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Baroness Wheeler
To ask His Majesty’s Government what steps they are taking to increase the United Kingdom’s share of global pharmaceutical research and development spending.
Baroness Wheeler (Lab)
My Lords, I am pleased to open this debate on behalf of my noble friend Lord Hunt, who sadly cannot be here today. As we know, this subject is dear to his heart and I am sure that the expertise of all noble Lords who will be speaking will do this important and vital issue full justice. I welcome the new Minister to his first Lords debate response and wish him well in addressing the mound of questions that he will face.
Our country faces a challenging time as we look to build back stronger from the impact of the pandemic. It has hit our people, our businesses and our growth hard, but here in the UK we already have a globally leading life sciences industry which, if we take the appropriate steps, can be central to unlocking our economic recovery. The industry currently makes up 18% of all R&D investment across the UK economy. It is the largest private R&D spending sector. In 2020, it was worth £5 billion and contributed more than half a million jobs to the UK.
Existing literature suggests that every pound invested in private R&D today leads to a stream of future benefits to the economy as a whole, equivalent to 50p per year in perpetuity. This sector’s R&D brings these benefits across a diverse geographic presence, with significant hubs in the south and north of England, Scotland, Wales and Northern Ireland. With private capital and UK industry playing the largest role in pharmaceutical R&D, they need policy stability and consistency in order to feel confident in investing. The Government must help, not hinder, this.
This kind of R&D has huge value for the NHS and its patients, not just through the end-stage innovation that is produced but through clinical trials. These are a valuable source of revenue to the NHS and provide access to medicines for patients with limited or no-treatment options in routine care, such as people with cancer, dementia and rare diseases.
The UK has the potential to be a global leader in life sciences R&D. We have a mature ecosystem, have historically been a leader in early-stage clinical research and have made huge strides with early access to advanced therapy medicinal products. However, this debate is vital today because of deep concerns that the UK is slipping against our competitor countries in a number of key areas. Between 2012 and 2019, the UK’s share of global pharmaceutical R&D expenditure fell from 7.7% to 4.1%. This has led to a loss on average of £3.2 billion per year for the past eight years. Since 2009, our manufacturing production volumes have fallen by 29% and 7,000 jobs have been lost and, between 2018 and 2020, the UK slipped down the global rankings across all phases of industry clinical trial delivery.
We can and must do something now. Urgent implementation of the Life Sciences Vision—it has been welcomed by the sector, which co-developed it—is now critical as the UK’s international competitors, spurred on by the pandemic, are moving at pace to enhance their life sciences offer and capture internationally mobile investment. Can the Minister say when the promised implementation plan for the one year anniversary of the vision, due last July, is to be published? Can he also reaffirm that the Government remain committed to the vision, not least its core ambition to make
“the UK the best place in the world to trial and test products at scale”?
The current uncertainty is not helping the deeply worrying situation that we are in. Moreover, an effective, joined-up approach is also needed on the Government’s wider overall science research and development strategy. We have had a number of separate R&D roadmaps, science plans, strategies and sector deals, ARIA and two reorganisations of the UKRI, for example, but without overall coherence across the board.
I will make a few points on specific issues, which I am sure will be followed up by noble Lords. First, as I have said, despite a strong policy ambition to make the UK a destination of choice for cutting-edge research, the delivery of industry clinical trials within the NHS is in crisis. In addition to the impact on patients, this means less R&D investment in the UK. The pandemic obviously had an impact, but it cannot be ignored that the UK was beginning to decline pre Covid.
Secondly, the use of health data is an area of vast potential, but we have had several false starts, for example care.data and the more recent GPDPR incidents. The data revolution is increasingly fuelling new breakthroughs in treatment, diagnostics and patient pathway redesign and is a key tool to support NHS staff. Given its large and diverse patient pool, the NHS has unique potential to be one of the most effective engines for data research. However, although this potential is well recognised, repeated attempts by successive Governments have failed to make best use of this resource, predominantly as a result of failing to engage both public and clinicians. As a result, the current state of play is a disparate data environment, with many custodians, different access arrangements and a lack of interoperability.
The Government’s Data Saves Lives strategy has taken on board many of the recommendations put forward by Professor Ben Goldacre in his independent review. Stakeholders such as the ABPI, which represents the research-based pharmaceutical sector in the UK, are urging that this must be a comprehensive strategy that appropriately balances the need for effective safeguards and public engagement with the ability of accredited researchers to appropriately access data to perform valuable research.
The false starts suffered from a chronic lack of co-ordination and failure to integrate effective communication with policy development and technical implementation. Provided that we can learn from these past mistakes, pressing forward will significantly enhance UK attractiveness as a destination for research. Will the Minister update the House on the action that the Government are taking?
Thirdly, the key issue is how we make the NHS an innovation partner—one of the areas with which we are struggling most. The life sciences sector is a strongly interconnected ecosystem. An NHS that supports innovation is central to this ecosystem and for that reason is one of the preconditions of success for the Life Sciences Vision. However, right now, the NHS struggles to approve these medicines for use and to provide access for patients once they are approved. Just 68% of medicines approved by the European Medicines Agency were made available in England between 2017 and 2020.
Looking at the uptake of medicines recommended by NICE, we see that the use of these in the UK typically lags behind that in other countries for at least five years after launch. For example, between 2016 and 2020, UK uptake was 60% of the average of 15 comparator countries in the first three years and still below average after five years, despite rising to 81%. This is contributing to patient outcomes falling behind those in countries in Scandinavia, as well as the Netherlands and Spain, for example. Recent data highlights how the UK ranks 17th out of 18 countries for life expectancy, is the worst for stroke and heart attack survival and ranks 16th out of 18 for five types of cancer.
Supporting access to and uptake of innovative medicines is critical not only to delivering better patient outcomes but to creating a thriving life sciences ecosystem. It is because of this link that in 2017 this House secured the amendment to the medical supplies Act specifically recognising that, when enacting policy in the scope of the Act, the Government must take due consideration of the consequences for the life sciences industry and the UK economy that depends on it.
Will the Minister say what action he will take to ensure that patients can benefit from the latest medicines and that the NHS supports a thriving life sciences sector in the UK? Specifically on the UK’s vaccination programme, so vital in the battle against Covid, how do the Government aim to deliver their pledge to develop new vaccines within 100 days? Will the Government continue with their plan to sell off our flagship vaccine manufacturing centre in Oxford? Does this not fly in the face of an effective pharma strategy and send out completely the wrong signals abroad?
In conclusion, recent analysis suggests that effective endorsement and delivery on the Life Sciences Vision could generate an additional £68 billion in GDP over the next 30 years through increased R&D alone and deliver 85,000 jobs through increased exports. We can also ensure that new medicines in the UK continue to be developed, trialled and launched here, meaning that patients benefit from the most innovative treatments in the world. This should be at the heart of the Government’s priorities to deliver growth and place the NHS on a sustainable footing for the future. The Government must act swiftly and decisively to reverse the very worrying downward trends in our life sciences competitiveness in relation to the rest of the world.
Lord Goodlad (Con)
My Lords, I congratulate the noble Lord, Lord Hunt of Kings Heath, on initiating this timely debate and thank the noble Baroness, Lady Wheeler, for stepping in and speaking so knowledgeably and authoritatively. As she said, this country is a world leader in the life sciences, and we now face serious but welcome competition from Europe, the United States, China and elsewhere.
An area of opportunity to attract increased pharmaceutical investment into the United Kingdom is dementia research. Dementia is among the world’s greatest health challenges. It has a large patient population, with many millions of people worldwide living with the condition and increasing demand for treatment. Currently, no treatments are available to stop, slow or cure the diseases that cause dementia, hence the pharmaceutical industry’s recognition of the opportunity and necessity for investment in this field. There have been research breakthroughs recently and there is now a pipeline of promising treatments. It is widely believed in the industry that we are at a tipping point for progress.
Over the last five years, we have unfortunately seen an overall decline in the number of dementia trials being initiated in this country and the number of participants in each trial. Government investment in dementia research, which is smaller than that of industry, fell from £83.9 million in 2018-19 to £15.7 million in 2019-20, putting us at risk of falling behind our global competitors.
The Government recently announced the national dementia mission, which will hopefully be a galvanising body like recent task forces in other fields. They have also announced a 10-year plan for dementia focused on supporting and expediting clinical trials. In August, they recommitted the £160 million of funding promised in the 2019 election manifesto, described then as the “dementia moonshot”. It would be helpful if the Minister, whom I congratulate on his appointment and welcome to this Committee for the first time, could today or, more realistically, very soon flesh out how these commitments are to be implemented. To do so would be an important signal to the pharmaceutical and global life science industries that this country’s ambitions in this important area are a serious reality.
It would also be a signal to the people of this country that the Government are serious about dementia, the leading cause of death for women for more than a decade and the fastest-growing health condition in the UK. As well as the suffering and distress it causes, it is predicted to be the most expensive health condition to treat by 2030. Dementia, directly or individually, affects very nearly every family in the land. Attracting investment and research into the condition should be a very high priority for the Government.
Baroness Brinton (LD)
My Lords, I too congratulate the noble Lord, Lord Hunt, on securing this debate and thank the noble Baroness, Lady Wheeler, for stepping in at such short notice and giving us such a comprehensive introduction. I also thank the ABPI, Roche, STOPAIDS, dementia awareness and the Lords Library for their very helpful briefing.
Four decades ago, I was a manager at Newmarket Venture Capital in the City. We funded the first wave of spinning out monoclonal antibodies. I remember one of the senior managers involved with it saying, “This will transform pharmaceutical treatments over the next few years”. She was right. A hundred years ago, my great-grandmother, who also had rheumatoid arthritis, had been told there was no treatment other than gold injections. She was in a wheelchair and unable to use her hands because they were so badly deformed.
Twenty years ago, I started on disease-modifying drugs and these days, along with many other people with my condition, I use a JAK inhibitor, which is a tablet that I take once in the morning and once at night. I used to have to spend a whole day in hospital having my infusion of a monoclonal antibody. We need to recognise the enormous advance in pharmaceutical work that has transformed the work of the NHS. It has reduced the number of beds needed and addressed a large number of other issues. But only one in 10,000 compounds and only 7.9% of medicines that get to clinical development actually make it to approval. It takes around eight to 12 years from initial discovery to launch, although I really hope that we have learned some lessons from the Covid pandemic and are able to start speeding things up somewhat.
Between 2015 and 2019, 43% of NICE recommendations were optimised for access to new medicines. This meant that they were recommended for a smaller patient population than the medicine had originally been approved for by either the European Medicines Agency or the MHRA. Of those optimised recommendations, around two-thirds recommended treatment in less than half the approved population. So, from a patient perspective, in the UK, a large number of patients are not getting access to the treatments that have been approved. The uptake of new medicines is a major concern. For more than 75 medicines recommended by NICE and launched between 2013 and 2019, the per capita utilisation in the first three years was around 64%, which was around the average in 15 comparator countries.
I want to focus on advanced therapy medicine products, the use of data and the voluntary pricing system, also known as VPAS. Advanced therapy medicine products are new, revolutionary medicines based on genes, tissues or cells and have the potential to save, lengthen and improve patients’ lives by treating the root cause of diseases. But they present challenges to health systems because they are so different from traditional medicines. Because they are used as a one-time-only treatment, they have a very high up-front cost, particularly if it takes 10 to 12 years to develop them and possibly up to £1 billion in research costs.
Currently, only a very small number of ATMP treatments are on the market and the NHS is managing to provide access despite these challenges. But, looking at monoclonal antibodies and the way that they are used now, it is likely that ATMPs will become the go-to drug for the future. Unfortunately, already we are behind other countries such as France, which is taking a very forward-facing example. France introduced a measure in its 2023 social security financing bill to allow innovative payment models to be used for ATMPs to share the risk between the manufacturer and the healthcare system.
We must not forget the transformative use of global pharma R&D, especially that which has been developed in the UK, in the spend on the wider world. It is one of the big lessons that we learned from the Covid pandemic. Oxford’s early R&D for the vaccine platform became the AstraZeneca vaccine, but unfortunately those technologies were unobtainable and inaccessible to most of the globe. Many noble Lords present spoke about that in your Lordships’ House during the Covid pandemic. We must make sure that that does not happen again, so I ask the Minister, what lessons have been learned from developing these drugs and how can we share that technology, probably through TRIPS waivers and other systems. in the future?
On data, during the passage of the Health and Care Bill, many Members across the House discussed the use of patient data and the safety net that we needed, but there is absolutely no doubt that the NHS has unique potential, given its large and diverse patient pool, to be one of the most effective engines for research. The Data Saves Lives strategy, announced earlier this year, is a good vehicle to overcome these barriers, and it was very much welcomed by the pharma sector. In implementing the strategy, I hope that the Government and the NHS will work to ensure that the national trusted research environment is fit for purpose, and has the necessary functionality to enable safe, high-quality research and the use of advanced analytical tools to derive insights. I am particularly concerned about this after the patient data—the care.data—and the GP data débâcles of this year and five years ago. It is really important that patients’ data can be protected.
Briefly, on VPAS, the Voluntary Scheme for Branded Medicines Pricing and Access between the UK Government and the pharmaceutical industry has historically been very useful, but Roche says that fluctuations of spend are now causing a rapid increase in VPAS payment rates, undermining the industry’s ability to sustain and invest in the UK. There has been a 10% jump from 5% to 15% over the last year and, worryingly, there is a projection that this may increase to over 30% next year. The worry is that this will impact the whole of the sector. Can the Minister say whether the Government are discussing VPAS with the extended life sciences sector?
Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure to follow the noble Baroness, Lady Brinton. I thank the noble Lord, Lord Hunt of Kings Heath, for securing this debate, and the noble Baroness, Lady Wheeler, for so effectively introducing it.
I start this debate from a philosophically different position from other speakers. What we in the UK— and the world—need is not just or even primarily the most effective, efficient pharmaceutical research and development; more than that, we need the best possible health research and development, which often may not involve pharmaceuticals at all but instead improving public health by addressing the social and environmental determinants of health, so pharmaceuticals are needed less and can be reserved—saved—for the most essential, important and unavoidable uses, some of which the noble Baroness, Lady Brinton, just outlined. The noble Lord, Lord Goodlad, just focused on dementia, but of course huge and increasing amounts of research show that addressing issues such as diet, exercise and air pollution can have a tremendous impact on reducing the impact of dementia, and we must not forget that focus.
We are now living in the age of shocks. We have already had one pandemic shock in Covid-19, still continuing, both in the spread of the SARS-CoV-2 virus and the huge and little-understood impacts of long Covid, and we know that others threaten, including the avian flu virus that is cutting such a dreadful swathe through our wild bird populations—and the factory farming systems that incubated it.
So, were I to be wording this question, I would rather ask how the UK most effectively contributes to global health, and in pharmaceutical research—with our current academic and industry frames—we certainly play an important part. But some of our role should surely be to promote and support research and development of pharmaceuticals in the global south to strengthen systems there. I will restrain myself from venturing off into the disgraceful state of ODA funding, although I directly ask the Minister what assessment the Government have conducted on the dangers of the UK failing to deliver the support that others do to the Global Fund, given the assessment that the UK’s current plans could put over 700,000 lives at risk and lead to over 17 million new infections across the three diseases it covers?
What I will focus on specifically is influenced by an issue that many may have seen highlighted last week in the New Statesman in an interview with Dame Sally Davies, the first female Chief Medical Officer of England. It focused on antimicrobial resistance, on which Dame Sally said:
“I do wonder how long I have to go on pushing this. Have I failed? Well I haven’t succeeded, have I, or we wouldn’t be sat here.”
I have to warn the Committee that I am planning on pushing hard on this in the coming months, with the assistance of two brilliant senior interns, Julze Alejandre and Emily Stevenson, whose work is supported by the British Society for Antimicrobial Chemotherapy.
So how is this relevant to pharmaceutical research in the UK? As a rich nation with a well-developed health system, we need to provide a framework for drug development and purchase that acknowledges the need not just to look at the immediate impact of a treatment on a patient but its full impact on public and environmental health. How biodegradable is a drug, what is its ecotoxicity, and what will be the complete impacts of its development, manufacture and use? The Environment Agency has just started providing funding to a new research group looking at the impact of biocides and cross-resistance—but that is starting at the other end, after the damage has been done.
If we think of the UK as a place that truly seeks to understand the impact of medicines, both existing and developing, we can look to the pharmaceutical formulary used in the Stockholm region in Sweden, which considers not just the efficacy and safety, pharmaceutical suitability and cost effectiveness of drugs, as does the NHS, but their environmental impacts. Should not the UK, to provide “world-leading” research and treatment, be operating on the same basis?
I turn now to some specific questions, of which I have given prior notice, about the environment for research, development and use of drugs, particularly relating to the Government’s approach to the European Commission’s water framework directive, which sets out a watch list of priority substances. Once they are included on the watch list, EU states are required to monitor these substances, and the inclusion of these compounds helps to raise research interest in these agents, including their AMR selective potential at environmentally relevant concentrations. Until recently, the data used to inform selection of compounds on the watch list determined ecological risk based only on ecotoxicology tests, and it was only in 2020 that AMR selection risk was also considered as an end point.
Featured on the watch list, updated in August this year with five more drugs, are a variety of compounds with a host of essential applications, including antibiotics, antidepressants, synthetic hormones, diabetes maintenance medication and both human antifungals and agricultural fungicides. Can the Minister update me on how this EU update will be treated in the UK, and how talk of sweeping aside regulatory frameworks transferred from the EU to the UK after Brexit that has arrived with the new Prime Minister will be treated in this area of assessing water issues?
In the post-Brexit era and considering the potential risks of these pharmaceuticals on the environment and in terms of AMR, as a proportion of the UK’s pharmaceutical research and development budget, what is the commitment of His Majesty’s Government to ensuring that the monitoring and reporting of these pharmaceuticals will be done in the UK in a more robust, comprehensive and transparent manner? We were after all promised stronger environmental protections after Brexit. In addition, what are the Government doing to ensure that the results of these environmental monitoring assessments are available for researchers and healthcare providers so that they can make informed and wise decisions in choosing and developing pharmaceuticals that have less ecological impact and risk in terms of AMR?
A number of noble Lords will remember that one of the first votes that I called in your Lordships’ House was as a result of sheer exasperation at the Government’s failure to take seriously in the Medicines and Medical Devices Act, as it now is, the environmental, particularly AMR, risks of human medicines, to mirror the terminology in the Bill used for veterinary medicines. The Minister today has the opportunity to reassure me that, with even more concerning scientific research in the area since then, the Government are now taking it seriously.
Baroness Walmsley (LD)
My Lords, I thank the noble Baroness, Lady Wheeler, for introducing this important debate so comprehensively. There is no doubt that the R&D and manufacture of new medicines already contribute in a major way to our economy, but it is also clear that there is considerable potential for improving that contribution in the interests of patients, the levelling-up agenda and the economy. However, as the noble Baroness said, over the past 25 years there has been a manufacturing capacity reduction of 25%, while other countries, such as Ireland, have seen an increase. We also saw how India produced a lot of our vaccines during the Covid pandemic.
Pharmaceutical companies can choose where they make their medicines, since they sell them all over the world, so what are the factors that they consider when deciding where to invest their capital and create well-paid jobs? Access to skills is important, as is the supply chain infrastructure, the regulatory environment, the attractiveness of the fiscal environment and upfront capital grants. Importantly, at this time of economic crisis, I should mention the importance of stability. In the past, companies have chosen the UK on that factor alone, even when other factors might have been better elsewhere.
There are many things we can do to make us more competitive. Ensuring that local communities have the right skills to attract these companies is vital and, at this time of pressure on public spending, the last thing we need to see is a cut in further and higher education opportunities, particularly in the poorer demographic areas.
As far as capital grants are concerned, the life sciences innovative manufacturing fund, £60 million over three years, is a small step in the right direction compared with our international competitors. This fund is vastly oversubscribed but could contribute to the Government’s growth ambitions. Are there any plans to increase it? The returns in increased profits, wages and taxes would surely pay for it in a few years. We must also encourage companies to increase their own capital investment in manufacturing capacity here. If capital expenditure were to be recognised within the R&D tax credit system, it would encourage them to invest more of their own money in the UK.
We need to get this right in the interests of patients, since UK manufacture of clinical trial medicines, for example, would get innovative medicines to patients quicker. It is really important that we do everything possible to speed up the time it takes to get new medicines to patients, because we are not doing very well at the moment. UK patients have lower access to innovative medicines than those in other countries, as my noble friend Lady Brinton said. For example, 43% of positive recommendations made by NICE between 2015 and 2019 were for a narrower population of patients than other regulators. Even when medicines are cleared by NICE, five years after they are approved for the NHS they are reaching only 64% of the patients reached by other nations. This could be because we spend less on medicines than other countries—9% of the healthcare budget, the lowest in the G7, compared with the average of 14% to 18%.
I now turn to clinical trials, which are so important to getting cutting-edge medicines to patients. In the last four years the UK has slipped down the international rankings for the number of clinical trials and the number of patients taking part, despite the Government’s declared ambition to make us a go-to country. The number of patients involved has almost halved during that period. This represents a cost to the NHS of around £447 million in the last financial year alone. Given that we heard from NHSE’s chief financial officer than the NHS is now short of £20 billion per year simply due to inflation in the cost of goods and services unless it can make serious cuts, surely the opportunity to save money by hosting more clinical trials is almost irresistible.
However, one of the problems is capacity. We have lost thousands of beds over recent years, as recognised by the Government recently in their announcement of 7,000 new ones. We have lost thousands of staff and are not training enough to take their place. Without adequate numbers of health professionals, we will not be able to host these beneficial clinical trials. That is why your Lordships focused so hard on the need for effective workforce planning during the passage of the Health and Care Act 2022.
The effect of this on patients is central to why we must improve their access to potentially life-saving treatments—but it is actually diminishing, partly because the setting-up time of trials is so slow. This also discourages companies, of course, despite the attractiveness of the NHS with its enormous cohort of patients. Relevant to the levelling-up agenda is the discrepancy between patients’ access to clinical trials in different parts of the UK. Cancer Research UK found that cancer patients in west London were 71% more likely to have opportunities to take part in research than patients in Cheshire and Merseyside.
I share the concern of the noble Lord, Lord Goodlad, about Alzheimer’s and dementia research. There is huge potential here for the UK to become a global leader—but again we are lagging behind. Over the past five years we have seen a decline in the number of dementia clinical trials taking place in the UK, and the number of participants. Since 2020, the number of phase 3 trials has increased in Germany, France and Italy but fallen here. So can I ask the Minister whether the Government are still committed to the £160 million of funding promised in their manifesto and recommitted to in August this year? Will the Government adhere to the recently announced national dementia mission? I ask because they have dropped so many other very important health-related measures which had been agreed by Parliament. I refer to the mental health Bill, the anti-smoking strategy following the Khan review, the health disparities White Paper and all the anti-obesity measures in the Health and Care Act—which we appear to have wasted our time on.
Looking forward, there are several other areas of research that show great promise and in which we have an opportunity to lead the world. My noble friend has talked about advanced gene and cell therapies. Those should be made and trialled here to make the most of the economic opportunities as well as the benefits for patients.
Lord Patel (CB)
My Lords, I might end up repeating some things that have already been said, but that will just reinforce the important aspects of this debate. I thank the noble Lord, Lord Hunt, for initiating it, and the noble Baroness, Lady Wheeler, for introducing it.
I was going to try to focus on two things. One was clinical trials and the other was potential research into dementia. We know that clinical trials are an important part of domestic R&D, an important source of revenue for the NHS and a critical way of delivering early access to promising treatments for patients. As has already been mentioned, in the 2018-19 financial year, in addition to the revenue generated, there were £30 million of pharmaceutical product cost savings from trials supported by the NIHR clinical trials network. Numerous studies have also shown that research-active NHS facilities deliver better patient outcomes.
It has already been said that the UK has slipped down the global rankings and our reputation as a reliable destination to locate clinical trials is taking a hit. The National Institute for Health and Care Research found that there were about 28,000 participants recruited into clinical trials in 2021-22, compared with over 50,000 in 2017-18, and patients in different parts of the country, as the noble Baroness, Lady Walmsley, has already mentioned, have wildly varying experiences of being able to participate in research. The noble Baroness gave the particular example of cancer research. As she said, cancer patients in west London are 71% more likely to be asked to take part compared with those in some other areas. That is quite shocking, because cancer research trials were one area where we excelled.
The pandemic obviously had an impact on this decline. R&D leaders in the NHS estimate—again, as the noble Baroness, Lady Walmsley, mentioned—that we lost something of the order of £0.5 billion. But it cannot be ignored that the UK was beginning to decline pre Covid, and our post-pandemic recovery is lagging behind that of other countries. Even Spain has now overtaken us in the world ranking of clinical trials. We are now number 8, whereas some years ago we were number 2.
There are ways that we can tackle this, including by streamlining the slow set-up of recruitment to studies. So can I ask the Minister what the Government are doing to prioritise the recovery of industry clinical trials in the UK and ensure that research is embedded as part of routine NHS care across the whole of the UK? I think he has a golden opportunity as a new Minister to get some people into his office and demand that we change this declining position. Clinical trials should be a key part of our NHS research agenda.
I will now return to some aspects of dementia research that the noble Lord, Lord Goodlad, mentioned. It is the ambition in the life sciences vision of the Government to escalate novel treatments for dementia. As has already been mentioned, Alzheimer’s Research UK is concerned that the government commitment to research into Alzheimer’s is now slowing—to put it mildly. We know that dementia is the world’s biggest health challenge, with almost 1 million people in the United Kingdom alone suffering, and we know the heartbreak it causes not just to individuals but to their families.
Traditionally, this area has been risky for investment, but the commitment of dementia researchers over many years has led to some recent scientific breakthroughs and a growing pipeline of new treatments in clinical trials from which we in the United Kingdom are not benefiting. In recent news, a treatment called Lecanemab has shown in initial phase 3 clinical trials that it can slow down patients’ decline in memory and thinking. It is very promising. Taking these together, this means that dementia research is at a tipping point of progress. Continued life science investment is crucial to delivering the safe and effective treatments that people with dementia desperately need.
Over the past five years, we have seen an overall decline in the number of dementia trials being initiated in the UK and the number of participants in each trial. The noble Baroness, Lady Walmsley, mentioned how Germany, France and other countries have outstripped us in initiating dementia clinical trials, which is sad to have to admit. One of the reasons is that as a country we identify the problem at a later stage of the disease. We currently diagnose people with dementia too late, so their condition has progressed beyond the point where they are eligible to take part in clinical research. There is therefore a need for the NHS to address the diagnostics of dementia. Again, the point has already been made about government investment, which declined from 2018-19 to 2019-20. So the plea for the Government to have a plan to focus attention on dementia research is well made and I hope the Minister will say whether the Government have a plan to take forward research in dementia as identified in the Life Sciences Vision report of July 2021.
Lord Kakkar (CB)
My Lords, I apologise for not having added my name to the list. I was responsible for chairing a meeting elsewhere and did not anticipate finishing on time. I am grateful for the indulgence of noble Lords in permitting me to intervene in the gap. In so doing, I declare my interests as chairman of King’s Health Partners and of the Office for Strategic Coordination of Health Research and as an active researcher with studies in the national research portfolio.
I, too, thank the noble Baroness, Lady Wheeler, for introducing this debate so thoughtfully, building, of course, on the immense contributions the noble Lord, Lord Hunt, has made over many years in debates on this question.
I shall confine my comments to the increasing problem that the deteriorating performance in clinical research in our country is having on the capacity to invite inward investment in research and development, as we have heard in this debate.
The National Institute for Health and Care Research is responsible for the application of public funds to ensure that there is infrastructure and capacity available within the clinical research network to deliver our national research portfolio. Is the Minister content that the public funding made available to NIHR to establish that infrastructure and create that capacity in the CRN is appropriately applied? Of course, the NIHR has recognised that there are currently important problems in the delivery of clinical research and is trying to take steps to ensure that the rather bloated national portfolio of approved studies is reduced in some way by the removal of studies that are identified to be underperforming or poorly performing. But this action itself has a profound impact on the perception of the standing of our country as a suitable location for inward investment of research funding to undertake clinical trials. Are His Majesty’s Government content that the approach being taken with regard to management of the portfolio and the problems associated with the size of the portfolio that predate Covid are the appropriate steps? Are appropriate measures being taken to ensure that there is no perceptional impact in terms of reducing the attractiveness of the United Kingdom for overseas funding for clinical research in such a way that it undermines the overall life sciences vision and strategy?
It is important to try to understand where the application of funding to drive the clinical research effort nationally is being directed. Again, can the Minister confirm that there is an appropriate mapping of the populations where the research effort and opportunity might be achieved against where the infrastructure funding to deliver that research is being applied, so that there is a targeted approach that ensures that maximum capacity is delivered, particularly in the medium term, to overcome these particular clinical research problems?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con) (Maiden Speech)
My Lords, I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Wheeler, for arranging the debate on this vitally important topic. Despite this being the fifth time that I have spoken in the last four days, this is technically my maiden speech. I believe it is customary to start with a few personal remarks, and if that means that I go slightly over time, I beg the indulgence of being given time to make sure that I answer the points properly as well.
First, I thank Black Rod, the staff and the police for my fantastic introduction. I thank my noble friend Lord Nash for his encouragement for me to join the Lords, my noble friend Lord Courtown for his last-minute introduction of me when he had to step in, and my noble friend Lord Kamall, whom I have known since university in 1988. I thank all noble Lords for the kindness that they have shown me, and their welcomes. I especially thank the doorkeepers, who were fantastic to my family on the day of the introduction and have been fantastic at preventing me getting too lost in the myriad corridors.
On a personal note, I am the product of a very loving family. My grandparents and mum were nurses. My dads—I had two dads, for reasons I will tell noble Lords at some later stage—were a policeman and an advertising executive. My wife is a dentist. I went to the local comprehensive school and spent much of my life in and out of A&E—and continue to do so because I still, perhaps unwisely, play rugby. As a result, I like to think that I am very much the product of the public sector and the public system.
I have three children, whom I want to mention so that they are in Hansard: Ben, Sam and Xavi, who are surprised and bemused to now be known as “Honourables”. I have had a very varied career, and I hope to use that experience to add value to a lot of these debates. I have been a CEO, a CFO, an HR director, a strategy director and a chair in lots of different industries, including consulting, retail, media, health and construction. More recently, I have been an entrepreneur in many different fields. At the same time, I have had public sector experience: I was deputy leader of Westminster Council and have been the lead NED on MHCLG and DfT, and worked with the Department for Work and Pensions. I could be seen as a veritable jack of all trades—and if I could master one, it would probably be capturing the language of the House as quickly as possible. I ask noble Lords to forgive me while I learn.
Most of all, I want to talk about the type of Minister that I would like to be. I love learning about new industries, sharing ideas and using critical and constructive challenge to make better decisions. I like to say, “Two plus two equals five”. Noble Lords will find me wanting to share my thoughts and ideas and to hear and discuss theirs, ideally sitting around a table. I must admit that I find this a bit weird. There are a lot of good comments here about how we all want to grow the industry, and I would usually do this around a round table with a cup of coffee, where we are having a good discussion. Maybe that is something we can do as a follow-up to this.
I like to hear and share ideas. I know that sharing my thoughts at an early stage may sometimes get me into trouble—I like to brainstorm—and create many opportunities for people to make political hay, but I want to take that risk because, in our hearts, I think we are all here because we care about our country and want to make it a better place. I put my trust in your Lordships to share some of those thoughts at an early stage so that you can, hopefully, build on some of the good thoughts and politely help me discard the poor ones—I promise there will be many of those—and not to make too much political hay along the way, except maybe on some of the ideas that may be more naive.
Most of all, I would like to be known as a thoughtful Minister, someone who thought, listened and got things done. Part of the reason I am delighted is that I realise I will be here, hopefully, for many years and will make many friends along the way from all sides of the House. I was given this tie by the noble Lord, Lord Alli, 20 years ago on my birthday when I used to work with him at ITV. I still consider him a friend and hope to make many more here.
Turning to the subject at hand, I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Wheeler. I firmly believe that to achieve—dare I say it?— growth, growth, growth you have to pick sectors where the UK has an advantage and leverage them. I have some familiarity with the media sector. After the financial crash, there was a real push to say that it should be one of the sectors we did more about. We did very good things to leverage the key assets, the BBC and ITV. We built an ecosystem. We had critical mass around setting up the BBC in Manchester, alongside Granada, where we could attract the best people and companies. I see a lot of similarities in how we are talking about trying to create ecosystems here, which I will come to later. The BBC has BBC Worldwide, which was set up to leverage that fantastic institution; I feel there are parallels with many of the comments I have heard today about how we can use the NHS and clinical research to better effect.
Life sciences is a high-profile sector, as the noble Baroness, Lady Wheeler, mentioned, and it makes a major economic and scientific contribution to the UK. We have a long and rich heritage in this sector, from Edward Jenner’s development of the world’s first vaccine to our fantastic development of the Covid-19 vaccine. As previously mentioned, it is also responsible for £4.5 billion of R&D investment per year, which I believe is about 20% of the whole economy. It has led to such things as the £1 billion investment by Merck in the MSD UK Discovery Centre and the construction around King’s Cross of AstraZeneca’s £1 billion global R&D centre. Importantly, unlike many other tech sectors much of this wealth is spread across the UK and is not London-centric.
However, as noble Lords have rightly mentioned, we cannot rest on our laurels. There are many places where we should and want to do better. I would like to help us do so. That is why, as my noble friend Lord Goodlad mentioned, the Government published our Life Sciences Vision. I am happy to write later to say how we are following up on that and making sure we implement it. The vision reflects the sentiment of many noble Lords’ speeches that, to grow our proportion of global pharmaceutical investment, we must improve every aspect of the life science ecosystem.
I will address that by looking at four areas. First, as was mentioned, in terms of investing in R&D, in the spending review we have committed £5 billion for the sector by 2024-25. This is the largest uplift in public R&D spending we have ever seen. It includes a major uplift for the National Institute for Health and Care Research. The Government also committed to raise R&D spending to its highest level ever—£22 billion by 2026-27.
As part of this investment in R&D, the Government are particularly focused on investing in areas of global strength such as these. This includes £341 million for Genomics England, so ably chaired by my noble friend Lady Blackwood. We are determined to maintain our international leadership in this important field. Fitting in with a lot of the comments on the importance of big data in this field, we are also investing £200 million in a major new data for R&D programme.
Secondly, as acknowledged by noble Lords, we need to do more to make sure the NHS plays its full role. Amanda Pritchard, the chief executive of NHS England, has been unambiguous in stressing the criticality of research, even at times of great service pressure. I am sure we are all aware of initiatives such as the GRAIL blood test and the work being done on it. At the same time, I have had personal experience of the fact that in clinical trials we are not as effective as we should be. I think we all recognise this, and points were ably brought up by the noble Baronesses, Lady Wheeler and Lady Walmsley, and the noble Lords, Lord Patel and Lord Kakkar. I go back to my analogy of BBC Worldwide. Is there something we should be doing to leverage off the NHS more? It is something I would like to pick up further. Maybe we can have a discussion, perhaps around a round table, at some later point and share ideas on how to make the best of that.
Big data was another point brought up by the noble Baronesses, Lady Wheeler and Lady Brinton. We all know that there are fantastic opportunities in big data that we are not fully utilising. We all understand that there are lots of thorny issues around that, such as protecting patients’ anonymity, but at the same time there is a huge opportunity that we are not making the most of.
Thirdly, as the noble Baroness, Lady Walmsley, quite rightly pointed out, we need to make sure that the business environment and the whole ecosystem are as hospitable to inward investment as possible. I highlight the work to improve life sciences’ access to finance and to give a strong pipeline to SMEs. I do not mean just things such as the £500 million committed by the Chancellor to the long-term investment fund but initiatives such as the EIS, which I am sure many of us are familiar with, and the R&D tax credits so that we can get investment in at that vital stage. On attracting and developing the right ecosystem for all this, I would like to understand further whether there is scope to use our investment zones so that they can benefit this area.
My noble friend Lord Goodlad and the noble Baroness, Lady Walmsley, talked quite rightly about dementia and the potential of the dementia moonshot and asked whether we are really following up on that. I undertake to write to give noble Lords a full picture of where we are backing that. I was very interested in the insight of the noble Baroness, Lady Brinton, about new market venture capital and how we get this capital into this sector. It is vital. Again, these are all points that I would like to pick up around a table.
As far as I am aware, we are aware of the potential impact of the VPAS. I have been a CFO, and I understand that suddenly hearing that your sales line might go down by 15%, 20% or 30% is pretty important knowledge; I get it. I know that we are undertaking a consultation to understand how to make sure that this system works going forward. I think we all agree that there are a lot of good aspects and agree with the intent of what we are trying to do.
Fourthly, inspired by the Vaccine Taskforce, we are delivering a series of healthcare missions focused on the leading causes of death and disease. These missions will fuse private sector ingenuity with the UK’s scientific excellence, drawing in significant private investment in areas such as dementia, cancer and mental health, which were mentioned by many speakers.
I particularly thank the noble Baroness, Lady Bennett, for a lot of her thoughtful comments and for writing some of them beforehand. I realise that I am about to run out of time, so I probably cannot answer them specifically. I will be pleased to write to her. As an ex-economics student, I was interested in how she talked about understanding the externalities of a lot of the investment in drugs and their impact. I would like to turn my thoughts further to that when I get my feet further under the table.
The Government are confident that through Life Sciences Vision we will develop the end-to-end improvements required to attract an ever-growing proportion of pharmaceutical investment to the UK. At the same time, I hope noble Lords see that I, for one, am not resting on any laurels here. There is a lot more we can do and a lot that I want to learn from the wisdom and comments made in this Room. We will be relentless in picking up these opportunities.
With that, I once again pay tribute to the noble Lord, Lord Hunt, for securing this important debate and, in his absence, to the noble Baroness, Lady Wheeler. I reiterate my commitment to serving the House and Government faithfully in my role as Minister for as long as I have the honour to do so.