Life Sciences Industrial Strategy (Science and Technology Committee Report)

Baroness Young of Old Scone Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Baroness Young of Old Scone (Lab)]

My Lords, I too served on the life sciences and industrial strategy Select Committee, and I commend the excellent chairmanship of the noble Lord, Lord Patel. I am not going to talk about buses. I am going to talk about the NHS.

The Government’s ambition to make the UK the most attractive place for national and international investment is highly commendable, particularly in life sciences, where we are already a global leader, though as an aside to the main question for debate, I would recommend to the House as obligatory viewing the appearances last night and this morning of Sir Paul Nurse, Director of the Francis Crick Institute. Sir Paul has, with his great authority, laid out clearly that we are in imminent and real risk of squandering this position of global leadership in life sciences research and innovation as a result of Brexit and particularly the lack of clarity about the negotiations and process.

One of the reasons we should be a global leader in life sciences is that we have the NHS, which provides increasing access to large-scale, long-term databases and a testbed for innovation on a national scale. The UK biobank is an example, with half a million participants across the country and a growing resource for medical research. There are many other future opportunities for capitalising on the NHS in this way. I am going to focus particularly on recommendations 16 to 20 from the report, which are about the role of the NHS.

The Government’s response outlined an additional £500 million in government funding for the life sciences sector as part of the sector deal and that,

“our globally renowned NHS will be a key partner in delivering the deal”.

But when taking evidence from a range of research and NHS bodies, it became clear to the committee—focused by the NHS on the adoption and spread of life sciences—that innovations in support of research and improved patient care were simply not happening either at pace or at scale. The Government have put in place actions to encourage adoption of life sciences innovation by the NHS. They have relicensed the Academic Health Science Networks for a further five years and given them a more explicit focus on the nationwide adoption of proven innovations. AHSNs have committed to nationwide adoption spread goals, but only for seven programmes over the next two years. This seems to me too little, too slowly. Indeed, the view of some witnesses was that the AHSNs were trivial in scale and lacked oomph. Throughout their response the Government list how NHS England, NHS Improvement and the AHSNs figure in some individual programmes for innovation adoption, but the response fails to focus on how the NHS can be developed as a fundamentally innovative organisation and system.

So let me turn to the relevant committee recommendations, what we heard from witnesses and what the Government said in response. Recommendation 16 is particularly germane: it says that the current structure of the NHS stifles innovation and that a focus on cost control and lack of co-ordination between NHS bodies means adoption and the spread of innovations are not given the priority they require.

The Government in response to this issue have set up yet another new group, called the NHS life sciences and innovation group. In common with the noble Baroness, Lady Neville-Jones, I was concerned that we were seeing yet another group. It reminded me of the old story of the politician who when he identifies a problem makes a speech, and when he identifies a serious problem makes a series of speeches. We seem here to have a series of committees, the one layered on the other. What is needed is not another committee or a range of small-scale initiatives, but a concerted, integrated approach to changing the whole culture of the NHS away from cost reduction and risk avoidance to one embracing innovation.

I recognise that the Government have outlined their response—again, I quote:

“Working with clinicians, managers, policy makers, industry and charities we are developing plans to expand the pipeline of innovations proven to be effective, and their subsequent adoption at pace and scale”.


I recognise that progress has been made on implementing NHS England’s published 12 actions to support and apply research across the NHS. I recognise that NHS England,

“is exploring additional financial incentives for increasing the adoption of innovation, for example through the development of CQUIN indicators, and linkage to best practice tariffs”.

However, it was clear from across the evidence that we received from NHS England, NHS Improvement and others that the NHS sees new things as cost and not opportunity, and that its objective is not to spend money. NHS Improvement told us that innovation,

“is not the centrepiece of what the NHS is trying to do … securing productivity is”.

We had much discussion about the more abstruse definitions of innovation. There were “additive innovations” and “substitutive innovations”. Additive innovation is where the innovation provides higher levels of care but costs more; substitutive innovations provide higher standards of care and save money. There seems to be a notional commitment from the NHS to adopt the substitutive innovations but not the additive ones, since those would cost more and cannot square with pressurised NHS budgets. Yet we are clear that the additive innovations could be some of the most promising and profitable for UK plc.

Even the substitutive innovations, which improve standards and save money, are not being adopted by the NHS nationwide at pace. I therefore commend wholeheartedly to the House the committee’s recommendation 20, which urges mandation,

“of those innovations that have been shown to improve patient outcomes and provide good value for money”.

A small start on this has been made in the past. Medicines approved by NICE are allegedly mandated to the NHS, but local CCGs do not always approve local adoption. It is interesting that the Accelerated Access Review did not address non-adoption by local clinicians or CCGs. CCGs can decide what to do individually. We appear to have lost the N from NHS, in that decisions are now made in such a delegated way that any central mandation simply does not happen.

Let me illustrate the lack of co-ordinated effort in making one national decision on best practice which could then swiftly be adopted across the whole system. When I was chief executive of Diabetes UK, we developed innovative best practice care pathways which would improve care for people with diabetes and save substantial sums of money. We first offered them to the NHS, but there was no real mechanism for introducing standardised best practice across the system. In desperation, I offered them to the then Chancellor, George Osborne, and told him that I could save him £1 billion from the NHS budget on the basis of them. I am still waiting for a reply. In the end, we as a charity had to hike a dedicated change team around every CCG and trust, persuading them one by one to adopt best practice which would save them money. We did not charge them; we simply took our costs from the money they saved.

I commend an initiative by NHS Improvement which also uses boots on the ground to persuade trusts and CCGs one by one. It is called Getting It Right First Time, a programme which has now expanded to cover more than 90 specialties working with local clinical networks. However, mandation of best practice, validated once at national level and then mandated across this allegedly “National” Health Service, would be so much more immediate. It should not have to be this difficult to get these things to happen.

The USA does not have the national test bed for innovation that the NHS represents, except perhaps on a smaller scale in the veterans administration hospitals. Oversight by the medical insurance companies, by managed healthcare organisations and by commercial and not-for-profit hospital chains shows how innovation and best practice standardisation can be mandated and backed up by local key performance indicators.

Why is mandation of innovation which improves patient outcomes and saves money not supported by the Government as an easy way forward? We can no longer as a nation afford an NHS which is highly variable in terms of innovation and value for money at the whim of local CCGs, trusts and individual clinicians.

I have one last challenge for the Government. As yet, we do not have a strategy for developing and exploiting innovation to meet the real future challenges of the NHS: ageing, multiple complex conditions, resistant infections, antibiotic resistance and general immune system compromise—to name but a few. How do we fill the “somebody needs to” gap? What does government plan in this respect to really anticipate the future in our innovation and research strategy as part of the industrial strategy? It is a vital strategy; we are a global leader and are in danger of losing that position. The Government need to show more bottle over this strategy.