Home Care Workers

Lilian Greenwood Excerpts

Wednesday 6th March 2013 Westminster Hall

[Mr Smith]

Absolutely, and I am coming to that point. I could not get myself completely ready in the limited time that some care workers have; some are allocated 15-minute slots for visits.

When things go wrong, it is vital that staff speak out, yet too often care workers feel vulnerable and not in a position to do so. I note that last month, the Secretary of State for Health said that he was “very sympathetic” to extending to home care workers the duty to whistleblow that the Government are thinking of applying to nurses. I urge the Minister to do so.

It is crucial that inspection is extensive, robust and effective. It is all the more so given the importance of care and the fact that it takes place in people’s homes, away from immediate supervision. There are concerns about that in Oxfordshire right now. Our local paper, the Oxford Mail—I am sure you will remember it well, Mr Turner, from your time in Oxford—has highlighted concerns raised by our local patient voice and county councillors about the adequacy of local CQC inspection arrangements. In November, there were just two inspectors for Oxfordshire, and even now there are only five, who between them are responsible for inspecting 447 health and social care institutions and thousands of home care visits.

There is all-party concern. Conservative councillor Jim Couchman, who chairs the county’s adult services scrutiny committee as well as being a member of the health overview and scrutiny committee, said after meeting the CQC:

“We did get pretty worried by what we saw as an extremely ill-equipped organisation to deal with the responsibility accrued to it…The CQC is not a proper inspection team in any way, shape or form.”

Councillor Couchman has also told me since that apart from the enormity of the task required of such a small staff, the most surprising fact was that recruits did not need any experience or knowledge of the NHS, health care or social services. The CQC seemed more concerned about whether new staff had a background in regulation.

I was also concerned that when asked to talk to the Oxford Mail, the Care Quality Commission declined. When such worries are being voiced, it is all the more important for a body such as the CQC to come forward and answer questions as a basic responsibility of public accountability, as well as to take the chance to build public confidence rather than undermining it, as the CQC ended up doing. Will the Minister look into the position on care quality inspection in Oxfordshire? More generally, will he ensure that the commission has sufficient inspectors across the country with the right experience to do the job?

Feedback from users and their families is another important yardstick by which to lever up care standards. Our county council uses individual visits and client satisfaction surveys to inform contract monitoring. However, a wider public satisfaction rating is needed for the plethora of care agencies. One of the paradoxes of modern life is that, if advice is wanted on the standards of service providers such as restaurants, hotels and garages, or of products such as cars and electrical goods, there is no end of reviews out there to guide people, but for something as important as helping someone to find a good care provider, there seems to be nowhere to look for advice. In theory there is competition for provision, but in reality all the customers are groping around in the dark. That is a good reason not to emulate in mainstream NHS provision the privatisation that has already happened in care services.

Underpinning all that, action is desperately needed on the terms and conditions of care workers. They are doing a demanding job, often on the lowest wages and with minimal security. According to the Unison “Time to care” survey, more than half of home care workers overall and more than 80% in the private sector are not paid for travel time or costs; it has been estimated that between 150,000 and 200,000 home care workers are in effect paid less than the national minimum wage as a result. To make matters worse, more than half of private sector home care workers have a zero-hours contract with no guaranteed pay, and more than half of all home care workers reported that in the past year things have got worse for them on pay, working time and the duties expected of them.

[Lilian Greenwood (Nottingham South) (Lab)]

I thank my right hon. Friend for setting out clearly some of the home care issues. Does he agree that zero-hours contracts in particular make it difficult to ensure continuity of care for clients and difficult for a provider to invest in its staff, because they are constantly having to look for alternative work to make up the hours to obtain a decent income to support themselves and their families?

[Mr Smith]

My hon. Friend makes an excellent point, and must be reading my mind, because my next sentence was that zero-hours contracts present real problems for continuity of care, which was the point she made. It is important that vulnerable clients in particular have carers whom they know, trust and have built up a relationship with.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. It is a pleasure to follow all the speakers, who fully and excellently set out the case for care workers.

When I read the “Time to Care” report, I had an enormous feeling of déjà vu. Before becoming a Member of Parliament, I worked for Unison as a full-time officer. Back in the 1990s, one of my first jobs as a young officer was supporting the Derbyshire county council home helps joint consultative committee. “Home helps” was the name given to home care workers in Derbyshire, of whom there were thousands. The joint consultative committee used to bring together representatives of home care workers from across the county with senior management of social services, including the director of social services, who so understood the important role of home care that he was always prepared to attend meetings to listen to the views of home care representatives. It was an opportunity for them to raise their concerns and the issues that their members faced.

The 1990s was a period of huge change for such workers. The role of home helps was changing immensely: they moved from providing a service that was basically helping older people with cleaning, shopping, meals and even, back then, laying fires, to providing much more intimate personal care and dealing with people with increasingly complex needs. It was also a period of budget cuts, which accounts for the feeling of déjà vu. There was pressure to change services, to make them efficient, obviously, but also to open them to the private market.

I vividly remember Derbyshire home helps raising concerns about a proposed move to a time-recording system. When they arrived at a service user’s house, the first thing they had to do was telephone to tell social services where they were, so that there was much more detailed information on the amount of time they spent with each service user. A concern they raised at the time was that doing so would change their focus, so that rather than their prime focus being on the needs of the service user, their top priority when they arrived was to record their time so that social services could properly cost the service.

I also remember home helps raising concerns about short calls that did not allow them time to care, to listen to what services users wanted or to respond to their priorities.

[Andrew George]

The hon. Lady makes an excellent point about recording arrival and departure times. Often the system simply fails, not only in rural areas, where mobile coverage is poor, but when using the cared for person’s telephone. Carers often cannot get through and calling becomes a greater obsession than providing the care itself.

[Lilian Greenwood]

The hon. Gentleman is absolutely right. I remember well the representative from the High Peak area constantly making that exact point, which was that there was poor mobile phone coverage. They talked about how much of their time would be spent dealing with the telephone instead of focusing on the person who required their assistance. There were also worries about travel time.

I particularly remember the concerns of people who worked alongside private sector care providers where, they reported, staff training was often inadequate and there was often a high turnover of staff. They also reported that the care providers frequently did not provide personal protective equipment; they talked about the lack of rubber gloves and the like. We often had discussions about which tasks home helps were given time to carry out. They often pointed out that their service users wanted and needed things that might not be what the carers were commissioned to provide.

Unison’s “Time to Care” report and the Care Quality Commission’s “Not Just a Number” inspection programme made me wonder whether we should have listened more closely to the concerns and issues raised by those Derbyshire home helps 20 years ago, particularly when, in describing the current context, the CQC talked about the

“increasing pressure on social care budgets and the rise in the number of people with complex care needs and dementia.”

In describing its key findings—as my right hon. Friend the Member for Oxford East said, a quarter of services fell below the standards expected—the CQC said:

“What is concerning is that our findings come as no surprise to people, their families and carers, care workers and providers themselves.”

The findings really do not come as a surprise, because they are exactly the issues that have been raised over many years.

The CQC highlighted several problems, including service users

“not being kept informed about late arrivals, different care workers from one visit to another, not having their preferences clearly documented, a lack of support for care staff to carry out their work, and failure to address the ongoing issues around travel time.”

Those are responsibilities of not just this Government but the previous Government, but the pressure on social services that are commissioning care services is even greater now, and we need to look again at what is required.

There is great similarity between the findings of the CQC and Unison’s “Time to Care” report. Although the care and welfare of service users is the most important focus, the CQC found that staff felt

“unsupported by their management teams and not…able to deliver care in the right way because they are too rushed, with no travel time and unscheduled visits added to their day.”

It also reported a lack of planning and supervision for staff. Training needs were not identified, staff were not confident in using their equipment, and inductions were not always completed following recognised standards.

As the hon. Member for St Ives (Andrew George) said, the voices of care workers are often not heard in debates such as this one. We ought to address that today. I was pleased to see that Unison’s report included many quotes from individual home care workers. It provided an opportunity for them to have a say and to talk about their experiences. My hon. Friend the Member for Wirral South (Alison McGovern) has already quoted one of the home care workers who contributed to the report, saying they did not have time to spend with their service users and they had to rush between calls.

One of the most important issues is about older people. I imagine that many hon. Members have this experience when they are out canvassing in their communities: they knock on the door of an older person, and perhaps the Member is the only person they have spoken to that day. Their priority is to talk to someone who is willing to listen. That was well recognised by one of the care workers who contributed to the report, who said that

“care is not just about duties but communication and many providers do not allow for this…How can half an hour be enough to get someone up, dressed, meds given and have a chat? People are being failed by a system which does not recognise importance of person-centred care.”

There are many quotes in the “Time to Care” report, which I am sure the Minister has read. I hope that he listens to the voices of home care workers and the issues that they raise.

It is vital that, like the director of social services in Derbyshire back in the 1990s, we listen to the voice of home care workers, because they meet service users every day. Most of them are incredibly committed to providing a good-quality service and ensuring that people receive the support that they need. It is also vital that we do not simply listen to them, but act. Will the Minister meet home care workers and their representatives to discuss the findings of Unison’s “Time to Care” and the CQC report? Will he set out today how he intends to respond to the findings of those reports?

--- Later in debate ---

[Norman Lamb]

I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.

I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.

When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.

[Lilian Greenwood]

rose—

[Norman Lamb]

I am conscious that time is tight and I want to address the remaining points.

The hon. Member for Erith and Thamesmead (Teresa Pearce), who is no longer in her seat, raised concerns about potentially bogus arrangements in her constituency in Bexley. I think that she is writing to me on that matter, and I will be happy to look into it.

Care providers are also responsible for ensuring that their services meet the requirements in regulations and essential standards. The regulator, the Care Quality Commission, has powers that it can use to make sure that that happens. The CQC has our full support to use those powers as it sees fit to drive improvements in services. It is worth taking a moment to talk about the CQC report, which we have been discussing this morning. Between April and July 2012, the CQC inspected 250 registered home care providers as part of a themed programme to highlight respecting and involving people who use services and safeguarding them from abuse and neglect. To ensure that everything was examined thoroughly, it involved the people who use the services as well as the people who provide them. It looked at how staff are supported and how standards are maintained. Overall, the CQC found that 74% of the services that it inspected met the standards, and about a quarter did not. That is unacceptable and we must all focus our attention on those services.

The right hon. Gentleman referred to concerns about CQC’s capabilities in Oxfordshire, and I am aware of local media attention on that. My officials have raised those concerns with CQC and they were assured that it is on track to achieve its goal of inspecting 100% of adult social care locations across Oxfordshire by 31 March, that its Oxfordshire compliance team now consists of 10 full-time inspectors and that, after a period of recruitment, CQC has had no vacancies in the area since last December. If concerns continue, I urge the right hon. Gentleman to contact me and I will be happy to look into them further.

The importance of commissioning must be stressed. Commissioning over short periods of time—that race to the bottom—is unacceptable. We must commission on the basis of quality, as the hon. Member for Leicester West said. Finally, let me thank the right hon. Gentleman for securing such an important subject for debate.