Covid-19: Self-isolation Payment Scheme
Lord McKenzie of Luton Excerpts(3 years, 8 months ago)
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Lord Bethell (Con)
My Lords, under the current scheme, benefits are provided to those who live in Blackburn with Darwen, Oldham or Pendle. It does not extend to other areas. We will assess the impact of this scheme and review whether it should or could be extended in any way.
Lord McKenzie of Luton (Lab) [V]
My Lords, support for the most vulnerable in undertaking self-isolation should not just, as suggested, be a matter of financial support, important though that is. It should include emotional and mental health support to the household. Does the Minister agree? What provision is being made for this sort of support? In so far as it is provided by local authorities, will adequate funding be made available to them?
Lord Bethell (Con)
The noble Lord is entirely right. The decision to isolate is extremely tough for a great many people, both economically and psychologically. The importance of isolation is absolutely critical in our battle against Covid. We have to think of ways of supporting people in every way we can. That is the responsibility of local authorities, and we have provided them with £300 million of funding to support their isolation, test and trace programme. I would like to pay tribute to local authorities that are doing a fantastic job of putting support in place for those who are isolating in expectation of the winter.
Queen’s Speech
Lord McKenzie of Luton Excerpts(4 years, 6 months ago)
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Lord McKenzie of Luton (Lab)
My Lords, it is a great pleasure to follow the noble Baroness, Lady Meacher, and I applaud her campaign. Recent years have seen a number of key changes to the UK pensions landscape, some concerning accumulation, such as auto-enrolment and master trusts, and some decumulation, notably pension freedoms. Some concern compliance and regulation, such as the charge cap, but, as the Pension Schemes Bill demonstrates, there is still much to do. On much, but not all, of it there is an underlying political consensus.
Auto-enrolment has rightly been acknowledged as a huge success, but data from the Pensions Regulator has shown that more than 9 million workers are not enrolled in a workplace pension scheme and, as usual, it is the low paid and those with several jobs, mostly women, who are missing out. What needs to be done to expand the scope of AE is well known and, although it is right to assess the impact of the 8% contribution level on opting out, we should make faster progress if we are to address the national challenge of undersaving. Expanding the scope to include the self-employed and others with non-standard forms of employment, lowering the age criteria and calculating earnings from the first pound earned will make a difference.
There is a long-standing issue concerning workers earning below the tax personal allowance whose employer enrols them into a net pay arrangement. Opportunities to address the inequity of tax relief for the low paid in these circumstances are not unfamiliar to HMRC. They exist and should be addressed.
As for pension freedoms, a policy introduced under the coalition Government without proper thought and analysis has proved to hold significant risks for savers and has left the FCA and TPA having to play catch up. Recent FCA data identifies that some 646,000 pension pots were accessed in the year to March 2019, with more than half withdrawn in full and almost half accessed without advice or guidance. This raises the prospect of avoidable financial harm, particularly from pension scams and unsustainable withdrawal rates. TPR and FCA research points to the increasing threat posed by pension scams.
We agree with the Government that it is high time to strengthen the oversight of pension saving, including powers to tackle irresponsible management of private sector schemes, and to have enhanced powers for the regulator. The “clearer, quicker, tougher” approach included in the Bill for TPR looks to be headed in the right direction, but it will have to be tested in Committee.
Nearly two-thirds of UK adults have multiple pension pots, which is not surprising given that the average person will have around 11 jobs over their lifetime. The PPI’s last pension survey revealed that 6% of unregulated pots are considered to have gone missing by providers, amounting to a staggering £10 billion. This is why we support a pensions dashboard that will compel providers to make consumer data available. It will increase individual awareness and understanding of their pension information, but we are mindful of concerns expressed about the absence of representation from the auto-enrolment sector on the steering group. How such arrangements are to be structured and operated will be important. The quality of scheme data will be fundamental to its success. Recent research has found that to be trusted, the dashboard should be government-funded. How do the Government respond to this?
Our consideration of pensions policy has hitherto been typically a binary matter characterised by DB or DC schemes. There is another way; the noble Lord, Lord Willetts, mentioned it. In 2017, following on from but not implementing the provisions of the Pension Schemes Act 2015, Royal Mail and the CWU agreed a new pensions arrangement: a collective defined contribution arrangement, as used in the Dutch and Danish systems. Multiple studies show that in the right circumstances a CDC can give a better outcome than others available, but it needs to be understood that that it is not guaranteed. It also needs to be understood that a CDC provides a target income, and work needs to be done to ensure that workers are aware of that and properly informed of its implications. We know that CDC schemes enjoy the support of the CBI, the TUC, the PLSA and the DWP Select Committee. Indeed, the RSA and the Pensions Policy Institute have been promoting a regulated form of CDC for a number of years. The Bill contains much that we have to examine, notwithstanding that we inherently support the CDC approach.
Queen’s Speech
Lord McKenzie of Luton Excerpts(6 years, 10 months ago)
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Lord McKenzie of Luton (Lab)
My Lords, as the Minister announced at the start of the debate, we have a Financial Guidance and Claims Bill on which we commence our parliamentary scrutiny next week. Without pre-empting that process, I will use my brief time to talk to some issues surrounding or arising from that legislation.
The Bill’s stated aims—worthy aims—are to increase levels of financial capability, reduce levels of problem debt and improve public understanding of occupational and personal pensions by merging three existing guidance bodies. It also introduces a tougher and welcome regulation regime to tackle the range of conduct issues and problems in the claims management market. But it is all very high level and vague, and we will have to sort this out in Committee. It also has the good ambition of a national strategy to improve the financial capabilities of members of the public.
We will judge the salience of the Bill by its contribution to some of the most pressing problems facing our country at the moment. We will need to consider whether it is a missed opportunity to contribute more to combating financial exclusion, which holds back the life chances of so many of our fellow citizens. We know that levels of financial capability in the UK are low and that many people face significant challenges when it comes to managing money, avoiding debt, building up savings in the short term and balancing this with retirement savings.
The House of Lords Select Committee, very ably chaired by the noble Baroness, Lady Tyler of Enfield, addressed these matters in its recent report, Tackling Financial Exclusion, identifying those most at risk of financial exclusion as including, not surprisingly, those on low income or living in poverty as well as those who lack digital access or capability. Data provided to the committee suggested that one in six struggles to identify the balance on their bank statement, 40% of the working-age population have less than £100 in savings and 23% of adults do not possess basic digital skills. Just yesterday, the press were full of the depressing report of the Social Mobility Commission, setting out what limited progress we had made in reducing inequality between rich and poor over the last two decades—referred to by my noble friend Lord Whitty.
On the same day, we heard dire warnings about the build-up of unsecured consumer borrowing. Evidence provided to the Select Committee suggested that the average UK household now owes some £12,887, and concerns have been expressed by debt agencies about the rise in calls concerning rent arrears, energy and water bills, telephone bills and council tax. Of course, the Government are not without blame in this matter. The transfer to local authorities of responsibility for council tax support schemes, with a starting 10% reduction in resource and subsequent cuts in funding, is having a direct impact on arrears. We know that the monthly payment of universal credit and the introduction of waiting days are further driving people into poverty—the bedroom tax and benefit cap likewise. Perhaps I may digress a bit to ask the Minister to confirm what I thought he said at the start of our proceedings: that the bedroom tax is not to be applied to those families rehoused as a consequence of the dreadful fire in Kensington. If austerity is truly to end, when is all this going to change?
The pensions landscape has been the subject of significant change in recent years, making access to robust guidance imperative, and we might expect more change in the future. We are grateful to the ABI for its briefing, which encompasses some of this. Auto-enrolment continues to generate significant pensions take-up, and of course there is greater flexibility in when pensions can be accessed and how they are taken. The Government have announced the scope of the review of auto-enrolment, with the prospect that its application can be extended. This would be welcome.
The need for guidance and support on pensions is very much relevant to these recent changes, and I hope we have learned the lesson of bringing in radical changes to the pensions system without laying the groundwork of consultations and safeguards, backed by access to robust guidance.
On the horizon is the prospect of the secondary annuity market being advanced, changes to DB schemes and the emerging potential for a pensions dashboard. We await the decision on the state pension age.
The introduction of pension freedoms in 2015 also spawned an industry in scamming, involving fraudulently extracting money from individuals’ retirement savings. Some lost the entirety of their pension pots—an unimaginable trauma for someone whose working life was assumed to have been over. Promoting awareness of the techniques used is essential if we are going to make progress.
As for improvements to the regulation of claims management companies, an independent review carried out by Carol Brady has identified the need for change. The review exposed the depth of the skulduggery that continues in the sector: non-compliance with rules, misleading advertising and speculative and unnecessary claims. In supporting stronger regulation, though, we should bear in mind that CMCs can and should play a role in providing access to justice and can provide a check on the complaint-handling processes of individual businesses.
Our ambition for the Bill is to see it be part of a process of a step change in improving financial inclusion and reducing financial exclusion. The report of the Select Committee has charted the way.
Mesothelioma
Lord McKenzie of Luton Excerpts(7 years, 6 months ago)
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Lord McKenzie of Luton (Lab)
My Lords, this has been a brief but exceptionally well-informed debate. We have heard from noble Lords whose understanding of mesothelioma has been driven by a family experience, a colleague’s experience or a friend’s experience. We have also heard from the medical fraternity and its expertise. I thank my noble friend Lord Wills for initiating this debate and acknowledge the work which he, together with the noble Lords, Lord Alton and Lord Giddens, and others, have done since our last debate on this topic a year ago. We should remember, as have others, the tireless efforts of Lord Avebury, who campaigned persistently for the sufferers of mesothelioma.
Obtaining justice for sufferers of mesothelioma has been a long and tortuous journey. I think that it is fair to say that, until recent times, efforts have been concentrated on seeking to ensure that sufferers and their families have received material support—money—to help them cope with the traumatic effects of this invariably fatal and excruciatingly painful condition. This journey has encompassed access to the industrial injuries disablement benefit; the 1979 compensation Act for work-related mesothelioma where the employer no longer exists or their liability policy cannot be traced; efforts to improve retracement policies; the 2008 diffuse mesothelioma scheme, where there is no nexus; and then the diffuse mesothelioma payment scheme, which is funded by insurance companies. Each of these in its own way has made access to support more secure, however inadequate. We have praised before the work of the noble Lord, Lord Freud, in delivering the 2014 payment scheme and condemned the historic reluctance of insurers to meet their moral obligations. We note that the payment scheme was able to raise payment levels to 100% of average civil claims in 2015. Perhaps the Minister can confirm that this has been maintained. It is understood that it is driven by the benefits of better tracing of employer liability insurance policies. Again, perhaps the Minister could confirm that.
Last year, the Minister acknowledged that it was wrong to look at mesothelioma as a legacy issue. The projections are that it may have peaked, but it will be with us for a very long time. Moreover, the causes of mesothelioma—exposure to asbestos—are still too prevalent in our environment, especially, as we have heard today, in schools. We may be more aware about how it should be managed—the HSE gives advice on it—but we know that practice is not always followed and people will cut corners. The noble Baroness, Lady Finlay, spoke about the effects of this on children. Seeking a cure remains the imperative. When we discussed the Bill of the noble Lord, Lord Alton, there was some disagreement about precisely how much research had been undertaken previously—how much might be generic and how much was specifically focused. The Minister argued that the problem was not lack of funding but a lack of quality research proposals—I think that this was the position asserted by the noble Earl, Lord Howe, in the previous debate on that Bill. Can the Minister now bring some clarity to this issue? What has been the outcome of the strategy to stimulate more research projects?
The Government should be congratulated on their allocation of £5 million of LIBOR fines to establish a national mesothelioma centre. The announcement, of course, made specific reference to service veterans, but this centre is to be a collaboration, it is understood, between four leading institutions which will form a hub—I presume that it will be a virtual hub. It would be good to hear from the Minister, as a practical matter, how the funding of this is to be organised and how it is to go about undertaking and supporting research. It is to be welcomed, but this is still not on equal footing with the rest of cancer research. Nevertheless, “progress is waiting to be made” was the expression, but not without continuing pressure from a range of noble Lords and Members of the other place, those noble Lords who have participated in this debate and, of course, the continuing suffering of those who endure this terrible condition.
Accident and Emergency Departments
Lord McKenzie of Luton Excerpts(8 years, 5 months ago)
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Lord Prior of Brampton
The noble Lord makes a good point. If qualified people take the call, the level of risk they are prepared to absorb will be greater, and that applies throughout the whole system.
Lord McKenzie of Luton (Lab)
My Lords, I draw attention to my interest in the register. As we have heard from the Minister, the Government seem to accept the case that accident prevention programmes can have a significant beneficial impact on A&E attendances, but the Minister says that it is all down to local authorities. Given the huge cuts in local authority spending, with more announced just last week, what is the Minister’s assessment of the opportunities of local authorities to gain this benefit?
Lord Prior of Brampton
The report done by Queen Mary’s, which was based in Oxford, indicated that the under-fives attending A&E departments accounted for 7% of all attendances, which gives an idea of the scale of what we might try to achieve. The reduction, in real terms, in local authority spending over the next five years is 3.9% per annum. Our feeling is that local authorities are well equipped to live with that kind of reduction.
Mesothelioma (Amendment) Bill [HL]
Lord McKenzie of Luton Excerpts(8 years, 5 months ago)
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Lord McKenzie of Luton (Lab)
My Lords, it is a great privilege to follow the noble Lord, Lord Alton, on this matter. I had planned to speak briefly, but in support of this Bill, which, as the noble Lord says, has cross-party support. I pay tribute to him for the assiduous way in which he has pursued the issue, and the very comprehensive introduction that he has just given us to his Bill. He did that through the various stages of the Mesothelioma Act 2014, and since, and clearly has a powerful coalition of Peers to support him. That Act is an important milestone in helping sufferers of mesothelioma and their dependants. We should continue to give credit to the Government—then the coalition Government—driven very much by the noble Lord, Lord Freud, who had ministerial responsibility.
Now is perhaps not the occasion to review how the Act is working in its detail, as it is still in its transitional phase; it is understood that payments under the scheme are being undertaken at 100% of the scheduled amounts for claimants, although the noble Lord, Lord Alton, has raised an important challenge on the current levy amount. At the time of the debate on the Bill, it was clear that 3% was the amount to be contributed, and 3% was somehow magically the level at which it would not have to be included in an uplift on charges by the insurance industry. The Act recognised that, although it is not possible to identify in all circumstances each current insurer that would have written employer liability insurance for the various employers over the years, there was a collective responsibility to contribute to providing compensation when there was a nexus with work—and, along the way, there were the various attempts to improve the tracing of policies. There was also a recognition that insurers should contribute to the medical research to address this terrible condition, either to mitigate their risk or to recognise that the link to asbestos was known for some time and not all insurance companies have a proud record of preserving employer liability insurance records. The fact is, as we have heard, insurance companies have contributed to resources over the years, and it is on record during the passage of the Mesothelioma Act that the ABI made it clear to us when we were in opposition that it was prepared to match-fund with government research. The noble Lord, Lord Alton, made the important point that ad hoc, one-off contributions are not spreading the burden where it should be, across the industry.
We have heard from the noble Lord about how many die from mesothelioma each year. We know that it is caused by exposure to asbestos, that it is a long latency disease and invariably fatal. We should recognise that, notwithstanding this, it is not just a matter of the past; asbestos still abounds, not least, as we have heard, in our schools. The HSE has campaigned vigorously to alert people to the risk, in the Silent Killer campaign, and there are strong regulations in place. But we know that some will still want to cut corners. The cause of mesothelioma has not gone away.
When the issue was debated on Report on the Mesothelioma Bill, the argument was advanced on behalf of the Government that it was not a question of money, that what was holding back progress on research into mesothelioma was a lack of high-quality research applications, and that there is a long-standing and widely accepted principle that the use of medical research funds should be determined not just by the importance of the topic but by the quality of the research and its value for money. There are those contributing today who understand these issues far better than I do, but it seems to me that the noble Lord, Lord Alton, is not arguing to support mesothelioma research whatever the quality; his Bill does not seek some override of the established principles, but is about getting extra sources of funding.
On Report on 17 July 2013, the then Health Minister, the noble Earl, Lord Howe, set down four steps, which we have heard about today, designed to encourage the bringing forward of high-quality research applications. These were:
“First, the National Institute for Health Research will ask the James Lind Alliance to establish one of its priority-setting partnerships. This will bring together patients, carers and clinicians to identify and prioritise unanswered questions about treatment for mesothelioma and related diseases. It will help target future research, and, incidentally, will be another good example of where patients, the public and professionals are brought into the decision-making process on health.
Secondly, the National Institute for Health Research will issue what is called a highlight notice to the research community, indicating its interest in encouraging applications for research funding into mesothelioma and related diseases. This would do exactly what the noble Lord, Lord Alton, wants, and what the noble Lord, Lord Empey, suggested. It would make mesothelioma a priority area.
Thirdly, the highlight notice would be accompanied by an offer to potential applicants to make use of the NIHR’s research design service, which helps prospective applicants to develop competitive research proposals … Finally, the NIHR is currently in discussion with the MRC and Cancer Research UK about convening a meeting to bring together researchers to develop new research proposals in this area”.—[Official Report, 17/7/13; col. 786.]
Will the Minister give the House an update on those four areas? What progress has been made? To what extent has this in practice stimulated high-quality applications?
Today, I received in the post a communication from the Asbestos Victims’ Support Group Forum outlining the challenges asbestos victims still face which we should clearly help them address. Supporting this Bill sponsored by the noble Lord, Lord Alton, will help to ensure that the future may hold some hope for those afflicted by this terrible disease.
Local Authorities: Public Health Budget
Lord McKenzie of Luton Excerpts(8 years, 9 months ago)
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Lord Prior of Brampton
A condition of the grant to local authorities is that they take on the responsibilities that the Secretary of State has under the Health and Social Care Act to reduce inequalities. As statutory bodies, local authorities have a duty under the Equality Act 2010 to provide equal opportunities for people with protected characteristics.
Lord McKenzie of Luton (Lab)
My Lords, just last month, the Secretary of State for Health told the Commons:
“The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention”.—[Official Report, Commons, 2/6/15; col. 459.]
Two days later, on 4 June, the Chancellor announced a £200 million cut in the Budget. How joined up is that, and how is it justified?
Lord Prior of Brampton
Most people in this House will recognise that a strong and successful National Health Service depends on a strong and successful economy. Sometimes Governments have to take difficult decisions to improve the long-term strength of the economy, which is what we did in that case.
Care Sector
Lord McKenzie of Luton Excerpts(9 years, 5 months ago)
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Lord McKenzie of Luton (Lab)
My Lords, we should thank my noble friend Lady Kingsmill for initiating this debate, but more importantly for her work and that of her team in producing a significant review of working conditions in the care sector. The review was commissioned by Ed Miliband to see what could be done to tackle exploitative working practices in the sector and so improve the quality of care within the existing care budget. The review seeks to do this as well as produce a vision for the longer term that does not have this funding constraint. Like, I suspect, a number of noble Lords in this debate, I have an elderly relative in receipt of domiciliary care, and the messages and analysis in this report ring very true.
Care work is in crisis and care workers need to be treated fairly and to be valued if they in turn are to deliver quality services to their clients. As my noble friend has stressed, care workers are undervalued, underpaid, undertrained and underregulated. This leads to high rates of staff turnover, and for clients, constant changes in carers, erratic timings of visits, missed appointments and no continuity of client engagement. The review has been produced at a time when much else is going on in the world of caring. We are in the era of dramatic cuts to funding for local authorities; demographic change, which the LGA say has run at about 3% of the service budget for the past four years; implementation of the Care Act and the Better Care Fund; the consequences of the Supreme Court judgment that changed the definition of “deprivation of liberty”; and changes in technology that are enabling people to live more safely at home.
The spending pressures on local authorities are having a profound adverse effect on the sector. A National Audit Office report issued just last week sets out the stark facts. Real-terms reductions in government funding to local authorities for the period 2010-11 to 2015-16 amount to 37%. If council tax is included, the reduction is 25%. Moreover, local authorities with the highest levels of deprivation have seen the greatest reductions in their spending power. The NAO report shows that local authorities’ main response to reductions in government funding has been to reduce spending: in the four years to 2013-14, on employees by 15%, and on running costs by 6.7%, although they have tried to protect spending on statutory services for vulnerable people. Notwithstanding this, over the period of this Government, adult social care expenditure is estimated to fall by 8.7%. But those authorities that have been suffering the biggest reductions in spending power—the most deprived—have seen budgeted spend on adult services fall by nearly 13%. Those at the other end of the spectrum have seen a fall of just 1.2%. This is an ugly inequality, which must be addressed.
The Local Government Association’s Adult Social Care Funding: 2014 State of the Nation Report concludes that adult social care funding has been kept under some control through a combination of budget savings, the NHS transfer and at least £0.9 billion of savings by other departments. It considers the medium term to be particularly challenging, with an estimated funding gap over the period to 2020 of £4.3 billion. It also says that the Better Care Fund, to help develop better integration with health, will not provide an immediate solution. These budget pressures are undoubtedly being visited on those who need adult services as well as those who are working in the sector. In 2013-14 there was a 5% decrease in the total number of people receiving services and an increase in the number of authorities tightening eligibility criteria. Delayed discharges from hospitals are at their highest rate ever.
In terms of service levels, as my noble friend’s review highlights, there is increasing use of 15-minute visits, a practice that drives poor-quality care and exploitative working practices. The review stresses that such a limited time means that carers are simply unable to give the human interaction that service users need. We agree with this, and given the opportunity, will work with councils and care providers to bring this practice to an end.
The review also confronts us with the shocking statistic that between 160,000 and 220,000 care workers are paid less than the minimum wage. This is often due to failure to pay workers for time spent travelling between care visits; this can be made worse by incompetent management who are not always familiar with an area and arrange schedules that zig-zag across the town. Equally to be deprecated is the growth in compulsory zero-hours contracts, which create financial instability for carers and an environment in which bad employer practices are likely to be unchallenged.
We have already set out our plans to ban the use of exploitative zero-hours contracts and to improve enforcement of the minimum wage. Fines for non-payment of the minimum wage should be increased to £50,000 and we will champion the living wage through “make work pay” contracts. We have also signed up to the CQC being given an inspection role in the commissioning of care. There are other recommendations in this splendid review which we still have under consideration.
On funding, my noble friend has already shown how there is room to improve workforce planning and commissioning to generate savings. Obviously, the big challenge for the future is to raise standards and save money by the better integration of health and social care. We are committed to a £2.5 billion transformation fund that will cover both the NHS and social care and includes money to pay for 5,000 home care workers.
My noble friend Lady Kingsmill has given us a glimpse of the future and a vision of the professionalisation of care work—a cause towards which we should be proud to work.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I begin by congratulating the noble Baroness, Lady Kingsmill, on securing debating time for this Motion and on her opening speech. I thank all noble Lords for their excellent and thoughtful contributions.
I say immediately that working conditions in the care sector are very important for the well-being of our nation. We know that there are issues of concern and the Government are taking action. The White Paper, Caring for our Future: Reforming Care and Support, and the Care Act set out clearly what care and support system we want to achieve. Everything we want to achieve will depend on the competence, commitment and sensitivity of care workers. The positive relationships that are formed with people needing care are essential to providing good care.
The Department of Health is committed to ensuring that there are the right numbers of people with the right skills, knowledge and behaviours to deliver the quality, compassionate care that people need. We know that the recruitment and retention of care workers is fundamental to this. In that connection, I listened with great care to the noble Lord, Lord Curry. We published the recruitment and retention strategy in May 2011 in conjunction with Skills for Care, which worked to address the issue of how we attract and retain more people in social care. A refreshed recruitment and retention strategy was launched in September this year. Skills for Care leads the DH recruitment and retention working group, which will progress the implementation of the recommendations in the new strategy.
We have done three things straightaway. We have doubled the number of social care apprenticeships starts; we have launched a new care ambassadors service; and we have launched and piloted a values-based recruitment toolkit for the sector. Our aim is to continue this important work by supporting employers.
Registered managers, referred to in the noble Baroness’s report, have a vital front-line responsibility, and it is imperative that they are supported and do not feel isolated. We have worked closely with the National Skills Academy for Social Care to launch a national programme of support for registered managers.
The noble Baroness, Lady Kingsmill, proposed that we should introduce a licence to practise. I am afraid I need to make it clear to her that we do not think that a licence to practise is necessary or desirable. The idea of compulsory statutory regulation can seem an attractive means of ensuring patient safety, but our view is that regulation is no substitute for a culture of compassion, safe delegation and effective supervision. Putting people on a centrally held register does not guarantee public protection. Instead, the key is for employers, commissioners and providers to make sure that they have the right processes in place to ensure that they have the right staff with the right skills to deliver the right care.
Systems and processes are already in place to provide public assurance, including Care Quality Commission registration requirements and the Disclosure and Barring Service, which are being enhanced with the new chief inspectors. Under the leadership of the Chief Inspector of Adult Social Care, the CQC has put in place specialist inspection teams that subject care providers to more effective scrutiny and result in a rating that celebrates outstanding care as well as identifying where there are problems. Therefore, I cannot agree with the noble Baroness’s contention that the CQC’s requirements are somehow weaker than they were.
Better skills and training are an important part of raising standards overall. Camilla Cavendish told us that social care support workers and healthcare assistants do not have consistent training and do not have a clear status or standard job titles. I can tell my noble friend Lady Gardner that we are on track to introduce a care certificate for new healthcare assistants and social care support workers from 1 April 2015. This means that there will be specific standards for the training of new care workers.
My noble friend Lady Gardner expressed concern that employers and agencies train only for their own organisations and my noble friend Lady Brinton asked about the support that exists to enable staff to build their qualifications. Skills for Care has produced a range of training materials that are recognised across the sector. I mentioned the care certificate that we are introducing. In general, I would say that we are committed to working with employers to ensure that this part of the workforce receives high-quality and consistent training to enable them to deliver the best standards of support and care to patients and service users.
My noble friend Lady Brinton asked specifically about BME staff. The department has worked with the National Skills Academy for Social Care to produce training and development support for BME staff to enable them to progress to higher levels within the sector. As regards incentives for small businesses to train staff, which my noble friend also asked me about, small social care businesses are able to apply to Skills for Care for funding to help train their staff. The department provides £12 million to Skills for Care for this very purpose. However, it is incumbent on small businesses to ensure, like bigger enterprises, that their staff are appropriately trained and competent to carry out their role.
The noble Baroness, Lady Kingsmill, called for a care contract to be held between local authorities and care providers setting out working conditions and employment law. The statutory guidance to the Care Act which we launched recently is clear that when local authorities commission services they should make sure that care providers comply with national minimum wage legislation. The statutory guidance is also clear that, in most circumstances, very short home care visits are not appropriate to deliver intimate care needs. In addition, new fundamental standards will come into force next year. These new standards cover staffing and will allow the CQC to prosecute those providers that are responsible for the most serious failings in care. The CQC has an enormously challenging task in transforming its approach to the regulation and inspection of providers of social care.
We are also asking employers and employees working in care to sign up to the social care commitment, pledging to improve the quality of the workforce. My noble friend Lady Brinton once again asked what can be done to improve rates of pay in the sector, a concern also raised by the noble Lords, Lord Lipsey and Lord Kennedy. Under the Care Act, local authorities will be required to shape their whole local markets to ensure that they are sustainable, diverse and offer high-quality care and support for people in their local area. The Act is clear that a local authority’s own commissioning is a key driver in shaping the market. Ultimately, local authorities, not the Government, are responsible for the commissioning of services. However, when commissioning, a local authority must ensure that it promotes a sustainable market that delivers high-quality services for all local people. The department has developed statutory guidance to support local authorities to meet these new duties when commissioning and we are working with the Association of Directors of Adult Social Services, the Local Government Association and other partners to develop a set of commissioning standards which will, again, help local authorities to improve in this area.
The noble Lord, Lord Lipsey, asked specifically what we are doing to make sure that local authorities pay fair fees, while the noble Lord, Lord Birt, drew attention to the disparity in some instances between the actual costs of care and the fees paid by local authorities. We are clear that local authorities should have regard to the cost of care when setting prices. The Care Act sets out a duty on local authorities to have regard to the importance of sustaining the market as a whole, as I mentioned earlier, to meet the needs of local people. That will include where the local authority commissions services itself, considering the impact of how it contracts with individual providers, including the price it pays in fees. Contracting is of course a local matter, with fees paid to providers best left, in our view, to local negotiations in an open market that reflects local conditions.
My noble friend Lady Chisholm spoke powerfully and knowledgeably about the role of unpaid carers. I would say to her that the Government fully recognise the role of unpaid carers, who do an invaluable job in providing care for their loved ones. My department agrees that unpaid carers need support in the form of breaks. There are examples being provided by local authorities and charities, but as my noble friend knows, the Care Act is ushering in a significant new set of rights, effectively putting—for the first time—their needs on an equal footing with those of the individuals they look after.
We agree with the noble Baroness, Lady Kingsmill, that low pay can be a concern for some working in this sector. It was a concern also raised with particular emphasis by the noble Lords, Lord McKenzie and Lord Curry. The Government do not directly employ care workers, but let me be clear: non-compliance with the national minimum wage is not acceptable. That is why we are working across government on enforcement activity. I can tell the noble Baroness, Lady Andrews, that HMRC is responsible for ensuring that staff receive the minimum wage and it takes that role seriously. It has set out the action it has taken in the care sector in a report published last November. While the CQC does not itself enforce national minimum wage legislation, where its inspections uncover evidence that suggests the employer may not be paying the minimum wage, we would expect the commission to pass that intelligence to HMRC for its consideration. HMRC is continuing to carry out enforcement action in the social care sector. It will investigate all complaints made by care workers that their employer is not paying them the national minimum wage. Between April 2011 and March 2013, HMRC undertook a targeted enforcement exercise in the care sector. The work investigated complaints relating to 224 employers. Evidence of non-compliance was found in nearly half the cases and resulted in payments of more than £1 million in arrears to care workers.
I can tell the noble Lord, Lord McKenzie, and the noble Baroness, Lady Andrews, in particular that we are taking a tough approach to naming and shaming any providers who do not comply with our national minimum wage laws, with a more robust scheme now in place for cases opened after October 2013. Cases involving care workers often take longer to investigate than comparable cases in other sectors for a number of reasons, but we anticipate that the first examples of care providers to be named under the new scheme will appear in the next few months. Social care providers who have not paid the national minimum wage previously will be required to pay workers the money owed to them, to pay a penalty for failing to meet their legal obligations, and to change their practices to ensure future compliance.
The terms and conditions of employment for social care workers are essentially a matter for local employers within the existing requirements of employment legislation. However, it is important that the Department of Health continues to work with local authorities to ensure that the providers they commission services from have a high-quality workforce with fair terms and conditions. That brings me to zero-hours contracts. These contracts, when used responsibly, may be appropriate in some circumstances and can offer flexibility and opportunities to both the employer and the individual. The Government are committed to ensuring that zero-hours contracts are used fairly and have included provisions in the Small Business, Enterprise and Employment Bill banning exclusivity clauses in employment contracts that do not guarantee any hours. The Bill was introduced into Parliament on 23 June. Following feedback from stakeholders on the ban on exclusivity clauses, the Department for Business, Innovation and Skills is consulting further on how to prevent unscrupulous employers evading the exclusivity ban.
The noble Lord, Lord McKenzie, spoke powerfully about 15-minute visits. Short care visits are not normally adequate for the needs of service users. We know that care workers find 15-minute appointments demotivating because they are unable to complete their tasks within the time and develop meaningful relationships. We will continue to learn from the best employers and commissioners about how this situation can be improved. A focused peer challenge that will use elements of the commissioning standards will be piloted with two reviews by ADASS and the LGA in the coming months. We agree that in most cases very short visits are incompatible with high-quality care and the Care Act sends a clear message: commissioning services without properly considering the impact on people’s well-being is unacceptable.
However, it would be inappropriate to introduce a blanket ban on 15-minute home care visits since they may be appropriate in certain circumstances; for instance, when checking medication has been taken. A more fundamental culture shift towards a focus on outcomes through guidance and support is, we think, the way forward. Ultimately, local authorities are responsible for the commissioning of services, as I have indicated, but we agree, as does ADASS, that inappropriately short home care visits should be discouraged.
My noble friend Lady Brinton asked about the repatriation of foreign workers. I will need to write to her about that. Turning to a point raised by the noble Baroness, Lady Kingsmill, in relation to Southern Cross, the new Care Act establishes the CQC as the financial regulator for the largest social care providers. It will look at the finances of these providers and, where financial failure is likely, it will warn the affected local authorities to ensure that there is no gap in care services. The regime will not prop up failing providers but ensure continuity of care services for those affected, which surely is the most important consideration.
In response to some of the remarks made by the noble Lord, Lord Birt, with which I agree for the most part, it is worth reflecting that an effective market has been operating in social care for the best part of 20 years. Increasingly, private providers and third-sector organisations have provided services. They have done so effectively but, as in any market, some providers leave and others join. Exits can happen for any number of reasons but what we do not want to see is the kind of disruption to the market that the Southern Cross debacle could have led to had it not been managed successfully.
Delivering high-quality care is dependent upon a range of factors and uppermost is having a workforce that has the right attitudes, values, skills and qualifications. I hope that noble Lords will accept from my remarks that we have a programme of work in hand that is aimed at improving working conditions. We are working across government to tackle non-compliance with the national minimum wage. We are also making it clear that commissioners of services should ensure fair pay, terms and conditions and compliance with the national minimum wage when commissioning services, and we are ensuring set standards of training are introduced. These are surely the key pillars on which to ensure an attractive and fulfilling career can be built for this vital sector of the workforce.
Lord McKenzie of Luton
I apologise for interrupting the Minister. Is it the Government’s view that in determining whether or not the national minimum wage has been paid, the time spent travelling between client visits should be included?
NHS: Accident and Emergency Units
Lord McKenzie of Luton Excerpts(10 years, 5 months ago)
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Lord McKenzie of Luton (Lab)
My Lords, I am grateful to my noble friend Lady McDonagh for initiating this, albeit brief, debate. I plan to use my three minutes to focus on one point. Before I do so, I will say that it is hard to look aside from the mounting problems of A&E departments, spoken to powerfully by my noble friend and evidenced by the number of patients waiting longer than four hours, the numbers waiting on trolleys, the increase of bed days lost because of delayed discharges and staffing problems. A&E departments undoubtedly are struggling to cope. All of this is exacerbated, as identified by the Health Select Committee, by the inadequacy of information about the nature of the demand placed on the service.
There has been hardly any focus in the wider debate on accident prevention in the first place. Prevention would be investing to save: to save on pain and suffering, even death; to prevent days lost at school or work; and to save costs to the NHS, A&E and the welfare system. The current chaos compels us to be radical. At least one-third of the nation’s A&E attendances are the result of accidental injuries. There are millions of injuries every year that are 100% preventable, according to the Office for National Statistics. These injuries are rising as a significant proportion of the overall pressure on A&E because we have stopped investing in the tried and tested antidote. We should not be negligent about the safety of our citizens, our duty to our health professionals and the very future of our National Health Service.
The country’s longest-standing safety charity, the Royal Society for the Prevention of Accidents, of which I am delighted to say that I am now president and in respect of which I declare my interest, has already shown what can be done. In Liverpool, for example, it ran a home safety scheme, working with disadvantaged families with children under five. Equipment such as stair gates, fireguards and blind-cord shorteners were fitted in the homes of those most at risk. Parents were given practical advice to help them keep their children safe. This is not rocket science. The result was that A&E admissions for zero to five year-olds plummeted by about 50% over two years—against the trend, as home accidents have been rising steadily over recent decades.
There is no doubt that increased funding for accident prevention initiatives and a task force to co-ordinate national action could lead to a major reduction in the number of deaths and injuries and the call on A&E departments. The answer is not just more resources or different approaches to treatment, but an alternative that is staring us full in the face. Accidents are the main cause of preventable early death for most of our lives, costing the state £20 billion to £30 billion each year. Given all this, is it not time that we rediscovered that prevention is always better than cure?
Pneumoconiosis etc. (Workers’ Compensation) (Payment of Claims) (Amendment) Regulations 2013
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Lord Avebury
My Lords, I echo what the noble Lord, Lord Wigley, has said about the commitments that were made two years ago and about the inconsistency of the Government’s response to the demands that were made, I think in both Houses, at that time. When the equivalent to this order was debated two years ago there was criticism by the noble Lord, Lord McKenzie, and my noble friend Lord German of the gap which had developed between payments under the Child Maintenance and Other Payments Act 2008 to living mesothelioma sufferers and to their dependants after they had died. As the noble Lord, Lord Wigley, has said, it may take some time before a claim is submitted. Very ill patients may not be capable of addressing the matter in time. Equally, it is very awkward for relatives of the sufferer or for the local Asbestos Victims Support Group to get a signature from a patient who may be in great pain and on the point of dying, so that a claim can be submitted on his behalf.
The result was that in 2011, there were 2,952 in-life claims and 270 dependency claims. The Minister gave some statistics about the payments made to these individuals but it would be useful if, when he winds up, he could say something about the rates of claims submitted and separate them into in-life and dependency for 2013 and for the years up to the plateau which he says will occur in 2016. I think that that is a year later than we had previously been told.
In 2011, the average in-life payment was £15,204, while the average dependency payment was £9,026, which is trivial enough compensation when you think about someone who has got this frightful disease and even more so for the widow who has gone through the traumatic experience of seeing her husband die in excruciating pain. Of course, these payments are intended to tide the patient or the widow over pending the settlement of a claim which may lie against the former employer in whose service the exposure to asbestos occurred. For some patients, however, as the noble Lord has explained, the discrepancy is actually widening this year. One would have no hint of this from either the order or the Explanatory Memorandum, but the widow of a mesothelioma victim aged 67 at the time of his death will get £7,180 in 2013, compared with the equivalent figure in 2012 of £7,915 and £17,799 for the in-life claimant.
As the noble Lord, Lord Wigley, said, the reason for that discrepancy, the 9% cut, was explained by the DWP by the fact that it had made a mistake in 2010 in calculating the dependency payments for all ages at 50% plus disablement, and that resulted in overpayments to the band of dependency claimants we are concerned with in 2011 and 2012. As a result of that mistake, the dependency rate moved closer to the in-life rate, which, as I said, was clearly the intention of both Houses when we debated the matter in 2011. Nothing in the Explanatory Memorandum gives a hint of that bizarre outcome. I would be grateful if the Minister could explain why it was not drawn to the attention, at least of the Asbestos Victims Support Groups Forum UK, run by Mr Tony Whitston, who discovered it only by accident.
I should also like my noble friend to explain why we have departed from the principle that used to operate. When a mistake of this nature occurred that operated to the benefit of the citizen, we used to say that public faith was thereby pledged and that the Government would stick to the errors made and pay the amounts now to be issued in recognition of the mistake. Since 2008, lump-sum payments have been recovered by the DWP claims recovery unit in cases where civil claims for compensation are successful, and £21.3 million was recovered under the scheme in 2011. The Government expect that a further £49 million will be recovered over a 10-year period through the tariff scheme funded by insurers to pay compensation in cases where it is not possible to trace employers’ liability insurance.
If the Minister could give an estimate—I do not suggest that he should immediately, but when he has had a chance to discuss it with officials—of the net cost of dependency payments over the 10 years, based on the assumption that equalisation would be achieved in a straight line over that period, that would be helpful. The calculation should assume that over the same period, the cut-off age for those payments is raised from 67 and over to 77 and over, the cut-off age for in-life payments over the same 10 years. That would be useful in assessing the likelihood of being able to equalise the payments over that 10-year period.
I recognise that we will not secure any improvement in the lump-sum payment scheme for this year, because the parliamentary process does not allow that to happen. It is a defect in our system that so much is done by secondary legislation, which cannot be amended. In cases like this, where the Government obviously know that what they are proposing is highly controversial, they should offer the stakeholders concerned the chance to put their views forward at a Select Committee-type hearing before coming to a final decision. It is surely wrong that Parliament should be confined to expressing nugatory complaints about decisions such as this which affect people with mortal illnesses.
Lord McKenzie of Luton
My Lords, I start by thanking the noble Earl, Lord Howe, for introducing the regulations. I am bound to say that we are used to seeing a DWP Minister deal with them, but we are delighted that it is the noble Earl. I do not know whether that is a passage of a change in policy; we would be interested to hear if it is.
We have made known our general position on uprating by CPI rather than RPI, and that has not changed, but we can support the thrust of the regulations and maintain consensus about these two very important schemes. We are delighted in particular that these payments have not been subjected to the 1% uprating cap.
I note that the alignment of payments between the two schemes both for claimants and dependants has been maintained, and this is obviously something that we support. It is an important matter. But both the noble Lords, Lord Wigley and Lord Avebury, raised the point about the disparity between claimants and their dependants. Certainly, it is my recollection that it was the aspiration that the gap between these amounts be closed, or at least narrowed. Perhaps the Minister can tell us when an assessment was last made of the prospect of achieving this and whether there are any plans to do so.
Both noble Lords who have spoken referred to an error in 2010 and a correction to it which seemed to slip through the Explanatory Notes that we have today. That is quite possible, but an error in 2010 would have been on our watch if it was in the early part of the year. I was trying to recall what that might be. Certainly, if the adjustments that have flowed from it have not been fully explained, that is not good practice, and we would be interested to hear from the Minister on that point.
I am aware from the Cancer Research UK website of several clinical trials being undertaken in respect of mesothelioma and I wonder whether the Minister, wearing his Department of Health hat, has anything that he wishes to impart on the subject. I was going to ask a question about projections of peak numbers, but he dealt with that in his presentation.
The Minister also dealt with the question of pre-1948 schemes saying that people previously under those schemes would be transferred to IIDB. He said that most would receive an increase of up to £5 per week and obviously that is to be welcomed. He also said that no one would lose out, but is that as a result of specific transitional arrangements and protections that are in the scheme?
The Minister pre-empted another question. He has given us an update on the amounts of compensation paid under the two schemes for the previous year and the current year. But perhaps he can also let us have the figures for compensation recovery for these same periods. Compensation recovery was meant to fund certainly the 2008 scheme and contribute to the 1979 scheme.
On the subject of compensation recovery, the tracing and availability of employer liability insurance is clearly relevant. The Minister will be aware of the consultation launched by the previous Government—indeed, he referred to it—on the Employers’ Liability Insurance Bureau as a fund of last resort when employer liability policies could not be traced. The Government's belated response to that consultation—it was slipped out on the last day of the parliamentary Session in July 2012—was a huge disappointment.
Despite what the Minister said in introducing the regulations, could we have an update on progress on this? There are concerns around the scope of the bureau, time limits for making claims and opportunities for dependants to engage. The formulation that we heard a moment ago was that these things would go forward when parliamentary time allowed. We have a week spare as a result of the extra week that we were granted just today, so I am not sure what the pressure on the parliamentary timetable is that precludes this coming forward. It has been a long-term aspiration because we know that there are difficulties in identifying employer liability insurance policies.
The Minister will also be aware of government plans to change the basis on which employees will be able to claim compensation for injury and ill-health caused by work. There is the proposition that claims in the future will have to be based on establishing negligence. What assessment have the Government made of this change, which was rejected by noble Lords in a vote just yesterday? What is the assessment of its impact on compensation recoveries generally and as a source of funding for the 1979 Act and 2008 Act schemes?
Notwithstanding those questions, these are two important schemes that bring some relief to the thousands of people who are afflicted by these terrible diseases, and we will maintain the consensus and support the regulations.
Earl Howe
I am advised from the highest authority that the answer to that question is no. If I can supply the noble Lord with any further information, I would be happy to do so. The noble Lord, Lord McKenzie, asked me whether I could give him any further information on the progress for the new meso scheme. The Department for Work and Pensions is actively working with stakeholders, including the Asbestos Victims Support Group to develop this scheme. Unfortunately, I am not in a position to say anything ahead of the gracious Speech—but we might or might not hear something to our advantage on that occasion.
However, I can say that we fully understand that people who develop diffuse mesothelioma as a result of their negligent exposure to asbestos at work and who are unable to trace a relevant employer or their employers’ liability insurance policy to claim against would be eligible to claim from this scheme. We appreciate the urgency of the situation. As I have mentioned, eligible claimants diagnosed with diffuse mesothelioma from 25 July 2012 onwards will be able to receive a payment once the scheme commences.
I am aware that there may be one or two questions I have not been able to answer, some of which I have already referred to. However, I hope that in the main I have covered the issues raised and I commend the regulations to the Committee.
Lord McKenzie of Luton
Before the noble Earl sits down, I should like to thank him because he has gone through a lot of detail for us today. As regards the potential impact of the debate we are having generally about changes to the Health and Safety at Work etc. Act, civil liability and negligence, has there been any assessment of the relevance of that to compensation recoveries that are factored into the funding of the schemes that we are talking about today?
Earl Howe
My answer to that would be expressed in general terms. It is a longstanding principle that people should not be compensated twice. Usually, where social security benefits have been paid, they are recovered from compensation where people have been successful in a subsequent civil claim. That is the underlying thinking that is guiding us. But again, if I can enlighten the noble Lord further, I will do so in a letter.