NHS: Health Improvements

Earl Howe Excerpts

Wednesday 26th November 2014 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I begin by thanking the noble Lord, Lord Kakkar, for having tabled this debate, and all noble Lords who have spoken with passion and insight on these very important matters, and from a rich variety of perspectives.

Our ambition is for the people of this nation to live as well as possible for as long as possible. However, trends show that we can expect ill health in many of our later years, health inequalities persist, and the cost of ill health is increasing. The Government are clear that the National Health Service innovation and research are critical for addressing these challenges and I welcome this opportunity to discuss the impact of our strategies.

In the Five Year Forward View, NHS England and its partners commit to driving improvements in health through developing, testing and spreading innovation across the health system. This encompasses a wide range of activity and is part of the response to NHS commitments in the mandate to support research and innovation. The NHS has a unique position as a population-focused comprehensive health service, so we are building on this to facilitate more cost-effective randomised control trials as well as observational studies to support initial research.

We are setting up real-world innovation test bed sites linked to academic health science networks and centres. In these test beds, combinatorial approaches can bring together innovations where the benefit of combinations could be greater than the sum of their parts. That principle of integrated working in health was well illustrated by the noble Lord, Lord Mawson, in the context of which he spoke. I will be happy to look into the latest developments in Tower Hamlets and write to him.

A core plank of the health service’s approach to innovation will be improving the connectedness of information and data, providing whole data sets that enable the effect of new innovations to be tracked and assessed across all parts of the health system. I listened with great attention to my noble friend Lady Brinton. I agree that unlocking the value of data is a key challenge in improving health outcomes. As she will know, it is a thorny issue but there are exciting developments; for example, Manchester AHSN is exploring how to connect the NHS data across its whole region.

As a result, we anticipate broader adoption of innovations such as the Airedale telecare service, which I visited last week. This has transformed care provision for care home residents where it has been deployed, reducing the number of disruptive visits to hospital by more than half, and cutting the need for hospital admission by 35%.

The Five Year Forward View builds on the progress made under Innovation Health and Wealth, published in 2011. As a result of this work, innovation has a much higher profile within the NHS than it did, relationships with industry are stronger, and we are starting to see very encouraging signs of improvement in the uptake and utility of innovation. Since the publication of Innovation Health and Wealth, the NICE Implementation Collaborative has been established to provide practical solutions to overcome barriers to adoption of NICE-approved innovations. NHS England has launched Innovation Exchange and Innovation Connect, two key platforms to enhance the development and spread of innovation. Medical technology briefings have been introduced to provide the NHS with guidance on emerging medical technologies, and Innovation Challenge Prizes are now celebrating the groundbreaking innovations developed in the NHS and delivering better health outcomes for patients.

Not only that but in 2013 England became the first country in the world to implement a universal system of academic health science networks, AHSNs. These act as system integrators, linking all parts of the health landscape, including every commissioner and provider of health services in their geography, with industry and academia. Through their work to build a culture of partnership and collaboration and to drive adoption of innovation into practice, AHSNs help to improve the health of their local populations. As the noble Lord, Lord Kakkar, is no doubt aware, University College London Partners AHSN has taken major strides forward in the fight to prevent strokes. A preventive strategy is being introduced across the whole UCL Partners region, which could prevent 700 strokes each year and save more than 200 lives. This project is supporting primary care to improve the management and detection of people with atrial fibrillation and increase the number of people on appropriate anticoagulation medicines. Early work over a six-month period in one borough, Camden, has resulted in 131 more people with atrial fibrillation now taking appropriate anticoagulation drugs. Using the learning from this work, they have an opportunity to roll out similar interventions across a further 19 boroughs in the partnership.

I have referred to some of the things addressing the concerns that the noble Lord, Lord Turnberg, raised about the dissemination of innovation. There is also another innovation. The Department of Health is working very closely with NHS England and other key stakeholders to develop the innovation scorecard in order to make it a more useful tool in helping the NHS to understand and address unjustified variation in the spread and adoption of innovative new treatments. It is designed to help users—clinicians, patients, commissioning groups, government and other stakeholders—to understand and monitor the uptake of innovations in the NHS. In doing so, the innovation scorecard should ultimately be used to promote an equitable spread of clinically effective, cost-effective innovations at an appropriately rapid pace, and to encourage the decommissioning of outmoded practice where appropriate. This will help to ensure that innovations have the greatest impact in driving better health outcomes.

In NHS research, our achievements over the past five years are also extensive. Recruitment to trials and studies through the NIHR clinical research network has increased by over 30%. There were more than 600,000 participants in 2013-14; more than 99% of trusts were involved. Recruitment to commercial studies has increased by 26% in just one year, including 35 first global patients.

Following the landmark report by the Academy of Medical Sciences in 2011, we have established the Health Research Authority and awarded £4.5 million for delivery of a unified approval process and we are driving forward financial consequences for poor performance against the 70-day benchmark for recruiting the first patient to a trial. In five years, NIHR revenue spend has increased from £851 million to £987 million which demonstrates our commitment to NHS research even in the prevailing economic climate. In addition, the Health and Social Care Act is a milestone, creating unprecedented powers and duties at all levels to promote research. By the end of this year, NHS England will share a plan with the Department of Health for delivery of its research objective.

In the past, public health research has been neglected, and I particularly want to mention how the NIHR has brought about a step change in building the evidence base to drive health improvement. Fulfilling a commitment in our public health White Paper, we have established the NIHR School for Public Health Research. The NIHR public health research programme is looking at issues as diverse as air pollution, traffic accidents and binge drinking. To help to increase research capability in this field, the NIHR is funding a wide range of fellowships.

The noble Lord, Lord Kakkar, expressed concern about amendments to the proposed EU general data protection regulation, which could prevent health research involving personal data from taking place. Many of these concerns centre on amendments to the proposed regulation that have been agreed by the Civil Liberties, Justice and Home Affairs Committee of the European Parliament. The Government’s view is that the ability of researchers to process personal data in the way that they are legitimately able to do at present must be preserved. We remain attentive to the concerns raised and will continue to engage with representatives of the research community about the processing of personal data for medical research purposes under the proposed regulation.

As noble Lords know, work on the Medical Innovation Bill is ongoing. This Bill, introduced to your Lordships’ House by my noble friend Lord Saatchi, sets out a series of steps that doctors can choose to take when innovating. This is to give them confidence they have acted responsibly, with the intention of reducing doctors’ fears about claims in clinical negligence. The Government are pleased that the amendments that my noble friend tabled to help ensure patient safety were accepted by your Lordships’ House in Committee on 24 October. The Bill will now proceed to Report.

I cannot in the time available do justice to all the questions that have been asked; I shall, of course, write in relation to those questions that I have not had time to answer. I will, however, address as many as I can. The noble Lord, Lord Kakkar, asked about the follow-on from Innovation Health and Wealth and my honourable friend George Freeman’s review. NHS England has stated its intention to increase alignment between different supporting organisations for innovation, which will take account of the work and governance of Innovation Health and Wealth as well as the issue of the innovation culture in the NHS. As regards the Five Year Forward View and the medtech review, the review announced by George Freeman will look at the whole pathway for new treatments from bench to bedside, and these two must closely dovetail, as I am sure is clear to all. Of course, the AHSNs have a key role to play in that connection.

My noble friend Lady Brinton spoke about arthritis research and, in particular, patient participation in research. NIHR investment in musculoskeletal disease research has increased from £15.5 million in 2009-10 to £25.6 million in 2013-14. In May this year, the NIHR published Promoting a ‘Research Active’ Nation. It set out a new programme of work to encourage greater public engagement and participation in research.

I will have to write to the noble Lord, Lord Kakkar, on the sunset review to which he referred. My noble friend Lord Selsdon spoke about the potential of stem cells. He will, I am sure, be interested to know that the Government have an extensive agenda to seize the potential of stem cells for new groundbreaking treatments, and are working in close partnership with industry in this field. I am afraid that time is against me, and while I would like to respond to further questions from the noble Lord, Lord Turnberg, I hope he will forgive me if I pen him a letter about those.

In conclusion, I have outlined some of the major steps that we are taking through our strategies for NHS innovation and research. These are already impacting positively on the health of the population and, I am convinced, hold the promise of health outcomes as good as any in the world.

Committee adjourned at 9.09 pm.