Covid-19: Response

Lord Turnberg Excerpts

Wednesday 3rd June 2020 Lords Chamber

[Lord Bethell]

My Lords, I bow to the experience and wisdom of the noble Lord, Lord Patel, particularly in the matter of racism in the NHS. I would not for a moment suggest that there is no racism at all in the NHS—or any large organisation—and I deeply regret any bad experiences he may have had. The accusation, however, was of structural racism in the NHS, and that is what I push back against. The NHS as an organisation is not racist, and I reject the suggestion that it is.

As for the matrix of success, that is an extremely perceptive question, and a bloody tough one—exactly the kind I would expect from the noble Lord. To summarise, it is to reduce R: if we can get a lid on R0 and stop the index case from spreading the disease to more people, then Test and Trace will have succeeded.

[Lord Turnberg (Lab)]

My Lords, like the Minister I too went to have my Covid test recently. There was hardly anyone there—lots of testing stations but no customers and no queues. I was in and out in five minutes. I was not surprised, therefore, that while 200,000 tests a day are available, many fewer are being taken up. I ask the noble Lord, therefore, whether the Government will open testing to the wider public and not restrict it to those with symptoms. There are many asymptomatic carriers and we need to know who they are and where they are.

I also reiterate the question about how soon test results will be available in hours rather than days. We can do it, but when will it be rolled out?

Covid-19: Care Homes

Lord Turnberg Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

My Lords, the guidance has been reviewed by the CMO, and we stand by it. I can confirm that all patients leaving hospital for care homes are, as a routine, tested. When they arrive at a care home, they are treated as if they might have Covid, and they are put into an area of isolation, until either the test has come through or their diagnosis has been confirmed. This is a way of protecting care homes, and it is necessary to continue the traffic of people from hospital to care homes, in order to have the beds available for those who need them more.

[Lord Turnberg (Lab)]

My Lords, among the many reasons why we have done so badly in protecting our care home residents from this dreadful illness is the almost complete lack of adequate public health services at the local level. A few years ago, when I was chairman of the then Public Health Laboratory Service, we had a robust network of public health expertise in every locality which did all the testing and tracing of infectious diseases across the country. All that has been eroded over very many years, and I fear we have lost that local expertise—the doctors and the other staff that could have done the job that we are now left struggling to fulfil far too late. I ask the noble Lord whether he will make it a priority now, as a matter of urgency, to begin to fill that huge gap in our network of local public health services.

[Lord Bethell]

The noble Lord is more expert on the history of public health than I am, but I do not doubt the story that he talked about. I reassure him that Covid has definitely made us all think again about the very clear priority that local public health provision must and will provide. I would like to pay testimony to those public health officials—public health directors, environmental health officers, infection control officers—who play, and are currently playing, a huge role in controlling the epidemic.

Covid-19: Social Care Services

Lord Turnberg Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Turnberg (Non-Afl)]

My Lords, I want to raise three questions with the Minister. None of them is entirely novel since they concern testing, how we treat care home staff and the logistics of government control. Those who are gifted with hindsight can see clearly now where the Government have gone wrong. But you do not need to have much of a retrospect-a-scope to know that we have been extraordinarily slow in recognising that care homes were ticking time bombs, full of closely gathered and extremely vulnerable elderly people, being looked after by carers who had long been the most underappreciated and undersupported of health workers. One might have thought that this combination was a disaster waiting to happen but, rather than getting into the blame, we must look at what is needed now.

First, in order to get a much firmer grip the Government should appoint a Minister or, better still, a well-respected authority to oversee the logistics of providing protection to care home residents and staff. Whoever is appointed should have that as his or her sole responsibility. It is no good dissipating responsibilities between different parts of the Government. It should be one person with no other responsibilities, focused entirely on co-ordinating the response and reporting regularly to Ministers. Is this already happening and, if not, can it be undertaken sometime soon?

Secondly, it is now clear that we seem to have more capacity to test people for the virus than people able to access the tests. The reasons why care workers and residents cannot do so have been well rehearsed in the debate so far, and the answer is obvious: we must take the test to those who need it. I hear that the Government intend to set up a system of mobile testing units, which can go around care homes and elsewhere, and that the Army will be involved. That is a step in the right direction, but can the Minister say how quickly that can be scaled up? Why do we need the Army when taking samples from staff and residents requires only about an hour or so of training, and we have a huge number of volunteers ready to help?

Thirdly and finally, we have been debating in this Chamber—for ever, it seems—the parlous position of care home staff: how underappreciated, poorly paid and unregulated they are. Several noble Lords, including my noble friends Lord Hain, Lord Hunt, Lady Pitkeathley and Lady Wheeler, talked about the terrible position they are in. The coronavirus is now transforming our neglect of them into a form of hero worship. We must take advantage of this new-found recognition to change the way we show our appreciation as we come out of these horrible times. Whatever we do, we must recognise that a majority of our care homes are in the private sector, where they have long struggled to keep their head above water. We must include them in the rescue. Local authorities need support now. I ask the Minister: when the Government at long last come to their review of social care, will they put the conditions of care workers right at its heart?

[The Deputy Speaker]

I apologise, but I ask the noble Baroness, Lady Warwick of Undercliffe, to close the box that has a small cross on it, in the middle of the command bar. If she could do that, that would help, as the screen is distracting for others.

NHS: Targets

Lord Turnberg Excerpts

Thursday 6th February 2020 Lords Chamber

[Lord Turnberg (Non-Afl)]

My Lords, I am grateful to my noble friend Lord Hunt for getting this debate and setting out the facts in such a devastating way. I heartily endorse his words. May I also say how much I appreciated the maiden speech of my noble friend Lady Wilcox? It was a breath of fresh air.

When I saw the announcement about this debate, I thought: “Here we go again. We will go around the well-worn track of rising demands from an increasingly ageing population needing more and more expensive treatments, while at the same time we suffer from inadequate staffing levels, poor buildings falling to pieces, lower morale and barely enough money to keep our heads above water.” While many patients seem satisfied, and indeed many—as we have heard—praise the services for acute, one-off care, the long-term sick and disabled are poorly cared for, especially by community services.

Of course, both the NHS and social services need more money. We are still way behind the level of 10 years ago and have some way to go to catch up, but we have to face the fact that if we are to match demand to resources, we will have to be much cleverer and more efficient in how we provide care.

I will talk about just two things that we must do, with or without the additional funding that we desperately need. First, we must find a way of bridging the gap between the way we fund the NHS and the way we fund social care. The current divide is a nightmare of inefficiency.

I will give noble Lords an example. Imagine an elderly gentleman sitting in a bed in a crowded NHS hospital, having been brought in following a fall in which he injured himself. He has been repaired and is ready for home, but he lives alone. There is no one there to look after him as he recovers and no obvious places available in the local care home. It is a weekend, and no one is available in the social care department until Monday. Meanwhile, patients are piling up in the A&E department, waiting for the bed that the current occupant is keen to leave. That is the normal Catch-22 situation in far too many places.

Now imagine another situation in which the hospital trust itself has the budget for social care, employs its own social care staff in the community and funds its own care homes. It does not have to negotiate with any other organisation when it wants to bring in or discharge any of the patients in its community. It simply uses its own resources. It is the integrated, undivided care system that we have long been talking about. I fear it is the one I have been banging on about for ever.

That system has been in operation for some years now in Salford, in the hospital where I happily spent most of my working life, Salford Royal. David Dalton, the then chief executive, gained the confidence of the local authority so that it was happy to hand over the social care budget for the common good of the whole population of Salford—250,000 people. He used it very well. Indeed, the hospital trust now runs Salford’s mental health services and employs a number of GP practices, so that the whole care system works as one. Staff morale is high, as they recognise that they are all involved in providing high-quality, efficient care. I should say that David Dalton took advantage of my having left Salford to undertake all these changes.

So it is possible to run an effective and efficient combined NHS and social care service that works and saves money, but why have we not been able to spread that system more widely? Of course, much depends on the personalities locally and the confidence they can gain to trust each other, but should the Government not be providing the push and stimulus to combine these services, inadequately funded though they both are? There are likely to be many variations on the theme of integrated services. For really radical change, the Treasury should be changing its funding model and merging these two streams. Meanwhile, will the Minister spend a little time examining what can be done short of that, perhaps even by visiting Salford, where a number of previous Health Secretaries have already been, to see how it can be done and then persuade her colleagues in the department to bestir themselves?

Briefly, my second concern is the care and support of our staff in the community and in care homes. It is no secret that these workers are the lifeblood of care in the community and we rely on them absolutely to look after the huge number of people that I fear society has tended to ignore. Yet these critically important staff are vastly underrated, underappreciated and underpaid. It is a scandal. Of course we should pay them more—at the moment, they would not even reach the lower cap that would allow them entry from the EU—but equally importantly we should provide them with not a voluntary but an obligatory training programme, give them a qualification and offer the possibility of career progression. We certainly need to do more to give them the respect and recognition that they rightly deserve.