Home Care Workers

Alison McGovern Excerpts

Wednesday 6th March 2013 Westminster Hall

[Alison McGovern (Wirral South) (Lab)]

I begin by congratulating my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. There could not be a more important subject on which to have a Westminster Hall debate. I also thank the hon. Member for St Ives (Andrew George), who made a very important contribution. To add more thanks, the recent CQC and Unison reports have been incredibly helpful; for those of us who have been thinking about care for some time, the two reports have crystallised and explained, in a well researched way, the substantial challenge that we face.

If I may make a slightly parochial Merseyside remark, this is an extremely important issue for us, especially in Wirral, where we have an ageing population, which, I must say, we are very glad about. We are glad and proud that our grandparents and parents are living longer, but with that pride comes responsibility. That is why the challenge that we face is very important. I would like to thank my constituents, who have been very good in coming to several public meetings with me on the subject of care. I have asked them to help me think about that issue, because I know that many of them face this challenge. They have willingly given up their time to inform me about their concerns, and I am incredibly grateful.

I have also been lucky in the Wirral because home care staff have met me and given me the benefit of their experience, along with council officers and councillors. I recognise that the problem is shared across all those groups. We are going to fix the problem together, and we are here today to ask the Minister whether he will join us in helping to do that.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On the point she just mentioned, does the hon. Lady agree that one of the pleasing aspects of this issue is the number of active senior citizens in all our constituencies who want, in a voluntary capacity, to involve themselves in the debate to try and lift the standards and ensure that we give the proper care to people in their own homes?

[Alison McGovern]

I could not agree more. Only last Friday, I was with Heswall Soroptimists, a very committed group of women who volunteer in our community, and who raised various issues about care. That is only one example of committed groups of citizens who are keen to be involved in finding a solution.

It is important that we make the moral case for change. Too often, people in need of care in their homes are hidden from our society, and people who need support, by their nature, can find significant barriers to their participation in democracy. Therefore, it is extremely important that politicians take the time to speak up for them. I have been meeting regularly with Wirral officers to try and work through some of those issues, and specifically, to discuss whether there is a way that we can improve the quality of care in our borough.

On that note, I flag to the Minister that such conversations are made much more difficult by the funding settlement that local government has received. The fact that local government has taken the biggest cuts from Whitehall has certainly impeded my ability, locally in the Wirral, to get change. I ask the Minister to note that point, and next time that he has conversations with Cabinet Ministers and the Treasury, to remind them of local government’s role in care and of the important challenge that we are trying to meet.

In discussions with Wirral council officers, we have also been trying to consider how to tackle the problem of information that has already been flagged. For people who are trying to procure care, it is difficult to know what quality standards they can expect and what the market looks like. I sympathise greatly with the points made by my right hon. Friend the Member for Oxford East about the role of markets in what is, I would argue, a bit of the economy that does not necessarily lend itself well to markets. I hope that hon. Members will forgive me if I sound like a bit of an economics geek when I say that, in any case, markets do not work well when participants have insufficient information. I believe that if we cannot solve that problem, the current system will never work.

I will move on to talk about two aspects of home care that have repeatedly been shown to be very important to my constituents. As I mentioned, we have had several public meetings in the Wirral to discuss these issues, and we have tried to bring together both those who work in care and those who receive care so that we can see the problems from either side of the coin. Those two aspects are 15-minute appointments and zero-hours contracts. Those two issues typify the insecurity at work and low investment in skills that home care workers face.

First, on 15-minute appointments, it might have been mentioned that the recent Unison report found that 46% of staff felt that they had to rush visits—that is nearly half the workers going into the homes of people who are very important and need help. The result is the feedback that I receive that due care and attention cannot be given to people. I am talking about basic matters of respect, such as addressing the person concerned as they would wish to be addressed.

Let me give an example from my own constituency. A care worker was in a couple’s home to make some food for them, but said that they were able to do that for only one member of the couple—the husband or wife—because that was all that they had been allocated time for. Most people expect to be able to sit down to a meal with their partner. That is a basic thing that we all expect to be able to do in our lives. Fifteen-minute appointments may or may not have been the cause of the problem in that case, but if 15-minute appointments mean that the normal standards that we would all expect to be upheld have to be disregarded, that is not a system that will work well.

I will read out a quote from one of the care workers to whom Unison spoke:

“When the person you go to needs more care or has incontinence you are only allocated 15 minutes for a meal and have to leave them. I haven’t left a client like that and would go over my time (although not paid for it), but it does mean you are running late for other calls.”

I cannot imagine what it must be like for someone to turn up at a person’s home and find, if they are incontinent, that the worst has happened. They are supposed to be there only to make them a sandwich or whatever and they must decide between being late for the next person, which will cause stress, or, frankly, rushing around doing things that they know they will not be paid for, which will cause them stress. At the same time, they are trying to make that individual feel better about what has happened. What skills and talents does someone need to make that situation go well? We should first admire the people who do this job, but also question what in the system is causing such a breakdown.

One aspect of this subject that I have highlighted as a result of listening to my constituents is that too much of the way in which our system works is task-orientated, not person-orientated. Dignity is extremely important. Increasingly, people have recognised that the way in which we treat others in society is ever more important. When we are asking people to do a list of tasks—no more and no less—rather than think about the individual and try to help them with whatever their needs are, we will not fix the problem. Individuals will feel bad about the care that they receive rather than feeling that it is a help to them. Another care worker quoted in the Unison report expressed that very clearly:

“I never seem to have enough time for the human contact and care that these people deserve.”

That is a lesson to us all.

Secondly, on zero-hours contracts, my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) and I have recently commenced a survey that is designed to listen to people across all industries who have experienced being asked to do or have taken on zero-hours contracts. Of course, for people who want a bit of work but do not need it to be regular—students or others—zero-hours contracts may not be such a problem. However, I think we all recognise in this Chamber the problems with that flexibility and insecurity in a world in which people are trying to provide routine, predictability and attention to detail for some quite vulnerable people. I think we would all question the appropriateness of zero-hours contracts.

There are two problems with zero-hours contracts that we need to consider. The first is inconsistent care. My constituents tell me that they would like to know who the person is who will be turning up and they would like visits to be predictable and regular, not least because of respect and dignity issues, such as knowing the little details. Often, people who need care face communication barriers. Understanding in detail how a person communicates is extremely important, so consistency of care could not be more important. How do zero-hours contracts support consistency of care?

The second issue is stress. Insecurity at work causes stress, and in a world in which we are asking people, as I mentioned in my example, to turn up and help vulnerable people, we need them to feel confident and secure and to have enough skills to be able to tackle whatever problems are there. Recent research has shown the impact of stress and insecurity for those working in care on the manner of treatment received by the people for whom they are caring. That is an important message to us all as politicians. What responsibility can we take for creating more security at work for those who care for vulnerable people?

Comments have already been made about the pay levels in the sector. They are clearly low. Low pay plus zero-hours contracts mean that we will have people of relatively low skill. I mean “low skill” in the technical sense; I would argue that people who work in care are extremely skilled and extremely able practically, given what they have to deal with. However, investment in skills will clearly not happen where there is low pay and an insecure labour market.

Having described the problem, I will conclude by describing what I believe might be part of the solution. First, working in home care needs to be seen as an aspirational job. There is no reason why someone should not work in care and aspire to management, to moving up in their career. We need to find pathways through the career chain so that we can make this a genuinely aspirational job. A significant number of our young people are out of work. We need to demonstrate to them that home care work is valued in society and that if they pursue such a career, they will be invested in and respected as members of our society. We need to make that absolutely clear.

I again thank my right hon. Friend the Member for Oxford East for securing the debate. There could not be a more important subject than this. I hope that the Minister will respond positively and explain what we can do to bring some change to the sector.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Turner.

I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this incredibly important debate. As was pointed out by the shadow Minister, the hon. Member for Leicester West (Liz Kendall), the subject is too often neglected. It is literally hidden behind closed doors, and it does not get the attention it deserves. I also thank my hon. Friend the Member for St Ives (Andrew George), and the hon. Members for Wirral South (Alison McGovern), for Strangford (Jim Shannon)—he drew attention to the brilliant work done by Crossroads in many parts of the country—and for Nottingham South (Lilian Greenwood), who spoke from direct personal experience.

I totally agree with the shadow Minister that the health and care system has not kept pace with the demands and challenges of an ageing society, and that we need a fundamental re-engineering of how we deliver care. I have a passionate belief in the need to shift towards an integrated care model, in which we shape services around the needs of the individual, rather than those of the institution, which is a shift that must happen.

Before I go into details, let me say that I applaud Unison for having undertaken the report that several hon. Members have mentioned. When its staff wrote to me about the report, I asked officials to meet them, and they will meet soon. I, too, asked to meet them, and I will discuss their concerns with them next month. I recently met some care workers, with another hon. Member, to hear directly from them, and I want to experience myself what goes on—often behind closed doors.

The right hon. Member for Oxford East mentioned whistleblowers, and I have a lot of sympathy with the points he made. Last January, the Government extended the Government-funded whistleblowing helpline to the whole of the care sector, so that any care worker can find out how to pursue their concerns. Of course, as employees, care workers have employment law protection, and we should encourage them all to use their rights.

The Government want to do all we can to ensure that standards of care remain as high as possible, and indeed improve. That is the challenge we all face. People who receive home care and their families should be able to expect the highest quality of care every time. I am aware of the many examples of poor care. The right hon. Gentleman and other hon. Members drew our attention to some pretty shocking case studies and to the fact that someone can have up to 13 different care workers over a relatively short space of time. As the hon. Member for Leicester West said, it is completely unacceptable that a person has to receive quite intimate care from someone whom they have never met before. Moreover, the idea of a zero-hours contract is, in most circumstances, completely incompatible with a model of high quality care, in which the individual really gets to know their care worker.

The CQC report “Not just a number” highlighted some serious concerns, which we must take action to address. The responsibility for bringing about improvement rests with all the key players, including the providers, the councils and the regulator. The Government too must take their share of the responsibility here. The trick is to erase the bad, keep the good and improve services across the board.

The care and support White Paper sets out our intentions to improve the standard of social care. We will do that primarily by investing in people—by focusing attention on the staff who provide care in the first place. I want to join the right hon. Gentleman and other hon. Members in paying tribute to care workers, the vast majority of whom do really excellent work, often in difficult circumstances. They work under real pressures because of the way in which care is commissioned over very short spaces of time. We are seeing a race to the bottom, and we must move away from that. It puts care workers under impossible pressure and it does not provide good quality care.

Another matter I feel strongly about, and to which I referred in my response to the Winterbourne View scandal, is that there must be much more effective corporate accountability. Some companies are making very good money out of home care, so accountability must go with that profit making. It is unacceptable that home care providers sometimes allow negligent care to take place under their watch, and they must be held to account for it. Poor care, private or public, should be condemned wherever it exists. We must not have the idea that poor care exists only in the private sector. It was intolerable that hundreds of people died in Mid-Staffordshire hospital, an NHS hospital, as a result of poor care, and it is equally unacceptable when it happens under the watch of a private provider.

It is impossible to speak about improving standards without also talking about human capital. Care workers who feel valued and encouraged will perform better; it is as simple as that. The more attention the Government pay to the skills, training and personal development of the work force, the better are our chances of improving standards. After all, it is the care workers, not us in Parliament, who ultimately provide the care. We must increase the capacity and the capability of the social care work force, give people better information about care providers and improve the performance of the regulator, the Care Quality Commission. All those things will make social care a more attractive place for people to work and, most importantly, improve the quality of services.

We will shortly introduce new minimum standards to improve training for care staff to make sure that all employees have the foundations for excellence. My focus must be on training and standards, and ensuring that they apply across the board. I am dubious about the idea of creating a new regulator or of using the Nursing and Midwifery Council, which has not had a great record, to regulate some 1.5 million people. The money that is available should perhaps go to the front-line workers, rather than on creating new bureaucratic structures. I will give way to the hon. Lady, and ask her to be very quick if she does not mind.

[Alison McGovern]

I will be speedy. I have listened carefully to what the Minister has said about the causes of the problem. He does not seem to have mentioned funding pressures on local government. Will he respond to that point, because it is a massive constraint on improvements in the sector?

[Norman Lamb]

I will directly address that point. The analysis of the independent King’s Fund said that provided councils apply the money that the Government have allocated to care and undertake proper efficiency savings, which the previous Labour Government recognised had to happen across health and care, they should be able to continue to provide the level of service that exists at present. We need to think more fundamentally about a much more integrated approach between health and care. We can save resources and improve care if we bring the systems much more closely together.

It was, I think, the hon. Member for Wirral South who made the point about looking at care as an aspirational role.

[Alison McGovern]

indicated assent.

[Norman Lamb]

I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.

I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.

When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.