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Lord McColl of Dulwich: My Lords, I have not suggested that we stop all training in obstetrics; what I suggested was whether, as we are making 100 redundant every year, it is sensible to recruit more. The plans are to recruit 65 starting in April of this year and that has been agreed at the Department of Health. Why?
I suggest that we do not recruit 65 this year. How on earth can that possibly be disruptive to the service, when all these people are there? I suggest that we do what we
used to do in the old days: do not sack them; keep them on, but stop bringing in more trainees who are less experienced. Why do we not do that?The junior staff in this country will be in utter despair when they read what the noble Lord has just said. They will realise that he gives the impression that he does not understand what he is talking about. Could I have an answer to the question why we do not stop the recruitment of trainees for just one year? That would do something, though I think that it should be done for several years.
Could I also ask the noble Lord about the £5.4 million which has been taken out of the obstetrics training budget this year and given to another specialty? Why could not that be used to create more consultant posts?
Baroness Ramsay of Cartvale: My Lords, I must remind the House that this is Report stage and the Minister is winding up on an amendment. It would be very useful if noble Lords refreshed themselves from the Companion for guidance on procedure in relation to the Report stage of this Bill.
10 p.m.
Lord Hunt of Kings Heath: My Lords, I am grateful for the clarification by the noble Lord, Lord McColl, of the point he is raising. He is presumably suggesting that the recruitment of trainees be stopped for a certain period. I believe that that would have a negative effect on future recruitment to the specialty overall.
Nevertheless, we have reduced the number of higher specialist trainees in obstetrics and gynaecology in order to try to bring supply and demand back into balance. As my noble friend explained at Committee stage, a working group with membership drawn from the medical and midwifery professions and from NHS management has been exploring every angle to improve the staffing position in this specialty. A way forward has now been agreed. We shall launch a series of local workshops, including NHS trusts, health authorities, the professions and others to take the agenda forward.
There clearly can be no complacency about the matters which have been raised by noble Lords in this debate. I do not believe that the amendment itself offers the appropriate way forward but the comments which have been made have been extremely valuable and I will ensure that those are communicated to the people most concerned with these issues.
We are dealing with difficult issues to which, to my certain knowledge, the NHS has not found a solution in the 50 years or more of its existence. I believe that the only sensible and proper way forward is by a continuing dialogue between those responsible for setting targets and dealing with medical workforce issues at a national level and those responsible for managing the National Health Service at a local level. I believe that we have the machinery to enable that to happen. It will not be easy and it will take time; nonetheless, I think that we
have the right mechanism with which to deal with the issue. On that basis, I ask the noble Lord to withdraw his amendment.
Lord McColl of Dulwich: My Lords, I apologise for speaking in an intervention; I thought that I was responding to the amendment. The Minister's reply was disappointing, and a large number of junior staff will be utterly dismayed. Indeed, patients will become more apprehensive as they see their services deteriorating. I cannot for the life of me imagine why the Government cannot stop training this year and possibly next. There is no way in which that will make a hole in the service. We have been there before, we did that years ago, and there was no lack of recruitment or continuity in the service when trainees were retained instead of being sacked. It is a myth and I do not understand how it was perpetuated. And it will be seen as a myth by the vast number of trainees who are looking forward to a solution to the problem.
The Minister today and the noble Baroness, Lady Hayman, previously said that the Government did not believe in diktat. It was not so long ago that the Secretary of State threatened to sack all the chief executives of the trusts if they did not reduce the number of people on the waiting lists. We all know that the number is irrelevant; what matters is how long they wait. If he can do that with something as irrelevant as the number of people on the waiting list, why can he not say to the NHS trusts, "We have a problem. We would like you to restore the 33 per cent. cut made last year in the number of new consultant obstetric posts"? The problem is so serious that I wish to test the opinion of the House.
10.7 p.m.
On Question, Whether the said amendment (No. 21) shall be agreed to?
Their Lordships divided: Contents, 30; Not-Contents, 71.
Annaly, L.
Astor of Hever, L.
Belstead, L.
Berners, B.
Blackwell, L.
Burnham, L. [Teller.]
Butterworth, L.
Coleraine, L.
Colwyn, L.
Cox, B.
Dundonald, E.
Fookes, B.
Fraser of Carmyllie, L.
Gardner of Parkes, B.
Henley, L. [Teller.]
HolmPatrick, L.
Howe, E.
Hunt of Wirral, L.
Inglewood, L.
Kingsland, L.
Lyell, L.
McColl of Dulwich, L.
Masham of Ilton, B.
Oxfuird, V.
Pilkington of Oxenford, L.
Renton, L.
Skelmersdale, L.
Stockton, E.
Wise, L.
Wynford, L.
Acton, L.
Ahmed, L.
Alli, L.
Amos, B.
Archer of Sandwell, L.
Bach, L.
Bassam of Brighton, L.
Berkeley, L.
Bragg, L.
Burlison, L.
Carter, L. [Teller.]
Clarke of Hampstead, L.
Clinton-Davis, L.
Crawley, B.
Davies of Oldham, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Dixon, L.
Donoughue, L.
Dubs, L.
Evans of Parkside, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Gould of Potternewton, B.
Grenfell, L.
Hacking, L.
Hardie, L.
Hardy of Wath, L.
Harris of Haringey, L.
Hayman, B.
Hogg of Cumbernauld, L.
Hollis of Heigham, B.
Howie of Troon, L.
Hoyle, L.
Hughes, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. [Lord Chancellor.]
Islwyn, L.
Judd, L.
Kennedy of The Shaws, B.
Lockwood, B.
Lofthouse of Pontefract, L.
Macdonald of Tradeston, L.
Mackenzie of Framwellgate, L.
McIntosh of Haringey, L. [Teller.]
Milner of Leeds, L.
Monkswell, L.
Montague of Oxford, L.
Morris of Castle Morris, L.
Murray of Epping Forest, L.
Pitkeathley, B.
Ponsonby of Shulbrede, L.
Ramsay of Cartvale, B.
Randall of St. Budeaux, L.
Renwick of Clifton, L.
Sainsbury of Turville, L.
Sawyer, L.
Sefton of Garston, L.
Simon, V.
Simon of Highbury, L.
Stone of Blackheath, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Thomas of Macclesfield, L.
Thornton, B.
Uddin, B.
Varley, L.
Warner, L.
Watson of Invergowrie, L.
Winston, L.
Resolved in the negative, and amendment disagreed to accordingly.
10.15 p.m.
Clause 8 [Establishment orders]:
Earl Howe moved Amendment No. 23:
The noble Earl said: My Lords, this is an important amendment, but it is an amendment not without some irony. Last week the Minister for Public Health, Tessa Jowell, launched the healthy workplace initiative, which is designed to encourage employers to commit themselves to improve health in the workplace. Better health in the workplace leads to better productivity, fewer accidents and less absence through sickness. That is all extremely worthwhile.
Unfortunately, there is one organisation in which health, safety and welfare are not universally guaranteed, and that is the NHS. Access to occupational health services in the NHS throughout the UK is patchy, particularly in the primary care sector. It is true that there exists guidance from the NHS Executive on occupational health policy, but that guidance is only "commended"; it is not monitored, nor enforced. Meanwhile, prosecutions of health authorities and trusts for breaches of health and safety legislation are on the increase. That is bad for staff and bad for patients.
The NHS should have an across-the-board facility to provide occupational health services for members of the NHS workforce. Those services could be organised and co-ordinated regionally. Within a district the organisation could be undertaken by an occupational health doctor and a senior occupational health nurse, alongside a human resources officer. That team would share accountability with the health authority.
The responsibility should not stop at that level. The NHS Executive should take the ultimate responsibility for monitoring the availability of occupational health services across the NHS. One million people work within the National Health Service. At a time when patient demand is increasing and staff numbers are low, it is all the more important that there should be proper professional structures in place, designed to help reduce work stress, eliminate hazards in the workplace, ensure the provision of lifting and handling equipment and carry out those matters identified in the Green Paper, Our Healthier Nation, aimed at raising standards of health. I beg to move.
Page 9, line 2, at end insert--
("( ) The functions which shall be specified in an order under subsection (1) above include a duty to comply with any direction the Secretary of State may make in respect of the establishment of an occupational health service.").
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