The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, my noble friend Lord Saatchi introduced this debate most compellingly and very movingly, and I thank him for bringing a subject of such importance to us and one on which your Lordships have considerable expertise, as this debate has amply shown.
Let me start, as many speakers have done, by focusing on the NHS. The unique and integrated nature of the health service has brought many advantages. Since the NHS was established in 1948, innovation has brought incalculable benefits for patients. Treatments have been improved, as has health policy. Inequalities have been reduced. Productivity has been increased. However, while the NHS is recognised as a world leader at invention, the spread of those inventions within the NHS has often been too slow, and sometimes even the best of them fail to achieve widespread use. It still takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice. This is not acceptable. Patients have the right to expect better health, better care and better value from their NHS.
We need to make sure that our staff can get the best, transformative, most innovative ideas, products and clinical practice spread at pace and at scale so that every patient benefits. That cannot happen without innovative minds working with the best resources in a creative and supportive environment. As the noble Lord, Lord Winston, reminded us so powerfully, research is an essential part of the innovation pathway. The Government’s investment in basic health research through the Medical Research Council underpins invention, and our investment in applied health research through the NIHR underpins evaluation. Translation of research is also vital for innovation to progress along the pathway. I hope that the noble Lord, Lord Patel, will be pleased to know that the Government are investing a record £800 million over five years in a series of NIHR biomedical research centres and units. These are translating scientific breakthroughs into better treatments for patients.
Demands on healthcare continue to rise for now and the foreseeable future. We must meet those demands from within our current real-terms funding, while at the same time improve quality. Accelerated change is not so much a goal as an absolute necessity. This means that doing more of what we have always done is no longer an option. We need to radically transform the way in which we deliver services. Innovation is the only way in which we can meet these demands. Spreading innovations in large disaggregated organisations is notoriously difficult. It is one of the biggest challenges facing the NHS. Systematic bottlenecks come with the territory. To make things harder still, technology adoption can be very complex, often requiring significant and disruptive reorganisation. New methods can require different expertise and mean new training, while care pathways have to be overhauled and existing procedures decommissioned. There can be financial barriers or issues of silo-budgeting. Of course, if we are to change this there have to be effective and efficient ways for innovations to reach the patients who need them. This must be across the NHS. That is why implementing the recommendations in Sir David Nicholson’s report, Innovation, Health and Wealth, is crucial. It set out a delivery agenda for spreading innovation at pace and scale throughout the NHS. Its programme is designed as an integrated set of measures that will together support the NHS in achieving a systematic and profound change in the way in which services are delivered.
The innovation landscape before the publication of IHW lacked transparency and accountability; there was variable compliance with NICE technology appraisals, and the picture was confused and cluttered with layers of organisations seeking to serve as gateways for interaction between the NHS, academia and industry partners. Value for money for patients, the NHS, UK plc and healthcare partners was, I have to say, doubtful and innovation was not a central priority throughout the system. IHW seeks to overcome barriers to innovation that have built up over decades, and aims to deliver long-term, sustainable change embedded right at the heart of the NHS. To do that, we need not only to change structures and process but, as the noble Lord, Lord Kakkar, reminded us, to change culture and behaviour—and this takes time.
Innovation is a top priority for the new NHS. This was most recently illustrated by the publication of its planning guidance on 18 December which clearly stated:
“All NHS organisations should demonstrate how they are driving innovation and developing delivery mechanisms for long-term success and sustainability of innovation in their health economy”.
To spread ideas right across the NHS means working collaboratively with all those who have an interest. I am completely in agreement with my noble friend Lord Ribeiro on this. This is why we want to see a more systematic delivery mechanism so that innovation spreads quickly and successfully through the NHS. This can happen in a number of ways, in particular through Academic Health Science Networks, or AHSNs. The NHS needs a stronger relationship with the scientific and academic communities and industry to develop solutions to healthcare problems and get existing solutions spread at pace and scale. AHSNs present a unique opportunity to align clinical research, informatics, innovation, training and education and healthcare delivery—exactly the issues highlighted by the noble Lord, Lord Winston. They will improve patient and population outcomes by translating research into practice, developing and implementing integrated healthcare services. My noble friend Lord Saatchi will be glad to know that our ambition is for every NHS hospital to be part of an AHSN.
The noble Baroness, Lady Masham, expressed her view that clinical research was somewhat of a poor relation in comparison to delivery of services. We have done a great deal to turn that situation around. Through its integrated academic training programme, the NIHR has taken a lead in reversing the decline in clinical academic careers. Around 250 NIHR academic clinical fellowships and 100 NIHR clinical lectureships are now available annually for medics. Last month we announced the award of five new NIHR research professorships in the second competition for these awards, and a third round is under way.
The noble Lord, Lord Winston, my noble friend Lord Willis and the noble Baroness, Lady Warwick, focused on regulation and the varying degree to which it can be a force for good. I listened with concern to what my noble friend Lord Willis had to say about the Health Research Authority. He is so up to date that I probably do not need to tell him this, but the House may be interested to hear that the HRA is collaborating with other regulatory and advisory bodies, for example the MHRA, to create a unified approval process for the approval of health research and to promote consistent and proportionate standards for compliance and inspection. This should reduce the impact of regulation on research-active businesses, universities and NHS trusts; it will improve the timeliness of decisions about research projects and hence improve the cost-effectiveness of their delivery; and it has the clear support of the Academy of Medical Sciences’ review of health regulation and governance.
My noble friend Lord Ryder rightly focused on earlier access to drugs. That is one of the reasons why we have introduced the cancer drugs fund, as the noble Lord, Lord Turnberg, was kind enough to mention, of £600 million over three years. Clinicians can now proscribe the cancer drugs that they feel their patients will benefit from, and 23,000 patients have already benefited from it. I will write to him on the future of the fund.
My noble friend Lord Willis referred to adaptive licensing. This is a subject in which I have taken a personal interest. It is an important area but, I would say, one in which there are many complexities. He is quite right that the MHRA has convened an expert advisory group to consider matters such as this, and I attended its meeting last October. However, we need pharmaceutical companies to come forward and nominate candidates for adaptive licensing. So far, despite asking, no such candidates have been proposed, but we are pressing forward in that area as fast as we can.
My noble friend Lord Ryder also referred to genomic and personalised medicine, an area of major importance in the delivery of personalised medicine, as he said. My right honourable friend the Prime Minister announced on 10 December that the ambition of the UK is to achieve a paradigm shift in the development of high throughput genome sequencing. Our ambition is to sequence 100,000 patients and have a small number of contracts in place to deliver this from 2014. From a standing start, I think that is going to be an impressive achievement, and we are on track to deliver it.
My noble friend Lord Saatchi took us very movingly to the subject of cancer, and a number of other noble Lords have also spoken about it. I fully recognise that, with cancer, screening and the identification of symptoms are vital, and perhaps the single most important thing that will improve outcomes. I will write to my noble friend about this, because all is not lost in this area. We have cause for hope, contrary to what he said, not least in ovarian cancer, where there has been a slow but steady improvement in one and five-year survival rates over the past few years.
My noble friend Lord Ribeiro rightly focused on the slowness of adoption of techniques developed in the UK. I agree that that is the problem. It is one that we are trying to address, but it is a matter of culture, which, as I have said, takes time to change. In addressing long-term culture change, we are seeking to make innovation at pace and scale everybody’s business in the NHS. People throughout the service have to feel ownership of the agenda. The IHW programme is bringing together a community of leaders at different levels in the system who will work together over the next few months to build commitment and ownership in the NHS, to ensure that innovation really is at the heart of the way the NHS does business.
As so often, time is my enemy. I have a number of other things that I would like to have said if I had had more time, not least to my noble friend Lord Rennard, the noble Baronesses, Lady Masham, Lady Finlay and Lady Morgan, and, indeed, others. If they will allow, I will write to them all and to other noble Lords whose questions I have not answered.
I believe we can point to a great deal of progress being made at a time of great change in the NHS, but much more needs to be done to deliver the improvements we need. We must not be complacent, and I am not. We owe it to patients, the public and our stakeholders to achieve that systematic adoption and diffusion of innovation that I have referred to. We are committed to a future in which innovation is a core function of the NHS. That will help us achieve our overall aim, which is to have health outcomes as good as any in the world.