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7.19 pm
Mr. Simon Hughes (Southwark and Bermondsey): I am privileged to be able to take part in this debate and I do so wearing my hat as the Member of Parliament for
Guy's hospital, which, as the right hon. Member for City of London and Westminster, South (Mr. Brooke) introduced the Bill by saying and the Minister and other colleagues will know, is one of the sites for the united medical and dental schools--one of the partners in the proposed merger.
I must give one word of historical reply to my neighbour across the river, the right hon. Member for City of London and Westminster, South, who like me represents a constituency with one of the oldest pedigrees in the country. There have been Members of Parliament for Southwark since the 13th century. I believe that there have been more than 400, reflecting the fact not that they have each had a short span, but that there were two at a time for each of the constituencies until last century.
One of the great pleasures of a constituency such as mine--which is more rightly now called Southwark and Bermondsey, reflecting the two old boroughs south of the river--is looking after and advancing the causes of those institutions that are historically part of our community. We do so conscious of our history, but also conscious of our present. It is no mistake or accident that two of the greatest issues facing the Governments of our time are the futures of our education and health systems. The Bill is a microcosm at the higher education end of that debate, as it concerns the best arrangements in one part of the country for the best conjuncture of education and health.
The question is simple: to merge or not to merge. I will not divide the House on Second Reading. My job is to pose some questions that flow from the proposition of the right hon. Member for City of London and Westminster, South that there should be a merger--a proposition supported by the Minister.
The House will be relieved to know that I will not repeat the speech of the right hon. Member by tracing the history of how we come to be here. Due to a series of developments in London medical education, we have ended up with a merged medical and dental school south of the river, on two sites: the St. Thomas's site in Waterloo, just over the bridge from here in the constituency of the hon. Member for Vauxhall (Miss Hoey); and the Guy's site, at London Bridge in my constituency.
A merger is proposed between that institution and King's college, which provides academic teaching on the north bank of the river and clinical teaching on the south bank at King's College hospital, Camberwell. Ancillary issues are involved: students live in residential institutions, which are scattered around and are mainly south of the river.
It may surprise the right hon. Member for City of London and Westminster, South to learn that I do not intend principally to raise issues to do with health care and Guy's, although I am concerned about the linkage. The right hon. Gentleman stated three propositions as unarguable--one touches on the intervention of the hon. Member for Merthyr Tydfil and Rhymney(Mr. Rowlands). They are perfectly credible propositions, but I want to question them in turn, because there are counter-arguments.
The first proposition is that it is widely agreed that integration is a good thing. Although that is so, several reputable people dispute it in the case of London teaching hospitals and schools, so it is not an unarguable proposition.
The second proposition was that there is a critical mass for medical and dental academic institutions. I agree that there is, but I take issue with the claim that the merger is necessary for, and will produce, that critical mass. Indeed, the merger will make for a much larger institution than is normal in this country and countries of a similar size, and much larger than is recommended. It will be a very large institution, and there are arguments against it being so big.
Thirdly, on the intervention by the hon. Member for Merthyr Tydfil and Rhymney, I will not assert that the proposal does not have considerable support--I cannot do so. I do not doubt that there is majority support. However, I am aware from approaches made to me that that support is not unanimous, or even overwhelming. The people who are probably the most troubled are the students, but others who are academically involved in UDMS and, I gather, in King's--that is not in my constituency, so I know less about it--have certain concerns.
Given that I think that there will probably be no recorded vote on Second Reading, the hon. Member may want to make further inquiries, and I can put him in touch with some of the people who are concerned about some of the implications. I am grateful for his interest as a former graduate of King's, which is an eminent university college.
The right hon. Member for City of London and Westminster, South first tackled the drafting of the Bill, which is straightforward. The proposition is that, if there is to be a merger, one needs such a Bill. I will not discuss the details of the drafting, which will be a relief to some of those involved in it, whom I have known for a long time--I would not want them to be offended, but that is a more personal matter.
The Bill provides for an appointed day for the merger, and the date pencilled in is August next year. My collaboration will depend on whether I get assurances on and satisfactory answers to my questions--the date may have to be later.
Two other matters arise from the Bill's drafting. First, it will be a blessed relief to those living south of the river that we will lose a name that no one understands and gain one that, in theory, everyone would understand. The united medical and dental schools could be anywhere from John o'Groats to Land's End, or certainly from Aberdeen to Plymouth. It was not a very clever title--it was a bit clinical. I would not defend such a title, in which the historic names of the two original hospitals were lost.
However, I am not sure that the new title provided for in clause 12--
It is a minor issue, but we must get the name right. We want one with which we can all associate. No matter where they were educated, all hon. Members will agree that names matter a great deal.
Mr. Rowlands:
I do not quite understand what the hon. Gentleman objects to. The Local Government (Wales) Act 1994 left us with Rhondda Cynon Taff.
Mr. Hughes:
I remember that debate. I was educated in Wales and I still follow Welsh issues. However, even Rhondda Cynon Taff is only a third as long as the name proposed in the Bill. I do not want make a big deal about that, but it is a muddle that tries to get everyone's name into the title.
Thirdly, I should like the right hon. Member for City of London and Westminster, South to deal with the historical concern about the trust funds that belong to the trustees of the existing institutions. As in all such cases, there is some concern that, if the trust funds are merged, control will be lost and their original historic purposes will not be fulfilled.
I have seen the memorandum from the Charity Commissioners that says they are happy, and I know how the law on the merger of trusts works. There is, to put it mildly, nervousness that there may be a loss of control of funds that were given for particular purposes as a result of the merger. If there continues to be discontent, could the trust funds held by the trustees of the various institutions remain separate and be excluded from the Bill? That could be done under the law. If it would allay concerns, I might well argue for it.
The section of the documentation supporting the Bill called "The rationale for the merger" sets out the merged colleges' seven strategic objectives, which the right hon. Member for City of London and Westminster, South summarised.
First, there is the issue of critical mass. It is argued that the merger of two successful university institutions will result in the critical mass necessary to obtain a secure, linked set of academic centres of excellence that will enable us to keep our international reputation.
We are talking about institutions that already have a high international reputation. London medical schools dominate the top ten list of institutions that receive Medical Research Council funding. In the international lists of institutions with the highest academic standards and their research grants and successes, UMDS does extraordinarily well.
For example, in 1989 the French newspaper Liberation published a guide to the top 100 universities in Europe. London's medical schools came top of that guide, which stated:
A London university medicine administrator told my office only last week that Singapore and Malaysia will pay for their students to study in England only at Oxbridge or London university. For medicine and dentistry, they will not pay for them to go anywhere else.
I am sure that there is no dispute in the House that it is important that any change we make to the structures must safeguard and enhance the academic reputation and international pre-eminence of the institutions.
If we merge the two institutions, what will the student numbers be? What is the pattern of academic institutions in Britain and elsewhere? A learned article in the British Medical Journal in 1993 entitled "Undergraduate Medical Education" appeared in a selection of articles called "London after Tomlinson". It is both recent and academically attested. I hope that it will make my argument clear. It states:
The article continues:
People are seriously troubled about that. On the mainland of Europe, there are often hundreds of students doing an academic course at any one time. It may be possible to get away with that with academic teaching--a point that replicates our debates about class size. I am doubtful about that argument, and it has never been our tradition in England. In medicine, dentistry and applied sciences generally, the argument is even less strong.
The merger will also produce a dental school much larger than all other dental schools in Britain. Apart from Glasgow, dental schools have student intakes of less than 60. The optimum size recommended by the royal colleges and others is between 65 and 75. The UMDS figure is at present 88. I am not merely advancing a layperson's argument; the Nuffield inquiry into dental education, for example, made that point.
It has been put to me by academics and students that a dental school that takes 140 students a year would, under any foreseeable arrangements, be unmanageable. For heaven's sake, let us examine whether the critical mass
will not be far too big. Where is the evidence that such a big school will work? There are no parallels, and the proposition is not supported by the academic evidence.
The second strategic objective argues that the merger will
My university experience suggests that medics, dentists and vets do not naturally spend all their time with students studying other subjects, but traditionally stay together. It may be argued that that is not a good thing socially, but the argument for such mixing seems less well made in London than in any other place in the country as the collegiate structure already provides such opportunities.
I accept that UMDS is a free-standing university medical and dental school, and that such institutions are now in a minority. But that does not mean that its students are isolated either from those undertaking the other professional training mentioned by the Bill's promoters or from students studying other subjects. It is not as if UMDS students will be miles away from other students, whether undergraduates or postgraduates, studying something else.
There is also the questionable argument whether it will be better to integrate in this way. I challenge that argument, not because I believe that it is definitely wrong, but because strong and valid academic arguments suggest that it is not necessarily good. The arguments are as follows: if a highly regarded, internationally successful medical and dental school already exists, the benefits of merging may well be outweighed by the disadvantages. To put the question crudely: will the merger result in a sum greater than its constituent parts?
The recent experience of Bart's, Queen Mary and Westfield, and the London, which have done a double merger, shows that the merger may bring no short-term advantages, although it is accepted that it may have long-term advantages. Can we be sure of the long-term advantages when it looks as though there will be few, if any, short-term advantages?
Unit costs per student in London are already less than the national average. London medical students do not cost more than other medical students. Students at UMDS cost the taxpayer not more, but less, than average. What is the advantage of merging with another institution when that does not necessarily bring better value for money?
There are some strong arguments about the nature of the academic teaching. One argument is that there will be generic teaching--that has been going on at UDMS for some time. There is an argument that one can have too much generic teaching. There is an argument that, if someone is studying medicine or dentistry, he wants specific teaching and does not necessarily want to be entirely integrated into a course of life sciences.
At Bristol university, the joint lectures that were set up between the dentists, medics and other life science students have been abandoned because they became too
general. It does not automatically follow that it is a good thing for non-clinical teaching to be carried out with other people if it is inappropriate. It would be the same as insisting on all-class teaching, when it would be more appropriate to set or stream. We must be satisfied about what we are doing; we must not blindly undertake such a policy when there is evidence that it has not worked elsewhere.
There are already links with other institutions--UMDS has strong modular links with University college London, for example. Why should it not be better to continue with that mix-and-match form of curriculum development rather than put everyone together on one integrated course as the proposal suggests? If the proposal were adopted and life sciences, medicine and dentistry were integrated, would that work in practice?
We must consider the fact that people studying for an ordinary life science degree such as biochemistry have a traditional academic year cycle, while people studying for a medical or dental degree have different cycles--they go on location to other hospitals, they go on electives elsewhere, they undertake six-month stints in different places, and they have shorter holidays. There are practical questions about whether the system will work. Those questions are raised both by the students and by those who teach them. They say that they are achieving perfectly good results, so why should anyone seek to integrate them when that may be contrived and unnatural?
The third strategic objective argues that the merger will
Another question which arises links this debate to the one about Guy's hospital. The current proposal that the Minister of State and his colleagues are advancing about Guy's hospital will leave vacant considerable amounts of space in at least one of the tower blocks that currently form part of the Guy's hospital site.
It is no good looking at the cost of the academic development separately from the costs of the health service development. The cost of the health service development is the cost of Philip Harris house, which has escalated from about £50 million to well over£100 million. There is the cost of new build for mothers and children at Riddell house and other sites at St. Thomas's hospital and other further capital developments--all of which are eventually meant to be recouped in lower revenue costs.
There are serious concerns that, under the Bill, we are committing ourselves to large amounts of taxpayers' money which happens to be in the pocket marked "education" rather than "health". Under the heading of health we have committed ourselves to further money to build unnecessary buildings. They are unnecessary, because space will be available in buildings that already exist.
The Minister said that next year--I will believe it when I see it--the building at Guy's hospital that was to have been called Philip Harris house--history is being rewritten, and it is now to be known only as phase III--will eventually be open. It was due to be opened about two years ago, but there have been all sorts of problems and some less well explained delays. The National Audit Office is currently investigating the matter.
That building is meant to accommodate many of the health service facilities on the Guy's hospital site, but there will still be the two other relatively recently built buildings that are intended for health use. It will be helpful to know whether they will be used for health, or whether, as people at Guy's hospital and in the neighbouring community fear, they will be left virtually empty. In that case, they could be put to academic use. If so, why spend £140 million to put up buildings, some of which will not be needed because the necessary space will be available on part of the same hospital site at Guy's?
That is why I say that the cost-effective use of space and recurrent and capital funding must be examined in the context not just of the Higher Education Funding Council for England budget, but of the funding budget of the Department of Health. It is no good disregarding the fact that there will be a cumulative cost to the taxpayer, so the two must be looked at together.
The fourth rationale for the change is that it will consolidate the biomedical sciences currently taught on six sites on the Guy's medical school and hospital site at London Bridge. I understand the frustrations that have led to King's seeking to rationalise the use of its properties; working on one site instead of six would, of course, be an improvement. I will therefore not argue against the fourth rationale, but I want an assurance in writing that all the biomedical sciences will indeed be on one site. It is no good arguing for consolidation if students are moved either to the Denmark hill site in Camberwell or to the St. Thomas's site at Waterloo. We need to be sure that everything will be consolidated on the one Guy's hospital site.
The fifth argument is that the teaching of future doctors, dentists, nurses and other health care professionals should be combined. The idea is to integrate teaching in the health service, and I agree with it. It seems a worthwhile objective, with which I would not quibble.
The sixth proposal, however, cannot be borne out by the facts. It is that we should link the education of medical and dental students to the clinical work of a hospital site,
That is nonsense and unnecessary. If academic work is to be consolidated on the west side of the Maze pond--the western half of the Guy's hospital site--then the
eastern half on the other side of the road should be used for medical health care. There is room to do that, because there is certainly room for a hospital with the number of beds needed to make the project viable on the other side of the site.
It appears that, wittingly or unwittingly, the Government are trying to implement two contradictory policies. Consolidating teaching with clinical practice is more important than ever nowadays, because students do not do a straightforward two-year pre-clinical and then go on to clinical: they start clinical work earlier. On the other hand, the Government are so arranging things that students can do this less frequently. The students in the combined institution will spend all their lives doing their lectures on one site, occasionally talking to out-patients and those who occupy the remaining beds there, but for all other work with patients, they will have to go to another site. That is exactly what we want to avoid.
The vertical integration of the curriculum with the clinical work of the hospital site will thus not be achieved by the Bill. The solution is to vary the proposals of the Minister for Health and his colleagues, who, over time, want to move most of the beds down the road to theSt. Thomas's site. There is a good academically backed case for keeping a reasonable number of medical and surgical beds at the Guy's hospital site, where it can act as a secondary and tertiary hospital.
That is not inconsistent with the Government's strategy--I agree with it--of rationalising specialties; but that does not necessarily mean rationalising all specialties on one site--certainly not if the money does not add up. The longer the process continues, the more Philip Harris house and the building programme will cost. It will then become less necessary to start building on other sites, such as the mother and baby site at St. Thomas's.
When this Bill, as opposed to the merger, was first thought of, there was a proposal to have hospital services on both sites. Guy's and St. Thomas's would merge into one trust, so the reorganisation of services had not yet been fully worked out. Since then, however, cardiac, renal and neurological services have been rationalised, as had to happen because there was a need to consolidate. But there was then a failure to take into account precisely what the optimal mix of specialties and beds would be.
There are strong academic arguments to the effect that hospitals with up to 1,400 beds--that is what the merger implies--are far too big in terms of organisation, morale and business management. The Americans, the Scandinavians and academics in the UK are, according to all I read and hear, reaching the view that great big hospital sites bringing all beds under one roof no longer offer the best hospital organisation models.
That being so, the best logical solution is to use the space of the Guy's site and the space that King's decided it did not need in New Guy's house and Guy's tower for the original health service purposes. That will also be cheaper, because it will integrate academic and clinical work, and it will allow out-patients at the Guy's hospital site as well as other sorts of treatments there. This idea is also consistent with the fact that the most modern building in the entire health service, Philip Harris house, will just have been built.
Finally, the last rationale is that the merged college will be able to concentrate medically related research groups alongside medical teaching and hospital services for
patients, thus increasing the opportunities for effective collaboration and cross-fertilisation of ideas. Hooray and amen to that. In that case, let us have the teaching and the clinical activity on the same site, so that the research, teaching and clinical activity can be together. If it is the plan for Guy's to be the academic site, let it be the academic site, but do not, at the same time, pull the rug from under us and take the medical activity away. It is not so easy to take the dental activity away.
The logic behind this argument is fatally flawed. People are arguing for the integration of a medical and dental school with a university college, which is fine; and they are arguing to put it on one site, which is also fine. However, they have realised that the site will lose most of the clinical activity that is needed.
I shall ask the Minister a specific question, and I am keen to get a specific answer. Will he give an undertaking that, after the proposed merger, the students will not be going to the King's college site or to the St. Thomas's site for their academic teaching? If they continue to go to the King's college site or to the St. Thomas's site, the purpose of consolidating will not be met.
It will be nonsense if, in theory, we consolidate and bring the three sites together, but, in practice, a significant number of the students still have to be bussed to three different sites south of the river. We need to be clear about this: either we go down a put-it-all-on-one-site road or we do not. If we do not, the merger is not nearly as justified; if we do, for heaven's sake let us put the clinical activity in the same place.
How much of the cost of the whole merger project and the creation of the whole new academic site is dependent on the private finance initiative? It is a coincidence that the debate is taking place on the day that the annual conference of the British Medical Association started. One of the BMA's great concerns--apart from the fact that it thinks that the health service is greatly underfunded, with which everyone in the health service could not but concur--is that the PFI has been dreamed up by the Government as a way of saving money, but that it has never been proven to be a good idea. There is no evidence that the PFI is delivering the goods.
For example, it was reported in the national press at the weekend that in Scotland the flagship of the PFI still has not had its contract signed--in fact, I understand that none of the PFI contracts has been signed. Last year, the Treasury was unpersuaded that the PFI was a good thing, and the Treasury Select Committee has expressed many doubts.
The people running the hospitals and the people in the health service are concerned that the PFI means that we will be signing up to deals that commit the provision of a set of services and facilities for 10, 20, 30, 40 or 50 years to someone else, and that the health service will not have the power to manage it. Some crucial questions in relation to this issue are: how much is dependent on PFI?; how secure is the PFI money?; will it be there?; will it be guaranteed?
One of my concerns--it is shared more widely; in fact, my hon. Friend the Member for Bath (Mr. Foster), the Liberal Democrat spokesman on education and employment matters, has voiced this concern in the past, and may elaborate on it if he catches your eye, Mr.
Deputy Speaker--is that there have been many examples in the past where the promise of capital finance has never been delivered. What guarantee is there that the money is secure? What guarantee is there that it will not be cut in the years ahead? I refer to south London and to the Institute of Psychiatry, which is on the Maudsley site on Denmark Hill. It has had to face significant cuts, which has made it extremely difficult for it to carry on its work.
If we are going to have the proposal, does the money come with it? Will the Minister or the sponsor say that it will be guaranteed, and that there will be no going back? In addition, is that logical and consistent with all the development and all the money that is being spent at the St. Thomas's site and at the King's college site? Will that expenditure militate against future expenditure to provide some similar services at Guy's, if that is the implication of the Bill?
I have expressed the concerns of the students and the academics. I now refer to what seems to many local people to be a better solution. We may be rushing to go down a complete merger road when there may be a solution that goes in the same direction but does not have the same disadvantages. Is a gun being placed at the heads of the UMDS and King's college? How much is this an entirely cost-driven question? The Higher Education Funding Council is literally saying--because these are its instructions--"We are going to go for the cheapest option, as opposed to the one that produces the best answer for medical education in London."
Tomlinson said in his report that changes in University Funding Council funding have led to pressures for more efficiency in teaching. These changes have increased the need to rationalise resources and to remove the duplication of posts. I subscribe to that view. However, one increasingly gets the impression that things are being so cost driven in higher education and in the health service that we will do so at the risk of academic excellence or the best arrangement of academic or medical resources.
Would it not be possible to have a federal structure, instead of a merger, for King's college medical and dental school and UMDS? Why could there not be a closer collaboration that allows them to develop how they want to work together rather than have them forced to come together? Why can that not be pursued, particularly if it would be no more expensive than the current proposals--and, indeed, might save some of the costs? Some eminent people concerned with this debate would have no problem with such a structure.
I understand that it is simply the funding authorities that are saying, "Even if it is cheaper or the same cost, we will not pay up unless you go down the road that we insist on." That seems to be going beyond the remit of the funding council. Its job is to provide funds for the best service; it is not its job to take away decisions from autonomous institutions. If they decide that something is better or more efficient, they should be allowed to pursue it.
That has happened over the river. As hon. Members will remember from debates in this place over the past few years, Bart's was forced to merge in two stages--there was a federation of east London colleges in the 1980s, and it has been forced into a merger in the last few years.
That was not a happy experience for everyone--there were certainly some very unhappy academics and students. It was argued that the merger put at risk some
of the things that the individual institutions had developed, such as their academic expertise and their reputation. Those of us south of the river still need to be persuaded. Are we going to have a forced marriage? It has to be done with the voluntary consent of everyone, not because they have a gun to their heads.
Is there a danger under clause 5 that some of the money currently held by the trust funds of the two institutions will be lost to other activities at King's? I do not mean that other areas of King's should not be properly funded, but is there any risk? There must be a factual answer to the question. Can any of the money currently held by the trustees of UMDS or by the trustees of King's college medical and dental school be directed away from medicine and dentistry to elsewhere?
If we are going to go down the merger road, what evidence is there--not from this debate, not from people in the university of London and not from people in the colleges in question, but from friends elsewhere--that a much bigger institution would do any better academically? London university has some continuing small academically excellent institutions. The London school of hygiene and tropical medicine, for example, has managed to retain its academic excellence in spite of its small size. The school of oriental and African studies proves that institutions do not have to be big to be better in academia or to punch their weight in the world's research journals. The more the Internet and university computer networks are used, the less we need to force people to be together on the same site.
In any event, collaboration is only so good, in that many of the links are with the private sector, especially for the health service--for example, with the pharmaceutical companies and international conglomerates. Why cannot they continue to fund the organisations as they do at present?
What about the students? My understanding is that a report in 1990--the second report of the Departments of Health and of Education's steering group on medical and dental education--proposed a set of undergraduate policies and plans for medical and dental students so that development of sites and their studies should always be enhanced by better teaching practice and circumstances. That has not been done, and the formal consultation process with the interested parties has not taken place. Why not? The interested parties should have a say through the procedures that were recommended.
I wish to make a specific point about dentistry, and the dental hospital and dental school that is currently at Guy's. The proposal would mean that there would be about 2,200 biomedical students on the Guy's site. I am worried that, if we have 450 medical and dental students--that could be the maximum--together, the logic of merger will not be carried out. That group will be too big to be taught together, so it will be split up anyway. I understand that the physical geography of the proposed buildings means that the group will divide into two. If that is the case, the solution is not a solution. It would create a big organisation, but the students would have to be divided up after all.
The dental school is the highest rated dental school for academic results in the country. The school, the students and many of the people associated with them have expressed reservations, for the reasons I gave earlier. We have seen the closure of three dental schools in the past
15 years. Given those facts, there is a real risk that, if we consolidated the dental teaching on one site, the institution would paradoxically become much more vulnerable, not much stronger.
There are other dental schools around the country, and people who are cynical and sceptical feel that it would be easy, once the dental school was based at one institution, to say at some stage in the future--if other services were moved away--"There is no medical clinical work on the Guy's site, apart from out-patients, and there is only dental clinical work being conducted on the Guy's site, and it would be sensible to put the clinical work together with academic work, so let's consolidate the dentistry elsewhere. We don't need it here."
Clearly that would be nonsense, and a betrayal of the tradition. I do not suggest that that is in people's minds at the moment, but it is a possible outcome if we consolidate in a way that people are unhappy about and that the students, lecturers and teachers have not been persuaded is the right way.
Where are we? The proposal on the table appears to be led by the Higher Education Funding Council. It appears to be based on the fact that it will be cheaper, yet strong arguments suggest that it will not. It appears to be based on the fact that it is universally agreed, but significant groups of people are unhappy. The proposal appears to be based on the fact that it will consolidate teaching between life sciences and medical and dental science, but some people who have experience of doing that have thought better of it and unstitched such arrangements elsewhere.
The proposal appears to be based on the premise that we need a big institution, but all the best practice elsewhere suggests that such a large number of dental and medical students would be too big and other institutions are smaller. It appears to be based on the premise that we will put everybody together on one site, but, as I have clearly argued, the understanding is that we would not get everybody on the same site; nor would we get medical activity in teaching terms and medical activity in clinical terms on the same site.
There are some serious flaws in the argument. It is not surprising, therefore, that the proposal has taken so long to get so far. It is not surprising that, in recent months, in the words of somebody who spoke to me about it, there has been a lot of shadow boxing, but not everybody has been willing to sign on the bottom line. Yes, the councils have approved the proposal and, yes, eminent voices are in favour, but they are all in favour only on balance, with reservations or with concerns.
Before the House completes its consideration of the Bill, I give notice that, if my questions are not answered--not only for my purposes, but for those who have come to see me about the issue--a whole raft of amendments will be tabled on Report. We probably should not as yet accept the proposals, no matter how tight the time deadline.
"the Guy's, King's College and St. Thomas' Hospitals' Medical and Dental School"--
is a wonderful solution. It will not fit with ease on a rugby shirt, a rowing vest or anything else unless one is a very large fellow indeed, or a large woman. [Interruption.] Women's rugby is all the rage nowadays, and it will be an Olympic sport before we know where we are. Some of the people to be seen at St. Thomas' hospital and Guy's would be good candidates--if they do not play rugby already.
"The density of its network is such that this premier position is in no way a surprise: the different colleges of the university each on their own cover the full range of specialities."
There is a strong argument that it is the nature of the current institutions that attracts interest, investment and bright students from elsewhere.
"The Tomlinson report recommends the incorporation of all medical colleges into multifaculty institutions without giving any academic evaluation of its desirability . . . There are, however, few data to support the thesis that undergraduate medical education is more effective when conducted in a multifaculty environment."
I shall return to that point.
"the resulting medical colleges within the capital would be extraordinarily large, with some medical student intakes approaching 350. The General Medical Council's proposals for undergraduate education strongly recommend a reduction in the factual overload often generated within basic science faculties."
The article then debates integration, to which I shall return, before addressing the numbers question, about which it states:
"If the Tomlinson proposal was grounded in the belief that such mergers would produce economies of scale there is in fact little evidence to suggest that economies of scale exist in institutions that have merged.
The new college will be considerably larger than other institutions in this country or in the United States. In paragraph 195, Tomlinson predicted that an intake of more than 200 to 250 would be bad, managerially and organisationally. The merger will produce an intake of 300. Chicago and Johns Hopkins, one of the most prominent medical schools in the United States, have a maximum intake of 100; Stanford's maximum is about 65. Are we sure that such large academic intake cohorts will benefit students?
Our personal prediction would be that in 10-20 years the debate will focus on how to unscramble these large schools, bringing ourselves into line with those in the United States, where intakes of 100 to 150 students are deemed desirable."
"improve significantly the opportunities for interdisciplinary and interdisciplinary integration in pursuit of both teaching and research excellence."
That might be the case in parts of the country where there is not already a federal university. The parts of the university of London about which we are talking are near each other. London students are part of a larger family--if they want to mix, they mix; if they do not want to mix, they do not.
"provide a cost-effective institution, both in terms of space utilisation and recurrent and capital funding."
There are some serious questions to answer. I gather that the proposal will cost about £140 million--I should be grateful for confirmation. I also gather that, of that figure, about £70 million will be for the new biomedical block that is to come to the Guy's hospital site. I should say in passing that I hope that everybody will talk about it as the Guy's hospital site, not the London Bridge site--a title that has started to creep in as a way of writing Guy's hospital out of titles. Not surprisingly, the people at Guy's do not take too kindly to that.
"thus ensuring vertical integration of the curriculum, the key requirement of both the General Medical Council and Dental Councils in relation to future medical and dental education".
That would be fine if, after accommodating all the medical and dental students in the new buildings at Guy's hospital, the teaching were done on the same site. But the Minister for Health and his colleagues have been busy shipping most of the in-patient beds away from Guy's hospital and off to St. Thomas's. That will defeat the object of the Bill. Academic work will be done on the Guy's hospital site, with out-patients, mental health patients and patients using the 112 elective beds, but most of the beds containing the patients on whom the students will need to learn will be at St. Thomas's, a mile or so down the road.
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