Sandra
Gidley: I welcome these amendments because they give us a
chance to probe where some of this money may be going. Before I
progress with my arguments I was a little concerned by the closing
remark of the hon. Member for Eddisbury, who talked about a culture of
resistance in the health service. My experience of a lot of workers in
the health service
is—
Mr.
Stephen O'Brien: It was
managers.
Sandra
Gidley: And managers. My experience is that they are not
averse to change, although the hon. Gentleman may have spoken to
different people from me. There is a lot of innovation out there, but
sadly it is not recognised by many people, including politicians, it
would seem.
One of my
concerns about the Bill relates to clause 14(1), which
states:
“The
Secretary of State may make payments as prizes to promote innovation in
the provision of health services in
England”, but
says nothing whatever about the NHS. I therefore welcome amendment 18,
which makes it clear that the prize may relate to
“work in any
field relevant to the
NHS”. However,
it occurred to me that a team employed in the private sector could do
work relevant to the NHS and apply for a prize. It would be a concern
to many of us if public money could, as a result of the way in which
the
Bill is drafted, be diverted to the private sector. I hope the Minister
can reassure us on that. Where do independent sector treatment centres
come into this? What would happen if a team was doing something in such
a centre? I have
another concern. When we talk about the NHS, innovation and prizes, we
focus almost exclusively on secondary care. If we are serious about
moving care towards the primary sector, we need a mechanism to ensure
that that happens. For example, optometrists or dentists could have
good ideas for prizes or innovation. My concern is that worthy
committees full of specialists in secondary care will be set up and
will focus automatically on secondary care, biasing what is done.
Innovation is not just about the flashy new procedures, and it is not
necessarily about the research; sometimes, it is just about thinking
outside the box and coming up with a new way of delivering services
that is more convenient for patients and the public and which could
probably reduce some of the strain on the secondary sector.
When the fine
detail is worked out, I very much hope that the prizes will not just be
a means of congratulating those who already have quite a number of
areas in which to show off their expertise. I hope that they will truly
embrace all the NHS.
Mr.
Mike O'Brien: This has been a helpful debate, and the hon.
Member for Romsey has made some thoughtful points, to which I will
return in a moment.
The aim of
the prizes is to reward breakthroughs in the provision of health
services in England, so the provisions relate to the NHS. The
challenges will be designed to tackle some of our major health issues
and bring about not only radical breakthroughs in the prevention and
treatment of lifestyle diseases, but changes in the way in which things
are managed and delivered. That includes secondary and primary
care.
I strongly
take the point from the hon. Member for Eddisbury that innovation could
mean the development to a new level of existing ideas—he is
absolutely right about that. The nature of the process makes it
difficult to assess the quality of what is being done and to draw
attention to it.
We will have
to handle the prizes properly, and to some extent the hon. Member for
Romsey is right that there will be a committee of the great and the
good—there always is in such things. We will have to make sure
that we have the right distribution of responsibilities on that
committee, so that it not only focuses on the obvious issue of
developments in secondary care, but includes management and
delivery.
I agree with
the hon. Member for Eddisbury, although I would not quite put it in the
way that he did, that there is a lack of reward and recognition in the
NHS system. The prizes are a way to incentivise people and focus minds.
They are a way to reward people and to recognise that some people are
anxious to make changes.
Unlike the
hon. Member for Romsey, I agree with the hon. Gentleman that sometimes
in management there is a culture of resistance, inertia or lack of
innovation about the way things are done. If we can provide incentives
such as this to organisations to be more innovative, to show that we
are prepared to put resources behind new ideas that can improve patient
care, then we
will truly feed into that emphasis on quality that came out of the
review by my noble Friend Lord Darzi. That review focuses on ways that
we can improve the quality of the NHS and the quality of delivery and
recognise that we have passed the stage where we just need to focus on
raising minimum standards. This is not just about minimum standards; we
have to have a continued focus on that, but we now need to move to a
higher level and look at how we improve the quality of what the NHS
delivers at the top—make the best better, make the mediocre the
best and ensure that we improve quality throughout the NHS. The scheme is
primarily focused at ensuring that people working in the NHS are able
to see the benefits and recognition for their work in making a
breakthrough. This is not restricted to the NHS; it is available to
those working in academia. We want to ensure that there is a regional
focus. The £220 million regional innovation fund has been
launched and we will target resources at helping front-line staff to
develop, grow and spread new ideas, delivering real improvements in the
quality of the care people receive. Academic health science centre
status has been awarded to five partnerships following the process of
peer review by an international panel of experts. Academic health
science centres will bring together world-class research, teaching and
health care delivery, so that developments in research can be more
rapidly translated into improvements in patient care in the NHS and
around the
world. We
are not restricting the award of prizes to those in the NHS, but we are
ensuring that there is a focus on NHS workers knowing that they are
available to them, that a challenge is being set and that if the
challenge is met internationally or in another sector, a prize may be
awarded. That will happen only if the idea is demonstrated to be
replicable in the NHS. On amendment 136 we would not expect to award a
prize simply for the promotion of innovation in itself. There needs to
be an actual breakthrough and it needs to be replicable in the NHS;
promotion of a project is one element of that. We need to be able to
show that this idea, wonderful breakthrough that it is, can produce a
wider benefit, not only in the NHS but, we hope, in some cases beyond
that and possibly around the
world. On
amendment 137 we are not intending to make payments in instalments. The
challenge prizes are not about giving money in the form of grants for
work to be undertaken, which the amendment seems to suggest. This is
about rewarding work that has been done—we have got an
innovation, we award the prize and then that money can be used to
replicate or extend the innovation or move it to the next stage. We are
going to award prizes for what has been
done. The
hon. Member for Eddisbury asked whether this is meddling in innovation.
Innovation often happens anyway; this is an encouragement of
innovation. In that encouraging innovation and the development of new
ideas is meddling, yes it is. It is trying to provide a prize for those
who excel and to reward excellence. That is something that we should be
doing. We do not want to detract from those in the NHS pursuing
innovation; on the contrary, we want to encourage
it. The
hon. Member for Romsey in her thoughtful speech asked whether this
money would go to the independent sector were it to provide an
innovation or breakthrough that helps patients. It will, if it helps
patients and if it is replicable throughout the NHS. If we can take the
innovation from a private sector organisation and transfer it to the
NHS, or if we can find ways in which it will benefit patients in the
NHS, it will go to a private sector organisation. It is to reward
something from which the NHS will benefit. I hope that I
have dealt with most of the points that were raised by both the hon.
Members and that the amendment will be
withdrawn.
Mr.
Stephen O'Brien: I am grateful to the Minister for
addressing the matter carefully. As he recognises, we are concerned
about this area. There will be significant benefits from getting this
right. It has been helpful that he has clarified that the intent that
lies behind this, which flows from the Darzi report, is that it is
intended to reward breakthrough and reputable innovations or
innovations upon developments. It is a post facto reward, so the
question will be whether that is a sufficient pull-through incentive
and motivator to influence people to shoot for the prize and to make
sure that this inculcates more of a culture of innovative
activity.
The
Minister’s last answer was helpful because it is the equivalent
of reaching a commercialisable stage in the private sector but
absolutely focused on the public sector ethos of the NHS. With that
clarity, I can see that the amendments may not wholly fit with that
intent. The debate has been helpful, however, and I dare say the
Committee of the great and the good, as the Minister described it, may
find our exchanges useful in setting their own terms of reference and
the expectations that are going to be laid upon them. I beg to ask
leave to withdraw the amendment.
Amendment,
by leave,
withdrawn.
The
Chairman: It may be helpful to the Committee in the
interests of progress if we do not to have a separate debate on clause
stand-part because the amendments seem to cover fully the substance of
the important clause 14. Although the clause is important, it is very
short.
Mr.
Stephen O'Brien: I beg to move amendment 19, in
clause 14, page 11, line 3, at
end insert— ‘(4) The
committee shall advise
on— (a) the selection of
candidates for innovation
prizes; (b) the payment awarded
to each prize
winner.’.
The
Chairman: With this it will be convenient to take
amendment 20 in
clause 14, page 11, line 3, at
end insert— ‘(4) The
Secretary of State and his appointed committee may not determine the
field, discipline or sector in which candidates for innovation prizes
must develop their
innovations.’.
Mr.
O'Brien: Thank you, Mr. Key. These amendments
cover the rest of the subject, so the absence of a stand part debate is
not an issue.
Amendments 19
and 20 lead on from the issues that we have just discussed in the last
group. There is a concern that, by allowing the Committee to identify
challenges—a word that the Minister picked up in his last
response—for innovators to tackle, the Government will be
undermining the entire concept of innovation.
Amendments 19 and 20 aim to define more precisely the role of the
Committee and to ensure that they do not determine the field,
discipline or sector from which the innovation must come. One example
is the case raised by Lord Darzi himself as an example of NHS
innovation—the introduction of drug eluting stents in
angioplasty. This innovation came about directly as a result of the
experiences of interventional cardiologists who were involved in
angioplasty procedures on a daily basis and familiar with the use of
stents and catheters in heart surgery. These clinicians identified a
need for the innovation after witnessing first hand the cases of
patients who would have benefited from a drug eluting stent in their
artery. It was the clinicians as opposed to the authorities who
identified the need for an innovation or the challenge that needed
solving. If innovation is about finding solutions to the problems we
encounter in our everyday experience, why should we have these problems
defined for us by the powers that be? Surely the prerogative to
innovate and decide where to innovate should lie with the NHS
professionals and staff themselves, not with a small committee that
will inevitably have a more limited capacity to understand the scope
for innovation in every specialism in the NHS.
I hope the
Minister will take this opportunity to assure the Committee that the
committee that is set up will be wide-ranging enough in its areas of
expertise to identify sectors where innovation is required. On the
subject of the committee’s composition, in its brief to me the
BMA raised the interesting proposition of placing patients and members
of the public on the panel. Not only would this create public interest
in NHS innovation, it would also give an incentive to applicants to
ensure that their innovations directly impact upon patient care. When I
asked the Minister prior to the Bill for an evidence base for the use
of innovation prizes, he gave the example of the X Prize—a $10
million award for innovation across the globe. The X Prize website
states:
“Rather
than awarding money to honor past achievements or directly funding
research, an X Prize incites innovation by tapping into our competitive
and entrepreneurial
spirits.” If
the Minister is using this prize as his model for NHS innovation, I
have to ask why he is proposing to award prizes retrospectively for
research and other innovations. I hope that he has some evidence base
for awarding prizes retrospectively, a point which was confirmed in the
previous group of
amendments. I
also question the need for legislation when the impact assessment
states that the Secretary of State’s existing powers already
allow him to backfill the costs of research. It also states that the
first round of prizes will be launched in 2009, while the legislation
itself will not come into play until 2010. I assume, therefore, that
the Bill is not actually the source of the power that the Secretary of
State needs in order to get this
going. 12
noon
Sandra
Gidley: I note your desire not to have a clause stand part
debate, Mr Key, so I shall try to incorporate my extra comments into
the points I am about to make. Amendment 19 mentions what the Committee
shall advise on. We have some very vague criteria. It would be helpful
if those criteria were pinned down a little more. One thing that
concerned me was the setting up of yet another
committee.
Mr.
Mike O'Brien: I am sorry, I didn’t catch the point
that the hon. Lady was making. Someone coughed and I did not hear
it.
Sandra
Gidley: We are setting up yet another committee, but
presumably an existing committee could advise on these prizes. Clause
14(3)
says: “The
Secretary of State may establish a committee...and may pay
remuneration”. This
also worried me slightly. It is fair enough to remunerate someone from
an outside body, but I suspect that most people on this committee
already work for the NHS in some capacity. I seek some reassurance that
they will not receive extra payments for their work on this committee
when, presumably, their time on the committee will be at the expense of
their other
work. It
would also be helpful if the Minister could clarify whether these
payments are going to go to individuals, heading teams or other teams,
or whether they will go to the trust that will be implementing the
work. I am not entirely clear who will benefit from these prizes. I am
comfortable with the concept of prizes, because it is always nice for
the work of staff to be recognised, it gives people an impetus and a
feel-good factor and NHS workers need some of that, but I am not
entirely clear who will benefit from these
payments. Amendment
20 seems to want to ensure that the Secretary of State or the committee
do
not “determine
the field, discipline or sector in which candidates for innovation
prizes must develop their
innovations”. I
understand the thought behind this, but bearing in mind my earlier
comments, there is another way to look at this problem. I raised
concerns earlier that primary care may not receive its share of the
prizes. Concerns were raised on Second Reading , including by the hon.
Member for Eddisbury, that the right sort of research may not
necessarily feature highly. Is there a case for ensuring that at least
some of the money is allocated to each of these sectors? One would not
wish to be too prescriptive, but this would help the committee to
concentrate its thinking on ensuring a breadth of awards across primary
and secondary care and embracing what is regarded as the more pure
research arena. It would be helpful to know whether there is any
thinking on that.
My final
comment is, again, about money. Things will get very tight, so will
this be a new pot of money, or will resources be diverted from an
existing awards scheme?
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