NHS: Health Improvements

Lord Turnberg Excerpts

Wednesday 26th November 2014 Grand Committee

[Lord Turnberg (Lab)]

My Lords, it is about two years since I last stood in for the Opposition Front Bench, so I reckon that I have been forgiven for my previous appearance. It is a pleasure to speak after what has been a fascinating debate, and of course I am grateful to the noble Lord, Lord Kakkar, for introducing it in his usual erudite manner. If anyone is an expert in innovation, he is. I declare my interest as a scientific adviser to the Association of Medical Research Charities.

The noble Lord, Lord Kakkar, is surely correct in asking the question in the title of this debate about what impact innovation has had on the NHS. Of course, we need to know much more about how helpful all the innovations that we are introducing into medical practice really are, but it is easier said than done. It is rather like trying to measure the productivity of services like nursing or medicine. Economists tell me that it is easy to measure the productivity of material goods, but what do you measure in services? Is it the number of patients seen, the number cured, patient satisfaction or other intangibles? It is not straightforward. Furthermore, we may know that something works under the carefully controlled conditions of a clinical trial, but we do not know how effective it might be in the hurly-burly of clinical practice. It may take many years before an innovative treatment is widely taken up. Even when it is, it may take a long time before we see its impact on a reasonably representative number of patients. So, although it is essential that we try our best to trace the relationship between innovation and improved care, it is not straightforward. Despite those difficulties, it is clear that the UK is really pretty good at innovation and we are doing well from advances in medicine. We are all living longer than ever before, gaining about two years of life expectancy for every 10 years that go by, and at least half of that improvement has been shown to be due to advances in medical treatment. So we must be doing something right.

When I look back—if noble Lords will forgive me for looking back—at what medical practice was like when I started as a young doctor more than 50 years ago, the transformations have been remarkable. In 1957, there were few effective treatments for cardiovascular disease. Heart attacks had a high mortality rate. There was no angioplasty or bypass surgery. There was nothing for childhood leukaemia—uniformly fatal then, but now mostly cured. Hip replacement surgery was hazardous and rarely successful; that was before John Charnley, who the noble Lord, Lord Selsdon, mentioned. There were no knee replacements or cochlear implants and there was no organ transplantation. I remember going round the wards and seeing rows of polio victims lying immobile in iron lungs. Thankfully, all that has gone.

Medical innovation has been a constant during my lifetime, and patients are infinitely better off, even in the absence of a good system for monitoring its impact. Now we are on the cusp of an even more dramatic change in medical care, with remarkable advances in genomics, digital health and regenerative medicine, and the UK is at the forefront in most of these fields. As the noble Lord, Lord Kakkar, said, the Government, to their credit, are supportive in a number of ways. They set the scene with their Innovation, Health and Wealth report a couple of years ago. The NIHR, under Dame Sally Davies’s direction, is producing results, not least through its very successful academic health science networks and centres, as the noble Baroness, Lady Brinton, emphasised. The various innovation initiatives are also very helpful. The recent rationalisation of ethical approval processes and regulation by the HRA is bearing fruit, and the moves now afoot to reduce the time taken for regulatory approval by the MHRA and the EMA are very welcome. They should help bring much needed drugs to market more quickly for patients and, at the same time, encourage the pharmaceutical industry to invest.

Of course, not everything in the garden is rosy. For example, there are still things to be done by NHS England to speed up its approval of drugs for rare diseases. The recent report from Genetic Alliance UK found that there are no fewer than eight committees involved in assessing these innovative drugs and no fewer than 11 stages to be gone through before approval. Clearly that cannot be right. Perhaps most important is the thorny problem of the woefully slow dissemination into clinical practice of all the fruits of our excellence in innovation. This resonates very much with the remarks of the noble Lord, Lord Mawson. It is here that the Government need to focus much more effort. The barriers to spread and to practice are multiple and well known. They include not simply a medical profession that is not always eager to accept change—although there is some of that, particularly in general practice, where pressures to provide the service are high and distracting—and a lack of tools and expertise to be able to take up innovation. Even more importantly, there is a lack of continuity at trust chief executive level, where few stay in post longer than two years. Introducing change and innovation in a hospital takes years of planning and the winning of hearts and minds not only in the hospital but in the community, but managers are too often taken up with immediate fire-fighting pressures and only just begin to think about the longer term before they are moved on.

Then there are the funding issues that bedevil the introduction of new treatments. CCGs and trusts are too often reluctant to fund new drugs because of costs. This is especially true of the high-cost so-called personalised medicines that are being developed to treat smaller and smaller subgroups of patients. None of this is helped, of course, by the uncertainty surrounding the future of the Cancer Drugs Fund or the continuation of funding for the academic health science networks. Some clarity there would be helpful.

The UK does extraordinarily well at innovation and has a health service in which a million patients are seen every 36 hours, and they are patients that we have in our care for the whole of their lives. What a marvellous opportunity that provides to innovate for the good of everyone. However, if we are to take full advantage of these wonderful resources, we must place much more emphasis on overcoming the multiple barriers to dissemination that are getting in the way. I hope that the noble Earl will comment on how the Government will address them and the many other issues raised by other noble Lords.