Medical Innovation Bill [HL]

Debate between Baroness Masham of Ilton and Baroness Wheeler

Friday 24th October 2014 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I support what the noble Lord, Lord Blencathra, has said. The use of drugs seems much more flexible in the private sector than in the National Health Service. I ask the Minister to look very closely at the funding of these drugs if they are to be accepted in the Bill.

[Baroness Wheeler]

My Lords, I am pleased that Amendment 28 has been grouped with the amendment of my noble friend Lord Winston and the noble Lord, Lord Pannick, as we have considerable sympathy with their attempts to define innovation. I understand that it is a probing amendment. We consider that the Bill would benefit from a clearer understanding of what we mean by innovation and indeed of some of the exclusions that would apply that were referenced in the earlier comments on Amendment 19. I am grateful to my noble friend Lord Giddens. His perspective on that was helpful. I look forward to the response on that.

Amendment 28 is also a probing amendment and underlines that medical innovation and the adoption of new treatments require the whole NHS to make both research and innovation its business. The Secretary of State, the NHS regulators and all the key NHS bodies have a clear responsibility and the authority that they need; they need to use it. We have had many debates in this House that recognise the scale and pace of innovation taking place across the NHS and the frustrating barriers that prevent innovative treatments being adopted.

The noble Lord, Lord Saatchi, considers that doctors’ fear of medical litigation or disciplinary proceedings is a key factor that,

“reinforces a culture of fear and defensive medicine in the NHS”.

Whether medical litigation evidence supports that or not, we need to keep emphasising that it is just one of a number of barriers that have to be overcome. I know that the noble Lord recognises this as the context for his Bill. As Sir Robert Francis QC puts it:

“The real obstacles to responsible innovation are not to be found in the Bolam test but in the minefield of regulation and bureaucratic inertia which doctors presumably have to surmount, not to mention the reluctance to fund innovative treatment”.

The contribution of the noble Lord, Lord Blencathra, underlines that we are far too slow in this country to introduce new treatments.

The Health Research Authority is still yet to make a real impact on speeding up the painfully slow, complex and bureaucratic process of getting innovation in care and treatment adopted in the NHS. There is huge frustration across the NHS that existing pathways and mechanisms are not being fully used, such as the single portal of entry and single application procedures for clinical trials. NHS trusts’ slow implementation of the UK life sciences strategy, Innovation, Health and Wealth, and the very low level of awareness and action that they have taken on that strategy are continuing causes for concern.

Most important too is the role of Health Education England in ensuring that innovation and research are incorporated into the education and training of key medical and other health staff. The excellent vision report from the Association of Medical Research Charities, which my noble friend Lord Turnberg takes every opportunity to raise and endorse, showed the huge challenges we face in building support among doctors and patients for participating in research that leads to innovation.

As research and innovation go hand in hand, we were keen to include reference to research and innovation in our amendment, but I hear what has been said by the noble Lord, Lord Saatchi, and the Minister on this. I note that the Medical Defence Union, while now supporting the changes the noble Lord, Lord Saatchi, has made to the Bill, also makes the point about the importance of research being included because that is where most innovation takes place. It is concerned on this issue because it feels that many doctors are likely to be uncertain about whether the Bill would apply to innovation they are contemplating. This may hold up a proposed treatment or procedure while they check the position. In most cases, the Bill will not apply. Even where innovation arises out of a research project, doctors are likely to want to ensure that information gathered in treating the patient contributes to overall research in that area, and the MDU is concerned that the wording of the Bill may prevent that. I would be grateful for comments on this point from either the noble Lord, Lord Saatchi, or the Minister.

Our amendment seeks to place the Bill in the context of the duty of the Secretary of State and the key bodies of the NHS to support responsible innovation in medical treatment and makes it clear that that is the overall purpose of the Bill. I would welcome a response from the noble Lord, Lord Saatchi, on whether, despite his desire to keep the Bill short, he considers that a clear definition of the core concept of innovation, as the noble Lord, Lord Pannick, said, could be incorporated into the Bill as a reference to its overarching purpose. I would also appreciate the Minister’s comments on this.

Health and Social Care Bill

Debate between Baroness Masham of Ilton and Baroness Wheeler

Monday 27th February 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I have put my name to Amendment 99. Will the Minister tell the House a bit more about the clinical senates? He has spoken about them previously but it would be interesting to hear a bit more about who will actually be on them, who will pay for them and how will they give their information. There are many people, especially in the cancer field, who would like to know more.

[Baroness Wheeler]

My Lords, we strongly support the amendments in this group, which underline the importance of the NHS Commissioning Board and CCGs seeking advice from healthcare practitioners from across the patient care pathway, including local clinical specialists and allied health professionals, and going beyond professional input to seek advice from organisations with expertise in the experience of patients.

We hope that the Government will recognise the strong case put forward by the noble Baroness, Lady Finlay, and other speakers to these amendments for also recognising the expertise of patients’ organisations in the Bill and ensure that commissioners seek their advice as well as that of health professionals. By this we mean patients’ organisations not just being consulted but being genuinely involved in helping to co-design or co-produce services. Many patients’ organisations, such as the Stroke Association for example, are key providers of local services such as reablement or information, advice and support services to stroke survivors, carers and family members across the country. They have first-hand, direct experience of the issues that matter most to patients across the whole care pathway, hospital and community. Involvement of patient groups would also help the patient voice in the clinical senates and networks, which the noble Baroness, Lady Masham, also mentioned. To remind the Government, this approach was supported by the clinical workstream of the Future Forum, round one, but was overlooked in the Government's response. Now is a good opportunity to address this issue.

Amendment 65, tabled by the noble Lord, Lord Patel, and the noble Baroness, Lady Finlay, deals with information collected by the board on the safety of services provided by the health service being made available to healthcare providers, the Care Quality Commission and HealthWatch England, local authorities and professional organisations in healthcare. We fully support this, along with the caveat provided by Amendment 66 that the information should be freely available without charge. I hope that the Minister will accept the need to make progress on this important issue and reassure the House about the involvement of healthcare professionals and patient organisations in developing the commissioning plans.

[Earl Howe]

My Lords, this has been an interesting and worthwhile debate and I appreciate the concern that the noble Baroness, Lady Finlay, and other noble Lords have demonstrated throughout the Bill’s proceedings to ensure that the board and CCGs benefit from as wide a range of advice as possible. The Government have been clear that everyone with a role to play in securing the best possible services for local people should be able to do so. The NHS Future Forum recommended that we strengthen the legislative duties to help achieve this, which is why the duties on the board and CCGs to obtain appropriate advice were strengthened in another place to incorporate the wording used to define the comprehensive health service and to ensure that it was clear that such advice should come from persons who, taken together, have a broad range of professional expertise.

I mentioned clinical senates on the last group of amendments. Of course we envisage a role for clinical senates in the arrangements for how these duties are fulfilled, providing not just clinical but multidisciplinary advice from professionals from public health and social care alongside patient and public representation and other groups as appropriate. The noble Baroness, Lady Masham, asked me specifically about clinical senates. They will be established as strategic advisory bodies, with a clear focus on quality improvement and improving outcomes. They will bring together clinicians with strong clinical credibility, drawn from across the disciplines, as I have mentioned. They will include patients and members of the public as well. They will have a role, too, in advancing public understanding of health and healthcare.

Why do we need clinical senates? Commissioning is at its best when it is a collaboration of professionals, based on a shared drive for continuous quality improvement. Maximum participation will be key here. The Future Forum report showed:

“There was universal agreement that people would be”,

better served if their,

“care were designed around their needs and based on the input of the public, patients and carers, health and social care professionals”,

the voluntary sector, “and specialist societies”. The exact detail of who will be part of the clinical senates, the number that will exist and the roles that they may have are all to be determined through a process of discussion and engagement, but I hope that I have outlined, at least in broad terms, what they will be there to do.

Health and Social Care Bill

Debate between Baroness Masham of Ilton and Baroness Wheeler

Thursday 15th December 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I shall add just a few words. If we do not get this matter right, we, the Members of the House of Lords, will be blamed. I hope that Ministers will act on what has been said this evening.

[Baroness Wheeler]

My Lords, noble Lords have spoken to their amendments effectively and comprehensively, so I will not deal with all the amendments. I start by giving our support to the spirit behind Amendment 318BA, tabled by my noble friend Lord Whitty and the noble Lord, Lord Low, and Amendment 322, tabled by my noble friends Lord Rooker and Lord Harris. They underline the crucial need to uphold the independence of local healthwatch organisations by enabling them to carry out their activities as they see fit, subject to any directions from Healthwatch England, and emphasise that they must not be regarded as either servants or agents of the local authority.

Local independence is vital for people to have trust and confidence in their local healthwatch organisations to articulate their priorities and the needs of the local community. To be effective, they must be able to scrutinise how consortia and health and well-being boards have undertaken public engagement and transparency, and how they are ensuring that the patient voice is embedded in the care pathway design. They also need to be able to scrutinise how lay representatives on consortia and health and well-being boards themselves undertake public engagement and transparency.

Amendment 318E in the name of the noble Baroness, Lady Cumberlege, would require local healthwatch organisations to provide the NHS Commissioning Board with their opinion on whether local plans take proper account of their views, as evidence in reports and recommendations. We support this, and of course underline that CCGs must also be required to consult local healthwatch organisations while commissioning plans are drawn up and developed.

On the question of how local healthwatch organisations are funded, we need to recognise the widespread concern raised by noble Lords and current LINks organisations that the arrangements for local healthwatch organisations and their dependence on funding from local authorities compromise their independence, particularly in terms of public perception and confidence in their role and work. With local authorities having greater involvement in healthcare—particularly public health—how will healthwatch organisations be able to exercise the independence that the public would expect?

A number of amendments seek to address that issue, either through guaranteeing resources or prescribing how the local authority should take decisions in relation to its commissioning of healthwatch, the allocation of resources and the governance arrangements. Perversely, some of them could have the unintentional consequence of tying in local healthwatch groups to the local authority more tightly. In view of the current economic climate and the massive cuts that local authorities are having to make, the concerns and unease over the future resourcing of local healthwatch organisations need to be addressed. I hope that the Minister will recognise this as a major issue, consult all stakeholders and come back to us on Report with reassurances and solutions.

This is the first time we have touched on the new independent advocacy services that local authorities will be required to establish to provide assistance to individuals making complaints about health or community care services or providers, including using the local healthwatch organisation to deliver this service. We are very sympathetic to Amendment 324 from the noble Lords, Lord Rix and Lord Wigley, and the noble Viscount, Lord Tenby. It seeks to prevent any case being dismissed from the outset or midway through as too complex or lengthy. Complaints against the health service are often complex and require long periods of support to be provided to the complainant. It is a service that should be provided to all users, and provision will need to be made to support people with mental health problems and learning difficulties, as well as people with disabilities.

We support Amendment 325 in the names of my noble friends Lord Rooker and Lord Harris. This would provide for advocacy to cover complaints about both health and social care. I look forward to the Minister’s response on these issues.