Care Workers

John Robertson Excerpts

Wednesday 5th November 2014 Westminster Hall

[Joan Walley (Stoke-on-Trent North) (Lab)]

May I, too, declare an interest, as a Unison member, and say how important it is that this issue has been flagged up in the debate? Given the concerns about this issue, should home care not be part and parcel of the discussions about the future of the NHS? We need to keep people out of accident and emergency and out of hospitals. If there is no care in the community, we will put more expense on the NHS and provide worse care. Does my right hon. Friend agree that, in discussions about the future of the NHS, we should make absolutely sure that these workers are paid a proper rate for the job and that travelling time is included? The Care Quality Commission has a vital role in this.

[John Robertson (in the Chair)]

Order. I ask hon. Members to keep interventions a bit shorter.

[Mr Smith]

I agree with my hon. Friend on all points. If this country is to get the standard of care we want, social care—home as well as residential—must be regarded as a central part of health service provision. The debate on health provision cannot be confined to the future of the NHS.

Providers made the point to me that 15-minute visits should be banned, except perhaps for check-up visits when other visits are being made to the person on the same day. I am pleased to say that since I raised that issue in our previous Westminster Hall debate about care, Oxfordshire county council has decided to phase them out. Others must do so too. There is a need for sustained funding and a co-ordinated push for training, to bring social care staff up to the standards required for commissioned services.

We need a scheme of accreditation that makes crossover into the NHS and back possible if we are to provide a career pathway to attract young people, and indeed some older people, into the care profession. Training should be part of an overall package that attracts people into care work. A carer who has had training should have certification that they can take with them to another employer. Those are points that providers have put to me. They point out that too many agencies do not even give carers their certificates, so they have no proof, and must go through the assessment—where it is provided—again. We must also have regard to the fact that the public and media perception of care too often stops at the NHS, and does not include social care. Protecting the NHS goes only part way to protecting our care system. We will protect the NHS by protecting social care, and that means that more money must go to local government. That is another point put to me by providers.

On the question of zero-hours contracts, I have been in touch with two local providers who have tried to offer salaried employment as an alternative, but have had little take-up, partly because employees are juggling a second job, and partly because they value the flexibility that allows them not to work, for example, on certain weekends. The zero-hours culture is deeply entrenched in home care work, and it will not be easy to change it, but I believe we must. The key priorities must be to ensure: that the contract does not preclude the employee from taking other work—it is disgraceful that it ever could; that the employee has reasonable freedom to take or refuse work as they like, to have time with their own family, for example; and that an exclusive zero-hours contract is not imposed. Let us also remember, however, the point of view of the person being cared for, the most important person in the debate. They usually want continuity in care, and they are less likely to get that with zero-hours contracts, under which a different carer will be sent to them time after time.

As well as the bigger reforms that I have mentioned, there are practical steps, which may vary a bit from locality to locality, that can make home carers’ jobs a little less of a struggle, and I will talk about some that are relevant in Oxfordshire. In Oxford, we have extensive residents parking zones. Home care workers must find one of the sparse two-hour spaces or get a visitor permit from the client and stick it on their car. That is one third of their 15-minute visit gone. Otherwise, they risk a fine—which is of course levied by the same county council that pays their employer to send them on the call. A way of recognising the value of home carers’ work would be to give them a permit to park in residents parking zones when visiting clients.

Another example, which is probably even more widely relevant, is that people who work in the NHS branch of the care system get a free winter flu jab. A home care worker on the minimum wage often will not get a jab unless they spend two or three hours’ worth of their meagre pay on buying one. Recognition of the value of their work could include giving them a free jab, either on the NHS or by requiring employers to make them available. I checked the 2014-15 Public Health England flu immunisation programme guidance, to which the Minister may want to refer. It states that flu immunisation should of course be offered to health and social care staff who are in direct contact with patients and service users. It states that they should be vaccinated by their employer as part of an occupational health programme. However, that raises the question of what happens when an employer does not offer the vaccination: is it the same as when an employer does not pay the minimum wage, and nothing happens?

I think there is a growing consensus among clients and providers, councils and trade unions, about what needs to be done in the vital service area of care. First, better funding is needed for social and home care. People will not get the standard of care that they need and deserve without it. The NHS chief executive’s vision of more care being provided in the community will be a mirage unless we raise care workers’ status and terms and conditions. Secondly, we need rigorous enforcement of the minimum wage and promotion of the living wage. Thirdly, care workers should have the right not to have a zero-hours contract forced on them. Fourthly, commissioning should encourage responsible providers. Fifthly, there should be investment in training and career pathways for care workers, with proper accreditation of care work. Sixthly, there should be regulation of the social care work force. That could start with the record of those unfit to practise that the Health and Care Professions Council has advocated.

We should all recognise the enormous value of the work that home carers do, and translate that recognition into action to improve their status, pay and training, to nurture good providers who are good employers, and to drive out the rogue operators. We would do well to remember every day that our loved ones, and we ourselves, are likely to need a home carer some day. Much good work is done by front-line carers, but too many of them are treated shabbily. That must be stopped. We must make sure that carers get the status, training and pay that they deserve, so that those who need care and those who give it can enjoy better lives, with dignity and respect.

[Several hon. Members]

rose—

[John Robertson (in the Chair)]

Order. If hon. Members will be sensible, there will enough time for everyone to take part. I will not impose time limits at this point.

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[Several hon. Members]

rose—

[John Robertson (in the Chair)]

Order. If Members could keep their contribution to eight minutes, that would be very helpful.

--- Later in debate ---

[Helen Jones (Warrington North) (Lab)]

I rise to make a brief contribution to the debate. The issues have been set out admirably by my right hon. Friend the Member for Oxford East (Mr Smith) and others. I apologise in advance for the fact that I cannot stay for the wind-ups.

We are facing a scandalous situation. The people who do some of the most difficult jobs in our society are not even reaching the minimum wage because of the scams that are being perpetrated in the care sector. They are not paid for travel, they are on zero-hours contracts, and other scams are perpetrated against them. When I talk to care workers in my constituency, I see that they are decent people who just want to do a decent week’s work, and I can see what that means. They have to rush between appointments, and they feel guilty about not being able to spend time with their clients. They believe that the care they are giving is not of the quality that people should receive.

Care is not just about getting somebody washed and dressed, or giving them their breakfast; it is what it says it is. Care is about spending time with people, listening to them and talking about the problems they face. It says much about our care workers that, as well as worrying about their own wages, as they are entitled to do, they worry about the impact on their clients of what is, frankly, a rotten system.

Let us consider what really happens. If care workers are on zero-hours contracts, they are paid only for their actual appointments, and not for their travelling time. It is estimated that 220,000 people are not being paid the minimum wage. That has been allowed to happen for far too long—those 220,000 people cannot meet their bills at the end of the week, despite working full time. Does the Minister honestly understand what that means? I do, because I remember it from my earlier life. It means running out of money by the end of the week and relying on friends or family to help out. Friends and family bring things saying, “Well, I got it as a two-for-one offer,” or, “This was on sale,” but people know they were not and that their friends and family are trying to spare their feelings. Zero-hours contracts mean that it is a crisis when a child needs a new pair of shoes or grows out of their coat. That is the position that we inflict on people who do some of the most difficult jobs in our society by caring for the elderly and the disabled—the most vulnerable. I suspect that most of us in this room could never do those jobs, except for my hon. Friend the Member for Blaydon (Mr Anderson), who has actually done it.

Her Majesty’s Revenue and Customs found that nearly half of the firms it inspected in the care sector were not paying the minimum wage. Very few of those firms have even been named and shamed. How many of them have actually been prosecuted? As the Minister said, they are criminals. In what other sector of life would we say to a criminal, “We know you are doing it, and we would like you to stop. We are not actually taking you to court, and we are not prosecuting you. We know you are a burglar, but will you just give it up?” We do that with the minimum wage, which is an absolute disgrace. The Government must take responsibility. Yes, some local councils must take responsibility, too. It is true that local councils do not always monitor the contracts that they give out, do not ensure that people are paid properly and do not check workers’ wages, but that is not surprising given the situation in which they find themselves.

It is all very well for the right hon. Member for Sutton and Cheam (Paul Burstow) to tell us about the duties he imposed on local councils, but if we will the end, we have to will the means. It is a fact that the councils that face the most draconian cuts under the Government’s Local Government Finance Act 2012 are also the councils that have the highest levels of long-term disability and the biggest need for social care.

If the Government want to impose duties on local councils, they have an obligation to ensure that those councils have money available to meet those duties, otherwise councils will simply put the responsibility elsewhere and fail to meet their own. We know what happens when such systems are in place, and we know what happens when care workers cannot spend enough time with their clients: health problems go undetected, and people’s feelings of loneliness and isolation increase, driving up mental health problems. There are more falls and more admissions to hospital. There is a cost to the people concerned, and to the NHS, because a good care system cannot be run on the cheap. It requires properly trained, properly paid and properly supervised staff. The most vulnerable people in our society deserve no less. The Government have been trying to run care on the cheap, on the backs of dedicated workers who are being treated shamefully, and it is time that that stopped.

[John Robertson (in the Chair)]

I thank hon. Members for their use of time.