Home Care Workers

Jim Shannon Excerpts

Wednesday 6th March 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I, too, thank the right hon. Member for Oxford East (Mr Smith) and congratulate him on bringing this matter to the House for consideration. There will not be one person in the House or outside it who is unaware of the importance of home care workers and what they do. Unfortunately, we can all tell horror stories like those that the right hon. Gentleman told at the start of the debate, but we also have many good stories of care workers who do tremendous work. Where would we be without the good work that they do?

Thanks to medical innovation, people have a longer life expectancy now than they had in the past. As a result, people are trying to live at home just a wee bit longer before they go into a residential or nursing home. A great many people now retire to my constituency of Strangford, because it has the seaside and is also a lovely place to be, and we are very pleased that they are coming to live in our area. However, they are people of a certain generation, and the expectation of people in Northern Ireland is the same as that of people in the rest of the United Kingdom—that they will live that wee bit longer. I believe the Government have been encouraging families to help at home before turning to residential nursing care.

There must be robust regulation of care workers to ensure safety and value for money. In the news, we often hear horror stories of someone taking advantage of the elderly or vulnerable. Hearing such stories concerns and annoys me, but it is not the case in the vast majority of circumstances. There should be regulated training and assessment as well as funding and help, to ensure that we get things right, which is the gist of the debate today.

In the past I have spoken about the difficulties that welfare reform will bring for carers. I shall use the example of my brother, who had a motorbike accident approximately eight and a half years ago that left him with some brain injuries. My parents are well into their 80s—81 and 83, mum and dad—and their ability to cope with my brother and his particular circumstances lessens as every year passes, because the nature of life is that the older we get, the less physically able we are. We are very pleased and blessed to have my brother able to speak and converse with us; the difference is that our Keith will never be able to work again or, as he would love to, ride a motorbike again—that will never happen. He is able to keep his independence due to the carers who come to see him, and they are tremendous. There is perhaps not as much funding as there should be in the NHS for carers; Keith is reliant on his disability living allowance to pay for the help he needs. If that were to change, he would have to be placed in a facility with full-time carers, which would adversely affect his mental health and cost the Government a lot more to provide. That is my honest-to-goodness, personal opinion in the case of someone close to me.

Such situations are replicated across my constituency and in constituencies across the UK; there are many cases. It is essential that home care continues. If people cannot afford to pay for reputable carers, it is more likely that they will look for carers who are less expensive and perhaps less qualified. That is why the Government must regulate more now.

I make a plea for Crossroads Caring for Carers Northern Ireland, which primarily provides domiciliary respite care. It has offered that service for carers in Northern Ireland since 1984, and provides in excess of 200,000 hours of respite care to more than 1,200 families per year. It does tremendous work, as do many others. The service is unique, because it is aimed specifically at the carer. Crossroads is committed to providing a quality, flexible home-care service; its care attendants enable the carer to have a break, by carrying out whatever tasks the carer would normally do. Carers can take a break from caring, in the knowledge that those they care for are receiving quality care from Crossroads. In other words, every bit of quality care will be provided by Crossroads. A break from caring is invaluable in reducing the psychological and emotional stress that many carers face. Crossroads domiciliary respite care helps carers to continue to provide the support they give to a sick, disabled or elderly person.

The care provision is tailored to each caring situation; everyone is unique and the service adjusts to the unique circumstances. Individual care plans are agreed between Crossroads, the carer and the person with care needs. People decide for themselves what help and support they need, and Crossroads responds. Care attendants help with a range of personal care tasks, ranging from bathing and personal hygiene to complex care needs. Through their families, I regularly meet many constituents who have complex care needs. Crossroads adopts a flexible support approach, with care attendants helping with almost any task that is part of everyday living.

Funding for Crossroads is under stress, as I said, so less and less help can be given. That brings us to the thrust of the debate: people are left in situations where they must look to cheaper alternatives, which are not always better. It bears repeating that the Government must address care in the home needs. Too many people are living in dirty homes and not being fed enough. There is only so much that families can do. Although we are trying to save money, care in the community cannot bear the brunt of what the changes will bring. Crossroads Caring has lost the bulk of its funding due to cuts. That will mean more elderly people living in unfit conditions because too much is required of their carers. With respect, the Government do not seem to understand that if they put a little into respite help for carers now, it will mean that carers can continue to care rather than giving up and putting their loved ones into state-sponsored homes, which are more expensive and where issues with carers are more apparent. Saving a penny now will soon mean spending thousands later. I hope when the Minister responds, he will give some indication of the Government’s strategy.

Those advertising care at the moment can do so while providing little training or checks on their staff, as hon. Members have indicated, and that must end. There must be regulation, qualifications and a set standard to which all carers and service providers adhere. When the Government set that in place, we will hear fewer horror stories and more feel-good stories, of which there are thousands and thousands. They are not the stories that make the press; they are about the many carers who go above and beyond their calling to provide care.

As an elected representative—as an MP and a former Assembly Member and councillor—I know of the good work that carers do. They come to me regularly, in their own time, to seek help for those for whom they care. I am always impressed by the fact that carers spend additional time on those for whom they care—above and beyond what is expected. We hear the negative stories, but the good ones always make us feel much better about the good work that carers do in our constituencies.

I am sure that, like me, colleagues feel there must be proper training and monitoring and that it must be put in place in a timely fashion. As each day passes, more people are being cared for at home. We have a duty to ensure first, the regulation of all carers; secondly, the safety of those being cared for; and, thirdly, and most important, peace of mind for the family of the person who needs care. I congratulate the right hon. Member for Oxford East on securing the debate. I look forward to a good answer from the Minister and to his support.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner, and to follow my hon. Friend the Member for Nottingham South (Lilian Greenwood) and all other hon. Members who have spoken.

I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing today’s debate. Home care workers often work in isolated environments, and the people who receive care are isolated. Too often, they do not have a voice, and one of our jobs as Members of Parliament is to provide a voice for the voiceless. My right hon. Friend has helped us to do that today.

The issue is extremely important. More than 800,000 people provide home care in the UK. Some 80% of them are women, and their median age is about 40. They provide vital, intimate and personal services to more than 1 million of the most vulnerable people in society. If any other policy area had that scale of figures, this debate would be on the Floor of the House, with many other hon. Members present. It is good to have hon. Members here in this debate, but the issue that requires addressing is a huge one.

The help that home care workers provide is crucial for older and disabled people, because it helps them do what they want, which is to stay living independently in their own homes. It is crucial for families, who often have to go out to work and cannot provide support and care for their elderly relatives. Also, they might not live nearby, as I know well myself. Home care help is crucial also for the public finances and taxpayers, because if we can keep more people living healthily and independently at home and not going into hospital, taxpayers will receive better value for money.

Like other hon. Members who have spoken today, I have been concerned about the issue for a long time. Last May, I held a domiciliary care summit in Parliament with the United Kingdom Homecare Association, with 50 providers coming along. I have work-shadowed home care workers in my constituency, including Amanda White. Going out on an early-morning shift with her was an eye-opening experience. I also speak to many older and disabled people and care workers in my constituency and across the country. Many of the points that I have heard have been repeated by right hon. and hon. Members today.

There are many examples of excellent, decent and respectful care. The home care workers to whom I have spoken, including Amanda, love their job. They feel that they are doing something important for vulnerable people, helping them to live the kinds of lives that they want. However, the overwhelming picture is of a vicious downward spiral, with ever-increasing demand and ever-decreasing budgets, poorly paid, motivated and trained staff, and poor-quality care. Just to summarise, I will go through five issues that many hon. Members have raised today.

The first issue is low pay. Many people do not get even the minimum wage at the end of the week, because they are not paid travel times. Unison’s survey, “Time to care”, which hon. Members have mentioned, found that half of those who responded said that they did not get paid travel time, rising to more than 80% in the private sector. King’s college London has found that between 150,000 and 220,000 people working in the social care sector get paid less than the minimum wage. I will ask the Minister some questions about that towards the end.

The second issue concerns shorter and shorter visits for people with higher and higher levels of need. It is important to remember that as budgets are squeezed, councils raise their eligibility criteria, so people who need care and support at home have greater needs but get shorter and shorter visits. According to the UK Homecare Association, three quarters of visits are for 30 minutes or less, and one in 10 visits are for only 15 minutes. As several hon. Members have said, that is completely inadequate to get someone up, washed, dressed and fed, particularly if they have dementia. Anyone who knows someone or has a family member with dementia will know that they often struggle in the morning, which is a really disorientating time.

[Jim Shannon]

One thing that carers provide to those on whom they call is a wee bit of a chat in the morning—someone to speak to—because many people have no one at all to speak to. When they come in, they light the fire and do all the things that the hon. Lady has mentioned, but communication between carers and those they visit is important. Does she think that that should be given more time?

[Liz Kendall]

Care and communication is vital for people with all sorts of frailties and conditions, but particularly for those with dementia, as carers try to keep their memories and brains going. Those people often feel lost in a fog, and having some kind of contact is vital to keeping them going, so it is important.

We have heard about the problems of call cramming, with carers being rushed, getting late to one client and leaving early for the next. Older people are worried when they are left waiting on their own, and staff are frustrated that they have to rush in and out.

The third issue that has been raised is zero-hours contracts. As hon. Members have said, such contracts are very bad for workers, because they find it difficult to budget and plan their lives. Zero-hours contracts make it hard to attract people to the sector. They are also terrible for the users—older and disabled people who do not get continuity of care. I cannot imagine someone coming round to get me out of my bed and take me to the shower. I would be naked and they would be washing me, but I would not know who they were, because they would often be different people each time. We would not put up with that for ourselves, and we should not expect it for older people either.

The fourth issue is the lack of training, which is a real problem in dementia care. It is only since having known people with dementia that I have fully understood why they are seen to get aggressive: they do not, but they are frustrated because they cannot remember things. Carers need detailed training for that.

The fifth issue is the vicious downward spiral or vicious circle that leads to poor care for users of services and real problems for staff. The last UK Homecare Association report states that vacancy rates are at 21%, so we are simply repeating the problems.

In my remaining time, I want to make three comments about why that is all happening and what we need to do. Clearly, demand has increased in recent years. However, as my hon. Friend the Member for Wirral South (Alison McGovern) said, when local councils’ budgets are being cut by a third, when adult social care is 40% of their budget on average and their biggest discretionary spend, and when the money that the Government say they have transferred from the NHS has not been ring-fenced, it is inevitable that care budgets are being cut. Figures from the Department for Communities and Local Government—the Government’s own figures—show that more than £1.3 billion has been cut from older people’s social care budgets since the coalition came to power.

There are a few deeper things going on. First, the caring profession is mostly delivered by women and is low-skilled. Such professions have always been neglected in the past, so that is a concern. Secondly, the problem is invisible: it concerns isolated staff and isolated, frail older people who do not have a voice. In talking about the care crisis, I always tell people that I have received five letters about the care crisis in my constituency and 99 about saving forests. I am passionate about forests, but getting only five letters on the care crisis shows that this is an issue of isolation and we should stand up about it.