Health and Social Care Bill

My Lords, I shall speak in support of Amendments 40 and 42, which, as the noble Lord, Lord Willis, said, are very much appreciated and welcomed. They reflect the Government’s acceptance of the importance of research and making this an express duty on the Secretary of State. Some years ago, Professor Sackett made the medical profession aware of the term ““evidence-based medicine””. I should like to think that we have all adopted it in our clinical practices over the years. As a surgeon, I speak from a surgical perspective. In the 18th century John Hunter was approached by Edward Jenner with his dilemma about children in Gloucestershire who were being afflicted by cowpox. He wrote to John Hunter, saying, ““I’m thinking about doing something about this and would like to cure the children in this area with a vaccination made from cowpox””. John Hunter replied, ““Don’t think about it, do the experiment””. We in surgery consider Hunter the father of scientific surgery but our problem is that we are, perhaps, not quite as cerebral as our physician colleagues. All they have to do is learn the discipline, acquire the knowledge and prescribe the tablets. On the other hand, we not only have to learn but must then apply our knowledge in carrying out the operation. There are two skills that we must acquire. For us poor surgeons, it is often a long sentence—spent not only in a laboratory but in the theatre, putting into practice what we have learnt. Earlier, a noble Lord—I think it was the noble Lord, Lord Warner—used the term ““from the bedside to the bench””, which is very important. The whole concept behind translational research has been to get our trainees and doctors away from idea that all they have to do is stay in the lab, beavering away. It is about the patient. One of the things that surgeons try to do is take a problem from the bedside into the lab, apply stringent tests to it and then bring it back in the form of treatment, which might be by medication or an operative technique. The problem for surgeons is that research and the assessment of research often lead to new innovations, treatments and operations, which have to be learnt. Time must be put aside for them to be learnt. Surgery has, in many ways, been the Cinderella of medical research. I say this with some feeling because of the NIHR budget of £1 billion, some of which goes to medical research, plus all the other funding that comes in from charitable causes. The share of the NIHR budget that goes to surgery is less than 2 per cent. Twelve million people a year are treated medically in this country. One-third of them will be exposed to surgery somewhere along the line. Yet look at the pittance of research money that goes to surgery. I know that I will hear from my noble friends, as I am often rightly told by Dame Sally Davies, that you will not get anywhere unless you put the right papers and research in, and you get the quality of research that is published in Nature and Science. However, that has been a real problem for us. There have been many ways of assessing research. The research assessment exercise was a brilliant exercise in universities but it looked at the criteria of publication and scientific worth. Surgery is about patients and clinical research. In surgery, that has led to a reduction in academic surgical professorial posts from 30 to 15 in the past 10 years. The number of clinical academic posts has been reduced and, despite the wonderful work done by Sir Mark Wolpert in getting clinical academic posts, there are not enough. Many of our surgical trainees are not getting the training in research that they should have. Therefore, it is very important that surgery and all aspects of medical practice should be underpinned by an ethos of research. I shall tell noble Lords one little story that perhaps explains some of the problems that can arise if you do not do this. I am sure noble Lords will recall, from the 1990s, a terrible scandal in the newspapers about a lady who had a laparoscopic operation and developed a major bowel complication. I think her name was Silverman. At that time there was a big newspaper campaign about the botched surgery that was undertaken by surgeons who were ill trained. The reason for this was that it happened at the time of the introduction of laparoscopic keyhole surgery. I am a general surgeon. Give me a knife and fork and I can operate, but to use a telescope with long, thin instruments while looking at a television screen you need hand-eye co-ordination. Nowadays all our kids are brought up on Playstations and so on. They can do it; it is not a problem. Go to any fairground in the country and you will see kids who could be surgeons. However, my generation had real difficulty in converting from open surgery, where you look at what you are doing, to operating through a television screen with your hands moving independently. Quite a few of those surgeons who tried to take on this new operation did not realise that they did not have the hand-eye co-ordination to do it. The net result was disasters and complications, and patients suffered. As a direct result of the fallout from Silverman, the Government of the day—I am sorry to say they were the party on this side—agreed with the Department of Health to set up a national training programme. This was based at three centres in London, Leeds and Guildford. They set up the Minimal Access Therapy Training Units. The idea was to teach doctors—not just trainees but consultants as well—how to perform this operation properly, and for them to be properly scrutinised in doing so. I am sorry that he is not in his seat, because the noble Lord, Lord Darzi, was our college’s first laparoscopic tutor. He was the person given the responsibility of rolling out this training programme. With some money and help from the department at the time, we were able to kick-start this programme, which has become a national programme whereby nearly every hospital has access through a regional network of some sort or another. I declare an interest, in that I am proud to say that I was president at the time when we opened our own much bigger minimal-skills training unit at the college. I have come from the college where we are running a military operative surgical training course in those facilities. We are benefiting many people who need the practical skills to do surgery. Therefore, in answer to Amendment 42, which addresses funding, it is essential that the ring-fencing suggested by the noble Lord, Lord Willis, in the context of the NIHR is absolutely essential. We have a situation that I am sure the noble Lord, Lord Warner, remembers well—in fact he referred to it. In 2006, when I was president of the college, I remember quite a few of my pronouncements in the newspapers about my absolute horror that the training programme for junior doctors was being raided by the Department of Health. I am not sure if the noble Lord was there at the time.