Health Bill [HL]

I am grateful for the contributions made by noble Lords. Let me start by reminding the Committee of our debate at Second Reading, when I clearly said that the next-stage review, High Quality Care for All, made a significant commitment to changing the culture of the NHS by stating that quality will be its organising principle. We should also recognise that quality is a moving target, and the reason it is constantly moving is because of the innovations made by both those who work in the health service and those outside who translate such innovations into patient benefits. This policy is one of many set out in High Quality Care for All through which we are trying to address the challenges referred to by the noble Earl when it comes to the culture of the uptake of innovation in the health service. I believe that it is one of the most important enablers in the effort to ensure that quality remains in a state of constant improvement. Indeed, perhaps I may share an example over the past eight years where innovation has had a huge impact: the area of cardiovascular disease. Post the NHS Plan and during the passage of the Health and Social Care Bill in 2003, many of our debates concerned the long waiting lists for patients requiring coronary artery bypass graft procedures. I see that the noble Lord, Lord Crisp, is here; at the time, we were trying to ensure that we increased the workforce, or at least the number of surgeons who were able to perform coronary artery bypass grafts, because we had an 18-month waiting list and many patients were dying while on the list. It is fascinating to see what happened in the following five years. I shall go through them one by one. First, the major innovation, which was taken up in the NHS fairly quickly, was the concept of angioplasty and stents. A number of drug-eluting stents came in, and that is a fantastic example of innovation. Secondly, at the same time the statin trials were published. I am delighted to say that the bulk of those trials were carried out in this country on NHS patients, and they showed the benefits of statins. Thirdly, and I am sure there will be another debate on this, there was the ban on smoking in public places, which I am sure we will see the fruits of when it comes to cardiovascular disease. I have given the Committee three areas of innovation in five years that have reduced the overall mortality rates of cardiovascular disease in this country by 46 per cent to 47 per cent. That is why I talk about a moving target; innovation comes in, and the NHS needs to be ready for it. I shall describe the package in High Quality Care for All. Innovation prizes are only a small part of our enablers in the system—the nudgers—to transform that culture. One of them, which the noble Earl referred to, is the innovation fund that we are about to launch through the strategic health authorities, which is, if I am correct, up to £200 million. At the same time we are introducing a number of innovation vehicles into the health service with the creation of the academic health science centres. The Committee may be aware that this week a number of organisations have come to be interviewed by an international committee that is assessing their applications to become such centres, which are a vehicle by which universities and NHS providers can be brought together into a different type of governance structure, ultimately driving innovation in the health service. In addition, I have made reference to the health innovation and education clusters that we will be launching in due course. I hope I have given a flavour of what innovation will be all about in the NHS in the next decade. I shall move on to Clause 12 and describe some of the specifics of the prize, how we see it being administered and some examples of the NHS’s contribution historically to innovation. Under existing legislation, the NHS Act 2006, my right honourable friend the Secretary of State for Health can currently award grants for future research purposes. That is clear. In terms of awarding prizes, the power is limited and does not extend to awarding money retrospectively to recognise and reward work that has already been completed. I am grateful to the noble Baroness, Lady Murphy, who raised the issue of Peter Mansfield. I know something about this subject because imaging is an area of research that I have an interest in. She could not have picked a better example. It was 1967 in Nottingham when Peter Mansfield built the first MRI device. I think the point being made was that he was recognised as a Nobel laureate, but he was not recognised until 2005 for that achievement, and even then not in this country. The noble Baroness has made the case for such a prize being given to people who have made huge scientific contributions in this country. I am sad to say also that the fruit of Mansfield’s discovery did not happen in the NHS; there were more MRI machines and more patients being imaged with MRI across the pond, as they say. That is the culture. I am very grateful for the noble Baroness’s intervention. I do not think that we recognise our major contributors in this country, whether they are scientists or NHS workers, and this is our attempt to do so. I could make many other references. We have had a tradition of medical innovators. I shall mention three people who have had a huge impact on the surgery as we know it today. They include Florence Nightingale and Alexander Fleming. Penicillin was discovered accidentally, I know; the individual happened to work in my organisation, went on holiday and when he came back he saw the fungus. That had a huge impact. Again, that individual was not recognised in this country. Joseph Lister introduced asepsis into surgical techniques. The NHS has a proud history of innovation and innovators. We are trying to encourage that and acknowledge these achievements.