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The new PCA is very different from the old eligibility test. In particular, the number of descriptors identifying physical disabilities that will be taken into account has been much reduced. There is a much wider appreciation of mental disabilities, which is good. It is unsurprising that such a large modification has caused concern among claimants and the organisations that represent them. Credible reviews that assess whether the new assessments are needed in successfully identifying claimants and putting them on to the correct components will do much to reassure these claimants and to identify any of the problems that many of them are foretelling. Similarly, there is much uncertainty about the computer system that is being used. I thank the Government and Atos Origin for giving us the opportunity to see it in action, but watching the demonstration of a program that was developed for incapacity benefit and has not yet been finalised for ESA is hardly the same as observing the latter in the field.

4.30 pm

We all hope that the new ESA and PCA will lay people’s fears to rest as they are rolled out and given a chance to prove themselves. However, I hope that the Minister will be able to provide me with further reassurances that any future blips will be picked up and addressed by a thorough review process.

As I said, this amendment states that the report should appear annually for the first five years after Clauses 8 and 9 come into effect. That should be long enough to have the new system fully up and running; if it is not working properly by then, we really will have to go back to the drawing board and it is quite possible that a new Act will be required. Even if it is not, a major reform of the regulations will be necessary. We ought to know in advance of that happening. I beg to move.

Lord Oakeshott of Seagrove Bay: My Lords, having run the first lap of this amendment in Committee, I am happy to pass the baton to the noble Lord, Lord Skelmersdale, to move it here. We support him in that; perhaps he will return the compliment on Third Reading with another amendment. We shall see.

As we said in Grand Committee, there was considerable cross-party support in another place for amendments along these lines. I made it clear in Committee and do so again today that we do not regard as satisfactory the assurances from the Minister about what is effectively an internal review. It seems a classic example of a controlled review of which Sir Humphrey in “Yes Minister” and “Yes, Prime Minister” would have been proud.

19 Mar 2007 : Column 1037

The amendment is very reasonable—indeed, it is modest, as it gives the Government the opportunity to choose where the independent review comes from. I cannot see how the Government can possibly object, if they really support transparency and a proper process of post-legislative scrutiny by Parliament of what are, after all, major changes in legislation, which could affect many of the most vulnerable in our society. We are happy to support the amendment.

Lord McKenzie of Luton: My Lords, I recognise the concern underlying the amendment that the revised PCA descriptors and scores should be subject to independent evaluation following the implementation of the employment and support allowance.

I repeat the undertaking given by the Minister for Employment and Welfare Reform in another place that there will be independent monitoring of the revised PCA descriptors and scores assessing limited capability for work. Moreover, I can today commit to ensuring that this covers the first five years of operation, rather than the two years to which we have already committed. I also confirm that reports of the independent monitoring will be placed in the Libraries and that as usual they will be subject to parliamentary scrutiny by means of Parliamentary Questions, Select Committees and so on.

The Government are, of course, committed to evidence-based policy making and recognise the value of seeking information that will help to establish the effectiveness of policy initiatives and their implementation. As I said in Committee, a large amount of research and review is undertaken over a whole range of policy areas and those reports are routinely published. A working paper on performance in Pathways areas was published in January last year and, as of December 2006, we have produced Pathways statistics on a quarterly basis. Furthermore, we routinely publish externally commissioned research reports as soon as they are available. Ten such reports on Pathways have been completed to date.

We are currently evaluating the impact of Pathways on both new and existing customers in the first seven areas. The focus will be on employment, benefit exits, earnings and health and we are also evaluating the impact of Pathways as it expands to cover more districts. As we progress with our evaluation over larger areas, there will be a greater opportunity to look at sub-groups. This will include further analysis of the impact of Pathways on customers with a mental health condition.

In addition to the quantitative assessments, we are exploring attitudes and experiences of Pathways participants and key Jobcentre Plus and provider staff. This planned evaluation will continue until 2009. We are due also to evaluate the impact of provider-led Pathways.

We need to maintain a balance between seeking information and monitoring that helps inform policy-making and ensuring that the information gathered is appropriate and represents a responsible use of resources. We would not, for instance, wish to be obliged to provide annual reports where it has been

19 Mar 2007 : Column 1038

established that the revised PCA is effectively identifying those people who have limited capability for work.

I hope that I have reassured noble Lords that there will be an effective process of evaluation, that we will extend it over five years, and that those reports will be in the public domain and available to Parliament through the normal means. I hope that noble Lords will see that as a better route forward than an obligation to produce annual reports at fixed points in time. I ask the noble Lord to withdraw the amendment on that basis.

Lord Skelmersdale: My Lords, I am grateful to the Minister. I was grateful to him when I heard of the original undertaking to carry out independent monitoring for the first two years. The Minister now announces that this is to cover the first five years. I rather wonder whether my amendment had anything to do with that. Whether it did or not, I am delighted that the results will be published and placed in the Library.

The Minister announced a whole range of “assessments”—dare I call them that?—which were to be made of the process during that five years. The trouble is that the results will come out rather piecemeal. There will be no document which puts them together appropriately as they come out and there will be no single booklet that we can read. If we are particularly assiduous in looking at these things, we will know what has happened—what has gone right and what has gone wrong. We may even know what remedies are to be proposed. However, what we will not know, at least if I correctly understood what the Minister said, is how many people the ESA has been successful in getting into work, thereby achieving their and our ambition; and we will not know how the trend in applications for the benefit is going, because, clearly, over a period, even in the first five years, one would expect a considerable drop in the number of applications for the benefit. Indeed, we have already seen a drop in the past year for which we have had figures. Perhaps it is a flash in the pan—one does not know.

Therefore, even though I accept at face value what the Minister said, his response is not satisfactory. I wish to press the amendment—

Lord McKenzie of Luton: My Lords, before the noble Lord sits down, perhaps I may press him on the matter. He said that his amendment calls for an independent report. I reassured him that there will be an independent report. He said that there would be no document which pooled together all our reports. Some of those reports are independent; some are internally produced for management purposes—they will be a mixture. To require that they be fed into one independent report would in the case of some require an additional layer of work and resource which I respectfully suggest to him is not necessary.

The noble Lord asked how we will know whether the process is successful in getting people into work and said that we must have an annual report to determine it. Some people’s journeys into work, and

19 Mar 2007 : Column 1039

judging whether the process is successful, will not always be capable of being quantified and identified in a rigid annual cycle. That is why an independent review, to which the Government are committed, is a better way of addressing this matter than forcing a narrow annual report to be made. Particularly in the early period, such a report is unlikely to be able to judge with full effectiveness the journeys that some people are making into work, because they would not necessarily appear in employment statistics. I impress that on the noble Lord and ask him not to press his amendment.

Lord Oakeshott of Seagrove Bay: My Lords, before the noble Lord sits down again—I am not quite sure which noble Lord will sit down, but before either or both of them do—I would like to say that the business of a regular, annual report is exactly the point. It is not rigid, but a reasonable and regular period in which to report. Otherwise, I am afraid that the plethora of different reports, to which the Minister referred, will enable the Government to fix the time and the place. The report will not be properly independent and annual and it seems perfectly reasonable to ask for one which is independent, annual and fixed for the first five years.

Lord Skelmersdale: My Lords, the Minister obviously does not want to come back. I have already tried to beg to press the amendment once and I am going to do so again. This time, I hope it will be for the final time. I wish to test the opinion of the House.

4.40 pm

On Question, Whether the said amendment (No. 16) shall be agreed to?

Their Lordships divided: Contents, 150; Not-Contents, 133.

Division No. 1

CONTENTS
Addington, L. [Teller]
Allenby of Megiddo, V.
Alton of Liverpool, L.
Attlee, E.
Avebury, L.
Barker, B.
Beaumont of Whitley, L.
Best, L.
Biffen, L.
Blackwell, L.
Blaker, L.
Bonham-Carter of Yarnbury, B.
Bowness, L.
Bradshaw, L.
Bridgeman, V.
Brougham and Vaux, L.
Byford, B.
Caithness, E.
Cameron of Dillington, L.
Campbell of Alloway, L.
Carnegy of Lour, B.
Cathcart, E.
Chadlington, L.
Chelmsford, Bp.
Clement-Jones, L.
Cobbold, L.
Colwyn, L.
Cope of Berkeley, L. [Teller]
Cotter, L.
Crickhowell, L.
Darcy de Knayth, B.
De Mauley, L.
Denham, L.
Dholakia, L.
Dundee, E.
Dykes, L.
Eames, L.
Eccles, V.
Eccles of Moulton, B.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Falkland, V.
Falkner of Margravine, B.
Fookes, B.
Forsyth of Drumlean, L.
Fraser of Carmyllie, L.
Freeman, L.
Garden, L.


19 Mar 2007 : Column 1040

Geddes, L.
Glentoran, L.
Goodhart, L.
Goodlad, L.
Greengross, B.
Hamilton of Epsom, L.
Hamwee, B.
Hanham, B.
Hanningfield, L.
Harris of Richmond, B.
Hayhoe, L.
Henley, L.
Higgins, L.
Hodgson of Astley Abbotts, L.
Home, E.
Hooper, B.
Howarth of Breckland, B.
Howe, E.
Howe of Idlicote, B.
James of Blackheath, L.
Jenkin of Roding, L.
Jones of Cheltenham, L.
Jopling, L.
Kingsland, L.
Kirkwood of Kirkhope, L.
Knight of Collingtree, B.
Lee of Trafford, L.
Low of Dalston, L.
Luke, L.
McColl of Dulwich, L.
Maclennan of Rogart, L.
McNally, L.
Maginnis of Drumglass, L.
Mar, C.
Mar and Kellie, E.
Marlesford, L.
Masham of Ilton, B.
May of Oxford, L.
Mayhew of Twysden, L.
Meacher, B.
Miller of Chilthorne Domer, B.
Miller of Hendon, B.
Monson, L.
Montgomery of Alamein, V.
Morris of Bolton, B.
Murton of Lindisfarne, L.
Naseby, L.
Neuberger, B.
Noakes, B.
Northesk, E.
Northover, B.
Oakeshott of Seagrove Bay, L.
O'Cathain, B.
Palmer, L.
Park of Monmouth, B.
Parkinson, L.
Patel, L.
Patel of Bradford, L.
Perry of Southwark, B.
Plumb, L.
Razzall, L.
Reay, L.
Redesdale, L.
Roberts of Conwy, L.
Roberts of Llandudno, L.
Rodgers of Quarry Bank, L.
Rogan, L.
Roper, L.
Rotherwick, L.
Russell-Johnston, L.
Sainsbury of Preston Candover, L.
St. John of Bletso, L.
Scott of Needham Market, B.
Seccombe, B.
Sharples, B.
Shephard of Northwold, B.
Shutt of Greetland, L.
Skelmersdale, L.
Smith of Clifton, L.
Stern, B.
Stewartby, L.
Stoddart of Swindon, L.
Strathclyde, L.
Swinfen, L.
Taverne, L.
Taylor of Holbeach, L.
Teverson, L.
Thomas of Gresford, L.
Thomas of Swynnerton, L.
Thomas of Walliswood, B.
Thomas of Winchester, B.
Tordoff, L.
Trenchard, V.
Trimble, L.
Trumpington, B.
Tyler, L.
Ullswater, V.
Vallance of Tummel, L.
Verma, B.
Wallace of Saltaire, L.
Walmsley, B.

NOT CONTENTS
Acton, L.
Adonis, L.
Ahmed, L.
Alli, L.
Amos, B. [Lord President.]
Anderson of Swansea, L.
Andrews, B.
Archer of Sandwell, L.
Ashton of Upholland, B.
Bach, L.
Barnett, L.
Bassam of Brighton, L.
Bernstein of Craigweil, L.
Billingham, B.
Bilston, L.
Borrie, L.
Boyd of Duncansby, L.
Bragg, L.
Brooke of Alverthorpe, L.
Brookman, L.
Brooks of Tremorfa, L.
Christopher, L.
Clark of Windermere, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Corbett of Castle Vale, L.
Corston, B.
Craig of Radley, L.
Crawley, B.
David, B.
Davies of Coity, L.
Davies of Oldham, L. [Teller]
Desai, L.
Dubs, L.
Eatwell, L.
Elder, L.
Elystan-Morgan, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Falconer of Thoroton, L. [Lord Chancellor.]
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Filkin, L.


19 Mar 2007 : Column 1041

Foster of Bishop Auckland, L.
Foulkes of Cumnock, L.
Fyfe of Fairfield, L.
Gale, B.
Gibson of Market Rasen, B.
Giddens, L.
Golding, B.
Goldsmith, L.
Gordon of Strathblane, L.
Goudie, B.
Gould of Brookwood, L.
Graham of Edmonton, L.
Griffiths of Burry Port, L.
Grocott, L. [Teller]
Harris of Haringey, L.
Harrison, L.
Hart of Chilton, L.
Haskel, L.
Haworth, L.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howarth of Newport, L.
Howells of St. Davids, B.
Howie of Troon, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Janner of Braunstone, L.
Jay of Paddington, B.
Jones of Whitchurch, B.
Jordan, L.
Judd, L.
King of West Bromwich, L.
Kirkhill, L.
Leitch, L.
Lipsey, L.
Lofthouse of Pontefract, L.
McDonagh, B.
Macdonald of Tradeston, L.
McIntosh of Haringey, L.
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
McKenzie of Luton, L.
Mason of Barnsley, L.
Moonie, L.
Morgan, L.
Morgan of Drefelin, B.
Morgan of Huyton, B.
Morris of Aberavon, L.
O'Neill of Clackmannan, L.
Ouseley, L.
Patel of Blackburn, L.
Pendry, L.
Prys-Davies, L.
Quin, B.
Ramsay of Cartvale, B.
Randall of St. Budeaux, L.
Rea, L.
Rendell of Babergh, B.
Richard, L.
Robertson of Port Ellen, L.
Rooker, L.
Rosser, L.
Royall of Blaisdon, B.
Sawyer, L.
Scotland of Asthal, B.
Sewel, L.
Simon, V.
Snape, L.
Soley, L.
Stone of Blackheath, L.
Strabolgi, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Taylor of Bolton, B.
Thomas of Macclesfield, L.
Thornton, B.
Tomlinson, L.
Triesman, L.
Truscott, L.
Tunnicliffe, L.
Turnberg, L.
Turner of Camden, B.
Warner, L.
Warwick of Undercliffe, B.
Watson of Invergowrie, L.
Whitaker, B.
Williams of Elvel, L.
Williamson of Horton, L.
Winston, L.
Woolmer of Leeds, L.

Resolved in the affirmative, and amendment agreed to accordingly.

Health: Modernising Medical Careers

4.51 pm

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, with the leave of the House, I shall repeat a Statement made earlier today by my right honourable friend the Secretary of State for Health. The Statement is as follows:

“In the Written Ministerial Statements of 7 and 13 March, I set out the Department of Health’s plan for an immediate review of the first round of the new national recruitment and selection process for doctors in postgraduate training. As part of the Modernising Medical Careers—MMC—reforms of postgraduate medical training, new specialty training programmes will be introduced in August 2007. “To support implementation, a new national recruitment and selection process was introduced this year, facilitated by the online Medical Training Application Service—MTAS. That process sets out

19 Mar 2007 : Column 1042

national recruitment and selection criteria, documentation and standards, replacing the countless local appointment processes that had previously been in place. The new arrangements were developed with the help of the medical royal colleges, trainee doctors and others. We will continue to work with them to ensure that trainee doctors are properly supported and fairly treated, and that the NHS is able to train and recruit the best doctors for the future.“Doctors have been applying for their preferred specialty training programme since 22 January 2007 and interviews have already begun. A large number of posts will not be filled in the first round and we have stressed to those interviewing in round 1 that they should not consider appointing unless they are absolutely satisfied with the calibre of candidates. “It is clear that there have been concerns about the selection process, and that the process as a whole has created a high degree of insecurity among applicants and, indeed, more widely in the profession. We therefore commissioned an immediate review to establish what had gone well and what needed to be improved to create greater confidence in the process.“The review is independent, being led by Professor Neil Douglas, vice-president of the Academy of Medical Royal Colleges and president of the Royal College of Physicians of Edinburgh. Members of the review group include representatives of the royal colleges, the British Medical Association, the four United Kingdom health departments and employers. “The review group has considered a wide range of evidence and listened carefully to the concerns of the profession and NHS employers. As a result, the review group has agreed immediate action, but will also continue its work throughout March. The review group decided that round 1 should continue, with a number of changes to strengthen implementation at every level. In particular, all eligible applicants for level 3 and 4 speciality training—ST—will be guaranteed an interview for their first or second choice of training post; that includes those who have so far been offered only their third or fourth choice. All applicants at ST1 who have not been shortlisted for any interviews will have their application reviewed and may be offered an interview in round 1. If not, they will be offered career guidance and support to enter round 2. All applicants for ST2 who have not been shortlisted for interview will be offered a face-to-face review with a trained medical adviser to determine whether they meet the shortlisting criteria. Those who meet the criteria may be offered an interview in round 1. Those who are not selected for interview will be offered career guidance and support to enter round 2.“We expect over 5,000 more doctors to be interviewed in round 1 as a result of these changes. We will also publish on the MMC and MTAS websites details of competition ratios by specialty and entry level, to help applicants to consider their

19 Mar 2007 : Column 1043

options for the second round, together with further advice and information for candidates. In addition, further significant changes will be made to the application form and the scoring system, to improve selection in the second round. The revised approach will be tested and agreed with the royal colleges, junior doctors, postgraduate deans and employers. I am grateful to Professor Douglas and his colleagues for their continuing work on the review group. We will publish the group’s final report once it is completed”.

My Lords, that concludes the Statement.

4.55 pm

Lord McColl of Dulwich: My Lords, I thank the Minister for repeating the Statement made by the Secretary of State in another place. Knowing what a charming Minister he is, I am sure he will avoid the mistakes of the Secretary of State in her answers to questions. She was asked six times if she would apologise for the shambles that we find ourselves in. Unfortunately, she would not. It was also unfortunate that she started blaming others for the shambles. It was a pity; all she needed to say was, “It is a shambles, we are sorry for the inconvenience and we are going to put it right”. That would have been very acceptable.

To be fair to the Government, MCC has been discussed for three years and the Government have taken notice of what people have been saying. For instance, they agreed with the Royal College of Physicians in its desire to have longer training before entering specialist training, like gastroenterology. The Government agreed that there could be another two years for securing membership of the Royal College of Physicians before entering further specialities. That was good.

There is a very big problem in surgery. As noble Lords are probably aware, there are five or six SHO—senior house officer—posts for every training post in surgery. That is an unfair disadvantage, but it has been so for a long time. Those who were not successful in securing a post could stay in the SHO post until a vacancy occurred. The problem with the arrangement that we have got is that it is like a big bang; it has come in too quickly, whereas the Calman system was phased in gradually—that would have been much better.

As was mentioned in another place, one of the problems has been the scoring arrangements. For instance, if you had a PhD, you got one point. On the other hand, if you wrote a good essay on “How I Deal with Stress”, you got four points. If you produced a poster at a meeting, that would be three points. It takes about an hour to prepare a poster for a meeting; it takes three years to get a PhD and you have a very tough exam at the end of it. There is something radically wrong. Not having the curriculum vitae in front of the examiners is a serious disadvantage indeed.

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