HL Deb 13 June 2002 vol 636 cc402-15

2 After clause 2, insert the following new clause— Duty of Primary Care Trusts, NHS trusts and Strategic Health Authorities regarding education, training and research

Primary Care Trusts, NHS trusts and Strategic Health Authorities shall have a duty to safeguard and promote education, training and research"

The Commons disagreed to this amendment for the following reason

2A Because the law already provides adequately for education, training and research.

Lord Hunt of Kings Heath

My Lords, I beg to move that the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A.

During the passage of the Bill through this House we had some important debates on the whole issue of education, training and research in the NHS in England and Wales. I want to assure noble Lords that the points raised in those debates have been taken very seriously indeed by the Government and that we are exercised to ensure that the NHS, universities, the DfES and HEFC all play their part in ensuring that those issues are dealt with satisfactorily and that there is a co-ordinated response across all those sectors.

During earlier debate, I informed the House of a number of pieces of work that we have put in train which I believe indicate the importance we attach to these matters. We have reviewed the range of existing national liaison arrangements between the Department of Health, the Department for Education and Skills and a range of organisations in the independent sector. We have done so with a view to recasting them into more effective and efficient strategic partnerships to bring together the multi-professional wider health system and broader education and research agendas. We are therefore providing the practical support the modernisation programme requires.

Officials in both my department and the Department for Education and Skills are now drawing up proposals which would see a new national framework, with senior representations from both departments, to ensure effective joint working to take forward the education, research and service agendas and to take an overview of the interplay between them.

Progress has already been made and I am very pleased that it was possible for the Department of Health to agree "a strategic alliance" with the Higher Education Funding Council for England. This alliance, which covers learning, teaching and research, builds on the early alliance between the department and HEFCE on research. A notable feature is that it will cover both health and social care. The alliance will provide a framework of partnerships with higher education at national level, facilitating the establishment of local health and education sector partnerships. These partnership arrangements will promote delivery of NHS planned commitments on workforce development.

We have already instigated further work to ensure the success of the medical school expansion. The Department of Health and HEFCE have established a joint group to oversee the implementation of that expansion. The group will include the chair of the General Medical Council's education committee within its membership. Part of the group's remit will be to monitor recruitment to posts needed to facilitate the expansion of medical students. It will identify other issues related to the expansion and recommend appropriate action.

While this group will look at medical schools specifically, I want to emphasise to noble Lords that we recognise the shared interest in monitoring the situation for all teaching academics and the adequacy of the supply of all health professionals and we will ensure that this is not overshadowed.

We have also agreed that one of the seven non-executive members for each strategic health authority will be from an institution within the higher education sector responsible for delivery of pre-registration education in medicine, dentistry, pharmacy, nursing or other allied health profession. The NHS Appointments Commission will interview candidates and the candidate who best meets the requirements of the post will be appointed. It is anticipated that these measures will result in a mixture of representation from medical schools and, I stress, other institutions within the relevant university. This will ensure appropriate expertise is available to the strategic health authority sector as a whole.

As far as the legislative framework is concerned, I believe that what we have in place meets the concerns of noble Lords. I do not accept that adding the suggested duty would of itself ensure that education, training and research are taken more seriously than is already the case. Moreover, the duty would be difficult to define and it would be even more difficult to define what a breach of that duty would be. Surely, the creation of a statutory duty must be sufficiently precise for those who must discharge the duty to know exactly what they must do and what action or inaction will amount to a breach of that duty. Without such precision a statutory duty has no teeth. It is for those reasons that I do not believe there is a place for the duty on the face of the legislation.

There is a further important reason why the amendment relating to Welsh NHS organisations is inappropriate. The Bill establishes local health boards in Wales and provides enabling powers for the National Assembly to decide how they should function. It is surely wrong in principle that we should seek to fetter the Assembly's deliberations by being prescriptive in this one area.

Much of our debate, though I accept not exclusively, was about the role of primary care trusts. They will take on all their functions under Shifting the Balance of Power by next April. Additionally, 30 primary care trusts will have been designed as teaching primary care trusts, mainly in deprived and under-staffed areas, to provide teaching, research and clinical opportunities for primary and community care professionals to support and improve the delivery of services to local populations.

This is a very exciting development. Teaching primary care trusts will work alongside local universities to provide a learning environment for their own organisation and staff, as well as a local resource for the wider health community. These and other PCTs will have access to shared resources for research governance and management. A network of PCTs will be designated to maintain this capacity from 2003–4.

The national primary and care trust development programme has been established as part of a set of measures to ensure that these primary care trusts are fully equipped to take on their new functions. It has been recognised that, in addition to developing the general competencies of primary care trusts, more detailed work is required over a longer period on certain matters.

Noble Lords may well be aware that my right honourable friend the Minister for Health announced in another place that one of those subjects will be that of research, education and training issues affecting primary care trusts across the range of those functions. The aim will be to pull together a number of front-line primary care trusts and other key individuals and organisations to take their work forward. That will be a very important way of ensuring that PCTs discharge their functions in this area. There is no doubt that the debate in this House during the passage of the Bill was a very important element in informing the programme that we are now to take forward.

We are not talking just about the role of primary care trusts. Strategic health authorities have an important role to play too—that of creating a coherent strategic framework and of ensuring, through building, capacity and supporting performance improvements, that the primary care trusts are enabled to deliver their full range of responsibilities.

We believe that these changes will bring benefits to education, training and research in and for the NHS as well as to services for patients. We want to hear very much from the service about combining the NHS service commitment with academic duties. My right honourable friend the Minister for Health, with Mrs Margaret Hodge, the Minister of State for Lifelong Learning and Higher Education, will he meeting the chair of the BMA's medical academics staff committee on 26th June to discuss the impact of the research assessment exercise on the medical academic workforce.

I fully accept that we need to monitor the changes closely to ensure that there are no unintended consequences and that the arrangements we have put in place are bedding down well. Once primary care trusts are operating fully in their new, wider role and there is experience of how they work, the time will be right to begin a review of education, training and research in the NHS.

I am therefore pleased to announce today that there will be a joint ministerial review of education, training and research in and for the National Health Service across England and Wales. The review will take into account the concerns expressed by noble Lords on these matters. I want to stress that it will cover the full range of health care professions and not just doctors. The review will look at, for example, how the new arrangements set out in Shifting the Balance of Power and those created by this Bill impact on the role of primary care trusts, NHS trusts and strategic health authorities in education, training and research across the whole of the NHS. The review will examine the partnerships between the new and existing NHS bodies and higher and further education to ensure that they continue to work well.

These issues are clearly also important in Wales. The review will come at a helpful time for informing the process of implementing local health boards in Wales. The Welsh Assembly has already shown its commitment to research through its research and development strategy, which is currently out to consultation. It seeks to put research and development on a firm footing and covers wider collaboration with trusts and local health groups. However, the review broadens the focus, and the Assembly will give full consideration to any proposals that go beyond those in the strategy. The review will also helpfully inform the development of the Assembly's strategy on continuing professional development in the NHS, which is due to be produced in 2004, and will take forward many of the issues around education, training, and research in the NHS in Wales.

I hope that I have demonstrated that the Government have listened most carefully to the arguments put forward by noble Lords throughout the passage of the Bill. I also hope that noble Lords will accept that the review I have announced this afternoon will be an excellent way in which to monitor and take forward further issues of concern over the next year or so. On that basis, I trust that the House will be able to accept the amendment that I have put forward.

Moved, That the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A.—(Lord Hunt of Kings Heath.)

5.15 p.m.

Baroness Northover

rose to move, as an amendment to the Motion that the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A, leave out "not".

The noble Baroness said: My Lords, as we have heard, this is a key issue for the future of the NHS. I have no hesitation at all in bringing this amendment back for your Lordships to reconsider. At Third Reading your Lordships approved this amendment, but it was then overturned in another place. The amendment would make it a duty for primary care trusts, hospital trusts and strategic health authorities to safeguard and promote education, training, and research.

As we have just heard, it was claimed in the other place that our amendment was unnecessary: Because the law already provides adequately for education, training and research". We cannot agree that the amendment is not necessary. During our debates in this House we heard about the problems that such areas already encounter, many of which were mentioned by the Minister. With the reorganisations proposed in the Bill and the devolution to primary care level, such problems could become more acute. That is why we put forward the amendment in the first place; that is why we are moving it again today.

As we heard at early stages of the Bill's proceedings, PCTs can support education, training and research; but they do not have to, except in a few exceptional circumstances. The view was also expressed by the Minister that dedicated funding streams would be safe. He stated that he did not believe that primary care trusts would be under pressure to spend that money for other purposes. However, during earlier debates, we learnt that that has already happened. Therefore, our task is to ensure that research, education and training are protected and encouraged when PCTs come to set their budgets.

At earlier stages, we and others expressed acute worries about these areas. Since the passage of the original amendment in this House, I am glad to see that the Government have made some welcome moves. The Minister was kind enough to write to me on the subject, and he expanded on that this afternoon. His proposal is that there should be a ministerial review of the arrangements for education, training and research in and for the NHS. In his first letter on the subject, the Minister stated that the review should take place once PCTs have had a chance to take on their full range of functions and the new system had bedded down. If the review highlighted areas of concern, he stated: We would consider preparing guidance and, should it prove necessary, issue directions to PCTs and/or other NHS bodies". I explained to the Minister in my reply to that letter that I remain concerned on a number of points. I expressed surprise that departmental officials and lawyers felt, as he indicated—and, indeed, indicated again today—that they would have difficulty defining the duty to support research, training and education and, consequently, a breach of such a duty. I pointed out that in the secondary sector there is now a research and development structure with monitoring mechanisms, targets and accountability. Therefore, there should be no reason why a similar structure should not exist in primary care. This could be of utmost importance for the furthering of public health, given that the majority of health problems are contained in primary care, although some may progress to secondary care. The Secretary of State also has such a duty. So it is definable, even though it may not be working as effectively as we would all like to see.

I also noted that the Minister's proposed review would take place only at some unspecified time in the future. There was no indication of who might be involved in the review, whether it would be independent, whether it would include experts, or whether it would be made public in any way; neither was it spelt out as to how Parliament was to discover the nature of its conclusions. It also seemed as if it would be a one-off process, rather than providing more constant audit.

I was also most concerned that setting new arrangements for PCTs in place under the Bill, without building in the protection that we have been seeking, would mean that patterns would develop, which, as time went on, would become more difficult to change. It clearly needs to be part of the culture of the NHS that support for research, training and education is built in at every level. This was highlighted on Tuesday of this week in relation to the Question tabled by my noble friend Lord Clement-Jones about medical education—the problem of trying to increase the number of doctors when at the same time we are losing clinical academics hand over fist. Now is simply not the time to trust to things working out without strong mechanisms being in place to ensure that they do.

I gather that the Minister proposes that the terms of reference for the review should be set by the end of this year, and that it should begin work early in 2003. I remain concerned about the time-scale. I am anxious to hear what the Minister has to say in that respect, given the problems that already exist in these areas. I should also like to be assured that such a review will address some of the key issues involved. Will the review examine whether adequate facilities are available for these areas? Will it examine whether those working in these areas will have protected time and not, for example, be expected to work 80 hours a week in order to be both a clinician and a researcher or teacher? Will it look at whether the money for these areas is adequately ring-fenced, given the fact that we already see devices such as service charges, money being siphoned off, and money from foundations being siphoned oil'? Above all, will the review report to Parliament? Will we be able to see what its conclusions are?

We know that there is a tension between the need to deliver a service both rapidly and effectively and the need to look long term. We know that there is a tension between the need to meet the budget this year and the need to plan for the long term. The latter is already apparent in the NHS. We need to build into the new arrangements protection for the long term, not simply delivery in the short term. That we why we have such concerns.

As Professor Peter Lachmann of the Academy of Medical Sciences puts it: At a time when there is an urgent need to secure more service provision there is obviously a temptation to concentrate all resources on that need. While this is entirely understandable, it is an example of 'burning the furniture to heat the house'. If British medicine is, in the longer term, to provide a high-quality service to its patients, then a high level of teaching and research must be preserved". That is surely exactly right and it is what the amendment is about. I beg to move.

Moved, as an amendment to the Motion that the House do not insist on their Amendment No. 2 to which the Commons have disagreed for their reason numbered 2A, leave out "not".—(Baroness Northover.)

5.30 p.m.

Baroness Carnegy of Lour

My Lords., I listened with great interest to what the noble Baroness said. However, I say to her that, when we ask the Government to think again about something, I believe that we have a responsibility to listen carefully to the answer and, if, as individual Members of the House, we consider it to be satisfactory, to decide accordingly.

I believe that this issue requires to be raised and discussed. It was required of us to ask the Commons to think again. They have thought again The Government have said a number of things that they did not say previously. I was very interested to hear that they propose a review. I believe that the House has scored a bull's eye. Personally, I shall not be of a mind to vote against the Government on this occasion.

Baroness Noakes

My Lords, the other place rejected amendments which sought to insert new clauses after Clauses 4 and 6 because the law already provides adequately for education, training and research. I believe that that is disingenuous. The law does place a duty on the Secretary of State in relation to facilities for clinical teaching and research in connection with clinical medicine and clinical dentistry. That sounds rather good, but it suffers from serious weaknesses. It is phrased only in terms of clinical medicine and dentistry. But, of course, as we discussed earlier in this House, education, training and research goes far wider than that. Indeed, as the Minister agreed, it needs to cover the education, training and research for all other healthcare professional groups and, indeed, one might say, for every other significant group of staff in the NHS.

In another place it was said that that duty will be delegated to PCTs. But, of course, that is only part of the story. Unless the duty to safeguard and promote education, training and research is held at all levels, it will be ineffective. While, as has already been said, PCTs are enormously important for education, training and research in primary and community care and are also important if they commission services in the acute sector where teaching and research needs to be protected, that duty needs to go beyond PCTs.

The duty does not have an impact on strategic health authorities. Some of us are still bewildered as to what strategic health authorities will, in practice, do. Coherent strategic frameworks do not help some of us to understand that. But, in any event, we believe that they should have the same responsibilities as other parts of the NHS concerning a duty in relation to education, training and research. Of course, trusts also need a duty but at present they have only certain powers.

Therefore, we have a duty which is imperfect in coverage and imperfect in reach and a patchwork of duties and powers which simply do not cover the whole territory. If we believed that this imperfect legal framework nevertheless caused no problems in practice, we should not be here this afternoon debating this clause. The plain fact is that there are problems in practice. During the passage of the Bill in your Lordships' House we heard from many noble Lords of the type of problem being encountered.

The Minister said that the duty is difficult to define. I find that argument very difficult to follow. The terms "education", "training" and "research" can bear their natural meaning. Of course, the Bill must be interpreted in the context of the NHS because that is what it relates to. The Department of Health will doubtless issue guidance on the practical implications of the existence of a duty. With the department's normal consultative processes, I am sure that ultimately that would not result in any problems so far as concerns a satisfactory understanding throughout the NHS of what such a duty meant and, therefore, what the breach of such a duty meant.

The Minister has sought to seduce us with the prospect of a ministerial review of education, training and research. That is a very interesting idea, although it falls short of the duty which the clauses addressed. We are pleased about the scope of the review in terms of covering all parts of the healthcare professions with regard to education, training and research. That is welcome. But before we on these Benches decide finally what to do about the Commons response to our new clauses, we should like to hear more from the Minister about the review. As the noble Baroness, Lady Northover, said, timing is clearly important. A start date of early 2003 does not sound particularly early. But, perhaps more importantly, when will the review be expected to end? Kicking something into the long grass is not an attractive alternative to our clauses.

Another issue concerns who is to be involved. The Minister talked of a ministerial review. It would be interesting to know which Minister will lead the review. Of course, noble Lords have a considerable respect for the Minister, and it would clearly be a bonus if he were to lead it. But, in addition to Ministers, can the noble Lord say who else is likely to be involved in the review and, in particular, which experts would be expected to work alongside Ministers?

Lastly, there is the question of reporting, which the noble Baroness, Lady Northover, also raised. I ask the Minister to give an assurance to the House that the outcome of the review will be published and, indeed, that the Government will be prepared to have the issues debated in your Lordships' House following publication of the review. I shall listen with keen interest to the response of the Minister.

Baroness Finlay of Llandaff

My Lords, under Section 51 of the National Health Service Act 1977, the Secretary of State does, indeed, have a duty to provide facilities for teaching and research. In his reply to the debate on the Bill on 16th May, the Minister reassured the House that powers exist to safeguard education, training and research. Today, the Minister has given most welcome reassurances and words of comfort. Those intentions are fully accepted and appreciated.

I am particularly heartened to have confirmation of the representation on the strategic health authority of someone from an undergraduate education institution concerned with healthcare professionals. I am heartened that the rolling-out of the medical student expansion programme will be monitored, and I am sure that the meeting with the BMA will be important. I have had a very warm meeting with Jane Hutt in Wales and was most reassured by that. She is certainly well appraised of the challenges that exist in education and research. With the reassurances following that meeting, I accept that it would be inappropriate to press for an amendment to appear on the face of the Bill in relation to Wales. However, it does not remove the need to ensure that a duty on those who provide and commission services is clearly spelled out.

The situation on the ground shows worrying trends. The chairman of the Council of Heads of Medical Schools, with whom I spoke today, remains concerned that primary care trusts will not appreciate the relevance of the wider education and research issues in relation to their functions, including primary care placements for medical and other healthcare professionals, the impact of their commissioning decisions on teaching and research in NHS trusts and primary care, and the growing importance of research in primary care for the future quality of healthcare overall.

On 16th May, the Minister reported his discussions with the Council of Heads of Medical Schools and explored ways of implementing and ensuring some of the changes that had been called for in this House. Some of those reassurances have been given in his reply today. However, the need still remains to ensure what safeguards are in place and how they will be audited. Questions have been asked by the noble Baronesses, Lady Northover and Lady Noakes, which I shall not reiterate. That must be attached to the concept of a ministerial review, which is welcome.

Many PCT public consultation documents contain nothing about education or research, suggesting that PCTs may not understand the importance of integrating clinical teaching and research activities, although such documents discussed in full clinical governance issues and therefore training issues. The Minister asked previously about definitions of "education" and "research". I suggest that in this context education is the process of acquiring the knowledge, skills, competencies and attitudes to enter the healthcare professions and therefore is different from training issues. Training issues are essential for the Government's agenda.

Professor Carol Black, president elect of the Royal College of Physicians, has a particular concern that the short-term service pressures and financial constraints risk decreasing the quality of care across the board as central forces to meet targets take priority over the research inquiry into and management of less common conditions. The pressures on trusts to deliver against targets are enormous.

Professor Thompson, Dean of Southampton Medical School, has become aware that in his area the trust does not even want the development of new clinical chairs using Higher Education Funding Council for England (HEFCE) funding because it might divert from the model of a district general hospital that the PCTs seem to want in bringing in complex, rare cases. It is possible that that attitude could completely stifle clinical academic development.

There is an underfunding of services by primary care trusts. That has been offset by the service increment for teaching (SIFT) and R&D inflation, which has been used to fund the clinical expansion. The Council of Heads of Medical Schools has been concerned that new and untried systems could refocus the primary care trusts towards a strategy of viewing teaching hospitals as district general hospitals rather than as centres of excellence, although I fully accept the reassurances given today by the Minister about teaching primary care trusts and how those will differ from other primary care trusts.

Research has been shown to have a direct and immediate benefit on the NHS. Current examples include the M RC acute back pain study, which showed that exercise is more effective than rest. The cost savings can be measured in man hours at work, decreased direct and indirect or secondary complication costs, and savings for society overall. Some research findings, such as day case surgery, have been widely implemented.

However, to reach undergraduates it is essential that facilities are available. The erosion is subtle. Education facilities in many district general hospital wards have now been taken for clinical usage needs, such as offices. The new Wythenshawe Hospital provides excellent facilities in its PFI building but is, by common consent, already too small and the academic block is certainly smaller than was wanted. There are similar problems in Manchester in securing a research place in psychiatry. Although there is a good intention, that has never been confirmed in writing because of the pressures which the mental health trust is under.

Professor Anne Louise Kinmonth, professor of general practice in Cambridge, stated that the systems are untried. The educational budgets to which the Minister referred are being brought together under the workforce confederation, which will hold the margin between education, staff development, service and the systems to research developments. The previous service increment for teaching money will be incorporated in a consolidated budget. I ask the Minister how the accountability will be monitored to ensure that the duty of the Secretary of State under the 1977 Act is fulfilled.

The research and education outcomes provide perverse incentives for clinical academia. The need to have high ratings of 5 or 5⋆ to maintain income have meant that research pressures take priority over teaching, yet if the ratings are down and academics are lost, the very people who are required to do the teaching are lost to the system.

Thus, the duty on the face of the Bill will ensure that the current duty of the Secretary of State is devolved out to the primary care trusts, NHS trusts and strategic health authorities, where the commissioning decisions are taken. Such an amendment is entirely consistent with the tenor of government policy and with the accountability recommendations of Follett and, indeed, is completely compatible with the reassurances given today by the Minister.

5.45 p.m.

Lord Turnberg

My Lords, while I strongly support the amendment proposed by the noble Baroness, Lady Northover—how could I not support it—it is the case that the Secretary of State already has a duty to protect teaching and research in the NHS. It is also the case that teaching and research are not simply the responsibility of PCTs and strategic health authorities. Universities, funding councils, research funding bodies and charities play dominant roles but inevitably so much of teaching and research goes on within the NHS and by NHS staff that they must play a part in protecting those vital roles.

The Government are unwilling to see that responsibility reiterated on the face of the Bill, which I understand. It is good to hear that the Minister is unequivocal in making clear that all parts of the NHS have not only a responsibility to their patients now but also a responsibility to teach and train future staff and to promote research on which so much of the treatment of future patients depends.

I was delighted to hear about the ministerial review. That is a tremendous response. I hope that there is not a hint of procrastination here because there is a degree of urgency. New medical students will appear in October. Medical schools are at present suffering problems concerning redundant staff. That paradox of more students and fewer staff is one which needs urgent attention. Those are not the direct responsibilities of PCTs or strategic health authorities but part of a much wider picture. I hope that the ministerial review will in practice cover rather more than the elements we are discussing in this amendment.

Lord Hunt of Kings Heath

: My Lords, I am grateful to all noble Lords who have contributed to the debate and for the recognition that the Government have indeed listened to the points raised throughout the passage of the Bill. I want to make clear that we all have a common interest here. Teaching and research is important not just in its own right but is essential if the NHS is to receive the increase in staff it requires in the many professions covered by that heading and is important to the NHS as a whole and to the United Kingdom as a whole.

It is essential that we have a strong science base, a strong teaching base and a strong research base. The Department of Health has much wider responsibilities than simply the well-being of the National Health Service. It is in the interests of my department, just as it is in the interests of the Department for Education and Skills, to ensure that this works effectively and well. There is no argument between myself and other noble Lords on these matters.

I have already stated—my noble friend Lord Turnberg put it very well—why the Government do not consider that the legislative option is the appropriate or workable option. Certainly, that was the view of the other place when it considered the Lords amendments on the Bill. I believe that the key question is whether we have the mechanism in place to ensure that, first, there is a strong partnership between my department, the DfES and HEFCE to ensure that we have a grip on these issues at national level, and secondly, whether we have a performance management system within the NHS to ensure that the duties are carried out effectively at local level. I believe that my earlier points point to the fact that we have the mechanisms available at national level. Secondly, through the performance management regime, we can ensure that the relevant partnership between the NHS and universities is effective at local level. But I do not underestimate the importance of the review that I have announced today. It will be a very important review.

I shall now attempt to answer the specific questions put to me about the review. It will be administered by officials from the departments concerned—the Department of Health, the Department for Education and Skills, and, most importantly, the Wales Office and the National Assembly for Wales. Ministers from each department will oversee it. I can confirm that all other key stakeholders will be offered the opportunity to contribute. I shall encourage consultation with those whose interests are most closely concerned, including experts in the field of health, education and research, to ensure that the review is properly informed and that it covers the range of healthcare professions and not just doctors.

In response to the point raised by the noble Baroness, Lady Northover, while the review will have a defined end point—it is important that all reviews have a defined end point—it may be a recommendation of the review that further ongoing or periodic reviews should be carried out.

I anticipate that the review will start early next year. I understand the points made about timing. I recognise that there is a need to get on with the matter. Equally, there is an argument for allowing PCTs to bed down for some time. I fully accept that we have said that the issue is not solely confined to PCTs. When we first debated it, we debated long and hard about the role of primary care trusts. I have listened carefully to the points raised this afternoon. I am prepared to say that rather than set the terms of reference by the end of the year, I shall try to ensure that they are agreed in the autumn, and that the review should start as soon as possible after that.

The original intent was for the review's findings to be published by 2004. I am keen not to be pressed to give an exact date and time. But in the light of everything that I have heard today, I shall seek to ensure that the review completes its first period of work some time in 2003.

Copies of the report from the review will be made available in the Libraries of both Houses. As noble Lords will know, it is not in the gift of the Government to decide what we debate in your Lordships' House. That is a matter for the usual channels. However, I would very much welcome a debate and shall try and ensure that one takes place.

If the review finds areas of concern, one option would be for guidance to be given to primary care trusts, strategic health authorities and NHS trusts wherever necessary—I am sure that that applies also for the Welsh Assemblyx2014;and, if necessary, the issuing of directions. Later in the year we shall make a further announcement about the review.

So far as concerns the specific issues raised by the noble Baroness, Lady Northover, we can pick up the issue of ring-fencing, money for education and Ramp;D, although money for education, training and research in the NHS is already ring-fenced in central budgets and allocated for those purposes. I understand that she will say that there are some other issues here. Of course the review will be able to look at them.

In relation to the issue of protected time, I am well aware of the pressure and tension between clinical academics, whose responsibility on the one hand is to the NHS and on the other within universities, where both are being pressured to do everything they can. In terms of funding—because that is very important to that element—we are developing a funding formula for NHS Ramp;D. That will provide elements of funding in proportion to the time commitment of research-active staff. That will clearly make matters much more transparent and will help to deal with the issue of protected time. I shall go further and say that the review will have the core objective of considering whether the right balance is being struck between care for NHS patients, research and teaching. That surely goes to the core of many of the concerns expressed today.

I hope that in the light of what I have said the noble Baroness will feel able to withdraw her amendment. The Government have moved a long way and I hope that that will be recognised.

Baroness Northover

My Lords, I thank the Minister for that reply. I thank noble Lords for their participation in today's debate and in previous debates on the Bill. It has been striking how concern over this issue has crossed party lines and has come from all parts of the House. I am very grateful for the expert reports offered from within the House.

I am glad that the Government have responded as they have. They clearly recognise how important this issue is and that all is not well. Therefore, a review is required and these matters must be closely examined. I am pleased that the noble Baroness, Lady Carnegy, who is not in her place at the moment, thinks that we have scored a bull's-eye. Obviously, if we have—I trust that we have—that owes much to everyone in this House. Of course I shall follow the noble Baroness's advice.

We welcome the Government's moves, but we are very much going on trust. We trust that the review will be rapid. I am happy to see that there are moves to try to speed that up. It must be thorough, probing and long-sighted in its deliberations. I was glad to hear that some of my concerns have been explicitly addressed. The point about ring-fencing is something that we have addressed. I know that much funding is supposed to go to education and research. We have heard about how it does not always work out that way. I am pleased that the idea of protected time for research and training will be addressed.

I am happy that the review's conclusions will be made public. That is extremely important. Therefore, we can all take forward these issues and make sure that the identified problems will be addressed. We shall continue to watch what is happening. It will be a while before the review starts and there are some pressing problems now. I hope that we can work together to try to take things forward. In that spirit, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

On Question, Motion agreed to.