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Baroness Jay of Paddington moved Amendment No. 18:


Page 12, line 19, at end insert:
("( (aa) after that subsection insert—
"( ) For the purpose of ensuring the effective integration of clinical teaching and research within the National Health Service, the Secretary of State shall, in relation to any committee, office or other body which he establishes to exercise any regional management function within the National Health Service, provide, following consultation with the relevant universities, that at least one member of that committee, office or body is a representative of the university medical or dental schools within that region.".").

The noble Baroness said: In the absence of the noble Lord, Lord Walton, and with his permission, I rise to move the amendment, which also stands in my name and that of the noble Baroness, Lady Robson. With this amendment I also speak to Amendment No. 24.

The purpose of these two amendments is to formalise the involvement of academic medicine in the new NHS structures, and to probe the Government's present rather unsatisfactory suggestions for resolving this question.

Universities with undergraduate medical and dental schools have a key role in underpinning the National Health Service. The noble Lord, Lord Walton, who unfortunately cannot be with us today, and the noble Lord, Lord Dainton, were eloquent in exploring the importance of this role at Second Reading. The noble Lord, Lord Walton, in referring back to the debates on this subject that were held in this House in 1990 during the passage of the Health Service and Community Care Bill, said:


the link between the universities and the health service—


    "is even more important now than it was at that time".—[Official Report, 6/3/95; col. 26.]

Amendment No. 24 refers to the membership of the new health authorities. As the Committee will know, the Government accepted in the other place that the new health authorities will have a statutory duty to include a member from a local university where that is relevant. However, this is a provision to be contained in regulations—regulations which are, of course, as yet unknown. But the professional bodies, led by the Committee of Vice-Chancellors and Principals, is anxious that the regulations ensure that the new arrangements work at least as well as the existing ones.

There are many concerns and uncertainties surrounding, for example, the merger of academic institutions and institutions involved with research. Members of the Committee will remember that we heard the noble Lord, Lord Walton, refer to the particular problems of the National Hospital for Neurology and Nervous Diseases earlier this week and the potential threat to academic work and research because of the potential merger when that hospital is moved. There are also concerns and uncertainties about the new arrangements for medical training and for funding

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research. They are such that the Committee for Vice-Chancellors and Principals feels that its members would have much more confidence in the future if the Government were to accept this amendment and the requirement for university representation on local health authorities were placed on the face of the Bill.

There is even greater anxiety about the new regional outposts of the Department of Health which are the subject of Amendment No. 18. At present, relevant universities have statutory membership of regional health authorities, which enables them to participate in planning and decision-making at that level. If the universities are not included in the new regional arrangements, their important contribution will be lost. And, very importantly, the issues of postgraduate medical education and the supervision of vocational training for general practitioners will be thrown into disarray.

Another crucial area is the distribution of the special funding for teaching and research—what the noble Lord, Lord Walton, referred to at Second Reading as "that animal known as SIFTR". This money, which sustains most of the innovative work in the health service, must be distributed on a strategic basis with universities playing a leading role. It is inappropriate that this should be done at the local health authority or trust level. It is difficult to see how the strategic role of the universities in distributing and helping to guide and advise on SIFTR can be achieved effectively if the universities are not formally linked to the new regional offices. That is the purpose of this amendment.

I understand that there has been correspondence between the Secretary of State and Dr. Edwards, who is the chairman of the CVCP, about achieving effective arrangements without the statutory requirements of legislation. I understand that the Secretary of State told Dr. Edwards that regional directors have been reminded that they should take account of the views of the universities "in appropriate circumstances". However, Dr. Edwards wrote to the Secretary of State on 1st March stating that this was an inadequate safeguard. He said that there was a need for a clear and unambiguous formal mechanism. He went on to say:


    "The fact that letters have to be written reminding Regional Directors to take account of the views of universities 'in appropriate circumstances' underlines the very heart of the problem. From my own experience, and that of other statutory university representatives at the regional level it is precisely when they are in at the decision making level that their role is most valuable in alerting and reminding their colleagues of the implications of health service-led decisions on the research and teaching base. It is not clear from your letter who is to decide when and what would be 'appropriate circumstances'".

The CVCP has further asked that, if it is unacceptable to the Government that the arrangement for a formal link between its members in the universities and the regional outposts is included in statute, they should at least be consulted about the regulations which will govern the appointments and arrangements. I understand further that the Secretary of State again responded to the CVCP in the past week offering informal discussion but no proper consultation about the regulations. Quite rightly, the CVCP does not feel that this is good enough.

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All of this is of great significance to distinguished members of the medical profession, and indeed to the universities in general. It is also very important to the users of the NHS. The academic medicine which has underpinned standards of care and improved services for patients has been a very important ingredient in the National Health Service in the past. We have heard that in the present and the future evidence-based health service care is to be the theme of the new health service. I hope very much that in the spirit of maintaining excellence, the Government will be able to accept these amendments. I beg to move.

Baroness Robson of Kiddington: I rise to support these two amendments. We on these Benches consider them to be two of the most important amendments to the Bill.

The success of the NHS is largely dependent on the quality of doctors and dentists trained and educated in university medical and dental schools and on the research which leads to advances in medical care. Close co-operation between clinicians employed by the universities and those employed by the NHS is essential for the maintenance of medical standards in the future.

Health authorities inevitably have to make decisions which may have an impact on medical training and research. It is most important that there is a member who combines expertise both in clinical practice and in teaching and research drawn from the universities. The Government have recognised the need for universities which have medical and dental schools to be members of the relevant health authorities. As the noble Baroness, Lady Jay, said, that will be a requirement contained in the regulations.

I am not fond of things contained in regulations. This is such an important issue that it should be on the face of the Bill. On the other hand, at present the universities have statutory membership of the RHAs. When the RHAs are abolished and replaced by regional outposts of the NHS Executive, there is no requirement for relevant universities to be part of the regional office. To me that is an enormous mistake, I urge the Government to think again.

3.45 p.m.

Baroness Gardner of Parkes: I agree with the statements that have been made about the importance of this issue, but I believe that it will be covered by regulations. I rise to speak on these amendments only because the noble Baroness, Lady Jay, brought out a point about the National Hospital for Neurology and Nervous Diseases, which I feel was rather a red herring. It was about as inaccurate as the Evening Standard reports, which said that this was a shotgun marriage and the hospital would be closed by the end of April. That is not the situation at all. The hospital has been told to choose a partner for itself.

The noble Lord, Lord Walton, is a great expert in this field and I am sorry that he is not in the Chamber. He might perhaps have put the case slightly differently or perhaps his points would have been accepted. But I do not believe that this amendment is in any way related to the future of that particular hospital. Everyone wishes to

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ensure a safe future for the National. The present decisions that have been made have been announced in order to give the hospital itself time to consider what it wants to do.

As chairman of the Royal Free hospital, I know that we should love to have that hospital as a partner. But I read in the newspaper that it is much more likely to go to the UCL. But we do have close working links with the National now and there will be combined medical schools of University College and the Royal Free; so there is no question but that the institute will go to that combined body, as will most of the postgraduate institutes in that area.

I feel that that matter is a small red herring in relation to these amendments. I could not let it go without some comment.


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