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Lord Craig of Radley: My Lords, I thank the Minister for his reply. If the Minister were to be shot in the footI imply no personally inflicted injuryhe would not wish it to be amputated without anaesthetic or the presence of an orthopaedic surgeon. Will he assure the House that fully manned and equipped medical services are essential to the morale and effectiveness of the front line?
Lord Henley: My Lords, I fully agree with the noble and gallant Lord. There are currently some shortfalls in manning certain specialisations. I should mention in particular anaesthetists. I understand that this is a wider problem which extends throughout the National Health Service. It is not just a problem for the defence medical services. I can assure the noble and gallant Lord that steps are being taken to address such problems. With regard to morale in the defence medical services, they have obviously been through great changes and it is understandable that people should have concerns about their future. But I can give an assurance that the future of the DMS is bright and the prospects will continue for a worthwhile and varied career for service medical personnel in the finest health care regime in the country.
Lord Henley: My Lords, as my noble friend will know, we recently published a new paper on the future of the reserves. In the past we have made use of Territorial Army doctors and medical personnel when necessary. We shall continue to make use of them as and when it is
Lord Dean of Beswick: My Lords, if particular medical expertise not readily available to the Armed Forces is urgently needed for a specific case, can the Minister say whether the Armed Forces will have access to some of the centres of excellence in the National Health Service which can provide that expertise?
Lord Henley: My Lords, obviously if such a case arose we would make use of the National Health Service if necessary. I was trying to assure the noble and gallant Lord that we believe that the size of the defence medical services will be sufficient for all our operational requirements.
Lord Ironside: My Lords, can my noble friend say whether he feels that the balance of serving doctors and surgeons in each of the services is now about right? The numbers in each of the services seems to be disproportionate. In the Navy there are 309; in the Army, 217; and in the RAF, 403. There is also not a good balance among the nursing staff. There are 96 in the Royal Navy, 422 in the Army and 127 in the RAF. It would appear therefore that there is an imbalance. Can the Minister say whether there is any way of bringing each service more into balance from the point of view of serving doctors and surgeons?
Lord Henley: My Lords, we are happy that the numbers in all three services will be sufficient, as I made clear earlier, for supporting fully all the operational requirements of the Armed Forces, whether it is a single service or all three services. They will be capable of supporting simultaneous operations; for example, at the present time the emergency commitments in Angola, the Falklands and Bosnia-Herzegovina.
Lord Williams of Elvel: My Lords, can the Minister say whether there is interchangeability of medical expertise between the different services? For example, can a Navy doctor legitimately don an Army uniform or an Army doctor legitimately don a Navy uniform if the occasion requires? It would seem that, along with the joint staff college that we have been discussing, it would be a sensible arrangement.
Lord Henley: My Lords, I cannot say whether or not they can actually change uniform. However, the noble Lord will appreciate that there will be one single Ministry of Defence hospital, which will be tri-service. There will be a single tri-service defence medical service. There will then be a number of Ministry of Defence hospital units attached to NHS hospitals. One will be in Plymouth, which I imagine will have more of a naval flavour; one will be near Aldershot and will no doubt have more of an Army flavour. But there is no reason why individual doctors in individual services cannot move across services to enable a naval doctor to operate on the foot of an Army soldier.
Lord Ashley of Stoke: My Lords, to take my noble friend's question a little further, obviously by definition the Armed Forces must have first call on the medical services. However, if those medical services are not required by the Armed Forces for emergencies or anything else, will they be available for civilians who may need such services and who are on waiting lists for medical treatment?
Lord Henley: My Lords, the noble Lord is right to stress that defence medical services are to provide for the Armed Forces, and particularly for the Armed Forces' front line role. Obviously they will be able to provide a degree of assistance for dependants within the Armed Forces, not as of right, but where there is a degree of slack or where there is a need to provide appropriate training to our own specialists which they cannot obtain purely from looking after a constituency of relatively fit young men and women.
Lord Vivian: My Lords, will my noble friend review the date of the closure of the Queen Elizabeth Military Hospital at Woolwich in view of the fact that it would appear that it is to close at the same time as the new military wings being established in the National Health Service hospitals at Frimley and Peterborough?
Lord Williams of Elvel: My Lords, can I press the Minister a little further on this Question? Let us assume that certain emergencies arise, short of a full-scale war as mentioned in the Question, and there are civilian casualties. Can I take it that if the defence medical services are not employed at the front line, they will be available for those civilian casualties as well?
Lord Craig of Radley: My Lords, in view of the shortage in certain consultant specialisations dealing with trauma, which the Minister acknowledged, can he say what additional steps the Government have in mind to correct the shortfall?
Lord Henley: My Lords, as I said, we are taking steps to look at the specific problems in relation to anaesthetists. Where shortages occur in other areas we shall have to look hard at the situation, insisting that consultants stay on rather than taking premature voluntary retirement, should they be seeking that. It is important that we keep those numbers up. We shall look at all possible means to make sure that numbers in each speciality are kept up to the appropriate level.
Lord Lucas: My Lords, to date 1,200 schools in Great Britain have applied for grant-maintained or self-governing status. Of those, 1,070 are now self-governing and a further 42 have applications in the pipeline. Self-government benefits schools and the communities they serve. That is why the sector continues to grow and flourish.
Lord Geddes: My Lords, I thank my noble friend for that encouraging reply, but can he tell the House whether, for those schools which have made the switch from local education authority to grant-maintained status, the numbers of pupils in what are now the grant-maintained schools have increased? Indeed, perhaps more relevant, can he say whether the numbers of teachers employed in such grant-maintained schools have increased?
Lord Lucas: My Lords, yes. While one cannot be too exact about the figures, it appears from our information that pupil numbers in grant-maintained schools are growing faster than average. The proportion of the schools' budgets spent on teachers is also rising and the number of teachers increases when the school goes grant maintained.
Lord Dean of Beswick: My Lords, while the Minister is expounding the success of opt-out schools, can he say whether the Government intend to help those schools which have already found themselves to be drastically short of funds, which may result in their having to lay off teachers? What does the Minister intend to do about that?
Lord Lucas: My Lords, as I said before, it has been a difficult year for funding in education, and grant-maintained schools are subject to the same restraints as other schools.
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