Government puts greater focus on research in the health bill

Posted on June 14, 2011 by

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The government responded to the NHS future forum today, outlining how they will change their plans to reform the NHS.

This includes changes we were calling for to build research into the health system.

  • Placing a duty to promote research on the Secretary of State and the new clinical commissioning groups (what before today were called “GP commissioning consortia”)
  • ensuring treatment costs for patients who are taking part in research (sometimes known as Excess Treatment Costs) are covered
  • embedding a culture of research and innovation
  • and establishing Public Health England independently from the Department of Health so it can provide independent advice on public health issues.

Some of these changes will require amendments to the Bill. The bill is currently paused before report stage in the Commons and is yet to enter the Lords. The government intend to return to committee stage to allow the Public Bill Committee to take a look at changed parts of the bill – we should get more detail on the changes and how the process will move forward over the coming weeks.

Background

In July 2010, the government published a white paper, Equity and Excellence: Liberating the NHS, which proposed changest to how the NHS works. The Health & Social Care Bill was published on 19 January 2011 and aims to make the legislative changes necessary to put these proposals into action. It makes little explicit mention of research but is reorganising the architecture in ways which will impact research.

The Bill completed committee stage in the Commons where, in response to growing concern over the proposals in it, it was paused to allow the government to “pause, listen and engage” and consider making changes to Bill.

They did this by establishing the NHS Future Forum which, led by Steve Field, set out to “listen” and make recommendations to government on how the reforms should be changed.

AMRC joined other organisations with concerns over how the reforms will effect health research – including medical research charities and the academy of medical sciences – to send a joint submission to the future forum. Our key messages were:

  • embed a duty to promote research throughout the system.
  • develop mechanisms to mitigate the impacts of localisation on research
  • clarify the payment of excess treatment costs in the new commissioning structures
  • create incentives for research
  • ensure independent advice to government is maintained
  • develop a system that supports and strengthens meaningful patient and public involvement in research

Yesterday the NHS Future Forum reported, addressing some of our concerns in their recommendations:

(Page 12)

..At a national level, to ensure the provision of independent scientific advice to the public and the government is not compromised we advise against establishing Public Health England fully within the Department of Health.

(Page 28)
…Support for research and innovation is also important for evidence based commissioning and practice so the report recommends that commissioning consortia should have a duty to promote research and innovation and the use of research evidence in the NHS.

(more detail on this in my previous post)

What happened today?

The government responded to the NHS Future Forum, announcing how they will change their planned reforms.

There is a section addressing research:

Research

  • We will create a new duty for the Secretary of State to promote research.
  • We will create a new duty for clinical commissioning groups to promote research and innovation and the use of research evidence, in line with the current duty on the NHS Commissioning Board.
  • We will ensure that a culture of research and innovation is embedded in the arrangements for both the Board and Public Health England.
  • We will also make sure that clinical commissioning groups and the NHS Commissioning Board ensure that treatment costs for patients who are taking part in research funded by Government and Research Charity partner organisations are funded through normal arrangements for commissioning patient care, as set out in existing guidance

Which addresses several of the key issues we raised – particularly our concern that all the bodies making up the reformed NHS need to have a duty to do research and there needs to be clear leadership from the top or it could slip down the list of priorities…

And on Public Health England – we were concerned that proposals to establish Public Health England within the Department of Health would mean it would not be able to provide independent public health advice on what can be quite controversial issues.

Independent public health advice 

  • Public Health England will be established as an executive agency of the Department of Health, subject to completing the normal government approval processes for establishing new bodies. This will ensure that expert and scientific advice is independent, while at the same time integrating policy and action to allow a more joined-up approach to health protection and emergency planning. We will make further announcements in the government response to the Public Health White Paper.

The response also emphasises the government’s commitment to embedding the NHS constitution and upholding patients rights as laid out in this. The NHS constitution includes commitments to supporting research and ensuring patients are notified of opportunities to join in relevant research and are free to choose whether they wish to do so.

There is also a section on protecting confidentiality which recognises the value of patient data for health research and the need to support greater, safe & secure access:

Protecting confidentiality

  • We have heard concerns that the powers in the Bill for the Information Centre in relation to personal information are too broad. We will consider further how to amend the Bill to protect patient confidentiality in a way that supports our plans to drive quality improvement through greater access to information; and to promote high quality research

This response does not cover all the issues we have raised. We’re still concerned about how moves towards localisation will effect research, how patient and public involvement will work for research etc. so lots still to work out.

What now?

The announcements today are brilliant news for research and we are welcoming them.

But there’s still lots to do. Lots of issues need to be worked out. The government has undertaken to embed a culture of research & innovation but there will be a lot of work going forward to work out how this will work in practice, incentives that will be developed etc.

Some of these changes will mean changes to the bill and some of them are longer term. We know government are now planning to send bits of the changed bill back to the public bill committee to take another look before it can “un-pause” and start making its way through the legislative process. The government is planning to announce further detail on all this over the coming weeks.

Posted in: Policy