Health and Social Care Bill

My Lords, I was really pleased to see Clause 5 extend the duties of the Secretary of State with regard to research and its use. Clause 5 is a necessary acknowledgement of the extremely important role of medical and scientific research in ensuring that we deliver high-quality healthcare. The noble Lord, Lord Willis, and other noble Lords have spelt out graphically the dependence of improvements in treatments on research. In his response to questions raised at Second Reading, the noble Earl, Lord Howe, repeated the Government’s assurance that a culture of research and innovation would be embedded in the structural changes to the NHS proposed in the Bill. It is a fine promise, but I am concerned as to whether the Bill in its current form is able to deliver this in practice. The lack of detail or clarity across the Bill about the role of and commitment to research in the reformed NHS has been noted by a number of noble Lords. For this reason, Clause 5 needs to be stronger and more explicit. Embedding research across the complex NHS system requires proactive, top-down, leadership. Clause 5, as it currently stands, does not define how the Secretary of State would provide such leadership. Acknowledging that such research needs to be promoted stops short of an active commitment to promote research, or indeed of saying what that action would look like. We need a clearer indication of the strength of the research duty on the Secretary of State. I therefore support the amendments to Clause 5 which are in the names of the noble Lords, Lord Willis, Lord Walton and Lord Warner, and the noble Baroness, Lady Morgan. I applaud their call for more clarification of the extent of the Secretary of State’s duties towards research. Amendment 40 takes an important step in explicitly introducing a responsibility on the Secretary of State to promote the development of research findings for clinical application in the health service, and to ensure that we develop the necessary information skills and technology to support this application. Developing an environment in the NHS where research findings are taken up in support of the development of clinical applications is vital if we are to integrate innovation genuinely into the fabric of the NHS. Only with this happening will we ensure that the best care is provided quickly to patients and that we have more cost-effective health services. Only by embedding a research culture in the NHS which is driven from the top will we continue to attract commercial investment and R&D into the UK. As the Association of Medical Research Charities has observed, having one of the largest single healthcare systems in the world should offer us a unique strategic advantage in terms of resources for medical research and innovation. Yet we know that in practice the adoption and spread of innovation within the NHS can be slow and unsatisfactory. The innovation review being carried out by the NHS chief executive is exploring how we can accelerate the adoption and diffusion of innovations in the NHS, but I have no doubt that strong leadership from the Secretary of State will be required to support this. I also strongly support Amendment 42 in its attempt to establish an explicit responsibility on the Secretary of State to safeguard the funding of research and its application to health services. This amendment seeks to clarify how the bodies within the new structure of the NHS—the clinical commissioning groups and the NHS Commissioning Board—will take responsibility for treatment costs currently incurred for patients taking part in research funded by the Government or by research charity partner organisations. These excess treatment costs are currently distributed via PCTs’ commissioning budgets, but the Department of Health has no enforcement powers to ensure these are paid. We need more clarity on how the CCGs will be supported to build expertise in this area. In addition, the duties of the NHS Commissioning Board regarding research are unclear. I believe it is necessary to toughen up the board’s commitment to promote research, rather than require it merely to, "““have regard to the need””," to promote it. I know that amendments to later clauses in the Bill have been tabled to address both these points. The new duty on the Secretary of State to promote research reflects the core role of research in the NHS and is a very important step. The overriding aim of these amendments is to achieve a clearer commitment from the Government on the extent of the duties of a reformed NHS towards research. We need stronger, clearer language, and more detail as to what these duties will mean in practice. I hope the Minister is able to give us answers to the comprehensive range of questions raised by the noble Lord, Lord Willis. As has been noted in this debate and at Second Reading, medical research in the UK—through our universities and hospitals, our health research charities and our medical science industries—has been a long-standing success story. Its importance to a world-class National Health Service is not in doubt. Embedding a culture of research and innovation in the new structures of the NHS is one of the key challenges to be met by this Bill, but we have some way to go yet before that is achieved.