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House of Lords Hansard
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Academic Health Science Centres
02 July 2019
Volume 798

Question for Short Debate

Asked by

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To ask Her Majesty’s Government what is their policy and timetable for re-designating academic health science centres.

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My Lords, I thank those other Members of the House, some of them very distinguished in health issues, who have put their names down to speak. Someone pointed out to me that if I were unfortunate enough to suffer a stroke, this would be the moment to do it.

I declare an interest as recorded in the register of interests. I serve as a non-executive member of the board of an AHSC—namely, King’s Health Partners, which includes King’s College London, King’s College Hospital, Guy’s and St Thomas’ and the South London and Maudsley NHS Foundation Trust. From 2009 to 2014, I chaired the board of King’s Health Partners.

I need not remind your Lordships what an exciting time this is for advances in medical science. The concept of academic health science centres offers a means to exploit those opportunities for the benefit of people locally, nationally and across the world. By bringing together great biomedical research institutions with outstanding teaching and clinical hospitals, it offers the opportunity not only to trial advances in medical science but to bring them to fruition for the care of patients.

Apart from the United States, which pioneered the concept of AHSCs, the United Kingdom is perhaps the country best equipped to make the most of those opportunities. In London and our great academic centres, we have ground-breaking research universities: colocated with long established and world-famous teaching and clinical hospitals. In 2009, the NIHR accredited the first five AHSCs: three based in London, one in Cambridge and one in Manchester. In 2014, following a further competition, they were reaccredited and a further one in Oxford was added. The accreditation was for five years and is due to be renewed in 2019.

It is important to recognise that this was simply a structural initiative. No extra money was provided and the institutions remain fully within the state sector. King’s Health Partners is the AHSC which I know best. This year, we celebrated our 10th anniversary. I believe that our achievements over that time, stimulated by the AHSC initiative, have been impressive. Brilliantly led—indeed, driven—by its chief executive, Sir Robert Lechler, assisted by a small but outstanding team, the reach of King’s Health Partners has been remarkable.

As I said, the underlying concept of AHSCs is to bring together frontier-breaking research with teaching and clinical care. Sir Robert approached this in King’s Health Partners by establishing 22 clinical academic groups, embracing the full range of medical specialties and bringing together from the four institutions the leading members in each.

King’s Health Partners has a number of assets which have assisted in making the most of those opportunities: two NIHR biomedical research centres, which provide unparalleled facilities for experimental medicine and in which 600 clinical trials are current at any one time, covering more than 3000 patients; the leading research institute in the country in psychiatry, psychology and neuroscience, colocated with the leading hospital in the care of mental illness, which has enabled advances to be made from the increasing recognition of the links between physical and psychological illness; and a diversity of population in south London, where the widest range of physical and psychological conditions give unique opportunities for research and treatment.

In addition to the advances made in individual specialities, King’s Health Partners has pioneered a number of other advances. As a response to the ever-increasing demands on health services, it has pioneered the concept of value-based healthcare and preventive measures, not least through the concept of the vital five factors in the prevention of disease—blood pressure, obesity, mental health, alcohol intake, and smoking habits—which have been promulgated through KHP’s academic health science network in south London. This work will make a real difference in reducing future demands on the health services, as well as giving people the prospect of happier and healthier lives, and is of course a key plank in the long-term plan for the health service.

At a recent seminar to celebrate the 10th anniversary of the AHSC, we had presentations of some of the advances made in patient care over the last 10 years that have made a major contribution to the life prospects of patients. They include: treatment for Hodgkin’s lymphoma avoiding the side-effects of radiotherapy in children; advances in the application of naloxone for heroin addicts; genetic treatment to reduce inheritance of breast and ovarian cancer; separation of the elements of cannabis so that the benign element can be used in patients; a new approach to recognition and treatment of prenatal eclampsia; MRI recognition of scar tissue to assist life-saving treatment of heart attacks; and improvements of means to prevent rejection in organ transplantation. On top of that, we can be immensely proud of the contribution that British science has made to dealing with the Ebola epidemics in Africa. There is so much going on that it is impossible to cover it all in one speech—for example, exploitation of the opportunity provided by informatics to join up patient records across our health system.

I am sure that the other AHSCs can tell a similar story. The nub of it is this. Certainly on the basis of my experience, the concept of AHSCs has been an outstanding success. They promote a national asset in which the United Kingdom is a real world leader. They are a magnet for talent and worth investing in. At a time of severe pressure on resources, they make a major contribution to more cost-effective healthcare for our National Health Service. There is great potential still to be tapped.

Reaccreditation will provide both a stimulus and an opportunity. It would be cost effective if that were accompanied by a modest financial grant. We are talking of only a small handful of millions, which would make a big difference—chickenfeed in relation to the overall cost of the NHS. Therefore, I hope that in her reply the Minister will provide that encouragement, and in particular give us a firm timetable for the process of reaccreditation. King’s Health Partners has been preparing itself for that and is waiting for the signal.

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My Lords, I thank the noble Lord, Lord Butler, for calling this debate on this vital topic. I also think the Library for its briefing. I declare my interests both as a visiting professor at Imperial College AHSC, where I work with the noble Lord, Lord Darzi, and as a former Minister with responsibility for this area of policy.

The topic that we are really discussing today is innovation in the NHS and how we make the most of it. It strikes me that medical innovation is both our greatest opportunity and our greatest challenge. It is our greatest opportunity because for the first time we face the prospect of truly personalised medicines that could take hitherto untreatable and often terminal illnesses and cure them for life. We face the glorious fact that we in this country are responsible for huge amounts of medical innovation in our universities, our hospitals and elsewhere besides. However, it is also our greatest challenge because of the NHS’s reputation for adopting innovation, which, frankly, is not good, not least because there is huge pressure on database services to deliver the basics, meaning that many staff do not have the resources or the time that they need to adopt innovation. So at once innovation is our greatest strength but its adoption is our Achilles heel.

The Minister knows this better than anyone. She knows the importance of tackling this topic and resolving the tension. In the six months that she has been Minister she has already shown great resolve in this, both through the creation of the boosted accelerated access collaborative, and through her work on health data to take advantage of that opportunity and the launch of NHSX. Those are all crucial factors as we move towards the idea—a culture change, really—of thinking of the NHS not just as a health delivery organisation but as a research and development one too.

As the noble Lord, Lord Butler, alluded to, in this sense AHSCs are both a microcosm and an exemplar. They demonstrate, in one connected set of institutions, the ability to move from basic science in the lab all the way through to clinical application. I have seen the benefit of that myself when visiting UCL and the biomedical research centres at Oxford, where patients were among the very first in the world to have treatments for their cancers that had been invented in the labs just metres down the corridor.

I believe that redesignation is essential, not just to retain this excellence but, critically, to lead the system to a different and more research-oriented future. I speak from experience when I say that I know it has been the intention to redesignate, and I believe that that is still the case. I look forward to the Minister describing how and when that is going to happen. This time, though, I think we need to do it not just as a badge on these fantastic institutions but with a specific dual purpose with funding attached. The first of those purposes would be to prototype the bench-to-bedside approach and then to roll it out through the NHS. The truth is that we have fantastic adoption in some parts of the NHS but it is extremely patchy. I believe that AHSCs should be given a system leadership role to demonstrate what can be done and then work with other trusts to make sure that that can happen.

Secondly, as I have said, we in this country have one of the greatest opportunities that exist in the whole medical research realm through the use and the maximisation of value of our health data assets, something that we have discussed many times in this House, and using the wonderful technologies that we have in artificial intelligence—many of the leading-edge technologies are developed in this country—to apply them to the healthcare challenges that we face. That would not only give us the chance to change what happens for patients in the NHS but would retain our global leadership in this area.

I would very much appreciate hearing whether the Minister shares these ambitions for our AHSCs. I believe that through that redesignation, by giving them a turbo-boosted purpose and extra funding, they can lead the way for the future.

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My Lords, I am grateful to the noble Lord, Lord Butler of Brockwell, for initiating this important debate. As he did, I took part in the debate nearly nine years ago introduced by the noble Baroness, Lady Finlay of Llandaff. I was a non-executive director at King’s at that time and an independent panel member of the National Institute for Health Research. I was going to say a bit about King’s but I think the noble Lord has covered that, and I will spare the rest of the company. However, I chaired consultant appointment panels for a number of years, and it was clear from the calibre of applicants, all with research and international experience, that the AHSCs were expected to provide an atmosphere in which they could work and flourish.

My first question to the Minister is: given the internationalism of the best clinicians, how will the Government ensure the flow of talent needed and maintain that standard? In her speech to the Association of British HealthTech Industries last month, she said that,

“we must be relentless in our drive to ensure that the UK maintains its place at the cutting edge of health innovation”.

Only yesterday, in repeating the Statement on the NHS long-term plan, the Minister referred to,

“more investment in research and innovation”.—[Official Report, 1/7/19; col. 1270.]

Does she consider £39 million sufficient to maintain AHSCs as centres of excellence? The Government have enjoyed a lot of good will from these institutions and structures. I wonder whether it has now worn a little thin.

The noble Baroness, Lady Finlay of Llandaff, is sorry not to have been able to take part in this debate; she is on her way to Bangor—I am sure that there is a song about that somewhere. She indicated that what she regards as the jewel in the crown could be in jeopardy. Grants are so hard to come by that we are not growing our next generation of researchers. What action is being taken?

I want us to be able to compete on the world stage to attract the best consultants, researchers and innovators and, of course, to keep pharmaceutical companies here in the UK, but this is ultimately all about people. Perhaps I may give two examples from King’s. The CAR-T, or chimeric antigen receptor T-cell, to which the noble Lord, Lord Butler, has referred, is treating adult patients with lymphoma. Mike Simpson, a 62 year- old solicitor from Durham, was one of the first to receive the treatment. He said:

“I’m incredibly grateful for being given the opportunity to have this therapy … I describe it as my L’Oréal treatment… because I’m worth it”.

King’s College researchers, along with Cambridge University, have identified why arteries harden and how a medication used to treat acne could be an effective treatment for the condition. Trials are due to start shortly. I am sure that such exciting and positive developments sometimes help us forget the shortage of, and growing need for, skills in the health service, but we should feel proud of them and ensure that they continue. I hope that the Minister can answer my questions.

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I, too, thank the noble Lord, Lord Butler, for initiating this debate. Given the number of people who will no doubt speak on behalf of different academic health science centres, the Committee should take it as read that I believe that they are all doing excellent work, because I want to explore one or two other areas.

On the need for a 21st-century research-led healthcare system, there is no political discord whatever—I think that we all agree on that, full stop. When the noble Lord, Lord Patel, managed to get the words “research led” on to the statute book during the passage of the Health and Social Care Act 2012, it was remarkable because it created a journey to which I think we all aspired.

There were some excellent signs. The early establishment of some academic health science centres during the years of the Labour Government was positive. In 2014, it was good to see the re-designation of six of them, five of them being in the “golden triangle” and the other in Manchester. I believed that was exciting but hoped it would pave the way for more. Why is there excellent research only in the south-east rather than elsewhere in the country? So far, that expansion has not transpired. If we simply go ahead and re-designate those already there, what will happen to my area, Yorkshire and the Humber? Are we saying that there are no initiatives worthy of designation in Yorkshire and the Humber or the north-east? Surely not. I hope that the Minister will take that on board.

My first plea in any reaccreditation exercise is to include areas that have a strong track record of collaboration between academia and research. In so doing, please use the opportunity to simplify structures that Peter Drucker once described as,

“the most complex in human history”.

Drucker was interesting, but it cannot be right to have differing governance, finance, clinical and political structures in each of the organisations, most with scant involvement of the people they serve. I have a great deal of time for Drucker but he had not looked at the rest of the health research landscape when he made his comments. As Professor Ovseiko argued in 2014, in a superb article on improving accountability through alignment, unless our model of competing structures for research, education, patient care and funding is radically streamlined we will not realise the huge potential for improved patient care that lies within our grasp.

The current landscape defies logical examination. We now have academic health science networks in every region with a remarkably similar mission to the AHSCs, except that they have a budget. Some have close ties with their AHSC, if it exists—not so in Yorkshire and the Humber—some do not. They should surely be brought together within the AHSN using its organisational structures, which are already there and are being paid for by the taxpayer. What about the collaborations for leadership in applied health research and care—the CLAHRCs—of which I am currently chairman, which are soon to be replaced by another set of organisations, the applied research collaborations, for which I am a prospective chairman? Again, some have close ties with a regional AHSN, some do not. For good measure, how do we ensure that our remarkable research effort actually benefits all our citizens, not simply the regions where the organisations currently are?

Finally, money is essential in this. We have a host of small elements of money. We need this to be properly funded. The whole nation needs to be involved and to take this wonderful opportunity forward.

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My Lords, I also thank my noble friend Lord Butler of Brockwell for introducing this debate so thoughtfully. I declare my interest as chairman of University College London Partners, one of the designated AHSCs, and professor of surgery at University College London. As we have heard from the noble Lord, AHSCs were first designated some 10 years ago, following the review by the noble Lord, Lord Darzi of Denham, at the 60th anniversary of the NHS. Their clear purpose was to overcome the two translational gaps: the one between a discovery and establishing a therapy in man, and the one between that and ensuring it can be used more broadly across a relevant population. As we have also heard, there has been huge success in achieving the two objectives of overcoming translational gaps 1 and 2 with great effect on outcomes for individual patients, performance in broad health economies and opportunities for wealth creation in our country. It should be borne in mind that the life sciences represent, after financial services, the second most important part of our economy.

The nature and complexity of innovation and the broader questions attending health systems have changed over that 10-year period. We are faced with demographic change and important fiscal challenge and restraint in health economies. It is broadly accepted that the adoption of innovation is critical if health economies are to remain sustainable. Organisations such as academic health science centres therefore have a pivotal role. As we have heard, successive Governments have recognised not only the potential role of these centres, but the broader question of innovation in health economies through the creation of other designations, such as AHSNs, collaborations for applied research, biomedical research centres and so on. As we come to this third designation for academic health science centres, the question for Her Majesty’s Government is: what specific purpose do they see for AHSCs in the changed landscape for innovation in our health economies? Where do the AHSCs sit in terms of these other structures and designations, how are they to be co-ordinated, and how will we determine their success? We also have to try to understand whether the designation of academic health science centres in the future will be attended by contractual obligations, as we saw recently in the redesignation of the academic health science networks. To date, each of the AHSCs has been able to perform effectively, but driving its own agenda determined by its own local priorities and regional, national and global opportunities. Will that be the case in the future?

There remains also an outstanding question about how government and arm’s-length bodies in the NHS propose to facilitate the most important opportunity for academic health science centres: that is, their capacity to mobilise data across complex health economies and bring those to bear, not only on drug discovery but on changing the patterns and application of clinical care, development of the workforce, and of course the utilisation of vital resource most effectively. Do Her Majesty’s Government propose to deal with this particular question of mobilising the opportunity for health informatics in redesignation of academic health science centres? Finally, as we have heard, these designations come without any funding. Is it proposed that, at the time of redesignation, some funding is provided to the AHSCs?

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My Lords, I also thank the noble Lord, Lord Butler of Brockwell, for calling this debate on the future policy of academic health science centres. I declare an interest: I chair the Accelerated Access Collaborative, I am a non-executive director of NHS Improvement, and I am professor of surgery at Imperial College London.

As some in this House may recall, in 2007 I led a review of London’s healthcare—A Framework for Action —which recommended the creation of a number of AHSCs in the capital. That created significant noise nationally. Subsequently, in 2008 we published the NHS next-stage review, called High Quality Care For All, and the Department of Health, under the auspices of the NIHR, commissioned five academic health science centres nationally.

AHSCs are organisations that hold a joint and equal responsibility for the delivery of healthcare, education and research. The combination of scientific method and clinical care has been seen as the fastest means of ensuring that scientific advances are translated into improvements in patient care. The establishment of the AHSCs in the UK was through a competitive process, as we heard earlier, judged by an international panel, and represented an attempt to regain this lost momentum. With no additional funding, the universities and their NHS partners in these five centres pledged to combine strategy, operations, and in some cases finance to deliver innovations in teaching, research and service delivery. Over the last decade, as we have heard, the AHSCs, with their BRCs, have made a significant contribution to translational research. Translation has typically either meant “bench to bedside”, meaning basic science to first in human use, or “knowledge translation”, meaning uptake of new innovations. This brings me to the Accelerated Access Collaborative and its role in the NHS innovation landscape.

The AAC is a convening board bringing together NHS commissioners and providers, NHS arm’s-length bodies, industry, patient organisations and Government to ensure that the innovation landscape builds a strong pipeline of proven innovations that meets the service needs and to increase the adoption and diffusion of such across the NHS. The remit of the AAC has recently been expanded by the announcement of the noble Baroness, Lady Blackwood, to include six priorities: implementing a system to identify the best new innovations; setting up a single point of call for innovators, so they can understand the system and where to go for support; signalling the needs of clinicians and patients, so innovators know which problems they need to solve; establishing a globally leading testing infrastructure, so innovators can generate the evidence they need to get their products into the NHS; and overseeing a health innovation funding strategy that ensures that public money is focused on the areas of greatest impact for the NHS and our patients.

In light of all this, I see the AHSCs as having a unique and distinct contribution to make to the innovation ecosystem and the priorities of the AAC by providing a pragmatic testing environment, enhancing the uptake of innovation through their expertise in research methods, access to data and our great NHS clinicians.

The Accelerated Access Collaborative will work with the department of health over the next month to define further the role the AHSCs and their future designation.

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My Lords, I, too, thank the noble Lord, Lord Butler, for this debate. I am thankful to follow the presentation of the noble Lord, Lord Darzi; after all, he was the one who started the whole concept of the AAC. I am glad that the noble Lord, Lord Prior of Brampton, will follow me because he might be interested in what I have to say.

Hitherto we have all been supportive of the idea and the successes of the academic health science centres, so let me take a slightly radical view. If we are serious about how good our academic health centres are, we should look at models that really deliver the change. The noble Lord, Lord Darzi, mentioned teaching, research, innovation and clinical application, the key themes of the successful, leading research-based academic health centres in the United States. Are we saying that we have been serious in adopting this in our clinical practice, taking scientific inquiry into clinical application? Yes, of course we have started and have been successful.

In the United States, however, policy-making in healthcare involves a pluralistic approach. In our case it is the department of health that decides on the policy. If academic health science centres are to be successful, they need to be part of that policy-making. That has implications for us to be more pluralistic and for the academic health centres to be involved. For instance, if we agree that this is a good idea, the recognition of the distinctive nature and contribution of academic health science centres might greatly facilitate the development and implementation of policy in a number of areas. These include addressing the current crisis in clinical academic careers in the United Kingdom, growing and modernising the NHS workforce and meeting concerns over clinical governance.

There are, however, additional questions of interest to society that cannot be adequately framed in the absence of an academic health science centre concept. For example, what is the role of AHSCs in supporting government objectives for UK success in a knowledge-based economy—the so-called strategy for life sciences that we are now developing—in improving the impact of research, and in technology transfer? How can AHSCs leverage their academic resources to contribute to improved quality in the NHS? What is the social and economic contribution of AHSCs to local communities? Can AHSCs provide leadership in the development of new models of partnership working and the development of clinical networks? Even to pose these questions it may be necessary to develop a model that is unique to Britain.

Academic health science centres have hitherto been extremely successful. They need to be supported even more and included more in developing our policies.

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My Lords, I should first declare an interest as chairman of NHS England and a non-executive director of Genomics England. I support the noble Lord, Lord Butler, especially and all the arguments other noble Lords have made.

I will begin by taking noble Lords’ minds back to 1980, when two Senators in the US, Senator Bayh and Senator Dole, passed the Bayh-Dole legislation, which forced universities receiving money for federal research to commercialise their IP. Until that day the IP had sat in the ivory towers of the universities and had not been exploited. From 1980 on we saw this extraordinary growth in Silicon Valley and, latterly, Boston as universities were forced to commercialise their intellectual property.

We have been much slower in the UK. Until recently, universities, particularly Oxford and Cambridge, were ivory towers. That has changed and the AHSCs are part of that change. We have developed an ecosystem in the UK that is both hard to replicate elsewhere and extensive. Whether it is the BRCs, the HSCs, the AHSNs, the Crick or the LMB, we have an extraordinary and competitive life sciences ecosystem. It is becoming even more competitive as we see the convergence of biology with data, statistics, computer sciences and artificial intelligence. That puts the UK in a very strong position.

Money comes into this. I have done the Minister’s job and I was involved at BEIS with the industrial strategy. Our problem is that our ambition is so low. Our ambition was to get up to the OECD average for research spending in five years—2.4% of GNP, at a time when the Germans were already at more than 3%. We have to argue for £5 million for a new LICRE digital application across London. We have to argue for £20 million or £15 million for a new dataset for people with polygenic risk scores, for example. We are fiddling while the rest of the world—China and the US—is putting huge resources into this. When I was working on the industrial strategy, I looked at countries as diverse as Singapore, Israel, Ireland and Switzerland, where there was active government involvement in research and industrial strategy. America is always seen as the land of small government, but the NIH is a massive funder of life sciences research.

I do not know how we can change the mindset of the Treasury and the British Government. The only good thing that might come out of Brexit, which I think is a universally bad thing, is that it will provide us with a big shot in the arm. Whether we put in the money through AHSCs or through other vehicles in our ecosystem—UKRI, the MRC, the BBSRC—I do not care, as long as we get more money into fundamental, basic research and support the translational research for the BRCs, the NIHR and the AHSCs. I am fully in alignment with the redesignations of AHSCs. Whether more money comes in through them or other parts of the ecosystem, we have a huge opportunity in life sciences. I know that the Minister supports that, too.

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My Lords, I thank my noble friend Lord Butler of Brockwell for bringing up the matter of redesignating academic health science centres. As noble Lords know, the six NHS university health partnerships that have been designated by the department of health are Cambridge, Imperial College London, King’s Health Partners in London, Manchester, Oxford and University College London. I ask your Lordships and the Minister to look at a map, where you will see that Scotland and the north of England have been left out. There is a serious north-south divide. Both Newcastle University and Glasgow do some excellent work. Will the Government extend the list to include the north of England and Scotland, so that the work to research new treatments and to improve health education and patient care can also be promoted in these areas? That would help to alleviate the discrimination between north and south.

I declare an interest as president of the Spinal Injuries Association. There is a great need for research. Spinal injury causing paralysis is life-changing. Several bodies are raising money for this, on aspects such as bowels, bladders, pressure sores and sexual matters. Some of this research has links to some of the six partnerships on the list, but the ultimate aim is to find a way of joining the spinal cord. That needs global co-operation and the highest dedicated research, with hospitals and universities working together.

The disruption that Brexit is having on the NHS is evident. I have several reasons for being concerned about the £30,000 threshold, and universities may also have concerns. What assessment have the Government made of the impact of the £30,000 threshold on delivering research and on specific groups such as early-career researchers, part-time staff, technicians and other specialists working in the UK?

Many people with disabilities of all sorts live in hope that universities will find cures for their condition. It would be helpful if NICE were able to speed up its assessment of technology, which is increasing as research moves on at a great pace.

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My Lords, I shall describe how I tried to enhance the co-operation and understanding between academia and hospitals by having all the trainees in a third of the south-east region spend a year or two on the academic side. In 1971, as professor of surgery at Guy’s Hospital, I started a comprehensive training programme that lasted until the trainees were appointed to a consultant post.

Several years were spent in district general hospitals and several years at Guy’s. The trainees experienced a wide range of surgical disciplines, including anaesthetics and intensive care. They also spent a year or two on the research side, including a year at Harvard. This gave them an involvement in research that they carried with them into their consultant work in the NHS. In addition, many of them became professors of surgery. The Guy’s Hospital training programme gave junior staff not only more comprehensive training but more security and a more stable family life. It also shared out the junior staff more fairly with the district general hospitals in a third of the south-east region. Most important of all, it encouraged young trainees to embrace academia early on in their career.

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My Lords, I join everyone in thanking the noble Lord, Lord Butler of Brockwell, for putting forward for discussion this important subject of the future of the academic health science centres. I thank the noble Baroness, Lady Masham, for asking: what about Yorkshire? I say that as a Bradfordian.

We could probably have done with at least another hour to do justice to this subject and indeed to the distinguished speakers who have taken part, such as my noble friend Lord Darzi. We have four ex-Ministers here, and then the Minister herself. It is all right; I have been in rooms like this with virtually everyone in the room knowing more than I do about the subject being talked about.

I think we would all agree that these health centres provide essential research in medicine, clinical trials, cancer treatments, mental and physical health integration and much more. At a time of such uncertainty regarding our collaboration with Europe colleagues to conduct health science research due to Brexit, it is vital that we have clarity on the next steps for the academic health science centres in the UK. I agree with the noble Lord, Lord Prior, about the lack of ambition regarding finance, funding and our position on research. I am not sure that I quite understood whether he thought that Brexit was a good or bad thing for the future of research, and I will come back to that.

I have declared in the register of interests that I am a member of the Camden Clinical Commissioning Group, so I am at the foothills of the NHS. However, I am aware of the research done by Moorfields and UCL on, for example, laser treatment for glaucoma, which is important to our CCG. The treatment is said to have had high success rates, with the research suggesting an annual saving to the NHS of £1.5 million in direct treatment costs, potentially rising to £250 million if the treatment proves beneficial for patients with later-stage glaucoma. In Camden CCG, we are proud that our area has many major research centres—Moorfields, UCL and Great Ormond Street—and regard our job as primary care commissioners as being to make sure that we co-operate with them.

I return to Brexit. One of the health science partners, the University of Cambridge, stated:

“Both the NHS and the UK life sciences industry desperately need clarity and certainty to plan successfully for Brexit, and time has almost run out”.

That was in March, but it remains true, and the Government must consider what solid solutions can be offered. If we fall out of the European Union at the end of October, that presents an enormous challenge to the centres. It makes it more important that they exist and receive sufficient funding, I agree, but the collaborations that need to be carried out across Europe and the world seem to become more difficult. I would like the Minister’s view on that.

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My Lords, I thank the noble Lord, Lord Butler, for raising this question on AHSCs. I pay tribute to his work as the former chair and now non-executive director at the King’s Health Partners AHSC and to his speech setting out some of the achievements that have been delivered. This has been a supremely expert debate, so I feel somewhat cautious in summing up. I thank noble Lords who have spoken this afternoon about their work in AHSCs, notably the noble Lords, Lord Kakkar, Lord Patel and Lord Darzi, and my noble friends Lord Prior and Lord O’Shaughnessy, who have been so instrumental in developing the system to where it is today. This is a timely debate because, as many noble Lords said, we are developing policy options for AHSCs going beyond the current designation. As noble Lords know, it is due to end in December this year. I acknowledge that this is a tense time for AHSCs, which will now be thinking about planning their future strategy. I am grateful to the noble Lord, Lord Willis, for making the point that this is a cross-party issue and that there is wide agreement across the Chamber about the importance of AHSCs. I will say at the front that there is also consensus about the need to go forward to designation; the question is how we do that.

First, in response to some of the wider points that were made in the debate, I say that the Government recognise the critical role that health research plays not only in fuelling the life sciences sector, which is one of the most productive within our economy, but in driving up the quality of diagnosis, treatment and care in the NHS. We are committed to creating the best environment for clinical research and to achieving the ambition set out not only in the life sciences strategy but in the sector deals. This is the only sector to have two sector deals, and that is because of the quality of the sector and the relationship between research, industry and the NHS, which has developed into an outstanding ecosystem in the past few years. We have to pay tribute to the role that the NHS long-term plan will play in that, due in no small part to the leadership role of my noble friend Lord Prior.

This country is a world leader in health research, with a world-class science base and three of the top 10 globally ranked universities. As my noble friend Lord Prior said, we have an extraordinary life sciences sector, and we must be as ambitious as we possibly can be in driving it forward. We are investing more than £1 billion per year through the NIHR to fund research, skills and facilities to enable high-quality research. I can answer the noble Baroness, Lady Donaghy: about £100 million of that was invested in a range of training programmes, and we have also created the NIHR training academy so that we can think about how we link that to international training.

We must ensure that we protect the valuable collaborations that we have because that ensures that we have the highest quality clinical research in the world. The commitment to increase our R&D investment from 1.7%, which has quite frankly not been good enough, to 2.4% and beyond that to 3% was hard won from the Treasury. I know that because I was one of the first to campaign on this as chair of the Science and Technology Select Committee some time ago. I will be one of the first to join noble Lords across the Committee in campaigning to drive further and faster, as we must not only have this commitment from our leadership candidates—and I am sure that others will join us in that—but keep driving forward blue-sky investment and further investment through the people, programmes, centres of excellence and the NIHR. That is how we will have an integrated health and research system which is one of the best in the world, designed to transform scientific breakthroughs into life-saving treatments.

The noble Baroness, Lady Donaghy, is right that we should be proud of what we have already achieved. Between them, the existing AHSCs cover health research and education in a wide range of clinical disciplines including mental and physical healthcare, cancer, cardiovascular and inflammatory diseases. It would not be right it we did not pay tribute to some of that today. Noble Lords have already done that. While we do not fund the AHSCs specifically, of the 20 NIHR biomedical research centres, 12 are at the heart of these six AHSCs, representing more than £700 million of NIHR investment over five years from April 2017. This significant NIHR-funded research infrastructure is key to enabling its engines for world-class excellence in early translational biomedical research.

The existing AHSCs were designated based on recommendations made by an independent panel, which we heard about from the noble Lord, Lord Darzi. On the regional spread, I am afraid that the noble Baroness, Lady Masham, will be disappointed that they can be designated only in England, not in Scotland, but it is open to the new designating committee to consider the regional spread as that goes forward.

Over the past 10 years, the six AHSCs have facilitated the strategic alignment of some of our leading NHS providers and their university partners in world-class research and health education, leading to improvements in patient care and playing an important role in driving economic growth through partnerships with industry, including life sciences companies, which is one of our key priorities. It is through this strategic alignment that these partners have secured funding. An example is the £10 million funding from UKRI for a new centre for medical imaging and AI at King’s Health Partners as part of the industrial strategy challenge fund. The noble Lord, Lord Kakkar, spoke about the success of UCL Partners, which has, among many things, been leading on the adoption of a learning health system to standardise data entry. This has allowed seven CCGs to trial and support interventions into early detection of atrial fibrillation, which is a key priority of the long-term plan, and for primary care networks. Specific examples are the ways that we are going to change healthcare for individuals. Imperial AHSC has supported North West London STP’s integrated care record to bring together the health and social care information of 2.3 million patients in the sector, enabling the identification of patient cohorts and the evaluation of service developments.

London’s three AHSCs are collaborating through the MedCity initiative to grow the life sciences cluster of London and the greater south-east, working with the Oxford and Cambridge AHSCs. In Manchester—not in the south-east—the AHSC is working with the AHSN to align research and education into the health and social care priorities of the Greater Manchester population. A single blood test-driven decision aid for patients presenting with chest pain at the emergency department is being rolled out. Since June 2016, more than 7,000 patients have been treated using this tool and the diagnosis of acute myocardial infarction was ruled out in more than 99% of cases, with patients returning home within hours of their arrival in the emergency department. This is evidence of how the AHSCs have changed clinical practice on the ground. Additional data published today by the NHIR clinical research network shows that NHS trusts which are part of the six AHSCs have undertaken more than 3,600 clinical studies and recruited 148,495 participants in 2018-19.We know that other academic health science partnerships have formed, further strengthening the health research and health education interface in London but, as my noble friend Lord O’Shaughnessy said, we must ensure that the deep research base that we have in this country is matched by a health system that embraces innovation and translates research funding into improved patient care, so that innovators can develop, test and deliver those products that patients and clinicians need and so that examples such as those I have just given can be adopted.

We know that in the past the system has been too fragmented, too complex for innovators to navigate and too slow to adopt promising technologies. That is why last summer, at my noble friend’s instigation, the department undertook an innovation landscape review, which identified the need for a system which was more joined up between healthcare partners, and for improved support for late-stage evidence and a better strategic alignment of priorities, such as how we support emerging technologies, including AI, drug discovery, mentioned by the noble Lord, Lord Kakkar, and precision medicine.

As my noble friend Lord Prior pointed out, it is also important to recognise the role of collaboration between NHS, industry and academia. During the landscape review, we found huge appetite for change and more ambition within the healthcare stakeholders who need to implement it. That is why the sector deals, the NHS long-term plan and the tech vision have all begun the process of transforming a significant part of strategy within government policy. Through the establishment of the accelerated access review and NHSX, as has been mentioned, we have started to build the necessary infrastructure effectively to support health innovation in this country. Under the expert leadership of the noble Lord, Lord Darzi, the AAC brings together senior leaders from the key government, NHS and industry partners with patient and clinician representatives to promote innovation within the NHS. Already, the AAC has made significant progress in supporting uptake.

We must agree that AHSCs and other structures must work hand in hand with AHSMs and wider innovation infrastructure to ensure that this is wired into the ARCs and will be in AHSCs. This is why I have asked the AAC to consider AHSCs, to ensure that the whole system is joined up, because that is what it is leading on. It is important that we give the AAC and the noble Lord the opportunity to build a cohesive health, research and innovation ecosystem that meets the challenges that we have set and the ambitions that we need our life sciences sector to deliver. That is why I have asked the AAC to consider AHSCs’ role within the health system as part of the boost agreement. That will ensure that the future designation of AHSCs complements the innovation support landscape, rather than adding further complexity. The AHSCs will therefore support the AAC in achieving its new objectives, including commitments to establish globally leading testing infrastructure, improving the system’s capacity to adopt innovation.

We plan to extend the existing DHSC AHSC designation until March 2020 to enable that new designation process to be held. We will announce the timescales soon. I appreciate that is not necessarily the answer that noble Lords want, but I hope that the strategic vision, the need for ambition and the purpose, which is to deliver innovation for patients which changes their quality of care and the ambition of our life sciences ecosystem is understood as the reason for that change.

Sitting suspended.