Care Workers: Foreign Worker Visas

Baroness Fraser of Craigmaddie Excerpts

Wednesday 18th June 2025 Lords Chamber

Asked by

[Baroness Fraser of Craigmaddie]

To ask His Majesty’s Government what plans they have to increase the number of care workers across the United Kingdom once care worker visas for foreign workers are discontinued.

[Baroness Fraser of Craigmaddie (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as chief executive of Cerebral Palsy Scotland.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the Government are reducing reliance on international recruitment in adult social care and working to improve domestic recruitment and retention. In England, we are introducing the first fair pay agreement for adult social care, implementing the first universal career structure and providing £12 million this year for staff to complete training and qualifications. These changes will help attract staff to the sector, and provide proper recognition and opportunities for them to build their careers.

[Baroness Fraser of Craigmaddie (Con)]

I thank the Minister for her Answer and apologise if it feels like Groundhog Day, because I know she answered a very similar Question from the noble Lord, Lord Wood, on Monday. As the Minister well knows, solving the recruitment and retention crisis in this sector is long term, will take cross-party work and has many regional variables. In her Answer, she referred to what the Government are able to do in England, but in Scotland, where at the moment a quarter of rural and island carers come from outside the UK, we have a real issue. One provider said to me, “It’s not just about money. Despite paying above-average wages, we haven’t interviewed a British person for over three and half years”. In many rural and remote areas, agency staff are both unaffordable and unavailable. Will the Minister feed back to her colleagues in the Home Office that any cliff edge or one-size-fits-all approach that fails to take into consideration regional challenges threatens to devastate an already fragile service?

[Baroness Merron (Lab)]

First, I pay tribute to the noble Baroness for her leadership of Cerebral Palsy Scotland. As I know she is aware, adult social care is devolved, which is why I made reference to England only. I am very happy to raise the points the noble Baroness made with the Foreign Office—sorry, with the Home Office.

NHS and Care Volunteer Responders Service

Baroness Fraser of Craigmaddie Excerpts

Tuesday 20th May 2025 Lords Chamber

[Baroness Merron (Lab)]

There is a role for charitable organisations. One example is hospices. As I have been told many times in this Chamber, as well as outside it, many hospices and other charities, including air ambulances, welcome and relish the freedom they have as charities and do not want government funding or intervention. Of course, we very much respect and appreciate the role that the Air Ambulance Service plays. My own brother was saved some 10 years ago, so I feel very connected to this point. He is grateful, as am I.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I hear what the Minister says—that this is about a new scheme that will encourage volunteers within the NHS. However, sadly, data shows that instances of volunteering are declining across this country. Does the Minister know what measures will be put in place to ensure that all the volunteers who are currently on the scheme that is going to be closed are supported into whatever the requirements are in the new scheme? Having to go through DBS checks again, reapplying or anything like that might just put barriers in the way of supporting people who are already valued into the new scheme.

[Baroness Merron (Lab)]

I understand that point. It is important to retain and develop people’s interest and commitment. The new portal will be a one-stop shop and will be much better at achieving what the noble Baroness and I seek. I know, having heard about it already, that it has functionality that is not there now. I cannot currently put in my postcode and find out what volunteering opportunities there are, which seems ever so basic—we do that on many other fronts. The new portal will allow that. In other words, the potential volunteers will find it much more accessible and will be matched better. The standards of recruitment will be higher and we will retain people. The noble Baroness makes a very good point—it is why NHSE has written to everybody on the old functionality.

National Carers Strategy

Baroness Fraser of Craigmaddie Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare an interest as chief executive of Cerebral Palsy Scotland. Disabled adults of working age tell me that one of the reasons they have to fall back on family and unpaid carers is the dire shortage of availability of good PAs to help them work and live. Can the Minister confirm that the national carers strategy will look at access to PAs for working-age adults?

[Baroness Merron (Lab)]

I do have to say to the noble Baroness that I have not committed to a national carers strategy. However, in our joined-up approach, we will certainly be looking at what is needed. That will be very much part of our considerations on the workforce strategy, which Minister Karin Smyth will be leading on. It is crucial to the delivery of services.

Palliative and End-of-life Care: Funding

Baroness Fraser of Craigmaddie Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is absolutely right, and I certainly agree with the points she has made. Those who care for their loved ones are absolutely crucial to ensuring that the right care is provided in the right place and the right way for that person. Everybody is individual, and we want a society where everybody receives the right kind of care at the end of their life. That should be a time of dignity, and we want to provide that.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, people with neurological conditions face many barriers to accessing palliative care, even though it could do them a huge amount of good. The answers to this are better identification of individual needs and better collaboration between palliative and neurological services. Can the Minister assure me that she will look at this? There is a great inequity in access to palliative care. I declare my interest as a chair of the Scottish Government’s neurological advisory committee.

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise this, and I can give her that assurance. She raises the point about identification of people with specific needs. I am interested to see that there are some very good examples of local good practice—for example, in Dorset, where they have proactively gone out to identify who needs palliative and end-of-life care. By so doing, they have raised the percentage of the local population who should be receiving it. That is a model we will want to look at. With regard to those who have particular needs, as the noble Baroness describes, I think that model will be helpful too.

Covid-19 Inquiry

Baroness Fraser of Craigmaddie Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I am delighted to contribute to this debate on the resilience and preparedness of the United Kingdom. I take the point made by the noble Baroness, Lady Thornton, that this is only the first of a number of modules, but it came as no surprise to me that the module 1 report concluded that:

“Emergency planning generally failed to account sufficiently for the pre-existing health and societal inequalities and deprivation in society”,


and that there was

“a failure to engage appropriately with those who know their communities best, such as local authorities, the voluntary sector and community groups”.

I declare my interests as laid out in the register. I was at the time of the pandemic, and still am, the chief executive of Cerebral Palsy Scotland, as well as chair of the Scottish Government’s National Advisory Committee for Neurological Conditions. I have also given much written and verbal evidence to the Scottish Covid inquiry under the chairmanship of the honourable Lord Brailsford. I share the frustration of the noble Lord, Lord Browne of Ladyton, that politics got in the way of the Governments of Holyrood and Westminster working together, and I slightly despair that we need to have two separate Covid inquiries running at the same time. The conclusions drawn in this module by the noble and learned Baroness, Lady Hallett, resonate with my experience and the experience of people with cerebral palsy during the pandemic, and I will concentrate on that today.

Right from the very earliest days, cerebral palsy was cited by the UK and devolved Governments and in the media as being a specific condition that left you more at risk from Covid-19. This messaging, which was based at the start on very little clinical evidence, continued all the way through to the rollout of the vaccination programme, when people with CP were able to get their vaccinations early. However, it was coupled with the cessation of support services that this population relies on, which meant that people with CP and their families were left with considerable anxiety regarding what they should and could do to remain well.

In March 2020, with no consultation with disabled people themselves or the organisations that support them, all face-to-face services ceased. Community physiotherapy, occupational therapy and other AHP services were not deemed “essential”. Some adults with CP moved back to live with their sometimes rather elderly parents and family for lockdown, and some were too anxious about infection to allow carers into their home.

The inquiry’s report says that there was

“a failure to appreciate the full extent of the impact of government measures and long-term risks”

from the Covid pandemic

“on … those with poor health or other vulnerabilities”.

These groups were already vulnerable, and yet what was essential to keep them well was denied them because such services were not deemed essential by those who were making the decisions. This reduction in services, together with restrictions that left many struggling to manage their condition, caused isolation and increased anxiety that we are still struggling to recover from today—over four years later. Medication, for example, was seen as a priority but physical therapy, occupational therapy or speech and language services were not, yet for people with CP, these are as vital to access on a regular basis as medication is for other conditions.

The closure of schools in particular had an extremely detrimental effect not only on children with CP but on their families. Anxiety levels about the risks to children with CP were such that many families did not feel confident to send their child into school even if a place was available. However, school time for these children is more than just about providing education. It is where therapy appointments happen, it benefits mental health and well-being through opportunities for social interaction, and it provides vital respite for family carers. Many children with CP have one-to-one support for their learning in school, yet families were left to cope unsupported with the demands of physical care needs in addition to educational needs. Many parents also had to juggle the requirements of non-disabled siblings or potentially trying to work from home. It is unsurprising that this stress had specific physical and mental health consequences.

The problems caused by the lack of understanding of people with CP were starkly illustrated by the implementation of shielding. Despite the Scottish Government reaching out to organisations such as Cerebral Palsy Scotland, there was no coherent approach. Due to a chronic lack of data on this population, people with CP could not be identified centrally, so many approached their local GP or paediatrician, allied health professionals or social workers to ask to be shielded, and professionals would err on the side of caution and suggest that people did shield without much thought for the consequences. Many more people with CP chose to voluntarily class themselves as “shielding” compared with the actual numbers who received an official letter. Those people who received an official letter tended also to have other conditions, which meant that they were possibly more vulnerable to Covid as a result of comorbidities rather than CP, and they were certainly more visible to health professionals and easier to identify. However, it added to the picture of inconsistency, and we know that people fell through the gaps.

People did not understand the logic of who was or was not meant to shield, or where to go or who to ask for trusted information. The picture reported to Cerebral Palsy Scotland illustrated many variations across the country and that health and social care professionals, as well as people themselves, did not feel equipped to take decisions about their own level of risk.

I commend particularly the inquiry report’s recommendation 5 on improving data and research for future pandemics. I was glad to hear the noble Baroness, Lady Merron, address in her opening remarks actions that the Government wish to take on this. People with cerebral palsy are invisible to service providers. The lack of a cerebral palsy register meant that, although they were very visibly classed as vulnerable, health and care and educational professionals did not have adequate data to identify where these people were within their communities and, given the umbrella nature of the condition, it was impossible for them to identify who actually was vulnerable and provide them with adequate support, as opposed to those with milder CP, who could be reassured and who could have been at no greater risk from Covid than the rest of the population.

I hope the Government will take the inquiry’s recommendations seriously and will work in partnership with the devolved Administrations to improve our data and planning, and thus our resilience. Unfortunately, people with cerebral palsy remain invisible today, and I would welcome the opportunity to work with the Minister and her team to ensure that policymakers, service providers and professionals can identify this population, so that never again will decisions about them be made in isolation, with such devastating long- term consequences.

NHS: Neurology Care

Baroness Fraser of Craigmaddie Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. I had the opportunity to join the Neurology Alliance forum today, which was quite timely. I think its approach is entirely right in looking at what we can do to help people get on with an active life and back into the workforce, understanding that the economic impact of that is key. We have set up the neuroscience transformation programme, which the Neurology Alliance is on board with, which we think will tackle many of the issues that the noble Lord mentions.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare an interest as chair of the Scottish Government’s advisory committee on neurological conditions and as chief executive of Cerebral Palsy Scotland. People with neurological conditions are faced with navigating a very complicated maze of services straddling primary care, secondary care and social care. Some conditions have well-defined pathways; many other conditions, such as cerebral palsy, do not. If the Government are not going to look at an overall neurological strategy such as the one that we have in Scotland, what practical steps will they take to help people with neurological conditions navigate these confusing services, so that they get the right support at the right time?

[Lord Markham (Con)]

My noble friend is correct. The important step towards this was our appointment of the first national clinical director of neurology over the last year. The task force put out a progressive neurological conditions toolkit which sets out the pathways exactly as my noble friend mentions. It shows the treatments for over 600 conditions. This is a complex area so it is vital that the pathways are understood in each area and patients can understand how to navigate them.

Adult Social Care (Adult Social Care Committee Report)

Baroness Fraser of Craigmaddie Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I was privileged to sit on the Adult Social Care Committee, which was so ably and sensitively chaired by the noble Baroness, Lady Andrews. I thank her for her comprehensive introduction to the debate.

I found it incredibly hard to think of what to say; it has all been said many times. We know what needs to be done. I pay tribute to my noble friend the Minister for his work and perseverance in this area, because I know that he knows what needs to be done and that he understands this sector, but we do not seem to be moving the dial one iota for people.

I travelled down from Scotland this morning, and our experience of attempts to create a national care service is not one I wish to recommend to the House. So far, its development has cost £1.26 million in engagement, £1.38 million in staff costs, an accountability agreement with local authorities and the NHS and an inadequate skeleton Bill that has been delayed three times. As Scotland illustrates, the top-down approach does not work. It is expensive and futile and, despite all the time and money spent on it, not one person’s care in Scotland has been improved.

For me, the Government’s People at the Heart of Care is based on very sound conservative principles, but we will not enable people to have choice and control unless plans are backed up by funding and action. Our committee’s report illustrates how carers, paid and unpaid, are key to ensuring that those who draw on care can indeed lead a “gloriously ordinary life”.

We heard of the huge challenges experienced by people in being able to find good PAs. The Government acknowledged in their response to the report that personal assistants are “invaluable”, yet this crucial and apparently valued workforce is unregulated, too often paid only the minimum wage, on zero-hours contracts and not funded enough to be employed full-time, and has no access to ongoing training and no recognised qualifications.

The Government have promised to improve career pathways and opportunities for progression within the adult social care workforce, and have identified £250 million to do this. Can the Minister give us any details on how this is to be spent? How could it help more people access PAs? I have encouraged the Minister before to look at the charity ENABLE’s PA model in Scotland, and do so again to support this.

As the noble Baroness, Lady Andrews, said, unpaid carers carry a huge burden but are largely unseen, unappreciated and ignored. The Minister will not be surprised to hear me calling yet again for improved identification. The discrepancy in the estimated number of unpaid carers of between 2.4 million and 6.5 million in our report illustrates how woeful our ability to identify this key group currently is.

In May the Government updated their road map for better data for adult social care, which recognises that while a variety of various sources capture some information on unpaid carers, they lack consistency and coverage. As I understand it, a new regular survey focused on unpaid carers is to be created. Can the Minister give us any update on these plans?

The Government’s vision that data should be collected once and shared with those who need it is one of those common-sense statements that sound really simple, but that I know will be very difficult to achieve and implement. Who will social care data be shared with? Will people needing care and their unpaid carers have access to their data? There are examples given, such as GP records being shared with home care managers and authorised social care staff, but who is classed as “authorised” in this context?

My worry is that social care provision is still far too far down the priority list. At the recent party conferences, neither the Prime Minister nor the leader of the Opposition spent any time discussing social care. Even the Minister for Social Care spoke about integrated healthcare teams and community health services, not social care. She spoke about how we continue to look at health and care through the prism of the NHS, saying:

“It often feels like the acute hospital is like the sun in the NHS solar system with everything else spinning round it. But it doesn’t have to be that way”.


She is right. I agree with her, but until we turn the telescope around and focus on enabling people to lead a gloriously ordinary life, social care will always lose out.

National Health Service: Major Conditions Strategy

Baroness Fraser of Craigmaddie Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. The Government, and in particular my noble and learned friend Lord Bellamy on behalf of the whole MoJ team, fully support the noble Viscount’s remarks on the Powers of Attorney Bill and warmly thank him, Stephen Metcalfe MP and all the others for their efforts on the Bill.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I congratulate the Minister on concentrating on the importance of person-centred care, particularly for people with long-term conditions. I declare an interest as chief executive of Cerebral Palsy Scotland. Cerebral palsy is a good example of this, because we actually have very good NICE guidelines for the treatment of adults with CP but there seems to be nothing we can do to ensure that integrated care boards around the country follow those guidelines. Can the Minister explain why?

[Lord Markham (Con)]

My noble friend is absolutely correct, in that we are setting out the whole emphasis of what we are trying to do here. It is really ingrained in those pathways. It is about culture and behaviour as a whole, rather than a silo-based scheme, looking at the whole patient. Once we have got those pathways set up properly, it is Ministers’ job—I have mentioned before that we each look after six or seven ICBs—to hold them to account and make sure they are following those pathways.

Mental Health Services: Huntington’s Disease

Baroness Fraser of Craigmaddie Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

The plan with the neuroscience transformation programme is to give that pathway to every ICS, which it should follow and commission to, to make sure that specific treatment is in place. It is a complex area, as we all know. Again, as I understand it, there are more than 7,000 rare conditions. I want to be open about the ability to put in place a specific individual care co-ordinator for every one of those, but we need to make sure that ICSs have enough skills in their locker—for want of a better word—so that they can recognise the situations and make sure they are commissioning to the plan.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare my interests as chair of the Scottish Government’s neurological advisory committee and a trustee of the Neurological Alliance of Scotland. This is an issue not just for people with Huntington’s disease but for people with other neurodegenerative conditions, such as Parkinson’s. NICE standards for people with Parkinson’s recommend the prescription of Clozapine for hallucinations or delusions, but only psychiatrists are enabled to prescribe it; therefore, people with Parkinson’s do not have access to this treatment because neurologists cannot prescribe it. Will the Minister look at this? Maybe this is one way to ensure that people get the treatment they need.

[Lord Markham (Con)]

Yes, I think is probably the best answer I can give in the circumstances. I will absolutely do that and will write to my noble friend.

Adult Social Care: Challenge Procedures

Baroness Fraser of Craigmaddie Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

First, I take issue with the inadequacy comment. Some 89% of people expressed a high level of satisfaction with the social care provided, which, although not 100%, is pretty good, as I think everyone would agree. As I said, the workplace plan has been drafted. I am afraid I cannot give an exact date of publication—I believe there are local purdah issues now—but I can say that it will be soon.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, one of the things this House has heard about many times is our reliance on unpaid carers and the important role they play in helping people who draw on adult social care to navigate the system. The 2014 Care Act put a duty on local authorities to identify unpaid carers, but that is not happening. What can the Government do to identify unpaid carers, so that we can support them more readily?

[Lord Markham (Con)]

I thank my noble friend for that question. The Government absolutely recognise the role that unpaid carers play—I have fulfilled such a role myself for a number of years—and it something we are working towards. We have introduced the leave provisions and a certain level of payments for them; that may be modest but it is a step in the right direction. Again, the whole idea of getting the CQC in this space is that it can start monitoring local authority provision and ensure that it is identifying unpaid carers, among other things.