NHS: Innovation

Lord Hunt of Kings Heath Excerpts

Thursday 11th June 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank my noble friend Lord Wills for opening this debate in an excellent way. I am going to talk a little bit about NHS procurement so I should declare an interest as president of both GS1 and the HCSA.

It is my great privilege to anticipate the Minister’s maiden speech, congratulate him on it and welcome him to your Lordships’ House. He is a distinguished businessman, politician and, latterly, was chairman of the fantastic Norfolk and Norwich University Hospital and the Care Quality Commission. I think it is fair to say that he inherited the CQC in a somewhat fragile state. It is to his great credit that he and chief executive David Behan have stabilised the position. I do not take the Roy Lilley approach to the CQC. Of course there will always be issues about its methodology and the way it practises regulation, but I have no doubt that under the leadership of the noble Lord, Lord Prior, the CQC was definitely going in the right direction, and we owe him a great debt for that. I should also say that I particularly appreciated the fact that he and his chief executive made themselves available frequently to politicians, and that approachability is also very much respected and appreciated. I am sure that that will also characterise his frequent appearances in your Lordships’ House in our many health debates.

This is a very important question. We have the great paradox that this country has, as my noble friend Lord Turnberg suggested, a hugely impressive life science base and much-valued R&D. Even today, with all the pressures on UK pharma, there are still many drugs in the top 100 globally which have been developed in this country, yet we have a real problem in adoption by the National Health Service. My fear is always that unless we can dramatically change the approach of the NHS, we will put at risk future global investment in this country.

I shall start by referring to the points raised by my noble friend in opening the debate, on giant-cell arteritis. I have come across similar problems in another disease area—we have had debates on them in your Lordships’ House: one on PAWS GIST, and another on neurofibromatosis NF-1—and my experience is exactly the same as my noble friend’s. The problem is where there are small numbers of patient groups and effectively no national strategy. CCGs simply do not have the capacity, capability or desire to do anything about it at a local level, and GPs are inundated with guidance on one thing or another, making it very unfair to attack GPs on this matter. It is clear that we lack a strategy within NHS England for dealing with these patient groups—these disease areas—where they involve a small number of people. Like my noble friend, I have had a number of meetings with officials at NHS England who are clearly completely overwhelmed by the task in hand. There is no decision-making structure that I can see where you can ask, “Who in NHS England is responsible for giant-cell arteritis?”. It is quite clear that no one has responsibility. They may well have a clinical director who has some vague oversight, but that is as good as it gets.

What has happened to the clinical directors is disgraceful. Under the Labour Government they were employed in the department, with direct access to Ministers. Now they are part-timers in NHS England, with no support and no access to the top of the office, and are left in an impossible position. I hope the noble Lord will sort that out. I also hope he will encourage NHS England to take a much more progressive view on innovation. I welcome a number of the Government’s initiatives, such as AHSNs and the current accelerated access review. Those are strongly welcomed. I know that Mr George Freeman, in his department, shares the concern that we have about the need for adoption in the NHS. However, someone has to sort NHS England out.

We have already heard about the problem of drugs that do not go through the NICE cycle. Basically, NHS England has set up a rationing tool to delay their introduction; that is why there are so many committees—it is simply a rationing tool. The gross example of this relates to the new PPRS agreement on drugs. In that area I congratulate the Government on negotiating an agreement whereby over a five-year period, if drug costs go up a certain level, a rebate is paid out to government. Every quarter a rebate is paid back. I think we have now gone through 18 months, so another rebate is due shortly. The money coming back could have been used to finance new and innovative medicines, but no—it is simply being taken and put into general allocations. There was an opportunity there for the pharmaceutical industry to finance the introduction of innovative new drugs, because we know what the drug costs will be over a five-year period. However, my understanding is that because NHS England was not part of those negotiations, and despite what it says in the NHS Five Year Forward View and Simon Stevens’ commitment to innovation, the practice of NHS England is in fact to stamp on innovation, because the only thing it is interested in is containing costs, and it sees that at a very crude level.

As the noble Lord will know, the 2012 Act has effectively been disowned by the Secretary of State. Every announcement that has been made in the last few weeks suggests that we are going back to good old command and control, and thank goodness for that. The Minister needs to take a grip on this, otherwise we will have another debate on innovation every year. Frankly, it is clear that the NHS is not going to adopt proven innovative new developments, techniques and medicines.

My final point concerns the report of my noble friend Lord Carter, which was published today. I am very grateful to my noble friend for the work that he has done, and I absolutely agree with him when he says that a better approach to purchasing will bring good returns. Again, it has been abundantly clear that we need a central, directional approach to procurement if we are to get those savings. The question that I want to put to the Minister relates to a new approach to purchasing, where essentially the Department of Health or NHS England, on behalf of the NHS, will commit itself to volume purchasing in order to get the kinds of savings that we want. Can he ensure that in the discussions that he takes forward it will be clear to the people doing the negotiations that part of the outcome will be a willingness to invest in innovation? I think that there is the potential for very good, longer-term agreements with industry in which the NHS, because it can commit to volumes, can achieve considerable savings. However, the deal has to be that the NHS adopts new, innovative products and medicines, rather than a penny-pinching approach, which in the end will be cost effective.

I know that some of those matters come within the responsibilities of the noble Lord, Lord Prior. He is warmly welcomed to this House and to his position, and we very much look forward to hearing his maiden speech.