(7 years, 8 months ago)
Lords ChamberMy Lords, I add my congratulations to those of other noble Lords to my noble friend Lord Selborne on this extremely good report. I hope that his committee can build on that report and that it will form a very big part of our industrial strategy.
I do not think there is any doubt that research is one of the jewels in the UK’s crown, but we should never take it for granted. The report is called A Time For Boldness and I agree with the noble Lord, Lord Mendelsohn, that while it may be an unusual title for something from the House of Lords, we do need boldness. I have heard, in talking to many other people about the industrial strategy, that the UK is incorrigibly incrementalist. When the noble Lord, Lord Hennessy, asks, “Where is the magic?” or “Where has the magic not been?”, it is because we have been incorrigibly incrementalist. So it is a time for boldness. If Brexit does only one thing, if it acts as a catalyst for change and boldness, then it will have achieved considerably more than the eight industrial strategies that the noble Lord, Lord Hennessy, referred to. We should take Brexit as a catalyst for change.
As noble Lords have mentioned, of course there are risks, but I say to noble Lords who are naturally enthusiasts and naturally positive people that, if they become too pessimistic about the future, they will help create this perception that post-docs and younger academics to whom they referred have—the feeling that somehow things are not good. I say to the noble Lord, Lord Winston, for whom I have huge respect, that although I cannot comment on the state of current reproductive medicine at Imperial, if he walks down the corridor he will see one of his colleagues, the noble Lord, Lord Darzi, and what is being done on robotic surgery, for example. Imperial is at the absolute forefront of many technologies and the noble Lord, Lord Winston, should not forget that.
The noble Lord, Lord Mair, referred to issues at Cambridge. Again, if we take an area such as artificial intelligence, Cambridge is clearly among the world leaders. Look at robotics and go down to Bristol and see what Bristol University is doing in robotics. We have some world-class technology still in the UK. If we want evidence of recent investments, we can look at the £60 million Novo Nordisk investment around diabetes at Oxford University, or the new investments that GSK and Apple are making in this country. Google has made huge investments, through DeepMind, in artificial intelligence in this country. So let us not be too depressed about the future when a lot of very good things are happening.
It is not unreasonable that we have focused today on what I will call the consequences of Brexit rather than looking slightly more fundamentally at the causes of Brexit. Actually, the causes of Brexit, together with the consequences of Brexit, are what we should be looking at, because, if we are honest, many of our difficulties predate Brexit. They predate even our accession to the European Union back in 1972. I think we set these out pretty clearly in the industrial strategy. We have gone through various stages of industrial strategy. We have gone through big government, nationalisation after the war and the sort of tri-partite power-sharing of the 1960s and 1970s, with the CBI, the TUC and the Government sitting around trying to sort things out. We then went to the privatisation and markets of the 1980s and then, more recently, with the coalition Government, we had more of a focus on sectors, but the one common constant throughout that time is that we have had low productivity in this country. Today, after all the iterations we have gone through, we are still 20% or maybe 30% behind the leading countries of Europe and the USA. The Green Paper is explicit about that, as indeed was Andy Haldane, the chief economist of the Bank of England, in his speech, if anyone saw it earlier this week. We have a productivity problem in this country.
It is not just a productivity problem. Since the 1980s—with the third Industrial Revolution, the information technology revolution and, as we move increasingly into what is called the fourth Industrial Revolution, with machine learning and artificial intelligence, as ever more cognitive skills get replaced by machines, rather than just manual skills—we have seen to some extent a hollowing-out of the labour market, as Andy Haldane put it, which is resulting in more inequality. In our country, we have not just societal inequality but geographic inequality. We have a hugely successful and productive area in London, particularly, and the south-east more generally, but that level of productivity is not shared in the rest of the country. That is why what we face today is a productivity question but also an inequality question. Those are the questions we really have to address and that is the context in which we should see the research and innovation strategy.
The emerging themes of the industrial strategy—some of the magic that I hope we will be able to identify—are, of course, around the vocational skills that the noble Baroness, Lady Morgan, mentioned earlier. It is clearly critical that we address that. Looking back, perhaps one of the great policy mistakes that successive Governments made was to encourage too many people to go to university at the expense of vocational training, apprenticeship training and the like. The work that David Sainsbury—the noble Lord, Lord Sainsbury—has done in that area is hugely important and I hope that it will be a critical part of our industrial strategy.
Then there is place: we have to address the fact that many parts of the UK have not done as well as they could. Look back at the history of towns such as Liverpool, Manchester, Sheffield and Birmingham: if we can rebuild those civic institutions, there is a chance that we can rebuild those clusters of technology and manufacturing that we used to have.
I turn to research, which is the specific issue that we are debating. In terms of the message and narrative, the Government could not have been more explicit that science and innovation are critical to our future. As noble Lords know, that was set out in the White Paper published in February this year, from which I will read a short extract:
“The Government is committed to building on the UK’s world-leading science base—including more Nobel Laureates than any country outside the United States—and making the UK the go-to nation for scientists, innovators and investors in technology”.
I appreciate that fine words butter no parsnips but look at the actions we have taken: the Treasury has underwritten all successful bids for Horizon 2020 funding and we have provided further assurance by confirming that existing EU students and those starting courses in 2016-17 and 2017-18 will continue to be eligible for student loans and home fee status. We have also provided assurance about postgraduate support through research council studentships. These will remain open to EU students starting courses in 2017-18.
We have gone further to support a healthy science and technology ecosystem in this country than ever before. We are spending an extra £4.7 billion on research over the rest of this Parliament, with an extra £2 billion a year by 2020-21. That is the biggest increase in research spending since 1979, so we are putting our money where our mouth is. Our new industrial strategy challenge fund will direct some of that investment to scientific research and in particular to the development of a number of priority technologies, helping to address Britain’s historic weakness on commercialisation and turning our world-leading research into long-term success.
I tend to look to the USA—just look at the work that DARPA has done over the years. The federal funding of research in the US is far higher than it is in our country. That country, which purports to have small government, spends on a per capita basis significantly more on research than we do. Through institutions such as DARPA, the USA has managed to turn that into huge commercial success. Just look at the iPhone, which is probably the most obvious success: nearly all the technology in the iPhone, whether it is the chip, the global positioning, the LCD or whatever it happens to be, came out of federally funded research. That was of course taken up by great entrepreneurs, backed up by deep capital markets to turn it into a huge commercial success. That is something we need to do but in many of these areas, whether in robotics, AI, machine learning or whatever, we still have some fantastic technology in this country.
I turn to the issue that I think concerns noble Lords the most: attracting people. Can we attract the world’s best people into this country? I agree that if we cannot do that, then we have a serious problem. It has been said that perception is hugely important, but let me quote the Prime Minister:
“I want this United Kingdom to emerge from this period of change stronger, fairer, more united and more outward-looking than ever before. I want us to be a secure, prosperous, tolerant country—a magnet for international talent and a home to the pioneers and innovators who will shape the world ahead. I want us to be a truly Global Britain—the best friend and neighbour to our European partners, but a country that reaches beyond the borders of Europe too”.
David Davis also said that pulling out of the European Union does not,
“mean pulling up the drawbridge. That’s also not in our national interest. We will always welcome those with the skills, the drive and the expertise to make our nation better still. If we are to win in the global marketplace, we must win the global battle for talent. Britain has always been one of the most tolerant and welcoming places on the face of the earth. It must and it will remain so”.
We should not confuse our rightful desire to have control of our immigration policy with a policy that is anti people coming into this country. The two are not in conflict with each other. It is perfectly reasonable for any country to want to have some control over levels of immigration. That does not mean that we are in any way against immigration or, in particular, against encouraging people to come in with the skills and talents that we need to grow and maintain our research base.
I turn to what we are doing in that area. In terms of putting our money where our mouth is in that respect, we have announced a £250-million investment from the national productivity investment fund, which will include £90 million to fund 1,000 new PhD places. At least 85% of those will be in STEM disciplines and 40% will directly help to strengthen collaboration between business and academia through industrial partnerships. There will be a further £160 million to support new fellowships for early and mid-career researchers. We also announced over £100 million on global research talent over the next four years to attract the brightest minds to the UK and help maintain the UK’s position as a world leader in R&D. This includes £50 million which will be ring-fenced for fellowship programmes to attract global talent in areas that align with the industrial strategy. For example, that could be in life sciences or battery technology. Over £50 million of existing international funds will support fellowships that attract researchers to the UK from emerging research powerhouses such as India, China, Brazil and Mexico.
Not only do we have a compelling narrative in this Government about wanting to attract the best of the world to this country; I also believe that we are putting a lot more resource and funding into research in this country. Yet there is a perception out there that we are somehow not doing either of those things. To some extent, that perception is built up by people in this House who are incorrigibly pessimistic. We have some great technology and research in this country and we should start to talk it up.
I was going to be very trivial by wondering whether the Minister might care to apply for the vacant post of the reproductive professor at Imperial.
I may have many talents but I think that is one post that I am not qualified to do.
I did not address the particular issue that was raised by the noble Lord, Lord Krebs. I would like to meet him on that issue to understand more about it before I reply to him.
(8 years, 1 month ago)
Lords ChamberMy Lords, is the Minister aware that, although there may be enough people wanting to apply to medical school, many of the brightest and the best are now completely turned off doing medicine because of the relationship with the Secretary of State for Health? This is a very serious mistrust and, whether they are male or female, the brightest and best are often not applying. There is increasing evidence for this in most medical schools, and indeed in schools as well.
I respect the views of the noble Lord but I have looked very carefully at the number of applications coming into medical schools in 2016 compared with the previous year. In 2016, there were 20,100 applications for all medical schools, including in Scotland. The previous year the figure was 20,390, so there is no firm evidence to support the view that the noble Lord expresses. There were some rumours that St George’s was having trouble filling its places. I have investigated that and understand that it was a result not of any lack of demand but of the fact that it wanted to wait until A-level results had come through so that it could choose the best candidates based on those results. So I do not think there is any evidence to substantiate the noble Lord’s point.
(8 years, 4 months ago)
Lords ChamberMy Lords, the CMO’s guidelines are 14 units of alcohol per week, which is based on 67 different independent systematic reviews of what constitutes low-risk drinking. That is the best advice that we have available to us and it is entirely up to people whether they take it or not.
My Lords, the Chief Medical Officer famously said recently, “When I reach for a glass of wine, I think of cancer”. Does the Minister seriously think that exaggerations of that kind actually help the public perception of alcohol or mean that as a consequence our experts are completely ignored?
My Lords, as I said earlier, I think that the CMO’s guidelines are based on independent scientific advice. How that advice is communicated to the public is a different issue and the CMO is currently consulting on how we should express that scientific advice in ways that will have the maximum impact so that the public will take due notice of it.
(8 years, 7 months ago)
Lords ChamberI think that all good employers recognise that having the trust and confidence of their staff is fundamental. No employer, government or private, would wish to have the outcome we have in this situation. As I said earlier, there are absolutely no winners from this dispute, and the Government regret as much as anybody that we have come to this particular pass.
Does the noble Lord agree—I am sure he does—that the great majority of junior hospital doctors, whatever the situation, are deeply altruistic people and remain so? They see this strike as part of that altruism, as is very clear from talking to them, and I am sure the Minister would agree about that. Does he not feel that one risk is the long-term damage not just to the health service but as regards people who are thinking of coming into the health service in the future? The young people whom I see in universities and even in schools are now asking me, “Should I actually be doing medicine?”. Does the noble Lord agree that some kind of compromise at this stage would be better, as it might well save money, rather than cause more anguish and more money to be spent in the long term?
My Lords, I certainly agree that some of the best and finest young people in Britain go into medicine. It is a wonderful vocation—I use the word “vocation” advisedly. We have had three years of trying to come to a compromise and there comes a point in any negotiation when you have to draw stumps, although it is very unfortunate and very sad when that happens. Over that three-year period there were opportunities for both sides to come to an agreement and it is tragic that we did not do so, but I feel that after three years the Secretary of State had little option but to accept the advice of Sir David Dalton.
(8 years, 10 months ago)
Lords ChamberThe noble Baroness raises a very important point that we are highly dependent in a whole range of medical specialties on overseas doctors and of course overseas nurses as well. Health Education England is expanding the number of training places, in particular for GPs; we hope to have an extra 5,000 GPs in place by the end of this Parliament.
My Lords, I apologise for interrupting the noble Baroness. The Government’s stated objective is essentially to cover NHS hospitals 24/7—that is, with weekend working. Many hospital managers—for example, those in Birmingham—have pointed out that they are perfectly able to staff their hospitals fully under the existing contract. Can the Minister tell us how many NHS hospitals in the United Kingdom have closed as a result of inadequate staffing at weekends?
My Lords, it is not a question of hospitals closing at weekends because of inadequate staffing; it is a question of whether hospitals are able to offer high-quality care throughout the weekend. Some hospitals can but some cannot. We have seen, for example, the reorganisation of stroke care in London. Providing high-quality seven-day services for stroke care can have a significant impact on the quality of patient care. This seven-day issue is not just about junior doctors by any means; it is a question of having diagnostics, senior doctors and a whole range of other specialties on duty over the weekend.
(8 years, 10 months ago)
Lords ChamberI understand that all the relevant documents are being made available to the expert working group. The chair of the association looking after the children who have been damaged by these pregnancies is an observer on that committee.
My Lords, with deference to my noble friend’s Question, is it not a fact that 40 years on—it is actually more than 40 years because the last letter in the British Medical Journal was in 1977 on things that had happened previously—it is now really impossible to decide the precise nature of what happened after the dosage of Primodos? While an inquiry might be helpful to some people, it is very unlikely that we will uncover anything that will be really useful in the future. Is not the message to pregnant women that they are not advised to take any kind of drug during pregnancy?
My Lords, the noble Lord is clearly an expert in this field. If the advice is that pregnant women should not take any kind of drug during pregnancy, that must be the right advice. I agree with him that many of these documents go right back to the early 1950s and many are in German rather than English. The quantity of documentation is enormous. That is one reason why this review has taken so long. However, the people on the expert working group are very distinguished clinicians and are doing the best they can in very difficult circumstances.
(8 years, 10 months ago)
Lords ChamberMy Lords, given that homo sapiens is a species that is programmed to eat carbohydrate and fat, what estimate have the Government made of how much childhood obesity is due to epigenetic factors rather than simply eating sugar and carbohydrate later on in life? Might this not be programming earlier in the generation perhaps as the result of previous generations’ environment? This is an essential point in understanding obesity.
The noble Lord makes an interesting point to which I cannot give an answer from the Dispatch Box. It is clear that epigenetic factors are important. It is not just about behaviour: rather, it is also the genes that we have inherited from our forebears and the fact that we have entirely different nutrition and an entirely different way of life today from that of 70,000 years ago. Would it be all right if I write to the noble Lord and explain that more fully?
(9 years ago)
Lords ChamberIt is hard to know what the right figures are. After this debate, we need to sort out exactly what the figures are.
I hate to disagree with my noble friend, but one problem with mesothelioma research is that Cancer Research UK, for example, puts such funding partly in the box of lung cancer funding—it is a different form of lung cancer. There is a risk that we may be underestimating the amount of money being spent. That always happens when these figures are bandied about. I am not suggesting that we should not be spending more—or less—but it is very difficult to be precise about the figures sometimes cited.
We probably cannot today sort out the figures in the way we would like. It will be very difficult to allocate some of the more generic research expenditure. Let us move on from funding, if we can.
I think the answer to that question is that the Health and Safety Executive would have prime responsibility for them. I think the point that the noble Baroness is making is that the local authority no longer has the responsibility it would have over local authority schools. I will look into that issue and write to the noble Baroness.
Before the Minister sits down, and I apologise for prolonging this debate for longer than necessary, does he agree that medical advances in every field are often very serendipitous? The classic example would be the completely unfunded discovery of penicillin when it was first produced, and it was subsequently only mediocrely funded until we had a wartime crisis.
In about an hour’s time the Minister will be answering a Question about doctors’ overtime. One of the critical issues that has not been discussed in that debate has been raised by Jeremy Farrar, the director of the Wellcome Trust, who points out that one of the real issues is the problem with young doctors being able to do research in a very generic way, which has all sorts of benefits, including clinical mesothelioma research. That is a fundamental problem. We in this country are very good at medical research and on the whole we fund it quite well, although obviously we would like to have more funding, but providing the environment for continuing research is essential for what we are discussing in this Second Reading debate.
I thank the noble Lord for that comment. We in this country are often highly self-critical but actually we have a remarkable record on research. We have three of the top medical academic institutions in the world in this country: Oxford, Cambridge and Imperial. We have UCLH, King’s and Manchester. We have some extraordinary research organisations in this country. There is, I guess, an issue over quality and quality control. There are an awful lot of clinicians who do research that may not be to the—
(9 years ago)
Lords ChamberMy Lords, the threshold for strike should be very high because of the vocational and professional dedication of doctors. Certainly, the threshold should be higher than it usually is for pay and conditions issues such as the one before us today.
My Lords, I deeply regret the tone of the statement. I understand that that is not the responsibility of the noble Lord, Lord Prior. I also respect very much his attitude, which is, I think, respected by the whole House. We have to say very clearly that this is an unprecedented situation. I do not think the nature of how junior doctors feel is understood. Already, there are more doctors in medical schools looking at going overseas—they are actually asking me whether they should be working in this country. The key issue is one we discussed in today’s earlier debate: the backbone of a good NHS is the good research we do. Research is massively threatened by what the Secretary of State is proposing. That has been emphasised by Jeremy Farrar, who, after all, is a very independent person as head of the Wellcome Trust. Would the Minister be kind enough to address that issue?
I agree. It is tragic that we are in this situation. My son is a medical student and I meet many of his friends; they do not want to be in this position. Concerns have been raised about whether junior doctors will have time to do research or will lose out on their progression if they do. That should be discussed and argued out with the BMA sitting around the table.
(9 years, 1 month ago)
Lords ChamberIt is too early. I cannot give the noble Baroness specific figures for last year’s spending, but we believe that they will show an increase of some £300 million over the year before. We have made it very clear to NHS England in the mandate that we expect spending on mental health services to increase this year and that every CCG in the country will see a real-terms increase in mental health spending compared with the previous year.
My Lords, we are very grateful that money is being spent on waiting times, but will the Minister be kind enough to comment on a particular situation that occurred just a few weeks ago? The husband of a colleague of mine had a severe manic episode and was in a hospital casualty department for the best part of the day and the whole night, most of the time not being seen. He waited for two days before a bed could be found, not at that hospital, nor at his local mental hospital. Eventually, a bed was found some distance away. Does the Minister feel that that is satisfactory?
The noble Lord makes a very good point. It is totally unsatisfactory that beds are not available for people suffering a severe mental health crisis. However, looking at the research done by the noble Lord, Lord Crisp, it is not the number of beds that is a problem, but the use of the beds we currently have. Far too many people still in in-patient beds could be treated outside. The answer is not more beds, but using the beds we have more effectively. I completely agree with the noble Lord. What he described I have seen myself. It is totally unsatisfactory.
(9 years, 4 months ago)
Lords ChamberI think that the noble Baroness will know that we are due to go out to consultation on this matter, and that is an important issue that will be taken into consideration.
My Lords, does the noble Lord not recognise that this Question goes much broader than just the confines of the issue that we are discussing? Local authorities have an effect on the environment, transport, housing, poverty and a whole range of social issues that absolutely affect public health. Until that is sorted out, this is going to be a major problem in this country.
The noble Lord makes a good point that goes considerably broader than the Question. I accept that many of these things are inextricably linked.
(9 years, 4 months ago)
Lords ChamberMy Lords, the level of stillbirths in England is too high, whether from multiple or single births. The MBRRACE-UK report indicates that if we had the same rates as in Sweden or Norway, many more children would survive in this country. One of the problems that the noble Baroness puts her finger on is that the tariff system may discourage some neonatal units from referring cases to specialist referral units.
My Lords, the large number of multiple births in this country is very largely due—probably half due—to the practice of in vitro fertilisation. A very large number of patients are coming into this country having been referred to clinics overseas that do not accept the regulations on limiting embryo transfer. Does the Minister have figures on this and is there something that the Government can do to stop this practice, which is seriously increasing the cost of perinatal care and the tragedy for mothers?
The Government may have figures on this. I do not have figures here today, but I shall certainly endeavour to find them as soon as I can and perhaps follow it up with the noble Lord in a meeting outside this House.