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Lord Clement-Jones: I want briefly to associate those of us on these Benches with the amendment tabled by the noble Lord, Lord Turnberg.

It used to be the other way about: young, ambitious doctors in hospitals wanted to do research as part of the trail that led certainly to academic medicine but also to senior NHS consulting jobs. Unfortunately, that seems to be less the case now. I hope that we are not going down a slope that further diminishes the importance of research, which has been diminished during the past 10 years or so in our teaching hospitals, but which historically has been of enormously high quality. Some contributions have been highly significant. It is not just a question of scientists doing

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such work; clinical doctors can contribute a huge amount. We should recognise that, which is why the amendment is so welcome.

Lord Hunt of Kings Heath: I echo the remarks of my noble friend Lord Turnberg and the noble Lord, Lord Clement-Jones. No one should underestimate the critical importance of high-quality teaching research in our hospitals—not only for its benefit to patients but for the contribution that it makes to the science base in this country and to UK plc. It can be no coincidence that we in this country have one of the strongest pharmaceutical-based industries. Much of that is based on the excellence of our scientific research and expertise but also on the high quality of teaching research in NHS hospitals.

The amendment is probing, but my noble friend is right. During the past few years there has been concern that in the inevitable emphasis on services to patients—which is right—the duty of the NHS to support teaching research has perhaps sometimes been underestimated.

It is not just a question of what happens in the NHS locally; it is also a question for the Department of Health, the Department for Education and Skills, the Higher Education Funding Council for England and other government departments. If we are really serious about this country having a strong science base, we must acknowledge the critical importance of the NHS in teaching research. I hope that between Committee and Report my noble friend the Minister will consider whether the department can take up other issues with HEFCE and the DfES to ensure that we support teaching research in this country.

Baroness Finlay of Llandaff: I, too, rise to speak in support of the amendment. I have already declared my interest as vice-dean of a medical school. Tomorrow I shall be attending the Council of Heads of Medical Schools at a meeting in Belfast. The issue of teaching and research is of fundamental concern to all medical schools across the UK.

Those who have already spoken in the debate have emphasised most eloquently the important contribution that teaching and research make to the advancement of our standards of care, as well as to that of the care that patients receive. The noble Lord, Lord Turnberg, was absolutely correct to say that an ethos supporting teaching and research must filter through the whole of an NHS organisation—the whole trust—from the top to every single layer.

There are enough hurdles and difficulties already in place for those who are trying to pursue high-quality research without trying to do so in an environment that they perceive as becoming increasingly closed to their pursuing the advancement of science for the welfare of the people of this nation. If we do not invest in teaching and research we will pay and pay dearly in years to come.

Lord Chan: Apart from the remarks of my noble friend and the noble Lord on university medical research and teaching, such a provision is essential if

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we are to improve primary care. We have now made public health a basic primary care issue, but there will be no improvement in that field if we do not guard a research ethos. Many think that foundation trusts might be the mechanism to give hospitals added incentive to carry out research that will influence teaching. We should remind ourselves that we are increasing numbers of students and doctors. Britain attracts many overseas doctors and students. Basic primary and secondary care are essential, as is the next generation of our doctors.

Lord Brooke of Sutton Mandeville: I hesitate to intervene at this late hour. I speak from a very narrow, London perspective. The constituency that I represented formerly in another place, when its final boundaries were settled by the Boundary Commission, had contained six teaching hospitals when I started as a Member of Parliament. Over 24 years I lived through the rationalisation of that process. I experienced RAWP in the early stages, the decisions taken to merge various teaching hospitals with others outside, and the process that occurred in the University of London. Yet I was always conscious that those hospitals derived their pre-eminence from traditions that went back 200 years and that, therefore, they had a particular contribution to make to the history of medicine in this country.

I do not propose to embroider or embellish anything said by my noble friend Lord Howe or the noble Lord, Lord Turnberg, in speaking to their amendments, except to say that, from that narrow perspective, I am immensely conscious of our heritage and concerned that we manage to maintain it. I declare an incidental interest as Pro-Chancellor of the University of London, the umbrella organisation for those medical schools that remain within our purview. In all other respects, I follow the 18th century example of the Member of Parliament who spoke immediately after Edmund Burke saying, "Ditto to Mr Burke". I do not propose to keep the Committee any longer by repeating remarks made by others already.

11 p.m.

Lord Warner: Before responding to Amendments Nos. 163 and 164, I shall make a few general remarks that, I hope, will reassure Members of the Committee who spoke, particularly those behind me and on the Cross Benches. The Government accept that research is important. I must confess that it is part of my portfolio within the Department of Health. But, in my short time in the department, I have learnt some pretty complex issues surrounding research activity in the NHS and the links between advances in science and carrying those through clinical trials to the ultimate benefits of patients. It is not a simple area; there have been problems of some standing for some time. The issues require attention outside the Bill, and we are considering them.

En passant, NTRAC, which has shown what can be achieved in the field of cancer, demonstrates how one can bring NHS resources to help take advances in

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science through a clinical trial stage to the great benefits of patients. We must get better at those mechanisms. I am not sure that amendments to the Bill will deal with the kinds of problems about which my noble friends behind me are concerned, but, without making any promises, I shall look at the ideas behind Amendment No. 164 and see whether there is anything more that we can do.

Amendment No. 163 is not likely to achieve the noble Earl's objective. Under Clause 14(6), NHS foundation trusts must be authorised and may be required to carry out research, education or training. To safeguard NHS essential services, the independent regulator will, under its terms of authorisation, require foundation trusts to offer certain protected services, including essential education, training and research programmes as well as NHS clinical services. If a university reconfigures or changes services in the way described by the noble Earl, the independent regulator will need to take that into account in protecting provision of related services by the foundation trust.

Amendment No. 163 deletes the words "and may require" from Clause 14(6). Therefore, although NHS foundation trusts would still be authorised to carry out research and training activities, the regulator would not be able to require that they do so. The amendment therefore removes the regulator's power to protect those services, which I am not sure is what the noble Earl is trying to achieve.

On Amendment No. 164, for reasons that I have already stated, we think there is already adequate provision in the Bill to ensure that the regulator protects the needs of research in giving a particular authorisation. For example, we expect that NHS foundation trusts will provide clinical learning opportunities and placements for nursing, medical and dental students, cadets and staff undertaking NVQ postgraduate training for junior medical and dental staff, and placements for pre-registration students in other health professions. We take very seriously the issues relating to education and training and the linked issues of research. However, as I said earlier, I am happy to look again at this particular amendment to see if there is a drafting improvement that can be made that would signal the Government's commitment to the wider issues of research that I have mentioned.

Earl Howe: This has been a very useful debate and I entirely associate myself with the comments of the noble Lord, Lord Turnberg, and the very wise comments of the noble Lords, Lord Hunt and Lord Chan, and the noble Baroness, Lady Finlay. The continuation of teaching and research in foundation trusts is of fundamental importance. I believe that there is a place for an amendment of the type proposed by the noble Lord, Lord Turnberg. However, that is different from saying that the regulator should have a prescriptive power to insist that particular programmes of research should be pursued. That is my difficulty with this clause. I have nothing against the regulator protecting research or educational activity as a generality, but it is out of place for him to do so in a specific sense.

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I bow to the Minister's better judgment on the wording of my amendment. It may not achieve what I had intended. I will go away and think about a different formulation because this is certainly a matter to which we will return at a later stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 164, 165 and 166 not moved.]

Clause 14 agreed to.

Clause 15 [Private health care]:

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