Social Care Reform

Barbara Keeley Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

My hon. Friend is absolutely right. At the heart of care is the workforce. They are the individuals who are providing the care and who make the difference day in, day out for those who need their important care. Absolutely, I want to make sure that we have the workforce across social care. We need to ensure we have the training there and greater career progression opportunities for those who work in social care.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

It has been reported that the Prime Minister is in favour of finally implementing the cap on care costs legislated for in 2014. While that would be welcome, it would do nothing to support working age adults with a disability to live independently, nothing for the 1.9 million older people with unmet needs and nothing to improve pay and conditions for care staff. Does the Minister recognise that a cap on care costs alone does not go far enough, and can she confirm that further measures to deal with these other needs will be part of any reforms?

[Helen Whately]

I hope the hon. Lady will forgive me if I am not drawn on specific models of funding or paying for care, but the Government and I recognise that we have on the one hand the challenge of catastrophic costs and the problems some people face of having to sell their home to pay for their care, which many Members have mentioned already today, but also we have the other part of the system, which is those who receive care funded by the state. Many of them are of working age, as well as there being older people. She is right: in our social care reform, we need to look across the breadth of the system.

Covid-19 Update

Barbara Keeley Excerpts

Monday 14th June 2021 Commons Chamber

[Matt Hancock]

I of course understand why many in the wedding industry and many who are planning to get married in the next month would prefer to be able to do so without any of these rules at all. I do not want these rules either, but, unfortunately, we have a virus that is growing again. We have to take the extra time to allow the vaccines to come through, so the social distancing rules are staying in place right across the board. Carving them out for one very specific activity is something that we looked at, but that we found a very, very difficult decision to take for all sorts of reasons, legal and practical, and in terms of fairness to everybody right across the board in different circumstances.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I wish to return to the question of surge vaccinations. Case rates in Salford are higher than they have been since mid-January. They are five times higher than the national average and they are doubling around every seven days. We need to get vaccines into arms as quickly as possible, but this week we only have 3,500 doses of Pfizer, and that is falling to 2,200 doses next week. Despite promises from the Secretary of State of enhanced support and some talk of surge vaccinations in hotspots such as Salford, that lack of doses of the Pfizer vaccine is the major barrier to getting everyone in Salford jabbed. Will the Secretary of State remove that barrier? Will he make sure that we get the supply of Pfizer and the flexibility to vaccinate all our over-18-year-olds?

[Matt Hancock]

I am afraid that my reply is the same as it was to the hon. Member for Rochdale (Sir Tony Lloyd), which is that supply is the rate-limiting factor.

[Barbara Keeley]

indicated dissent.

[Matt Hancock]

The hon. Lady shakes her head, but it is a matter of fact that supply has been the rate-limiting factor throughout. We will do everything we can to support vaccination using the doses that we have. As she well knows, the UK, thankfully, is right at the front of the global race to get vaccinated, and that is because we bought early in very large bulk. Of course, we have worked to make that supply as big as possible as fast as possible. We go as fast as we can, but we cannot go faster than we can.

Winterbourne View Hospital and the Transforming Care Programme

Barbara Keeley Excerpts

Thursday 10th June 2021 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I beg to move,

That this House has considered the 10th anniversary of the investigation into the Winterbourne View Hospital and the Transforming Care Programme.  

It is a pleasure to speak in this debate with you in the Chair, Ms McVey. I thank the Backbench Business Committee for allocating time for this important debate.

The debate is being held to mark the 10th anniversary of the BBC “Panorama” programme that revealed the scandalous treatment of autistic people and people with learning disabilities in Winterbourne View Hospital. One of the experts on the programme said that Winterbourne View was

“run by a group of bullies for their own entertainment.”

It should shame everyone involved in the healthcare system that it took a team of journalists to uncover those abuses, when complaints from whistleblower Terry Bryan were ignored by the management of Castlebeck, which ran the hospital, and by the regulator, the Care Quality Commission.

I recently re-watched the programme—a decade on, the abuse shown is still shocking. At the time, it was rightly described as “torture”. One resident was showered while fully clothed, and had mouthwash poured in her eyes. On the same day, she had jugs of cold water poured over her head and was kept outside in March until she was shivering. Another resident was asked by a member of staff whether they wanted the staff member to

“get a cheese grater and grate their face off”’.

Residents were slapped and held down under chairs. They had their hair pulled and were pinned down while medication was forced into their mouths. One resident was so distressed by that treatment that she tried to throw herself out of a second-floor window and was then mocked by staff.

That behaviour was the end result of a system that did not see residents as people. Rather than the person-centred support that we would rightly expect in any hospital, a closed culture developed where abuse became normalised. Such abuse should not have been left to be uncovered by a journalist and secret filming. A whistleblower, Terry Bryan, had taken his concerns to the management of Castlebeck, then to the local safeguarding board, then to the Royal College of Nursing and then to the Care Quality Commission on three separate occasions. It was only when all that led to no action that he approached the BBC.

Ultimately, 11 members of staff at Winterbourne View pleaded guilty to neglect or abuse, and six of them ended up spending time in jail. However, Winterbourne View was not just a failure of one hospital or a few staff—although it certainly was that. The people in that hospital were let down by the entire system: from a provider that did not pay enough to attract or retain dedicated or qualified staff and did not supervise or manage them, to a regulator that failed to listen to the concerns of a whistleblower and to commissioners who were happy to put people in that hospital and then fail to monitor the placement or follow up with discharge plans.

Since 2011, residents in other in-patient units have been subject to similar abuse. As recently as 2019, another BBC “Panorama” programme uncovered similar treatment at Whorlton Hall in County Durham. Staff there were filmed verbally and physically abusing residents.

If the residents of Winterbourne View were let down by a system that simply did not place enough value on them to intervene, everyone who has faced abuse in those units since 2011 has been let down by a string of Governments, who have failed to take the action necessary to stop the abuse happening.

The only way we can ensure that there is no abusive treatment in those units is to move autistic people and people with learning disabilities into the community, where they can be given appropriate support to live independently. In 2011, following those shocking revelations, the Government seemed to recognise that, and David Cameron pledged to close all inappropriate in-patient units by 2014—but that was only the first in a long line of broken promises. By 2014, there were still thousands of people detained in those inappropriate institutions.

In 2015, NHS England pledged to reduce the number of people in assessment and treatment units by between 35% and 50% by 2019, but that target was missed, with the number falling only 5%. NHS England then pushed the target back a year, but that was also missed. By April 2020, the number of people in in-patient units had fallen only 15% in five years.

The NHS long-term plan then committed to reducing the number in units by 50% of the 2015 level by 2024, but on the current trajectory that will be yet another target the Government do not get close to meeting. A decade after the abuse at Winterbourne View was uncovered, more than 2,000 people are still detained in inappropriate institutions. As today’s learning disability mortality review shows, people with learning disabilities who end up in mental health units are nearly five times more likely to die young than their peers. The mistreatment people experience in those units stays with them for life, even after they are discharged. On average, people in such units have been detained in some form of hospital placement for more than five years.

What progress we have seen has been painfully slow. We still see hundreds of people admitted to in-patient units every year, and the number of children detained has risen by a third since 2015. We normally talk of admission to hospital being for care or for treatment, but neither of those words is appropriate here, and far too many people admitted to such a unit will have stories of poor treatment and abuse by staff.

Dan was left scarred by poor treatment in in-patient units, which led to him trying to overdose on pills when he was discharged, and then being detained in hospital for another 18 months. Kayleigh was moved from Winterbourne View to another hospital. Within weeks, she had been pushed and hit, and had made more serious accusations against the staff. Ryan was first detained when he was 17. Over the years, he has been isolated and held in long-term segregation. He has been heavily medicated with drugs so powerful that their side effects meant he had to have 18 teeth removed.

Hospital reports show that Ryan has experienced broken bones, and other injuries that sometimes were treated only after a week had passed. Ryan was supposed to be discharged three years ago. He has had an independent case review, which flagged urgent issues with his care. Over the past year, his family have seen their visits restricted and there have been covid-19 outbreaks on his ward. Despite media attention and legal support, Ryan’s discharge plan stalled repeatedly. While things are now looking up for him, hundreds of other people have not been so lucky, and it should not need TV crews and lawyers to get people basic dignity and proper care and support.

People end up in these totally inappropriate units because the funding is not available to support them in the community. One Winterbourne View resident, Dan, had previously been supported at home by a small specialist provider. When it asked for funding for two more hours a day of support so it could manage the triggers that set off Dan’s challenging behaviour, it was turned down. Dan’s family were then told they had no choice but to allow him to be moved to an assessment and treatment unit. That removed him from his home and from his support network. In the unit, Dan was forcibly restrained and ultimately ended up in Winterbourne View. That abusive care cost the Government £3,500 a week—far more than the extra couple of support hours he needed to remain at home.

Clearly, that was not inevitable. After the BBC’s “Panorama” programme, Dan’s family were supported to move him back home. A suitable property was found in his home village and the care staff who had worked with him before he was admitted to Winterbourne View were rehired. Nearly a decade later, he is still living independently in his own home. Unfortunately, such success stories are far too rare.

A similar story is that of a young autistic woman, Bethany, which I have raised many times in the House. She ended up in in-patient units because her local authority said it needed

“a break from paying for her support”.

By sending her to an assessment and treatment unit, it could shift the burden of funding to the NHS. That is the root cause of the Government’s failure to address this scandal over the last decade. If people are moved out of an in-patient unit, they need to be moved somewhere they will be supported. Under our current system, that kind of community support is funded by local authorities, which have had £9 billion taken out of their social care budgets over the past 10 years. Supporting a person with learning disabilities who might have complex needs is not cheap when compared with many other social care packages, so it is not surprising that cash-strapped local authorities have tried to pass the buck on funding to the NHS.

In the 1980s and 1990s, when the long-term psychiatric hospitals were closed, there was a system of dowries whereby the funding moved with the person as they were discharged to a local authority. That discouraged the kind of siloed thinking that sees a person’s human rights denied because a local authority cannot afford to fund the care they need. The Government could have reinstated those dowries. They could have given local authorities far more funding to ensure that they can support autistic people and people with learning disabilities properly in the community. They could have matched the ambition of their rhetoric with the resources that are needed.

Instead, we currently have a £62 million funding pot spread over three years to support people to be discharged. High-quality community support for people moved out of those units can cost as much as £100,000 a year, but even that is much less expensive than placements in private hospitals, which can cost six times as much. That means that the Government’s funding settlement is probably only enough to discharge 200 of the 2,000 people currently trapped in in-patient units. Because the funding only runs for three years, there is a real risk that when the funding runs out, those people will be readmitted to an in-patient unit.

We are not talking about huge sums of money when compared with the expenditure the Government have taken on over the last year. In 2019, the Labour party proposed spending £355 million a year on dedicated and targeted support, which would have been sufficient to move everyone currently in an in-patient unit into their community.

At the same time as discharging the 2,000 people currently detained, we also need to ensure that nobody else is admitted to those units, and we may need legislative measures to ensure that that happens. Underpinning any changes must be the reform of our adult social care system. We are still awaiting the details of that long-promised reform, but perhaps the Minister can tell us more today. Perhaps she can tell us whether the Government’s reform will increase funding so that local authorities can afford to support everyone who needs help to live independently in their community, including autistic people and people with learning disabilities. If it will not, one of the largest issues in our social care system will be left unaddressed.

It is a decade since BBC “Panorama” revealed the appalling treatment of the residents of Winterbourne View. As a society, we could and should have taken that as a cue to say, “Never again,” and to ensure that all autistic people and people with learning disabilities were given the support they needed to live independently in their own communities. Instead, we have had a decade of broken promises and broken targets. Rather than putting in place an ambitious programme of change, the Government have repeatedly promised reform while simultaneously cutting the funding for the very local services that would deliver that reform.

Autistic people and people with learning disabilities trapped in those inappropriate institutions cannot afford to wait any longer. Rather than more empty promises, they need legal changes to end the use of detention. Alongside that, we must see a radical programme of investment in community social care services to support them to live independently in bespoke accommodation, with care packages designed around their needs. We need a new commissioner, independent of Government, to oversee the process of moving people out of those institutions and hold the Government to account if they fail to make the progress that is needed.

After a decade of failure, I hope today the Minister can give autistic people and people with learning disabilities and their families the reassurance that they need and deserve, because it is long past time that we fixed this problem. However slow the progress, there is no excuse for not making sure all the people detained in institutions are safe. That needs to happen now—today. The two most important changes are the proper oversight of community provision, which is centred round choice and personalisation. We need bespoke packages of accommodation and care, not institutions. People can live happily and independently with an environment and support made for them.

[Esther McVey (in the Chair)]

I remind Members that we will be going to the Front Benchers no later than 4.25 pm, and we would also like to hear Barbara Keeley wind up within that time limit.

--- Later in debate ---

[Barbara Keeley [V]]

I thank the organisations and campaigners who supported the debate, including Mencap, Rightful Lives—particularly Julie Newcombe—Care England, Dimensions and the Equality and Human Rights Commission for their support and briefings, to which other Members have rightly referred.

There is not a lot of time left, but I have heard across the different contributions—I thank colleagues for them—a real desire for change. We do not agree on every last detail of that—not everybody agrees with my recommendation to have a commissioner—but there is a real hunger and desire for change. Across the contributions, a great deal was said about personalisation, changing cultures, having pride in the NHS and not binding us to its failings, to which the hon. Member for Peterborough (Paul Bristow) referred. My hon. Friend the Member for Leicester West (Liz Kendall) rightly talked about putting families in the driving seat of change.

A decade after Winterbourne View, it simply is not acceptable that people are still detained, when they could and should be supported in the community. There is real agreement about that. I hope the Minister will listen to what has been said and ensure that the necessary resources and political leadership are delivered, so that we can ensure that the horrors of Winterbourne View are finally a thing of the past.

Question put and agreed to.

Resolved,

That this House has considered the 10th anniversary of the investigation into the Winterbourne View Hospital and the Transforming Care Programme.

Covid-19 Update

Barbara Keeley Excerpts

Monday 7th June 2021 Commons Chamber

[Matt Hancock]

I am delighted by that question, because the data that I put in my statement was right off the press—it is new data. I am absolutely happy to look at how it is published and on what basis. I hear my right hon. Friend’s call for it to be published daily; we do update most of this data daily on the website. We have not got to that point yet—we have done a first cut of the data up to 3 June, as I read out—but the critical question is how many cases are translating into hospitalisations and then into deaths. I am very glad that we were able to do the first cut today, and I will see what I can do on publication.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

The Government are pushing through a data grab that will see GP patient records held on a central database, which will, in turn, be available to private companies. Anyone getting the covid-19 vaccine from 1 July will have their GP record updated and so uploaded to that database on that day, often without their knowledge. There are enough fears adding to vaccine hesitancy and the Government are now adding concerns about data privacy to that, so will the Secretary of State agree to stop this data grab, undertake a full consultation with patients about sharing their personal data and publicise just how they can opt out?

[Matt Hancock]

The way the hon. Lady characterises this policy proposal is not accurate. People listening to this debate should be reassured that the privacy and security of their data are absolutely paramount. I look forward to her working with the NHS and with government to reassure people about the use of their data, because, ultimately, by making sure that we can understand what is happening, we can find better treatments, improve individuals’ treatment and save lives. This is all about making sure we use the best of modern technology to save lives and, in the process, improve the privacy and security of data. I hope she will take that message and reassurance and pass it on to her constituents and others with whom she is working, because, ultimately, improving and saving lives is the NHS’s historic mission and this policy proposal is just another small step in that.

Covid-19: Government Handling and Preparedness

Barbara Keeley Excerpts

Thursday 27th May 2021 Commons Chamber

[Matt Hancock]

I am absolutely delighted my hon. Friend has had his first jab; I did not know he was old enough yet. It is very important that you take decisions in government based on the information that you have at the time. Of course, you can go and assess things based on information you have afterwards, but you can only take decisions on the information that you have, and that is why an unprecedented crisis like this leads to unprecedented challenges, and what you have to do is tackle those challenges as best you possibly can.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

At the start of this pandemic, covid-19 was seeded into care homes by a discharge policy that required care homes to take asymptomatic patients. A letter from Kent and Medway CCG to care providers dated 26 March 2020 made it clear that they were asked to take such patients whether they had been tested or not. Yesterday, the joint Select Committee inquiry heard that the Prime Minister was told by the Secretary of State that testing would be in place for these patients. I am asking quite specifically: did he know that the discharge process did not require testing, and did he sign off this policy, which led to thousands of avoidable deaths of vulnerable people and many deaths of care staff?

[Matt Hancock]

I have answered this question many times, and the challenge is that we had to build the testing capacity. At that time, of course I was focused on protecting people in care homes and in building that testing capacity, so that we had the daily tests to be able to ensure that availability was more widespread. That is at the heart of the importance of the then 100,000 target, and we are now up to a position where we have millions of tests available per day.

A Plan for the NHS and Social Care

Barbara Keeley Excerpts

Wednesday 19th May 2021 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

This is a Queen’s Speech that lacks the ambition to deliver the transformative change that our country needs and wants. Despite repeated promises, the Government have no plans for how to fix the biggest challenges facing our country today. They have no solution to the rising problems of insecure and low-paid work, they have no solution to address the ever-increasing backlog of treatment needed in the NHS, and they have no solution to tackle the climate emergency. Nowhere is this lack of ambition clearer than on social care.

More than 10 years after the Conservatives entered Government, they still have no solution to the problems facing our broken social care system. Since 2017, the Conservatives have promised 10 times to bring forward proposals for social care and every time they have broken their promises. This continual kicking the can of reform down the road is letting down the people who need care: unpaid family carers and care staff. People deserve to be able to access care to support them to live independently in their own homes for longer, supported by care staff who are paid at least a real living wage. Instead, they face rising charges for care services, shrinking support packages, wage freezes for care staff and no respite for unpaid carers. A Health Minister told me in a debate I led on a carers strategy that only 45,000 carers had received respite care in 2019-20. That is a disgraceful record from the Government when there are now 13.6 million unpaid carers.

The Secretary of State said earlier that the long-promised reforms to mental health law will come in the next Session, rather than this one. We are coming up to the 10th anniversary of the revelations of abuse at Winterbourne View and the Government have failed dismally on the promises they made to close abusive in-patient units and support people to live in the community. Delaying to the next Session will mean two more years in abusive settings. I call on the Secretary of State to bring forward new legislation in this Session, so we can finally change this appalling situation.

With our Greater Manchester Mayor Andy Burnham, we have seen the difference that radical local government can make to people’s lives, with action on homelessness and radical plans to create a public transport system that works for everyone. Instead of building on those plans to deliver transformational change, the Government are content to let people down with this thin Queen’s Speech. Rather than giving our hard-working nurses and doctors a real pay rise to recognise the work they have done this year, they are tinkering with NHS structures and handing more powers to the Secretary of State. Rather than bringing forward plans to ensure older and disabled people can continue to live in their own homes, they are once again kicking the can of social care reform down the road. Rather than bringing forward legislation to protect people at work and end the appalling practice of fire and rehire, they are seeking to roll out unnecessary voter ID legislation. The people of this country deserve better and I urge the Government to change their approach, live up to their promises, and deliver the real change this country needs.

Covid-19: Social Care

Barbara Keeley Excerpts

Thursday 22nd April 2021 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this important debate with you in the Chair, Mr Twigg. I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing it and on the way she opened it. It is the first time I have spoken in a Westminster Hall debate in the Boothroyd Room as well.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit very hard over the past year. Of course, it is not just care home residents who have died from the virus. We know that people with learning disabilities were around six times more likely to die from covid-19 than the general population. Every single one of those deaths was a tragedy that we must never forget.

Beyond that appalling death toll, there are staff who worked far beyond what would normally be expected of them, many of whom have also been hit hard by the deaths of people they have known for years. There are also care home residents who have been cut off from friends and family for months on end and other care users who have gone without vital support in order to avoid contracting covid.

The Government made the fundamentally flawed decision at the start of the pandemic to allow local authorities to overlook their obligations under the Care Act 2014. While these social care easements were used by only a handful of local authorities, and have now been withdrawn, the reality is that many people using social care saw their services cut back.

Over two thirds of people with learning disabilities reported that they had their care packages cut in the first wave of the pandemic. The vast majority of these will not have lived in areas that implemented Care Act easements, meaning they should not have seen changes to their care packages. As a result, four out of five family carers have been forced to take on more unpaid care for the person with a learning disability. Nearly nine out of 10 people with a learning disability have not had all their social care reinstated, so their family members and carers are still having to increase the care they give.

Where services were still provided, restrictions on visiting often failed to consider the damage that isolation does to people’s wellbeing. I accept that there were times when visiting had to be paused, but the use of blanket bans and maintaining restrictions beyond those imposed on the rest of society left residents isolated and seriously impacted their wellbeing. The issue is exemplified by the current guidance on visits out of care homes, as referred to by my hon. Friend.

The Government have finally relented on allowing the over 65s to go on visits out of their care homes, but they are expected to isolate for two weeks on their return. As I raised with the Secretary of State for Health and Social Care this week, a traveller from Brazil or India must isolate for only 10 days when they arrive in this country. Are we seriously saying that an older person on a visit, who sits outside for an hour or two with a family member who has tested negative, is more of a threat than someone coming from a country that is seeing a hundred times more covid cases than the UK? In addition, as my hon. Friend rightly raised, the issue of residents having to isolate after voting must be sorted out before election day.

Earlier in the pandemic, there was a blanket ban on visiting for people with learning disabilities living in care homes or those living in supported living settings. Many of the people covered by these bans lived alone in their own homes, with carers coming in to support them but, because of the lack of clear guidance, they were told they could not form a support bubble and they could not have visitors. This was disproportionate and it risked creating closed cultures in some services, because neither family members nor Care Quality Commission inspectors were able to visit to monitor the development of any inappropriate practices. At its worst, I heard from the mother of a young person with learning disabilities that the social worker had to ask care staff to bring the young person to the window to prove he was still alive.

I am glad that we have now moved away from the position of blanket bans, but people living in care homes and in supported living settings need a concrete reassurance that they will never again be denied fundamental rights, such as contact with family members. If this means implementing robust testing procedures for some time yet, that is what should happen.

I want to turn to care staff, whose work and commitment have gone above and beyond over the last year, because they deserve better support. As my hon. Friend said in her opening speech, at the start of the pandemic we heard about care home staff leaving their families to move into care homes full time, so they could ensure they did not unwittingly bring in the virus. Care staff also took on additional roles, because NHS staff switched to online consultations or were unable to visit due to ongoing covid outbreaks. Much of what care staff did was involved with end-of-life care.

The Select Committee on Health and Social Care heard from one member of care staff who told us this:

“We have done things that are on a par with other medical professions…we have a duty to care, and we do the job for a reason.”

If the crisis of the pandemic showed us anything, it was that without the hard work and commitment of care staff our care system simply would not work. We must remember the 470 social care staff who died from covid, including Jane Rowbotham, a care home manager in my constituency. Despite all that, care staff remain chronically underpaid and undervalued, with poor recruitment and retention rates. There is, rightly, outrage at the idea that NHS staff will get a real-terms pay cut this year, but most care staff will not get any rise either. The reality is that most of them will be asked to accept a pay freeze, at best, despite rising workloads and all the additional responsibilities.

There are 112,000 care job vacancies, and the turnover rate is 30%: those workforce issues cannot be allowed to continue indefinitely. Without extra funding, care providers are not in a place to provide extra support to their staff. Since the start of the pandemic they have taken on extra costs, from extra PPE to deep cleaning, while there has been a drastic decline in the number of care home residents. They were struggling to make ends meet before, and the additional funding provided by the Government simply has not been sufficient to meet their needs.

The Local Government Association estimates that adult social care services have faced additional costs of £6.6 billion in tackling the pandemic, with PPE alone costing more than £4 billion. The National Audit Office has reported that many local authorities will have to rely on reserves to balance their budgets this year, and there is little confidence about the setting of budgets beyond that, to meet needs that have increased during the pandemic.

It is clear that since the emergence of the virus last year, the social care sector has often been overlooked by the Government. Ministers claim to have put a protective ring around care homes at the same time as hospitals were actively discharging covid patients into care homes, without testing them. Care homes, in turn, were not resourced for the measures that they needed to control an outbreak. Residents have gone without contact with their friends and families because of limits on visits, which still involve a longer quarantine period for a care home resident who spends an hour sitting outside with a family member than there is for an international traveller coming back from a red-list country. Staff who have done so much to keep the care system going are rewarded only with the offer of a CARE badge. There is no pay rise or bonus as offered to care staff by the Welsh Labour Government.

All that is not good enough. When the Minister responds to the debate, I hope that we shall get more than warm words for social care. We need solid commitments. The pandemic has to be a turning point in the way we treat care staff. In the past year we have all seen that the work done by care staff—whether in a care home, providing domiciliary care, or in supported living—is every bit as important as the work done by NHS staff. It is time for social care staff to have parity of esteem with NHS staff, and for a workforce strategy for social care that has better pay, conditions and training for the staff who have given so much. It is way past time for the Government to take action to fix social care funding as they have promised to do repeatedly in the past 10 years.

--- Later in debate ---

[The Minister for Care (Helen Whately)]

I will do so. It is a pleasure to serve under your chairmanship, Mr Twigg. I wish the shadow Minister’s mother a happy birthday today.

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my right hon. Friend the Member for Ashford (Damian Green) for securing this debate on social care and covid and for the work they do as co-chairs of the APPG on adult social care, bringing the sector together and being a voice for it in Parliament and beyond.

As the hon. Lady and my right hon. Friend said—as, in fact, all speakers today have said, and as we all know —the pandemic has been cruel to those who receive social care, especially those living in care homes around the world, here in the UK, and indeed in England. Sadly, both residents and care staff have lost their lives, and each one will be missed by friends, family, and those who love them. I thank those working in social care—staff in care homes, home care workers, those supporting people in extra care and supported living, personal assistants, social workers, and millions of unpaid carers as well—for all they have done during the pandemic, and are continuing to do now, to care for those who rely on their care and could not live without it.

Members have spoken about the many challenges the sector has faced during the pandemic. I want to outline some of the things that the Government have done to support social care, with a level of intervention—a level of support—that is unprecedented for social care, and rightly so in the circumstances of the pandemic. First, the hon. Member for Dulwich and West Norwood spoke about the extra costs that social care has faced during the pandemic. We have put in £1.8 billion of specific, ring-fenced covid funding for social care during the pandemic, including £1.3 billion for infection control measures, and providers have told me what a huge difference this support has made to them and how essential it has been all the way through the pandemic.

Secondly, the Government have stepped in to provide PPE to the social care sector, and PPE has been available free for many months via a portal to meet the covid needs of social care providers on demand. Over 2 billion items of PPE have been supplied to the social care sector, and the Government have committed to continue PPE supply through to March 2022.

Thirdly, social care has been prioritised as our testing volumes have increased. Last summer, we introduced weekly polymerase chain reaction testing for care home staff, and since December, that has been supplemented by twice-weekly lateral flow device tests. That has made a difference, because we can not only quickly identify when a staff member may be covid positive but, through the introduction of the LFD tests, we are able to identify whether a member of staff is covid positive before they set foot in the care home. During this time, we have sent out over 28 million PCR tests and 47 million LFD tests to the social care sector across care homes, home care, supported living, and other parts of the sector. We have also made rapid tests available to visitors, supported by £288 million of funding for the staff costs involved in that testing, to help people see loved ones. I will say more about visiting in a moment.

Fourthly, many hon. Members have spoken about the impact of the pandemic on the social care workforce. Again, we cannot thank care workers enough for what they have done, and how they have gone the extra mile time and again. Through the virtual visits I have made to care homes and the conversations I have had, I have seen what staff have done, particularly to step in and support residents at a time when visiting has been restricted.

I also know the difficult experiences that some care workers have been through. We have specifically advised care providers to use some of the funding for paid sick leave for social care staff who have had to isolate due to covid. We have also put in place mental health support for the social care workforce, seeking as far as we can to mirror the mental health support offer to NHS staff, and we will continue to see how we can support staff through the mental health impacts of the pandemic.

As hon. Members have said, we know that there are workforce shortages within social care, and at times covid has made that harder, with staff rightly taking time to isolate. Recognising that, we provided £120 million of funding for the workforce capacity fund, which was passed to local authorities to boost staffing for the sector during the second wave.

To increase the voice of the social care sector and to give further leadership—particularly clinical leadership—to the social care workforce, we appointed the fantastic Deborah Sturdy as the chief nurse for social care. She is already doing brilliant work with the sector and the workforce, and contributing to plans for the workforce of the future.

To increase our understanding of the social care situation on the ground, we created a social care data dashboard as a single point of information for the system. We came into the pandemic with relatively small amounts of timely data about social care; as hon. Members know, it is a highly fragmented system, with over 25,000 different providers. We have built a way of having up-to-date information and self-reported data from providers, which has given us truly valuable information to which local authorities also have access. It gives a good sense of what has been happening on the ground.

We have also established a regional assurance team for social care, as this is now the Department of Health and Social Care. They are a group of people with great experience in the sector who have been able to reach out during the pandemic, working with local authorities, directors of public health, providers and others, to understand some of the challenges being faced and provide more localised support.

On visiting, on many occasions we have developed an iterated visiting guidance, responding to requests from the sector for a steer on how to manage the challenge of wanting people in care homes to be visited while acknowledging the risks to residents of more people coming through the door. We have drawn a huge amount of clinical guidance from the deputy chief medical officer of Public Health England on how we can enable safe visiting. Clearly, we have substantial caution because we know the great risks to care home residents when covid gets in and how difficult it is to stop an outbreak from spreading through a care home, even with the PPE, the testing and the other things I have outlined. One reason why we introduced visitor testing was to reduce that risk.

Since 12 April, care homes have been able to open up to two visitors, and the essential care giver scheme addresses particular need. I look forward to care homes being able to continue to open up, step by step, through the combination of lower infection rates and vaccination, to enable people to once again spend much more time with their loved ones.

Several hon. Members spoke about visits out. I recognise the importance of both having visitors at care homes and being able to leave—to go out and about. This applies to older people, but particularly to families who have relatives of working age in residential settings, who I have spoken to. Often, somebody of working age might come out every weekend to spend time with their mum and dad, and their family. Clearly, they have not been able to do that during the pandemic.

I ask other hon. Members with an interest in this subject to listen to the Joint Committee on Human Rights sitting held yesterday, when I was asked about this. With me was Dr Éamonn O’Moore from Public Health England, who explained in some detail, which we do not have time for today, the reason for the caution around visiting out and the clinical reasons for the requirement to isolate for 14 days on return. To respond to the hon. Member for Worsley and Eccles South, I should say that that is not the same as somebody coming from overseas to the UK and quarantining, because of the particular circumstances within care homes. There may be people who are very vulnerable. In the event that someone brings covid into the care home, that can lead to an outbreak, which can lead, sadly, to people dying. Therefore, rightly, the issue is taken seriously.

I assure colleagues that, as Dr O’Moore said to the Health and Social Care Committee yesterday, I have asked Public Health England to provide advice on how to make more visits possible—particularly those with lower risk, such as those outdoors—and on what could be done to reduce quarantine requirements afterwards. I am mindful of the May elections and of those who might want to vote in person.

My right hon. Friend the Member for Ashford rightly said that vaccines are the answer to allowing more visiting and for much of life to come back to normal, for those who receive social care. We prioritised the social care sector for vaccinations—and particularly care homes, who were top of the list. The vaccine was offered to all care homes by the end of January, on time. Soon, all residents who can be vaccinated will have been offered their second dose.

The impact of vaccination is already being seen, with the rates of covid coming right down in care homes. There are still some outbreaks and I would caution those listening to the debate that the vaccine is not 100% effective. Many residents have had their second dose but others are still only on their first, and it is important in that situation that the precautions continue. For instance, we are continuing to urge care homes to make sure that staff use PPE and infection control measures, even when everyone has been vaccinated. However, there are far fewer outbreaks and the consequences are much less serious. I want to use this opportunity to thank the NHS vaccination teams, and the social care workforce, who have been involved in the tremendous and lifesaving effort to vaccinate so many thousands of people in social care.

Many hon. Members spoke about the importance of reform, and how the pandemic has shone a light on the social care sector and the need for reform. I truly welcome the support for reform among hon. Members who have taken part in the debate in this room and virtually. Some steps have begun, and I urge the hon. Member for Dulwich and West Norwood to look again at some of the social care content in the health and social care White Paper, including the voice of social care in integrated care systems—and I agree with the point made by my right hon. Friend the Member for Ashford that it is not just about a local authority voice, but the wider sector.

The White Paper also proposes the introduction of a new oversight and assurance system for social care, which I see as an important part of building on the experiences of the pandemic, to give us more oversight and the ability to drive quality and outcomes more strongly for those who receive social care. It also includes steps to support better use of data and data sharing for social care.

Those things are, however, just the beginning and we need to go further. We have committed to go further and to publishing a long-term plan for social care this year.

[Barbara Keeley]

As the Minister is talking about the White Paper, I wanted to point out that we have talked quite a lot about unpaid carers in the debate, but they are not mentioned once in the White Paper. Carers’ organisations took that in a bad way and felt that all the efforts that unpaid carers put in during the pandemic were not recognised at all. The Minister and the Health Secretary need to address that.

[Helen Whately]

The hon. Member makes a really important point, and I really appreciate how she has spoken about unpaid carers during this debate. I absolutely recognise the crucial role of unpaid carers, the things that unpaid carers do and the demands on and challenges for unpaid carers during the pandemic. I absolutely see unpaid carers as part of the breadth of the social care system that we must consider for the reforms as we go forward.

I very much welcomed the expertise, in the room and virtually, on social care reform. My right hon. Friend the Member for Ashford reminded us that the reform debate has been going on for nearly 25 years. He has extremely valuable experience. My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) has great experience from local government and flagged the work of Sir Paul Carter, whom I know because he is the former leader of Kent County Council and I am a Kent MP. I will indeed be looking at the work that my hon. Friend mentioned. My hon. Friend the Member for Somerton and Frome (David Warburton) called for a social care workforce strategy. Yes, absolutely, as part of the reform work, we need and plan to bring forward a strategy for the social care workforce.

I am conscious of the time and so that is probably as far as I can go today, but broadly, I truly welcome the support for social care reform expressed during this debate. I assure those in the room and all those listening to the debate that we are determined to seize this moment. We have supported social care at an unprecedented level during the pandemic; on the back of that, we are determined to bring forward the reform that we know social care needs.

Covid-19 Update

Barbara Keeley Excerpts

Monday 19th April 2021 Commons Chamber

[Matt Hancock]

Any decisions like that would be based on the evidence, and we have far more evidence now than we did when making these decisions previously. I fully expect that there will be some areas of life, without the need for laws in this place, where people will behave more cautiously than previously. The wearing of masks is one—before this pandemic, wearing a mask in public in this country was extremely unusual. I imagine that some people will wear masks, and choose to wear masks, for some time to come. Our goal is to manage this virus and the pandemic that it has caused more like flu—in fact, like flu. Flu comes through each year. We do take action to deal with flu—we take action on nosocomial infection in hospitals and through the flu vaccine programme—but we do not stop normal life as we know it. That is the overall attitude and approach. My right hon. Friend mentions that four reviews were set out as part of the road map and they will, of course, have to conclude. But that is my hope because, as he knows, I very firmly believe that this vaccine is breaking that link. We can see it in the data every single day and in the way that the country is responding. It is uplifting.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I add my praise to the team rolling out vaccines in Salford, led by Salford Primary Care Together, which is doing a remarkable job. The current guidance on visits out from care homes says that any resident who makes a visit outside a care home must self-isolate for 14 days on their return, even if all they have done on their visit is to sit outside with a family member. This is longer than people have to quarantine when returning from red list countries, including India, which has the most cases in the world. This is clearly disproportionate, so will the Secretary of State set out what he is doing to enable regular testing to be used to cut this self-isolation requirement for care home residents?

[Matt Hancock]

The hon. Lady raises an important point on a subject that she knows extremely well. If I may, could I give her the respect of considering the question and writing to her with a full reply, because it is a very important question and I want to make sure that we get it right? Maybe we can then have a correspondence to make sure that we get to the right result.

NHS Pay

Barbara Keeley Excerpts

Wednesday 24th March 2021 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

It is a pleasure to speak in this important debate with you in the Chair, Mr Hosie, and I congratulate my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) on securing it.

We are all, rightly, incredibly grateful for the work that NHS staff have done over the last year. They have consistently gone above and beyond to cope with surges of demand in hospitals, to care for people with covid and to support family members who could not visit those patients. Now, the NHS is running the largest vaccination drive we have ever seen. As a reward for this, the Government have proposed a miserly 1% pay rise. With inflation set to rise over the next year, that will mean that NHS staff who have done so much will actually receive a real-terms pay cut. That is shameful and insulting. Ministers should have recommended a real-terms pay rise for NHS staff.

The pay proposal for NHS staff manages to be both wrong and unpopular. More than two thirds of those surveyed, including nearly 60% of Conservative voters, think that a 1% pay rise is less than our NHS staff deserve—but some NHS staff are even more underpaid. Last week, I met healthcare assistants from the north-west to listen to them talk about their roles and their pay. Band 2 healthcare assistants are among the lowest paid NHS staff. In theory, they carry out personal care tasks for patients, such as feeding, bathing and dressing. However, many healthcare assistants are in fact carrying out more wide-ranging and demanding tasks, such as casting broken bones, washing and sealing wounds, and carrying out observations or cannulations—tasks that should be carried out by a band 3 healthcare assistant, who would be paid nearly £2,000 a year more.

In one NHS trust in Greater Manchester, 98% of the healthcare assistants are employed on band 2, compared with a regional average of only 55%. That is straightforwardly keeping costs down by employing staff on one band and asking them to do the work of a higher-paid band. They are being systematically underpaid for the work they do. It is not acceptable. All NHS staff deserve to be fairly paid. When the Minister sums up, can she confirm that Ministers will ensure that all trusts have the funding they need to pay healthcare assistants fairly for the work that they are doing?

Finally, I want to come back to the 1%. For a healthcare assistant I talked to last week, who earns £9.80 an hour, the 1% increase will mean 9p an hour extra. A better pay rise is needed if we want NHS staff to stay in their vital roles in the vaccine roll-out, on covid wards and in handling the big backlog of elective surgery, screening and routine services. A better pay rise is deserved by NHS staff, who went above and beyond in the pandemic, who risked their lives and those of their families, and whom we applauded week in, week out. Clapping does not pay the bills. NHS staff are worth more than the miserly 1% on offer, and the public overwhelmingly agree.

Social Care Reform

Barbara Keeley Excerpts

Thursday 18th March 2021 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I beg to move,

That this House has considered social reform and the social care workforce.

It is good to have you in the Chair for this important debate, Dr Huq. I am pleased to open the debate. I pay tribute to the House staff who have enabled Westminster Hall debates to return with virtual participation.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit hard over the past year. However, the fundamental problems in social care long predate the pandemic. A decade of underfunding meant that we were in a situation, even before the pandemic, where 1.5 million people were not getting the social care they needed. While social care is, rightly, the last thing to be cut by local councils, the reality is that areas that have seen half of their central funding cut since 2010 are left with little choice. Underfunding has led to fewer care packages, cuts to care packages and providers being asked to take contracts that do not even cover their costs.

One clear illustration of how this is going wrong can be found in long-stay in-patient wards, where 2,000 autistic people and people with learning disabilities are detained, at enormous cost to the NHS. One reason for that is the lack of resources in the community to support them. When local authorities cannot afford care and support in the community for autistic people and people with learning disabilities, it becomes easier to put them into inappropriate NHS in-patient units, even though community support would be cheaper and more appropriate. We also have older people forced to sell their homes because they are unable to access publicly funded care support until they have exhausted almost all their assets.

There has been much focus on care in care homes during the pandemic, due of course to the tragic death toll among people living in those homes, but we must also focus on the fact that social care is needed by working-age disabled people too, and that proposals for reform must cover their needs. In fact, one in three users of publicly funded care is under the age of 65, whereas only one in four is an older person in a care home, so the crisis in our care system affects more than vulnerable older people. It is a crisis not only of catastrophic costs, but of hundreds of thousands of people being denied the opportunity to live their lives as they would choose.

This is not a new problem. The reality is that social care has been struggling for more than a decade now. That is why the last Labour Government published a White Paper in 2010 proposing major reforms to the way social care is delivered and funded. However, once in government after the 2010 general election, the Conservative-Liberal Democrat coalition decided to drop those proposals in favour of starting another commission on reform. That led to the provisions of the Care Act 2014, including legislating for a lifetime cap on care costs, based on the recommendations of the Dilnot commission. That would have addressed some of the issues with the social care system, although I do not think any of us believed that it was anything like the full solution. Since that change was first delayed by the new Conservative Government in 2015, we have had any number of promises of future reform.

Ahead of the 2017 election, the then Prime Minister promised far-reaching reforms but promptly abandoned them. After that election, a Green Paper was promised by the end of 2017. At the end of 2017, the cap on care costs was completely abandoned and a new deadline of mid-2018 was set for the Green Paper. That was pushed back to autumn 2018, and then to the end of 2018. In early 2019, we were told to expect a Green Paper by April 2019.

When the current Prime Minister took office, he claimed to have a social care plan ready to go, and he repeated that claim during the 2019 general election. The Conservatives’ manifesto at the last election said that they would seek a “cross-party consensus”, but they have not tried to seek that consensus. In fact, a fairly broad consensus on the future of social care has developed. Politicians from across the spectrum, including the Health and Social Care Committee and the House of Lords Economic Affairs Committee, have endorsed the model of free personal care as introduced by Labour in Scotland. That system is not perfect, but it should be a strong position to start from. However, rather than acting on that consensus, we are still waiting for proposals nearly 18 months after the 2019 election.

When the Minister speaks, she may tell us that the Government are working hard on their proposals and will publish them shortly. She would be the third Minister of State to tell me that since the Government dropped their commitment to the cap on care costs, and we have already missed at least 10 deadlines for reform. That simply is not good enough. We need action now, not the promise of jam tomorrow.

If there is a team of civil servants working on this issue, there a few points that they should consider in order for reform of social care to work. First, reform must deliver a fair deal for care staff. If the crisis of the pandemic showed us anything, it was that without the hard work put in by care staff our care system simply would not work, but too often care staff are underpaid, undervalued and given few opportunities to progress. To fill the more than 100,000 vacancies we have for care staff, social care needs to become a career of choice, with better pay and conditions and better training. When the average starting salary is only £15,000, it is little wonder that people are not turning to a career in social care.

As a starting point, reform should mean that all care staff are paid the real living wage, as my own local authority of Salford is now doing. We need to see investment so that the social care sector offers training opportunities and real career progression for staff, recognising their skills and experience. If we are to fill the vacancies in social care, we need a wide strategy working across Departments to recruit and train the workforce that we need.

The Prime Minister has said that he wants to end the scandal of people needing to sell their homes in order to pay for care. It is right that we should address the issue of catastrophic costs, but that cannot be the only ambition of social care reform. If all we do is end catastrophic costs, we will still have nearly 2 million people not getting the support they need. With providers struggling to make ends meet, local authorities are left with no choice but to cut budgets even further.

We need reform that expands access to social care services. Over the past five years, we have seen fewer older people receiving care every year as eligibility thresholds have crept up in response to budget pressures. Preventive care is increasingly uncommon, with intervention mainly coming after a crisis. Rather than providing low-level support to enable people to continue living independently at home, we are increasingly providing care only once there is no prospect of someone living independently.

When the Health and Social Care Committee looked at access to care, one witness, Anna Severwright, told us:

“I feel that I am not able to live a normal life. I do not have enough hours”—

of care—

“to be able to go out at the weekends and in the evenings, and do a lot of the normal things that make life worth living.”

That is not good enough. People should not see their horizons limited solely because they need social care, but with budgets under ever-increasing pressure, money for anything other than the basics of care is rarely available. There is a better way to deliver social care than 15-minute care visits, and people should not have curfews on their lives because care is not available in the evening.

As well as funding care properly, we could embrace the spirit of the Care Act 2014 and ensure that care packages meet people’s social and emotional needs as well as their physical ones. That kind of person-centred support would enable more working-age disabled people to be productive members of society while also supporting older adults to enjoy later life. At root, social care should be about supporting people to live happy and fulfilled lives without facing financial ruin.

There is a very poor level of support for unpaid carers. There are 13.6 million people providing care to a friend or family member. Without them, our social care system would not cope. Funding for respite care is increasingly hard to get. Many carers say that they would use a respite break to attend a medical appointment.

Responding to an Adjournment debate that I led last Friday, the Minister for Patient Safety, Suicide Prevention and Mental Health said that

“45,000 carers have received respite or other carer support delivered to the person they care for.”—[Official Report, 12 March 2021; Vol. 690, c. 1212.]

We have 13.6 million unpaid carers, including 4.5 million who started caring during the pandemic. For a Health Minister to report that only 45,000 carers received respite care is an appalling record. We must do much more to support unpaid carers, and we could improve their lives by funding formal care services better.

It is now seven years since we put the Care Act into law, but the Government still have not delivered for people who use social care. After years of broken promises and delayed announcements, there is anger at the way social care has been underfunded and reform neglected. This has led to people who rely on social care going without the support they need to live fulfilling lives.

Underfunding has led to care staff being paid the minimum wage and not being given the time they need to provide high-quality care. It has also led to many thousands of people facing catastrophic costs of care, often having to sell their homes to pay for it, and over the past year it has meant 30,000 care home residents dying with covid-19. They were caught in a perfect storm of an NHS discharge policy that seeded infections into care homes before providers could implement infection control measures.

People who use social care deserve better than all of this. They deserve reform that delivers a fully funded, person-centred care system that meets their needs, and they need it now, not at some point in the distant future.

[Dr Rupa Huq (in the Chair)]

Given the popularity of the debate, and the fact that we have three Front-Bench spokespeople and a concluding statement from Barbara Keeley at the end, I am going to start with a time limit of three and a half minutes. There will be a clock visible at the side of Members’ screens, and the chaps here can pull the plug if they go over the limit. With all that in mind, I will start with Andrew Lewer.

--- Later in debate ---

[Barbara Keeley [V]]

I am glad that we have, through this debate, paid tribute to the care staff who have been on the frontline of the pandemic and who have stepped up and done a fantastic job. My hon. Friends the Members for Luton North (Sarah Owen) and for Dulwich and West Norwood (Helen Hayes) did that and many other contributions highlighted it too.

From the debate, I would say that there is a real cross-party commitment to improve the pay and conditions, the training and the career progression of care staff, but we have a long way to go to do that. I am glad that a number of hon. Members talked about the important role of unpaid carers. I have recently highlighted the fact that our millions of unpaid carers were not mentioned once in the White Paper on health and social care. That must be addressed because they are partners in care.

I join others in thanking all right hon. and hon. Members for their contributions to this important debate. I believe there is cross-party support for reforming social care so that it delivers better for the people who need social care, for the care staff who deliver it and for unpaid carers who would rely on it if it were better than it is.

I thank the Future Social Care Coalition and other campaigners for their support and briefings ahead of the debate, and the House of Commons Library for its briefing. I cautiously welcome the Minister’s promise that the Government are working on reforms and will bring them forward this year. I hope that is not another promise that ends up being broken.

As I said at the start of the debate, we have seen too many broken promises and everyone involved in social care deserves better than what we have. As the right hon. Member for South West Surrey (Jeremy Hunt) and my hon. Friend the Member for Leicester West (Liz Kendall) both said, if we cannot fix this system now, after the terrible year for the care sector during the pandemic, then we never will. Let us grasp that opportunity.

Question put and agreed to.

Resolved,

That this House has considered social reform and the social care workforce.