My Lords, this is a really useful short debate. I begin by saying that members
of the Committee should not feel anxious; I feel that there is a degree of anxiety which needs to be allayed.
Local health providers and their clinical leaders have told us that they are well placed to understand the changing shape of services and the way in which their workforce must respond to deliver high-quality services to patients. They are able to link workforce planning to service and financial planning, something that has not always been done well in the past and which has contributed to failings in workforce planning.
Following consultation, we have chosen to give local education and training boards a statutory basis as committees of Health Education England. But the policy intent, reflected in the Bill, is that they are not mere local delivery arms of a national body. Rather, they are a key part of decentralising power, so for the first time, the providers of health services will have clear responsibility and accountability for the planning, commissioning and quality management of education and training for their workforce.
The mandate to the Health Education England special health authority includes a clear objective to support more autonomous local decision-making on behalf of local communities. A critical measure of the success of Health Education England at national level will be the effectiveness with which its engagement with the LETBs and employers results in greater responsibility and accountability for workforce development being taken by employers at local level.
At the same time, with localism comes accountability. HEE will need to hold LETBs to account for their investment in education and training and delivery against key priorities. Of course, there needs to be co-ordination in the approach to planning and delivering education and training. That is why the Government, and the vast majority of stakeholders, believe that we have got the balance right in establishing Health Education England as a national leadership organisation for education and training, with local providers securing greater autonomy and accountability through the LETBs. There will always be national level priorities and objectives for workforce development and, rightly, Ministers want reassurance through Health Education England that they are being addressed, but the policy intent is to do that in a way that strikes a balance between the national and the more local perspectives.
Amendment 22 is intended to ensure that duties under Clause 86 extend to the LETBs. I appreciated the balanced comments of the noble Lord, Lord Hunt of Kings Heath, and wholeheartedly agree that local education and training boards, given a statutory basis as committees of Health Education England, should support Health Education England in the delivery of key national duties, including those in Clause 86. As commissioners of education and training, Health Education England and the LETBs will work with education partners, service providers and professional regulators to ensure that the education and training that is provided in education institutions and in health service settings continually improves and delivers health professionals who are fit for purpose and who meet the needs of employers, patients and service users.
We have already discussed the importance of research and the role that local education and training boards can play in supporting the diffusion of research and
innovation. By promoting the NHS constitution through its workforce planning and education and training activities, HEE and the LETBs will help to ensure that staff develop the correct values and behaviours to practise in the NHS and the public health system.
Amendment 47 would amend Clause 92 to place an obligation on Health Education England to provide guidance on how it will ensure that providers of health services co-operate with local education and training boards. Clause 92 builds on an existing duty introduced by the Health and Social Care Act 2012, which places a legal obligation on commissioners to make arrangements with providers to secure their co-operation with the Secretary of State on education and training. The purpose of that duty is to ensure co-operation with the local education and training board to support workforce planning activities, the provision of workforce information and the delivery of education and training to healthcare workers. That is an important step in ensuring that the system is well integrated and that all providers play their part in supporting essential education and training activity.
To emphasise that, and in answer to a question put to me by the noble Lord, Lord Hunt, Clause 92 provides that regulations,
“must require specified commissioners ... to include in the arrangements under the National Health Service Act 2006 ... terms to ensure that”,
providers co-operate with the LETB.
The Government have already put in place measures to deliver the duty in the Health and Social Care Act 2012, which came into effect on 1 April 2013, by amending the commissioning contracts and supporting regulations for the delivery of services, so that they now require co-operation on education and training.
It will be the regulations rather than any guidance which will set out how the duty is to be implemented. The level of co-operation, the information requested and the obligations required may vary over time. It is therefore more appropriate to enable this level of administrative and procedural detail to be set by regulations rather than in the Bill.
Turning next to Amendments 38, 41 and 50, as we have previously discussed, it is important that Health Education England and the LETBs have access to people with expertise and knowledge on education and training matters. The postgraduate deans have great knowledge and expertise and, through the local education and training boards, they are now an integral part of the new system, working alongside other colleagues to strengthen the multidisciplinary approach to planning and developing the workforce. It is important to remember here that Health Education England and the LETBs have responsibility for the education and training of all the professions. Although medical training is a very important element of their functions, the LETBs have a much broader focus.
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It is important that we give LETBs the flexibility to determine who sits on their boards. To be appointed in the first place, local education and training boards need to demonstrate to Health Education England that they have the right governance arrangements and
the right mix of people on their board to ensure that it has the skills, knowledge and expertise to carry out its functions.
The Bill makes provision in Clause 91 for those involved in education and training, such as universities, to be eligible to sit on a LETB. We know that all the 13 LETBs established by the HEE special health authority have a university representative on their board.
Amendment 52 seeks to place a requirement on Health Education England to direct a LETB to amend its education and training plan if not doing so would lead to a failure to ensure national workforce priorities are implemented. I am pleased to be able to reassure the Committee that such a provision already exists in the Bill. Education and training plans will be submitted to HEE for review and approval. If, after reviewing the plan, HEE considers that it does not suitably support nationally agreed priorities and outcomes, subsections (6) and (7) provide the power to require the local education and training board to amend the plan.
On Amendments 49 and 51, the Government agree that it is important that local partners across the health and care system are able to be involved in the development of education and training plans. That is why we have made provision for providers of health services, commissioners of health services and health and well-being boards to be involved in plans’ development.
The noble Baroness, Lady Pitkeathley, asked whether there were any examples of patients and carers already involved in LETBs. HEE will have a patient advisory forum as part of its advisory structure. At a local level, the appointment criteria set out that LETBs must link in to patient forums and take account of patients’ views.
I also point out that the Bill enables Health Education England to direct LETBs to involve other persons in the development of their plans. The criteria that the Health Education England special health authority uses to appoint LETBs require it to demonstrate meaningful and effective engagement with a much wider range of partners across health, public health, social care and the education and research sectors. This includes patient groups, students and trainees, and the range of professional bodies and professional regulators with an interest in education and training.
I hope that the Committee feels reassured that local education and training boards are crucial to support Health Education England in carrying out its education and training functions. I therefore hope that the noble Lord feels content to withdraw the amendment.