The Long-term Sustainability of the NHS and Adult Social Care

Lord Winston Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Winston (Lab)]

My Lords, I thank the noble Lord, Lord Patel, for obtaining this debate and for his excellent report. I declare just one interest as a fellow of the Academy of Medical Sciences, and it is in that capacity that I want to speak in this debate to follow what the noble Baroness, Lady Bloomfield, said.

To extend the coverage of this report, we perhaps need to consider academic medicine a bit more carefully. Sir Robert Lechler, the president of the Academy of Medical Sciences, has written that the identification, training, development and retention of a new breed of clinical academic and research staff is essential for the NHS and UK science. They have to be digitally aware and properly trained in those things as well. He added that the academic health science centres, which were started some 12 years ago, have a clear role in the future of healthcare research and should be valued and should continue to be supported to be as effective as possible.

One of the issues is staff retention at those academic healthcare centres. This is a major problem. For example, in London, as I think I rather wryly pointed out to the noble Lord, Lord Prior, on one occasion when he was responding to a debate, after 12 years we are still looking for a professor of reproductive medicine to fill the chair that I left. We just cannot find anyone because of the expense of living in London and because, in this sector, the market has ensured that people are not working in academe or the NHS; they have gone private. I will come back to that point in a second. So this is critical, and we need to ensure new work practices and models for care delivery, and they have to be supported through research. In my view and that of the academy, that will require protected research time for medical professionals and the maintenance of funding. In particular, that must mean research for consultants, particularly in teaching hospitals.

We often boast about the advances that we have made in this country in medical care. The list is significant: organ transplantation, of course, thanks to Peter Medawar; antibody research, which has been mentioned; cancer research; and treatment for HIV. MRI and ultrasound were both started in this country. University College London is leading in some of the advances in neuroscience. In my own field, in vitro fertilisation and the screening of genetic disease were started in this country.

It is interesting to consider that we debated mitochondrial treatments for families with these diseases three years ago, in February 2015, and we agreed that that should be done. Three years later, as far as I am aware, there has not been a single treatment. Why should it take so long to get permission to do that when we have agreed in Parliament that it is essential? Think of those families who are waiting as a result of that research and those who have watched the child die of a horrible disease within the first two years of life. That seems wrong to me, and we should recognise that we need to implement our research in every field that we can.

One of the problems is something that I think was started by the Tory Party, although the Labour Government supported it: the internal market. Once we had the internal market, we could not centralise expertise in the way that we had before. We were able to develop very large patient bases, we could have better research and data, we could have much better trials and we could have training for people who could then go out to other parts of the country and improve what was going on in the health service.

A key issue is the need for young medical scientists. It is a major problem that lecturer posts, which are essential for research, are too few in this country and not fully supported, and often it is very difficult to make certain that you are going to get continued progression up to senior lecturer level. It used to be a huge advantage in medical research to have a PhD with an MD degree, but you could argue that it is now a disadvantage. We have young scientists who find that they cannot do clinical research in their hospitals because the NHS is just too difficult and too pressurised for them to do that at the moment. That is a massive problem.

As has been said repeatedly in this debate, we should also be looking at people as well as projects. It was interesting to read the article by the noble Viscount, Lord Ridley, in the Times this morning about the 100,000 Genomes Project. Of course it is a very interesting project and it may lead to important data, but as yet that has not been validated. We need to understand that we have to have investment in young people who are going to do the research. That is very important.

Time is short in this debate and I do not want to go on at great length, but I hope that, rather than just a complacent answer—I do not mean in any way to be discourteous—we can have an assurance from the Minister that we will see the academic health science centres, which have been such a success, continued. The one at Imperial College is a model for lots of reasons. It does many of the things that we have been saying in the report, such as collaboration: physicists, engineers, chemists, mathematicians and economists as well as medics work side by side to ensure that the research is promulgated and pushed in the best possible direction. However, those centres are fragile, and we need to ensure that the funding is secured and continued for the long term. If it is not, it is going to be very difficult to maintain the excellence in the health service, which I think will fall. The same must apply to the huge success of NIHR, which has been a massive advantage to research and is another form of collaboration. I hope the Minister will give us assurances on this point.