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Lord Hunt of Kings Heath: I am not as yet convinced that the words "teaching and research" need to be included in the Bill, partly because the reference to teaching and research is already fully included in other NHS legislation. For example, Section 5(2)(d) of the National Health Service Act 1977 provides the Secretary of State with the power to conduct or assist others to conduct research into any matters relating to the causation, prevention, diagnosis or treatment of illness. Under Paragraphs 14 and 15 of Part III of Schedule 5A to the 1977 Act, primary care trusts 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 facilities for research by other persons. Under Section 51 of the 1977 Act, the Secretary of State has a duty 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". Paragraph 11 of Schedule 2 to the 1990 Act states: "An NHS Trust may provide training for persons employed or likely to be employed by the trust or otherwise in the provision of services ... and make facilities and staff available in connection with training by a university or any other body providing training in connection with the health service". Earl Howe: I cannot help but notice that, in that very helpful list which the Minister has just read out, many of the powers, apart from those that he related to the Secretary of State, are permissive only. They are not duties. I think that that is the concern that has been expressed. There may be the power to do all these things at a local level, but will this function in practice be squeezed out?
Lord Hunt of Kings Heath: The short answer to that is no, because the NHS and the Government cannot allow teaching research to be squeezed out.
Baroness Finlay of Llandaff: I am grateful to the Minister for giving way, and I should like to build on the previous comment. As the dates of the legislation which the Minister cited demonstrate, the desire to incorporate teaching has existed for well over 10 years. A paper from Freeman & Sweeney is entitled, Why general practitioners do not implement evidence: qualitative study, and an article in this week's BMJ calls for primary care organisations to create learning environments that capitalise on the wealth of knowledge. I fear that, unless the Government seriously consider including these requirements in legislation, they will continue drifting on the matter as they seem to have done for many years.
Baroness Cumberlege: What is very good about this amendment is that it uses the words "a duty", and therefore imposes an obligation. In his reply, the Minister seems to have rested his case on the fact that the strategic health authorities will do the monitoring. However, is that not trying to put right something once it has happened? It is very difficult to do that in research because research has to be continuous and, in research, one is working with a defined patient population. I think that, in research, the danger lies in the PCTs' contracting and commissioning work. In teaching, I think that the danger lies in the pressure on the service, in that, as I explained, so much of teaching today has to be done in primary care.
Lord Hunt of Kings Heath: I fully accept what the noble Baroness has just said. However, it does not
seem to follow that simply including this amendment in the Bill would necessarily lead to any specific change.The question surely is this. Is teaching research important to the National Health Service? If it is, how can we ensure that due recognition is given to that fact not only at government level but at the NHS local level? I believe that teaching research is critically important: it is important to the quality of services and to the quality of research in this country. Moreover, it is important not only to the National Health Service; it is important also to UK plc in terms of our science base and future investment in research and development. I do not believe that the House should have any doubt at all that the Government regard the proper support of teaching research as critically important. I am simply saying that amending the Bill as proposed would not be helpful when the powers that I have read out are clearly available for use by the NHS. I do not expect strategic health authorities to interfere and inhibit the role of primary care trusts.
Primary care trusts have a prime role to play in ensuring—first through the workforce confederations—that sufficient teaching places are commissioned and that the conditions are right for research and teaching. The point about the strategic health authorities is that they are there to check and to ensure that things are not going wrong. As I said last week in our debate on strategic health authorities, if there were a specific case in which an individual primary care trust was not prepared to play ball, we would have the lever of performance management as a means of intervening.
My general expectation, however, is that primary care trusts will wish to support teaching research. The impact of the increasing number of training practices has in itself had such a beneficial impact on the overall performance of primary care and the quality of services that I believe that a great swathe of primary care and primary care trusts will see the benefit of supporting teaching and research. As I said, the establishment of teaching primary care trusts is in itself a visible sign of primary care commitment to teaching and research.
I have no doubt that all the points raised by noble Lords are extremely important. They are important to the Government. We wish to ensure that effective teaching research does take place. However, I doubt whether the amendments in this group really would lead to a difference in approach or a real improvement in the way in which teaching research is dealt with. Although it is a major challenge for the NHS, it has to be dealt with effectively by means of the type of mechanism I have discussed.
Baroness Masham of Ilton: Before the Minister sits down, perhaps I may point out that Amendment No. 41 is not grouped with other amendments but stands on its own. Does it not emphasise the need to include research in the Bill. What harm could that do?
Lord Hunt of Kings Heath: The noble Baroness is quite right: the amendment is not grouped but
separate. Surely there are three points here. First, even if that were in the Bill, it would have to be interpreted by the department in terms of its meaning for individual organisations. That is no different from the current position. Secondly, it would apply only to primary care trusts. Although one may wish to go down that path, I doubt that there is any specific reason to single out primary care trusts. Thirdly, as I have made clear, current NHS legislation already very comprehensively covers the issue of teaching and research.
Baroness Northover: I thank the Minister for his reply and noble Lords for their contribution to this mini-debate. I seem to have struck a chord. I may not have written this amendment quite as it should be. No doubt I shall have to revisit it, but revisit it we will need to do because there is clearly a lot of concern about this.
What has motivated me is what we have seen happen at secondary and tertiary levels in terms of teaching and research. They are not a key priority for those who are trying to fill financial black holes. The noble Earl, Lord Howe, hit the nail on the head. If this is a duty, then in a way that gives a power to those who are trying to ensure that teaching and research at PCT level is given its due emphasis. If it is not, then when the question is raised as to how resources are to be spent it will simply be pushed aside. I therefore disagree with what the Minister has said. There is a purpose in having something like this built, as a duty, into the list of priorities of PCTs.
I am very struck by what noble Lords have said about the situation at all levels of the health service: for example, the fact that we do not even have ethics committees in place. No decision has been made about that. Clearly there has been a decision within the Department of Health that it is not a key priority; that they need not address it yet; that other things have to happen first.
Lord Hunt of Kings Heath: I am most grateful to the noble Baroness for giving way. I thought that I had said that we have decided to keep the research ethics committees based at health authority level up to October this year. They will then be picked up by primary care trusts. We are now holding discussions on how best those arrangements might then be conducted at primary care trust level. I do not see how it follows that the Government regard it as an unimportant issue.
Baroness Northover: It seems to me that, if it were a high priority, and given that the PCT has to play such a key role in the health service so very soon, it would have been taken somewhat further forward.
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