National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Lord Kakkar Excerpts

Tuesday 1st December 2015 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I must first apologise to the Minister for not appearing at his briefing yesterday and for coming late to his initial remarks. That will not stop me speaking, if I may.

The regulations are clearly designed to save money. They have little to do with correcting what is a major underlying defect in the tariff system: the perverse incentives that tariffs have introduced. My noble friend Lord Hunt has dealt pretty well with how the regulations were aimed at raising the threshold at which objections can be raised and, equally importantly, levelling the playing field to allow small providers with limited budgets to have the same voting power as very large teaching hospitals with billion-pound budgets, which provide more than 95% of the service. It is rather like non-league football clubs and those in the Premier League having the same voice in their commercial activities. The problem is that, to get 66% of all organisations, including all the small ones, puts those trusts that provide more than 90% of the service in hock to those who provide less than 10%. So it is not much wonder that the highly specialised hospitals—the Marsden and Great Ormond Street, the Institute of Neurology, the Christie hospital and so on—are voicing strong concerns about the impact on them. Of course, that is why the Government want to shackle them—to keep costs down—but that is at the risk of denying high-quality specialised care to those who need it.

All that has been well rehearsed by my noble friend Lord Hunt and other noble Lords. I really wanted to point out that the regulations do nothing to get round the unintended consequences and perverse incentives of the tariff system, which I raised with the Minister in a previous debate. That system encourages trusts to go down the route of using devices to gain higher incomes and discourages cross-referral between specialists within a hospital when a trust can gain two fees for two referrals from general practice. It discourages consultants from using phone-in follow-up out-patient clinics to save patients the need to travel in to be seen, as a visit to a hospital incurs a higher fee on the tariff. I agree with the noble Lord, Lord Warner, as he rails against the acute hospitals, but I do not necessarily agree with all his solutions.

I support my noble friend’s amendment. The regulations are unwarranted and damage those who provide the vast majority of the service, while doing nothing to get at one of the major defects in the tariff system.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of University College London Partners, an academic health science centre which has a number of important providers. The Minister made a very important point about the five-year forward view and the need to encourage new models of care working that ensure collaboration beyond institutional boundaries —and, indeed, to go further and look at new models of funding, including those of accountable care organisations. With a view to a potential journey towards more effective commissioning, and therefore more intuitive constructing of a tariff to support general acute services and more specialised services, will the proposals that the Minister brings to the House today aid that journey? Will looking at these regulations in the way proposed help institutions to work more effectively together, recognising the opportunity to look at tariffs that focus on pathways of care rather than individual segments of care, so ensuring the Government’s objective to ensure that valuable resources committed to the provision of healthcare are used most efficiently? There is a recognition that there will have to be greater attention to these matters as we go forward, and every opportunity should be used to ensure that that objective is achieved. One of the most important is the approach to setting the tariff and, therefore, these regulations.

[Lord Prior of Brampton]

My Lords, as always in these debates, we have had some pertinent and useful contributions. I shall take some of the points raised in reverse order. On the very important point raised by the noble Lord, Lord Kakkar, a profound change is happening in how we will deliver care over the next five years, which will be very much more based around a system rather than the institution. I think that the noble Lord, Lord Hunt, would agree with that; we will move from a payment-by-results system that has been very much based around individual pieces of care delivered in acute hospitals, to other payments systems, such as a capitation system or a whole pathway system. That is going to happen.

Mesothelioma (Amendment) Bill [HL]

Lord Kakkar Excerpts

Friday 20th November 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I, too, join noble Lords in thanking and congratulating my noble friend Lord Alton of Liverpool on introducing the Second Reading of his important Private Member’s Bill, and in so doing I declare my own interest as professor of surgery at University College London, an institution with a very active research interest and base in many different cancers.

There is no doubt, as we have heard in this debate, that mesothelioma represents an important burden of disease for our country—there were some 2,500 deaths from mesothelioma in 2013—but also, going forward, it represents a substantial burden of disease in the years to come, with a predicted 56,000 deaths in the period 2014-2044. We have also heard that mesothelioma represents a particularly nasty form of disease with a very peculiar natural history, potentially seen to develop over many decades in an unpredictable fashion, where there is no therapeutic intervention today that can offer a chance of a cure, where diagnosis is often late, and where palliative care, although advancing, still does not provide patients with any meaningful hope of long-term survival.

Under these circumstances, it was quite right for my noble friend to have put forward amendments in Committee and on Report, when the Mesothelioma Act 2014 was passing through your Lordships’ House. I was interested in my noble friend’s proposition on that occasion because there is evidence that the research base on mesothelioma is limited. With a disease that we understand so little about, it seemed intuitive that, using the opportunity of mechanisms made available by the Diffuse Mesothelioma Payment Scheme, an additional levy might provide a base for enhanced research funding in this area. This is important because, without such funding, it is impossible for many researchers to make the long-term commitment to create a group and study a disease over many years or decades, to ensure that advances in understanding are made available. The noble Lord, Lord Winston, made important points in this area.

This is not only a question of research into the specific disease of mesothelioma, but of ensuring that understanding generated in other areas of cancer research, and cell biology more broadly, can be applied to it. There is now an increasing emphasis on understanding that, if we are going to improve outcomes for patients with a variety of different cancers, and other chronic long-term conditions, we need to move away from a generalised approach to managing disease towards personalised, precision medicine: understanding, at a molecular and cellular level, the mutations driving a particular cancer, such as mesothelioma, then developing biological therapies to target them. The problem at the moment is there is an insufficient molecular characterisation of mesothelioma to ensure that this disease can avail itself of all the other advances taking place in research generally.

On 17 July 2013, when the Mesothelioma Bill was debated on Report, as recorded in col. 786 of vol. 747 of the Official Report, the then Minister, the noble Earl, Lord Howe, answered a number of points. As we have already heard, it was argued then that the correct approach was not to ensure more funding for mesothelioma research but that other mechanisms be used to stimulate more research proposals, which would then be funded if they were of sufficient quality. That seemed a reasonable argument. We have heard the four principal mechanisms that were suggested: first, that the National Institute of Health Research convene a workshop of the principal funding charities, such as Cancer Research UK, the Medical Research Council and others—I understand that that took place in May 2014; secondly, that a highlight notice be published by the National Institute for Health Research, identifying this as a priority area for research—this happened in September 2014; thirdly, that a priority-setting partnership be convened—the James Lind Alliance did this with a variety of stakeholder groups in December 2014. Fourthly, it was suggested that the National Institute for Health Research make its research design service available to help researchers come forward with research studies which were properly designed from a methodological point of view and so would enjoy a greater chance of research funding. What progress has been made in each of those areas; what were the outcomes of those four specific initiatives?

In that same debate, in 2013, we heard that MRC funding for mesothelioma had increased from £0.8 million in the financial year 2009-10 to some £2.4 million in 2011-12. Has the increase in Medical Research Council support for mesothelioma research continued on that upward trajectory, or has funding fallen back? How many more applications have been received by the funding councils, by the National Institute for Health Research or the research charities, as a result of the four specific initiatives that were offered to your Lordships’ House at the time of that debate? It would be very reassuring if there were evidence that there have been more high-quality applications; that more groups are coming together to study mesothelioma; and that there is greater collaboration between those dedicated groups and other groups working on more fundamental areas of cancer biology, or other tumours that share a similar characteristic and biology to mesothelioma, such as some of the sarcomas. If that has not happened, the assumption that by facilitating this type of conversation we would see more research is not going to deliver the kick-start in activity that we require. It may therefore be important to revisit the question of a specific levy, providing more funding and greater incentive and reassurance for researchers to come together and focus on this area.

Ultimately, research is about helping patients, and large numbers of our fellow citizens will suffer from mesothelioma in the years to come. If we can provide greater hope that they might have a better quality of life or, indeed, be cured of this disease, through an enhanced research effort, then we should proceed along those lines.

Health: Global Health

Lord Kakkar Excerpts

Monday 26th October 2015 Lords Chamber

[Lord Prior of Brampton]

The Ebola crisis was indeed a wake-up call. There is no doubt that the leading role we play in the WHO is hugely important, so I agree fully with the noble Lord. The work we are doing on antimicrobial resistance is another example of the very important role the WHO can play, as does our Chief Medical Officer, Sally Davies.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chair of University College London Partners and an officer of the all-party group. This report identifies that our country is No. 1 among the G7 nations in terms of the impact of its medical research, as judged by citation impact. How do Her Majesty’s Government propose to ensure that the NHS continues to develop the foundation for that medical research impact?

[Lord Prior of Brampton]

The noble Lord raises an interesting point. Not only are there more citations of research conducted in Britain, but we co-operate with other countries far more than any other country. We also have in the BMJ, the Lancet and Nature the three leading medical and science magazines. The Government are determined to maintain Britain’s position as one of the leading medical research and life sciences nations in the world, and will carry on supporting that industry.

Primary Care: Targets

Lord Kakkar Excerpts

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a very good point. There is an increasing and important role for high-street and community pharmacists in delivering healthcare.

[Lord Kakkar (CB)]

My Lords, I declare my interests as chairman of UCL Partners and as UK Business Ambassador for Healthcare and Life Sciences. What strategy do Her Majesty’s Government have to ensure that NHS prescribers can continue to provide innovative therapies and interventions for their patients?

[Lord Prior of Brampton]

The noble Lord makes an interesting point. I do not have an answer to give him today, but perhaps I may reflect on that and come back to him.

NHS: Financial Performance

Lord Kakkar Excerpts

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is worth reminding your Lordships that there was considerable consensus around the five-year forward view. I think that the noble Baroness’s party wholly signed up to it and, along with the Conservative Party, to committing £8 billion of extra money to the NHS over the lifetime of this Parliament. We stand by that. The NHS, in its turn, agreed to find £22 billion-worth of efficiency savings, which I think the noble Baroness accepted when she was part of the coalition Government. That is still the situation so I do not think that we need a new settlement. There is a settlement: it is called the five-year forward view and we are fully committed to it.

The noble Baroness raised the issue of integration. I agree 100% with her and it is an essential part of the five-year forward view—the vanguards are based on it. I remind noble Lords that the spending in the UK per capita on health is $3,200. In France it is $4,100 and in Germany it is $4,800. The NHS does a remarkable job in delivering world-class healthcare, which is rated by the Commonwealth commission and other independent agencies as among the best in the world, with considerably fewer resources than any other developed system in the world.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of University College London Partners. What assessment have Her Majesty’s Government made of the potential contribution of accountable care organisations to addressing the need to advance quality outcomes in the NHS and its financial performance?

[Lord Prior of Brampton]

I thank the noble Lord for that perceptive and interesting observation. The accountable care organisation is one whose time has come. A health organisation with a capitated budget is indeed the way forward. It will drive the integration that the noble Baroness was talking about earlier on. It is a key part of this Government’s health strategy to support accountable care organisations.

National Health Service: Sustainability

Lord Kakkar Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I, too, join in congratulating my noble friend Lord Patel on introducing this vitally important debate in such a thoughtful way. I declare my own interests as professor of surgery at University College London and chairman of University College London Partners’ academic health science system.

The question of sustainability regarding the NHS is not merely one of how we preserve existing services in a prolonged period of further austerity, but rather how we develop a new framework that can deal with the changing environment in which healthcare will have to be delivered, with expanding need that will exist for decades to come. We have already heard in this insightful debate that the 1.9 million of our fellow citizens currently living with more than one long-term condition will increase by 2018 to some 2.9 million. The number of people living with arthritis will double by 2030, and the number of those living with diabetes, and of those living with dementia, will double by 2050. Success in healthcare through the application of technology, advancements and the application of knowledge derived from medical research have resulted in greater cancer survivorship, for example, but those who survive malignant disease are more likely to see a specialist in any given year and to avail themselves of general practice services. Wherever we look, we will see increased demand.

Much thought has been given to the need for change and innovation among providers of healthcare services, and a consensus now indeed exists. There was recognition only recently of the need for greater flexibility to be given to healthcare providers to ensure that they can start to address these challenges. The review published by Sir David Dalton last year began to address this issue. It rightly identifies the need to ensure that clinical services are consistently delivered across the country, but in focusing on variation it potentially consolidates a cultural problem that makes it difficult for providers to show the courage to experiment and introduce into clinical practice new models of care, some of which may succeed and some of which may fail, but with those that succeed adopted more broadly across the system to improve clinical outcomes and drive efficiency.

In the past, part of the proposed solution to improve the performance of providers was to introduce new legislation. The hope was that such legislation would improve the opportunity for providers to show greater flexibility and to be more innovative. Examples include the introduction of foundation trusts in 2004, and the ability for a multiplicity of providers to offer services afforded by the Health and Social Care Act 2012. Do Her Majesty’s Government believe that the current legislation, which offers significant opportunities for providers to show flexibility and innovate, is being fully exploited by healthcare providers in both the public and private sectors? Do they believe that further legislation is the answer to improving the ability of providers to innovate? What evidence is there that, two years after their creation, academic health science networks, which were designed to enable the introduction of innovation at pace and scale across health economies, are delivering the advances, improvements in care and efficiency improvements that were anticipated? In this regard, I remind noble Lords that I chair an academic health science network associated with University College London.

Beyond legislation and driving a culture change regarding innovation, there has been increasing emphasis on trying to determine how our NHS sits in comparison with other healthcare systems. There appears to be some disparity in the conclusions reached. For instance, last year the Commonwealth Fund published its regular analysis of 10 healthcare systems and concluded that the NHS remains the number one healthcare system in terms of safe, effective, patient-centred care. As we have heard already in this debate, the Quality Watch report by the Nuffield Trust and the Health Foundation, which was published last week, concludes that among 14 OECD countries with similar increases in demand in their healthcare system, the NHS does not perform as well, with relatively high mortality rates at 30 days for stroke and myocardial infarction and relatively poor survival rates at five years for malignant disease. What role do Her Majesty’s Government believe that international comparisons play, and what methodology is the most effective for us to refer to in trying to analyse where our healthcare system sits in comparison with others?

What analysis have Her Majesty’s Government made of other healthcare systems that are committed to equity of access and universal coverage—such as those in Germany and the Netherlands—but which use different models of funding that care, and what can we learn from those models? Have they addressed similar challenges in a more effective fashion? Have those models and systems of care been more effective at dealing with prevention as well with the management of patients with chronic conditions, at providing autonomy for healthcare providers, and at ensuring that innovation can be applied and adopted in the most effective and rapid fashion?

Finally, how do Her Majesty’s Government propose to go about building the long-term consensus that all noble Lords who have contributed to this debate believe is vital if the longer-term sustainability of our healthcare system is to be secured? Do Her Majesty’s Government believe that there is need for an independent commission to establish cross-party consensus on this matter and to inform public debate, which is vital if we are to carry our fellow citizens with us as we address what will be one of the most challenging and important questions facing those responsible for public policy in the coming years?

Medical Innovation Bill [HL]

Lord Kakkar Excerpts

Friday 23rd January 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, having tabled an amendment to the Bill on patient safety, I am happy to support the amendment.

[Lord Kakkar (CB)]

My Lords, I declare my interest as professor of surgery at University College London and as a member of the General Medical Council, although I do not speak for the council in this Chamber.

I thank the noble Lords, Lord Winston and Lord Saatchi, for having tabled this important amendment. It goes to the heart of good medical practice, of course, always to innovate—but always to innovate, first and foremost, with absolute regard to patient safety. The fact that the amendment will now appear in the Bill will provide absolute clarity on what is required to discharge that patient safety responsibility with regard to innovation, as described in the Bill, which is vitally important. I strongly support the amendment. Once again I thank the noble Lord, Lord Winston, for his contributions in the passage of the Bill and, in particular, for tabling this important amendment.

[Lord Pannick (CB)]

My Lords, I, too, welcome the amendment. It will further emphasise that, in order to be lawful, medical innovation must be responsible. The criterion of responsibility has been the essence of the law on this subject since the judgment of Mr Justice McNair in the Bolam case in 1957, when he said that a doctor,

“is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art”.

That may provide some reassurance to the noble Baroness, Lady Gardner of Parkes, that the courts will easily understand what is involved in the amendment.

The amendment will reassure many of those concerned about patient safety. The words will further confirm what I understood to be the Minister’s statement in Committee that the Bill is not intended to alter the substance of the Bolam test but to provide a practical means by which innovative doctors can take steps in advance of carrying out the treatment.

Like the noble Lord, Lord Winston, I am less confident than the noble Lord, Lord Saatchi, that this Bill will have much, if any, beneficial effect. I am doubtful that the fear of litigation deters responsible innovation, but I have been reassured by the amendments that the Bill will certainly do no harm. I thank the noble Lord, Lord Saatchi, for the responsible manner in which he has responded to concerns about the Bill by welcoming amendments of this sort. I also thank Mr Daniel Greenberg, a former parliamentary draftsman, now an expert consultant, for the assistance that he has provided to many noble Lords, including myself, on the issues raised.

--- Later in debate ---

[Baroness Masham of Ilton (CB)]

My Lords, I am very pleased to support this amendment, to which I have added my name. Within the rare disease community, there is significant unmet medical need, and research and innovation are seen as the means through which new therapies for currently untreatable conditions will be developed. For this to make a difference to patients, the barriers to medical research and the adaption and integration of research and innovation into the NHS need to be addressed. Therefore, it is vital to ensure that registries are created to enable the collection and exploitation of real-world patient data and to promote the sharing of research findings and best practice.

The Royal College of Pathologists says that, unfortunately, this Bill, allowing the results of new tests and treatments to go unrecorded, will hinder its work and medical science more widely. Without the mandatory recording of results of such treatments, unexpected adverse outcomes and irresponsible activity will be harder to detect and prevent.

All results of innovative treatments should be centrally recorded, reported and publicly accessible. This must include both positive and negative outcomes and feedback from patients. Without the mandatory recording of results, the public benefits of medical innovation will not be achieved and the advantages to future patients will be lost.

I am pleased that the noble Lord, Lord Saatchi, is supporting this amendment. I hope that the Government will, too. I would like to ask whether patients from both the NHS and the private sector are covered by the Bill. In my view, all patients who wish it should be able to benefit from innovation as long as it is fully explained to them and is felt to be as safe as possible.

There are many splendid trusts which support medical research. I hope that if this Bill becomes an Act they may find it possible to help fund the register.

[Lord Kakkar]

My Lords, I remind noble Lords of my interests, stated earlier, as professor of surgery at University College and as a member of the GMC, but I do not speak for the council in this Chamber.

I thank the noble Lord, Lord Hunt of Kings Heath, for once again bringing this issue to your Lordships’ House. It is critically important, and probably one of its most vital elements is that there is the opportunity for registration of innovative interventions and therapies.

Clearly, providing transparency and the opportunity for sharing the outcomes of such innovations rapidly and broadly across clinical communities in this country and internationally is of so much importance. It will allow colleagues to understand what has been achieved and not achieved; it will allow those with other ideas to build on knowledge gained from experience to date; and it will ensure that through transparency we have the best opportunity to ensure the greatest patient protection. I am very grateful to the noble Lord, Lord Saatchi, for having considered this issue carefully and having come to the place where he has put his name to the amendment and supports it. I hope that Her Majesty’s Government will be able to consider this issue. The measure enjoys substantial support and will be a vital contribution to this long journey with regard to innovation, ensuring that we can do the best for patients as rapidly as possible without undermining the very best practice and the ability to share knowledge, and ultimately ensuring that this Bill enhances patient safety.

[Lord Giddens (Lab)]

My Lords, I strongly support this amendment and hope the Government will take it seriously because we are talking here about not innovation but scientific innovation. Science is a collective enterprise. It depends on the accumulation of evidence. It is crucial that that be recognised formally somewhere in the Bill, with this embodied as part of the advancement of scientific progress more generally.

National Health Service

Lord Kakkar Excerpts

Thursday 8th January 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join in thanking the noble Lord, Lord Turnberg, for securing this important debate, and in so doing I declare my own interests as professor of surgery at University College London, consultant surgeon at University College London Hospitals NHS Foundation Trust, and chairman of University College London Partners, our academic health science centre and network.

It is striking that in 1948, some 48% of the population failed to reach the age of 65. Recently it was calculated that only 18% of the population would fail to do so. That is a remarkable manifestation of how important universal access to free healthcare has been in securing the health prospects of our fellow citizens. It is also striking that by 2025, it is estimated that 18 million of our fellow citizens will be living with a long-term chronic condition. With an ageing population and all that chronic disease, it is inevitable that there will be increasing demands on the facilities and resources available for the provision of healthcare. Indeed, we have seen in recent weeks increasing demands being made on accident and emergency services. The Nuffield Trust recently published a report which estimates that by 2022, if the current changes in demographics with an ageing population and the present growth in demand is maintained on a similar trajectory, we will need to provide 6.2 million extra bed days a year, which equates to some 17,000 extra hospital beds, the equivalent of 22 new 800-bed hospitals. It is therefore important that the noble Lord has tabled this debate about the future of the NHS because we must ask how we will address this increase in demand.

We have also heard that it is not only about an increase in demand. Quite rightly, it is about an increase in expectation. That is because in the United Kingdom we pride ourselves on having invested substantially in a strong science and research base and in biomedical research. Much of that investment is taxpayer-funded, and it is therefore absolutely right that our fellow citizens expect to see the benefits of that research applied to improvements in healthcare and the provision of better long-term prospects for a healthy life long into old age.

The noble Baroness, Lady Cumberlege, mentioned the recent US Commonwealth Fund report grading 11 different healthcare systems. Ten healthcare systems from around the world are compared to the United States system, and once again, for 2013, the NHS ranks number one for the quality of care—that is, the efficiency of care, the safety of care, patient-centred care and the co-ordination of care. Interestingly, however, we rank 10th out of the 11 nations in providing healthy lives for our citizens. So there is more to do to deliver effective healthcare and, in this regard, as has been noted in the debate, it is important to pay attention to the NHS England Five Year Forward View. Quite clearly, the funding models described in that Five Year Forward View expect some degree of efficiency gain further to the substantial gains that have been achieved during the lifetime of this Parliament. What assessment have Her Majesty’s Government made of how much of that additional gain in efficiency will be derived through the application of innovative therapies and interventions as well as innovative models for the delivery of care?

In this regard, it is particularly important to take note of the announcement made yesterday by NHS England of the national Innovation Accelerator programme and of the appointment of the new national director of new models of care. In this regard, I emphasise my declaration of interest as chairman of UCL Partners, as UCL Partners is the host for the national Innovation Accelerator programme, which is being supported by NHS England and the Health Foundation.

There is no doubt that innovation plays, and has played in recent years, an important role in the delivery of healthcare. What assessment has been made of the emphasis on the adoption of innovation, for instance the approach towards telemedicine? What progress has been made in providing telemedicine solutions to the management of chronic long-term conditions for the 3 million people living with long-term conditions that it is anticipated would be covered through these new strategies by 2017?

In addition, of course, there has been great emphasis on the whole area of personalised medicine, and the announcement of the 100,000 genome mapping programme. Again, I wonder whether the noble Earl could comment on how much progress has been made in that regard. How much progress also has been made in respect of the UK Biobank and the development of a national health and informatics strategy combining data from all of those to provide a very strong basis for improving health outcomes and driving improved healthcare for our fellow citizens?

The challenge for improved workforce planning will also need to be addressed. As part of changes introduced in the Health and Social Care Act 2012, Health Education England was to take an important role in ensuring that local needs for the provision of healthcare—understanding the local needs of local populations—would better drive workforce planning. Is the noble Earl content that that journey has begun and that Health Education England is able to perform in that way?

Finally, great emphasis was put on the need to develop clinical leadership. In this regard, I wonder what assessment has been made of the NHS Leadership Academy and when we might see the report of the noble Lord, Lord Rose of Monewden, and his assessment of how leadership in the NHS might be improved to ensure a greater chance of our achieving the goals that we all share.

Alcohol-related Disease

Lord Kakkar Excerpts

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My Lords, I am sure the noble Lord would not expect me to agree with him on the position of Mr Crosby in relation to the drinks industry. We feel it right to engage with the industry because it is in a position of influence over consumers, and we have seen, through the responsibility deals, some real progress, which it has instigated at our prompting. I recognise the issue that the noble Lord raises on price. That, of course, is only one aspect of the issue of alcohol consumption and its prevention.

[Lord Kakkar (CB)]

My Lords, I declare my interest as professor of surgery at University College London. A recent Lancet commission on liver disease in the UK has identified alcoholic liver disease as an increasing cause of mortality in our country. What measures do Her Majesty’s Government propose to take to improve both expertise and facilities for the early detection and treatment of liver disease in primary care?

[Earl Howe]

My Lords, increasingly, GPs are being made aware of the need to upskill in this area. Of course, it is not just GPs but local authorities who have responsibilities in the arena of public health to make sure that excessive drinking is discouraged. I can write to the noble Lord with the precise details of the GP training that I am aware of.

NHS: Health Improvements

Lord Kakkar Excerpts

Wednesday 26th November 2014 Grand Committee

Asked by

[Lord Kakkar]

To ask Her Majesty’s Government what impact the National Health Service innovation and research strategies have had on health improvement.

[Lord Kakkar (CB)]

My Lords, I declare my interests as Professor of Surgery at University College London, chairman of University College London Partners and UK Business Ambassador for Healthcare and Life Sciences.

It is a great privilege to open a debate on the subject of innovation in the NHS since I believe that at no time in the history of the NHS has innovation been so much at the centre of policy and thinking as it is now—for example, the life sciences strategy announced by the Prime Minister in December 2011, the subsequent Innovation, Health and Wealth report that focused on developing academic health science networks, the creation of academic health science centres, building on the record of the previous Government or, indeed, for the first time in the history of the NHS, including in a Bill the obligation for the Secretary of State, NHS England and clinical commissioning groups to promote research in the NHS.

The environment for research and innovation is at an all-time high. This is particularly important because it is well recognised that from establishing a therapeutic innovation or technical innovation that could improve healthcare, it takes some 17 years for it to be fully embraced and embedded in a healthcare system. This remains a shocking statistic throughout the world given that many of these innovations have the capacity to impact clinical outcomes profoundly, in many cases by reducing mortality and burden for patients.

But beyond the importance with regard to health gain that innovation can provide to the NHS, it is well recognised that many innovations, such as improved ways of delivering the practice of healthcare, can have a profound impact on the utilisation of healthcare resources. We are uniquely positioned in this country to have a life sciences and healthcare ecosystem given our unique National Health Service, our extraordinary universities, some of the leading biomedical research institutions in the world and our small and medium-sized enterprise sector around healthcare and the life sciences. This ecosystem has led to the development of a life sciences industry in this country which is second only to financial services in its importance to the economy, employing some 170,000 people, providing around £52 billion to the economy, and with 5,000 enterprises. This achievement is reflected in the success of our healthcare and life sciences research. A nation with about 1% of the world’s population provides 12% of the annual cited published output in the biomedical sciences globally. We have a huge investment, be it through government and the charitable sectors—and, of course, from industry research and development—in our universities and health service. Every pound of that investment provides a return of 39 pence per annum in perpetuity, which is a quite remarkable contribution to our economy.

There is much that we must do to ensure that this commitment to innovation in the NHS is sustained. At the time of the one-year review following the original publication of the Innovation, Health and Wealth strategy, it was agreed that there would be a sunset review of some 60 organisations involved in innovation and improvement in the NHS. That is a very important commitment to satisfy all involved, particularly the taxpayer, that the commitment to innovation was funded and directed in the most appropriate fashion to deliver tangible results in terms of both health gain and wealth creation for society more broadly. In October, in another place, the noble Earl’s ministerial colleague George Freeman answered a Question where he indicated that that sunset review had been undertaken with regard to what was described as the fragmented landscape for innovation organisations in the NHS, but it was not proposed to publish it. That is a little disappointing because the insights from that important review of the innovation landscape and the many organisations contributing to it could help those organisations that are going to remain in the innovation space in the NHS to better understand the successes and failures of those who have been there previously and organise themselves in the most efficient fashion to deliver the vitally important health gains that innovation can provide to our healthcare system. Can the Minister comment a bit on the sunset review and, in particular, whether there might be some opportunity for those organisations that remain in the innovation landscape to learn from its findings?

Much has been made, quite rightly, of the NHS Five Year Forward View, announced by the chief executive of NHS England on 20 November. It is an exciting document that addresses the question of innovation. One interesting conclusion is that the Government remain committed to innovation in the NHS. It is not entirely clear how that forward view sits with the commitments previously made and, in particular, the work of the Innovation, Health and Wealth Implementation Board in NHS England. This is an important issue, because co-ordination of the different strategies and commitments in the innovation space in the NHS is vitally important. How will that co-ordination be achieved in the future? It was not entirely clear from the NHS Five Year Forward View how that would be achieved. Will be it through an ongoing responsibility for the Innovation, Health and Wealth Implementation Board? What role will the academic health science networks, created as a part of that original review, play in the forward view with regard to innovation in the NHS over the next five years?

There was also the important announcement just last week, again by the noble Earl’s ministerial colleague George Freeman, with regard to the innovative medicines and medical tech review, which proposes to determine how we can better develop medicines that will have a big impact on patient outcome more rapidly in our country and provide additional funding to drive forward a more efficient process for the development and evaluation of innovative medicines and technologies. How will that strategy sit with regard to the already established structures of the academic health science networks, which are there to drive a collaboration between healthcare organisations, universities and the independent commercial sector in terms of the life sciences and biomedical research?

There is a very important obligation for government to lead on a culture change with regard to innovation. There is no question that mechanisms and organisations have been established to drive forward the NHS innovation agenda. There is also a need to focus on the culture in NHS institutions both in the community and in the hospital sector to ensure that the provision of innovative therapies is at the heart of clinical practice for all healthcare professionals. I wonder what approach Her Majesty’s Government propose to take towards ensuring that there is a cultural transformation in the adoption of innovative strategies in terms of pace and scale both within individual institutions and across health economies. There is also an important question about regulation, because it can impede research and innovation and the adoption of innovative strategies. We saw this, for instance, with regard to the European clinical trials directive, which had a devastating effect on clinical research output. A revised directive is to be adopted but there are concerns that that may not be done by the 2016 proposed deadline. Is the Minister able to provide some further information on that?

Lastly, there is a real concern in the biomedical research community about the proposed European data protection regulation that will replace the current directive. As originally drafted by the Commission it seemed a sensible approach to data protection but, as amended by the European Parliament, it presents a real threat to the conduct of major research programmes that have a profound impact on the delivery of healthcare, particularly the 100,000 Genomes Project, the UK Biobank and the conduct of cancer registries. These are all at the heart not only of the research effort that is a fundamental part of our nation’s strategy, but also of the delivery of healthcare. Can the Minister comment on where the negotiations are to ensure that the detrimental aspects of this data protection regulation will not apply to our country?