Covid-19: Social Care

Helen Hayes Excerpts

Thursday 22nd April 2021 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered social care and the covid-19 outbreak.

It is a pleasure to serve under your chairmanship, Mr Twigg, and to speak in this debate in person—for me, for the first time in the Boothroyd Room. I am grateful to the Backbench Business Committee for allocating time for this debate, and to my co-chair of the all-party parliamentary group on adult social care, the right hon. Member for Ashford (Damian Green), for co-sponsoring it.

The APPG on adult social care has a working group of representatives from the social care sector, including not-for-profit care home providers, sector-wide bodies such as the National Care Forum and Skills for Care, and people with lived experience of managing their own care at home. From the start of the covid-19 pandemic, the working group met weekly to discuss the experience on the ground of each of the membership organisations and the individuals represented on it. I am also grateful to the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall), and to the Minister herself for meeting the working group during that time.

Week by week, those meetings gave a vital live insight into the multiple devastating impacts of the covid-19 pandemic on the care sector. They often provided a reality check against what the Government were announcing. The right hon. Member for Ashford and I felt strongly that it was important to bring the weight of this collective experience before the House so that it may inform urgent discussions about the future of social care.

At the outset, it is important to acknowledge the diversity of the social care sector, as there is always a tendency to focus mainly on care homes for older adults when we talk about social care. It also encompasses care homes for working-age adults and people who receive all types of care in their own homes and in supported housing.

The covid-19 pandemic took a dreadful toll across the whole sector. Perhaps the most shocking figure, well reported, is that between March and June 2020, 40% of all deaths from covid-19 were care home residents. The deaths have continued, with a further 12,000 deaths of care home residents since January 2021 alone. More than 34,000 people with dementia have died from covid-19, and tens of thousands more have seen their condition deteriorate at an increased pace due to limited support and contact with loved ones. Those figures mask a human story: the tens of thousands of families grieving the loss of a precious loved one, remembering the full richness of the lives they lived, and the thousands more families grieving the loss of precious time that they cannot get back with loved ones whose dementia has deteriorated.

At least 850 social care workers have died due to covid-19. That figure is likely to be higher given the lack of availability of testing to confirm diagnosis in the early weeks of the pandemic. The vast majority of the care workers are women, many are black, Asian and from other ethnic minorities, and many had dedicated their lives to looking after other people. Each one leaves a grieving family, and we must acknowledge their service and sacrifice.

The figures also belie the diversity of the social care sector, because they do not include the impact on people receiving care in their homes, who were often vulnerable to coronavirus infection from carers visiting multiple homes. Sometimes, they felt unable to receive care at all, due to the risk of infection, resulting in untold hardship and difficulty. The figures also do not include the impact on unpaid carers, often left isolated and unsupported, or the impact on people living in unregulated supported housing.

Each week, the APPG working group heard of the problems accessing personal protective equipment and covid-19 testing. Providers were operating in the dark, with their hands tied behind their back, unable to know who was carrying covid-19 in their care homes and without access to full infection control measures.

Covid-19 ripped through many care homes, as the access to testing and urgent need to free up hospital beds for covid patients meant that undiagnosed covid-positive patients continued to be discharged from hospitals into care homes. The completely unacceptable blanket use of “do not resuscitate” orders for care home residents further speaks to the disregard for the most vulnerable members of our communities at the start of the pandemic.

I pay tribute to social care workers who stepped up to do extraordinary things in these horrendous circumstances —staff who moved into care homes, leaving their families in order to avoid the risk that they were a source of infection; staff who, again and again, held the hands of the residents in their care as they lay dying, when their loved ones were unable to be there; and staff who went out of their way to facilitate FaceTime calls to maintain contact with relatives who could not visit. Social care staff must be recognised for their immense contribution during the pandemic.

I will dwell for a moment on the mental health impacts of the pandemic, in the light of the situation that I have described. It is easy to forget that care homes are communities. Staff look after the same residents week after week, and relationships become like family. Many staff who watched residents and colleagues dying from coronavirus have experienced the trauma of bereavement many times over during the past year. I recall listening to one social care worker describing the first time in many weeks that residents with dementia in her home were able to come together for a music therapy session. One resident, looking around the room, said, “Where is everyone?” not understanding that so many residents had passed away. It is heartbreaking.

Contrary to the words of the Prime Minister and the Secretary of State for Health and Social Care, there was no protective ring around care homes or other vulnerable residents receiving social care at the start of the pandemic. The need for urgent reform of social care has been known for a long time. We have had more than a decade of detailed cross-party work on social care. The funding gaps are quantified. The international best practice is well understood. The range of options available for reform are known. What has been lacking is the political will at the very top of Government to deliver it.

Despite the Prime Minister promising in July 2019 that a plan was ready and that he would begin cross-party talks, there has been no progress nearly two years on. The Government have published the NHS White Paper, which barely mentions social care. We are told that there will be a 10-year plan for social care, but for all those working in social care, and relying on social care day by day, reform is long overdue. They are struggling to understand why the Government have dragged their feet so much for so long, for a sector that has such a profound impact on quality of life for so many people every single day.

From the perspective of the APPG working group, what are the priorities for the Government as we reflect on the impact of the covid-19 pandemic on social care? First, the promised public inquiry on the covid-19 pandemic must include a separate strand on social care, so that the lessons can be learned for future pandemic planning and social care can be better protected the next time we face such a terrible challenge.

Secondly, the Government must start the long-promised cross-party talks. Social care needs long-term reform, based on cross-party agreement. That will not be achieved by the Government announcing plans at short notice and simply expecting everyone to vote for them. It needs a process, properly resourced and entered into in good faith, to secure that agreement.

Thirdly, it is vital that co-production is at the heart of social care reform. Social care reform must be delivered in partnership with those who live and breathe social care every single day as residents in care homes, people who manage their own care at home, older people and working-age adults, social care workers, unpaid carers and local authorities. The Government must set out a process for co-producing reform with those who have the most knowledge and experience to contribute.

Fourthly, reform must address pay and terms and conditions for social care workers. Social care work is highly skilled and demanding and can be very rewarding, but there is not a route to social care reform that avoids the issue of pay. As well as making a huge difference to the lives of millions of people every day, social care contributes £46.2 billion to the UK economy each year. However, in many parts of the country it is still possible to earn more at the local supermarket than in social care. That cannot continue.

I pay tribute to Unison for its work in establishing the ethical care charter, which guarantees domiciliary care workers the real living wage, and an end to zero-hours contracts and 15-minute visits. It has been adopted by many councils, including Southwark, which covers part of my constituency. It not only benefits care workers, but helps build resilience in the social care system. This should not be left to the discretion of individual councils. There is a chronic shortage of social care workers, and the trauma that many have experienced during the pandemic is likely to make the situation worse. Social care must be seen as a rewarding career in which everyone is paid a decent wage. There has been no commitment from the Government to increase pay for social care workers, and I call on the Minister to change that urgently.

On long-term reform, the Government’s proposals must be comprehensive. In the discussion of social care, all too often there is a failure to acknowledge the diversity of the sector and a dominant focus on care for older people, which ignores the needs of working-age adults, who account for almost half of all spending on adult social care. It also ignores the unregulated provision in which much care and support is delivered, and the needs of unpaid carers, who save the economy a colossal £132 billion each year.

We need a social care system that makes high-quality care and support available to everyone who needs it across a wide range of different settings. Although I hope the Minister will respond on the urgent need for long-term reform, there are also some very pressing short-term concerns that are important for the social care sector right now. The first is the question of additional funding for infection control. Social care providers have faced huge additional costs as a consequence of the need to use personal protective equipment and employ additional staff to cover for sickness absence, or to avoid agency staff travelling between care homes. Despite the anticipated release of covid restrictions in June, it is highly likely that the need for enhanced infection control in care homes, and for domiciliary care workers, will continue. However, the current funding allocation runs out in June. Can the Minister confirm whether ongoing funding will be provided for infection control in care homes beyond June?

Secondly, many care providers have raised with me the very restrictive nature of the 14-day quarantine requirement for residents who leave care homes, which means that if a resident leaves a care home, even for only a few hours, they have to quarantine for 14 days. Having entirely failed to protect care homes from coronavirus infections at the start of the pandemic, the Government are now applying a much more restrictive standard to care homes as restrictions are lifted elsewhere. Can the Minister please explain under what legislation the guidance could be enforced? What are the implications for the deprivation of liberty?

Importantly, what will be the implications for care home residents who wish to vote in local elections on 6 May? Requiring residents to isolate for 14 days after attending a polling station will surely deter many from exercising their democratic right to vote. In anticipation of the guidance, there has been no dedicated effort to encourage residents to vote by post, or to make them aware of the implications of it, and it is now too late to sign up for postal votes. Will the Minister consider moving to an approach based on testing, vaccination, social distancing and PPE in order to enable care home residents to leave their care homes for voting and other essential purposes?

In conclusion, I thank each and every social care worker for their immense contribution during the past year of the coronavirus pandemic, and I remember each worker, care home resident or vulnerable adult whose life has been lost. I pay tribute to the scientists and NHS workers who have delivered the vaccine roll-out with such rapid speed, so that we can now see the beginning of the end of this terrible pandemic. However, acknowledging the immense contribution of the social care sector at the frontline of the coronavirus pandemic can be done properly only by making a firm commitment on the funding and reform that social care so desperately needs, and I hope the Minister will take the opportunity to do that today.

--- Later in debate ---

[Helen Hayes]

I thank all right hon. and hon. Members who have contributed to the debate today. It has been a reflective debate and one full of immense experience and knowledge of the social care sector, and that is very welcome.

In the couple of minutes that I have, I will push back slightly on some of the Minister’s comments. It was disappointing that she mentioned additional funding, PPE and testing and talked only about the things that the Government did later on in the pandemic—the very deep trauma experienced by the social care sector with regard to a shortage of PPE and lack of access to testing was in the early months. I feel that, by failing to mention it, she does a disservice to those workers and residents in the social care sector who really suffered the impact of the Government’s failure to plan ahead of time for a pandemic and their failure to deliver and get swiftly off the blocks when the pandemic hit.

The point that I would like to make about the health and social care White Paper is that it talks about integration, but without talking about social care reform, and that cannot happen. We have an NHS, which is a well organised national system, founded on a statutory basis; and we have social care, which is not a system but a fragmented and diverse set of organisations and individual families all struggling and all brought to breaking point by the lack of funding, the lack of organisation and the lack of overall structure and accountability.

If there is to be integration, it has to be integration on the basis of parity of esteem, and that involves the Government getting to grips with the question of reform. I urge the Minister just to take seriously the voice of the APPG and the sector, to continue to engage and, most importantly, to start a structured process for cross-party talks, so that together we can deliver the change that the social care sector so desperately needs.

Question put and agreed to.

Resolved,

That this House has considered social care and the covid-19 outbreak.