HC Deb 11 February 1963 vol 671 cc1073-86

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hughes-Young.]

9.58 p.m.

Mr. James Boyden (Bishop Auckland)

When this subject was asked for on the Adjournment, by error it was put down for reply by the Treasury. It was, rightly, subsequently transferred to the Secretary for Technical Co-operation. Unfortunately, tonight the Minister is ill, and the Parliamentary Secretary to the Ministry of Health has courteously agreed to reply to the debate. I am very sorry for the reason that has caused the hon. Gentleman to be here, and I hope that it will very soon be remedied. But this gives me an opportunity which I welcome to tackle his Department on a number of issues.

In order that medical aid to the developing countries can be properly executed there must be the closest cooperation between the Department of Technical Co-operation, the Treasury and the Ministry of Health. Even though this is so, just as justice must be seen to be done, so this must be seen to be done. So far as I can see, certainly in this House, the co-operation does not make itself manifest. For example, the sums of money to be devoted to medical assistance have not been made clear. It is not clear from what I have seen of the attitude of the Ministry of Health in answering Questions. Indeed, on occasions when I have tried to put Questions to the Ministry of Health I have been referred to the Department of Technical Co-operation although I should have thought that it would have been much better for the Ministry of Health to have attempted to answer. It would also seem highly desirable, indeed imperative, that there should be a good deal of Parliamentary discussion on this subject in order that the country, as well as the House, should be able to judge what progress is being made and will be made.

It being Ten o'clock, the Motion for the Adjournment lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. I. Fraser.]

Mr. Boyden

I therefore put it to the hon. Member that three things should be done by way of showing greater interest in this matter. There should be an annual report from the Department of Technical Co-operation, possibly divided into matters of health and matters of education, etc., but certainly there should be put together, in respect of medical aid to developing countries some compact documents to which hon. Members and the public can turn to see progress. Certainly there should be an annual debate in which hon. Members can participate. There should be possibly biennial but certainly fairly frequent Commonwealth conferences on the subject so that the whole world can see what Britain and the Commonwealth are doing.

Much of this debate must be centred on the Porritt Report. That is the Report of Sir Arthur Porritt and his Working Party on Medical Aid to the Developing Countries. I should like to join the Secretary for Technical Co-operation in paying tribute to Sir Arthur and his Working Party and say that there have been few Reports so practical, so pointed, and so short. It is a model of what Reports should be if they are to be carried into execution.

But, having said that, I am bound to ask, considering how fast the Committee worked—it took four months to produce its conclusions—why it has taken so long for the Report to be printed and to be brought before the House. It looks to me as though the printing of the Report has taken three times longer than the production of the arguments and the recommendations.

I hope, too, that the rather inauspicious format is not an indication of the importance which the Treasury attaches to the Report, because for a Report of this importance it is a little odd to produce it in the kind of type and the kind of way in which it has been produced.

I also hope that the fact that there is little enthusiastic reference to the Minister of Health in the Report is not significant and that the Minister will be able to explain that the Ministry of Health is as zealous as the Report regarded the Department of Technical Cooperation, because, referring to those from the Department of Technical Cooperation attending the deliberations of the Working Party, the Report said that they showed an eager and constructive interest in its proceedings. But there was no mention of a similar interest by the Treasury or by the Ministry of Health.

According to the Working Party, and certainly in the view of many of us, the problem is of great urgency. The last few lines of the Report read: The Working Party hopes that the most urgent attention will be given to its proposals and that temporary considerations of economy will not be allowed to delay the implementation of measures which become daily more necessary. During the four months over which its work has been spread, there has been continuously brought to the Working Party's notice new evidence of the further decline of British influence in the medical field overseas. It is for this reason that the Working Party has regarded its task as one which has to be completed, with whatever sacrifice of detailed study, in the shortest possible time. I was very struck by Dr. Spooner's Appendix III in the Report, in which he referred to the fact that the Hayter Report to the University Grants Committee on the development of Oriental, African and Slavonic studies contained no reference at all to medicine. I confess that I read the Hayter Report with very considerable interest. The Scarbrough Report had a great deal of influence in Durham University, and I have known for a long time of the excellent work that has gone on in oriental studies in that university.

I read the Report very carefully, but until my attention was drawn to it by this Appendix I had not noticed that medicine had been so completely left out, yet medicine, surely, is one of the foundations upon which British influence in overseas countries, particularly in the Empire, has made it greatest contribution. Livingstone is fundamental to the glories of the Empire that was and the Commonwealth that continues. I feel that we are not, perhaps, following in the path of the eminent Victorians by applying to the modern age the sort of techniques and contributions we should be applying quite as brilliantly as was the case in Victorian times.

Be that as it may, I understand that a good many countries these days are stepping up their medical aid to developing countries—Russia, the Federal Republic of Germany, Yugoslavia, the United States—and I do not, of course, count this a disadvantage. It is highly desirable that medical aid should be provided wherever it is needed, but it seems to me that Britain should be making more running than it is. I hope that the hon. Gentleman will be able to say that events have overtaken the statement I have quoted from the Porritt Report, and that we are running faster than we were.

I note, for example, that in the Sudan, British sisters are being replaced by Yugoslays; that in Ghana—where, of course, we had an excellent Oxbridge University tradition—the medical school is being run by the United States; that in Egypt the Americans and the Germans are setting up research institutes. In all these places—although, naturally, the developing countries welcome aid from wherever it may come—it would seem to be a slipping back that that aid is not being provided by Britain.

Perhaps I may turn to what seems to be the most important part of the Porritt Report. If I leave out any references to nurses it is not because I think the subject unimportant but because I must concentrate on one or two particular aspects. As a preliminary, I would ask: does the Department of Technical Co-operation accept the main objective of the Porritt Report, which is that our aid should be, as it were, teaching aid; that we should provide teachers for overseas; that we should have leading doctors and nurses going back from England to their own countries so that our influence could be brought to bear on this as a main aspect?

If we spread our efforts too far we might not achieve the results we might otherwise achieve. In any case, we obviously cannot staff hospitals all over the world, nor would it be the wish of some developing countries that British medical officers should still be there. In other words, the fundamental need is to concentrate our efforts on those aspects of medical aid which will influence the leading doctors and nurses in Commonwealth and developing countries.

It is for that reason that I should like to turn to the four chapters relating to the training of doctors. Perhaps I may skip Chapter 2 on undergraduate training, except to say that in Britain we are still suffering from the effects of the Willink Report, and the tardy way in which the Ministry of Health has acknowledged that the Report was inaccurate. It is doubtful today whether we can produce enough undergraduates in our own medical schools for our own needs. The Porritt Committee rightly says that to provide places for overseas undergraduates is very difficult, but I want to indulge in a little special pleading, just as my hon. Friend the Member for Durham (Mr. Grey) has done with my support. Would the Parliamentary Secretary—and not only he himself, he is here, and I did not expect him, but the Secretary for Technical Co-operation, —consider the possibilities of a medical school in Durham?

There are one or two very strong reasons why there should be a medical school there. Durham has a very long tradition of residential college life, and a medical school there in which, perhaps, half the students were from overseas and half were British medical students, would have one very great advantage which very few other universities would provide.

Places for students could be made in the colleges quite naturally without any special provision of a segregated unit for overseas students and without the students being dispersed over lodgings. One of the things that makes the greatest difficulties for overseas students, that is, accommodation, could be provided in Durham.

Add to this that Durham people are famous for their hospitality and are very interested in overseas developments, and Durham would be able to provide all requirements for a good medical school. There is a project for a new hospital in Durham which could well become the university hospital. There are also developments on Tees-side which could be integrated with the work of a medical school in Durham. I leave that special pleading. Even if this does not come about there must be new medical schools, and one of the arguments for them is the increased training need for undergraduates from overseas.

One of the most difficult problems is mentioned in Chapter 3, the question of bringing into England overseas medical post-graduates for training and experience. We all know that if the overseas post-graduates working in the National Health Service were withdrawn the Service would collapse. The Report states that about 100 doctors from overseas are coming to Britain every month. There are two categories of post-graduate overseas students who need special attention, and I mention the easier category first. There are those who come to the medical schools of the teaching hospitals.

The Committee's recommendation is that there should be Technical Cooperation Department bursaries in increasing numbers for these students. I believe that the figure discussed in the Committee was between 100 and 200. I hope that the Parliamentary Secretary can give some indication whether this proposal is accepted, the amount of money that may be available for it and the number of bursaries.

It is the second problem that is much more difficult. It concerns the Ministry of Health more than the Department of Technical Co-operation and that is the training of overseas post-graduates to take up posts in the National Health Service away from London. All of us are concerned with the weaknesses of post-graduate medical education. The Pickering Report is not under consideration here at the moment, but the general question of our own British post-graduate education is of considerable importance.

I venture to quote what the Porritt Working Party says about post-graduate education for overseas visitors: The Working Party views with the greatest concern the fact that many young doctors from the developing countries who come to this country for post-graduate experience return home with no more experience of British medicine than they have been able to acquire in small hospitals far from teaching centres where they have received a minimum of supervised training. I was very disappointed when I put to the Minister of Health a particular reference to this matter in a Question on 28th January. I asked the Minister what steps he is taking to implement the recommendation of the Porritt Working Party on Medical Aid to the Developing Countries, that doctors from overseas taking up posts in the National Health Service undergo a two months' clinical assessment in selected hospitals and that subsequently they are provided with much improved post-graduate training if they receive posts in non-teaching regional hospitals. The right hon. Gentleman gave an Answer which I thought was neither particularly courteous nor informative. He said: It is the responsibility of employing authorities to assess the suitability of applicants for particular appointments. A member of a regional hospital board might be expected to know that. The Answer continued: Schemes for post-graduate medical education are being developed in regional hospitals with the help of the Nuffield Provincial Hospitals Trust".—[OFFICIAL REPORT, 28th January, 1963; Vol. 44, c. 122.] This, again, is mentioned in the Porritt Report and the Minister might have expected anyone asking the Question to have read the Report. What is being done about this fundamental problem? It is a matter for the Ministry of Health as well as the Department of Technical Co-operation and my view is that it is not enough to rely upon voluntary sources of finance.

I turn to Chapter 4 and the question of British graduates going overseas. I understand that a code is being drawn up. The Ministry itself should see that a great many of the pernickety regulations which exist now are reduced in the interests of British doctors in the National Health Service going overseas. I understand, for example, that a consultant appointed from, say, the West Indies is allowed only four increments from the basic minimum scale, so that a man aged 50 coming back to England would receive the sort of salary given to a 36-year-old. Could the superannuation regulations be revised so that someone retiring from the National Health Service need not lose his superannuation on taking up an overseas post?

There are a great many other matters into which I would like the Minister of Health to look to see whether the regulations could be revised concerning doctors who wish to go to overseas countries. By doing this they gain the experience of our senior people and this should be most valuable. I see that time is against me and, although there are many other matters to which I should like to refer, I will only say in regard to Chapter 5 that the necessity to develop aid in public health is as important as the other matters I have mentioned. As time does not permit me to go into this matter I hope that the Secretary for Technical Co-operation will give me an indication of what he proposes to do by correspondence.

10.17 p.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

I regret that my right hon. Friend is unable to reply owing to an indisposition, and I share the wish of the hon. Member for Bishop Auckland (Mr. Boyden) that he makes a quick recovery. In the circumstances, I will do my best to answer the points he has made. I do so gladly, partly because when I was Under-Secretary for Commonwealth Relations—and, indeed, long before that—I had a deep and continuing interest in the problem of providing aid for developing countries overseas, and partly because, in any event, we in the Ministry of Health have an interest in the subject he has raised tonight.

I should at the outset make it plain that the policy of Her Majesty's Government in providing technical assistance is to meet the requests of developing countries in whatever form they appear.

I make this point because it could be that while one developing country devotes a high proportion of its requests to medical aid, others may prefer to ask for technical assistance in education, geological surveys agricultural development and so on. This is clearly accepted in the Porritt Report, and it is bound to influence strongly all that we do in implementing the recommendations of the Report.

The Department of Technical Cooperation is responsible for promoting and co-ordinating Britain's technical assistance to developing countries, not only the self-governing countries of the Commonwealth but the dependent territories which still look to us for help and guidance, and also certain foreign countries as well. It was essential that such a co-ordinating Department should be set up.

When the Department of Technical Co-operation was set up about eighteen months ago, recognising that the choice and initiative rested with the developing countries, we were concerned to ensure that funds and facilities were available to meet such requests as were reasonably made. To this end, a number of committees was set up to investigate all the various fields of assistance. In the medical field, my right hon. Friend was particularly fortunate because, owing to the enthusiasm of the medical profession itself and of Sir Arthur Porritt in particular, leading members of the profession offered to make this survey themselves, provided that they were given reasonable assistance.

The hon. Member asked why their report had taken so long to come to light. It is not a Departmental publication. It is the Report of a Working Party, an independent body, although from the outset, as its, members themselves said, they drew encouragement from the eager and constructive interest shown in their proceedings by the Department of Technical Co-operation. The delay was due to the fact that the Report involved new financial provision which could be considered only in the context of the Estimates of the Department of Technical Co-operation for 1963–64.

We now have that Report, and I know that my right hon. Friend would like me to take this opportunity to express our warm appreciation, and to underline everything that has been said by the hon. Member, of the work of Sir Arthur and his distinguished colleagues. Partly because the British medical profession has such a high reputation the world over and partly because of the intangible links which still bind Commonwealth countries together, this interest of the profession in the less well-developed and less well-equipped countries of our family of nations is both timely and welcome.

The hon. Member suggested that Britain was falling behind in this regard, but neither my right hon. Friend nor I could accept that. Such a view pays very little regard to the constitutional changes resulting from independence. If, indeed, Ghana or the Sudan desire to employ people from other nations, that is their affair and not ours. It is due also to the desire of other donor countries, particularly the United States, to make their own distinctive contribution and not least to the important consideration which I mentioned at the outset—the fact that the determination of priorities in calling for aid rests with the developing countries and not with us.

It is also right to say that there are very few countries today which devote so high a proportion of their national income per capita to overseas development as a whole. Indeed, our present contribution in medical aid to the developing countries is not inconsiderable, although I do not want to suggest for a moment that it is always necessarily supported by Government funds. What matters in this context is the willingness to provide facilities and whether this is in evidence.

Today, there are 900 undergraduate students from overseas studying in our medical schools. There are 9,000 student nurses from the Commonwealth in our hospitals. Nearly half the doctors at registrar level in our hospitals are from overseas. In the last two years the Department of Technical Co-operation has arranged and paid for post-graduate training for 265 doctors and 170 nursing sisters from overseas, and that is in addition to 170 doctors who came from the dependent territories for post-graduate training at the expense of their own Governments. There are 1,385 medical staff who are designated under the Overseas Service Aid Scheme at a cost for the coming year of £1.6 million.

In the last two years, my right hon. Friend's Department has recruited 131 doctors for service overseas. Many medical appointments have been made under the Colombo Plan and the Special Commonwealth African Assistance Plan. Medical equipment provided under these plans in 1961.62 was of the value of £68,000. In addition, my right hon. Friend's Department is currently spending £262,000 in support of medical research for the benefit of developing countries.

The House will agree that this adds up to a significant contribution, but I agree with the implication of the Report that we must put ourselves in the position of being able to do more. This means, of course, the provision of more training facilities here and the despatch of further medical personnel overseas. The limiting factor here, however, is not the provision of funds but the willingness to make the facilities available and the ability to find the men and women to go overseas and work there. While training facilities have, generally speaking, been made available, my right hon. Friend and I must confess to some disappointment at the lack of response to serve overseas.

It is against this background that the Working Party's Report is so valuable. My right hon. Friend is anxious to make a detailed statement about the Government's attitude towards the specific recommendations in the Report as soon as possible, but, had he been here tonight, it would have been premature for him to have said anything on this score because he had his detailed talks on the subject with Sir Arthur Porritt only last Thursday. I can assure the hon. Gentleman, however, that my right hon. Friend will make a statement at the earliest opportunity. Meanwhile, I am very glad to say that the Government accept the greater part of the recommendations in the Report.

The hon. Gentleman referred to postgraduate training. Here, the Government propose to create 25 bursaries for post-graduates from the developing countries. These will be administered on lines similar to those provided under the Colombo Plan. The selection procedures by the Department, the universities and the medical schools are being worked out now.

The hon. Gentleman mentioned, also, the supervision of post-graduate education in non-teaching hospitals. The House will be glad to know that this is now in hand, with the aid of £250,000 provided by the Nuffield Provincial Hospitals Trust. The hon. Gentleman referred to the proposal that there should be a scheme of clinical assessment of doctors coming from overseas. This is not without difficulties. The House will appreciate that assessment of the suitability of applicants for posts is the responsibility of the hospital boards; they are the employing authorities. These doctors will be working in British hospitals dealing with our patients and I do not think, therefore, that the answer which my right hon. Friend gave the other day was unsatisfactory. It was the only answer he could have given. My right hon. Friend would certainly be interested, however, in being kept in touch with any scheme which a hospital board might work out, perhaps with funds from a trust or other non-official sources.

I am glad to say that the Government propose, also, to make a major contribution in advancing public health overseas. As the Report points out, we have a great fund of expert knowledge in this country of public health problems overseas. We can take great pride in the contribution which our countrymen have made in preventive medicine in so many countries. Accordingly, we intend to aim at the establishment in all of 12 senior and 6 junior lectureships in 1963.64 at the two tropical schools.

As my right hon. Friend told the hon. Gentleman the other day, we are also very interested in the recommendations in Chapter 6 dealing with facilities for training nurses overseas. Although, as I have said, we accept, with one or two minor exceptions, the recommendations in the Report, I frankly confess that I doubt whether mere acceptance of recommendations will be sufficient to fill the vacancies which now exist at all levels, from general practitioners to consultants, from nurses to matrons, and those which will continue to arise, until sufficient personnel from the developing countries have been trained in the years to come.

At present, my right hon. Friend has 235 vacancies to fill, and other agencies have vacancies, too. If we are to fill all these, we must create in the medical profession and the hospital boards a climate of opinion as favourable to service overseas as that already created in the teaching profession. I do not minimise the difficulty of this task. However, publicity may help, and my right hon. Friend and I are grateful to the hon. Gentleman for ventilating thins matter tonight.

My right hon. Friend has discussed this aspect of the problem with Sir Arthur Porritt. I am glad to say that Sir Arthur has offered all possible help and will advise my right hon. Friend on how his Department's activities in this matter can best be directed.

The hon. Gentleman asked about an annual report on medical aid. I do not think that this would be practicable because of the vast number of agencies concerned. However, my right hon. Friend hopes to give as much information as possible in the Annual Report which his Department will publish. I shall certainly pass on the suggestion about an annual debate. Over and above this, I think that Parliamentary Questions may be the best answer.

As regards the provision of funds, my right hon. Friend has previously said that his Department's Estimates for the coming year will take account of the Working Party's recommendations, including those which I have mentioned tonight. He is only too well aware of the disparity between medical services in this country and those in most of the developing countries overseas. We must do all we can.

The Question having been proposed at Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.