§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sackville]
11.30 pm§ Mr. David Tredinnick (Bosworth)I must record how grateful I am to Mr. Speaker for allowing me this opportunity to raise the general topic of Department of Health funding of medical research, and the specific needs of some vital research projects in Leicestershire.
First, however, it is important to comment upon the change in the level of public funding for medical research through the main channel of the Medical Research Council. It is a great credit to the Government that the funds available for medical research have dramatically increased since they came to power in 1979. The Library has provided me with the relevant statistics, from which it is clear that that funding has increased by 47 per cent. In 1981–82, funding increased by a record 28 per cent. and by a further 11 per cent. in 1989–90.
The funding for heart disease research has been similarly significant. In 1985–86, the level of funding stood at £4.6 million, but in 1989–90 it increased to £5.5 million. In addition, in 1989–90, about £2.5 million of such research was directly funded by the Department of Health. Tonight I hope to be able to persuade my hon. Friend to part with just a little more money.
The United Kingdom has one of the worst records for heart disease, so research is essential and crucial. Recently, my constituents began to lobby me to work for more funds for research into heart problems, and drew my attention 1.o work at Groby road hospital, Leicester, into mechanical heart valve noises. An observer might reasonably ask about the significance of such noises, and the short answer is that they can establish whether a valve is faulty. Unfortunately, that is a critical issue today, because, in the early 1980s, a number of faulty valves were fitted.
It has been established that faulty valves have been responsible for at least 250 deaths worldwide. In Britain, 5,000 patients were fitted with those devices. They were withdrawn, however, in the mid-1980s, and although the failure risk of those valves—it is important to stress this —is one in 13,000 as against one in 25,000 for all heart valves, it is enough to cause concern. I have a letter from a constituent who possesses two of those faulty valves. I have received other letters and representations from constituents and others in Leicestershire.
Apart from the problem of strut failure in the valves, there is the second, related, problem of the clotting of the valve. Research currently under way at Groby road hospital in Leicester, it is suggested, can establish whether a valve is faulty. That research is concerned with a new way of using valve sounds to detect defects, and it was to appeal for funds to allow that research to continue that I originally requested this debate. The issue has been of sufficient concern for the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) to form a national heart valves action group with the intention of banning hear valves that are not approved by the Government.
The technique for assessing a faulty valve can be explained simply. If one hits an empty cup with a spoon, a characteristic noise is heard. If a blob of Blue-tak or some other substance is affixed to the cup and the cup is then struck like a bell, the noise will be noticeably different. A similar effect occurs when clots form on mechanical 1227 prosthetic heart valves, and that provides the only means available for the detection of clots. The technique is studying emissions that occur outside the audio spectrum and cannot be heard using a stethoscope.
If a clot is detected early, it can be dissolved. If not, it will eventually interfere with the valve operation, and emergency surgery will be necessary, with a consequent high mortality and high cost. There must be a trade-off here in that, if the art can be perfected, the costs of long-term and expensive surgery must be reduced.
I said that my intention was to ask for additional support for one Leicestershire research project. But having spent time researching for this debate, I feel that I must draw the attention of the House to others in Leicestershire. Hon. Members in all parts of the House are aware that the demand for medical resources far outstrips our ability to provide them. Despite the record increase in funding during our tenure of office, there must be additional ways of raising money. In that connection, I draw attention to Medisearch, which has been established in Leicestershire as a registered charity and which supports medical research at the university of Leicester medical school and teaching hospitals in the county, the royal infirmary, Leicester general hospital and Groby road and Glenfield hospitals.
In the past, Medisearch has helped research into cot deaths, high blood pressure, strokes and heart disease, high risk pregnancies, diabetes, rheumatoid arthritis, eye problems of the elderly, kidney transplants and diseases in newborn children. Funds are now urgently needed for research into breast cancer, heart disease, childhood asthma, failing eyesight in the elderly, cystic fibrosis, infertility and brain damage in infants.
Medisearch's task is to help bridge the gap between the public funding and educational funding of medical research. It is more applied than pure research. In other words, it must be of relevance both to the teaching and application sides in the county hospitals. Priorities at present are for breast cancer research, and of course the cross-fertilisation of research ideas from one project to another is considered important in preventing unnecessary duplication and overlap.
Medisearch was established many years ago in Leicester to develop the desires of Leicestershire people and local industry to provide such support. Recently, to expand its work to meet the increasing requirements and rewards of research, the trustees have appointed a full-time fund-raising director. He has made tremendous strides in seeking out money with a range of activities which hon. Members would be pleased to claim as part of their fund-raising activities, and I pay tribute to him.
Apart from the research at Groby road to which I have referred, there are other examples of research projects in the county which currently need funding and which illustrates the effective use of applied medical research in Leicestershire. There is, for instance, the extra-corporeal membrane oxygeneration project—ECMO. The equipment permits the treatment of cardiorespiratory failure when other measures have failed or are not appropriate, such as the breathing of meconium at birth. If a baby is put on an ordinary ventilator, it will usually die. ECMO will 1228 keep a baby alive until the lungs recover, and there have been several striking successes, but the treatment costs £5,000 a case.
Then there is the detection of respiratory problems in infants, especially those less than a year old. Research is needed for viral infections and for babies at risk of cot death. A respiratory function laboratory is being developed in Leicester royal infirmary, but £250,000-worth of equipment is needed to monitor breathing, heart rate and oxygenation.
Thirdly, there is asthma. Asthma is more prevalent in pre-school children, we know, but we need to research its origins and the environmental factors that contribute to this frightening condition. Monitoring equipment is needed for hospitals and for children who are followed up at home.
Fourthly, I must mention islet cells from the pancreas. Work on transplanting pancreatic islet cells is advanced in Leicestershire, which is used to treating diabetics. If it works, the new treatment would remove the need for lifetime insulin injections. The condition affects about one in 600 British children. After experimental work, trials are now needed on humans to determine appropriate locations for transplant and the methodology of injections.
Fifthly, I refer to implantable defibrillators. It is now possible to implant computerised pacemakers that detect irregular ventricles or heartbeats and restore normal heart rhythm, but the treatment costs more than £10,000 per case, and we need trials to find out how effective they are.
I am grateful to Mr. Speaker for the opportunity to discuss Department of Health funding for medical research. I have brought to the Minister's attention the worries of heart valve patients in my constituency. People concerned about their own condition are visiting the House tonight. I have highlighted some of the important research in Leicestershire and I have drawn to my hon. Friend's attention Medisearch, which bridges the public and private sectors; and I have referred to five other examples of excellent research in Leicestershire. I commend them to my hon. Friend and hope that he will look on them favourably.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick) on raising a subject of considerable importance to anyone interested in the future of health care in Britain. The national health service's provision of health care is and will always remain critically dependent on research —to develop new treatments, to discover new drugs and to furnish a better understanding of how the body works, thereby enabling doctors to treat conditions and diseases that previous generations regarded as disabling and beyond the power of physicians.
One of the most exciting aspects of medical science is the fact that clinicians will never be content to admit defeat in the face of conditions or diseases. They always want —rightly—to find new ways of treating them and of helping the patients. Medical research, funded by the Department of Health, or by the Department of Education and Science, or by the private sector, has a vital role to 1229 play in improving health care for patients of the NHS and ensuring that the frontiers of medical science are for ever being extended.
Any analysis, however, superficial, of the history of medical science in Britain could not fail to be impressed by the pace and extent of advance —over quite a short period —in the quality of care in our hospitals. That is the result of the investment of time and money in medical research.
The subject chosen by my hon. Friend is of considerable importance to everyone interested in the future of health care in Britain. The scale of research and the progress made in expanding the commitment to research in recent years are remarkable. The figures for research in England made the case for me. My hon. Friend reasonably sought to concentrate on Department of Health research funding, but it would be wrong to look at that in isolation arid not examine the total research effort that is devoted to advancing medical science and improving the quality of health care available to patients.
By far the biggest investment in health research is not in the public sector but in the private sector. It is estimated that our pharmaceutical industry invests £793 million a year in medical research. I stress that such research is important to the national health service, and it is considerably to the credit of the pharmaceutical industry that its research effort, although essential to the industry's survival, makes a major contribution to the national effort to find new ways to treat disease and improve the condition off patients.
My constituency is close to that of my hon. Friend, and he will know that it is the location of two major drug companies, both of which are greatly committed to research. One of them employs many of my constituents in medical research. Perhaps some of my hon. Friend's constituents also work in Fisons. It would be quite wrong to overlook that part of our total medical research effort.
In the independent sector, substantial research is funded by voluntary contributions to research charities. Medisearch is one such charity, about which my hon. Friend spoke. In addition, there is funding through the university councils, as part of the core activity of our universities. There is funding through the Medical Research Council, which is part of the research council effort, and both of those are in the budget of the Department of Education and Science. The Department of Health has a national research budget, and local research is organised within the national health service. Other agencies are also funded by the Department of Health.
In 1989–90, the latest year for which I have complete figures, the total expenditure on health research in England, quite apart from the other countries of the United Kingdom, was almost 1.4 billion. The expenditure on medical research is the equivalent of almost 1p on income tax. That is a substantial investment and commitment to medical research in the public and private sectors.
I have sought to stress the importance of setting the Medical Research Council in context, but it is often picked out as the bellwether of the Government's contribution and commitment. Since 1979, the resources available to the council have risen by more than 26 per cent. in real terms. No one can doubt the commitment to and the scale of medical research in Britain.
The importance of medical research was stressed in a report published in 1988 by the House of Lords Select Committee on Science and Technology entitled "Priorities 1230 in Medical Research". That report suggested that we should establish a national health research authority in order to try to ensure that some of the officially directed research programmes would have greater unity of purpose and priority.
In response to that report, the Government published a White Paper in December 1989 also entitled "Priorities in Medical Research" in which we announced that we did not intend to proceed with the proposal for a national health research authority, but that we intended instead to appoint a chief of research and development as a member of the national health service management executive who would be responsible for, among other things, ensuring that the opportunities that existed for national health service management to act as a catalyst for research were taken in order to introduce a properly prioritised approach to health research. Professor Michael Peckham will be taking up those duties in January 1991.
Not only are we committing the resources, but we are looking all the time to ensure that we get value for money for public sector resources and that we take every opportunity to ensure that our commitment to medical research is carried through in a real and effective way.
My hon. Friend was anxious to look not only at the national scene —it is important to be clear about the national perspective on medical research—but at what was going on in Leicestershire, a county which both he and I have the honour to represent. He mentioned a number of schemes, and I want to comment on some of them.
First, my hon. Friend mentioned the research going on in Leicestershire into ways to monitor and improve mechanical heart valves. I hope that the final report of the research carried out at Groby road hospital will provide information on what further possible studies might be justified. If the acoustic assessment technique to which my hon. Friend referred proved capable of detecting early clot formation on mechanical heart valves, I understand that equipment already on the market could be modified by the manufacturer to provide a machine for that purpose for the NHS.
It has been suggested that the acoustic assessment technique might also be capable of early diagnosis of the mechanical failure of those heart valves. If proposals by an established research organisation were made to the Department to pursue that line of research, they would receive consideration alongside all the other claims and proposals in the competition for research resources within the Department.
The Department treats seriously the safety of artificial heart valves. We are kept fully informed of matters relating to failure and we are in close touch with manufacturers and relevant regulatory authorities abroad. Since 1985, when the Shiley valve was withdrawn from the United Kingdom market, I am pleased to say that there have been no reports of mechanical heart valve failure in Britain. None the less, that is an important issue in Leicestershire, and I have constituents who are committed to the continuation of those programmes.
My hon. Friend spoke also about proposals for research in the county on the detection of respiratory problems in infants under one year old and the related subject—to a layman, at least—of asthma. I take a personal interest in both, because my own two-and-a-halfyear-old daughter has the misfortune to be a mild asthma sufferer, so I have seen at first hand the problems that that 1231 condition can cause. If there is an opportunity to undertake research into ameliorating those related problems, no one will be better pleased than me.
My hon. Friend asked about the possibilities of research into extra-corporeal membrane oxygenation—a technique in which blood is oxygenated outside the body. In effect, it amounts to an artificial lung. Conventionally, that technology is used in open heart surgery, while the lungs and heart are being operated upon, and it is referred to as cardio-pulmonary bypass. A pioneering study was undertaken in the United Kingdom by cardio-thoracic surgeons in Leicester to investigate the treatment of newborn babies with damaged lungs—due, for example, to inhalation of poisonous fluid.
That technique involves the use of specially developed apparatus that minimises the trauma to the blood by the artificial lung, so that it can be used for much longer periods—allowing the damaged lung to heal. If that can be made to work, it will offer an exciting opportunity. It is yet another illustration of the type of research to which I referred at the beginning of my remarks and which, if followed through, can lead to developments in medical technology and treatment that will in future break barriers, and cure conditions that previous generations found impossible to manage.
All the proposals from within the county to which my hon. Friend referred are a tribute to the inventiveness and ideas of Leicestershire people that test the frontiers of medical knowledge. As a Leicestershire Member of Parliament myself, and as someone interested in the promotion of medical research, I am obviously open to all such ideas. However, I must tell my hon. Friend that, as 1232 ever, all proposals must expect to participate in the competition for resources that is a necessary element in the priority process in any budgeting context.
§ Mr. TredinnickNevertheless, will my hon. Friend confirm that he will look carefully at the proposals that come before him, even if they may on occasions be a little controversial?
§ Mr. DorrellOf course I will examine with care the proposals that come before me, and I shall try to disregard the extent to which they are controversial. To the extent that I am asked to make any decisions on the allocation of research resources, it seems important that I should assess them on their merits and not on the nature of the campaigns that are engendered either for or against them.
I may add—it would be absurd were it otherwise—that the allocation of resources to specific research programmes is not something in which a politician is qualified to intervene. In the whole of our research programme—not just in medical research—we operate a system whereby the politicians allocate the resources, but leave the choice between the competing claims of different groups of scientists to people who are more likely to make informed judgments about their relative merits.
As my hon. Friend knows, I am by background a business man, not a scientist. I would not claim to be able to make a properly informed decision about the different competing claims to which my hon. Friend refers. However, I can commit the Government to maintaining a medical research programme that will allow for choices to be made by people better qualified than me, to ensure that opportunities for continuing to push forward the boundaries of medical science continue to be taken.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Twelve midnight.