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Lord Turnberg: My Lords, in welcoming the order, I have to express an interest as a past president of the Royal College of Physicians and past chairman of the Specialist Training Authority. May I also say how much I appreciate the way in which my noble friend and her officials have explained the detail of the order to me, and how the department and its officials have consulted all and sundry in reaching what I believe is a very satisfactory order.
I particularly welcome the bringing together of the Specialist Training Authority and the authority that regulates general practitioner training. I welcome the facility to take on board experience as part of the ability to assess individual doctors, and the encouragement to look at overseas doctors, who have sometimes had a difficult job getting into the system. Of course, the increase in lay and NHS representation is to the good. I believe all those things are very valuable.
As my noble friend said, concerns have been raised about the powers of the Secretary of State. I think that I am reassured by the suggestion that he or she will have to demonstrate reasonableness in bringing the board to order. I was particularly concerned at one point about medical Royal College representation on the board. I am moderately reassured and I believe that the colleges are moderately reassured.
I want to comment briefly on why it is important that the colleges are adequately represented. The colleges are, and have been for very many years, responsible for developing all the various curricula for all the various specialties, as well as general practitioner training. They set up the training programmes and have a number of specialist training courses.
One has only to visit the Royal College of Surgeons or the Royal College of Obstetricians and Gynaecologists and to see the special training methods they have adopted, which allow young surgeons to practise on inanimate models before being let loose on the public, to recognise how valuable all that is. They ensure that trainees go through all the programmes; they set the exams; they run the examination process; and they assess all the competences.
Incidentally, the colleges are already assessing competences. That will not be new for them; it will be a continuation overseen by the board. Therefore, it is not absolutely new. The colleges visit all the establishments concerned with trainingall the hospitals and so onand ensure that they are up to standard.
The colleges will also welcome the ability to assess experience. The Specialist Training Authority was very constrained by the European directive in its ability to assess experience. It seems that this new order will help to get round that problem. In all that, the colleges work very hard. My own old college, the
All that vital experience should not be lost and should be used in the new board. It is helpful that six places will be available to the colleges. I hope that my noble friend will be able to reassure us that that is a minimum figure and that at least that number will be representatives.
I want to raise another point concerning the responsibilities of the board with regard to the supervision of training. It is hard to imagine how that responsibility will be fulfilled without the board being able to delegate it to colleges and to postgraduate deans. I make a similar point in relation to visiting. I cannot imagine that the board will visit establishments where training takes place. It will have to delegate that responsibility. Therefore, I would welcome a reassurance from the Minister about the ability to delegate responsibilities.
Lord Patel: My Lords, I, too, welcome the order that brings postgraduate medical education in general practice and specialties under one statutory organisation. Like my noble friend, in a true sense, Lord Turnberg, I also declare an interest. I am the immediate past chairman of the Specialist Training Authoritya body that will be replaced by the new board. I have also been president of the Royal College of Obstetricians and Gynaecologists and chairman of both the Scottish and United Kingdom Academies of Medical Royal Colleges and faculties. All those organisations are concerned primarily with promoting and establishing medical education.
The order creates an opportunity to bring some fresh thinking to the way doctors are trained to meet the needs of the health service and to change the way that medical care is delivered in this country from much of care today, particularly emergency care, being delivered by doctors in training to care being provided by doctors who are fully competent to provide it, and who have gone through a structured competency-based training and assessment.
To be able to bring about the changes proposed in the order, the board must be independent of government and organisations primarily concerned with devising and delivering programmes of medical education. At the same time, the board must work closely with and support organisations such as the Royal Colleges which are, in the main, as all noble Lords have said, responsible for postgraduate medical education.
While there have been anxieties about appropriate Royal College representation on the boardthat has been mentioned several timesseveral of the college presidents who have spoken to me recently are content with the proposed arrangements and are looking forward to the establishment of the board. Yes, they have concerns that appropriate representation will also be maintained, and significantly so in the various committees. I, too, support the comments of the noble
It is right that the board and its committees should have significant lay representation. That is lacking on the current board of the STA, which has representatives from all the medical Royal Colleges, two representatives from the GMC, two lay representatives and one postgraduate dean. On many occasions during my chairmanship of the STA, the dominance of the Royal College representation on the board slowed the progress towards reforming curricula, introducing competency-based curricula, competency-based assessments, further training of doctors in non-consultant career grades and reform of so-called hospital visiting. My hair has turned grey trying to bring uniformity to hospital visiting processes that could be adopted by all the colleges. I exclude here the Royal College of General Practitioners, which has a very good system.
I do not criticise colleges for that; I merely give an example of how the board, working in a co-ordinated way, could bring about changes that would benefit medical education and training. The independence of the board should help to strengthen its role in those areas. The board should also be independent of the Government. The Minister's assurance on that would be comforting to the colleges.
Having said that, I believe it to be right that the Secretary of State has reserve and default powers to be used if the board is not discharging its function. I hope that those powers could be used only following a comprehensive external review of the board's work. The board has to be accountable.
Two other areas need clarification and reassurance. I hope the Minister will be able to give that. The current arrangements for recognising training undertaken outside the United Kingdom and EEA countries are not satisfactory. That has also been mentioned by all noble Lords. Thousands of doctors working at staff grade and associate specialist grade providing excellent care fail to get on to the specialist register and are disheartened, demoralised and feel discriminated against. At the initiation of the STA, over 3,500 doctors applied for entry to try to have their training and qualifications recognised. Over 50 per cent failed to do so.
The proposals in the order that include recognition of medical experience along with qualification and training and considering doctors' eligibility to be put on specialist registers, together with the proposals relating to top up training in the United Kingdom, will allow for many of those excellent doctors to get on to a specialist register and obtain consultant positions. I do not think it is beyond the wit of man to find a way to provide this type of training in a proper institution where training is possible.
The board must make sure that that happens; otherwise it will fail in its duty. I hope that this will be one of several outputs by which the board will be judged in the review. While the order proposes that a
The recognition of qualification, training and experience should also make it possible for overseas doctors to come here and continue their training in order to get on to a specialist register. I agree with the noble Lord, Lord Clement-Jones, that that should not just apply to those in academic and research positions but to others in service positions.
The final area on which I want to comment relates to the board's responsibility for setting up an appeals panel. During my chairmanship of the Specialist Training Authority, on occasions the independence of the present appeals system was challenged. While none of the formal appeals succeeded, I hope that the Minister can give a reassurance that the proposed appeals panel system will provide for the establishment of an open and independent appeals system which can also demonstrate a clear separation of the appeals panel from the board.
Perhaps I may also comment on the subject mentioned by the Minister about a proposed new careers structure being developedUnfinished Business. I look forward to it eagerly. I hope that I shall have a lot to say about the matter. The career structure for doctors, in particular in training, needs to be revisited. I hope that that will be simplified and not made more complicated.
In conclusion, apart from those areas that I have mentioned which require some further work by the board, I support the order and look forward to the establishment of the Post-graduate Medical Education and Training Board. I shall follow its work with great interest.
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