Covid-19 Update

Lord Turnberg Excerpts

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.

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.

Health Service Safety Investigations Bill [HL]

Lord Turnberg Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Lord Turnberg (Non-Afl)]

My Lords, I should declare my interest after a lifetime spent in the National Health Service and as a past president of a medical royal college, so of course I welcome a Bill on patient safety, even if it may be some time before we see it again. I am sorry to sound a rather negative note, but as I read the Bill, I did wonder how it would work in practice. I became increasingly concerned that, in its present form, it may not have the balance quite right between the major themes of investigation of serious qualifying incidents and the need to encourage local clinical staff involvement—and whether, because of that, it will frustrate its purpose of improving patient safety. This point has been made by several noble Lords who have spoken. So I thought it might be worth trying to see how the Bill would have worked if it had been in operation back in the 1970s, when I was involved in a rather tragic case of my own—I am afraid that I go back rather a long time.

I was a consultant physician in Manchester in 1978 or 1979 when we had an elderly patient in the ward with a gallstone stuck in her bile duct, blocking the flow of bile. She was in her 90s, frail and jaundiced and a very poor risk for an operation. So we decided on an experimental, non-invasive treatment in which we would try to dissolve the stone by infusing a solvent directly into the bile duct via a tube through her nose. All went well until one evening a junior doctor on my unit came in to inject the next dose of solvent. Instead of injecting it through the nasal tube, she put it into a drip going into the patient’s vein—a very big mistake, which, I am afraid, caused the tragic death of the poor lady. Noble Lords may imagine how devastated we all were when we realised what had happened.

Now the immediate question was how such a tragic event could happen and who was to blame. These are the questions that might be posed under this safety investigation Bill were it in operation, but then it was me and my team who tried to answer the questions. Was the junior doctor who gave the injection at fault? She might have known better if she had understood what we were doing when she came on our ward rounds. Or perhaps it was the registrar on call, who was not around at the time and should have supervised her in this new type of treatment. Or perhaps it was the nurse, who came with her and handed her the syringe. One might have expected her to have known something about it. Perhaps the pharmacy that sent up the injection was at fault. They should have labelled the solvent more clearly as not for intravenous injection, perhaps with a fitting that could not fit on to an IV line. Or of course perhaps the fault lay with me for not giving clear enough instructions to my junior staff. I was certainly the one who shouldered the burden of breaking the news to the relatives that we had made a huge error that caused the death of their loved one; and it was I who appeared before the coroner.

Forgive me for using this sad case, but it illustrates the catalogue of errors—a multi-system failure—that can have such devastating consequences and where ascribing blame to individuals is so fraught with difficulties. But more important than the blame game is what one should do when it happens to prevent it happening again. I can tell noble Lords what we did and ask what might have happened if the Bill in front of us had been enacted.

First, we did not try to make any excuses to ourselves or to the relatives. We were completely open. I said how sorry I was that it had happened, in the belief, like the noble Lord, Lord Hunt, that saying sorry that someone has suffered is never a mistake; it is an expression of sympathy, and the fear that saying sorry leaves one open to litigation is just untrue. I have never believed that a sense of compassion is a confession of guilt. Then we initiated a full inquiry with all the staff—the doctors, nurses, pharmacists and everyone who was engaged—into the causes of the tragedy, and we made a full set of recommendations that were applied at every level.

The question now is in what way this new Bill would have helped or hindered this process. It is very unlikely that it would have prevented that particular episode from happening, but would it make it any easier after the event? Would it have encouraged us to report to the new statutory body for investigation? And would that have improved patient safety? There was no criminal intent by anyone in our case, yet the Bill seems to hint at that sort of investigation rather than for errors of judgment. Perhaps more important is the question of whether it will inhibit medical and caring staff from disclosure of mistakes.

The Explanatory Notes start off in fine form talking of providing a safe place and the promotion of learning throughout the NHS. They talk of providing advice, guidance and training and of the need to learn from mistakes so that helpful information can be spread. All that sounds admirable and would no doubt have been helpful in our case, but when one reads the Bill itself the accent is on investigation by an external body with little sign of the encouragement that will be so essential if anyone is going to admit to their errors. If it is going to be effective, it will need to shift its focus from top-down, external, big-brother investigation to providing the safe place where practitioners can really feel free to come forward with their difficulties. Certainly it should be capable of thorough investigation where it is needed, but on many more occasions—we heard from the noble Lord, Lord O’Shaughnessy, about how many occasions—support is needed to help to ensure that the much more common errors of judgment are not penalised and that lessons can be learned from them. The emphasis in the Bill is, to my mind, too far over to the external investigation side and not enough to the encouragement of practitioners to come forward to engage with learning lessons from their errors. I am not convinced that I would have been more or less open than I was all those years ago.

I shall finish with a word about the role of the medical examiner proposed in the Bill. I presume that it is the same person whom the GMC talked of years ago. The important question has always been about where busy doctors will find the time to take on this role. If it becomes a statutory position, will it take, say, one session a week? It probably will not, but it might. If so, will we be able to fund 10% more staff simply to cope with this important duty? Perhaps it will take less time, but it will still take time and staff, and without the funds that will be necessary, it will not happen as we hope. Can the Minister explain?

I fear I may have sounded somewhat negative about this Bill, but that is not because I do not think we need to focus hard on improving patient safety now more than ever. However, I remain somewhat unconvinced that this Bill will fill that need sufficiently well. The accent here is on investigation of serious cases, and that is fine. There is some overlap with the GMC and other regulatory bodies which are doing a good job. What we need, and what I hope we will see in the Bill after the election, is a shift of focus to the encouragement, engagement, involvement and support of those who are directly responsible, at the coalface, across the field, for the safety of patients, so that they can freely admit when things go wrong and learn from their mistakes. It is because these words—encouragement, engagement and involvement—are missing that I fear the Bill will not achieve what we hope for. The Minister used the words “completely candid”; I remain to be convinced that this Bill will encourage candour in the way she hopes.

Vaccine Hesitancy

Lord Turnberg Excerpts

Monday 1st April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness raises a very important point which is that while social media can be used to spread disinformation or misinformation, it can also be used in a positive way to spread the positive value of vaccinations. That is why we want to work with those who have doubts about vaccination to highlight the benefits of vaccinations, the protection that they bring from the very serious diseases which she highlighted and how safe they are. A wealth of information is available online through trusted NHS channels which will enable parents to make well-informed decisions about getting their children vaccinated. I encourage the noble Baroness to highlight in her event next week some of the channels which are available and which we will continue to push.

[Lord Turnberg (Lab)]

My Lords, vaccination programmes are the most effective public health measures we can imagine. I have two questions. First, what are the Government doing to ensure that pharmaceutical companies are encouraged to develop new vaccines for diseases? Secondly, I understand that some schools have made it imperative for parents to ensure that their children are vaccinated before they can attend the school. Is this something that we can extend?

[Baroness Blackwood of North Oxford]

The noble Lord raises an important point. There are global shortages of some vaccines on occasion and, when that happens, discussions with manufacturers are ongoing. There is also ongoing work to develop new vaccines. That is part of the life sciences strategy and sector deal, which the noble Lord may be aware of. Public Health England advises clinicians on how to prioritise available vaccines when these situations occur.

I think that I covered the question of compulsory vaccinations and schools that restrict access to vaccinations in my first Answer. Public Health England and clinicians do not believe that this is the appropriate route, as medical care in the UK is delivered by informed consent. Generally, those who are hesitant about vaccinations respond better to people working closely with them to explain the benefits of vaccines and how safe they are; otherwise, the risk is that children will be withdrawn from schooling entirely, which would be a much worse outcome for the children involved.

Health: Pancreatic Cancer Treatment

Lord Turnberg Excerpts

Wednesday 19th December 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness makes a very important point. I am sure that she is aware of the 14 Be Clear on Cancer campaigns that have been run over the last eight years, which are absolutely about raising the salience of these issues and making sure that people know the signs they should be looking for and can come to GPs earlier. We are seeing fewer people presenting with cancer diagnosis through emergency departments, which have the worst outcomes, and more coming through GPs. Of course, as I said, we are investing in these rapid diagnostic centres as well.

[Lord Turnberg (Lab)]

My Lords, the problem with pancreatic cancer is that, by the time a patient has symptoms and a diagnosis has been made, it is almost always too late. It hides itself away for far too long. The only way to make a real impact is by having some sort of method of determining whether someone will get pancreatic cancer by having a screening programme. That depends very much on new research into the ways in which we can detect cancer cells from DNA and the peripheral blood. Research into that area is vital if we are to make any impact on pancreatic cancer. Does the noble Lord agree?

[Lord O’Shaughnessy]

I absolutely agree on that point. I hoped we would pass the “Lord Young test” with a jargon-free and, at least, succinct White Paper—the Life Sciences Sector Deal 2, which we published recently. It outlines some very important commitments to research in this area, including the creation of new early diagnosis cohorts, using a cohort of healthy people to look for early signs. That is one of the investments we are making, as well as investment through the National Institute for Health Research. We are looking for those exciting innovations, like liquid biopsies, that can help us get the signs earlier.

NHS: Specialist Services in Remote Areas

Lord Turnberg Excerpts

Tuesday 11th December 2018 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, there is one important way in which patients in remote parts of the country can access specialist care: telemedicine. It is quite easy to send X-ray pictures, scans and blood test results online, and even to interview patients. I send things via WhatsApp to my children almost every other day. It is entirely possible for me to do that on my iPhone; surely the NHS can do it too. I understand that Wales has managed to do it quite well. Is it possible for us to do the same in England?

[Lord O’Shaughnessy]

The noble Lord is right. Of course it is possible for us to do it in England; it is happening all over the country. Telemedicine offers fantastic opportunities, such as Skype-based GP consultations. Indeed, there is the example of Morecambe Bay’s remote clinician pilots in a variety of specialisms, such as gastroenterology and mental health care. Clearly, that is important. I point the noble Lord to the tech vision published by my relatively new Secretary of State this autumn, which points out the massive potential for digital health in reducing these kinds of inequalities.

Adult Social Care

Lord Turnberg Excerpts

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right that there is a need for more money in the social care system. That is why, in addition to the funding set out in the spending review, the Government have put £9.4 billion over three years into the system in the short term. The point he makes, which is right, is about the long-term sustainability of the settlement. I would point him to the seven principles underpinning the Green Paper, which my right honourable friend set out. One of those is a sustainable funding model—a model which, as we have said, cannot put pressure on the NHS. That means that we need to find the money to ensure that it can subsist.

[Lord Turnberg (Lab)]

My Lords, the noble Lord is well aware that we need more money for social care, and that integrated care is vital. He may also be aware that Salford has successfully integrated health and social care. I am sorry to keep banging on about Salford, but it is where I spent many happy years working. It has done it very successfully, and Sir David Dalton has led it wisely. What lessons are being learned centrally, not just from abroad but from the UK and similar experiments?

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and he is absolutely right to highlight Salford, as he always does, because it is the root of the integrated care service being put in place in Greater Manchester with unique devolution powers, and we want to see that model rolled out across the country. Of course, the point of that is to ensure a better interface between the National Health Service and social care, so that one of the problems that bedevils us at the moment—delayed transfers of care—does not get in the way of proper care.