Care Workers

Debate between Andrew Smith and John Robertson

Wednesday 5th November 2014 Westminster Hall

[Joan Walley (Stoke-on-Trent North) (Lab)]

May I, too, declare an interest, as a Unison member, and say how important it is that this issue has been flagged up in the debate? Given the concerns about this issue, should home care not be part and parcel of the discussions about the future of the NHS? We need to keep people out of accident and emergency and out of hospitals. If there is no care in the community, we will put more expense on the NHS and provide worse care. Does my right hon. Friend agree that, in discussions about the future of the NHS, we should make absolutely sure that these workers are paid a proper rate for the job and that travelling time is included? The Care Quality Commission has a vital role in this.

[John Robertson (in the Chair)]

Order. I ask hon. Members to keep interventions a bit shorter.

[Mr Smith]

I agree with my hon. Friend on all points. If this country is to get the standard of care we want, social care—home as well as residential—must be regarded as a central part of health service provision. The debate on health provision cannot be confined to the future of the NHS.

Providers made the point to me that 15-minute visits should be banned, except perhaps for check-up visits when other visits are being made to the person on the same day. I am pleased to say that since I raised that issue in our previous Westminster Hall debate about care, Oxfordshire county council has decided to phase them out. Others must do so too. There is a need for sustained funding and a co-ordinated push for training, to bring social care staff up to the standards required for commissioned services.

We need a scheme of accreditation that makes crossover into the NHS and back possible if we are to provide a career pathway to attract young people, and indeed some older people, into the care profession. Training should be part of an overall package that attracts people into care work. A carer who has had training should have certification that they can take with them to another employer. Those are points that providers have put to me. They point out that too many agencies do not even give carers their certificates, so they have no proof, and must go through the assessment—where it is provided—again. We must also have regard to the fact that the public and media perception of care too often stops at the NHS, and does not include social care. Protecting the NHS goes only part way to protecting our care system. We will protect the NHS by protecting social care, and that means that more money must go to local government. That is another point put to me by providers.

On the question of zero-hours contracts, I have been in touch with two local providers who have tried to offer salaried employment as an alternative, but have had little take-up, partly because employees are juggling a second job, and partly because they value the flexibility that allows them not to work, for example, on certain weekends. The zero-hours culture is deeply entrenched in home care work, and it will not be easy to change it, but I believe we must. The key priorities must be to ensure: that the contract does not preclude the employee from taking other work—it is disgraceful that it ever could; that the employee has reasonable freedom to take or refuse work as they like, to have time with their own family, for example; and that an exclusive zero-hours contract is not imposed. Let us also remember, however, the point of view of the person being cared for, the most important person in the debate. They usually want continuity in care, and they are less likely to get that with zero-hours contracts, under which a different carer will be sent to them time after time.

As well as the bigger reforms that I have mentioned, there are practical steps, which may vary a bit from locality to locality, that can make home carers’ jobs a little less of a struggle, and I will talk about some that are relevant in Oxfordshire. In Oxford, we have extensive residents parking zones. Home care workers must find one of the sparse two-hour spaces or get a visitor permit from the client and stick it on their car. That is one third of their 15-minute visit gone. Otherwise, they risk a fine—which is of course levied by the same county council that pays their employer to send them on the call. A way of recognising the value of home carers’ work would be to give them a permit to park in residents parking zones when visiting clients.

Another example, which is probably even more widely relevant, is that people who work in the NHS branch of the care system get a free winter flu jab. A home care worker on the minimum wage often will not get a jab unless they spend two or three hours’ worth of their meagre pay on buying one. Recognition of the value of their work could include giving them a free jab, either on the NHS or by requiring employers to make them available. I checked the 2014-15 Public Health England flu immunisation programme guidance, to which the Minister may want to refer. It states that flu immunisation should of course be offered to health and social care staff who are in direct contact with patients and service users. It states that they should be vaccinated by their employer as part of an occupational health programme. However, that raises the question of what happens when an employer does not offer the vaccination: is it the same as when an employer does not pay the minimum wage, and nothing happens?

I think there is a growing consensus among clients and providers, councils and trade unions, about what needs to be done in the vital service area of care. First, better funding is needed for social and home care. People will not get the standard of care that they need and deserve without it. The NHS chief executive’s vision of more care being provided in the community will be a mirage unless we raise care workers’ status and terms and conditions. Secondly, we need rigorous enforcement of the minimum wage and promotion of the living wage. Thirdly, care workers should have the right not to have a zero-hours contract forced on them. Fourthly, commissioning should encourage responsible providers. Fifthly, there should be investment in training and career pathways for care workers, with proper accreditation of care work. Sixthly, there should be regulation of the social care work force. That could start with the record of those unfit to practise that the Health and Care Professions Council has advocated.

We should all recognise the enormous value of the work that home carers do, and translate that recognition into action to improve their status, pay and training, to nurture good providers who are good employers, and to drive out the rogue operators. We would do well to remember every day that our loved ones, and we ourselves, are likely to need a home carer some day. Much good work is done by front-line carers, but too many of them are treated shabbily. That must be stopped. We must make sure that carers get the status, training and pay that they deserve, so that those who need care and those who give it can enjoy better lives, with dignity and respect.

Disability Living Allowance

Debate between Andrew Smith and John Robertson

Wednesday 23rd March 2011 Westminster Hall

[John Robertson]

My hon. Friend makes a good point and I will use a couple of cases as examples as I go through my speech.

On page 37 of the DWP consultation document, there is a list of automatic entitlements that the Government propose to remove, including one for blind people—the “severely visually impaired”. That entitlement was brought in as result of my amendment to the 2009 Act. The DWP consultation posed many more questions than it answered. We learned that the assessment for the new personal independence payment, which I will call “PIP”, will

“prioritise support on those individuals who face the greatest day-to-day challenges and who are therefore likely to experience higher costs.”

However, that wording was sufficiently vague that it could be overshadowed and interpreted in the light of other developments. Rules on eligibility would be restricted in such a way as to question the ongoing entitlement of disabled people in receipt of the lowest rates of the care and mobility components. PIP would consist of a mobility and daily living component, but unlike the existing care component, the new daily living component would comprise two rates, not three. An individual’s adaptation to their impairment would be taken into account in determining entitlement to PIP, presumably as a cost-cutting exercise.

I will not deal now with the plans to remove DLA mobility from individuals in residential care, as those plans were the subject of another Westminster Hall debate that was secured by the hon. Member for Arfon (Hywel Williams). I will simply add that it is reassuring that the Government will review mobility provisions for people living in care settings, but I still note the intention to remove DLA mobility for people in residential care in 2013, albeit one year later than originally proposed.

One of my most serious concerns relates to the Government’s plans to end automatic entitlement to DLA for people who clearly ought to have it, including the higher mobility component for people who have severe mental health problems, who are deafblind or are severely visually impaired. Individuals with those disabilities, along with people who are double amputees, automatically qualify for the higher rate, because they meet the strict criteria on the severity of their impairment.

That automatic entitlement is a clear and administratively efficient way of identifying disabled people with the highest level of mobility needs. In future, each case will be looked at individually, except the cases of people who are living with a terminal illness. Organisations for disabled people tell me that they do not believe that that is a sensible approach, as it will increase the costs of assessment while leading to the same outcome as the original system, and people with the most severe impairments will still receive the higher rate of benefit.

As I have mentioned, in three weeks’ time, more than 20,000 people in the UK with severe sight loss will be entitled, for the first time, to the higher rate mobility component of DLA and they will receive the extra £30 a week that they need in their pockets to maintain a decent quality of life. I tabled my amendment to the 2009 Act in the first place because of my strongly held belief that there is no good reason for discriminating between someone who faces physical barriers to mobility and someone who is unable to move around safely and independently as a result of blindness.

I want to tell the Minister about one of my constituents, as his case was the one that spurred me on to table the amendment to the 2009 Act in the first place. Alan McDonald has been blind from birth, has orientation problems and faces huge hurdles in getting around. He is unable to use public transport because of his difficulties in getting on and off buses and trains. Either he has to spend his other benefits on taxis, although they are meant to provide other support, or he is forced to rely on his sister to give him a lift to wherever he needs to go; otherwise, he has to stay at home.

Alan’s blindness is not the only barrier to his mobility. For example, when I tabled the amendment to the 2009 Act he was awaiting a second kidney transplant and was due to undergo surgery for hardening of the arteries. Despite all those difficulties, however, he was told on several occasions that he simply did not qualify for the higher-rate mobility component of DLA, because he was physically able to walk. Yes, he could walk—he could walk into wheelie bins, or into a set of traffic lights, or even into the middle of the road where he would be knocked down; but he could walk, so he did not get the money.

The barriers that Alan faces are just as great as those faced by someone who cannot walk, and the current situation is nonsensical. I believe that the Minister has to consider such things. It is unbelievable that somebody with such disabilities might not receive the higher rate of disability allowance in two years’ time, having finally received it after all these years.

Blind people such as Alan are justifiably angry about the discriminatory and unfair treatment that they receive, but they will feel even angrier and let down when the DLA mobility component, which comes into being in April, is taken away from them in just two years’ time. That will put them back to square one.

Many charities have contacted me because they are alarmed about the Government’s proposals. For example, the Guide Dogs for the Blind Association is concerned about the proposal that PIP should replace DLA. In particular, the association is concerned about the proposal in the DWP report on DLA reform proposals to

“take greater account of aids and adaptations”.

Taking into account the use of aids and adaptations when assessing eligibility could inadvertently penalise an individual who uses such equipment to try to reduce some of the difficulties that they face as a disabled person.

[Mr Andrew Smith (Oxford East) (Lab)]

I commend my hon. Friend’s campaign and the passion with which he is putting a very powerful case. Has he been contacted by the National Autistic Society? I ask that because there is enormous concern on the part of those who care for autistic people and those with family members who are autistic, as DLA is crucial for communication, travel and services for autistic people. It is crucial that access to DLA be retained for autistic people as well as for the other people whom my hon. Friend has mentioned.

[John Robertson]

I thank my right hon. Friend, who has more than a little reputation of looking after these people, both as a Minister and as a member of the previous Government. I congratulate him on the work that he has done. I have been contacted by so many groups that I could not possibly name them all in my speech today. If I miss any of them out, it is not because I want to do so, but because my speech is time-limited, but yes, I have received correspondence from the National Autistic Society and I thank my right hon. Friend for his input.

Any reduction in disability-related benefits simply because of someone’s access to equipment could significantly inhibit their efforts to lead a more independent life. Disability-related benefits enable people not only to live independently, but to participate in community activities. Such community engagement could include volunteering, which is a core component of the big society and could help someone to gain skills and experience that could enable them to go on to seek and obtain work.

Several wrong assumptions could be made about the effectiveness of aids and adaptations. They might work for some individuals, but others might struggle with them. Issuing someone with a cane or a low-vision aid such as a monocular, does not necessarily mean that that person will continue to use it, or use it correctly. Even if the aids and adaptations are used appropriately, they are likely to have only limited uses. For example, a liquid level indicator might help someone safely to make a hot drink, but it will not make it any easier for them to make a meal to go with that drink. How will the Government help these people?

I know of another gentleman, David Griffith from Walthamstow in London, who receives the mobility component of DLA because he is deafblind, like Alan. He uses his DLA to pay for taxis, and for other support in getting out and about. He also tries to walk in his local area, and has recently applied for a guide dog because he has had a few near misses with cars of late. However, having heard a feature on the BBC Radio 4 programme “In Touch,” he is now worried that becoming a guide dog owner might result in the removal of his DLA. Under the proposals, a guide dog would enhance his life and make him safer in one element of his mobility, but he would never have the independence that sighted people have. He would not be able to jump out of the way of the car that was about to hit him, and he might travel on a bus that he did not mean to get on in the first place.