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Lord Walton of Detchant: My Lords, does the Minister accept that in a country which prides itself on its technological expertise, it is extraordinary that a computerised system designed to improve the postgraduate training of doctors has failed so abysmally to satisfy the needs of the health service and of the medical professionand that at a time when the vastly expensive Connecting for Health system is also struggling to fulfil its objectives? What can be done to ensure that the computerised system will be fit for purposeto use a popular phrase?
Bearing in mind the point made by the noble Baroness, Lady Barker, is the Minister satisfied that there really are enough training posts to be occupied by all of those coming out of the foundation programmes? Is he aware of press publicity concerning demoralised doctors being invited in considerable numbers to go to Australia, for example? Those doctors have been trained at great public expense in the UK and are much needed by the National Health Service. It is a very serious situation and it is good to know that the MTAS programme has been put on hold in favour of the old-fashioned system that had its defects, but at least gave doctors adequate notice before they took up new appointments.
Lord Hunt of Kings Heath: My Lords, I want to draw a distinction between the Modernising Medical Careers programme and MTAS, which is a technical system by which applicants made their preferences known, through which their interviews were arranged and which informed them of their success or otherwise. The principles of Modernising Medical Careers hold good and are widely supported by the profession, which made a considerable contribution to their development.
It is clear that there have been issues and problems with the MTAS system and that is why in the next stage we will look to local deaneries to do the work required in matching applicants to available posts. There are lessons to be learnt and that is why we have established Sir John Tookes review.
I have already told the House that we are working with the Postgraduate Medical Education and Training Board to establish whether more training postsand how manycould be created. However, I caution the House that it would be wrong suddenly to create a huge number of extra training posts if, at the end of the training programme, the consultant or GP jobs were not available. It is important that we keep in balance the workforce requirements of the NHS and the number of training places.
Yes, there are over 30,000 applicants and the number of training places is about 22,000 to 23,000; but there has always been an oversupply of candidates for training posts. There has been a bulge this year, because there have been applications from many candidates who have been working in the NHS for several years and who have always been looking for further training opportunities. However, most of the applicants work in the NHS and will continue to work in it, but some will not be successful in getting on these training programmes. That is no different from what happened in previous years.
The Lord Bishop of Peterborough: My Lords, does the Minister accept that what has happened has not only damaged peoples confidence in the system but, in a number of cases, has also damaged individual applicants confidence in their own sense of vocation? What plans do the Government have to seek to restore that sense of vocation in these young doctors and in the profession generally, which is so important to the well-being of our society?
Lord Hunt of Kings Heath: My Lords, I thank the right reverend Prelate for that question. I have no doubt that the events of the past few weeks and months have caused a great deal of anxiety to junior doctors applying for specialty training posts. There is no doubt about that; nor is there any doubt that they are dedicated people who have a vocation to help people and to work in the National Health Service. I fully accept the right reverend Prelates challenge: we have to ensure that this system works and that the value of our junior doctors is fully recognised. In a sense, the response that I gave to the noble Baroness, Lady Finlay, about pastoral care applies to junior doctors generally. It will be very important for all of us in the National Health Service to ensure that those doctors understand that we greatly value the work that they do and the contribution that they can make in the future.
Lord Tomlinson: My Lords, does my noble friend accept that when the noble Earl, Lord Howe, referred to the disaster that Ministers have presided over, it would have been an even greater disaster for patients if we had kept the number of training places for doctors at the level that it was at when this Government came into power? We are now dealing with problems of success in doctor training, not problems of failure. Will the Minister accept that I regard it as a sign of strength in politicians when they change their mind on the basis of empirical evidence? I do not regard it as a weakness, and I commend my noble friend for repeating the Statement, which reflects that change of mind.
We should not allow the bad newsand it is bad newsabout the need for training places for doctors to overshadow other news about the National Health Service that has come out today; for example, the report of the Healthcare Commission.
Lord Tomlinson: My Lords, does my noble friend recognise that, in this context, the report shows that overall the National Health Service is doing a good job? Patients gave a vote of confidence in the overall level of care. I remind him that Anna Walker, chief executive of the Healthcare Commission, said:
Lord Hunt of Kings Heath: My Lords, my noble friend has raised some very relevant questions. It is worth making the point that the Healthcare Commissions report showed an ever-higher degree of satisfaction with the NHS among patients. My noble friend is right that one reason why we need to reform medical training is that we now have many more doctors. We increased the number of training places and there are 30,000 extra doctors in the health service. That is why waiting times have come down and why we have opened new facilities, and it is why we have to ensure that our doctors of the future are given the best possible training. That is what Modernising Medical Careers is about: it is about getting rid of the old, inconsistent, patchy approach to training. I am absolutely convinced that the outcome, as we have seen from the foundation course for very junior doctors, is that we will get better doctors and higher-quality patient services.
Baroness Thomas of Walliswood: My Lords, I am one of those who have nothing but praise for the current state of patient treatment in the NHS, particularly in London, where my family has been very blessed in having had remarkably good treatment. However, will the Minister acknowledge that the anxieties, the impression of disorder and the poor arrangements surrounding the promotion of junior doctors onwards will have a knock-on effect on those who may still be at school but are thinking of entering the profession? What will the Government do to try to reassure these young people who are taking A-levels, which will take them on to medical school, that, by the time they reach the same position as those who are being examined at the moment, they will not be subjected to the same sort of chaos?
Lord Hunt of Kings Heath: My Lords, there is nothing fundamentally wrong with the modernised medical careers programme. We have dealt with the issues as they have arisen, such as the problems with MTAS. That is why we set up the review group and accepted its advice to place responsibility in the local deaneries for the next part of the MTAS process. The quality of candidates coming through into medical schools is of a very high order, and information is beginning to reach us suggesting that many of the candidates who have been interviewed for the specialty training posts are first rate. It is no coincidence that one of the reasons why we have such a strong research-based pharmaceutical industry is the quality of our clinical staff, and the quality of our science base. I assure the noble Baroness that we shall do everything we can to enhance that reputation.
Lord McColl of Dulwich: My Lords, the question of how morale can be restored has been asked. When the Secretary of State in another place was asked to apologise six times during the discussions, she refused, but the good news is that our Minister here, the noble Lord, Lord Hunt, has apologised. That was very much appreciated. There is no doubt that when the Government make mistakes, they should apologise and avoid attacking the medical profession and accusing it of making mistakes. A lot of remarks have been made about the old-boy networkthe Minister used those words himself. Many hospitals have tried very hard over many years to make a serious attempt always to appoint the best candidates. When I mentioned that in a previous discussion, the Minister dismissed it as a one-off.
Let me explain that if you put, say, 100 applications in order of merit on the basis of previous exam results, clinical assessments, and so on, then give that list to another group of peopleperhaps the consultantsto see whether they agree, you end up with a list in order of merit. A secretary then gives the top one their choice and so on all the way down. There is no way that you can have an old-boy network as you cannot fix a job at all. Many centres in the country tried and established that system, and the old-boy network was precluded in many places.
On the business of trying to avoid mistakes in the future, have we in place a system that will avoid awarding one point to a candidate with a PhD, and four points to a candidate who writes rather a good essay on how to manage stress?
Lord Hunt of Kings Heath: My Lords, I hold the noble Lord in high regard. He is a brilliant doctor and has done sterling work in the health service over many years. I would never accuse him of being part of the old-boy network, but there have been strong criticisms about the traditional approach. I take the noble Lords point about working with doctors and medical bodies, which I have always sought to do because I think that that is the only way to achieve success in the health service. However, I was making the point that they were all involved in the discussion on the principles of changing the approach to training. They gave broad acceptance because of the concerns expressed about the previous system.
Baroness Miller of Hendon: My Lords, I accept absolutely what my noble friend Lord McColl said about how much we appreciate the Minister apologising for what has happened; it made a difference. However, I find it difficult to understand that, in the course of a very short, compact Statement on a longstanding problem, the Minister said, Of course, we will learn lessons. He repeated that in an answer. Will there be a time when we have learnt the lessons? We are hearing about this problem rather too much.
The noble Lord, Lord Tomlinson, may well laugh at that, but the other report he mentioned as being published today, although irrelevant to the subject of this Statement, is perhaps relevant in another way. The Government always seem to bury bad news when they have some good news to put out, which is why, if I may say so, we have ended up with such a tiny Statement.
Lord Hunt of Kings Heath: My Lords, the noble Baroness is being a little unfair. The Statement reflects two things. First, on the basis of the report on security, we have referred that matter to the police, so there is little I can add. The second part of the Statement related to the work of the review body, and encapsulated its discussions at its previous meeting. In addition to a number of oral Statements, we have issued regular Written Ministerial Statements and will continue to do so. The review group meets on a regular basis, at times weekly, and deals with specific issues. The Statement today was about a specific issue.
Moving from the old system to the new one was a huge challenge; there is no question about that. The foundation programme has worked very well. Indications are that the recruitment and interview process for GPs has worked well. We should not allow the immediate issues and problems which have been identified to undermine this whole process. At the end of the day, it is about a better training programme for the doctors, which means that we will ultimately get better, high quality, care. We must focus on that.
The noble Baroness said: The objective of the amendment is to give the Committee the opportunity to consider exactly what probation should be for in relation to the principles which should underlie the Bill. I hope it might bring some clarity to the remainder of our proceedings on the Bill.
I am grateful to the noble Lord, Lord Ramsbotham, and the noble Baroness, Lady Howe of Idlicote, for tabling their amendment to mine, because it gives the Committee the chance of a full and, I hope, conclusive debate on this vital matter. I anticipate that the Government will not have difficulty with the drafting of my amendment, simply because I abstracted the text from their own Management of Offenders and Sentencing Bill, the Offender Management Bill mark 1, of early 2005. Furthermore, after my honourable friend Mr Edward Garnier had moved his amendment in Committee in another place on 11 January 2007, at col. 9, the Minister said that he would consider the matter. On Report, the Government then introduced the text in a different part of the Bill, in Clause 2, where it presently lies, fulfilling a rather different function. We welcomed that improvement to the Bill, so my text has a happy history. I hope it will have a happy future, too, but we will see about that.
I accept that my amendment goes beyond the remit of the Governments amendment to Clause 2; it does so on purpose. The amendment sets out the principles that should apply broadly to the Bill. They should guide those who provide probation services, whether it be the Lord Chancellor, probation trusts, private companies or the voluntary sector. Those principles should, as a minimum, comprise: protecting the public, reducing reoffending, the appropriate punishment of offenders, making offenders aware of the effects of their acts on victims and rehabilitating offenders. The amendment tabled by the noble Lord, Lord Ramsbotham, would remove from that list my reference to,
The Probation Service has been the victim of continual reorganisation since 1997; now it faces yet another. It is essential that those who will provide services under the new system have guidance on the proper functions of probation. I do not doubt that the professional members of the Probation Service already follow the principles set out in my amendment in their management of offenders, and we should recall that they do so in the most difficult circumstances. Their clients are the most difficult in society to care for or to control. Statistics tell us that they are largely drug users, dishonest and disorganised. If the public are to have confidence in non-custodial sentences and the extension of their use in futurefor example, in monitoring those on bail and in the supervision of offenders released into the communityit is vital that the protection of the public is a key principle that applies to all probation providers. In particular, we must remind ourselves that probation provision will comprise a much wider range of organisations.
I realise that public expectations of what the probation services can achieve in public protection are often unrealistic, particularly when newspaper reports fan the flames of fear, but it must none the less be a key principle. What will the lines of accountability be to ensure that all those tasked with public protection do the job effectively? What will be the sanctions if they do not? How soon can those sanctions be imposed to prevent injury to individuals or property? How can that be achieved without imposing on the system an overburdened and overburdening bureaucracy?
The Government have trumpeted their assertion that the Bill is all about reducing reoffending; so that part of my amendment will, I hope, find favour. It is clearly what the public wish to see as the outcome of probation supervision. The reoffending rate for adult prisoners within two years of their release from custody is around 67 per cent, while the rate for young offenders, we are told, is nearer 80 per centappalling rates, which all of us wish to see reduced.
Rehabilitation must go hand in hand with a reduction of reoffending, because if one is rehabilitated one simply does not reoffend. Rehabilitation has a further important benefit: it improves the lives of the offenders family. Indeed, society as a whole can benefit where rehabilitation teaches new skills and a sense of responsibility. However, we must all recognise that that comes at a cost. Rehabilitation must include some form of resettlement and aftercare; otherwise, we simply lose people back into the criminal justice system. Services and programmes offered by probation providers need to be varied and effective to fit the individuals needs. The voluntary sector already plays a vital role here but it certainly could be much more significant given the chance.
It is important that offenders are made aware of the effect of their crimes on victims, but I certainly was not born yesterday: I realise that that is difficult to achieve when trying to rehabilitate offenders. It makes a difference to the behaviour of some if they are shown the impact of their behaviour on the community or an individual; for others, it is a case of saying So what?, showing two fingers and walking away. However, it is worth the effort of making them realise the impact they have. It is an important ally of the work on rehabilitation and the reduction of reoffending.
Is that the role of the Probation Service and is it a principle that should be in the Bill? I believe that it is. The clearest example of its relevance is the breach procedure that is taken by the Probation Service when an offender does not comply with the terms of his order or when a person simply fails to comply with his bail conditions. As a magistrate, I used to sit on hearings when breach proceedings had been taken and were before us. I was always impressed by the judgment exercised by the Probation Service in making the decision about when to bring breach proceedings. The court did not have to impose further punishment or recall the person to prison. That was a decision for the court.
In the briefing provided for this debate by the National Association of Probation OfficersI asked it for its assistanceI see that the number of persons breached for failure to comply with an order has increased fourfold in the past five years. That is an alarming statistic. I understand NAPOs concern that the Government have increasingly emphasised probations role in terms of punishment and public protection. I fully agree with the view expressed by the Lord Chief Justice, the noble and learned Lord, Lord Phillips of Worth Matravers, at the centenary conference of the Probation Service, which was held last week. He said that,
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