| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Roberts of Conwy: My Lords, I speak to Amendment No. 11 which is also in this group. It seeks to empower the National Assembly of Wales to direct local health boards in Wales to support and promote teaching and research. Of course it may be argued that the Assembly already has such power under Clause 6 and subsection (2) of new Section 16BB and that my amendment is unnecessary. But at least it serves the purpose of drawing attention to the need to promote teaching and research in the NHS in Wales as elsewhere. Indeed, I would have attached the substance of this amendment to the duties of health authorities in Wales, but there has not been much talk about health authorities, although of course they are to be created under Clause 1.
The noble Baroness, Lady Northover, and my noble friend Lady Noakes have already advanced the general case in relation to England. I shall not repeat those arguments, which are just as applicable, if not more so, to Wales.
I am especially concerned about the University of Wales, College of Medicine in Cardiff, which is the only medical college in the Principality, and not just because I am its honorary president. It requires the support not only of its local health authorities but of others, because the college places many of its graduates in hospitals and practices throughout Wales. It is clearly important that the 22 proposed local health boards and 15 trusts in Wales should support those placements, because they involve our future doctors and consultants.
The College of Medicine and some of the other colleges of the University of Wales provide other courses for health professionals and, again, the support of local health boards and trusts is essential—and likely to increase in the years ahead as the Government's modernisation plans develop and NHS staff require retraining to fulfil them.
Of course, the Minister's Statement after the publication of the White Paper referred not only to 15,000 extra doctors but to 35,000 more nurses. They must all be trained, and others will also require training. The College of Medicine in Wales trains dentists, nurses and other health professionals.
Indeed, it is the college of the NHS in Wales. It is vital that it is fully supported in its teaching and research at all levels of the organisation that it serves.
Baroness Finlay of Llandaff: My Lords, I shall speak to Amendments Nos. 5 and 11, to both of which my name is attached, and in support of Amendment No. 8. It may initially appear that there is a discrepancy between the wording of Amendments Nos. 5 and 11, but I shall explain that the spirit behind them is identical.
In his Statement on the NHS Plan, the Minister told the House that the investment would provide 35,000 more nurses, 15,000 more doctors, 40 new hospitals and 500 primary care centres. Of course, a new hospital requires many professionals other than doctors and nurses. The noble Baroness, Lady Northover, highlighted the severe shortage of clinical academics—I must declare an interest as a clinical academic and vice-dean of the University of Wales College of Medicine.
Investment in the NHS requires training of new staff and their clinical placement. As the noble Lord, Lord Roberts of Conwy, outlined, those placements are made throughout the NHS in Wales and are also for medical students and other healthcare students from England, Scotland and Northern Ireland. The placements are crucially important and provide the clinical exposure that is the strength of the United Kingdom training system. They are where students learn to integrate science and clinical care.
I have recently completed a visit to an NHS trust that takes students from the University of Wales College of Medicine. Chief executives of all trusts value the importance of an affiliation with a teaching institution. They recognise that that is how they recruit high-calibre staff and maintain clinical standards in their current staff, who are involved in teaching and are challenged by students.
I turn from teaching to education and training. Teaching is an activity from a teacher towards others, but much learning is now self-directed, so training may be a more appropriate word for the broader range of activity that goes beyond undergraduate or postgraduate education. Training requires facilities for continued professional development—library facilities, seminar rooms for teaching, tutorials and discussion groups—as well as protected time. All of that costs money.
The document, Delivering the NHS Plan, alludes to the development of the NHS university, which will allow individually tailored professional development. That is to be applauded, but it will also require resources.
Another area that has not yet been touched on is the importance of training and retraining of senior staff to maintain staff in the NHS, rather than lose them through early retirement. In June 2000, a BMA survey found that 62 per cent of consultant surgeons—419 out of 676—planned to retire early. That represents an enormous loss of expertise to the NHS. An Answer to a Question in the other House about early retirements
from hospitals stated that approximately one third of all retirements of hospital doctors was premature, through either early retirement or ill-health. Premature retirement was defined as prior to the normal retirement age of the NHS pension scheme—60. Of course, it is to be hoped that many people stay on beyond 60. I think that 60 is young to be retiring—I am sure that many noble Lords would agree.I turn again to the document, Delivering the NHS Plan. It states:
- "Foundation trusts will . . . abide by the NHS principles",
- "promote diversity and encourage innovation".
In many areas, outcome measures are remarkably crude—for example, death rates, infection rates, failed discharge and so on—and do not capture the quality of life change for the individual patient. Patients must wherever possible leave the episode of care feeling better than when they entered it. Where that is not biologically possible, they should certainly feel that their distress has been lessened and that they and their families are supported. We should now be measuring those sorts of subtle outcomes.
There is also a need for quantitative and epidemiological studies, which all need funding. The research councils have inadequate funding, which does not meet the research cost to answer the current urgent questions in healthcare. There are costs in entering patients in trials, so even where an NHS unit, wherever it is, is a collaborator, a hidden cost is involved. But there is good evidence that patients in trials do better.
There is no better example of that than the management of childhood leukaemia. The co-ordination of trials meant that all children with leukaemia were entered in them. In my working lifetime, the picture has changed from a very high mortality rate when I first qualified to an expectation of successful treatment of the primary disease today. That is a real compliment to co-ordinated research. It is only with collaborative research across the board that such a thing can happen. For such collaborative research to be promoted in all sectors requires investment from the health service that must cross all boundaries, from primary to secondary and tertiary care across to the voluntary sector and into private partnerships.
I therefore seek reassurance from the Minister that the duty of education, training and research will be safeguarded, and that each strategic health authority in England and organisation in Wales will have a university representative on its board. That would ensure rigorous quality control of education, training and research to inform the strategic health authority and other planning bodies and that services falling
within the body's remit are evaluated. That also applies to primary care trust boards and all NHS trust boards.The primary care sector will carry increasing responsibility. It will be more involved in teaching of all disciplines as more education and training occur in the community and with the increased budget for primary care and its increased workload and delivery of care. It is there that research questions must be asked, to allow cost efficacy to be assessed and ensure that needs are met. All those in healthcare, whatever their role, must have that duty explicitly laid out in the Bill, to ensure that the important safeguards of the quality of the service are not lost.
6 p.m.
Lord Thomas of Gresford: My Lords, Clause 6 sets out in legislative form the policy of the National Assembly for Wales. I read the Assembly debates—in Committee and plenary session—and I found that it did not turn its attention to the substance of the matter referred to in Amendment No. 11.
It is not for me to add anything to the arguments that have been so fully and ably expressed by those who have spoken. I support the amendment.
Baroness Cumberlege: My Lords, I support Amendments Nos. 5, 8 and 11. I have examined some of the consultation documents that were generated by PCGs when they sought PCT status. Many of them are excellent and are full of hope and commitment. However, I could find little mention of a serious intent to include teaching and research, save for specifically financed pilot projects. If the NHS Plan is to be successfully implemented, PCTs must contribute to the academic life of the NHS. For PCTs that cover a medical school or university, that is not just important: it is essential.
I shall not go into great detail about the number of placements necessary, but, as chairman of St George's Hospital Medical School Council, I know that it is already a struggle to find enough placements, not only for medical students, nurses and the professions allied to medicine, but also for social workers. That is important for the future of the health service. We shall have to work more closely in teams, and those who are part of the teams must understand clearly how the NHS works and how care—social care and healthcare—is given.
In Committee, the Minister said:
- "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".—[Official Report, 18/3/02; col. 1117.]
Medical schools have also sustained devastating financial knocks delivered through the research assessment exercise. The new formula has had unintended consequences, and the medical schools' research budgets have suffered greatly. In London, there has been a reduction of 20 per cent in the funding for five-star clinical research, and GR funding, which used to be weighted in favour of medicine, has been removed. There really is a crisis.
If we are to attract high quality academic staff, it is essential that they have the time and space to carry out their teaching and research duties. I appreciate that the workforce confederations will commission teaching, but it will be up to the PCTs to make provision for an environment that is conducive to teaching. I am concerned that PCTs will be so anxious to hit the Government's delivery targets and avoid another visit from CHI or prevent a run-in with the local authority's overview and scrutiny committee that they will avoid the added costs of teaching and research. I can understand that PCTs will be pressurised and will seek every ounce of energy and commitment from those working on the wards and in the surgeries. There will be no capacity to fulfil the academic duties that are so necessary to the future of the NHS.
In their monitoring, strategic health authorities must be generous towards academic clinicians and give them the permission to do what their academic posts demand in addition to their service requirements. I hope that that monitoring will take that into account. PCTs and strategic health authorities would welcome such a duty, to give them cover in relation not only to the commissioning of work but also to the day-to-day running of services.
I shall digress for a moment. I remember when my son took to motorbikes. That was in the days before helmets were compulsory. I was extremely concerned for his safety, and, once the law had been introduced, I was able to say to him, "I am sorry, but you must wear your helmet. It is the law". My noble friend Lady Noakes drew a clear distinction between powers and duties. In this case, a power would be welcomed by the PCTs and the strategic health authorities.
In Committee, the Minister said:
- "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".—[Official Report, 18/3/02; col. 1118.]
In Committee, the Minister was sympathetic to our concerns. He said:
- "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".—[Official Report, 18/3/02; col. 1117.]
| Next Section | Back to Table of Contents | Lords Hansard Home Page |