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House of Lords

Tuesday, 11th June 2002.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers—Read by the Lord Bishop of Bristol.

Medical Schools: Teaching Staff

Lord Clement-Jones asked Her Majesty's Government:

    Whether their commitments on medical training are compatible with cuts in teaching staff at medical schools.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the additional costs of teaching the increased number of medical students were fully taken into account at the last spending review. The Department of Health and the Higher Education Funding Council are monitoring implementation of medical school expansion and will assess whether shortages of clinical academic staff are an issue.

Lord Clement-Jones: My Lords, I note the Minister's reply, but I hope that in monitoring the situation the Government will recognise that the current situation is extremely dire. Redundancies have taken place or are planned at a host of medical colleges including Bart's, Imperial College, King's, Leicester, Leeds and Newcastle. There are 300 unfilled academic posts in our medical schools, yet we anticipate a 63 per cent increase in medical students up to 2005. The Minister will undoubtedly be aware that this is in large part due to the vagaries of the research assessment exercise, which is grossly underfunded and operates against academic medicine. When will the Government get their act together and have genuinely joined-up government with the Higher Education Funding Council?

Lord Hunt of Kings Heath: My Lords, the noble Lord has made a number of comments. However, on the core question of universities' ability to handle the increase in medical school places, which is critical to implementation of the NHS Plan, I remind him that medical schools bid for extra places on the basis of their statement that they can recruit the required number of staff to teach the medical students admitted to their schools. In each of the past three years, despite the problems they have talked about, universities have in fact exceeded their targets. I am not complacent and the Government are not complacent—we are monitoring the situation—but I do not believe that the situation is as bleak as the noble Lord suggests.

Lord Walton of Detchant: My Lords, does the Minister accept that there is a longstanding agreement under which clinical academic staff in medical schools

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are expected to spend up to six half-days a week in clinical work and up to five half-days in teaching and research? Is he aware that a recent survey has indicated that, because of pressure by NHS managers to see more and more patients, many clinical academic staff are spending between 40 and 58 hours a week in clinical work to the detriment of their teaching and their research productivity? Is this not a major disincentive to the recruitment of clinical academics, as the noble Lord, Lord Clement-Jones, said? What will the Government do to see that that longstanding agreement is implemented?

Lord Hunt of Kings Heath: My Lords, if there are pressures in the system in relation to the employment of clinical academics—both from the NHS in terms of teaching commitment and from universities in terms of research commitment—then that is clearly one of the issues that the Department of Health and the Higher Education Funding Council will have to explore and discuss. That is why we recently announced the establishment of a strategic alliance between those two organisations to pick up the very issues that the noble Lord, Lord Walton, talked about.

Baroness Gardner of Parkes: My Lords, is it not a fact that training encompasses not only undergraduate training but postgraduate training? There is an impossible situation in which we have a severe shortage of medical consultant staff but people cannot find training places in order to become consultant staff. The National Health Service is suffering desperately as a result. What answer does the Minister have to the problem?

Lord Hunt of Kings Heath: My Lords, the NHS is increasing considerably the number of doctors it employs. As the noble Baroness suggests, to do that we shall have to expand the number of medical school places. At the same time, we are depending on our hard-pressed medical staff to make a major contribution to the teaching of those medical students, which inevitably produces pressure and bottlenecks in the system. The noble Baroness may well have been referring to an article in The Times on 7th June by Sir Peter Morris, president of the Royal College of Surgeons. Of course we are discussing with the Royal College and with other medical bodies how we should tackle those issues. They are not easy to deal with, but we are determined to tackle them.

Lord Turnberg: My Lords, does my noble friend agree that responsibility for the clear reduction in funding for medical schools lies with the Department for Education and Skills? Does he agree that co-ordination between the Department of Health and the Department for Education and Skills might be worthy of greater effort?

Lord Hunt of Kings Heath: My Lords, yes, this is a partnership between the education and the health sectors. It is clearly incumbent on my department, on the DfES and on the Higher Education Funding

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Council to work together. That is why we formed the strategic alliance between the Department of Health and the HEFC. Later in the month, my right honourable friend Mr John Hutton is meeting with Mrs Margaret Hodge at the DfES and with the BMA to discuss some of these issues. We shall continue to ensure that both departments work together to monitor the situation.

Lord Naseby: My Lords, does the Minister accept that there is a problem? Does he further accept that a whole new batch of medical students will start in September? Can the House be assured that all this co-ordination and the meetings later in the month will result in positive steps to deal with the problem by September?

Lord Hunt of Kings Heath: My Lords, the fact is that the medical schools that have taken part in our expansion programme have all given commitments that they will meet the demands being placed upon them. As I say, the record over the past three years is that not only have medical schools met those targets, they have exceeded them. Of course, some medical schools are currently facing certain issues and challenges. In the recent research assessment exercise, some medical schools did better than others. But, overall, there is no hard evidence to suggest that we shall not meet those medical education targets.

Lord Mackie of Benshie: My Lords, is not the simple answer to pay doctors who teach in hospitals rather more money than they receive at present?

Lord Hunt of Kings Heath: My Lords, I do not believe that it is simply a question of what doctors are paid. We have an independent pay review body. The Government have accepted the recommendations of the review bodies in each year that they have reported during our term of office. As I indicated, I believe that we need to examine the dual pressures placed on clinical academics by their responsibilities to both the NHS and the universities. However, I also believe that we are receiving tremendous support throughout the country for these expanded medical places and for the remarkable increase in doctors which will come about as a result of that expansion.

London Underground

2.44 p.m.

Lord Peyton of Yeovil asked Her Majesty's Government:

    What prospect they now see of an end to the uncertainties and hazards experienced by passengers on the London Underground.

Lord McIntosh of Haringey: My Lords, the recent announcement that London Underground has signed contracts for the modernisation of the Tube will end

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the uncertainties over funding and deliver a massive, much-needed injection of resources into the Underground.

Lord Peyton of Yeovil: My Lords, I wonder whether I could gently inquire what on earth is going on. Would I be right to suppose that a kind of trench warfare is taking place with Mr Kiley and the Mayor on one side and the Department of Transport and the Treasury on the other, with ammunition being supplied to both sides by over-paid consultants? One begins to wonder what attention is being given to passengers. Are the Government satisfied about the safety of the system?

Lord McIntosh of Haringey: My Lords, I always enjoy the definition given by the noble Lord, Lord Peyton, of "gently". No trench warfare is going on between the Mayor and the Department of Transport. In fact, we are on target to transfer the assets to Transport for London later this year. The negotiations on that point are going well.

As to the question of over-paid consultants, the amounts spent have certainly not been comparable with the vast amounts of expenditure on consultants incurred by the previous government during the disastrous privatisation of the railway system. In fact, although the costs are high, they are always high. They always seem to me to be too high, but we have made considerable savings by using the same consultants for both the Government and London Transport.

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