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The Minister of State, Department of Health (Norman Lamb)
It is a pleasure to serve under your chairmanship, Mr Turner.
I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this incredibly important debate. As was pointed out by the shadow Minister, the hon. Member for Leicester West (Liz Kendall), the subject is too often neglected. It is literally hidden behind closed doors, and it does not get the attention it deserves. I also thank my hon. Friend the Member for St Ives (Andrew George), and the hon. Members for Wirral South (Alison McGovern), for Strangford (Jim Shannon)—he drew attention to the brilliant work done by Crossroads in many parts of the country—and for Nottingham South (Lilian Greenwood), who spoke from direct personal experience.
I totally agree with the shadow Minister that the health and care system has not kept pace with the demands and challenges of an ageing society, and that we need a fundamental re-engineering of how we deliver care. I have a passionate belief in the need to shift towards an integrated care model, in which we shape services around the needs of the individual, rather than those of the institution, which is a shift that must happen.
Before I go into details, let me say that I applaud Unison for having undertaken the report that several hon. Members have mentioned. When its staff wrote to me about the report, I asked officials to meet them, and they will meet soon. I, too, asked to meet them, and I will discuss their concerns with them next month. I recently met some care workers, with another hon. Member, to hear directly from them, and I want to experience myself what goes on—often behind closed doors.
The right hon. Member for Oxford East mentioned whistleblowers, and I have a lot of sympathy with the points he made. Last January, the Government extended the Government-funded whistleblowing helpline to the whole of the care sector, so that any care worker can find out how to pursue their concerns. Of course, as employees, care workers have employment law protection, and we should encourage them all to use their rights.
The Government want to do all we can to ensure that standards of care remain as high as possible, and indeed improve. That is the challenge we all face. People who receive home care and their families should be able to expect the highest quality of care every time. I am aware of the many examples of poor care. The right hon. Gentleman and other hon. Members drew our attention to some pretty shocking case studies and to the fact that someone can have up to 13 different care workers over a relatively short space of time. As the hon. Member for Leicester West said, it is completely unacceptable that a person has to receive quite intimate care from someone whom they have never met before. Moreover, the idea of a zero-hours contract is, in most circumstances, completely incompatible with a model of high quality care, in which the individual really gets to know their care worker.
The CQC report “Not just a number” highlighted some serious concerns, which we must take action to address. The responsibility for bringing about improvement rests with all the key players, including the providers, the councils and the regulator. The Government too must take their share of the responsibility here. The trick is to erase the bad, keep the good and improve services across the board.
The care and support White Paper sets out our intentions to improve the standard of social care. We will do that primarily by investing in people—by focusing attention on the staff who provide care in the first place. I want to join the right hon. Gentleman and other hon. Members in paying tribute to care workers, the vast majority of whom do really excellent work, often in difficult circumstances. They work under real pressures because of the way in which care is commissioned over very short spaces of time. We are seeing a race to the bottom, and we must move away from that. It puts care workers under impossible pressure and it does not provide good quality care.
Another matter I feel strongly about, and to which I referred in my response to the Winterbourne View scandal, is that there must be much more effective corporate accountability. Some companies are making very good money out of home care, so accountability must go with that profit making. It is unacceptable that home care providers sometimes allow negligent care to take place under their watch, and they must be held to account for it. Poor care, private or public, should be condemned wherever it exists. We must not have the idea that poor care exists only in the private sector. It was intolerable that hundreds of people died in Mid-Staffordshire hospital, an NHS hospital, as a result of poor care, and it is equally unacceptable when it happens under the watch of a private provider.
It is impossible to speak about improving standards without also talking about human capital. Care workers who feel valued and encouraged will perform better; it is as simple as that. The more attention the Government pay to the skills, training and personal development of the work force, the better are our chances of improving standards. After all, it is the care workers, not us in Parliament, who ultimately provide the care. We must increase the capacity and the capability of the social care work force, give people better information about care providers and improve the performance of the regulator, the Care Quality Commission. All those things will make social care a more attractive place for people to work and, most importantly, improve the quality of services.
We will shortly introduce new minimum standards to improve training for care staff to make sure that all employees have the foundations for excellence. My focus must be on training and standards, and ensuring that they apply across the board. I am dubious about the idea of creating a new regulator or of using the Nursing and Midwifery Council, which has not had a great record, to regulate some 1.5 million people. The money that is available should perhaps go to the front-line workers, rather than on creating new bureaucratic structures. I will give way to the hon. Lady, and ask her to be very quick if she does not mind.
Alison McGovern
I will be speedy. I have listened carefully to what the Minister has said about the causes of the problem. He does not seem to have mentioned funding pressures on local government. Will he respond to that point, because it is a massive constraint on improvements in the sector?
Norman Lamb
I will directly address that point. The analysis of the independent King’s Fund said that provided councils apply the money that the Government have allocated to care and undertake proper efficiency savings, which the previous Labour Government recognised had to happen across health and care, they should be able to continue to provide the level of service that exists at present. We need to think more fundamentally about a much more integrated approach between health and care. We can save resources and improve care if we bring the systems much more closely together.
It was, I think, the hon. Member for Wirral South who made the point about looking at care as an aspirational role.
Norman Lamb
I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.
I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.
When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.
Norman Lamb
I am conscious that time is tight and I want to address the remaining points.
The hon. Member for Erith and Thamesmead (Teresa Pearce), who is no longer in her seat, raised concerns about potentially bogus arrangements in her constituency in Bexley. I think that she is writing to me on that matter, and I will be happy to look into it.
Care providers are also responsible for ensuring that their services meet the requirements in regulations and essential standards. The regulator, the Care Quality Commission, has powers that it can use to make sure that that happens. The CQC has our full support to use those powers as it sees fit to drive improvements in services. It is worth taking a moment to talk about the CQC report, which we have been discussing this morning. Between April and July 2012, the CQC inspected 250 registered home care providers as part of a themed programme to highlight respecting and involving people who use services and safeguarding them from abuse and neglect. To ensure that everything was examined thoroughly, it involved the people who use the services as well as the people who provide them. It looked at how staff are supported and how standards are maintained. Overall, the CQC found that 74% of the services that it inspected met the standards, and about a quarter did not. That is unacceptable and we must all focus our attention on those services.
The right hon. Gentleman referred to concerns about CQC’s capabilities in Oxfordshire, and I am aware of local media attention on that. My officials have raised those concerns with CQC and they were assured that it is on track to achieve its goal of inspecting 100% of adult social care locations across Oxfordshire by 31 March, that its Oxfordshire compliance team now consists of 10 full-time inspectors and that, after a period of recruitment, CQC has had no vacancies in the area since last December. If concerns continue, I urge the right hon. Gentleman to contact me and I will be happy to look into them further.
The importance of commissioning must be stressed. Commissioning over short periods of time—that race to the bottom—is unacceptable. We must commission on the basis of quality, as the hon. Member for Leicester West said. Finally, let me thank the right hon. Gentleman for securing such an important subject for debate.