Health and Social Care Bill

Lord Walton of Detchant Excerpts

Tuesday 25th October 2011 Lords Chamber

Moved by

[Lord Walton of Detchant]

2: Clause 1, page 2, line 1, at end insert—
“(c) in the provision of education and training of the health care workforce”

[Lord Walton of Detchant]

My Lords, I was locked out. As the spirit of reminiscence is in the air, I greatly enjoyed listening to the many impassioned speeches on the first amendment. I look back, as a fervent supporter of the NHS, upon the days when, as a medical student in 1944 and an officer in the British Medical Students Association, I confronted the then Minister for Health, Mr Willink, lobbying against the Act because I was pressed by the BMA. Subsequently, as I said at Second Reading, I learnt as a houseman what the horrors of the pre-NHS medical process were in the UK.

Clause 1 of the Bill, which inserts new Clause 1(1) in the National Health Service Act 2006, is very similar to what we learnt in the 1946 Act, which was so closely quoted by the noble and learned Lord, Lord Mackay of Clashfern. I am tabling this amendment with my noble friend Lord Patel because the wording in the Bill at the moment says:

“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of illness”.

Those objectives cannot be achieved without improving the provision of education and training for the healthcare workforce—hence the reason for tabling this amendment with my noble friend Lord Patel. The other amendments grouped with ours come to a similar conclusion. The wording is different and so is the emphasis, but they all have the same objective: putting a requirement for the NHS to provide education and training for its workers into the Bill.

When the NHS began, it was recognised that a partnership needed to be established with the universities and the other higher education organisations that trained doctors, dentists and other healthcare professionals. In the original contracts of doctors working in the National Health Service, it was fully recognised that academic clinicians employed by the universities would devote part of their time to teaching and research, but would give clinical services to the NHS for about half their time. In return, it was also accepted as an article of faith from the beginning of the National Health Service that consultants working in the NHS would be required to undertake teaching, for instance of medical students.

The financial responsibility for training undergraduate doctors and dentists was that of the universities, but from the inception of the NHS it was made absolutely clear that postgraduate training of its specialists, dentists and, later, nurses was the financial responsibility of the National Health Service. That has always been the case. To that end, the NHS paid for and established postgraduate deanships in every region of the country. Those postgraduate deans continue, and supervise the training of specialist surgeons, physicians, dentists and more recently, to an extent, the postgraduate and continuing education of other healthcare professionals. Our purpose in tabling this amendment is to make certain that this responsibility is acknowledged in the Bill.

It is clear that government Amendment 43 reaches much the same kind of objective, but responsibility for training and education is so crucial that it should be highlighted in Clause 1. It is absolutely essential. Having said that, there are many uncertainties about which the Bill is lamentably silent. For instance, in what sense is postgraduate training of the NHS workforce enshrined in mechanisms in partnership with the universities? What will be the future of postgraduate deans? We understand that they are to be retained, but who will employ them? The NHS will be required to fund them, but where will they be placed? If they are housed in the so-called clinical senates, how many senates will there be, where will they be located and what will their responsibilities be in the provision of postgraduate education and training? Will their responsibilities take full account of the statutory responsibilities of the regulatory authorities, such as the General Medical Council, the General Dental Council, the Nursing and Midwifery Council and so on? Will that be enshrined in statute?

Even more crucially, if certain NHS organisations are to be taken over by any willing provider—I am not saying that this will come about—what mechanism will be introduced in the Bill to require that those NHS bodies will still provide the facilities for education and training of the workforce? That is absolutely crucial. An exactly similar requirement is needed to make certain that commissioning bodies and the national Commissioning Board have a responsibility to maintain the high quality of education and training that has been such a feature of our NHS, in collaboration with universities and other higher education bodies, ever since the NHS was established. These issues are not included in the Bill and require to be included. I beg to move.

--- Later in debate ---

[Lord Davies of Stamford]

I am afraid that I must stress this point a little further. This debate has revealed a fundamental contradiction in the Government’s position. The Minister argues that Amendment 43 adequately defines the responsibilities that the Secretary of State will have for ensuring that there is an adequate system of medical training and education in this country. It may or may not be the case that the formulation in Amendment 43 is adequate, and we must decide on that matter today.

At the same time, though, the Minister is confessing that the powers that will be given to the Secretary of State in order to fulfil those responsibilities have not yet been defined. We do not know what they are. They have not been decided yet. Surely it is a fatal mistake in life to give anyone responsibility without being clear that they have the powers to undertake it. That is precisely the position in which the Government are placing the Secretary of State.

[Lord Walton of Detchant]

My Lords, before the debate on these amendments concludes, it had not been the intention of my noble friend Lord Patel and me, on coming to the Committee today, to divide on our Amendment 2. However, our view has been changed a little in the sense that the support that that amendment has had from all sides of the House has been very powerful. I shall read again what the actual Bill says. Under the heading,

“Secretary of State’s duty to promote comprehensive health service”,

it says:

“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of illness”.

All that we have suggested in Amendment 2 is the addition of a paragraph (c) to secure improvement,

“in the provision of education and training of the health care workforce”.

I find it difficult to suggest that any Government could refuse that amendment. It could be complementary to government Amendment 43. Will the Minister, who everyone in this House feels great respect for, take the amendment away, talk to the Government about it and see whether they might accept it as a government amendment on Report?

[Earl Howe]

I will happily consider that between now and Report, as indeed I will consider all the points that have been powerfully made in this debate. I have quite a lot more to say in answer to various questions that have been raised, and I hope that I will be given the opportunity to do so.

The Government’s amendment, quite consciously, does not confer any new powers on the Secretary of State. It requires him to exercise his existing powers to provide an existing system. The duty means that he would have to intervene if the system was failing and ineffective. He has a range of powers, including the powers to provide or commission training under Section 63 of the 1968 Act, as referred to in subsection (2) of the Government’s amendment. However, the point is that future legislation may add further powers to those that the Secretary of State already has, and that is what I cannot pre-empt in my reply today.

--- Later in debate ---

[Lord Patel]

That depends on the interpretation of the word “care”.

[Lord Walton of Detchant]

My Lords, this has been a lengthy debate on an extremely complex and difficult matter in a complex and detailed Bill. Medical education and training of the entire NHS workforce is absolutely crucial and it is vital that it appears in this Bill. That is why I very much hope that the Minister will take away Amendment 2 and think about trying to persuade the Government to adopt it. Other issues that have been raised will not go away. For instance, my medical colleague, the noble Lord, Lord Alderdice, talked about psychotherapists. There was also talk about the crucial problem of the future of healthcare assistants.

I would remind your Lordships that 15 years ago I steered through this House the Bills to regulate chiropractors, followed by regulation of osteopaths, so that they are now regulated by statute. I also chaired the House of Lords Select Committee on complementary and alternative medicine, which held a detailed inquiry. In that field, too, it is good to know that herbal medicine practitioners are close to being regulated. Therefore people who work in other aspects of healthcare will have to consider whether or not they will need and require statutory registration and regulation, though not in this Bill perhaps.

The government amendment is right as far as it goes, but it leaves a massive amount of information still up in the air. The Minister has given us a comprehensive and detailed report about the future of Health Education England. There is already a body called Health Education England, which has been in existence for some little time. I do not know what its provenance is now, but it is chaired by my close friend, Sir Christopher Edwards, who is a former vice-chancellor of the University of Newcastle upon Tyne. He has chaired a body called Health Education England for a while.

[Lord Patel]

It is Medical Education England.

[Lord Walton of Detchant]

Medical Education England, I beg your pardon. Will that body disappear with the development of Health Education England? Do we know what the provenance of that body is going to be or who is going to fund it? What is its constitution going to be and what are its authorities? Will it have the authority to deal with the issues that we raised in this debate about the crucial importance of making certain that commissioning groups, trusts and even private providers offer facilities for education and training.

I shall not go on. I am happy now to withdraw the amendment in my name, but I believe that these issues are so important that they should not await the tabling of another government Bill on education. The Government should introduce something into this Bill to make the future of health education and training clear. I beg leave to withdraw Amendment 2.

Amendment 2 withdrawn.