Health and Social Care Bill

My Lords, I warmly support this group of amendments, so ably proposed by the noble Lord, Lord Willis. The questions which he has posed to the Minister are of considerable importance. I do not propose to repeat them, but I look forward to hearing the answers. In my professional lifetime, there is no doubt at all that research has transformed the practice of medicine. Research is the lifeblood of medicine. After all, antibiotics have been effective in depleting very many of the infectious diseases which I knew as a young doctor. Programmes of vaccination and inoculation have been successful in banishing smallpox from the world and, in the near future, it is probable that poliomyelitis will become a disease of yesterday as well—it is likely that there will be no such cases in the world in future. The conditions of childhood which so ravished children when I was a young doctor, such as diphtheria, scarlet fever and, to an extent, measles and German measles have been successfully controlled by vaccination. In particular, in relation to rubella or German measles, that programme has prevented the birth of children with many birth defects which resulted from infection with that virus in pregnant women. There is no doubt, too, that the developments in diagnostic techniques, imaging, computerised tomography and other techniques, such as magnetic resonance imaging and so on, have transformed diagnosis. So, too, have many other techniques which have been introduced into medicine in the course of the last few years. Now, many painful and devastating operations have been prevented by interventional radiology, whereby under X-ray control, for example, in people with heart disease the passage of catheters into the coronary arteries can deal with that disease, even though in some cases there is a need for open-heart surgery. I could go on: there is hip replacement and joint replacement of all kinds, or the use of steroids in the management of autoimmune diseases. These have transformed the progress of medicine and, as the noble Lord, Lord Willis, said, today's discovery in basic medical science brings tomorrow's development in patient care. This is a lesson which we all have to recognise. That is called translational research; you translate the result of the basic research in the laboratory, or basic clinical research, into effective treatment of disease. All of these things are happening all around us and, as the noble Lord, Lord Willis, said, the evidence is clear that when one looks at research citations and publications in learned journals, for instance, there are many more published in the United States but, if you translate those citations according to population this country, the United Kingdom, in its research productivity in the field of medicine, stands the highest in the world. Yet obstacles and problems which have been encountered over the years have to be overcome. Fifteen years ago, on behalf of your Lordships’ Select Committee on Science and Technology, I chaired a sub-committee inquiry into research in the NHS. From its very beginning, the National Health Service provided limited funds for research purposes and there was a locally operated clinical research scheme. It was helpful in that it helped many young doctors and medical scientists to take their first steps in research by receiving small grants to help them to conduct such investigations, but the actual amount of money expended in that way and the results of this research were very limited. The outcome of the inquiry which I chaired was that the Culyer report followed, presented by the Government, and when my report was debated in your Lordships' House the Government of the day committed 1.5 per cent of the total expenditure of the NHS to research. Since that day, in fact, it has risen slowly from 0.7 per cent to 0.8 and 0.9 per cent, and has stuck at that figure. Nevertheless, as the actual costs of the NHS have escalated, so the money becoming available from that background has increased substantially and it is this that has led to the establishment of the National Institute for Health Research which, as the noble Lord, Lord Willis, said, is so ably chaired by Dame Sally Davies, who is also the Government’s Chief Medical Officer. We must not of course forget the contributions that have been made by the Medical Research Council. I was involved with the MRC for 16 years and was on the council for four years, and so got to learn a good deal about its productivity. It had a series of priorities, many of which related to the incidence of disease in the community in which it promoted research. Fundamentally, however, it looked to support research in the universities and in research institutes which were often orientated to specific problems. Alongside that, as the noble Lord, Lord Willis, said, we must not overlook the contributions of research charities such as the Wellcome Trust, the Cancer Research Campaign and very many more, with many of which I have been specifically involved. They have made a tremendous contribution and, as I have often said in teaching medical students and young doctors, not only does research nurture patient care development but the resultant research has meant that although there are still many incurable diseases in medicine, there is none which cannot have its effects modified to a greater or lesser extent by pharmacological, physical and psychological means. These have made a major contribution and I have to pay tribute to the work of the pharmaceutical industry in the United Kingdom which, despite problems which it has encountered, nevertheless in my view remains the jewel in Britain's industrial crown. These are crucially important issues, but why is research in the NHS so specifically important? It is because the availability of excellent records and very well defined populations has meant that, for instance, in epidemiological research and in research into the effects of drugs as tested in clinical trials the NHS has been a wonderful source for such activities. In the course of the last few years, however, clinical trials have been prejudiced, not least by the complexity of requirements for ethical approval—particularly in the case of multicentre trials, where a whole series of different organisations have been required to give ethical approval. There has also been a more recent problem from the European Union directive on clinical trials, which has to some extent had a difficult effect. However, the recent report of the Academy of Medical Sciences on research governance and support—a review chaired most ably by Sir Michael Rawlins—has brought clarity and extraordinary new developments into this field. I am happy to say that the Minister and the Government appear to have recognised that this report is one of great importance and that, when implemented, as the Government propose, in a health research agency, which will be created as a new special health authority, it should streamline the process of research in the United Kingdom and make clinical trials very much easier to carry out. Leaving aside clinical trials, though, NHS research involves other activities such as operational research, research into how health procedures can be carried out, research into their effectiveness and a whole series of research activities that have a sociological context—looking at the care of the elderly, for instance, or the development of new drugs and management mechanisms for dementia. I was delighted that recently a major grant from the Department of Health went to the Institute for Ageing and Health in Newcastle, in which I have personal interest and which is one of the most outstanding research depots in the world, examining the effects of ageing upon the human population and bringing up ideas to overcome some of its most devastating effects. So, developments are happening. I seek support in principle from the Minister for the amendments, which are intended to put flesh on the bone. Clause 5—strengthened, I hope, by Amendment 39, which was moved by the noble Lord, Lord Willis—is actually all right so far as it goes, but it is crucial in my opinion that there should be more detail. I would also like an assurance from the Minister that when the National Institute for Health Research is absorbed into the National Commissioning Board, as it will be, its funding, based upon the Culyer and Cooksey reports of long ago, will be preserved and indeed ring-fenced. I support the amendments most warmly.