Health and Social Care Bill

My Lords, as this is the first day of a new stage of the Bill, I am required to start by declaring my interests. I am chair of the Heart of England NHS Foundation Trust; president of the Royal Society of Public Health, the Fluoridation Society and the Health Care Supply Association, consultant trainer with Cumberlege Connections and member of the advisory council of Easy Care. The noble Lord, Lord Cotter, put his finger on it when he spoke of concerns about the quality of nursing care in some parts of the NHS. This has led in the last few months to considerable debate about the quality of education and training of nurses and indeed healthcare assistants. We will, of course, be coming back to that issue later in Committee. However, it has served to illustrate the critical importance of education and training of the healthcare workforce, be they doctors, nurses, AHPs or indeed even psychotherapists. My Amendments 6 and 44 seek to ensure that the Secretary of State exercises leadership and responsibility in this area. This is very important in the context of the Government’s intention to create a much more diverse and disparate healthcare system in the future. It is essential that we protect the integrity of a national approach to professional education and training. Past experience shows that, particularly at a time of financial stringency, the NHS has sometimes been tempted to cut spending on education and training because it has been seen as an easy short-term way to reduce expenditure. It is essential that the Secretary of State assumes responsibility for ensuring sufficient training commissions and the assurance of quality and standards. The Government have made it clear that they wish to establish a special health authority, Health Education England, which is going to provide leadership and quality assurance across the system. Alongside that the Government are proposing greater local provider involvement in education and training with provider-led skills networks taking on responsibilities for strategic workforce development. I have noted the concern of the noble Lord, Lord Patel, in this area. I agree that there are real risks unless a national framework is set with national co-ordination. Like my noble friend Lord Warner, as a health Minister I made a number of rather painful appearances before the Health Select Committee to explain why the NHS was not investing sufficiently in education and training. Like him, I found that strategic health authorities have been very helpful in intervening locally when there were problems. Who will intervene locally if there are problems in the future? Will it be the clinical senates? Will it be the local offices of the national commissioning board, which I believe to be inevitable? Will it be the commissioning support units that are going to be set up to support clinical commissioning groups? It would be very helpful to know who at a regional or local level will be able to take some kind of leadership role, particularly when there is evidence of things going wrong. However, I believe it is right there should be more local provider involvement in education and training. Many of the current discussions between commissioners and the universities and the other providers of education take place without NHS trusts being present. Yet the quality of training is crucial to the future workforce in those trusts. If students are to get practical training in NHS hospitals they need the active support of those hospitals. It makes sense to involve NHS trusts more. I notice that in his extensive letter to us following Second Reading the noble Earl in relation to education and training did not mention NHS trusts at all. He uses the word ““provider””. I hope that is not symptomatic of an approach by the Government which is going to write out ““NHS trust”” and only use the term ““provider”” in their unwise attempts to set up a competitive market in the NHS. Will the noble Earl give an assurance that the private sector will be required to make a contribution to the cost of education and training? The noble Lord, Lord Walton, made that point at the beginning of our debate. This becomes very important if contracts are given to the private sector that undermine the ability of NHS trusts to provide comprehensive services. This is why cherry-picking is so feared in the health service and it would be grossly unfair if private sector companies which win such contracts did not have an obligation to contribute to education and training. At the national level, I have already referred to the establishment of Health Education England. I hope the noble Earl can inform the House what is proposed and specifically what would be the relationship between it and the Secretary of State. I hope that he can confirm that this is not an attempt to move responsibility for education and training offshore and to absolve the Secretary of State of proper accountability to Parliament for ensuring the cohesive nature of education and training. I would like him to assure me that the number of training commissions will be decided nationally by the Secretary of State. Unless that happens, we will not have the national planning that my noble friends Lord Davies and Lord Warner referred to. Without some kind of national planning, we will go back to the bad old days of commissions being reduced in times of financial difficulty and the health service in a few years finding itself with a great shortage because we have not trained enough new people to come in. There will then be panic and a huge expansion in training commissions. A few years later, we will have unemployed professionals unable to get jobs within the health service. It was because of that continual feature of the NHS over many years that a national framework was developed. It is absolutely essential that the Secretary of State retains responsibility for that. I also hope that the Minister will respond to the noble Lord, Lord Walton, who asked him about the place of clinical senates, the national regulatory bodies and the deaneries in the new setup. Can the Minister assure me that his amendment gives the Secretary of State a comprehensive duty and appropriate powers? It uses the phrase ““any relevant enactment”” and defines it thus: "““In subsection (1), ‘relevant enactment’ means section 63 of the Health Services and Public Health Act 1968””—" of blessed memory— "““and any other enactment under which the Secretary of State has functions which could be exercised for the purpose of securing that there is such an effective system as is mentioned in that subsection””." That is parliamentary counsel at its very best. But what does it mean? I am worried that it is rather a restrictive definition of the powers of the Secretary of State. I should be grateful if the Minister could respond to that point. In particular, can he assure me that the Secretary of State will have sufficient power in relation to the budget for education and training and the number of training commissions linked to national workforce planning, that there will be structures to underpin a comprehensive approach, that public health doctors will be covered, that standards will be set and monitored, that Health Education England will be properly accountable to the Secretary of State and thence to Parliament, and that the duty on the Secretary of State will embrace all parts of the NHS and other providers? Above all, can he assure me that the ethos that my noble friend Lord Winston mentioned, of a commitment on the part of all those in the health service to education and training, will continue under the new arrangements?