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Mr. Simon Burns (West Chelmsford): I listened carefully to the Minister and I appreciate his acknowledging that the amendments were tabled in all good faith. However, he went on to say that they were superfluous; I do not concur with that aspect of his analysis. As the Minister will know, concerns have been expressed in many areas by a large number of individuals both inside and outside the NHS about the terms of medical education, training and research. The amendments apply to England and Wales; they have the widest possible terms and embrace all aspects of education, training and research relevant to the NHS.

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I am sure that we all agree about the importance of education, training and research, but we cannot ignore problems in respect of their delivery, which is at the heart of our disagreement with the Minister. We want to focus on the size of the problem and whether existing NHS structures allow education, training and research to thrive and prosper. No one would disagree that our final goal is to ensure that they do so, but our disagreement or, rather, our change of emphasis, concerns the way in which we maximise opportunities and ensure that delivery goes beyond mere rhetoric and lives up to expectations. The issue at stake is not simply the existence of powers in NHS legislation, but whether they are being used to their full extent to maximise benefits and opportunities, which is why the proposed new clauses use the word "duty" in their titles. Will the Minister explain again why he believes that that word is superfluous, instead of regarding it as a back-up in the armoury of delivery to ensure that we achieve the end that we all seek?

While we all agree about the importance of education and its vital role in the NHS, it is plain to many people, particularly those involved in training and research, that those disciplines are vulnerable and threatened in the NHS. There is abundant anecdotal evidence that teaching and research resources are currently squeezed in NHS trusts. Lecture theatres are used for other purposes; there is a staffing crisis in universities; and doctors are so overwhelmed by day-to-day demands on their time, which affect their health care functions, that there is little or no time for research. It is all too tempting to sit back, secure in the comfort of the extra resources to which the Minister referred this afternoon and the possible extra resources that will emanate from last month's Budget. Citing statistics, however, will not make the problem go away; after all, part of the problem has been the squeeze on finances.

The problem, however, is not as simple as that. It is far from clear that any extra resources will find their way into teaching and research, as the Minister hopes. The crux of the matter is whether all the bodies in the NHS with a role in teaching, research and education will deliver the enhanced service we all hope for. I have doubts, for example, about primary care trusts and their lack of expertise and experience. The Minister may say with some justification that as PCTs bed down and gain experience, that problem may be minimised. The fact is that, as we made abundantly clear in Committee, the time scale for the introduction of PCTs was rushed; there will be problems with the new bodies' lack of experience and their ability to cope with their heavy responsibilities.

I have no doubt—and I hope that no doubts arise—that PCTs will build up experience and that the fears and concerns expressed in the initial stages of their creation will be removed. None the less, experience is a problem in the early stages, as it will be in any new organisation. The trusts have been asked in these early days to concentrate on identifying and providing acute care and other health services. However, if all their time and effort is concentrated on the delivery of health care—everyone would agree that that is their main function—problems may arise if they have to cut corners in the early stages because of those demands.

Education, training and research are a classic issue that PCTs will always feel they can pick up on later while seeking now to minimise the other problems concerning

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health care provision. Another problem is that the trusts' natural orientation is towards primary care. For those reasons, I do not believe that there can be certainty that PCTs will commission so as to promote and safeguard education, training and research to the extent that we would have hoped and expected them to do, especially in their early days.

The safeguarding of those elements of the health service, on whose importance we all agree, is still not addressed by strategic health authorities. The Government have stressed the role of SHAs in terms of the performance management of PCTs that fail to achieve what the authorities believe they should achieve on education and research. I am deeply sceptical, however, about whether the introduction of such loose structures and untried processes at this stage of the reforms will solve the problem.

Nevertheless, there is one sure way we can safeguard the three critical areas in question and put beyond any doubt the responsibility of NHS bodies for those vital elements, which are crucial if our health service is to continue to make improvements and enhancements and to deliver quality treatment. That solution is for the Minister to think again and accept the amendments introduced by another place—a place that is renowned for being not the partisan and highly political body that this House often is, but a more reflective body, which in debates about the Bill has drawn on the expertise of people who have spent a considerable proportion of their professional lives in the health service and in health and research in general. It would be unwise not to heed their wise words and reflective views and to seek to reverse a measure that was introduced into the Bill not to cause trouble but to strengthen, encourage and enhance training, research and education.

In the light of the reasonable way in which I have tried to convince the Minister of the argument, I hope that he will understand in an equally reasonable way that as we are considering such a crucial matter it would be wise to strengthen and reinforce the message by agreeing to the amendments, instead of deciding that they are superfluous and relying on the provisions as they stood before the Bill was amended.

Dr. Evan Harris (Oxford, West and Abingdon): I speak in support of the Lords amendments and against the motions to disagree on the basis of, first, a series of problems that exist at the level of academic medicine and teaching and research; secondly, an additional problem caused by Government policy, which puts more pressure on primary care trusts not to deal with the problem; and thirdly, a question mark over whether there is any problem with introducing the amendments. The Government may suspect that they will not be effective, but I do not believe that they would do any harm.

There are significant problems in education, training and research. There are also significant numbers of vacancies in academic medicine, and that situation is not getting any better; if anything, it is getting worse. Without the people to do the training—and, indeed, the people to train the trainers—we shall not have a work force in the future. A briefing provided by the British Medical Association tells us that the number of medical academics as a proportion of the work force has fallen from 11 to 8 per cent.

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That fall is partly the result of an increase in the numbers of staff, but I would argue that there is an a priori reason for the proportion to stay the same, because as we recruit new staff they will initially be at a junior level, and we are still not seeing enough resources going to provide either the trainers or the trainers for the trainers. The significant problems in the recruitment of medical academics are often due to the pressures on them, and the lack of resources they feel they have in terms of time, equipment, hardware and space to do the teaching that is required.

A further component of the need to ensure that resources are allocated to this area is the desperate need for consultant expansion. If resources were spent on education and research because of the amendment that has been made in the House of Lords, the side effects would be that a significant amount of that money would be extra funding, and that extra priority would be given to consultant expansion. I have said to the Government—and to the Minister who is speaking for them today—on many occasions since 1997 that they must safeguard consultant expansion and ensure that resources go into enabling senior-level consultant staff to do high-quality work, research and training, rather than allowing the expansion of sub-consultant and non-consultant career grade posts, which, for all their merit, are almost by definition not involved in the training of the next generation of specialists; they are almost entirely service-related posts.

Until the Government can do something about the explosion of such posts, I will have little faith in their ability to ensure that there will be sufficient numbers of people to do important work such as the research that is led—although not exclusively carried out—by consultants, and the training that ought do be done almost entirely by fully trained specialists. Were the Government to introduce, through separate legislation, the means of controlling this explosion in sub-consultant grades and non-consultant career grades, we would be much more inclined to support the position that they are taking here and—I suppose that this is what counts for the Government in terms of the size of their majority—in another place. The Minister will accept that I have raised this issue several times; I have never had a satisfactory answer. Perhaps, with this Government, I never will.

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