Health and Social Care Bill

My Lords, I was locked out. As the spirit of reminiscence is in the air, I greatly enjoyed listening to the many impassioned speeches on the first amendment. I look back, as a fervent supporter of the NHS, upon the days when, as a medical student in 1944 and an officer in the British Medical Students Association, I confronted the then Minister for Health, Mr Willink, lobbying against the Act because I was pressed by the BMA. Subsequently, as I said at Second Reading, I learnt as a houseman what the horrors of the pre-NHS medical process were in the UK. Clause 1 of the Bill, which inserts new Clause 1(1) in the National Health Service Act 2006, is very similar to what we learnt in the 1946 Act, which was so closely quoted by the noble and learned Lord, Lord Mackay of Clashfern. I am tabling this amendment with my noble friend Lord Patel because the wording in the Bill at the moment says: "““The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of illness””." Those objectives cannot be achieved without improving the provision of education and training for the healthcare workforce—hence the reason for tabling this amendment with my noble friend Lord Patel. The other amendments grouped with ours come to a similar conclusion. The wording is different and so is the emphasis, but they all have the same objective: putting a requirement for the NHS to provide education and training for its workers into the Bill. When the NHS began, it was recognised that a partnership needed to be established with the universities and the other higher education organisations that trained doctors, dentists and other healthcare professionals. In the original contracts of doctors working in the National Health Service, it was fully recognised that academic clinicians employed by the universities would devote part of their time to teaching and research, but would give clinical services to the NHS for about half their time. In return, it was also accepted as an article of faith from the beginning of the National Health Service that consultants working in the NHS would be required to undertake teaching, for instance of medical students. The financial responsibility for training undergraduate doctors and dentists was that of the universities, but from the inception of the NHS it was made absolutely clear that postgraduate training of its specialists, dentists and, later, nurses was the financial responsibility of the National Health Service. That has always been the case. To that end, the NHS paid for and established postgraduate deanships in every region of the country. Those postgraduate deans continue, and supervise the training of specialist surgeons, physicians, dentists and more recently, to an extent, the postgraduate and continuing education of other healthcare professionals. Our purpose in tabling this amendment is to make certain that this responsibility is acknowledged in the Bill. It is clear that government Amendment 43 reaches much the same kind of objective, but responsibility for training and education is so crucial that it should be highlighted in Clause 1. It is absolutely essential. Having said that, there are many uncertainties about which the Bill is lamentably silent. For instance, in what sense is postgraduate training of the NHS workforce enshrined in mechanisms in partnership with the universities? What will be the future of postgraduate deans? We understand that they are to be retained, but who will employ them? The NHS will be required to fund them, but where will they be placed? If they are housed in the so-called clinical senates, how many senates will there be, where will they be located and what will their responsibilities be in the provision of postgraduate education and training? Will their responsibilities take full account of the statutory responsibilities of the regulatory authorities, such as the General Medical Council, the General Dental Council, the Nursing and Midwifery Council and so on? Will that be enshrined in statute? Even more crucially, if certain NHS organisations are to be taken over by any willing provider—I am not saying that this will come about—what mechanism will be introduced in the Bill to require that those NHS bodies will still provide the facilities for education and training of the workforce? That is absolutely crucial. An exactly similar requirement is needed to make certain that commissioning bodies and the national Commissioning Board have a responsibility to maintain the high quality of education and training that has been such a feature of our NHS, in collaboration with universities and other higher education bodies, ever since the NHS was established. These issues are not included in the Bill and require to be included. I beg to move.