NHS: Performance and Innovation

Baroness Bennett of Manor Castle Excerpts

Thursday 15th June 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to take part in this select but very interesting debate, which is small in number but rich in content. I thank the noble Lord, Lord Scriven, for securing it. I will take a different approach from that of other noble Lords so far—perhaps a slightly stereotypical green approach. While we are talking about the current performance of the NHS and innovation, I will focus on the NHS’s environmental impacts.

The noble Lord, Lord Scriven, said that we have a 1940s health service in its structures and systems. We are in the 21st century and in a climate emergency and nature crisis, consideration of which has not been built into the system. I will major on aspects related to the comments made by the noble Lord, Lord Addington, about the centralisation of the system. Indeed, the noble Lord, Lord Crisp, was just talking about that and about how it prevents innovation and people taking action.

Let me do a little frame-setting. The NHS is responsible for 5% of the UK’s climate emissions and 40% of public service emissions. NHS England has a large focus on carbon emissions. Interestingly, NHS Scotland is leading on antimicrobial resistance and dealing with that area of environmental impact, and NHS Wales is focused on the environmental determinants of health and taking that approach. Each NHS can learn from the others, and a more joined-up approach is desperately needed. As I will come to, in Europe there is a lead on the impact of general pharmaceuticals on the environment, and we are not joined up with that at all.

The noble Lord, Lord Scriven, approached this in a positive way. I will do the same, in some places by highlighting success stories. The NHS has a net-zero carbon target by 2040. All NHS England estates now use 100% renewable electricity and 99% of waste is diverted from landfill. There are issues around incineration, but obviously there will always have to be some of that. It is worth stressing how much money this has saved the NHS, with a cost saving of £36 million and a £10 million investment in one year in energy-efficient technologies having positive impacts.

Slightly less obvious is an exciting development on which Scotland is leading the way and NHS England is following. Scotland has banned the use of desflurane, an anaesthetic with a global warming potential 2,500 times that of carbon dioxide. NHS England will be banning it in 2024. This is one of the leading ways in which thinking about the negative environmental impacts of medicines is happening. There is also an exciting new plan being developed for reducing the carbon impact from the use of inhalers. Much is happening, but everyone agrees that much more must happen.

I want to focus on an area that I have been majoring on since 2020, when we began debating the Medicines and Medical Devices Bill: the impact of pharmaceuticals on the environment. I saw the noble Baroness, Lady Cumberlege, in her place earlier, who wrote the very important report, First Do No Harm, which still needs to be implemented. When we think about the use of pharmaceuticals in the NHS, we have not thought sufficiently about the harm that they are doing.

What I am about to say draws heavily on a meeting I had recently with the pharmaceutical industry and my British Society for Antimicrobial Chemotherapy senior interns. I also worked with Paul-Enguerrand Fady, who is working with the Foundation to Prevent Antibiotic Resistance, which is based in Stockholm. Paul-Enguerrand is working here in Parliament, and I would urge anyone who is interested in antimicrobial resistance to get in contact. A whole series of events is being held to inform parliamentarians about this, and there is a chance to learn cutting-edge science with that.

From this meeting, I learned about the PREMIER project, a multi-disciplinary consortium of 25 public and private sector groups across Europe, proactively working to manage the environmental impact of general medicines, especially those with limited data availability. It is exploring ways to incorporate environmental considerations early in the drug development process to steer the development of new drugs. It aims to establish a new European standard of environmental protection and reassurance, for patients and society at large, that medicines are increasingly safe for the environment. If the Minister is not aware of this project, can he make himself aware? This is a Europe-wide project. I very much hope that NHS England will be following on and adopting this, not seeking to go it alone in an area where clear leadership is already happening. I do not expect an answer today but can the Minister look into that and get back to me on how the Government are looking at the outcome of that project?

I point out that the PREMIER project is working only on general pharmaceuticals; it is not working on antimicrobials or endocrine active molecules. Potentially, the UK Government could take a lead in ensuring that this project is broadened to include these crucial pharmaceuticals which we know are having a big impact on our environment and our environmental health. It was suggested at this meeting that there is a role for the Government Office for Science in promoting such connectedness in its position as an apolitical, evidence-based organisation. Being cross-departmental, it helps in focusing on systems thinking. The Government potentially have a convening role here to work with a variety of stakeholders. Can the Minister consider how they might take a role in that area?

I said that I would focus on some positives, and I noted that NHS Scotland is very much leading on the impact of pharmaceuticals on the environment. I draw the attention of the Minister to a project in the highlands. NHS Highland got a £100,000 grant from the Medical Research Council to develop a framework to reduce environmental pollution from healthcare practices. This is the first time that this has been done in the UK. Its leader is Sharon Pfleger, a consultant in pharmaceutical public health working with the University of Nottingham and the University of Highlands and Islands. This builds on the work of the cross-sector One Health Breakthrough Partnership, which has a data visualisation tool that helps to understand the link between medicine use and the presence of pharmaceuticals in the environment. I draw the attention of the Minister’s department to that.

Having looked around these islands I see that Wales, as I mentioned, is leading on environmental determinants of health. The Welsh NHS Confederation produced an interesting response to a Climate Change, Environment and Infrastructure Committee consultation on the Environment (Air Quality and Soundscapes) (Wales) Bill. I urge NHS England to contribute to cross-governmental working in this way. It is a very interesting model and we need to see this happening.

I have praised Wales and Scotland, so I should find a project in England to praise and focus on. Some work is happening in Cornwall. I draw here on the work of Roberta Fuller, who is head of hospital reconfiguration at the Women’s and Children’s Hospital at the Royal Cornwall Hospitals NHS Trust. Ms Fuller is working on how to ensure that a new hospital meets the best possible environmental standards. Drawing on the comments of the noble Lords, Lord Addington and Lord Crisp, I quote a paragraph from Ms Fuller’s reflections:

“What will it take to move away from traditional top-down funding allocation towards the kind of cross-industry partnering and thought leadership needed to meet these extremely challenging climate goals?”


Empowering people must be at the heart of tackling the issues that I am talking about, but of course there are so many other issues.

Finally, I will reflect a little on innovation. We have heard the word a great deal from the Government in recent weeks. I am afraid that, very often, when we hear members of the Government talking about it, they are talking about inventing new products that people will make profits from, usually involving shiny new things and, indeed, new pills. Of course, we know that the kind of innovation that I and pretty much all speakers in this debate have been talking about is about doing things differently and more smartly, and operating in ways that acknowledge the One Health paradigm: that our health is entirely dependent on the health of our environment. I would love to see more analysis and understanding from the Government that this is innovation. Innovation may, dare I say it, less directly involve GDP: you are not selling things but improving the public health of the population. We all know about the productivity crisis, the labour shortage and all the problems arising from the absolutely parlous state of public health in the UK at the moment.

In that light, I want to take a step away from the environment side to focus on an issue raised by the noble Lord, Lord Parekh, about the problems of obesity and the threats that it presents to our health. We have been talking about obesity, and it has been almost impossible recently to open a newspaper without seeing talk of the new Wegovy and these other weight-loss drugs. Newspapers have been quoting NHS sources suggesting that, eventually, 12 million people might be treated with Wegovy and similar weight-loss drugs in the NHS. I find that statistic truly horrifying. These are very new drugs, and we have very little idea of how long people might have to take them and what the long-term effects are: they simply have not been around for very long.

Yet, at the same time, we have Dr David Unwin in Southport. He has been an absolutely huge pioneer, starting from the grass roots up, in working to reverse type 2 diabetes. This was thought impossible until recently. What is interesting is that, reading accounts from him, he credits the initial impetus as coming from one patient who said to him, “Why have you been prescribing this drug for me for 10 years when I went off, researched for myself and found that I could change my diet?” Through diet reversal, this patient no longer had type 2 diabetes. We had one patient talking to one doctor, who started to innovate. This is starting to be rolled out around the NHS, but why are the Government not trumpeting it from the rooftops? When we hear the Prime Minister talking about innovation, would it not be great if he were talking about innovation in terms like this? This is a home-built, British innovation done in the grass roots—not based in a university, nor based in Oxbridge, and perhaps that is why we are not hearing about it. But we need to hear far more about this kind of innovation and empower much more of it.

On which line, I will finish with a reflection. I have talked about this ever since I came into your Lordships’ House, virtually. This is a request for innovation in government rather than directly in the NHS, and the Minister has heard it from me before. I am sure that he and all other Members of your Lordships’ House have noticed the strong media focus in recent weeks on the health impacts of ultra-processed foods, which are very clearly causing massive costs to our NHS. The Government have continually declined to acknowledge ultra-processed foods as a category, despite the fact that the Welsh Government, the WHO and many other groups around the world do. My request to the Minister is not to give me a total government turnaround today, but I will ask him whether he will commit to going back to the department and talking about where the latest science is on ultra-processed foods. This media focus has come from the publication of one book, but there are new peer-reviewed research articles coming out every week about the issue.