Oral Answers to Questions

Emma Lewell-Buck Excerpts

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

I very much appreciated and supported the findings of the Health Select Committee report into children and young people’s mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people’s mental well-being, we can achieve much better results.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Despite what the Minister says, in South Shields, financial challenges have contributed to the closure of Bede wing mental health ward. This means that acute in-patient services are no longer provided in our borough. Can the Minister explain why mental health services are, in fact, being eroded under this Government?

[Norman Lamb]

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

National Health Service (Amended Duties and Powers) Bill

Emma Lewell-Buck Excerpts

Friday 21st November 2014 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I would like to offer my support for the Bill and congratulate my hon. Friend the Member for Eltham (Clive Efford) on bringing it to the House.

Members will be pleased that I intend to keep my comments brief. Our NHS is a monumental achievement and one that my party remains deeply proud of. There are many people alive today who remember what life was like before the NHS and who would never go back to a time when the poor could not afford treatment for preventable illnesses. That is the generation that truly understands what the NHS means and why we must protect it.

That is not to say that people today take the NHS for granted. In fact my inbox, like those of other hon. Members, has been overflowing with e-mails from constituents worried about the future of our health service. They want the principle of free and equal access protected and the needs of patients put before profit, as they should be. I and those people are afraid of the direction the NHS is heading in under this Government. We see the Tories wedging open the door for private companies to come in and deliver services, and we see hospitals encouraged to take on ever more private patients.

People do not believe the Government’s spin: they know that the changes are part of the creeping privatisation being encouraged by the Tories and that the reorganisation in the 2012 Act was all about Tory ideology, not patient care. The reorganisation wasted £3 billion and has seen millions more spent on tendering exercises and competition lawyers which could have been spent on treatment for those who genuinely needed it. They also know that they cannot trust a Health Secretary who has previously backed calls to dismantle the NHS or a party that brought the NHS to the brink of collapse the last time it was in power. Back then, it took a Labour Government to save the NHS, and now history is repeating itself.

The constituents who have written to me, the people I was proud to join on the NHS march earlier this year and those I joined last night for a vigil outside Parliament understand what is at stake. The NHS is more than just a service; it is a principle of fairness. Illness and accidents strike us all at some point, often without warning and leaving us little time to plan, and before the NHS, this kind of misfortune could destroy lives and condemn families to extreme poverty. Now we have a service that says nobody, whether rich or poor, should have their life ruined by misfortune. That is the principle that my hon. Friends and I are standing up for today.

Care Workers

Emma Lewell-Buck Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on bringing the debate to the House today. A number of colleagues have already spoken about the minimum wage, so I will try not to dwell on those issues too long, and will address some of the other significant and worrying challenges that care staff face.

Too many care workers are underpaid for the work that they do. Unison estimates that, altogether, 220,000 are not paid the minimum wage. HMRC found that half of care providers fail to pay the minimum wage and, despite the consequences of that for care workers, their families, the overall quality of the care work force and the standard of care that people receive, the Government have continued to fail to act.

The failure to pay for travel time is a common tactic and should not be difficult to fix. Earlier this year, during the passage of the Bill that became the Care Act 2014, I and Opposition colleagues raised the minimum wage issue time and again. We tabled amendments on Report asking Ministers to look specifically at travel time and travel costs. We were told that that would be addressed in the guidance that was published at the end of last month. I think that it is fair to say that the guidance is nowhere near strong enough. It says:

“Remuneration should be at least sufficient to comply with the national minimum wage legislation”.

To me, that says that it should be, but it does not have to be. It says that it would be nice if providers paid their staff a decent wage, but that there is no requirement for them to do so.

[The Minister of State, Department of Health (Norman Lamb)]

I just point out to the hon. Lady that this is a criminal offence; it is not an option. I totally agree with the points made by the hon. Member for Sheffield Central (Paul Blomfield). It is a criminal offence, and this is not an optional matter. There is no doubt in the law. Employers have to pay for travel time between appointments at people’s homes.

[Mrs Lewell-Buck]

I thank the Minister for that intervention. If that is the case, why is the guidance not stronger? What I read out is not the language of the minimum wage. The minimum wage is not a target, but a right.

[Mr Andrew Smith]

Does my hon. Friend agree that it is not good enough for the Minister simply to say “It is a criminal offence”, as though that solves the problem? It is not solving the problem, because hundreds of thousands of workers are not having their legal rights protected. In his speech, he needs to tell us what he is going to do about that.

[Mrs Lewell-Buck]

I could not agree more. The guidance should include a proper requirement for compliance with the minimum wage law; otherwise it will simply be ignored, as it currently is. I hope that the Minister will commit to strengthening that requirement when he sums up the debate.

Providers might also be convinced to pay their staff a fair wage if they thought that they might suffer consequences for non-payment, but it seems, sadly, that under this Government there are no consequences. The Government told us that they would “name and shame” companies that failed to pay the minimum wage, but so far only a handful have been named and not one of them has been from the social care sector. That is unbelievable when we consider that HMRC believes that half of providers are non-compliant. The Government’s relaxed attitude lets providers know that they can continue to ignore minimum wage laws with no consequences.

In all this, we have to remember that what affects care staff also affects the people they care for. Quality social care needs well trained, motivated staff who are able to build a strong relationship with those they care for. All the evidence suggests that things are moving in the opposite direction. The care sector is not an attractive place to work right now.

The weak requirements on the minimum wage create an unfair playing field for care providers. With the funding pressures facing councils, the incentive to commission on cost is stronger than ever, and as long as the wage is considered a target and not a requirement, providers that pay a fair wage will be at a disadvantage, compared with those that break the rules. The providers that win contracts will be those that are least able to attract and retain well trained staff, and service users will lose out as a result.

Pay is not the only problem. Care workers have told me horror stories about the way in which they are managed and the effect that that has on the people they care for. Timetabling of visits is a disaster. Appointments are booked back to back, so staff do not get to spend the time with clients that they are allocated. If a client needs a little extra help, dedicated care workers often go back in their free time. I have also heard of cases in which incompetent management has meant that multiple staff have been booked to cover the same appointment. After they have all shown up at the client’s home, only one of them has been paid. Not only is that bad for staff, but it means that clients sometimes do not see the same carer twice in a week, and they never get a proper introduction to a new staff member. Clients are expected to let a stranger into their home because they say that they come from an agency. The system owes people better than that.

Staff have told me that the training and supervision offered by some providers is close to non-existent. One employee told me that their training consisted of being given a set of forms to fill in, after which they were given no feedback and no professional advice or support. Not only were they not paid for that training, but they were told that they would be financially penalised if it was not completed in time. Essentially, they were training themselves, and the provider took no responsibility for making sure that its staff were fit to do their jobs.

Even on important matters of safeguarding, some staff received no training, and they were entirely unprepared to deal with situations in which they thought a client was at risk of harm. Worse still, although staff in such a situation should be able to refer the matter to a manager, in some cases even the managers did not appear to understand how safeguarding procedures worked or how to proceed, with the result that at-risk clients were left in serious danger. As many care staff work on zero-hours contracts, they are afraid to speak out. They cannot afford to challenge their employer or properly advocate on behalf of their clients, because if they do, they find that they are denied shifts.

That is why there should be a proper system of oversight, and it is why Opposition colleagues and I tabled amendments to the Care Bill to give the Care Quality Commission responsibility for overseeing the commissioning of services. It is not enough for the CQC simply to inspect services on the ground, because by the time an inspection is carried out, serious failings could have occurred. The CQC should look at the standards on which local authorities commission, to make sure that the providers to which they award contracts can do the job properly.

Between low pay, stressful working conditions and lack of support, it is no wonder that many skilled care staff are leaving the sector as fast as they can. To stand up for vulnerable people in care, we have to stand up for our dedicated and hard-working care staff. If the Government want to show that they value high-quality care, they need to start holding providers to account and making sure that they take their obligations to staff seriously.

Oral Answers to Questions

Emma Lewell-Buck Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

I share my hon. Friend’s concerns that the car park charges in some hospitals are just too high. I understand that hospitals have financial pressures, as do many parts of the system, but I am happy to talk to him on another occasion about what specifically can be done on this issue.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Annually 30,000 applications for funeral payments are rejected, leaving families committed to expensive funerals that they cannot afford. People who are approaching end of life are not advised, as part of their palliative care, about planning for funeral costs or their eligibility for support. What is the Secretary of State going to do to remedy this?

[Norman Lamb]

The hon. Lady raises an important issue and I am very happy to discuss her concerns further with her.

Health

Emma Lewell-Buck Excerpts

Monday 9th June 2014 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Our national health service is undisputedly one of the greatest achievements of any Government, yet the crisis that the NHS has experienced under the Government’s disastrous privatisation, threatens the survival of services and the quality of patient care. I am proud that it was a Labour Government who created the NHS, and I am proud it is a Labour Government who will reverse the damage done by the Health and Social Care Act 2012. In our health service, more than 4,000 senior nursing posts have been lost since 2010. Accident and emergency performances in the year following the Government’s reorganisation were the worst in a decade. Last year, South Tyneside hospital in my constituency had to cancel operations because of unprecedented demand for A and E services. Only two weeks ago, it emerged that the NHS in England had failed to meet a performance target for cancer waiting times for the first time ever.

The Government’s failed reorganisation has increased wasteful spending. The NHS now spends more on senior managers and management consultants than ever before, and it is increasingly bogged down in competition law, forcing it to spend money on lawyers that could have gone towards patient care. The pressures on our health service stretch well beyond hospital waiting rooms, as demand for NHS services is affected by trends in public health and the quality of social care. In those areas, we have seen massive cuts to local authority budgets of £2.7 billion. Faced with cuts of that scale, local authorities have been left with impossible decisions and have been forced to cut services, knowing that in doing so they would increase pressure on the health service.

Those who are lucky enough to be entitled to care find that their care worker can only stay with them for 15 minutes. These workers are poorly paid, with over 300,000 on zero-hours contracts. A third do not receive proper training. Unsurprisingly, staff turnover is high, so many clients do not manage to build a relationship with their carer. The Care Act 2014, which was passed in the last Session, presented an opportunity to address some of those issues, but unfortunately it was an opportunity that the coalition parties did not take. They rejected Labour amendments on low pay and zero-hours contracts that would have improved the standard of care that people receive. They also ignored charities that warned that the new eligibility criteria for support would exclude hundreds of thousands of people from the care system.

Of course, there are challenges facing social care, but we do not solve the problem by cutting support for those with moderate needs, only for them to end up in hospital. Last year’s QualityWatch report showed that about one in five hospital admissions could be prevented by better social care. The ultimate goal should be an integrated system like the one argued for by my right hon. Friend the Member for Leigh (Andy Burnham). The Government at least pay lip service to that idea, but in practical terms they have done very little. The better care fund announced last June was meant for that purpose, but it was actually just money diverted from existing NHS services, proving that the Government are not serious about promoting integration.

Underlying all of that are broader questions about public health. Poverty and ill health often go hand in hand, and malnutrition in particular has become a frighteningly normal part of life in Britain today. I know parents who skip meals so that their children can eat, and people for whom food banks are the only thing standing between them and starvation. Malnutrition affects an estimated 3 million people in the UK, which is a scandal in the fourth richest country in the world.

The previous Government left office with fewer people in poverty than when they arrived. Child and pensioner poverty fell even after the financial crisis took hold, and we were well on our way to eliminating child poverty by 2020. But under the coalition, this trend has been reversed, and instead of eliminating poverty by the end of this decade the Child Poverty Action Group estimates that the number in poverty will have risen to 4.7 million.

The coalition has allowed this crisis to develop, and the Queen’s Speech needed to recognise families’ desperation by delivering help with living costs such as food, energy and rent. Poverty, and food poverty especially, has a knock-on effect for our health system. Experts have warned that there is a public health emergency. We are beginning to see diseases such as rickets returning as children no longer receive the balanced diet they need. The symptoms of poverty pose serious challenges to our health service in the long term.

Our national health service survives in spite of this Government, not because of them. It is strong because of its work force and because of a public who resolutely believe in it and value it. In communities around the country, families are fed not because their country’s Government have helped them to find decent work, but because their fellow citizens give up their time to lend a helping hand. Our country faces some of its biggest challenges for generations, and people feel that Britain is no longer working for them. Worse yet, people feel that politics has no answers to the difficult questions of our time. All these challenges need a Government who are willing to be bold, but this Queen’s Speech gave no hope of that. It was more of the same from a coalition that has long outstayed its welcome.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

And the prize for patience goes to Nic Dakin.

Care Bill [Lords]

Emma Lewell-Buck Excerpts

Tuesday 11th March 2014 Commons Chamber

[Steve Baker]

I am extremely grateful to the Minister for that reassurance because in my constituency there is really only one story: the loss of services, and, because of the way the clause has been presented by Labour Members, people are worried about that.

It has been said that these hospitals are categorically different because they exist in a broader health economy, but that is not why they are different. Any business exists as part of a wider economy with dependencies and so on—the hon. Member for Lewisham West and Penge (Jim Dowd) suggested the example of Comet versus Currys. In private enterprise, if the administrator turned up and shut down our competitors when we failed, it would obviously be absurd, but the truth is that both sides of the House have made a positive decision to use the techniques of state socialism to provide health care. That choice has consequences, one of which is this clause.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It will come as no surprise that I support the proposal to remove clause 119 from the Bill. Of all reforms in the Bill, this clause has attracted the most attention from my constituents. They recognise it for what it is—a frightening power grab by central Government that will put services across the whole country at risk from the Secretary of State. It is a cynical move from the Government, who in their wildly unpopular top-down reorganisation of our beloved NHS claimed that they wanted to put more power in the hands of doctors. Now they seek to give sweeping new powers to the Secretary of State.

It is of course true that some NHS trusts and foundation trusts find themselves in tough financial situations, and in those difficult situations decisions will have to be made so that services continue to operate. That is what the TSA regime was set up to do, and it is an appropriate process for dealing with the difficulties within a trust. It is true that trusts do not operate in complete isolation, but the TSA is already required to act with the interests of the wider health service in mind.

[Mr Jim Cunningham (Coventry South) (Lab)]

My hon. Friend is right when she says that the Secretary of State wants the power to privatise—I will be brutal about it—NHS services. We must recall—this is why we cannot believe the Minister or the Secretary of State—that before and during the general election, the Prime Minister said that there would be no top-down reorganisation of the national health service—[Interruption.]

[Mr Cunningham]

I am sure my hon. Friend will agree that the changes the Government want to make are in order to privatise the national health service through the back door. That is why the Secretary of State wants that power. Equally, we cannot believe the Secretary of State because, during the general election, the Prime Minister said that there would be no major changes to the national health service, and no top-down reorganisation. Why should we believe this lot now?

[Mrs Lewell-Buck]

I could not agree more with my hon. Friend.

TSAs can consider the impact on neighbouring authorities when making their recommendations, but they cannot and should not reconfigure services in well-performing trusts. Well-run trusts can and do collaborate with their neighbours, and play a role in reconfiguring services to help to achieve financial stability, but that must be voluntary. It is wrong for the Government to act through TSAs to reconfigure services in well-run trusts, and to do so against the wishes of local people and clinicians. It is also wrong that the opinions of health care professionals should be overruled by financial concerns, especially when the decisions being made affect trusts that are not at financial risk. That undermines the ability of health care professionals to act in the interests of their public.

The Government’s defence of the proposal is that clause 119 is a clarification of existing law, and yet the amendment was tabled in the other place while the Government’s appeal over the downgrading of services at Lewisham was still being considered. Surely it is the role of the courts to interpret and therefore clarify the law. It is more likely that the Government anticipated that their appeal would be rejected, as it was, and acted to expand the powers of TSAs so that reconfigurations such as that proposed for Lewisham could go ahead in future. I want to be clear: when any Government amends legislation so that it can be interpreted differently in the courts, they are not clarifying things but changing them.

[Paul Burstow]

I take the hon. Lady’s general point and understand why she is making it, but yesterday we debated new clause 11, which would have made clear a mistake that hon. Members on both sides of the House believe the courts made on the applicability of human rights legislation to social care that is publicly provided within private institutions. In that instance, we were not changing the law, but trying to ensure that the courts interpreted it correctly in the first place. There are instances when we do that.

[Mrs Lewell-Buck]

I agree with the right hon. Gentleman, but I do not believe it applies to clause 119.

My constituents are not especially concerned by the technicalities of legislation. The letters and e-mails I receive show concern with the practicalities of clause 119. People tell me that they fear for local services because, as more trusts fall into financial difficulties—more than 30 are reported to be in serious danger of doing so—the Secretary of State’s power will spread over a wide region. Perhaps the trusts that those people or their relatives use will not have a TSA appointed, but it is likely that services in their area will collaborate with trusts that do have one appointed. That makes them a target.

If the heroic efforts of the people of Lewisham and my hon. Friends are anything to go by, public concern will quickly turn to public outrage and protest if clause 119 makes it to the statute book. Lewisham has shown the Government the strength of opposition they can expect when they attempt to force unpopular reconfigurations on local communities. It is difficult to understand why they propose using that model throughout the country, but it appears that that is their intention.

I am concerned that, by taking that approach and using the TSA regime for a purpose for which it was never intended, the Government will make it more difficult to have a level-headed discussion on meeting financial challenges. We need a mature debate on how to adapt services to improve sustainability, but clause 119 will lead to pitched battles up and down the country over the closure of individual departments. The clause has attracted more controversy than any other in the Bill, and with good reason. It ignores the will of clinicians and the communities they serve. It puts at risk services in every corner of the UK. The Government must change course now.

[Karen Lumley (Redditch) (Con)]

I shall make a short contribution on clause 119. I agree with the principle behind the clause and the Bill, but we must ensure that the NHS can operate properly and efficiently, and provide our constituents with the care they deserve. My hon. Friend the Minister and my right hon. Friend the Secretary of State know very well of the review in Worcestershire in the past two years. My hospital—the Alexandra—has been in the spotlight. We have fought long and hard to retain services locally. I pay tribute to the tireless campaigners who, like me, are desperate to keep our services. Finally, we have seen a clinical solution to the problem. We all welcome that in Redditch, but it is not the end of the story—I wish it were.

--- Later in debate ---

[Mrs Lewell-Buck]

I shall be brief. Throughout the passage of the Bill, I have felt that there is considerable consensus on what a good social care system should look like. For that reason, I am disappointed that the Government failed to be more accommodating towards a number of reasonable amendments tabled by the Opposition. In particular, I still cannot understand the Government’s decision to remove the CQC’s duty to inspect commissioning, which stood as part of the original Bill and mysteriously disappeared when it was in the Lords.

There are worse elements of the Bill, such as clause 119. We heard earlier that this is a grave threat to every hospital and community in our country. Members on the Government Benches supported the clause today, but I expect most of them will regret doing so at some point in the future. Yet again, this has been a sad day for our health service on this Government’s watch. Underpinning everything we have discussed in the many hours of debate on the Bill is the fact that local authorities all over the country are experiencing a funding crisis, driven by a Government who appear unconcerned about the effects of their spending cuts on the poor and the vulnerable. Even the sensible reforms in the Bill will not benefit everybody.

I shall end on this point. Those people who are seeing their care packages disappear, those who are locked out of the care system, and everyone who turns up at a hospital to find that departments are shut—let them know that it is this coalition’s fault. I hope all coalition members are proud of themselves.

Care Bill [Lords]

Emma Lewell-Buck Excerpts

Monday 10th March 2014 Commons Chamber

[Mr Robert Buckland (South Swindon) (Con)]

My amendments 27 and 28 are on safeguarding. Clause 42 contains a raft of measures that will go some way to enhancing the powers and role of the authorities in dealing with disturbing and worrying cases of abuse or neglect, which we hear about all too often when it comes to the care of vulnerable adults.

Amendment 27 relates to the definition of abuse in clause 42(3), which rightly makes reference to financial abuse. We are all aware of the rising phenomenon of financial abuse, where older people and those with learning difficulties have been preyed on, sometimes by their own family, for financial gain. My worry is that, while a distinct reference to financial abuse is welcome, there is a danger of creating an imbalance that will make other forms of abuse less relevant or important.

Statistics from the Health and Social Care Information Centre on the number of safeguarding referrals in the last year for which records are available show that the most common causes or types of abuse are physical abuse and neglect. My concern is that they do not appear in the Bill. It would perhaps be better to have an amendment, along the lines of the one I have tabled, that acknowledges different types of abuse and refers the matter to guidance that could be carefully and comprehensively drafted, so that practitioners can be safe in the knowledge that one type of abuse does not take precedence over another. This is an issue that has been raised in the other place and in Committee here. The Government have said they are concerned that defining abuse further might restrict the scope of a local authority’s duty to inquire, but my concern, and the concern of organisations such as Mencap, is that not having a reference to other forms of abuse might lead to an undue focus on financial abuse only, to the detriment of others.

Amendment 28 would place a duty on relevant partners, such as those providing care and support, to notify the local authority if they believe an adult is at risk of abuse. It is clear that local authorities cannot be expected to identify all types of abuse themselves, or to rely on the good will of other people or agencies. If relevant partners, including providers of care, had a duty to report that adults were at risk of abuse, that would make their responsibilities clear, and would help to secure greater transparency. I, and others, fear that leaving the matter to guidance would pose a risk that the duty would not be taken seriously enough. A legal duty for relevant partners has already been introduced in Wales, and the amendment seeks to mirror that.

We are familiar with the existing framework relating to adult safeguarding boards and the joint agency working that takes place, but concerns that arise day in, day out are not always reported, and, sadly, there is also under-reporting of concerns from hospitals. While there are many examples of local excellence in the development of safeguarding procedures, I fear, as do others, that there will be too much of a patchwork and not enough of a national framework. It is essential for us to know, wherever we live, that the standards of reporting and obligations placed on agencies and other partners to make that all-important report about abuse are consistent. Because adults are often much more isolated than children and young people who are surrounded by a framework, a duty to report when an adult is at risk could be considered to be more crucial.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I shall speak briefly about new clauses 17 and 18 and amendments 31 to 33, which stand in my name.

New clauses 17 and 18 go to the heart of the social care profession. They say a great deal about how much we value the care of vulnerable and older people. New clause 17 would reveal the full extent of poor employment practices in the care sector, including zero-hours contracts and failure to pay the national minimum wage. Good social care thrives on the provision of well-trained, motivated staff who can develop proper relationships with the people whom they visit, but we know that that does not happen. According to the Social Care Workforce Research Unit, more than 150,000 people in the care work force earn less than the national minimum wage. Poor pay not only affects employee morale, but makes it difficult to attract skilled staff and encourages high staff turnover. None of that is good for service users, who need to have confidence and trust in the people who visit them.

The Government promised to get tough on employers who do not pay the national minimum wage, but so far only five employers have been “named and shamed”. Not one of them was in the care sector, which is worrying given how widespread we know the problem to be. New clause 17 would give a clear picture of the state of the sector, and would create a foundation for possible action.

New clause 18 would create a requirement for local authorities to consider how the employment practices of providers they commission might affect the quality of care. The aim is to build checks into the system so that standards are not allowed to slip. Training is a particular concern: more than 40% of respondents to a Unison survey reported that they had not been given specialised training to deal with the specific needs of clients with conditions such as dementia. Nearly a quarter reported that they were required to carry out medical procedures or give medicine to clients when they had not been trained to do so. More worryingly, a care worker who spoke to me recently told me that it was standard practice in the agency to leave tablets for clients by their bedsides to save the cost of another visit later in the evening to ensure that the client had taken his or her medication. That means, essentially, that hundreds of vulnerable, confused people who are not in control of their own care are left to control their own medicine.

The issue of 15-minute care visits has rightly attracted considerable attention, not just because they often make the practicalities of care impossible, but because they eliminate almost any chance for a relationship to develop between carer and client. An under-reported crisis among older people is growing isolation, and the carer may be the only person to whom many of them speak on most days. That has real, measurable impacts on people’s well-being, and is made worse by those flying visits. New clause 18 would force authorities to take such factors into account when commissioning services.

A care worker on a zero-hours contract told me that it was common for 15 or 30- minute visits to be scheduled back to back, which gave him time to do only the bare minimum. He had no time to speak to his clients, or to go the extra mile to keep them comfortable. He often drops in on them in his spare time just to ensure that they are okay. On one occasion, he arrived at a client’s home to find that the man had fallen and needed to go to hospital. The man asked whether the care worker—a constituent of mine—could go with him, and my constituent rang his employers to see whether that was possible. He was told that it was not. It is extremely worrying to see cases in which social care has lost that basic element of compassion. Employers must be required to build some kind of flexibility into their practices.

My own experience in adult social care has convinced me that a general duty of well-being is simply not enough.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Because of the local government cuts, people are no longer thinking about that general duty of well-being. What is almost a “something is better than nothing” attitude has crept in and replaced concern for the well-being and care of the individual, who should be receiving quality care.

[Mrs Lewell-Buck]

I entirely agree. The budgets of council adult social care departments are now so stretched that they fill a gap wherever they can, as cheaply as they can.

[Andrew George (St Ives) (LD)]

The hon. Lady is making an excellent point. In new clause 32, I propose that the Secretary of State should undertake a review of care standards, including hourly pay and other kinds of remuneration for home care workers. Does she agree that unless we have decent national standards for visiting times and remuneration, we shall be faced continually with a race to the bottom?

[Mrs Lewell-Buck]

I apologise for not having read the hon. Gentleman’s new clause. I have been focusing on my own new clauses and amendments, but I will look at his new clause at a later stage.

Amendments 31 to 33 would establish firm time scales for assessments and reviews of service users’ care needs. During the Bill’s passage so far, the Opposition have repeatedly tried to raise the issue of the funding gap in adult social care, which threatens some of the positive changes that the Bill would bring about. In my constituency, our local authority has been forced to make £24.3 million-worth of savings, with predictable consequences. One of the consequences for local authorities has been a decline in the regularity of assessments and reviews. I have spoken to people whose assessments have been grossly delayed; I have also visited care homes in which some residents have not been reviewed for up to three years, during which time their needs may have changed dramatically and their support may have become inadequate.

It is easy to understand how that happens. Under-resourced departments must set priorities, and routine steps such as the reviewing of someone’s care plan are often at the bottom of the list because there is no pressure for them to be taken in a timely way. However, those steps are very important, because they identify changes in a person’s condition which, if ignored, might lead them to a crisis point. The amendments would reverse a worrying trend which has seen delayed assessments rise significantly since 2010, when 18.7% of new clients waited four weeks or more for an assessment. By 2011-12, the latest year for which figures are available, the figure had risen to 22.7%. In some individual local authorities, the change is even more worrying. In one authority, the number of new clients waiting to be assessed jumped from 12.6% to 70.7% between 2010 and 2012. It is important to remember that those are not just percentages, but represent vulnerable people whose needs are not being met.

In Committee, the Minister said that he was concerned about assessments being rushed to meet the timetable, and that a simplistic time scale would not be tailored to meet individual needs. I agree that that is of concern, but it should not be necessary for the time scale drawn up by the Secretary of State to be a “one size fits all”. The timetable for more complex cases could take into account the more complex nature of the assessment and allow more time for completion. It would be much more dangerous to have no benchmark at all and for those people to have their assessments delayed and their needs not met. The amendments would improve the situation for people with more complex needs, for whom putting support in place quickly is most important.

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[Norman Lamb]

Thank you very much, Madam Deputy Speaker.

For some people, the care planning process may be relatively simple, but for people with complex needs it is important that the plan is carefully produced and agreed with the person in order to meet their care and support needs effectively and appropriately.

[Mrs Lewell-Buck]

Will the Minister give way?

[Norman Lamb]

I do not have time, I am afraid.

We will set out in guidance best practice on conducting care plans. I hope that that reassures the hon. Member for South Shields (Mrs Lewell-Buck).

Amendment 26 is unnecessary because the concepts of independent living and inclusion in the community are already core parts of the duty to promote individual well-being. We have merely captured them in more concrete ways rather than using those terms, which are too unclear, as the Law Commission agreed.

Schedule 2 to the Children Act 1989 requires local authorities to keep registers of sight-impaired children, and amendments 22 to 25 would only duplicate that. We have committed to explicitly reinforcing this duty in the forthcoming code of practice for children and young people with special educational needs or disabilities.

I turn briefly to the Government amendments. Amendments 1 and 2 simply clarify the scope of the regulation-making powers as set out in the other place by Lord Howe, the Under-Secretary with responsibility for quality. They ensure that regulations can specify where local authorities do have the power to be more generous and contribute to the costs of an adult with resources above the financial limit, as well as where they do not.

Amendment 3 allows regulations to specify where certain costs do not have to form part of the personal budget and thus do not count towards the cap on care costs. It has always been the intention that some provision, such as reablement, should be a universal, free service and therefore should not be incorporated in the personal budget. Such exemptions will not apply to general care and support that a local authority can charge for.

Amendments 4 and 5 correct small drafting omissions in clause 34. Amendment 6 will enable us to make provision in the regulations for the appeals system for the investigation of the appeals body itself—for example, regarding allegations of maladministration. Amendment 14 sets out that, as per usual practice, we will use affirmative regulations if we need to amend primary legislation as part of the appeals regulations.

Finally, on amendment 7, the feedback from local authorities is that it would make sense for them to have flexibility to be able to delegate functions relating to direct payments if they so wish. We agree and have accordingly tabled an amendment to remove the prohibition related to that.

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[Mr Dorrell]

I am grateful to the Minister for his encouragement that I am on the right path.

There is a serious question here. I agree with my right hon. Friend the Member for Sutton and Cheam that, at a local level, the health and wellbeing board is the organisation best placed to move forward with the process of more joined-up commissioning. How we, as MPs, satisfy ourselves that this is happening to the required standard, with the required levels of economic efficiency across the system as a whole and above the level of the health and wellbeing board, is one of the questions left unanswered by the institutions we currently have. I am not entirely persuaded that the CQC should be encouraged into what I regard as a vacuum.

[Mrs Lewell-Buck]

I will speak to amendment 19 and echo some of the excellent comments made by my hon. Friend the Member for Copeland (Mr Reed).

Amendment 19 would reinstate the Care Quality Commission’s duty to inspect the commissioning of adult social care services by local authorities. The case for the amendment is very simple: the quality of commissioning has a huge impact on the quality of care that people receive. It is extremely important that our adult social care system includes checks to ensure that commissioning is of a high standard. At present, this is not the case.

The current model of sector-led improvement introduced by this Government in 2010 leaves it to local authority peer reviews to identify failure. In practice, this means that neighbouring authorities that already work in close collaboration inspect each other, but only when a neighbouring authority volunteers for inspection. Of course, local authorities that are confident in their commissioning practices are happy to volunteer themselves for scrutiny, but what about those that do not volunteer? It is surely those authorities that we should be most concerned about, yet under the current system they are not subject to proper oversight. Worryingly, the majority of authorities have not been assessed under the peer review scheme. In total, 127 local authorities have not had their commissioning reviewed since 2010. We would not allow this type of reckless leniency with any other service that looks after our most vulnerable. I am certain that it should not continue.

It is clear that when it comes to inspecting local authorities’ commissioning practices, some uniformity and impartiality are needed. The CQC is best positioned to carry out that duty. Certainly, the chief executive of the CQC thinks so, commenting that he has not

“spoken to any national provider association who doesn’t think councils should be inspected”

and believes that

“the removal of that power from CQC was seen as a retrograde step”.

When this proposal was raised in Committee, the Minister insisted that it was unnecessary. He argued that CQC inspection of providers could identify patterns of poor commissioning that would be grounds for a special review.

[Mr Tom Clarke]

My hon. Friend is making a convincing case. I have a background in local government. Does she agree that if statutory obligations are placed on local authorities, it is important that that they should be followed by the appropriate resources, but that that is not always the case?

[Mrs Lewell-Buck]

I agree completely, and I will echo my right hon. Friend’s comments later in my speech.

I have some doubts about how effective CQC inspection of providers would be in practice. It is not clear at what point the CQC would recognise that poor provision was caused by poor commissioning practices. A handful of poor examples could be just that, or it could be evidence of a more systemic problem. Given the need for the Secretary of State’s approval before a special review is undertaken, I am concerned that the threshold of proof needed will be extremely high. Furthermore, CQC inspectors will not visit all providers in a single local authority area at the same time. In practice, it could take some months before information is collated and a pattern of failure detected that might indicate sub-standard commissioning. There is also a doubt about who will be joining up the dots to link months’ worth of inspections to a local area’s commissioning practices. In short, how will anyone ever know that poor providers are linked to poor commissioning by a particular local authority? The reality is that by the time the CQC recognises that there is a case for a special review, numerous safeguarding issues could have arisen.

I am concerned that, under the model the Minister advocated in Committee, action will be taken only once patterns of poor care have already taken root in a local authority. Surely that is the wrong way round. We need to prevent poor care arising from substandard commissioning, rather than wait for problems to become embedded in the system. This not only makes sense financially: from a safeguarding perspective, it is essential. I am concerned that without rigorous oversight, social care departments will find it easier to allow standards to slip.

In Committee, the Minister argued that the duty for local authorities to consider well-being would incentivise good practice. I do not believe that this is enough. I do not want to be critical of any local authority’s will to ensure the well-being of their service users, but I know from personal experience that these departments face intense pressure. If something is not built into the system, it is less of a priority. If departments know that the CQC will not be knocking on the door this year, they will concentrate on more urgent matters—trust me, in adult social care there are always urgent matters. Knowing that they are subject to regular oversight makes departments foster a culture of good practice.

In discussions I have had with providers and commissioners, they say they are in favour of reinstating the clause. Commissioners, whose day job is to fill gaps in services and to do so in the most cost-effective way, are worried that their decisions are not properly scrutinised, and that any mistakes they may unwittingly make will go unchallenged. Providers want it to be clear when they are at fault or when failure is down to poor commissioning. They do not want under-resourced providers to be punished simply because the rates that they receive from the local authority are too low to provide decent care.

I remain puzzled about why, although in June last year the Minister admitted that sector-led improvement had serious shortcomings for weaker-performing councils and, presumably because of his doubts, the Bill originally included the new clause, yet in October, for some reason, it was removed on Report in the other place, and the Minister has now moved from being in favour of CQC inspection of commissioning to being against it. I was also puzzled when the Minister repeated his concern about sector-led improvement in Committee. Following an intervention from the right hon. Member for Sutton and Cheam (Paul Burstow), he said that he shared the right hon. Gentleman’s view that

“the danger with sector-led improvement is that those bodies who are up for change and improvement take part and those who are dysfunctional and failing do not engage.” —[Official Report, Care Public Bill Committee, 28 January 2014; c. 442.]

Given that the CQC, providers and commissioners—along with the Minister— recognise the blind spots that exist in the sector-led improvement system, I hope that the Minister is open to convincing on the issue. If he is not convinced, I hope that he will be able to explain what he could not explain in Committee, namely why he and the Government changed their minds.

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[Paul Burstow]

rose—

[Mrs Lewell-Buck]

rose—

[Norman Lamb]

I will give way to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) first.

[Norman Lamb]

Subject to the fact that the CQC is an independent body, I will certainly reinforce that point in my discussions with it. In the context of mental health, we were discussing with the CQC only last week the importance of the role of commissioning as well as that of provision. I entirely accept that good care can be provided only if we get both the commissioning side and the provider side right: the two must go together.

Is it appropriate to set out the specifics of a review of commissioning in the Bill? I do not believe that it is. Flexibility is vital. While the CQC has a power to conduct special reviews and investigations of commissioning, that must be set in the context of other measures in the Bill that will strengthen the duties that local authorities must fulfil in exercising their care and support functions.

[Mrs Lewell-Buck]

Perhaps I am being impatient—the Minister may deal with this point later in his speech—but I should like to know who will routinely review local authority commissioning. If no one will be doing that, how will the CQC know that poor commissioning is taking place in a local authority area?

[Norman Lamb]

I take very seriously the point that the hon. Lady has raised, but if she will allow me to continue to present my argument, I shall be happy to return to it later if necessary.

The important new measures include an express duty to promote people’s well-being—a duty to shape local care markets to ensure that they are sustainable and diverse, and offer high quality care and support. The Department will work with the local government and adult social care sector to produce statutory guidance on local authority commissioning of care and support. However, a CQC review of commissioning remains an option. I reassure right hon. and hon. Members that we will review evidence of concerns about local authorities’ commissioning practice to establish whether it is appropriate to ask the CQC to undertake a targeted review under section 48 of the Health and Social Care Act 2008. Getting the message out to commissioners that the powers will be used is important in itself to concentrate minds. They will be under the spotlight if they fail in their commissioning responsibilities.

New clause 12 would require the CQC to consider integration of care as part of its performance assessments of registered providers of health and adult social care. In Committee, my right hon. Friend the Member for Sutton and Cheam made a strong case for the new system of performance ratings to be carried out by the CQC to look at care pathways, rather than focusing on separate institutions in isolation. He makes a very good case. I explained that a central tenet for the Government is that the independence of the CQC improves its effectiveness as a regulator. Clause 89 removes nine separate powers for the Secretary of State to intervene in the day-to-day workings of the commission, and we have deliberately removed the Secretary of State’s power to devise or approve the system for performance assessments and ratings.

The CQC has to be responsible for the system of performance assessment that it introduces, and placing specific requirements on the commission in legislation would not help in that regard. That is not to say that the CQC should not look into the integration of care. I told the Committee that I would pursue that matter in my discussions with the CQC, and I have done so. I have spoken to the CQC chair, David Prior, and to the chief executive. I am pleased to say that in that regard we are pushing at an open door. They absolutely understand the case that my right hon. Friend makes.

In recent weeks, the commission’s chief executive, David Behan, has set out plans for the CQC to carry out thematic inspections to look at the care pathways for different conditions. One such thematic programme will look at how people with dementia are handled by relevant services in a geographical area—acute health care, primary health care and adult social care, for example. Another is looking at how people move across transition points, such as when a disabled child becomes an adult—a point at which too often services fall down.

Care Bill [Lords]

Emma Lewell-Buck Excerpts

Monday 16th December 2013 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to follow so many passionate and marvellous speeches, and I hope that my speech does them justice.

Prior to joining this House I was involved professionally and personally in the adult social care arena. Throughout that involvement I met some amazing, dedicated and brave people, many of whom were being denied the full service they deserved, and working in a system that hindered their ability to deliver fully what they knew their clients needed.

There is nothing worse than having to tell a person who is already struggling with daily life because of their condition or that of a family member that, due to funding cuts, they will get a reduced service or get no service at all anymore from their local authority. My local authority, like many others, has been restricted to offering care only to those who meet the critical and substantial criteria of fair access to care. In reality, that means that an elderly or disabled person who was struggling with laundry and housework, or who was given support with daily living or to access services or employment, may no longer receive that vital support.

The Bill is a missed opportunity to make such scenarios a thing of the past because it does nothing to address the funding crisis in adult social care. That funding crisis has led to the collapse in support for those most in need, leaving many people without access to essential services. It is not only the Labour party that has raised concerns about the absence of any funding plans in the Bill; Age UK, the Local Government Association, the Care and Support Alliance, Carers UK and the Royal National Institute of Blind People share the same concerns. According to a report published today by the Personal Social Services Research Unit,

“the scale of reductions in spending and provision…are almost certainly without precedent in the history of adult social care.”

I know from consultations I have led that people in my constituency want to remain in their homes and receive care at home for as long as they can, but those people often end up suffering from chronic loneliness and isolation, receiving, perhaps, a 15-minute visit perhaps twice a day. We need to think urgently about how we can prevent people who remain in their homes from becoming socially isolated. Although loneliness may not be seen as an illness as such, anyone who speaks to people who have suffered day after day, alone in their homes, will hear that that is what hurts them the most: the loneliness. Age UK describes loneliness as the “hidden killer”. It is therefore disappointing that the Bill removes the Care Quality Commission’s existing duty to inspect and assess the way in which councils commission adult social care services. That could have been one of the few safeguards against the proliferation of 15-minute visits.

Labour recognises that improving care standards for service users means improving things for care workers themselves, and that is why we have launched a review of exploitation in the social care sector. I welcome the review, because my husband works in the care sector. He is currently on a zero-hours contract, with irregular hours and at the mercy of his employers, and is constrained by the limited time that he can offer his clients. My husband did not seek employment in the care sector to swell the coffers of those who make money from care for the vulnerable in our society; he did it because he wanted to make people happy and comfortable in their homes. My husband and I know that the benefit of improving the standards of care at home, and enabling more people to receive care at home, is that we will see fewer people in hospital and fewer residential care admissions, which are both stressful and incredibly costly.

The local authority covering my constituency is the seventh hardest hit in the country. Its central funding has been cut by an average of £262 per person. We have higher-than-average proportions of people aged over 65, over 75 and over 85. We also have more than 1,000 people with dementia, and a higher than average number of people suffering from long-term conditions. Between 2011 and 2012, a higher than average number of people were subject to completely new social care assessments. Our rate of permanent admissions for people to residential care is 71% higher than the national average, and we currently have just under 6,000 adult social care clients receiving a service.

The year 2020 is often described as “year zero” for council budgets. Only core front-line services are expected to be delivered, and they are expected to be delivered at a reduced level. If preventive services continue to be cut and if there continues to be an impact on early pathways to care, people will be eligible for care only when they have deteriorated to the point at which their need is urgent and their care needs are significantly more costly.

Given the situation in my constituency, it is no surprise that the fear expressed repeatedly by people in South Shields is that they will not be able to afford their care in later life. For my constituents, the measure of the Bill’s success will be whether it forces them to sell their homes to pay for care in their old age. It seems that it will fall well short, because, as my right hon. Friend the Member for Leigh (Andy Burnham) pointed out at the beginning of the debate, people will still have to sell their homes.

The Dilnot commission proposed a £35,000 cap on care costs; the Government have set the cap at £72,000. The commission proposed a universal scheme for loans to help to cover care home fees; the Government have means-tested it. That means that it will take the average person nearly five years to hit the Government’s cap. It is estimated that six out of seven people will die before receiving any help from their local councils. My constituents deserve to know the truth so that they can plan for their futures, and it is a shame that the Government are not prepared to share it with them.

The fact that money is scarce does not mean that we should withdraw from our responsibility to care for the elderly and the disabled. Our response should be to rethink radically the way in which we deliver those services. We do not need to dismantle what is already in place; we simply need to think about how the services can work better together, and how we can meet the needs of people now and the needs of future generations. More crucially, however, we need to set out plans to fund this adequately. We know that the Government have legislated for fragmentation and that health funding in areas such as mine is being stripped back. We also know that if the Government wanted immediately to address the funding crisis in our social care system, they could implement Labour’s plan to use £700 million from this year’s NHS underspend. Will they do this and do right by the people who need the services the most?

I support elements of the Bill, but I am not sure how, without explaining how our future adult social care will be properly funded, any of these proposals can become a sustainable reality. I make a plea today, not just on behalf of my constituents, but in memory of all the people I have worked with—my deceased grandmother, uncle and elderly neighbour, all of whom I helped care for, and all the strong and amazing people let down by a system that can no longer support them. I hope the Minister is listening and that he will support our amendment.