In the Lords yesterday; getting GPs excited about health research

Posted on January 14, 2011 by

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Lord Turnberg, who is AMRC’s scientific adviser, had a short debate focused on the NHS in the Lords yesterday afternoon,  exploring some of the impacts all the proposed changes will have on the front-line and specialised services patients receive. Medical research was one of the areas he focused on. Particularly how GPs, with their new role in commissioning, will be supported and given incentives to get involved in research and how this will impact on the care patients receive. Earl Howe was the health minister responding.

Background

In July, the government published a health white paper outlining big changes they plan to make to the NHS. Since then they have been consulting widely and developing their plans. A Health and Social Care Bill which will lay out their final proposals and lay the legislative groundwork to start putting the plans into action is expected to be published shortly.

The full title of the yesterday’s debate was:

To ask Her Majesty’s Government what steps they are taking to ensure that the proposed changes to the National Health Service will not damage front-line and specialised services.

You can read it here.

Interesting bits about research

The debate was about much more than just the role of research in the NHS, picking up on lots of issues; where NICE will fit in the new system;  concern over how services will be integrated in the new system and how it will be ensured that they are joined-up; concern that current expertise developed in networks etc, such as the successful cancer networks, is not lost in reorganisation but is captured in the new structures. But a couple of the peers posed a few interesting questions about research which the minister tackled.

Lord Turnberg kicked off the debate, welcoming the government’s investment in health research and posing questions about:

  • the future of OSCHR (the Office for Strategic Co-ordination of Health Research which was set up following a review by David Cooksey with a remit to co-ordinate funding of health research in the UK);
  • the impact the move towards localism will have on research, do GPs really want to be involved in research, commission research, are their incentives in place to encourage them to value research;
  • and following the Academy of Medical Sciences report published on Tuesday (see previous post) whether the government would be taking action to change the way research is regulated.

I want to say something about localism and its impact on research. In previous debates, the Minister was reassuringly clear about his commitment to research in the NHS, and the relative protection of the NHS research budget is of course very welcome. I congratulate the noble Earl and Dame Sally Davies for their efforts in achieving this. In this respect, what is to happen to OSCHR, the Office for Strategic Co-ordination of Health Research, the body set up to help co-ordinate research funding between the MRC and the NHS?

My main concern here is the role of GPs and the consortia in commissioning research and teaching. A recent survey by the Association of Medical Research Charities and Involve found that the vast majority of patients were happy to give consent for the use of their personal data for research, but that few GPs were interested in research, and that even the fairly straightforward business of seeking consent from patients was regarded by many as difficult and too time consuming. Therefore, if GPs are to have a key role in NHS research, it will be vital to give them some sort of incentive for their involvement. I should be very interested in hearing more from the noble Earl about how he thinks we might provide this stimulus.

Finally on research, I expect that the Minister will have seen the excellent recent report from the Academy of Medical Sciences, commissioned by his department, on the regulation of research. Is it his expectation that the Government will accept the recommendations in the report, particularly those relevant to streamlining regulation?

Lord Winston also focused on research, expressing concerns over the impact a move away from centralisation in the health service will have on development of expertise, teaching and research:

Centralisation is also important for innovation. The key issue is how these expected changes in the health service will affect our excellence in research. What I really want is reassurance from the noble Earl that the sorts of things that were developed in the health service hitherto will not be difficult to achieve under the current proposals in the White Paper. For example, it seems impossible to imagine that in vitro fertilisation could develop as a research procedure in the structure as proposed. Certainly, during my time at Hammersmith, I saw by-pass surgery, transplant surgery and the cancer smear test being developed, and many other examples of innovative surgery and medicine. Many of the great institutions, such as Great Ormond Street, Hammersmith, and some in Liverpool, Manchester and elsewhere have been made great and international because they have been able to function in a way that it is difficult to see will continue under the structure in this White Paper. I want to make certain that the Minister agrees-I know he does-that the jewel in our crown is the National Health Service. A very special aspect of that, which is internationally recognised, is the unique nature of academic medicine in this country. I would like him to tell us how academic medicine will be protected and will flourish in the structure of the White Paper.

What did the minister say?

On research, Earl Howe reaffirmed that OSCHR will play a key role in the new system coordinating health research and looking forward to identify anticipate future directions of research; he recognised the concerns that GP consortia need incentives to get involved in research and that government was acting on these, and confirmed that government are in the process of considering how best to act on the Academy’s recommendations for streamlining the regulation of research.

…there will be payment incentives for quality through the Quality and Outcomes Framework, CQUIN and the tariff. Under the health and social care Bill, which will be introduced shortly, the Secretary of State, the NHS commissioning board and GP consortia will also be required to act with a view to securing continuous quality improvement in services provided by the NHS….

…The noble Lord, Lord Turnberg, asked what is to happen to OSCHR, the Office for Strategic Co-ordination of Health Research. It has done a fine job over the past three years. It is a very useful mechanism for facilitating processes for joint working, focusing particularly on translational research. That body will continue with an increased focus on co-ordination and foresight.

The noble Lord also asked how GP consortia will be incentivised to be involved in health research. I recognise his concerns. There is not time for me to say a lot, but the department is funding the National Institute for Health Research Primary Care Research Network. This brings together a wide range of primary care health professionals and is dedicated to expanding clinical research in primary care. The Academy of Medical Science’s report, which the noble Lord referred to, was published this week. We welcome the report and we are carefully considering how to implement its recommendations. I will write to him further on that.

The noble Lord, Lord Winston, asked in particular about how academic medicine will be protected. The Government recognise the crucial importance of academic medicine; we are increasing funding for health research, as has been mentioned, part of which supports lectureships and other awards, and we are currently consulting on our proposals for education and training. However, again, perhaps I may write to the noble Lord with further and better particulars.

Posted in: Policy