My Lords, it is a pleasure to follow the noble Lord, who was chief executive at my father’s hospital. I refer to my role as chair of Genomics England, as declared in the register.
The future of health and care must be collaboration, increased productivity and innovation. To that end, there is much to welcome in the Bill. As the noble Lord, Lord Stevens, put it so clearly in his outstanding maiden speech, the Bill is based on recommendations from NHSEI and local health and care leaders, so it is no surprise that it removes statutory barriers that are preventing front-line NHS leaders responding to current challenges. The NHS Confederation agrees. It says that it is not a top-down reorganisation; it is providing a legislative framework for what is already happening on the ground. The King’s Fund says that it has nothing to do with privatisation.
Moreover, I cannot count the number of times we in this place have agreed that integration of services is absolutely critical for delivering higher quality care, and this Bill enables that through health and care partnerships. We have also frequently violently agreed on the unintended consequences of the internal market, so I am looking forward to an outbreak of consensus on the abolition of mandatory tendering, as well as the many public health measures for which I have heard many in this place campaign. It is a move away from competition to collaboration, which can be only beneficial, particularly when the NHS is facing so much pressure.
Having said that, I also say that there are many genuine issues for debate. Others have raised workforce planning, social care and the Secretary of State’s powers very eloquently, so I will not speak to them now—there will be time for debate—but I strongly associate myself with the eloquent contribution of my noble friend Lady Harding. Instead, I add my voice to those who have called for the Bill to go further on clinical research. Evidence shows that research-active hospitals have better patient outcomes, more satisfied staff and higher CQC ratings. For patients such as me with rare diseases, participation in clinical research may be the only way to access effective treatment. We have all seen the impact of the pandemic on the landscape of research. On the one hand, the response to Covid-19 has been phenomenal. RECOVERY, PRINCIPLE and the vaccine trials have all demonstrated our capacity to deliver clinical research with global impact at unprecedented pace and scale. We should be incredibly proud of that.
On the other hand, non-Covid clinical research has faced enormous disruption. Many studies have been paused or cancelled altogether, as those research staff
were redeployed either to front-line activity or to Covid studies. Data from the ABPI shows that the number of participants enrolled in commercial clinical trials was 15% lower in June 2021 compared to June 2019, while in Spain and Italy enrolment rose by more than a third during the same period. As a result, the UK has now fallen to fifth in Europe in phase 3 trials initiated per year. As we restart care, we must ensure that non-Covid research is also reprioritised. Of course, that will require the staff and resources to ensure capacity to deliver research at the same time as NHS recovery. I believe that this is exactly what the Minister wants. The Government have set an ambition for the UK to be the destination of choice for clinical research, but we have to ensure that we have the capacity within the health and care system to deliver that research and prioritise it while delivering that recovery. We can start with that today.
Like the 2012 Act, the Bill only includes a duty “to promote research” in Clause 19. While welcome, that has too often allowed clinical research to fall down the agenda. We can do more. The Bill provides a once-in-a-decade opportunity for us to embed research right at the heart of the NHS by putting that ambition on a statutory footing.
The Bill would be stronger if we mandated integrated care boards to ensure that the NHS organisations for which they are responsible are conducting clinical research. They should publish and transparently track that research in their annual reports and joint forward plans to understand exactly how that clinical research is being delivered in a way that meets the needs of local communities and ensures that they are increasing the diversity of participation.
Those proposals are supported by a long list of medical research and patient charities, as I am sure would be expected, but also by a number of colleagues in the other place who tried to push forward such amendments. Sadly, so far, they have failed. I urge the Minister to think again as the Bill goes through the House, because we have the opportunity with it to encode clinical research—and the hope that it gives so many—directly into the DNA of the NHS. Please do not let this opportunity pass as we take the Bill through this House.
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