Genomic Medicine: S&T Committee Report

Lord Warner Excerpts

Wednesday 9th June 2010 Lords Chamber

[Lord Warner]

My Lords, I begin by saying what a privilege it was to serve on this inquiry, which was so skilfully chaired by the noble Lord, Lord Patel. We owe him a great deal of gratitude for ensuring the presence of scientific stars of a positive World Cup standard, who appeared before us to give evidence that helped to inform our report. I also look forward to the appearance of my noble friend Lord Winston on the Front Bench. I wish only that the Labour Party had thought of the idea of guest spokesmen on the Front Bench when I was a Minister. I thank Tim Aitman and wish him a happy birthday and thank all the clerks’ office staff for the work that they put in.

This was an important report for the NHS and patients. It is based on extensive evidence-gathering. As a committee, we were fully seized of the state of the public finances, and we went to some trouble not to produce a wish-list of things to please scientists and damage the Government’s finances further. We have been hard-headed in the recommendations we have made, with a strong focus on things that will benefit patients. What is, however, clear is that in the world of genomic medicine things will not stand still but will change at a rapid pace whatever a UK Government do about this report. It looks as though linking therapies for identifiable individuals with common diseases is progressing very rapidly, and we cannot ignore, as the noble Lord, Lord Taverne, said, the speed of that progress.

The UK has traditionally been a world leader in the field of genetics and we were told consistently that it has punched above its weight in genomic research. That was reflected in the 2003 White Paper that I was involved in as the responsible Health Minister. The world moves on, with many advances overseas, especially in the US and China, but the UK still has a major advantage if we choose to use it wisely—a National Health Service, with universal population coverage and health data. This provides a strong scope for population-based approaches to early diagnosis of diseases and targeted personal drug therapies. Moreover, the cost of burgeoning genetic knowledge is falling rapidly, as the noble Lord, Lord Patel, described so well.

The pace of change presents serious challenges to government and the NHS. To be honest, I found the previous Government's response to our report disappointing and, if I may say so, in some respects slightly complacent. I note that respected bodies such as the Wellcome Trust, and others, were also disappointed in that response. Too much of it looked back to what the Government had done rather than forward to what the Government and the NHS needed to do, given the pace of change. I can see that there could be a case for setting up a Human Genomics Strategy Group, which seems to be the cornerstone of the previous Government's response, but my fear is that this will be a poorly resourced talking shop with no clear mission statement and without the authority to drive change. For me, the unwillingness to produce a new White Paper that looks ahead for five to 10 years and sets out a new agenda for genomics within an NHS context is a sign of the Department of Health's reluctance to define and drive a new agenda through a HGSG or alternative machinery. After so many years around government, I have developed an expertise in recognising bureaucratic inertia, which is what this could be interpreted as. So my first question to the Minister is whether he and his colleagues in the new Government are willing to revisit the issue of producing a forward-looking White Paper and creating a more sharply defined machinery for driving forward a new agenda in this area. That would be totally consistent with the efficiency and quality agenda for the NHS that the new Government wish to produce.

I shall confine myself to a few specific issues on the other points in the report around the translation of this new knowledge into patient benefit. The NHS in my experience has a mixed track record in translating discoveries from the lab to the bedside. There are four of these translation aspects in the report that I have concerns about. The first is extending the remit of NICE to evaluate validity, utility and cost-benefits of genomic tests for common diseases. The noble Baroness, Lady Finlay, has spoken in more detail about this critical area. We thought that it was best to place this responsibility on an existing, respected body, and I think that that was the right thing to do. However, as a former Minister responsible for NICE, I know how many new duties have been piled upon it. Can we be confident that NICE will have the resources, including the specialised expertise, to take on this demanding new role, and when can we expect to see this new role featuring substantively in NICE's work programme?

My second area of concern relates to pathology, on which the noble Earl, Lord Selborne, has spoken. We deliberately proposed centralising laboratory services for molecular pathology as a way of making the efficiency savings that would fund much of the new equipment that will be required and on the basis of evidence given to us, particularly in relation to Oxford from Sir John Bell.

Amalgamation also goes with the flow of the two reports on NHS pathology services by my noble friend Lord Carter of Coles, who, if I may put it this way, I unleashed on these services when I was a Minister nearly five years ago. However, never underestimate the capacity of parts of the NHS to resist change. As the committee indicated in its report, implementation of the Carter proposals has been painfully slow, given the scale of the possible savings that the noble Earl, Lord Selborne, described. The previous Government’s response on this issue was hardly galvanising, even though they sort of accepted our recommendation. Their proposal was that SHA medical directors were to lead work on pathology service redesign to bring together pathology and genetics laboratories. I certainly would not have bet the farm on this achieving change quickly in the face of longstanding resistance from many local consultant pathologists, but if SHAs are to be abolished in 2012, I would expect even less to happen between now and then.

Will the Minister have another look at this whole area, including the Carter recommendations, and come up with a more convincing plan that is also likely to deliver substantial savings and improve services? I remind him that when I was a Minister setting up the Carter review, we were thinking then in terms of 20 per cent savings on the cost of the pathology services by consolidation and amalgamation.

My third area of concern is commissioning, where the previous Government rejected the committee's recommendation that changes were needed in the commissioning of genetic tests because of the inconsistency across the NHS in the provision of genetic tests and genetic testing for subtypes of common diseases. The noble Lord, Lord Patel, has already referred to the risk of a postcode lottery with regard to the availability of these tests. The then Government wanted to rely on the web portal NHS evidence to inform commissioners, and on the current commissioning arrangements. The respected PHG Foundation has sided with the committee after expert workshops looked at this issue among others. In a report published last month, the foundation said that the DoH,

“should review how NHS funding mechanisms act as a barrier to the utilisation of new tests”,

and that, in effect, these make it difficult to realise cost savings throughout the healthcare economy. Given that the new Government have in mind new approaches to commissioning, this would seem a good opportunity to revisit the concerns over the commissioning of genetic tests that others have raised. Will the Minister be prepared to do this?

My final point relates to issue of medical bioinformatics, which is critical to success in this area, as other noble Lords have mentioned. All the evidence that we received suggested that a shortage of bioinformatics personnel and kit was likely to be one of the greatest impediments that the NHS would face in using the new genetic knowledge. I am pleased that the previous Government accepted that more secure funding for the European Bioinformatics Institute was needed. We hope that this will not be a victim of cuts. However, I have grave doubts about whether the DoH is doing enough to provide sufficient bioinformatics capability to the NHS through its Modernising Scientific Careers programme, which seems to be its process of choice. That is why we recommended the establishment of an institute of biomedical informatics. I encourage the Minister to get his colleagues to look again at this proposal, particularly drawing on the potential for savings, as a number of us have said, from consolidation in the pathology area.

I recognise that there is a lot of detail in these questions and that the Minister may well need to take further advice. We should say to him, though, that the Science and Technology Committee—I hope—will continue to keep a beady eye on this area and progress in it.

Queen's Speech

Lord Warner Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Warner]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Murphy, with whose speech I largely agree. The Government would do well to take heed of many of the remarks that she and the noble Lord, Lord Patel, have made.

I shall speak today on adult social care and the NHS but, first, I congratulate the two Ministers on their new appointments. As one of the Ministers that the noble Earl, Lord Howe, has seen off, I congratulate him on his strong grasp of health and social care. Even when he was skewering me as a Minister, it was always done with elegance and with a sense of doing so in the best interests of the NHS.

I greatly enjoyed the maiden speech of the noble Lord, Lord Hill. It reminded me that it was one of his former boss’s ideas on GP fund holding that I pinched and turned into practised-based commissioning. I have never owned up to that publicly but this seems an appropriate occasion to do so.

I begin by congratulating the Government on administering a speedy coup de grâce to the ill-conceived Personal Care at Home Act. This has removed an important roadblock to achieving sustainable long-term reform in this area. Unlike the noble Lord, Lord Sutherland of Houndwood, I welcome the idea of an independent commission to look into this. I think that we need to dig quite a few people out of rather entrenched positions on some of these issues, and a commission of independent mind might help us to do that. However, it is important that it focuses quickly on the considerable amount of common ground that exists among different shades of opinion in this area. A few of us identified this common ground in March in a pamphlet produced on a cross-party basis with Sir Derek Wanless. I know that Ministers have seen that pamphlet but when we were writing it, it was very clear that there was a large measure of agreement on many issues in this area, and that is something on which the commission needs to build.

It is clear from the public debate so far that total funding for adult social care has to be increased significantly to cope with demography. It is also clear that there has to be a larger contribution from individuals and families who can afford it, rather than from the taxpayer. It is equally clear that risk-pooling through some form of insurance has a key role to play. These points are all well documented and well settled, and we need to build on them. We need to do more—and I hope that the commission will do this—to engage the insurance industry in ways forward in this area.

Before leaving the subject of social care, perhaps I may say a few words about the idea of a national care service. Like all parties, the Government rightly want to achieve more integration of health and social care for the benefit of service users. No one could disagree with that. However, I suggest that a better starting point for improved integration is the local commissioning role, rather than just concentrating on the provider side. This will particularly be the case if GPs are to be more powerful service commissioners in the future. We now need joint commissioning which supports more personal budgets and user choice and which creates greater diversity of service providers. It seems to me that the rather statist-sounding national care service is not self-evidently the best way to achieve this, and we need to look at that idea very carefully before we take it too much further forward.

I turn briefly to the subject of dementia, which has been raised a number of times today. I support and welcome the Government’s decision to prioritise dementia research but I would encourage them to think more widely about whether the current allocation of service and financial responsibilities for dementia between the NHS and social care is right. After all, dementia is very much an illness; it is a disease, and I wonder whether the NHS is bearing its full proportion of the burden in this area. Another look at that might change some of the calculations that the independent commission might have to make in adult social care. I do not have a strong view on that, but it is an area that we should look at again.

Turning to the NHS, the Labour Government’s record on investment in the NHS was outstanding. We recognised that that needed to be done after almost two decades of parsimony in the 1980s and 1990s. I shall not recite all the figures; many in this House have heard me recite them from the Front Bench many times. However, I emphasise one point: the independent evidence from the Nuffield Trust shows that the much maligned targets did a lot to improve services, however much NHS staff disliked them. Before we ditch targets we should consider whether, in a democratically parliamentary accountable system like the NHS, we have a few levers in Richmond House that enable us to satisfy the public that taxpayers’ money has been spent reasonably well.

Latterly—the noble Baroness, Lady Murphy, put it very well—my party lost its appetite for NHS reform and certainly lost its appetite for some of the agenda that was promised in the 2005 Labour election manifesto, particularly those parts about more competition and greater diversity of providers to give patients more choice. I am a little hesitant about asking the coalition Government to help to implement that Labour Party manifesto. I notice in the new health Bill that this Government are to make Monitor into a proper economic regulator, a move which I have long supported. This is a good opportunity to ditch, once and for all, the rather misguided idea of the NHS as a preferred provider. A good start could be made by starting with market-testing PCT provider services, which the Department of Health has already said are inefficient and lacking in good productivity. I wonder whether the noble Earl can say whether there will be a review of some of the mergers that have quietly taken place or are in prospect of some of these less than efficient PCT provider services.

There is not time for me to go into any other areas of the NHS. As the new Government tackle the very difficult financial challenges ahead, which the NHS has never faced in its history on this kind of scale, I hope we in this House can settle down and discuss all these changes, which would have been inevitable whoever had won the election, and start doing so in a constructive and non-partisan way.