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Baroness Morgan of Drefelin: My Lords, for some time the Department for Work and Pensions has been the lead department on disabilities, but it is fair to say that my honourable friend Anne McGuire MP has worked widely across government in preparation for signing the convention. With her expertise and the strong relationships that she has built up with the stakeholders—with organisations representing disabled people and disabled people themselves—it is right that she and her office should take forward this work. I do not believe that the United Kingdom is out of step. We have been at the forefront of taking
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Lord Skelmersdale: My Lords, the Minister will know—indeed, she almost said—that it is one thing to sign a convention or a treaty; it is quite another to ratify it. Given that more than 20 countries are in the EU, all of which have signed the convention, and given that only 20 states need to ratify the convention for it to come into force, what pressure are the Government putting on fellow EU countries to do just that?
Baroness Morgan of Drefelin: My Lords, my honourable friend Anne McGuire is meeting EU Ministers. We are working closely with them to identify the key issues around shared competency. It is the first time that the EU has signed a convention, so we are in new territory. The absolute timetable for ratification is beyond our control, but I must stress that we would not have signed the convention if we were not absolutely committed to ratifying it and to making the most of the opportunities, not just within the UK, but internationally, to put disabled people’s rights on the agenda.
Baroness McIntosh of Hudnall: My Lords, notwithstanding the good news on the number of signatories to the convention so far, what further pressure is coming from the FCO and DfID to increase the number?
Baroness Morgan of Drefelin: My Lords, I am very pleased that already our embassies around the world have started to promote the convention. The Foreign Office and DfID are working closely with DWP to make sure that we are all working in the right direction. We will lobby Governments and we will fund projects leading to long-term changes, promoting best practice and changes in behaviour wherever possible. We are committed to making the convention a really positive and progressive move forward.
NHS: Doctors’ Training
11.29 am
Lord Turnberg asked Her Majesty’s Government:
How many doctors they estimate will fail to obtain a training post this year as a result of recent problems with the appointments system.
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, we are working to ensure that no doctors will fail to obtain a training post because of problems with the MTAS. As has always been the case, some doctors will be unsuccessful in obtaining a post because of the intense competition.
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Lord Turnberg: My Lords, I thank my noble friend for his short reply. I should make it clear that I am not trying to lay all the blame for this disaster at the feet of the Government, because it is unclear to me who was responsible. However, this has happened when we can ill afford to lose such a large cohort of doctors, and the BMA suggests that the numbers may be rather higher than each year’s output from UK medical schools. What can be done to support and encourage these doctors to continue in medicine? Many of them have young families to support, but they suddenly find that no training posts are available and their careers are blighted. What can be done to ensure that we keep them in the NHS and do not waste this powerful resource?
Lord Hunt of Kings Heath: My Lords, as I said in the Answer, there has always been competition for specialty training posts, as there ought to be; these are the consultants and GPs of the future. Clearly, we want to ensure that the process is back on track and that the interview process is as rigorous as possible. Most of the doctors who are applying for the specialty training places already work in the NHS. We very much hope that those who are unsuccessful will be able to continue working in the NHS and we will establish ways of helping them to do so.
Baroness Masham of Ilton: My Lords, how many doctors who have chosen their specialty have not been interviewed and are sitting in limbo getting very disillusioned and disheartened?
Lord Hunt of Kings Heath: My Lords, no one should be sitting in limbo. As I have already said, most of those doctors are either currently in training posts or working in the National Health Service. My understanding is that approximately 40,000 interviews were due to have taken place in round 1A, which should have been completed, and around 17,000 interviews may take place in round 1B. As the outcome of that process, training posts will be offered. Following that, further training posts will be available for unsuccessful applicants, and that will take place according to the timetable laid down by the review body that we have established to help us in this area.
The Earl of Listowel: My Lords—
The Earl of Listowel: My Lords, does the Minister recall that in 2004 the vacancy rate for consultant psychiatry posts was double the average of all other consultant posts at 9.6 per cent compared with 4.3 per cent? Is he taking any special measures to ensure that the specialisms in psychiatry are not impeded by the current problems?
Lord Hunt of Kings Heath: My Lords, there is no reason why they should be. Part of the work being done with doctors who apply for training for specialty posts involves showing them the ratio of applicants to places, and, in specialties where there is a shortage, that may be a way of encouraging more people to
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Baroness Uddin: My Lords, are those of Bangladeshi origin being unfairly treated in this process?
Lord Hunt of Kings Heath: My Lords, discussions have taken place with representatives of overseas doctors and doctors from various ethnic groups. Of course, we aim to make this process as fair as possible.
Earl Howe: My Lords, the Minister will be aware of the appalling security breach revealed by Channel 4 the other day. In her Statement on Tuesday in another place, the Secretary of State said that confidential information about junior doctors stored on the MTAS website was accessed by,
- “21 different internet addresses, mostly belonging to postgraduate deaneries”.—[Official Report, Commons, 1/5/07; col. 1367.]
Can the Minister confirm whether any of those internet addresses were not from postgraduate deaneries? If not, who else accessed the confidential details held on the MTAS website?
Lord Hunt of Kings Heath: My Lords, the noble Earl will know that we are deeply concerned about the breach and, indeed, about the nature of the information that was made available. Two things have happened. First, an inquiry is still taking place. We hope to get the result of it very shortly—over the next few days—and we will then be able to give as many details as possible about what happened. Secondly, an independent company was brought in last weekend to carry out a review of the current security procedures. It made a number of recommendations, which are being acted on, and a further audit of the security system is taking place. The system has not gone live and will not do so until we are satisfied that it is as secure as possible.
Baroness Neuberger: My Lords, given the response that the Minister has just made to the noble Earl, can he assure the House that the full inquiry into the MTAS system and applications for medical placements will be fully independent of government?
Lord Hunt of Kings Heath: My Lords, first, most of the key decisions around this new system have been made in collaboration with the Government and various medical organisations. Secondly, two reviews are taking place. One is the Douglas review, which is looking at immediate issues, and which has been extremely helpful in advising the Government on how to deal with the current problems. A second review will be chaired by Sir John Tooke. Of course, he is a wholly independent person, and we shall listen carefully to the advice that he offers.
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Business of the House: Debates Today
11.36 am
The Lord President of the Council (Baroness Amos): My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That the debate on the Motion in the name of Lord Patel set down for today shall be limited to three hours and the debate on the two Motions in the name of Lord Broers to two hours.—(Baroness Amos.)
On Question, Motion agreed to.
Stem Cell Research
11.37 am
Lord Patel rose to call attention to the potential benefits of stem cell research and related issues; and to move for Papers
The noble Lord said: My Lords, I am delighted that so many distinguished noble Lords will take part in this debate, and I look forward to listening to all the speeches. I am particularly pleased that my noble and right reverend friend Lord Harries of Pentregarth, the former Bishop of Oxford, who chaired the Stem Cell Select Committee, and the noble Lord, Lord Winston, an eminent stem cell scientist, will be taking part.
Stem cell research is undoubtedly the most exciting area of biomedical research. What makes it so exciting? Stem cell science has the potential to deliver cures for diseases that were hitherto untreatable, by harvesting the growth of cells and tissues in the laboratory and using them to replace diseased tissues with healthy cells.
Regrettably, there has been much premature hype, occasional misinformation and a lack of dialogue between those with opposing views in certain areas of stem cell research. The hope—not hype—is that stem cell research will, in combination with technologies such as tissue engineering, contribute to the field of regenerative medicine and help to develop therapies for diseases such as Parkinson’s, diabetes, heart failure, spinal cord injuries, and potentially Alzheimer’s.
There are several types of stem cells with varying capacities to give rise to other cell types. The embryonic stem cells, first identified by Sir Martin Evans in 1981, derived from early-phase embryo are the most versatile. Therefore, these cells are often referred to as pluripotent cells. Research on the basic biology of these cells—what regulates them, what programmes their differentiation, what is their behaviour in disease, including cancers, cell death, and so on—will be crucial if we are to find therapies for diseases.
Apart from these embryonic stem cells, there are several types of adult stem cells, which are multipotent and able to give rise to limited numbers of cell types. Such cells are found in bone marrow, blood, cord blood and other sites. Some—for example, bone marrow on rare occasions—have been
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There are other preliminary but none the less exciting developments showing early clinical success, such as eye stem cells for corneal damage, periodontal stem cells for gum damage, bone marrow mesenchymal cells for heart failure, using autologous—the patient's own—stem cells or donor cells from cord blood or bone marrow. Just last week I heard some preliminary successful clinical applications of using autologous stem cells to treat age-related macular degeneration, which affects some 3 million people over the age of 60 in the United Kingdom alone.
All adult stem cell therapies are patient-specific. Patient-specific treatment is expensive. Scaling up has challenges, both biological and technical. Because embryonic stem cells are easy to culture and keep in a stable undifferentiated form—and therefore potentially capable of mass production, using robotics to do so—they offer potential benefits in treatment on a large scale. Adult stem cells are currently harder to isolate, keep in culture and produce in large quantities. Studies of embryonic stem cells from different species will, in due course, provide better understanding of the factors that control differentiation and proliferation of stem cells, research that will make the wider use of adult stem cells possible.
What we already know makes me feel confident that, before too long, the way we treat some diseases today will have changed, using more cell therapy and tissue engineering. It is most important to realise that we need to pursue research on all types of stem cells, and see it as complementary rather than a competing alternative. Adult stem cell research has been going on for decades. Embryonic stem cell research has only been going for the last four years, and even then with a limited number of stem cell lines. None the less, studies on both animal and human stem cells have demonstrated some remarkable advances: stem cells restoring neuronal damage, developing kidneys, developing new neurons and generating pancreatic beta cells that could produce insulin, and reversing Parkinson’s disease damage. In addition, stem cell research has the potential to contribute to drug development, toxicology and immunology—studies with implications for animal and human testing of drugs and transplantation.
I shall say a little about the UK’s position in stem cell research and regulation. Before I do so, I declare my interests. I currently chair the Stem Cell Oversight Committee and the Stem Cell Bank committee, the UK National Stem Cell Network and the yet-to-be-funded steering group of the Stem Cell Immunology Programme. I am chancellor of the University of Dundee and vice-president of the Royal Society of Edinburgh, responsible for the section on life sciences.
Currently in stem cell research, the United Kingdom is undoubtedly the global leader. What we have put in place is the envy of much of the world, because of strong parliamentary and government support, measured but clearly defined legislation, an
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Recognising the importance of stem cell science to the economy, the Chancellor of the Exchequer, Gordon Brown, commissioned a report from Sir John Pattison, UK Stem Cell Initiative, to set out a 10-year vision on stem cell research to consolidate the UK’s current position and become a global leader in stem cell therapy and technology. The Government accepted the report in full, including all the recommendations, even those related to finance; the Chancellor said so in his Budget speech.
So far, it all sounds fantastic. Over the last year, however, we have begun to see evidence of a failure of commitment and mixed messages, particularly on funding for research and regulation from the Government. I will pick up on two key areas of recommendations in the Pattison report, related to funding and timely and judicious regulation. The report includes a chart of the cost of implementing the recommendations over a 10-year period in incremental stages. The total cost over that period is in the region of £630 million. Adding up the funding from both the charities and councils so far amounts to about £40 million up to last year. However, there is already evidence that year-on-year commitment to funding is not being maintained. We are probably already £30 million short of the recommended projection. It is important to note that this is at a time when other countries are scaling up their funding enormously, especially China and the United States of America, where the climate for stem cell research is changing. California alone will spend $300 million per year for 10 years from public funding and possibly $200 million per year from private funding. Other countries scaling up funding are Singapore, India, Australia, Sweden and South Korea. China is likely to outstrip even the USA in research and in facilities related to stem cells. It has state-of-the-art facilities and is recruiting scientists. Biomedical research is seen as a future economic driver.
It is important to realise that if we do not keep pace, we will lose momentum and our lead position. We will fail to recruit because all these countries are also trying to recruit. We will fail to develop further capacity. We will fail to train future generations of stem cell scientists. We will fail to translate science into therapy. Worse, we may lose our leaders in stem cell science and the technologies that we have developed. So I hope the Government will commit
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Let me now turn to regulation in relation to stem cell research. Two areas of regulation need fairly urgent attention. The first relates to the accreditation of good manufacturing practice—GMP—facilities for developing stem cell lines for research and therapy. Just now, there is confusion as to who is responsible for the accreditation of such facilities and the end result is that no regulatory authority is prepared to take it on. We need an authority with statutory responsibility to accredit such facilities. I have yet to be convinced that the new amalgamated HFEA and tissues authority—RATE—will be up to such tasks, but I have no doubt other noble Lords will refer to that. Regulations related to recognising, accrediting and, if required, monitoring GMP facilities for stem cell work are urgently needed.
Let me now turn to regulation related to embryo research. There is much debate and some concern about whether in vitro stem cell research should be allowed on hybrid and chimera embryos. The House of Commons Science and Technology Select Committee, having taken evidence, recommended that such research should be allowed. On the other hand, in the White Paper reviewing the Human Fertilisation and Embryology Act, the Government proposed that the creation of hybrid and chimera embryos in vitro should not be allowed. The HFEA is engaged in a public consultation; I hope it will be a properly informed consultation. The evidence given by research councils and charities to the Science and Technology Committee supported the need for such research. The Academy of Medical Sciences—in which I declare an interest as a fellow—will report and provide evidence to HFEA consultation.
It is important to understand what is proposed and why in terms of science. I fully accept that the public must finally decide whether such research should be allowed, not the scientists, so public consultation is absolutely important. What is proposed is using animal ova from cows or rabbits to carry out cell nuclear transfer, in which the nucleus from an ovum will be removed and a human somatic cell nucleus inserted. The resulting embryo in vitro will have 99.9 per cent human DNA and 0.1 per cent cytoplasmic—non-nuclear—animal DNA, hence the term cybrids. An embryonic stem cell will be obtained at the five- to six-day stage to develop stem cell lines. The use of animal ova would not be necessary if there was a plentiful supply of human ova, particularly fresh human ova, which there is not.
Why do scientists feel that they need this particular aspect of stem cell research? If we are to understand the behaviour and the biology of stem cell lines and develop therapies, it is necessary to develop stem cell lines that carry diseased genes, such as stem cell lines with genetic markers of motor neurone disease, diabetes, cancers and so on. This can best be achieved by using cells from affected individuals and by cell nuclear transfer techniques obtaining embryonic stem cell lines that carry the marker gene, which is a
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