Covid-19: Social Care Services

Debate between Lord Turnberg and Baroness Finlay of Llandaff

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.

Medical Innovation Bill [HL]

Debate between Lord Turnberg and Baroness Finlay of Llandaff

Friday 12th December 2014 Lords Chamber

[Lord Turnberg]

My Lords, the purpose of the amendment is to ensure that all attempts at innovation are recorded, not simply those that are successful. A voluntary register might allow those who have some mishap with their innovation not to register. The whole point of having a more than voluntary register is important. I am very supportive of the amendment.

[Baroness Finlay of Llandaff (CB)]

My Lords, I hesitate to intervene, but I think the amendment is extremely important. There is a principle of audit in medical practice, of going back and looking to see whether what you think was going to happen is what happened. There is also the process of the appraisal and relicensing of doctors, and a need to report, in that process, where problems have occurred. The advantage of a properly maintained register is that it would support an audit. If there is a doctor who is overinnovating, if I could use that phrase, beyond the amount that we would expect given the patient population, it would also ensure that that would be easily and rapidly picked up.

The point made by the noble Lord, Lord Turnberg, that there is a tendency for people to record good results but not bad results, is important. There is a move, in the publishing of the results of clinical trials, to request that all results, negative and positive, are published and in the open domain. The amendment, as far as I can see, would be consistent with that move and pressure for openness. It would also provide transparency. I have not spoken to other amendments on this, but this amendment may go quite a long way to allay some people’s fears, which I think are completely understandable—in fact, the fears of all—that things could be going on under the radar in a way that is not transparent, open and properly audited.

Health and Social Care Bill

Debate between Lord Turnberg and Baroness Finlay of Llandaff

Wednesday 29th February 2012 Lords Chamber

[Lord Turnberg]

My Lords, I am afraid that my name is not attached to the amendment moved by the noble Baroness, Lady Cumberlege. I was not quick enough to get in the queue of people who wanted to get their names on this, but I have been banging on a little about the disappearance of the HPA and the need for an independent body just as is described in this amendment—and even better in the other amendments seeking a special health authority. I suppose we are not likely to get that this evening but we may be able to get somewhere with Amendment 162.

What I find very difficult to understand is why the Secretary of State would want to take this on. Having chaired the PHLS and then the HPA and now Public Health England, which is an even bigger body with even more responsibilities and a whole host of practical activities—scientific, laboratory, epidemiological—why would a government department want to take that on? Is it that it did not trust the HPA? Is it to save money? Did the HPA in some way fail? What is the rationale for the Secretary of State to want to take it inside the department and lose that level of independence, that ability to look outside and that facility to take advice from independent chairmen and members of the board?

If the department wants this job done—and I do not doubt that it wants this job done very well indeed—it cannot expect to do it as well within the department as an agency that was directly responsible and directly answerable to the Secretary of State but had that degree of independence that would give confidence to the public and the profession that it was doing a good job. I find it difficult to imagine why that cannot be done, and I do not understand the reasons why not.

[Baroness Finlay of Llandaff]

My Lords, I also did not put my name on this amendment because there was not enough space for more than four names.

I have a concern that the Health Protection Agency itself may have been a bit like a prophet in its own land and that it was not recognised fully until now, when we see its disappearance, just how important the work is that it has been doing, both nationally and internationally. Apart from already earning money for the UK, its potential to carry on doing so in the emerging large economies in other parts of the world and expanding its scientific input is enormous. It has the role not only of public health but of anticipating what threats may emerge in the future, particularly in the range of toxins that it looks at and studies.

These amendments seem to solve a problem that we have all heard about. We have all been at meetings; we have all met with the relevant people. I really hope that we will not just get told that this cannot happen for a variety of reasons. The amendments seem to be solving a problem that has only been created as a result of these changes. I cannot see that there is anything to lose, except that if the amendments are not accepted we might lose the capacity to earn international research funds in the future.

Health and Social Care Bill

Debate between Lord Turnberg and Baroness Finlay of Llandaff

Wednesday 29th February 2012 Lords Chamber

[Lord Turnberg]

My Lords, my name is attached to Amendments 121, 122 and 126. I will not repeat the wise and reasonable words of the noble Lord, Lord Patel, who presented the case for these amendments very well. As an honorary fellow of the faculty, I am privy to all its innumerable e-mails and newsletters which set out many of its concerns—and it has many, as I am sure the noble Baroness is aware. These amendments will go a little way to assuage some of those difficulties and they fit very well with the Government’s intentions.

The publication of the Department of Health’s document, Public Health in Local Government, on the role of the director of public health sets out well the intentions of the Government. They may not be strong enough but they are certainly entirely appropriate. Amendments 121 and 122 go some way to putting in the Bill the emphasis that the Government intend from their own document. I hope that the noble Baroness will see fit to accept these amendments.

Amendment 126 deals with the tricky business of disease outbreaks and the role of the director of public health. Again, the noble Lord, Lord Patel, emphasised with examples the sort of problems that can arise in a situation where responsibility for public health is with local authorities but is also with the health service. I am a former chairman of the Public Health Laboratory Service, which dealt with outbreaks of infections around the country and had a very strong co-ordinating role. For example, leaving aside the two examples mentioned by the noble Lord, Lord Patel, if you have an outbreak of food poisoning in two separate parts of the country, you do not know whether they are connected unless you are able to do the special tests—the special serology—that is done centrally and in a co-ordinated way between directors of public health.

What is unclear—Amendment 126 goes some way to help this—is that, in emphasising the need for the director of public health to work closely with Public Health England, the documents that have been produced are a little silent on the relationship that the directors of public health will have with Public Health England. That is a key interrelationship that has to be fostered. It should be much clearer. Perhaps this amendment does not do it far enough but at least it leads us in that direction.

Two other areas are not talked about in the document. There is a rather weak statement about the role of the local authority in ensuring continuing professional development and training and education. We have covered training and education in other amendments and the Government have been very helpful in that regard. Here we have a slightly different situation with the local authorities being responsible for the contracts for directors of public health and their staff. There is a role in education and training for them. How that will be achieved is not entirely clear; nor is it entirely clear how the local authorities will be encouraged to ensure that the directors of public health can undertake research, which is an important element.

The documents that the Government have produced make great play of words such as “innovation”, “leading the field” and “keeping ahead”. We cannot do that without research, so it is important that research comes in here somewhere. I hope that the Government will listen to this.

[Baroness Finlay of Llandaff]

My Lords, my name is attached to Amendments 121 and 126. I will not repeat the arguments that have already been laid out so clearly by my noble friend Lord Patel. However, as regards Amendment 126, in an emergency clear lines of communication are absolutely essential and must be worked out. Indeed, they must be tested before the event.

We do not need to think only about infections. We need to think about toxins, accidental or deliberate releases of all kinds of chemical substances, and all kinds of contamination that can be a threat to public health. When an emergency arises, the problem is that it is too late to work out those clear paths of communication and access to essential resources. Provision has to be made in national planning.