Clause 14 - Authorised services
Health and Social Care (Community Health and Standards) Bill
10:30 am
Mr Chris Grayling (Epsom and Ewell, Conservative)
The hon. Gentleman will not draw me down that line because I do not want to tread on the good offices of the Chair by taking the debate into the area of social inclusion.
A decision taken in the Department for Education and Skills is reducing the amount of money available for medical schools to manage their affairs in the next financial year. Those medical schools are, almost invariably, inextricably linked to their local NHS trusts. Their medical professionals are involved in tuition, giving lectures and teaching students, but they also carry out research and undertake clinical work in the local NHS trusts. The decision to remove 2.2 per cent. of the teaching budget for this year will force medical schools to make decisions about staffing levels, financial commitments to research and the areas in which they can carry out research. That will have an impact, by definition, on the NHS trust that works directly alongside them.
A further example involves the recent research assessment exercise carried out by the HEFC into the effectiveness of the research carried out in medical schools and, correspondingly, the reallocation of funding in medical schools to focus resources on those areas that have particular expertise and excellence in delivering academic research. That change came into full effect during the financial year 2002-03.
As a consequence, over the past 12 months, Queen Mary's medical school—part of the University of London—was forced to significantly restructure its research base to concentrate its specialisms in certain areas. It had to lose some areas of research in which it had previously been involved, in order to make better use of its resources. In the past financial year, Queen Mary's received £2.6 million less research funding from HEFC, and was forced to streamline its medical activities as a result. All medical schools had to go through that same process of rationalisation, with one exception in London.
If a medical school is rationalised and the decision is taken that it no longer needs to carry out research in gynaecology, the gynaecological specialist who has been part of that medical school may decide to seek employment elsewhere because there is no longer a true purpose to being in that school. That specialist will want to work in a medical school in which gynaecology is still a strong part of the research base.
As a result, the local medical school will no longer have a gynaecologist, and the local NHS trust will no longer have that researcher, teacher and senior clinician who doubles up as an operational member of the national health service and a tutor of future doctors. Therein lies the problem, and therein lies the rationale behind amendment (a).
My concern, Mr. Griffiths, is that it risks putting an unrealistic tie on medical schools and on the trusts to which they are attached. Consequently, it would have an adverse, knock-on effect, which would create problems in the operational side of the NHS. The assessment or authorisation that the regulator put together could require an NHS trust to carry out research in several areas. That NHS trust would almost certainly carry out that research in conjunction with the medical school that sat alongside it.
However, when medical schools are forced to drop their half of research because of decisions taken to reallocate funding—decisions taken in the education arena rather than in the health care arena—inevitably some trusts will be forced to drop their half of research also. The risk is that the regulator could require a trust to do something that it was no longer able to do because the academic half of its work had disappeared due to funding changes.
The concern is not that it is wrong for the regulator to authorise trusts to carry out research on the provision of health care, but that the regulator could require trusts to carry out research that the trust was no longer able to do, because of changes within the medical school that sat alongside it. The purpose of the amendment is not to undermine the role of research in the NHS or to undermine the partnerships that rightly and properly exist between the NHS and medical schools, but to accept that changes can and do take place within the medical and research world.
A process of research assessment exercises takes place every few years, which inevitably reshapes the way in which medical research is carried out, so a requirement in law for the regulator to require a trust to do something might cause significant operational problems. I hope that the Minister will consider these issues and, if unwilling to accept the amendment, will give a commitment to explore ways in which flexibility could be left within the system to reflect changes that result from academic and educational decision-making rather than from NHS decision-making.
With regard to other amendments to rule out subsections (6) and (7), the Minster is right to say that there is a philosophical difference between the Opposition and those on the Government Benches about the way in which freedom should be deployed to foundation hospitals. Those subsections are further examples of parts of the Bill that significantly curtail the freedoms of foundation hospitals. The Government do not have the courage of their convictions. It is totally ludicrous to believe that hospitals will drop wholesale the services that they provide to their customers—the services for which their primary care trusts pay. They will continue to deliver as broad-ranging, effective and good a service as they can. Otherwise, frankly, once the national tariff is introduced, hospitals will not have the income. However, they will not have patients either, because doctors will go out of their way to move their patients elsewhere. Hospitals need work to do. They need to offer services. They need to be excellent at what they do, and they need to attract the right professionals.
There is no likelihood that giving hospitals freedom of choice over what services they offer and how they reflect the needs of their community would destroy the services they provide and undermine the NHS. It would do what I thought the Government intended to do, which was to say to local hospital managers that they could have the freedom to run their hospitals. Yet here are two subsections that clearly set up a process of deciding centrally—this time through a regulator rather than through the Secretary of State—what
hospitals can and cannot do. That is just plain wrong. The Government should have the courage of their convictions and give trusts freedom, rather than just a little flexibility to do some stuff around the margins. That is particularly important at a time when the Government are driving the process of reconfiguration within the health service.
It encourages services to move into community hospitals; greater diversity of provision; and the establishment of specialist clinics, such as the regional orthopaedic centre in my constituency, and the diagnostic and treatment centres that are being set up around the country.
The Government say that they are trying to create a flexible environment for health care, but they are not willing to give their hospitals the freedoms that they will need to respond, adapt and develop in that environment. There is no need to straitjacket hospitals by giving the regulator the duty to decide on the range of services. We could and should give foundation hospitals the freedom to meet their own local needs. My party does not believe that the Government are doing that in this clause.
Given the Minister's comments, I shall not press amendment (a).
Amendment agreed to.