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.

Osteoporosis: Early Detection

Lord Turnberg Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

As a player of rugby, which probably has far too many impacts, I agree with the sentiment that exercise is always a good thing, whatever stage of life one is at. Also, we all know that vitamin D is a vital part of helping against bone weaknesses. Things as simple as spending more time in the sun in summer or taking vitamin D supplements in the winter are vital prevention methods. I agree about exercise, but all these measures should be rewarded and promoted.

[Lord Turnberg (Lab)]

I am sorry to correct the Minister but vitamin D does not affect osteoporosis. It is helpful for osteomalacia, the softening of the bones due to vitamin D deficiency, but not very useful for osteoporosis. Exercise is valuable, and at any age it is the only thing that prevents osteoporosis. There are treatments available for osteoporosis but they are not very nice—they involve injections—and are quite expensive. Exercise is the thing.

[Lord Markham (Con)]

I thank the noble Lord. As I say, part of the beauty of this job is being educated. I will take that back to my officials and query them on my briefing.

Respiratory Syncytial Virus

Lord Turnberg Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

Yes. I should probably declare an interest, having set up a PCR business—in the private sector, I might add. I know at first hand from that how versatile these PCR machines are. They can be used to diagnose all these sorts of treatments, so we absolutely have to make sure we keep that strategic capacity alive.

[Lord Turnberg (Lab)]

My Lords, we were obviously ill prepared for the Covid outbreak. How prepared does the Minister think we are now for track and trace and delivery of PCR tests? What resources do we have in place to cover that?

[Lord Markham (Con)]

We have the PCR capacity in place. Clearly, as responsible Ministers spending-wise, we are ramping some of that down because we do not need the sort of capacity we had before. From personal knowledge, I can promise that there are a lot of these PCR machines knocking around, so that capacity really is there. There was a Question a few days ago about how prepared we are for the next epidemic. Clearly, we will get the findings of the Covid inquiry, but the whole purpose of setting up the UKHSA was to make sure we have the proper preparations around for next time.

NHS Winter Pressures

Lord Turnberg Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

I wholeheartedly agree with my noble friend that the pharmacies are the front line. We realise that they have been underutilised in the past. Actually, the plan of using them more for patients will put more funding their way, which I hope will support them, just as allocating Covid vaccinations to many pharmacies provided support. I hope my noble friend will see that this plan should add to the viability of a number of pharmacies by putting more business their way. They are a crucial part of the front line.

[Lord Turnberg (Lab)]

My Lords, this focus on the number of hospital beds may be at the wrong end. It is much more fruitful to think about why staff are so dissatisfied and unhappy that they wish to leave and do so in droves. We have to do more to improve the morale of the nursing and medical professions and, in particular, those who work in the community—the care workers. We are losing them in great numbers; they are not coping. The reason is partly their pay, and we must pay them a reasonable rate, but it is also that they are completely disillusioned as people do not take them seriously. They do not have a professional qualification or a proper training programme. They do not have the possibility of career progression. We must do more to encourage them and ensure that they have a satisfactory career. If we do, we could possibly get more patients out of those beds that were building up, and perhaps help reduce the queues of ambulances.

[Lord Markham (Con)]

I agree that we need a whole-system approach. Workforce is a key part of that, including the adult social care workforce. Again, as all noble Lords did, I welcome the advent of the agreement to do a workforce plan, which needs to take all these factors into account. We need to make sure that it is an attractive place to work, and that people see it as a career progression—and that it is modular so that you can start in social care and, if you want to, progress into other parts of the health service.

Hospital Beds: Social Care

Lord Turnberg Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

We are absolutely aware that we need long-term plans and forecasts. That is also one of the things that the healthcare workforce plan will take into account: it will look at exactly where the capacity needs to be on a regional basis going forward so that we have the right number of hospital beds and social care places for an elderly and growing demographic in terms of age groups.

[Lord Turnberg (Lab)]

My Lords, is it not the case that patients are stuck in hospital because social care staff are leaving in droves? They are leaving because they are not respected, not given a career and not paid sufficiently. Should we not be doing something about retaining these vital social care staff?

[Lord Markham (Con)]

The number of care workers is key to all this and I delighted to say that the latest data shows that we are back to the levels of April 2021. Too many people have left, but we have managed to fill the gaps with the international recruitment fund and other measures. We all agree that we need to progress that further, but we are now making the increases that are needed in this space.

Streptococcus A: Antibiotics

Lord Turnberg Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Markham (Con)]

My understanding is that there are measures in place to ensure that the people supplying in those circumstances are not losing out because of profiteering. The most essential message today is that that supply is available to anyone who needs it, so I will take that back.

[Lord Turnberg (Lab)]

My Lords, is it the manufacturers in the pharmaceutical industry or the wholesalers—the middlemen—who are making the profits? What mechanisms are available to clamp down on them?

[Lord Markham (Con)]

The key mechanisms always involve broadening the supply chain. I have given exactly that instruction to the department, which is very much taking it on board. It is looking at supply across a number of sources, not just from the UK but worldwide, as well as the substitution of antibiotics. Penicillin is currently the advised one, but a number of others are being advised right now which will also work well, so that there is as much choice as possible.

Adult Social Care

Lord Turnberg Excerpts

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

I have not read the report, which was published a few years ago—I will always stand up and say when I have read something and when I have not, and will not pretend to have read something that I have not. But I am aware of the issue. I was a local councillor many moons ago and am aware of the issue of the narrow tax base on which we are sometimes asking to draw, so it is a much wider question. That is why I am glad that a lot of this funding has come from central government as a down payment towards that. As I have mentioned many times, I accept that we need to find some long-term solutions in this space.

[Lord Turnberg (Lab)]

My Lords, the question of pay is very important of course, but the other element is the respect and self-respect that a professional is due. That can come only if they have a nationally recognised training programme, qualification and registration, none of which they have. Will the noble Lord think about how we might achieve that? At least that will bring more people into the profession.

[Lord Markham (Con)]

I agree with the noble Lord that we need to make this an appealing profession and, as the noble Lord says, that involves more than just pay. We know that retention is vital, so I agree that having it properly recognised professionally is the direction of travel. At the same time, I am very glad to say that, for a lot of the money we are talking about—the £2.8 billion next year, for instance—some 70% will trickle down into wages, so I am pleased that it will actually be felt in the pockets of the carers, which again will help with recruitment and retention.

Health: Pancreatic Cancer

Lord Turnberg Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct: pancreatic is probably one of the cruellest of cancers. We have a 10-year cancer plan; to answer his question, we are going through 5,000 responses, and we are analysing them and will report back shortly. On research, we are performing over 70 different pancreatic cancer studies. Key to all of this is not just early diagnosis; more important than ever, in this awareness month, is making sure that people are aware and go to their doctors early if they have any concerns at all.

[Lord Turnberg (Lab)]

My Lords, one of the problems of this nasty cancer is that, by the time any symptoms occur, it is often too late. We desperately need some sort of screening test. Recent research has suggested that we may be able to pick it up in the bloodstream using a so-called liquid biopsy. What research is being done on this now?

[Lord Markham (Con)]

I understand that the leader in this field is GRAIL. This blood screening is happening in America right now, and NICE is undertaking studies in this field to see whether it should be brought to the UK. We will have its findings. I agree that pancreatic cancer is an area where early detection is key. It is not just about the screening but about people going to their doctor if they have any concerns at all, as I say. We have non-specific symptoms pathways to help doctors to detect what is wrong.

NHS: Nurses

Lord Turnberg Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

I totally agree that retention and attracting people into the profession are key. I like to think that we are looking at all these things in the round, taking into account the £5,000 grant, the service they are giving, and their conditions and pay going forward. As ever, this is a moving feast, for want of a better term, so we will keep looking at it to make sure we continue to both attract and retain the domestic and international staff numbers.

[Lord Turnberg (Lab)]

My Lords, have the Government made any assessment of the reasons why so many nurses are wanting to leave, and, if so, what remedies are being suggested by them?

[Lord Markham (Con)]

The Nuffield study was very interesting: of the reasons for people leaving, 43% said retirement, 22% said it was for personal reasons, and 18% said it was due to too much pressure. Again, in quoting those figures I accept that there is work we need to do on this. Clearly, 18% leaving due to too much pressure is something we rightly need to be concerned about. I know that is why we set up the 40 mental health and well-being hubs with a £45 million investment, to look at whether we can address some of those pressures. Most of all, though, I completely agree that we need to recruit as many nurses as we can so that we have as big a supply as possible to ensure that we continue to relieve any pressures that exist.

Nursing: Recruitment

Lord Turnberg Excerpts

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct that this is a long-term pipeline. We have 72,000 nurses in training at the moment. To be clear, there is no cap at all on student places. We are seeking to increase them as much as possible, and we put a £5,000-a-year grant in so that trainee nurses could enjoy superior levels of financial support than other students. The fact that we have a pipeline of 72,000 shows that this is working, but that pipeline is not capped, so if we can get more people in, we definitely want to do that.

[Lord Turnberg (Lab)]

No matter how many nurses we try to recruit, we never seem to catch up with the rate of loss. What are the Government doing to help retention of nurses? We must try to encourage them and support them to stay. What plans are there to do that, and what plans have the Government got to bring back nurses who have left or retired?

[Lord Markham (Con)]

First, we are actually exceeding the number of leavers. There were 36,000 people who left last year and 45,000 who joined—a net increase of 9,000. That is not to say that we do not want to retain people. I absolutely accept the premise that we do, which is why we have a retention programme in place to ensure that we are able to do so. We also have a restart programme to help people who have left to get back into nursing in a quick and easy way. Overall, the main point here is that the number of joiners is exceeding the number of leavers. We are more than catching the number up; we are exceeding it.