| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
7.39 p.m.
Lord Winston: My Lords, it was a pleasure to listen to the noble Lord, Lord Glenarthur, who is a wonderful advocate for St. Mary's Hospital. He has introduced a most important debate which is obviously very dear to my heart also. I promise your Lordships that I shall not be speaking on behalf of Hammersmith Hospital; I am not sure that I could match the noble Lord's advocacy. I am sure that all noble Lords will listen with great pleasure to the noble Lord, Lord Hussey of North Bradley, who is to speak next and to make his maiden speech.
I should like briefly to draw your Lordships' attention to what is truly a unique opportunity. It is a world-class opportunity for west London. With the opportunity afforded by Imperial College School of Medicine, we have the opportunity to make what by any standards will truly be a world-class medical school with St. Mary's Hospital, the National Heart & Lung Institute, Hammersmith Hospital, Queen Charlotte's Hospital and Charing Cross and Westminster Hospital. That medical school will have a budget which will probably exceed that of Harvard and which will compare more than favourably with the Mayo Clinic and with Johns Hopkins Hospital. There is no doubt that it is a fantastic
opportunity for Britain and for British medicine. It is most important that it does not founder. As your Lordships will know, it has an outstanding HEFCE rating which is improving all the time. We are pleased to see that happening at St. Mary's Hospital. It is great news. We are dealing with five-star institutions which will contribute greatly to medical education.There is no doubt in my mind that the research done at that medical school will have the most major impact on the whole of the NHS. It is not just a question of individual specialties, although some have been mentioned, such as chest disease, vascular medicine, obstetrics and gynaecology and renal and liver medicine. It is also important to point out that at St. Mary's Hospital major and important research has been conducted into the value of primary care. Added to that, which is of crucial interest and great importance to the health service, there has been throughout the medical school an increasing focus placed on the need for evidence-based medicine and the evaluation of results.
Two essential problems face Imperial College School of Medicine. The first is the inevitable concern about the Culyer exercise. It is an important exercise and it is understandable that the Government want to spread the funding across the country, but there is a risk of diluting academic funds to be truly competitive. We feel strongly that the Government are right to recognise the need for selectivity. That is something that the Government have emphasised and this is an ideal opportunity to implement it. We hope very much that the funds will not be diluted too much. Of course, they need to be competed for, but they are important. Clearly, one problem is that if those funds are withdrawn to any extent, the effect on the trusts will be profound. They may founder in consequence because they depend on that sort of money.
The other concern was raised by the noble Lord, Lord Glenarthur. I refer to the question of competition between trusts. It is most important that we find a way to increase co-operation between trusts. We have done that in my own group. We have a close collaboration with St. Mary's Hospital on reproductive medicine. I believe that it could be a model for many other branches. It is ridiculous, for example, that 50 renal transplants are carried out at St. Mary's with rather a few more than 30 being carried out at Hammersmith. Whatever the figures, surely it is much more sensible to share the proceeds and the academic value. It would be terrible if such a strong academic institution which has such potential foundered simply because of failed NHS partnerships. I hope that the Government will do all that they can to support this.
7.43 p.m.
Lord Hussey of North Bradley: My Lords, it is a great honour, albeit a daunting one, to address your Lordships for the first time and I hope I may crave your customary indulgence to those making their maiden speech.
I am most grateful to the noble Lord, Lord Glenarthur, for raising this important issue. I must first declare an interest. I have been chairman of the Royal
Marsden Hospital since 1985 and on the board of the Institute of Cancer Research. They work as one. On behalf of the King's Fund, I am chairing for the second time its Commission on London Health--possibly another triumph of hope over experience.We have just received a formidable report from the deans of London's medical schools stressing that London is a medical power-house with a world-wide reputation for clinical care, research and education. It is an under-valued national asset, contributing notably to our economy. Brains, ideas and their application are the currency of the future. Top quality patient care depends on top quality research. Yet university funding for equipment has been cut by 30 per cent. and core staff numbers are being reduced. Investment in London's academic medicine must be a priority for our national prosperity.
What is true of London as a whole is certainly true of west London which on its own has an outstanding concentration of medical excellence. Many changes have taken place since the Tomlinson and King's Fund reports. Among their recommendations was further rationalisation in research and patient care. I firmly supported that, but I did not support the suggestion that the Royal Marsden and the Royal Brompton should be closed and rebuilt on the site of Charing Cross Hospital. Happily, those eccentric proposals were blown away. The Marsden was not closed and I should like to thank your Lordships for your great support, for which the hospital and, more importantly, its patients are deeply grateful.
Five years later, I hope that your Lordships will feel that your efforts were not wasted. For each of its first three years, the Marsden Trust has operated within its budget. Moreover, in the recent HEFCE review, the institute and the Marsden came second out of 30 undergraduate and post-graduate medical schools--second to Oxford University. If it had to be a university, I must say that I am glad that it was Oxford.
Imperial College, the Hammersmith and the Brompton also finished high in the merit table. We need not fear for the quality of research in west London, but for its funding. The Marsden's research grant is reduced by £15 million and NHS prices will increase by 140 per cent. Although the money is redistributed among the authorities, I fear that they may use it for purposes other than the referral of their patients to specialist hospitals. That is bad for patients, bad for research and bad for the hospital. We must maintain the necessary patient flow critical to our clinical research programme. But, as the noble Lord, Lord Winston, said, there is increasing collaboration. I believe that the most important is the grouping around Imperial College. I hope that the Institute of Cancer Research will shortly become involved in that.
However, there are problems. More people are reaching an age when they are likely to need treatment and are living longer just at the moment that that treatment becomes more expensive. There has been an explosive growth in medical technology, especially in expensive but effective drugs. The cost of treatment in some areas outweighs the savings in others. More capital investment is needed. In the Marsden, we have
opened a new breast and diagnostic unit, entirely paid for by voluntary contributions. I believe that it will be increasingly difficult to sustain the health service on its present funding, a point also made by the academic deans.Finally, I should like to pay a tribute to the nursing profession with which I have been connected for many years, starting during the war when I was nursed by German Catholic nuns who tended us prisoners with dedication and compassion, demonstrating also an unexpected talent for bartering our cigarettes for eggs and vegetables on the black market. In retrospect, they were quite exceptionally politically correct. The part played by nurses and their impact on the morale and health of patients is often overlooked, as is the benefit of nursing research. There is increasing evidence that the care of specialist nurses, accustomed to handling the challenging problems of pain, disability and emotional stress can lead to patients getting better more quickly or at least to making their lives more comfortable. For that reason, the institute has recently established a Chair of Nursing Research. Specialist cancer nurses are at the forefront of cancer treatment.
I believe in the health service. Support for it is deeply rooted across the nation and across all political parties, but in the past 50 years the terms of trade have changed. The equation between what the national budget can afford and what treatments the developments in research technology and medicine have made possible is increasingly difficult to balance. In some way, that balance must be restored.
7.50 p.m.
Lord Butterfield: My Lords, I am greatly honoured that I have been given the opportunity to speak immediately after my old colleague the noble Lord, Lord Hussey, and to congratulate him on his splendid maiden speech. That is the main responsibility of the immediately following speaker. He has spoken knowledgeably. I shall spend most of my few minutes praising Duke Hussey rather than developing the themes that may come forward in the health service.
I agree with much of what previous speakers have already said. As a former professor of the University of London who is very concerned about the London schools, I hope that there will not be a battle between the academic units and the clinicians. What this city needs is collaboration. That word has been used on all sides of the House. Whatever happens, I make the plea to leaders and Ministers that collaboration should be encouraged.
I should like to say a little about the noble Lord, Lord Hussey. In the summer of 1942 a number of cricketers were sitting around in Vincent's Club in Oxford. They were greatly worried about how they would dismiss John Bridger, who was then a leading and prolific all-rounder for Cambridge. Somebody said that there was a chap in Trinity who had got Bridger out in all of the house matches when he was at Rugby. We called in Duke Hussey who did exactly as we wished. He got Bridger out at the very beginning of his bowling spell. He complained, quite rightly, that I had taken him off
too soon; otherwise, the match would have been won before tea. Never mind. He then went off to join the Grenadier Guards and served bravely and splendidly in Italy. He was wounded and lost a foot. Noble Lords have heard that he was nursed by some splendid German nuns.Since the Second World War he has had what can only be described as an incredible career. I consulted Who's Who and Dod's and made a few notes. This man was managing director of Harmsworth Publications soon after his return in top gear. He was on the executive board of the Thomson Organisation. He was chief executive and managing director of The Times during a very difficult period for that newspaper. Those of us who watched him in his time there were firmly of the opinion that Duke would make sure that good sense prevailed rather than wild politics.
He went on to become director of William Collins, and for 10 years was chairman of the BBC. Some of your Lordships went with me to a luncheon with Duke just before he stepped down. He made a prodigious after-lunch speech. We have much to look forward to if we can get this man on his feet many times. The most memorable point in the speech that I remember, which is related very closely to the remarks of the noble Lord, Lord Glenarthur, about the need to watch the costs of the health service, was Duke's comment that he was the man who taught the BBC a four-letter word. I was rather shocked. He said that the word was "cash". One had to appreciate that one could not do everything one wished because there were cash limits.
Duke Hussey has been on the board of the British Council and chairman of the King's Fund London Committee. He is also a trustee of the Rhodes Trust, which is quite an achievement, and also an honorary Fellow of his college, Oxford Trinity. I say to the noble Lord, Lord Hussey, that we look forward with immense pleasure to hearing him make many contributions from the Floor of this House, and perhaps elsewhere, in the future.
7.54 p.m.
Lord Walton of Detchant: My Lords, I am sure that many noble Lords share my sense of frustration in not being able, because of constraints of time, to hear a longer contribution from the noble Lord, Lord Hussey, whose distinction in so many fields, as the noble Lord, Lord Butterfield, said, is outstanding. He has given us an intriguing foretaste of things to come; we trust that we shall hear from him many more times.
In discussing this Question, I propose to depend to an extent on my personal experience in many years of practice in neuroscience. When I first began training in this field there were consultants who worked for part of the time at the London teaching hospitals and for part of the time at hospitals like the National, Queen Square, or Maida Vale. They were able through their observational and descriptive skills to make major advances in that field. How the situation has changed. There has been the development of new technology--magnificent new methods of imaging--and the related clinical neurosciences of neurophysiology and so many
more, and the burgeoning advances in molecular biology bringing in sight gene therapy for some of the most crippling neurological disorders which have transformed the situation. All are demanding of time, expertise, expensive equipment and, very largely, demanding of collaboration between doctors and scientists working in the laboratory.Why does this Question concentrate on research? Research is the lifeblood of medicine. Today's discovery in basic laboratory research brings tomorrow's practical developments in patient care. I believe that in today's health service it is increasingly difficult to bring home that message to some managers who are obsessed, very reasonably, with the crucial importance of increasing patient throughput. In neurology one can take the example of Parkinson's disease. The discovery by some Viennese pharmacologists many years ago revealed that the substance dopamine was not being secreted by cells at the base of the brain. This led to the introduction of levodopa.
When the Tomlinson Committee and the King's Fund Committee began their work there were 11 departments of clinical neuroscience scattered throughout London and 10 departments of oncology. Frankly, some of them were not viable because of limited resources and staffing. Hence, it has become crucially important that these highly specialised skills should be concentrated into much larger units where doctors can work alongside basic scientists, with particular emphasis on their being placed in association with multi-faculty colleges such as Imperial College, to which the noble Lord, Lord Winston, and others have referred. That policy is bearing fruit. Previously many of those isolated departments scattered throughout London received rather low ratings in the research assessment exercise. But as the Deans Report on academic medicine in London has clearly demonstrated, these multi-faculty institutions and the departments of clinical science with which they are associated are now rising steadily within the research assessment scale.
I had the privilege of chairing an inquiry by your Lordships' Select Committee on Science and Technology into academic medicine, particularly medical research in the light of the NHS reforms. We were pleased that the Government were committed to devoting 1.5 per cent. of the NHS budget to R&D. It is crucial that part of that budget should be used to preserve the infrastructure for biomedical research within our teaching hospitals and within these institutions in London. It is also crucial that part of that money should be used to preserve the tertiary referrals that are the lifeblood of clinical research and which have seriously declined. In particular, as a consequence, the interests of the special hospitals such as Hammersmith, the National Heart and the National Hospital for Neurology and Neurosurgery must be preserved.
Finally, there is a very serious concern about the future of clinical academic medicine. There are 57 vacant chairs in the UK, and far too many early retirements are occurring at the moment. We trust that the inquiry sponsored by the committee of vice-chancellors and chaired by Sir Rex Richards will come up with firm
recommendations on the future of clinical academic medicine of which the Minister and her colleagues will take careful note.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |