Local Government and Social Care Funding

Part of the debate – in the House of Commons at 6:00 pm on 24th April 2019.

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Photo of Laura Smith Laura Smith Shadow Minister (Cabinet Office) 6:00 pm, 24th April 2019

It is a pleasure to follow Dr Wollaston.

Having listened to the contributions today, it seems that there is a consensus that our social care system is broken, but some Members seem to be living with their heads in the clouds. To describe our social care system as broken is an understatement: it is a national scandal of which we should be ashamed. I am certain that Members present get the same casework as I get. It is the stuff of nightmares. Social care is one of those issues that genuinely keeps me awake at night.

Behind all the statistics that we hear today, there is a heartbreaking human reality. As many others will have done, I have sat and fought back the tears as I have listened to those at my local surgeries who are exhausted from the battle to get the most basic level of support for their loved ones. We have only to read some of the reports from recent Care Quality Commission inspections to get a feel for the state of our social care system today. It is beyond broken.

One report, following an inspection in Crewe and Nantwich last year, found one person with injuries that were unaccounted for. It described another person as

“extremely anxious and afraid that they would be injured”,

and said that they

“lay in their bed in the foetal position” and that

“their feet were dirty and their hair matted.”

I will never forget visiting an older lady in a nursing home who was still haunted by her experience in a previous facility, where she had suffered the most undignified neglect—a lady left shocked and confused after decades of working and paying taxes and paying national insurance contributions.

Today, I wish to focus our attention on those who work in social care. It takes a certain kind of person to work in the care sector, and I pay tribute to them all. They experience this rotten system almost every single day of their lives, yet they carry on with compassion and professionalism, despite the poverty pay and despite feeling ignored and undervalued by the Government. These are the people we rely on to protect the dignity and independence of our relatives, friends and neighbours.

What does it say about us as a nation that our social care workforce is one of the most exploited and underpaid? I cannot even imagine how it must feel to be that type of person and to be forced to leave somebody who is under their care before they have had the time to wash them, or to help them to eat. But who cares for the carers? A care worker described how staff morale was at rock bottom, with many care workers suffering from poor mental health and worried about their job security, relying on food banks and payday loans, too scared to take time off sick. He said he felt that care workers have no voice and no respect.

As if things were not bad enough, one group of care workers, many of whom already work for the minimum wage, face losing hundreds of pounds a month because their employer, Alternative Futures Group, has taken the decision to slash payments for sleep-in shifts. Sleep-in shifts are an integral part of our care service that the Government have a statutory obligation to provide. I have spoken many times previously about the importance of this work.

Calling them sleep-in shifts can often lead to people getting the wrong impression. One of the affected workers explained to me in an email this week:

“Sometimes you have to deal with emergency situations and take a client to hospital. You never properly sleep –
you are half-awake all night –
listening in case that person needs you. Often, we are up 5 or 6 times a night, taking them to the toilet or calming them down when they are agitated”.

She went on to describe how she often finished a sleep-in shift only to start another day in work, often going days without seeing her three children. For her, the cut in pay will mean losing £300 a month—the cost of her bills. She is now having to consider getting a second job, or even leaving the job that she loves. One of her colleagues whom I met recently is already working a second job. She also goes days at a time without seeing her child. Both ladies work with adults with learning difficulties and their duties include administering medication, PEG—percutaneous endoscopic gastrostomy —feeding, as well as washing, dressing, helping with finances and facilitating day trips.

As well as physical support, these workers also provide emotional support for the people for whom they care. Their passion for their work shines through, but the cut to their income has been the final straw and, for the first time ever, these workers have been left with no option other than to take industrial action. I stand in solidarity with those workers—as should every Member here today. They are in no way to blame for the problems in our social care system.

I questioned AFG’s decision to cut the rate of pay for sleep-in shifts given that there has been no reduction in the payment that it receives from Cheshire East Council. Its response was somewhat alarming: it claims that the funding provided by the council has never been sufficient to cover the full costs of paying the national living wage rate for sleep-ins. The charity says that its position is that

“it wants to pay above the national minimum wage for all care hours” but that this requires additional funding. I share AFG’s concerns about what it describes as

“the dire situation funding of care is having on hard-working care staff.”

However, Cheshire East Council assures me that it does not pay providers any less for sleep-in support than it does for waking-night support and that it believes that care providers should be paying at least the national minimum wage rate. When I recently asked what the Government were doing to make sure that local authorities have enough funding to allow providers to pay sleep-ins at the national living wage rate, the Chief Secretary to the Treasury replied that it was currently working on this with the Department of Health and Social Care, which implies that it is not being paid.

Will the Government accept responsibility for this dispute and admit that they are not providing adequate funding? If they do not, we really need to explore why this funding is not reaching the frontline. Whatever the case, it is the overworked and underpaid care workers who are paying the price, as well as the elderly and vulnerable members of our communities who rely on this vital service.

In her summing up, I hope that the Minister will address the following points. First, what advice do the Government currently give to social care providers and commissioning authorities in light of the current legal situation regarding payment for sleep-in shifts? Will she join me in calling on AFG to take up Unison’s offer of a meeting to continue these negotiations in the hope of resolving this ongoing dispute? Secondly, will she commit to looking into the dispute to determine whether AFG receives sufficient funding to pay its workers at the national living wage rate? Thirdly, will she acknowledge that the Government could simply pass new legislation, positively applying the national living wage rate to sleep-in shifts? That would give the sector the certainty that it needs and make sure that care workers are remunerated as so many believe they should be.

We have been repeatedly promised a social care Green Paper, which will focus on a valued workforce as one of its principles, but I have little faith that it will ever even appear. It has been delayed for the fifth time since the Government first promised to publish it before I was even elected two years ago. If it is published, I am confident that it will not contain the radical solutions that this country owes to its elderly citizens and to the most vulnerable people in our communities.

Our problems in social care are systemic and structural. The only beneficiaries of the system are the private companies that are profiting from this misery and it is they who benefit from this Government’s inaction. In previous debates, I have raised my concerns about how, without any real debate, market values have penetrated areas where they do not belong, and social care is perhaps the worst example of this. As far back as 2016, the Centre for Health and the Public Interest outlined the failings of privatised adult social care. Research commissioned by Independent Age has produced several policy options that serve as a starting point for any political discussion, and it shows just what can be done where there is a will to do so.

We need to address these failings now, with an immediate uplift in funding, while we build a sustainable model for the future. Not to do so is a political choice and a clear expression of how this Government prioritise the elderly and most vulnerable people we represent, and those whom we employ to provide care services. Those working in social care need to be listened to. They can help us to build a national care service that is based on need and not profitability—one that is centred on independent living for all and dignity in later life.