Disabled People: Personal Assistants

Baroness Thomas of Winchester Excerpts

Wednesday 7th September 2022 Lords Chamber

[Baroness Thomas of Winchester (LD) [V]]

My Lords, the Minister has partly replied, but can he say a bit more about Home Office bureaucracy which is holding up the recruitment of care workers from overseas?

[Lord Kamall (Con)]

One issue that I think noble Lords across the House agree on is a suggestion made by the noble Baroness, Lady Thornton. If we want to make sure that we have the right number of workers, we should improve training over here, but there will clearly be a skills gap in this country and therefore we need to look overseas. Sadly, as I said earlier, under the Home Office rules at the moment, individual employers do not count as sponsors. Officials in the department are having conversations with DWP to look at whether that can be rectified, or whether there is a way to find a trusted sponsor.

Neurological Conditions

Baroness Thomas of Winchester Excerpts

Thursday 9th June 2022 Grand Committee

[Baroness Thomas of Winchester (LD) [V]]

My Lords, I too thank the noble Lord, Lord Dubs, for securing this debate, and the Neurological Alliance for undertaking such a large patient survey of people living with a neurological condition in the UK. Its findings include the views of people like me who are living with a muscle-wasting or neuromuscular condition, in my case Pompe Disease.

Muscular Dystrophy UK recently published Shining a Light, a report which demonstrated that people living with muscle-wasting conditions have struggled to access critical services such as specialist muscle clinical appointments, specialist respiratory care and specialist neuromuscular physiotherapy, especially because of the pandemic and shielding. This lack of provision has had a negative impact on their overall physical and mental well-being.

As a result, an ever-increasing backlog of patients is waiting for appointments and, in many cases, the delay in access to specialist services has resulted in a more acute progression of a person’s condition. This has, in turn, led to the need for additional treatments and longer stays in hospital, thus putting even more pressure on an already strained service. This is evident as Muscular Dystrophy UK’s findings indicated that delayed access to muscle clinics, physiotherapy and hydrotherapy would result in irreversible muscle weakness and muscle loss.

All people living with muscle-wasting conditions should be able to access fully equipped multidisciplinary teams, diagnostics and clinical services when they need them, no matter where they live in the UK. Staffing is a crucial aspect of improving neuromuscular care, and I support the need for the Government to develop a strategy to attract, recruit and retain the neuroscience workforce, specifically the front-line specialist nurses and other clinicians needed to deliver holistic care on a sustainable basis. I believe, as others have said, that establishing a neuro task force will go some way to solving this increasingly complex problem affecting this patient community.

Adult Social Care

Baroness Thomas of Winchester Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Thomas of Winchester (LD) [V]]

My Lords, could the Minister say exactly what the Government are doing right now to recruit more carers, in view of the huge shortfall in the workforce? Are they largely leaving it to hard-pressed local authorities?

[Lord Kamall (Con)]

The Government are in conversation with local authorities at the moment to look at the short-term issues. That is why we have announced increases in funding, particularly as part of the winter plan. The White Paper we are talking about today looks at the longer term, but we have also recognised the short-term issues, which is why we have announced these increases in spending.

Covid-19 Vaccinations

Baroness Thomas of Winchester Excerpts

Monday 8th November 2021 Lords Chamber

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Thomas of Winchester, is taking part remotely and I invite her to speak.

[Baroness Thomas of Winchester (LD) [V]]

My Lords, will the Minister look into booster vaccines for vulnerable people such as me who need to be vaccinated at home? There is never any information about this cohort of people who are at the mercy of there being a healthcare professional from a local surgery available. There is a danger that they may be overlooked by surgeries, some of which might be overwhelmed at this time.

[Lord Kamall (Con)]

The NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or a consultant if they have not done so already. I understand that that includes the option to be vaccinated at home, but I will double-check and write to the noble Baroness.

Social Care in England

Baroness Thomas of Winchester Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Thomas of Winchester (LD) [V]]

My Lords, I declare that I receive self-funded care and disability living allowance. I thank the noble Baroness, Lady Pitkeathley, for securing this debate, and for her very powerful opening speech. I will speak very briefly about home carers. This is a growing sector whose growth has been accelerated by the pandemic.

As others have said, more money is needed right away to pay such carers a better wage, and for their travelling time in rural areas, where there are more home carers, and in towns with heavy traffic. This cannot wait until 2023. As we have heard, carers are among the lowest-paid workers, earning less than cleaners and shop workers. This is appalling as most of them are highly skilled. Demand for care from working-age adults rather than from older people is increasing, as we have heard, although as the population ages, this will change quite rapidly. Also, there are about 112,000 vacancies for carers. According to the recent King’s Fund report, more experienced care workers earn only about 12 pence more than those starting their careers, which is one reason why the workforce needs more pay, training and development.

I turn very briefly to unpaid carers. The whole care system would collapse if they did not exist. As the noble Baroness, Lady Pitkeathley, said, they save the economy literally billions every year. I would like to ask the Minister what the uptake of the carer’s allowance is. It is quite a complicated allowance and is not generous, so my message to the Government is to make sure that carers are better rewarded and that the carer’s allowance is simplified and increased.

Social Care and the Role of Carers

Baroness Thomas of Winchester Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Thomas of Winchester (LD) [V]]

My Lords, I shall speak about home carers which is something I know about as I have them myself. So, I declare that interest. I feel strongly that being a carer is not a low-skilled job. Even helping to dress a frail, elderly or disabled person safely is a skill which should be recognised. Disabled people might be under the care of well-paid hospital consultants, but the consultants could not do their job without the day-to-day work of competent but low-paid carers. Half-hour-only visits are common, with no travelling time paid. It is not uncommon for carers to be the first people to find that a client has fallen or even has died in the night. Carers, particularly in large cities, are often from overseas and have to get used to difficult clients who sometimes resort to mild racial abuse, particularly if those clients are slipping into dementia. Good carers are like gold dust. They should be much better rewarded.

Covid-19: Vaccination Prioritisation

Baroness Thomas of Winchester Excerpts

Wednesday 25th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the underlying principles of the advice of the JCVI are to reduce mortality, to improve population health by reducing serious disease and to protect the NHS and the social care system. The basic insight is that the risk of serious disease and death from Covid increases exponentially with age and increases in those with a number of underlying health conditions. Those are the basic principles of the interim advice and they will evolve over time.

[Baroness Thomas of Winchester (LD) [V]]

My Lords, what consideration will be given to the vaccination of up to 250,000 care assistants employed by disabled people under the direct payments scheme who are not on the radar of any care providers or local authorities?

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well for care providers. The prioritised list starts currently with older adult residents in care homes and care home workers, but she makes the case for the 250,000 who may not be on that principal list. That is something that I will take away with me.

Queen’s Speech

Baroness Thomas of Winchester Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Thomas of Winchester (LD)]

My Lords, I shall speak briefly about the Government’s national disability strategy, the plan for which was published in an additional paper with the gracious Speech. The plan makes some very bold promises, saying that it wants to

“use all the levers of Government to support disabled people to achieve their potential”,

and that it will be developed with disabled people, disability organisations and charities and will include housing, education and transport. This is obviously good news, particularly if all government departments are to be involved. But the Government must put some real energy and determination into following through what they are proposing, and we need regular updates to find out exactly how they are going about this task. Who will be in overall charge of formulating the strategy? Will it be the Minister for Disabled People? Is there a rigorous timeframe?

If I sound somewhat sceptical, it is because we have been here or hereabouts before and nothing much has happened. Look at housing; here I echo what the noble Baroness, Lady Warwick, said. We spent last year hearing promises about a consultation on housing that would include accessible and adaptable housing, but this has not even started yet. Why was the Bill to exempt public lavatories from paying business rates withdrawn? This was another blow for helping disabled people have the confidence to get out and about. I hope it will be reintroduced as soon as possible.

I see that there is to be a Green Paper about the benefits system and how that affects disabled people. One specific measure is that a PIP award will now have a minimum award length to stop constant assessments—I should think so too. But the whole PIP process needs to be looked at afresh. It is nothing short of a scandal that 75% of PIP appeals are overturned at the tribunal stage. I ask the Minister to commit to a review of the whole PIP process, including the training of assessors. There is a very long waiting time for tribunals, which are expensive for the Government and stressful for claimants, so getting the initial assessments right and reviewing the points system must be of prime importance.

I hope the Minister, in replying to this, will not be tempted to recite the amount the Government are now spending on disability benefits, because this does not automatically make it the right amount. If the Government are really serious in wanting disabled people to be able to fulfil their potential, they must be prepared to put money behind any proposals they put forward for development in the new strategy. Most importantly, they must involve and consult disabled people every step of the way.

Unpaid Carers: Support

Baroness Thomas of Winchester Excerpts

Thursday 13th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord will know that the spending review has not yet started, so I cannot tell him what is happening in the negotiations. What I can tell him about is the work that has already gone on to improve social care funding: giving local authorities access to around £10 billion more in dedicated funding for social care from 2017-18 to 2019-20; an additional £410 million of new money to improve social care for older people, people with disabilities and children; and £240 million more for winter pressures. However, the noble Lord is absolutely right that it is no good improving the medium to long-term outlook for social care if we do not ensure that we also address the immediate challenges that it faces.

[Baroness Thomas of Winchester (LD)]

My Lords, the right reverend Prelate mentioned one group of carers. I would like to ask about those from the BME community, many of whom do not know about the benefits to which they would be entitled—the carer’s allowance, for example, and even the national insurance waivers that come with it. What are the Government proactively doing to support them?

[Baroness Blackwood of North Oxford]

This is a really important question, because the carer’s allowance has increased and is available as a non-means-tested support. I can reveal today that one of the key issues that is being looked at as part of the social care Green Paper is ensuring that financial support and employment status for carers are clearer, so that they can access all the support they are entitled to, but also to try to make things simpler.

Brexit: Health and Welfare

Baroness Thomas of Winchester Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Thomas of Winchester (LD)]

My Lords, I too salute my noble friend for securing this timely debate. Last year, seven of us spoke on this subject, when the emphasis was on the effect of Brexit on disabled people. We are now talking about the effect of Brexit on the health and welfare of everyone in the UK, but many of the same arguments are valid. Of course, “welfare” means many things: it means well-being, but it also means aid and benefits. Therefore, I will touch on a future without the European Social Fund, where negotiations concern reciprocal social security benefits, the blue badge scheme and the European health insurance card, which we currently all have. First, however, I will say something about EU health workers—as absolutely every speaker in this debate has so far.

Since the previous debate, I have spent much of my time in either a hotel or a hospital, where I have witnessed at first hand the extent to which both sectors rely heavily on workers from the EU, several of whom are now my friends. I have found EU workers outstanding in their work ethic, courtesy and willingness to go the extra mile. We are a rapidly ageing population, so our health and care needs will inevitably ramp up. I wish I was confident that all government departments had factored that into their future plans. Disabled people will also live longer with more complex conditions, so the UK needs as many good health and care workers as it can possibly take. Yet, not surprisingly, the numbers from Europe are dropping fast. Many of these invaluable people sense that the climate has changed and feel they are no longer welcome. I find this perception shocking and deeply shaming, and try to counter it whenever I can. Luckily for us, many other EU workers are not going down this route—perhaps because they are settled, with children at school.

Many younger disabled people who need full-time personal assistants—they prefer that term to “care workers”—are really worried about a potential shortage. What is not generally known is that emergency PA cover is often found from EU countries. One of Muscular Dystrophy UK’s trailblazers said:

“When I need someone at the last minute as an emergency, they often fly in from elsewhere in Europe”.


I was going to cite a whole lot of figures but I do not think there is any point as noble Lords have already done that. However, the independent Migration Advisory Committee, which was commissioned by the Government to advise on the new border policy, is not due to report until the autumn, so there will be uncertainty for many months to come. That makes planning for the future extremely difficult for everyone—we do not know what the status of these invaluable workers from the European Union will be. The King’s Fund has also speculated on how restrictive the future policy will be, and whether the set-up will focus on high-skilled labour or will target specific shortages.

While talking about the importance of EU workers in both the health and hospitality sectors, I should like to put in a word for those doing low-skilled but vital jobs, such as cleaners—thousands of whom are not British. I fear that Brexiteers who were critical about freedom of movement rather implied—as I think the noble Lord, Lord Balfe, said—that only high-skilled migrants would be welcome. This is very short-sighted when we know that many crucial but low-skilled jobs are difficult to fill with British-born workers—I think the noble Baroness, Lady Warwick, mentioned this too. Are the Government taking any initiative to make sure that we hang on to our EU workers in the health, care and hospitality sectors? Many younger disabled people have had their care packages slashed already because of cuts. In the future this could be because of the chronic shortage of labour, not just the expense.

Last year I spoke about the long-standing provision in EU law to co-ordinate social security schemes for people moving within the EU and the EEA. Can the Minister tell us where the negotiations are with regard to this reciprocity? Similarly, with the blue badge disabled parking scheme, will there be reciprocal arrangements with EU member states after the UK leaves the EU? As we have heard, around 27 million people in the UK currently hold a European health insurance card, yet we do not know what is going to happen to that. Will any rights we hang on to be portable?

A different matter entirely is the question of the European structural funds, of which the European Social Fund is an important part. Very basically, the structural funds aim to level the playing field between regions in the EU by helping fund projects in less developed regions, largely through local authorities. Two areas in the UK which have received a lot of funding are west Wales and the West Country. The European Social Fund promotes the EU’s employment objectives by providing financial assistance for vocational training, retraining and job creation schemes. It partners thousands of small projects run by neighbourhood charities and not-for-profit organisations to help disadvantaged people find work; for example, projects which try to improve the employability of people with disabilities. Although the Government have said that they will guarantee funding for existing projects even after we have left the EU, will new projects under this heading get funding? We know that the Government are going to replace the structural funds with the UK shared prosperity fund but we have no details. The Government say that it will be,

“cheap to administer, low in bureaucracy and targeted where it is needed most”,

but we have absolutely no idea how it will work.

Others have mentioned, at length, the European Medicines Agency, which is moving—perhaps it has moved already—to the Netherlands. We know that the Prime Minister is keen that we should have some sort of membership of the agency, for which we should pay, but we do not know what the other member states think of this plan. We certainly do not want to have to set up a parallel body. The risk is that the UK not playing any part at all in EMA processes might result in the UK being behind the EU in the queue for approval of new treatments for all kinds of rare diseases. For boys with Duchenne muscular dystrophy, who have only a certain number of days on which they can walk, this will be tragic. In any case, as a result of Brexit, the influence the UK will have on the EMA will be significantly diminished compared with the role which the Medicines and Healthcare products Regulatory Agency currently plays within the EMA. Negotiations should try to secure the quickest access to treatments for UK patients.

Others have mentioned clinical trials. Currently clinical trials must comply with the clinical trials directive, soon to be replaced by the clinical trials regulation. This much more satisfactory new regulation will apply from 2018, facilitating large pan-European trials. Should the UK no longer be governed by the clinical trials regulation, UK involvement in these trials may become more difficult and costly. We need to adopt the new regulation to ensure harmonisation and the continuation of UK participation in Europe-wide trials.