Life Sciences Industrial Strategy (Science and Technology Committee Report)

Lord Fox Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Lord Fox (LD)]

My Lords, I had the pleasure of serving on the Select Committee during this inquiry and join the noble Lord, Lord Patel, in thanking the advisers, clerks and assistants for the sterling work that they put in. I commend the noble Lord not just for his speech but for his handling of a complex and long inquiry. As we know, it produced a comprehensive report and a long response from the Government. I shall try to restrict my comments to implementation, innovation, data, R&D spend and people.

It was entirely predictable—and we have already heard it in preceding speeches—that a lot of what we would be debating today is the nexus between this strategy and the National Health Service. For that reason, while it is always a pleasure to see the noble Lord, Lord Henley, sitting on the Front Bench opposite, I am a little disappointed that we do not have a representative of the Department of Health, which, largely speaking, will be called on to answer 90% of the questions raised in this debate.

On implementation, as you can tell from the report, the Select Committee was exercised by a fear that implementation would be a real problem, and the complexity of the NHS only added to that fear. As the noble Baroness, Lady Neville-Jones, set out, we made some serious attempts at clarifying the accountabilities and governance for that implementation, but it is quite clear that the Government have not picked up on very much of it. I join the noble Baroness in asking the Minister to undertake to publish what the milestones are for the implementation process and regularly to update us on what one hopes will be the achievements commensurate with them.

On a separate issue, it is also clear that the industrial strategy challenge fund is being used to push certain elements of this strategy. I would like the Minister to clarify how decisions around the industrial strategy challenge fund are taken. What is the process for pointing that fund at particular projects and issues?

On the subject of independent scrutiny, the recommendation of the Select Committee was for the creation of a new statutory “Office for Industrial Strategy”, something along the lines of the Office for Budget Responsibility. Clearly, the Government have not picked up on this, but they should understand that the need for involving Parliament in the scrutiny of this strategy is very important. The whole point of having the industrial strategy is that it spans different parliamentary periods: it has to last more than the lifespan of one Government. To have a scrutiny process that is independent and reports to Parliament is part of the way in which we will sustain that strategy through several or many Governments. I ask the Government to look again at the independence and make sure that whatever emerges in terms of scrutiny is fully independent and reports to Parliament.

On the subject of innovation, this is clearly a keystone for the success of the strategy. I am sure there is general agreement that the UK is gifted many great innovators. As we have just heard from the noble Baroness, Lady Young, the challenge is to get these innovations into the NHS as routine NHS care. Innovative treatments improve the long-term prospects of patients and, while sometimes costing more today, reduce the need for future expense. Thereby hangs the Catch-22 that we have just heard about in detail: the NHS routinely accounts for the initial cost of the treatment, not the long-term savings that accrue in treatment that does not have to happen. This has to change and the process by which the NHS accounts for its success has to be better managed.

In response to our recommendation, the Government say that work is under way to address the challenge of supporting “proven innovations”. Perhaps the Minister will outline what an innovation needs to do to be proven before it is adopted in the NHS. What are the proof points that the NHS needs for this implementation? Meanwhile, how are budgets actually being flexed to make this happen?

No one reading the Government’s responses to recommendations 9 to 14 can be anything other than confounded by the complexity. I have to say that I knew the NHS was complex, but I did not have the scintilla of an idea of how complex, as already alluded to by the noble Baroness, Lady Neville-Jones. As well as AHSNs there are ITT/ITP, AAC, AAP, CQUIN, NHSI—not to be confused with NHSE—DHSC, LSC and no doubt as many acronyms as you can pull up. I note that the noble Lord, Lord O’Shaughnessy, is leading a review to simplify this innovation landscape: perhaps that explains why he is not sitting on the Benches opposite. Put simply, how much, in total, are the Government spending on genuine innovation within the NHS? Do they even know?

Turning to data, clearly the new Health Secretary has focused on this of late. Without sounding patronising, most people in a new job concentrate on what they know. The proof will be whether this enthusiasm survives when other issues take over on his agenda, but his current energy in that area is welcome. I am also pleased that the Government seem to agree with the Select Committee’s recommendations around data. I remind noble Lords that those recommendations can be summarised as: the collection of usable data; standard format for that data—and I would add, on my own account, a standard taxonomy within that format; linkage between different systems, as our chairman alluded to; rules for commercial exploitation, and we will come back to that; and a programme to gain public acceptance. These are very important. This is not trivial and not without cost, so how is this going to be accounted for within our archipelago of health systems?

Key to the public acceptance of the use of data—this is really important—is that the public understand that the commercial use of this data will benefit the NHS, and therefore society as a whole, rather than just individual commercial concerns. In their response, the Government say they have identified three exemplar areas to start working on this and two more were going to be identified in June. Perhaps the Minister can let us know where those areas are. What I am more interested to know is when this work will be assessed, who will be doing the assessing and, more importantly, how the lessons learned from these exemplars will be distributed across the whole system. Once again, with respect to the capture and use of the data, the government response outlines a complex set of solutions and we have to try to simplify. I realise that we are starting from a complex position, but adding more to an already complex situation is never usually a solution.

As the noble Lord, Lord Patel, pointed out, there is another really important element around commercial exploitation and the contracts around how these are delivered. It is vital to ensure that the benefits of this data are properly reaped by the NHS itself. So can the Minister set out how the Government view the balance between the commercial interests of the private sector and the needs and the benefits that the NHS can derive from ownership of that valuable data? There is a balance: who is working on that balance and how will it be articulated in terms of contracts going forward?

With regards to informed consent, the Government have said they will give patients the ability to opt out of data. That in itself is important, but it works only if they know what they are opting out of: if they understand what their data is, what it is going to be used for, and how anonymisation will work for them. Serious energy must be put into a public education process, so that people understand the nature of their data and how it could be used. Just to give people an opt-out without understanding that is to squander their data and perhaps to lose value for society and for the NHS. Can we have an undertaking of a process of public education and know who will be leading that process?

On the plan to devote 2.4% of GDP to R&D, which fits around this, we welcome the Government’s undertaking to drag the United Kingdom back up to around the average of where we ought to be, but clearly, in this strategy and many others, a lot of the money is going to be coming from the private sector. In this case, what is the balance? How much money is expected to come from the private sector and how much from the Government? I reinforce the idea that the thoughts of Sir Paul Nurse should be required reading. I do not know whether noble Lords heard the “Today” programme, where Sam Gyimah, the Science Minister, and Sir Paul Nurse had a very reasoned and interesting debate. It was very good that the Minister was put up to have that debate—it was commendable by the Government and it was a good debate—but he was not able to explain where the £1 billion that we will not be getting from the European science programmes, from Horizon 2020, will come from. Which budget will it come from? Undertakings have been made in a general sense, but at the moment there is no specific budget to replace that money, and that will make the 2.4% not just difficult but impossible.

Finally, for the strategy to work, the UK needs to have the very best people working on it. We are all agreed on this. The Government have to understand that raising a quota is not the solution to this. A reduction in the size of the form that has to be filled in is not a solution. They are replacing free movement of Europe’s top scientists with a form. To use a phrase used in other contexts, it would be putting friction into that system—and that friction will put people off and prevent them coming in. Again, Sir Paul Nurse was very clear on this issue, as were the other Nobel laureates who signed the letter that was sent around. Further, unless future plans for this new immigration process also include the families of those people—the same can be said for healthcare workers, by the way—then we will lose very many people.

In conclusion, I got an overall sense from the Government’s response that they were fairly grumpy about this report, and I would say, “Please don’t be”. The report was based, as the chairman set out, on a great deal of evidence. All of us genuinely want the life sciences strategy to succeed; we all think it vital and pivotal to the future of this country. At the very least, this will require four conditions to be met. First, we have to have an implementation process and protocols that drive it forward. Secondly, the NHS has to be empowered and resourced to raise its head above the daily issues and be able to introduce innovation. Thirdly, the structured gathering of patient data, signed off by the patients themselves, must be made available to be used for the benefit of the whole of UK society and not just the private sector. Finally, sustained and consistent investment in research and development, and full access to the best possible people around the world, are needed. If we meet those four criteria, the strategy will be a success and Great Britain and the United Kingdom will be healthier and will also be wealthier.