NHS: Patient Data

Lord Kakkar Excerpts

Tuesday 25th February 2014 Lords Chamber

[Earl Howe]

I entirely agree with the noble Lord. This is a vital programme which will bring real benefits to patients. It has major potential benefits for research and public health. It commands generally wide stakeholder support. However, there is no doubt that concerns over how this has been explained to patients have been raised and those concerns need to be addressed. I agree that the next six months will be crucial in pursuing that aim but it is essential that this programme commands public support.

[Lord Kakkar (CB)]

My Lords, I declare an interest as professor of surgery at University College London. What assessment have Her Majesty’s Government made of the proposed European data protection regulation which, if passed, has the potential to impact seriously on our national strategies with regard to health informatics and biomedical research?

[Earl Howe]

My Lords, we take that concern extremely seriously. The draft text that has been published by the so-called LIBE committee would, if enacted, pose serious obstacles for our research effort in this country. We are taking every opportunity and using every effort to persuade both the Parliament and the European Commission that the original text is the one we should go with. That work is on-going and the Ministry of Justice is leading on it.

Mesothelioma: Research Funding

Lord Kakkar Excerpts

Thursday 16th January 2014 Grand Committee

[Lord Kakkar (CB)]

My Lords, I join in congratulating the noble Lord, Lord Alton of Liverpool, on having secured this important debate, and in so doing declare my own interest as professor of surgery at University College London. Responding to discussion on Report on 17 July last year, the noble Earl, Lord Howe, made a number of important points with regard to the opportunity to build capacity in the research base available to address the important problem of mesothelioma. I would like to explore first with him what progress has been made in the four specific areas that he kindly mentioned during that debate.

The first was the opportunity for the National Institute for Health Research to seek the assistance of the James Lind Alliance to determine priorities with regard to mesothelioma research, bringing together not only the research community but patients and other stakeholders. Secondly, there was a commitment that the National Institute for Health Research would be in a position to issue a highlight notice to the research community identifying that the institute—in consultation, I assume, with the Office for Strategic Co-ordination of Health Research—had identified mesothelioma as a key national priority research topic, thereby activating not only research groups with a specific ongoing interest in mesothelioma but those with peripheral interests that could be brought to bear to address the question of mesothelioma research. I wonder whether that notice has been issued and, if not, when it is planned that it would be.

Thirdly, there was the offer that the National Institute for Health Research would make its research design service available to the research community, specifically to start identifying designs of clinical studies that could be undertaken to help to advance our understanding of mesothelioma research. Lastly, there was a commitment to bring together interested parties in research funding, particularly Cancer Research UK and the Medical Research Council, to have a conference of experts and those parties interested in mesothelioma research to determine how a national co-operative effort could be taken forward. I wonder whether any of those undertakings have indeed happened or in what timeframe it is planned that they might be discharged.

It is clear that the situation in which mesothelioma research finds itself is nothing new. At many times, and for many other diseases, there has been recognition that a new strategic research focus needs to be developed at national level. I would argue that with the National Institute for Health Research now well established and in place in the NHS in England, we are uniquely positioned to take forward a strategic approach, not only to building research capacity but in ensuring collaboration across those groups devoted at the moment to mesothelioma research and other groups who have technologies and interests—we have heard peripheral examples of the management of acute myeloid leukaemia—so that they are brought together with some strategic focus and direction. I wonder whether the Minister is able to provide your Lordships with an understanding of what point those discussions have reached.

In addition, we now have across the NHS in England well established academic health science networks, 15 of which cover the entire country. I declare my interest as chairman elect of University College London Partners. I wonder whether opportunities might be brought to bear for promoting research and collaboration between academic institutions, the NHS and industry, which are at the core of the purpose of the academic health science networks. Those 15 networks would then be asked to see how they might contribute, through their participant organisations, in a national research effort to promote further understanding and a more accelerated research programme on mesothelioma.

Tobacco: Packaging

Lord Kakkar Excerpts

Thursday 28th November 2013 Lords Chamber

[Earl Howe]

My Lords, it is clear from the debates in the other place and from our debates in Committee on the Children and Families Bill, that there is emerging evidence that needs to be considered. That evidence has emerged since the consultation. I am not in a position to make a judgment on that. I think Sir Cyril Chantler is the best person to do it.

[Lord Kakkar (CB)]

My Lords, I declare my interest as a member of the board of UCL Partners, currently chaired by Sir Cyril Chantler, and I congratulate Her Majesty’s Government on the excellent choice of Sir Cyril to lead this important review. Can the noble Earl confirm that Sir Cyril will be completely free to define both the methodology that he will apply for the review and the question that he will address?

NHS: Accident and Emergency Units

Lord Kakkar Excerpts

Tuesday 26th November 2013 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join noble Lords in thanking the noble Baroness, Lady McDonagh, for having secured this important debate. I declare my interest as professor of surgery at University College London and chairman-elect of UCLPartners Academic Health Science Partnership.

No consideration of the future plans for accident and emergency departments can take place without recognising the important factors that are driving demand in A&E. The most important of these is the growing number of frail elderly patients with multiple comorbidities, as my noble friend Lord Patel has already mentioned. The population aged over 85 has grown at more than three and a half times the rate of the rest of the population in the past 10 years. It is striking that 9% of those aged over 75 have experienced an emergency admission through accident and emergency in the past year. This demonstrates that there is considerable demand and that this considerable demand will grow.

We know that the way that we plan and deliver services for those who are frail, elderly and have multiple comorbidities is not providing the kind of service, the degree of confidence and the relief of anxiety that these patients require. We also recognise that those who are cared for in nursing homes and care homes, who find themselves in an acute situation, will be attended to by excellent paramedics and the ambulance service, but the default position will always be to take these individuals to hospital and very frequently for these individuals to be admitted and then to spend long periods of time in hospital. This is wrong.

With regard to the plans of NHS England, can the Minister tell us what advice is now being provided to local commissioning groups in terms of the commissioning of more holistic and integrated services that recognise the needs of the frail elderly in the community and can better understand how those needs are met, and how the services are delivered in an integrated fashion with local hospitals, while avoiding admission through accident and emergency?

What discussion has taken place about addressing the important problems of workforce development, to help us ensure that we have a medical and paramedical workforce developed for the needs of these large numbers of frail elderly patients with multiple comorbidities? What position has Health Education England taken, and how is this central advice being delivered to local education and training boards to ensure that an appropriate workforce is delivered, able to deliver multidisciplinary care to reduce the demand on accident and emergency services and manage patients rather better in the community?

Finally, may I ask the Minister how much progress has been made on the development of locally sensitive information technology projects that allow a connection between information held on frail elderly patients with multiple comorbidities in different care environments, be it in social care, in primary clinical care in the community or in hospital care? Such information could be shared effectively to reduce the burden on accident and emergency departments.

NHS: EU Legislation

Lord Kakkar Excerpts

Monday 21st October 2013 Lords Chamber

Asked by

[Lord Kakkar]

To ask Her Majesty’s Government what recent assessment they have made of the impact of European Union legislation on training and service delivery in the National Health Service.

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

We are aware that concerns exist about the impact of EU legislation on some areas of training and service delivery within the NHS. That is why we recently announced the review of the implementation and impact of the working time directive, to be led by the Royal College of Surgeons. This follows the balance of competences review for health, which included concerns about the impact of this directive on continuity of care and doctors’ training.

[Lord Kakkar (CB)]

My Lords, I declare an interest as professor of surgery at University College London. In 2010, the then Secretary of State for Health and Secretary of State for Business, Innovation and Skills were due to commence robust negotiations with our European partners on the working time regulations. Despite the welcome announcement of the current Health Secretary’s further review of the impact of those regulations, do the Government stand by their commitment to repeal this detrimental legislation as it applies to healthcare? This is now increasingly cited by coroners as having contributed to patient harm. Moreover, our trainees tell us that it is now undermining their ability to acquire the necessary skills for future independent consultant practice. Patients and doctors alike now blame these regulations for a destruction of professionalism in our health service.

[Earl Howe]

My Lords, it is the impact on our health service that we want the Royal College of Surgeons to look at specifically. In the coalition agreement, we committed to limiting the application of the working time directive in the UK, including in the NHS. Nobody wants to go back to the bad old days of tired doctors, but it is important for the working time directive to have more flexibility for a health service that operates on a 24-hour basis. Increased flexibility for the NHS would allow it to take account of local needs and practices, while at the same time ensuring the health and safety of the workforce. We stand prepared to work with partners in Europe to that end. I believe there is strong support in the NHS for this.

NHS: Accident and Emergency Services

Lord Kakkar Excerpts

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

My Lords, there are many factors at play here. There is no doubt that the GP contract severed the legal responsibility that individual GPs had to look after their patients out of hours. It would be idle for me to stand here and say that that has had no effect on A&E attendances. Patients are confused now about whom to contact out of hours and many turn up at A&E when perhaps they should not have done so.

[Lord Kakkar]

My Lords, I declare my interest as professor of surgery at University College London and chair of quality for University College London Partners. What progress has been made in the commissioning of integrated care services across hospitals and the community for frail, elderly patients with multiple co-morbidities, who frequently have to attend A&E for the lack of such services?

[Earl Howe]

Not for the first time, the noble Lord hits on an extremely important aspect of the problem that we are facing. It is the frail elderly who often turn up at A&E with a crisis in their health when that crisis could have been averted. That is why Sir Bruce Keogh has been tasked to look across the piece at the whole system to see how we can ensure that the frail elderly in particular are served better by the health service, not least to prevent the exacerbation of long-term conditions.

NHS: Association of Medical Research Charities Report

Lord Kakkar Excerpts

Thursday 27th June 2013 Grand Committee

[Lord Kakkar]

My Lords, I join in thanking the noble Lord, Lord Turnberg, for having secured this important debate and the Association of Medical Research Charities for having undertaken this very important work. In so doing, I declare my interest as professor of surgery at University College London, as chair for quality of UCLPartners, which is one of the five designated academic health science centres, as a member of the General Medical Council, and as vice-chair of the All-Party Parliamentary Group on Medical Research.

This report is fundamentally important because it highlights three vital issues with regard to the future of research in our NHS: that we must develop a culture, as we have heard from the noble Lord, Lord Turnberg, so that every patient is given the opportunity to participate in research; that all those who work in our healthcare system are made aware of those opportunities and are given the opportunity to develop as researchers; and finally, that the NHS, having promoted and facilitated all that important research actually adopts its findings to improve clinical outcomes and, indeed, to ensure that we use vital resources for healthcare much more effectively.

There is no doubt that Her Majesty’s Government need to be congratulated in this regard, because for the past three years, we have seen a relentless commitment to medical research in the legislation that has been brought before this Parliament. In particular, for the first time, legislation enshrines in statute the obligation of the Secretary of State to promote research and provides for the new arm’s length bodies to have a statutory obligation for research, which is vital. The reasons for this are clear. In terms of health gain, there is no doubt that the adoption of innovation into routine clinical practice will help us improve clinical outcomes for large numbers of patients, while in terms of the efficient use of resources, there is no question that some of the currently available innovations will help us to ensure that the funds available for routine healthcare can be used more effectively.

In broad economic terms, we know, for instance, that the life sciences industry—another area of government focus—is vital to future economic development in our country. As an industry, it is responsible for about £50 billion of economic activity annually, with 160,000 employees in this country. We also know that it is a net exporter, bringing in vital revenue to the country of some £7 billion per annum, and that from the point of view of investing in research, be it public or charitable funds, every £1 invested will provide 39p in economic return in perpetuity to our economy, so that is vital too.

It is not only in economic terms that the Government have started to look at the opportunities here. They have also done so in terms of the structures that might be provided to facilitate research, which is where this important research provides vital insights. However, a large number of bodies have been created recently to promote research in our NHS. We have heard about the academic health science centres. There are, of course, also academic health science networks, which will appear across the NHS in England and bring together academia, industry and the National Health Service. We have the clinical research networks, which are there to promote research at the local level within the footprints and geographies of the academic health science networks. We have the local education and training boards, which will play a vital role in the education of future academics and those who wish to participate in research, both clinicians and other healthcare professionals. We also have the centres for leadership in applied health research and care, which will promote research into outcomes in the NHS. How are these important structures to be co-ordinated at a local level to deliver the benefits envisaged?

We also have, at national level, Health Education England, which will have an important role in training academics and in setting a national priority in that regard. We have the Health Research Authority, the Medical Research Council and the Department for Business, Innovation and Skills, where the Higher Education Funding Council’s funding for medical schools rests. Again, those important national bodies will, with the National Health Service Commissioning Board and NHS England, all have an important role at national level to ensure that vital funds and resources are properly co-ordinated. How are we in this Parliament to know that all these new structures are working successfully and delivering what is envisaged? What metrics have been defined at the birth of these organisations with regard to their performance in research in the NHS? How will this Parliament hold those organisations, and indeed Her Majesty’s Government, to account regarding the investment of public money in those organisations and the outputs that are achieved?

For the first time, the Health and Social Care Act includes an obligation on clinical commissioning groups to promote research. What measures were undertaken in the authorisation of CCGs to ensure that there was a definition of their contractual obligations to NHS England to deliver that research agenda? How will the CCGs be held to account? If they fail to promote research, what sanctions are available against them to ensure that they deliver the research agenda?

I come finally to the question of regulation. I have spoken a number of times in your Lordships’ House about the problem of the European clinical trials directive. We heard about the deterioration in research activity in clinical trials, which is a result of the application of that directive over 10 years. What progress has been made regarding the renegotiation of the clinical trials directive in Europe?

Health and Social Care

Lord Kakkar Excerpts

Wednesday 5th June 2013 Lords Chamber

[Earl Howe]

I can indeed, and I can do so with confidence because the three chief inspectors that we propose to create—one of whom, the Chief Inspector of Hospitals, has already been appointed—will be working as part of the Care Quality Commission. They will be senior employees of the CQC and their job will certainly be to align the methodology that they use to assess good and poor care.

[Lord Kakkar]

My Lords, I declare my interest as professor of surgery and consultant surgery at University College London Hospital. During the passage of the Health and Social Care Act 2012, there was a discussion about the need to ensure that there was an ongoing focus on integrated care between community hospitals and tertiary services. This needed to be attended by a focus on the development of metrics that would describe whole pathways of care outcomes for patients. What progress has been made with regard to the development of those whole pathway metrics?

[Earl Howe]

The noble Lord hits upon a point of central importance. The outcomes framework clearly sets out where the different parts of the health and care system share responsibility for outcomes and support joint working in the way that I have described. However, we are committed to developing a measure of people’s experience of integrated care for use in the outcomes frameworks. That is a work in progress. Meanwhile, a place holder was included within both the NHS and adult social care outcomes frameworks when they were refreshed in November last year. We have highlighted the development of this measure in the public health outcomes framework, so I hope to give the noble Lord further news in a few months’ time.

NHS: Mid Staffordshire NHS Foundation Trust

Lord Kakkar Excerpts

Monday 11th March 2013 Lords Chamber

[Lord Kakkar]

My Lords, I join other noble Lords in thanking my noble friend Lord Patel for having secured this important debate. I declare my own interest as professor of surgery at University College, consultant surgeon at University College Hospital, and a member of the General Medical Council. There can only be one north star guiding the way we operate in the National Health Service and the way we deliver care, and that must be our patients. In his report, Sir Robert Francis refers to a deterioration in cultures and values. We must find ways to ensure that the cultures and the values that must attend the delivery of healthcare are rapidly restored in our healthcare system.

One way that this may be achieved is by revisiting the question of professionalism. All of us in the health service today work in multidisciplinary teams and, quite rightly, those teams are comprised of clinicians, nurses, other therapists, healthcare assistants and indeed managers who help us to utilise effectively the resources available for healthcare. Those teams can work only if there is mutual respect, but there must also be professionalism.

With regard to clinicians—and I talk here particularly about consultants in hospitals—we need to move to a position where once again consultants are accountable for the management of, and delivery of care for, the patients for whom they have responsibility. They must have the authority to deliver that responsibility for care, and with that responsibility and authority they must be held accountable for the outcomes of their patients. That is very clear. Ultimately, it is vital that patients and the public generally recognise, and are able to have confidence in, the fact that when they are admitted into hospital they will be managed and be under the care of a named healthcare professional—a consultant—who will take that responsibility, have that authority and be held accountable.

In terms of the management of the ward environment, it seems sensible to return to the ward being under the leadership of a named senior nurse—a sister or a charge nurse. Their name might appear at the entrance to the ward, and the name of the consultant responsible for the individual patient’s care might appear under the name of that patient at the head of the bed, so that there is no doubt about who has responsibility for both the ward setting and the individual care of the patient.

In the Francis report, we also see reference to broader questions of culture and values. Part of restoring professionalism will be revisiting once again the contract of employment for healthcare professionals—both consultants in hospitals and general practitioners in primary care. We need to move away from the consultant contract being principally one of contractual obligation and take it back to a place where it is one of vocational commitment, where patients can be absolutely certain that there will be continuity of care and that those with named responsibility for their care will be available to ensure that that is discharged.

The other important area for restoring the culture and values in our healthcare system is leadership. In this regard, in his report Sir Robert Francis has paid attention to the possibility of the staff college model. At University College London Partners, where I have an involvement, I am patron of the UCLP staff college. There, we have taken a model built on the Army staff college at Shrivenham, and we have a faculty from that institution attending our staff college to help to develop the leaders in our healthcare system. The model is simple. It focuses, first, on the self-reflection of those offering themselves for leadership positions so that they might question whether they have the ability to do that, and it then develops a leadership culture that puts at its head responsibility for those whom one is leading to ensure that they are developed to deliver the necessary care for the patients.

The development of leadership, culture and values must also attend the entire period of postgraduate training for all healthcare professionals. In this regard, I should like to ask the Minister what role the local education training boards will play in particular, in conjunction with the medical royal colleges and the General Medical Council, in ensuring that the curriculum for postgraduate training includes appropriate emphasis on culture, values and the development of leadership.

Health: Medical Innovation

Lord Kakkar Excerpts

Wednesday 16th January 2013 Lords Chamber

[Lord Kakkar]

My Lords, I, too, thank the noble Lord, Lord Saatchi, for having introduced this important debate with so much courage and with such intellectual power. In doing so, I declare my interests as Professor of Surgery at University College London, as Chair for Clinical Quality in our academic health sciences centre, UCL Partners, and as an active clinical researcher.

Innovation is absolutely at the heart of improving clinical practice and outcomes for our patients. It is only right that patients, their relatives and the public expect the profession and government to do all they can to ensure, first, that the research necessary to develop innovative treatments and diagnostic strategies is promoted at national and local levels, and that, once we become aware of innovation—be it through research in our own country or anywhere else in the world—it is quickly identified, adopted and placed in clinical practice. Her Majesty’s Government have placed a particular emphasis on this. Driving a research commitment in the Health and Social Care Bill for the first time, ensuring an obligation on the Secretary of State for Health to promote research and development in the NHS, was an important statutory development. We have the commitment of funding through the National Institute for Health Research, the biomedical research centres and their associated units, and the academic health science centres, which all promote early-phase, experimental and clinical research in our healthcare system.

However, Her Majesty’s Government have also recognised the problem of adopting the findings of that innovation and diffusing it more broadly across the healthcare system and across larger proportions and populations of patients. The recent report, Innovation, Health and Wealth, has identified the need for the development of academic health science networks with a clear obligation to ensure that high-impact innovation is quickly adopted and diffused across populations and healthcare systems, and that the recognised therapies that have been shown to have important clinical benefit and are approved by NICE through its guidance mechanisms are applied more broadly across populations for which we are responsible.

We have also heard in this debate that there are important hurdles to innovation in our healthcare system. These hurdles are regulatory, they are potentially legal and they are cultural in terms of the way that clinical practitioners and others work in the National Health Service and healthcare systems more broadly.

With regard to regulation, I should like to ask the Minister about one particular problem that we have heard about today—the European clinical trials directive. I know that Her Majesty’s Government are involved in negotiations at the European level to overcome some of the problems associated with this directive, which has been damaging to clinical research in our country. Is the noble Earl able to give an update on the progress that has been made there and on what changes might be made to this regulation in the future?

With regard to the legal problem, the noble Lord, Lord Saatchi, identified case law which suggests that there may be anxiety in clinicians’ minds about innovating when it comes to the individual patient in front of them. This may indeed be a very important problem and something that needs to be addressed. As we have heard in this debate, it needs to be addressed in a sensitive and careful way to ensure appropriate innovation and to ensure that clinicians who are in a position to innovate do so effectively but that any deleterious effect is not allowed to take place.

Then there is the question of culture. This is particularly important because much of the debate today has focused on what the views of clinicians and researchers, the healthcare system and indeed the Government may be on innovation. However, we must also look at innovation from the patients’ point of view, as well as that of their relatives. They are right to expect that when they need it most, innovation, wherever it is, is responsibly applied to the management of their case. In all the important work to drive innovation, and the research and development of biomedicine that has been achieved in our country so far, we must be sensitive to the fact that we may not be meeting the expectations of patients—our fellow human beings—when they are at their most vulnerable, and therefore more may need to be done to drive an improved culture for the adoption of innovation and the improvement of practice in our country.