Health and Social Care Bill

My Lords, with the greatest respect, I will not go into who left me the junior hospital doctors issue. He will recall that my first day as a Minister was actually the first day of Committee on the glorious Mental Health Bill, and that was a blessed memory, I must say. My experience was that the health service let us down on training commissions, because at the time they were facing a financial difficulty and it was all too easy to cut those commissions. The result was that Ministers essentially took it upon themselves to put central controls back into the system. My concern is that if the NCB simply has research in its budgetary responsibility and there are severe pressures, it is just too easy to dip into it. The problem is also, as my noble friend Lord Warner said, that, as we know, sometimes research budgets take a little time to kick in, but once you do it you are funding for three, five, seven years. Again, in each financial year, an amount is probably available in the winter that had not been spent. The problem is that you will never get that resource back again. The second point that I would like to put to the noble Earl is about clinical commissioning groups. How do we ensure that their commissioning decisions support research? My noble friend Lord Turnberg said that research is no cottage industry, but clinical commissioning groups are the epitome of a cottage industry. He also referred to the fact that GPs have little history of undertaking research and commitment to it. Yet we are handing them billions and billions of pounds, quite remarkably, on the basis of no evidence whatsoever that I can see that they are fitted to discharge that responsibility. I ask the noble Earl where we can have assurance that clinical commissioning groups will be prepared to invest in services where there is a strong research base. The third challenge is to NHS trusts and NHS foundation trusts. The noble Lord, Lord Ribeiro, put his hand on it when he talked about the reduction in the number of clinical academic posts. I believe that NHS trusts have a great role to play in encouraging their clinicians and in encouraging joint posts with universities. Again, I worry that the focus on job plans and the productivity of clinicians will discourage research because the emphasis will be on patient throughput. How are we going to ensure that that does not happen? I take the point made by the noble Lord, Lord Ribeiro, about surgeons’ practical skills. What about simulation centres in training to help surgical teams to work together and the research base involved in that? What about nursing and AHP research? Also, what about clinical trials? There is a real risk of losing clinical trials to other countries. If the pharmaceutical industry feels that clinical trials are not encouraged in this country, there is a risk that it will take some of its R&D work abroad as well. I listened with great interest to what the noble Lord, Lord Walton, said about the need to streamline the approval process. I welcome the Government’s proposals and commitment to improve and streamline that process, and it is something that we on this side of the House very much support. Above all, we need to deal with the question of implementing research. Earlier, we talked about besetting sins. It has long been a besetting sin that the NHS has been very slow to implement proven research, and I am very concerned about this. The pharmaceutical industry continually makes a point about the UK’s slowness to take up new medicines. Although the PPRS puts a cap on profits, it allows the industry to set a price for each medicine, and the industry has always regarded this as a good situation in which to be because that price can then be set in other countries. The noble Earl talked only two days ago about the proposed introduction of value-based pricing. Without going into the methodology, I should like to ask him whether, through such pricing, the industry is going to lose the flexibility to set prices. Is there not a risk that we will make the UK a less attractive place for the industry to develop R&D in the future? That brings me to the Department of Health. Although it was there to sponsor the industry, there was always a risk that, because of its concern about NHS budgets, ultimately it would be much more concerned about holding down prices. In the great endeavour to ensure that this country continues to have a strong research base in the health sector, I should like an assurance from the Minister that, in its sponsorship of the pharmaceutical industry, the department will be as concerned to ensure that the industry is strong as it will be to hold down prices. I know that this has been another long debate, but I think that nothing is more important in this country than health-based research. Tonight, our concern is not so much about the wording of the amendments as about hearing how the Government will ensure that we continue to prioritise research in the future.