Clause 14
Health Bill [Lords]
11:30 am
Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)
We now move away from direct payments into innovation, and in particular this one-clause provision in chapter 4 on innovation prizes. I welcome attempts to aid the spread of innovation in the NHS and recognise that this is not only an area in need of improvement but an area with a large amount of potential. Innovation in the NHS, if given the chance to flourish, can motivate and incentivise staff to drive forward improvements to services and it can also furnish British business and industry with opportunities to develop NHS innovations, many of which may have been inspired by the ideas of NHS staff. In that respect, I declare an interest as the parliamentary adviser to the Manufacturing Technologies Association, who manufacture some extraordinarily precise, very small instruments which are used as part of NHS innovations. Through amendments 18, 136 and 137, I want to address gaps in the legislation concerning the scope of the prizes. I will address my queries on the prizes themselves later on.
The amendments seek to ensure that the innovation prizes are open to all NHS employees and to any groups or organisations affiliated to that service. They broaden the scope of prizes to include the promotion of innovation, and enable them to be paid in instalments so that staff can develop a long-term strategy for the uptake of their ideas.
Amendment 18 addresses Lord Darzi’s clarification on the fourth day of the Lords Grand Committee, that the prizes could be awarded to
“people working in the health service but not necessarily employed by it.”—[Official Report, House of Lords, 5 March 2009; Vol. 708, c. 324.]
He said he was aware of
“many people with university appointments who do full clinical work in the health service on honorary contracts.”—[Official Report, House of Lords, 5 March 2009; Vol. 708, c. 324.]
I can confirm that in a non-remunerative position. I am the vice-chairman at the Liverpool School of Tropical Medicine. I also sit on the board of the Innovative Vector Control Consortium, a research organisation trying to find an alternative molecular structure to DDT. The research going on there will have a direct impact if there is success. The Liverpool School of Tropical Medicine is already having an impact on many things in the health service and there is a fantastic collaboration between it and the university hospitals in Liverpool.
Lord Darzi was right to cite these people as a potential source of innovations, but there is a danger that they could be discriminated against if it is not overtly stated in the Bill that prizes are open not only to NHS employees. The British Medical Association expressed its support when it said that amendment 18 would clarify that medical academics are eligible for the prizes.
I am also concerned that the challenge of an innovation prize decided on by the committee might limit the pool of applicants to a particular field of specialism, and in so doing, discriminate against other NHS staff. By emphasising the breadth of the prize in primary legislation through the amendment, I hope to guard against its application to a specific group of NHS employees or a particular field of expertise. The prize’s potential would, therefore, be maximised to inspire everyone in the NHS to innovate. Will the Minister give an assurance that the Committee will not limit the scope of applicants to the prizes by defining too stringently the discipline from which the innovation must originate?
By extending the remit of the prizes to award the promotion of innovation through amendment 137, NHS staff who play a significant role in generating uptake of innovative ideas, and encouraging others to innovate, may be rewarded through the prize. While promotional work will be harder to define, its inclusion in the prize will encourage not only potential innovators, but those with the potential to facilitate the spread of innovation across the organisation. In the next group of amendments, I hope to have the opportunity to discuss the idea that the problem facing the NHS is not so much the dearth of innovative ideas, but their uptake across the service. Promotional activities can greatly aid the spread of innovation, which is why I propose to include them in the scope of innovation prizes. In parenthesis, from my own experience in the manufacturing industry, there is a great concentration on the word “innovation”, but people readily forget that a lot of that comes through developments of existing technology and building on prior innovations. There is often a great problem in giving the developments the same weight as blue-sky thinking innovations. We need to recognise that often 90 per cent.—in most fields—of what is regarded as innovation is in fact a development of an existing practice or idea.
There is a good example of how promotional activities can be fundamental to the spread of innovation in my own constituency at Leighton hospital near Crewe—the Leighton exposition. Since 2004, Mid Cheshire Hospitals NHS Foundation Trust has used its research and development office to set up an effective information dissemination forum to provide opportunities for local clinicians and researchers to network with one another and discuss their practices, ideas and collaborations. The event also showcases the work of local health care research and audit. I attended the last evaluation and am grateful to David Cade and Sasi Willmott, who always produce a brochure with everything set out and documented. There is a prize for the winning entry that is judged by three external, high-powered academic adjudicators. The 60 innovations that were exhibited at the 2008 event bear witness to the fact that innovative ideas are alive and kicking in the NHS. Events such as the Leighton exposition help innovators to promote those ideas among colleagues and, therefore, generate uptake.
The Leighton exposition also demonstrates that it is the clinicians and researchers who are best placed to identify the challenges across the NHS. Innovations at the exposition included identifying reasons for delays in in-patient ultrasound scans, improving access to community services for elderly people after discharge from hospital and an analysis of whether proposals from the National Institute for Health and Clinical Excellence are useful in clinical practice. All these topics originated from staff who identified independently an area of research or a problem in need of a solution. If innovative events such as these are going ahead in trusts such as Mid Cheshire, and if innovators are succeeding in identifying areas of the NHS that are in need of innovation, it questions why the Government are investing in costly prizes that might inadvertently rob innovators of their role. By identifying a challenge for innovators to tackle, the innovation prize committee may be meddling unnecessarily in the innovation process. I hope to seek an assurance from the Minister that the creation of a national prize for innovation will not detract from home-grown, grass-roots initiatives such as the example I have outlined from my constituency—at Leighton hospital, near Crewe.
Amendment 136 would enable the organisers of events such as the Leighton exposition to apply for innovation prizes as the promoters of innovation. I hope the Minister will acknowledge that the promotion of innovation at a local level can be as effective in aiding the spread of innovation as rewarding the innovators themselves. The example of Leighton raises questions over whether innovation prizes will really overcome the obstacles that inhibit innovation in the NHS. The Secretary of State identified the problem with NHS innovation on Second Reading. He said that
“the NHS is good at invention, but it can be slow to adopt new technologies and treatments, and the spread of new ideas is variable.”—[Official Report, 8 June 2009; Vol. 493, c. 542.]
I wholeheartedly agree with the diagnosis of the problem but I question the remedy. Prizes may reward innovation that has already taken place—which, if I understand it correctly, is the main legislative purpose of the Bill—but I fail to see how this change in the rules will encourage the spread of innovation. The problem is surely one of morale. The uptake of innovation is negligent because morale among staff is low. Too often staff have seen their ideas go nowhere, which is disheartening and dispiriting. A recent report by the NHS Confederation called “Future of leadership: Leading innovation” highlighted the lack of uptake of ideas as a source of low morale among staff. It pointed to the preponderance of risk-averse middle managers in the NHS whose work loads are orientated towards short-term targets, rather than encouraging and championing innovative ideas among their staff. It also emphasised the overly bureaucratic mechanisms through which innovators must pass before they can generate uptake for their innovation. The requirement for the clinician to write a business case was seen as a significant obstacle: it is perceived by staff as a way of saying no to innovation rather than as a vehicle to secure funds and uptake.
Amendment 137 aims to aid staff in generating uptake of ideas by allowing prizes for innovative ideas to be paid in instalments. Each instalment could be dependent on a new stage of implementation, thereby encouraging staff to support an innovative idea and see it through to completion. The problem facing the NHS with regard to innovation runs much deeper than generating ideas. A prize is a great way of rewarding the few innovators who have made it through the gauntlet of securing the support of their colleagues and managers. Only a small number of people can successfully negotiate a heavy target-driven work load to find the time and resources to innovate. However, for the majority of NHS staff, an innovation prize in and of itself will not enable them to overcome these barriers.
I hope the Minister will mention in his response the newly established innovation funds held by the SHAs. He may well say that the prizes are designed to work in conjunction with these funds to spread innovation. I welcome that funding and I hope it will provide much-needed capital for those seeking to develop their innovations. I hope he will also take the opportunity to give an indication of how he intends to change the culture of resistance amongst managers and other NHS staff—a culture that, we would argue, is hampered through a somewhat target-centric NHS. This is an issue that runs much deeper than simply the cash that comes with the prize.