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Baroness Cumberlege: My Lords, we discussed a similar amendment in Committee when the noble Lord, Lord Walton, was unable to attend. I am glad that today he has been able to contribute his considerable expertise. It is recognised nationally and internationally. I am grateful for this opportunity to emphasise again the Government's commitment to the vital partnership

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between the universities and the NHS. Perhaps I may reiterate my earlier comments. We intend to continue to work closely with the universities to maintain the highest standards of education and research. We agree entirely with the noble Lord, Lord Addington, and the noble Baroness, Lady Jay, that it is a crucial link.

As the noble Lord, Lord Walton, said, the new health authorities will have membership; it will be laid down in regulations. They will be required to include a medical or dental school member on their boards as a representative and as a non-executive member.

The new regional offices will be firmly part of the Department of Health. Their advisory and liaison arrangements will be much more closely linked with the national advisory framework. The regional offices will be different from the old regional health authorities and, as the noble Lord said, it would be inappropriate for their management boards to include representatives of outside bodies. However, there will be many other links between universities and the Department of Health at regional level.

As I made clear in our previous debate, regional chairmen will have a special responsibility in this area. Perhaps I may clarify a point which the noble Lord may have misunderstood in an earlier debate. There will not be eight NHS policy boards reflected in each region. There will be one national policy board, as indeed there is now, upon which the regional chairmen will sit. But there is nothing to stop regional chairmen within their regions building any mechanisms they wish in order to strengthen those links. Indeed, that was my situation when I was regional chairman at South-East Thames. We had a clear structure that incorporated the university representatives who were not members of the health authority but had a contribution to make in that they were involved in the medical schools—the deans, and so on. So there is much opportunity there.

The postgraduate medical deans also form a strong and important link since they will be fully involved in both the regional offices and the universities. We are just completing consultation on the document which my department published last month, Options for the Future of Postgraduate Medical and Dental Education. We believe that the proposals contained in that paper can be developed to provide an effective and acceptable basis for managing postgraduate education.

We also discussed in our earlier debate the "10 key principles", referred to by the noble Lord, Lord Walton. These guide effective working relationships between the universities and the NHS, in particular at regional level. The recent report of the Higher Education Funding Councils' Joint Medical Advisory Committee found that the principles were well regarded and were seen to provide an essential point of reference at a time of change. The committee recommended that the principles should be rewritten to reflect the new NHS. That is being given active consideration at present. We shall, of course, involve the universities in any changes that are made.

Your Lordships have raised concerns about research and development. On 11th April the Government published a plan to implement the Culyer Report, Supporting Research and Development in the NHS.

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Under the new research funding system, National Health Service research and development funds are to be raised through a levy on NHS purchasers and distributed via cost-based contracts. Contracts will be for research, research facilities and service support for research. The new system will aim to target NHS research and development funds to important work of high scientific quality.

Input from people with a university research background will be essential, especially during the development stage when we are agreeing definitions of coverage and eligibility for funding. Regional offices will, of course, work closely with universities in drawing up and managing contracts for NHS funding of research.

I can assure your Lordships that research and development will remain a top priority in the new NHS. Each of the new regional offices will have a senior post of regional director of research and development. Part of their role will be to develop extensive networks so that the views of all interested bodies, particularly universities, can influence their decisions.

We are continuing to have regular and constructive discussions with the Committee of Vice-Chancellors and Principals about the changes in the Bill. Indeed, there is to be a meeting in the next few days between the CVCP and NHS Executive directors to discuss the CVCP's concerns about liaison between universities and regional offices. I am sure that those discussions will lead to an effective framework to ensure that regional offices work closely and constructively with universities. In the light of those comments, I hope that the noble Lord will withdraw his amendment.

Lord Walton of Detchant: My Lords, I am grateful, as always, to the Minister for her comprehensive reply. She has given us a number of important reassurances about the interrelationship between the universities and the NHS. Since there is to be a meeting between the Committee of Vice-Chancellors and Principals and members of the National Health Service Executive or the Government, I trust that we can await the outcome of that meeting before deciding whether to bring back further amendments at Third Reading. Incidentally, the Minister said that that meeting was to be held in the next few days. My understanding is that it has been cancelled, or at least postponed. However, we trust that it will take place in the near future.

I, like my colleagues in the universities, will read the Minister's comments carefully. The issue of regional representation or the non-representation of the regional university voice is crucial. I had not understood that the policy board would be a purely national body. I trust that the regional chairmen may be persuaded to create mini-policy boards at regional office level because of the crucial nature of the relationship and its importance to the future. However, in the light of what the Minister said, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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6.15 p.m.

Baroness Jay of Paddington moved Amendment No. 10:


Page 19, line 34, after ("Authority") insert ("but of whom one shall be a Chair of the Social Services Committee of a local authority in the area for which the Health Authority is to act").

The noble Baroness said: My Lords, my amendment is designed to establish a formal working relationship at board level between the new health authorities and the social services of the relevant local authorities. In a sense, it does not cover the same ground as that discussed on the previous amendment introduced by the noble Lord, Lord Walton, but is designed to try to make more precise and more formal the relationships which are vital to the work of the new health service and community care arrangements.

Noble Lords will be aware that it is the Government's aim to transfer more and more health services from hospitals, from the acute sector to the community and primary care, and that the boundaries between medical treatment and social care are becoming ever more blurred. We have seen some of the difficulties that that has caused for both health and local authorities in the past one-and-a-half years. The problems of funding and managing care in the community for the mentally ill, the disabled and the elderly, have been discussed in your Lordships' House on many occasions. Like other services they are now the joint responsibility of health and social services authorities.

In the past few years we have also seen the development of The Health of the Nation programme which crucially depends on co-operation and collaboration between, among others, local environment and education agencies and health authorities. We cannot expect to have successful "healthy alliances" on issues such as air pollution and asthma and sexual health education in schools if those responsible for the programmes are working from different parts of the social and health services and perhaps working in demarcated isolated.

Noble Lords will be aware that Clause 22(1) of the National Health Service Act 1977 places a statutory duty on health and local authorities to co-operate to secure the health and welfare of their residents. But the formal mechanism for achieving that has been through the joint consultative committees which, in my many years' experience of membership of two such committees, has always been the least satisfactory and least practically effective part of health authority work. My discussions with local authority colleagues, both past and present, suggest that they feel the same.

The amendment is designed to breathe new life into inter-agency co-operation at a formal level by bringing social services into the heart of the new health authorities. I suspect that the Minister will say in response that the Government prefer to rely on good practice and guidance to achieve co-operation. I am sure that in some places that will be enough. I am impressed, for example, by the recently published Community Care Plan for Westminster 1995/96. That local authority document is signed jointly by the director of social services from the local authority and the chief executive of the local health authority. The proposals emphasise

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the importance of their joint planning teams. Interestingly, they measure their performance against key area targets suggested by the Department of Health. The document also says that there are longer-term issues which the Department of Health has asked them to continue to address. Those include focusing on,


    "developing care management; making sure that continuing care responsibilities are made clear; developing the 'enabling' role of the local authority; learning to manage the market for social care and improving collaboration between agencies".

That is obviously an example of good practice which has been largely driven by officers of the local authority and executive directors of the health authority. It depends on effective working relationships between individuals.

However, there is nothing in the new Bill and little in the guidance to ensure either that that kind of good practice continues or, perhaps in other places, gets started. The whole crucial system could collapse if particular individuals moved to other posts or there were bad personal relationships between the executive officers involved.

Surely, it would be more sensible if the relationship were formalised by making the chair of social services a member of the health authority board. Community care plans would then, in the current jargon, be jointly owned. If the Government or the Department of Health would prefer to make the local social services director an executive member of the new board, ex officio—which could be specified in regulations—we would find that satisfactory. But the important issue is to create an unavoidable requirement for health authorities and social services to work together.

There seems to be an inconsistency in the Bill of relying on good practice, for example, in that area and, as we discussed earlier, in professional representation on health authority boards; but not in other areas—particularly in regard to professional advice which we discussed in relation to Amendment No. 2. Paragraph 3 of Schedule 1 to the Bill requires health authorities to secure professional advice. The presence of the social services in the health authority is at least as important and, therefore, should be given the statutory force of the other type of advice by making the chair of the social services committee or the director of social services an integral part of the new health authorities. I beg to move.


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