Health and Care Bill

Debate between Baroness Verma and Baroness Hollins

Lords Hansard - Part 1 & Committee stage
Monday 24th January 2022 Lords Chamber

[Baroness Verma (Con)]

My Lords, I declare my interest in the register. I am making a very short intervention just to talk about care workers. While there has been a great emphasis on the NHS, the crisis that the care sector is facing now is absolutely devastating. I was with care managers this morning, and they were wondering how they were going to manage the next few weeks, never mind the next few years. I urge the Government to understand that it is not just about added training and it is certainly not about planning for the future when the crisis is now. The crisis in the future cannot actually be estimated now, because we are in a crisis now.

So I urge the Government to look at the key issue around the sectors, and that is money. It is funding. We devalue the very people we expect to have value for in looking after the elderly, the disabled and those who need help. I came here not wanting to intervene today, but I was actually pushed by what I saw this morning with my care managers. They are absolutely struggling, trying to work out where they are going to find these magical beings who do not exist, because they have left the sector as a result of being so poorly paid, so badly treated and so deeply undervalued by everyone. I just wanted to put that intervention on record because, while we do need workforce planning, the problem is that we are so far behind the curve that it is going to take one mighty big plan to get this right.

[Baroness Hollins (CB)]

My Lords, I would like to follow the noble Baroness because my amendment relates to this issue. My Amendment 174 would require the Secretary of State to publish a report on the work undertaken to bring parity of pay between health and social care services.

When reflecting on the pandemic, it is clear that we owe an enormous debt of gratitude to our key workers, who went above and beyond the call of duty to keep people safe and healthy. Their efforts resulted in a deserved pay rise for NHS front-line staff. However, it highlighted the disparity between the treatment of healthcare staff and social care staff. While we clapped for both every Thursday, the gap in pay and reward between the two professions has grown even larger. This amendment reflects the undeniable need to see care staff recognised equally alongside NHS staff.

The social care workforce is, and needs to be, highly skilled. It holds a heavy weight of responsibility for the well-being and safety of vulnerable adults and children. Staff are trained to support medication, undertake PEG feeding, deal with seizures and administer first aid. They help people manage their finances, health and well-being, and they provide emotional support. They operate within a highly regulated sector, necessitating an understanding of health and safety, mental capacity and deprivation of liberty law, safeguarding and even how to positively manage challenging behaviour. The importance of their role cannot be underestimated. Indeed, the same can be said for other, highly skilled allied health professionals, such as nurses and occupational therapists, whose breadth of interventions provide enormous value within the care sector, as well as within the NHS. The turnover rate is just so high. It is unsurprising that staff such as nurses and OTs who can do so are more likely to seek better paid employment in the NHS.

A report recently commissioned by Community Integrated Care shows that many front-line workers in social care are financially “significantly undervalued” by as much as 39%—nearly £7,000 a year—compared to equivalent publicly funded positions. Social care struggles to match pay conditions available within the health sector, including pensions, annual leave entitlements and sick pay. That means that, when faced with the choice of working in either sector, individuals are more likely choose to work in health, if they can. We must help foster a culture of collaboration between the NHS and social care.

Skills for Care estimates that the adult social care workforce in England employs over 1.5 million people, yet there remains a major recruitment and retention crisis which, without intervention, is only likely to get worse. Currently, there are over 100,000 vacancies—that is around 6.8%—with projections estimating that nearly 500,000 new jobs will be needed to meet demand within social care by 2035. The turnover rate of staff is estimated to be over 30%, and higher still among those on zero-hour contracts.

Pay is not a panacea for addressing this issue. Much of it comes down to better wages being offered in other sectors which are able to use market forces to drive up employee pay. Furthermore, if terms and conditions are more closely aligned between social care and the NHS, staff may be able to move more easily between sectors, providing the continuity of care for their patients in the community, which is so valued by so many people.

Social care has been defined as a low-paying industry by the Low Pay Commission every year since the first report of the Low Pay Commission on the national minimum wage in 1998. The average pay for support workers in England who assist people to live independently in the community is £17,695, or £9.05 per hour, which is 45p per hour below the real living wage—that is the average. It seems nonsensical for a single system to have staff working at similar levels but some being paid significantly less than others. The Government have previously argued that, because of the existence of private providers in the care market, they cannot mandate a level of pay for care staff. But this just does not hold up to scrutiny: providers are paid an hourly rate for the contracts they are given by the local authority. This means that there is a conduit through which a fair rate for providers, and by extension employees, could be set.

The continued insistence that an increase in the national living wage is suitable remuneration for care staff does not reflect the level of skill and dedication that they display. While this may reduce the barrier to entering the adult social care workforce, we are still left with problems retaining what will go on to become a much more experienced workforce. There is very little incentive to stay in terms of pay promotion, and the experience pay gap has reduced even more, to something like 1% per hour in the past year. We must address this issue to support this workforce, now and for the future.

Higher pay and lower vacancy rates have been associated with more favourable outcomes during inspections by the Care Quality Commission, which is not surprising. Put simply, a stronger and more valued workforce improves patient care and retention. The demand for the skills of the workforce, now and for the future, means that ensuring parity of pay and conditions between the health and social care sectors is of paramount importance in the care, rehabilitation and protection of people who need this support.

I thank Mencap for a very good brief, Skills for Care for excellent statistics, and my noble friend Lady Finlay for supporting my amendment. I hope that the Minister will see its value.

Children: Parenting for Success in School

Debate between Baroness Verma and Baroness Hollins

Thursday 3rd February 2011 Lords Chamber

[Baroness Hollins]

My Lords, it is a real pleasure to be able to welcome the noble Lord, Lord Ahmad of Wimbledon, and to congratulate him on his maiden speech. I want to mention that we share not just Wimbledon in our title but a great love for Wimbledon and Merton, where he is very well known. The noble Lord has already had a stellar career in the financial sector and is an expert in marketing, but we have also heard about his contributions to the voluntary sector. He has also made a huge contribution to local government. I know too that the noble Lord has a lot of international connections and I look forward to getting to know him and seeing something of his youthful energy applied to the work of this House in the future.

I am grateful to my noble friend Lord Northbourne for introducing this debate. The topic is close to my heart as I originally trained as a child psychiatrist. My daughter is also a consultant psychiatrist and psychotherapist working in the field of perinatal mental health and infant development. I am going to focus on the role of specialist mental health services in enabling vulnerable parents to be successful in preparing their children for school.

Graham Allen’s report brings something to our attention that I am particularly pleased about. On page 40 he mentions the impact that unresolved trauma in youth can have on later parenting. He also draws attention to the importance of early intervention in leading to permanent improvements in a child’s health and developmental outcomes, but he stresses that this must happen in the first months and years of life, and even during pregnancy.

Research has increased our understanding of the importance of early experience for later child health and development. The evidence is strong. The emotional and physical environment and relationships during pregnancy and infancy are crucially important in enabling a child to be successful in school and in later life. This applies equally to children with learning disabilities, whose parents must also come to terms with their disability.

The evidence tells us that the first relationships in life are central to healthy development. Professor Schore, from UCLA, says that,

“the child’s first relationship, the one with the mother, acts as a template, as it permanently molds the individual’s capacities to enter all later emotional relationships”.

This profound statement has been understood within the psychoanalytic and psychotherapeutic traditions for decades, but now this has been recognised on a neurobiological level. He explains that the architecture of the growing baby’s brain will reflect the quality of the relationships that it has adapted to. The circuits formed during these early years, when the brain is most plastic, may last a lifetime. A baby needs a mother who can help him by responding sensitively to his distress, so the baby feels understood and can begin to manage his own physical and emotional experiences, both now and in later life. This is the foundation of communication, and when communication is absent the health of this emotional attachment needs attention.

Margot Waddell’s book Inside Lives: Psychoanalysis and the Growth of the Personality gives some excellent examples—which I do not have time to share with your Lordships now—which show well how a parent helps a small child to develop a capacity for learning by helping to manage their emotional experiences. Waddell explains:

“Something happened … which enabled the child to feel understood … Inseparable from this, no doubt, is an experience of being loved and of loving, and the deepening expectation of similar feelings to, and from, others”.

Without a stable early emotional development, children will be less able to form relationships and communicate with others, to learn or to take advantage of their school experiences. The early relationship with mother impacts on peer relationships at nursery and at school, and this can further affect the child’s ability to enjoy school and to be able to share in and learn from group activities.

So what early intervention programmes or treatments can help those who are struggling? An effective intervention recommended in Graham Allen’s report is the family nurse partnership. This programme was developed in the United States over 30 years ago but it has also had impressive results here in the United Kingdom—for example, by improving educational achievement and parenting practices, and by reducing child abuse and crime.

However, some women need more specialised mental health interventions to improve outcomes for their children and will not be able to respond to social or community-level interventions alone. Serious problems can affect women of all ages, cultures and socio-economic groups—for example, parents who themselves have experienced abuse and neglect are more likely to need health-led interventions—and there are other special cases.

Research is clear that mental health problems such as depression, psychosis and anxiety during pregnancy not only carry significant risks for mother and baby but can have long-lasting effects on cognitive, emotional and behavioural development. The complexity of attachment difficulties can be better understood by carrying out psychiatric and psychotherapeutic assessments. Health-led interventions are needed to address these complex and painful situations.

Perinatal and parent-infant psychotherapy can treat distressing experiences such as depression, anxiety and terror by understanding the cause of the difficulties and by focusing on improving the relationship between mother and baby from pregnancy onwards.

Tertiary centres such as the Cassel Hospital are also needed. Sadly, the future of the Cassel is under question. I hope the Minister will recognise the importance of providing specialist mental health services for mothers and their infants rather than waiting for child psychiatry services to intervene at a later stage when problems have already become established.

[Baroness Verma]

I remind noble Lords that this is a timed debate and that they have five minutes.