Health Bill [HL]

My Lords, I appreciate the wise contributions of the three noble Baronesses who preceded me; what they said has much resonance for me. Many important aspects of healthcare are brought together in this Bill, but I will concentrate on three topics: first, the NHS constitution, particularly paragraph 3, which describes the commitment to the promotion of research and teaching; secondly, the innovation fund; and, thirdly, the amendment to tobacco legislation. The constitution is obviously a valuable document in that it places several responsibilities on the service and sets out clearly what patients should expect from it. The Bill is meant to enshrine this in legislation, at least in part. While it describes how the constitution should be revised and how often it should be updated, it is a little short on setting duties. As the noble Baroness, Lady Emerton, and the noble Lord, Lord Rea, said, it is less than clear how a duty to have regard to the constitution will be fulfilled. It seems that the main requirement is for trusts to publish information about the quality of their services in certain unspecified ““prescribed information””. I will focus on the part of the constitution that refers to research and teaching. I hasten to express my interests as scientific adviser of the Association of Medical Research Charities and as an ex-clinician and researcher. The constitution is helpful in that it outlines the fundamental part that research plays in the NHS now and for the future and how important it is that patients be given the opportunity to take part in research relevant to them. The fact is that our future health and well-being are heavily dependent on research and teaching now. That makes economic sense, too. The recent study commissioned by the Academy of Medical Sciences, the Wellcome Trust and others measured the economic returns in productivity and productive life gains from research and showed that for every pound invested we get 39p a year every year thereafter from it. That is not a bad investment. Research is well worth while and sits right at the heart of any service that aspires to high quality, but it is unclear how the NHS will ensure that patients are made aware of the need for research and its importance to them. Past experience suggests that NHS trusts are unlikely to give that a high priority in their busy agendas. The noble Baroness, Lady Wall, told us of the pressures on trusts. In Chapter 2 of the Bill, trusts are given the duty to report on the quality of their service. However, unless the requirement is strengthened, it is likely that research will be slid over. It will be important to include in the prescribed information under Clause 6(3) the requirement to describe how research and teaching are being fostered, how patients are being informed of research, the opportunities for them to be engaged in it and the ways in which data about them can play such an important part in research. Today is not the time to discuss the value of patient data to medical research, save to say that we desperately need to solve the dilemma of how such research can be done while at the same time preserving patients’ confidence in trusts. The whole issue of consent will have to be solved; it has remained a serious problem, despite so many efforts to resolve it for so long. I shall now comment briefly on the innovation fund described in Chapter 4 of Part 1. This seems an excellent idea on the face of it, as it will capitalise on the large number of bright and enthusiastic men and women in the health service who have already introduced many innovations. These have often worked well in the local environment but may not have received much publicity and have not spread across the service because of that. This fund should help to spread innovations more widely. Details are scanty, however, and two aspects of the scheme bother me. First, on the cost, the Explanatory Notes suggest that £5 million will be made available, of which £1 million will be for administration. That is 20 per cent on administration, which is far too high. Any grant-giving body that I have been associated with would never support such high administrative costs. They should be cut. The second anxiety is the idea, also in the Explanatory Notes, that an expert panel will devise the challenges that those in the service will follow. That is quite the wrong way round. Innovation is a grass-roots activity. The people on the ground should be innovating. Expert panels should be making judgments on whether the proposals put to them are really worthwhile innovations; they should not be innovating from on high. I hope that that will be looked at again. I very much appreciate the Government’s efforts to strengthen the anti-smoking legislation. I am very supportive of the measures to restrict advertising, but I wonder whether we can go further and restrict the point-of-sale displays. That is already done in a number of other countries and is, apparently, effective. I am struck, too, by the arguments made to me about doing even more than is proposed in the Bill by removing vending machines altogether. It is unclear to me how it will be possible to keep an eye on vending machines, as is proposed in the Bill, so that children will not be able to sneak in. I just do not think that that will work. I am not at all sure why someone who wants to buy cigarettes cannot get them from the innumerable outlets where they are for sale. We do not need vending machines for the necessities of life such as food, so why for cigarettes? These machines are for instant gratification of an immediate need felt when a smoker passes one. We would be better off without them and I hope that we can strengthen the Bill by getting rid of them.