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Lord Hunt of Kings Heath: It is difficult for me to say the extent to which each of the 303 primary care trusts has filled each position. I can make two specific points. The chief executives, who will be in place in all but six primary care trusts, will be a combination of those who were already in post in the existing primary care trusts and chief executives who have been appointed as a result of the new primary care trusts coming into being on 1st April.

I certainly accept that we now envisage PCTs taking on a great deal of responsibility that might not have been envisaged by some primary care trusts when they appointed their chief executives. It will be for each primary care trust to consider those responsibilities and assess the strength and calibre of its existing management team. Equally, the development programme that we have put in place will enable the NHS to give support and encouragement to existing post holders as well as new post holders.

The chief executive is the key appointment to be made for primary care trusts that come into being on 1st April. Once the chief executives are in place in the new organisations, they can work with the chairs and the non-executives to get on with filling the other senior positions. We hope that that will be done as quickly as possible. My point in my original response to the noble Baroness was that I expect there to be interim arrangements in place to ensure that primary care trusts are ready to go live on 1st April. That is one aspect of the responsibilities of health authorities in providing the support required by PCTs in the interim period.

Baroness Noakes: I thank the Minister for that. Who determines whether a PCT is ready? The Minister said that it was for PCTs to consider whether their chief executives were strong enough for the roles that they would have to carry out. Is he saying that at the time that the Secretary of State makes the delegation of

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functions to primary care trusts, he will not have carefully considered the preparedness of the individual trusts? The Minister explained the process and the matters that were considered in the creation of PCTs. I am sure that he accepts that there will be a lot of gaps in the capabilities needed on day one, when the functions are delegated. I am very unclear as to what information flows will be coming to the department before the button is pressed on the responsibilities falling on the shoulders of PCTs. What processes does the department have—or is it expecting to leave the matter entirely to the PCTs?

Lord Hunt of Kings Heath: In the assessment that is made in agreeing to the establishment of new primary care trusts, the department takes a number of factors into account before Ministers are asked to make a decision. One of the criteria for making a decision is whether there is sufficient evidence to indicate that the proposed primary care trust is fit for the purpose. That includes consideration of whether the application identifies effective governing and leadership arrangements and whether those arrangements will deliver the local primary care trust's vision.

The noble Baroness also asked about existing primary care trusts. That is a matter for local decision. If a primary care trust is taking on more responsibilities, the board of that trust needs to see whether the management arrangements and the calibre of its leadership cadre are up to new responsibilities. The same would apply to any other NHS organisation.

In addition, we debated the role of strategic health authorities last Thursday. It is also the case that strategic health authorities will want to ensure that leadership within primary care trusts is effective, and that is also part of its performance management function. I should be surprised if the noble Baroness were suggesting that the Secretary of State should adopt a highly centralist approach to judging the capability and performance of each primary care trust chief executive. We have in place a sufficient process to ensure that judgments can be made about leadership capability as well as development programmes to help those leaders show just what they are capable of.

Baroness Carnegy of Lour: Before my noble friend continues—I apologise to her for confusing her with the noble Earl; I do not know why I did it, but I do know the difference—what the Minister is saying will not do. I am very shocked at this, as I am sure others are. In order for the Government to be able to say that they are decentralising and how enthusiastic they are about it—some of us are doubtful about the extent of this decentralisation—they are prepared to let bodies take on enormous responsibilities when their chief executives may or may not continue at the moment. It is impossible to say when the finance director will take over, because he does not at present exist in a number of trusts. The Health Service cannot be asked to do that just to get political will across to the nation. The Government should ask themselves whether we need

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to hurry so much. People will accept a short delay until the whole matter is put in order. They are making a great mistake, and I should have thought that politically it will be disastrous for the future.

Lord Hunt of Kings Heath: If the noble Baroness were to ask primary care trusts whether they would like another year to potter around trying to reach the state of preparedness that she suggests they have not yet reached, they would say that that would be the worst possible thing that could happen to them. They know that they have to take on the challenge of major responsibilities, but they want to get on with the job.

The assessment criteria under which we have judged the effectiveness of primary care trusts to take on their responsibilities, combined with a development programme and the overseeing role of health authorities to ensure that things are done correctly, that there are no gaps, that the infrastructure is in place, give me confidence that the NHS is well able to take on the new structure from 1st April this year, and I believe that it should be allowed to get on with it.

Baroness Noakes: Having listened to what the Minister has said, I am left profoundly unconvinced. We are told that an assessment is made of leadership. That is all very well, but leadership does not necessarily deliver a fully functioning organisation on the ground. There is a big gap between an assessment of leadership over the past few months and knowing, when the Secretary of State comes to make the delegation, that these organisations are ready and able to take on those functions. I do not believe that it is centralist to have a proper assessment of the new organisations. The new organisations may be jumping up and down, saying that they are ready, but that does not mean that they are ready. That is why Amendment No. 52 was designed to put an independent assessment into the process.

I had expected the Minister to inform me of the comprehensive and robust procedures that the Department of Health will adopt to ensure that PCTs are not given their new functions unless they are sure that they are completely ready. When referring to this amendment, the Minister said that he thought the CHI was not up to the job, which I found rather surprising—

Lord Hunt of Kings Heath: I am grateful to the noble Baroness for giving way. I hesitated to read out to the Committee the criteria for assessment because I thought it would extend our debate for many more minutes than that. Perhaps it would help the noble Baroness if I were to write to her, setting out the criteria for assessment. If she sees the extent and range of those criteria, she may feel somewhat reassured.

3.45 p.m.

Baroness Noakes: I should be most grateful to receive that information. However, at this stage I remain sceptical about whether or not anything that has been said today has met the point of whether or not, first, PCTs are currently ready for their new

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functions and, secondly and perhaps more importantly, anyone in the Department of Health will know in October, or whenever the new functions are delegated, that that is the case. I am sure that we shall want to return to that matter at a later stage. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 37 to 40 not moved.]

Clause 2 agreed to.

Schedule 2 agreed to.

Baroness Northover moved Amendment No. 41:

    After Clause 2, insert the following new clause—

Primary Care Trusts shall have a duty to foster and safeguard teaching and research."

The noble Baroness said: Amendment No. 41 requires primary care trusts to foster and safeguard teaching and research. This amendment should hardly be necessary. It should, of course, be a "given" that teaching and research should be integral to the Health Service at every level. However, with the pressure to meet targets, deadlines and budgets, it has become clear that teaching and research can too often be squeezed out. Therefore, only by enshrining in the Bill a duty to foster research and teaching will it be protected. The NHS has an outstanding record in both, yet we know that both are currently under threat.

The noble Lord will doubtless recall that on 21st November 2001 the noble Lord, Lord Walton of Detchant, introduced an important debate on the issues now confronting medical teaching and research. That debate highlighted most acutely the problems facing those areas. If we are to have joined-up thinking, we need to remember those problems as we consider this Bill. As we heard then, the requirement to teach students, treat patients and conduct research means that clinical teachers have impossible demands made on their time. For a number of years the recruitment and retention of clinical academics has been a major problem.

According to a recent BMA survey, the heavy pressure of NHS work leaves little time for vital research. Comments in the survey include:

    "The NHS has turned its back on research",


    "the clinical work runs away with the show".

Until the serious problem of recruitment and retention of medical teachers is addressed, the Government's plan to educate and train extra doctors for the NHS will not succeed. But that is not just a problem at secondary or tertiary level. The ethos of teaching and research must run right through the NHS. The public has much greater contact with primary care than with secondary care. There is a role for the PCTs in a wider teaching brief—teaching public awareness. PCTs should have a key role in preventive care. They should also play a part in promoting research among the public, helping to

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persuade people that it is in the wider public interest to participate in research and trials. If they do not take such a lead, distrust of research may well become unstoppable.

In teaching future doctors and other health professionals, PCTs clearly have a vital role to play. Those working in this sector must not be so overburdened that they cannot do that. Therefore, it has to be clear to those in administration, government and the Department of Health that they need to look to the wider picture. Much research would be better carried out at primary level if only the infrastructure were there. For example, in programmes such as screening, GPs often play the key role in compliance—hence those instances in which letters sent to patients supposedly from the GP are in reality drafted and sent by the hospital co-ordinating the trial. The poor GP has no time to play much of an active part. That is surely in no-one's interest.

If we are to see a shift of emphasis within the National Health Service to PCTs, it is vital that their aims should be clear. Teaching and research should be integral to those aims. Given that PCTs are still in their infancy, it is important that this is written into their brief. I would like to be sure that it is and I would like to know how we can be sure that research and teaching will not be squeezed out as currently happens. I beg to move.

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