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Lord Rea: My Lords, once again I thank the noble Baroness for amplifying the Government's plans for postgraduate medical education. The Royal Colleges, the CVCP and postgraduate medical deans will want to consider carefully the statement that the noble Baroness has just made. A definite advance has been made. Without promising not to return to the matter at Third Reading, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Walton of Detchant moved Amendment No. 9:

Page 12, line 14, at end insert:
("( ) after that subsection insert—
"( ) For the purpose of ensuring the effective integration of clinical teaching and research within the National Health Service, the Secretary of State shall, in relation to any relevant committee, office or other body which he establishes to exercise any regional management function within the National Health Service, provide, following consultation with the relevant universities, that at least one member of that committee, office or body is a representative of the university medical or dental schools within that region.".").

The noble Lord said: My Lords, I rise to move the amendment standing in my name on the Marshalled List and in the names of the noble Lord, Lord Jenkin of Roding, the noble Baroness, Lady Robson of Kiddington, and the noble Baroness, Lady Jay of Paddington. The noble Lord, Lord Jenkin, who is unable to be present this afternoon, has given me permission to say that he supports fully the principles outlined in the amendment.

In the late 1960s I was a member of a regional health authority. At that time I held a consultant contract in the NHS coupled with a personal chair in the university. It became clear to me that the inter-relationship between the National Health Service on the one hand and the universities with medical and dental schools on the other was crucial and vital to the future of health services and to teaching and research in medicine, dentistry and the other health services.

When I became dean of the medical school in 1971 I was surprised when a senior government Minister expressed astonishment on learning that clinical academic staff employed by universities were heavily involved in providing clinical services to patients. In

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fact, throughout the history of the National Health Service those holding clinical contracts with universities have provided extensive services to patients. When I held the particular appointment to which I referred the clinical load that I carried was almost as great as, if not at times greater than, that of my colleagues employed wholly by the National Health Service.

Later, when I became chairman of the Education Committee of the General Medical Council, and subsequently its president, it came as a surprise to many of us in academic medicine to learn that there was no formal liaison mechanism between the then Department of Education on the one hand, responsible for the funding of the universities through the University Grants Committee, and the Department of Health on the other, responsible for providing the clinical facilities for medical and dental teaching. One of the actions that we pursued at that time, which I am glad to say was successful, was to persuade those two departments to come together. Hence a liaison committee was created under the chairmanship of the then Permanent Secretary at the Department of Health, Sir Christopher France.

That particular body has grown and its role has been extended until it is now the steering group for undergraduate medical and dental education and research. It is chaired by the current Permanent Secretary at the Department of Health.

Through that mechanism the relationships between the universities with medical and dental schools and the National Health Service have become much closer. Ten key principles outlining the basis of that relationship have been promulgated. I understand that those principles will be carried forward in the changes that result from this Health Authorities Bill.

One other factor of great importance which I learnt as the dean of a medical school was that at that time, some 25 years ago, it was regarded as inappropriate, if not illegal, for money to be transferred across the divide between the Department of Education on the one hand and the Department of Health on the other. Happily, that principle was soon breached because, as time went by, it became increasingly clear to those working in the health service that if there was an area within the health service where the standard of patient care and of research and education was not as high as it ought to be one of the best ways of improving those standards and of developing services was to create a chair or a senior academic post with supporting staff to try to raise the quality of the services in those particular medical, dental and other disciplines.

As a consequence, the Department of Health, through its regional health authorities, began a process of funding academic posts in the universities across the country, to such an extent that in some medical schools 40 per cent. of clinical academic posts are now funded by the Department of Health. That underlines the crucial importance of that inter-relationship between the NHS on the one hand and the universities with medical and dental schools on the other.

We have been given assurances that that process will continue, even when the regional structure has been changed as proposed in this Bill. We in the university sector were much reassured on reading the Hansard

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transcript of the Committee stage debate. I deeply regret that because of a professional commitment elsewhere in the United Kingdom I was unable to be present. I was very happy to read the words of the Minister when she said that:

    "The Government are strongly committed to the vital partnership between the universities and the new National Health Service. We will work with them to achieve the highest standards of education and research".—[Official Report, 30/3/95; col. 1718.]

We were also much encouraged to learn, as a result of an amendment tabled at that stage, that the universities' position would be strengthened and that the Government were able to give a clear undertaking that, in regulations, they would require the health authorities whose areas include a medical or dental school to have a university representative as a non-executive member. That was a very reassuring development, and we were delighted to have that assurance.

However, that still left a serious anxiety about the position in the regions. As the Minister said:

    "The regional offices are very different bodies from the old RHAs. They will not have boards on which different groups are represented. Therefore, it will not be appropriate to have a university representative within the regional office".

We fully accept that, because the regional offices will be staffed by people who are part of the National Health Service Management Executive. It would be inappropriate to have a university appointee employed in such an office. We know that there will still be a powerful university voice at national level. But surely it is not beyond the wit of man to devise a mechanism whereby universities can play a major statutory, advisory role at regional level. It is true that many of the regional directors of research and development are at present, and are likely to be in the future, distinguished academics. But they do not necessarily speak on behalf of the universities at which they have previously worked.

I was much encouraged earlier today to learn from the Minister that the regional chairmen will in future be non-executive members of the policy boards at regional level. If we were to be reassured that the university voice would be heard through an agreement that the university would have the right to appoint, in consultation, a non-executive member of the regional policy board, I believe that most of the anxieties that we feel in relation to the future would be allayed.

The postgraduate dean will be a key link between the regional office and the university. I have had the privilege of seeing the consultative document which was recently circulated. I believe that it is absolutely right that the postgraduate dean in future should be jointly appointed by a contract held on the one hand with the regional office and on the other with the university. However, it may not be necessary for the postgraduate dean to be housed in the regional office as many postgraduate deans are already provided with satisfactory accommodation in the universities, funded under the partnership with the universities which is so crucial to the future.

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Those are the major concerns we have. I trust that the Minister will be able to assure us that there is a likelihood that the regional policy boards—they are concerned with the crucial, strategic developments in relation to patient care, teaching and research in which the universities play such a vital role—will be able to have a non-executive university appointee in their membership. I beg to move.

6 p.m.

Lord Addington: My Lords, the noble Lord makes an important point. Integration between universities and the health service is far closer than in virtually any other area regarding universities. The fields of activity are directly connected. The frontier of medical knowledge affects healthcare very quickly. It is appropriate that there should be such representation.

Baroness Jay of Paddington: My Lords, I support the amendment. It is unfortunate that it is necessary for the noble Lord, Lord Walton of Detchant, to bring forward such an amendment at this stage. As we discussed at Second Reading and in Committee, we are all aware of the consultation, for example, between the chairman of the CVCP, the Department of Health and others professionally involved in this area to seek to resolve the issue before the Bill reached this stage in your Lordships' House. But still it is unclear what will happen. In introducing the amendment, the noble Lord underlined this important area. It is particularly unfortunate that arrangements are still not in place.

Noble Lords will remember that in Committee I referred to the correspondence between Dr. Edwards, chairman of the CVCP, and the Secretary of State. The chairman stated that for the Department of Health to write to regional directors asking them to remember that universities should be consulted in appropriate circumstances underlined the heart of the problem. It gave no assurances about the appropriate circumstances. It left the process of consultation to the individual decision of regional directors.

Noble Lords have made an incontrovertible statement: that a formal, clear and unambiguous mechanism needs to be in place before we start the new arrangements. The noble Lord, Lord Walton, emphasised the important role of academic medicine in the higher ranks of the medical profession. As the noble Lord, Lord Addington, said, it is equally important to patients that that extremely important connection is maintained. If we are to have an effective, knowledge-based health service, as Ministers constantly tell us that we have—it is an ambition to which we all subscribe—we must ensure that the important links between academic medicine and the health service are maintained at every level so that standards of excellence are not simply maintained but continue to be improved.

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