Social Care Reform

Debate between Rupa Huq and Barbara Keeley

Thursday 18th March 2021 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I beg to move,

That this House has considered social reform and the social care workforce.

It is good to have you in the Chair for this important debate, Dr Huq. I am pleased to open the debate. I pay tribute to the House staff who have enabled Westminster Hall debates to return with virtual participation.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit hard over the past year. However, the fundamental problems in social care long predate the pandemic. A decade of underfunding meant that we were in a situation, even before the pandemic, where 1.5 million people were not getting the social care they needed. While social care is, rightly, the last thing to be cut by local councils, the reality is that areas that have seen half of their central funding cut since 2010 are left with little choice. Underfunding has led to fewer care packages, cuts to care packages and providers being asked to take contracts that do not even cover their costs.

One clear illustration of how this is going wrong can be found in long-stay in-patient wards, where 2,000 autistic people and people with learning disabilities are detained, at enormous cost to the NHS. One reason for that is the lack of resources in the community to support them. When local authorities cannot afford care and support in the community for autistic people and people with learning disabilities, it becomes easier to put them into inappropriate NHS in-patient units, even though community support would be cheaper and more appropriate. We also have older people forced to sell their homes because they are unable to access publicly funded care support until they have exhausted almost all their assets.

There has been much focus on care in care homes during the pandemic, due of course to the tragic death toll among people living in those homes, but we must also focus on the fact that social care is needed by working-age disabled people too, and that proposals for reform must cover their needs. In fact, one in three users of publicly funded care is under the age of 65, whereas only one in four is an older person in a care home, so the crisis in our care system affects more than vulnerable older people. It is a crisis not only of catastrophic costs, but of hundreds of thousands of people being denied the opportunity to live their lives as they would choose.

This is not a new problem. The reality is that social care has been struggling for more than a decade now. That is why the last Labour Government published a White Paper in 2010 proposing major reforms to the way social care is delivered and funded. However, once in government after the 2010 general election, the Conservative-Liberal Democrat coalition decided to drop those proposals in favour of starting another commission on reform. That led to the provisions of the Care Act 2014, including legislating for a lifetime cap on care costs, based on the recommendations of the Dilnot commission. That would have addressed some of the issues with the social care system, although I do not think any of us believed that it was anything like the full solution. Since that change was first delayed by the new Conservative Government in 2015, we have had any number of promises of future reform.

Ahead of the 2017 election, the then Prime Minister promised far-reaching reforms but promptly abandoned them. After that election, a Green Paper was promised by the end of 2017. At the end of 2017, the cap on care costs was completely abandoned and a new deadline of mid-2018 was set for the Green Paper. That was pushed back to autumn 2018, and then to the end of 2018. In early 2019, we were told to expect a Green Paper by April 2019.

When the current Prime Minister took office, he claimed to have a social care plan ready to go, and he repeated that claim during the 2019 general election. The Conservatives’ manifesto at the last election said that they would seek a “cross-party consensus”, but they have not tried to seek that consensus. In fact, a fairly broad consensus on the future of social care has developed. Politicians from across the spectrum, including the Health and Social Care Committee and the House of Lords Economic Affairs Committee, have endorsed the model of free personal care as introduced by Labour in Scotland. That system is not perfect, but it should be a strong position to start from. However, rather than acting on that consensus, we are still waiting for proposals nearly 18 months after the 2019 election.

When the Minister speaks, she may tell us that the Government are working hard on their proposals and will publish them shortly. She would be the third Minister of State to tell me that since the Government dropped their commitment to the cap on care costs, and we have already missed at least 10 deadlines for reform. That simply is not good enough. We need action now, not the promise of jam tomorrow.

If there is a team of civil servants working on this issue, there a few points that they should consider in order for reform of social care to work. First, reform must deliver a fair deal for care staff. If the crisis of the pandemic showed us anything, it was that without the hard work put in by care staff our care system simply would not work, but too often care staff are underpaid, undervalued and given few opportunities to progress. To fill the more than 100,000 vacancies we have for care staff, social care needs to become a career of choice, with better pay and conditions and better training. When the average starting salary is only £15,000, it is little wonder that people are not turning to a career in social care.

As a starting point, reform should mean that all care staff are paid the real living wage, as my own local authority of Salford is now doing. We need to see investment so that the social care sector offers training opportunities and real career progression for staff, recognising their skills and experience. If we are to fill the vacancies in social care, we need a wide strategy working across Departments to recruit and train the workforce that we need.

The Prime Minister has said that he wants to end the scandal of people needing to sell their homes in order to pay for care. It is right that we should address the issue of catastrophic costs, but that cannot be the only ambition of social care reform. If all we do is end catastrophic costs, we will still have nearly 2 million people not getting the support they need. With providers struggling to make ends meet, local authorities are left with no choice but to cut budgets even further.

We need reform that expands access to social care services. Over the past five years, we have seen fewer older people receiving care every year as eligibility thresholds have crept up in response to budget pressures. Preventive care is increasingly uncommon, with intervention mainly coming after a crisis. Rather than providing low-level support to enable people to continue living independently at home, we are increasingly providing care only once there is no prospect of someone living independently.

When the Health and Social Care Committee looked at access to care, one witness, Anna Severwright, told us:

“I feel that I am not able to live a normal life. I do not have enough hours”—

of care—

“to be able to go out at the weekends and in the evenings, and do a lot of the normal things that make life worth living.”

That is not good enough. People should not see their horizons limited solely because they need social care, but with budgets under ever-increasing pressure, money for anything other than the basics of care is rarely available. There is a better way to deliver social care than 15-minute care visits, and people should not have curfews on their lives because care is not available in the evening.

As well as funding care properly, we could embrace the spirit of the Care Act 2014 and ensure that care packages meet people’s social and emotional needs as well as their physical ones. That kind of person-centred support would enable more working-age disabled people to be productive members of society while also supporting older adults to enjoy later life. At root, social care should be about supporting people to live happy and fulfilled lives without facing financial ruin.

There is a very poor level of support for unpaid carers. There are 13.6 million people providing care to a friend or family member. Without them, our social care system would not cope. Funding for respite care is increasingly hard to get. Many carers say that they would use a respite break to attend a medical appointment.

Responding to an Adjournment debate that I led last Friday, the Minister for Patient Safety, Suicide Prevention and Mental Health said that

“45,000 carers have received respite or other carer support delivered to the person they care for.”—[Official Report, 12 March 2021; Vol. 690, c. 1212.]

We have 13.6 million unpaid carers, including 4.5 million who started caring during the pandemic. For a Health Minister to report that only 45,000 carers received respite care is an appalling record. We must do much more to support unpaid carers, and we could improve their lives by funding formal care services better.

It is now seven years since we put the Care Act into law, but the Government still have not delivered for people who use social care. After years of broken promises and delayed announcements, there is anger at the way social care has been underfunded and reform neglected. This has led to people who rely on social care going without the support they need to live fulfilling lives.

Underfunding has led to care staff being paid the minimum wage and not being given the time they need to provide high-quality care. It has also led to many thousands of people facing catastrophic costs of care, often having to sell their homes to pay for it, and over the past year it has meant 30,000 care home residents dying with covid-19. They were caught in a perfect storm of an NHS discharge policy that seeded infections into care homes before providers could implement infection control measures.

People who use social care deserve better than all of this. They deserve reform that delivers a fully funded, person-centred care system that meets their needs, and they need it now, not at some point in the distant future.

[Dr Rupa Huq (in the Chair)]

Given the popularity of the debate, and the fact that we have three Front-Bench spokespeople and a concluding statement from Barbara Keeley at the end, I am going to start with a time limit of three and a half minutes. There will be a clock visible at the side of Members’ screens, and the chaps here can pull the plug if they go over the limit. With all that in mind, I will start with Andrew Lewer.

State Pension Age (Women)

Debate between Rupa Huq and Barbara Keeley

Thursday 7th January 2016 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

First, I congratulate the hon. Member for Paisley and Renfrewshire South (Mhairi Black) on her outstanding opening speech, and the Backbench Business Committee on allocating time for this important debate. I am heartened to see the support from my Front-Bench colleagues, including my neighbour, my right hon. Friend the Member for Leigh (Andy Burnham), and my hon. Friends the Members for Oldham East and Saddleworth (Debbie Abrahams) for Newcastle upon Tyne North (Catherine McKinnell) and for Stretford and Urmston (Kate Green)—she is also my neighbour. I know that they all strongly support this campaign and the women in their constituencies who are affected by this issue. I congratulate the WASPI campaigners, who have worked tirelessly on this issue. They have now gained 107,000 signatures—perhaps 108,000 since the start of this debate.

The increases in the state pension age made by the Pensions Act 1995 and the Pensions Act 2011 have had a disproportionate impact on 1950s-born women. As we have heard, many received little or no notification of the changes, despite the Government saying that people must have 10 years’ notice of such changes. Indeed, the financial journalist Paul Lewis found that none of the 1950s-born women had been given 10 years' notice. In the worst case—we have heard about one of the worst cases from my hon. Friend the Member for Bishop Auckland (Helen Goodman)—women were told at 57 and a half that their pension age would rise from 60 to 66. Women who expected to retire at 60 can now find themselves without a job, without a pension and without money to live on.

The former Pensions Minister, Steve Webb, has admitted that the Government made “a bad decision” over these changes. His excuse was that Ministers had not been properly briefed. It appears that civil servants did do a poor job on this legislation; astonishingly, the impact assessment for the 2011 Act states in its conclusion:

“Overall…based on the available evidence, the change to the previous timetable will not have a disproportionate impact on any group compared to another.”

[Dr Huq]

The fact that my hon. Friend had a recent debate in Westminster Hall on this very subject should send a message to the Government that people want action on it. Does she agree with my constituent Linda Gregory, who was born in 1953 and points out that she has been working since the age of 15 and therefore is being penalised even more than people entering the workplace at the age, which is the normal standard nowadays?

[Barbara Keeley]

I absolutely agree with what my hon. Friend says and I thank her for coming to that earlier debate.

It seems unbelievable that civil servants and Ministers could believe that taking billions in pensions away from a particular group, adding years to their state pension age and then not informing them in good time would not have a disproportionate impact on that group.

State Pension Age Equalisation

Debate between Rupa Huq and Barbara Keeley

Wednesday 2nd December 2015 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I beg to move,

That this House has considered the effect of state pension age equalisation on women born in the 1950s.

It is a pleasure to serve under your chairmanship, Mr Davies. I start by paying tribute to my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), who was the first MP to raise this issue in Parliament in this Session. The debate is about the effect of the changes to the state pension age imposed on women born in the 1950s by the Pensions Act 1995 and the Pensions Act 2011, and I will focus on three areas: the acceleration of changes to the state pension age; the lack of appropriate notification from the Government; and the impact of the changes.

State pension age equalisation started with the 1995 Act. The then Conservative Government set out a timetable to equalise the pension ages for men and women at 65. From April 2020, women born in April 1955 or later would get their pension at 65. In May 2010, the coalition agreement stated:

“We will phase out the default retirement age and hold a review to set the date at which the state pension age starts to rise to 66, although it will not be sooner than 2016 for men and 2020 for women.”

That pledge was broken when the coalition Government decided to accelerate the planned changes, a move that would particularly hit women born in the 1950s.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend is making a powerful speech. Does she agree that the people who are treated most iniquitously are those born in 1954? My constituent Michele Carlile of Hanger Hill says that an extra six years were hiked on to her pension age with no warning. That generation did not have the equal opportunities that created independent pension funds, and they did not have free nursery places; they had bad divorce settlements from men. This is another example of how this Tory Government have treated women shoddily.

[Barbara Keeley]

I agree, and I thank my hon. Friend for making those points so early in the debate.

The changes brought about by the 2011 Act affect the lives of millions of women born in 1954 and throughout the 1950s who are unfairly bearing the burden and the personal costs of increasing the state pension age. The changes were controversial at the time, and there was great debate about the need to address the unfair consequences of the Act. Speaking to Channel 4 News in May 2011, the director general of Saga said:

“Men won’t have any increase before 2018 and no man will have his pension increased by more than one year. Half a million women will. We accept that the pension age will have to rise but it is the timing and the broken promise that we feel is unfair. No money will be saved during this Parliament, so it’s got not about cutting the deficit. We don’t need to hurry this through to have a sustainable pension system…Many women are furious and desperate about how they are going to manage, particularly the more vulnerable women who may already have retired, who may be ill or be caring for someone. They may have made careful plans for retirement, only to have the Government pull the rug from under their feet. They can’t just work for longer, because they may have retired already.”

--- Later in debate ---

[Barbara Keeley]

The hon. Gentleman is quite right and I will come on to cases of how people are managing, citing my constituents and other people I have heard from.

Some of the women affected have been hit twice: by the original proposals in 1995 and by the acceleration of the changes through the Pensions Act 2011. Now they are angry and feel that they are bearing a disproportionate burden, as the hon. Gentleman has just said.

The acceleration of the changes to the state pension age can mean that women born just months apart, and who were possibly in the same class group at school, receive their state pension at very different ages. In some cases, a one-year difference in date of birth can mean a woman will receive her state pension three and a half years later than other women. The campaign group Women Against State Pension Inequality tells me that it is not campaigning against the equalisation of the pension age in itself; I think hon. Members will understand that that equalisation was going to happen. It is opposed to the way the changes have been enacted and to the lack of transitional protection for the women born in the 1950s who are hit hardest by the changes.

The women affected put their faith in a state pension system into which most of them had paid all their working lives. They expected that they would be treated fairly and that they would be told about major changes with sufficient notice. However, most of them were given short notice of these changes and some of them have received no information at all. The women affected believe that the Government have failed in their duty of care by not taking reasonable steps to ensure that they were notified individually and in a timely way. They have been left with inadequate time to plan for a major change to their financial circumstances, which has caused great uncertainty and worry for those who have been planning for retirement.

A number of constituents have given me examples that show the significant impact these changes are having on their lives. One of them has worked for more than 44 years and raised two children. She suffers with osteoarthritis. She tells me she that she suffered the indignity of having to attend the jobcentre, only to be told that she was entitled to just six months’ jobseeker’s allowance. Now she is unable to find work and has to use her hard-earned savings, which is a similar point to the one that the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin) made earlier. My constituent told me:

“I must watch my savings dwindle on living costs rather than enjoyment, I wish I had not bothered being frugal all my life, as by the time I get my pension I will be broke or dead.”

Another constituent, Christine, is 61 and has worked since she was 15. She has osteoarthritis in both knees and has had a knee replacement. She cannot apply for her pension until 2019 and she told me:

“I am one of those women you would say is ‘old school’. Worked hard all my life, no maternity leave, no help with child care, just got on with it. Carrying on working thinking you will retire at 60, but since then my retirement age has changed 3 times. There is no guarantee it will not change again. I will probably be dead before I am able to retire.”

Another told me:

“At the age of 61, I find myself unemployed…If the Government had not moved the goalposts, I would have been able to retire last year. How are you supposed to live on £75 a week?”

She tells me that she has a mortgage and her outgoings are double the size of her income.

A constituent of a colleague told me that she was born in 1954, which is similar to the case already raised by my hon. Friend the Member for Ealing Central and Acton (Dr Huq), and that she was given only two years’ notice of the changes to state pension age. She is supported by her husband now, as she has no income of her own. She suffers mental ill health and has been unable to cope with the assessment process for employment and support allowance.

Case after case that I have been told about show how many women in their early 60s have health problems that stop them working, or that they need to give up work to care for someone else.

In an article on the gender gap in pensions, the Fawcett Society points out that the Chancellor appears to be delighted with the savings he made from his policy on state pension age equalisation, despite the really negative effects on women born in the 1950s, which I have been outlining. Speaking of the Government’s changes at the Global Investment Conference 2013, he said:

“These changes…the savings dwarf almost everything else you do, I mean they are absolutely enormous savings. You’re not necessarily reducing the entitlement of people who are retired, you’re just increasing the age at which that retirement entitlement kicks in”.

[Dr Huq]

Does my hon. Friend agree that this Government need to stop seeing people as just anomalies on a spreadsheet? The cases that she has highlighted are those of real-life individuals, and apparently there are 300,000 people born between 6 December 1953 and 5 October 1954 who have been hit twice by Tory pension changes, and these issues need addressing.

[Barbara Keeley]

Indeed, and as I was just saying, the Chancellor made the comment:

“You’re just increasing the age at which that retirement entitlement kicks in”.

He went on to say:

“It was actually one of the less controversial things we have done”—

amazingly—

“and yet it has probably saved more money than anything else we have done.”

That relates to the point that the hon. Member for Kirkcaldy and Cowdenbeath made about “choice”.

Sugary Drinks Tax

Debate between Rupa Huq and Barbara Keeley

Monday 30th November 2015 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I am a late contributor to a long debate, so some of what I say will have been touched on, but I hope it is not all déjà vu.

Apparently today is the first day of Sugar Awareness Week, after “black Friday” and “cyber weekend”, or whatever—it is all good to know. According to Mick Armstrong, chair of the British Dental Association:

“Britain is addicted to sugar, and inaction can no longer be justified, either morally or financially.”

The debate, which to some extent reflects Britain’s love affair with sugar, is not the result of an intellectual curiosity, as subjects discussed in this Chamber often are, but arises from a petition. We have heard the figures —150,000 people have signed it—and we see it reflected in the number of people in the Public Gallery today.

One in four children leave primary school clinically obese—the hon. Member for Totnes (Dr Wollaston) said it is one in three—so we have to do something about the ticking health time bomb. The cost to the NHS runs into billions—my hon. Friend the Member for Warrington North (Helen Jones) mentioned £6 billion. Some people argue that the state should not interfere in such things, but it would not be the first time, because it is something that Governments of both complexions have done before, and as a result we have seen a reduction in the number of adult smokers in this country.

The clamour for action on sugary drinks and the arguments in favour of the funds raised going to tackle public health problems have received not inconsiderable public attention, at a time when health budgets are being squeezed. There is also the weight of expert opinion, not only the much mentioned one-time “naked chef” Jamie Oliver, but the Health Committee, chaired by the hon. Member for Totnes, who spoke movingly and powerfully earlier—she was a doctor first and an MP second—the British Medical Association, the British Heart Foundation, Diabetes UK and the British Dental Association. Hitherto, however, all appeals have fallen on deaf ears in the Government. The Royal College of Paediatrics and Child Health conducted a poll that revealed that 53% of the public support a tax measure.

Public Health England, in its sugar reduction action plan, states that the recommended proportion of added sugar in people’s diets should be 5%, but at the moment it is more like 12% for adults in this country. Added sugar accounts for 14.7% of calorie intake for children and 15.6% for teenagers. I am a mum myself and understand pester power and the attraction of sugary drinks. For under-threes, 27% of added sugar intake comes from soft drinks; for 11 to 18-year-olds, the category that I am a mum of, that figure rises to 40%. Furthermore, it is the 11 to 18-year-olds with the least amount of money who are attracted by cheaper alternatives to drinks such as water. Why is it that in any sweet shop water is more expensive than fizzy drinks?

Sugary drinks give a short fix of energy and have no nutritional value, while at the other end of the process the NHS is treating people for preventable illness. We have heard how most children in this country who go under general anaesthetic are doing so for tooth decay. Many hon. Members have also mentioned the figures for type 2 diabetes; 22,000 people in my constituency live with it, and it is responsible for a death every seven seconds in the G20 member states, which is a higher rate than HIV and malaria combined. At a meeting of the all-party group on diabetes, chaired by my right hon. Friend the Member for Leicester East (Keith Vaz), who is no longer in his place, we heard an impassioned speech from “St Jamie”, as one of my constituents called him at the weekend. I believe that in Jamie Oliver’s own restaurants there is a 10p levy on fizzy drinks.

On the one hand we have campaign groups and medical professionals, but on the other hand there is the argument about the nanny state. Many hon. Members have said that the solution is severalfold. The food and drink industries need to act more responsibly—they are the main lobbyists against the sugar tax—instead of arguing that any tax would be passed on to consumers and end up being a tax on the poor. They have also warned of sinister factory inspections and claimed that the tax would be unworkable, but they are acting in their own interests and not with the NHS health bill at heart. In Mexico, as we have discussed, a reduction in sales took place when a tax was introduced. I am almost reminded of that television programme set in the 1950s or ’60s, “Mad Men”, which is about the advertising industry. The advertisers in it say, “It’s not bad for you”, when they know it is.

There are good commercial operators. In my constituency is the UK headquarters of the French dairy company, Danone, which has its “Eat Like a Champ” programme, which 35 children will go through this year. It is unbranded, so no one knows it is a Danone programme, but it introduces healthy eating, diet and so on throughout the London boroughs. The programme has been developed with the British Nutrition Foundation. Such initiatives should be encouraged. The programme is also supported by Diversity—the pop group, not the concept—as its ambassadors. Danone is doing that as part of its corporate social responsibility. The hon. Member for Britvic—the hon. Member for Rugby (Mark Pawsey)—has gone now, but—

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Says the hon. Member for Danone.

[Dr Huq]

Yes, sorry. I am a secret lemonade drinker—no, I’m not.

I want to be brief, but we are discussing something important. Voluntary agreements do not seem to be moving fast enough. As everyone has said, we need a range of different approaches, and hiking up sugary drink prices by pennies is part of that. As for the industry’s worry that the cost would have to be passed on to consumers, the industry itself could absorb or partly absorb the cost.

Eleven to 18-year-olds will choose drinks based on price, because they are short on cash, although other factors could come into play—peer pressure, habit, availability and so on. We need to think smartly about things such as advertising bans, which have been mentioned, encouraging physical activity, curbing “buy one, get one free” types of promotions, discounting fruit and veg, and considering portion sizes. In New York the authorities have banned the largest size of soda cups.

I want to ask the Minister what happened to the ban on fried chicken shops at school gates, because I still seem to have them in my constituency. Such a ban was talked about, and it would be good if its implementation could be accelerated. Also, what about minimum unit prices for alcohol? If sugary drink prices go up but alcohol prices are low, there could be some awful, cataclysmic thing going on as a result, possibly—