National Institute for Health and Care Excellence

Lord Turnberg Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question but also for highlighting the fact that NICE is trying to change the way it works to be more flexible and responsive. The new subscription-style payment model that the NHS is developing has been designed to try to address the lack of new antimicrobials being developed and the growing threat posed by antimicrobial resistance, or AMR. The recent guidance from NICE on the two new AMRs is a world first and an important step forward. What NHS England has now got to do is enter into negotiations with the manufacturer, with a view to making them available to NHS patients.

[Lord Turnberg (Lab)]

My Lords, NICE is a remarkably effective organisation, but is the Minister aware of the gross inefficiencies in the system which operates in order for health technology assessment approvals to occur? There is a huge number of committees through which this process has to go. Is there any way of reducing this nightmare?

[Lord Kamall (Con)]

I am aware of some of those issues, but I wonder whether the noble Lord could write to me with some more specific examples. In my meetings with various organisations, including the Health Technology Alliance and others, wherever they have raised these issues we have looked at them. The NHS, the department, NICE and others are trying to work with suppliers, manufacturers and providers to see how it can be more responsive. If we are going to realise the life sciences vision, we have to make sure that we make the best of the NHS as a global centre of excellence and show that we are at the forefront of research.

International Healthcare Outcomes

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Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

When we looked at the statistics, which clearly included data from the OECD, some were repeated from the Civitas report, which ranked the UK as quite good in some places and as needing more work in others. In 2019, the UK was ranked as having the fifth highest mortality rate out of 21 countries. Given that, in a long-term plan published in January 2019, the Government outlined commitments to improving stroke services, including better stroke rehabilitation services. Because we have a better understanding of strokes, we also have new ways of tackling the issue.

[Lord Turnberg (Lab)]

My Lords, I think everyone agrees that primary care is in disarray. I met a young general practitioner, aged 51, who was about to retire because she could not stand the pressures being placed on her. It is not simply a matter of manpower or workforce planning; it is a matter of doing something urgent now. What are the Government’s plans?

[Lord Kamall (Con)]

I had a meeting only a few days ago with the person responsible for primary care—a doctor herself. One of the issues we discussed is how we make more effective use of different levels of primary care. What is interesting here is that primary care has, over time, taken on some of the services that used to be provided by secondary care. At the same time, some of those primary care services are now being contracted out or delegated out to, say, pharmacists or physiotherapists, et cetera. We are looking at a solution-focused way of tackling these issues, rather than focusing on who provides the care.

NHS Mental Health Patients in Private Hospitals

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Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

I should remind noble Lords that the noble Baroness said that she was not against private provision out of principle. Private provision can be very helpful and has always worked with the NHS, ever since it was founded. If we think about responders—for example, the impact of lockdown on many people—we have seen an increase in mental health needs. What do you do to increase the provision of mental health services? Do you wait for a new NHS hospital to be built? No—if there is a private provider out there, or an independent provider that can provide those services, you engage them. That is why the NHS and the independent sector, working together, is a really important partnership.

[Lord Turnberg (Lab)]

My Lords, is the noble Lord aware of the Migration Advisory Committee’s report, which pointed out what we all know: poor pay is driving social care workers, including mental health workers, out of the service and into the private sector? For example, they are losing more through inflation than they can keep up with and their pay certainly runs behind private sector pay. I understand that a social care worker can earn more in an Amazon distribution centre than they can in the social care sector. Can the Minister bring to the notice of the Treasury the damage that this policy is doing?

[Lord Kamall (Con)]

The noble Lord clearly discusses an important point: we have to have the appropriate workforce. The Government have begun a register of social care to work out who is in the workforce, what qualifications they have and what improvements we have to make to social care. We should also remember that social care providers are a mixture of private homes and state provision. At the same time, we have to make sure that we have the right people, locally trained. For example, the visa system encourages people to come and work in our social care system as well.

Covid-19: Restrictions

Lord Turnberg Excerpts

Monday 14th March 2022 Lords Chamber

[Lord Kamall (Con)]

I can see that that may well be a reasonable request, so why do I not discuss what is relevant and perhaps write to all noble Lords?

[Lord Turnberg (Lab)]

Does the Minister agree that there is a link between the recent upsurge in cases and the decision to stop wearing masks on 1 March?

[Lord Kamall (Con)]

It is interesting that, when I was talking to some of the modellers and scientists about this, they said that whenever they look at models of changes in behaviour, they count in or consider that there will be some uptick because of people relaxing measures. Even though we are moving from a position where it was legal to where it is guidance, they reckon that number in, but they still felt that it was not significant enough not to go forward with the change in strategy.

Medical Schools: Training Places

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Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

When it comes to workforce plans, particularly in local areas where there is understaffing, we are very much focused on specialisms that are understaffed.

[Lord Turnberg (Lab)]

My Lords, we are losing doctors more rapidly than we can train them, and it has been like that for a while. The average age at which a physician retires is now 58; it used to be 62. What are the Government doing to help doctors stay in post and to bring them back part-time after retirement to help the NHS?

[Lord Kamall (Con)]

As the noble Lord will be aware, there is a temporary measure to bring doctors back, without affecting their pensions, which lasts until 2024. We are looking into whether that should be continued, as well as increasing the number of training places.

Health and Care Bill

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2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I draw attention to my previous career as a physician in various guises. Much more importantly, I welcome the noble Lord, Lord Stevens, and congratulate him on his maiden speech.

All Governments think they know what is best for the country and its population, and nowhere is that more obvious than in this Bill. It is full of valuable ideas and aspirations, which are undoubtedly welcome, but those aspirations are entirely dependent on two critical preconditions: first, stopping the damaging loss of clinical staff and, secondly, the rapid repair of the serious deficiencies in social care. That we have too few nurses and doctors in hospital and in general practice is obvious to anyone, and no one denies that we need a workforce plan for the future. Even though we know that similar plans have tended to be somewhat inaccurate in the past, we should make it a duty to have regular assessments of need every two years, as was called for in the other place.

But now the immediate problem is not so much recruitment but an unprecedented rate of loss of staff. There is a big hole in the bucket as staff have become overworked, frustrated and, far too often, at their wits’ end. Last year, we stood in the street and clapped our NHS staff in, but now, frankly, too many feel clapped out, so it is hardly surprising that nurses and doctors are tempted to leave the service. The average age of physicians retiring is now 58, according to the Royal College of Physicians, when it was 62 just two years ago. What a waste—and it is not helped by the ridiculous pension restrictions that mean the longer consultants continue to work, the more their pension is reduced. At the same time, nurses and support workers are too often in despair and GPs find themselves unable to cope with their growing workload.

Will the Minister now focus more on filling the hole than trying only to fill the bucket from the top? Will he consider new ways in which we can encourage retention: reducing non-clinical bureaucratic duties; introducing more attractive options during a clinical career; offering opportunities for nurses and doctors to come back into the service after retirement, perhaps into part-time sessional work; and sorting out the crazy rule on pensions that is such a disincentive to doctors? There is much that can be done now, through much more emphasis on retaining the workforce we have and on the return of those who have left.

I turn now to social care, which is in such a sorry state. Our patients in the NHS suffer too. According to the Royal College of Physicians, about 25% of medical beds are occupied by patients who would be much better off at home but who cannot get there. That is a quarter of beds used up when we desperately need more beds.

Of course, the White Paper on social care is a welcome step forward and, again, it is full of aspirations for the care workers on whom the service is entirely dependent. They do a tremendous job, and they deserve all the respect that we can give them, just as they respect those for whom they care. But it is clear that we do not give them that respect. It is not much wonder that they feel unappreciated, so that sickness and turnover rates are high, or that 42,000 care workers left the service in the last six months, according to the Nuffield Trust. We barely pay them enough, just around the living wage, but important though pay is, there is more to it than that. There is some training, run by their own organisation, but of course it is not mandatory. Just imagine being employed in such an important job for which there is no professional qualification, no official registration and no clear career pathway. In other words, it may seem to some a dead-end job.

I ask the Minister, as we have done many times in the past, whether he will offer our dedicated care workers the respect they deserve by making sure that they are paid at a rate commensurate with their responsibilities, that they can be registered, as every other health worker is, after a mandatory training programme, and that they have access to a career pathway in which they can see promotion as a reward for all their hard work. They deserve nothing less.

Crohn’s Disease and Ulcerative Colitis

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Thursday 15th April 2021 Lords Chamber

[Lord Bethell (Con)]

I am afraid that the management of public toilets is outside the reach of the department, but I will take that idea back to the department and write to the person responsible.

[Lord Turnberg (Lab) [V]]

My Lords, when I was a gastroenterologist, I knew that patients with inflammatory bowel disease did best when managed by a team made up of a gastroenterologist, surgeon and specialist nurse. Too often now, patients are denied access to such teams. In view of what the Minister has said, will this team approach be part of how we might correct this deficiency?

[Lord Bethell (Con)]

I would like to reassure the noble Lord that the scenario I described typically includes two gastroenterology consultants, a clinical intermediate fellow, a GP partner and a patient representative. It is exactly this kind of team approach that delivers the best patient outcomes, as the noble Lord rightly outlined.

Folic Acid

Lord Turnberg Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the consultation on the proposal to fortify flour ran for 12 weeks from 13 June to 9 September 2019 and was undertaken on a UK-wide basis. The pilot ran extremely successfully; the use of the supplements by the flour manufacturers was affordable and their implementation of the pilot was achieved without much disruption, and it was an encouraging experience that gives us good evidence for taking this matter forwards.

[Lord Turnberg (Lab) [V]]

My Lords, the science is clear that folate supplementation is absolutely safe and a remarkably effective public health measure. Does the noble Lord agree that further delay would be unconscionable, especially for the children still being born with spina bifida?

[Lord Bethell (Con)]

My Lords, delay is frustrating. I completely share the noble Lord’s frustration. Unfortunately, we are handling an epidemic and, once we have got plans in place for the second wave, we will turn our attention to this important and valued matter.

Medicines and Medical Devices Bill

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2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Lord Turnberg (Lab) [V]]

My Lords, I, like most other noble Lords, have been inundated with briefings from a range of interested parties. Of course, everyone sees the Bill as important and absolutely essential as we leave the EU, but there is a widespread fear that, as it stands, it leaves far too many uncertainties.

The main issue at stake is that the Bill has too little detail and leaves too many actions to the regulations that the Secretary of State may or may not wish to put in place at some unspecified date. It gives the impression that the Bill has been written in haste. The fact that the Explanatory Notes are longer than the Bill speaks volumes. Here are a few of the areas where we should seek greater clarity in the Bill and not in some uncertain future secondary legislation.

The first is the clinical trials directive. It is absolutely essential that we get this, or the successor to the EU regulations, right when those regulations are no longer available to us. Heaven knows we in the UK spent enough time trying to get the directive fit for purpose. I remember spending much frustrating time in Brussels arguing the case for the workable scheme that eventually emerged, and now it seems that we will have to start again with a UK version. The research community and the pharmaceutical industry are deeply concerned that, in undertaking the clinical trials essential both for patient safety and for the timely availability of new drugs, we do not place new barriers in their way.

Can the Minister reassure us that, whatever regulations we put in place, we can interrogate them and that they are entirely compatible with the EU schemes so that we can avoid all that time-wasting frustration of submitting applications to more than one body? There is a fear that anyone conducting trials in Europe will have to employ expensive lawyers in Brussels to sort out the problems. Can he also ensure that the MHRA is given a clear remit for what is likely to be its enhanced role and that it is given the resources necessary to take on the extra work?

While I am on about clinical trials, it is clear that for many rare diseases there are just too few cases in the UK alone and that trials of new treatments have to be done with the much larger populations available across Europe. We can do this now, but can the Minister tell us whether and how it will be possible to do so in the future? For the very many rare diseases—there is a large number of them—will we be able to continue trials across Europe without all sorts of hurdles getting in the way, and will we get the full alignment so essential if we are to encourage industry investment and if our patients are to receive new treatments as rapidly as those in the rest of the world? There are opportunities to sort out some of the issues surrounding data protection and confidentiality in relation to clinical trials.

Then there is the whole question of the safety of medical devices, on which we have the important and very impressive report of the noble Baroness, Lady Cumberlege. How could anyone listening to her impassioned speech today resist her pleas? Her recommendations are clear and necessary. Will the Government take them up? Will they ensure that Britain remains at the forefront in developing safe and effective devices by making all new devices before and after development registrable and trackable so that all outcomes can be monitored? Does the Minister agree that the appointment of a patient safety commissioner, as the noble Baroness, Lady Cumberlege, proposes, would be a very positive move? Patients certainly need some sort of shepherd to take them through the myriad regulatory bodies. They, and we, need that.

There are many other concerns with the Bill where matters are skimmed over and left to be dealt with by regulations that bypass parliamentary scrutiny. I hope that the Minister will tell us when he expects those regulations to be available and that he will help us to fill in those huge gaps.

Covid-19 Update

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Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

It is my understanding that many day centres will be reopened, although they will have to undergo a very careful risk assessment and, depending on the physical layout, may not be able to open at full capacity. However, I am happy to check that point and reply to the noble Baroness in detail. The issue of agency staff is a big problem, particularly where the staff are itinerant, but I remind her that we are embarked on a massive recruitment programme for the social care sector, including a large recruitment marketing campaign. That is bearing fruit and we are filling spaces very quickly.

[Lord Turnberg (Lab) [V]]

My Lords, when will the Government begin to make the test available to the whole population and not just to those with symptoms, so that we can discover the 80% of asymptomatic carriers? If there is a lack of capacity, why not use private and university labs around the country, as is the case at the Francis Crick Institute in London?

[Lord Bethell]

My Lords, there is very wide access to tests. Anyone who wants a test can apply for one today and, in almost any location in the country, will get one this afternoon. Whole-population testing is not the Government’s strategy, because testing at this level of prevalence would throw up more danger of wrong results than positive results. In terms of private and university labs, I absolutely pay tribute to the Crick, the University of Birmingham, the University of Cambridge and all other university and private labs that have contributed to the test and trace programme.