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My Lords, back in November, when I had just come back from cycling around Beijing and seeing at first hand the health service in China, I spoke later that day in a similar debate when the noble Earl, Lord Howe, admonished me for being somewhat acerbic in my comments about the health service. I hope that he has forgiven me, because I think a combination of my jet lag, my passion for the health service-like his passion for the health service, which I greatly respect-and the anxiety that one sometimes feels when speaking from these Benches, and for me the unusual taste of being very briefly on the Front Bench, resulted in my being rather stronger in my remarks than perhaps I should have been. I would, however, like to ask him some questions about the third issue that the noble Lord, Lord Turnberg, has produced in his debate, and I congratulate him on introducing it. May I also say what a pleasure it is to see that the noble Baroness, Lady Jolly, has put her name down to make her maiden speech in this debate? We look forward to hearing her in just a moment.
Noble Lords must forgive me if I concentrate on hospital medicine, but that is the area I know best. I remember many years ago, from my experience in the United States-when I was a visiting professor in Baltimore and Boston, and later in Texas-that the Americans were very surprised at the massive surgical experience that we could gain in the health service in this country because of the way in which the service was run. We could centralise many specialised services and do very advanced work that was both innovative and useful for research. One issue is that, while this has been more difficult since the introduction of the internal market, there have been at least some attempts to get back to doing exactly that.
Many aspects are really important for centralisation. First of all, that kind of centralisation is best for some patients with particular needs if they can travel to a service. That often means that they are going to get the best medicine. It is a question not of patient choice but of making sure that they get the best treatment from the most qualified people. Secondly, that kind of centralisation is ideal as a pull for teaching. It is also excellent-indeed, some people would say essential-for training people to make sure that we get the best surgeons. It is a problem that the noble Earl, Lord Howe is very conscious of, given the changes that have happened as a result not of the NHS but of European pressures, which have made things more difficult.
Centralisation is also important for innovation. The key issue is how these expected changes in the health service will affect our excellence in research. What I really want is reassurance from the noble Earl that the sorts of things that were developed in the health service hitherto will not be difficult to achieve under the current proposals in the White Paper. For example, it seems impossible to imagine that in vitro fertilisation could develop as a research procedure in the structure as proposed. Certainly, during my time at Hammersmith, I saw by-pass surgery, transplant surgery and the cancer smear test being developed, and many other examples of innovative surgery and medicine. Many of the great institutions, such as Great Ormond Street, Hammersmith, and some in Liverpool, Manchester and elsewhere have been made great and international because they have been able to function in a way that it is difficult to see will continue under the structure in this White Paper. I want to make certain that the Minister agrees-I know he does-that the jewel in our crown is the National Health Service. A very special aspect of that, which is internationally recognised, is the unique nature of academic medicine in this country. I would like him to tell us how academic medicine will be protected and will flourish in the structure of the White Paper.