Health and Social Care Bill

My Lords, this has been a very useful debate. Perhaps I can begin with a clear statement that the Government are committed to the education, training and continuing development of the healthcare workforce. This is fundamental in supporting the delivery of excellent healthcare services across the NHS. I am pleased that so many noble Lords share that view. We are, however, in the rather odd position of having before us two groups of amendments on education and training. Given that we still await a further debate on the subject today, I should like to reserve some of the detail of my remarks, if I may, for that debate, when I address one of the amendments in the name of the noble Lord, Lord Patel. However, to begin with, and for now, I think that it will be helpful if I set the scene. First, I confirm to the noble Baroness, Lady Finlay, that we made clear in Liberating the NHS: Developing the Healthcare Workforce—From Design to Delivery, which was published recently, that we are committed to a national framework for education and training, with Health Education England providing national leadership and being directly accountable to the Secretary of State. Health Education England will ensure that the healthcare workforce has the right skills, behaviours and training, and is available in the right numbers to support the delivery of excellent healthcare and health improvement. It will work with a range of key partners, including the medical royal colleges, professional regulators and the academic and research sectors. The national input and oversight will be there in all the areas which, rightly, the noble Baroness is concerned about. Health Education England and the wider education and training system will, as I said, remain accountable to the Secretary of State, who will have a duty to secure an effective system for the planning and delivery of education and training in the NHS. Employers and healthcare professionals will play a leading role in workforce planning and development through the establishment of local education and training boards, working with the education and research sectors. I shall have more to say about that in a moment. I can reassure noble Lords straight away that postgraduate deans will continue to be a critically important part of the medical training arrangements. The Government listened to the concerns expressed in Committee by a number of Peers that the Bill did not go far enough in safeguarding the future education and training system. In this group of amendments, which I shall speak to shortly, we have tabled a number of proposals designed to address the gaps that noble Lords identified. On Amendment 2, tabled by the noble Baroness, Lady Finlay, the Government have already introduced a duty for the Secretary of State to maintain an effective system for education and training. Our duty is more comprehensive than this amendment in that it applies to the whole healthcare workforce and not just doctors. The noble Baroness asked about the scope of Clause 6. Our duty applies to people who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England. This covers healthcare professionals at the centre of delivering healthcare, including doctors, dentists, nurses, midwives, pharmacists, healthcare scientists and the allied health professions. It includes registered and unregistered professions. It also covers non-clinical staff who are involved in, for example, the commissioning or administration of services. In the light of that, I hope that the noble Baroness will feel reassured to some extent and feel able to withdraw her amendment. The noble Lord, Lord Walton, put particular emphasis on the universities being involved in local education and training boards. We wholeheartedly agree that it is crucial that universities and other education providers are integral partners in the planning, commissioning and delivery of education. Health Education England will set robust criteria for the establishment of the local boards, and strong and meaningful partnerships with universities will be a key element of that assessment. The core purpose of the local boards is to lead planning and education commissioning to ensure security of supply of the local health and care workforce and to support national workforce priorities set by Health Education England. They will have a number of functions which I have detailed in a recent letter to noble Lords. One of them will be to hold and allocate funding for education and training. Others will be to commission education and training, to secure quality and value from education and training providers and to secure the partnerships that we want to see with clinicians, CCGs, local authorities, health and well-being boards, universities and other providers of education, research and innovation. At the same time, however, Health Education England will be overseeing that, securing national coherence and greater transparency in the education and training investments that employers make in their workforce. The noble Lord, Lord Turnberg, asked me about the role of the royal colleges and postgraduate deans. We have no intention of tampering with national standards. Professional regulators will continue to set professional standards. The royal colleges will continue to shape curricula and will work in partnership with Health Education England to ensure that education and training reflect best practice and are of high quality. Professional regulators have a statutory responsibility for setting standards and ensuring those standards are met and maintained. The new system goes further because we have developed quality indicators that will bring quality to the heart of the commissioning process. The education outcomes framework, which I will say a bit more about when I come to address the later amendments tabled by the noble Lord, Lord Patel, will set out the outcomes expected to achieve quality healthcare, education and training. Indeed, one of Health Education England’s key functions is to promote high-quality education and training that is responsive to the changing needs of patients and local communities. Let me say a little more in answer to the noble Lord, Lord Walton, about postgraduate deans. Postgraduate deans will remain critical to these training arrangements. We expect local education and training boards to be able to demonstrate that their postgraduate deans will be able to act independently of any perceived conflict of interest that may arise between training and service priorities. There will be clear checks and balances in place and quality metrics to hold local education providers to account for the quality of the education that they deliver. Postgraduate deans will have all the powers that they have now to respond to concerns about the quality of training, to take action where required to improve standards and to assure the professional regulators and Health Education England that poor performance, if it occurs, is identified and tackled. In the new system, they will have what I hope will be the welcome support of the local education and training board, and, if necessary, Health Education England, to challenge poor quality and behaviours. We believe that the checks and balances will be there in the system. The noble Lords, Lord Walton of Detchant and Lord Hunt of Kings Heath, asked about the involvement of qualified providers other than NHS providers. All providers of NHS-funded services will be expected to participate in the planning and delivery of education and training. Health Education England will allocate funding for investment in the future workforce only to those that participate. We will be considering in future weeks what additional duties we might place on all providers when we look at proposals for a future Bill on education and training. The noble Lord, Lord Hunt of Kings Heath, referred to funding. Many respondents to the consultation called for education and training funding to be protected. We agree, so we will ensure that Health Education England establishes transparent systems to make sure that organisations that receive MPET funding are held to account for using it for the education and training of the NHS workforce. As I said, the Government have listened to the concerns expressed in Committee by a number of Peers. We have already introduced the duty on the Secretary of State to exercise his functions so as to secure an effective system for education and training. Amendment 15 puts more flesh on that duty by specifying the Acts that contain functions that must be exercised by the Secretary of State so as to discharge his education and training duty. Building on that, we have tabled amendments to strengthen links with the wider system. Amendments 61 and 104 place duties on the board and on CCGs to have regard to the need to promote education and training. These duties are designed to ensure that commissioners of NHS services consider the planning, commissioning and delivery of education and training when carrying out their functions. Nationally, Health Education England will work with the NHS Commissioning Board to ensure that its strategic framework for education, training and workforce planning reflects service commissioning priorities and that workforce development implications of innovation and changes in the pattern and nature of services are addressed and identified. As I indicated earlier, CCGs will work with the local education and training boards to consider the workforce implications of their local service commissioning decisions. The other amendments tabled in this group by noble Lords are, I believe, designed to have much the same effect. I hope that noble Lords will be reassured by the vision I have set out for education and training and by the amendments that we are proposing, and that they will feel able to support those amendments in due course when they are moved and, for now, to withdraw theirs.