Health Bill [HL]

My Lords, with these amendments the noble Lord, Lord Walton of Detchant, has once again hit the nail on the head, and I very much support the case that he has put forward, especially in relation to education and training. There is a fundamental problem here to which the noble Lord alluded in tactful terms and the noble Baroness, Lady Finlay, drew attention to more explicitly. It is that many NHS organisations, if not the majority, do not regard education and training as part of their core business. They may pay lip service to them, they may be able to show that education and training are taking place, but for many organisations whose primary day-to-day preoccupation is to deliver services efficiently and effectively to patients, education and training are not in the forefront of their priorities. Unfortunately, this is particularly true of foundation trusts. There are some notable exceptions to that generalisation which we could all name, but the letter of the law which states that foundation trusts must include education and training as part of their core mission does not tend to occupy centre stage in the deliberations of foundation trust boards. Nor is it something to which Monitor devotes a large amount of attention. I may be wrong in that perception, but there seems to be insufficient accountability for success or failure in this area. We remember all too well what happened in 2006 when the NHS budget came under particularly heavy pressure. Trusts were told that they had to break even or do better, no matter what it took. Surprise, surprise, it was the education budget which was cut quite ruthlessly. I have a figure which came from the Nursing Times, which stated that strategic health authorities skimmed more than £70 million from education and training budgets during 2007-08. The years ahead are likely to give rise to equal, if not worse, budgetary pressures. The education budget is an easy target, because the general public do not notice whether it is being spent or not, but the harm that cuts like that do over the long term is considerable. The training of staff is not something that you can abandon and return to from year to year; it is a long-term enterprise. The universities, whose core business is to deliver training, much of it in collaboration with the health service, are placed in an impossible position if the NHS decides to adopt any sort of stop/go policy. I am told that the problem tends to be worse in trusts that are aspiring to become foundation trusts, because those organisations cut back on their costs to achieve the desired set of financial ratios, and the cutting of costs inevitably means cutting back on people, which in turn impacts directly on supervision ratios at ward level. That kind of economy has an immediate and obvious impact on the quality of training. Anecdotally at least, cuts are said to account for some of the high drop-out rates that there have been in nurse training, for example. Equally, I am told that in primary care the quality of work placements is on the whole poor. Part of the problem is that doctors’ surgeries have only a limited physical capacity, but the more fundamental issue is that for primary care practitioners, education is not a core part of their mission. There is no measure which impinges on a service provider for a failure to engage with the next generation of professionals. Yet, in a very real sense, NHS organisations owe it to themselves to be mentors and custodians of the next generation. They also owe it to us as patients, and we need to be very careful that this key function of the health service receives adequate recognition in the way that the NHS Constitution is applied. Those responsible for delivering education and training in healthcare must be held to account for their performance. I hope that with his close knowledge of the NHS, the Minister will want to focus on the concerns which the noble Lord, Lord Walton, has raised, and that the Minister will also want to make sure that the opportunities presented by having an NHS Constitution with rights and duties within it are not missed.