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Baroness Masham of Ilton: My Lords, I shall give an example. My cousin, who is a microbiologist, was attached to a teaching hospital and the university in Leeds. He found that he just did not have enough time to do clinical research, and he went to teach in Malaysia. He loved working there and is now settled in Australia with his wife and children. The world is small, when people have written interesting medical papers.
We must try to keep young, keen medical people who are research-minded in this country. I support the call for the promotion of teaching and research to be written into the Bill, as proposed in Amendment No. 8.
Baroness Gibson of Market Rasen: My Lords, I too am aware of the concern that has been expressed in the House and elsewhere about the future of academic medicine. I shall explain to the House why I chose to intervene in the debate.
Before I came to your Lordships' House, I worked for Amicus, the trade union, many of whose members are healthcare professionals. When I went to Amicus, I was made aware of the need for research and training. Indeed, I have worked with our members over the years in pressing that need.
It is vital to recognise the importance of education, training and research. Not only should they be furthered but, as was pointed out so eloquently by the noble Baroness, Lady Finlay of Llandaff, it is essential that the necessary funding is provided to support such activities.
I certainly support the idea behind the amendments but, having looked into the proposals and listened to the debates both today and in Committee, I wonder whether they are really needed. I take the points that have been raised by a number of speakers about the difference between a power and a duty, but I understand that we already have in place statutory powers in other legislation which ensure that education, training and research are not forgotten. Perhaps those powers should be looked at in more detail before we decide to put something more into the Bill, otherwise we may find that we err towards repetition.
For example, the Secretary of State has powers to ensure that research is undertaken. I am sure that both the current and future Secretaries of State will take those responsibilities very seriously. Health authorities and primary care trusts have such powers delegated by regulations. I know that some noble Lords do not
think that they are strong enough, but perhaps we should seek to express them more forcefully rather than adding anything further to the Bill.The noble Baroness, Lady Northover, stated that medical academics must be recognised as being of vital importance. Of course she was absolutely right to make that point, but perhaps I am a little more optimistic than are other noble Baronesses who have spoken so far. I believe that PCT and SHA members will ensure that they concentrate positively and constructively on training and research. I agree that expertise has to be retained and that research into models and quality of care is extremely important. However, I return to my main point: by introducing these amendments we shall err towards repetition. There are already in place in legislation powers that should be exercised.
Baroness McFarlane of Llandaff: My Lords, I rise to speak in support of the amendments. I am often asked a number of questions about the quality of nursing education today and whether it has deteriorated. The usual attitude is that, "things are not what they were". My view of the current position is that nursing education is lacking in high quality clinical supervision from registered nurses in practice situations. I believe that that has developed as a result of a shortage of nursing staff. Perhaps education in the clinical setting is the last thing that a busy registered nurse will consider taking on.
Similarly, academics in nursing find themselves short of time to devote to clinical supervision. For that reason, I believe that rather than allow nursing education, and education for the other health professions, to fall to the bottom of the pile, we should look to placing a duty on the authorities to provide for the education of the professions.
The noble Baroness, Lady Northover, has already referred to the very informative debate recently initiated by my noble friend Lord Walton of Detchant. I know that he was distressed to have to leave the House this afternoon before we came to these amendments. He fully supports them.
I believe that the need to ensure that adequate research facilities for all the health professions are in place is of absolutely paramount importance. When we consider the duty of "quality", we refer frequently to the need for evidence-based practice. Unless adequate research is undertaken across all the health professions, so that we can say with some assurance that the care being given is based on sound evidence, then the quality of care will suffer every time. I, too, wish to add my support for these amendments.
6.15 p.m.
Lord Turnberg: My Lords, I have enormous sympathy with the principle underlying the amendments. As a superannuated clinical academic, how could I not have sympathy for them? However, I am not sure whether they would necessarily achieve what is desired.
Undoubtedly there are major problems with regard to academic medicine. We have heard about many of them from noble Lords this afternoon. We have nowhere near enough clinical academics, in particular at a time when the need for more teachers in medicine has never been greater. We are increasing by 50 per cent our medical student numbers, so that from around three years hence we shall produce some 6,000 doctors a year rather than the current figure of 4,000 a year. Someone has to be in place to teach all those students.
The problems faced by academics are numerous. Of course they have to deliver clinical services as well as fulfilling their teaching and research roles. All these points are outlined in a publication from the Academy of Medical Sciences on threats to academic medicine, which I recommend to noble Lords. I should express an interest in that I am vice-president of the Academy of Medical Sciences.
All that is made worse by problems with regard to the university funding formula. The research assessment exercise seemed to have been disproportionately biased against those disciplines relevant to medicine. Furthermore, all kinds of other difficulties are now arising, in particular in the London teaching hospitals, about which we heard earlier. However, this is largely a matter for the Department for Education and Skills and the Higher Education Funding Council. Of course the Department of Health has a major interest, but we cannot lay all these problems at the doors of the primary care trusts and the strategic health authorities, although they will have to be supportive.
Most of the funding for teaching and research comes through other routes: through the universities, the research charities and the research councils, while the Research and Development Division at the Department of Health provides infrastructure support for such research and teaching. Thus while I believe that the PCTs and SHAs will need to play a role, we cannot expect them to deliver on all the deficiencies that can be identified in academic medicine; many of them lie at the feet of many other bodies.
Lord Hunt of Kings Heath: My Lords, this has been an interesting debate. As I said in Committee, it is very important that the NHS maintains high quality teaching and research, not only for the NHS as a service but also, I suggest, on behalf of the wider interests of this country. We have always enjoyed a high reputation as regards the quality of our teaching and research. That is why, for example, the research-based pharmaceutical industry invests so heavily in research into new drugs and medicines in this country. Clearly the Government have a responsibility for ensuring that we maintain overall our pre-eminent position in this area.
With regard to the argument over the amendments, I think it is clear that the relevant statutory powers already exist. Noble Lords have already referred to Section 5(2)(d) of the National Health Service Act 1977 which gives a power to the Secretary of State to,
- "conduct, or assist [others] . . . to conduct, research".
- "conduct, commission or assist in the conduct of research",
- "make officers and facilities available in connection with training by a university or any other body providing training in connection with the health service".
- "An NHS trust may undertake and commission research and make available staff and facilities for research by other persons".
- "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".
I accept that in relation to some of those powers there is an issue in regard to power and duty, but surely my noble friend put her finger on it when she said that, given the powers which are clearly already there, the question is how to make sure that it happens effectively. That is the challenge. It will not be helped by placing a duty on the face of the Bill; it will be helped by the Department of Health and the Department for Education and Skills taking their responsibilities seriously and ensuring that there is a coherent approach throughout the educational and health sectors.
I understand the point raised by the noble Baroness, Lady Northover, and her concern that funding for teaching and research should not be squeezed out by other more pressing and immediate priorities of primary care trusts. But, as my noble friend Lord Turnberg pointed out, it is precisely to ensure its protection that NHS funding for supporting research and development, and learning and personal development, is managed as central budgets allocated directly to NHS providers, including primary care organisations. These funding streams are accounted for separately. Other dedicated funding streams for teaching and learning, such as PGEA and study leave for general practitioners, are also managed separately to ensure their proper protection. I do not believe that primary care trusts will be under pressure to spend that money for other purposes.
But it is not only a question of funding; primary care trusts have a positive role to play in engaging in teaching and research issues and in providing the right environment. That is why we are supporting the development of health and education sector partnerships at the strategic health authority level and below. This recognises the need to engage whole health and education communities and to consider the interplay between education, training and research and development issues and local health services. We see that partnership embracing not only acute teaching trusts and partners in schools and further education but also links between NHS employers and education
providers, on which the workforce development confederations that we have established are currently focusing.I have suggested that the amendments cover areas and powers which the Secretary of State has been given already to support such teaching and research activities. However, I fully understand that particular arguments have been made on the recruitment and retention of medical teachers. As I suggested in Committee, the Government are giving a great deal of consideration to this matter. Much of the responsibility for dealing with the issue rests within higher education rather than with the Department of Health.
Universities employ clinical academics, with funds for research infrastructure, and the direct costs of teaching medical, dental, pharmacy and optometry students allocated to universities by the Higher Education Funding Council for England. The NHS responsibility is for supporting the service costs of hosting research and development and clinical teaching.
I accept that there are pressures in this area; there is no doubt about that. It is because of that that the Department of Health and HEFCE have recently agreed a strategic alliance which covers education as well as research issues. The intention is to enable better joint working on these issues of mutual concern .
It is worth noting that, despite the concerns expressed about the availability of clinical academics, the majority of existing medical schools have considerably expanded their intakes since 1999 and most have plans for future growth. At the same time, four new medical schools, three new centres of medical education and a satellite graduate entry medical school are currently in the process of being created. I should say to those universities which took part in the application process that one of the issues they addressed in their bids to become new medical schools or to have expansion take place was that of having sufficient clinical academic staff.
In view of the concerns expressed about this issue, the department and HEFCE have agreed to set up a joint monitoring group to take an overview of the expansion of medical student numbers. The General Medical Council's education committee will also be involved. Although medical student education is not the direct responsibility of the Department of Health, our officials have been discussing with HEFCE what further action needs to be undertaken to respond to the perceived problem.
Ultimately, action at national level between the various government departments and HEFCE is the right way forward. I do not accept that writing duties on the face of the Bill, particularly in respect of primary care trusts, would have an influential impact on issues relating to the recruitment of academics in universities.
As to Amendment No. 11, the noble Lord, Lord Roberts, referred to the role of the College of Medicine at the University of Wales in Cardiff. I acknowledge the quality of that university's medical education
department. I accept that for Wales its links to teaching, research and the clinical activities of NHS trusts are vitally important. However, ultimately, those are matters for the Welsh Assembly. If it has not yet had full discussions on those matters, I have no doubt that it will do so in the future. It is inappropriate to include specific limited examples in a general permissive power. That would frustrate the intentions behind the establishment of the Welsh Assembly.I hope that I have indicated that the concern of noble Lords to ensure that teaching and research is given its proper place in the NHS is accepted and supported by the Government. I do not believe that PCTs will be the prime movers in dealing with issues such as the shortage of clinical academics, but they do have a role to play in ensuring that we have the right kind of environment in which teaching and research activities take place.
The substantive argument surrounding teaching and research is that they are matters for the department, other government departments and HEFCE to deal with. PCTs can support the process, but the argument is not advanced by seeking to add powers and duties on the face of the Bill.
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