NHS: Health Improvements

Lord Kakkar Excerpts

Wednesday 26th November 2014 Grand Committee

Asked by

[Lord Kakkar]

To ask Her Majesty’s Government what impact the National Health Service innovation and research strategies have had on health improvement.

[Lord Kakkar (CB)]

My Lords, I declare my interests as Professor of Surgery at University College London, chairman of University College London Partners and UK Business Ambassador for Healthcare and Life Sciences.

It is a great privilege to open a debate on the subject of innovation in the NHS since I believe that at no time in the history of the NHS has innovation been so much at the centre of policy and thinking as it is now—for example, the life sciences strategy announced by the Prime Minister in December 2011, the subsequent Innovation, Health and Wealth report that focused on developing academic health science networks, the creation of academic health science centres, building on the record of the previous Government or, indeed, for the first time in the history of the NHS, including in a Bill the obligation for the Secretary of State, NHS England and clinical commissioning groups to promote research in the NHS.

The environment for research and innovation is at an all-time high. This is particularly important because it is well recognised that from establishing a therapeutic innovation or technical innovation that could improve healthcare, it takes some 17 years for it to be fully embraced and embedded in a healthcare system. This remains a shocking statistic throughout the world given that many of these innovations have the capacity to impact clinical outcomes profoundly, in many cases by reducing mortality and burden for patients.

But beyond the importance with regard to health gain that innovation can provide to the NHS, it is well recognised that many innovations, such as improved ways of delivering the practice of healthcare, can have a profound impact on the utilisation of healthcare resources. We are uniquely positioned in this country to have a life sciences and healthcare ecosystem given our unique National Health Service, our extraordinary universities, some of the leading biomedical research institutions in the world and our small and medium-sized enterprise sector around healthcare and the life sciences. This ecosystem has led to the development of a life sciences industry in this country which is second only to financial services in its importance to the economy, employing some 170,000 people, providing around £52 billion to the economy, and with 5,000 enterprises. This achievement is reflected in the success of our healthcare and life sciences research. A nation with about 1% of the world’s population provides 12% of the annual cited published output in the biomedical sciences globally. We have a huge investment, be it through government and the charitable sectors—and, of course, from industry research and development—in our universities and health service. Every pound of that investment provides a return of 39 pence per annum in perpetuity, which is a quite remarkable contribution to our economy.

There is much that we must do to ensure that this commitment to innovation in the NHS is sustained. At the time of the one-year review following the original publication of the Innovation, Health and Wealth strategy, it was agreed that there would be a sunset review of some 60 organisations involved in innovation and improvement in the NHS. That is a very important commitment to satisfy all involved, particularly the taxpayer, that the commitment to innovation was funded and directed in the most appropriate fashion to deliver tangible results in terms of both health gain and wealth creation for society more broadly. In October, in another place, the noble Earl’s ministerial colleague George Freeman answered a Question where he indicated that that sunset review had been undertaken with regard to what was described as the fragmented landscape for innovation organisations in the NHS, but it was not proposed to publish it. That is a little disappointing because the insights from that important review of the innovation landscape and the many organisations contributing to it could help those organisations that are going to remain in the innovation space in the NHS to better understand the successes and failures of those who have been there previously and organise themselves in the most efficient fashion to deliver the vitally important health gains that innovation can provide to our healthcare system. Can the Minister comment a bit on the sunset review and, in particular, whether there might be some opportunity for those organisations that remain in the innovation landscape to learn from its findings?

Much has been made, quite rightly, of the NHS Five Year Forward View, announced by the chief executive of NHS England on 20 November. It is an exciting document that addresses the question of innovation. One interesting conclusion is that the Government remain committed to innovation in the NHS. It is not entirely clear how that forward view sits with the commitments previously made and, in particular, the work of the Innovation, Health and Wealth Implementation Board in NHS England. This is an important issue, because co-ordination of the different strategies and commitments in the innovation space in the NHS is vitally important. How will that co-ordination be achieved in the future? It was not entirely clear from the NHS Five Year Forward View how that would be achieved. Will be it through an ongoing responsibility for the Innovation, Health and Wealth Implementation Board? What role will the academic health science networks, created as a part of that original review, play in the forward view with regard to innovation in the NHS over the next five years?

There was also the important announcement just last week, again by the noble Earl’s ministerial colleague George Freeman, with regard to the innovative medicines and medical tech review, which proposes to determine how we can better develop medicines that will have a big impact on patient outcome more rapidly in our country and provide additional funding to drive forward a more efficient process for the development and evaluation of innovative medicines and technologies. How will that strategy sit with regard to the already established structures of the academic health science networks, which are there to drive a collaboration between healthcare organisations, universities and the independent commercial sector in terms of the life sciences and biomedical research?

There is a very important obligation for government to lead on a culture change with regard to innovation. There is no question that mechanisms and organisations have been established to drive forward the NHS innovation agenda. There is also a need to focus on the culture in NHS institutions both in the community and in the hospital sector to ensure that the provision of innovative therapies is at the heart of clinical practice for all healthcare professionals. I wonder what approach Her Majesty’s Government propose to take towards ensuring that there is a cultural transformation in the adoption of innovative strategies in terms of pace and scale both within individual institutions and across health economies. There is also an important question about regulation, because it can impede research and innovation and the adoption of innovative strategies. We saw this, for instance, with regard to the European clinical trials directive, which had a devastating effect on clinical research output. A revised directive is to be adopted but there are concerns that that may not be done by the 2016 proposed deadline. Is the Minister able to provide some further information on that?

Lastly, there is a real concern in the biomedical research community about the proposed European data protection regulation that will replace the current directive. As originally drafted by the Commission it seemed a sensible approach to data protection but, as amended by the European Parliament, it presents a real threat to the conduct of major research programmes that have a profound impact on the delivery of healthcare, particularly the 100,000 Genomes Project, the UK Biobank and the conduct of cancer registries. These are all at the heart not only of the research effort that is a fundamental part of our nation’s strategy, but also of the delivery of healthcare. Can the Minister comment on where the negotiations are to ensure that the detrimental aspects of this data protection regulation will not apply to our country?