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Lord Hunt of Kings Heath: My Lords, I am grateful to all noble Lords who have contributed to the debate and for the recognition that the Government have indeed listened to the points raised throughout the passage of the Bill. I want to make clear that we all have a common interest here. Teaching and research is important not just in its own right but is essential if the NHS is to receive the increase in staff it requires in the many professions covered by that heading and is important to the NHS as a whole and to the United Kingdom as a whole.

It is essential that we have a strong science base, a strong teaching base and a strong research base. The Department of Health has much wider responsibilities

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than simply the well-being of the National Health Service. It is in the interests of my department, just as it is in the interests of the Department for Education and Skills, to ensure that this works effectively and well. There is no argument between myself and other noble Lords on these matters.

I have already stated—my noble friend Lord Turnberg put it very well—why the Government do not consider that the legislative option is the appropriate or workable option. Certainly, that was the view of the other place when it considered the Lords amendments on the Bill. I believe that the key question is whether we have the mechanism in place to ensure that, first, there is a strong partnership between my department, the DfES and HEFCE to ensure that we have a grip on these issues at national level, and secondly, whether we have a performance management system within the NHS to ensure that the duties are carried out effectively at local level. I believe that my earlier points point to the fact that we have the mechanisms available at national level. Secondly, through the performance management regime, we can ensure that the relevant partnership between the NHS and universities is effective at local level. But I do not underestimate the importance of the review that I have announced today. It will be a very important review.

I shall now attempt to answer the specific questions put to me about the review. It will be administered by officials from the departments concerned—the Department of Health, the Department for Education and Skills, and, most importantly, the Wales Office and the National Assembly for Wales. Ministers from each department will oversee it. I can confirm that all other key stakeholders will be offered the opportunity to contribute. I shall encourage consultation with those whose interests are most closely concerned, including experts in the field of health, education and research, to ensure that the review is properly informed and that it covers the range of healthcare professions and not just doctors.

In response to the point raised by the noble Baroness, Lady Northover, while the review will have a defined end point—it is important that all reviews have a defined end point—it may be a recommendation of the review that further ongoing or periodic reviews should be carried out.

I anticipate that the review will start early next year. I understand the points made about timing. I recognise that there is a need to get on with the matter. Equally, there is an argument for allowing PCTs to bed down for some time. I fully accept that we have said that the issue is not solely confined to PCTs. When we first debated it, we debated long and hard about the role of primary care trusts. I have listened carefully to the points raised this afternoon. I am prepared to say that rather than set the terms of reference by the end of the year, I shall try to ensure that they are agreed in the autumn, and that the review should start as soon as possible after that.

The original intent was for the review's findings to be published by 2004. I am keen not to be pressed to give an exact date and time. But in the light of

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everything that I have heard today, I shall seek to ensure that the review completes its first period of work some time in 2003.

Copies of the report from the review will be made available in the Libraries of both Houses. As noble Lords will know, it is not in the gift of the Government to decide what we debate in your Lordships' House. That is a matter for the usual channels. However, I would very much welcome a debate and shall try and ensure that one takes place.

If the review finds areas of concern, one option would be for guidance to be given to primary care trusts, strategic health authorities and NHS trusts wherever necessary—I am sure that that applies also for the Welsh Assembly—and, if necessary, the issuing of directions. Later in the year we shall make a further announcement about the review.

So far as concerns the specific issues raised by the noble Baroness, Lady Northover, we can pick up the issue of ring-fencing, money for education and R&D, although money for education, training and research in the NHS is already ring-fenced in central budgets and allocated for those purposes. I understand that she will say that there are some other issues here. Of course the review will be able to look at them.

In relation to the issue of protected time, I am well aware of the pressure and tension between clinical academics, whose responsibility on the one hand is to the NHS and on the other within universities, where both are being pressured to do everything they can. In terms of funding—because that is very important to that element—we are developing a funding formula for NHS R&D. That will provide elements of funding in proportion to the time commitment of research-active staff. That will clearly make matters much more transparent and will help to deal with the issue of protected time. I shall go further and say that the review will have the core objective of considering whether the right balance is being struck between care for NHS patients, research and teaching. That surely goes to the core of many of the concerns expressed today.

I hope that in the light of what I have said the noble Baroness will feel able to withdraw her amendment. The Government have moved a long way and I hope that that will be recognised.

Baroness Northover: My Lords, I thank the Minister for that reply. I thank noble Lords for their participation in today's debate and in previous debates on the Bill. It has been striking how concern over this issue has crossed party lines and has come from all parts of the House. I am very grateful for the expert reports offered from within the House.

I am glad that the Government have responded as they have. They clearly recognise how important this issue is and that all is not well. Therefore, a review is required and these matters must be closely examined. I am pleased that the noble Baroness, Lady Carnegy, who is not in her place at the moment, thinks that we have scored a bull's-eye. Obviously, if we have—I trust

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that we have—that owes much to everyone in this House. Of course I shall follow the noble Baroness's advice.

We welcome the Government's moves, but we are very much going on trust. We trust that the review will be rapid. I am happy to see that there are moves to try to speed that up. It must be thorough, probing and long-sighted in its deliberations. I was glad to hear that some of my concerns have been explicitly addressed. The point about ring-fencing is something that we have addressed. I know that much funding is supposed to go to education and research. We have heard about how it does not always work out that way. I am pleased that the idea of protected time for research and training will be addressed.

I am happy that the review's conclusions will be made public. That is extremely important. Therefore, we can all take forward these issues and make sure that the identified problems will be addressed. We shall continue to watch what is happening. It will be a while before the review starts and there are some pressing problems now. I hope that we can work together to try to take things forward. In that spirit, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

On Question, Motion agreed to.


4After clause 6, insert the following new clause—

    "Duty of Local Health and NHS trusts regarding education, training and research in Wales

Local Health Boards and NHS trusts, and those commissioning specialist services on behalf of the National Assembly for Wales, shall have a duty to safeguard and promote education, training and research."

    The Commons disagreed to this amendment for the following reason

    4ABecause the law already provides adequately for education, training and research.

Lord Hunt of Kings Heath: My Lords, I beg to move that the House do not insist on their Amendment No. 4 to which the Commons have disagreed for their reason numbered 4A.

Moved, That the House do not insist on their Amendment No. 4 to which the Commons have disagreed for their reason numbered 4A.—(Lord Hunt of Kings Heath.)

On Question, Motion agreed to.


6Before Clause 16, insert the following new clause—

    "Establishment of Patients' Councils

    (1) The Secretary of State shall, subject to subsection (2), establish a body to be known as a Patients' Council ("Council") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c. 15) (functions of overview and scrutiny committees).

    (2) Each Council shall comprise members of the relevant Primary Care Trust Patients, Forums and NHS trust Patients' Forums operating in that area and representatives from the relevant community interest groups.

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    (3) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.

    (4) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—

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