Skills for Care Report

Lord Markham Excerpts

Thursday 13th October 2022 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they plan to take in response to the report by Skills for Care The state of the adult social care sector and workforce in England 2022, published on 11 October, which shows that there are 165,000 vacancies in the social care workforce and that this workforce has shrunk for the first time in 10 years.

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

My Lords, we are investing in adult social care. We have made £500 million available to support discharge from hospital into the community and bolster the workforce this winter; that is on top of record funding to support our 10-year plan as set out in the People at the Heart of Care White Paper. We are backing recruitment at home and abroad with a £15 million international recruitment fund and a new domestic campaign, which we will launch shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister. I expected him to mention the £500 million workforce fund, of course, but he will know that it has been described as a drop in the ocean and that councils are calling for far more to be pumped into better pay and recruitment in the social care workforce. I do not want to be disrespectful to the new Minister, who I know has a lot on his plate, but I wonder whether he and the Government really understand the scale of the crisis in social care. Some 50,000 people left an already inadequate workforce last year; that is not surprising when they can get better pay and conditions in Tesco, and when one in five care workers is in poverty despite being in full-time work.

The previous Prime Minister told us that he would fix social care. The current Prime Minister has withdrawn the levy that would eventually have provided extra funds, with no indication of how those funds will be replaced. Is the Minister aware that, meanwhile, thousands of older and disabled people, both in their own homes and in care homes, are being neglected and deprived of services in a way that no decent society should tolerate? Will he acknowledge both the depth of the crisis and the fact that we need a step change in the way we value social care and the dedicated people who provide it?

--- Later in debate ---

[Lord Markham (Con)]

First, let me say that we value social care. As the noble Baroness will be aware, the £500 million was in addition to a £5.4 billion increase over three years. Again, that underlines the importance that we see behind adult social care and how it is a crucial part of our whole plan, as outlined in ABCD, not only to give the right conditions and dignity for the elderly people whom the noble Baroness mentions but as a vital way of releasing space in our hospitals—this drives right through the system—to create space both in A&E and through the rest of the care system. It is an area of vital interest and something that I can assure noble Lords has a lot of focus from the department.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I strongly welcome the Government’s action to put care workers on the shortage occupation list this year, which is important for unlocking immediate supply. However, might I ask the Minister to note two key points from Skills for Care’s report, which are important for further action for sustainable care workers? The first is that, although the retention rate has remained more or less stable since last year, the starter rate has fallen from 37.3% to 30.8%. Can I suggest that the Minister looks at more incentives for starters? The second point is that, on average, employers with favourable work metrics such as high levels of learning and development have better CQC ratings. Given the UQ coming up later, that is another critical area to look at for improvement.

[Lord Markham (Con)]

My Lords, my noble friend is correct that this is also a labour supply issue. Part of the benefit of living in an economy with full employment is, of course, that there is little unemployment. Part of the downside of that is the competition for jobs. My noble friend rightly points out the need to recruit more in this sector; that is why I am pleased that she mentioned the work we are doing to add this sector to the essential workers list so that we can recruit people from overseas and get essential workers in.

[Lord Patel (CB)]

My Lords, I welcome the Minister to his post. I look forward to working with him. In that spirit, I ask him this: where might I find the data relating to the long-term planning for the NHS and social care workforce? If such data does not exist, will he agree that such planning data should be made available as a matter of urgency?

[Lord Markham (Con)]

My Lords, my understanding is that there is a 10-year plan as part of a workforce plan, which rightly looks at the issues raised by the noble Lord. As I mentioned in my answer to the previous question, the workforce is key to this sector. We employ 1.5 million people; I think that they account for about 5% of our whole workforce. So making sure that this is an area that people want to come and work in, that people enjoy and that people see as a vocation is vital and will be part of the plan. I will look up the data requested and reply in writing.

[Baroness Chakrabarti (Lab)]

My Lords, I, too, welcome the Minister to his place. I congratulate him on the tone of his responses so far. I agree with him that the workforce is key. Another feature of the report is that a quarter of the adult social care workforce are on zero-hours contracts and get paid £1 an hour less than healthcare assistants on average. Given the projection in the report that, if we are to keep up with our ageing population, we will need the best part of 500,000 more of these workers by 2035, we must address their low pay, must we not?

[Lord Markham (Con)]

The noble Baroness is correct that a number of people are on zero-hours contracts. As I am sure she is aware, their employment is through a number of agencies and local authorities, but it is an issue in a number of places and goes to the wider conversation about how we make this sector an attractive place to work. Earlier, my colleague mentioned the Skills for Care working group, which found that a significant proportion of all employers—around 20%—have a turnover rate of only around 10% versus the 29% average. So, clearly there are areas where certain employers do a fantastic job of not only recruiting but retaining, and making the sector an attractive place to work. I believe that the whole emphasis of the conversation we are having now is exactly about how to make this sector an attractive place to work because, as we all know, it is a vital part of our care and health system.

[Baroness Brinton (LD)]

My Lords, the Minister referred to the £500 million investment in social care but this is only his fourth day in the job. Many people in your Lordships’ House know that that money is for winter pressures and was omitted from the budget for the NHS and social care at the beginning of the year. Without it, social care would be in even deeper trouble than it is now. The noble Baroness, Lady Chakrabarti, made an extremely important point about zero-hours contracts. The problem of staff working in domiciliary care is that there is not enough money even to allow them to be paid for travelling between clients. There is a real shortage of money. This is a group of dedicated workers who are being treated very badly. Will the Minister undertake to look at this particular problem?

[Lord Markham (Con)]

Any industry with the sort of turnover rate that was mentioned earlier demonstrates that there is a need to look further into it, so I absolutely accept the premise of the question and, as I mentioned before, the importance of this area. As I have said before, this is also about looking at areas of best practice because we can always look to spend more money but we know that there are limitations on the public purse. I would not be doing my job if I did not try to see where we can learn from good employers, employ those practices and see whether we can spread them wider so that everyone has the same level.

The other point that I made previously was about opening this up. We know that our healthcare system is founded on good workers from all around the world. They can be a bedrock. I am delighted that we are looking into that area now. We are starting to see good numbers of people coming in from abroad. It is an excellent level of entry into our country. There are a number of things we can do to improve the situation but I completely agree with the noble Baroness on the importance of tackling it.

[Baroness Wheeler (Lab)]

My Lords, the Health Foundation has described the Skills for Care report as yet another signal of a social care system on its knees, with care providers struggling to compete with other employers and, in many cases, unable even to pay the national minimum wage to essential care staff. As we have heard, the figures are that one in five residential care workers in the UK was living in poverty, and that was before the cost of living crisis, compared with one in eight of all workers, which is a shocking figure in itself. When will the Government commit specifically to addressing the appalling low pay and poor working conditions throughout the social care sector?

[Lord Markham (Con)]

My understanding is that the pay of carers is always at least the national living wage. I will look into that, but that is my understanding. That is not to say that where they deserve, and should be paid, more that this should not be the case, but the national living wage is set, as the noble Baroness will be aware, exactly as it says: a national living wage. In terms of the cost of living pressures, the energy price cap is of course about focusing on those people who need it most, so there are a number of measures that we are putting in place to ensure that this happens. Most of all, it is about ensuring that this is a good, safe and enjoyable vocation for people.