Care Sector

Baroness Andrews Excerpts

Tuesday 25th November 2014 Lords Chamber

[Baroness Andrews (Lab)]

My Lords, it is a real privilege to take part in this debate. Like so many other noble Lords, I am extremely grateful to my noble friend for creating the opportunity for us to have this debate but even more so, obviously, for the force and clarity with which she presented the evidence and the recommendations of the report. She said that while writing the report she was shocked. I was certainly shocked when reading it.

This is a report that sets out a long-term and sustainable future for care workers and deals with the historical failures and the immediate challenges. In summary, it graphically describes a largely poor, privatised workforce marked by low status and low wages, who work in intensely personal and stressful conditions, in uncertainty and insecurity, with poor and unco-ordinated training, few national standards, a weak and fragmented regulatory environment, irresponsible procurement and poor workforce planning and management skills. That summary of working conditions could have been written as an account of early industrial Britain, where rights and effective regulation were won, but largely by men and for men. The difference is that we are not dealing with history but very much with the present and with a workforce that is largely female, highly fragmented and comprises a high proportion—70%—of immigrant workers. They are not dealing with machinery or factory processes. As many noble Lords have said, they are dealing with the most frail and elderly and the consistently lonely in our society, many of whom have chronic and complex conditions which require highly skilled under -standing as well as compassion. Many of them are confused and lonely and the visit by the care worker is often the highlight of their day because it is about emotional as well as physical support. When one considers that the visit can be rationed to 15 minutes, it diminishes the carer just as much as the client and is a recipe for bullying conditions as well as for neglect.

Andrew Smith said in a recent debate in the other place that luck and money were only too likely to decide people’s quality of care. My family were very lucky. My mother was looked after by a wonderful collective of Welsh aunties in her residential care home—Cartref Aneurin Bevan—who were not only affectionate but highly skilled and gave all the time that they could to these wonderful elderly ladies and gentlemen. They were typical of the kindness and selflessness that we have always relied on and which, unfortunately, we have always exploited. This report shows that this is no longer sustainable. It has never been sustainable but we have neglected to challenge it. Changing this is not just about finding the money because the crucial failure is the failure to value the sector, to promote and articulate the workers’ skills and to understand that this is the front line of healthcare, not just community care.

This is a notoriously low-paid sector, as the Low Pay Unit recently documented. As we have heard, wages have been driven down by the failure of providers to pay more than 200,000 of these workers the minimum wage, the refusal to pay travel costs and by the fact that a fifth of workers are on zero-hours contracts and there is very little career progression or incentive. What makes the failure to enforce the minimum wage more intolerable—which makes me angry—is that there are mechanisms in place to limit the exploitation of care workers that are simply not being used.

Astonishingly, HMRC, having revealed the extent of the breach of the minimum wage regulations, has stopped carrying out proactive investigations of compliance in home care. One in five councils responding to an ADSS survey did not even know whether their providers paid the minimum wage. The only recourse care workers have is to ring up HMRC’s pay and rights helpline. I am fairly sure that that does not go down well with their employers. So can the Minister tell me exactly what he and his department are doing to galvanise HMRC into doing its simple duty of rooting out this total failure? Will he agree to meet HMRC and BIS to take the concerns in the report forward? Does he agree with me and other noble Lords that we should aim for a living wage and not a minimum wage? All this means that this is a sector that sets records for vacancy and turnover rates. A culture of uncertainty means that thousands of care workers do not know where their next paid work will come from and where clients face a stream of strangers in their houses. The Minister in the other place said that it would not survive without migrant workers, who account for about 17% of the workforce. Perhaps the Minister can say whether he endorses that opinion, which was so clearly expressed.

As my noble friend Lord McKenzie has shown, all the problems have been exacerbated by cruel cuts in funding. Without acknowledging that reality, it is difficult to see how the Care Act, with all its good intentions, and the guidance will bring about the changes that we want to see. In contracts that in reality are bound to be driven by price, how will the guidance be able to enforce the intention that local authorities’ contract terms, conditions and fee levels will not compromise the ability of care providers to pay at least minimum wages? Does the Minister agree that the guidance would be much more effective if it simply said that councils “must” act to end illegal practices rather than “should”? There have been some very good changes—I count the care certificate among them—but without the implementation of the recommendations in this report we will not see the scale of changes that we need to see.