My Lords, I have an amendment in this grouping. It addresses the duty that I would like to see on clinical commissioning groups to promote education and training of the current and future NHS workforce. The reason for putting the future in is because of the undergraduates who are studying to become healthcare professionals. This is important because we know that primary care placements at undergraduate level have a significant influence on career choices and therefore on career progression. The quality of training and the quality of care given by the tutor who is their tutor in primary care is influenced by having undergraduates with them. That applies across all the disciplines that work in the community.
The other point is that general practitioners will need training in commissioning responsibilities in the future. Therefore, if we are to attract the brightest and best of our undergraduate clinical workforce to work in the community and eventually contribute in clinical commissioning groups, they need to have excellent exposure at an undergraduate level.
I also support the other amendments in the group so eloquently introduced by my noble friend Lord Kakkar. I strongly support the comments made by all the other noble Lords who have spoken. We need to have this duty at every level-at Secretary of State level, at commissioning board level and, as I have suggested, at clinical commissioning group level. The one area that we have not addressed and that is not in the amendments is the way that Monitor grants licenses. We might need to come on to that at a later stage when we discuss Monitor.
There is a particular need for planning medical education and training and having it planned nationally. It takes 15 years, on average, from start to finish to develop a specialist in highly technical, very complicated areas of medicine. There are about 32 small specialities, and in-depth local intelligence and intelligence within that speciality are needed to know both the numbers that are needed in the future and to horizon scan and look at the type of training that will need to be delivered and whether things will change. A simple example is in surgery, to which reference has already been made, where keyhole surgery came about. My discipline, the development of palliative medicine as a distinct speciality, has completely altered the face of some of the care in both hospitals and the community, and it has a significant workforce which is still developing.
There is also a need for reliable information on education and training so that the Centre for Workforce Intelligence can work with the proposed Health Education England to ensure that there is good information and opinion decisions. Quality management of education and training in medicine is currently undertaken by the deaneries, by and large, and that should be built on. They provide independent quality assurance. If the dean is the responsible officer and has a ring-fenced budget and a financial lever, they can withhold funding for posts and have been shown in many parts of the UK to rapidly drive up quality where there have been concerns about the training environment into which trainees were going. It is not difficult to expand that system to take on postgraduate deanery structures for the other disciplines as well.
I strongly endorse the need for the allied healthcare professionals and nursing to come under the new structure as well. There is a need for inter-professional working and learning. Inter-professional learning and integrated delivery of services with integrated learning will drive up the quality of care and ensure the development of good clinical leadership so that we bring the level of the best into the delivery and content of education and training.
The commissioning groups, in particular, must ensure that there are appropriate facilities for education and training. The quality of the commissioning they do at a local level, with both NHS and other providers, will ensure that undergraduate and postgraduate students can be placed in and learn from a wide range of services. We will then have a workforce fit for the future.
Health Education England, when established, can audit the local education and training boards and maintain a national perspective. There is worrying information about the way things are going. I have spoken to the Medical Schools Council, which recently surveyed medical school involvement in the development of the emerging local education and training boards. It indicates a variable extent to which higher educational institutions are involved in planning and suggests that the structures will vary widely. In some areas, such as the north-west and the east Midlands, medical schools and higher educational institutes appear to be actively excluded from the developing local education and training boards. This is extremely worrying because in service transformation there needs to be quality control and academic rigour. Medical schools are required by the General Medical Council to act as quality managers of clinical placements but, by excluding those which are providing education from the local education and training boards, we risk having a serious disconnect in the way that services develop and are delivered, and in the way that our workforce is trained.