Queen’s Speech

Baroness Verma Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Verma (Con)]

My Lords, I refer to my interests, as listed in the register.

It is welcome that the Government have referred to social care in the gracious Speech. However, adult social care is in crisis and has been for a number of years. The issues of cost and funding will only get more difficult if Governments are not willing to see the social care sector through the same lens as they see the NHS. As a provider of homecare over the last 20 years, I am aware that, with a reduction in funding and in the time available for care workers to deliver care calls, the increasing requirements imposed on providers by local authorities cannot be met.

We all recognise that we have a growing ageing population. Living longer should be not a burden but a celebration. It should be recognised as a sign of improved living standards. However, it appears that, although politicians are willing to go out and actively and publicly claim their admiration and affection for the NHS—they are absolutely right to do so—it is not about loving the NHS so much as loving the people who work in it and the people who are looked after by it. Why cannot politicians do the same in relation to the incredible and challenging work carried out by those delivering adult social care within our communities? Millions of people depend on the services of trained, poorly paid care staff, who provide a lifeline to families struggling to care for their loved ones.

I will focus on adult social care, predominantly around the older age group. Care staff deliver care across all age groups and to people with varying degrees of disabilities, whether they are physical or unseen disabilities. For far too long, the social care sector has required a fundamental shift in how that care is delivered. Instead of tinkering around the edges with intermittent small injections of funding to fend off crisis after crisis, a total rethink is needed of how care within the community setting is delivered. There is already a challenge in making the care sector an attractive place to work. Pay is low and the working conditions are deeply challenging, and an expectation of increasing responsibilities is making care work an ever-demanding job that offers few benefits but increases stress for both care workers and families.

Recruitment in the care sector has hit an all-time low. Providers are worried about the tone that has been taken in the Brexit debate on immigrants and immigration, and they fear that care provision will face serious employment problems. Filling vacancies is already extremely difficult. It is unrealistic to assume that the gap will be filled by local people because, as is evident in the NHS, those posts have always required immigrants to come in to support our critical infrastructures. The Government are talking about a points-based system and skilled workers being welcome in the UK. However, unless we are able to provide home-grown workforces to deliver for an increasingly ageing population, our hospitals will have further expensive challenges thrust upon them.

A realistic and pragmatic approach has to be taken to respond to the challenges that we face. Unless there is a fundamental shift in how care provision is viewed in this country, people who have worked throughout their lives and contributed to the growth of this great nation will increasingly be airbrushed out of society and out of government commitments. They are not seen as vote-winners or contributors. Although we have a housing crisis, it should not be acceptable for people wishing to downsize to smaller properties as they get older to have no available provision, or choice about where they spend their later years. Going into a residential home or a nursing home should not be among the few options available. It seems that, once you have less to offer, you are redundant and surplus to requirements, and can be put out of sight and out of mind. What a reflection of the country we are becoming.

The one inevitability in our lives is that we will grow old. Surely, it is not beyond our wit to develop a care system that provides care, dignity and independence. The feedback that we continually receive from our clients and their families is that care must be about more than just addressing physical needs such as washing, showering and toileting. It is about mental well-being and continuing to engage with the community at large. It is about being socially active and feeling valued. Offering a more holistic approach to care in a community setting would fundamentally reduce the pressures associated with people having to visit the NHS.

Although we talk about NHS staff with affection, care staff in the community are viewed in a completely negative way. Both systems support people in our communities, yet the care sector, which acts as a complete support system for millions of families, is, unfortunately, disregarded. I urge the Government to rethink how care provision is delivered and funded, and not to make it the Cinderella arm of looking after people. The demands associated with health and well-being will not reduce; instead, as we grow in number, they will increase. Unless we see a fundamental shift in how care provision is funded and care staff are rewarded in their pay packets, this crisis will most definitely grow and create unsustainable pressure on the NHS.

Brexit: Health and Social Care Workforce

Baroness Verma Excerpts

Thursday 13th December 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the right reverend Prelate for the opportunity to say that we value every person who works in this country in those professions. We want to ensure that they are able to stay and contribute to the health and wealth of our country. I point out we are improving both recruitment and retention not only through increases in the living wage but through changes to the Agenda for Change pay deal concluded earlier this year. It will give 1 million staff at least a 3% pay increase by the end of 2018-19, and increase the starting salary of a nurse by nearly 10% to almost £25,000 by 2021.

[Baroness Verma (Con)]

My Lords, we all value the increased living wage—I speak as a provider of social care, and my interests are listed in the register. Will the Government ring fence the extra funding that they rightly put into social care, so that local authorities have to pass it on to providers? Providers have increased costs, and we cannot pass the money on to our care workers because we simply cannot afford it.

[Lord O'Shaughnessy]

I recognise the picture that my noble friend paints. It is of course incredibly important that money gets to the front line. I am sure that she is aware of this, but I would point out the operation of the Better Care Fund, which brings together local authority and NHS funding specifically to support social care provision. The amounts of money going through that have been increasing over recent years.

The NHS

Baroness Verma Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Verma (Con)]

My Lords, I am delighted to speak in this debate celebrating the 70th anniversary of the National Health Service. I join all noble Lords in congratulating the noble Lord, Lord Darzi, on opening the debate. The NHS is proudly the envy of the world but, with the increase in population and the discovery of new illnesses and diseases over time, we need a fresh way of looking at how it will function in the next 70 years. In saying this, I would like to speak about a part of the health service that is often seen as a separate arm but really should be an integrated and well-bedded key component of the delivery of care that the NHS must provide.

I declare an interest as a provider of adult social care, through a business I started 18 years ago. Since that time, we have seen huge changes both to the National Health Service and to social care. In my opinion, we should see them as two parts of the same ecosystem. Instead, they have had to fight for budgets and space within the political debate.

There seems to be a huge deficit in the understanding of how social care is delivered and how well funded the social care system should be to support the NHS. Every day, we hear politicians saying how much they love the NHS. It does not matter from which part of the political spectrum they come, but this mantra never includes the words that they also love social care. Until we have a radical change in our thinking about social care, understanding that it is part and parcel of the delivery of support in the health systems, the burdens on the health service will continue to increase and the funding of social care will continue to decrease.

An easy example to illustrate this is that, if you suffer from cancer, you would expect the health service to provide medical care and support to you free. Why then should someone who has dementia not have the same support at the point of need, just because they are being cared for in a residential setting? It is unjust to pit one type of illness against another, and it needs to be addressed, if we are to be a community that values justice and respect for everyone. With age come new challenges of illness specific to growing older. Does that mean that because we want people to live in their own homes we ignore their needs?

Social care is not just for the elderly; it also supports those with disabilities across the whole age spectrum, so it is high time to rethink how our health service and social care work are made to work as one. Social care has always been the poor relative of our healthcare systems yet, as we become more and more dependent on treating people at home, there is a large recognition that we are fast running short of adequately trained care workers to support people in their communities. The fact that funding for social care is delivered through local authorities and is never ring-fenced means that often any extra funding from government may be used for other immediate pressures faced by local authorities. That cannot be right.

If adequate resources were put into providing people with access to well-trained and better paid care workers, it would have an immediate and huge positive financial impact on the NHS, in terms of improved exercise, dietary plans and mental well-being. How does the input of social care providers get integrated into Ministers’ wider thinking about policy? I urge the Minister not to call just on the work of clinical commissioning groups. We know that there are huge gaps in social care provision; trying to find people to work in the social care sector is getting ever harder. How does the Minister feel we are going to fill the gaps of doctors, nurses, therapists, cleaners and carers once we leave the EU? The NHS cannot change for the sake of change; the Government must understand that you cannot fix a problem unless you fully understand what all the solutions are.

Social Care

Baroness Verma Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I can absolutely provide that reassurance on the voluntary sector. The noble Baroness is quite right to highlight the vital role it plays—it is essential and critical to this sector. On falls, she will know just how important reducing falls is. The disabled facilities grant is increasing. It is not a well-known bit of government spending and not talked about much, but it amounts to about half a billion pounds a year. It can have a really big impact by keeping people in their homes for up to four years longer, reducing falls by 40%. It is something we have had the opportunity to discuss in this House recently. It is critical. She is quite right to focus on the frontier between health and social care and making sure that it flows and works well.

On child carers, I will write with more details about what the action plan covers, but clearly we will make sure that it looks at all carers, because a carer could be of almost any age. As she pointed out, it includes very young children as well as people in their 80s and 90s. A true carers approach would encompass all of them.

[Baroness Verma (Con)]

My Lords, I thank my noble friend for the Statement. I refer to my registered interests. I will ask my noble friend about two issues. The first is respite care, which seems too often to be missed, particularly when there are reduced services. Services have been cut back for many service users. When family members have to manage the burden we need to have some discussions on extra respite support. Secondly—I am a broken record on this—we need seriously to look at the value we put on paying care workers a proper return on the work they do, given the extra responsibilities being put on them all the time.

[Lord O'Shaughnessy]

I am grateful to my noble friend for raising both those points. She is quite right about respite care. Local authorities have a duty to provide it, but I also note that there is pressure on the system. Indeed, the issue of one particular respite home, Nascot Lawn, has been raised. It is something I am interested in and I am looking at it. I will take that point away. We are trying to look at the care service in the round, so respite care must be part of that.

My noble friend is right about paying care workers properly. We have increased the national minimum wage, now moving on to the national living wage, precisely to provide a proper recompense for people who work in that sector and, critically, to start to provide a proper career structure so that people can move on, add to their skills and progress while staying in the caring profession.

Adult Social Care in England

Baroness Verma Excerpts

Tuesday 10th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I agree in part with what the noble Baroness said in the sense that demographic change represents a big challenge. She mentioned the over-100s. The population of over-85s will double between now and 2037. As the CQC report makes clear, many of those people will have difficulty with the basic behaviours and actions they need to be able to live independently. That is the big challenge that we face. The report provides a very honest exposure of strengths and weaknesses in the current system. The strengths are there, though the noble Baroness perhaps did not give them as much credit as they deserve. The report says:

“Overall, the quality of care remains relatively stable, with the majority of all care rated as good and improvements in some services”.


Indeed, only 1% of services are rated inadequate. Clearly we want that percentage to be zero but it is better than in other sectors. I do not disagree with the noble Baroness about the demographic challenges we face. As I said in my first Answer, we are trying to put more funding in, to recruit more staff and raise quality now that we have this national threshold. We hope to decrease variation and then look for a long-term solution that will solve this problem that we have all been wandering around for the last 20 years.

[Baroness Verma (Con)]

My Lords, as a care provider for the last 17 years I say humbly to my noble friend that we need to pay care staff a proper wage so that they can actually have a life that is not just about existing. I am told constantly that local councils are being given extra funding. It is not trickling down to the providers and there needs to be a really serious look at the level of funding and at what we are entitled to pay care staff, because with Brexit around the corner we are going to need ever more of our own homegrown talent to provide those places.