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The Lord Bishop of Southwark: My Lords, I too welcome the Government's Statement. The most reverend Primate the Archbishop of Canterbury has taken a personal interest in the situation. Indeed, he met regional faith leaders earlier in the year. His personal envoy, Canon Andrew White, has been extremely active in trying to find a solution to the Church of the Nativity siege. We continue to be willing to play a constructive part if we can be helpful.
We in the Church receive many painful stories, as do others; in our case, from Palestinian Christians. We urge the Government and our Jewish friends in this country to encourage the Israeli Government to allow the UN fact-finding team to be admitted swiftly to Jenin. It is difficult to see how there can be progress until that takes place.
Baroness Amos: My Lords, I welcome that statement from the right reverend Prelate. It is important that a constructive role is played by all faiths in this conflict. A number of different initiatives are being taken behind the scenes in that respect. I commend those and thank the right reverend Prelate for his comments.
Lord Richard: My Lords, I begin by apologising to the House for rising straight after my noble friend Lord Janner sat down. It was because, not perhaps for the first time in our 40 or 50 years' acquaintance, what he said provoked me to the extent that I wished to respond immediately.
Is my noble friend aware that the last two sentences of the remarks of my noble friend Lord Janner prove beyond peradventure the need for an objective assessment of what actually went on in Jenin? For my noble friend to say that the Palestinian story is a myth is, with respect, not helpful. I do not know whether it is—and he does not know whether it is, although he thinks that he has more evidence than I have.
Perhaps I may ask one question which I hope is practical. If the Israeli Government continue to deny access to the UN fact-finding team, what are the Government proposing that the UN should do, that the US should do and that we should do?
Baroness Amos: My Lords, I agree with my noble friend Lord Richard that we need an objective assessment. We have all agreed that the fact-finding mission would be a way to deliver that, and we need that regardless of the comments made by my noble friend Lord Janner. This House and the Government are of the view that that fact-finding mission is necessary.
In terms of "What next?", we need to keep talking. In addition, the UN Secretary-General, Kofi Annan, will make recommendations to the UN Security Council if the fact-finding mission continues to be refused entry.
Lord Wright of Richmond: My Lords, last week I asked the noble Baroness what representations we were making to remove the restrictions on the movement of President Arafat. I warmly congratulate the Government on the steps that they have taken which we hope will end those restrictions.
Unlike most Members of this House, I listened to the debate in the other place this afternoon. I commend to the noble Lord, Lord Janner, two horrific accounts from his honourable friends who recently visited Jenin. Does the Minister agree that it will be extremely difficult to find a more objective and distinguished team than Mr Sommaruga, Mrs Ogata and Mr Ahtisaari?
Baroness Amos: My Lords, I thank the noble Lord for recognising that we worked hard to end the restrictions on President Arafat. I am aware that at times in this House the noble Lord did not feel that we were working hard enough or fast enough.
We realise that there are conflicting accounts. I am aware, for example, that my honourable friend Ann Clwyd returned from her visit to Jenin with her own view of what had happened. That is why we are supporting the UN fact-finding mission. We need an objective assessment as quickly as possible to enable the whole international community to take a view.
National Health Service Reform and Health Care Professions Bill
5.38 p.m.
Consideration of amendments on Report resumed.
Baroness Northover moved Amendment No. 5:
- After Clause 2, insert the following new clause—
The noble Baroness said: My Lords, various themes emerge in this Bill. As the Government seek to devolve—a laudable enough aim—there is a real danger that certain responsibilities that currently exist within the NHS will not be delivered as PCTs look to the immediate needs of the majority of their immediate population. Those are areas of service which even now are delivered on a patchy basis, often dropping to the bottom of the list of priorities. We have already seen that happen with public health and have debated how best to ensure that strategic health authorities and PCTs have a duty and responsibility to deliver on that, and how fragmented teams in different PCTs may well find it a challenge to bring their concerns to the fore.
In much the same way, education, training and research are long-term needs within the service, which the Government must have a duty to foster, but which with the pressure of immediate events at local level may not seem the highest of priorities. It is rather like using money for long-term capital projects: it is down the line that the benefits are seen, yet it is today's budget and time that must be devoted to ensuring this future.
In Committee, we moved an amendment which spoke of the need for it to be a duty for PCTs to foster and safeguard teaching and research. We have now broadened that out. The amendment places a responsibility on strategic health authorities and PCTs to safeguard and promote education, training and research.
In Committee it was pointed out that some PCTs will have a duty concerning teaching, but the point here is to ensure that this runs throughout the health service and not just a part of it.
Presently, there is no obligation on managers to encourage teaching and research in these new PCTs. They have not been around for very long. Yet here they are with vastly increased budgets and therefore the power to make things happen—or not. This is a matter of national importance which must be carried right through to the local level.
I was glad that in Committee the Minister said that it is in the interests of the NHS and the Government to ensure that we address these areas. I was also glad to hear that he was sympathetic to the aims of my amendment. But he then argued that the Secretary of State retained the power to ensure that this was happening and that therefore my amendment was not necessary. I ask him to think again.
Let us look at the situation now without such devolution. We had the debate back in November introduced by the noble Lord, Lord Walton of Detchant, which highlighted the problem of insufficient people undertaking research and teaching and the enormous pressures on those who are carrying this out. But this is a problem that is already becoming more and more acute. If one looks at today's Evening Standard its headline is, "Promise of extra doctors". That is hopeless. The article makes the point that the Government's pledge to provide 15,000 extra doctors for the NHS cannot be met if severe shortages in teaching staff get even worse.
We hear in this article that at Guy's, King's and St Thomas' about 50 staff are at imminent risk—about 20 per cent of the workforce. The BMA anticipates that following consultation, 10 to 12 will go voluntarily, but there will be roughly 40 who are judged as "surplus to requirements". Of course we hear the usual tale that Guy's, St Thomas' and King's are looking to save money to reduce their debts. We all know that it is unlikely that other trusts in London will absorb those made redundant into full-time NHS contracts. So how, if the Government are to meet their
As a senior lecturer at Guy's, King's and St Thomas's, Dr Wierztichi puts the matter today in this way:
The Minister also stated that an NHS trust may provide training. Again "may", not "must". But the noble Lord also said that research and teaching must be undertaken because the NHS must support teaching and research. But who will undertake the responsibility to carry through such a laudable aim? When a manager decides at a meeting between competing priorities, how do we ensure that research and teaching—or any such long-term aims—are anywhere near the top of the agenda?
I am certain that the Minister shares with all of us the desire to see teaching and research flourish in the NHS. However, that desire must be carried through into obligations on those who are in a position to decide whether or not it is carried out. Otherwise, with the best will in the world, and all the resources at the Chancellor's disposal, the NHS simply will not have the long-term future that I am sure the Minister and certainly we wish to see. I beg to move.
Baroness Noakes: My Lords, I rise to speak to Amendment No. 8 which is grouped with Amendment No. 5. I support Amendment No. 5 and agree with the points made by the noble Baroness, Lady Northover. Amendment No. 8 goes a little further. There are two main differences between the two amendments. Amendment No. 8 extends the duty in relation to teaching and research beyond PCTs and strategic health authorities to include NHS trusts.
It is clearly important that there is a duty in relation to teaching and research and that that covers those who commission the services. Without that the funding will not be secure and teaching and research could easily be squeezed out by other priorities. But we must not forget the provider side of the equation. While trusts have powers under the 1990 Act in relation to teaching and research I believe that they do not have corresponding duties.
Secondly, Amendment No. 8 expands on what is meant by teaching and research. We typically think of that as covering medical teaching and research. The
There are other differences in wording between the two amendments. I do not want to debate semantic points. The amendments are at one in wishing to ensure that teaching and research thrive and prosper. I believe that creating a duty would have a positive effect. It will strengthen the hand of those seeking budgets to cover teaching and research and ensure that that is kept high on the agenda for all who plan, commission and deliver services within the NHS.
"DUTY OF PRIMARY CARE TRUSTS AND STRATEGIC HEALTH AUTHORITIES REGARDING EDUCATION, TRAINING AND RESEARCH
Primary Care Trusts and Strategic Health Authorities shall have a duty to safeguard and promote education, training and research."
"It is crazy. The number of medical students is increasing but the number of medical academics is falling because of the redundancies. If the Government does not start seeing medical academics as a priority, it will be impossible to achieve the Government's targets".
That is what is happening now, today, before devolution, when the Secretary of State theoretically has more control over matters. What happens when matters are devolved? It does not reassure me to hear, as the Minister put the matter in Committee, that PCTs are empowered to conduct, commission or assist the conduct of research. Empowered does not ensure. That means that they can, but it does not say that they have to.
5.45 p.m.
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