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Baroness Carnegy of Lour: My Lords, I shall briefly amplify what my noble friend said. For several years, I was chairman of a medical research ethics committee. We considered about 350 research projects every year. Those projects took place in our area—we were attached to a teaching hospital and to a university—because so many GPs, hospitals and other NHS people were willing to take part in research. If hospitals or GP surgeries were not prepared to take part, much of that research could not take place. The Minister well knows that there must be a constant search for new drugs, which requires new trials over a wide area of the country. It is essential that GPs and hospitals at trust level are prepared to take part in those trials.

Apart from that, the knowledge that research is taking place locally helps to recruit local people to take part in research as victims, as it were. That is important. It also makes for a lively NHS staff. Teaching and training must continue, even at cleaner level, but if research does not continue people are not aware that practices must be constantly updated—tried out, undertaken and established—in order to run a good show. There is no question but that that must be an obligation at trust level. I hope that the Minister will give in, because so far his response has been somewhat inadequate.

Baroness Emerton: My Lords, I, too, want to speak in favour of the amendment. If healthcare is to be effective and improved, we must promote and safeguard education, training and research not only in

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medicine but in so many other healthcare professions—in nursing, midwifery, physiotherapy and so on. That is why I welcome the breadth of the terms of the amendment.

We must bear in mind that research in some of those professions started later than in medicine. I was associated with some of the first research into clinical nursing in the 1960s, which was sponsored by the Department of Health. We therefore have a much shorter history of research into nursing than has the medical profession. That is why I support the amendment with all my heart.

Baroness Finlay of Llandaff: My Lords, I rise not only to speak to the amendment but to explain the reason for the difference between its wording and that of Amendment No. 3, which stands in my name. The push for increased learning and the culture of learning across the NHS has been widely heralded as government policy. We have clearly heard the arguments why more resources need to go into education, training and research.

Perhaps I may briefly illustrate that with an example from this morning in my hospital medical school. There were not enough tutorial rooms for one group of students to be taught, and 40 of them were trailing across the campus and looking for a room. The increased number of students coming through the system is putting an enormous pressure on teaching space. Sadly, the powers that are meant to be in place to ensure that their education and training is supported have not been implemented and have not kept pace.

There is great concern that with the new private finance initiative bills for new hospitals, finance is not being set aside to ensure adequate teaching rooms. There should be tutorial rooms on wards so that the high standard of clinical training for which this country is renowned can continue, but making a room available and ensuring that it remains available costs money. In many hospitals around the country, a teaching room was set aside but has been taken over and not replaced because of the pressure for office space.

The reason for the different wording of Amendment No. 3 is that the pattern of commissioning services in Wales will be different from that in England and it has not been finally decided whether there will be three health authorities. Hence the phrase,

"those commissioning specialist services on behalf of the National Assembly for Wales".

I understand from the Minister, Jane Hutt, that there will be three offices of the National Assembly for Wales—one in the North, one in the West and one in the South-East—which will take over many of the duties and commissioning obligations currently held by the health authorities which are in the process of being abolished. It is certain that not all of those responsibilities will be devolved to local health boards, because they are not ready to cope with complex commissioning. They will fall between the boards and the specialist commissioning body for Wales, which

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will deal with rare and highly specialised commissioning. So commissioning of services such as cancer services, which cut across all trusts, needs to occur at a level that is currently not clearly determined.

Hence the different wording, but the amendments are compatible in spirit and in placing a duty on those at all levels—out in the community and in hospitals—to ensure that the high standards for which Britain has been renowned do not slip. Sadly, the Research Assessment Exercise demonstrated that over the years there has been slippage in academic surgery departments. The number of them that are world-class is declining, but those arguments have already been eloquently made by other noble Lords.

4 p.m.

Lord Roberts of Conwy: My Lords, I support the amendments in the group, particularly Amendment No. 3, which applies the basic principles to Wales, where, as the noble Baroness, Lady Finlay of Llandaff, said, the organisation of the health service is to be somewhat different.

As the noble Baroness, Lady Northover, said, we covered this ground in Committee. The Minister made great play of the fact that other NHS legislation gave permissive powers to promote education, training and research. As my noble friend Lord Howe said, those permissive powers do not amount to a duty. Your Lordships generally believe that such a duty should be imposed on the authorities named in the new clauses. The need for such a duty is particularly pressing, now that the Government have admitted that more frontline staff will be required, if their ambitions for the NHS are to have the slightest chance of being achieved.

We are all aware of current staff vacancies in the medical schools. I have a report from the Council of Heads of Medical Schools that gives all the details. There are 73 unfilled professorial posts out of 1,042 full-time equivalents. There are 118 reader/senior lecturer vacancies out of 1,663 posts and 136 lecturer vacancies out of 844 posts. Those are fairly high percentages. The report says that the percentage of vacant posts is a cause for concern, especially in the context of the rapid expansion of medical education.

I suspect that the report is somewhat dated by now. If anything, the situation has worsened, since the publication of the report, as the noble Lord, Lord Walton of Detchant, intimated. The need for training, education and research is more pressing than ever. There should be a duty on the authorities to promote them.

Lord Clement-Jones: My Lords, some powerful points have already been made, and I shall speak briefly in support of the amendment in my name and the names of my noble friend Lady Northover and others.

The safeguarding of teaching, training and research at all levels is extremely important. The amendment is well designed to do that. One could go through the

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range of training, research and teaching, as several noble Lords have done in a cogent manner. For me, the tip of the iceberg was revealed in a report that appeared in The Times on Monday about redundancies at Guy's, King's and St Thomas's Hospitals. There have been reports about Imperial College and Queen Mary and Westfield College. I understand that further redundancies are on the way at Queen Mary and Westfield College. At a time when, as the noble Lord, Lord Walton of Detchant, said, we are meant to be increasing the number of places for medical students, such reports are symptomatic of the place of teaching and research in the Government's thinking—rather low down.

Although the same system of research assessment takes place in Scotland, it does not have, as far as I am aware—I have been there for the past few days—the same problem as we do. In England—I stress England, although it may apply to Wales too—there is a problem with joined-up government. Once the research assessment has been carried out and grades given, a funding problem arises. I suspect also that medical research carried out by clinicians is not rated as highly for the purposes of the RAE as pure science research. That is also a symptom of the problem.

It is a matter of enormous concern. We will not have the increase in the number of doctors that we need, unless we do things properly. This is a first step. Government action is needed, but a signal of this kind would go all the way through the NHS and would be extremely important.

Baroness Masham of Ilton: My Lords, at lunchtime today, one of your Lordships told me that he had to travel to South Africa every month to get treatment for leukaemia. The procedure is not undertaken in the UK. We are slipping behind in several areas of serious healthcare. In that case, the countries that can provide the treatment for the noble Lord's leukaemia are South Africa, the United States and Israel. Why is it not available in Britain? I support the amendment.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, it has been an interesting debate. I agree with the noble Baroness, Lady Noakes, that there is no disagreement about the importance of teaching and research in the National Health Service. The argument is about the best way to ensure that the NHS gives appropriate support to teaching and research.

Noble Lords kindly referred to the comments that I made at earlier stages of the Bill's progress. They will know that I am not convinced that the best way forward is to create a duty in the Bill, especially as the amendments do not define the words "education", "training" and "research". If the amendments were accepted, they would leave only a vague sense of what was required by NHS organisations. I must also repeat the point that I made at earlier stages, although I shall not repeat the various references to earlier legislation. Legislation already allows the Secretary of State to support teaching and research and to ensure that arrangements are made for such facilities—a subject

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raised by the noble Baroness, Lady Finlay of Llandaff—as he considers are reasonably required by any university for clinical teaching and research.

Notwithstanding the legislation, the real issue—and the core of the argument—is how we ensure that the NHS takes those matters seriously. I accept that that is the challenge, particularly for primary care trusts. I had a meeting this week with the Council of Heads of Medical Schools that was, in the light of our earlier debates, most useful and constructive. I had a welcome opportunity to explore with the council ways in which we could ensure that primary care trusts provided the necessary support, by which I mean engaging patients and carers in support of teaching and research; fostering the special opportunities for research available in primary care; teaching the entire range of health profession students; and taking full account of teaching and research in their commissioning of local and more distant hospital and specialist services.

I told the council that the Government expected that the primary care trusts would grasp the opportunity to ensure the long-term success of the NHS Plan and the continuing contribution of the NHS to health-related research and education. I accept the point made by the noble Baroness, Lady Cumberlege, about the extraordinary expansion of research capability among primary care workers and general practitioners.

The Government have listened carefully to the arguments made by noble Lords at each stage of the Bill's passage. I am in no doubt about the need to modernise the arrangements for liaison and partnership between the health and education sectors, in order to address some of the issues raised. The noble Lord, Lord Clement-Jones, suggested that there was some defect in the arrangements for liaison between the Department of Health and the Department for Education and Skills. While I do not necessarily accept that is so, I agree that we need to streamline the liaison arrangements between the two Departments and other organisations in the education sector. Officials in my Department and the DFES are drawing up proposals to develop a new national framework to ensure joint working, to take forward the education, research and service agendas—and to obtain an overview of the inter-relationship between them. The role of primary care trusts will of course be part of that consideration and the Permanent Secretary at the Department of Health will play a leading role.

Agreement has already been announced for a strategic alliance between my department and the Higher Education Funding Council for England. That alliance covers learning, teaching and research and builds on the earlier alliance between the Department and HEFCE on research issues. This is the ideal opportunity to pick up on some of the matters raised by your Lordships.

The noble Baroness, Lady Carnegy, mentioned her work in regard to research ethic committees—and I agree with her points. This morning, in the Ministerial high-level strategic group that my Department and others, including the DTI, have with the research-based pharmaceutical industry, agreement was

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reached between the industry and the Government to institute work that will look specifically at how primary care trusts can contribute more effectively to clinical research.

A number of points were made about clinical academics and that profession's relationship with the expansion in medical school places. The Department of Health and HEFCE have established a joint group to oversee the implementation of medical schools expansion. That group's membership will include the Chair of the General Medical Council's education committee. Part of the group's remit will be to monitor recruitment to posts needed to facilitate the expansion of medical students. It will identify other issues related to that expansion and recommend appropriate action. The group's first meeting is scheduled for tomorrow. Clinical academic staffing is a key issue on the agenda.

The noble Baroness, Lady McFarlane, is right to suggest that we ought not to confine our remarks to medical teaching and research. I pay tribute to the noble Baroness's pioneering work in excellence in nursing research and teaching. My comments in terms of principles should be applied to the other health professions.

It is good to welcome back the noble Lord, Lord Walton, to our debates. He specifically mentioned issues relating to clinical scientists. Last year, I was pleased to launch a new clinical scientists scheme—which came about as a result of long-standing concerns about clinical academic career prospects. A report by the Academy of Medical Science recommended extra clinical scientific posts and we were able to build on that recommendation.

In additional to work at national level, I envisage local partnerships involving strategic health authorities, workforce development confederations, primary care trusts, NHS trusts, universities and other education establishments. Those partnerships will in the main be across the areas of strategic health authorities—which in any case have a strong performance management role in relation to PCTs and will be well able to pick up on issues of concern if they consider that the actions of PCTs are damaging the interests of teaching research in their strategic health authority areas.

It is extremely important that one of the non-executive members for each strategic health authority will be from an institution within the higher education sector responsible for the delivery of pre-registration education in medicine, dentistry, pharmacy, nursing or other allied health professions. That will enable strategic health authorities to be clear about their responsibilities in relation to teaching and research. My experience of non-executives appointed from higher education institutes is that they are not backward at coming froward. I am sure that they will be encouraged to do so.

The noble Baronesses, Lady Northover and Lady Noakes, were concerned that central funding for research, learning and development would not be spent appropriately at local level. All the funding is allocated directly to NHS providers, including

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primary care organisations. Funding streams are separately accounted for while other dedicated funding streams for teaching and learning—such as the PGEA and study leave for general practitioners—are also managed separately, to ensure their protection. Those arrangements secure the teaching and research funding protection that your Lordships rightfully sought.

As to the amendments, PFI is a bit of a red herring. I invite the noble Baroness, Lady Finlay, to visit the Norwich and Norfolk NHS Trust, which only opened a few months ago. There is a new medical school across the road. The noble Baroness would see for herself that it is impossible within a PFI scheme to enhance teaching, research and clinical services.

Amendment No. 3 would confer a general power on the Welsh Assembly to establish local health boards. As to my comments about teaching research, such matters are for the Welsh Assembly. It would be inappropriate to include specific limited examples in a general permissive power, as that would frustrate the whole purpose of establishing a national assembly. I assure the noble Baroness and others that I recognise the issues that have been raised.

4.15 p.m.

Baroness Finlay of Llandaff: My Lords, it is not the intention to sabotage the role of the National Assembly for Wales. Its purpose is to ensure equal provision and that standards of educational facilities in Wales match those in England.

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