Allied Health Professionals: Prescribing Responsibilities

Lord Butler of Brockwell Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord for his question and absolutely agree with the direction of travel. We are keen that every clinician should work at the top of their profession, and to bring in people with allied skills who can supplement that and prescribe as well. We need to be careful, because there is obviously a danger of overprescribing. But in general, we totally agree and want to extend this as far as possible.

[Lord Butler of Brockwell (CB)]

My Lords, I congratulate the Government on fulfilling their promise, made in reply to a Question for Short Debate in this House, to extend prescribing rights to paramedics by the end of last year. However, that was no fewer than four years after the extension had been approved by the Advisory Council on the Misuse of Drugs. Why did it take so long? Will the Minister undertake that future properly approved extensions will be implemented more quickly?

[Lord Markham (Con)]

Yes, because the noble Lord is correct: it should not take so long. We all agree with the approach. So noble Lords understand, there is a two-step process. First, the body to which we are trying to extend this needs to be agreed by a review of the Commission on Human Medicines; then, the Advisory Council on the Misuse of Drugs need to take a look at it. We are all aware of the dangers of anti-microbial resistance, which is why we need to be careful about things such as antibiotic prescribing. But in general, we want to do this as fast as possible.

NHS: Gambling Treatment Services

Lord Butler of Brockwell Excerpts

Monday 28th March 2022 Lords Chamber

[Lord Kamall (Con)]

The former Public Health England, now the Office for Health Improvement and Disparities, works closely with us, particularly on this issue. We understand the call for a compulsory levy. Indeed, as I am sure many noble Lords will be aware, DCMS recently conducted a review of the Gambling Act 2005. The DHSC was part of that, looking at the impact of gambling on health. Gambling is now recognised as an addiction, as opposed to any other issue. We are looking at this and considering all options. The Government received 16,000 responses to the consultation; we are looking at that and will publish the White Paper soon.

[Lord Butler of Brockwell (CB)]

My Lords, with respect, the Minister did not really answer the question about the financing of these services. Does he accept, or understand, that those who treat and research gambling conditions are reluctant to accept funds that are voluntarily provided by the gambling industry?

[Lord Kamall (Con)]

I completely recognise the noble Lord’s point, which is why we welcome the fact that GambleAware will no longer fund the two clinics in London and Leeds. NHS England has stepped forward on that, but we are reviewing this overall, in a holistic way. When we have an issue that is considered across government, we must make sure that it is all joined up. The Department for Digital, Culture, Media and Sport has been leading the review into the Gambling Act 2005, and has asked the Office for Health Improvement and Disparities and the Department of Health and Social Care to feed into it, along with all the other stakeholders.

Academic Health Science Centres

Lord Butler of Brockwell Excerpts

Tuesday 2nd July 2019 Grand Committee

Asked by

[Lord Butler of Brockwell]

To ask Her Majesty’s Government what is their policy and timetable for re-designating academic health science centres.

[Lord Butler of Brockwell (CB)]

My Lords, I thank those other Members of the House, some of them very distinguished in health issues, who have put their names down to speak. Someone pointed out to me that if I were unfortunate enough to suffer a stroke, this would be the moment to do it.

I declare an interest as recorded in the register of interests. I serve as a non-executive member of the board of an AHSC—namely, King’s Health Partners, which includes King’s College London, King’s College Hospital, Guy’s and St Thomas’ and the South London and Maudsley NHS Foundation Trust. From 2009 to 2014, I chaired the board of King’s Health Partners.

I need not remind your Lordships what an exciting time this is for advances in medical science. The concept of academic health science centres offers a means to exploit those opportunities for the benefit of people locally, nationally and across the world. By bringing together great biomedical research institutions with outstanding teaching and clinical hospitals, it offers the opportunity not only to trial advances in medical science but to bring them to fruition for the care of patients.

Apart from the United States, which pioneered the concept of AHSCs, the United Kingdom is perhaps the country best equipped to make the most of those opportunities. In London and our great academic centres, we have ground-breaking research universities: colocated with long established and world-famous teaching and clinical hospitals. In 2009, the NIHR accredited the first five AHSCs: three based in London, one in Cambridge and one in Manchester. In 2014, following a further competition, they were reaccredited and a further one in Oxford was added. The accreditation was for five years and is due to be renewed in 2019.

It is important to recognise that this was simply a structural initiative. No extra money was provided and the institutions remain fully within the state sector. King’s Health Partners is the AHSC which I know best. This year, we celebrated our 10th anniversary. I believe that our achievements over that time, stimulated by the AHSC initiative, have been impressive. Brilliantly led—indeed, driven—by its chief executive, Sir Robert Lechler, assisted by a small but outstanding team, the reach of King’s Health Partners has been remarkable.

As I said, the underlying concept of AHSCs is to bring together frontier-breaking research with teaching and clinical care. Sir Robert approached this in King’s Health Partners by establishing 22 clinical academic groups, embracing the full range of medical specialties and bringing together from the four institutions the leading members in each.

King’s Health Partners has a number of assets which have assisted in making the most of those opportunities: two NIHR biomedical research centres, which provide unparalleled facilities for experimental medicine and in which 600 clinical trials are current at any one time, covering more than 3000 patients; the leading research institute in the country in psychiatry, psychology and neuroscience, colocated with the leading hospital in the care of mental illness, which has enabled advances to be made from the increasing recognition of the links between physical and psychological illness; and a diversity of population in south London, where the widest range of physical and psychological conditions give unique opportunities for research and treatment.

In addition to the advances made in individual specialities, King’s Health Partners has pioneered a number of other advances. As a response to the ever-increasing demands on health services, it has pioneered the concept of value-based healthcare and preventive measures, not least through the concept of the vital five factors in the prevention of disease—blood pressure, obesity, mental health, alcohol intake, and smoking habits—which have been promulgated through KHP’s academic health science network in south London. This work will make a real difference in reducing future demands on the health services, as well as giving people the prospect of happier and healthier lives, and is of course a key plank in the long-term plan for the health service.

At a recent seminar to celebrate the 10th anniversary of the AHSC, we had presentations of some of the advances made in patient care over the last 10 years that have made a major contribution to the life prospects of patients. They include: treatment for Hodgkin’s lymphoma avoiding the side-effects of radiotherapy in children; advances in the application of naloxone for heroin addicts; genetic treatment to reduce inheritance of breast and ovarian cancer; separation of the elements of cannabis so that the benign element can be used in patients; a new approach to recognition and treatment of prenatal eclampsia; MRI recognition of scar tissue to assist life-saving treatment of heart attacks; and improvements of means to prevent rejection in organ transplantation. On top of that, we can be immensely proud of the contribution that British science has made to dealing with the Ebola epidemics in Africa. There is so much going on that it is impossible to cover it all in one speech—for example, exploitation of the opportunity provided by informatics to join up patient records across our health system.

I am sure that the other AHSCs can tell a similar story. The nub of it is this. Certainly on the basis of my experience, the concept of AHSCs has been an outstanding success. They promote a national asset in which the United Kingdom is a real world leader. They are a magnet for talent and worth investing in. At a time of severe pressure on resources, they make a major contribution to more cost-effective healthcare for our National Health Service. There is great potential still to be tapped.

Reaccreditation will provide both a stimulus and an opportunity. It would be cost effective if that were accompanied by a modest financial grant. We are talking of only a small handful of millions, which would make a big difference—chickenfeed in relation to the overall cost of the NHS. Therefore, I hope that in her reply the Minister will provide that encouragement, and in particular give us a firm timetable for the process of reaccreditation. King’s Health Partners has been preparing itself for that and is waiting for the signal.

Healthcare (International Arrangements) Bill

Lord Butler of Brockwell Excerpts

Committee: 2nd sitting (Hansard): House of Lords
Thursday 21st February 2019 Lords Chamber

[Lord Foulkes of Cumnock]

Thank you. I wonder what the noble Baronesses, Lady Blackwood and Lady Manzoor, and the noble Lord, Lord Young, think of the possibility of my good friend Jeremy Corbyn bringing in legislation through statutory instrument after statutory instrument without any ability for scrutiny by a Conservative Opposition. That has to be thought about. This is a parliamentary democracy and people have to think about that and about what they are storing up for themselves. That is exactly what is happening.

I go back to the excellent speech by the noble and learned Lord, Lord Judge. He said:

“A late Victorian, or maybe Edwardian, professor of history described Henry VIII as ‘the mighty lord who broke the bonds of Rome’, but even Henry VIII was compelled to do it through express, primary legislation enacted in the Reformation Parliament. On one view, it may be a misdescription to call this a Henry VIII clause. Bearing in mind that it applies to both UK and EU primary legislation, perhaps in this context it is a Henry XVI clause”.—[Official Report, 19/2/19; col. 2171.]


That was a wonderful description.

Earlier, at Question Time, the noble and learned Lord said that we might issue a stamp commemorating 40 years since the last statutory instrument was overturned by the other place. We all thought that was very amusing and it was a lovely description, but it is a very serious matter. I understand the take it or leave it approach to appropriate secondary legislation, but when the issues considered ought to be dealt with through primary legislation, we get into very dangerous territory indeed. I hope the Minister, in the context of this Bill, and the Government, in the wider context of other Bills, will realise the constitutional implications of what they are proposing and that their short-term political expediency will have some long-term consequences that they might live to regret.

[Lord Butler of Brockwell (CB)]

My Lords, I agree with the noble Lord that our parliamentary processes for dealing with statutory instruments are unsatisfactory—in particular, that we cannot amend them. But is not the remedy in Parliament’s hands? If we were a little bolder and rejected some statutory instruments, it would not be difficult for the Government to reintroduce them in an amended form. The amendment could be very slight. It seems that statutory instruments are necessary, particularly when we are dealing with all those that result from our leaving the European Union. Therefore, we need to look very carefully at the parliamentary process for dealing with them. It seems, as the noble Lord, Lord Young of Cookham, said at Question Time, that this is in Parliament’s hands. We could be bolder and achieve the objective of amending statutory instruments by rejecting some of them.

[Lord Mackay of Clashfern (Con)]

My Lords, it is important to realise that statutory instruments are a very useful way of dealing with particular situations, but of course it is extremely important that the powers to make these instruments are properly scrutinised and narrow. As the noble Lord, Lord Wilson of Dinton, said on the previous day this Bill was being considered, in his day parliamentary counsel would say, “What do you want to use this for?” If the reply was, “I’m not sure”, they would say, “Well, in that case I’m not drafting it until you know what it is for”.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, this has been a very powerful and useful debate to have as a precursor to the one we are about to have, where we will again address the nature of the powers in the Bill. I enjoy it very much when noble Lords such as the noble and learned Lord, Lord Hope, use the words “rather unfortunate”. Of course, in House of Lords-speak, which the Minister will become accustomed to, it is a very serious thing to say of a piece of legislation that its drafting is rather unfortunate. I want to say how much I appreciated the interventions from the noble Lord, Lord Butler, and the noble and learned Lord, Lord Mackay of Clashfern, to whom I always listen most carefully.

My noble friend Lord Foulkes referred to discussions that may take place outside this Chamber on whether statutory instruments should be referred back, but actually we know from the past that, when your Lordships become exercised about a statutory instrument, we see threats in the press about our existence and, “How dare they!”. That is a serious problem, so I think there is an issue that we need to address that is broader than just this Bill.

[Lord Butler of Brockwell]

It seems to me that the situation is exactly the same with amendments to primary legislation. Governments will often put pressure on their Back-Benchers to support it, but very often the Government are defeated on amendments and legislation is thereby improved. I cannot see why the same thing should not happen with statutory instruments.

[Baroness Thornton]

The noble Lord and I absolutely agree about that, and the noble Lord is quite right. I am not saying that one would bow to that pressure at all. Your Lordships’ House has a proud record of persuading the Government to change both statutory instruments and primary legislation with regard to the powers that they have.

I shall say one final thing. It is not the case that these issues were not raised by my honourable friends in the House of Commons; in fact, they were. Indeed, the Delegated Powers Committee’s first report on the Bill was quoted extensively in Committee in the Commons; unfortunately, the votes were not there to carry its effects through. We might think about changing that at a later stage in the Bill.

Health and Social Care Bill

Lord Butler of Brockwell Excerpts

Tuesday 13th December 2011 Lords Chamber

[Baroness Thornton]

My Lords, we have yet again leapt to a larger group, and I know that the noble Lord, Lord Clement-Jones, will get his turn, although possibly not until after dinner. We have moved on to a large group of amendments that concern pricing and the setting of tariffs. Many other noble Lords have tabled amendments in this group, as indeed has the Minister. I do not intend to make a long speech, but I will address the issue of pricing.

On reading the Bill you would think that having a tariff in the sense of a complete list of NHS services with all the prices and currencies set out was just around the corner, but I suggest that that is a bit of a myth. Even well developed healthcare systems that are much more market-orientated than our NHS are still a long way from such a state; we are years or perhaps decades away from that condition. For a start, for many services there are no data—not just bad or incomplete data, but none. Getting the datasets defined, collecting the data, then making the analysis, road-testing and rollout will take time. The Minister might like to tell us just how large the team in the Department of Health working on this task is, because I have to say that I heard that it is small and getting smaller as the cuts bite. But, of course, there is always KPMG or McKinsey to step in. Apart from anything else, it seems that this Bill is intent on creating a lot of jobs for lawyers and now, we see, for accountants too.

We are in the midst of a major argument about how relevant different types of currency and tariff might be, with some suggesting that returning to block payments might be better, in the interest of integration, stability and cohesion. This has been stamped on by the operating framework but that does not mean that it will not happen. Using choice and the right financial incentives to drive change in the system is the new orthodoxy. Some are trying to find out how different currencies, uses of penalties and fines and even bonus payments can reward good outcomes and deter bad. This has now extended to how to incentivise integration. These are all problems for which we would like to have answers. We are years away from a system where all these levers are available in the way that the Bill likes to suggest that they are.

In mentioning the framework, we should point out that the re-emergence of price competition shows the need for some communication between the chief executive and the Secretary of State.

Who, then, sets the prices? The arguments are well balanced. My noble friend Lord Warner argues in his book that it should be the national Commissioning Board. He is not in his place at the moment, but I have read his book. However, the national Commissioning Board is in the ludicrous position of also being the commissioner of local services. Monitor may also be compromised, as it is aligned to providers. So we return to the role of the Secretary of State. In any event it must surely be for the Secretary of State to determine the strategic approach, namely the global uplift or reduction. Our priorities for a system as determined by the Secretary of State also need translating so that the incentives are aligned to the desired outcomes, something the NHS has not always been good at. If the Secretary of State determines the approach within the strategy, then we may need genuine independent input into the detailed work of pricing and tariff. At the very least, a full list of the proposed tariffs should be published along with all the data and the analysis, so that the big brains of people at organisations like the King’s Fund and the Nuffield Foundation can tell everyone what is wrong.

Widespread consultation before any major change is a good idea, as is road testing changes before inflicting them and all the suffering of the unintended consequences that may arise. In the end, we think that the Secretary of State must make the strategic decisions in this crucial part of the economic architecture. It cannot be handed over to a quango.

The details of the amendments in my name and the name of my noble friend are as follows. Amendment 277B would insert a new clause which would place a duty on commissioners as to the continuous improvement in terms of cost, value for money and the needs of patients. It would also encourage co-operation with health and well-being boards, patients and the public. It would allow the Secretary of State to issue guidance, via regulations, including in relation to whether,

“competition for the provision of a service may or may not be appropriate”,

and in relation to,

“the circumstances for use of tenders as a result of a service review”.

Noble Lords who were here this morning—which now seems like a long time ago—may remember that, when I explained the overall purpose of our amendments to reconfigure Part 3 of the Bill, the setting of prices was part of that.

Amendments 288J and 289 are about setting a national tariff: they would make it a matter of policy for the Secretary of State, and not a matter for Monitor. Amendment 291B would ensure that regulations relating to the national tariff must state how the prices and methods were determined and how any proposed changes to the national tariff,

“will be subject to proper evaluation and testing” ,

as well as dealing with evidence of consultation between the Secretary of State and Monitor. As the national tariff should not vary in relation to different descriptions of provider, Amendment 292ZC would deal with that issue and the issue of a preferred provider. Monitor should also have no powers over commissioners—in this instance, in relation to the tariff—as commissioners are regulated by the board. We oppose the question that Clauses 116 to 121 stand part of the Bill, because we believe that the Secretary of State should set the national tariff: if the Secretary of State were to set the national tariff, then those clauses would be unnecessary. Once more, as you can see, we are reducing the size of this part through our amendments.

Amendment 294LA would insert a provision that regulations must be laid to issue “guidance on the circumstances” in which there can be local modification of prices. That decision should not be for commissioners and the providers of healthcare services alone. Amendment 294LB would provide that any local modifications of prices would occur with the approval of both Monitor and the board. Amendment 294LC also concerns local modifications of prices: it would ensure that if they were approved, Monitor would have to notify the relevant health and well-being boards. Amendment 294MA deals with situations in which a provider fails to reach an agreement with a commissioner about local variation of prices: in such circumstances it would allow Monitor to authorise such changes only,

“with the consent of the Board”.

Amendment 294MB would ensure that no modification of prices could happen,

“without the consent of the Secretary of State”.

In the area of the setting of prices we are perfectly happy to acknowledge that this may not be a perfect set of amendments. But we think that the very important matter of who sets the prices, and where the accountabilities lie, needs to be discussed. I beg to move.

[Lord Butler of Brockwell]

My Lords, I shall speak to Amendments 288H and 291A, in my name and the names of the noble Lords, Lord Newton of Braintree and Lord Turnberg. The amendments are related. Like other amendments in this group, they relate to the tariff—that is, the remuneration which a healthcare provider receives for a healthcare service. The amendments to which I am speaking are designed to facilitate the introduction of new treatments made possible by the development of new technology. When an innovative treatment requires a new procedure code or an updated healthcare resource group classification, a new code can take up to three years to be implemented and a new healthcare research group can take up to six years to develop. Meanwhile, NHS trusts cannot be remunerated for potentially useful and cost-effective improvements made possible by new technology.

In Germany, an intermediate step has been developed, under which providers can apply for an on-top payment while a new code is being developed. This is known in Germany as the NUB system, although I hope that noble Lords will not ask me to say what NUB stands for. These amendments provide for a similar “innovation tariff” to be provided in the United Kingdom, to allow for providers to be remunerated for an innovative procedure on a temporary basis while a new procedure code or healthcare research group is being developed.

These amendments are in line with the Government’s Strategy for UK Life Sciences, which was published last week, but are not already covered by it. I hope therefore that the Minister will give sympathetic consideration to the introduction of arrangements of this sort to facilitate the introduction of health improvements made possible by new technology.

[Baroness Gould of Potternewton]

My Lords, I shall speak to Amendment 292A. As it stands, Clause 114(11) will have a negative effect on the provision of sexual and reproductive health services. This arises from the transfer of sexual health commissioning, along with public health, to local authorities.

Clause 114 requires Monitor to publish “the national tariff”, but an amendment put down by the Government in the other place inserted subsection (11), which specifically exempts public health services from the national tariff. As sexual health services are set to be a public health responsibility, it will mean that genito-urinary medicine and sexual and reproductive health services will be excluded.

Sexual health professionals are deeply concerned by the impact that the absence of a national tariff may have on the provision of sexual health services. There are a number of providers of sexual and reproductive health services in the community and many are funded by a payment-by-results tariff system, commissioned by PCTs. The Bill as it is now drafted makes it very unclear how those services can expect to be commissioned by local authorities. Without a national tariff, the expectation at best would be to have a local tariff implemented, based on a national tariff. At worst, providers will return to a system of block contracts.

Health and Social Care Bill

Lord Butler of Brockwell Excerpts

Monday 28th November 2011 Lords Chamber

[Lord Stoddart of Swindon]

How long is it likely to take for the appeal and the decision? If the decision disallows the appeal, will the Government accept that?

[Lord Butler of Brockwell]

My Lords, the problem is not what may be contained in a particular risk register, as the Minister has said, but the precedent that it sets for all other risk registers. There may be nothing in this register that is particularly sensational or has not been released. However, once this case is conceded it will nullify the effect of all risk registers across government. If people think these risk registers are valuable it must be the case, as the Minister has said, that people look at the worst risks and do so frankly, and if they make them anodyne then the purpose of the registers is entirely lost.

[Lord Elton]

My Lords, I hope that the noble Baroness, Lady Thornton, will remember those words when she is considering her next intervention on this matter. Bear in mind that what she says then will be taken as the yardstick of what any Government of her colour are expected to do when they eventually—one hopes at a great distance of time—take our place.

--- Later in debate ---

Moved by

[Lord Butler of Brockwell]

109A: Clause 20, page 17, leave out lines 33 and 34 and insert—
“(5) In discharging its duty under subsection (1), the Board must publish guidance for clinical commissioning groups that includes the option to opt out and explains the extent of compliance with—
(a) the quality standards prepared by NICE under section 231 of the Health and Social Care Act 2011;(b) indicators included within the NHS Outcomes Framework; and(c) minimum standards set by the Board on patient related outcomes measures.”

[The Lord Speaker (Baroness D'Souza)]

My Lords, I advise the Committee that if the amendment is agreed to, Amendments 110 and 110ZA cannot be moved by reason of pre-emption.

[Lord Butler of Brockwell]

My Lords, with the agreement of the noble Lord, Lord Newton, I move Amendment 109A, which stands in my name and his. I can do so briefly, although the amendment is important and, I hope, helpful. I declare an interest as the chair of King's Health Partners, an academic health science centre. Part of the centre's mission is to accelerate the translation of research into patient care—getting a faster process from bench to bedside. It is in that capacity that I move the amendment.

The focus in the Bill on outcomes for patients is very welcome. It is also welcome that Clause 20 gives the Commissioning Board a duty to promote compliance with the quality standards prepared by NICE, as well as guidance published by the Secretary of State. There may be circumstances in which there are good local reasons why NHS providers should not comply with NICE guidelines. One such circumstance may be where there are innovative treatments that have been approved but with which NICE guidance has not yet caught up. We do not want the clause to stifle the introduction of such initiatives, which the creation of AHSCs is designed to promote and which are greatly in the interests of both British industry and patients. For this reason, Amendment 109A introduces an element of flexibility through a comply-or-explain regime. It will give providers the opportunity, in cases where there are good reasons why they should not comply with the NICE guidelines, to depart from them provided they can explain their non-compliance satisfactorily. That is all I need to say about the amendment. I beg to move.

[Lord Newton of Braintree]

My Lords, I chip in briefly in support of the amendment. I hasten to assure my noble friends on the Front Bench that this is a probing amendment and that I have no intention of pushing my luck. I have been so open and transparent as to share with the Minister every word of the briefing that I received and that led to the amendment. He knows what it is about. Therefore, I am looking for a measured, constructive and well informed response. I have no interests to declare except the public interest. The healthcare industry—the interests of which underlie the amendment—is important. It contains a lot of small and medium-sized enterprises of a potentially and actually very successful kind. We ought to encourage them, and I hope that the Minister will do his best.

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[Earl Howe]

My Lords, in the interests of time I suggest that I write to noble Lords on those questions, and I am happy to do so. However, I say to my noble friend Lady Cumberlege that I recognise the particular importance of the maternity quality standard. I will try to find out for her what stage NICE has reached or is likely to reach within a certain timescale, and if I can provide her with any further information I will be happy to do so.

[Lord Butler of Brockwell]

My Lords, I am grateful to the Minister for his comments in response to Amendment 109A and I thank the other noble Lords who have supported it. The noble Lord, Lord Newton, said that this is a probing amendment. As the Minister has said, there is a question of balance here: we want the Commissioning Board to be an effective promoter of standards, but on the other hand we do not want the arrangements to put an unnecessary brake on innovation. I am sure that the noble Lord will consider carefully what the Minister has said. In the mean time, I beg leave to withdraw the amendment.

Amendment 109A withdrawn.

NHS: Global Health

Lord Butler of Brockwell Excerpts

Monday 20th December 2010 Lords Chamber

[Lord Butler of Brockwell]

My Lords, as the noble Lord, Lord Crisp, has said, the interest in this subject is demonstrated by the number of speakers who are taking part in this short debate and the number of others who would have liked to have done so. The time could have been filled many times over. We should be grateful to the noble Lord, Lord Crisp, not only for initiating the debate but for the leadership he has given in this subject both by his report in 2007 and in what he is doing now.

I declare an interest as chair of the academic health science centre King’s Health Partners. Academic health science centres are by their nature well suited to promote and give leadership to this subject since they bring together research into global diseases, medical training—which can now be delivered remotely and is anyway a highly international business—and clinical care. The four members of King’s Health Partners—King’s College London, Guy’s and St Thomas’s, King’s College Hospital and the South London and Maudsley—already have individually a proud and established history in various areas of global health. We have had a 10-year partnership with the Tropical Health and Education Trust—THET—to which other speakers have referred. This was recently reinforced in February of this year by the signing of a memorandum of understanding and the co-location of THET Somaliland and the THET executive team at King’s College Hospital in Denmark Hill. We also have partnerships with the University of California, San Francisco and two other organisations that have been mentioned in this debate: Medsin, the national student global health network, and Alma Mata, the national postgraduate doctor global health network, both of which were mentioned by the noble Lord, Lord Crisp.

Being located in south London, where there are such ethnically and culturally diverse communities, this work has local as well as international significance. As others have said, global health these days is not a matter of looking outward to other countries; it begins and has relevance at home. It also has a strategic significance at the national level, which I do not think has been mentioned by other speakers. Quite rightly, investment in reducing inequalities within and between countries is integral to Untied Kingdom and EU global security strategies. The noble Lord, Lord Crisp, said that action now needs to be taken. King’s Health Partners can claim to be taking that action. We seek to bring together the expertise that exists in the various parts of our partnership. We recently agreed to set up a King’s Health Partners global health board, in addition to the board of the partnership.

This subject also, understandably and rightly, inspires young people and young doctors. Having recently attended a half-day seminar on the subject at King’s Health Partners, I saw what a great interest was expressed. The hall was packed to the gunnels. Like others, I eagerly look forward to what the Minister will say in response to the suggestions that have been made this evening to give a boost to this important and internationally vital work.

Health: Academic Health Partnerships

Lord Butler of Brockwell Excerpts

Monday 29th November 2010 Lords Chamber

[Lord Kakkar]

My Lords, I congratulate the noble Baroness, Lady Finlay of Llandaff, on having secured this important debate. I declare my own interest as a clinical academic and chairman for clinical quality at UCL Partners academic health science centre.

Healthcare systems around the world are facing considerable challenges. We know that in developing countries there is now an epidemic of diseases not previously experienced in those countries, such as diabetes, obesity, cardiovascular disease and so on. In our own healthcare system, we face similar challenges from chronic diseases that will need to be managed in an effective way, frequently with attention on prevention rather than just on treatment. We also still face serious disparities in access to healthcare, clinical outcomes, escalating costs for healthcare and variable quality across the healthcare system, as we have seen this past weekend with the publication of the Dr Foster report on adverse events experienced throughout the healthcare system in England.

Over the past 50 years, many of the advances that have helped us to improve outcomes and the quality of care that we provide to patients have been academically led. There is a growing recognition that the contribution of academic medicine is potentially even greater now than in previous decades because the challenges that we face are much greater. As we have heard, there is a developing movement throughout the world, certainly in mature healthcare systems, for the development of academic health science centres, which are well placed to face the challenges that have been identified as the pathway of discovery care. That continuum needs to be bridged to ensure that research activity, stimulated by endeavour, careful thought and intellectual enterprise, can be converted into new interventions, therapies and systems and into pathways of healthcare to improve clinical outcomes.

It is now well recognised that there are two important gaps that academic medicine and institutions can overcome in this discovery care continuum. The first is the gap characterised as “from bench to bedside”, taking those discoveries and having appropriate translation medicine to ensure that those discoveries can be tested and presented to the wider clinical audience—clinical colleagues and other healthcare professionals, as we have heard—in such a way that they might be adopted to improve clinical care and outcomes.

The second gap is to move from a very difficult place where there is expert acceptance of the discoveries and their evaluation from basic and clinical research, and to ensure that those are broadly adopted. Indeed, it is quite shocking—here I must declare a further interest as director of the Thrombosis Research Institute in London, which is involved in many collaborative research programmes with industry in the area of thrombosis—that this weekend we saw, in the Dr Foster analysis of adverse events in our healthcare system, some 62,800 reported adverse events, 30,500 of which were deep-vein thrombosis or pulmonary embolism. That is quite striking as we have known for over 30 years, thanks to research, much of which was conducted in the institute that I am now director of, that there are simple ways to assess patients at risk of thromboembolism and simple methods that can be applied to those at risk to reduce their risk of developing a blood clot while in hospital or soon after being discharged. It is well recognised by experts. We have guidelines. Indeed, we have the active programme from the Department of Health in this area. There is still a gap, however, in its widespread adoption. I very strongly believe that academic health science systems have an important role to play in overcoming this gap and ensuring that what we understand can be applied not only in single institutions but broadly across healthcare systems to improve clinical outcomes, and in ensuring that the research effort is properly applied to benefit the largest number of potential patients.

We have also heard that there are important economic benefits to be derived from having a strong academic clinical base. One of the purposes of the five academic health science centres, which we have heard about previously in this debate, is to ensure that the United Kingdom remains an important target for inward investment by the bio-pharmaceutical industry for research and that the opportunity to collaborate with industry delivers not only clinical benefit for our patients but economic benefit for our country.

Will the Minister confirm—I am sure this is the case—that academic health science centres remain at the very heart of Her Majesty’s Government’s agenda for healthcare and ensuring that we can achieve the very best clinical outcomes, quality, access and value in our healthcare system? Will he also confirm that the opportunity will be taken to explore whether the remit of academic health science centres can be explored so that they focus much more on becoming academic health science systems across entire sectors or health economies, driving the potential for broader integration—both vertical integration across primary, secondary and tertiary care, and horizontal integration, as we have done at UCL Partners—in developing provider networks that are focused not on the outcomes that an individual institution can achieve but on the outcomes that are achievable across the entire patient pathway and are focused on improving clinical outcomes for the continuum of care, particularly for the management of patients with chronic conditions? Will he also confirm that we will look at how academic health science systems can facilitate primary care commissioning as that moves forward and is developed in the coming years, and that we will continue to ensure that the contributions that the United Kingdom can make globally to academic health science systems and centres are maintained and that our country continues to benefit from participation in those systems and centres?

[Lord Butler of Brockwell]

My Lords, I, too, thank the noble Baroness, Lady Finlay, for the opportunity to discuss what I think is a very exciting and positive feature of our national scene: the partnership between academic and health activity. It is also a pleasure to follow my noble friend Lord Kakkar, whose professional interests, as he has explained, lie in north London but whose personal interests lie, like mine, in south London.

The question asked by the noble Baroness, Lady Finlay, is how the Government propose to preserve academic health partnerships. I should declare an interest as chair of King’s Health Partners, one of the five national AHSCs about which the noble Baroness, Lady Donaghy, has already spoken so fluently. Indeed, I endorse everything that she said. The noble Baroness, Lady Finlay, was right to emphasise the great advantages that Britain has in contributing academic research to medicine and how this country punches above its weight in those areas. As the noble Lord, Lord Kakkar, said, this is not only a benefit to health treatment but an enormous economic benefit through the investment of big pharma in this country. Perhaps that investment is second only to financial services in its importance to the economy of the country. But it is fragile, and we have already seen some signs of that fragility with GSK’s decision to move many of its activities to Shanghai and Merck’s departure. We must strive to maintain this country’s attraction for big pharmaceutical companies. It is very reassuring that the Government recognise that. The emphasis on the importance of research in the Government’s White Paper is also greatly welcome.

As other speakers have said, the five AHSCs are among the most valuable instruments for bringing together academia and the National Health Service, which might, as the noble Lord, Lord Alderdice, said, have drifted away from each other somewhat in the past 15 years. I pay tribute to the steps that the previous Government took to reverse that trend, not least by establishing the AHSCs. To reflect on the partnership with which I am associated, what does that partnership bring together? In King’s College London, it brings an outstanding research university and a leading medical training institution; in Guy’s and St Thomas’ and King’s College Hospital, it brings two of the world’s leading teaching and clinical care hospitals; and in the South London and Maudsley Hospital, it brings one of the nation’s leading psychiatric hospitals.

I invite the House to consider what we can achieve in modern healthcare by closer links between those institutions. First, as has been mentioned, we can bring research and clinical care closer together, and accelerate the translation of the very exciting discoveries that are made all the time in research to the care of the patient.

Secondly, there can be a closer link between mental and physical care. I particularly emphasise this in the case of the partnership with which I am associated. It is a weakness of our present system that psychological morbidity in patients with physical illness and physical morbidity in patients with mental illness have not been sufficiently recognised and addressed.

Thirdly, there are the integrated pathways of care for patients. This is, I think, very close to the Government’s heart and their policy in the White Paper. Like the other two London AHSCs, King’s Health Partners is working with local GPs and local authorities to establish new models of preventive medicine and community care, as well as tertiary care.

Finally, there can be more effective medical training not only through the university and teaching hospitals but in the community through the health innovation and education cluster—the HIEC—for which King’s Health Partners has been given the lead for south London.

This link between research and clinical treatment is personified in the chief executive of King’s Health Partners, Professor Robert Lechler. He is not only a distinguished researcher and clinician at Guy’s Hospital but vice-principal of the university. This link is repeated in many others who hold joint appointments in the university and member hospitals. The challenge for the AHSCs is to realise the opportunities that these existing links represent.

As has been mentioned, the previous Government, in setting up the AHSCs, did not give them any extra funds, unlike the Dutch Government, who recognise the importance of their equivalent of AHSCs through higher-intensity payments for them. Despite the lack of a financial incentive, when I came into this work, I, like others who have spoken, was hugely impressed by the enthusiasm and commitment not only of the four partner institutions in the AHSC with which I am associated but also—again, this has been mentioned—among the world-renowned researchers and clinicians who form part of them. This really is a movement that is supported at the grassroots level by those who work in the field. Like others, I hope the Minister will be able to say tonight that the Government endorse the objectives that I have described and see AHSCs as crucial to achieving them.