NHS Funding Bill (Money Bill)

Lord Willis of Knaresborough Excerpts

3rd reading & 2nd reading & Committee negatived & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords & Committee negatived (Hansard) & Committee negatived (Hansard): House of Lords
Wednesday 26th February 2020 Lords Chamber

[Lord Willis of Knaresborough (LD)]

My Lords, I shall start my brief contribution on a positive note about the Bill. It is the first time for a considerable number of years that we have a Government who recognise that the NHS requires both additional and stable funding. That is something that the whole House should welcome.

However, the Bill is designed mainly for a political audience. It is certainly not the comprehensive framework for funding a world-class, integrated, 21st-century healthcare system that many across the Chamber would have liked to see. If it had been, it would have reflected the House of Lords report, The Long-term Sustainability of the NHS and Adult Social Care which has been mentioned on a number of occasions; four of us in the Chamber were members of the superb committee of the noble Lord, Lord Patel. Its report was a fundamental look at the way in which we should look for an integrated system, rather than try to find little ad hoc solutions.

The NHS does not, as the Bill implies, operate in a silo but is impacted by other interdependent factors, as many Peers have said. Capital adult social care costs, the challenge of educating and training a workforce and the application of ground-breaking technologies are just a number of the factors that determine health outcomes but do not feature in the Bill. As the Secretary of State and the Minister rightly said, this is only a floor, not a ceiling. They have also said that other proposals are afoot to deal with some of those issues, and we await with interest their arrival. However, having listened to a number of desperate pleas—and they are desperate pleas—about the future of mental health services, I will caution the House. Simply believing that we can add X number of mental health nurses, psychiatrists or consultants just like that is absolute nonsense. We need a totally different, radical approach to how we staff our health and care services.

I digress slightly, but 18 months ago I did a report for Health Education England on the mental health workforce in the future, 10 years ahead. I looked in particular at psychiatrists and psychologists and found that our universities are producing about 150,000 graduates a year with a psychology qualification. We produce 1,500 people with a psychology PhD, and about 3% of them go into the health service—yet we have spent all that money training them. When we ask, “Why don’t you—?”, the response is, “I’m sorry, that’s a different department. We can’t do that.” If the Minister takes nothing else from my speech, I urge him to think outside the box on this.

My main purpose in speaking in this debate is to raise an issue that has not been raised by others: medical research in the NHS, which is absolutely fundamental to 21st-century healthcare. I accept that Governments of all persuasions, from the Labour Government in 2006 and the Cooksey report right through to the current Government, have increasingly spent resources on health research. I declare interests as the chair of the Yorkshire and Humber Applied Research Collaboration and of the national Genomics Education Programme, and acknowledge my recent chairmanship of the Association of Medical Research Charities.

This Bill, with its provisions for stable, long-term funding increases, is an opportune moment for us to look at the potential of embedding research into the very fabric of the NHS, as intended by the Health and Social Care Act 2012. The amendment from the noble Lord, Lord Patel, said research should be a fundamental element of all activities in the NHS, yet that seems to have gone by the way.

I am delighted that we are getting a commitment of £33.9 billion a year by 2024. Whether it needs to be in legislation is doubtful, but I like that commitment. However, it goes nowhere to meeting the Government’s own contribution—pledged under Prime Minister May —to the long-term plan. The long-term plan committed to playing its full part in helping patients and the UK economy realise the benefits of research, as laid out in the Government’s Life Sciences Industrial Strategy. It also committed to incorporating key actions from the life sciences sector deals to make research and innovation one of the central drivers for progressing care quality and outcomes. Improving health outcomes for patients and the public will not be realised without further research and innovation. The pipeline of innovation is dependent on research taking place upstream as well as at the bedside.

Recognising the potential of research to lead to earlier diagnoses, more effective treatments and faster recoveries, the long-term plan—for all its faults, and I accept the very strident comment from the noble Lord, Lord Hunt, that every Government over the last 40 or 50 years have contributed to this—made a range of specific commitments: for example, to increase public participation in research and to sequence the genomes of 500,000 individuals by 2024. The latter offers particular hope for those with rare genetic conditions and opens a door to individualised, personalised medicine.

By embedding research, trusts can make even more progress in improving patient care and outcomes by implementing interventions that research has shown to be effective and decommissioning those that have proven ineffective. Taking out those things that do not work is an equally effective way of not only delivering high-quality care but tailoring it specifically to patient needs.

Patients and the public tell us that they want opportunities to be involved in research. Some 77% of those involved in Wellcome’s public attitudes survey last year said that they wanted their medical records to be used for medical research. Studies also suggest that engagement in research improves the job satisfaction of healthcare professionals, which in turn boosts morale, helps reduce burnout, improves retention and has direct implications on the heavy financial pressures on many hospital trusts.

By research, I do not necessarily mean pointy-headed people in white coats. Research is now conducted by midwives, nurses, pharmacists, primary care and public health practitioners, medical associate professionals, allied health professionals and others. In the nursing standards, which we completed only 18 months ago, it is now a requirement for student nurses to be involved in research methods as part of their undergraduate training. The people who work with patients on a day-to-day basis, by their bedside, are the best people to spot things that need improvement.

For research to take place, sustainability of funding is required. Industry and charities are willing to contribute—and do so—but it requires the taxpayer to take the lead, and this is not always the case at present. This gives me an opportunity to commend to the House the work of the charitable sector, in particular AMRC, its umbrella champion chaired by my noble friend Lord Sharkey. In 2017-18, AMRC members, which include the Wellcome Trust, the British Heart Foundation and other major charities, contributed £1.4 billion to medical research in the UK. Some 31% of non-commercial research in the NHS—more than is contributed by the Medical Research Council or the NIHR—comes from the charitable sector. In the same year, charities recruited over 200,000 people into more than 1,300 clinical studies.

The prize for translating research into patient outcomes is huge. Today, the UK is regarded as world leading in translating research dollars into health outcomes, and this must be supported and mainstreamed. The opportunity that health research brings to lower costs and to produce satisfaction for professionals working in the service and better patient outcomes is clearly a no-brainer and ought to be part and parcel of this settlement, so we are not left waiting for some fictional figure which might arrive down the road.