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Lord Avebury: My Lords, I am grateful to the noble Lord for giving way. I refer to a report on the set of reforms that were undertaken voluntarily by the Corporation that are outside the scope of the Bill and which are listed in the appendix to the full report on the ward boundaries. That report was supposed to be received within six years of the original undertaking. Can the noble Lord give us some good news about accelerating the report which is to be made under that heading?
Lord Jenkin of Roding: My Lords, at this stage I must disappoint the noble Lord. I do not think that I can give him that information. However, if your Lordships agree to a Second Reading, the Bill will proceed to Committee stage and it would seem to me an admirable point for the Committee to want to probe.
I drew the noble Lord's attention to what is in the Bill as regards reporting to Parliament. As regards human rights, if I may say so, I think that the noble Lord was straining at a gnat. I said that the noble and learned Lord, Lord Falconer of Thoroton, had endorsed the view of the promoters that the Bill complies with the European Convention on Human Rights. As the noble Lord, Lord Avebury, said, the noble and learned Lord said that he saw no need to dispute the conclusions of the promoters. I say with the greatest respect that I think that that is as good an endorsement as one would get. There was a great deal of discussion in the other place on the human rights aspect, as my noble friend Lord Brooke will confirm. The statement of the noble and learned Lord, Lord Falconer, was issued after the Bill reached this House, as is required by our Standing Orders.
I hope that I have gone some way to answer the questions posed by the noble Lord, Lord Avebury. I sense that the House may be anxious to proceed with the rest of the business on the Order Paper. Therefore, I shall sit down.
On Question, Bill read a second time, and committed to a Select Committee.
National Health Service Reform and Health Care Professions Bill
5.8 p.m.
Lord Hunt of Kings Heath: My Lords, I beg to move that the Commons reasons and amendments be now considered.
Moved, That the Commons reasons and amendments be now considered.—(Lord Hunt of Kings Heath.)
On Question, Motion agreed to.
2After clause 2, insert the following new clause—
During the passage of the Bill through this House we had some important debates on the whole issue of education, training and research in the NHS in England and Wales. I want to assure noble Lords that the points raised in those debates have been taken very seriously indeed by the Government and that we are exercised to ensure that the NHS, universities, the DfES and HEFC all play their part in ensuring that those issues are dealt with satisfactorily and that there is a co-ordinated response across all those sectors.
During earlier debate, I informed the House of a number of pieces of work that we have put in train which I believe indicate the importance we attach to these matters. We have reviewed the range of existing national liaison arrangements between the Department of Health, the Department for Education and Skills and a range of organisations in the independent sector. We have done so with a view to recasting them into more effective and efficient strategic partnerships to bring together the multi-professional wider health system and broader education and research agendas. We are therefore providing the practical support the modernisation programme requires.
Officials in both my department and the Department for Education and Skills are now drawing up proposals which would see a new national framework, with senior representations from both departments, to ensure effective joint working to take forward the education, research and service agendas and to take an overview of the interplay between them.
Progress has already been made and I am very pleased that it was possible for the Department of Health to agree "a strategic alliance" with the Higher Education Funding Council for England. This alliance, which covers learning, teaching and research, builds on the early alliance between the department and HEFCE on research. A notable feature is that it will cover both health and social care. The alliance will provide a framework of partnerships with higher
We have already instigated further work to ensure the success of the medical school expansion. The Department of Health and HEFCE have established a joint group to oversee the implementation of that expansion. The group will include the chair of the General Medical Council's education committee within its membership. 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 the expansion and recommend appropriate action.
While this group will look at medical schools specifically, I want to emphasise to noble Lords that we recognise the shared interest in monitoring the situation for all teaching academics and the adequacy of the supply of all health professionals and we will ensure that this is not overshadowed.
We have also agreed that one of the seven non-executive members for each strategic health authority will be from an institution within the higher education sector responsible for delivery of pre-registration education in medicine, dentistry, pharmacy, nursing or other allied health profession. The NHS Appointments Commission will interview candidates and the candidate who best meets the requirements of the post will be appointed. It is anticipated that these measures will result in a mixture of representation from medical schools and, I stress, other institutions within the relevant university. This will ensure appropriate expertise is available to the strategic health authority sector as a whole.
As far as the legislative framework is concerned, I believe that what we have in place meets the concerns of noble Lords. I do not accept that adding the suggested duty would of itself ensure that education, training and research are taken more seriously than is already the case. Moreover, the duty would be difficult to define and it would be even more difficult to define what a breach of that duty would be. Surely, the creation of a statutory duty must be sufficiently precise for those who must discharge the duty to know exactly what they must do and what action or inaction will amount to a breach of that duty. Without such precision a statutory duty has no teeth. It is for those reasons that I do not believe there is a place for the duty on the face of the legislation.
There is a further important reason why the amendment relating to Welsh NHS organisations is inappropriate. The Bill establishes local health boards in Wales and provides enabling powers for the National Assembly to decide how they should function. It is surely wrong in principle that we should seek to fetter the Assembly's deliberations by being prescriptive in this one area.
Much of our debate, though I accept not exclusively, was about the role of primary care trusts. They will take on all their functions under Shifting the Balance
This is a very exciting development. Teaching primary care trusts will work alongside local universities to provide a learning environment for their own organisation and staff, as well as a local resource for the wider health community. These and other PCTs will have access to shared resources for research governance and management. A network of PCTs will be designated to maintain this capacity from 2003-4.
The national primary and care trust development programme has been established as part of a set of measures to ensure that these primary care trusts are fully equipped to take on their new functions. It has been recognised that, in addition to developing the general competencies of primary care trusts, more detailed work is required over a longer period on certain matters.
Noble Lords may well be aware that my right honourable friend the Minister for Health announced in another place that one of those subjects will be that of research, education and training issues affecting primary care trusts across the range of those functions. The aim will be to pull together a number of front-line primary care trusts and other key individuals and organisations to take their work forward. That will be a very important way of ensuring that PCTs discharge their functions in this area. There is no doubt that the debate in this House during the passage of the Bill was a very important element in informing the programme that we are now to take forward.
We are not talking just about the role of primary care trusts. Strategic health authorities have an important role to play too—that of creating a coherent strategic framework and of ensuring, through building capacity and supporting performance improvements, that the primary care trusts are enabled to deliver their full range of responsibilities.
We believe that these changes will bring benefits to education, training and research in and for the NHS as well as to services for patients. We want to hear very much from the service about combining the NHS service commitment with academic duties. My right honourable friend the Minister for Health, with Mrs Margaret Hodge, the Minister of State for Lifelong Learning and Higher Education, will be meeting the chair of the BMA's medical academics staff committee on 26th June to discuss the impact of the research assessment exercise on the medical academic workforce.
I fully accept that we need to monitor the changes closely to ensure that there are no unintended consequences and that the arrangements we have put in place are bedding down well. Once primary care trusts are operating fully in their new, wider role and there is experience of how they work, the time will be right to begin a review of education, training and research in the NHS.
I am therefore pleased to announce today that there will be a joint ministerial review of education, training and research in and for the National Health Service across England and Wales. The review will take into account the concerns expressed by noble Lords on these matters. I want to stress that it will cover the full range of health care professions and not just doctors. The review will look at, for example, how the new arrangements set out in Shifting the Balance of Power and those created by this Bill impact on the role of primary care trusts, NHS trusts and strategic health authorities in education, training and research across the whole of the NHS. The review will examine the partnerships between the new and existing NHS bodies and higher and further education to ensure that they continue to work well.
These issues are clearly also important in Wales. The review will come at a helpful time for informing the process of implementing local health boards in Wales. The Welsh Assembly has already shown its commitment to research through its research and development strategy, which is currently out to consultation. It seeks to put research and development on a firm footing and covers wider collaboration with trusts and local health groups. However, the review broadens the focus, and the Assembly will give full consideration to any proposals that go beyond those in the strategy. The review will also helpfully inform the development of the Assembly's strategy on continuing professional development in the NHS, which is due to be produced in 2004, and will take forward many of the issues around education, training, and research in the NHS in Wales.
I hope that I have demonstrated that the Government have listened most carefully to the arguments put forward by noble Lords throughout the passage of the Bill. I also hope that noble Lords will accept that the review I have announced this afternoon will be an excellent way in which to monitor and take forward further issues of concern over the next year or so. On that basis, I trust that the House will be able to accept the amendment that I have put forward.
Moved, That the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A.—(Lord Hunt of Kings Heath.)
Baroness Northover rose to move, as an amendment to the Motion that the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A, leave out "not".
The noble Baroness said: My Lords, as we have heard, this is a key issue for the future of the NHS. I have no hesitation at all in bringing this amendment back for your Lordships to reconsider. At Third Reading your Lordships approved this amendment, but it was then overturned in another place. The amendment would make it a duty for primary care
As we have just heard, it was claimed in the other place that our amendment was unnecessary:
As we heard at early stages of the Bill's proceedings, PCTs can support education, training and research; but they do not have to, except in a few exceptional circumstances. The view was also expressed by the Minister that dedicated funding streams would be safe. He stated that he did not believe that primary care trusts would be under pressure to spend that money for other purposes. However, during earlier debates, we learnt that that has already happened. Therefore, our task is to ensure that research, education and training are protected and encouraged when PCTs come to set their budgets.
At earlier stages, we and others expressed acute worries about these areas. Since the passage of the original amendment in this House, I am glad to see that the Government have made some welcome moves. The Minister was kind enough to write to me on the subject, and he expanded on that this afternoon. His proposal is that there should be a ministerial review of the arrangements for education, training and research in and for the NHS. In his first letter on the subject, the Minister stated that the review should take place once PCTs have had a chance to take on their full range of functions and the new system had bedded down. If the review highlighted areas of concern, he stated:
I explained to the Minister in my reply to that letter that I remain concerned on a number of points. I expressed surprise that departmental officials and lawyers felt, as he indicated—and, indeed, indicated again today—that they would have difficulty defining the duty to support research, training and education and, consequently, a breach of such a duty. I pointed out that in the secondary sector there is now a research and development structure with monitoring mechanisms, targets and accountability. Therefore, there should be no reason why a similar structure should not exist in primary care. This could be of utmost importance for the furthering of public health, given that the majority of health problems are contained in primary care, although some may progress to secondary care. The Secretary of State also has such a duty. So it is definable, even though it may not be working as effectively as we would all like to see.
I also noted that the Minister's proposed review would take place only at some unspecified time in the future. There was no indication of who might be involved in the review, whether it would be independent, whether it would include experts, or whether it would be made public in any way; neither was it spelt out as to how Parliament was to discover the nature of its conclusions. It also seemed as if it would be a one-off process, rather than providing more constant audit.
I was also most concerned that setting new arrangements for PCTs in place under the Bill, without building in the protection that we have been seeking, would mean that patterns would develop, which, as time went on, would become more difficult to change. It clearly needs to be part of the culture of the NHS that support for research, training and education is built in at every level. This was highlighted on Tuesday of this week in relation to the Question tabled by my noble friend Lord Clement-Jones about medical education—the problem of trying to increase the number of doctors when at the same time we are losing clinical academics hand over fist. Now is simply not the time to trust to things working out without strong mechanisms being in place to ensure that they do.
I gather that the Minister proposes that the terms of reference for the review should be set by the end of this year, and that it should begin work early in 2003. I remain concerned about the time-scale. I am anxious to hear what the Minister has to say in that respect, given the problems that already exist in these areas. I should also like to be assured that such a review will address some of the key issues involved. Will the review examine whether adequate facilities are available for these areas? Will it examine whether those working in these areas will have protected time and not, for example, be expected to work 80 hours a week in order to be both a clinician and a researcher or teacher? Will it look at whether the money for these areas is adequately ring-fenced, given the fact that we already see devices such as service charges, money being siphoned off, and money from foundations being siphoned off? Above all, will the review report to Parliament? Will we be able to see what its conclusions are?
We know that there is a tension between the need to deliver a service both rapidly and effectively and the need to look long term. We know that there is a tension between the need to meet the budget this year and the need to plan for the long term. The latter is already apparent in the NHS. We need to build into the new arrangements protection for the long term, not simply delivery in the short term. That we why we have such concerns.
As Professor Peter Lachmann of the Academy of Medical Sciences puts it:
Moved, as an amendment to the Motion that the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A, leave out "not".—(Baroness Northover.)
Baroness Carnegy of Lour: My Lords, I listened with great interest to what the noble Baroness said. However, I say to her that, when we ask the Government to think again about something, I believe that we have a responsibility to listen carefully to the answer and, if, as individual Members of the House, we consider it to be satisfactory, to decide accordingly.
I believe that this issue requires to be raised and discussed. It was required of us to ask the Commons to think again. They have thought again. The Government have said a number of things that they did not say previously. I was very interested to hear that they propose a review. I believe that the House has scored a bull's eye. Personally, I shall not be of a mind to vote against the Government on this occasion.
"Duty of Primary Care Trusts, NHS trusts and Strategic Health Authorities regarding education, training and research
Primary Care Trusts, NHS trusts and Strategic Health Authorities shall have a duty to safeguard and promote education, training and research"
The Commons disagreed to this amendment for the following reason
Lord Hunt of Kings Heath: My Lords, I beg to move that the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A.
2A Because the law already provides adequately for education, training and research.
5.15 p.m.
"Because the law already provides adequately for education, training and research".
We cannot agree that the amendment is not necessary. During our debates in this House we heard about the problems that such areas already encounter, many of which were mentioned by the Minister. With the reorganisations proposed in the Bill and the devolution to primary care level, such problems could become more acute. That is why we put forward the amendment in the first place; that is why we are moving it again today.
"We would consider preparing guidance and, should it prove necessary, issue directions to PCTs and/or other NHS bodies".
"At a time when there is an urgent need to secure more service provision there is obviously a temptation to concentrate all resources on that need. While this is entirely understandable, it is an example of 'burning the furniture to heat the house'. If British medicine is, in the longer term, to provide a high-quality service to its patients, then a high level of teaching and research must be preserved".
That is surely exactly right and it is what the amendment is about. I beg to move.
5.30 p.m.
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