Under-occupancy Charge

Lord MacKenzie of Culkein Excerpts

Thursday 28th January 2016 Lords Chamber

[Lord Freud]

When we looked at the surveys on this originally, the figure was that roughly 20% of people might want to downsize in order not to have the subsidy removed. Many have downsized and local councils are stepping up the provision of appropriate housing—one-bedroom or two-bedroom flats—to match demand. So there are signs in the research we have conducted that people are adjusting to this policy.

[Lord MacKenzie of Culkein (Lab)]

I want to reinforce the point just made that “by and large” is not good enough in these sorts of cases. I cannot see for the life of me how any Government with a shred of decency think that having a panic room to protect vulnerable women in particular can be classed as a spare room. How on earth can the Government seek to appeal that?

[Lord Freud]

The people in these cases were receiving discretionary housing payments. These are small examples. Our guidance says that local authorities should prioritise these areas and we will reinforce that guidance. As I say, the Supreme Court will be judging this way of ameliorating complex areas. These are two examples. There are quite a lot of hard cases, and it is important that we get to all of them. If you start to define them all in legislation, you end up with a lot of legislation. The issue that the Supreme Court judges will be looking at is whether we are looking after the hard cases in the right way.

Welfare Reform and Work Bill

Lord MacKenzie of Culkein Excerpts

Monday 25th January 2016 Lords Chamber

[Lord McKenzie of Luton]

My Lords, in moving Amendment 31 in my name and that of my noble friend Lady Sherlock, I shall speak to our other amendments in this group. Noble Lords will be aware that this is also a rerun of the amendments discussed in Committee. We found the Government’s arguments on that occasion less than convincing. As they stand, Clauses 9 and 10 provide for the freezing of certain working-age benefits for four years until 2019-20. This would follow the 1% uprating imposed in 2013. Our amendments would require that these benefits instead be reviewed annually, taking account of inflation and the national economic situation.

We understand that the benefit freeze is designed to contribute to the Government’s cuts programme, and it is alarming that this measure will garner the Government some £3.5 billion in 2019-20, compared with a CPI uprating. This comes on top of benefit cuts and tax increases borne under the coalition, where the IFS reminds us—I raised this figure earlier—that, as a percentage of income, the poorest two deciles suffered the largest reductions. The End Child Poverty alliance reminds us that some 4.1 million families and 7.7 million children have already been affected by below-inflation rises over the last three years. As my noble friend Lady Lister pointed out in our previous debate, the inflation index does not properly capture the budgets of low-income families because they spend more on essentials, the costs of which have tended to rise faster than the average price index in recent years.

My noble friend Lady Sherlock articulated our major concern with the freeze, which is that it both cuts the link between prices and earnings and widens the gap between the income of the poorest and the living standards of the mainstream of society. It is part of a growing trend under this Government to uncouple eligibility for support from need. Our amendment would not preclude the Government freezing working-age benefits for four years, although it has manifesto cover for just two. It would at least cause the Government to confront the extent to which they are causing the poorest to miss out, and to account for their actions.

The Government’s rationale was that those on certain benefits—JSA was one—have done too well in the past few years in comparison with earnings and the minimum wage, and that the trend needed to be reversed. On 21 December, the noble Baroness, Lady Evans, told noble Lords that the Government had struck,

“a balance between the needs of claimants and affordability”.—[Official Report, 21/12/15; col. 2388.]

Perhaps we can hear how the needs of claimants have been assessed for these purposes. On what basis has it been determined that claimants can accommodate a real-terms reduction in their income for each of the next four years? What rate of inflation have the Government assumed in making this judgment? The noble Baroness told the House that 7% of global expenditure on social protection is spent in the UK, which has only 1% of the world’s population. Is it now the Government’s serious intent to benchmark UK social security spending against some of the poorest countries in the world?

So far as Amendment 32 is concerned, I look forward to hearing from my noble friend—and, indeed, namesake—but, so far as the support group is concerned, his amendment seeks to ensure that the full amount of the allowance is to be the subject of uprating, not just the support group addition. I wait to hear what he says, but it seems to me entirely reasonable, particularly since those in the support group are not able to work, so issues of work incentives have no application—but, equally, such individuals are generally unable to supplement their income. I support my noble friend’s amendment and I beg to move.

[Lord MacKenzie of Culkein (Lab)]

My Lords, I support Amendments 31, 33 and 34 in the names of my noble friends Lady Sherlock and Lord McKenzie of Luton. However, I shall concentrate on Amendment 32, which is almost but not quite the same as an amendment tabled in my name in Committee. I regret and apologise that I was unable to be in the House on that day. I am most grateful to the right reverend Prelate the Bishop of Durham for moving that amendment on my behalf—more importantly, perhaps, on behalf of people with life-limiting illnesses such as motor neurone disease.

In speaking to that amendment, the right reverend Prelate reminded the Committee of the promises made by the Conservative Party in the run-up to the general election. I want to refer to that promise again, writ large in its manifesto, which was to always protect the benefits for the most disabled. Despite that promise, the Bill before us does not fully protect people with life-limiting illnesses such as motor neurone disease and other similar rapidly progressing ghastly conditions. Either the words in the manifesto say what they mean and mean what they say or they do not. As of this moment, these promises are not being kept. Going some of the way is what has happened in the Bill—and some of the way is not fully protecting, and is not always protecting, benefits for the most disabled. Unless this amendment is agreed, or the Government come forward at Third Reading with something to produce the same outcome, they will have failed to keep that manifesto promise. I do not believe that is good enough in a modern, civilised society, where people with life-limiting illnesses should not be expected to suffer any more financial hardship than is the inevitable consequence of their illness.

People with motor neurone disease frequently end up having to build bedrooms and wet rooms downstairs, adapt furniture and face all sorts of costs. Couples who may have been reasonably comfortably off rapidly find themselves in considerable debt. As the right reverend Prelate the Bishop of Durham put it:

“Those whom we cannot reasonably expect to support themselves should not be expected to shoulder the burden of austerity”.—[Official Report, 21/12/15; col. 2405.]

The most disabled will lose perhaps more than £250 per annum by 2020 because the basic rate of the employment and support allowance is not exempted. I appreciate that the amendment in my name is rather complicated, but it is a serious attempt to right a potential wrong. If it is too complicated, I do not believe that it is beyond the wit of government to find another formula to produce a result that will give the full protection that is needed.

In Committee, the right reverend Prelate the Bishop of Durham expressed the hope that Ministers would give the matter further and serious consideration. The noble Baroness, Lady Evans of Bowes Park, said in response that benefits,

“are designed to provide a basic standard of living to those who are not in work but at a level that does not disincentivise moving into work”.—[Official Report, 21/12/15; col. 2406.]

People with life-limiting illnesses such as motor neurone disease are not disincentivised from going to work. They cannot go to work—would that they could. There is no behavioural change that people with these dreadful illnesses can make to get back into work. The noble Baroness, Lady Evans, concluded by agreeing that,

“we absolutely must provide suitable protections for disabled people”.—[Official Report, 21/12/15; col. 2407.]

However, she then did not support the amendment. The meaning of “suitable” is very different from the meaning of “full protection”, as was promised in the manifesto. A great many people with life-limiting illnesses, and their organisations such as the Motor Neurone Disease Association, take a great interest in what the Government will now do. I hope the Minister, for whom I have the greatest respect, will be able to say that he will bring something back at Third Reading along the lines of this amendment, which will honour the promise that the Government made in their manifesto in the run-up to the election.

[Baroness Evans of Bowes Park (Con)]

I thank noble Lords for tabling these amendments. I do not wish to spend too much time restating the same points that were made in Committee so I will keep my remarks brief. First, I address the amendments tabled by the noble Baroness, Lady Sherlock, and the noble Lord, Lord McKenzie, which replace the provisions in the freeze with a duty on the Secretary of State to review the benefits in question, having regard to inflation and the national economic situation.

I remind noble Lords that the provisions in Clauses 9 and 10 contribute £3.5 billion of the £12 billion of welfare savings by 2019-20 that the Government are committed to. The Government have a £35 billion consolidation plan, as the Chancellor set out in the summer Budget and the joint Autumn Statement and spending review, and we are on target to achieve a surplus of around £10 billion by 2019-20. The savings that the freeze provide therefore represent a significant proportion—10%—of the work that remains to be done through this Parliament to restore the nation’s finances.

Noble Lords have argued that these amendments would merely place a review on the freeze rather than remove it altogether, but they would remove the certainty provided by a legislated-for four-year freeze. This would lead to increased uncertainty about where the Government intend to find the necessary savings to restore the nation’s finances and could decrease market confidence in the Government’s ability to deliver their target surplus by 2019-20. Noble Lords have also raised concerns about the impact of this freeze. I reiterate that there are no cash losers to this policy and that inflation is still forecast, by the independent Office for Budget Responsibility, to be relatively low over the next two years, providing time for benefit recipients to adjust their finances to compensate. Furthermore, OBR forecasts at the Autumn Statement projected average earnings growth of around 3.9% by 2020, higher than projected inflation at around 2%, meaning many working families can expect to see the impact of the freeze offset by their rise in earnings. The annual average income of the poorest fifth of households has risen by £300 in real terms, compared to 2007-8.

I turn to the amendment in the name of the noble Lord, Lord MacKenzie of Culkein, regarding employment and support allowance. This amendment seeks to place into legislation a requirement for the support group component of ESA to be uprated by an additional amount above the amount it would otherwise be uprated by. This additional amount would be equal to the difference between the current main rate of ESA and that rate if it were uprated by inflation. I should remind noble Lords that, as said in Committee, those in the ESA support group receive an additional amount on top of the personal allowance—the support group component—which we have specifically exempted from the benefits freeze. Furthermore, the enhanced disability and severe disability premiums within ESA are also exempt from the freeze, as are benefits which contribute towards some of the additional costs of disability such as disability living allowance and personal independence payment.

Noble Lords will be aware that spending on main disability benefits went up by over £2 billion over the course of the last Parliament, and that the proportion of those in relative poverty who live in a family where someone is disabled has fallen since 2010. We believe that we are continuing to provide important protections for the most disabled through the exemptions we have from the freeze, and that this amendment is therefore not required.

In conclusion, the Government believe that the freeze strikes a necessary balance between making important welfare savings while having in place the protections for the most vulnerable and disabled. I therefore urge the noble Lord to withdraw the amendment.

--- Later in debate ---

Tabled by

[Lord MacKenzie of Culkein]

32: Clause 9, page 11, line 33, at end insert—
“( ) For each of the tax years ending with 5 April 2017, 5 April 2018, 5 April 2019 and 5 April 2020, the amount of the support group component of employment and support allowance is to be up-rated in accordance with Part X of the Social Security Administration Act 1992 (review and alteration of benefits) plus an additional sum equal to the difference between the value of the basic allowance of employment and support allowance as subject to subsection (1) and what the value of the basic allowance of employment and support allowance would have been had it been adjusted for inflation for the specified year.”

[Lord MacKenzie of Culkein]

My Lords, like my noble friend Lord McKenzie of Luton I find it deeply disappointing that the Government cannot take this away and give it some further consideration. It reminds me of the days when I used to be lead negotiator for Britain’s nurses and midwives. The management side across the table used to give us answers which I knew were not theirs but those of the Treasury. I think that is the case here again tonight. We are dealing with the dead hand of the Treasury but, unfortunately, they are not across the table where we can negotiate with them. I am sorry that we have reached this sad situation on behalf of people with these life-limiting illnesses.

Amendment 32 not moved.

Welfare Reform and Work Bill

Lord MacKenzie of Culkein Excerpts

Tuesday 17th November 2015 Lords Chamber

[Lord MacKenzie of Culkein (Lab)]

My Lords, I will try not to detain the House for too long at this hour. I want to speak, in particular, about the effects that this legislation will have on people with life-limiting illnesses and on those with terminal diagnoses. I want to follow on from a lot of what was said by the noble Lord, Lord Patel, and the right reverend Prelate the Bishop of St Albans and from some of the points made by the noble Baroness, Lady Browning.

As a nurse by profession, I could give many examples, but one that bears heavily on me is that of people living with motor neurone disease—that awful, usually rapidly progressing illness, which is always fatal. There is no cure, and it is a disease that I have seen at close hand.

We have heard much from the Government about the need to have a welfare system that is fair, that boosts employment; that is about choices, transforming lives, paying off the deficit and so on. The Conservative manifesto also promised—if I recall correctly—to protect people with disabilities and the most vulnerable in society. Therefore, I wonder why so many charitable organisations caring for the vulnerable and for those with differing disabilities are so concerned about the Bill—none more so than the Motor Neurone Disease Association, to which I should pay the warmest of tributes for its tireless work in supporting those living with MND and in supporting research into a possible cure.

One of the MNDA’s real concerns is the proposal to include the basic or main rate allowance of the employment support allowance in the freeze. People with motor neurone disease inevitably face rising costs as the disease progresses. If the Bill is enacted in its present form, they would be quite a bit worse off by 2019 or 2020.

A second issue causing much concern is the reduction in the benefit cap. This will undoubtedly have an adverse effect on those full-time, unpaid carers who do not live in the same household as the person they care for. This can include friends and/or family members who do not live in the same property. It could also include people who do live in the same property but who are counted as a separate household. For example, an adult living with and caring for an elderly parent or sibling may still be subject to the benefit cap. It cannot be right, therefore, that the inclusion of the carer’s allowance and bereavement allowance will affect full-time, unpaid carers in this way. In my view, these two allowances should be removed from the scope of the benefit cap.

Thirdly, there is very real concern about the question of mortgage interest. Converting this present benefit into a recoverable interest-bearing loan has the potential to leave many in great difficulty, not least those with an illness such as motor neurone disease, where the condition can deteriorate very quickly. In these situations, financial difficulties can follow just as rapidly. It cannot be right that people with life-limiting illnesses should be put in this position of possible financial crisis.

How can the waiting period of 39 weeks before qualifying for this new loan be justified? In not a few cases, 39 weeks is actually longer than the time between diagnosis of motor neurone disease and death. The cumulative effect of the reforms I have referred to is a potentially adverse effect for many people with life-limiting illnesses.

All Governments will sometimes propose or do things that provoke disappointment, anger and a whole gamut of other emotions and reactions. However, I suspect that anyone with a nursing background such as mine, and who is familiar with life-limiting illnesses, is entitled to be profoundly upset and not a little angry that any political party that claims to be on the side of the people, not least people with illness and disability, would seek to deal with the deficit on the backs of those living with always fatal illnesses such as motor neurone disease.

Nothing in these proposals has anything whatever to do with fairness, boosting employment or making work pay. Penalising people with life-limiting illness will do nothing to build an economy based on higher pay—or any of the other reasons that might be advanced as justification for this Bill. Except it will, perhaps, make the tiniest of tiny dents in the deficit. But if so, to how many decimal points would the Treasury have to go to measure that very tiny dent? Even if it were measurable, the Treasury would never publish such a calculation. Given the track record of that department in recent times, it is not about caring but about dogma. Others are being left to pick up the pieces.

I do not believe for one moment that the Minister would wish these things on people with terminal illnesses or diseases such as motor neurone disease. I hope that he will, in replying, be able to give a commitment that the Government will attempt to address these very proper and real concerns raised on behalf of those with life-limiting illnesses, and that the Government can show that they are listening. I look forward very much to the Minister’s reply.

Queen’s Speech

Lord MacKenzie of Culkein Excerpts

Tuesday 14th May 2013 Lords Chamber

[Lord MacKenzie of Culkein]

My Lords, I had intended to speak on the draft care and support Bill and to deal with some of the positives in it, as well as some of the issues in the interface between health and social services. I had also intended to deal with the crisis in A&E departments and, inter alia, to be critical of the absence of Bills on important public health issues such as tobacco and the minimum pricing of alcohol. However, my noble friends Lord Hunt of Kings Heath and Lady Wheeler, as well as the noble Lord, Lord Patel, said all I wished to say on that, so I will not take up the time of the House by repeating it, save to say that I agreed with every word.

I will spend a little time on the issue of nurses and nursing. The image of the profession has taken something of a battering in the past few months. As a nurse I am saddened by the adverse publicity arising from Winterbourne View and Mid Staffs, among other places. There have been some shocking, inexcusable examples of bad nursing. I have no time for it; such staff should not be caring for the sick and vulnerable. They have no place in the health and caring services. However, the whole profession should not be made to carry the guilt for a few bad eggs. The opprobrium is not deserved because the vast majority are working their socks off every shift in increasingly difficult circumstances.

The Minister rightly said that,

“what went wrong at Mid Staffs was not typical of our NHS and … the vast majority of doctors and nurses give excellent care day in, day out. We must make sure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS”.—[Official Report, 26/3/13; col. 968.]

I could not agree more with these sentiments. My hope is that his words will resonate throughout the boardrooms of the service because it is clear that it is all too easy to slip into the sad state of affairs that was clearly evident at Mid Staffordshire.

It is clear from the Francis report that there are issues for nursing. The noble Lord, Lord Willis, said in the introduction to his report, Quality and Compassion: The Future of Nurse Education, that,

“there has been insufficient political or professional will to implement past recommendations”.

However, the big announcement from government was to propose something not recommended in the Francis report: having potential nurses working as healthcare assistants for a year before entering formal education. I cannot see where that idea came from, because there was no criticism of nurse education in Francis. Yet the Government ignored recommendations in the report that a registered specialist status should be created for the nursing care of older people, and ignored the recommendation that HCAs should have compulsory registration. Trusts are to be free to decide whether to have ward sisters spending more time on the ward and nurses more time at the bedside.

Recommendation 209 in the report, on a registration system for healthcare assistants, could not have been stronger. It is supported by most HCAs and is meat and drink to me because it reflects almost exactly the policy of my old union at the time of Project 2000. In supporting the move of nursing education into academia and the ending of the old enrolled nurse training, as it then was, we wanted a new second-level nurse and a fully qualified, accountable service for patients.

That did not happen, but wheels turn full circle and the same debate that we led then is now being rerun. There was an interesting letter to the Times on 24 April from Dr Anthony Carr, a distinguished former Chief Nursing Officer, fellow of the Royal College of Nursing and member of the Cumberlege committee that produce the excellent report, Neighbourhood Nursing, in the 1980s. Dr Carr’s letter chimes with much of our old policy. He first asked a question that deserves to be asked: how many patients today realise that their main nursing care is given by people with little or no training whatever? For HCAs he goes on to propose the solution of a year’s training and practice under the supervision of clinical teachers. He proposes that, if satisfactory, this should lead to a licence to practise, which should be overseen by the Nursing and Midwifery Council. That would give accountability, regulation and a national standard of training.

Piloting such an idea for HCAs would fit far better with the ethos of the Francis report than the fence-sitting, “we have not ruled out regulation and registration” approach taken by the Government. The Camilla Cavendish report is unlikely to go along with regulation and registration because that was not included in her terms of reference. However, I hope that she will still support the idea. She used to write pieces supporting registration, unless my memory is playing tricks.

I go back to the Government’s proposals that aspirant student nurses work for a year as HCAs, and to their spat with the Royal College of Nursing. The college does not need me to defend it. I have never been a member. When I started my nurse training, the college did not admit men into membership, so I joined another union and ended up as its general-secretary many years later. However, much more united these rival organisations for nurses than ever divided us. It is a bit thin, unpleasant and lacking in resonance for the Secretary of State to attack the college in the way that he did because it dared to disagree with the proposal that student nurses should first work as HCAs for a year.

The Secretary of State seeks to use the Francis recommendation about the RCN as a fig leaf. Staff organisations are entitled to give a considered response and to advocate on any proposals made by Governments that will have an effect on nurses and nursing, particularly when they have not been consulted in the first place. For the Department of Health to suggest that the RCN or anyone else who opposes such an idea lacks credibility is nonsense, not least because it appears that the idea of a year as an HCA before entering nurse education is the sort of policy that might have been thought up in front of the metaphorical shaving mirror.

It is not easy to separate professional issues from what might be referred to as pay and rations. It is right that the Royal College and UNISON should ask questions about where the funding will come from for this idea; where the supervision and mentorship are going to come from; where the vacancies are, if any; and whether these people will come within the Agenda for Change pay structure. They are right to point out the risk that they will pick up bad habits and, as we used to put it, the risk of “learning with Nellie”. They are right to ask whether the idea will work at all and whether it will lead to a better nurse than would be the case if the Francis recommendations were taken up instead. Above all, nursing organisations need to be consulted and involved before such announcements are considered or made. Enhancing the status of the profession and looking after pay and conditions can sometimes be separated and sometimes not. As General Secretary of my old union, I set up a professional department for precisely that reason.

I repeat that it cannot be right that the thrust of the problems facing the NHS is laid at the door of the nursing profession. Let us have a proper look at mandatory staffing ratios. Let us get ward sisters back on the ward, taking clinical charge. Let us get student nurses doing what Francis recommended, and find a way to ensure that there is hands-on practice during the three years of university education.

The Government have said some of the right things, post-Francis, on tightening up accountability, duty of candour for providers—although, as many others say, that needs to go further—and introducing the concept of a chief inspector for hospitals. I would like to see that post being held by a nurse, and to see the Government follow through as rapidly as possible in cutting the paperwork burden that nurses endure at the moment. I want to see nurse leaders in trusts responsible and accountable for the delivery of nursing care. They should not have several other portfolios added to their role. And yes—the nursing profession needs to challenge, perhaps more that it has ever done, and to stand on its professional feet. But there has to be a cultural change in the service as well, and Governments, managers and boards have to listen.

In conclusion, I hope that the Government listen and engage with nursing organisations on all these challenges that face the NHS, and in particular that of delivering consistent quality care.