Higher Education

My Lords, I add my thanks to the noble Lord, Lord Luce, for raising this debate, which has turned out to be an important one. A declaration of my personal interests will reveal the area that I want to cover. For many years, I have been a medical academic but also an NHS manager. Recently, I chaired a London strategic health authority, which is responsible for commissioning education and training places from higher and further education for the NHS. I now chair the council of St George’s, University of London—a health sciences university which, by the way, has the highest retention rate of any UK university. I have therefore looked at relations between the NHS and higher education from all sides now, as the Joni Mitchell song says, and I am afraid that I have looked, "““From up and down, and still somehow""It’s life’s illusions I recall””." When on earth will the new department of the DIUS agree a joint, long-term strategy with the Department of Health for educating the health and social care workforce that makes sense for both the NHS and for higher education? For many universities, which massively expanded their capacity to meet the voracious demand for nurses, allied health professionals and doctors in the past decade, the agreeable cash cow of the NHS has quite suddenly turned into our key strategic risk. Such is the volatility of NHS funding that it is not surprising that some universities are exiting from the fray altogether—City University, for example, which provided excellent quality university teaching for nursing education, is one that springs to mind. Important though the Darzi review is, strategic health authorities seem to have turned their attention away from education altogether since the recent reorganisation. Once more, we are back into the bust bit of the boom-and-bust cycle, which is the result of poor workforce planning on the part of the NHS, short-term vision and failure to communicate the need for changing skills; and, on the university side, a failure to address responsively the need for research excellence to be relevant to the needs of the NHS and for training to be tailored to the changing face of health and disease. I shall not touch on the recent reorganisation of postgraduate medical education, but that in itself poses significant challenges for the medical school in addressing the changing face of specialties and preparing undergraduates for the different kinds of specialties and the different needs of healthcare. There is no joint strategy between the two departments and agreed ways forward. The opportunities are vast for widening participation. There 1.3 million jobs in the NHS and 900,000 in social care services, of which 600,000 are in the independent sector. This workforce will continue to grow inexorably as the numbers of the very aged grow, and as those surviving with physical and mental disabilities demand and rightly expect the same life choices as the rest of us. We must have a joint, unified workforce with a common understanding of the basic principles of health and social care sciences. In spite of numerous initiatives such as foundation degrees, which have proved exceedingly difficult in the area of healthcare, the creation of new roles, joint NVQs at the bottom end of the life-skills training ladder, assistant practitioners and the like, we have somehow failed to address this serious problem. It is usually left to the initiatives of individual higher education institutes and interested professionals acting on their own behalf to create the cutting edge examples that get the right kind of children going through the diverse biological education and health science enthusiasms that we want them to adopt. It is this approach that will lead to a better workforce. At the moment, we are nowhere near there and a joint strategy has to be worked on very soon.