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Political Parties (Funding)

Mr. John Maples accordingly presented a Bill to make provision about the funding of political parties: And the same was read the First time; and ordered to be read a Second time on Friday 21 June, and to be printed [Bill 144].

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Orders of the Day

National Health Service Reform and Health Care Professions Bill (Programme) (No. 2)


Subsequent stages

    3. The proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—[Mr. McNulty.]

National Health Service Reform and Health Care Professions Bill

Lords amendments considered.

Mr. Speaker: I must draw the House's attention to the fact that privilege is involved in Lords amendment No. 6, which is to be considered today. If the House agrees to this Lords amendment, I shall ensure that the appropriate entry is made in the Journal.

New Clause

Lords amendment: No. 2, after clause 2, to insert the following new clause—Duty of Primary Care Trusts, NHS Trusts and Strategic Health Authorities regarding education, training and research.

3.45 pm

The Minister of State, Department of Health (Mr. John Hutton): I beg to move, That this House disagrees with the Lords in the said amendment.

Mr. Speaker: With this we may discuss Lords amendment No. 4.

Mr. Hutton: I should express right at the beginning of my remarks the fact that I fully understand the sentiments and concerns that underpin amendments Nos. 2 and 4, which were made to the Bill in another place. In particular, I am sure that we would all wish to ensure that the enormously important contribution that academic

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medicine makes to the national health service is properly safeguarded and that its international reputation for excellence is properly secured.

Fundamentally, the arguments in favour of the amendments are based on two assumptions, the first of which is that the existing legal framework to ensure that education, training and research is properly underpinned in the NHS is either inadequate or ineffective. I do not believe that to be the case. The necessary statutory powers already exist and help to ensure that a proper focus on education, teaching and research is maintained right across the service.

The second assumption is that the NHS does not take the question of education, training and research seriously enough—that it is too low a priority and that creating a new legal duty in this area will improve matters.

On the first of those two arguments, I remind the House that section 51 of the National Health Service Act 1977 places a clear duty on the Secretary of State to exercise his functions so as

    "to secure that there are made available such facilities as he considers are reasonably required by any university which has a medical or dental school, in connection with clinical teaching and with research connected with clinical medicine, or as the case may be, clinical dentistry".

That duty is already delegated to health authorities, and once the changes under "Shifting the Balance of Power within the NHS" take effect—and once the changes under the Bill take effect later this year—it will be delegated directly to primary care trusts across the country. The duty is no less of a duty because it is delegated by the Secretary of State to PCTs. The Secretary of State and, through him, PCTs, will have a duty under the section to ensure the provision of facilities that are necessary for clinical teaching and research.

Under paragraphs 14 and 15 of part 3 of schedule 5A to the 1977 Act, which broadly sets out the powers and duties of PCTs, PCTs are empowered to conduct, commission or assist the conduct of research and to make officers and facilities available in connection with training by a university or any other body providing training in connection with the health service.

Under paragraph 11 of schedule 2 to the National Health Service and Community Care Act 1990, an NHS trust may undertake and commission research and make available staff and provide facilities for research by other persons. Under paragraph 12 of schedule 2 to the 1990 Act, an NHS trust may also provide training for persons employed or likely to be employed by the trust or otherwise in the provision of services under the 1977 Act, and to make facilities and staff available in connection with training by a university or any other body providing training in connection with the health service.

Under section 5(2)(d) of the National Health Service Act 1977, the Secretary of State has the power to conduct, or assist others to conduct, by grants or otherwise, research into matters relating to the causation, prevention, diagnosis and treatment of illness, and into any such other matters connected with any service provided under the 1977 Act, as he considers appropriate.

In addition to those specific powers, if it appears to the Secretary of State that it is necessary under section 17 of the 1977 Act, as amended by the Bill, he has a power to

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give directions about their exercise of any functions to strategic health authorities, PCTs and NHS trusts. The exercise of all those powers in relation to health bodies in Wales has been devolved to the National Assembly for Wales.

Anyone with a fair mind would regard that description of legal powers and duties as a comprehensive one, which I believe provides a solid legal basis for education, training and research right across the NHS.

The Lords amendment was made with the best of intentions—I am absolutely sure of that—but it would be superfluous to include its provisions in the Bill. As a general principle, we should not legislate unless there is a clear and obvious need to do so. An adequate legal framework is already in place and can, if necessary, be supplemented by directions from the Secretary of State to strategic health authorities, PCTs and NHS trusts about the exercise of relevant functions. There is, in short, no substantive need for the amendment, and that is why we should not accept it. There is another set of difficulties with the amendment. It is too vague to be meaningful. It does not even define education, training or research, or limit the scope of those three concepts to the health sector; nor does it offer any way of measuring whether the bodies concerned are meeting their legal obligations.

The second argument in support of the amendments relates to the concern about whether there is sufficient focus on education, training and research in the NHS. I believe that there is. That is certainly true of resources. On research, the Department of Health has increased its research and development budget from £432 million in 1996–97 to £507 million in this financial year. In relation to education and training, the budget for multi- professional education and training—the new MPET budget—has increased from £1.7 billion in 1996–97 to £2.9 billion this year. Those are significant increases in resources. No one looking at those figures could say that the Government have not focused sufficiently on education and training issues.

The amendments are not necessary to protect the funding for education, training or research. NHS funding for supporting research and development and for education and training is already managed centrally, as I am sure the hon. Member for West Chelmsford (Mr. Burns) recalls from his time in the Department of Health. NHS education and training funding is allocated to local NHS work force development confederations, which bring together local NHS organisations, including primary care organisations. Those in turn have the responsibility to purchase NHS-funded education and training from higher education institutions in accordance with local work force requirements, of course taking account of national priorities. NHS trusts can also use their own funds to support education and training where appropriate.

PCTs in particular, therefore, will not be under pressure to spend that money for other purposes. We have no plans to put the funding for research into PCTs' allocations for patient care. The money for research is ring-fenced. Indeed, even the small amount of money that health authorities spend directly on commissioning public health research and development will in future be protected within a ring-fenced central research and development budget.

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The argument is not simply about money, however. It is right that we continue to look carefully at how we can improve present arrangements. That is why we will look for an increasingly closer collaboration between universities and research-active NHS bodies to guarantee the quality of research that meets the needs of patients and of staff delivering services at the front line.

We are already putting in place a new network of PCTs that will help to promote high standards of research governance and management across health and social care. The creation of that network by April next year is one of the targets in implementing the research governance framework for health and social care, which my Department published in March 2001. Those PCTs will have research management capacity that they will share with other PCTs around them, encouraging, I hope, a collaborative approach to research. By next April, we will also have in place around 30 new teaching PCTs, mainly in underprivileged and under-staffed areas to provide teaching, research and clinical opportunities for primary and community care professionals to support and improve the delivery of services to local populations. Teaching PCTs will work alongside local universities to provide a learning environment for their own organisation, as well as a local resource for the wider health community.

PCTs will also have the ability and opportunity to enhance the quality of patient care by engaging patients and carers in support of teaching and research; by fostering the special opportunities available in primary care for research and for teaching students across the range of health professions; and by taking full account of teaching and research in their commissioning of local and more distant hospital and specialist services. We expect PCTs to grasp those opportunities to ensure both the long-term success of the NHS plan and the continuing contribution of the NHS to health-related research and education.

To ensure that PCTs are fully equipped to take on their new functions, the national primary care trust development programme has been established. The programme recognises that, in addition to developing the general competencies of PCTs, more detailed work is required over a longer period on specific issues. I am pleased to be able to announce that one of those subjects will be the research, education and training issues affecting PCTs. The national primary care trust development programme will pull together a number of front-line PCTs, and other key individuals and organisations, to help to take that work forward. That will help to support PCTs in discharging their important responsibilities in that sector.

The Government are fully committed to investment in the NHS work force. The NHS plan has made that commitment clear, and our record in office confirms the priority that we rightly attach to education, training and research. Since 1997, the number of nurses has increased by 31,520; in the year between September 2000 and September 2001, the number of qualified nurses employed in the NHS increased by 14,430, or more than 4 per cent. Since 1997, the number of qualified scientific, therapeutic and technical staff has increased by almost 14,000; in the past year alone, the number of such staff has increased by 4,290 or 4 per cent. Since 1997, the number of doctors has increased by 9,550; there are now 99,170 doctors, excluding GP retainers, in the NHS in England. In the

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past year, the number of NHS doctors has increased by 2,850, or 3 per cent. I am glad to say that there are now 4,320 more consultants than there were in 1997.

The House will probably be grateful if I do not continue to read through that long list of statistics, but overall they are extremely positive. They confirm that we have prioritised that necessary investment, and that it is being made. We are committed to the development of that work through an expanded programme of education, training and research. The NHS plan and the most recent Budget underline those strong commitments. The Government are also committed to a modern NHS that values and makes use of research-based evidence in developing patient services.

Given the legal provisions that are currently available to sustain the proper focus on education, training and research, and the special arrangements that apply to the use of those resources in the NHS, I hope that the House agrees that amendment No. 2 is not necessary. Although I am sure that it is motivated by the best intentions, the circumstances in which we should and should not legislate are clear.

Amendment No. 4 would impose a similar statutory duty on local health boards, NHS trusts in Wales and specialist commissioning bodies in Wales. The position in Wales in respect of legal powers must now take into account the devolution settlement and the Government of Wales Act 1998. The existing powers and duties of the Secretary of State, laboriously described by me this afternoon, as they apply to the NHS in Wales have been devolved to the Welsh Assembly.

In addition, clause 6 confers on the Assembly a new general power both to establish local health boards and to determine their functions and duties. Consultation on the new structures will soon start in Wales. The problem with the amendment is that to a large extent it pre-empts that consultation exercise by establishing on the face of the Bill one of the duties of these new bodies; it is therefore inconsistent with the thrust of clause 6.

Were we to accept the amendment, we would in effect fetter the democratically elected devolved Administration in the exercise of their powers over those policy matters. The form, functions and responsibilities of local health boards are rightly matters for the Welsh Assembly to determine through regulations. Those regulations will be subject to scrutiny through the secondary legislation procedure, which will allow full open debate by Assembly Members. That is the right way to determine the functions of the new bodies in Wales, and that is what clause 6 already provides for. Amendment No. 4 would take us in the opposite direction, and for that reason, we should not agree to it.

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