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Baroness Morris of Bolton: My Lords, it is not good enough that the parents of children with autism and Asperger’s have to battle to get an initial diagnosis, an assessment of need and the services that they are entitled to, and they are often passed from pillar to post. Should there not be a simplification of the assessment process so that these vulnerable children do not fall in the gap between health, education and social services?

Lord Adonis: My Lords, the noble Baroness will need to tell me what she means by a simplification. The statementing process in place at the moment is there precisely to safeguard the interests of parents and children, to ensure that they have the opportunity to properly access services and in particular to contest decisions taken or judgments made by local authorities where they do not agree with them. Simplification might not necessarily serve the interests of those children or their parents at all. If the noble Baroness has specific proposals she would like to put to me, I will of course study them seriously.

Lord Addington: My Lords, with virtually all the hidden disabilities, most of the problems occur in two places: first, where the parents are not savvy or informed enough to try to drive the educational system forward themselves and, secondly, where the person involved is spotted too late to benefit from the system. When will the Government be satisfied that every school in the country stands a reasonable chance of picking out a working-class child who has marginal Asperger’s?

Lord Adonis: My Lords, I am not in a position to answer the noble Lord’s question about every school in the country, but if one asks whether we are significantly investing in the training of teachers for this purpose, the answer is yes. For example, we are introducing mandatory national accredited training for all special educational needs co-ordinators in schools. That will apply to all new SENCOs from next year, and that measure, among others, will significantly improve the capacity of schools to engage in early diagnosis.

Lord Maginnis of Drumglass: My Lords, is the Minister aware that the Celtic Nations Autism Partnership, comprising Northern Ireland, Wales and Scotland, has already embarked on initiatives to try to co-ordinate the provision of autism services across departmental boundaries; that an independent review of autism services in Northern Ireland is due to report at the end of this month; and that the Welsh Assembly, together with Autism Cymru, is progressing its own 10-year plan? Are Her Majesty’s Government willing therefore to support and build on the Celtic nations’ initiatives, so that government departments, the voluntary sector and others throughout the United Kingdom work together without creating more unnecessary delay?

Lord Adonis: My Lords, we are aware of the developments in Northern Ireland and Wales and will pay close attention to the plans to which the noble Lord referred when they are published. If there are lessons that we can learn for practice in England, we will do so.



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Lord Clement-Jones: My Lords, I declare an interest as the chair of TreeHouse. Does the Minister agree with many who advocate a 10-year strategy and many organisations in the field that, with growing numbers of children diagnosed with autism, it is of increasing importance to look at the transition between school and adulthood, and that co-ordination between the different government departments and local authority departments is crucial? Is government strategy addressing that?

Lord Adonis: My Lords, the noble Lord raises an important subject, to which TreeHouse has paid considerable attention. The training that TreeHouse provides is in no small part geared towards ensuring much better provision in respect of transition, and much better provision linking special schools and specialist support services with mainstream schools and educators. That is a big theme of TreeHouse, and I am sure that the wider education service has a great deal more to learn from it.

Medical Education

3.27 pm

Baroness Finlay of Llandaff asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, I express my and the Government’s thanks to Sir John for the enormous dedication that he has shown in completing his review. It is a substantial and timely contribution for which the Government are tremendously grateful. I also thank the medical profession for the help that it gave him throughout the review. The department will respond swiftly to his recommendations. The Government are determined that the nation will benefit from world-class medical training in England.

Baroness Finlay of Llandaff: My Lords, I thank the Minister for his reply and his fitting tribute to Sir John. I declare my interest in postgraduate medical education. Having invested £250,000 in each undergraduate’s training in the UK, how do the Government plan to deal with the overprovision of 40 per cent in relation to doctors applying in this round, and to ensure that they can access their e-mails to see their job offers when working in the NHS? Given the failure that was identified in managing the MMC process, are the Government considering the need for and the purposes and functions of a co-ordinating body for NHS medical education in England, as has been proposed by Sir John Tooke, to lead on and take responsibility for training issues into the future?

Lord Darzi of Denham: My Lords, let me make clear two important points when we talk about medical education. There are two separate entities of doctors: those who are employed, whom we are not talking

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about, versus doctors in training opportunities. This year, there will be nine opportunities for postgraduate training across England and a further 10,000 training posts, which are already filled through a run-through training system. We can never predict the number of applicants to a specific number of training posts, but that is separate from opportunities to obtain a job in the NHS.

On Sir John Tooke’s recent recommendation, which is of great interest, we have to remember that it was not in the interim report. However, it is fresh thinking and certainly welcomed by the department. It is extremely important that we think about the functionality and the clear accountability of structures before we create a structure. We have had that experience in the creation of the MMC structure. The recommendation is very creative, but we should think quite hard about it.

Lord Winston: My Lords, I am sure that my noble friend agrees that an efficient and caring workforce is a happy one. One of the serious problems now is that young doctors are applying for jobs where they do not necessarily know the consultant or the team for whom they are working. Will the Government look again at the system under which we both trained—the old firm system—whereby one can have a close relationship with a group of doctors and work much more as a team, something which is, sadly, increasingly lacking from the NHS and is compounded by the problem of Modernising Medical Careers at present?

Lord Darzi of Denham: My Lords, my noble friend raises the important issue of the relationship between a trainee and the trainer. The purpose of Modernising Medical Careers was to get over the variability in the quality of training. In certain parts of the country, there was no agreed curriculum or standard of assessment. I strongly believe that the ethos of MMC is correct. However, when it comes to the selection and the process in which MMC should be implemented, my noble friend raises an important point. In 2008 we feel that the deaneries at a local level should be carrying out the selection. I also agree with him that the NHS and its local needs should determine the number of posts at a local level. That should also be considered in the light of the Tooke recommendations.

Baroness Tonge: My Lords—

Lord Walton of Detchant: My Lords—

Noble Lords: Cross Bench!

Lord Walton of Detchant: My Lords, does the Minister accept that ever since the National Health Service began, there has been fierce competition for the best registrar posts, particularly in the most popular specialties? However, in the light of the evidence and the numerical information included in these reports by Sir John Tooke—they are admirable and have been doing their best to correct what has become a very serious situation—is it not now necessary to increase the number of specialist registrar posts within the National Health Service to make the best use of the training opportunities for these young doctors? We should bear in mind that an increasing number of

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general practitioners and consultants are taking early retirement, and it is crucial that there be suitable replacements for them when they retire.

Lord Darzi of Denham: My Lords, the noble Lord makes a point about increasing the number of training opportunities. I am conscious that there is a desire to increase those numbers. However, this is taxpayers’ money and we need to recognise that opening the tap on one end is not going to deal with how we manage those who end with fully trained and certified job opportunities in the future.

Baroness Trumpington: My Lords, could the Minster turn towards the microphone please?

Lord Darzi of Denham: Yes, my Lords, I will. I was referring to the caution that we should have if we increase the number of training posts. We would have difficulties in creating consultant opportunities at the end of that training ladder. However, forecasting workforce needs is becoming a global challenge, because the medical workforce is becoming a challenge for most countries trying to design their medical education needs.

Baroness Tonge: My Lords, will the Minister give us an assurance that in future the Government will ring-fence money given to trusts for the training of doctors, and not allow it to be used for paying off their deficits?

Lord Darzi of Denham: My Lords, the funding for the multiprofessional educational and training budgets that the noble Baroness, Lady Tonge, refers to is about £4.3 billion a year, an increase of about 3.6 per cent. I certainly guarantee that that budget will be ring-fenced for education and training needs. The budget for medical education has increased from nearly £590 million in 1997 to about £1.6 billion. That is an increase of 170 per cent in the funding for training opportunities for medical doctors.

Lord McColl of Dulwich: My Lords, the Minster and I are aware of the meetings held in hospitals throughout the land every week to discuss possible mistakes that have been made. In view of all the mistakes that have been made over this subject, will the Minister consider introducing similar meetings into the Department of Health to discuss all the mistakes? We call them mortality morbidity meetings; we would only be interested in morbidity.

Lord Darzi of Denham: My Lords, I acknowledge the mistake in relation to the implementation of MMC last year. I was one of the trainers and carried a number of trainees with me. That was a difficult and challenging time. The previous Secretary of State has publicly acknowledged that that was a mistake and apologised to the trainees and their families.

The noble Lord raises what happened around 1 August. I am sure that he will agree that it is important to put on record that clinical colleagues took a lot of their free time to interview candidates across the country to ensure that the right individuals were appointed at the right time. The deaneries and

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strategic health authorities co-ordinated that activity around June or July, which ensured that our hospitals will be fully staffed on 1 August this year.

Local Transport Bill [HL]

3.36 pm

Report received.

Clause 3 [The senior traffic commissioner]:

Lord Bassam of Brighton moved Amendment No. 1:

“( ) such organisations representative of the interests of local government, of London government, of Integrated Transport Authorities and of Passenger Transport Executives as the senior traffic commissioner thinks fit;”

The noble Lord said: My Lords, Clause 3 inserts new Section 4C into the Public Passenger Vehicles Act 1981, allowing the new statutory senior traffic commissioner, as would be appointed under new Section 4A of that Act, to issue directions and general guidance to the other traffic commissioners on the exercise of their functions.

New Section 4C(4) of the 1981 Act imposes a statutory obligation on the senior traffic commissioner to consult a range of bodies—including the Secretary of State, Scottish and Welsh Ministers—before issuing directions and guidance under new Section 4C(1). New Section 4C(4)(e) obliges the senior traffic commissioner to consult such organisations representative of the passenger vehicles and haulage operators as he thinks fit. This provides some discretion as to which particular organisations should be consulted on a case-by-case basis.

During Grand Committee debate on 6 December, the noble Lord, Lord Rosser, tabled an amendment to include representatives of local transport authorities among the named bodies that the senior traffic commissioner must consult as he sees fit under new Section 4C(4)(e). The Government agreed to consider this amendment.

While we believe that consulting such bodies is already possible under the existing wording at the very end of subsection (4), we accept there may be value to including representatives of local transport authorities among the list of named bodies. In particular, it would provide further useful clarification on the general purpose of consultation under this section and require the senior traffic commissioner to consider on a case-by-case basis which particular organisations it might be appropriate to consult. However, in tabling this amendment, we believe it is important that we should not suggest consultation with a particular level of local government. The senior traffic commissioner will continue to exercise discretion in individual cases.

I thank the noble Lord, Lord Rosser, for his helpful amendment. It has usefully made us think again about this matter, and I hope it deals satisfactorily with the points that he and other noble Lords raised in Committee. For those reasons, I beg to move.



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Lord Hanningfield: My Lords, for once, I welcome a government amendment. While the Minister did not prescribe what level of local government is to be consulted, one assumes that the traffic commissioners would consult the relevant level. This is a welcome addition to the consultation processes in the Bill.

Lord Rosser: My Lords, I, too, thank my noble friend for this amendment and for giving consideration to the point raised in an amendment I moved in Committee. The amendment he has tabled addresses the issue.

On Question, amendment agreed to.

Clause 9 [Local transport plans]:

Earl Attlee moved Amendment No. 2:

The noble Earl said: My Lords, during the passage of the Road Safety Bill, noble Lords raised the issue of rural roadside adverts. These are positioned alongside motorways, trunk roads and roads on the primary network. They are aimed at motorists driving at high speed; we are not talking about urban roads with low speed limits and a large volume of adverts aimed at slow-moving or stationary motorists.

The road safety risk caused by completely unnecessary distractions is obvious to anyone interested in road safety. The first noble Lord to raise this issue was, I think, the noble Lord, Lord Harrison, and I am pleased to see him in his place. Since we last debated this issue there has been a large and obvious increase in the number, the size and the sophistication of these adverts. There is also evidence of larger commercial organisations coming into the market. That is inevitable, given the clearly ineffective enforcement action by central government. In other words, it is not being effective at getting the local authorities to deal with the problem. It would be highly undesirable for farmers to get used to this income stream, because it will have to be turned off at some point—better sooner rather than later.

These adverts are regulated by the Town and Country Planning (Control of Advertisements) (England) Regulations (SI 2007/783). I hope the Minister can reassure the House that not only are the regulations comprehensive and detailed—they are, but I could not understand them when I read them—but also that they provide local authorities with all the powers that they need. I hope we do not need more regulations, with all their attendant pitfalls. For instance, we would not want to arrive at the next general election to find that we had accidentally banned all political roadside adverts, which are not a problem because they are erected for short periods, they only set the mood music, they do not require the recording of any details by drivers and of course they are not for commercial purposes.

Central government needs to ensure that the current legislation is used, and to informally tell the advertising industry to knock it off. If the Government do not succeed in reducing the number and the size of these

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adverts, it is almost inevitable that a very serious accident will occur when one driver is distracted and drives at speed into a stationary object or another vehicle. If the moving vehicle is a truck and the stationary vehicle is a school minibus, I dread to think what the coroner’s report would say and I would certainly not want to be the Minister explaining to Parliament why nothing had been done to avoid such a clear and present danger.

Is the Minister satisfied that the regulations, which were laid only last year, are effective? If he is, why do we still have the problem? What is he doing about it—or does he believe that the problem is not one for central government? I beg to move.


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