Health and Social Care Bill

My Lords, I beg to move Amendment 47A, which stands also in the names of my noble friends Lord Walton of Detchant and Lord Patel, who, regrettably, cannot attend the Committee this afternoon. In moving this important amendment and speaking to Amendment 133 in this group, I wish to recognise the important statement made by the Minister on the first day in Committee on 25 October, when he made the case for an amendment to place a duty on the Secretary of State to exercise his function so as to secure an effective education and training system. This is an important and much welcomed recognition of the fact that education and training is absolutely critical to the delivery of healthcare. The Minister will recognise that, without an appropriate system of education and training, whether it be for a surgeon or a physiotherapist, a neurosurgeon or a nurse, a physician or a radiographer, or indeed a psychiatrist or an occupational therapist, patients will be put at risk. The important gains that the Bill proposes in terms of improving clinical outcomes will not be achieved and vital resources will be squandered. Education is at the heart of delivering effective healthcare. The professions, the public and indeed government have had previous experience of the introduction of changes in education and training with modernising medical careers that cause severe anxiety and disruption and have made all exceedingly sensitive to the importance of ensuring that any change in systems in the future provides the best opportunity for the patients who have to use health services in our country. It is well recognised that Her Majesty’s Government wish to deal with education and training in a responsible and sensitive way, and it is broadly recognised that the changes proposed by the Bill raise anxieties about how education and training might be discharged in the future. In this regard, the commitment of the Government to seeking further clarification and the views of the NHS Future Forum is an important initiative. However, it would be impossible for the Bill to proceed unless there were absolute clarity with regard to education and training. The intention is that employers will play a much greater role in the future discharge of education and training functions, and there is no doubt that the education and training system must be sensitive to the needs of the service and, most of all, to the needs of patients. We must also ensure, however, that two vital issues are addressed. The first is the ongoing interaction and engagement with the academic sector, universities and educational expertise. It would not be right for employers alone to determine the nature and content of curricula associated with the training of the healthcare workforce. Secondly, notwithstanding that there will be a second Bill—most likely in the next Session of Parliament—to deal with health workforce education and training, it is critical that enough detail is associated with this Bill to ensure that we can continue with confidence in planning and organising the arrangements for the healthcare workforce to be appropriately trained and educated. With regard to interaction with those bodies, authorities and universities that have an expertise in the education of the healthcare workforce, will the Minister confirm that it is indeed the Government’s intention that, in the proposal to establish Heath Education England—whether as a special health authority in the intervening period and, thereafter, ultimately as a statutory arm’s-length body in a future Bill—there will be a requirement for Health Education England to engage fully with the academic sector? Will the development of curricula for the training of different disciplines in the healthcare workforce be set in partnership by service providers, employers and academic institutions working together to develop the curriculum? Will the working of local education and training boards be such that there is a clear relationship between them and Health Education England? Will the boards be composed of appropriate academic-health service partnerships to ensure that the valuable expertise in both the service and the academic sector can be brought into play to develop appropriate curricula and ensure that they are delivered to the highest standard; that those curricula are developed to meet both service needs and, most importantly, patient needs; and that, within the structure of local education and training boards, there are non-executive independent directors who ensure that any potential conflicts of interest are overcome? We have certainly been fortunate in having strong deaneries that have accumulated large volumes of expertise in and insight into the delivery of postgraduate medical education and training. It is important that these functions and this expertise are not lost in the system, and that postgraduate deans are potentially housed in universities in the future so that their important functions can continue to be delivered as part of the local education and training board structure. It is critical that there is an obligation on Health Education England to have an appropriate level of engagement and interaction with the royal colleges in medicine and other professional colleges. They are the regulatory bodies that play an important role in the supervision of training and the development of standards for practice in our country. Heath Education England should also be under an obligation to ensure that any qualified provider—NHS trusts, general medical practitioners and others—who ultimately has the responsibility and privilege of delivering NHS services has regard to providing appropriate education and training opportunities. This is vital, as the basis of education and training in our country has always been strong clinical exposure. If many of those clinical opportunities for training move to different service providers, the opportunities for education and training must not be lost. Amendment 133 deals with a further responsibility of the board and commissioning groups—to ensure that these interactions are properly addressed and that opportunities for training are not lost but well understood. I recognise that the Government are considering these matters through the work of the NHS Future Forum and in other consultations. The purpose of tabling these amendments is to probe the Government’s view about education and training, and to determine whether there remains a strong commitment to academic service partnerships to drive forward education, training, innovation and research opportunities. These are all vital in ensuring that we have the highest-quality healthcare workforce for the future. They will also help us to understand better how Her Majesty’s Government envisage the relationship between Health Education England and local education and training boards. Other amendments in this group deal with the important question of the future funding of education and training, and the importance of funding being ring-fenced and applied only for this purpose, rather than being put into potential jeopardy and used for other elements of the responsibility of the NHS Commissioning Board.