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Lord Macaulay of Bragar: My Lords, before the noble Baroness sits down perhaps she will deal with the point that I raised as to the cost arising to the public purse from the Home Secretary's illegal actions in introducing the tariff scheme. The Minister did not deal with that issue at all. I accept that she may not have figures available now, but will she give an undertaking to provide the figures to the House, perhaps in a month from now?

Baroness Blatch: My Lords, the important point is that claimants have been treated fairly in the intervening period. The question of whether parliamentary time has cost money is not the only point raised during the course of the debate that I have not dealt with. I hope that the noble Lord will forgive me for not answering the question, of which I was not given notice. If I can produce some quantifiable figures I shall write to the noble Lord.

On Question, Bill read a second time, and committed to a Committee of the Whole House.

Consolidated Fund (Appropriation) Bill

6.52 p.m.

The Minister of State, Department of Social Security (Lord Mackay of Ardbrecknish): My Lords, I beg to move that the Bill be now read a second time.

Moved, That the Bill be now read a second time.—(Lord Mackay of Ardbrecknish.)

On Question, Bill read a second time; Committee negatived. Then, Standing Order No. 44 having been dispensed with (pursuant to Resolution of 17th July), Bill read a third time, and passed.

Queen Mary and Westfield College Bill

6.53 p.m.

Lord Jenkin of Roding: My Lords, I beg to move that the Bill be now read a second time.

I am tempted to follow the procedure of my noble friend Lord Mackay of Ardbrecknish, but I have a suspicion that we may take a little longer than on the Consolidated Fund (Appropriation) Bill.

The Bill is promoted by three colleges of the University of London: Queen Mary and Westfield College, of which I have the honour to be a Fellow; St. Bartholomew's hospital medical college; and the

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London hospital medical college. The central purpose of the Bill is to enable these three colleges to merge together into a single institution. The colleges intend to create a new medical and dental school to be called St. Bartholomew's and The Royal London Hospital School of Medicine and Dentistry.

As well as being a Fellow of QMW—as Queen Mary and Westfield College is commonly known—I was the Secretary of State for Health and Social Services in 1980-81 when, with the benefit of the advice of the committee under the chairmanship of the noble Lord, Lord Flowers, whom I am very pleased to see will speak in the debate, I recommended that the two medical schools and what was at that time Queen Mary College should form a consortium, with the pre-clinical departments transferred to Queen Mary College. That grouping of the three institutions, which became known as BLQ—Barts, London and Queen Mary—was the subject of widespread consultation, and after some hesitation it was agreed to proceed. Accordingly, in 1990 the two medical colleges transferred their pre-clinical departments to Queen Mary and Westfield College where a new faculty of basic medical sciences was established. The three colleges also came together in the City and East London Confederation of Medicine and Dentistry. Under those arrangements the medical and dental students spend the first two years of their course at Queen Mary and Westfield College and then complete their clinical training at Bart's and the London.

It is now the wish of those three colleges to build on that collaboration by merging into a single institution. That proposal has a history. The process of integrating the teaching of medicine in London with multi-faculty colleges in fact goes back much further—to 1968 when the Royal Commission on Medical Education, under the chairmanship of Lord Todd, recommended that pre-clinical students should study in a multi-faculty environment. The London medical schools were unusual in being free-standing independent colleges and not part of multi-faculty institutions. Initially, as with BLQ, it was the pre-clinical departments which were the subject of the first moves but, later, full mergers took place. As I am sure noble Lords are aware, the University College hospital medical school was merged with University College London in 1979, King's College hospital medical school was merged with King's College London in 1983, St. Mary's hospital medical school was merged with Imperial College in 1988; and in that same year the Middlesex hospital medical school was merged with University College.

It is now widely accepted that there are great advantages in medical schools being fully integrated into multi-faculty university institutions in that way. It is regarded as being good for the student experience and for the curriculum; it is also now regarded as essential if medical and dental research is to reach the highest levels.

So, when in October 1992 the Tomlinson Report into health services and medical education and research in London recommended the linking of the two medical schools of Bart's and the London with what was by then Queen Mary and Westfield College, that was in full accord with practice and earlier recommendations.

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That is the purpose of this Bill. It will bring the three colleges together into one institution. The pre-clinical departments from the Bart's medical college and the London medical college have been together now for some five years in a splendid purpose-built building on the Mile End campus of QMW called the faculty of basic medical sciences. The Bill will complete the process of the merger of the three colleges into one institution.

The Bill has wide support. The governing bodies, the councils, of all three colleges are fully behind the Bill. They wish to see the merger and the creation of the new unified school. So, too, are the staffs of the colleges. I believe it has the support of my noble friends on the Front Bench and also of noble Lords on the Front Benches opposite.

There is one point that needs to be made clear, particularly in the light of debates in another place. Although the merger was recommended by Sir Bernard Tomlinson, it stands entirely separate from any question surrounding the future of St. Bartholomew's hospital or, indeed, of any other aspect of the reconfiguration of health services in London. This Bill is about medical and dental education; it is not about the delivery of NHS services. Indeed, the merger of the colleges is fully justified in its own right, irrespective of what may or may not be the future of medical services at St. Bartholomew's hospital in West Smithfield. As I am sure noble Lords fully understand—it is right to spell it out—the medical college is an entirely distinct and separate legal entity from the hospital.

The Bart's college council resolved to promote this Bill and to merge with the other two colleges before the decision to close Bart's hospital was taken. If hospital activity continues on the West Smithfield site, then the new medical school's teaching and research will likewise continue on that site. But if there is to be no clinical activity at Smithfield—and that is not a decision which rests with any of the colleges—then that activity must perforce take place elsewhere. In either case this Bill, and the merger which it seeks to bring about, is the right way forward in the interests of medical and dental education and research.

Of course, nothing affecting medical education or services in London can be without controversy. This Bill was opposed in another place mainly because it was thought that opposition to the merger of the medical schools might strengthen the case for the retention of Bart's hospital. But even the most cursory scrutiny of the debates will show that to have been a thoroughly mistaken view. The Second Reading of the Bill in another place was moved by my right honourable friend Peter Shore, himself an avowed opponent of the closure of Bart's hospital. The Third Reading was moved by my right honourable friend Peter Brooke, who achieved some notoriety when he attacked the proposals for Bart's of the then Secretary of State for Health. They opposed the closure of Bart's. Each in turn moved a debate on the Bill. The argument that the Bill has anything to do with the closure of Bart's has been firmly blown out of the water. Given the strength of support for the Bill and for the principles which have advised the

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proposals for merger, the Bill received resounding majorities in another place. At Second Reading the majority was 164 to 19; and on Third Reading, 213 to 56.

A new objection has more recently been raised by way of justifying opposition to this Bill. The petitions which have been laid reflect that new ground. It is said that the Bill aims to destroy one of the world's greatest medical schools—St. Bartholomew's hospital medical college. Although the decision to merge was taken by the council of the college, and although the dean of the college signed the petition to bring the Bill forward, it is said that they are misguided, have responded only to external pressure and direction, and presumably, therefore, that their views should be disregarded.

Even that argument is founded upon a complete misunderstanding. The Bill will not destroy St. Bartholomew's hospital medical college other than in a purely formal and legal sense. It is a merger Bill. It will link this distinguished college with another distinguished medical school at Whitechapel and bring about a significant strengthening of the academic and research base largely in brand new buildings and facilities. All that is good at Bart's medical college will be preserved and will continue to flourish.

It is not surprising that those who carry responsibility at St. Bartholomew's hospital medical college have been alive to the realities of the situation. They have seen the developments taking place elsewhere in London—I referred to them a few moments ago—creating some of the strongest and most dynamic medical schools in strong multi-faculty institutions in the country. They have been aware—sometimes painfully aware—of the fierce competition for the best students and for research grants and for the most talented academic and research staff. They have realised the need to strengthen interdisciplinary links. They have recognised the need to raise research ratings in order to bring in more funds from the Higher Education Funding Council. Of course, the college's decision to seek this merger is not unrelated to what is going on in the worlds of higher education and medicine generally. But to argue, as has been done, that it is not a decision freely arrived at on the basis of a careful and rational consideration of all the arguments, is absurd, even grotesque, particularly when one knows, as many noble Lords do, the kind of people who are members of that college council.

Before I conclude, I should like to say a word about the Motion for an Instruction tabled by the noble Lord, Lord McGregor of Durris. He is quite right that Clause 7 will have the effect of widening the powers of the trustees of the St. Bartholomew's hospital medical college trust. I should explain that that is a separate charitable trust. If one is familiar with the main teaching hospitals, they have special trusts of that kind. He is right in saying that the powers will be widened because the Bill will substitute the name of Queen Mary and Westfield College for that of St. Bartholomew's hospital medical college. Everyone agrees, however, that it would not be appropriate for these trust moneys to be spent on things other than for the support of medicine and dentistry.

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Accordingly—this addresses the point of the noble Lord's Instruction—a formal agreement to that effect has now been reached between the principal of Queen Mary and Westfield College, Professor Zellick, and the chairman of the trust, Sir Anthony Dawson, which has the support of all Sir Anthony's fellow trustees.

As a result, the council of Queen Mary and Westfield College unanimously resolved to take steps, outside the Bill, to seek to amend the terms of the trust deed following merger. The council affirmed,


    "unequivocally that it wishes to see the Trust acting for the benefit of medicine and dentistry in the College following merger and warmly welcomes the role it will play in support of the new School".

In any case, the trustees continue to have full discretion to devote their resources to the support of medicine and dentistry within QMW if that is their wish, as it is expected to be.

I have had the opportunity of discussions with the noble Lord, Lord McGregor of Durris. I believe that he is now fully apprised. I think that he will accept that Sir Anthony Dawson and his fellow trustees do not believe that the Bill needs to be amended in the sense of the Instruction. Given the urgent need now to move forward swiftly, and to avoid any possible risk of the Bill being returned to the maelstrom of another place (I hope that that is not unparliamentary language), perhaps the noble Lord will be persuaded not to press his Motion.

I conclude on a personal note. Some years ago I was privileged to serve on the council of Westfield College. I formed a great affection and respect for that college and could, therefore, entirely understand and sympathise with the anguish when, towards the end of the 1980s, it became necessary for that college to merge with Queen Mary College to form QMW. To have to abandon the attractive campus in Hampstead for the Mile End Road was an extremely difficult and painful decision. Nevertheless, with the committed support and enthusiasm of all involved, that merger has produced great academic and related benefits. QMW is now the fourth largest college in the University of London with over 6,000 students. Its reputation as a teaching and research college is extremely high. When this Bill becomes law, and it merges with the two medical schools of Bart's and the London, the new institution will be able to seize with great enthusiasm the opportunities that that merger will offer.

The Bill is essential to achieve the objective of a single, fully integrated institution within the University of London, and I commend it to your Lordships. I beg to move.

Moved, That the Bill be now read a second time.—(Lord Jenkin of Roding.)

7.9 p.m.

Lord McGregor of Durris: My Lords, I observe with some trepidation that my intention stated on the Order Paper—to move an Instruction to the Select Committee to whom the Queen Mary and Westfield College Bill will be committed—seems to have provided three past and notably distinguished vice-chancellors of the university, in which I taught for most of my working life, with the prospect of an

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afternoon's shooting. Let me assure them and other noble Lords that I am not worth the waste of a single cartridge.

I assure noble Lords at the outset that I support the merger of the colleges, for the reasons given so succinctly and effectively by the noble Lord, Lord Jenkin of Roding. I have no desire to criticise the present policy of the University of London to reform medical education. Indeed, I wish it had happened in my time when I thought that doctors exercised far too much domination over the university. I then had my hopes—like many others—falsified by the failure to act on the recommendations of the Todd Commission.

Most certainly, I shall not discuss or discourse upon the past history or future prospects (or lack of them) of St. Bartholomew's hospital. They have no bearing upon the anxiety which led me to put down my Instruction.

Clause 7(1) of the Bill will, as the noble Lord, Lord Jenkin, explained, prejudice the objects of the charitable trust of St. Bartholomew's hospital medical college. At present, the trust is authorised to seek the promotion and advancement of all aspects of the medical college and education in the college and to hold the trust's assets for those purposes. Under the terms of the Bill, however, the assets of the trust will be held upon different terms, as Queen Mary and Westfield College will replace the medical college as the remaining body. That would mean that any of the assets held by the trust after the amalgamation could be applied towards the promotion and advancement of any form of education of the unified body and need not necessarily be confined to medicine, surgery or dentistry. While this new body will include the medical college, the situation would still be that funds could be spent outside the present objectives to which the trustees are confined.

My concern is that as the funds administered by the trust were raised by public subscription with the intention of them being devoted to medical and dental education and research, it would be improper to ride roughshod over the wishes of the donors.

I am happy to know, however, that—as the noble Lord, Lord Jenkin, explained—that view is now shared by the council of Queen Mary and Westfield College. Yesterday, the principal was kind enough to send me a copy of the resolution passed unanimously by the college council and from which the noble Lord, Lord Jenkin, quoted. Professor Zellick gave me permission also to quote from it directly. I do not propose to do so because it would be pointless to repeat what the noble Lord has already said.

I add that I also have the permission of the chairman of the medical college trust, Sir Anthony Dawson, to say that he was consulted about the phrasing of the resolution and that he is happy with it, as are his fellow trustees.

Accordingly, the differences of opinion that have clustered around the merging of the colleges have been greatly eased by recent discussions and agreements. The principle that my Instruction sought to establish—namely, that funds subscribed for charitable purposes should be used for the purposes for which they were subscribed—has been entirely accepted by all the bodies involved, in so far as I understand it is possible for them

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to accept it. The result is that I do not intend to move my Instruction at the appropriate time. Its purpose was no more than to focus attention on what I regard as the peremptory requirement of maintaining the integrity of charitable bequests.

7.16 p.m.

Lord Annan: My Lords, the noble Lord, Lord Jenkin, set up the case with such clarity and force that I hardly think much more needs to be said. I wish to emphasise that the mergers began often for financial reasons. The schools and institutes of the University of London and all the medical schools and institutes used to be given grants by the court of the University of London, where a sizeable bureaucracy operated and flourished. The Senate House, which was also meant to co-ordinate the academic activities of the constituent parts of the university—and very time-consuming and self-indulgent those boards and committees were—created a further bureaucracy.

However, when the financial axe fell in the 1980s, it became clear that the university had to be reorganised. The Senate House bureaucracy was cut and slashed but, most striking of all, many of the small colleges were compelled to marry. Before the debacle, when I was vice-chancellor, I remember trying to persuade Bedford and Westfield to do so, but in the end they had to be dragged to the altar. Perhaps they might have been wiser had they earlier chosen a partner rather nearer home, but they had a much warmer welcome where they went than they would have got in the centre of London.

I call the amalgamations "shotgun marriages" because the bride was pregnant. The smaller colleges brought with them not only devoted staff but the dowry of their sites and buildings. Last Friday I was giving a paper in Queen Mary College to a learned society. I was absolutely amazed by the transformation. Indeed, I could not find my way among the new buildings. Vast new palaces have arisen, financed by the sale of the site buildings and other assets of Westfield College. This, I believe, will also be echoed when the medical schools are amalgamated.

I do not wish to be disingenuous, of course; there is a medical issue here. I shall leave to the noble Lords, Lord Flowers and Lord Quirk, to relate the history of why, ever since Lord Todd's Royal Commission on Medical Education, the University of London has been wrestling with the problem of rationalising the number of medical schools. But I will just say this. Long ago it was recognised that doctors ought to gain a much more profound understanding when they are medical students of basic medical science. All medical courses begin therefore with the study of pre-clinical subjects: physiology, anatomy, pharmacology and the like. Now, the pre-clinical teaching, which was very strong when it was carried out in large multi-faculty schools such as University College, which numbered such famous scientists as Sir Andrew Huxley in physiology, Sir James Black and Heinz Schild in pharmacology, J. Z. Young in anatomy. When those people were there, obviously the medical students benefited enormously from their presence. But most of the London medical schools had very small pre-clinical departments which

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could not attract the research funds or the staff that they deserved. That is why pre-clinical teaching at Bart's and the Royal London has already been moved to Queen Mary College, and why the pre-clinical departments at Guy's and St. Thomas's hope to find a new site when they can merge with the pre-clinical departments of King's.

I shall say no more about that, except that the 12 London medical schools are falling in line with medical schools in the rest of the country, all of which are anchored to multi-faculty institutions. That is of course what the General Medical Council wants, and what the Higher Education Funding Council wants. I am very glad indeed to understand from the Labour Benches that we shall have some support for this Bill. I believe that the statement in another place that Bart's medical college will be destroyed is totally false. On the contrary, floreat et florebit. If the Government change their mind and preserve Bart's as a hospital with a full range of clinical departments, then of course clinical teaching will be continued there. If they do not, then it will not be continued. But that is a matter that is wholly distinct from this Bill.

There remains the caveat of the noble Lord, Lord McGregor. I must say that I understood the noble Lord's concern only too well. I have seen a number of dubious transactions in universities. I have seen chairs in accounting converted to the study of the more esoteric crevices of economics. I have seen bequests to teach drama used to fund lectureships in English literature. And who can forget the dismay of Lord Nuffield at seeing a college which he hoped would teach practical engineering and train industrialists converted into a temple for the social studies by that wily operator Lord Lindsay of Birker?

But surely in this case, can we credit for one second that the doctors and medical scientists of the college would meekly accept the malversation of their funds to endow the study of palaeontology? I very much appreciated the account by the noble Lord, Lord McGregor, of the reasons why he was prompted to move his amendment, but also the reasons why he will in fact withdraw it. With great respect, although it is perfectly true that bogeys do exist, this bogey is a pumpkin, and fit only to frighten tiny tots. I hope that the Bill will have a smooth passage through Committee.

7.22 p.m.

Lord Flowers: My Lords, the Bill was admirably explained by the noble Lord, Lord Jenkin of Roding. The noble Lord, Lord Annan, has already made some of the points that I might otherwise have made, and made some other remarks, too, which perhaps I would not have made. It seems therefore unnecessary for me to say much more than that I warmly support the Bill. As the second of the Three Musketeers—who once carried shotguns, however—there are perhaps two points that I might briefly make by way of emphasis.

First, the sole purpose of the Bill is to unite, with their concurrence, three academic institutions of the University of London. Some years after the noble Lord, Lord Annan, was vice-chancellor, I had the honour to become vice-chancellor of London. I therefore declare

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my interest. It is an interest arising from my profound respect and affection for those three institutions and from my concern for their future welfare within the university, and not from any formal connection that I have with any of them or with the university itself at the present time. I merely wish them well.

The Bill does not affect any of the hospitals with which those institutions are concerned. At the risk of a little overkill, perhaps I may say that the hospitals do not belong to the University of London; they belong to the National Health Service. Medical schools are separate entities from hospitals, legally distinct and with different paymasters. The merger proposed in this Bill would continue to be proposed by the institutions concerned even if the disposition of hospitals were different. Likewise, the future of the hospitals does not depend on whether or not this merger takes place. There has been great confusion on this matter, which is why I take the liberty of rubbing it in a little, even though it was already stated very clearly by the noble Lord, Lord Jenkin.

For 30 years or more, the University of London and the Government have been advised that the great potential strength of London medicine will manifest itself again only if its multiplicity of medical schools are brought together into a few major centres, each containing in addition a multifaculty school to provide all the links with science, technology and the humanities which are indispensable to modern medicine. Each centre will then, in all but name, constitute a fully-fledged university in its own right. Each will have the potential to be first-rate in medicine as in other subjects. Contrary to popular belief, not all London medical schools are first-rate at the present time. There are plenty of statistics to establish that beyond any doubt.

I made a modest contribution myself some 15 years ago to the advice to which I referred, together with the noble Lord, Lord Butterfield, who is to speak later, and a number of others, at the request of the university, which was fully aware of the impending decline of its medical prowess. The noble Lord, Lord Jenkin of Roding, was good enough to recall that.

In more recent years there has been wide agreement that there should be just four such centres in London, associated with University College in the north; Imperial College in the west; King's College in the south; and Queen Mary and Westfield College in the east. Only in that way can the needs of teaching and research be catered for in modern circumstances, as well as the needs of patient care. So this Bill is to merge together the London hospital medical college, St. Batholomew's hospital medical college, and the multi-faculty Queen Mary and Westfield College. The names of all three institutions will be preserved in the merger, not only to emphasise their historic roles but also to continue in a larger context their distinct characteristics.

It has often been said that you can always tell a Bart's man, but you cannot tell him much. I expect that in the future that will be said of members of the three newly merged colleges as if they were all from Bart's. Good gracious me!

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But there is another source of common misunderstanding, and this is my second point. It is often said that one should first of all provide equitably for patient care, and when that has been done find some way for the medical schools to fit in. After all, it is said, the patients should come first. There are other noble Lords who are much more able than I to explain the difficulties of trying to satisfy in that manner the teaching and research needs of medical schools, with their necessarily multifarious priorities and specialities, I shall only say, as someone who in the past has had to grapple with this problem, that every serious study has come to the conclusion that, at least in London—where for the size of its population there is an over-abundance, not of hospitals in general but of teaching hospitals and medical schools in particular—that is not the way to go about it. The major centres of teaching and research have to be settled first and the generality of patient care can then follow.

It is very much to the credit of this Government and especially Mrs. Virginia Bottomley when she was Secretary of State for Health that they have at last tried to tackle the problem of London medicine the right way round. It would have been so easy and politically so much more palatable to have put if off yet again in response to popular but uncomprehending pressure. I know that that remark was not strictly relevant to the passage of the Bill, but I thought that it was time that I stood up to be counted in the matter.

The Bill is not a government measure, but it sets in place one of the cornerstones of London medicine. It is going about it the right way round. I commend it to your Lordships.

7.30 p.m.

Lord Quirk: My Lords, it would seem that any opposition to this Bill must rest upon misconception. Let me therefore begin by re-emphasising the sharp and essential distinction between the organisation of medical care and the organisation of medical training.

The first, as the noble Lord, Lord Flowers, reminded us, responds to the imperatives of demography together with the most efficient disposition of high skills and specialised equipment. The second is dictated by purely educational desiderata, and it is only with the second that the Queen Mary and Westfield College Bill is concerned. To be specific, the future of St. Bartholomew's hospital has no bearing upon the future of St. Bartholomew's medical college, on which alone the Bill before us impinges.

That impingement is not new. It did not arise as the result of or in connection with the Department of Health's recent consideration of hospital deployment. It is not true, to quote a "Save Bart's" leaflet dated 14th July that crossed my desk this morning that:


    "the proposal was in fact designed to facilitate the closure of St. Bartholomew's Hospital".

So far from this being in fact "a fact", the proposal was formulated on solely educational grounds, as the noble Lord, Lord Jenkin, pointed out and reminded us in his opening speech, by the Royal Commission on Medical Education under the chairmanship of Lord Todd.

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The Todd Commission was thoroughly expert and authoritative, as befitted a body with so distinguished a chairman. It included men and women in the very forefront of medicine and medical education. There were Josephine Barnes, Peter Medawar, Robert Platt (who was subsequently ennobled); and there were heads of a couple of London medical schools, like Brian Windeyer and John Ellis.

The Royal Commission's report in 1968 (Cmnd 3569) took the view that changes in the training of doctors required more laboratory science and more interaction with disciplines beyond the purely clinical. The commission argued convincingly that, to achieve the critical scientific and professional mass as well as the desirable intellectual mix, a medical school not only needed to have an annual intake of at least 200 students but also needed to be an integral part of a multi-faculty institution, so that medical students were not isolated from chemists, physicists and engineers, nor yet from philosophers and historians.

Confronted by the situation in London, where there were no fewer than 12 medical schools fulfilling none of those conditions, and with several mustering an annual intake below 100, the Todd Commission recommended a radical programme of mergers. The one that concerns us today is firmly adumbrated in paragraph 438 of the 1968 report, which recommended combining the Bart's and the London medical colleges so as:


    "to become in due course the medical faculty of Queen Mary College".

The report went on to note that that college had the rare feature among the University of London's institutions of having space in which "physical expansion is possible" together with just such an environment of "natural and behavioural sciences" as the Royal Commission sought for the enrichment of medical education.

That was 1968, and the academic thrust of the Todd Report was widely accepted as thoroughly sound. But if a week is a long time in politics, a decade is a very short time in academe, and when I became the University of London's vice-chancellor in 1981, in succession to the noble Lord, Lord Annan, I was confronted—as had been the Todd Commission 16 years earlier—by 12 medical schools, together with the need for collegiate rationalisation, as the noble Lord, Lord Annan, has reminded us, that went far beyond medicine.

Like the Todd commissioners, I was struck by the potential of Queen Mary College, and it was promptly identified as a growth area. The college's science and engineering were first expanded, and ultimately the humanities too, not least through the merger which brought, as the noble Lord, Lord Jenkin, reminded us, the additional strengths of Westfield College to the Mile End Road. In other words, at the present time, the enlarged and enriched Queen Mary and Westfield College is an incomparably superior body in which to combine the Bart's and London medical colleges than even the Todd Commission could have envisaged.

Many in your Lordships' House, both past and present, have striven to see the goals achieved that are set out in this Bill, among them Lord Todd, Lord Platt and the noble Lord, Lord Dainton, and of course those

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who are here this afternoon, including the trio of London University's former vice-chancellors who are speaking today. The case for what was proposed was powerful enough 30 years ago; today it is overwhelming.

7.38 p.m.

Lord Walton of Detchant: My Lords, after listening to the remarkably comprehensive and detailed opening speech by the noble Lord, Lord Jenkin of Roding, and subsequently to three former vice-chancellors of the University of London, I begin to recognise with even greater strength than in the past the force of the comment made by one academic, who said how surprised he was that the vice-chancellor's room was so sparsely furnished with nothing but a throne and a prayer mat.

This is a Bill which I believe deserves the universal support of this House. The record in teaching and research of the London medical schools over the past half century at least has been one of outstanding achievement. There is no doubt that they can be proud of all that they have done for medical teaching and research. But, as other noble Lords have said this afternoon, the Todd Commission warned that the quality of London's medical education was threatened by having 12 medical schools, each with an independent teaching hospital but with no direct contact with a multi-faculty college and only a tenuous contact with the university.

Those 30 years have seen a revolution in medical education. There has been the development of new curricula with increasing integration between the pre-clinical and clinical subjects, with a massive development in knowledge of basic medical sciences, which in turn has had a tremendous impact upon clinical practice and patient care; there has also been a proper increase in the emphasis on the social and behavioural sciences and on an increasing degree of teaching in the community in collaboration with family doctors and others, and with individuals working in the other caring professions. That has led many medical schools to revise their curricula, not only under pressure from the education committee of the General Medical Council, but based on sound medical principles.

Speaking as someone who was, for 10 years, dean of a provincial medical school and for a time chairman of the education committee of the General Medical Council, it became apparent in the 1970s that some of the London medical schools were being slow to move with the times, not only in revising their curricula, but also in developing to the full the research expertise required by modern medicine and that that was, in some respects, largely a result of their isolation. That did not mean that centres of excellence in London did not exist; indeed they did, and some of them flourished, but that was by no means universal. It became increasingly clear that mergers of the type which the Bill provides were crucial to the future of London medicine.

An article published in The Times Higher Educational Supplement in May said,


    "Institutional loyalties undoubtedly remain, but there is a new pragmatism, largely due to financial pressures"—

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as the noble Lord, Lord Annan, said—but partly due, and very properly so, to educational ones and to the needs of research which require a far greater concentration of expensive research facilities and equipment, but perhaps above all, a concentration of teams of individuals working in groups in larger institutions where they can bring their full research expertise to bear. As the article said,


    "Free standing medical schools, facing demands for strategic plans from the Higher Education Funding Council, see value in being anchored to larger, more flexible institutions. Merger leads to critical mass: uniting strengths can create something bigger than the sum of the parts, particularly valuable when confronting the continuing pressure of the research assessment exercise".

This proposed merger, as set out in detail in the Bill, is not only timely but, as others have said, it is long overdue. These mergers will bring London into line with the rest of the country since only the capital, by historical accident, has provided in the past medical education through separate, free-standing institutions. Bringing medicine into multi-faculty colleges will help to implement the curriculum reforms even now being demanded by the current education committee of the General Medical Council, and it will also result in bringing together teams which will have the facility, the ability and all of the opportunities to carry forward the frontiers of medicine through research with the inevitable consequences of improvement in patient care.

7.43 p.m.

Lord Butterfield: My Lords, I must open with a declaration of interest; it is, that somewhere in the interstices of the affairs of the House a Bill is coming forward from Guy's and St. Thomas's for a similar merger, so I am particularly anxious that this merger is not in any way impeded, so creating a bad field for those of us who come later.

Perhaps I can say to the noble Lord, Lord Annan, that this marriage between St. Thomas's and Guy's was by no means a shotgun marriage; it was based on a subject about which we have been hearing this evening; namely, history. After all, Guy's was across the road from St. Thomas's when St. Thomas's was situated by London Bridge before that great woman, Florence Nightingale, moved it to the other side of the river opposite your Lordships' House.

As has been pointed out, this Bill is part of medical adaptations to changes in demography; changes in the distribution of medical skills outside London and throughout the country; and, in some ways, it is a reflection of the changes in what is expected of doctors and medicine today. We have heard how important it is that if young people are going to work in teams, they need a wide range of contacts with basic science, the social sciences, engineering, ethics, molecular biology and many other subjects. They are engendered by working, living, learning and researching in multi-faculty institutions, a point which was heavily emphasised by previous speakers.

The Bill reflects one of the four centres of medical education which is evolving in London. I am grateful to my noble friend Lord Quirk for mentioning the name of Sir John Ellis. Those of us who were embroiled in the

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affairs around the time of Lord Todd's commission, recognised him as being the mastermind behind the idea of bringing Bart's and the London hospital and Queen Mary's together.

I want to say also how important it is that before we leave this subject we send out strong messages of support to Bart's and the clinical people who work there. You cannot tell a Bart's man much, if anything; this I know. But it should not be forgotten that nothing geographic or demographic can take away the incredible past of that hospital. It is enshrined in William Harvey. So long as there is a college of physicians in London which embraces the spirit of William Harvey as an experimental observer; as a man who changed the attitude towards how the body and the heart worked, William Harvey's memory will be kept alive and Bart's will be revered all over the world, as it has been.

I say to my friends from Bart's, and I have many, that, whatever may come out of the maldistribution of hospital sites and the changes in the demography, "Do not worry. You will not be lost to history, whatever happens to the Smithfield site".

This is a digression and I hope your Lordships will forgive me, but I should also like to say that when I look back on my own medical education I am astonished how often I have been involved with colleges of education, medical schools and so forth which have had shifts of sites. A former dean of Bart's is in the Chamber watching us tonight. He did not enjoy the Radcliffe Infirmary. I went through Oxford before him. The Radcliffe Infirmary in Oxford that I knew has been translated to the new Radcliffe. I am now living in Cambridge. The clinical school with which I was associated started there and was set up in a new hospital. St. Thomas's itself changed sites.

A decade is a short time for academic affairs; a century is not too quick for social change; but we may see dramatic changes in Docklands. I cannot believe that we shall not see something develop in Docklands, rather like what has been developing in Thamesmead. The awkward part about this is that people from the universities of Oxford and Cambridge will want to go to Bart's to row in the Olympic stretch that is to be set up within the twinkling of an eye in Docklands.

I cogitated a little while, but I want to end on another figment of my imagination. I have mentioned some places that had two centres but I am suddenly reminded that in that great city of New York the New York hospital has had three centres. I went to the trouble to check the dates in order to encourage people from Bart's to realise that, even when in the next century they get to developing things in Docklands and East London, there is still a chance that they can go further afield out into Essex, where, as the noble Lord, Lord Jenkin, knows well, there are many opportunities. The New York hospital started by Trinity Church down by Wall Street. It was opened first in 1791—that is long ago in America but a very short time for us. It moved into mid-Manhattan—16th Street and 5th Avenue—in 1877 and finally to its East River site, where it is the Cornell Medical Centre now, in 1932. The important point is that 1932 was so soon after a terrible depression in

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America that they saw the importance of putting medical buildings at the head of the priorities for new developments.

I have said those things because I do not want people at Bart's to feel that we are not anxious to maintain and follow their incredible reputation in this field of endeavour. In that spirit I support the Bill.

7.51 p.m.

Lord Broadbridge: My Lords, I am going to take a rather different line from earlier speakers. Perhaps that is because I do not have the enlightened advantage of being a former vice-chancellor of London University, although my research in microbiology at Oxford was supervised by a Nobel Prize winner.

By way of introduction perhaps I may say that it seems to me that this Private Bill has been propelled through Parliament with surprising and perhaps suspicious haste. The more debate we have, the more Members are involved, the longer it will take. Yet, in another place the Bill had to be blocked to secure debate and was whipped by the government party, although the Opposition had a free vote. The final fact that leads me to suspect the promoters' motives is the Short Title of the Bill. It is a travesty of what it should be, perhaps, as I mentioned in starting, to curtail involvement and debate and therefore hasten its passage by the obscurity of its title. Surely the Short Title of the Bill should be "The St. Batholomew's Royal London and Queen Mary and Westfield College Bill". I believe that the Short Title of a Bill should be as informative as possible as to the contents of the Bill. I do not believe that that applies to the Short Title of this Bill.

This place buzzes like a hive of bees at the mention of Bart's; so does another place. So I wonder why Bart's and the Royal London's names were omitted. I fear I can only suspect the ulterior motives I mentioned. The last Question put at Committee stage is "That this be the Title of the Bill". In 20 years in your Lordships' House I have never heard anyone shout "Not-Content", but I am sorely tempted; or perhaps to seek an amendment at some stage.

The nub of this Bill is to formalise into one institution, with its own warden, principal, dean and one common legal, financial and administrative procedure, these three bodies which function very well together at present as the City and East London Confederation of Medicine and Dentistry. As with criminal injury compensation, which your Lordships have just been debating, I believe the best policy is to consider the situation of the victim before the event—in this case the merger—with the situation afterwards, and to try and make an informed judgment about the merits of proceeding to full merger into one institution.

The medical college at St. Bartholomew's has existed almost since Rahere's foundation in 1123. After a short while there were apprentices who worked with the doctors, and they, in effect, were the first medical students. Today Bart's medical school is the greatest centre of excellence in medical training in London. In examination pass rates, starting with 1989, it has come

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respectively—out of the nine London medical colleges—second, first, third, first, first and third, and in distinctions second, first, first, first, third and first. The latest results, for 1994, rank it in first place in distinctions yet again.

Although technically a Private Bill, this Bill is effectively now a government Bill since they whipped it in another place, a government whose great Conservative philosopher Edmund Burke based his theories of excellence on the virtues of custom, tradition, stability, renewal and excellence. In nearly 900 years of continuous operation the medical students of Bart's hospital have followed that tradition, as well as the great hospital itself, of course. In other words, if things are working very well indeed, leave them alone.

The confederation I mentioned earlier is working excellently, Bart's students being based in first class and integrated teaching surroundings—that is, the hospital. It is being asked in this Bill to become part of an institutional whole which will involve a three-site operation with all the unknowns that that entails and formal unity with Queen Mary and Westfield College, which is hardly medical, and the Royal London, which has, comparatively, little teaching facility. Thus, we move from proof of the excellent to the unknown, not a particularly good recipe. And why with such urgency? The combined institution is supposed to start operating this 1st August, hardly a feasibility in view of the recess of Parliament until mid-October and the need for subsequent stages of the Bill here. But, overall, why take the risks inevitably involved?

I have left two factors unspoken for. First, the future of the great hospital with which Bart's medical school is integrated and, secondly, why Bart's has put its name to this Bill. First then, the future of Bart's hospital. Continuation seems more likely than for some time. I mention this only in the sense that the medical college is obviously integrated with the hospital; not that one affects the other, as has been said already. I have heard it from the lips of the Leader of the Opposition, in answer to the direct question, that he will not allow St. Bartholomew's hospital to close, and will probably restore the accident and emergency department. I sit on the non-political Cross-Benches, but those who specialise in omens and signs tell me that, in racing terms, the return of a Labour Government in the next two years is extremely likely. I suppose this Government cannot be expected to make allowances for what a possible Opposition turned Government would do, but regardless of that we have a new Secretary of State in this Government in the place of the discredited Mrs. Bottomley—


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