Life Sciences Industrial Strategy (Science and Technology Committee Report) — House of Lords, 2018-10-23
Topic: Health
Leslie Turnberg (Labour, Centre-left): My Lords, I too congratulate the noble Lord, Lord Patel, and his committee on this excellent and timely report. I hope I will not disappoint the Minister too much by saying that I will concentrate on the NHS and the huge effort that is needed to introduce innovations into clinical practice The Government’s response is strong on what they are trying to do to stimulate even greater innovation and it is hard not to commend them for describing their willingness to put more money in and to develop high-level administrative structures—albeit perhaps too many and too high-level—to encourage and oversee advances in the sciences. Their response is strong on efforts to implement the methods by which these aims might be achieved. But—there is always a but—everyone knows that we in Britain are excellent innovators and inventors but are much poorer at translating innovations into clinical practice for the benefit of patients. Here I echo the wise words of my noble friends Lady Young and Lord Hunt. We are pretty good at defining the problems that are preventing translation but much poorer at defining the solutions. We tend to have masses of data but a paucity of actions based on the data. I will use the example of an interesting effort to introduce a pretty simple innovation into preventive medicine I am indebted to Professor Trisha Greenhalgh, whom I heard speak about this recently. She is professor of primary care health science at Oxford and she told us about a trial she was involved with in Newham. The problem they were trying to solve was how to prevent patients with significant memory loss wandering off and getting lost—not too uncommon, you might think. Why not put a simple monitoring device—a GPS system—on their wrists? Let them wear it and whoever was monitoring them would always know where they were. This is a bright idea and so simple that you may wonder why no one has thought of it before. Of course, nothing is so simple. They tried it out on about 20 people with memory loss in Newham to see if it would work. They immediately came up against a series of problems and at the end of a very few weeks only four people out of the 20 were wearing the device, and they soon stopped A whole range of issues was raised. Would people with dementia be happy to wear the monitoring devices? Who would do the monitoring? Family members might be at work or elsewhere. Nurses and social workers are already extremely stretched and overworked. Some even voiced their opposition to people wearing monitoring devices on the basis that it would interfere with individual liberties. They raised the spectre of state interference. They also wondered whether a GPS device of this sort might be a medical device needing approval by the Medicines and Healthcare products Regulatory Agency and, if so, what sort of regulation would be needed. If someone complained, would it not be important for the professionals to get indemnity insurance first If this simple device came up against a whole range of hurdles, what hope is there for more complex interventions? It is always the case, I am afraid, that interventions are going to be perceived as disruptive by those who have to introduce them—both the patients and the medical professionals—and they are being introduced in a system that is constantly evolving anyway and many of those who are in it are overworked and stressed, as we have heard. We have reached a situation where it is now at least as valuable, if not more so, to put money into research on delivery uptake—that is jargon for accepting innovations—than on original discovery I started by saying that it is much easier to describe the barriers to translation than it is to produce solutions so I will point to where solutions may be found. The first is the recognition by those with the novel bright ideas that these barriers exist. It is no use complaining about the reticence and resistance to change of a backward-looking profession, as there is a tendency to do, I fear. This is a particularly cynical accusation when so many of the innovations that are introduced are the result of efforts by the medical profession itself. The first condition that has to be accepted by all these wonderful high-level committees and authorities that encourage innovation is that on the ground in our hospitals and general practices everyone is overstretched and distracted. The reality is that to gain the interest and confidence of busy doctors and nurses you have to ensure that all the systems are fully worked out; that all the support, technology and personnel are in place to make it simple and straightforward to introduce the innovation; that all the regulatory processes are fully approved; and that the patients are fully informed, their illnesses are suitable for any novel treatment and they are entirely willing to receive it Most importantly, if all those are in place and everyone is happy, it needs to be shown not only that the innovations can be used and that they work but that the outcome for patients is beneficial. That is the key. So when some remarkable advance is announced by the Secretary of State or anyone else, and he then stands back and waits for the service simply to get on with it, he will be missing the mark. There are many steps and hurdles to be overcome when one understands the reality of the health service. What we need is research into the ways in which we can overcome the barriers to adoption and how translation into practice is currently prevented. We need that research just as much as the research that goes into invention and innovation. Without it, we will continue to underachieve I am delighted that the noble Lord, Lord O’Shaughnessy, has been given the responsibility of simplifying the innovation landscape and developing policies to encourage the adoption and spread of proven innovations. The Government’s response document talks of innovations being adopted "at pace and scale"—everything now has to be at pace and scale. I wish him luck with that There is a recommendation in the report that financial incentives should be offered to encourage acceptance of innovations on the ground. I am sure that that would be helpful but I fear that it will be insufficient. Early in the Government’s response comes a statement that we have, I think, heard before: "Our globally-renowned NHS will be a key partner in delivering the deal" And so say all of us. But before you can begin to change to early adoption of innovations at real pace and scale, it has to be accepted that the reality of day-to-day pressures on the ground just gets in the way I hope the Minister recognises the difficulties and will tell us how he believes they can be tackled. I hope he will be able to address at least some of the problems I have outlined.