Diabetes-related Complications

Liz McInnes Excerpts

Tuesday 7th June 2016 Westminster Hall

[John Howell (Henley) (Con)]

I thank the hon. Lady very much for the speech she is making and for securing the debate. I want to take her up on the point she has just made. There is a belief that diabetes is not curable; actually, diabetes is curable. It is curable by the individual going through a process of losing fat around the liver, which takes away the—

[Liz McInnes (Heywood and Middleton) (Lab)]

indicated dissent.

[John Howell]

The hon. Lady is shaking her head. I am a living example of someone who has cured diabetes. I wonder whether more patient-centred education would be a big help to the NHS.

--- Later in debate ---

[Liz McInnes]

I wish to make the point that the hon. Member for Henley (John Howell) is talking about type 2 diabetes, which can be cured by weight loss. Type 1 diabetes, which is insulin-dependent, cannot.

[John Howell]

I did mean type 2 diabetes.

--- Later in debate ---

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to my hon. Friend the Member for Dewsbury (Paula Sherriff) for securing this important debate. We both have a background of working in healthcare and we share an interest in health issues, particularly when it comes to health inequalities and postcode lotteries of healthcare provision.

As my hon. Friend said, we recently visited the excellent diabetic foot clinic at King’s College hospital. I will be honest: when I received the invitation, it was only my interest in diabetes that led to my accepting it. I did not expect to come away from a diabetic foot clinic feeling inspired, but inspired I most certainly was. I spoke to the doctors, nurses, healthcare assistants, researchers and, most importantly, the patients. I heard from patients whose limbs had been saved from amputation by the amazingly skilled, dedicated and knowledgeable staff—patients who had arrived at the foot clinic clutching letters from their doctors that stated, “There is no alternative other than to amputate this limb.” Those patients were lucky because they had talked to people such as diabetes specialist nurses, who had suggested that they consult the diabetic foot clinic to get a second opinion.

We spoke to a farmer from Kent who had been kicked by one of his cows. He had a wound on his foot that would not heal and he had been advised by the hospital that a below-knee amputation was the only solution. The farmer talked to us about his family farm, about how he would have been unable to carry on working had the amputation gone ahead and about how grateful he was for his referral to the foot clinic. The staff there had been able to treat the wound and it was well on the way to recovery by the time we saw it. They had saved his limb and consequently his business and his family’s livelihood, with all the concomitant savings to the NHS. So many of the people we spoke to told us stories like that; he was just one of them.

I was absolutely blown away by the incredible work done by that clinic, but, as has been pointed out, the care provided there is not universal and there are currently no national drivers to lower amputation rates across the country. It has already been stated that four out of five of these amputations are avoidable. I particularly liked the comment by the hon. Member for St Ives (Derek Thomas) that we should aim to get to a point at which amputation is seen as a failure rather than as a form of treatment.

My hon. Friend the Member for Dewsbury has quoted quite a lot of my speech. [Laughter.] So I will be brief. She referred to this, but it deserves repetition. In 2013, the Health Secretary committed to reducing the rate of diabetes-related amputations by 50% over five years. The amputation rate has in fact remained steady. Little progress appears to have been made towards the commitment. I do not think it does any harm to repeat that point and to hope for a response.

[Mr Jamie Reed]

My hon. Friend is making an excellent point. Does she agree that there is a regional dimension? There is a GP shortfall of 40% across the north of England. If the gateway treatment for type 1 and type 2 diabetes is through primary care and accessibility is limited in certain parts of this country, clearly, we will get much worse outcomes.

[Liz McInnes]

I thank my hon. Friend for that intervention. He is absolutely right. In my own constituency of Heywood and Middleton, I have also come across the problem of people being unable to get access to GPs. I am a member of the all-party group on diabetes and we have come across the problem time and again.

Patients have told the APPG that, when they first went to see the GP with the full-blown symptoms of diabetes, the GP took weeks to diagnose them. We have a real problem with GPs’ awareness of the condition of diabetes, even though it is common. Perhaps it is just the patients who come to our APPGs, but they all seem to come with the same tale, so perhaps there is a job of work to be done to standardise GPs’ education on diabetes.

We have touched on the subject of variations in care around the country. Because of the regional variations, far too many people are experiencing short and long-term complications, which can have a huge impact on their and their family’s quality of life. It is also very costly to the NHS.

I want to talk about a major clinical audit that is going on at the moment, the national diabetes audit, which measures the effectiveness of diabetes healthcare against NICE clinical guidelines and NICE quality standards in England and Wales. That audit provides an overview of the quality of diabetes care at national, clinical commissioning group, acute trust and GP practice levels. Through the collection of the data, the national diabetes audit can produce reports for a range of stakeholders to drive changes and improve the quality of services and health outcomes for people with diabetes.

Again, we see regional variations in participation in the national diabetes audit. The latest NDA report produced in January this year showed that participation in the audit had dropped to 57%; it is thought that that can be attributed to a change from an opt-out to an opt-in system for GP practices, plus variations in the ease of use of the three different IT systems used by GP practices. I am very disappointed to say that, in my constituency, which is covered by the Heywood, Middleton and Rochdale CCG, not one GP practice is participating in the national diabetes audit. It is really important that participation be improved; better data help CCGs to more effectively set priorities and evaluate improvements. If we are not collecting the data, there is no way we can plan for improving the outcomes for people with diabetes. NHS England should make participation in the national diabetes audit mandatory as an important step towards improving diabetes care.

Several Members have already talked about the importance of education. An important aspect of avoidance and prevention of complications of diabetes lies in educating diabetics to help them to better understand and therefore manage their condition. With 69% of diabetics saying they do not fully understand their condition, there is clearly a need for education to be made available and accessible.

As has already been pointed out, more than a third of CCGs do not currently commission specific courses for people with type 1 and type 2 diabetes, despite national guidance. In my own constituency, only about 20% of people with diabetes are offered a course, and the take-up is alarmingly low, at around 6% to 7%. One reason that people give for not taking up the offer of a course is that their employer will not give them time off to attend. There is a real job of work to be done to persuade employers that supporting their employees to attend the courses will have all-round benefits for the employer and the employee in terms of reduced sickness absence and a healthier and more productive employee.

I know that the Minister shares my interest in promoting diabetes education, which is key to preventing the major complications of diabetes. I am interested to hear her views and whether she has any plans to improve access to education.

Junior Doctors Contract

Liz McInnes Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

It is a great tragedy that the dispute unfolded in the way that it did, and I am sure that people with different agendas have not played constructive roles at various points. Given that we now have an agreement, I want to move forward positively and say that the lesson of the last 10 days is that when people sit down and negotiate about all the outstanding issues with a Government who are trying to make care safer and better for patients, we get a result that is good for everyone.

[Liz McInnes (Heywood and Middleton) (Lab)]

It is not the time to claim victory: this negotiated agreement now has to be put to the members of the British Medical Association. Will the Secretary of State acknowledge that his own refusal to negotiate exacerbated this crisis? Will he cease referring to the British Medical Association as a militant trade union, and will he heed the call from my hon. Friend the shadow Secretary of State for a period of silence in order to avoid antagonising the junior doctors still further?

[Mr Hunt]

Let us be absolutely clear: there was never a refusal to negotiate on the Government’s side. We have now developed a lot of trust between the Government and the BMA leadership, but until that point it balloted for industrial action without even sitting down and talking to the Government, and it refused to discuss the issue of weekend pay premiums, which was the crucial change we needed for a seven-day NHS. It was when the BMA changed its position in those areas that we were able to have constructive talks, and that is why it deserves great credit for coming to the table and negotiating—something it had not wanted to do previously—and that led to the solution.

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 10th May 2016 Commons Chamber

[Alistair Burt]

I am aware of significant problems in Cornwall that a number of Members have brought to me, and they are very complex. The clinical commissioning group is building on existing work with NHS England to address the financial challenges facing NHS Kernow and the wider local health and care system. Statutory directions were put in place late last year to support the CCG’s work with local partners in ensuring that services are affordable as well as good. An independently led capability and capacity review is being completed and an action plan is being implemented. I encourage the CCG to continue to work closely with NHS England to help to put its finances on a firmer foundation to achieve its integration plans. There is a further meeting planned locally tomorrow.

[Liz McInnes (Heywood and Middleton) (Lab)]

We recently had a Westminster Hall debate on care workers not even being paid the national minimum wage, and now we have private social care providers saying that they will not be able to afford the new national living wage. How does the Department intend to address this impending crisis?

[Alistair Burt]

It is absolutely essential that workers are paid the national minimum wage, and for care workers that includes travel. The Department has been very clear in that regard. Extra money is being provided to local authorities to pay for social care, as we know, but matters are tight—I am well aware of that. We are looking to providers and local authority providers to meet their statutory obligations to ensure that hard-pressed care workers have the financial support they need to do their vital job.

NHS Bursaries

Liz McInnes Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for that intervention. It brings me neatly on to my next point, which is that the great virtue of these reforms to student finance is that we will be able to increase student finance support—maintenance support—by 25%.

The hon. Member for Lewisham East made some clear and sensible points. She suggested that training as a student nurse was different from being a history undergraduate, because student nurses have less time to take on a second job. There is therefore even more reason to provide better maintenance support for them. However, she has not come to tell the House that she will provide 25% additional maintenance support for students who do not have time to do a second job. She has not made that commitment, yet she has criticised our efforts to increase maintenance support by 25% precisely to help those people who would not otherwise be able to take time out to take on a university course. She cannot have it both ways. She cannot criticise us for the reforms we are undertaking while at the same time saying that students need greater support. It is precisely through these reforms that we are producing the support that so many students require.

[Liz McInnes (Heywood and Middleton) (Lab)]

The Minister talks about maintenance support, but can he clarify that that support will no longer be in the form of a grant, and will now be in the form of a loan? Does he acknowledge that that will land students in even more debt when they finally qualify?

[Ben Gummer]

By reforming the system so that this becomes a loan rather than a grant, we are able to produce 25% extra support for these students while they are training, much as with the rest of the student population.

The results relating to newly qualified nurses are not as the hon. Member for Lewisham East suggests. She should be very clear in the way she addresses this question, because all of us, whatever our views on this subject, have a duty to inform the public properly. It would be remiss of all of us, even those who disagree with the policy as she does, to mislead potential students into thinking that they will have to pay more than they would otherwise. She said that students would have to pay hundreds of pounds more in repayments once they had qualified. That is just not the case. We anticipate that a newly qualified nurse will pay roughly £90 a year more; that will be about the same as they are currently paying, because of the way in which student payment finance is gradated. The impact on newly qualified nurses will therefore not be anywhere near the impact that she has suggested. She should be very careful about how she addresses her points; otherwise, people could receive an impression about these loans that is not actually a fact.

World Autism Awareness Week

Liz McInnes Excerpts

Thursday 28th April 2016 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to be the final Back-Bench speaker in this fantastic debate. I have been here for the whole of it, and I particularly thank my hon. Friends the Members for Birmingham, Yardley (Jess Phillips) and for Stalybridge and Hyde (Jonathan Reynolds) for their amazingly personal speeches, which brought home to everybody what it is like being the parent of an autistic child. It would be remiss of me not to thank also the right hon. Member for Chesham and Amersham (Mrs Gillan) for securing the debate and for all her brilliant work. [Interruption.] She is indicating she wants me to get on, so I will.

I could not help but compare the incidence of autism to that of dementia. The figures are very similar: an estimated 800,000 people live with dementia in the UK, compared to an estimated 700,000 on the autistic spectrum. While I would not wish to play one off against the other, it is significant that the Government spend on autism awareness is £325,000, whereas the spend on dementia awareness, at £2.3 million, is significantly more—although campaigners would probably say it is not enough. I pay tribute to the National Autistic Society, which has done fantastic work to raise awareness of autism, and, like many hon. Members, I welcome the “Too Much Information” campaign.

Many Members have mentioned waiting times for diagnosis, which is a really important part of dealing with autism as it helps people to take control of their lives and to unlock barriers to essential support and services, and it enables families to better understand their child and to explain to them their many years of feeling different. We have talked about how long adults and children have to wait for a diagnosis. The NICE quality standard on autism is clear that, once referred, people should wait no longer than three months for their first diagnostic appointment, but that is clearly not being consistently met across the country. The NAS calls on the Government and NHS England to prioritise reducing waiting times for autism diagnoses, which would also help the NHS to reach its own goals of preventing mental illness. Will the Minister task NHS England with monitoring diagnosis waiting times for each clinical commissioning group, in order to reduce health inequalities for autistic people in line with NHS England’s mandate?

I will touch on teacher training, although much of what I wanted to say has been said. The vast majority of autistic children—over 70%—are in mainstream education, meaning that every teacher is likely to have children with autism in their classes during their career. A constituent of mine, Julie Atkins, got in touch when she heard I was taking part in the debate. She said:

“My son attends mainstream secondary school…and although he has a certain level of good support, there are a number of teachers who do not ‘get him’. Every child on the spectrum is different and an hour’s ASD training does not give people the understanding they need. There is no rule book and more empathy and understanding of sensory issues would help teachers to understand why my son may be fine one day and not the next.”

I support the call for autism awareness training to be included in the new teacher training framework. The words of my constituent explain why it is necessary.

I was pleased to see the initiative at the Asda store in my neighbouring constituency of Blackley and Broughton. The store manager, Simon Lea, said he wanted to help, having seen a boy with autism struggling to cope in the shop. On Saturday 7 May, therefore, in order to help autistic and disabled shoppers, the store will open an hour early, with no electronic distractions, such as escalators, music and televisions, and the public address system will not be used for announcements. I might well go there myself.

Junior Doctors Contracts

Liz McInnes Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend, who eloquently makes the point that this is a moment of opportunity for the NHS. We have been through some terrible problems at Mid Staffs and a number of other hospitals where there were serious issues with the quality of care, and now we are going on a journey to make the NHS one of the safest healthcare systems in the world. That means facing up to these problems, not ducking them, and that is what is going to happen for the time that I am Health Secretary.

[Liz McInnes (Heywood and Middleton) (Lab)]

The junior doctors I have spoken to are concerned about unsafe staffing levels and unworkable rotas as a result of the imposition of this contract. They ask me to make it clear to patients and to the public that the two strike days are nine hours in length and will last from 8 am until 5 pm, and that emergency care will be provided by consultants. The solution is in the Health Secretary’s hands: withdraw the imposition of this contract and get back round the negotiating table.

[Mr Hunt]

As I have said many times, were we to do that we would be giving the BMA a veto over a manifesto commitment, and no union should have a veto over what an elected Government do. I hope that what I said in my statement will give comfort to the hon. Lady and some of her constituents that we are increasing staffing levels in the NHS to deal with the extra pressures. With regard to unworkable rotas, perhaps she will go and tell the BMA to sit round the table and talk to its local trust managements so that we can get those rotas to work, because the way to sort out these problems is to sit down and discuss them.

Junior Doctors Contracts

Liz McInnes Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

I absolutely agree. It is entirely legitimate to disagree with the Government of the day about contract reform—we have tried to make the case as to why that reform is important—but it is wrong for patients to pay the price for that disagreement. While the NHS can cope with the withdrawal of labour for elective care, it is a much bigger deal when emergency care is withdrawn, and people throughout the NHS are extremely worried about the impact of that. Doctors should also worry about how the public will view their profession if they proceed with this wholly unnecessary step.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am glad the Secretary of State has come to the Chamber to answer the urgent question—I witnessed for myself his eagerness to get here as he sprinted across Portcullis House.

There is a real lack of clarity in this debate. “Agenda for Change” staff get paid a premium rate for working unsocial hours. Foundation trusts’ freedom to set rates allows them only to improve conditions and pay, not to diminish them. May I add that 98% of those who voted in the BMA’s ballot supported industrial action, including the full withdrawal of labour? May I suggest that the Secretary of State arm himself with the facts and get back round the negotiating table?

[Mr Hunt]

The hon. Lady is right that I sprinted here—I was a little concerned that Defence questions might not last the full hour, although they did, and I am sure Mr Speaker is pleased about that. The point I would make about the ballot, which did receive the overwhelming support of junior doctors, is that it happened before they knew what the deal on the table was. On the heated issue of Saturday premium rates, we ended up with a proposal where the Government agreed to pay premium pay on Saturdays for any doctors who work one Saturday or more a month. At the moment, therefore, we have this extreme step—the withdrawal of emergency care—to boost the pay of doctors who work less than one Saturday a month. I think many members of the public will say that that is not proportionate.

Contaminated Blood

Liz McInnes Excerpts

Tuesday 12th April 2016 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

First, I pay tribute to my predecessor, Jim Dobbin, who worked tirelessly on this issue on behalf of his and my constituents in Heywood and Middleton.

As many Members have already identified, this scandal has affected thousands of people who were infected with hepatitis C and HIV through NHS blood products in the 1970s and 1980s. It has been described as

“the worst treatment disaster in the history of the NHS”,

and was responsible for the deaths of thousands of haemophilia patients. It has, quite simply, been a nightmare for sufferers and their families. It is a nightmare that continues. It has taken away the careers, hopes, dreams and aspirations of thousands of people, including constituents of mine, just because they needed blood.

I thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) and the hon. Member for Colne Valley (Jason McCartney), the co-chairs of the all-party group on haemophilia and contaminated blood. Their inquiry into current support for those affected by the contaminated blood scandal in the UK is a superb analysis. The current system for administering compensation is a nightmare and a scandal in itself. We are still in the absurd position of having five trusts, two private companies and three registered charities which give various kinds of assistance to the people affected. The people who should be helped most, the victims, are very far from happy with the present situation.

The all-party group’s report highlights that many beneficiaries are in poverty. At present, the widows and widowers of hepatitis C infectees receive no ongoing financial support whatever. The majority of people with hepatitis C—namely, those with chronic stage 1 hepatitis C—also receive no ongoing payments. People can apply for discretionary payments for all manner of items through the three charities, but, as has already been highlighted, many find the process of having to provide evidence of need for help deeply frustrating. They feel as though they are begging. Registrants report being left completely in the dark about what discretionary support is available to them. This has meant that some people have not received payments they were entitled to. Many more people with hepatitis C are aware of the trusts’ existence, with considerable issues of low take-up. Many people with hepatitis C are unable to obtain payments from their trusts because the NHS has lost their hospital records, or because the trust has denied they are at the sufficient stage of hepatitis C infection to warrant support, even though their own hepatologists have insisted that they are.

The report recommends that the Government second a public health doctor to the five trusts to ascertain the needs of beneficiaries and set Government funding at the level commensurate with need. This also means extending some form of ongoing payments to those with stage 1 hepatitis C and giving the widows of hepatitis C infectees entitlement to the same payments as those of HIV infectees. The trust system has to be reformed and nobody should be left in the dark: they should be told precisely what support is available to them. Those facing difficulties providing proof that they were infected should also be able to get help with their applications.

During the Westminster Hall debate on contaminated blood on 9 September 2015, the Minister was questioned on the commencement date of the public consultation on support for those affected by infected blood. She stated it would occur before the end of the year. It was announced on 21 January 2016. The statement on the launch of the public consultation announced funding of £100 million for the proposals set out in the consultation. That is in addition to the current spend and the £25 million already announced in 2015. The Department of Health previously estimated £455 million as the future cost of meeting payments for the assorted schemes. It is not clear whether the £125 million is in addition to that, or represents projected funding being brought forward.

We wish to know how the Department of Health intends to distribute the £125 million. I appreciate that the consultation has not concluded yet, but a rough outline would be appreciated. Is it intended to end all discretionary or top-up payments to those who receive ongoing payments? Are there plans to allow special discretionary payments for dependants—either partners or children? Will there be a review mechanism regarding the freezing of the level of payments at £15,000, or will the sum remain at £15,000 regardless?

[Several hon. Members rose—]

Junior Doctors: Industrial Action

Liz McInnes Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

The credit that the hon. Gentleman has kindly given me is due to Sir David Dalton, who achieved the 90% agreement on the contract. As for the remaining 10%, his judgment was that the junior doctors committee would refuse to negotiate. At that point, the Government had to make a decision about whether to proceed or to cave in. We decided to proceed, which is why we will implement the contract later this year.

[Liz McInnes (Heywood and Middleton) (Lab)]

I worked for the NHS for 33 years, so I know that NHS staff do not take strike action lightly. The Government’s failure to negotiate has fuelled this crisis in our NHS. The BMA said in its statement yesterday that it wanted to end the dispute through talks. I implore the Minister to get back round that table for the sake of patients and every citizen of this country.

[Ben Gummer]

Back in November, the BMA said that it wished to discuss Saturday pay rates, and then went back on that promise—one that it had made at ACAS. That is something that, in my experience, normal trade unions do not do. In my experience, they hold to their word when they have made a promise at ACAS. Given that repeated breach of good faith, it is hard to understand how a return to talks would achieve what the hon. Lady thinks it would. That is why it is so important to move ahead with the vast majority that has been agreed, and introduce this contract, which is better for patients and better for doctors.

[Ben Gummer]

The hon. Gentleman is the last person to speak from the Opposition Benches. I note that he of all people—this saddens me—also fails to condemn this withdrawal of emergency cover. I am afraid that in the absence of that condemnation, the House will only draw the conclusion that the Labour party supports the withdrawal of emergency action in this strike.

[Liz McInnes]

On a point of order, Mr Speaker.

[Mr Speaker]

That will come after business questions, and I feel sure that the hon. Lady will be in her place, perched and ready to pounce with her point of order at the appropriate moment. We will await that prospect, I am sure, with eager anticipation.

National Minimum Wage: Care Sector

Liz McInnes Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank my hon. Friend the Member for Sheffield Central (Paul Blomfield) for obtaining the debate. I will try to be brief.

The Labour party recognised the issue with the social care system prior to the last general election. In our 2015 manifesto we promised to end 15-minute visits and introduce year of care budgets, to incentivise better care in the home. We promised to recruit 5,000 new home care workers—an entirely new arm of the NHS—to help to care for those with the greatest needs at home. We promised to tackle workforce exploitation in the care sector, and to ban the use of zero-hours contracts where regular hours were being worked, improving the working lives of carers. However, that was not to be.

Figures show that up to 220,000 home care workers are illegally paid less than the minimum wage. Investigations by HMRC between 2011 and 2015 found that 41% of care providers were guilty of non-compliance. As has been mentioned, the Resolution Foundation has calculated that care workers are collectively cheated of £130 million a year.

--- Later in debate ---

On resuming—

[Liz McInnes]

One major way in which care workers are denied the national minimum wage, which has been referred to throughout this debate, is for the care providers to refuse to pay for travel time between calls. I had never heard of the practice, which my hon. Friend the Member for Sheffield Central described, of care workers being paid a miserly 12p per hour for travel time. That, to me, sounds more like a cycling rate.

The law states that workers must be paid at least the national minimum wage for travel that is a part of their work and not incidental to it. If someone’s work consists of assignments carried out at different places between which they are obliged to travel, the time they take to do so is regarded in law as work time and must be paid accordingly. The National Institute for Health and Care Excellence stated that care providers should ensure that workers have time to do their job without being rushed and without compromising the dignity and wellbeing of the person who uses the services. Not paying for travel time makes that impossible.

The BBC recently reported on a group of home care workers who are Unison members, who are owed up to £2,500 each as a consequence of being paid less than the national minimum wage—again, because they were not paid for travel time. In a recent case, which was settled out of court, a worker was paid £1,250 in compensation for non-payment of travel time.

Furthermore, in summer 2015, HMRC launched a new national minimum wage campaign, which allows employers who have not been paying their workers the national minimum wage to escape punishment. Employers who are guilty of non-compliance can now just notify HMRC of their transgression, declare that they have paid their workers any money owed, and agree to obey the law in future.

That all contradicts the Prime Minister’s August 2015 claim that

“the message is clear: underpay your staff, and you will pay the price.”

Such employers are not paying the price. We need a major change in policy if the Government are serious about stamping out that deep-rooted practice and protecting the legal rights of home care workers. The Government should make regulations, as provided for under section 12 of the National Minimum Wage Act 1998, requiring employers to provide their workers with a statement demonstrating compliance with the national minimum wage. The exploitation of care workers must stop; we must ensure that they get the pay to which they are entitled.