Care Sector

Baroness Kingsmill Excerpts

Tuesday 25th November 2014 Lords Chamber

Moved by

[Baroness Kingsmill]

To move that this House takes note of working conditions in the care sector.

[Baroness Kingsmill (Lab)]

My Lords, I am delighted to have the opportunity today to throw some light on this difficult and not very well publicised area of employment. Care workers are probably the most invisible members of the United Kingdom’s workforce. I have recently written a review of their working conditions and I was shocked. In the past, I was an employment lawyer for many years. I knew very little about the care sector and I am very grateful to those Members of the House here today who know an awful lot more about it than me.

Although I knew very little about the care sector, as a former employment lawyer I knew a lot about employment. This was my fourth report on employment conditions in various sectors of the economy. The previous one was on the fashion industry and the unhealthy terms and conditions of catwalk models. I have to tell the House that there are far fewer people working as models in the United Kingdom than there are care workers and yet you would not have thought so, given the amount of publicity that particular report received. It became known as the “skinny models” report and it was all over the press. This report, however, on the terms and conditions of care workers, passed almost unnoticed. When I sought some media attention for tonight’s debate, they said, “Give us the news element of this”. What they really meant was, “Tell us some ghastly story about some hideous happenings in a care home or about people who have been badly treated”. That is what creates the attention around this sector. I am, therefore, particularly grateful for the opportunity to throw a little more light on this area and for other noble Lords to add their experience to the debate.

We all know that care is not a glamorous occupation. It involves dealing with vulnerable people on a daily basis, entering the homes of elderly and disabled people in distant locations, providing intimate care and support and, often, prompting the taking of vital medication. Engaging with elderly people with dementia, Alzheimer’s and multiple conditions, in short bursts throughout the day, is a difficult occupation which none of us would find easy to do on a daily basis. These activities do not take place in high-tech hospitals with white-coated doctors and eager students. They do not take place in a colourful playroom with engaging staff and constant activities until the users are collected at the end of the day. They take place in people’s homes and care homes where there are multiple residents with multiple conditions.

Care plays a vital role in our society. Care workers deliver the support needed to people nearing the ends of their lives, to people who are disabled and to people with chronic illnesses, enabling them to live comfortably and in a dignified way. Yet it is the poorest people in our economy who are dealing with our most vulnerable people. The people in this sector are paid less than those in any other of our economy. They are looking after our most vulnerable citizens, in many cases in the most awful of circumstances, yet we value them the least and pay them the worst. Their conditions of work are among the worst.

Care workers are undervalued, underpaid, undertrained and underregulated. There are between 1.5 million and 1.8 million people working in the care sector and we do not know who they are at all. There is no register of care workers in this country. They come and they go, they ebb and they flow, we do not know who they are or where they come from. There is no system of regulation at all. I compare and contrast this with, for example, the care of children, where there are limits. Childminders have to be trained, are limited in the number of people they can care for, and have status. They are not particularly well paid either, but they have career progression and an opportunity to acquire qualifications and improve themselves.

Care workers do not have the status of childminders and they certainly do not have the status of nurses, although they often undertake in people’s homes many of the services that nurses provide in hospitals. They are subject to no regulation or registration. When I was looking into it, I often heard people saying, “I am just a care worker”. It sounded so unfair because there are, among them, some incredibly dedicated and committed people who love what they do and love the people they are taking care of.

However, their work is far more complicated than they give themselves credit for. They often have to deal with complex feeding methods. They have to learn how to use hoists for moving clients, but they are not taught this; they have to learn it on the job and many of them suffer injuries while doing so. They learn how to dress wounds, how to administer medication and, above all, how to provide vital emotional and domestic support for vulnerable people. It is certainly not a job for the faint-hearted and it is certainly not just a job. However, as I said, they are subject to some of the worst conditions of any workers in the United Kingdom. Their wages are almost universally either the national minimum wage or no more than 15% above that minimum. Frequently, even the national minimum wage is ignored, with employers refusing to pay domiciliary workers for the time it takes them to travel between clients.

Many care workers do not know what hours they will be working from week to week. Zero-hours contracts, which we have all read about, play a huge role in the sector and destabilise workers’ lives. Qualifications are patchy, the Care Quality Commission’s requirements have been reduced, and the provision of care has been increasingly focused on the independent sector. Training varies considerably, with no real common framework for care workers. The workforce tends to be older women or migrant workers. Many older women who have never really been in the workforce before but have been bringing up families and have been in so-called caring roles for most of their lives think that, when their children leave home or no longer have the dependence they once had, they can do something that they are good at. They feel as though they have no choice—that this is the only thing they can do—and often that is the case.

The same applies to migrant workers. Frequently, agencies bring in migrant workers from different countries. In many cases, they are subject to the most minimal checks on who they are and what their background is. In many cases, English is not their first language, and indeed often they do not speak very good English at all, yet they are looking after people who are anxious and vulnerable and who need support. That is not to say that brilliant care is not often given by these very same people, but it makes for a risky situation if people cannot communicate properly with those who are looking after them.

It would be very good if there were more young people in care work, but young people rarely enter this sector. There is no career progression and no status, and it is badly paid. It would be very good if we could get career progression going in this area, but at the moment younger people are not interested because it does not exist.

The truth of the matter is that care is in crisis. The exploitation of workers in the care industry has highlighted how badly they are treated, and it has highlighted the severity of the situation regarding their ability to deliver quality care to some of our most vulnerable citizens. Poor conditions for workers often lead to poor quality of service for clients, and this is particularly the case with the elderly and the disabled.

It has to be said that the pressure of austerity measures on local authorities has led to years of underfunding and to chronic conditions for care workers and service users alike. Throughout my work on the review that I have recently undertaken, the call from all sides and from all parties was for greater funding in the care sector. Underfunding the care sector is a false economy. If we truly valued care, there would be less need for vulnerable people to go to hospital, with both a benefit for the public purse and a benefit for the service users, who would avoid the trauma and uncertainty of a hospital visit.

Let us not forget that the care industry is big business. Research from Skills for Care estimates that it is worth about £43 billion to the UK economy, and it is growing as the population ages. Care for the elderly is a lucrative industry. Despite this, it is characterised by a plethora of small businesses dependent on diminishing local authority budgets. Even the largest provider, Four Seasons Health Care, has only a 5.2% market share.

It is a sector that has been beset by scandal. Companies such as Southern Cross Healthcare, which operated 750 care homes and employed 41,000 staff until it closed in 2012 with huge debts, have left the industry with a bad a reputation for poor financial management. Many smaller providers are also just hanging on by the skin of their teeth, threatened with closure. The sector is haunted by the spectre of abuse, such as the horrific case last year of the Orchid View care home. Given that it is likely that most of us will spend the last two years of our lives in receipt of some form of paid care, it is a sector that merits a brighter light being shone on it, and I am particularly grateful for the opportunity to do so this evening.

--- Later in debate ---

[Baroness Kingsmill]

My Lords, I am delighted by the response to this debate. I did not expect that there would be as many speakers as there were, and I am very grateful to those who have stayed late and made such valuable contributions. I have had a number of tweets; I happen to know that people are watching this debate and many of them are going to be very pleased by the universal support, encouragement and appreciation that have been given to social workers.

Although every speaker has spoken warmly of the contributions that those care workers have made, the fact is that we are exploiting their dedication and commitment. We are looking at a group of workers who through their commitment and dedication have invited their own exploitation. We all know what needs to be done. My noble friend Lord Lipsey pointed out that there have been many reports prior to my own that have said more or less exactly the same thing in different words. We know what needs to be done. We know how to fix it.

I tried extremely hard in my report to make recommendations that were not going to have serious financial impacts, because we are all very much aware of the limitations on government spending, both for this Government and probably the next. But the fact remains that there is a case for priorities and we are not making a priority of these most vulnerable people. I am very grateful to other noble Lords who pointed this out.

Truthfully, this is a dysfunctional market. It was interesting to hear the noble Earl talk about the functioning of the market, but the fact is that it has all the characteristics of a dysfunctional market. I sympathise hugely with the noble Lord, Lord Curry, whose efforts to create a proper working environment for the care workers in his employ are being increasingly frustrated by his inability to recruit and retain proper staff.

Although, as I say, I tried to keep my recommendations to those that would cost little money, the fact is that we need more money. We need more money and the only source of that money is the Government, so we must find a way of finding that.

Motion agreed.