Health and Social Care Bill

My Lords, I think I am the first person to speak in this section of our proceedings this afternoon who is not either a doctor or a specialist in some branch of science very close to medicine—in the case of the noble Lord, Lord Mawhinney, biochemistry. An enormous strength of this House is that we can bring to bear such expertise and personal knowledge in our proceedings on a Bill such as this, and it greatly adds to our credibility in the nation as a whole. Equally, I am not a Platonist in any sense. It would be a disaster for democracy if the only people who took part in debating and determining legislation were those with a professional background or current professional involvement in the field concerned, so I make no apology for speaking. It has been something of a tradition so far this afternoon to say a few words about one’s personal or family backgrounds in the field of the NHS. I will briefly follow that tradition. I am the third or fourth person to say this this afternoon, but my father also was a GP in the NHS, for 40 years, and an enormous believer in the NHS—he actually qualified a year or two after the NHS Act came into effect. I think that he believed that the NHS was a sacred institution, and I probably inherited some of that sentiment. His great political hero was Nye Bevan. Although he came to believe that something of a mixed economy, both on the supply and demand side, was necessary in the NHS—because otherwise great resources which were available to it would no longer be available to it—he avoided taking on private patients during his whole career. This was on the grounds that if he did not give them a better deal than his NHS patients he would be cheating the private patients; and that if he gave them a better deal than his NHS patients, he would be cheating his NHS patients. He was not prepared to put himself in that position, although of course he did treat his partners’ private patients when they were on leave. That says enough about my family background in this area. The matter of education and training is fundamental to the NHS—and has been, as the noble Lord, Lord Walton, and others, have pointed out. It has been a symbiotic relationship since 1947. It has been absolutely understood that medical teaching and education were inextricably linked with the delivery of NHS medical care; not just the formal requirement on consultants in teaching hospitals to teach—obviously part of the quid pro quo for their prestigious appointments—but right through the system, including in non-teaching hospitals. This includes the obligation to take on junior doctors and train them properly—the anecdote of the noble Lord, Lord Winston, went to the heart of that tradition; the very fine ethos of the medical profession to take on trainees right through the primary and secondary systems. That has been the case for all that time since 1947. It is so enormously important that it should continue. Quite clearly, education and training are an existential requirement of the NHS. What has also been in place since 1947 and which has been accepted by successive Governments—I am not sure to what extent it is practiced at the present time—is a willingness to plan forward, to look and see if one has to make assumptions —one is never going to be exact about this. To look and see, taking account of doctors coming from abroad, of British-trained medical students who then want to emigrate; what kind of numbers we are going to have in the future, what kind of numbers we might need, and to modulate the supply against that anticipated level of demand. That is called planning, a word which I know is a very negative word for the present Government. I do not know whether that itself has had some influence on the point I am coming to. The astonishing point I now come to is that education and training were not originally considered by the Government to be an absolute primordial, elemental responsibility of the Secretary of State and of the NHS, going forward. We had obligations in the Bill as it was originally presented to us from another place, for the Secretary of State to ensure that there was proper consideration given to removing inequalities, to maintaining common autonomy, to encouraging the promotion of research, which is obviously very important, and I commend the Government for that; and to promote public health—again enormously important, and I again commend the Government for that. There is nothing at all about education and training. It was an afterthought. I suspect that the explanation does great credit to the Minister. We in the House know that he is extraordinarily well informed, conscientious and politically sensitive. I speculate—I have no inside knowledge; if I did, perhaps I would not be able to talk about it—that the Minister went to his colleagues and said, ““Good Lord, I can't possibly take this Bill to the House of Lords without something in it about education and training. I would be torn to pieces by the likes of the noble Lords, Lord Walton, Lord Patel and other distinguished people, and not only my reputation but the Government's would be in tatters, so we have to have something in the Bill””. I suspect that at the last minute he endeavoured to remedy the situation. If that is the case, I pay tribute to him; he did a very good day's work for the Government and, much more importantly, for the NHS. I am not sure that his amendment is adequate. I would like to have seen words in it such as ““comprehensive”” or ““integrated””. I sense that these concepts are deeply suspect to the Government. However, they are inherent in the concept of the NHS and in its success over several generations not merely in delivering healthcare, which is its main aim, but in preserving the extraordinarily high and internationally recognised quality of British medicine. That is a remarkable achievement that could not have been conceived of had there not been an effective system of training and education, proper planning to ensure that that took place and a symbiotic relationship between the delivery of healthcare and training for healthcare. I would like to know from the Government the explanation for treating education and training as an afterthought. Perhaps I will have the answer from the Liberal Democrat Benches straight away.