Health and Social Care Bill

Baroness Morgan of Drefelin Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Morgan of Drefelin]

My Lords, this has been a powerful debate already and, as number 51 on the speakers list, I represent perhaps the move into the beginnings of the home straight for the Minister and all the winders. I have been particularly impressed by the contributions today and am very much convinced by the arguments for the amendment of the noble Lord, Lord Owen, not least because of my concerns about the issues around Monitor and the failure regime. Given the lateness of the amendments, there is a need to scrutinise that part of the Bill and perhaps hear evidence from those outside this Chamber.

I want to focus on three important areas that have not been touched on in much detail so far: research; commissioning, particularly for cancer patients; and patient involvement. For the record, I declare an interest as chief executive of the research charity Breast Cancer Campaign.

On research, we have already heard from the noble Lord, Lord Willis, that the role of medical and scientific research in the promotion of high-quality healthcare is extremely important and highly significant. I am delighted that I am not the only one who has highlighted research today. The noble Lord, Lord Darzi, also made a very important point. We should not forget that long-term improvements in treatments are largely derived from and are dependent upon medical research, which requires long-term investment. The NHS offers a unique setting in the world for research and has enormous potential to enable and support advances in research. My concern is that we are still far from maximising the potential for patient benefit.

I am pleased that the Government have responded positively to concerns about the future for research in the NHS by introducing duties to promote research, which will be placed on the Secretary of State and commissioning consortia alongside the existing duty on the Commissioning Board. The AMRC and other medical research charities, including my own, have campaigned for that. However, I will be pressing the Minister to provide further detail as to what these duties will mean in practice. As the noble Lord, Lord Willis, said earlier, we need to be very careful that these duties are not just window dressing. In particular, I want it to be clear that there should be measurable benchmarks developed as a result of these duties.

I, too, must raise the issue of the regulation and governance of medical research. The key report by the Academy of Medical Sciences on this subject has been widely welcomed and I look forward to hearing more from the Minister about a timetable for the further development of the Health Research Authority—I do not understand at all why this cannot be in this Bill. Surely there is a great opportunity here to get that right and establish the authority.

The same Academy of Medical Sciences report raised the need to simplify the use of NHS patient data. This is a really important opportunity for progress. Another example of the positive use of patient data is the million women study—a collaborative project among Cancer Research UK, the NHS and others that involves more than 1 million women aged 50 and over—which identified the cancer risks of hormone replacement therapy, which is a key issue for women in this country. Will the Minister explain what consideration he and his colleagues have given to taking action on patient data to ensure greater simplicity within the system in order to promote such vital research?

My second point is on commissioning. We have heard a lot about commissioning, but I want to focus particularly on the commissioning of cancer services. We know that improving outcomes in cancer can be promoted only by collaboration and by commissioning across primary, secondary and tertiary services and public health, taking into account the need for high-quality research, because we know that patients do better when they are part of clinical trials.

For example, radiotherapy is a service that needs to be co-ordinated at regional and national levels, as it requires large planning populations and has a significant capital cost to be considered. In a recent report by the Cancer Campaigning Group, 81 per cent of GPs surveyed said that they believed that radiotherapy should be commissioned at a regional or national level, but is this what is going to be proposed? I still do not fully understand that.

Another example is the commissioning of pathology, which I am also concerned about. This issue is close to my heart because Breast Cancer Campaign has established the UK’s first tissue bank, which has been a huge endeavour. NHS pathologists have contributed to that, often in their own time, and have really gone the extra mile because they believed in making the project happen. How that will work going forward is of great concern. We rely on a lot of good will from NHS employees to make research possible in this country.

The Cancer Campaigning Group—whose membership includes over 50 charities, including Macmillan Cancer Support, the Prostate Cancer Charity and Cancer Research UK, which I have already mentioned—has argued very strongly for the vital role that cancer networks must play, which must be maintained. The Government have listened to these arguments and made funding available to fund and support cancer networks, which are a vital source of expertise and drive in promoting improved quality in cancer services, but that is only until 2013. I hope that the Minister will be able to set out how the Government intend to guarantee the best future for cancer networks going forward.

I know that there are implications for other disease areas, too. I would be particularly interested to hear the Minister’s thoughts on how to ensure that networks receive sufficient funding, have the capacity to commission high-quality cancer care for patients at all stages of their cancer journey and have a suitable accountability structure. I would also like to hear about how their role can work in supporting patient involvement. I am happy for the Minister to write to me in response, because I have a feeling that he may have a lot of points to come on to later. We have all seen real improvements in cancer care in recent years in this country, which has been driven largely through collaboration and integration, and we need to understand how that can go forward.

In my last point, I want to say something quickly about patient involvement, which I believe is fundamental to improving the quality of care. “No decision about me without me” sounds great, but I understand that the assessment of the Richmond Group of patient-led health charities is that this principle has not yet been fully adopted in the context of NHS service design and planning processes. To do that would mean that the duties on commissioning bodies and Monitor to obtain advice in discharging their functions should be further extended to more fully encompass patient involvement.