sure that everyone in the sector feels the same.
I will focus particularly on the plight of the care workers because that is my background and area of interest. The noble Lord, Lord Forsyth, has mentioned them, but it is worth going into some of the privations that they suffer in a little more depth. They are under- valued, underpaid and definitely undertrained; they do not have the status of nurses or even of childminders. The sector is subject to very weak regulation: we just do not know who they are or what qualifications they hold, and they are not registered with any professional body. The workforce of 1.8 million people in England is almost invisible—that is, until you need them, when they become very important.
The low status and poor treatment of care workers have led to a really vicious downward spiral in one of the most difficult sectors for workers, with a huge amount of exploitation. It is not just that they are badly paid; most of them earn less than the minimum wage, if you take into account the fact that many of them do not get paid for working in between clients. They are not paid for the journeys that they make and are often subject to very exploitative zero-hours contracts, which destabilise their lives and make it extremely difficult for them to do their work properly.
The workforce tends to be older women or migrant workers, which may very well account for the fact that they are not given much priority within the health and care service generally. They are overlooked and, as I say, we do not really know who they are. Turnover among care workers is enormous—between 30% and 40%—because they are badly paid; sometimes the supermarket down the road is offering a pound an hour more, and they have to go. They are often the main wage earner in their family, and they have to go where they can earn the most money, so there is a terrible, very rapid, turnover.
In the context of the Covid crisis that we are suffering, care workers are seven times more likely than the rest of the population to become infected with it. There is a huge amount of absenteeism at the moment because of illness or isolation, and there is a vast unmet need for care workers at the moment.
The other issue that is important when we talk about care workers is the fact that they have no career opportunities. Attracting people into the profession is very difficult: there is no progression and it is seen as unskilled work, which it most certainly is not because, so often, they need to have the skills to deal with complex feeding methods, using hoists for moving patients, dressing wounds and administering medication, as well as providing vital domestic and emotional support for the care recipients. They have to do all of this in 15-minute slots, if they are a domiciliary worker—
Baroness Scott of Bybrook (Con)
I remind the noble Baroness of the four-minute time limit.
Baroness Kingsmill (Lab) [V]
On that point, I will sum up simply by saying that I commend this report and hope that action comes as a result of it.
Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019
Baroness Kingsmill Excerpts(5 years, 2 months ago)
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Baroness Thornton (Lab)
I thank the Minister for introducing these regulations. I also thank my noble friends Lord Rooker, Lady Jones and Lady Wheeler for carrying the bulk of the food standards instruments that we dealt with before the summer, when we seemed to do a great many of them. As the Minister said, these are important regulations because they address the process for approval of substances that may be used to remove surface contamination from products of animal origin.
As the noble Baroness confirmed, this SI was discussed earlier this year, but a great deal has changed since then, as we all know. We have a completely new Government, though I am pleased to see that the noble Baroness has remained in her job. What has not changed is the uncertainty over whether the UK will leave the EU in the next 15 days or so, with or without a deal, and the impact that could have. For the record, once again, we find ourselves back debating necessary statutory instruments and having to spend time and money putting through legislation in case of a no-deal Brexit.
We all agree that the safety of our food is of the utmost importance to our health and well-being. We have been fortunate to lead the world in food safety, in some areas. We have also had to learn some very hard lessons from our own food scares. We know that food safety must be protected at all costs. Therefore, I share the Government’s commitment to ensuring that there is no change in the high-level principles underpinning the day-to-day functioning of the food safety legal framework. Ensuring continuity for business and public health bodies is of the utmost importance and in the interest of the public. This has been the protection that the EU regulatory framework has afforded us in the UK.
While the Minister assures us that there is no substantive policy change, I need further reassurance. Paragraph 2.7 of the Explanatory Memorandum states:
“Following further policy deliberations, a revised approach to describing the process for approval of substances which may be used to remove surface contamination from products of animal origin is felt to be desirable”.
What does that revised approach consist of if it is not a policy change?
Why was this SI not among those we took through in March? What would have happened if we had left in March and this SI had not been on the statute book? What would have happened to this regulatory framework?
I am not convinced that the SI does not give some leeway for Ministers to approve substances that can be added to our food. I shall be interested to hear how confident the Minister is that the high standard of food safety will be maintained. What additional substances could be approved by Ministers if needed? How will that impact food safety? The safety of our food is hugely important and we cannot get this wrong, so I have made these very brief comments. I do not want to delay the Committee, but I welcome interventions from other noble Lords. We will, of course, not oppose this statutory instrument and I look forward to the Minister’s response.
Baroness Kingsmill (Lab)
My Lords, I shall add a few comments to my noble friend’s remarks on subjects that concern me considerably. I lived through the BSE food crisis. It was the result of what was described at the time as a minor change in the regulations. That minor change cost UK farmers something like £3.75 billion and led to the slaughter of very many cattle. Minor changes to regulations can make an enormous difference. Therefore, we should give this statutory instrument very careful scrutiny. It seems a little rushed, so I should like more explanation of why we have to rush it. It ought to be considered very carefully.
I notice in Hansard the words that the Minister repeated today: “for the moment”. That worries me slightly. What does it mean? Is there some intention to change things in the near future and is this SI just a means of getting something through fast, as it is necessary for the moment?
My concerns about this minor change in regulation are not simply about the food safety implications, although they are enormous, but about changes to the substance used to remove contamination from animals for human consumption. That can mean many different things and can have a huge impact not only on consumers’ health and safety but on animal welfare. I think particularly of what has become a bit of a euphemism for health and safety in food: chlorinated chicken. I am also concerned about the substances used to prepare farmed salmon for human consumption. I should like specific clarification of the Government’s intentions about future regulation in this area, to the extent that the Minister is able to give it.
One of the things that has always concerned me about these regulations—I have dealt with quite a few—is that there seems to be no sunset clause in the event that we do not leave without a deal. Is there a proposal for a sunset clause for these regulations? Can the Minister give us an assurance about the extent to which animal welfare has been taken into account? We all know that chlorinated chicken means treating at the last minute and that it does not matter what contamination the animal received beforehand; once you have washed it in the swimming pool, if you like, it will be okay for human consumption, which is not necessarily the case. It is important that such issues should be taken into account and considered in these regulations.
Care Sector
Baroness Kingsmill Excerpts(10 years ago)
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Baroness Kingsmill
To move that this House takes note of working conditions in the care sector.
Baroness Kingsmill (Lab)
My Lords, I am delighted to have the opportunity today to throw some light on this difficult and not very well publicised area of employment. Care workers are probably the most invisible members of the United Kingdom’s workforce. I have recently written a review of their working conditions and I was shocked. In the past, I was an employment lawyer for many years. I knew very little about the care sector and I am very grateful to those Members of the House here today who know an awful lot more about it than me.
Although I knew very little about the care sector, as a former employment lawyer I knew a lot about employment. This was my fourth report on employment conditions in various sectors of the economy. The previous one was on the fashion industry and the unhealthy terms and conditions of catwalk models. I have to tell the House that there are far fewer people working as models in the United Kingdom than there are care workers and yet you would not have thought so, given the amount of publicity that particular report received. It became known as the “skinny models” report and it was all over the press. This report, however, on the terms and conditions of care workers, passed almost unnoticed. When I sought some media attention for tonight’s debate, they said, “Give us the news element of this”. What they really meant was, “Tell us some ghastly story about some hideous happenings in a care home or about people who have been badly treated”. That is what creates the attention around this sector. I am, therefore, particularly grateful for the opportunity to throw a little more light on this area and for other noble Lords to add their experience to the debate.
We all know that care is not a glamorous occupation. It involves dealing with vulnerable people on a daily basis, entering the homes of elderly and disabled people in distant locations, providing intimate care and support and, often, prompting the taking of vital medication. Engaging with elderly people with dementia, Alzheimer’s and multiple conditions, in short bursts throughout the day, is a difficult occupation which none of us would find easy to do on a daily basis. These activities do not take place in high-tech hospitals with white-coated doctors and eager students. They do not take place in a colourful playroom with engaging staff and constant activities until the users are collected at the end of the day. They take place in people’s homes and care homes where there are multiple residents with multiple conditions.
Care plays a vital role in our society. Care workers deliver the support needed to people nearing the ends of their lives, to people who are disabled and to people with chronic illnesses, enabling them to live comfortably and in a dignified way. Yet it is the poorest people in our economy who are dealing with our most vulnerable people. The people in this sector are paid less than those in any other of our economy. They are looking after our most vulnerable citizens, in many cases in the most awful of circumstances, yet we value them the least and pay them the worst. Their conditions of work are among the worst.
Care workers are undervalued, underpaid, undertrained and underregulated. There are between 1.5 million and 1.8 million people working in the care sector and we do not know who they are at all. There is no register of care workers in this country. They come and they go, they ebb and they flow, we do not know who they are or where they come from. There is no system of regulation at all. I compare and contrast this with, for example, the care of children, where there are limits. Childminders have to be trained, are limited in the number of people they can care for, and have status. They are not particularly well paid either, but they have career progression and an opportunity to acquire qualifications and improve themselves.
Care workers do not have the status of childminders and they certainly do not have the status of nurses, although they often undertake in people’s homes many of the services that nurses provide in hospitals. They are subject to no regulation or registration. When I was looking into it, I often heard people saying, “I am just a care worker”. It sounded so unfair because there are, among them, some incredibly dedicated and committed people who love what they do and love the people they are taking care of.
However, their work is far more complicated than they give themselves credit for. They often have to deal with complex feeding methods. They have to learn how to use hoists for moving clients, but they are not taught this; they have to learn it on the job and many of them suffer injuries while doing so. They learn how to dress wounds, how to administer medication and, above all, how to provide vital emotional and domestic support for vulnerable people. It is certainly not a job for the faint-hearted and it is certainly not just a job. However, as I said, they are subject to some of the worst conditions of any workers in the United Kingdom. Their wages are almost universally either the national minimum wage or no more than 15% above that minimum. Frequently, even the national minimum wage is ignored, with employers refusing to pay domiciliary workers for the time it takes them to travel between clients.
Many care workers do not know what hours they will be working from week to week. Zero-hours contracts, which we have all read about, play a huge role in the sector and destabilise workers’ lives. Qualifications are patchy, the Care Quality Commission’s requirements have been reduced, and the provision of care has been increasingly focused on the independent sector. Training varies considerably, with no real common framework for care workers. The workforce tends to be older women or migrant workers. Many older women who have never really been in the workforce before but have been bringing up families and have been in so-called caring roles for most of their lives think that, when their children leave home or no longer have the dependence they once had, they can do something that they are good at. They feel as though they have no choice—that this is the only thing they can do—and often that is the case.
The same applies to migrant workers. Frequently, agencies bring in migrant workers from different countries. In many cases, they are subject to the most minimal checks on who they are and what their background is. In many cases, English is not their first language, and indeed often they do not speak very good English at all, yet they are looking after people who are anxious and vulnerable and who need support. That is not to say that brilliant care is not often given by these very same people, but it makes for a risky situation if people cannot communicate properly with those who are looking after them.
It would be very good if there were more young people in care work, but young people rarely enter this sector. There is no career progression and no status, and it is badly paid. It would be very good if we could get career progression going in this area, but at the moment younger people are not interested because it does not exist.
The truth of the matter is that care is in crisis. The exploitation of workers in the care industry has highlighted how badly they are treated, and it has highlighted the severity of the situation regarding their ability to deliver quality care to some of our most vulnerable citizens. Poor conditions for workers often lead to poor quality of service for clients, and this is particularly the case with the elderly and the disabled.
It has to be said that the pressure of austerity measures on local authorities has led to years of underfunding and to chronic conditions for care workers and service users alike. Throughout my work on the review that I have recently undertaken, the call from all sides and from all parties was for greater funding in the care sector. Underfunding the care sector is a false economy. If we truly valued care, there would be less need for vulnerable people to go to hospital, with both a benefit for the public purse and a benefit for the service users, who would avoid the trauma and uncertainty of a hospital visit.
Let us not forget that the care industry is big business. Research from Skills for Care estimates that it is worth about £43 billion to the UK economy, and it is growing as the population ages. Care for the elderly is a lucrative industry. Despite this, it is characterised by a plethora of small businesses dependent on diminishing local authority budgets. Even the largest provider, Four Seasons Health Care, has only a 5.2% market share.
It is a sector that has been beset by scandal. Companies such as Southern Cross Healthcare, which operated 750 care homes and employed 41,000 staff until it closed in 2012 with huge debts, have left the industry with a bad a reputation for poor financial management. Many smaller providers are also just hanging on by the skin of their teeth, threatened with closure. The sector is haunted by the spectre of abuse, such as the horrific case last year of the Orchid View care home. Given that it is likely that most of us will spend the last two years of our lives in receipt of some form of paid care, it is a sector that merits a brighter light being shone on it, and I am particularly grateful for the opportunity to do so this evening.
Baroness Kingsmill
My Lords, I am delighted by the response to this debate. I did not expect that there would be as many speakers as there were, and I am very grateful to those who have stayed late and made such valuable contributions. I have had a number of tweets; I happen to know that people are watching this debate and many of them are going to be very pleased by the universal support, encouragement and appreciation that have been given to social workers.
Although every speaker has spoken warmly of the contributions that those care workers have made, the fact is that we are exploiting their dedication and commitment. We are looking at a group of workers who through their commitment and dedication have invited their own exploitation. We all know what needs to be done. My noble friend Lord Lipsey pointed out that there have been many reports prior to my own that have said more or less exactly the same thing in different words. We know what needs to be done. We know how to fix it.
I tried extremely hard in my report to make recommendations that were not going to have serious financial impacts, because we are all very much aware of the limitations on government spending, both for this Government and probably the next. But the fact remains that there is a case for priorities and we are not making a priority of these most vulnerable people. I am very grateful to other noble Lords who pointed this out.
Truthfully, this is a dysfunctional market. It was interesting to hear the noble Earl talk about the functioning of the market, but the fact is that it has all the characteristics of a dysfunctional market. I sympathise hugely with the noble Lord, Lord Curry, whose efforts to create a proper working environment for the care workers in his employ are being increasingly frustrated by his inability to recruit and retain proper staff.
Although, as I say, I tried to keep my recommendations to those that would cost little money, the fact is that we need more money. We need more money and the only source of that money is the Government, so we must find a way of finding that.
Health and Social Care Bill
Baroness Kingsmill Excerpts(12 years, 10 months ago)
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Earl Howe
My Lords, I hope I have already explained that. In our conversation with the CQC, it made very clear that this would not be like any other requirement placed upon it. A requirement to prove candour will require the CQC to engage in a much more continuous and intensive process of monitoring than some of its other requirements. That was the distinction that it made and that is why it said that it did not have the capacity to fulfil this duty if it were built into the Bill.
I am afraid that the amendment would not be effective in meeting our shared objective. That is my problem with it. I have listened to the arguments put across by noble Lords in relation to primary care. I want to see openness in primary care as much as I do in secondary care. However, we still need to consider which requirements would work best in primary care.
Baroness Kingsmill
Can the Minister explain the distinction and why we cannot have both? It seems that culture change is best reinforced by legislative change, and the contractual point that the Minister made is a good idea.
Baroness Northover
For clarification, can I point out that only the mover of an amendment or the noble Lord in charge of a Bill should speak after the Minister on Report, other than for short questions of elucidation to the Minister or where the Minister speaks early to assist the House in debate? As this makes very clear, it is possible for a noble Lord to ask a short question about what the Minister has just said, but he or she should not introduce other speeches.