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Earl Russell: My Lords, has the Minister considered the figures for intermissions together with the figures for drop-outs?

Lord Davies of Oldham: My Lords, I quoted the drop-out figures. That was the cardinal figure described earlier. I stand by what I said.

The Government's vision of higher education is clear. We are committed to maintaining a world-class higher education system. We recognise that that takes money. We have to address that with the fairest funding arrangement for universities and students. We are investing £1.7 billion in higher education in the six years to 2003-04, a real-terms increase of 18 per cent. That includes significant new capital resources. There is extra on top for research.

For the first time in 15 years funding for students will rise in 2001-02 and the expansion of places will be fully funded thereafter. This is a considerable investment. It answers the important question raised by the noble Baroness about funding for higher education. It contrasts somewhat sharply with the record of the previous government.

A number of points were raised about student hardship. The noble Baroness, Lady McIntosh, will recognise that we addressed specifically the issue of dance and drama students. We knew that prior to our arrival in office in 1997 the country was in crisis in that

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area. The noble Baroness will recognise that our award scheme has produced guaranteed funding for up to 820 of our most talented students. We know that the rich seam of talent in our community goes far beyond that figure. The film "Billy Elliot" helped to illustrate that in a graphic way. It is important that we tap into that talent. But that scheme is real evidence that the Government are addressing themselves to the issue raised by my noble friend.

I turn to the differences in student support systems and the Scottish dimension. The Liberal Democrats have been fast learners with regard to the Scottish dimension. Five years ago the Liberal Democrats were emphasising their commitment to the maintenance grant. Three years ago their spokesman in another place commented favourably on the Government's proposals in the Teaching and Higher Education Act and supported our proposals on tuition fees and the loan system. The Liberal Democrat Party is now waxing strong on the advantages of the Scottish system.

We recognise that devolution will give other parts of the United Kingdom the opportunity to make their own decisions on funding. However, we recognise that there is a deficiency with regard to dedicated support for mature and, increasingly, part-time English students. It is important that we improve participation rates. Such resources, dedicated to those areas, would be difficult to raise if we followed the Scottish model. While it uses its resources for one particular area, it is without the resources that we intend to deploy for a specific range of support systems.

Since 1997 the hardship funds have quadrupled to £93 million a year. As the noble Earl indicated, students present needs. Every teacher in higher education is all too aware of the demands on hardship funds. But I maintain the obvious point: the funds represent a significant record of the Government. Those hardship funds are now available to higher education institutions at the beginning of the academic year. Therefore, they are able to plan more effectively to meet specific needs.

Earl Russell: My Lords, the increase mentioned by the Minister is genuine and welcome. The point I made was that the need applies to every single student. That was not recognised when the funds were set up.

Lord Davies of Oldham: My Lords, I am limited by time in dealing with these issues. I do not accept that every student attending higher education in England and Wales is suffering hardship. That is not the basis of the Callender report, much quoted today. It is not the basis of any serious analysis of student finance that I recall over the past two decades. Of course, students are poor; and some students suffer hardship and need. That is why we seek to target such students. That is why, for instance, mature student bursaries for childcare have been available this year; and from next September there will be increased help for student parents, in particular with the new childcare grant. Students facing real hardship are more prone to drop out of their courses.

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Opportunity bursaries of £2,000 are being introduced for bright students from less-well-off families. By 2002-03, 25,000 students will be able to benefit from those bursaries.

The concept of the Excellence Challenge requires real resources. The Excellence Challenge is providing £190 million over the next three years. This is dedicated to tackling the problem of attracting students from those backgrounds which are under-represented in higher education to enable schools, further education colleges and higher education institutions to encourage those students to present themselves for their higher education opportunity.

So the Government are active in those pressing areas which have been identified today. I recognise that there will never been enough resources to meet the needs of every student. However, I assure the House that the Government's student support arrangements are working well. Drop-out rates are not rocketing in the way suggested. There will always be worries over finance, but such worries should not be a barrier to higher education. There is no evidence that that is so at present. More students are going into higher education than ever before. The Government are making sure that extra financial help is available for a vulnerable group of students. Students in hardship can obtain help from the hardship funds. We intend our high ambitions to be fair and progressive. I commend them to the House.

Health and Social Care Bill

8.50 p.m.

House again in Committee on Clause 1.

Earl Howe moved Amendment No. 6:


    Page 2, line 2, at end insert--


"(3AB) The Secretary of State shall exercise his powers under subsection (3AA) solely with a view to securing the appropriate number of medical practitioners providing general medical services (under arrangements made under section 10) or providing personal medical services (under section 28C) in the area of each Health Authority, and in so doing the Secretary of State shall have regard to (inter alia)--
(a) the existing and anticipated need for such services in the relevant area,
(b) the existing and anticipated numbers of such medical practitioners in the relevant area,
(c) the cost in the relevant area of providing such services,
(d) the impact on other health services in the relevant area,
(e) the need for equity as between Health Authorities in the amounts allotted under subsection (3) (or varied under subsection (5)).
(3AC) Prior to exercising his powers under subsection (3AA), the Secretary of State shall publish details of the number of medical practitioners he considers appropriate for each Health Authority area for the purposes of subsection (3AB), and other matters taken into account in accordance with subsection (3) or (5).""

The noble Earl said: I shall speak also to Amendments Nos. 8, 11, 12, 14, 15 and 225. The amendments deal with how the Secretary of State will use the powers granted to him by Clause 1 to ensure

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that there is an adequate distribution of medical practitioners throughout England and Wales. Clause 21 abolishes the Medical Practices Committee, which, since the inception of the NHS, has undertaken the task of facilitating a fair and even spread of GPs throughout England and Wales relative to local populations. In 1946, the need for such workforce management was plain. There were areas of the country where the number of doctors per head of population was dangerously low, while more affluent areas could boast abundant doctor numbers with comparatively modest list sizes. The way in which the MPC has redressed those imbalances and maintained a continuing steady hand on the tiller has been very creditable. By the mid-1980s, the old restrictive classifications of areas as open or closed to doctors wishing to set up in practice were becoming redundant. By 1986, they had disappeared. Since the mid-1980s, the average list size per GP has continued to fall at a time when the number of whole-time equivalent GPs has remained constant. That illustrates the continuing effectiveness of the MPC's approach to its remit.

Against that background, many people are baffled as to why the Government wish to see the back of the MPC. It has had only limited powers to direct doctors to an area. It has no power to force a doctor to move to a particular post or region. However, the absence of regulatory power has not stood in the way of success. The MPC uses some sophisticated analytical models to evaluate GP workload in an area or even in a specific GP practice. The expertise necessary for those evaluations does not grow on trees. A priori, it seems self-evident that such expertise could not be replicated or distributed over 100 health authorities in the absence of a central body.

It may be a turn-up for the books for the Minister to hear me arguing for some centralised co-ordination, but I am fearful that without the MPC we shall be worse off. The ground that has been gained over the past 50 years could well be lost and it would not be easy to recapture it in a hurry. At a time when there are not enough GPs, I doubt that an approach based on simple resource allocation formulae will guarantee that under-doctored areas of the country are able to attract an adequate supply of practitioners.

I would have no problem with the idea of health authorities offering enhanced financial packages to GPs if GPs were in abundant supply. However, that is far from being the reality. Who will sort out the battles that are almost certain to arise between health authorities that are jockeying to compete for the same individuals? Some areas are bound to lose out.

It is ironic that the present Government should be creating such a market mechanism, having condemned and abolished the market mechanisms introduced by the Conservatives. The previous administration did not seriously contemplate the abolition of the MPC--and for sound reasons. That is why I am proposing a new independent medical practices advisory body that would advise the Secretary of State on any action that he needed to take to ensure a fair and adequate

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distribution of GPs. That advice would be published to enable groups representing patients to monitor national and regional trends.

If such a body is not set up, what safeguards will there be against a failure of the resource allocation formula? How will the Secretary of State avoid an area with an adequate supply of GPs suddenly finding itself starved of doctors as they are siphoned off elsewhere? I beg to move.


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