Health and Social Care Bill

My Lords, if I may, I will say to your Lordships’ House that this group of amendments is about Kevin. It is also about Kate. This is perhaps the first time that we have had an opportunity to look at a group of amendments that will have an immediate and direct effect on the patients and patient outcomes. In moving Amendment 39, I will also speak to Amendment 41 standing in my name and those of the noble Baroness, Lady Morgan, and the noble Lords, Lord Walton and Lord Warner. I should say from the outset that I am extremely supportive of other amendments in this group from noble Lords. Indeed, the fact that noble Lords from every quarter of the House recognised the importance of research and wanted to support this group of amendments demonstrates the real commitment that there is in seeing research at the centre of the new National Health Service. I listened to the previous debate, and much of the debate on Clause 1, and so far a great deal of the debate has been about structures. Not one piece of empirical evidence has been brought forward that demonstrates that the proposed structures, either now or in previous health Bills, have been there with evidence that they will improve the service. On what we are about to discuss now, there is a mass of empirical evidence to demonstrate that putting research at the centre of the National Health Service will improve patient care and outcomes—and that, if I may respectfully say so, is really what this Bill should be addressing. How do we make things better for our patients and how do give clinicians the very skills, tools, drugs and procedures that they need to make it better? Your Lordships received this week a lovely bound book by the British Heart Foundation entitled 50 Years at the Heart of Health. Throughout it there are a number of very interesting statistics. One that I draw to noble Lords’ attention is fact number 24. It says that in 1961 somebody died from cardiovascular disease in the UK every 98 seconds; in 2009, it was every 174 seconds. The reason for that dramatic change was twofold: first, the clinicians dealing with those patients; and, secondly, the research they had at their disposal to make the treatments more effective. We celebrate the fact that we ended up with a significant drop of some 78 per cent in outcomes of deaths, but the reality is that far too many patients still die of cardiovascular disease, and we need the research and new techniques to be able to deal with this. At the John Radcliffe Hospital, Oxford, an experimental new treatment using gene therapies to help prevent the onset of blindness is in its early stage of clinical trials. The use of gene therapies and of genomics and bioinformatics will make a radical difference to how we deal with our patients in future, offering them if not personalised healthcare at least far more targeted support for whatever disease they have. Other noble Lords will speak from great professional and personal depth about the use of research and its importance. I declare two interests: first, my belief that training the workforce in giving access to research is the best way in which to improve patient outcomes—and I think noble Lords would agree with that; and, secondly, I chair the Association of Medical Research Charities, whose 127 member charities contribute more than £1 billion a year to medical research, some 30 per cent of all expenditure in this area. We see daily the results of good clinical practice and research, but we also see the challenges that lie ahead. Of course, the UK starts from a very strong position. We are simply—and again there is clear evidence to support this—the most productive health research nation on earth when you judge the dollar input against research success. That fact was confirmed just last month by the global research report from Thomson Reuters. What we do not do nearly well enough is bring research to clinical practice quickly enough or exploit our advantage vigorously enough. To deal with that we require a quantum change in the regulatory framework and we need to use our NHS patient database far more effectively, which is why I am delighted that Amendment 40A in the name of the noble Lord, Lord Turnberg, who I will call my noble friend, begins the debate about how we use the National Health Service database much more effectively. Patients want to be involved in trials and they want the NHS to be involved. In June 2010 the Association of Medical Research Charities commissioned MORI to ask people whether they wanted their local NHS to be encouraged or required to support research. Ninety-three per cent said yes. The National Institute for Medical Research in its work with INVOLVE got exactly the same results when asking patient groups whether they wanted to be involved. The public have a thirst to be involved in research and we need to take that up. To be fair we ought also to congratulate the work that went on under the previous Government. The National Institute for Health Research, led by Professor Sally Davies, and the work that has been done since the Cooksey report on identifying NHS research resources and how to apply them has given us a huge start. We have recognised where the resources are. We know what the capabilities are. It is now a matter of using them. I welcome the fact that, for the first time in the history of the National Health Service, the Secretary of State will have a duty to promote research, as will the NHS Commissioning Board, the clinical commissioning groups and Public Health England. That is a huge step forward in putting research at the centre of the national health. I welcome, too, and recognise the importance of the changes that have come to this Bill. The fact that none of these things was in it when it began its journey and yet, following the review, we now see that research is in the Bill is something to build on and to commend the Minister and the Secretary of State for. The amendments that we are discussing today are probing, but they are the beginning of a process to elicit from the Minister how the duty of the Secretary of State will actually be carried out, because having a duty without defining that duty is a hollow gesture. What will be the extent of it? How will it be assessed, and who will assess it? How and to whom will it be reported? Crucially, how the culture of an organisation that is to see ever greater levels of devolution will retain the ability to require a research culture at the heart of everything it does is quite frankly beyond me, and we are looking for the Minister to explain how that will happen. These amendments seek to explore how far the research duty of the Secretary of State will compel him to lead the embedding of research across the National Health Service and public health systems at a national level. Amendment 39 seeks to leave out the words, "““have regard to the need to””." They are totally unnecessary. The Bill should say simply, ““The Secretary of State must promote””. That is a clear definition, a clear statement of intent. Perhaps the Minister will explain the meaning of the words. Surely if this new duty is to have real meaning, the words, "““have regard to the need to””," must be removed. Can the Minister provide more clarity on how this duty requires the Secretary of State to act to promote research and to use research evidence across the NHS? What powers will the Secretary of State have to make often overburdened clinicians, chief executives and governors put research at the heart of their own trusts, GP practices and commissioning groups? How will this duty extend to those who are private-sector or third-sector contractors? If a great deal of our services are to be delivered outside what we regard as the normal NHS structures, how will these people be encouraged to put research rather than profit or pure service delivery at the heart of their practices, or will it apply only to those organisations delivering NHS services within the NHS? Can the Minister provide more clarity on the extent of the Secretary of State’s duty to promote research and the use of research evidence contained in the very strange phrase, "““research on matters relevant to the health service””?" What does that actually mean? The phrase is incredibly broad. Virtually every aspect of health and social care that impacts on the treatment of patients could come within this responsibility. Surely that is not what is meant. Can the Minister provide further clarity on the research captured by this definition and reassure us that this will incorporate all research supported by the health service for the purpose of protecting the public in England from disease or other dangers to health? Amendment 41 seeks to make the duty of using research in the field of public health more explicit by adding, "““research supported by the health service for the purpose of protecting the public in England from disease or other dangers to health””." This amendment begins to explore for the first time the duty of the Secretary of State to protect the public from pandemics or other national health threats. If there has been a devolution of those responsibilities to other boards, where does the Secretary of State’s power begin and end, and what is his duty to ensure that there is adequate research in order to prevent those pandemics affecting the public as they have done in the past? It also begs the question of whether, if the Secretary of State is to lead and embed a culture change whereby no health research should fall outside his responsibility, this should include research in public health. Without rerunning the past debates about duties, I fully recognise that the Secretary of State will need responsible officers to help him perform or carry out his duties. Can my noble friend explain who will be the executive officer responsible to the Secretary of State for research in the NHS and in Public Health England? In a recent Answer to a Written Question I put down the Minister said: "““It is not expected that Public Health England will, itself, directly hold funds to commission research … the National Institute for Health Research (NIHR) will continue to take responsibility for the commissioning of public health research””.—[Official Report, 7/11/11; col. WA 20-21.]" But how will the NIHR, now to be wholly subsumed into the national Commissioning Board, carry out that function? Will the Chief Medical Officer, Professor Sally Davies, retain the equivalent of her current responsibilities as head of the National Institute for Medical Research, and by definition her responsibility for NHS research, or will that go to Sir David Nicholson as chief executive of the new national Commissioning Board? And what will happen to the £1 billion currently allocated and ring-fenced to NHS research, currently within Sally Davies’s budget and the NIHR? I ask this because there is an obvious concern that the Nicholson challenge to save £20 billion in four years could seriously affect NHS research if, in fact, it were deemed to be part of the pot led by Sir David Nicholson within the board. What guarantee can the Minister give that current research budgets in the National Health Service will be protected? We have those guarantees within the research councils, particularly the Medical Research Council. We need to have exactly that same guarantee within the Department of Health. I recognise, as I hope most people in the House do, the fantastic commitment we have seen through the CSR both for the Medical Research Council and the NIHR. We have seen the commitment to the new Crick centre in terms of basic and translational research. We can do nothing other than welcome the direction of travel of the Minister and the Secretary of State. This is not a carping set of questions; it is a genuine attempt to find answers. I do not expect my noble friend to have all the answers today. This is a probing set of amendments that seek to start a debate about the duties of the Secretary of State towards health. I hope that by the time we finish this preliminary skirmish about research we will be a little bit clearer. It would be extremely helpful if the Committee could have an organigram, or at least some diagrammatic form, of where the responsibilities will actually lie so that we know what the research landscape will be. That would help us to concentrate our minds on finding productive solutions. I beg to move.