NHS: Innovation

Baroness Walmsley Excerpts

Thursday 11th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I, too, welcome the Minister to his first debate. I also thank the noble Lord, Lord Wills, for using this debate to raise such an important issue. I, too, want to ask about fast-tracks although most of my remarks will be of a somewhat more general nature than those of the noble Lord.

The overriding purpose of innovation must be the better care and treatment of patients. Financial considerations are of course important but when patients’ lives are at risk, speed is of the essence, so we must do everything in our power to get proven new treatments and practices to patients without delay. A primary focus of innovative practice in the past two years has been the interface between health and social care. The devolution of new responsibilities to local authorities has the potential to let many flowers bloom and stimulate a lot of new thinking. However, local authorities, suffering deep cuts in their budgets and without ring-fencing of their adult social care and public health budgets, have found it very challenging to respond to their new powers. “No change” has not been an option. Indeed, in many areas, councillors and officials have felt that wholesale change is the only answer to providing integrated services to their ageing communities in a sustainable way.

A very good example of how this has been done is the Greater Manchester Integrated Care Programme. The 10 local authorities involved suffer some of the worst health outcomes and inequalities in the UK. The number of over-85s is forecast to rise by more than 28% in the next 20 years, while suboptimal management of these patients is currently placing significant strain on acute hospital services. As a result, older people in the area have high rates of emergency admission to hospital, of non-elective bed days and of readmission. What a challenge this is. By setting up three common integrated programmes with locally agreed variations that focus on user experience, health and well-being outcomes, productivity and multidisciplinary working, and with a strong programme of liaison and oversight, the 10 authorities have made real improvements in outcomes and reduced costs. Digital technology has been a key element in overcoming the barriers to integration. That was a quick skim through one very complex response to the Health and Social Care Act 2012. It is only one example of the innovation which councils all over the country are leading.

Turning to new drugs and equipment, as I understand it, the main control over whether these are approved for use in the NHS, and can therefore be commissioned by CCGs, is the NHS Business Services Authority. Some manufacturers are concerned that the approval process can take up to two years. When all the evidence for efficacy and cost effectiveness is available, this can surely be speeded up. Can the Minister say whether the Government are in favour of a fast-track procedure for drugs and equipment where all the evidence is available that would allow new ideas to be brought to the patient sooner? I can understand things taking longer if further evidence is needed, but some companies are in a position to bring all the evidence to the table. Such applications should be able to go through or be rejected very quickly if the figures do not stack up. Have the academic health science networks succeeded in their objective of ensuring rapid evaluation and early adoption of innovations?

Even when a piece of equipment has been NICE-approved, it can take far too long to reach all the patients who could benefit from it. For example, the latest innovation in diabetes treatment to be approved is the insulin pump. This has been available for four years and is suitable, according to NICE, for 12% of adult diabetics and 33% of children. However, distribution has reached only 4% of the patients who would benefit from it, far behind other European countries. This is not encouraging for other companies which are currently working on even more innovations to make the lives of thousands of diabetics better and safer.

Of course, it is not only drugs and equipment that must be considered. New practices and procedures at trust level and in primary care can also bring benefits to patients, raise standards and save the NHS money—standards being the key to a good health service. Very often even the low-hanging fruit is not plucked. I refer in particular to hospital infection control. There have been many examples of cases where better implementation of simple hygiene procedures can make an enormous difference in hospital-acquired infection levels. Yes, there are clever new things such as using bactericidal services and UV light cleaning equipment, a US invention being trialled in two hospitals over here. These have their place, but often much simpler solutions are overlooked. For example, I have recently been treated in two hospitals, one in England and one in Wales. The English one swabs patients for MRSA during their pre-operative assessment; the Welsh one does not. It is obvious which one has the higher rate of MRSA. This practice was recommended by the Science and Technology Committee of your Lordships’ House in 2003 when I was a member, in its report called Fighting Infection on the control of infectious diseases. It might have been a new idea then but it is not new any more and it is still not being used universally. It is a simple, cost-effective procedure and I am amazed that it is not being carried out in every hospital. So good care is not just about innovation, important though it is.

I believe that more use can be made of the simple things that we all use, such as the phone. Everybody has a phone—indeed, 4 billion people in the world use a mobile phone, whereas only 3 billion use a toothbrush. In Durham and Darlington, dieticians won an award from Health Service Journal for using telephony to improve the monitoring of patients with nutritional problems. Formerly, they could only see about six patients a day, but with this system, an automated phone call regularly goes to a patient who is self-administering prescribed nutritional supplements. They are asked to answer certain questions by pressing buttons on the phone. Clinicians receive an email alert if the information input is outside of predetermined parameters, or if they have failed to respond to the call. They can then check on the patient directly. This is a scheme well deserving of its award. This is a very simple mechanism but it improves productivity; patients love it and feel more confident in their treatment.

How many other uses could telephony be put to? We are lagging behind countries that we consider to be less developed than ours. Some years ago I went to India to look at some aspects of their health service. They were way ahead of us in what I would call distance health. In other words, because of the extreme rural nature of much of the country, and the fact that most medical expertise is located in the cities, they had set up village health centres with videolinks to hospitals. Doctors could be face to face with a patient many miles away, question him, get answers and even see the problem. The village health workers also helped with the consultation and could administer simple treatments under the instruction of the doctor.

We may not be as rural or poor as India, but we do have many patients who cannot get to their GP easily or get a timely appointment. It occurred to me at the time, years ago, that we could increase the productivity of our GPs if we had a system like that. The now discontinued NHS Direct was not popular with patients because the people at the end of the phone were not sufficiently well qualified, and too many people were just directed to their nearest A&E. Its replacement, NHS 111, has yet to prove itself. If it is co-ordinated properly with GPs’ practices and other services, as it is intended, it could be a great success, so I wonder whether the Minister can tell us how its success is being monitored and what role it will play in the Government’s ambition to make the NHS a 24/7 service. Finally, I look forward to the Minister’s maiden speech and to hearing some of the answers to my questions.