Health and Social Care Bill

Baroness Warwick of Undercliffe Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Warwick of Undercliffe]

My Lords, the Secretary of State in another place said that this Bill should aim,

“to improve the health of the people of this country and the health of the poorest fastest”.—[Official Report, Commons, 31/1/11; col. 605.]

Of course, all sides of this House would support such an aim. We can all agree that reforms of the NHS on some key issues are needed. When in government, my party started the current programme of reform to improve quality and productivity in line with the increased investment we made in the NHS.

Yet the changes to the NHS proposed in this Bill present us with a very different reality. Judging by my postbag, these changes have signally failed to engage the support of those in primary care, and have created huge anxieties among the people of this country. The Secretary of State has said that he wants,

“to move forward with the support of doctors, nurses and others who work in the NHS”.

Eminent clinicians and other medical professionals in their hundreds have shared with us their belief that the Bill as it stands will do irreparable harm to the NHS, to individual patients and to society as a whole.

I share, but do not intend to repeat, the many concerns voiced during this debate. Instead I want to focus on proposals which seem to me to impact particularly on education and training in the NHS. I am deeply anxious that the radical reorganisation proposed by this Bill will undermine the current UK-wide system of high level education, training and research. In particular, I am dismayed that we still do not know what will replace the strategic health authorities, responsible for the bulk of education and training. The SHAs host the postgraduate deaneries, which deliver postgraduate medical education, and which are responsible for the continuing professional development of all doctors and dentists. The intention seems to be that local skills networks of employers will take on many of the workload functions currently undertaken by the SHAs.

I cannot help but think that this is the wrong reform at the wrong time. The highly effective deaneries are able to tailor their workforce planning via local schemes within regional frameworks. I cannot see how the provider skills networks will do this more effectively or efficiently, particularly as there is no requirement for the networks to work with higher education institutions—the UK’s centres of scholarship and academic expertise.

Professional leadership in medical education, based on co-operation between the medical royal colleges and deaneries, is currently very strong. Devolving responsibilities to networks of providers would certainly weaken this. I know that the coalition has given a commitment that deaneries will still have oversight of the training of junior doctors pending further changes, but the long-term future of these deaneries is still uncertain. The “safe and robust transition” for the education and training system, promised by the coalition following the Future Forum, has still to be made clear. Indeed, the Future Forum said explicitly that education and training needs to be service sensitive but professionally and academically informed. I also say that I very much support and endorse the remarks made by the noble Baroness, Lady Emerton, about multiprofessional education and research.

I believe we could see fewer opportunities for education and training if the number of new providers of NHS services increases, as this Bill invites. There is real danger of conflicts of interest if training shifts to being employer led. Being “service dominated” rather than, as I believe it should be, “service informed” risks stagnation of educational provision and the danger of not addressing future workforce needs. I also fear that local employers would lack the necessary broad overview of medical workforce requirements, particularly given that specialist training can be as much as ten to 15 years following graduation.

The management, planning and oversight of the medical workforce can only be done at national and, more properly, at UK level. Can the Minister, in his response, explain whether there will be an explicit duty on the Secretary of State to retain a national, UK-wide system of high-level education and training? As we are discussing the duties of the Secretary of State, I remind the Government that it is the responsibility of the Secretary of State for Health to make available, in premises provided by him by virtue of the National Health Service Act 1977, as amended by subsequent legislation, such facilities as he considers are reasonably required by any institution in connection with clinical education and research.

That brings me to another area of concern, which is research. I am pleased to follow the noble Lord, Lord Willis, in his spirited advocacy for research. It is vital—for patient care but also for the economy of the UK—that research is not overlooked as we debate this Bill. The structural changes to the NHS proposed in this Bill could, as I see it, be a threat to the UK’s important biomedical research industry. We must ensure that every healthcare provider has a duty to train the next generation of doctors and nurses. Having a research culture embedded in the NHS, from the Secretary of State to clinical commissioning groups, is vital if we are to tackle some of the health challenges we face.

At the same time, the NHS’s consultant and professorial teaching staff must be incentivised to remain in the UK. The Secretary of State has had a report into the clinical excellence award scheme from the Review Body on Doctors’ and Dentists’ Remuneration on his desk since early July. Withdrawal of these awards would have a catastrophic effect on clinical academic careers and would immediately threaten the UK’s pre-eminence. I hope that the Minister will confirm that the Government do indeed value their research workers and will take the necessary steps to ensure that the UK remains competitive.

I said that I would not repeat the concerns of others, but I wish to add my voice to those calling for further scrutiny of the duties of the Secretary of State. I believe the House must consider seriously the unanimous conclusion of the all-party Constitution Committee. The duty to,

“provide or secure the provision of services”,

has been placed on the Government since the NHS was established in 1948. For more than 60 years, people have known that the Secretary of State and the elected Government are responsible for defining and providing a comprehensive health service.

The proposed change of wording is not simply a question of being pragmatic about how decisions are made. This is not about a nice distinction between the duty to provide and the duty to secure that services are provided, as the Minister in his opening remarks seemed to suggest. It goes to the heart of who takes responsibility for a national universal health service. I believe passionately that the Secretary of State must retain the duty to provide these services. In this way, ministerial accountability, responsibility and legal accountability are maintained.

Therefore, I support the amendment to the Motion that would refer that section of the Bill to a specially convened all-party Select Committee. This remains one of the most contentious aspects of this very controversial Bill. It is essential that we take the time to get it right.