NHS: Long-term Sustainability

Lord Turnberg Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I too thank the noble Lord, Lord Patel, for his very wise words when introducing this debate; I would expect nothing less. What a pleasure it was to hear the maiden speech of the noble Baroness, Lady Ramsey; I am sure we will hear more from her.

The excellent Library report for this debate suggests that there may be little benefit in seeking new ways of funding and new systems of delivering the NHS. I was reminded of the economist Maynard Keynes, who said that any proposed change should not only produce improvement but be sufficiently better to make up for the evils of transition. We have seen plenty of evils of transition over the years. I will focus on one set of problems among the many which need attention.

The difficulties faced by patients coming to hospitals have been well rehearsed: crowded emergency departments, queues of ambulances waiting outside, long waiting lists for patients needing to be admitted, cancelled operations—the list is endless. I am acutely aware of them as someone who has spent most of his working life in hospitals. However, if there are to be any solutions, they must be found outside hospitals and in the community, where social, community and primary care are hardly coping under their loads.

This is where the problems for hospitals, and for everywhere else, arise. Age UK noted that 700,000 elderly patients were attending emergency departments because they could not get an appointment to see their GP. Over 15% of acute hospital beds are occupied by patients waiting, sometimes weeks, to get out of hospital. Some patients wait so long for care in the community that they are much more ill by the time they reach hospital. It is therefore little wonder that hospitals are overwhelmed. So, I make no excuse for focusing on the problems in the community, as other noble Lords have. They have been accumulating for many years. Local authorities’ funding has been squeezed to the point where they clearly are not coping. Because almost two-thirds of their budget is spent on social and community care, these are being cut to the bone.

We now have far too many vacancies for health visitors and district nursing posts. Meals on wheels has disappeared and support services are squeezed out completely. Yet demand for social care is increasing. There were almost 2 million requests to social care departments in 2023, and waiting lists are growing. Some wait many months for assessments and when they get to the front of the queue, they have to go through a tortuous and bureaucratic process that few can understand. As others have said, it is a two-stage system: an assessment of whether they really need support, and of whether they can afford to pay. Few can understand it, and few can pass.

Then, there is the problem faced by the very large number of people cared for at home by relatives and friends. Many such carers give up paid employment to look after their relatives. If they apply for help and if they can get through the mountain of bureaucracy, they may be able to receive £76.75 per week—ludicrously low recompense when it is recognised that this huge number of independent carers, several million of them, are saving the Exchequer vast amounts of money. Surely, we can do better than that.

Finally, I will shine a light on what is a disgrace in social care: the way we treat our social care staff. We treat all NHS staff badly, but care staff are at the bottom of the pile. Not only are they the poorest paid employees, who can earn much more in jobs outside caring; they are also treated badly for the vital role they play. They do not have a nationally recognised training programme or an approved and registered qualification. The lack of a professional qualification or the prospect of career progression causes many to leave caring within the first 12 months. Some 10% of jobs are vacant—approximately165,000 vacancies are currently advertised—and high sickness and absentee rates are far too common. The picture I have described has been creeping up for years.

Will the Minister look again at how to make the careers of care home workers sufficiently attractive, so that we can retain as well as recruit them? Will he press for them to have professional qualifications after recognised training programmes, along with the prospect of career progression? Will he reduce the distressful level of bureaucracy faced by applicants for social care? If there is any more money—and quite large amounts were being bandied about last year that have not become visible on the ground—it should be focused where it would have most impact: on community and social care.

Pandemic Preparedness

Lord Turnberg Excerpts

Monday 15th April 2024 Lords Chamber

[Baroness Chakrabarti (Lab)]

My Lords, the Minister says that we have a—

[Lord Turnberg (Lab)]

My Lords—

[Noble Lords]

Turnberg!

[Lord Turnberg (Lab)]

My Lords, some years ago, when I was chairman of the Public Health Laboratory Service, we had 31 public health laboratories dotted around the country. Their role was to track and trace the sources of infections. We lost those in a review of the Public Health Laboratory Service, and I resigned as a result of that. What a loss that has been. What efforts are being made now to replace those laboratories which can do the track and trace that we desperately need?

[Lord Markham (Con)]

As the noble Lord mentions, one of the key pillars is having diagnostic capability. The noble Lord will be aware that, for the sequencing of all the different Covid strands, it was the UK that they were sent to because our diagnostic and sequencing ability is second to none. I am assured that that capability still exists and, with that, our ability to scale up diagnostic testing very quickly.

Cancer: Staffing

Lord Turnberg Excerpts

Thursday 14th March 2024 Lords Chamber

[Lord Markham (Con)]

As I mentioned, that was very much the big feature of the discussion that I had with the president of the Royal College of Radiologists just the other day. We have been growing the number of radiographers by about 3% every year, which is a good rate, and we look to increase that even further. The CDCs are about that. However, the actual demand is increasing by about 5% every year. Clearly, as well as recruitment, we need to make sure that we have effective diagnosis, and this is where the field of AI is very exciting. The radiographers are 100% behind it, because they really see the revolutionary effect it is bringing.

[Lord Turnberg (Lab)]

My Lords, we are certainly shortly of staff, and the problem is not increasing recruitment but enhancing retention. Staff are leaving because they are disillusioned and disaffected, and we do not treat them well enough. Any large business knows that, if you have a happy workforce, it will be productive. We certainly do not have that in the NHS. We certainly need to stop this dismissive attitude and enhance the conditions of their service, and it is not simply about pay. Does he agree?

[Lord Markham (Con)]

I totally agree that it is a range of things. I completely agree with the noble Lord that a good employer should be looking to make sure that employees have good working conditions and feel valued, and that there is an understanding culture in the workplace as well as decent pay. I say all this in the context that the workforce in the cancer space has actually increased by 56% since 2010, so it is not as if there have not been massive increases here. The actual number of treatments and diagnoses has gone up by more than 20% from pre-pandemic levels. So we are doing a lot in this space, but I agree with the noble Lord’s basic premise that we need to ensure that staff feel valued so they will want to carry on working.

Care Home Staffing

Lord Turnberg Excerpts

Thursday 18th January 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct that the recruitment of personal carers is harder. I know that this is close to his heart. I can probably serve him best by giving him a written reply setting out the details of what we are doing.

[Lord Turnberg (Lab)]

My Lords, to make this an attractive job for a care worker, we have to not only give them a pay rise above the national living wage, which is their basic pay, but make this into a profession. If they are professionals, they will then have a career structure that is recognised nationally. Will the Minister encourage that development?

[Lord Markham (Con)]

Yes, I totally agree. That is why we announced this career pathway last week, to try to do exactly what the noble Lord is talking about. It has been welcomed; I quoted from ADASS, but a number of other bodies have welcomed what we are trying to do. We aim to do what the noble Lord said: to make it a profession that people really want to join. There are qualifications for it, advancement and apprenticeships, which are all part of setting up a career structure.

NHS App: Medical Records

Lord Turnberg Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct. As the noble Lord, Lord Allan, said, there are many good uses for the app and data. As we all probably know, AI is only as good as the data that underlies it. The good situation we have—it is lovely to have a story for Christmas cheer—is that our 50 million primary care and hospital records are probably second to none around the world. We are already using that to positive effect, such as for image reading and using AI for cancer scans and strokes. We can also use that data for intelligent screening and, in future, for cause and effect to find cures, hopefully one day even for dementia.

[Lord Turnberg (Lab)]

While it is obviously important to control confidentiality of patient data, it is vital to be able to use data for medical research. Much research, such as epidemiological research, the relationship between smoking and ill health—obesity, diabetes and all sorts of diseases—would not be known much about unless we were able to handle patient data. In the rush to control, let us make sure we can still do research with patient data.

[Lord Markham (Con)]

Absolutely; it is about getting that balance correct. I welcomed the support of all sides of the House when we were introducing the FDP. A lot of work was done with noble Lords on that. The fact that the federated data platform was as well received as it was in the circumstances is because of support from all Members of the House on all sides, knowing the vital role of data in improving health outcomes.

Cancer Research UK Report

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Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

I do not think that the Government have come to a view but I understand the point. I will take that back to the department and the Treasury.

[Lord Turnberg (Lab)]

My Lords, we are doing reasonably well with certain cancers—leukaemias and breast cancer—but very badly with pancreatic cancer and colon cancer. Most of these are asymptomatic for a long while, until it is too late. We desperately need a test that will indicate that there is a disease coming. What research is being done in this area and what money is being spent on it?

[Lord Markham (Con)]

The noble Lord is absolutely correct that, while we have made good progress in many areas, pancreatic cancer is the hardest one and one where we need to do more. That is true all around the world, because the symptoms are so hard to detect. I will happily write with the details to give him an answer on that.

Sexually Transmitted Infections

Lord Turnberg Excerpts

Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

We are leading the world in all these areas. In a recent survey across the European nations, we came out top in sexual and reproductive health services, which I want on the record. Just last week, everything that we are doing in the HIV space was recognised as part of all this. This is another area in which we are looking to widen access as much as possible. I mentioned the examples of an online service in Brighton and, to the noble Lord, Lord Hunt, Pharmacy First. We are looking to make sure that access and testing are as widely available as possible.

[Lord Turnberg (Lab)]

My Lords, chlamydia is a cause of infertility. A vaccine has been developed and is in use. How far have we got with the programme of vaccination against chlamydia in both boys and girls?

[Lord Markham (Con)]

The noble Lord is correct: about 50% of all cases are of chlamydia, and it is undetectable in a lot of people. That is why we have started screening programmes of chlamydia in women, so that it can be picked up when it has been undetected, which we know can be done. As the noble Lord mentioned, we have a programme of chlamydia vaccinations for both females and males. From memory, I think the rate of boys vaccinated is about 30%, but I will come back in writing with the exact numbers.

NHS: Performance and Innovation

Lord Turnberg Excerpts

Thursday 15th June 2023 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I am extremely grateful for being able to speak in the gap. May I say how much I resonated with the speech by the noble Lord, Lord Scriven? I will follow him by talking not about the problems of the NHS—there are far too many of those—but about three possible innovations that might help.

The first relates to the integration of services within a locality. An innovation was introduced by David Dalton in Salford Royal Hospital and the whole town of Salford, with a population of 250,000. He arranged to oversee the care not only in the hospital but in the community. He employed GPs, set up the social care requirements, some social care homes and the mental health services. It was all under his control, and the local authority gave him the funding to do it. He did it locally. This was local innovation: local development of an integrated service with patients’ records available to all those involved in the care, including pharmacists. It was a remarkable innovation at the time. But it has not been followed to any great extent. There is lots of talk about integrated systems boards, and so on, but we need more of that sort of arrangement.

Second is public health and the preparedness for the next outbreak of a pandemic. Many years ago, probably before the Minister was born, I was chairman of something called the Public Health Laboratory Service. It was disbanded in 2004. It was changed to Public Health England and has had several other iterations since. One of its main attributes at the time was that it had a network of peripheral laboratories dotted around the country in every district, with specialists in public health. They detected outbreaks of E. coli infections, testing the water and the food. They were there to detect outbreaks wherever these occurred in the country and reported them straight back to the central laboratory in Colindale. In that way, we had a network that could detect and deal with infection as it occurred, wherever it was in the country. Unfortunately, it was a Labour Government who pruned the Public Health Laboratory Service and removed the network of laboratories that we had around the country. My second plea is therefore for the Government to reintroduce a service of that type, which involves peripheral laboratories.

Finally, the third point I wish to make is one that I have banged on about for some time, and which the Minister is probably bored of: social care, and the ability to give social care workers the respect they deserve by giving them career prospects, training, graduation and qualification. My time is up, but those are my three points.

General Practitioners: Recruitment and Retention

Lord Turnberg Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend makes a good point: if we are investing eight years in training, in the case of a GP, to ensure that they are at the top of their profession, so to speak, it is reasonable to expect them to work for a number of years in the UK so as to make good on that investment.

[Lord Turnberg (Lab)]

My Lords, one way of encouraging retention would be to relieve GPs of the burden of having to manage their service by making them salaried employees. How far have we got with that proposal?

[Lord Markham (Con)]

I actually think the partner model works very well for a lot of people and has been the bedrock of our GP service, as we know, since the beginning of the NHS. However, what is critically important is reducing the admin so that GPs can get more face-to-face time. Again, at Greystone House surgery in Redhill on Friday, I saw excellent examples of where those admin duties are being taken away so that doctors can do what they want—and are best trained—to do, which is face-to-face treatment of patients.

Social Care

Lord Turnberg Excerpts

Thursday 30th March 2023 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I also thank my noble friend Lady Andrews for introducing this debate in such an inspiring way. I was not a member of her committee and nor was I, for obvious reasons and much to my regret, a member of the Archbishops’ Commission, but I can hardly express ignorance of the reports or of the many reports that have come out before this, so I am fairly well informed.

We have become so used to debating a situation that has been a disgrace for so long that it has become a sort of constant background noise that we have managed to ignore. For example, we are all fully aware that, for many years, large numbers of patients have been stuck in acute hospital beds quite unnecessarily, when they would be much better cared for in the community, but they cannot be moved, sometimes for weeks, because there is no one out there to look after them. Nowadays, it is almost as difficult to get out of hospital as it is to get in. If that phrase sounds familiar, it is because I have used it many times before in the more than 20 years that I have been in this House. I may be a bit of a bore on the subject, but I will emphasise a few more obvious facts.

As others have mentioned, the number of patients who need care in the community is rising as the population ages, yet the number of staff available to support them is going down. No one seems surprised by that anymore. In my few remarks, I will concentrate on the workers on whom this whole shaky system is dependent; it is they with whom the buck stops.

The care workers’ lot is not a happy one. Recruitment is difficult and retention is worse. The turnover rate of care home staff is 35%; that is a third of staff leaving every year. I have heard various figures, such as 105,000 adult care worker vacancies advertised every day and 15,000 fewer filled posts last year than eight years earlier. As we have heard, pay is a significant factor in this poor recruitment and retention. An average of £9.60 an hour means many can earn more in jobs at Tesco or Amazon, and about a third of them are on zero-hours contracts, as we have heard.

But it is not just about pay. We must pay them at a rate commensurate with their responsibilities, but it is about much more than that. These workers are at the bottom of the feeding chain: they are underappreciated, underrated and underrespected. We know that nurses and doctors are widely respected in the community, but not care workers. There are no media articles extolling their virtues and no TV programmes or films with them as heroes. They are the neglected end of the health and social care system. “Entrenched invisibility” was the phrase I heard today, yet we absolutely depend on them. So many of the problems in the NHS—bed blockages, ambulance queues, long waits in A&E and departments on trolleys waiting for beds—are due directly to the paucity of care in the community. So it is here, with the care workers, that we should begin.

As we have heard today, we must give them the recognition and respect that they deserve, by not simply giving them a salary that recognises their important roles but much more than that. We must offer them a training programme that is both mandatory and nationally recognised. We must then give them a professional qualification and a place on a national register. Only in this way will they hold their heads up as qualified professionals, along with the prospect of career progression within care work or even on to a nursing career as, for example, nursing auxiliaries. Will the Minister please ensure that something along those lines is included in the long-awaited social care plan?

I know that this is not a novel set of proposals. I recently took a rather unrewarding look back at some of the speeches I have given on this topic in the Lords over the very many years that I have been here. I am more than used to not being listened to—how could I not be, having been married for more than 50 years? On this occasion, at least, I hope the Minister will give me a little more encouragement.