Medical Innovation Bill [HL]

Lord Giddens Excerpts

Friday 27th June 2014 Lords Chamber

[Lord Giddens (Lab)]

My Lords, I join other noble Lords in congratulating the noble Lord, Lord Saatchi, on his extraordinary determination in conceiving of the Bill and in bringing it this far. Many here will remember his opening comments in the short debate some while ago. The noble Lord, Lord Willis, who followed the noble Lord, Lord Saatchi, commented that in all his years in the House of Lords,

“I do not think I have ever heard a more moving, considerate or emotive speech than that of my noble friend Lord Saatchi”.—[Official Report, 16/1/13; col. 761.]

We have heard another emotive and powerful speech from the noble Lord this morning.

A good deal of public discussion and consultation has ensued since then. Emotion and compassion may remain the driving forces behind the Bill, but it must clearly be shaped by reason, since we are talking about promoting the cause of medical science. It is fair to say, as we have heard today, that core aspects of the Bill remain controversial and fiercely debated.

At the minimum, the noble Lord, Lord Saatchi, has stirred up a significant debate, which has involved many people, including patients, and has had the outcome of unsettling the medical establishment to some extent. I have been sitting here and the noble Lord, Lord Winston, has been fidgeting away through some of the observations that have been made; he himself gave an extremely interesting speech. However, whatever else happens, the noble Lord, Lord Saatchi, has already achieved a great deal by stirring up the issues and bringing them to widespread attention.

I lend my general support to the Bill, although I accept that there are some difficult problems to be resolved. I have a different view, as someone who has worked on innovation issues for some years, from most noble Lords who have spoken so far. I am a social scientist. If you look across the whole field of science and technology, we are living through a period of the greatest and most accelerated innovation in human history. There has never been a period with so many breakthroughs and transformations in so many areas of the sciences and other aspects of our lives. In terms of its speed, scope and global nature, this is a time of technological and scientific innovation simply beyond parallel.

In some areas which overlap heavily with medicine, innovation is exponential rather than simply linear. This is the backdrop to the concerns of the Bill, which I take to be—in some parts, anyway—about the widening gap between the accelerating pace of innovation and the time-consuming nature of established testing procedures. There is often good reason for caution in bringing new treatments to the patient. Yet with the onrush of advances it must make sense to pioneer much faster ways of deploying them, especially when the level of need is acute. We have heard from two noble Lords next to me that the medical profession is exploring various ways of doing this and it is necessary to do so. However, the proposals in the Bill are certainly worth pursuing to see whether they do add something different.

The point of the proposals as I understand them is not only—perhaps not even primarily—that some people close to death might be saved or have their suffering alleviated. It is, following what the noble Baroness, Lady O’Neill, has said, that their involvement could bring benefits to perhaps very large numbers of people in the future if this is seen as part of an ongoing learning process. Like everyone, I think that plenty of questions remain which need to be explored if and when the Bill proceeds. I will briefly mention three.

If the Bill’s objective is to be a kind of mutual learning process, which is how I see it—I was encouraged by what the noble Lord who referred to himself as a rat said in his contribution—we have to decide what would be the nature of the evidence base that is accumulated and who would police it. Open-source access will help but is clearly not enough in itself. I was reassured to hear that there is an Oxford initiative, referred to by the noble Lord, Lord Saatchi, which might be a beginning. This would need to be done in a systematic, co-ordinated way or it simply would not belong within the province of science.

Secondly, as the critics ask, are there adequate safeguards to prevent an imbalanced dialogue between patient, doctor and relatives? We know that it would not be the patient’s decision alone; relatives would almost certainly be called in along with the doctor. This issue has to be explored. Since patients are in a highly vulnerable position it is not always clear that there is an egalitarian dialogue between doctor and patient. I do not say that it cannot be achieved, but this has to be further explored.

Thirdly, as has been mentioned by noble Lords and is important for us social scientists, well motivated policies often have unintended consequences. These have to be thought about in advance. For example, a well publicised case in which a treatment backfires through this process might produce greater rather than less conservatism if it achieves a great deal of public attention. My question for the Minister is whether people are thinking about the possible unintended consequences. Have they been thoroughly scrutinised and thought through?

I hope that the Minister will comment on these points. However, I reiterate that the Bill should be taken forward, and repeat my congratulations to the noble Lord, Lord Saatchi, on his quite extraordinary, amazing persistence, involvement and capacity, and on the speaking qualities that he has demonstrated in pushing this on.