My Lords, I thank your Lordships for allowing me to come off the substitutes’ bench to take part in place of my noble friend Lady Jolly. I did not have the opportunity to speak on the last group, but if I had I would have strongly echoed the words of the noble Baroness, Lady Thornton. I do not believe that the Government’s amendments go anywhere near strengthening, clarifying or taking away the reservations that many of us have that the definition of “attractiveness” is one that largely depends on the watering down of regulation and standards and the increasing of commercial competitiveness. That is very
much germane to this set of amendments, because it is against this backdrop that the amendments from the noble Lord, Lord Lansley, sit.
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As I listened to the noble Lord, Lord Lansley, in his introduction about innovation and why innovation happens, or does not happen, around the NHS, I was immediately taken back to a meeting in one of the Rooms across the Corridor, during the passage of the legislation with which he is so much noted. A number of noble Lords present today were at that meeting, and it was about the development of local commissioning within the NHS. We had a doctor from a part of England who explained to us that, in his area, he and his colleagues in general practice had all the data that showed that, of the three different operations performed for the relief of carpal tunnel syndrome, one had a much better success rate and was much preferred by patients, yet was not being commissioned locally; the other two were. All the noble Lords in the Room said, “Why do you have to set up a company to commission this? Why can’t you get it done in the NHS?” He looked at us with a look of such despondency, and said, “I have been banging my head against a wall for so many years, I cannot do it any longer”.
I understand what the noble Lord, Lord Lansley, is trying to get at. My question is: do his amendments achieve that? In particular, the way in which he introduced Amendment 17, about the effect on the National Health Service, could be taken in a negative way, because the NHS is potentially such a big market, or potential demand within the NHS for a new treatment or a new procedure could be so big. I wonder whether there needs to be a bit more clarification in his amendments, just to get him to where he wants to get to.
I strongly support Amendment 85 in the name of the noble Lord, Lord Lansley. I happened to grow up with a parent who was deaf, so medical devices—hearing aids—are something that I have lived with all my life, and I know the importance of them. It was interesting for me to watch, particularly in the 1980s and 1990s, the extent to which the NHS lagged so far behind the private sector in developing audio technology. Yet people who were very deaf did not trust the private sector to advise them correctly on what they should do. They still had enormous faith in the NHS, even though the technology lagged so far behind.
One of the most important things that the NHS does is lend its credibility to new technologies, and this will perhaps be of increasing importance. We know that in terms of managing long-term chronic conditions —for example, asthma— remote technologies are going to become much more important. When they are adopted, those have an impact not only on individual patients and patients managing their conditions but on emergency admissions, which are very expensive for the NHS. All that is going to happen.
As other people have said in this debate, one of the biggest drags on innovation in the NHS is the way that the funding flows work, and those who do the investment very rarely see the benefits, and particularly not over time. We would like to support the noble Lord, Lord Lansley, particularly on Amendment 85, and would like to see Amendment 17 slightly adapted—and
I would say improved—but I take the point that these are every bit as necessary as some of the other things here to an overall definition of attractiveness.