Care Workers

Liz Kendall Excerpts

Wednesday 5th November 2014 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. Like all hon. Members who have spoken this morning, I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing this absolutely essential debate, particularly as this is annual living wage week. As Members of Parliament we all get hundreds of e-mails and letters from people calling for us to speak up for issues. I do not get a lot of e-mails from care workers because they are frantically working, but our job is to speak up for people who do not have a voice, which is what he has enabled us to do today. People have spoken passionately about this issue.

Although I do not have the experience of my hon. Friend the Member for Blaydon (Mr Anderson), one of the first things I did after becoming an MP was to do a shift with a care worker in my constituency. My goodness, was it an eye-opener. Amanda, from New Parks, loved her job, and she desperately wanted to care for people. She said that she never thought that she would make anything of her life, and doing that job gave her a real sense of fulfilment, but she was rushed off her feet. She was trying to fill in for staff who were off sick or who had left. She said to me, “The trouble is that girls get more money at Morrisons than they do doing this, and they get their hours set, so why wouldn’t they go and do something like that?” That was the start of my understanding of just what this means to people. From the other side, I have seen constituents and members of my family receive 15-minute home visits, which are not enough to get someone up, washed, dressed and fed. It is barely enough time to have a proper conversation, which causes problems for people who are left isolated in their own home.

Many hon. Members have spoken powerfully about how home carers are undervalued, underpaid and undertrained. Undervalued because they do not even get the dignity of having a decent contract—nationally, there are more than 300,000 care workers on zero-hours contracts. Underpaid because up to 220,000 care workers do not even get the minimum wage, let alone the living wage, when they are doing some of the most vital work in looking after people whom we care for and love, and who brought us into this world. And undertrained because around a third of care workers receive no ongoing training, yet they are doing some of the most vital, intimate and personal tasks.

We are seeing low staff morale and high turnover of around 20% to 30% annually. Vulnerable people do not even know who is going to come in and help to get them out of bed or take them to the toilet. I would want to know who is coming into my bedroom to get me out of bed, yet that is not the experience of many people. It is not just that the present situation is not good for care workers; it is not good for the people who use care or for taxpayers, either.

We are seeing ever-increasing numbers of elderly people ending up going into hospital when they do not need to be there, and getting stuck there, too. Delayed discharges from hospital are at their highest ever rate, costing more than £260 million in the past 12 months. That would pay for 37,000 people to have a whole year’s worth of home care. Where on earth is the sense in that?

Like my right hon. and hon. Friends, I believe that the Government are not doing enough to tackle the problem. Many hon. Members spoke about the new guidance for local authorities to look at whether their service providers are paying their staff below the minimum wage. I do not think that that is anywhere near strong enough. “Should” needs to be “must”. If people are not paying what they are legally required to, enforcement should be much tougher. It was a profound mistake for the Government to remove the Care Quality Commission’s role in assessing the quality of council commissioning. If the CQC was able to assess whether local councils were commissioning care properly, that would be a key thing to check them on.

In July, the Public Accounts Committee, chaired by my right hon. Friend the Member for Barking (Margaret Hodge), said that it was

“astonished that...seemingly little has been done to rectify”

the scale of non-payment of the minimum wage in the care sector.

In April this year HMRC replied to a freedom of information request that I submitted. It said that half of all the care providers that it had been investigating—more than 100 employers—had been failing to pay the minimum wage in some form, and that more than £1 million was owed to workers. Imagine that. If anyone had stolen—that is what this is—£1 million, action would be taken. I am disappointed that Ministers and HMRC have not named the providers involved. Despite the Minister saying that providers should be named and shamed, that simply has not happened in the care sector. I hope the Minister will explain why not.

Several hon. Members said we need to make sure that HMRC proactively looks at the underpayment of the minimum wage and not simply wait for care workers to ring the pay and work rights helpline. Only 19 workers did so in 2012-13. We know they are not being paid, but they are busy. They are rushing round. They have lives to live. We should have much more proactive measures.

[Mr Anderson]

My hon. Friend is absolutely right. People are busy, but they are also frightened. They have no protection. Employers have complete control over their lives with zero-hours contracts. If people complain, they will not get any more work. That is the truth.

[Liz Kendall]

My hon. Friend is absolutely right. I was going to come to that point. If someone is on a zero-hours contract, they will be too terrified to tell their employer that they are not paying the minimum wage. I am not yet convinced that the Minister is working closely enough with Ministers in the Department for Business, Innovation and Skills. According to an answer to a written question from my hon. Friend the Member for Stockton North (Alex Cunningham), the Minister has had just one meeting all year with BIS to discuss underpayment of the national minimum wage in the care sector. That is not good enough. We need more action.

Several of my right hon. and hon. Friends rightly said that £3.5 billion has been cut from local council adult social care budgets. Within that context, the pressures are building.

[Paul Burstow]

The hon. Lady and her Front-Bench colleagues want to convey the impression that in seven months’ time they will be in government and therefore making decisions about the allocation of resources for adult social care. Will she share her thinking?

[Liz Kendall]

I will, and I will come on to the extra money that we have committed to putting into health and social care. We are committed to a £2.5 billion transformation fund that will cover both the NHS and social care, and that includes money to pay for 5,000 home care workers. So we have said what we will do in addition to the ring-fenced money to try to kick-start the services in the community that patients and taxpayers need.

We have put care issues and exploitation in the care sector at the heart of our agenda. Baroness Denise Kingsmill conducted an excellent review for us on exploitation in the care sector. I encourage all Members to read it if they have not had a chance to do so already. She has set out tough, credible and realistic proposals, including on how to properly enforce the minimum wage, ban exploitative zero-hours contracts and end inappropriate 15-minute visits. She has called for better training for care workers and also for managers of care providers—that is essential—as well as support for ethical care charters such as that which Unison has promoted.

I want to say a little about what I saw yesterday, which was an inspiring example of a Labour council in Islington putting ethical care into practice. Yesterday I helped to launch and celebrate its new home care service contracts. Those will ensure that all home care staff are paid the London living wage—£8.80 an hour now, rising to £9.15 in January—including for travel time. Exploitative zero-hours contracts have been banned, and people are guaranteed a minimum of 16 hours a week.

The council is also giving far more say to the users of services so that they can decide how and when their hours of care will be provided, and, unless they specifically request a 15-minute visit, such visits will be ended, too. The changes to the contracts will benefit more than 500 home care workers, 9 out of 10 of whom are women. I met one yesterday, called Mary. When I talked to her about the difference the changes will make, she said, “It might not sound a lot for some people, but it means I can pay for my kids’ school lunches and make sure they have a decent hot meal in the evenings.” The changes will also benefit the 900 people whom the home care workers care for.

A Labour Government will back the actions of councils such as the Labour council in Islington. We will increase the fines for non-payment of the minimum wage to £50,000. We will champion the payment of the living wage through “make work pay” contracts, which give a tax break of up to £1,000 per worker to every company that signs up to the living wage. We will end the exploitative use of zero-hours contracts, too. As part of our £2.5 billion transformation fund, we will provide extra funding to support changes in the community and the services provided there, including 5,000 more home care workers.

I will end on a point that Islington council made. The changes cost the council more, but we have to think about the cost of not doing it: the cost to the NHS of avoidable emergency admissions and delayed discharges, and the cost to the taxpayer of people having to have their pay topped up when they want to be earning a decent living wage. There is a different way. Islington has shown the way. We will back its efforts and make sure we have a decent care system for those who work in it, those who use it, and all the families that rely on it.

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this debate on an incredibly important subject. I agree with him and the hon. Member for Strangford (Jim Shannon) that there are many great providers of care out there and vast numbers of extraordinarily dedicated care workers. Like the shadow Minister, I went out with a domiciliary care worker in London a while ago. He was from Sardinia, which makes the point that very large numbers of people from other countries, primarily from across the European continent, work in our care system. Without them and the dedicated work of care workers, the system would not survive. We should remember that in our debates about the movement of workers around Europe. Our health and care system depends on those dedicated workers, and the man I saw from Sardinia was a very impressive and dedicated man. He was earning a low income and not being paid for travel time between the stops in his working day, which I totally agree is completely unacceptable and a disgrace. I will come back to that issue a little later.

It is also important that we celebrate great care. I went to the first ever awards ceremony in my county of Norfolk that celebrates examples of fantastic care, and to see care workers who hitherto have never been recognised for the amazing work that they do was inspiring. Every part of the country should have similar exercises to acknowledge and celebrate great care.

Secondly, I wanted to comment on the point made by the right hon. Member for Oxford East that sometimes—indeed, quite often—the only companionship that people receive is from the paid care worker who visits their home once or twice a day. Does that not say that there is something profoundly wrong about our society, and if so, do we not all have to recognise that that must change? I have said this before, but we have inadvertently become a rather neglectful society. As our extended families have been dispersed far and wide, often older people are left rather stranded, living on their own, sometimes many miles—often, indeed, hundreds of miles—away from their loved ones. It is not a good society in which the only people seen by those older people are those who are paid to deliver care to them. The wider community and neighbours need to play a part in addressing this massive challenge that we face, whoever is in Government. There is absolutely a role for the total professionalism of paid staff, but the wider community must play its role, too.

There are amazing schemes such as the Cornwall pioneer project, in which volunteers work alongside GPs to combat people’s loneliness. There is also a brilliant community organisation called Friends and Neighbours in Sandwell, in the west midlands. That is a network in the poorest community in the west midlands, and yet volunteers give of themselves, and give companionship to people to give them their lives back. Those volunteers play a part in meeting this massive challenge we face.

Thirdly, part of the answer is for care workers to be far more embedded in joined-up and integrated teams of health and care workers. The work in Islington that the shadow Minister referred to is another of the brilliant and inspiring integrated care pioneer projects that join up health and care services and enable care workers to work alongside nurses, so that they recognise that they can possibly go on to become a nurse or a health care worker. Such projects give care workers a status and professionalism that they deserve, which can play an incredibly important part in this process.

Fourthly, I commend to right hon. and hon. Members an example from my county. The GP practice in the village of North Elmham, in the middle of Norfolk, has set up a social enterprise that provides domiciliary care to a widely dispersed rural area. As it is a social enterprise, it is able to pay its staff better. When staff stay and demonstrate reliability, they receive more pay. The consequence is that people know who their care worker is, there is continuity of care, and there is not, as the shadow Minister suggested is too often the case, a situation in which someone different turns up each night. I had a case—indeed, it involved Care UK—of an elderly lady finding a different man turning up each night to shower her, which was an assault on her dignity. The concept of locally based social enterprises, tied in closely to GP practices, seems to be an attractive way forward.

Fifthly, there is the issue of pay. To start with, I will say that Unison is right to campaign on pay; I support it in doing so, and I am very happy to work alongside it. The right hon. Member for Oxford East and others made the point that it appears that 220,000 people in the care sector are being paid below the minimum wage. That situation is completely unacceptable, and I hope that all of us in Westminster Hall today acknowledge that we find that practice to be totally unacceptable.

However, it was this Government who decided that Her Majesty’s Revenue and Customs should carry out a dedicated push in this sector to root out employers who are breaking the law in that respect. Indeed, I can confirm to the shadow Minister that I have specifically asked for a further dedicated focus on the care sector, because it is absolutely needed.

[Liz Kendall]

I am glad that that work is continuing. However, the Minister has said several times in the newspapers that care companies that do not pay the minimum wage should be named and shamed, and yet that has not happened. Why not?

[Norman Lamb]

I am grateful to the shadow Minister for raising that issue. When I was a Minister in the Department for Business, Innovation and Skills, I specifically pushed for a change in the rules to make it easier to name and shame poor employers. That process was not completed by the time I left BIS to go into the Department of Health, but I continue to push for it. Indeed, the rules were changed, so that whenever there is a notice of underpayment of the minimum wage, the employer is named.

There is a complication in the care sector, in that arrangements are often quite complex and reaching a final decision often requires an investigation to be carried out. However, I can assure right hon. and hon. Members that I anticipate the naming of poor companies within this sector in the relevantly near future. I totally support that process; there should be no hiding places for employers who break the law in that way.