Covid-19: Social Care

Debate between Liz Kendall and Derek Twigg

Thursday 22nd April 2021 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Twigg, and very nice to see so many people present in person. One of the things that we have all missed during this pandemic is human interaction, possibly even in Parliament.

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing this debate and on her brilliant speech, every word of which I agree with. I thank her and the right hon. Member for Ashford (Damian Green) for their work on the APPG. Every week, I have read the readout of their discussion, even if I have not been able to attend, and that real-time information has been hugely important. I also pay tribute to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who was the shadow Minister for Social Care before me and from whom I have learnt a great deal over many years.

I will say something about the impact of the pandemic on the users of services, staff, families and the wider community, who have not been touched on so far. I will also talk about the underlying reasons why we have failed to prioritise and secure longer-term reforms to social care. We cannot deal with a problem unless we understand why it is there; that is how we get progress.

As other hon. Members have said, the emerging tragedy in social care over the course of this pandemic will be etched on all our brains for the rest of our lives. To see 41,500 care home residents dying from covid-19, including those residents who ended up dying in hospital, has been brutal for every single one of those people, their families and all the staff who have gone through unimaginable horror caring for people at this difficult time.

The sad reality is that the proportion of care home residents who have died in England is higher than in almost any other country that we have data for, especially in Europe, where it is surpassed only by the proportion who died in care homes in Slovenia, Belgium and, unfortunately, Scotland—despite what the hon. Member for Linlithgow and East Falkirk (Martyn Day) said. Scotland has had one of the highest rates of care home resident deaths. That is a serious problem. I will come on to why, whatever Ministers said, I think that a protective ring of steel was not put around care homes. That is related to the deep-seated problems and our fundamental challenges. We must ensure that it never happens again.

People living with dementia have been particularly badly hit by the pandemic. A third of all covid-19 deaths have been of people living with dementia. Also, the deaths of people with dementia even where covid-19 has not been present have been significantly higher. I will say something about this later, but I think the fact that so many people in care homes have been prevented from seeing their loved ones means that those with dementia have gone downhill fast. When people lose their memory, which is what dementia is, their family is their memory. No matter how hard care home staff try, family are the ones who know what films people liked or what music they liked to play, and without their absolute involvement and interaction, we have seen many care home residents with dementia go downhill fast.

I also want to touch on a point made continually by my hon. Friend the Member for Worsley and Eccles South: the impact of covid-19 on people with learning disabilities. They are six times more likely to die than the general population and, horrifically, for those aged 18 to 34, they are 30 times more likely to die. To be honest, however, that should come as no surprise to us, because we know that people with learning disabilities have far worse health outcomes and are more likely to die early because of their lack of proper access to care.

Everybody has rightly paid tribute to the amazing work of care staff, who have given more than almost anybody during this pandemic. Tragically, they were twice as likely as the general population to die from covid-19 during the first wave. That presents two really big issues.

There was an appalling lack of access to PPE, especially in the first wave. I met frontline care workers who told terrible stories of having only one mask to last the whole day, from client to client, when seeing clients with dementia, who cannot help but spit on to the mask when they are talking, so the care worker thinks, “I haven’t got another mask to see my next client.” A survey by GMB found that 85% of frontline care workers said that they were worried about the risks to their own health and that of their families, and that one in five thought about quitting cause of the lack of PPE.

That has been compounded by the low pay and poor terms and conditions of frontline care workers. We have heard time and again that many workers who needed to self-isolate or shield were forced to take unpaid leave or rely on statutory sick pay, leaving them desperately out of pocket, unable to pay their bills and facing an awful choice between going to work or being unable to put food on the table. A Unison survey found that those are absolutely essential issues that must be addressed. One care worker said:

“I was Covid-positive after contracting it at work and was off for three weeks. I have a mortgage to pay and bills, and I don’t know how I’m expected to survive. I put my life on the line, survived and was repaid with SSP.”

Three quarters of frontline care workers do not make the real living wage. Many do not even make the minimum wage at the end of the week because they are not paid for travel time between clients. We cannot deliver a better system of social care without transforming the pay, terms, training and conditions of the care workforce.

On families, there are two issues. One is unpaid family carers, who have done so much more to care for their elderly or disabled loved ones during this pandemic. There were 9 million of them in the UK, but since the pandemic struck, there have been an extra 4.5 million—it is astonishing that we have not heard more about that during the debate. They are providing even more care than usual, without breaks, and their own physical and mental health has suffered as a result. Families are as important as the paid workforce in delivering care in this country. We need a new deal—a partnership between families and the Government—to support those carers in doing their best to look after their loved ones.

We then have the families who have been banned from seeing their loved ones in care homes, and who are now also unable even to take their loved ones out for a walk or a cup of tea, because they would have to self-isolate for 14 days. We have to completely rethink that. Since June, we have been arguing that families should be treated as key workers and have access to all the testing, PPE, vaccinations and so on, so that they can safely visit their loved ones. That is not just a term or a gimmick, however; they actually are key workers. We cannot have good-quality care for older or disabled people without families’ involvement.

I urge the Minister, as I have done many times when discussing this topic, to have a rethink about this. The guidance still is not working—it is wrong on the 14-day self-isolation—and we may have to look at legislation to enshrine the rights of care home residents. They are not prisoners. Quite frankly, if we all think that, when we end up in a care home, we will be banned from seeing our family and will not be allowed out, what kind of future is that? It will be a future that we fear, rather than a future for which we look forward to getting older, and that must change.

On the wider community, one of the positive things from the pandemic—I am very proud of what has happened in Leicester, the city that I represent—is how many voluntary groups and mutual aid groups have sprung up to try to do things such as helping older people with shopping, delivering it quicker than either the local authority or the private sector ever could. That support for the wider community—ringing older people to help them if they are isolated—has got to be part of our future social care system, too.

Let me move on to why we have seen the problems that we are all relating here. The immediate and glaring issue, as the Alzheimer’s Society has said, of why we have seen such problems in the care sector, is that the pandemic struck at a time when social care was already overstretched and undervalued. Local authority care budgets have been cut by £8 billion in real terms since 2010 and that has pushed many to absolute breaking point. It is not morally right, but it does not make economic sense either, because if staff are not paid properly and there is high turnover and vacancy rates and family carers are not supported and their health suffers and they end up in hospital, that costs us all far more.

It is also the failure to put in place long-term reforms, as the right hon. Member for Ashford (Damian Green) said. Why is that the case? It is a big challenge, but it is not rocket science, to ask for older and disabled people to live as normal a life and as full and fulfilling a life as possible, with help to get up, washed, dressed and fed, maybe go to the shops, with help for a disabled person to live independently and maybe have a job. It is not that complicated, yet we have ended up in this crisis. Why?

First, when the NHS and the wider welfare state was created, average life expectancy was 63. Now, it is 80. We did not live in a world where people lived for so many years, and so we have been scrabbling to catch up ever since, with a fragmented and piecemeal system. Secondly, in many ways we have left it to families—“This is a family issue; families should look after elderly or disabled relatives.” Yes, and they want to. They want to do all they can, but they need help and support, especially in a world where women work; they want to work and balance their family lives. Thirdly, it is about caring and caring is women’s work—undervalued, underpaid and yet some of the most important work in our society.

What that all adds up to is a failure to understand that a third of our lives will now be lived aged over 65. We have got to transform society—not just the care sector, but housing, transport and planning—because getting older should be something that we look forward to with hope and optimism, not fear. It is my lovely mum’s birthday today. She is so worried about the pandemic, but I am afraid, when I was discussing this debate, she said, “You know what, Liz? You know what we feel? At best, ignorable; at worst, expendable.” That is not a country that any of us want to live in.

The legacy of this pandemic must be to transform services and support so that every older and disabled person can live the life they choose. It is politically controversial and my strong advice to the Government would be to bring forward proposals early on, because the closer we get to an election, the worse it will be. The Labour party was accused of a death tax; the Conservatives have been accused of a dementia tax. In the end, it is not us who suffer. It is the people who use services and their families.

We need a long-term settlement for older and disabled people that pools our resources and shares our risks and has a fair balance of funding across the generations. That is surely within our grasp. I know Opposition Members will continue to do everything they can to secure a better future for all.

[Derek Twigg (in the Chair)]

I remind the Minister to leave a few minutes at the end for Helen Hayes to wind up.