Health Bill [HL]

My Lords, we have heard from many Lords. Again, let me declare an interest. I am a university employee and still remain one. I can sympathise with the noble Lords, Lord Walton and Lord Patel, and the noble Baronesses, Lady Emerton and Lady Finlay, who propose that the list of bodies that are under a duty to have regard to the NHS Constitution be extended to include bodies concerned with the education of health professionals and with the support and delivery of medical and scientific research. In addition to this amendment, I understand that the noble Lord believes that it would be appropriate to require the same bodies to be consulted on the 10-yearly review of the constitution. Amendment 34, which was tabled by the noble Lords, Lord Walton and Lord Patel, and the noble Baroness, Lady Finlay, would enable the Secretary of State to make payments to promote innovation or original research. Both research and education are the bedrocks of high-quality patient care. I hope that I can provide noble Lords with reassurances in relation to some of the concerns that have been raised today. First, by way of context, I reassure the noble Lord that education and research are of vital importance to the NHS. In 2009-10, £4.6 billion was allocated to strategic health authorities for education and training, and health research commissioned by the NHS has reached £1 billion for 2010-11. High Quality Care for All, on which I reported in July last year, set out our commitments to the establishment of, for example, academic health science centres, which will bring together a small number of health and academic partners to focus on world-class research, teaching and patient care, bringing the NHS and research ever closer in the history of the NHS. My report also sought closer working between the NHS and education institutions by proposing the creation of new health innovation and education clusters. These announcements will be made soon. These clusters will bring together many partners, across primary, community and secondary care, universities, colleges and industry. Bringing NHS organisations and higher education institutions together will promote learning and education between their members and will enable research findings to be applied more readily in improving patient care. The noble Earl, Lord Howe, raised the issue of NHS budgets. We have on many occasions debated how we protect these budgets and, within the contexts of the health innovation and education clusters, some of the policy reforms that we are introducing will create more transparency. I remember on numerous occasions the noble Baroness, Lady Tonge, asking how we protect these budgets. The best way to protect them is to introduce transparency and a tariff system, where a budget will follow a trainee. That is the way in which we hope we will reform our education system, under the guidance and the support of Medical Education England from the medical perspective, and working with nursing colleagues to find a more transparent way in which we can allocate our education and training budgets. On Amendment 6, I would like first to consider the NHS Constitution. The importance that we attach to both education and research is reflected in the third principle in the constitution, which states: ""The NHS aspires to the highest standards of excellence and professionalism … in the people it employs and the education, training and development they receive … and through its commitment to innovation and to the promotion and conduct of research"." In addition, although we have debated whether this amendment is necessary, I have to make the point that all education and training commissioned directly by the NHS is already covered by the legislation as drafted, as the noble Baroness, Lady Murphy, pointed out. Strategic health authorities and other NHS organisations will have to have regard to the constitution in everything that they do, including education and training. That should be included in commissioning education and training. However, the noble and learned Lord, Lord Mackay, always challenges me when it comes to issues of the law and I take the point that certain colleges, as far as royal charters are concerned, may not be able to do this. I will be more than happy to seek further legal advice and to bring this back when we come to the next phase of the Bill. I turn now to the new bodies concerned with the support and delivery of medical and scientific research. Primary care trusts and other trusts can undertake, commission and assist in research. Any of this research would be captured, I believe, by the duty to have regard to the constitution in Clause 2. The current definition of "NHS function" in Clause 2(3) refers to, ""any function … concerned with, or connected to, the provision, commissioning or regulation of NHS services"." I believe that this covers patient-facing research, where patients receiving NHS services are involved. On consultation on the constitution on a 10-yearly basis, I again reassure noble Lords that many groups involved with research, training and education of health professionals contributed to the production of the final NHS Constitution, such as the General Medical Council, the Medical Research Council and the Academy of Medical Sciences. Their contributions were valuable and we shall of course wish to involve them in any further changes to the constitution, including the 10-yearly review of the constitution and any more minor revisions, where they are affected. I now turn to the innovation prizes and the spirit in which they have been introduced. As I have said in the House before, I strongly believe that these prizes are intended to get the best minds in this country to focus on some of the challenges that will face us in the future, and those challenges will require major breakthrough discoveries. That is what I am referring to in relation to the prizes. I think that the noble Baroness, Lady Murphy, mentioned Peter Mansfield, who discovered MRI in 1967 in Nottingham. He was not recognised for his research until 2005, when he won the Nobel Prize. Many such discoveries occurred in this country, and their benefits were translated elsewhere around the globe before they had an impact on our NHS patients. Therefore, the drivers behind the NHS innovation prizes are major breakthroughs and major discoveries. My noble friend referred to innovation prizes and the use of the word "research". This is a question of semantics. The definition of "innovation" is the successful development and implementation of new ideas, commonly divided into three stages: identification or invention, which is one area that we discussed in relation to research; growth, including adoption, testing and evaluation; and diffusion. However, if noble Lords still believe that we can strengthen the definition, I shall be more than happy to do so. In that respect, I am delighted to report that tomorrow we will be announcing the appointment of Professor Sir John Bell, the president of the Academy of Medical Sciences, as interim chair of the expert panel. I shall be more than happy to discuss the words "research" and "innovation" and to come back to the matter at Third Reading. I think that we all agree about the purpose of these prizes and about the very major role that universities and other higher education providers can play in relation to research. I hope that I have reassured noble Lords that some of their amendments may not be necessary, but I am happy to seek further legal advice in relation to them and to come back at Third Reading.