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Lord Hunt of Kings Heath: My Lords, the noble Baroness should take up that matter with the Welsh Assembly. It is not an issue on which I, as a Department of Health Minister, can comment.

I hope that I have convinced your Lordships that I regard education, training and research as extremely important. I so agree with the noble Lord, Lord Walton, that high-quality teaching of research is crucial. It is the bedrock of the NHS and of the superb professionalism of our staff. It goes wider. It is a critical factor in the success of the UK as a nation. I understand that your Lordships are concerned not to see any dissipation—and no one should doubt my determination to enhance our teaching and research capacity. The proposed new clause is superfluous. Key is vigorous action.

Clear recognition of PCTs' responsibilities in teaching research, streamlining of the relationship between the Department of Health and the Department for Education and Skills, the strategic alliance between the Department and HEFCE, the initiation of work with the research-based pharmaceutical industry on PCT contribution to clinical research and the special group involving the Department and HEFCE to oversee the implementation of medical school expansion and pick

16 May 2002 : Column 440

up on points made about clinical academics is a powerful package of measures—one that will ensure that we enhance teaching research in this country.

Baroness Northover: My Lords, I thank the Minister for that reply and I thank noble Lords for their powerful contributions to the debate today and previously on the Bill. It seems as though the Government are taking some welcome measures, but it is a complex package with bits here and bits there. That underlines our belief that we need to have a duty on the face of the Bill.

We continue to believe that support for research, education and training must placed on the face of the Bill and not be allowed to become actions which "can" take place rather than "must" take place. During the passage of the Bill there have been opportunities for that change to be made but it has not happened. I therefore do not feel reassured and I wish to test the opinion of the House.

4.20 p.m.

On Question, Whether the said amendment (No. 1) shall be agreed to?

Their Lordships divided: Contents, 131; Not-Contents, 108.

Division No. 1


Aberdare, L.
Ackner, L.
Addington, L.
Alderdice, L.
Allenby of Megiddo, V.
Alton of Liverpool, L.
Ampthill, L.
Anelay of St Johns, B.
Ashcroft, L.
Astor, V.
Astor of Hever, L. [Teller]
Barker, B.
Blaker, L.
Blatch, B.
Boardman, L.
Bowness, L.
Bradshaw, L.
Brightman, L.
Brooke of Sutton Mandeville, L.
Burnham, L.
Byford, B.
Caithness, E.
Campbell of Alloway, L.
Carnegy of Lour, B.
Clement-Jones, L.
Cobbold, L.
Colwyn, L.
Cope of Berkeley, L.
Cox, B.
Craigavon, V.
Cuckney, L.
Cumberlege, B.
Darcy de Knayth, B.
Dean of Harptree, L.
Denham, L.
Dholakia, L.
Dixon-Smith, L.
Dundee, E.
Eden of Winton, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Ezra, L.
Ferrers, E.
Finlay of Llandaff, B.
Fookes, B.
Fowler, L.
Freeman, L.
Gardner of Parkes, B.
Geddes, L.
Greenway, L.
Harris of Richmond, B.
Hayhoe, L.
Henley, L.
Higgins, L.
Holderness, L.
Hooper, B.
Howarth of Breckland, B.
Howe, E.
Howell of Guildford, L.
Hunt of Wirral, L.
Jenkin of Roding, L.
Jenkins of Hillhead, L.
Jopling, L.
Kimball, L.
Lane of Horsell, L.
Lyell, L.
McColl of Dulwich, L.
McFarlane of Llandaff, B.
Mackay of Clashfern, L.
Mackie of Benshie, L.
McNally, L.
Mar, C.
Marlesford, L.
Masham of Ilton, B.
Miller of Hendon, B.
Monson, L.
Montrose, D.
Mowbray and Stourton, L.
Moynihan, L.
Murton of Lindisfarne, L.
Newby, L.
Noakes, B.
Northbrook, L.
Northesk, E.
Northover, B. [Teller]
O'Cathain, B.
O'Neill of Bengarve, B.
Oakeshott of Seagrove Bay, L.
Oppenheim-Barnes, B.
Oxford, Bp.
Park of Monmouth, B.
Patten, L.
Perry of Southwark, B.
Platt of Writtle, B.
Plumb, L.
Plummer of St. Marylebone, L.
Rawlings, B.
Razzall, L.
Rees, L.
Rennard, L.
Renton, L.
Roberts of Conwy, L.
Rodgers of Quarry Bank, L.
Roper, L.
Russell, E.
Saatchi, L.
Sandwich, E.
Seccombe, B.
Selborne, E.
Selsdon, L.
Soulsby of Swaffham Prior, L.
Stewartby, L.
Swinfen, L.
Taverne, L.
Tenby, V.
Thomas of Gresford, L.
Thomas of Gwydir, L.
Thomas of Walliswood, B.
Trefgarne, L.
Trumpington, B.
Vivian, L.
Waddington, L.
Wallace of Saltaire, L.
Walmsley, B.
Walpole, L.
Walton of Detchant, L.
Weatherill, L.
Wigoder, L.
Williams of Crosby, B.
Williamson of Horton, L.


Alli, L.
Andrews, B.
Archer of Sandwell, L.
Ashley of Stoke, L.
Ashton of Upholland, B.
Bassam of Brighton, L.
Berkeley, L.
Bernstein of Craigweil, L.
Billingham, B.
Blackstone, B.
Borrie, L.
Bragg, L.
Brett, L.
Brookman, L.
Bruce of Donington, L.
Campbell-Savours, L.
Carter, L. [Teller]
Christopher, L.
Clark of Windermere, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Corbett of Castle Vale, L.
Crawley, B.
David, B.
Davies of Coity, L.
Davies of Oldham, L.
Desai, L.
Dixon, L.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Elder, L.
Evans of Temple Guiting, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Filkin, L.
Fyfe of Fairfield, L.
Gale, B.
Gibson of Market Rasen, B.
Gilbert, L.
Gladwin of Clee, L.
Goldsmith, L.
Grabiner, L.
Graham of Edmonton, L.
Grenfell, L.
Grocott, L.
Harris of Haringey, L.
Haskel, L.
Hayman, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Chesterton, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. (Lord Chancellor)
Janner of Braunstone, L.
Jones, L.
Judd, L.
Layard, L.
Lea of Crondall, L.
Lipsey, L.
Lofthouse of Pontefract, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
Massey of Darwen, B.
Merlyn-Rees, L.
Milner of Leeds, L.
Mishcon, L.
Mitchell, L.
Morris of Aberavon, L.
Morris of Manchester, L.
Moser, L.
Nicol, B.
Pendry, L.
Peston, L.
Pitkeathley, B.
Ramsay of Cartvale, B.
Randall of St. Budeaux, L.
Rea, L.
Rendell of Babergh, B.
Richard, L.
Rooker, L.
Sainsbury of Turville, L.
Sawyer, L.
Scotland of Asthal, B.
Serota, B.
Sheldon, L.
Simon, V.
Stallard, L.
Strabolgi, L.
Temple-Morris, L.
Thornton, B.
Tomlinson, L.
Turner of Camden, B.
Uddin, B.
Walker of Doncaster, L.
Warwick of Undercliffe, B.
Wedderburn of Charlton, L.
Whitty, L.
Wilkins, B.
Williams of Elvel, L.
Williams of Mostyn, L. (Lord Privy Seal)
Woolmer of Leeds, L.

Resolved in the affirmative, and amendment agreed to accordingly.

16 May 2002 : Column 442

4.32 p.m.

Clause 3 [Directions: distribution of functions]:

Lord Clement-Jones moved Amendment No. 2:

    Page 4, line 9, at end insert "; or

( ) are to be exercisable by the National Specialist Commissioning Advisory Group,"

The noble Lord said: My Lords, I make no apology for coming back to the issue of specialised commissioning albeit, I hope, somewhat more briefly than in our discussions on Report, but I do so in order to obtain further and better particulars from the noble Lord, Lord Filkin, if he is responding. I am glad to see that he will. I recognise that the wording of the amendment may not provide the perfect vehicle for debate.

On Report, the noble Lord, Lord Filkin, declared that the Government were adopting a pragmatic approach to commissioning for specialised services. That was welcome, as was the information given to the House that the Minister of State, Mr Hutton, had commissioned a review with the intention of issuing guidance in the autumn on arrangements relating to the period beyond 2002-03. However, the importance of the issue and the need for national and regional commissioning merits recognition in the Bill.

In its last report in 1999-2000, the national specialist commissioning advisory group was asked to look at regional specialist commissioning. A new report must be somewhat overdue. It remarked that a common characteristic of these low volume services and treatment was that they were often of high cost requiring specialist technical expertise and a concentration of clinical care.

Implementing new arrangements for such services was a key aim of the original White Paper, The New NHS: Modern, Dependable issued shortly after the Government came to power. It concluded that the internal market's fragmentation between multiple GP fundholders, as they then were, and health authorities had made it difficult to ensure properly co-ordinated commissioning arrangements for those services. A more systematic approach was needed if fair access was to be guaranteed and if clinical staff were to be supported in developing the most suitable and effective care. The new arrangements should be capable of commanding the confidence of clinical units concerned while being clearly accountable to health authorities and PCTs. I believe that those criteria are valid today. I do not believe that the

16 May 2002 : Column 443

Government's current vague expressions on the way in which those arrangements will be carried out meet those criteria.

Let me take haemophilia as an example. Some 6,000 people are affected, costing about £115 million per annum to treat. Within this total, £20 million is spent on patients with inhibitors—that is, resistance to treatment with Factor VIII or IX as appropriate—principally in relation to the 100 or so with high titres. Immune tolerance treatment for such patients typically costs at least £1 million per patient. That is a high figure. Orthopaedic procedures, such as knee or hip replacements, are also very expensive as are major spontaneous bleeds.

Currently, commissioning for haemophilia is arranged by health authorities or specialist consortia, not least to spread the risk of costly and largely unpredictable episodes affecting patients with inhibitors. These arrangements are by no means considered perfect and there is broad support for a national approach to commissioning. Conversely, delegation of responsibility to primary care trusts has been described by Dr Mark Winter, chairman of the Haemophilia Alliance which represents patients and clinicians, as "a catastrophe waiting to happen".

I have taken one example of specialised commissioning and treatment. We must not assume that the problem will be solved if we delegate specialised commissioning to consortia of PCTs. We must consider those individual areas of specialised commissioning and decide what is appropriate for them, in particular whether national and regional commissioning are appropriate. We need clarity and accountability. We need to decide what is done at the appropriate level.

In referring to regional commissioning one is in a sense referring to strategic health authorities in the context of the Bill—although I regret it—but clearly there needs to be expertise and reference at the strategic health authority level if we are satisfactorily to have the expertise to commission some of these services.

The debate is perhaps a reprise but slightly more concrete in some respects. I hope that the Minister will be able to respond.

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