House of Lords debate the Science and Technology Committee report on the industrial strategy for life sciences
A House of Lords debate took place on 23 October 2018, discussing the report ‘Life Sciences Industrial Strategy: Who’s driving the bus?‘ published on 26 April 2018 by The House of Lords Science and Technology Committee. The debate also discussed the Government’s response to the report published in June 2018.
Key findings from the report were that although the Government has suggested that life sciences is a flagship sector, the delivery of firm action to support this rhetoric has been lacking. The report covered five main areas: the challenges of implementing the strategy, the role of the NHS, the availability of finance for innovative companies, access to a skilled, trained workforce, and scientific excellence.
Largely due to concerns over the lack of a plan for implementing the strategy and of independent monitoring and scrutiny, the Committee created key recommendations, including the establishment of a statutory body to monitor how well the strategy is being implemented.
The chairman of the debate, Lord Patel, opened the discussion with his main points from review of the Government response. These points were embellished upon, and further points added, throughout the debate by other speakers. Four main areas of discussion were developed though the debate and are presented as follows.
The Government response to the report
Concern over refusal of the Government to adopt the overall Life Sciences Industrial Strategy was shown by many. Baroness Neville-Jones said in the Government’s reply to the report they,
“were keen to demonstrate how much progress had already been made since the strategy was announced and since the committee wrote its report. It is fair to say that their reply contained a large number of initiatives. However, I do not understand why Ministers maintain a refusal to adopt the strategy as their own.”
She suggests that the notion of ownership is important for the success of the strategy. Lord Renfrew agreed, saying the Government needed to formally and explicitly adopt the report as Government policy.
Chairman Lord Patel highlighted while opening the debate, that the Government had not accepted the recommendation of establishment of a statutory body to monitor how well the strategy is being implemented, although had appointed an economist at the Bank of England to chair the Industrial Strategy Council, which will provide independent scrutiny and monitor performance. Baroness Neville-Jones later provided further insight by explaining the Government had decided on continuing with their previous plan of using two large committees. She shared her concern on this issue by stating,
“I have been inside Government and on boards long enough to know that boards of over 20 people, which is well above the Government’s own recommendations for good governance, meeting only intermittently will find it very difficult to generate the necessary sense of ownership, focus and cohesion to drive implementation, and this really worries me. Moreover, it is not clear how this big board will direct those below it. To deliver its central role, the NHS needs something more than lots of initiatives at varying levels of seniority and influence.”
This was a concern echoed by both Lord Desai, who suggested implementation of the strategy required a single lead person, and Baroness Young who said,
“In common with the noble Baroness, Lady Neville-Jones, I was concerned that we were seeing yet another group… We seem here to have a series of committees, the one layered on the other. What is needed is not another committee or a range of small-scale initiatives, but a concerted, integrated approach to changing the whole culture of the NHS away from cost reduction and risk avoidance to one embracing innovation.”
Multiple requests were made throughout the debate to the Minister, asking for published milestones and updates for the implementation process.
Innovation in the NHS
Continuing the theme of take-up, the NHS’s participation in strategies aimed to aid innovation in the NHS was discussed. The strongest views on this topic came from Lord Hunt, who is the president of the procurement association in the NHS. He claimed that there is a problem with the NHS adopting new innovations as rather than the overall value of an item, it is only the actual cost of products considered during procurement, stating:
“The irony is that the NHS is absolutely useless at adopting generally proven new innovations. I am sorry to say that the strategy is going to do nothing whatever to improve that… Unless something drastic happens the NHS will continue to refuse to take innovation seriously”
Through a real-life example he implied that there also needed to be clearer pathways to contracting for new innovations. Prior to this, Lord Fox had also suggested the Minister should clarify what an innovation needs to do to be proven before it is adopted in the NHS.
Lord Hunt added to this that it is the same for medicines as it is for new innovations stating,
“It is the same story with medicines… It seems to me that NHS England has no interest, or policy to do so, in saying that it is in the UK’s interest to invest in new medicines, many of which have been developed in this country but will not be developed here in future. We are absolutely at the tipping point of losing a lot of the pharma industry”
Lord Desai reasoned that it is the lack of finance that makes it difficult for the NHS to do what is expected of it, stating,
“The main thing about the NHS, which will always be the case, is that it is underfunded. It is a universal law that if you price something at zero you will have perpetual excess demand and you will have to ration. You will have to decide what to do and what not to do. Current needs are so acute that things such as innovation may happen, but they will not happen by policy but by accident… If you adopt an innovation and it goes wrong the whole world will descend on you—newspapers and everybody will say, “My God, why are they wasting money doing this?”… A centralised system is not very good for encouraging innovation…Let us be kind to the NHS and say that what it does it does very well but it will not be able to do other things that we want it to unless we generate some extra income for it.”
Baroness Morgan drew similar conclusions from her research for the Science and Technology Select Committee’s report saying that they had heard from NHS England that due to a tough funding regime, centres have to be sure an innovation will be beneficial before risking approval and funding, which the committee found concerning.
Lack of time from over-worked and stressed healthcare workers was also suggested as reasons for the lack of take-up of innovation strategies by both Baroness Neville-Jones and Lord Turnberg. Baroness Neville-Jones also clarified one of the report recommendations that the UK needs more investors with an understanding of science and technology so start-up companies can remain in the UK.
Baroness Young agreed not enough has been done to aid innovation, saying the Government’s relicensing of the Academic Health Science Networks (AHSNs) and focussing them on innovations seems to be too little, too slowly and she urged mandating of validated best practice and of the proven innovations that improve patient outcomes and provide good value for money. She also brought up the lack of a strategy for innovation to meet the future challenges of the NHS, such ageing, multiple complex conditions, antibiotic resistance and general immune system compromise.
Research and development
The vital role of the NHS in implementing the Life Sciences Industrial Strategy in terms of research was also discussed. It was stated by Lord Patel that progress has been made since the report, such as the NHS being represented on the implementation board. However, difficulties in accessing the NHS data and recent data exclusivity deals with the private sector were highlighted as concerns.
A response echoed by multiple speakers was that the NHS data is a valuable asset to the life sciences industry, although requires organisation. Lord Holmes stated,
“When it comes to data, perhaps our deepest well, if you will, is the NHS. But as other noble Lords have alluded to, what is NHS data? Does it exist? If it does, who owns it and what form is it in? What do we want to do with it? Can we do something useful with it? The great potential is that, as is all too often the case, the data is partial, patchy and fragmented.”
Funding for research was also discussed, and there was some positivity around this with Lord Bilimoria saying,
“I have stated time after time, in debate after debate, that this country underinvests in R&D and innovation. We invest 1.7% of GDP. I am very happy to hear the Government say that they will have a target of 2.4% of GDP by 2027. If you look at the chart of expenditure across the world, we are at 1.7% and the OECD average is 2.4%, which is where the Government want to get to.”
Lord Freyberg added a warning to this that it would not be possible to invest the targeted 2.4% of GDP into research and development unless the value of UK NHS health data was harnessed in a protected national infrastructure.
The importance of the UK public understanding that the commercial use of medical data will benefit the NHS was stressed by Lord Fox who stated,
“Serious energy must be put into a public education process, so that people understand the nature of their data and how it could be used. Just to give people an opt-out without understanding that is to squander their data and perhaps to lose value for society and for the NHS. Can we have an undertaking of a process of public education and know who will be leading that process?”
Although there was cautious optimism around the potential for the future of research and development in the UK, Viscount Hanworth warned,
“…these prospects are being severely stymied by Brexit. We have learned that already the EU certification of pharmaceuticals, which has been taking place largely in the UK where the European Medicines Agency has been based, is now taking place elsewhere. The agency will transfer to Amsterdam when the UK leaves the EU. In the event of a no-deal Brexit, our clinical trials will lose their validity as far as the EU is concerned and will have to be conducted elsewhere, or at least in conjunction with an EU partner.”
Maintenance of scientific talent in the UK
Concerns were unanimous amongst the speakers over the migration visa system being too expensive and tedious, and the potential impact of Brexit on this, which could put off scientific talent from the EU. Multiple references were made during the debate to the report by Sir Paul Nurse, Director of the Francis Crick Institute, which warned of the potential loss of European scientific talent in the UK. A prior MAP news report regarding this report is available here. Baroness Young stated,
“Sir Paul has, with his great authority, laid out clearly that we are in imminent and real risk of squandering this position of global leadership in life sciences research and innovation as a result of Brexit and particularly the lack of clarity about the negotiations and process.”
Lord Fox agreed, adding the new immigration process must also include the families of those people or many would still be lost from the workforce.
Baroness Neville-Jones also highlighted the requirement for STEM subjects in schools to continue to be prioritised for improvement to develop talent.
The concluding remarks were from the Parliamentary Under-Secretary of State, Department for Business, Energy and Industrial Strategy (Lord Henley) who made outline responses to the key questions made, such as agreeing the NHS has valuable data for research and a post-Brexit immigration system must be got right, but was unable to immediately reply to all questions and instead said he would co-ordinate a response to all those who had spoken. Lord Patel then stated he understood that after such a long debate the Minister would not have a full response yet but that he looked forward to receiving it.