Life Sciences Industrial Strategy (Science and Technology Committee Report)

Baroness Morgan of Huyton Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Baroness Morgan of Huyton (Lab)]

My Lords, I am pleased to be taking part in this important debate. I too was a member of the Science and Technology Select Committee which produced the report we are talking about, under the able chairmanship of the noble Lord, Lord Patel. It was a fascinating but very worrying inquiry. I draw attention to my interests in the register, particularly as chair of the Royal Brompton and Harefield NHS Trust, about which I will speak today. I will focus on the role of the NHS.

We all recognise that the NHS is vital to the success of the Government’s life sciences strategy. It is a unique asset that differentiates the UK from other countries. It is the big opportunity. The Government recognise this, but the challenge is not whether to recognise it but how to deliver on that opportunity. In our inquiry we heard extensively from industry that a silo approach to NHS budgeting and organisation makes innovation difficult, even when it is substitutive rather than additive —as my noble friend Lady Young said. In other words, even if a new treatment is an alternative and not an additional new approach, it is difficult to find a way through.

We also heard from NHS England that living within a tough funding regime means that the centre has to be sure of the benefits to the NHS of any innovation before any change can be approved and funded. Both these contributions, though understandable, were concerning to the committee. On top of this, the danger of the new NHS settlement is that too much of it will be used to prop up the existing service rather than to attempt to transform. It is an inevitable conflict. I sympathise with the Minister dealing with that one—although the noble Lord, Lord O’Shaughnessy, is not in his place.

I thought it would be useful to use a real example to highlight the realities and choices around innovation. It is very easy to talk about theory and potentially hugely positive macroeconomic effects. The life sciences strategy is defined by Sir John Bell as the application and harnessing of biological sciences and technology. If it is handled well, whether via the use of data, genomics, new drugs and treatments, new devices and approaches, and so on, it is absolutely also about better patient care and outcomes. I do not want to repeat the excellent contributions of my committee colleagues, so I will choose one disease, cystic fibrosis, to illustrate my point.

The Royal Brompton and Harefield Trust is a leader in the treatment of cystic fibrosis in both children and adults. CF is a life-limiting genetic disease that is caused by a defective gene which codes for a protein in cell membranes and therefore affects multiple organs in the body. Life is limited due to progressive lung disease, and those with CF are informed by their clinical teams, from an early age, that maintenance and awareness of lung function is important to maximise their life expectancy. As a result, people with CF are expected to attend clinics at their specialist centre regularly, to monitor their lung disease and receive treatment to prevent, halt or slow disease progression.

Our patients travel from all over the UK for specialist care and, through patient experience surveys, they report that attending a clinic so frequently for monitoring is significantly impacting on their quality of life. They must take time off work, arrange childcare and fund the significant cost of travel into central London. In addition to this, CF outpatient services at our hospital and other specialist centres are busy and frequently overbooked. This is a growing concern because research in this area has predicted an increase of 75% in the number of adults with CF. The good news is that this is due to advances in medical care and associated increased life expectancy, and further new drug trials are in the offing. However, the increasing pressure on services increases, for example, the serious danger of cross-infection, which is a significant issue for this patient group. Coming to hospital more or for longer than they absolutely have to is not good for their overall health.

A recently published guideline from NICE on cystic fibrosis has urged healthcare teams to consider providing telehealth as an option for routine monitoring, with benefits recognised both to the patient experience and in allocating hospital resources. The clinical team at the Royal Brompton and Harefield Trust has developed an innovation project that aims to address these challenges by empowering the person with CF to monitor their own health from home. Providing self-assessment equipment and a technology app platform to share that data with the healthcare team unlocks the team’s ability to provide remote, virtual consultations and advice. It will allow people with CF to gain a greater awareness of their overall health and to see the impact of lifestyle changes or new medicines. It is hoped that putting data in the patient’s hands will start to equalise the power dynamic that exists between patient and the healthcare team that currently holds much of the data used for clinical decision-making. It offers the trust the opportunity to reduce the number of in-hospital clinic appointments and consider how to allocate resources better in view of the growing patient population.

Although there is a lot of evidence from clinical practice indicating that the impact of this innovation will hugely improve both the clinical management of CF and patients’ experience of living with and managing this serious disease, there is no clear evidence yet that it can be economically sustainable. It is too soon to make and prove that hypothesis. The team are currently both tendering for the services of a technology partner to develop the platform and exploring with the current commissioner—the payer for our services, NHS England—how to pay for it. The platform is likely to demonstrate fairly quickly that the number of outpatient consultations between CF patients and the clinical team, especially face-to-face ones, can be greatly reduced, saving the patient travel costs and freeing up capacity in the hospital. Over the longer-term, the platform will enable the patient and the clinical team to identify the symptoms of an imminent exacerbation of the disease, which can then be managed so as to minimise the need for the patient to be admitted to the hospital as an in-patient.

If these cost savings and efficiencies from this innovation could be applied over a large number of patients, there is clear potential for the overall current budget spent by NHS England on CF to be reduced. But, crucially, the cost of running the platform in its first one to two years, when added to the existing costs of service provision, are almost certain to increase the current budget for CF, at a time when NHS England is looking to cut back on specialist service provision more generally.

My point in raising this as an example is not special pleading to the Minister, although I am sure he is listening, but to try to give a concrete example—there are so many others—of how current commissioning will need to change in order to support innovation. Innovation cannot and will not happen as part of the current regime. The systems, incentives and funding models are not right. Yet at all levels, whether in the individual clinical team, at NHS trust board level, in academic and business partners or nationally, we all want to deliver change and efficiencies. To make this work we need to be round the table having a serious, grown-up conversation.

I was struck by hearing evidence in the inquiry that genomics has been successfully developed as a comprehensive national strategy partly because it had, in effect, a separate organisation, so there was absolute focus and clarity around mission and delivery. If the life sciences strategy is to harness the power of the NHS and deliver both efficiencies and innovatory new treatments and approaches, it too will need absolute focus and accountability. It cannot be an add-on.

Sir John Bell’s excellent strategy and evidence to us identified a small window for us to get the incentives, the systems and the accountabilities sorted in order to realise the unique potential we have as an economy because of the power of the NHS. Can the Minister convince us today that the Government recognise this?