Life Sciences Industrial Strategy (Science and Technology Committee Report)

Lord Crisp Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Lord Crisp (CB)]

My Lords, it is getting late and I am speaking far down the list, so I shall try not to repeat what others have said. However, let me start by congratulating my noble friend Lord Patel and the committee on tackling this very important topic and pressing the Government on the urgent need for practical—I stress that word—and coherent steps for implementation. As I think every noble Lord has said, the life sciences and the wider health agenda are fundamental to our current and future prosperity. I am not going to comment on the issues of structures and leadership that other noble Lords have talked about but would simply note how vitally important they are in terms of making progress.

I must refer to staffing. Today’s press coverage and various briefings that we have all had highlight the fact that science is global, and we need a global workforce that can attract and retain the best. As we have just heard, there are massive risks here. Government support for this is vital and we need to keep a close eye—I hope that the committee itself will do so—on all the proposals on immigration that will come out, and that we will continue to argue for an approach that allows in the people we need. Also, it should not do that on an arbitrary salary level cut-off. The fact is that, in the academic and clinical fields, salaries are often low. People like research nurses are vital, yet they may well be earning below the salary levels proposed.

I turn to the NHS, on which I want to make three points. The first is about this being a two-way street. It is not just that the NHS can benefit innovation but that the NHS also benefits from innovation and development. Yesterday I spoke to Sir John Bell and he reminded me of this. He pointed out that recently he ran a competition for digital pathology which will be transformative. Our current ambitions, as he said, in early diagnosis may provide the best and cheapest route to improving outcomes in cancer. This will be absolutely central to the NHS, so there is potentially—although I stress the word “potentially”—an enormous win-win here.

However, that brings me to my second point: is what the Government are proposing to do to engage the NHS adequate, or is it that this is just another add-on from the point of view of the people who are trying to run the health service? Is it just another priority? Is it the centrepiece, as I think it was described in evidence to the committee? I can see how that will be a major obstacle. I have also noticed that other noble Lords have been talking about the fragmentation of approach; it being too little and too late, and about the need perhaps to mandate some of these changes. I also note the despair of the noble Lord, Lord Hunt, and am reminded of him chairing some 15 years ago the Pharmaceutical Industry Competitiveness Task Force with his normal energy and optimism. As a former chief executive of the NHS, and in fact the last chief executive who had a totally top-down structure, I will avoid being defensive about it and its ability to develop and tackle innovation. However, I recognise the description of the noble Lord, Lord Turnberg, of the clinical reality of what is actually happening in the NHS from day to day.

I want instead to touch on the word “transformation”. My noble friend Lord Patel and other noble Lords have talked about the need for transformation, but let me make one point. This may be about organisational change but perhaps we need to reconceptualise the whole issue. What would it be like if we start to look at the NHS as an important driver in itself of the economy, as a part of the productive sector rather than just a cost? What I am talking about is not just its support as a base for the life sciences and other great developments but also its development of a productive workforce. It is interesting to note that NHS Improvement thinks that the aim is about productivity in the NHS. What about the productivity of the workforce being part of the aim of what the NHS is there for? Moreover, what about the costs of ill health, which are being recorded very clearly? A report by a UN High-Level Commission on Health Employment and Economic Growth, published about two years ago, developed the links between health systems—in particular, investing in the health workforce—and economic growth in different countries. That is extremely relevant here.

I think that if we started to reconceptualise the NHS as being part of our future prosperity, driving economic as well as social growth in the country, the Government might start to think rather differently about some of their policies. They might consider some of the things that the noble Lord, Lord Fox, talked about: empowering and resourcing people and, as I would put it, improving healthcare and health, rather than empowering and resourcing people to take on innovation. “Innovation” can be a slightly awkward term; what we are actually talking about is improving health, and I use the word “health” deliberately, having recognised in the contribution of the noble Lord, Lord McColl, that it is about health and not just about healthcare and health services. If we took a different approach to the NHS overall, would the policies be different and would the NHS be looking at these things in a different way? Would it want to be a much better partner than we have heard it is?

In saying that, I would note that if we did that, we would not be the first country to do so. South Korea has identified health as one of the great growth sectors. The South Koreans are determined to have one of the best health systems in the world and they are using their great enterprise and ability to create a much larger part of their economy based around health, which is in any case now the largest industry sector in the world. There are examples of that.

I want to touch on my third point before coming back to considering what the future might look like. The NHS is a part, and only a part, of an extraordinarily rich and deep infrastructure that both indirectly and directly supports research, innovation and development. We have heard points made about getting innovation into the NHS, but let us also remember the other factors. For example, it is where most of our homegrown clinical scientists are trained and educated. It also inculcates an important set of collaborative and public interest values into the whole approach to research. That helps to maintain the credibility of UK research in the world because it is based on a clearly objective set of values. These are some of the things that we should think about as regards the NHS.

I want also to widen the argument slightly. I would argue that we need to think further about the life sciences sector within a very wide cross-sectoral approach to health and biomedical and life sciences as a whole. In 2015, the All-Party Parliamentary Group on Global Health, which I co-chair, asked the London School of Hygiene & Tropical Medicine to write a report on The UK’s Contribution to Health Globally. It identified four sectors: government, which included the NHS and DfID; commerce, which included all the life sciences in the sense that we are talking about them here; academia; and the voluntary sector. When you map those things out, you find that there is an extraordinary infrastructure. As my noble friend Lord Bilimoria mentioned, the UK has three of the five top-rated medical schools in the world—including Cambridge, he will no doubt be delighted to know, along with Oxford. We have two of the four highest-rated medical research journals and the top science journal in Nature. We have an extensive reach into health issues that are not just about the UK in that we are leaders in research into malaria and into neglected tropical diseases. The UK has an extraordinary footprint which, when we looked at it, was second only to the US and indeed beat it in a number of areas.

At that time—this was pre the referendum—we were beginning to worry that we were mapping the UK’s contribution to health in its peak period. Of course, that really will be the position post Brexit, assuming that Brexit happens. We argued that we need policies that strengthen both the whole health sector and the connections between not just the NHS and life sciences but the four elements. We argued that we should aspire to be a global health hub, by which I mean a go-to place globally for all aspects of health, whether it is academia, life sciences, professional education, health systems or international development—all areas where we have extraordinary strength.

I note that Korea is clearly going down this route. It is equally clear from recent developments in the past year or so that both Germany and Japan are stepping up their development in health as part of their economic development and influence on the global stage. I would just say that it is ironic that, when we produced that report, we thought that greater collaboration with Europe was one of the steps we should take to make sure that this vision could come about, but I will not dwell on that point.

We have been asked by the Lancet, the Wellcome Trust and others to revisit the report to pick up on recent developments around Brexit, new developments in science—including AI, which has developed rapidly in the past three or four years—new policies that approach bits of the health system such as Health Education England and Public Health England, which are becoming much more global in their outlook, and a range of other issues. That is so that we can re-present a vision that says that, actually, life sciences need to be part of this wider approach to health and there are huge dividends and benefits to be had from that. As I said, health is the biggest industry in the world by some counts. Now, it seems more important than ever that we get behind this whole health sector in the widest sense, building links across the four elements with real strategic intent.

Finally, turning again to the report, I offer my congratulations on a timely and important contribution and on pressing for practical action in this vital area.