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Lord Turnberg: I must apologise for entering the Chamber too late to hear the noble Baroness, Lady Northover, introduce her proposal. However, as an ex-dean of a medical school and as vice-president of
the Academy of Medical Sciences, I am desperately keen to see research and teaching fostered and safeguarded. It is in desperate need of that. The Academy of Medical Sciences is about to produce a report which highlights many of the difficulties facing academic medicine, teaching and research. These activities are under great threat at a time when we are keen to enhance them.The principle behind the amendment is entirely laudable—were it not for the fact that primary care trusts will have a big load on their shoulders. It is important that they are involved in research and teaching in the ways described. However, to expect them to have a prime responsibility in this area may be going a little far. This is not necessarily just a local problem; it is a matter of national importance. The responsibility for ensuring that research and teaching are fostered should lie not only with PCTs but also with strategic health authorities in particular, which will be in place in areas where there are medical schools and universities and will have an important role in encouraging relationships with the universities. To that end, I hope that when my noble friend responds he will consider how the functions of research and teaching can be encouraged, perhaps by members of the university and the medical school becoming members of strategic health authorities to ensure that there is a link at that level. This should foster what goes on at PCT level.
Although I like this idea, I am not sure that this amendment will meet the bill. Nevertheless, I hope that my noble friend the Minister will take it on board.
Lord Rea: As a former primary care physician, I strongly agree with the points made on all sides of the Committee. However, I am not absolutely sure that such an amendment is necessary on the face of the Bill or is the right way of doing things. I hope that my noble friend's response will reassure all Members of the Committee who have spoken as to the importance that the Government place on research and teaching in primary care.
Baroness Masham of Ilton: Drugs are one of the biggest items of cost in primary healthcare. Therefore, to find out which drugs are most effective, there must be research. The pharmaceutical industry needs that data. Primary healthcare is having more and more put on to it. It is vital that areas of the profession work together. Therefore, I support the spirit of the amendment.
Baroness Carnegy of Lour: In replying, will the Minister tell the Committee what the spread will be under the new arrangements of research ethics committees? Will there be an ethics committee in each strategic health authority which will look at research in the local area?
Lord Hunt of Kings Heath: This has been an extremely interesting debate, and one with which I have a great deal of sympathy. Clearly, it is very important that we have effective arrangements in place
for teaching and research functions within the National Health Service. Indeed, I would argue that it has been one of the great strengths of the NHS since its foundation that we have built up such strong links. I also accept that there are concerns about the recruitment of clinical academics and more generally about the pressures on clinicians within our teaching hospitals in terms of the amount of time that they have for teaching and hard clinical practice.The Department of Health is very much apprised of the challenges and issues that we face. Some months ago, the noble Lord, Lord Walton, introduced an interesting debate on those issues. At the time I talked about some of the proposals that the Government were taking forward, particularly in partnership with the Department for Education and Skills, such as the individual higher education institutes and the higher education funding councils. At a time when we see a massive expansion in the number of medical school places in our universities, it is important to ensure that we are able to attract clinical academics who can provide the kind of teaching and research that is evidently required. We must also ensure that the medical schools, in their expansion of places and the development of new medical schools, are able to attract people of the highest calibre. I assure noble Lords that it is in the interests of the National Health Service and the Government to ensure that we address some of the problems that noble Lords have raised in the debate.
Having said that, I am entirely sympathetic to the general comments made by noble Lords, although I am not sure that the amendments tabled by the noble Baroness are necessarily the right approach to this issue. The Secretary of State already has powers to support teaching research activities that have been delegated to health authorities and, through them, to primary care trusts. Primary care trusts also have their own directly conferred powers to conduct research and to make offices and facilities available to universities. By keeping that as a function of the Secretary of State, we are allowing maximum flexibility to involve all health service bodies
My noble friend Lord Turnberg raised a number of important issues. He asked whether a university representative would be appointed to a strategic health authority board. The Health Authorities (Membership and Procedure) Amendment (England) Regulations 2002 were laid before Parliament on 11th March to come into force on 1st April. They state that in relation to health authority membership,
- "One of the non-officer members to be appointed to an Authority shall be a person who holds a post in an institution within the higher education sector which provides education enabling students to fulfil criteria necessary for".
That appointment will be an extremely important one in terms of the role of the strategic health authority in ensuring that some of the issues raised by noble Lords are, in effect, carried out. I remind noble Lords that strategic health authorities will have the role of performance-managing primary care trusts and so they will be in a position to ensure that primary care trusts contribute what is necessary to enhance teaching and research within the National Health Service.
We have developed what we describe as work-force development confederations. Their responsibility within each local health community is to decide how money on education and training should be spent. Primary care trusts will be constituent members of those confederations and the performance of the confederations will be managed by strategic health authorities. As part of the strategic role of each strategic health authority, I see a particular responsibility for ensuring that the conditions are right for enhancing teaching and research.
The noble Baroness, Lady Finlay, pointed to the positive impact of teaching practices. I echo that. The experience of the NHS is that the teaching practices that are connected to university medical schools have an enormously positive role to play in the training of medical students and specialist registrars who are attracted to primary care. They also have a positive impact on the development of high quality practice within primary care.
In Birmingham the links between the medical schools and teaching practices in the inner city areas are seen as one positive way that we can overcome some of the recruitment and retention problems in inner city primary care practices. In the future we will want to enhance and to encourage that. I would expect primary care trusts themselves to see the value of much stronger links between constituent primary care practices within their primary care trusts and universities.
Part of the responsibility for ensuring the right conditions for teaching and research is having the right research governance framework so that research can be conducted properly. In March 2001 the Department of Health published a research governance framework that recommended framework agreements between organisations that collaborate on research work. The NHS Regional Research and Development Forum, the Medical Research Council and the Department of Health are co-ordinating discussions to develop a model framework agreement by April 2002.
It sets out that each primary care trust will have responsibilities related to research governance for research and development in primary, community and social care. By April 2003 there will be a national network of primary care trusts to act as host for shared research governance and management capacity.
Clearly, it is important that we are as encouraging as possible to research and to clinical trials. My work in the joint task force between the Government and the research-based pharmaceutical industry has identified a number of issues that need to be addressed to ensure that one has robust research governance, and that the
arrangements whereby clinical trials and research can take place are as straightforward and as non-bureaucratic as possible. Within that I would expect primary care trusts to play their full part.The noble Baroness, Lady Carnegy of Lour, asked me about research ethics committees. They will remain until October 2002 at health authority level and we are still discussing how, after that date, they can effectively be brought under primary care trust responsibility. A suggestion that may emerge is that one lead primary care trust within each strategic health authority area takes on a lead responsibility, but we are still working on those arrangements.
The noble Baroness, Lady Masham, asked me about drugs. Of course, we are keen to ensure that the most effective drugs are used within primary care. That is one reason that we have prescribing advisers who have been successful in advising individual GPs on their prescribing responsibilities. We also set up the National Institute for Clinical Excellence to give advice on what are the most cost-effective and clinically-effective drug treatments.
My noble friend Lady Pitkeathley asked about the development of teaching primary care trusts. In March 2001 my right honourable friend the Prime Minister announced that £25 million over a three-year period had been made available to develop a number of teaching primary care trusts across the country. That is a very exciting development. Those teaching primary care trusts will provide teaching and clinical opportunities for primary and community care professionals to support and improve the delivery of services for the local population. Their importance relates not only to individual primary care trusts; they will also stress to primary care generally the importance with which we regard teaching and research.
4.15 p.m.
Lord Walton of Detchant: If the Minister ultimately feels unable to accept this amendment, is it possible that, with his characteristic ingenuity, he could at least find a way of including the words "teaching and research" somewhere in the Bill? It is remarkable that a Bill of this magnitude and scope does not even mention those particular words of great importance to the future of the NHS.
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