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In my professional lifetime, there is no doubt at all that research has transformed the practice of medicine. Research is the lifeblood of medicine. After all, antibiotics have been effective in depleting very many of the infectious diseases which I knew as a young doctor. Programmes of vaccination and inoculation have been successful in banishing smallpox from the world and, in the near future, it is probable that poliomyelitis will become a disease of yesterday as well-it is likely that there will be no such cases in the world in future. The conditions of childhood which so ravished children when I was a young doctor, such as diphtheria, scarlet fever and, to an extent, measles and German measles have been successfully controlled by vaccination. In particular, in relation to rubella or German measles, that programme has prevented the birth of children with many birth defects which resulted from infection with that virus in pregnant women.
There is no doubt, too, that the developments in diagnostic techniques, imaging, computerised tomography and other techniques, such as magnetic resonance imaging and so on, have transformed diagnosis. So, too, have many other techniques which have been
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All of these things are happening all around us and, as the noble Lord, Lord Willis, said, the evidence is clear that when one looks at research citations and publications in learned journals, for instance, there are many more published in the United States but, if you translate those citations according to population this country, the United Kingdom, in its research productivity in the field of medicine, stands the highest in the world. Yet obstacles and problems which have been encountered over the years have to be overcome.
Fifteen years ago, on behalf of your Lordships' Select Committee on Science and Technology, I chaired a sub-committee inquiry into research in the NHS. From its very beginning, the National Health Service provided limited funds for research purposes and there was a locally operated clinical research scheme. It was helpful in that it helped many young doctors and medical scientists to take their first steps in research by receiving small grants to help them to conduct such investigations, but the actual amount of money expended in that way and the results of this research were very limited.
The outcome of the inquiry which I chaired was that the Culyer report followed, presented by the Government, and when my report was debated in your Lordships' House the Government of the day committed 1.5 per cent of the total expenditure of the NHS to research. Since that day, in fact, it has risen slowly from 0.7 per cent to 0.8 and 0.9 per cent, and has stuck at that figure. Nevertheless, as the actual costs of the NHS have escalated, so the money becoming available from that background has increased substantially and it is this that has led to the establishment of the National Institute for Health Research which, as the noble Lord, Lord Willis, said, is so ably chaired by Dame Sally Davies, who is also the Government's Chief Medical Officer.
We must not of course forget the contributions that have been made by the Medical Research Council. I was involved with the MRC for 16 years and was on the council for four years, and so got to learn a good deal about its productivity. It had a series of priorities, many of which related to the incidence of disease in the community in which it promoted research. Fundamentally, however, it looked to support research in the universities and in research institutes which were often orientated to specific problems.
Alongside that, as the noble Lord, Lord Willis, said, we must not overlook the contributions of research charities such as the Wellcome Trust, the Cancer Research Campaign and very many more, with many of which I have been specifically involved. They have made a tremendous contribution and, as I have often said in teaching medical students and young doctors, not only does research nurture patient care development but the resultant research has meant that although there are still many incurable diseases in medicine, there is none which cannot have its effects modified to a greater or lesser extent by pharmacological, physical and psychological means. These have made a major contribution and I have to pay tribute to the work of the pharmaceutical industry in the United Kingdom which, despite problems which it has encountered, nevertheless in my view remains the jewel in Britain's industrial crown.
These are crucially important issues, but why is research in the NHS so specifically important? It is because the availability of excellent records and very well defined populations has meant that, for instance, in epidemiological research and in research into the effects of drugs as tested in clinical trials the NHS has been a wonderful source for such activities. In the course of the last few years, however, clinical trials have been prejudiced, not least by the complexity of requirements for ethical approval-particularly in the case of multicentre trials, where a whole series of different organisations have been required to give ethical approval. There has also been a more recent problem from the European Union directive on clinical trials, which has to some extent had a difficult effect.
However, the recent report of the Academy of Medical Sciences on research governance and support-a review chaired most ably by Sir Michael Rawlins-has brought clarity and extraordinary new developments into this field. I am happy to say that the Minister and the Government appear to have recognised that this report is one of great importance and that, when implemented, as the Government propose, in a health research agency, which will be created as a new special health authority, it should streamline the process of research in the United Kingdom and make clinical trials very much easier to carry out.
Leaving aside clinical trials, though, NHS research involves other activities such as operational research, research into how health procedures can be carried out, research into their effectiveness and a whole series of research activities that have a sociological context-looking at the care of the elderly, for instance, or the development of new drugs and management mechanisms for dementia. I was delighted that recently a major grant from the Department of Health went to the Institute for Ageing and Health in Newcastle, in which I have personal interest and which is one of the most outstanding research depots in the world, examining the effects of ageing upon the human population and bringing up ideas to overcome some of its most devastating effects.
So, developments are happening. I seek support in principle from the Minister for the amendments, which are intended to put flesh on the bone. Clause 5-strengthened, I hope, by Amendment 39, which was
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Lord Warner: My Lords, I shall speak to Amendments 40 and 42 in my name and those of other noble Lords. I also support Amendments 39, 40A, 41, 74, 89E and 199ZA in the names of other noble Lords and to many of which I have added my own name.
The noble Lord, Lord Willis, did us a great service in setting out the argument for strengthening these provisions regarding the Secretary of State's duties on research. There is a bit of a conundrum, as he put it very well, about how a Secretary of State and indeed the NHS protects research and development in a devolved NHS. That is a difficult issue, and it is not good enough simply to have a general duty on the Secretary of State. As the noble Lord, Lord Walton, says, we need more flesh on the bone that gives some comfort to the idea that the Secretary of State, whoever he or she is, will actually take an interest and pursue some other aspects around the duty of promoting R&D. It is difficult to see how that duty could be protected without some degree of capability to intervene and ensure that the NHS pulls its weight in co-operating with R&D.
I turn to Amendments 40 and 42 in my name. I speak from the background of having been for two years the Minister responsible for NHS R&D when we started the reforms of the structure of R&D in the Department of Health and the NHS to produce much more focus to the R&D programme, to streamline some of its approval processes and to improve the translation of research to clinical care-the so-called movement from the lab to the bedside.
I, too, pay tribute to the work done by Dame Sally Davies-she was just plain Sally Davies in those days-and the leadership and persistence that she has shown in this area. The ideas that we were putting forward then for a National Institute of Health Research, which to some extent was based on the NIH model in the US, were not uniformly welcomed, if I may put it that way, by everyone across the NHS. It was deemed to be a bit too interventionist in some of the activities that were going on in the name of research and development in some of the dusty corners of the NHS. We have come a long way in that period. That is the background from which I speak, because I am keen to ensure that we do not go backwards in this area as we devolve more autonomy to the NHS.
It is relevant that I was also a member of this House's Science and Technology Committee, where I had the privilege of working on the inquiry into genomic medicine under the extremely skilful chairmanship of the noble Lord, Lord Patel. That experience has convinced me that we need to feature R&D much more prominently in the Bill, particularly the issue of translating R&D findings into clinical practice that benefits NHS patients. That is what Amendment 40 attempts to do.
However, Amendment 40 goes further in two other aspects of successful development of research findings and their application in clinical practice: the back-up of information technology and the informatics skills, which are often inadequate to back up basic scientific discoveries. One of the things that the-in my view much maligned-national programme for IT did was to make it easier for researchers to access the very important patient database that the NHS provides for them, and it makes it easier for them to collect the kind of patient samples, if I may put it as crudely as that, that they need for their research. However, the genomic medicine report also showed that we have some serious problems in this country about informatics skills in carrying forward R&D in the health and life sciences area. That is why those parts of the back-up services get a special mention in Amendment 40.
I turn to Amendment 42. The noble Lord, Lord Willis, put his finger on it: if the NIHR disappears into the maw of the National Commissioning Board, how will its budget be protected? Will there not be a temptation, if times are hard, to dip into that pot and use it for operational matters such as the delivery of services? As a Minister and a civil servant who has worked in this field for many years, I can say that there is a great temptation when the going gets rough financially to-I shall put this as kindly as I can-reach into the pot of R&D, and indeed the pot of education and training, which we will be coming to later. I have watched people, who shall remain nameless, find themselves unable to resist that temptation. That is why I feel strongly that we should put something in the Bill along the lines of Amendment 42 to try to ensure good conduct.
Sometimes R&D is a bit slow in spending its budget. That is quite convenient if you are running into a bit of financial difficulty during the financial year. What happens is that money gets held back because of some pressing need and it will not really matter if we take a bit longer to get on with this bit of R&D. I assure the House that I have observed a Chancellor who managed to announce the same NHS R&D budget increase in two successive Budgets, and he was not spotted by anyone in the media. It is possible for some of this "peas under the pot" manoeuvring to take place. We are talking about political temptation, and Amendment 42 would provide some encouragement to resist it. The temptation to dip into R&D budgets is of course not confined to the NHS, but we have an opportunity with the Bill to ensure better behaviour in the NHS regarding R&D.
Lord Turnberg: My Lords, I rise to speak to Amendments 40A and 199ZA in my name. I also want to comment on some other amendments in this group. I speak as a one-time medical researcher, a trustee of a number of medical research charities, and as a scientific adviser to the Association of Medical Research Charities. In that I work closely with my friend, the noble Lord, Lord Willis.
Research, as we have heard, is not an optional extra. It cannot be added on to the NHS as and when someone thinks it is needed; it is a vital and integral
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I can only re-emphasise what the noble Lords, Lord Willis and Lord Warner, have said. Even though research funding amounts to less than 1 per cent of the NHS budget-a pitifully small proportion in an organisation of this size-can we be reassured that it will not fall easy victim to the cuts we are going to see over the next few years? Is it really essential for this to be distributed through the Commissioning Board? Is it possible that it could come more directly via the Department of Health? I hope that the noble Earl will give us some comfort on this amendment. This is clearly of some importance and we almost certainly will have to come back to it at a later stage.
As we have heard, medical research in the United Kingdom punches way above its weight. By any measure, our outputs of research findings come high in any international league table and the fruits of our research are having a major impact on our health. We are living longer and healthier lives and one has only to look around your Lordships' House to see evidence of that. I suspect that there are few of us who are not taking one or more pills, keeping us in fine fettle. As the noble Lord, Lord Willis, said, the public at large is well aware of the benefits. According to a number of surveys, more than 90 per cent of patients and the public want us to do this research and, furthermore, want to be engaged in it as patients. They want this even if it does not benefit them directly but benefits only future generations. However, they also know that any patient who is part of a trial incidentally gets a better deal and better care as part of the research process.
They are enthusiastic supporters but that is not the only reason why we should be supporting research. There are considerable economic benefits too. The most recent of several studies that have shown this, Medical Research: What's it Worth? supported by the Rand Foundation and the Wellcome Trust, clearly showed that we gain between 35 and 40 per cent return per annum for every pound we put in. Although it takes several years for research done now to bear fruit-today it is coming from research done some years ago-the returns come from less sickness and absenteeism from work, greater productivity and less sickness benefit payments.
Research is a good thing all round and this Bill is a great opportunity to make sure we gain its full benefits. Amendment 39 emphasises the need for the Secretary of State to take his expressed desire to support research seriously and I strongly support that amendment. Amendment 199ZA, in my name, brings the same
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Researchers have to ask patients for consent but can do so only if the GP asks the patients for them first, and they are not at all keen. They say that there is not enough time. Yet their role is critical, not only to facilitate clinical research performed by others but to be responsible, through the CCGs, for commissioning those extra support costs that arise when research, funded by charities, the MRC and so on, is carried out. Research on patients supported, for example, by the British Heart Foundation or Cancer Research UK, often results in additional costs due to extra visits or more routine blood tests. Traditionally these should be funded by the commissioners of services. This Bill provides just the opportunity we need to make sure that those at the coal face, responsible for commissioning, can facilitate and fund this research.
I hope the Minister will consider the need to accept this or a similar amendment and examine how we might provide the inducements necessary to GPs and CCGs. A failure of CCGs to take on responsibility for creating the right environment in which we can gain the full value of external funders will be damaging.
I come now to the difficult issue of the use of patient data. How can we make sure it is possible to use clinical information about patients for research purposes? New Section 14X, to be inserted by Clause 23, describes the duties of clinical commissioning groups to promote research and includes the need to promote the use of evidence obtained from research for improving the health service. That is very good, but it says nothing of the other way round; of how we can use patients' data for research purposes. The amendment in my name, Amendment 199ZA, emphasises this point. The difficulty has been well rehearsed: how does one gain access to identifiable information about patients for research into their diseases while at the same time protecting their confidentiality and giving them all the reassurances that they need? It so happens that well over 90 per cent of patients are happy for information about them to be used for research, but the current system of safeguards goes well beyond the requirements of the Data Protection Act and is stifling much important research.
When data about patients are fully anonymised-a horrible word-and it is impossible for anyone including the researchers to identify a patient, then there is little or no trouble. However, when it is necessary for the researchers to know who the patients are, we get into problems. If, for instance, a researcher needed to use the cancer registry to look at whether patients with a given cancer were subject to some factors in their
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Amendment 41 brings up the important issue of funding for public health research. Here I speak as a former chairman of the Public Health Laboratory Service, the forerunner of the Health Protection Agency, which is also disappearing. I cannot speak too highly of the marvellous work it did and does in protecting the public's health. It is a fantastic organisation. It works on outbreaks of food poisoning, epidemics of flu and immunisation programmes against a whole host of infections, to say nothing of its work in radiological protection and on all sorts of biohazards. The point is that this organisation is at the forefront of its field and is the envy of the world because it is able to do fantastic world-leading research. It is highly dependent on a continuing research effort to keep ahead of the infections and other hazards that are continually evolving. It is vital that it continues to have access to research grant funds, particularly external grant income from the whole range of potential funders to which it has access now, such as the Medical Research Council, the Wellcome Trust and so on. I hope the noble Earl will reassure us on this. His Written Answer to the noble Lord, Lord Willis, yesterday did not give any confidence that the Public Health Laboratory Service will be able to apply to external bodies for funding.
Then there are the directors of public health and their teams. They, too, should be enabled to conduct high-quality research. The amendment makes that clear. How will they receive the necessary support and encouragement when they transfer into the local authorities? It is not at all clear that local authorities are keyed into this, so some reassurance on this point would be helpful. Most of these amendments are probing-I think they all are-and seek simply to gain a greater understanding of the ways in which I hope the Government will support the research effort.
Lord Ribeiro: My Lords, I shall speak in support of Amendments 40 and 42, which, as the noble Lord, Lord Willis, said, are very much appreciated and welcomed. They reflect the Government's acceptance of the importance of research and making this an express duty on the Secretary of State.
Some years ago, Professor Sackett made the medical profession aware of the term "evidence-based medicine". I should like to think that we have all adopted it in our clinical practices over the years. As a surgeon, I speak from a surgical perspective. In the 18th century John Hunter was approached by Edward Jenner with his dilemma about children in Gloucestershire who were being afflicted by cowpox. He wrote to John Hunter, saying, "I'm thinking about doing something about this and would like to cure the children in this area with a vaccination made from cowpox". John Hunter replied, "Don't think about it, do the experiment". We in surgery consider Hunter the father of scientific surgery but our problem is that we are, perhaps, not quite as cerebral as our physician colleagues. All they have to do is learn the discipline, acquire the knowledge and prescribe the tablets. On the other hand, we not only have to learn but must then apply our knowledge in carrying out the operation. There are two skills that we must acquire. For us poor surgeons, it is often a long sentence-spent not only in a laboratory but in the theatre, putting into practice what we have learnt.
Earlier, a noble Lord-I think it was the noble Lord, Lord Warner-used the term "from the bedside to the bench", which is very important. The whole concept behind translational research has been to get our trainees and doctors away from idea that all they have to do is stay in the lab, beavering away. It is about the patient. One of the things that surgeons try to do is take a problem from the bedside into the lab, apply stringent tests to it and then bring it back in the form of treatment, which might be by medication or an operative technique.
The problem for surgeons is that research and the assessment of research often lead to new innovations, treatments and operations, which have to be learnt. Time must be put aside for them to be learnt. Surgery has, in many ways, been the Cinderella of medical research. I say this with some feeling because of the NIHR budget of £1 billion, some of which goes to medical research, plus all the other funding that comes in from charitable causes. The share of the NIHR budget that goes to surgery is less than 2 per cent. Twelve million people a year are treated medically in this country. One-third of them will be exposed to surgery somewhere along the line. Yet look at the pittance of research money that goes to surgery.
I know that I will hear from my noble friends, as I am often rightly told by Dame Sally Davies, that you will not get anywhere unless you put the right papers and research in, and you get the quality of research that is published in Nature and Science. However, that has been a real problem for us. There have been many ways of assessing research. The research assessment exercise was a brilliant exercise in universities but it looked at the criteria of publication and scientific worth. Surgery is about patients and clinical research. In surgery, that has led to a reduction in academic surgical professorial posts from 30 to 15 in the past 10 years. The number of clinical academic posts has been reduced and, despite the wonderful work done by Sir Mark Wolpert in getting clinical academic posts,
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I shall tell noble Lords one little story that perhaps explains some of the problems that can arise if you do not do this. I am sure noble Lords will recall, from the 1990s, a terrible scandal in the newspapers about a lady who had a laparoscopic operation and developed a major bowel complication. I think her name was Silverman. At that time there was a big newspaper campaign about the botched surgery that was undertaken by surgeons who were ill trained. The reason for this was that it happened at the time of the introduction of laparoscopic keyhole surgery. I am a general surgeon. Give me a knife and fork and I can operate, but to use a telescope with long, thin instruments while looking at a television screen you need hand-eye co-ordination. Nowadays all our kids are brought up on Playstations and so on. They can do it; it is not a problem. Go to any fairground in the country and you will see kids who could be surgeons. However, my generation had real difficulty in converting from open surgery, where you look at what you are doing, to operating through a television screen with your hands moving independently. Quite a few of those surgeons who tried to take on this new operation did not realise that they did not have the hand-eye co-ordination to do it. The net result was disasters and complications, and patients suffered.
As a direct result of the fallout from Silverman, the Government of the day-I am sorry to say they were the party on this side-agreed with the Department of Health to set up a national training programme. This was based at three centres in London, Leeds and Guildford. They set up the Minimal Access Therapy Training Units. The idea was to teach doctors-not just trainees but consultants as well-how to perform this operation properly, and for them to be properly scrutinised in doing so.
I am sorry that he is not in his seat, because the noble Lord, Lord Darzi, was our college's first laparoscopic tutor. He was the person given the responsibility of rolling out this training programme. With some money and help from the department at the time, we were able to kick-start this programme, which has become a national programme whereby nearly every hospital has access through a regional network of some sort or another. I declare an interest, in that I am proud to say that I was president at the time when we opened our own much bigger minimal-skills training unit at the college. I have come from the college where we are running a military operative surgical training course in those facilities.
We are benefiting many people who need the practical skills to do surgery. Therefore, in answer to Amendment 42, which addresses funding, it is essential that the ring-fencing suggested by the noble Lord, Lord Willis, in the context of the NIHR is absolutely essential. We have a situation that I am sure the noble Lord, Lord Warner, remembers well-in fact he referred to it. In 2006, when I was president of the college, I remember quite a few of my pronouncements in the newspapers about my absolute horror that the training
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Lord Ribeiro: I rather suspected that the noble Lord did. That is why I felt able to make that reference. None the less, I launched a big campaign at the time because here was a budget-part of the NPEC budget-for nurses, doctors and so on that was being raided. It should have been a ring-fenced budget for training, yet the money was taken out of that budget to meet the NHS deficit. There is a real danger for the present Government if a situation should occur whereby the £1 billion budget-and there is no reason why it should be more than that-that has been set aside for research, particularly as the Secretary of State has taken responsibility to promote research, was found to come under the auspices of the chief executive of the NHS Commissioning Board, and that at times of trouble and trial that that money could be used.
Lord Patel: My Lords, my brief is brief-and I shall be brief. First, I congratulate the Government on putting the need to promote medical research at the centre stage of the Bill. We have criticised a lot of things and we may criticise some more, but the recognition that medical research is important to improve healthcare has been stated throughout the Bill.
It would be surprising if I said that I do not support these amendments-I support every one of them. By the way, I say to the noble Lord, Lord Ribeiro, that he was lucky that the noble Lord, Lord Darzi, was not in his place when he said that surgeons do not do research. He might have given the noble Lord, Lord Ribeiro, a tour around his department.
I have brief comments, but I shall focus particularly on the amendment in the name of the noble Lord, Lord Warner, that refers to the need for informatics to be properly established to promote research in healthcare. One of the key areas in biomedical and clinical research in the UK is focused on translational research, as other noble Lords have said, to try to get research into clinical care.
Informatics plays a key role in our ability to do translational research. There are three domains of informatics in biomedical research-biomedical informatics, medical informatics and translational research informatics. Translational research informatics is about getting multidisciplinary research into clinical practice, with clinical trials being the first step to it. As we have
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The noble Lords, Lord Willis and Lord Warner, referred to the rapid sequencing of the genome-whole-genome sequencing-that will impact on the whole of medicine. Recent rapid developments in DNA sequencing technologies have dramatically cut the cost and the time required to sequence a human genome to a point that it will soon be easier and cheaper to sequence each patient's genome and keep it in their notes. Every time they are diagnosed with or treated for a disease, a genome will be used to extract information. By combining that with our advancing understanding of genes and diseases, whole-genome sequencing is set to change the current clinical and public health practice by enabling more accurate, sophisticated and cost-effective genome testing.
Understanding the health impact of individual genomic variance presents a considerable challenge for analysis, interpretation and management of data. Managing that data will require bioinformatics to be established. The NHS should urgently develop clinical bioinformatics expertise and infrastructure to ensure clinical technical support for medical analysis and interpretation of genomic data. The amendment of the noble Lord, Lord Warner, that includes informatics is crucial in identifying that. If we are to succeed in applying the results of our research to patient care, we need to establish all these issues.
It is important that local authorities recognise that public health directors should be involved in research in the agenda that is being developed in the prevention of disease. Those are my brief comments.
Baroness Warwick of Undercliffe: My Lords, I was really pleased to see Clause 5 extend the duties of the Secretary of State with regard to research and its use. Clause 5 is a necessary acknowledgement of the extremely important role of medical and scientific research in ensuring that we deliver high-quality healthcare. The noble Lord, Lord Willis, and other noble Lords have spelt out graphically the dependence of improvements in treatments on research.
In his response to questions raised at Second Reading, the noble Earl, Lord Howe, repeated the Government's assurance that a culture of research and innovation would be embedded in the structural changes to the NHS proposed in the Bill. It is a fine promise, but I am concerned as to whether the Bill in its current form is able to deliver this in practice. The lack of detail or clarity across the Bill about the role of and commitment to research in the reformed NHS has been noted by a number of noble Lords. For this reason, Clause 5 needs to be stronger and more explicit.
Embedding research across the complex NHS system requires proactive, top-down, leadership. Clause 5, as it currently stands, does not define how the Secretary of State would provide such leadership. Acknowledging that such research needs to be promoted stops short of an active commitment to promote research, or indeed of saying what that action would look like.
We need a clearer indication of the strength of the research duty on the Secretary of State. I therefore support the amendments to Clause 5 which are in the names of the noble Lords, Lord Willis, Lord Walton and Lord Warner, and the noble Baroness, Lady Morgan. I applaud their call for more clarification of the extent of the Secretary of State's duties towards research.
Amendment 40 takes an important step in explicitly introducing a responsibility on the Secretary of State to promote the development of research findings for clinical application in the health service, and to ensure that we develop the necessary information skills and technology to support this application. Developing an environment in the NHS where research findings are taken up in support of the development of clinical applications is vital if we are to integrate innovation genuinely into the fabric of the NHS. Only with this happening will we ensure that the best care is provided quickly to patients and that we have more cost-effective health services. Only by embedding a research culture in the NHS which is driven from the top will we continue to attract commercial investment and R&D into the UK.
As the Association of Medical Research Charities has observed, having one of the largest single healthcare systems in the world should offer us a unique strategic advantage in terms of resources for medical research and innovation. Yet we know that in practice the adoption and spread of innovation within the NHS can be slow and unsatisfactory. The innovation review being carried out by the NHS chief executive is exploring how we can accelerate the adoption and diffusion of innovations in the NHS, but I have no doubt that strong leadership from the Secretary of State will be required to support this.
I also strongly support Amendment 42 in its attempt to establish an explicit responsibility on the Secretary of State to safeguard the funding of research and its application to health services. This amendment seeks to clarify how the bodies within the new structure of the NHS-the clinical commissioning groups and the NHS Commissioning Board-will take responsibility for treatment costs currently incurred for patients taking part in research funded by the Government or
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In addition, the duties of the NHS Commissioning Board regarding research are unclear. I believe it is necessary to toughen up the board's commitment to promote research, rather than require it merely to,
The new duty on the Secretary of State to promote research reflects the core role of research in the NHS and is a very important step. The overriding aim of these amendments is to achieve a clearer commitment from the Government on the extent of the duties of a reformed NHS towards research. We need stronger, clearer language, and more detail as to what these duties will mean in practice. I hope the Minister is able to give us answers to the comprehensive range of questions raised by the noble Lord, Lord Willis.
As has been noted in this debate and at Second Reading, medical research in the UK-through our universities and hospitals, our health research charities and our medical science industries-has been a long-standing success story. Its importance to a world-class National Health Service is not in doubt. Embedding a culture of research and innovation in the new structures of the NHS is one of the key challenges to be met by this Bill, but we have some way to go yet before that is achieved.
Lord Rea: My Lords, I have a short question, on a subject mentioned by my noble friend Lord Turnberg and others. The National Institute for Health Research is now directly related to the Department of Health. Is it going to stay there, or is it going to be moved over, as was suggested, to the NHS Commissioning Board? Is the funding going to be assured? I do not think that we are quite sure about these things.
Baroness Morgan of Drefelin: My Lords, I was delighted to lend my name in support of these amendments. We have had a tremendous debate, which is a sign that the Committee stage of the Bill is starting to get down to business and focus on some of the nitty-gritty, now that we have moved on from some of the more extremely high-level principles about whether or not we should see Clauses 1 and 4 in the Bill.
I very much support the opening remarks of the noble Lord, Lord Willis. He is chair of the Association of Medical Research Charities. I declare an interest myself as chief executive of a medical research charity, Breast Cancer Campaign. We are members of the noble Lord's association, and are very grateful to him for the leadership that he gives.
There are very few points I want to add to the debate, as it has already been very comprehensive. In thinking about this, I want to stress how incredibly important it is that we understand the role of research in the NHS as a driver for quality and improving
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We know that this is something that is not lost on the public. We have already heard what importance the public place on research delivery in the NHS-93 per cent of people asked by the AMRC in a MORI poll said that they wanted their local NHS to be encouraged or required to deliver research locally. That is an enormous vote of confidence in research in the NHS.
The public do not just say this in answer to surveys. They vote for research through their wallets, as we have already heard from a number of noble Lords. Medical research charities contribute £1 billion to research in this country. That is an enormous achievement.
The contribution that the NHS makes to medical research worldwide is very special indeed. It is quite simply a no-brainer that research has consistently delivered real progress for patients. I believe it is agreed that the NHS has a special and unique role to play, which is unparalleled in the world. We have already agreed around the House that in this country we punch above our weight, as the noble Lord, Lord Walton, said. As the noble Lord, Lord Turnberg, said very eloquently, we know that the UK generates over 10 per cent of the world's clinical science and health research outputs and has created nearly a quarter of the world's top 100 medicines. That is a great achievement. Now that the noble Lord, Lord Darzi, is back in his place, I can remind the House that in the earlier debate he commented on how life expectancy continues to rise, following on from the success of medical research.
As I said at Second Reading, there are many examples where the special nature of the NHS has contributed to progress. I mentioned particularly the million women study, supported by Cancer Research UK in partnership with the NHS, a collaboration that revealed the role of hormone replacement therapy in breast cancer risk-an enormous study, made possible by the NHS. I also talked about a project that my own charity is involved in. It is a real challenge. Noble Lords have already made many points about the difficulty in establishing informatics systems. We are working to establish a tissue bank, to look at breast cancer specifically, and to drive forward the vital role that genomics plays. This is also made possible by the NHS. There are many examples, as I have said.
I welcome this duty. It is the first time we have seen a duty of this nature on the Secretary of State, and it is a very important step forward, but if the duty is going to be meaningful we need to know-so I would like to hear from the Minister-what the Government will see as success in executing that duty. I want to understand what success will look like-what will be the benchmarks that the Secretary of State will use to know whether his duty has been executed successfully.
Will we continue to evaluate the contribution that NHS research makes to GDP? How will the NHS research duty play in to the research assessment exercise that is undertaken in higher education? Could that be used to show how effective partnerships work in the NHS, because it is often those partnerships between
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What will success look like for the Secretary of State? I have heard talk that a research tariff is being developed; that has been referred to in correspondence. I would be grateful if the noble Earl could explain whether it is and what the consultation process might be. There has been a suggestion that a diagram or an organigram might help us here when looking at how the funding streams might work. We had a meeting with Dame Sally Davies when that was on the agenda. We have been reassured that funding will work in the same way as in the past. I am not sure whether it can, so I should be grateful if the Minister could reassure us on how that would work and perhaps produce a diagram for us.
Baroness Emerton: My Lords, I have appreciated all the contributions on the amendments on research. There is just one thing that I take issue with: the contribution of the noble Lord, Lord Ribeiro, who said that his profession was the Cinderella of research. Other professions would describe themselves as being Cinderellas in terms of research funding. Obviously, I speak for nursing and midwifery, but also for the other healthcare professions, which are all graduate professions and which are concerned to give evidence-based practice wherever they are in the NHS. Perhaps the noble Earl could re-emphasise that it will be multiprofessional research. All the contributions this evening have been on medicine and scientific research, but the other professions can contribute an enormous amount. Nursing is very reliant on charitable, voluntary funds for its research and has done some tremendous research exercises in clinical procedures, as have the other professions-midwives and physiotherapists. Will the noble Earl consider this being a multiprofessional research board?
Lord Darzi of Denham: My Lords, I add my support to Amendment 42. I declare an obvious conflict: I am a recipient of funding from the National Institute of Health Research; I am also a senior fellow in the NIHR.
We should all be very proud that huge investment has gone into research in the NHS. The reforms of the past decade have been significant. We have been used as the exemplar across the globe not just on funding but on the structure and the processes, driving research within the NHS.
I should like to cover not just the health gains but the economic gains of research. Whichever way we look at it, the life science industry is worth about 4.3 per cent of our GDP. That is a significant contribution. The life science industry employs between 170,000 and
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Many noble Lords have already mentioned one of the most exciting disruptive innovations around the corner: the concept of stratified, personalised medicine. The NHS in the UK is in a unique position to attract funding into that area. Having a single patient record, if we have the right informatics, the right genotype and phenotype, we can drive innovation in that very important field, which will completely transform not just healthcare but the way that we deliver healthcare in future.
To do that, we need not just to incentivise the NHS with funding but make it more attractive by driving through research. It is a well known fact that there is a very strong correlation between organisations that do research and the quality of healthcare that they provide. That is well established, and that is why it is extremely important to ensure, when the CommissioningBoard may be inundated with different challenges-a significant amount of effort is going into this under the leadership of Dame Sally Davies-that we maintain and protect research funding in these turbulent times as the NHS refashions itself.
Baroness Finlay of Llandaff: In intervening in this interesting debate, I shall be very brief. I simply want the Minister to explain where the levers will be in the commissioning decisions to make sure that the principle of research that is being embedded across all the professions happens, given the multiplicity of providers and, as the noble Lord, Lord Turnberg, clearly outlined, the relative paucity of research in primary care but an increased push for more people to be cared for in the community across all the disciplines involved. A simple example of that is the problem that we now have with antibiotic resistance. There is potential overprescribing, but much of that prescribing is going on in primary care in the management of relatively simple conditions. If those are not researched into, we miss a fantastically important opportunity.
Lord Kakkar: My Lords, I support many of the amendments in the group. I do so as a biomedical research and clinical academic, therefore benefiting from many of the opportunities that the current systems for biomedical research in the National Health Service provide.
I start by congratulating Her Majesty's Government on having included for the Secretary of State for the first time in a health Bill responsibilities to promoting research. That is hugely important, because it allows us to secure what has been achieved to date in structures and funding going forward in the National Health Service.
There are, of course, anxieties, which we have heard in this important debate, which need to be addressed. Can the noble Earl provide clarification in three areas, notwithstanding the fact that the Bill already emphasises the responsibilities of the Secretary of State for Health? First, how is it is envisaged that the funding for biomedical research will be protected when that fund moves to the NHS Commissioning Board? Secondly, how will the clinical commissioning groups be responsible for promoting research in future, how will that be supervised by the NHS Commissioning Board, and will any form of instruction or performance measure be included in the supervision that the Commissioning Board provides for clinical commissioning groups?
Finally, how, within the proposed structure of the Commissioning Board, will there be encouragement and support for academic health science centres, as they currently exist, and in the future, potentially, academic health partnerships? They provide the opportunity both to drive forward opportunities for biomedical research to improve healthcare and the health gain for our population, and to drive forward the economic opportunities that attend the biomedical sciences industry in our country. However, they also drive forward opportunities for a broader population health gain through a focus on the tripartite mission of improved clinical care, education, training and research.
Lord Hunt of Kings Heath: My Lords, this has been a very interesting debate, and I am very grateful to the noble Lord, Lord Willis, and other noble Lords who have spoken in it very persuasively about the importance of research.
At heart, there are three particular questions that we put to the noble Earl, Lord Howe. First, how is funding for research to be protected? Secondly, how are we to ensure that strong leadership will be given from the centre? The third is the question of levers. What levers are there in this system to ensure that research is given a prominent place?
First, there can be no doubt whatsoever, as the noble Lord, Lord Willis, said, of the direct link between research and the quality of patient care. That must be at the forefront of our consideration. Secondly, he is also right about public health. Research into public health, evidence and epidemiology is vital if we are to improve the overall health of people living in this country. Thirdly, we have the contribution that research makes to UK plc, and specifically the contribution of the pharmaceutical industry.
When I chaired the competitive taskforce with the industry some years ago, we found that out of the 100 most important branded medicines at the time, 30 had been developed in the UK. Although the UK share of global spend on pharmaceuticals was about 2 per cent, our R&D contribution, including that of the industry, was about 10 per cent. I suspect that those figures have slipped a little since that report, but there is no question that the pharmaceutical industry in particular makes a huge contribution to our economy. We cannot be complacent about that in the future.
On the question of leadership, I was fortunate to be present at the recent annual conference of the NHS Confederation. I take the point made by the noble
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There is a big question about what exactly the duty of the Secretary of State will be with regard to research if we end up with a highly devolved structure in which the levers left to the Secretary of State will clearly be limited. It is clear that the day-to-day concerns of most people in the NHS are going to be diverted into a market-orientated culture, where, frankly, the kind of collaboration that research requires across NHS organisations may well be regarded as collusive behaviour by economic regulators and the competition authorities.
I speak with some experience of economic regulation. Ofgem was the last economic regulator with which I had regular dealings as Minister for Energy. What struck me was that regulators' concerns are much more about day-to-day issues than they are about the long-term viability of a particular industry. We found, with Ofgem, that we had to change the law to make sure that it had some regard to future customers rather than simply being concerned about the actual price of energy to the customers of today. If we have regulators whose main concern is about driving day-to-day competition, I wonder where issues of research come into play.
Lord Hunt of Kings Heath: Yes my Lords, but so was the overriding duty of Ofgem to the customer. The problem is how a regulator defines that responsibility. Since the Government are intent on this very foolish drive into competition, I believe that the risk is that the regulator will also be driven into thinking that that is its most important aim.
There are some real questions here, which I put to the noble Earl, about ensuring that there is sufficient concern, investment and leadership on the question of research. I would also ask the noble Earl how we protect and ring-fence the research budget. I ask him to think of the national Commissioning Board, faced with a hard winter, huge public concern and political pressure about funding, and the temptation to dip into the research budget. We all know that that happens. My noble friend Lord Warner and I were debating earlier who was responsible when there was real pressure on the training commissions. I thought it was my noble friend, actually, but we can continue to debate that.
Lord Hunt of Kings Heath: My Lords, with the greatest respect, I will not go into who left me the junior hospital doctors issue. He will recall that my
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My experience was that the health service let us down on training commissions, because at the time they were facing a financial difficulty and it was all too easy to cut those commissions. The result was that Ministers essentially took it upon themselves to put central controls back into the system. My concern is that if the NCB simply has research in its budgetary responsibility and there are severe pressures, it is just too easy to dip into it. The problem is also, as my noble friend Lord Warner said, that, as we know, sometimes research budgets take a little time to kick in, but once you do it you are funding for three, five, seven years. Again, in each financial year, an amount is probably available in the winter that had not been spent. The problem is that you will never get that resource back again.
The second point that I would like to put to the noble Earl is about clinical commissioning groups. How do we ensure that their commissioning decisions support research? My noble friend Lord Turnberg said that research is no cottage industry, but clinical commissioning groups are the epitome of a cottage industry. He also referred to the fact that GPs have little history of undertaking research and commitment to it. Yet we are handing them billions and billions of pounds, quite remarkably, on the basis of no evidence whatever that I can see that they are fitted to discharge that responsibility. I ask the noble Earl where we can have assurance that clinical commissioning groups will be prepared to invest in services where there is a strong research base.
The third challenge is to NHS trusts and NHS foundation trusts. The noble Lord, Lord Ribeiro, put his hand on it when he talked about the reduction in the number of clinical academic posts. I believe that NHS trusts have a great role to play in encouraging their clinicians and in encouraging joint posts with universities. Again, I worry that the focus on job plans and the productivity of clinicians will discourage research because the emphasis will be on patient throughput. How are we going to ensure that that does not happen?
I take the point made by the noble Lord, Lord Ribeiro, about surgeons' practical skills. What about simulation centres in training to help surgical teams to work together and the research base involved in that? What about nursing and AHP research? Also, what about clinical trials? There is a real risk of losing clinical trials to other countries. If the pharmaceutical industry feels that clinical trials are not encouraged in this country, there is a risk that it will take some of its R&D work abroad as well.
I listened with great interest to what the noble Lord, Lord Walton, said about the need to streamline the approval process. I welcome the Government's proposals and commitment to improve and streamline that process, and it is something that we on this side of the House very much support.
Above all, we need to deal with the question of implementing research. Earlier, we talked about besetting sins. It has long been a besetting sin that the NHS has
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The noble Earl talked only two days ago about the proposed introduction of value-based pricing. Without going into the methodology, I should like to ask him whether, through such pricing, the industry is going to lose the flexibility to set prices. Is there not a risk that we will make the UK a less attractive place for the industry to develop R&D in the future?
That brings me to the Department of Health. Although it was there to sponsor the industry, there was always a risk that, because of its concern about NHS budgets, ultimately it would be much more concerned about holding down prices. In the great endeavour to ensure that this country continues to have a strong research base in the health sector, I should like an assurance from the Minister that, in its sponsorship of the pharmaceutical industry, the department will be as concerned to ensure that the industry is strong as it will be to hold down prices.
I know that this has been another long debate, but I think that nothing is more important in this country than health-based research. Tonight, our concern is not so much about the wording of the amendments as about hearing how the Government will ensure that we continue to prioritise research in the future.
Clause 5 places a duty on the Secretary of State, for the first time, to have regard to the need to promote research within the health service. It also places equivalent duties on the Commissioning Board and clinical commissioning groups. The duty applies to research into matters relevant to the health service-I shall come on to that phrase later-and the use within the health service of evidence obtained from research.
I turn straight away to the amendments, beginning with Amendments 39 and 199ZA together, as they make the same changes to the research duties on the Secretary of State and clinical commissioning groups. Amendment 39, tabled by my noble friend Lord Willis and the noble Baroness, Lady Morgan, would require the Secretary of State to promote research within the health service and to promote the use of the evidence obtained from that research. The Bill as drafted requires the Secretary of State to have regard to the need to promote research in the health service. This means that the Secretary of State must bear in mind the importance of research when exercising any of his functions and consider how the exercise of those functions might in itself promote research or how it might influence the promotion of research by others. I have reflected on these two amendments and I can tell noble Lords that I sympathise with the arguments
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Amendment 40, tabled by the noble Lords, Lord Warner and Lord Patel, requires the Secretary of State to have regard to the need to develop research findings for clinical application in the health service. I agree with the noble Lords that this emphasis is important. We need to ensure that, wherever possible, research outcomes are translated into clinical practice. This is how the health service moves forward. The noble Lord, Lord Walton, as so often, was completely right in all that he said on that subject. As the duty is currently drafted, the Secretary of State is already required to have regard to the need to promote the use of evidence obtained from research. Therefore, we believe that this amendment would duplicate the existing duty.
Amendment 40 also refers to the need to ensure that staff have the relevant training and support where new technologies are introduced. We have brought forward an amendment to introduce a duty on the Secretary of State to exercise his functions so as to secure an effective system for education and training within the health service. The word "effective" is there for a purpose. Similarly, the NHS constitution makes a public pledge that all NHS providers should provide all their staff with access to appropriate training for their jobs, together with line management support to succeed. Therefore, again, in my view this amendment is unnecessary.
It may also help to reassure noble Lords if I refer to our consultation document, An Information Revolution. In this, we state that information management and IT capability are essential if we are to achieve improved healthcare outcomes. Our forthcoming information strategy will recognise the importance of informatics skills within the health service, and I hope that this will reassure noble Lords-in particular, the noble Lord, Lord Warner-that we are fully aware of the need to ensure that staff are able to maximise the benefits that new technologies can offer.
I now turn to Amendment 41, also tabled by my noble friend Lord Willis and the noble Baroness, Lady Morgan. This amendment would place an additional requirement on the Secretary of State to promote research into public health issues. Again, I agree with the principle behind the amendment-it is indeed true that advances in public health are shaped by research and evidence, and the noble Lord, Lord Turnberg, gave us a number of examples. In fact, this amendment can be dealt with quite simply. The duty on the Secretary of State, the board and clinical commissioning groups to have regard to the need to promote research applies to "the health service". That phrase encompasses both the NHS and public health services, and therefore the duties already apply to public health.
as examples of action that the Secretary of State may take under his wider duty in relation to protecting
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My noble friend Lord Willis asked me how the duty on the Secretary of State would be fulfilled in practice. It may be helpful if I briefly set out the work that is going on beyond the Bill to ensure that research is embedded in the new system. The department has recently published a document setting out initial proposals for the NHS Commissioning Board. Among other things, it emphasises that, to fulfil its purpose, the board should support,
There is also a clear indication in the department's document, Developing Clinical Commissioning Groups: Towards Authorisation, that clinical commissioning groups will be expected to demonstrate how they will promote research. These documents can be found on the Department of Health's website. I should be very happy to expand on this in a letter to my noble friend and other noble Lords.
In this area the noble Baroness, Lady Finlay, asked what the levers for research would be, and that question was echoed by a number of other noble Lords. I will expand on this in writing, but there are a number of parallel levers across government that will do this, ensuring that the UK's commercial and industrial landscape is, as the noble Lord, Lord Hunt, rightly emphasised, an attractive place to do research, and that we do not neglect any aspect of research-basic, translational and clinical-so it is about research across the piece. It is also about the pricing of medicines, about our skills base as a country and about encouraging the concept of clustering, linking universities and the NHS and industry. We have announced recently a large sum of money which will go towards biomedical research clusters and units. It is also about deregulation, streamlining research and creating the Health Research Authority to do that, the drivers in the NHS such as the tariff and, not least, holding bodies in the NHS-CCGs no less than others-accountable for the duties that are in this Bill. Accountability is the counterpart to the concept of autonomy.
I cannot say much to the noble Baroness, Lady Morgan, about the tariff. We do not envisage a separate tariff for research, but we will ensure that the systems and processes that the board and CCGs use for commissioning patient care ensure that research is supported and that treatment costs are funded by the NHS. This will specifically include a tariff. It is essential that the tariff for patient care incorporates the costs of patients who are taking part in research, and we will ensure that it does.
I turn to Amendment 42, which was tabled by the noble Lords, Lord Warner and Lord Patel, and my noble friend Lord Ribeiro. This amendment seeks to safeguard the funding of research by placing a requirement on the Secretary of State to ensure that there is adequate funding for research and the application of that research to the health service. The amendment also aims to ensure that clinical commissioning groups will fund the treatment of patients involved in research. I share the desire to protect research funding-as Minister for research, how could I not do so? My noble friend
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I heard from many noble Lords the concern about the research responsibility for the NIHR transferring across to the NHS Commissioning Board and how the budget could be protected in that event. I do not know where this idea has come from, but it is not accurate. The budget for the National Institute for Health Research is centrally held within the Department of Health and will remain so. The budget for research commissioning will not transfer to the NHS Commissioning Board. Dame Sally Davies, the Chief Medical Officer, retains a responsibility for the National Institute for Health Research and for the budget that is allocated to it to commission research. I hope that that reassures my noble friend and the noble Lords, Lord Walton, Lord Warner, Lord Turnberg and Lord Rea, and all others who have expressed worries on that score.
With respect to the research that takes place within the health service, alongside the Secretary of State's duty to have regard to the need to promote research, Clause 14(13) already gives him the powers to commission research or assist any person conducting research, including by providing financial assistance. An equivalent duty and powers are conferred on the board and clinical commissioning groups. We therefore believe that there are robust arrangements for safeguarding the funding of research already in place.
Amendment 74, proposed by the noble Lord, Lord Patel, would add the promotion of research and acting on research evidence to the list of steps that local authorities may take when exercising their new functions in relation to health improvement. The importance and value of high-quality research and evidence to public health are clear and well understood. We agree entirely that local government should make evidence-based decisions and we expect that Public Health England, the new executive agency, will help it to do that. We also agree that local government should be able to undertake or support research of its own. While this is not listed in Clause 9, because that list was drawn from the current functions of the Health Protection Agency, it is included in Clause 14(13) of the Bill. This clause gives local authorities a specific power to conduct, commission or assist research that is connected to their functions as part of the comprehensive health service. The list in Clause 9 is not prescriptive. As a rule, it must be for local authorities themselves to decide how best to use their own resources as autonomous bodies. Therefore, including research in Clause 9 would not make it mandatory. For that reason, we believe that this amendment would not add anything to the existing provision in Clause 14 and it is therefore unnecessary.
Amendment 89E, tabled by the noble Lord, Lord Hunt, would remove the power of the NHS Commissioning Board, clinical commissioning groups and local authorities to conduct research in relation to their health service functions. It would leave intact the
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Amendment 40A, tabled by the noble Lord, Lord Turnberg, and other noble Lords, would require the Secretary of State to have regard to the need to promote the use of information derived from patients for research purposes while taking full account of the confidentiality of information. I welcome the intent behind this amendment, but it is in fact unnecessary. We recognise the important role that patient data, if treated carefully and confidentially-and that I hope goes without saying-can play in improving the quality of health research. I spoke earlier about our consultation document AnInformation Revolution, in which we propose that the most important source of data is the patient's or the service user's care record generated at the point of care. Information in these records also provides much of the data needed for other secondary purposes: for commissioners, for managers, for care professionals and, importantly, for research. We are using the responses that we received to the consultation, together with the findings of the NHS Future Forum, to develop an information strategy for health and social care in England. This will highlight how increased transparency and greater access to information supports improvements in care and research. It is the major work stream. I can reassure the noble Lord that we value the use of patient information where confidentiality is appropriately protected as a source of research and that we are looking at ways to embed its use in our information strategy.
Lord Turnberg: Can the noble Earl give us any idea of the timescale over which we might see something emerging from this? It has been on the agenda for a very long time and we really need to move on it.
A great many noble Lords have asked me questions, some of which I have covered, but I suggest that in the interests of time it might be helpful if I followed up this debate in writing and in a way that will enable me to answer the questions in greater detail than I would now in any event.
Lord Warner: My Lords, in doing that will the Minister clarify what "health service" means? As I read the Bill, it sometimes looks as though public health is not included in that definition. It would be
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Earl Howe: I should be very glad to do so. The noble Lord may not be surprised to hear that, when I was being briefed for this Bill, I had to ask myself that very same question. The definition is there, but I think that it would be helpful if I set out the import of that phrase in its fullest sense.
I hope that I have said enough to encourage noble Lords not to press their amendments, but, in doing so, I reiterate my thanks to all noble Lords who have made such an excellent contribution to this debate.
Lord Willis of Knaresborough: My Lords, I thank the Minister for, as ever, a very courteous and thoughtful response to many of the issues which have been raised, in particular his response to Amendment 39 and his undertaking to reconsider "have regard to the need to", which appears to be a little bit of clumsy draftsmanship that would be unworthy of the Minister himself.
The Minister raised a number of important issues, including that to which the noble Lord, Lord Warner, referred. We have now had a definition of "health service" which includes public health. That means that public health research could lie within some local authorities, because a significant amount of public health will be devolved to local authorities. While I was pleased to hear the Minister say today that those people moving from the National Health Service to local authorities for public health matters would retain National Health Service terms and conditions, the reality is that they will be working under a local authority aegis and that research would therefore be an issue for local authorities rather than Public Health England-or so I understand, but we will probe that later.
On protecting funding, I was particularly grateful for the way in which my noble friend the Minister responded to the idea of ring-fencing. He spoke not of ring-fencing, but said that there had been an increase in budget. It would have been good if he could have made that comment. However, he did say that NIHR would remain a stand-alone organisation. That was news to me; I thought that it was going to move into other organisations. Quite frankly, that is good news. It has a reputation which demonstrates that research is very important and we can track how it is used and when. I thank the Minister for that.
I apologise profusely to the noble Baroness, Lady Emerton, for indicating that "research" meant the work that is coming out of universities and being translated for use at the bedside. She was quite right to remind us that "research" for the purposes of this Bill was all research, and that what should underpin all public policy, in the NHS or anywhere else, is research which gives you evidence to inform policy decisions. I thank her for that rebuke.
Lord Warner: I do not want to prolong this debate. I will read very carefully what the Minister said about protection of finance. We may want to come back to this issue to be reassured that all is well.
"( ) the proper conduct of research by establishing such structures and procedures as he deems necessary to prevent, detect and impose sanctions on research conduct"
Lord Willis of Knaresborough: I shall be very brief. In simple terms, the Secretary of State now has a duty to promote research. Clearly, that research must have integrity, and this amendment is about protecting that integrity. I think that we all agree that medical research is crucial to the UK's healthcare system, the economy-as the noble Lord, Lord Darzi, made clear in our previous debate-and our standing as an international research community. I make it clear to the Committee that the claim that the incidence of malpractice is widespread is wrong-there is not widespread malpractice in health research or in any part of our research base-but it would also be wrong to say that we have a perfect system and there is not some malpractice.
While peer review is an extremely robust method for assessing the quality of the science and the research, it was never intended as a mechanism to detect fraud. There is an assumption when you peer-review a piece of research that the data are accurate and that what you are doing is looking at the methodology, the evidence and the conclusions to see whether they stand up to scrutiny. You do not simply go back and look at the whole of the data.
We know that there are a number of irregular goings-on at various levels of research, particularly at junior level, from ghost-writing and guest authorship to plagiarism and falsification of data. As science, particularly medical science, relies on trust, it is important that we have a robust system in place which guarantees research integrity as far as it is possible. Andrew Wakefield, who built the case against the use of the MMR vaccine, based his evidence on a very small sample, falsified the data and manipulated patient records. It is clear that we need a system that would prevent that happening again. The reality is that it took seven years before that research was fully retracted and, to this day, the level of MMR vaccine uptake remains below the 95 per cent that we would regard as sufficient to confer immunity on the population. In other words, that incident of malpractice continues to have an effect. Children are being affected as a result and mothers in particular are worried.
"Oversight of research integrity in the UK is in need of revision. The current situation is unsatisfactory. We are concerned that the UK does not seem to have an oversight body for research
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They went on to say, quite rightly, that it was the responsibility of employers, whether they be universities, research laboratories or private organisations, to guarantee the integrity of their research. They said that they did not want there to be a new research integrity agency or an equivalent, but, instead, a "Research Integrity Concordat", which brought together universities and bodies involved with research and which the Government would oversee.
My reason for this amendment is to ask my noble friend the Minister what progress is being made to form a research integrity concordat. When do we actually expect that to be finalised? While there is evidence in Australia, Norway and the United States, where there are defined offices of research integrity, the Government have said that they do not want to go down that road; they actually want a concordat. For what it is worth, I support the Government on this; I think that that move is right. It is only right, however, if that concordat becomes a reality, so my real question to the Minister is about when it is going to become a reality. When can he assure the House that we do not need to have a different organisation in order to ensure that the duty of research-which is now going to be imposed on the Secretary of State-does not blow up in his face at some future date? I beg to move.
Lord Walton of Detchant: My Lords, I am glad that the noble Lord, Lord Willis, has raised this extremely important matter. Research misconduct is rare, but it happens. Several years ago, there were a number of quite cogent reports produced by Dr Frank Wells of the British Medical Association, Dr Stephen Lock, who was the editor of the British Medical Journal and his successor, Dr Richard Smith, which actually demonstrated that in a number of rare cases research results had been fabricated. This issue has been highlighted by a number of similar events in the United States and elsewhere. The universities, the research councils and a number of other bodies have looked at this matter and made a number of recommendations. I am not at all certain that this is the right place in this Bill for this issue to be raised, but the question needs further consideration by the Government-for instance, to decide whether this important issue should be in any way part of the remit of the proposed new medical research agency.
Earl Howe: My Lords, Amendment 41A, tabled by my noble friend Lord Willis, will require the Secretary of State to set up a system to ensure that research is conducted properly and ethically and that there are sanctions in place in cases of misconduct. Let me say straight away that I am in agreement with the intention of my noble friend in tabling this amendment; the
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Looking at the amendment as it is worded, I can assure my noble friend that there are already systems in place to ensure that research is conducted ethically. Research, as he knows, cannot proceed without ethics committee approval. I realise that this is a probing amendment, but equally, as it is worded, it overlooks an important element in the current system of accountability, because it would risk undermining the clear responsibility in research, as in clinical practice, that employers have for the conduct of their employees and that professional councils have in regulating their members. Both can impose sanctions on researchers if their conduct is found to be inappropriate. I do not see that it is the responsibility of the Secretary of State to impose sanctions on clinical professionals, and it should not be his responsibility to do so for researchers. In the future, the Health Research Authority will continue the good work of the National Research Ethics Service, working with others to prevent misconduct by ensuring that the ethics of research have independently reviewed by research ethics committees.
This evening, I am able to give a new commitment to my noble friend. I am happy to tell him that we intend to publish the draft clauses on research for pre-legislative scrutiny in the second Session of this Parliament. That scrutiny will enable my noble friend and other noble Lords to comment on the detail of our proposals for the Health Research Authority and, in turn, enable us to ensure that future legislation is fit for purpose. I hope my noble friend will welcome that pledge.
If I may, I will cover the question my noble friend asked me about the concordat in a letter to him following this debate. I hope I have reassured him that there are systems in place to ensure good conduct in research. Nevertheless, his points are well made and I shall reflect fully upon them. I can only say at the moment that the Health Research Authority intends to build on these systems. In the light of what I said, I hope my noble friend will feel able to withdraw his amendment.
After section 1D of the National Health Service Act 2006 insert-
(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.
(2) In subsection (1), "relevant enactment" means section 63 of the Health Services and Public Health Act 1968 and any other enactment under which the Secretary of State has functions which could be exercised for the purpose of securing that there is such an effective system as is mentioned in that subsection.""
After section 1D of the National Health Service Act 2006, insert-
The Secretary of State has a duty to maintain a national pay and bargaining system for healthcare staff, to cover those staff providing NHS services and services for the improvement of public health.""
Baroness Wheeler: My Lords, I am pleased to move this important amendment, supported by my noble friends Lady Thornton and Lord Hunt. The amendment would provide some much needed morale and security at a time of great upheaval for NHS staff. In turn, it would reassure patients that the morale of those treating or caring for them will not impact on the quality of care they receive. Let us just imagine how NHS staff must be feeling now, no matter how dedicated or determined they are to carry on providing the best care possible. There is the Nicholson challenge to implement £20 billion-worth of savings, which they know will seriously impact on patient care, they are facing huge disruption to services and patient care as primary care trusts and strategic health authorities are abolished under the enormous upheaval of reorganisation, and there is massive uncertainty about the future bargaining arrangements for their pay and conditions.
The amendment calls on the Government to commit to the continuation of national determination of pay and national collective bargaining for terms and conditions for NHS staff under the reorganised NHS, leaving employers and trade unions nationally to agree what local flexibilities should operate. The Government have so far failed to acknowledge the need to retain national workforce structures for terms and conditions, pay and bargaining. The Bill prescribes nothing on the pay systems that clinical commissioning groups should adopt, giving them greater leeway to break away from the existing long-established and well-tested pay systems for NHS staff.
Agenda for Changeis the single, national pay system in operation for the NHS and applies directly to all staff, excluding doctors, dentists and some very senior managers. It is well established, much respected by employers and staff and delivers equality-proof pay
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We know that most staff do not work in the NHS to get rich, despite the constant, distorted picture in some parts of the media about the levels of public sector pay and pensions. Nurses' pay starts from £21,000 a year and healthcare assistants from as little as £14,000 a year. The average public service pension is around £7,800 a year, but the average pension for a woman working in the NHS is only around £3,500 a year. If staff do not work for the NHS to get rich, what do they value? Job security is no longer the public sector staple employment motivator that it was: 13,000 redundancies have resulted from the current reorganisation. A recent survey by the Royal College of Nursing showed that an estimated 15,000 nurses and healthcare assistants expect to be made redundant in the next 12 months. Staff are not able to value job security any longer, but they do value fairness. Agenda for Change has delivered that, as well as equal pay.
In the uncertain environment caused by the reforms, having some guarantee about access to a fair, national pay system would at least provide an element of security. If, in the future, foundation trusts, with the heavy financial pressures they will face, start to abandon established pay rates and conditions, we fear that this will lead to the rapid downward spiralling of pay for staff, which will be particularly hard in these economic times. Staff morale and motivation are already suffering, and local pay bargaining would make it harder for the NHS to recruit and retain the best available staff, so in turn affecting patient service. Undermining staff pay and moving to local pay bargaining would also have a detrimental impact on patients. We must have an equitable spread of doctors, nurses and other professionals across the country. If local pay bargaining leads to many health staff moving away from a particular area, we could see the quality of service reduced there or patients having to wait longer because vacancies have not been filled. Agenda for Change is generally considered across the NHS to be a vast improvement on the previous fragmented and complex arrangements. It is seen as providing a firm basis for taking forward important, substantive issues, particularly equal pay, new ways of working and workforce reprofiling.
The amendment also explicitly refers to public health staff, because this is one of the major concerns for the NHS public health workforce, who continue to operate in limbo, unsure of exactly who will be employing them and on what pay, terms and conditions. The Government have promised a detailed public health workforce strategy in the autumn to support effective transition to the new system. When is the strategy to be published and what will be the consultation arrangements for all stakeholders? All we know now is that the directors of public health will transfer to local authorities, but precious little else is known yet about the arrangements for the remaining public health
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The amendment would give the Government a chance to provide some much needed solace for public health staff by committing that they should be covered by the same pay system as other health workers. It would also give hope and reassurance to all NHS staff about their future pay bargaining arrangements. I urge the Minister to respond positively.
Lord MacKenzie of Culkein: My Lords, I rise to support Amendment 45 and to follow on from my noble friend Lady Wheeler. I have spent quite a lot of my working life negotiating pay and conditions for staff in the National Health Service. I sat on four NHS Whitley councils for a very long time-one of them for 21 years. As a nurse, I was privileged to lead negotiations on behalf of Britain's nurses and midwives for quite a few years as chairman of the staff side of the Nursing and Midwifery Staffs Negotiating Council. So I know a little about the subject of this amendment and the possible consequences of any breakdown in national pay and conditions of service for National Health Service staff.
We have had nationally agreed pay and conditions ever since the inception of the National Health Service, with occasional attempts to break this down, particularly in the late 1980s. The Government of the day thought better of it and backed away. The old Whitley system stood the National Health Service in good stead for many years, but it was far from perfect and there was not always peace and harmony. There were problems in some years, going back, for example, to 1972 for ancillary staff, 1974 particularly for nurses and 1982 for most staff groups. The most recent that lingers in my memory was the ambulance dispute, which I think was in 1990.
Not all staff unions in 1983 agreed that the Government should set up a pay review body for nurses and midwives and professions allied to medicine. However, it was in my view an entirely sensible move, which by and large took a lot of heat out of relations between management and staff organisations for these two groups of staff. Why was the pay review body the right solution? The review body was independent and the staff unions were forced to undertake very detailed research into their pay claims. We used to spend many months getting that evidence right. The management side and government put in evidence as well. The Office of Manpower Economics, which provides the secretariat to the review body to this day, also carried out its own research. The review body took oral evidence from all of the parties. I led that for a number of years on behalf of the staff side. The members of the review body-academics and professionals-put us through the hoops, and any half-baked evidence would have been very quickly exposed. There was no question of
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The pay review body provided, for the most part, fair uplifts in pay. Sometimes we were disappointed but often the real anger from nurses and professions allied to medicine was more often directed at Governments, who had a habit of staging pay awards-except of course in election years. Other pay groups were brought into the purview of the review body in 2004 following the very long and detailed work to bring in the new pay structure, Agenda for Change, to which my noble friend Lady Wheeler referred. In 2007, all the remaining groups of NHS staff except doctors and dentists were brought into the National Health Service review body. The plethora of NHS Whitley councils-I think there were 10 when I was involved-has now been reduced to one.
Staff unions, NHS employers and the Department of Health have invested very heavily in making Agenda for Change work. The structure is underwritten by comprehensive job evaluation, a knowledge and skills framework and the national pay scales. Particularly importantly, it is equality-proofed. It provides some built-in local freedoms for employers, one example being to allow for recruitment and retention payments. It is supported, as my noble friend Lady Wheeler said, by staff, employers and trade unions. The worry is that we have already seen some efforts by some foundation trusts to impose alterations to Agenda for Change outside of the agreed local freedoms. Instead of the relative harmony that has existed over many years now, we have had unnecessary local hotspots with the inevitable problems of distrust and effects on morale.
The pressures on National Health Service staff over the next few years are going to be enormous. The most important focus should be-must be-on improving quality and driving efficiencies. We do not need that focus upset by employers and unions doing battle over local pay and rations. The last thing we need is fragmented and inconsistent systems of pay and conditions of service. The ratcheting up or down-probably mostly down-would in my opinion lead to equal pay litigation issues if the equality-proofed Agenda for Change structure breaks down.
This amendment will ensure that clinical commissioning groups and foundation trusts are not able to break down the systems so painstakingly put together in the past few years. Let us not move away from that tried and tested system where staff unions and employers can put their energies into giving evidence to an independent pay review body rather than expend these energies on local bargaining, which could create disharmony, industrial disputes and issues of morale. I hope we hear from the Minister that we will continue to have national pay bargaining in the National Health Service.
Baroness Murphy: My Lords, by now it will be no surprise to the Opposition that I do not support this amendment. It seems to be an extraordinary pedalling-backwards amendment. I ought to remind colleagues
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I do not see the Agenda for Change as being successful. Yes, it was better than the Whitley Council, which had 250 different scales and you did not know where you were; it was pretty grim. However, Agenda for Change has not been implemented with the learning and skills framework alongside in any more than 50 per cent of trusts. It has not led to productivity gains. It led to an uplift of pay but did not actually deliver what employers wanted it to deliver.
In my view, a good employment framework for local organisations must take account of local economic circumstances, the social demographic mix and the skills available in the local communities. Therefore, it must give local employers greater flexibility, as part of the autonomy of those organisations, and the ability to move away gradually from the situation that we have at the moment of profound skill shortages of nurses in some areas and an oversupply of some skills in other areas. If we could be more sensitive to local circumstances, we would get better values and rewards for staff in the NHS. I therefore very much support the Government's approach to this and do not support this amendment.
Lord Rooker: My Lords, I intervene briefly in this debate. It also gives me the opportunity to apologise to the House. I removed Amendments 35 and 36 at 10 pm on Monday because I could not guarantee to be here at 3.30 pm today. I apologise if it caused confusion, but I could not be here today at that time.
On Amendment 45, I would like to know the Government's position, because the noble Baroness said that the Government maintain their position. In some ways, the temptation for fragmentation is enormous. I am not sure whether the NHS is still the largest employer in Europe. As a totality, I think it probably is. However, we are talking here about England-or are we? The issue of devolution is crucial. I served for 12 months as a direct rule Minister in Northern Ireland, and I came across problems there relating to people doing the same job here. Also, of course, moving around Whitehall, as the Minister probably discovered himself, you go into departments and meet people doing more or less exactly the same job on vastly different salaries. The temptation of fragmentation was accepted at the centre of government, and that has led to significant problems of mobility for people moving even around Whitehall.
I am no expert on the NHS-I only know it as a patient and a family member of patients-but as far as I am concerned, it is a team effort. It is a bit like the
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Quite clearly, there will be transfers of public health staff who are working in local government and who are perhaps working to and with NHS rates of pay. That in itself will be a difficulty if people are going to work with colleagues in local government under a different scheme. While the Government take account of that, the temptation will be to level down to local government to get one size fits all at the local level. I do not think that that temptation ought to be accepted.
As for the issue of regional break-up, there was an argument about this many years ago when there was an attempt to pay teachers more who were prepared to go and work in the inner cities. You can have a local premium, and you can do some local work where there are factors, but in the case of nursing staff, particularly the lower-paid, and their ability to move around the country for career opportunities and to move their family, they are working within one service. Everybody knows that it is the NHS-the "N" is still there-but they are faced with the issue that, for the same job in the next region or the next but one region, they may be paid up to 10 per cent less and their pension and terms and conditions may be different. That could cause enormous problems.
I only spoke in the mental health debate last week, but the overall theme of the Bill and the many allegations that have been sent to noble Lords, of which the Minister will be aware, are that this is a grand plan-not now, but in the end-to fragment and break up the National Health Service, a plot hatched in the 1980s by Members of the other House who are currently members of the Government. The introduction of market forces into both the provision of care and other providers, and the temptation then to break up national pay bargaining to fit the new regime, which is supposed to be patient-oriented, is an enormous pressure on the Government. Ministers will be told that this will make sense at the local level. It may be asking a lot for the Minister to give a definitive response to this tonight, but the issues of industrial relations and pay bargaining in the NHS have to be settled well before the passage of this Bill, if only because during the period of implementation we do not, as my noble friend said, want discord among the staff as they implement what will be, I accept, many positive changes in the Bill.
The other issue that has to be raised, because we are talking about services to patients, is the pay and bargaining within service providers as the issue gets broken up. There will be some debates about charities,
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If we allow fragmentation at a local level, it would be wise for the Minister to say that the status quo will be maintained. I accept that the status quo has flexibility built in, as the noble Baroness said, but it is a flexibility that does not appear to have been used. This is a bit like the Scottish Government. They had the flexibility to put up income tax by 5 per cent, but it has never been done. This is the reality. You put in that flexibility but for various reasons there are barriers to actually using it. In this case, the evidence is that the flexibility has not been used except perhaps in extreme circumstances. I do not think that it would be a good idea if we went down this route. I think there is enough evidence to keep people working together as a team with a national perspective that allows job mobility and promotion without people being afraid of moving within the same service because of the pay and conditions. I do not think that it is a good idea, and I hope the Minister will be able to take a more positive approach to this issue, even if he can only state it in general terms.
both NHS and public health services. This would cover not only existing NHS organisations but any organisation providing services to the NHS. The amendment, as worded, goes against the Government's view that employers are best placed to determine the most appropriate pay and reward package to ensure that they recruit and retain the workforce that they need.
Our clear view is that it would be inappropriate to require independent and voluntary sector providers to adhere to NHS pay when NHS foundation trusts, as the noble Baroness, Lady Murphy, rightly pointed out, already have such freedoms. The Government believe that to deliver the best care for patients, this freedom should be extended to all NHS organisations. I also take the noble Baroness's point that while foundation trusts have the power to apply local terms and conditions for all staff, medical, clinical and administrative, very few trusts exercise those freedoms. There are around 400 trusts, and only one foundation trust-Southend-has departed from Agenda for Change, and the differences that it has negotiated are marginal.
Employers can continue to use national pay. I would just make it clear that nothing that I have said means that the Government see no role for national contracts and negotiating mechanisms. We believe that many
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The noble Lord, Lord MacKenzie of Culkein, spoke about the pay review bodies. The Government recognise that the review bodies bring an independent and expert view, valued by the Government and those representing public sector staff and employers. In the longer term, we will work with NHS employers and trade unions to explore appropriate arrangements for setting pay. He also highlighted the risks of local pay bargaining. The Agenda for Change pay system includes all the right checks and balances-for example, the national online job evaluation system-so employers locally can ensure equal pay for work of equal value, which is of course important. When employers decide to move away from national pay frameworks, they must of course continue their legal obligations under equalities legislation.
The noble Lord, Lord Rooker, spoke about the implications of pay devolution and enlarged on the theme begun by the noble Lord, Lord MacKenzie. I understand that the NHS Staff Council is engaged in constructive discussions with NHS trade unions about the challenges facing the NHS across the UK and the scale of the financial problems facing employers and their staff. NHS employers and trade unions recognise the contribution that national pay frameworks have made to the development of a modern and effective NHS and agree that it needs to be fit for purpose for employers, staff and patients in the short and longer term. Talks are continuing between the unions and employers; my understanding is that they want to work within national pay frameworks.
The noble Baroness, Lady Wheeler, asked specifically about the public health workforce strategy. We have been discussing with the NHS local authorities and others how the transition for public health can be managed most effectively for staff. We are working hard to get this right; we do not envisage applying a top-down approach to determining public health teams within local authorities. We will expect good employment law principles and practices to apply and any transfer that is a relevant transfer under the TUPE regulations will engage the TUPE principles. Additionally, the principles of the Cabinet Office statement of practice may apply.
I hope that, with those comments, noble Lords are reassured, although I cannot go as far as the amendment would invite me to go on imposing mandatory national arrangements across the piece. However, I hope that I have said enough to encourage the noble Lord to withdraw the amendment.
Lord Rooker: For the public health directors, who will be the employer? Will it be the local authority? In the sense that you can pay a director of education or children's services market rates around local government, will that be the same for the directors of public health, so that their salaries vary around the country? It would be the beginnings of a new service, in that sense. Do we know the answer to that?
Earl Howe: They will be employed by local authorities. It is too soon to say to the noble Lord what the pay grade of those people will be, but clearly they will be very senior officers within the local authority. Yes, strictly speaking, if there is freedom to set pay locally, there could be some variations around the country, but I would envisage that the pay grade of directors of public health will gravitate towards a certain figure, whatever that may be.
Earl Howe: My Lords, we value the pay review bodies, and there are no plans to disturb them at the moment. I sought to indicate that we continue to look at how pay arrangements are best structured. The pay review bodies do an extremely valuable job at present, as they have done for many years.
Baroness Wheeler: My Lords, I thank the Minister and other noble Lords who contributed to the debate, particularly my noble friend Lord MacKenzie for his reminder to us of the history of the establishment of the pay review bodies and the contribution that they have made, particularly to improving pay and industrial relations in the NHS.
I also thank my noble friend Lord Rooker for a number of comments that he made in support of the amendment, particularly the point that he made about operating the same job in a nearby locality for different pay and conditions, which would be likely to cause serious detriment to industrial relations. We are very concerned about that.
I deeply disagree with the noble Baroness, Lady Murphy. This is not a pedalling-back amendment. The foundation trusts, I would contend, have not implemented local pay bargaining because they know the implications for industrial relations and local employment rates and so on. Agenda for Change has introduced equal pay, as the Minister said, and provided a good framework for addressing issues of equal pay for equal value. It has certainly proved its worth.
I regret that the Minister is unable to offer any real comfort to those in the House who believe that honouring the long-standing pay and bargaining arrangements for NHS staff at national level is not only the fairest thing to do but the wisest course if we are to ensure that NHS staff morale does not plummet even further. It is an important issue and I give notice that I intend to raise this matter at a later stage. I beg leave to withdraw the amendment.
To ask Her Majesty's Government what assessment they have made of the impact of current and proposed wind farms and their supporting infrastructures on the communities and landscape of mid-Wales and Shropshire.
Lord Thomas of Gresford: My Lords, I welcome and congratulate the noble Baroness, Lady Stowell, on her first venture to the Dispatch Box. It is a pleasure to see her responding to this debate. I declare an interest as a former president of the Montgomeryshire Society with strong links to the Vrynwy and Meifod valleys. Together with my noble friend Lord Hooson I was engaged in resisting successfully the proposals to drown the Dulas valley near Llanidloes in the early 1970s to provide a regulating reservoir for Birmingham.
Two or three years ago my noble friend Lady Walmsley-my wife-and I visited a school in Llanfair Caereinion to present prizes given by the Montgomeryshire Society. While we were congratulating a bright young boy on the excellent prize he had won, I asked him, "What are your plans when you leave school?". He said he wanted to be a farmer. I asked whether it was sheep, cattle or arable farming that he had in mind. "No," he said, "Wind farming".
This is a timely debate, having regard to the KPMG report Thinking About the Affordable published this week. The report says that government plans for wind farms are too expensive and should be shelved in favour of cheaper nuclear and gas-fired power stations. Government plans to cut pollution by a third by 2020 rest heavily on wind power and will cost £108 billion to implement. The report says that shifting away from turbines towards nuclear and gas-fired power stations would slash the bill by £34 billion, which is equal to around £550 for every person in this country. Wind power is accordingly one of the most expensive forms of electricity generation to build. Wind farms are expensive to operate as they depend on nature, which means they often do not run at full capacity. It is claimed that they run at 31 per cent of capacity but analysis of past performance in the UK suggests that 21 per cent is nearer to the truth. I would be grateful to hear from the Minister the Government's reaction to this report.
In 2005 the Welsh Assembly Government issued TAN 8, the technical advice note meant to guide planning decisions relating to renewable energy projects. TAN 8 identified seven strategic search areas as suitable for concentrated, large-scale wind farm development, three of which were in mid-Wales. The focus is on mid-Wales because Snowdonia National Park lies to the north and Brecon Beacons National Park to the south. Targets for capacity have varied from 1.1 gigawatts originally to 2.5 gigawatts in 2007, falling back to 2 gigawatts in 2010, all to be constructed within the SSAs by 2015.
In mid-Wales, schemes have been proposed for 800 turbines up to 600 feet tall, spreading through the Severn valley and into the hills above the Meifod and Vyrnwy valleys. Of course, there are no connections to the national grid in the area so these schemes require a network of electricity pylons, running to a substation at either Abermule or Cefn Coch, spread over some 28 acres. That substation will require a link of 154-feet-tall mega-pylons across the rest of Montgomeryshire and into England, all the way through Shropshire to Telford some 45 miles away. There are currently some 200 pylons in existence in Powys. ScottishPower Renewables is into the second phase of its proposals to build a 135-megawatt wind farm of 35 pylons-the highest in Europe at 600 feet-on land that it has leased from the Forestry Commission in the Dyfnant forest. They will tower over Lake Vyrnwy and the beautiful countryside around. In response to the proposal for these pylons put forward by ScottishPower and National Grid, some 500 people turned up to a protest meeting at the Meifod rugby club-and this is a very small village-at the end of March. In May the biggest protest demonstration in the Welsh Assembly's history took place in Cardiff with some 2,000 people. In Welshpool in June, 2,000 people attended to protest and to watch on a large screen the proceedings of Powys County Council where a motion calling for the review of the TAN 8 policy was passed unanimously with only one abstention. Shropshire County Council has also declared itself to be unanimously against this proposal and all the parish councils involved have expressed their opposition. As a result of all this pressure Carwyn Jones, the Welsh Assembly Government's First Minister, realised finally what the previous Government had let loose with TAN 8 and in a reversal of previous policy said on 17 June:
"Planning guidelines on the number of wind farms should in future be regarded as an upper limit. The Welsh Government wants the UK government to devolve powers over large-scale energy generation projects. We cannot accept a position where decisions made outside Wales will lead to inappropriate development for the people of Wales. The Welsh Government believe this level of development is unacceptable in view of its wider impacts on the local area".
What is this Government's response? They have rejected Mr Jones's demand for further devolution but surely the Department of Energy and Climate Change will not ride roughshod over the express will of parish councils, county councils, the Welsh Assembly Government and, most importantly, the whole community of Montgomeryshire, Shropshire and beyond. According to the Telegraph on 9 October a spokesman for DECC said:
Who exactly is going to deal with these applications? Name the Minister. Who will balance the antagonism of local people, the expressed hostility of their
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For those who think that mid-Wales is an empty and barren land that does not matter, I advise them to read the report commissioned during the Dulas valley inquiry of 1970 from the University of Aberystwyth, which stressed the value of the strong community life, the strength of the culture and the human effects of the proposed development upon a mid-Wales community. At that time, the Secretary of State for Wales, Lord Cledwyn, determined and announced that no Welsh valley would be sacrificed again. It is time for the Secretary of State for Wales in the present Government to step in and to follow that precedent.
Lord Williams of Elvel: My Lords, the House will be most grateful to the noble Lord, Lord Thomas of Gresford, for introducing this subject and for concentrating on the theme of localism, which I want to follow up on because it is vitally important. It is a matter that has got slightly confused over the years. Let me start with TAN 8, which the noble Lord introduced us to.
TAN 8 went through a consultation process, a recent analysis of which has shown that 66 per cent of consultees opposed it and 7 per cent were in favour. Even at its promulgation, TAN 8 was unpopular with all the consultees who the Welsh Assembly Government had invited to comment. That went through to the selection of the SSAs. These strategic search areas were identified by a Danish company, Arup, on the grounds of simple criteria. Social conditions were not part of the criteria to identify them. The result was that we had three SSAs in mid-Wales, as the noble Lord, Lord Thomas, quite rightly points out-they were B, C and D, to be technical about it-where the criteria were basically the number of people who did not live there; that is, the most beautiful wildernesses in mid-Wales.
The result of TAN 8, curiously enough, has been slightly perverse. It was designed to stop what is known as pepper-potting, with wind turbines being put up all over Wales, and to concentrate on serious and strategic areas. The problem with that, as the noble Lord, Lord Thomas, has pointed out, is that this gave rise to large applications because if you were going to try and meet the targets which the Welsh Assembly Government had set in terms of carbon
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What happens is that these applications are outside the control of the Welsh Assembly Government, the local authority and local people, so they come to Westminster-originally under the Electricity Act 1989 but now, because of rearrangements in the planning mechanisms, these applications would come through the Infrastructure Planning Commission. We read in the Localism Bill that that commission is to be abolished, so that it will become an infrastructure planning inspectorate inside the general inspectorate. The ultimate decision would be for a Secretary of State. I have no quarrel with that remedy but I have a quarrel about which Secretary of State would be responsible for this-I follow the noble Lord, Lord Thomas. Would it be the Secretary of State for Energy and Climate Change, who sits for an English constituency? Would it be the Secretary of State for Wales, who sits for an English constituency? Would it be the Secretary of State for Communities and Local Government, who sits for an English constituency? In any way, it would be determined by somebody who has no particular interest in ensuring the benefits of mid-Wales.
We had an example of this in the previous Government, which I attacked then and would attack now. The wind farm at Cefn Croes, in the middle of the Cambrian Mountains-one of the most beautiful places in the world, let alone the United Kingdom-was opposed by every planning authority in mid-Wales. It went to London and one of my colleagues in the Westminster Government simply signed it off. Did he go and visit the site? No. Did he consult with various people? No. It was simple ideology: he wanted to ensure that there was enough capacity in whatever it was, however it was done. It is that which we must avoid.
What happens when an application for a wind farm of over 50 megawatts of installed capacity comes to the Secretary of State? Will he or she look at the criteria that Arup introduced to define these selected areas? What is important, wilderness and wind speed or social conditions and communities? What happens when the Secretary of State receives the application and says, "I'm not bothered about mid-Wales. That is not my interest at all"? We have to ensure that localism means something rather than simply being a theory. It would be perfectly possible to ensure by some mechanism or other that localism actually counted, and I hope very much that the Minister will give us that reassurance.
Lord Teverson: My Lords, I am very aware that I am not a resident of Wales so I shall be careful in what I say. However, some months ago, as part of a business trip-nothing to do with energy or renewables-I passed through central Wales. I stayed there for the evening and enjoyed the hospitality, the scenery and the countryside. I noticed a number of signs and placards there around renewable energy, so I fully
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It is important to remember the slightly broader context to this debate-that is not a justification, but it puts the debate in a broader context-of global warming and the need to decarbonise our electricity supply chain in this country and indeed further afield than that. Global warming exists, it is happening, it is dangerous and it will have major effects not just on our own country but much more widely. The Berkeley earth surface temperature study has recently taken place. A study that was originally very sceptical about the question of temperatures and global warming looked at the University of East Anglia results and the controversy about the Hadley Centre, and came back to say that global warming was really happening.
We have to go through the process of decarbonisation and the Government have some excellent strategies towards that: energy efficiency; new nuclear, which some of my colleagues might disagree with rather more; carbon capture and storage; and renewables. Why those four different things? Because this is such an important issue that we cannot have just one approach to it. We have to have a multifaceted approach to the problem, and that is true of electricity generation as well.
One small point about the KPMG report is that onshore wind generation is not one of the most expensive technologies but quite the opposite: it is actually one of the least expensive. Offshore wind, wave, geothermal and various other technologies are more expensive than onshore wind; that is not even slightly contestable. The other thing about the report-and I was rather surprised that KPMG put its name to something that was so shaky in its economic analysis-is that it looks purely at capital cost. Those of us who have had anything whatever to do with business or industry understand that, in terms of cash flow or assessing projects, looking only at capital cost means nothing. In fact, if we looked purely at that, we as a civilisation would still be in the stone age rather than where we are now. Some people might welcome that, but I personally am not one of those who are into deindustrialisation.
The important thing about renewables is that the ongoing fuel cost is far less. If we look at those countries such as Denmark and Spain that bothered to invest in renewables way back in the past, we see that the energy prices where there is a much higher renewable content have not increased at anything like the rate that our own energy costs have in the UK. I remind the Minister that in the five-year period 2004 to 2009, electricity costs went up by 75 per cent and gas costs by 120 per cent-far higher than any costs that would have resulted from renewable energy.
In fact, if we invest suitably in renewable energy we will have a much lower cost increase in future. Onshore wind generation is a good solution in terms of renewable energy and decarbonising the economy and a good way of tackling global warming. One of the cheaper ways of producing renewable energy is hydro-including
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The crux of this argument, with which I absolutely agree, is about the concentration of wind turbines in a particular area and providing access to the national grid, such as by building pylons. I have sympathy for Wales, and central Wales in particular, because the plans that have come back to the Welsh Government have delineated specific areas and there is a problem with that. What is required is for the Welsh Assembly and Government to look at changing those criteria and moving it away from DECC, which should not make those sorts of decisions for the UK. We would then have the right solution for Wales that would also challenge and affect global warming.
The current plans to construct a further 600 to 800 onshore turbines in mid-Wales are unacceptable on two counts. First, there is the wanton destruction of an extraordinary environment, which has already been referred to. Secondly, there is the further development of an inefficient and absurdly expensive solution to achieving the targets for CO2 emissions that the UK has undertaken, and for increased use of renewables.
Although mid-Wales constitutes some two-thirds of the land mass of our country, its population is small and, apart from sheep farming, tourism is the only other major sector upon which the economy is dependent. In addition to these 800 new onshore turbines, there is the installation-as has been mentioned-of a 20-acre electricity substation and 100 miles of new cable, mostly carried on 150-foot-high steel towers. No wonder the local populace is protesting.
According to the Country Guardian website, by August this year 275 different groups had been formed throughout the UK to object to the impact of planned wind farm developments, 30 of which are in Wales. That is 11 per cent of the total, which is disproportionate to the 5 per cent of the UK population that the area represents. It is too easy for Government and other industrial protagonists of this vandalism to characterise the protestors as guilty of nimbyism. That is a slanderous description. Their approach is not "nimby"; if anything, it is "nioby"-not in our back yard, and not in the nation's back yard that is the beautiful and unique topography of these isles, which both this Parliament and the devolved Administrations must have a primary duty to protect.
Financial analysis is available to all. Anyone can see that the costs far outweigh the effective generation of electricity in comparison to other sources. What can Government do to take the heat out of this most contentious issue and give leadership to the development
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Despite past cross-party support in the other place, led at that time by the previous Secretary of State for Wales, little has happened until now. A private sector consortium, Corlan Hafren, has set about the task of making it happen. It should be supported. Its plans appear to incorporate the most recent engineering developments, with environmental outcomes that are,
In addition to its extraordinary relevance to achieving UK targets, the construction and associated infrastructure of the barrage would be set to create 100,000 jobs. Perhaps the Minister would care to note the Financial Times report of 24 November 2010, in which the Secretary of State is reported as saying that,
"I think the Severn barrage will eventually happen and will provide about 7 per cent of all the electricity in the UK. When it does it will involve a lot of different businesses. But investors will need assurance that the government is behind it".
Finally, at the other end of the scale is biomass. In Wales the use of biomass fuel lags well behind that in Germany and other countries. The technology is proven, there are grants and funding incentives and a supply infrastructure is in place. Wales has an abundant timber resource: 13 per cent of its land mass is woodland, of which some 75,000 hectares is unmanaged private woodland. Biomass systems are not designed just for individual domestic use. Already there are examples of their use in Wales by organisations such as the new Rhondda hospital in Llwynypia and the Office for National Statistics in Newport. The Welsh Government happily lead the way, with a biomass system installed in the Senedd building.
There are alternatives. Let us pause and reconsider the effects of these policies in destroying our beautiful countryside. If we do not, the ugly results will be the inheritance of future generations at grossly unacceptable cost.
Lord Howie of Troon: My Lords, I hesitate to intervene in what is clearly a Welsh evening but I am happy to come to the aid of my fellow Celts on this
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I should say that I have a kind of background in Wales. Older Members of the House, if there are any present, may remember that I spent a lifetime in the construction industry and younger Members should take note of that now. In my civil engineering days I was involved in the Milford Haven power station, in a coal mine near Llanelli, in a gas works near Neath and in the Wylfa nuclear power station in north Wales. I have a background in the energy business, although I was on the construction side of the infrastructure for the industry.
I am with the noble Lord, Lord Teverson, in that I want to widen the debate from the specific mid-Wales aspect. I regard that as a microcosm of what is likely to happen through the rest of the country. Many years ago, as a relatively new Member of the House-I think that Jim Callaghan was the Prime Minister although I am not too sure-I drew attention to my experience with Milford Haven and suggested to the House that if we were to replace the Milford Haven oil-powered station, which produced 2,000 megawatts, we would have required something like 2,000 windmills, as we called them in those days. They have now been upgraded to wind turbines. I said at the time that they would stretch from Cardiff, at roughly every 100 yards, around the coast to the Mersey. The turbines are stronger now and would stretch for only half that distance-but that is the scale that we are talking about. I reminded the House more recently that if you took the Thames array-an offshore assembly that is no longer called a farm but an array-it would stretch from the House here in one direction as far as the Tate Modern and in the other direction as far as King's Cross railway station. We are talking about covering large swathes of the country with wind turbines, or windmills-call them what you like.
Speaking as an engineer, I would not mind that if they actually produced the energy that they are thought to produce. However, they do not. If one looks back to the coldest day of the winter in December last year, wind power produced 0.04 per cent-I repeat, 0.04 per cent-of the energy required to heat the homes of this country on that day. That figure is derisory. The idea that wind power, which is intermittent, can replace any other form of electricity production is a miasma at best. In order to make up for the periods when windmills are not producing electricity, there has to be a back-up. I refer again to Milford Haven. If we had had the 2,000 megawatts of wind power in Wales that failed, as it happened, last year, one would still have needed Milford Haven power station as a back-up. One would not have replaced it. The idea that windmills will help us is an illusion.
I shall conclude by drawing attention to a book published two years ago by James Lovelock. It is entitled The Vanishing Face of Gaia. He was a guru of Greenpeace at its beginning, but is now thought of as an apostate. We need 70 gigawatts of electricity. He said that the footprint of a nuclear power station producing 1 gigawatt is 30 acres. The footprint for 1 gigawatt of wind power is 1,000 square miles. I tend to giggle at that thought.
I shall not go on any longer, but I should say this. The Minister and the shadow Minister on the Front Bench should get hold of Lovelock's book and read it. If they read it and apply its message, they would save all the bother in mid-Wales and in the rest of the country as well.
Baroness Randerson: My Lords, the background to this debate is a very confused situation. It is confused because renewable energy development in Wales is divided between the UK Government and the Welsh Government, with 50 megawatts, as you have heard, as the dividing line. It is also confused because, to be honest, the Welsh Government have got themselves into a particular pickle over TAN 8, which is the guidance that has been referred to. This was never a good document, but it is now badly out of date. It was always too heavily reliant on wind power: there are 12 pages of guidance on wind power, but three pages on every other type of renewable energy.
It is also out of date because the capacity targets it refers to appear to be greatly exceeded now in terms of potential. In each of the seven designated areas, the capacity targets seem now to be understated. In fact the Welsh Government do not seem to know whether they are targets or maxima; various Welsh government documents refer to them variously as targets, or, on the other hand, as maxima. Yet the report last year by Arup showed that the planning applications in the pipeline at the moment far exceed the capacity targets. It is quite logical: as time goes on, technical capacity increases and therefore the targets that you set in 2005 are out of date by the time you get to 2011. Indeed, earlier this year the Welsh Government said that it was their aspiration to reach 2 gigawatts as a target in the seven areas by 2013 to 2015. Faced with an absolute uproar in mid-Wales, they are now rowing back from that. However, we do not know whether it is a target or a maximum.
I obviously agree with noble Lords who have stated how strongly they feel about the beauty of mid-Wales. I am a strong supporter of renewable energy but I believe that we have to preserve our best, and the wonderful and unique scenery of mid-Wales comes into that category. It is important to remember the importance of the tourism industry in that area as well. An area which has difficulty in attracting jobs cannot afford to lose its tourist industry.
There is a particular problem in mid-Wales because of the lack of grid infrastructure. This is what has sparked the latest opposition. At the moment, people feel very strongly about the mid-Wales connection project. TAN 8 is hopelessly optimistic on this as well. It said that if extra grid capacity were needed as a result of the wind farm development, it should come via underground cables. We know that that is far too expensive to contemplate on the scale which would be necessary. However, I have a letter from the Minister, written in July, which said:
"Where new grid is required, we expect the grid company and regulator to ensure that it is located, designed and installed as sensitively as possible, using appropriate techniques, including the use of undergrounding".
One point of confusion could be overcome if the power over developments of more than 50 megawatts could be delegated-devolved-to the Welsh Assembly. At the moment, the UK Government decide whether a wind farm can be developed and the Welsh Government decide the detail, if it is more than 50 megawatts. That is inappropriate. I strongly argue for devolution of those powers. The Silk commission has recently been established to consider the extent of Welsh devolution, and I very much hope that it will consider this issue as part of its remit. Given that TAN 8 envisaged that 1,700 megawatts in total would be coming from the seven SSAs, the 50-megawatt limit is a very low threshold. It is completely arbitrary. I argue that it appears increasingly out of date.
Finally, I return to my point that the balance of TAN 8 was wrong. Too much emphasis was placed on wind. We need much greater exploitation of Wales's greatest assets: its rivers and tides. The Severn barrage was sensibly abandoned by the coalition Government. It was too costly, it would come in too late and it would have destroyed a major SSSI, but there are good alternatives, and many of them.
Baroness Smith of Basildon: My Lords, your Lordships' House should thank the noble Lord, Lord Thomas of Gresford, for doing us a service by holding this debate in his name this evening. It has been a timely and stimulating debate with a great deal of interest in this House and beyond. It makes us understand the strongly held views on the issue. I shall take my lead from the noble Lords, Lord Teverson and Lord Howie of Troon, in addressing the general issues and lead from that into the specific ones.
I was interested in the exchange between the noble Lord, Lord Rowe-Beddoe, and the noble Baroness, Lady Randerson, about the Severn barrage. Whatever form of energy we suggest, there will be strongly held views on all sides of the argument, as we have heard this evening. However, we cannot underestimate the challenges that we face in seeking to improve the security of energy supply and to meet the Government's target to reduce carbon emissions. Today's report from the International Energy Agency has not been mentioned, although KPMG has. That report makes it clear that if no substantive action is taken to reduce reliance on fossil fuels and reduce carbon, we will have lost the opportunity to tackle climate change in the next five years-a sobering thought.
The UK is committed to increasing the amount of electricity generated from renewables, such as wind and solar, from 7 per cent to 30 per cent by 2020-although I have to say that, given the Government's appalling decision on the feed-in tariffs, it will be interesting to know how they can possibly reach those targets. The solar business has been virtually destroyed: 77 per cent of businesses that responded to a poll for BusinessGreen said that they will now scrap their plans to install solar PV; only 6 per cent said that they will carry on. I welcome the noble Baroness to the Dispatch Box tonight. Can she say anything about
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In the light of that decision, there will be greater attention on wind power. I found the speech of the noble Lord, Lord Thomas of Gresford, speaking from the Liberal Democrat Benches, interesting, as the Liberal Democrats were even more ambitious than the Government at the time of the previous election, and made even greater commitments in their election manifesto to renewable energy, as the noble Lord, Lord Teverson, mentioned. That manifesto stated:
"Climate change is the greatest challenge facing this generation. Liberal Democrats are unwavering in our commitment: runaway climate change must be stopped ... We will set a target for 40 per cent of UK electricity to come from clean, non-carbon-emitting sources by 2020, rising to 100 per cent by 2050",
At that time, I understand that the party was not in favour of new nuclear, so the remaining 25 per cent would have to have included significant onshore wind. Despite that commitment to offshore wind, it is significantly more expensive in both installation and maintenance-as the noble Lord, Lord Teverson, said-and is probably not as efficient as onshore wind. As people worry about turning on the heating as it gets colder, every effort must be taken to protect the consumer from even higher bills. If renewables, including wind power, can play a part in energy security and in keeping those longer-term costs down, we must act responsibly in the interests of the consumer. The noble Lord, Lord Thomas of Gresford, quoted KPMG's report; I was interested in the demolition of it made by the noble Lord, Lord Teverson, as I had read the same report. It is unfortunate that we do not have a full report from KPMG, so we cannot analyse the figures that it has put out. However, if we look at the options that the report seems to prefer, we can see that the costs that also have to be taken into account for new nuclear, as well as the capital bill-which would be less than for wind power-include not just the construction but the fuel, security and clean-up costs, which run into very large amounts.
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