Queen’s Speech

Debate between Lord Davies of Stamford and Lord Kakkar

Monday 26th June 2017 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a very great privilege to follow the noble Lord, Lord Mountevans, and to be the first in your Lordships’ House to be able to congratulate him on his magnificent maiden speech, so clearly informed by the wisdom, experience and insight he has developed through his distinguished career in the City, which culminated, as we have heard, in serving as the 688th Lord Mayor of the City of London. I had the opportunity to speak to the Lord Chief Justice this morning, who indicated to me that the noble Lord was a most successful Lord Mayor of the City of London. He is highly regarded throughout the City and beyond, and your Lordships’ House will benefit from his future contributions to the important work that we have the responsibility of discharging on behalf of our nation.

I also congratulate the Minister on the thoughtful way in which he introduced this debate and declare my interests as professor of surgery at University College London, chairman of UCLPartners and UK business ambassador for healthcare and life sciences. I shall concentrate my contribution in this debate on the area of life sciences.

We heard from the noble Lord, Lord Mountevans, that financial services represent the most important part of our economy, but beyond financial services the life sciences are the second. They are an industry and a sector predicated on the development over many decades of a very finely balanced ecosystem. At the heart of that ecosystem is the National Health Service. Four of the 10 leading universities of the world, three of the 10 universities leading specifically in the field of life sciences, and two of the top 10 pharma companies in the world are based here in the United Kingdom, between them employing some 200,000 people in more than 180 countries around the world and providing a surplus in excess of £20 billion a year to the UK economy. There are some 1,300 companies in our country manufacturing in the medical area. There are 3,500 small and medium-sized enterprises, 500 of which are exporting actively, and the life sciences industries employ some 235,000 people, which is just under 1% of total private sector employment in our country. Those are important statistics, because the life sciences sector not only makes an important contribution to the economy and to generating wealth but has the vital purpose of ensuring that we can improve healthcare and the outcomes we can achieve for our patients through the application of innovation and technology that has transformed life prospects over recent decades.

A recent UK Trade & Investment report, Strength and Opportunity in 2014, which looked at the life sciences sector in 2014, established that it was a true world leader. Since 2011, the sector has attracted some £7.5 billion of inward investment into our country, which has resulted in the creation of some 18,000 jobs. The medtech sector grew at some 5.8% per annum in the period 2009 to 2014, and the biotech sector some 4% per annum. Those are very impressive figures when one looks at the general pace of economic activity during that period, and something that cannot be neglected.

The Conservative Party manifesto at the last election committed to ensuring that the United Kingdom was the most innovative country in the world. Clearly, the gracious Speech has identified certain areas of innovation—we heard in the Minister’s introductory comments a particular focus on driverless cars and travel into space—but I hope that the Minister can confirm a continued emphasis on the area of life sciences. This important area of activity, which is so bound up with the public sector, our universities and the delivery of healthcare, will not thrive unless there continues to be a determined focus on ensuring that it can compete globally. It is a sector, beyond many others. that is exquisitely dependent on collaboration—across universities, across industries and between Governments. Any loss of focus in that area will result in our country paying a heavy price.

In that regard, would the Minister be able to address two or three questions? First, is he content that there will be the opportunity for sufficient focus on the life sciences sector so that it can continue to deliver as required without any further legislation to deal with some anomalies with regard to the environment in which it has to operate? In particular, is he content that UK Research and Innovation will be able to drive the kind of collaborations and co-operation among scientists and innovators, not only in our own country but across the European Union, and potentially in other fundamentally innovative economies such as the United States and the emerging innovative economies in the east, such as China and India?

Is the Minister content that the vital role that the National Health Service has to play with regard to innovation in the life sciences sector can be delivered, particularly with the adoption of innovation at scale and pace—innovation established in our own country and applied for the benefit of the patients in our National Health Service but also using the fundamental opportunities of the NHS to demonstrate to the rest of the world the value of what we can bring to drive improvements in global healthcare?

Finally, is the Minister content that the life sciences sector can be properly supported in the negotiations attending our exit from the European Union?

[Lord Davies of Stamford (Lab)]

Before the noble Lord sits down, I have been listening to him—

EU: Reform

Debate between Lord Davies of Stamford and Lord Kakkar

Thursday 9th January 2014 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join in thanking the noble Lord, Lord Dykes, for having secured this important debate, and, in so doing, declare my own interests as professor of surgery at University College London and a member of the General Medical Council.

The area of health and delivery of healthcare was not an area originally anticipated as having any competence at European Union level, specifically in the treaties. The delivery of healthcare and the allocation of healthcare resources along with the development of health policy were described as an area in which member states and national governments maintained absolute competence. The Department of Health balance of competence review, necessitated by the fact that, inadvertently, much European legislation and many directives have impacted on the delivery of healthcare, determined broadly that, in those areas where European regulation and directives have impacted on the delivery, it was positive. However, it identified a number of important areas where there were unintended detrimental consequences resulting from European regulation.

I shall concentrate on two areas that were highlighted in that competence review and in the third report of Session 2013-14 of the Science and Technology Committee of the other place. The first is the question of the European working time directive, which has been debated extensively in your Lordships’ House. I return to that because the directive continues to have a very important impact on the way that we are able to organise and deliver healthcare in our country and because the unintended consequences of its impact have been substantial.

The working time regulations have affected the quality of care. Although initially it was anticipated that restricting working time to 48 hours per week for trainees would promote patient safety and improve quality, regrettably that has not been the case in this country. Indeed, where the question of the duration of working hours for junior doctors has been studied carefully, particularly in the United States, it is clear from prospective evaluations that have been undertaken over a period of time that such a restricted period of working each week has a detrimental impact on patient safety.

There has clearly also been a detrimental impact on our ability to train junior doctors.

[Lord Davies of Stamford]

I am most grateful to the noble Lord for giving way. I greatly recognise and admire his expertise and experience in this area, but can he perhaps tell the House why our continental partners, in France and Germany and so on, do not seem to have had the same problem with the delivery of healthcare that he suggests we have had as a result of the directive?

[Lord Kakkar]

I thank the noble Lord for his intervention. That is because the application of the working time directive in those countries has been different from our rather fastidious application of the directive here in the United Kingdom. It is also due to the fact that the organisational structure for the delivery of healthcare is very different in France and Germany from the way that we deliver healthcare in our country.

Particularly in the craft specialties, such as my own specialty of surgery, trainees have found it increasingly difficult, within the restriction of 48 hours and the restricted period of time now available for specialist training, to develop the skills necessary to deliver independent consulting practice, which is very much a feature of the delivery of healthcare in our NHS but is rather different from countries such as France and Germany, where they tend to have larger departments with a much more hierarchical structure.

There has also been a substantial cost impact from the adoption of the working time regulations. In the first full year after their application across the National Health Service, an extra £200 million was spent on the provision of locums to fill rotas necessary to cover the provision of out-of-hours care within the NHS. Indeed, just for surgical specialties, the Royal College of Surgeons has assessed that an additional £60 million was spent to provide locums to cover surgical rotas. The Royal College of Surgeons estimates that, because of the application of the working time regulations, some 40,000 surgical hours are lost per month. Again, that has had a detrimental impact on ensuring that access to services can be adequately delivered to meet workload demands. Most worrying is the fact that, on a number of occasions, coroners have included in their narrative verdicts reference to the working time regulations as having had a detrimental impact on the care of individual patients.

Her Majesty’s Government recognise that this is an important challenge. Indeed, in 2010, the then Health Secretary and the Business Secretary announced that they were to initiate negotiations with our European partners not on withdrawing from the working time directive as it applies to healthcare but on ensuring greater flexibility, which would allow us to develop training schemes to meet the specific needs of the NHS in England in the training of our trainees. That resulted in the process being pursued through the mechanism of the social partners, but regrettably that negotiation has failed and the question has now been returned to the European Commission.

Clearly, this is an important area where action is required. As I have said, we need not to withdraw from the working time directive but to allow the necessary flexibility to allow working hours to increase from the current level of 48 hours to 56 or 65 hours, depending on what point trainees are at in their training and on what specialty or discipline they are training in. Can the Minister confirm that this might be a priority area in any further negotiations with our European partners?

The second area is the question of clinical research. Our country has a very distinguished heritage in terms of its contribution to biomedical research globally. The citations for research undertaken in our country are substantial. Some 12% of global citations for biomedical research are derived from research conducted in our country, a substantially greater proportion than in any other country in the world. Much of this is based on our distinguished history in delivering important clinical research. In 2001 6% of all patients entering clinical trials in the world came from the United Kingdom. By 2006, after application of the clinical trials directive, that had fallen to 1.4% and in the period 2007-11 there was a further 22% decline in the number of patients entered into clinical trials from our country.

The clinical trials directive has not only impacted on clinical research in our own country, it has affected all other European member states in terms of their competitiveness globally to deliver clinical research. The Medicines and Healthcare Products Regulatory Agency, which registers new clinical trials, identified in 2007 some 1,207 new trials registered. By 2011 it was down to 943. Clearly, the clinical trials directive is having a detrimental impact. It has, indeed, been renegotiated and a clinical trials regulation was agreed in 2012 by the European Parliament, due for application in 2016. The third report of the Science and Technology Committee of the other place identified ongoing concerns even about the newly drafted clinical trials regulation, concerns that were raised in evidence the committee received from the Academy of Medical Sciences and from the Wellcome Trust, a major funder of clinical research in our country.

In the area of clinical research, I suggest not that we withdraw from the clinical trials directive or the future clinical trials regulation, because there are important benefits to having a certain standard across the European Union, but that we should be able to ensure that flexibility provides for the specific environment in which we undertake and deliver clinical research in our country, with the strong national clinical governance mechanisms that we have in place, rather than find that the directive and the future regulation have had a detrimental impact on our ability to remain competitive in the life sciences area. The life sciences are an important feature of national activity, both in terms of ensuring excellence in our health service and in terms of the economic impact that life science industries have for our country.

Health and Social Care Bill

Debate between Lord Davies of Stamford and Lord Kakkar

Tuesday 25th October 2011 Lords Chamber

[Lord Davies of Stamford]

I certainly agree with the noble Baroness on that. If I have to speculate again, the only hypothesis that I can credibly come up with is that the education and training requirement was not initially in the Bill because the whole thing is a hurried, makeshift, politically driven, ill thought through and frankly almost frivolous exercise—an appalling way to treat a great national institution of which we are all so proud.

I return to the publication of the White Paper in 1944, to which the noble Lord, Lord Walton, referred. He even lobbied the Minister at the time, Mr Willink. It was before I was born and it is wonderful to see the noble Lord in such great form all these years later, defending the NHS. It was an all-party achievement. I am afraid that the Conservative Party in its modern form no longer has the deep commitment to what many of us feel is a matter of national consensus that we hope will continue.

I repeat that this is in no way a personal attack on the Minister: far from it. He did everything that he could to remedy the situation. However, the Government right through the election campaign were against any kind of top-down reorganisation of the health service. They come out with a half-baked Bill, are immediately attacked from many sides and make concessions. People continually run to David Nicholson and say, “You’d better redraft this or that, we haven't thought about this, we have a problem here, what do we do about this?”. David Nicholson dashes off something on a piece of paper and we get another amendment. It is not the way to legislate on any serious matter. It is certainly a lamentable way to legislate on our great National Health Service.

[Lord Kakkar]

My Lords, I strongly support the amendment in the names of the noble Lords, Lord Walton of Detchant and Lord Patel. I remind your Lordships of own interest as professor of surgery at University College, London. I point out that of all the Members of your Lordships' House who have a background in medicine, I completed my training most recently, some 12 years ago, and am acutely sensitive to the fact that training is vital if we are going to deliver high-quality care. I still remember vividly, and benefit from, the instruction that I was given in my training as a general surgeon.

The purpose of the Bill is to ensure that we provide the highest quality healthcare, achieving the very best outcomes and always putting the interests of the patients of our country at the centre of everything that we do. For this purpose, we need to achieve two fundamental objectives. We need high-quality education of undergraduates to prepare them properly for a life in any of the healthcare professions and to inspire them to be excellent doctors and other healthcare professionals. We must also ensure in postgraduate training that we train future doctors and other healthcare professionals to develop the skills that they require to deliver the best for our patients, and the judgment to apply their skills in an appropriate fashion.

Our system of training is so good and respected throughout the world because it is clinically based. Throughout, those who are fortunate enough to be taken on for training in positions in the National Health Service are exposed to, and have the great privilege to be involved in, the care of the patients of our country. However, the delivery of education and training is a hugely complex issue. Not only must we have the matter in the Bill; it must be dealt with in detail. Notwithstanding the fact that Her Majesty's Government propose to introduce a further Bill to deal with education and training in healthcare, which will be hugely welcome, in the intervening period we must recognise that the delivery of healthcare is integral to the delivery of education and training.

I give an example from training in surgery. Consultants who wish to take on training responsibility have to be trained to do so. They must make time available to have the training to become a trainer. They need to organise the delivery of their clinical practice in the care environment in which they work in a thoughtful fashion, to provide training opportunities for their trainees. Frequently that will mean that the utilisation of NHS resources is less efficient than if the facilities and sessions were delivered purely by a consultant. Training takes time; trainees work at a slower rate; they interrupt what they are doing to seek guidance; and they must be provided with the confidence to become good practitioners.

Beyond that, we need to release those working in our healthcare systems to support medical royal colleges and other professional bodies to set and then supervise the standards of training that must be applied across the National Health Service. That takes them away from clinical practice and again makes the utilisation of the resource potentially less efficient. For trainees, we have to provide an environment that supports training. This is complex, because it requires not only release from service commitments—again, this has an impact on resource utilisation in healthcare systems—but time within the delivery of clinical practice to learn to develop judgment in a fashion that is less efficient than it would be if the clinicians had been fully trained as medical or other healthcare practitioners.

For this reason, I strongly support the amendment that education and training must appear in the Bill as a commitment, an obligation on the Secretary of State for Health. We must also spend more time dealing with the issues that might present problems between the enactment of the Bill and the subsequent appearance of a future health Bill that deals specifically with education and training.

Armed Forces Bill

Debate between Lord Davies of Stamford and Lord Kakkar

Tuesday 6th September 2011 Grand Committee

[Lord Kakkar]

I speak to Amendment 11 in my name and that of the noble Lord, Lord Patel. The matters I wish to cover in this amendment were dealt with at Second Reading in my own contribution, and relate to the obligation as part of the covenant to make an annual report with regard to matters of healthcare that attend former or current membership of the Armed Forces.

The amendment proposes that that report be properly informed through the collection of objective evidence that will allow us to ensure that the conclusions reached with regard to the impact of service on health status and the requirement to access healthcare facilities are properly recorded, and that conclusions derived from that report can be used to inform the provision of services in the future.

The health consequences of membership of the Armed Forces receive coverage regularly in the media, but much of that is anecdotal reporting. It does not provide the opportunity to constructively understand the implications of service, or how health services should best be provided to ensure that those who have served our country in such an important way have available primary and more acute hospital services that meet their needs. A report to Parliament dealing with the healthcare consequences of membership of the Armed Forces is very welcome. If it is not properly informed by prospective research, however, it will be meaningless and provide little opportunity to report anything other than anecdote.

These two amendments are not onerous. They just ensure, in moving forward a report on the question of healthcare and health status, that questions are posed at the beginning of any reporting cycle; that objective evidence is collected using established public health methods to answer those questions; and that those questions are reported in a systematic fashion to inform future development of policy, and to ensure that we are not in any way denying services or the best possible health outcomes for those who have served our country.

[Lord Davies of Stamford]

My Lords, I say, first, that the Bill is extremely welcome. It is clear that Clause 2 is very well intended by the Government, but also that there has been a consensus among the contributions in Committee so far this afternoon that it does not go far enough and is inadequate. I congratulate all four supporters and proposers of the amendments who spoke; their contributions were extremely helpful. I will make one or two comments on each, starting with Amendment 11, tabled by the noble Lord, Lord Kakkar.

I totally agree with him that it is important that we should have professional analysis of the problems in the medical field before we start reporting on how adequate the medical facilities are, either for those who are serving or for those who have served. Clearly, we need to know what the problem is before we can assess the effectiveness of any solution that is proposed or implemented. However, with great respect to the noble Lord, I say that his amendment has it the wrong way round. It is wrong to wait for the stage after the reviewer has produced the review, at the point where the Secretary of State is going to publish the report, to have that specialist professional work done. We should start with that; it should be the evidential basis on which the reviewer works. He should compare the facilities in place with the professional advice on what the facilities ought to be. That work should be done at the outset, and I hope that if the reviewer is doing his job he will commission such work.

Under the proposals tabled by the right reverend Prelate the Bishop of Wakefield, my noble friend Lord Touhig and the noble Lord, Lord Ramsbotham, as well as in the original draft of the clause, there is provision for the reviewer to receive remuneration. Therefore, I do not see a problem in that. Perhaps we should not tell the reviewer exactly how to do his job, but we should express the hope, here and in other contexts, that he will commission professional work of the kind that has been suggested—or else there should be an obligation on him to commission the work. We should not leave it to the second stage of the Secretary of State.

I find myself entirely in agreement with Amendment 10, tabled by the noble Lord, Lord Palmer of Childs Hill. I do not know why anybody would disagree with it. The issue is one of making sure that the report covers what progress has been made in the provision of housing. This is not in any way a prescriptive obligation placed on anybody; it is purely descriptive and sets out the facts. I do not see why Parliament should resist a proposal, which is not unreasonably costly, that we should be given the facts when we ask the reviewer to review the state of housing. We need to know the facts relating to the portion of housing that is in the hands of housing associations. I am very much drawn to the proposal.

I turn to Amendment 9, put forward by the noble Lords, Lord Lee of Trafford and Lord Glenarthur, the noble Baroness, Lady Taylor, and the noble and gallant Lord, Lord Stirrup. At first sight I thought that it was a splendid proposal, but it is a little ambiguous. It states that the covenant report must include a statement that,

“the provisions of the report are compatible with subsection (2)(a)”.

I am not sure what that is intended to mean. Is it that the statements of fact in the reviewer's report are a correct description of the facts in the respective areas of health, education and local government? Or does it mean that any shortcomings that have been identified, and any recommendations that have been made, have been resolved and implemented by the time that the three Secretaries of State signed the statement? It is slightly unclear what is intended. If it is the latter, that has cost implications of a potentially unlimited kind, so the Treasury may see some difficulty in that. If it is merely a matter of the three Secretaries of State explicitly endorsing a description of the facts that the reviewer has uncovered, I see no objection at all: indeed, that would be extremely helpful.

Amendment 2, the key amendment in this group, is in the names of the right reverend Prelate the Bishop of Wakefield, and the noble Lords, Lord Ramsbotham and Lord Touhig. It is designed to address an obvious inadequacy in Clause 2 as produced by the Government; namely, first, the reviewer has to report only on “healthcare, education and housing” and, secondly,

“such other fields as the Secretary of State may determine”.

We know that “healthcare, education and housing” are not the full picture as far as the covenant is concerned. Several issues have been raised, notably veterans, which is terribly important. But there are also such issues as, for example, coroners’ inquests—this is a big issue which we will need to discuss during these proceedings and has been left out—and many other things.

Another aspect which concerns me is any potential discrimination which may exist against members of the Armed Forces. I am sorry to say that when I chaired the National Recognition of the Armed Forces report some years ago, we uncovered and documented in that report a number of cases of serious discrimination against members of the Armed Forces in this country. Luckily, we have not had incidents of that kind—at least not that I am aware of—in the past few years. But should such a situation arise again, the issue very much should be the target of a report by the reviewer on how the covenant is being implemented. I think that all sides of this Committee are agreed that there are many issues other than those three provided for in Clause 2.

Surely, the idea of the,

“other fields as the Secretary of State may determine”,

is ludicrous. This Bill would be a laughing stock if it went forward in that way. That someone should decide what aspects of fulfilment, responsibilities or behaviour should be reported on would be regarded as ludicrous in any other context and is, indeed, ludicrous in this context. That certainly should not stand.

Therefore, the proposals put forward by the right reverend Prelate the Bishop of Wakefield are very much to be welcomed. I see no obvious difficulties with any of the text of this provision and no reason why I should not support it if it comes to that point. It is again not a provision that places significant financial obligations on the Government. Of course, the reviewer has to be paid and he is allowed to run up some expenses and to pay his staff, which must be reasonable. We have already gone through one aspect of where he may legitimately incur expenses—for example, on professional medical advice. But these are small sums and very small beer. It could hardly be considered to be a serious financial liability.

I hope that the amendment commends itself to the Government. If they were to accept this, I believe that they would find immediately that there was a qualitative enhancement in the credibility and impact of the Bill as it becomes an Act of Parliament. It would make a real, historic change in the way in which this country regards the covenant, to which we all feel an obligation for the men and women who serve in our armed services.