Midwives: Bullying

Baroness O'Grady of Upper Holloway Excerpts

Tuesday 16th April 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct. This is the role of non-execs. Having done a bit of work on the Lucy Letby case, I understand that the non-execs should have said something. Obviously, the executives should have found out, but the non-execs clearly had a role. This is an excellent question. I have to be honest and say that I need to come back on it, if I may, so that I can give the noble Lord a full answer and make sure that this is happening.

[Baroness O’Grady of Upper Holloway (Lab)]

My Lords, does the Minister agree that we also need to tackle the conditions in which bullying can sometimes flourish? The Royal College of Midwives—the union representing midwives—published a report last week showing that over 100,000 hours of unpaid overtime are performed by midwives every week. Some 60% of midwives believe that staffing at their workplace is unsafe. Three-quarters of student midwives are expecting to graduate with £40,000 of debt. Surely it is time that we gave midwives the respect and the pay rise that they deserve.

[Lord Markham (Con)]

I agree. As ever with these things, there are a number of issues, of which pay is one. The introduction of the £5,000 a year support that we now give to all students is an important help with regard to debt. Work conditions are important, but key to it all is the culture. I have seen many examples where that has not been great. I was quite impressed by the Chief Midwifery Officer saying that every trust now has a midwife retention person whose job is to get into all these issues and make sure that they are addressed.

Social Care

Baroness O'Grady of Upper Holloway Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness O'Grady of Upper Holloway (Lab)]

My Lords, I congratulate my noble friend Lady Andrews and her committee, and the most reverend Primate the Archbishop of Canterbury, on two excellent reports, and address my contribution to the urgent recommendation for a proper social care workforce strategy.

I declare an interest. When I was general secretary of the TUC, we sought and secured core participant status in the Covid public inquiry. We worked closely with Covid bereaved families’ campaigns throughout. I believe that the evidence is there that many Covid deaths in care homes and among front-line workers—disproportionately among black and ethnic-minority workers—were entirely preventable. From the start, the Cinderella status of the social care service was symbolised by that failure to provide staff with proper PPE. The absence of proper sick pay also put staff and service users at terrible risk. Statutory sick pay is still far too low, at just £99 a week, and 2 million people in this country do not earn enough to qualify at all. No worker should be forced to choose between going into work and risking spreading a virus, or staying home but being unable to feed their family.

Many hoped that the pandemic would spark a sea-change in our social care service, and that severe cuts to local authority budgets, inflicted over many years, would be restored, but today the service is still subsidised by the love, the labour and the low pay of unpaid carers and the social care workforce, predominantly women. In my experience, staff care deeply for those whom they care for, and find their work profoundly satisfying. While progression routes are poor and training needs to be improved, be in no doubt that this is skilled work. However, that vocation is being exploited. Nearly a quarter of the workforce are on zero-hour contracts. Most care workers earn barely above the national minimum wage, which is currently £9.50 and due to rise to just £10.42 in April.

The Government rebranded the national minimum wage, calling it a living wage, but the real living wage, calculated according to how much it costs to lead a basic decent life, is much higher: £11.95 in London and £10.90 in the rest of the UK. The Resolution Foundation, along with many others, has argued that the bottom rate of pay for care workers needs to be significantly higher even than that, just to tackle the crisis in recruitment, retention and turnover. Service users, their families, and decent employers, know that even with the potential of new technologies, the heart of the service is human. How we treat and reward care workers reflects how much we, as a society, value those who receive care. No doubt the Government will ask how we pay for it. Part of the answer must be a fairer taxation system. It cannot be right that a care worker pays a bigger share of her income in tax than the private equity chief who buys up care homes, saddles them with debt, and then sells them on for profit.

I am proud that as part of its New Deal for Working People, Labour is committed to a policy of sectoral fair pay agreements, just as the New Zealand Government have introduced, and as is common across Europe. It is only right that first in the queue for a UK fair pay agreement should be social care workers. I hope that we can build a broad consensus for this approach, bringing Governments, employers and unions together to lift the status of social care as well as the pay, conditions and morale of staff. Investing in our social care service would relieve pressure on the NHS and, I hope, act as a catalyst for creating the decent and properly staffed and funded service that those in need of care deserve, and that care workers themselves have well and truly earned.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, it is my pleasure to respond to the excellent debate today, to follow so many distinguished speakers and, probably most of all, to hear, in my noble friend Lord Polak’s words, the politics being taken out of care. Today has been an excellent example of that, and I hope I can follow in that vein.

I regret that our social care report has not been published today. As noble Lords will be aware, we were hoping it would be published yesterday, and we were going to offer an embargoed copy of the report so that everyone could contribute. That is the reason for the delay in responding to both committee reports. I undertake that we will respond to both reports after we publish our social care report, and I personally offer a round table to everyone who is interested, where I will seek to bring the relevant officials along as well. I hope we can have a productive conversation in a similar vein to this one, where we all get around the table as people who care about this issue and, as mentioned, take the politics out of care.

I thank the noble Baroness, Lady Andrews, for securing today’s debate, all noble Lords across the Chamber for their thoughtful and considered contributions, and all those who have sat on the committees that have been mentioned. I feel that they have really added impetus to this whole debate. I hope the report that we offer will answer many of these points, build on the progress made so far in this space and bring a vision into reality.

Before I go into detail and respond to the reports, starting with the Lords Select Committee report, I would like to say how fitting the words “gloriously ordinary life” are. I was struck by the whole sense that, if I caught the phrase right, we can live in a place we call home, with the people we love and the things we care about. That is something that we can all agree with and commit to as our North Star and vision for what we hope to do.

Not only is it vital that we allow people to live in the way that they want but it is a vital part of our health service, as mentioned by my noble friend Lady Shephard and the noble Lord, Lord Turnberg, who had many brave words to say today. We all know it is vital to unblock the system. Some 13% of our beds are blocked at the moment, to answer my noble friend Lady Shephard’s point. As the noble Lord, Lord Turnberg, said, it is often as difficult to get out of hospital as it is to get into it. We have put in funding to help with this issue: £700 million of funding this year alone to help with discharge and £1.6 billion over the next two years. This whole debate shows that it is vital not just to the well-being of our people that we have a good system of social care but to our health service in improving the whole flow of the system.

On that, I reassure noble Lords that the Government recognise the importance of responding to the Lords Select Committee report. As mentioned, we will release a response shortly after the social care report is published—I hope, as I say, next week. I assure the committee that the Government agree with the vision in the report. We particularly welcome the committee’s view that social care does not have the voice and the visibility that it deserves. That often means that people are not supported to meet their ambitions. By rethinking attitudes to care and support, we can ensure that people access the care and support that meet their needs.

Equally, I thank the most reverend Primate the Archbishop of Canterbury, the right reverend Prelate the Bishop of Carlisle and the Commission on Reimagining Care for its recent report, Care and Support Reimagined: a National Care Covenant for England. I was struck by the words, “care based on faith and values”, where we recognise that we all have a mutual responsibility in delivering that. That struck a chord with me, along with the idea of the need to develop a national care covenant, where we all look to do our part in delivering the system. I look forward to developing those thoughts more at the round table.

It is important that we recognise the important contribution that communities and faith organisations make to adult social care. We echo the commission’s vision for care and support that is inclusive, universal and fair, and recognises our mutual responsibilities as citizens. The Government are keen to work collaboratively to make change a reality, and, having spoken to Minister Helen Whately, I know how much she enjoyed the meeting she had with the commission and how keen she is to drive forward the report.

I turn to the Government’s vision for adult social care. Again, I apologise; I feel that my hands are slightly tied behind my back, having to make this speech prior to the publication of our report. As we all know, back in December 2021 the Government published People at the Heart of Care. This set out a 10-year vision that put people at the centre of social care to make sure that everyone who draws on care and support feels empowered to have the choice, control and support they need to live independent and fulfilling lives. This is a vision that aims to make social care fair, accessible and of high quality, and to lead to better outcomes for people who draw on, work in and provide care and support. This Government remain committed to that vision.

I am pleased to report that the Government’s upcoming plan will outline how we will make progress towards this vision. It will also provide the clarity asked for by this House on key policy areas, including outlining how we plan to allocate the funding set aside for reform. Ahead of that publication, I would like to share some of the progress that the Government have made so far.

I start with the workforce, the importance of which the noble Lords, Lord Lipsey and Lord Prentis, and the noble Baronesses, Lady O’Grady and Lady Tyler, to name just a few, focused on. This was a point reiterated by our Prime Minister the other day. We all know that the social care workforce is one of our biggest assets, but we recognise the challenge we have right now to recruit a workforce of the right size, with the right skills, that feels appropriately motivated and rewarded. The Government have taken action to boost workforce capacity with recruitment opportunities both at home and abroad, with over 55,000 visas granted for care workers and senior care workers last year. This is complemented by our national recruitment campaign, Made with Care.

To respond to the points made by the noble Lord, Lord Turnberg, and the noble Baroness, Lady Wheeler, our upcoming plan for adult social care will include proposals for a new adult social care workforce pathway, building on our commitments in the People at the Heart of Care White Paper to give a career structure for people in this vital sector. Our chief nurse champions and raises the profile and visibility of nursing in social care, working alongside the Chief Social Worker for Adults to increase the recognition and appreciation of all our care workers.

On funding in this space—this is a point noble Lords have heard me make many times before but it is worth reflecting on—the £7.5 billion increase over the next two years will flow through to workers. The vital point is that it will largely flow through into the workforce.

Many noble Lords talked about technology. We all know that to increase workforce capacity we have to significantly increase the use of digital tools. Last year, we made £35 million available to the integrated care systems to support sector digitisation, including the adoption of digital social care records. As a result, approximately 52% of providers now have a digital social care record, up from 40% in December 2021, and we have plans to extend this much further. These records can provide up to 20 minutes per care worker per shift, and allow more time to provide care and support. Good data is fundamental to the delivery of high-quality care and, as the noble Baroness, Lady Barker, mentioned, sharing that data is vital as well. Our use and understanding of adult social care data is better than it has ever been, but we know there is a lot more to do.

From next month, our flagship client-level data project will become mandatory for local authorities in England. This will transform our understanding of people’s experiences and outcomes. For the first time, we will be able to track an individual’s journey through the health and care system to aid with navigating its difficulties—again, as mentioned by the most reverend Primate the Archbishop of Canterbury and my noble friend Lord Polak. Also as of Monday, the Care Quality Commission will begin to assess local authorities’ delivery of their Care Act duties, including those for unpaid carers. This will make good practice, positive outcomes and outstanding quality easier to spot locally and share nationally, while identifying where improvement and additional support is needed. But as much as data and technology could help, I totally agree with the point made by the noble Baroness, Lady Bennett: there is no substitution for the loving care of a human.

To ensure that care and support is personalised to people’s needs, our White Paper rightly sets out our ambition to support high-quality, safe and suitable homes, recognising that they can help people of all ages stay independent and healthy for longer. That is why, alongside the Department for Levelling Up, Housing and Communities, we will shortly launch the older peoples’ housing taskforce. It will bring together experts from across the sector to make recommendations on how people can access the housing they need.

I turn to the area of unpaid carers, which we all agree is the backbone. As noble Lords are aware, it is something that I have personal experience of. The point was brought out very well by my noble friend Lady Fraser, among others, because it is important that we recognise the vital role that unpaid carers play in our communities. We all owe them a debt of gratitude. Under the Care Act 2014, local authorities are required to undertake a carer’s assessment for any unpaid carer who appears to have a need for support, and to meet their eligible needs on request from that carer. This year, we have earmarked over £290 million for unpaid carers through the better care fund, including to provide short breaks and respite services. It is a step in the right direction; I use those words advisedly because carers are a vital area, as many noble Lords, particularly the noble Baroness, Lady Pitkeathley, have recognised, and there is a lot more that we need to do.

I hope that I have addressed many of the questions as I have gone through. I will try to pick up a few others and, as ever, follow up in writing in detail. It will be after the reports are published next week—and, to answer the noble Baroness, Lady Andrews, yes, we are planning to publish more on people at the heart of social care next week.

In answer to the noble Lord, Lord Bradley, yes, the ICBs will be at the forefront of this system for the planning and provision of social care. However, I will need to come back in writing on his question around the role of the DWP in analysing and reporting in this space.

In answer to the noble Baroness, Lady Campbell, we definitely embrace the principles of co-production. I hope that will come out in the report itself, as we work with 200 stakeholders in the provision of it all. We really hope to see the ICBs at the forefront of this and the better care fund being a key part of co-production.

I was struck by the point made by the noble Baroness, Lady Jolly, about 90 year-olds caring for 70 year-olds. I await my next Oral Question after the Recess.

The noble Baroness, Lady Donaghy, asked about help for providers on energy funding. Again, I hope noble Lords would agree that we have provided significant help. I am glad to see that, the last time I looked, gas prices were lower than last summer, when the action was prompted. They are moving in the right direction, but it is probably an example of needing to watch this space, while being mindful of the issue at stake there.

I hope that I have answered many of the questions raised. In conclusion, over the past year, the Government have invested significantly and have secured another £7.5 billion of funding for over the next two years—but this is only the start of the journey.

[Baroness O'Grady of Upper Holloway (Lab)]

Before the Minister sits down, can he provide an answer to the question about the media reports on cuts to the £500 million workforce budget?

[Lord Markham (Con)]

This is one of the areas covered in the report that will be published next week. At this stage, I can say only that the need for the training and development of our social care staff is understood and recognised in that report. I hope that it will give a response to the noble Baroness’s question, and that she understands why I cannot say more at this point.

Taking the words of the Select Committee’s report, I hope that these actions show that we are moving in the right direction

“to live in the place we call home, with the people … we love”,

based on faith, value and our own mutual responsibility in delivering that aim. Once again, I thank the noble Baroness, Lady Andrews, for securing the debate and this valuable opportunity to discuss the future of adult social care. I reiterate the hope that we can all gather at a round table to discuss this once the report has been announced and we have responded to the various other reports. Finally, I extend my thanks to everyone who works in the social care sector and to the unpaid carers for everything they do to support others.

Social Care: Workforce Strategy

Baroness O'Grady of Upper Holloway Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

We recognise the contribution that overseas workers can make here, as demonstrated by the 57,000 visas. I will need to come back to my noble friend in writing with details on his precise point on personal assistants.

[Baroness O’Grady of Upper Holloway (Lab)]

My Lords, on recruitment and retention, the Minister will be aware that the majority of care workers earn less than £10 an hour. Can he tell us when the majority of care workers will earn a real living wage?

[Lord Markham (Con)]

My understanding—I am doing this partially from memory so I will correct it if need be—is that the national living wage will come in shortly, in April. Care workers are paid that. I believe it is over £10, but I will confirm that.