NHS: Healthcare Data

Lord Mitchell Excerpts

Thursday 6th September 2018 Lords Chamber

[Lord Mitchell (CB)]

My Lords, I declare an interest as a shareholder in Sensyne Health plc, whose business is in medical artificial intelligence. I thank my noble friend Lord Freyberg for sponsoring this debate and for his truly excellent speech. He and I have been working closely together on this project for the past few months.

I very much enjoyed the speech by the noble Lord, Lord Bethell. He says he is a campaigner. I believe him, and I am a campaigner too so perhaps we can campaign together. I also thank Future Care Capital, which has been very supportive throughout, particularly Annemarie Naylor, who has kept me in line and continually encouraged me on this project.

My words today can be summed up very simply: I want to put as much pressure as I can to ensure that the huge potential value of our medical health records is channelled back to our NHS. I want that value to be maximised. In a letter to me in the final stages of the Data Protection Bill, and following some pretty intense lobbying, the Minister included the following sentence:

“We want to examine how we can maximise the value of the data for the benefit of the NHS and those who use and pay for it”.


I fought hard to have the words “maximise the value” inserted into that sentence, but I now read and detect that his department is looking to conclude commercial arrangements that are “fair” to all parties. I do not want to nitpick, but “fair” is a serious dilution of “maximise”. It is a soft, woolly word through which the international giants will drive a coach and horses. “Maximise” is strong and unambiguous. So I ask the Minister again: will commercial contracts between NHS trusts and private enterprise be maximised, as I would hope, or simply fair, which would benefit only big tech and big pharma?

When the Bill was passing through your Lordships’ House, it was frequently mentioned that data is the new oil—on Tuesday, no less a figure than the most reverend Primate the Archbishop of Canterbury described data as more valuable than gold—and there can be no doubt that medical records are probably the most valuable data of all. By sheer chance, we find ourselves sitting on a treasure trove of rich patient data. That is because the NHS goes back to 1948, and uniquely in the world it possesses tens of millions of patient records. On top of that, we have a diversified population, which makes these records even more valuable. Many authorities I have spoken to value this data as being worth billions of pounds.

Artificial intelligence, coupled with machine learning and complex software, can now produce algorithms that, together with highly professional supervision, are able to predict clinical issues quicker and much more accurately than has previously been the case. Every physician will tell you that the sooner potential patient issues are diagnosed, the more likely it is that there will be a successful outcome. Analogies are always tricky but I cannot help thinking about the North Sea oil exploration and discoveries, which have proven so beneficial to our economy since the 1980s. In oil, there are parallels with NHS medical records. In its natural state oil is crude and hard to capture, but with commitment and huge investment the sticky, viscous liquid can be turned into petroleum products. So it is with medical records. The data is incomplete, scrappy and located in hospitals up and down the country. It too needs to be mined and refined, but with major investment that can be done.

I have pushed hard for the setting up of a sovereign health fund into which the proceeds of income generated from the licensing of NHS medical data records can be placed. I know the thinking is more towards a regional approach, but I shall add a caveat. We can already see the digital companies crawling all over NHS trusts. It is evident that these trusts have been outnegotiated. At Moorfields, they entered into a barter agreement with DeepMind. They failed to realise that the real value is in the algorithms produced, which are coveted by healthcare providers, pharmaceutical companies and health insurance companies around the world. This is where the value is—in the worldwide intellectual property. Big tech knows it; the NHS does not. A sovereign health fund would develop a pool of commercial, clinical and digital expertise, able to negotiate head-to-head with the global companies. It would maximise value.

We have a fantastic opportunity to generate major income for the NHS. To succeed we need courage. Will the Minister and his department be brave and bold enough to ensure that our NHS gets the maximum value it deserves?

National Health Service

Lord Mitchell Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Mitchell (Lab)]

My Lords, first, I thank my noble friend Lord Turnberg for securing this debate. He is not only my noble friend but a personal friend. Few have committed more to the NHS than him. To the noble Baroness, Lady Watkins, I can say, “It’s over. You can relax, and you did really well”.

I speak as a parent of a junior doctor who qualified at the University of Nottingham and now is a resident doctor at NYU medical centre in New York. It might be interesting if I were to compare and contrast aspects of the two systems as seen through his eyes.

The first aspect is the teaching. At NYU each resident receives around 14 hours of high-powered classroom teaching each week. The regime is free food, phones off, high concentration. Lectures are given by specialist consultants. As he puts it, “Every day I lunch with giants”. At Nottingham he was lucky to get two hours per week.

As for attitude, at NYU he feels a valued member of the team; in the east Midlands he and all his colleagues felt underappreciated. Most NHS medical staff were disgruntled and demotivated. Of his colleagues in Nottingham, a third either left the profession or went to work abroad. Each one had cost the NHS £300,000 to train but, when they left to go elsewhere, no one noticed, no one took responsibility, there was no exit interview and no one cared.

Then there is the pay. In his final year in Nottingham, he earned about £40,000. It is true that his basic pay was £23,000 but, with unsocial hours banding, the pay soon mounted. At NYU he earns $60,000—exactly the same amount—but in the United States almost all junior doctors carry student loans in the region of a quarter of a million dollars, and repayment starts immediately.

Finally, there are the hours. Last month in New York, he worked 80 hours per week, as he has done every month. He works six days every week, including many weeks on night shift. Even on daytime shifts, he leaves home at 5 am and often gets home at 8 pm.

The American junior doctors are the ones with really unsocial working hours. They are the ones who struggle to make ends meet and the ones who should be complaining, but there are no picket lines to be seen on First Avenue and 32nd Street. The question is why? Let me hazard a guess. In much of the UK, junior doctors—indeed, even senior doctors—are treated as objects: cogs in the wheel or items on the spreadsheet to be moved here and there at will. There seems to be little realisation that to get the best out of people you have to encourage them, you have to integrate them as part of the team and, most of all, you have to make them feel valued. It is called leadership. Looking at this junior doctor crisis, there seems to be little of that in evidence in our NHS but it is what we really need.

Queen's Speech

Lord Mitchell Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Mitchell]

My Lords, I, too, congratulate the Minister—the noble Lord, Lord Hill of Oareford—the noble Lords, Lord Hall of Birkenhead and Lord Kakkar, and the right reverend Prelate the Bishop of Guildford. Each of them gave a magnificent maiden speech today and it is to our benefit that they join us in your Lordships' House.

My speech is on public health issues, but first I say a few words about education. My interest is that I am chair of an organisation called the e-Learning Foundation. We provide laptops to socially disadvantaged children; we have been amazingly successful in that. My predecessor was my noble friend Lady Morris of Yardley. I am stepping down this September and will be replaced as chairman by the Minister's soon-to-be noble friend, Phil Willis.

The Minister spoke about academies and, in particular, Mossbourne Academy. The late Sir Clive Bourne was a personal friend of mine, and it was his amazing energy—when he was terminally ill, I add—that enabled that school to grow. In two years, the old school was demolished and the new school rebuilt, with everything that is involved in setting up a new school. It opened in 2005; five years later, we have heard about its incredible results. His widow, Lady Joy Bourne, continues to be very involved with that school.

I know that everything that the Minister says about academies is true. It is equally true that with the use of laptops in schools we have provided phenomenal results. I encourage him to come to some of the schools using those laptops to see what has been achieved; I would be very happy to take him round.

This afternoon, I want to speak about a subject that I have raised in your Lordships' House several times, but with a new Government it is time to do it again. The subject is the labelling of bottles and containers warning of the dangers to the unborn foetus of its mother drinking alcohol. Briefly, the issue is this. Mothers-to-be who drink risk permanently damaging their babies. This occurs because alcohol in the mother's bloodstream passes to the foetus across the placenta. The foetus, because its organs are undeveloped, is unable to process this toxin, and major damage can occur. Foetal alcohol syndrome disorder is the name given to the complete range of disorders. In its mildest form, which affects one in a 100 live births, it can cause a series of behavioural attributes, such as acute attention deficit disorder. In its most acute form, which affects one in 1,000 babies, its effects are similar to acute brain damage. Simply put, the brain and other organs do not develop. Children with the most severe learning disabilities are affected. Their mental age is retarded and their cognitive abilities are limited. Often, they cannot even tell the time or find their way home. As young adults, they become disruptive and often turn to crime. Many cannot even hold down the simplest of jobs. Whatever their degree of disorder, they become a cost to society.

If today's mood is to cut costs, this is an easy way to do so without any downside. FASD is totally preventable and, if it is reduced, society gains. Knowledge among young women and, indeed, their partners of the damage they are running by drinking when pregnant is lamentably low. No one, least of all me, wants a nanny state; all I seek to do is to raise awareness of this danger. Just as was the case with the linkage between cigarette smoking and cancer, product labelling is a good place to start. Today, because of in-your-face labelling on tobacco products, few people can be unaware of their dangers. I am seeking to do the same with alcohol.

Three years ago, I introduced the Alcohol Labelling Bill into your Lordships’ House. It went through the usual stages and was passed. Then, as is the case with most Private Members' Bills, it died the death when we could not persuade the Government to give it time in the other place. In summary, the Bill said that if the alcohol industry did not abide by the terms of a memorandum of understanding that it had previously signed agreeing to include prominent labelling, legislation would be introduced to make it compulsory. I cannot tell noble Lords how many well meaning Ministers I discussed this issue with. Over numerous cups of tea, they told me that they were on the case, but they needed to complete this survey and that analysis and I could be assured that there would be a successful outcome. There was not.

Go into any supermarket today and examine the bottles. A few have labels prominently displayed, but more than 80 per cent do not. Others have an illustration that the French use. It shows the outlines of an elegant and obviously pregnant woman holding a champagne glass with a diagonal strike going through it. It is very cute, very chichi and very tasteful in a rue Saint-Honoré sort of way, but it has little relevance to the culture of girls on the binge buying cheap cider and vodka at the local supermarket and getting legless as quickly as possible. We see the evidence every weekend in our city centres, do we not? There is nothing very elegant about it. What is more, the illustrations on the bottles I have seen are so small that you would need a magnifying glass to see them.

The Americans have been much bolder on this issue, just as they were with tobacco. Any bottle, can or bar in the United States has a prominent label warning of the dangers to the unborn child of drinking while pregnant. They were introduced in 1989. Here is the stark truth: the alcohol industry runs circles around Governments. It lobbies hard, like the tobacco industry before it. It throws every impediment in front of the labelling proposals. No one seems to have the strength to stand up to it. This new Government have said that they intend to address our alcohol plague. We said the same but, if noble Lords will excuse the pun, I think we bottled it.

My first question to the noble Earl, Lord Howe, who has always been a tremendous supporter of what I am proposing, is will the coalition Government take on the alcohol industry? Will they make labelling prominent, unambiguous and compulsory? If the Government really want to reverse the cult of alcohol, will they consider banning alcohol adverting, just like the Labour Government banned tobacco advertising?