Life Sciences Industrial Strategy (Science and Technology Committee Report)

Baroness Morgan of Huyton Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Baroness Morgan of Huyton (Lab)]

My Lords, I am pleased to be taking part in this important debate. I too was a member of the Science and Technology Select Committee which produced the report we are talking about, under the able chairmanship of the noble Lord, Lord Patel. It was a fascinating but very worrying inquiry. I draw attention to my interests in the register, particularly as chair of the Royal Brompton and Harefield NHS Trust, about which I will speak today. I will focus on the role of the NHS.

We all recognise that the NHS is vital to the success of the Government’s life sciences strategy. It is a unique asset that differentiates the UK from other countries. It is the big opportunity. The Government recognise this, but the challenge is not whether to recognise it but how to deliver on that opportunity. In our inquiry we heard extensively from industry that a silo approach to NHS budgeting and organisation makes innovation difficult, even when it is substitutive rather than additive —as my noble friend Lady Young said. In other words, even if a new treatment is an alternative and not an additional new approach, it is difficult to find a way through.

We also heard from NHS England that living within a tough funding regime means that the centre has to be sure of the benefits to the NHS of any innovation before any change can be approved and funded. Both these contributions, though understandable, were concerning to the committee. On top of this, the danger of the new NHS settlement is that too much of it will be used to prop up the existing service rather than to attempt to transform. It is an inevitable conflict. I sympathise with the Minister dealing with that one—although the noble Lord, Lord O’Shaughnessy, is not in his place.

I thought it would be useful to use a real example to highlight the realities and choices around innovation. It is very easy to talk about theory and potentially hugely positive macroeconomic effects. The life sciences strategy is defined by Sir John Bell as the application and harnessing of biological sciences and technology. If it is handled well, whether via the use of data, genomics, new drugs and treatments, new devices and approaches, and so on, it is absolutely also about better patient care and outcomes. I do not want to repeat the excellent contributions of my committee colleagues, so I will choose one disease, cystic fibrosis, to illustrate my point.

The Royal Brompton and Harefield Trust is a leader in the treatment of cystic fibrosis in both children and adults. CF is a life-limiting genetic disease that is caused by a defective gene which codes for a protein in cell membranes and therefore affects multiple organs in the body. Life is limited due to progressive lung disease, and those with CF are informed by their clinical teams, from an early age, that maintenance and awareness of lung function is important to maximise their life expectancy. As a result, people with CF are expected to attend clinics at their specialist centre regularly, to monitor their lung disease and receive treatment to prevent, halt or slow disease progression.

Our patients travel from all over the UK for specialist care and, through patient experience surveys, they report that attending a clinic so frequently for monitoring is significantly impacting on their quality of life. They must take time off work, arrange childcare and fund the significant cost of travel into central London. In addition to this, CF outpatient services at our hospital and other specialist centres are busy and frequently overbooked. This is a growing concern because research in this area has predicted an increase of 75% in the number of adults with CF. The good news is that this is due to advances in medical care and associated increased life expectancy, and further new drug trials are in the offing. However, the increasing pressure on services increases, for example, the serious danger of cross-infection, which is a significant issue for this patient group. Coming to hospital more or for longer than they absolutely have to is not good for their overall health.

A recently published guideline from NICE on cystic fibrosis has urged healthcare teams to consider providing telehealth as an option for routine monitoring, with benefits recognised both to the patient experience and in allocating hospital resources. The clinical team at the Royal Brompton and Harefield Trust has developed an innovation project that aims to address these challenges by empowering the person with CF to monitor their own health from home. Providing self-assessment equipment and a technology app platform to share that data with the healthcare team unlocks the team’s ability to provide remote, virtual consultations and advice. It will allow people with CF to gain a greater awareness of their overall health and to see the impact of lifestyle changes or new medicines. It is hoped that putting data in the patient’s hands will start to equalise the power dynamic that exists between patient and the healthcare team that currently holds much of the data used for clinical decision-making. It offers the trust the opportunity to reduce the number of in-hospital clinic appointments and consider how to allocate resources better in view of the growing patient population.

Although there is a lot of evidence from clinical practice indicating that the impact of this innovation will hugely improve both the clinical management of CF and patients’ experience of living with and managing this serious disease, there is no clear evidence yet that it can be economically sustainable. It is too soon to make and prove that hypothesis. The team are currently both tendering for the services of a technology partner to develop the platform and exploring with the current commissioner—the payer for our services, NHS England—how to pay for it. The platform is likely to demonstrate fairly quickly that the number of outpatient consultations between CF patients and the clinical team, especially face-to-face ones, can be greatly reduced, saving the patient travel costs and freeing up capacity in the hospital. Over the longer-term, the platform will enable the patient and the clinical team to identify the symptoms of an imminent exacerbation of the disease, which can then be managed so as to minimise the need for the patient to be admitted to the hospital as an in-patient.

If these cost savings and efficiencies from this innovation could be applied over a large number of patients, there is clear potential for the overall current budget spent by NHS England on CF to be reduced. But, crucially, the cost of running the platform in its first one to two years, when added to the existing costs of service provision, are almost certain to increase the current budget for CF, at a time when NHS England is looking to cut back on specialist service provision more generally.

My point in raising this as an example is not special pleading to the Minister, although I am sure he is listening, but to try to give a concrete example—there are so many others—of how current commissioning will need to change in order to support innovation. Innovation cannot and will not happen as part of the current regime. The systems, incentives and funding models are not right. Yet at all levels, whether in the individual clinical team, at NHS trust board level, in academic and business partners or nationally, we all want to deliver change and efficiencies. To make this work we need to be round the table having a serious, grown-up conversation.

I was struck by hearing evidence in the inquiry that genomics has been successfully developed as a comprehensive national strategy partly because it had, in effect, a separate organisation, so there was absolute focus and clarity around mission and delivery. If the life sciences strategy is to harness the power of the NHS and deliver both efficiencies and innovatory new treatments and approaches, it too will need absolute focus and accountability. It cannot be an add-on.

Sir John Bell’s excellent strategy and evidence to us identified a small window for us to get the incentives, the systems and the accountabilities sorted in order to realise the unique potential we have as an economy because of the power of the NHS. Can the Minister convince us today that the Government recognise this?

Science and Innovation Strategy

Baroness Morgan of Huyton Excerpts

Monday 23rd October 2017 Lords Chamber

[Baroness Morgan of Huyton (Lab)]

My Lords, I echo the thanks to the noble Lord, Lord Patel, for his excellent introduction to this debate. I am fortunate to serve as a member of the Science and Technology Select Committee under his leadership, which followed the able leadership of the noble Earl, Lord Selborne, who initiated this area of scrutiny for the committee. I draw attention to my entries in the register.

This House scrutinises and discusses this subject matter repeatedly. The future industrial strategy is of paramount importance to the UK economy and the big issue, of course, is implementation. What? How? Where? We will rightly hear a lot today about HE and science but in my brief intervention I want to talk about a component that is often not talked about quite so much—the need for a real, quality, deliverable skills strategy that meets the future economic requirements of the country and does not jump to ticking boxes and obsessing about big target numbers: I think about the 3 million apprenticeships. We have been here before. All Governments want to talk big numbers, but all in different ways have failed to deliver the content, quality and skill sets needed to go forward.

We have, of course, talked about this before. In many ways, it went wrong with the Education Act 1944 and our failure to set up technical schools. That established a mindset of academic top dog, and everything else being the poor relations. Like many of us here today, I hark back to the days of ONCs leading to HNDs at strong local polytechnics, which could then be topped up to degree level if wanted. All this was replaced for well-meaning reasons, but the replacement technical structures and qualifications were frankly inadequate. In addition, FE colleges have been woefully underfunded and inadequately staffed for many years. Typically, the recent review of FE colleges looked only at financial sustainability, not skill needs or quality of provision. Employers tell me regularly that they have to retrain young people who come to them supposedly ready for work.

In 2015, the UK Commission for Employment and Skills found that 43% of STEM vacancies were hard to fill due to a shortage of skills. That is the biggest challenge facing London’s tech businesses, while the Tech Partnership says that 72% of large companies and 49% of SMEs are reporting skills gaps, with significant impacts on productivity. Engineering and construction firms are finding the situation increasingly difficult, and that is without Brexit.

The recent productivity figures have to be a huge wake-up call for us all. Put Brexit on top and the need for a complete change of gear in this area and honest appraisal of what is needed is apparent. We spend most of our time and money talking about schools and HE. I give an example of the sort of focus needed by the Government—that is, delivery of technicians. By that I mean workers possessing levels 3 to 5 STEM skills. Technicians are workers who apply proven techniques and procedures to the solution of practical problems. They carry supervisory or technical responsibility and competently deliver their skills across the fields of science, medicine, engineering and technology. They are in very short supply already. Every employer in these fields is desperate. The Government, frankly, are not joining up the dots sufficiently. For example, very little of the advanced learner loans—basically, the only way 24-plus year-olds can get funding for technician awards—are going to level 4-plus courses. In 2015-16, it was £8.6 million out of a total of £162 million.

Paul Lewis at King’s College—I declare an interest as vice-chair of council—has undertaken an interesting and illustrative piece of research on the role of technicians in life sciences. I know that the Minister is particularly interested in this area. The life sciences strategy is, of course, both a strategy in its own right but also an important strand of the industrial strategy. His research found that, as industrial biotechnology, cell therapy and regenerative medicine remain in the relatively early stages of their development and heavily involved in research, the focus has been on graduate and postgraduate skill needs, which are also in pretty short supply. However, sector-level bodies and employers readily acknowledge that any movement in the future to full-scale manufacturing—as we hope there will be —will demand increasing numbers of specialist manufacturing and laboratory technician roles. Significantly, many of the emerging roles in the life sciences sector could, and probably should, be carried out by technicians. These roles are highly routinised but take place in accordance with strict guidelines and standard operating procedures from which people must not deviate. Such roles place a premium on attention to detail, care in following instructions and practical skills—for example, on cell cultivation—rather than on graduate-level theoretical knowledge.

In practice, many manufacturing and lab support roles have hitherto often been filled by graduates. This overqualification can lead to difficulties. The graduates have greater theoretical knowledge than is essential, but they often lack the practical skills required to do the job effectively over a reasonable period of time. They often also become dissatisfied with the job, both with the highly routinised work and the relatively low pay. They may leave pretty quickly, which is frustrating for the employers, who have put the training in.

Apprenticeships could and should help, if planned properly. When it comes to planning and delivering apprenticeships, there are lessons from other specialist sectors, and it is now time to learn from them. We need small numbers. In any geographical area, small numbers make it difficult to get a training provider to collaborate properly under the current funding system. This needs to be planned properly. For example, we should look at centres of excellence, technician training that can cover a range of industries, more distance learning with residential blocks, involving the catapult centres, and so on. The point is that a practical, comprehensive piece of work needs to be done on this now.

I choose this issue of technicians to be illustrative of the wider issues. My plea to the Minister is that collectively we need to roll up our sleeves and deliver a properly thought-out, joined-up skills strategy—not have schools over there, FE here and HE somewhere else, planned by different departments at the moment with different Ministers and different civil servants. We need to try to avoid the big claims and the big numbers and plan a proper, detailed, quality provision that is absolutely essential for our economic future.