Health and Social Care Bill

My Lords, I agree that this has been an absolutely excellent debate and I have listened very carefully to all the contributions. Clause 5 places a duty on the Secretary of State, for the first time, to have regard to the need to promote research within the health service. It also places equivalent duties on the Commissioning Board and clinical commissioning groups. The duty applies to research into matters relevant to the health service—I shall come on to that phrase later—and the use within the health service of evidence obtained from research. I turn straight away to the amendments, beginning with Amendments 39 and 199ZA together, as they make the same changes to the research duties on the Secretary of State and clinical commissioning groups. Amendment 39, tabled by my noble friend Lord Willis and the noble Baroness, Lady Morgan, would require the Secretary of State to promote research within the health service and to promote the use of the evidence obtained from that research. The Bill as drafted requires the Secretary of State to have regard to the need to promote research in the health service. This means that the Secretary of State must bear in mind the importance of research when exercising any of his functions and consider how the exercise of those functions might in itself promote research or how it might influence the promotion of research by others. I have reflected on these two amendments and I can tell noble Lords that I sympathise with the arguments behind them. Of course, I fully recognise the importance of ensuring that research is promoted within the health service. Therefore, I now give a commitment, following this debate, to undertake a closer consideration of this duty. Amendment 40, tabled by the noble Lords, Lord Warner and Lord Patel, requires the Secretary of State to have regard to the need to develop research findings for clinical application in the health service. I agree with the noble Lords that this emphasis is important. We need to ensure that, wherever possible, research outcomes are translated into clinical practice. This is how the health service moves forward. The noble Lord, Lord Walton, as so often, was completely right in all that he said on that subject. As the duty is currently drafted, the Secretary of State is already required to have regard to the need to promote the use of evidence obtained from research. Therefore, we believe that this amendment would duplicate the existing duty. Amendment 40 also refers to the need to ensure that staff have the relevant training and support where new technologies are introduced. We have brought forward an amendment to introduce a duty on the Secretary of State to exercise his functions so as to secure an effective system for education and training within the health service. The word ““effective”” is there for a purpose. Similarly, the NHS constitution makes a public pledge that all NHS providers should provide all their staff with access to appropriate training for their jobs, together with line management support to succeed. Therefore, again, in my view this amendment is unnecessary. It may also help to reassure noble Lords if I refer to our consultation document, An Information Revolution. In this, we state that information management and IT capability are essential if we are to achieve improved healthcare outcomes. Our forthcoming information strategy will recognise the importance of informatics skills within the health service, and I hope that this will reassure noble Lords—in particular, the noble Lord, Lord Warner—that we are fully aware of the need to ensure that staff are able to maximise the benefits that new technologies can offer. I now turn to Amendment 41, also tabled by my noble friend Lord Willis and the noble Baroness, Lady Morgan. This amendment would place an additional requirement on the Secretary of State to promote research into public health issues. Again, I agree with the principle behind the amendment—it is indeed true that advances in public health are shaped by research and evidence, and the noble Lord, Lord Turnberg, gave us a number of examples. In fact, this amendment can be dealt with quite simply. The duty on the Secretary of State, the board and clinical commissioning groups to have regard to the need to promote research applies to ““the health service””. That phrase encompasses both the NHS and public health services, and therefore the duties already apply to public health. There are other clauses in the Bill that focus specifically on research into health protection. Clause 8 lists research and other steps, "““for advancing knowledge and understanding””," as examples of action that the Secretary of State may take under his wider duty in relation to protecting public health. Clause 14(13) expressly gives the Secretary of State, the NHS and local authorities the power to commission or assist research. My noble friend Lord Willis asked me how the duty on the Secretary of State would be fulfilled in practice. It may be helpful if I briefly set out the work that is going on beyond the Bill to ensure that research is embedded in the new system. The department has recently published a document setting out initial proposals for the NHS Commissioning Board. Among other things, it emphasises that, to fulfil its purpose, the board should support, "““a culture which promotes research and innovation””." There is also a clear indication in the department’s document, Developing Clinical Commissioning Groups: Towards Authorisation, that clinical commissioning groups will be expected to demonstrate how they will promote research. These documents can be found on the Department of Health’s website. I should be very happy to expand on this in a letter to my noble friend and other Lords. In this area the noble Baroness, Lady Finlay, asked what the levers for research would be, and that question was echoed by a number of other noble Lords. I will expand on this in writing, but there are a number of parallel levers across Government that will do this, ensuring that the UK’s commercial and industrial landscape is, as the noble Lord, Lord Hunt, rightly emphasised, an attractive place to do research, and that we do not neglect any aspect of research—basic, translational and clinical—so it is about research across the piece. It is also about the pricing of medicines, about our skills base as a country and about encouraging the concept of clustering, linking universities and the NHS and industry. We have announced recently a large sum of money which will go towards biomedical research clusters and units. It is also about deregulation, streamlining research and creating the Health Research Authority to do that, the drivers in the NHS such as the tariff and, not least, holding bodies in the NHS—CCGs no less than others—accountable for the duties that are in this Bill. Accountability is the counterpart to the concept of autonomy. I cannot say much to the noble Baroness, Lady Morgan, about the tariff. We do not envisage a separate tariff for research, but we will ensure that the systems and processes that the board and CCGs use for commissioning patient care ensure that research is supported and that treatment costs are funded by the NHS. This will specifically include a tariff. It is essential that the tariff for patient care incorporates the costs of patients who are taking part in research, and we will ensure that it does. I turn to Amendment 42, which was tabled by the noble Lords, Lord Warner, Lord Patel, and my noble friend Lord Ribeiro. This amendment seeks to safeguard the funding of research by placing a requirement on the Secretary of State to ensure that there is adequate funding for research and the application of that research to the health service. The amendment also aims to ensure that clinical commissioning groups will fund the treatment of patients involved in research. I share the desire to protect research funding—as Minister for research, how could I not do so? My noble friend Lord Willis need have no fears about our intent in this area. The Government have signalled their clear and strong support for research by increasing the research budget of the Department of Health in real terms over the current spending review period. I heard from many noble Lords the concern about the research responsibility for the NIHR transferring across to the NHS Commissioning Board and how the budget could be protected in that event. I do not know where this idea has come from, but it is not accurate. The budget for the National Institute for Health Research is centrally held within the Department of Health and will remain so. The budget for research commissioning will not transfer to the NHS Commissioning Board. Dame Sally Davies, the Chief Medical Officer, retains a responsibility for the National Institute for Health Research and for the budget that is allocated to it to commission research. I hope that that reassures my noble friend and the noble Lords, Lord Walton, Lord Warner, Lord Turnberg and Lord Rea, and all others who have expressed worries on that score. With respect to the research that takes place within the health service, alongside the Secretary of State’s duty to have regard to the need to promote research, Clause 14(13) already gives him the powers to commission research or assist any person conducting research, including by providing financial assistance. An equivalent duty and powers are conferred on the board and clinical commissioning groups. We therefore believe that there are robust arrangements for safeguarding the funding of research already in place. Amendment 74, proposed by the noble Lord, Lord Patel, would add the promotion of research and acting on research evidence to the list of steps that local authorities may take when exercising their new functions in relation to health improvement. The importance and value of high-quality research and evidence to public health are clear and well understood. We agree entirely that local government should make evidence-based decisions and we expect that Public Health England, the new executive agency, will help them to do that. We also agree that local government should be able to undertake or support research of its own. While this is not listed in Clause 9, because that list was drawn from the current functions of the Health Protection Agency, it is included in Clause 14(13) of the Bill. This clause gives local authorities a specific power to conduct, commission or assist research that is connected to their functions as part of the comprehensive health service. The list in Clause 9 is not prescriptive. As a rule, it must be for local authorities themselves to decide how best to use their own resources as autonomous bodies. Therefore, including research in Clause 9 would not make it mandatory. For that reason, we believe that this amendment would not add anything to the existing provision in Clause 14 and it is therefore unnecessary. Amendment 89E, tabled by the noble Lord, Lord Hunt, would remove the power of the NHS Commissioning Board, clinical commissioning groups and local authorities to conduct research in relation to their health service functions. It would leave intact the existing paragraph 13 of Schedule 1 to the NHS Act 2006, which confers the power to conduct or assist research solely on the Secretary of State. I am taking it now that the noble Lord did speak to that amendment. I confess to a measure of confusion over its intention. Currently, the Bill recognises that research and evidence-based care are needed throughout an effective health care system, a principle I would hope that all noble Lords would agree with—