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Baroness Jay of Paddington: Perhaps I may respond very briefly to the noble Baroness on that point. I am sorry if she felt that I spoke like the Evening Standard. That was not my intention. My hope was to sound much more like the noble Lord, Lord Walton. Obviously, I did not succeed.

I heard the Question put by the noble Lord, Lord Walton, on Monday. It did not reflect the positive virtues or otherwise of any alternative plan for the future of the National hospital. Indeed, any hospital which acquired that particular resource would be very fortunate. I believe that the noble Lord was referring in part to the uncertainty around the whole area of research and development and the research focus on hospitals in London, as well as other places in the country. It was that concern in this administrative area that I sought to illustrate, giving an example of the way in which the universities, if included in planning and strategy, automatically have a voice at the table, which they might not have under the new arrangements.

Baroness Gardner of Parkes: I thank the noble Baroness for that clarification. I agree that the institutes and research are extremely important. But the message that comes through to me very clearly on a day to day basis in the National Health Service is that everyone is very conscious of the importance of research. I do not believe that any of those research facilities are threatened. In fact, I believe that they will expand as time goes by.

Baroness McFarlane of Llandaff: As one who worked for 17 years in a medical school, I should like to add my support to this amendment. I worked and watched the very close relationship between the regional authorities, the health authorities and the trusts. I am convinced that it achieved a great deal in the interests not only of medical education, nursing education and education of other health professionals but also in research and the quality of clinical care. It would be unthinkable that we should lose any of that very close relationship between the authorities and the universities.

Lord Jenkin of Roding: I share the view of the noble Baroness, Lady McFarlane. It is unthinkable that there should not be a very proper close and continuous interaction between the medical schools, the universities

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and in particular the deans of the medical schools—I would also add the Royal colleges—and the organisation of the health service.

The problem arises with the abolition of regional health authorities and the conversion of the regions into outposts of the management executive. They are birds of a different feather; a different kind of animal to which one does not appoint, as it were, outside members. I have absolutely no doubt about the future turbulent process of change, which is already in train and affecting medical education and research. There is the Culyer Report and the Calman Report on the changing patterns of training for doctors; there will be the merger of two of the training grades (registrar and senior registrar); and there is the whole process of continuing postgraduate medical education. As employers address these matters, they will have a profound impact on the way in which the whole of the medical clinical manpower of the health service will be deployed.

I have previously declared my interest as chairman of the Forest Health Care Trust. That trust has had a preliminary look at the whole raft of issues which it will have to address. It has already indicated that some sort of prioritisation of those issues will be considered. It is a huge agenda.

I put to my noble friend on the Front Bench a point which I raised at Second Reading of the Bill; namely, that I am not yet convinced that the whole of that process, which is very properly being driven by the Department of Health and the management executive—indeed, principally by the chief medical officer and others—is at the moment being meshed in with the process of change, which is the subject of this Bill. It comes to a head with Amendment No. 18, with which I have some sympathy. I look forward with great interest to hearing whether my noble friend is able to put a little more flesh onto the bare bones of the suggestion that this matter will be dealt with by regulation. We want to hear exactly how the universities will have that continuing interaction at the regional level, so that the many issues which affect medical education and research are addressed with the full understanding and input of the universities. It is enormously important.

During the passage of the 1990 Bill we secured the representation on a trust with a teaching hospital of a university representative. Noble Lords will remember that I spoke in favour of that. I have to say to the noble Baroness, Lady Jay, that I am less convinced that the same applies to commissioning authorities. Their role will increasingly develop into a different one. Therefore, I have rather less sympathy with Amendment No. 24 than I have for Amendment No. 18. However, in one form or another, Amendment No. 18 appears to me to have cardinal importance as the health service develops because of the huge agenda of change that surrounds the whole question of medical education.

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I know that my noble friend the Minister is well seized of the issue, and I shall not take up any more time before she is able to reassure us. I should just like her to know that I, too, am concerned.

Baroness Cumberlege: I shall do my very best to clothe the skeleton to which my noble friend Lord Jenkin referred. I understand the concerns of the noble Baroness, Lady Jay, and very much respect the views of the noble Baronesses, Lady Robson and Lady McFarlane.

The Government are strongly committed to the vital partnership between universities and the new National Health Service. We will work with them to achieve the highest standards of education and research. Your Lordships will perhaps be aware of the major changes to the funding and support of research and development to which my noble friend has referred. Those developments were announced at the end of last year in response to the Culyer Report. The new measures will include: bringing together all NHS research and development funds into a single funding stream; an extra £8 million in 1995-96 for research commissioned by the NHS; and the creation of a national forum to bring together the major funders of health research to provide advice to the NHS and the Government. The new system will be put in place at the same time as the measures in this Bill on 1st April 1996. Before then, we look forward to the report of your Lordships' Committee on Science and Technology when it has completed its current inquiry into medical research.

There will continue to be a national NHS research and development strategy, but the regional offices will have an important role in informing national priority setting. Each region will have a director of research and development in a senior post.

As your Lordships have emphasised this afternoon, the relationship with the universities is crucial. For that reason, we have already given a clear undertaking that we will include in regulations a requirement that health authorities whose areas include a medical or dental school must have a university representative as a non-executive member. Trusts with significant teaching responsibilities already have a similar requirement. It is in line with our general approach to membership to specify that requirement in regulations. These will be made shortly after the Bill's passage.

The regional offices are very different bodies from the old RHAs. They will not have boards on which different groups are represented. Therefore, it will not be appropriate to have a university representative within the regional office. However, the Government recognise the need for links with universities at regional, and indeed national, level. There will continue to be important strategic bodies at national level, including the Steering Group on Undergraduate Medical and Dental Education and Research, chaired by the Department of Health's permanent secretary. Its members include representatives from the Committee of Vice-Chancellors and Principals, the general medical and dental councils and the Medical Research Council.

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The steering Group agreed the 10 key principles which will continue to guide NHS and university relationships. As regards medical workforce planning, the Advisory Group on Medical and Dental Education, Training and Staffing will continue. Chaired by the Chief Medical Officer, this brings together medical professional representatives with the NHS executive to advise Ministers and that executive. Planning the number of higher specialist trainees will be an important part of its work.

At regional level my right honourable friend the Secretary of State has asked the regional chairmen to take particular responsibility for building links with the universities. The postgraduate dean will be a key link between the regional office and the university, and the consultation paper published by the Government this week will help to ensure that we get the right arrangements in place for medical education at this level.

The noble Baroness, Lady Jay, mentioned the correspondence that had taken place between the Secretary of State and Dr. Edwards, chairman of the CVCP. Correspondence has indeed taken place. My right honourable friend the Secretary of State has willingly agreed to let Dr. Edwards have sight of and comment upon the final draft of the membership regulations as early as possible. In addition, the effectiveness and continuing relevance of the 10 key principles has just been examined in detail by the Joint Medical Advisory Committee of the Higher Education Funding Councils of England and Wales, Scotland and Northern Ireland. They have concluded that the NHS and universities continue to conduct an effective dialogue. We will ensure that that continues under the new arrangements in this Bill. I hope that the noble Baroness, Lady Jay, will be content with this, because it concerns the issues that she raises in relation to SIFTR. An advisory group with senior medical and education membership is reviewing the future arrangements for funding NHS teaching. That body has been asked to report by the end of March, which will allow time for us to consult key groups before implementation in 1996-97.

I deal finally with the point raised by my noble friend Lady Gardner of Parkes concerning the National Hospital. All of our endeavours are intended to strengthen the excellence and expertise of the institute and hospital. That was a point that I tried to make yesterday in the debate in your Lordships' House.

With those remarks, I very much hope that the noble Baroness will agree to withdraw this amendment.

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