Social Care: Workforce Strategy

Baroness Pitkeathley Excerpts

Wednesday 22nd March 2023 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government what plans they have, if any, to reduce their £500 million investment in the social care workforce; and when they will publish their strategy for increasing the size of that workforce.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Department of Health and Social Care will shortly publish a two-year plan for how it will reform the adult social care system. That publication will confirm the Government’s commitment to the 10-year vision set out in the People at the Heart of Care White Paper. It will provide specific detail on how we will implement workforce proposals, including funding activity and milestones.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but note that he has not assured me about the proposed or rumoured cuts to the current investment in the social care workforce. As he knows, these rumours have caused great distress to those trying to provide decent care to some of the most vulnerable in our society, against the background of a 13% vacancy rate—so one in eight posts is vacant—with subsequent difficulties in recruitment and retention. The money that has been promised seems very slow in reaching the front line, according to local authorities and carer organisations.

I am very glad to know that we are going to see the plan for the social care workforce; we have waited for it a long time. When we finally see it, which I hope will be before the House rises for the Easter Recess, will it ensure that those who work in social care are properly recognised, rewarded and trained so that, at last, their status is comparable with those who work in the NHS?

[Lord Markham (Con)]

I apologise because, in some ways, the timing is slightly unfortunate with the report coming out before the Recess, as is my understanding. I am not allowed to steal much of Minister Whateley’s thunder on that, but I will answer as best as I can. I hope that noble Lords will be pleased that questions around training, recognition of the importance of the service and career structure are all addressed in the report.

Physiotherapy: Rehabilitation Services

Baroness Pitkeathley Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Totally. I am sorry to hear that case, and I think that we would all agree that that is not the sort of service we would want to see. As I said, we have put increases in staff in place—there have been 3,300 extra staff since 2017—but, clearly, we need to do more. That is why I was very pleased to read that this area is an important part of the workforce plan, which noble Lords will be happy to hear we are now seeing drafts of.

[Baroness Pitkeathley (Lab)]

My Lords, if stroke survivors are imprisoned at home with a bed and a commode, as my noble friend’s Question suggests, does the Minister agree that their unpaid carers are similarly imprisoned? Is the lack of rehabilitation services part of the reason why the numbers of people giving more than 50 hours a week unpaid care is increasing rapidly, as the latest census figures suggest?

[Lord Markham (Con)]

As I said, physio is key to rehabilitation, whether for strokes, as we have discussed, or for any one of the number of reasons that people are in hospital and trying to come out. As I mentioned, we have seen increases: there are about 7% more people now in training each year, and that figure increases each year. We now have about 50,000 physios in the public and private sectors who are providing those types of services. Clearly, there are examples where we need to do more, but we are also making progress.

Times Health Commission

Baroness Pitkeathley Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

My experience of royal commissions is that they take a couple of years to report. I do not want to wait a couple of years. I want to get on with it now. We have some very good minds in the department working on it, with access to all of this. I am always willing to take on new ideas from new minds but we do not need a two-year report; we need action now.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that, in any investigation of health and social care, the voices of patients and users must be loud and strong? How are the Government going to ensure that this happens?

[Lord Markham (Con)]

Clearly, the patient has to be at the centre of everything. That is what the plan for patients is about. It is also what patient choice is about; we are using other ways to make sure that people can get treatment quickly when they need to. It involves using the independent sector, as pioneered by colleagues in this House, and learning lessons from that so that we can get on top of waiting lists, which we all agree we need to do.

Care Homes: Staffing

Baroness Pitkeathley Excerpts

Wednesday 11th January 2023 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government how they will ensure that care homes where they block-buy places to assist with hospital discharges are adequately staffed.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

On Monday, this Government announced an additional £200 million of funding for short-term NHS step-down care packages to help ease the pressure on local hospital beds. ICBs will work closely with local authorities to purchase places in care homes and other settings. Using their knowledge, they will commission appropriate beds where there is sufficient capacity, including workforce capacity, to meet patient needs.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that response, although it seems a bit more knee-jerk than it does a coherent strategy and it poses as many questions as it answers. For example, are the Government planning to pay care homes directly to pay recruited staff or to work through ICBs and local authorities only? What rates are to be paid? Will it be more than care workers currently earn, so as to compete with the retail sector? Given that there are 160,000 vacancies in the care workforce currently, where are those workers to come from, without pulling staff away from an already understaffed NHS?

[Lord Markham (Con)]

Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.

Excess Deaths in Private Homes

Baroness Pitkeathley Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend makes a challenging point. This will be a subject of the inquiry, on which I look forward to hearing more.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that one of the elements here may be the lack of support to family carers, who are often the element most involved in providing care at the last stages of life, and in particular the lack of willingness to engage with family carers, who are the people who know most about the condition? I have lost count of the number of family carers who have said to me, “They just didn’t want to know my side of this element.”

[Lord Markham (Con)]

I thank the noble Baroness. We have spoken before about this in the House. I agree with the general point that family carers, probably more than anyone, have great knowledge to bear, and so absolutely that should be an important component.

Hospital Beds: Social Care

Baroness Pitkeathley Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

Of course, the noble Baroness is aware that it is the third parties, whether it be the local authorities or the private sector, that employ them. But what we have done in terms of setting the national living wage, which I believe is around that amount, is exactly making sure that there is a minimum amount that these people can get. About 65% of the funding going into the system goes through to wages, so the £2.8 billion increase next year will flow largely into wages and salaries.

[Baroness Pitkeathley (Lab)]

Every one of the interventions we hear about points to the inadequacy of the social care system and every one of the interventions that the Minister makes, however well intentioned—and I do not dispute that they are well intentioned—concerns piecemeal reforms. Will the Government ever accept that the only thing that is going to solve this ongoing problem, which is only going to get worse, is a wholesale reform of the social care system?

[Lord Markham (Con)]

There are a lot of questions that we need to answer in this space—I absolutely accept that—and lots of things that need long-term thought. I think and hope that noble Lords are starting to see that thinking emerge. A lot more needs to be done at the moment, but I think that we accept that this is a long-term issue that needs to be resolved with help from all sides of the House.

Care Homes: Severely Disabled People

Baroness Pitkeathley Excerpts

Wednesday 30th November 2022 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of reports that some care charities have been forced to evict severely disabled people from their care homes because of disputes with local authorities about fees.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The disruption of care where it negatively impacts vulnerable service users is unacceptable. Under the Care Act, local authorities have a duty to shape their markets and provide services to those with eligible needs. The Government are providing up to £7.5 billion over the next two years to support adult social care and discharge. This historic funding boost will help local authorities to start addressing waiting lists, low fee rates and work- force pressures in the sector.

--- Later in debate ---

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but I cannot say that any of it was a surprise to me. Will he acknowledge that this is just the latest manifestation of a long-standing problem? For years, the social care system for adults with complex disabilities has been held together by charities and not-for-profits that have poured literally millions from their reserves into subsidising the services they provide for the NHS and local authorities. Now these organisations are in financial trouble and can no longer afford to do so. Those who are suffering are those in greatest need. Does the Minister agree that the whole system of funding for social care is broken and that the only solution is complete root-and-branch reform, not the piecemeal solutions offered by the Government?

[Lord Markham (Con)]

I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.

Social Care Sector: Staff Shortages

Baroness Pitkeathley Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend. Overseas and Commonwealth recruitment is a key area here, which is why I am delighted that we have addressed the visa restrictions and entered social care on an essential workers list. We have already seen 15,000 people come in this space, and that figure is increasing month on month. My noble friend is correct that this is a critical area for recruitment for us.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that the more problems there are with paid workers in social care, the more difficulties fall on the nearly 10 million unpaid carers. Of those who are receiving the carer’s allowance, 40% say that they are already in debt and not sure how they will manage through the winter. Does he also agree that, in view of the myriad problems in social care, it is time to listen to what the noble Lord, Lord Forsyth, asked the House last Thursday, and think about a proper review of the whole of social care?

[Lord Markham (Con)]

My Lords, I thank the noble Baroness. The new funds mentioned recognise that this is critical to the health of our National Health Service and the flow. As part of that, as I mentioned in my Answer, we are looking at staffing plans across allied health professions in the health and social care space, and it is vital that we get the recruitment to this area to solve the overall issue of flow and NHS wait times.

Long Covid

Baroness Pitkeathley Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

I offer warm congratulations to my noble friend on securing this debate and on the way in which she introduced it. She and other noble Lords will know that, by the time you get to this stage of a debate, there is not much new to say. However, I have been listening very carefully, and there is no doubt that there is a great deal of agreement about the fact that long Covid provides a new challenge for an already much-challenged health sector. In listening to the excellent speeches that have been made, I see three main problems about long Covid. There is the issue of recognition and awareness, the issue of treatment, and the issue of its impact.

The first problem seems to be knowing whether you have long Covid or not. The same could be said of Covid itself. When I tested positive for Covid last year, no one was more surprised than I; I thought I had a little head cold, and was astonished to find when I was tested here at your Lordships’ House that I was positive. I know many people have had the same experience. This very uncertainty of knowing whether you have long Covid adds to the anxiety of sufferers. Just this morning, I was speaking to a young man in his 30s who had such awful brain fog, as he called it, after getting long Covid, that he thought that he had senile dementia coming on. I am glad to say that he is now recovering.

This also applies to treatment. There seems to be no agreed accepted programme of treatment for long Covid sufferers and availability of treatment is patchy in the extreme. In many areas, it seems to depend on the chance of finding a sympathetic doctor or nurse. If you have had symptoms for more than four weeks that is supposed to be an indicator, but it is not always accepted that these are the same symptoms and that they are always present, as we have heard many noble Lords mention. There does not seem to be any agreement about that and we are all reminded of the experience of those with ME, which noble Baronesses have brought to our attention. Many people suffered for many years with what was called “yuppie flu”, and it was seen as the last resort of malingers, causing much distress to sufferers.

That brings me to the impact of long Covid. Much has been said about its effect on the labour and employment market. The Institute for Fiscal Studies has been mentioned by many. It said that

“long COVID shows some persistent labour market effects, with impacts being felt at least three months after infection”—

I emphasise “at least”. I remind your Lordships that we must consider these possible effects on the ability to work in the light of the terrible workforce problems that many noble Lords have mentioned, particularly in the health and social care sector. There are nearly 170,000 vacancies in social care alone already, and so many people are burned out and leaving the workforce. If long Covid further affects these shortages, as seems likely, we must be fearful of the ability of the NHS and social care to provide even the minimum care which citizens have a right to expect. As others have said, the need for further research and for action as a result of research already commissioned is urgent.

I must draw noble Lords’ attention to the particular problems faced by unpaid carers in this regard. We all know that many carers have been extremely careful with the possibility of catching Covid and have been shielding for much longer than the general population so that they do not pass it on to the person they care for. From a benefits perspective, people with a new illness, such as long Covid, who are of state pension age, must have evidenced health needs for six months before they can even claim attendance allowance. The cost of being impaired by long Covid will not be offset for this group or for their carer. As one carer said: “My husband may not be able to return to work due to long Covid, so the loss of half the monthly income, coupled with the rise of everything from fuel to heating costs and a new baby, will be devastating for us as a household”. One carer who themselves had long Covid said: “I am a carer who has long Covid and I am on a long waiting list to get help. I have been told that I will most likely have to wait for nine or 10 months before my initial appointment. I asked for my situation as a carer to be taken into consideration but I was told this was not considered as a circumstance that would merit any special consideration.” This is not acceptable.

There is no doubt that long Covid is having a negative impact on our nation, especially on the most vulnerable. We must take it seriously. We must give support in the benefits system, in practical support and in long-term policy around how this is going to affect us in the future. I hope the Minister will be able to confirm that the Government are committed to many of the things that have been called for today—better diagnosis, better collection of data, more consistent messaging and, above all, an understanding of the wide-ranging impact of long Covid on the health, both physical and mental, of our whole nation.

NHS: Discharge to Assess Policy

Baroness Pitkeathley Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

Carers are well valued, and the need to ensure that our social care workers are well valued was the subject of a lengthy debate that your Lordships will remember from a couple of weeks ago. In that, we set out our plans for recruitment—not only domestically but internationally. I am glad to say that, even since then, we have seen a further uptick in the number of people recruited from overseas. Overall, it is understood that this is a vital area as part of the ABCD—which still exists. The “C” for carers is still very much part of this, so we are actively monitoring those recruitment plans and making sure that we are trying to provide every element of support.

[Baroness Pitkeathley (Lab)]

My Lords, I hope the Minister will forgive me for correcting his figures but the figure we generally use for unpaid carers now is nearer 10 million since the pandemic. In view of the truly shocking statistics in the Carers UK report that was published today—I am glad that the Minister said it will inform the department’s policy—have the Government given any consideration to revisiting the carers action plan, which went out of date two years ago, or, better still, reviving the idea of a national carers strategy? The first one was published more than 20 years ago.

[Lord Markham (Con)]

My understanding is that part of the guidance will be informed by making sure that action for carers is there but, when I see the guidance, I will make sure that it covers those elements. I agree, as we all do, with the premise. If the carers action plan is out of date—again, this is legislation that this Government have brought forward to show that we understand the importance of carers—clearly it is something that I will take up.