HC Deb 08 March 1966 vol 725 cc2061-72

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

10.35 p.m.

Mr. David Price (Eastleigh)

I wish to raise tonight the question of the need for a teaching hospital and medical school in the Wessex Region. This is a matter which I have endeavoured to raise by the method of Parliamentary Question. I wish to make it clear that I have not been put up to this by Southampton University, which would be the beneficiary if a decision to provide such an establishment were made. It is clearly perfectly capable of arguing its own case before the appropriate authorities, principally the University Grants Committee. I raise the question on other, but I think, equally important grounds.

Firstly I contend that the Wessex Hospital Region is unique in not having its own teaching hospital and medical school. I must qualify this by saying that until recently one could say that the East Anglian Region was in the same position, but I understand that steps are being taken in the case of Cambridge which will in effect make it a full medical school. I shall argue that the development of our hospital services within our region suffers from the absence of a medical school and teaching hospital. My second ground is that the Wessex Region and Southampton University are uniquely placed to provide one of the new medical schools, which is needed nationally.

I do not want to hold the Minister too closely to proposals which he made when he spoke from the Box in opposition, but he once expressed the view that four new medical schools were needed. I would not argue the precise number. Certainly I would agree that further medical schools are necessary. I would, thirdly, contend that Wessex can provide a new teaching hospital, and a new medical school quicker and cheaper than any other region in the country.

Many of us in Wessex feel that the absence of a teaching hospital frustrates the achievement of the very highest level of service to our community which the right hon. Gentleman would expect us to provide. We have a number of reasons for this view.

A university medical school serves as the intellectual centre which attracts doctors of the highest calibre in a region. This is particularly true of a great provincial university like our own in Southampton, which, in many other realms, is trying to orientate itself round the needs of our region and is not, as was once the danger with some of the newer universities, simply rather a pale blueprint of Oxford, Cambridge and London.

We are striking out in a pattern of our own. The standards of good practice which permeate from a medical school to the periphery of the hospitals in the region are important. The dynamism in medicine and progress in medical practice depends upon active, continuing pursuit of research. Initiation and planning of research devolve upon the appropriate professorial units in the university's medical school.

Apart from teaching undergraduates, medical schools have an equally responsible rôle in providing continuing education for qualified doctors in general practice and public health, to give two instances. The Medical Officer of the County of Hampshire, part of which I have the honour to represent, has been particularly forward looking in working with our general practitioners to the extent that every general practice partnership has district nurses and midwives permanently allocated. I am sure that the right hon. Gentleman would be in favour of such moves. I have been a beneficiary as a patient myself. Our own general practice is now in the general practice centre which has been set up at Hythe by the cottage hospital with considerable support from the county. This is a development of which, I am sure, the Minister approves. On all sides, we would agree that this is the way that many of us would like to see general practice develop. I believe that the presence of a medical school in one's region would assist the integration of general practice with the hospital service.

Fourthly, a medical school has an equally important impact on nursing standards throughout a region. The presence of a medical school has always proved an incentive to nursing recruitment. I will not develop that theme, however, otherwise I might become a little Freudian in my argument.

Fifthly, a medical school identifies itself with the area in which it is situated. In some degree at least, it is able to mould its development to the medical needs of the population at large in the region.

The Wessex Region comprises a population of over 2 million people living in central southern England and the Isle of Wight. The Ministry of Health has been infinitely more intelligent than other Departments in recognising the distinctive features of central southern England and does not lump us with London and put us into a vast south-eastern region of 17–18 million people, which is far too big to make any sense in terms of the new concept of regionalism.

We are a rapidly growing area. In Hampshire, we have one of the fastest rates of increase, for example, in school population. I contend that on our own merits, we deserve a medical school. The Wessex Regional Hospital Board's plan for building two new large hospitals, in Southampton is admirably suited to meet the needs of a teaching hospital. The 1,800 or so high-quality acute beds planned in this programme would clearly support a medical school of economic size whatever changes may take place in the medical curriculum.

My second reason is the uniqueness of Wessex viewed nationally for a new medical school. The University of Southampton already possesses the academic infrastructure for a medical school. It is capable of providing most, if not all, of the pre-clinical courses. Equally, a considerable amount of fairly high-level postgraduate work is being undertaken. In the physiology and biochemistry department of the university, we are taking in 36 honours B.Sc. undergraduates a year. We have 38 postgraduate students taking a three-year course in research and we have an academic staff of a professor, a reader, eight lecturers and three post-doctoral fellows. In the attendant zoology department, we take in 20 honours B.Sc. undergraduates a year and 12 postgraduate students on research. There is an academic staff of a professor, a reader, eight lecturers and two post-doctoral fellows.

The research programmes which are being operated jointly between the university and the hospital board indicate both the academic quality of what is available in the region and the good spirit of co-operation between the hospital service and the university. I need point only to studies on induced hypothermia and extra-corporeal circulation which are being undertaken in the university, as well as research in micro-anatomy and physiology of the kidney, and research in audiology.

An advanced medical education programme at postgraduate level is organised by the Wessex Regional Board and supported by the university. These courses include general vocational training which is given to medical graduates during their pre-registration period, special vocational training for consultant status, including courses for primary and final F.F.A.R.C.S. and F.R.C.S., M.R.C.P. revision, pathology revision and continuing education for established doctors. In other words, we do pre-clinical work, postgraduate work and vocational work. All that we lack is the authority and Exchequer support to do the clinical work.

I am not taking this up as merely a local issue. In the need for more medical training facilities throughout the country, I believe that we are uniquely placed to provide a new medical school. Furthermore, if the decision were in our favour, the university and the teaching hospital would work with the hospital and the doctors of the region as a whole. As the right hon. Gentleman knows, not only is excellent work going on in Southampton. I need only mention the cardiac unit at the chest hospital, and the work of international repute which is carried on in Portsmouth, and that the Wessex Regional School of Psychiatry has been opened recently at Knowle, near Fareham. I think there is a very strong case for saying that the quality of the work in our region is unique in a region without a medical school.

My third reason very simply is that there is every indication that we could start a new medical school quicker and cheaper than anywhere else in Britain, and I should have thought that this would have appealed not only to the right hon. Gentleman but to his colleagues the Secretary of State for Education and Science and the Chancellor of the Exchequer. I shall not detain the House by going into the financial details but I am sure that if the right hon. Gentleman's Department were to investigate—it may have done—the financial consequences of such a decision the right hon. Gentleman would find that it would be the cheapest, and certainly the quickest in terms of admitting medical undergraduates at the earliest possible date.

I have only one fear, which is that—though my espionage system is not always as good as that of some others—the decision may go to Hull because of North versus South politics. I hope I am wrong. I shall be delighted if the right hon. Gentleman can disabuse my fear and assure me that my information is wrong.

My final plea is this. Even if the right hen. Gentleman feels he must defer making any decision because he has been pressed by the Chancellor on financial grounds, I would seriously counsel him to make the decision so that everyone knows what is going to happen, even though he may have to defer for a year or two the implementation of the decision. He will appreciate that, from the planning point of view, we must know in making our development schemes, both for hospitals in the region and in the university, whether we are really going to get a medical school and a teaching hospital or not. I very much hope that the decision will be in our favour.

10.47 p.m.

Sir John Fletcher-Cooke (Southampton, Test)

I am most grateful to my hon. Friend the Member for Eastleigh (Mr. David Price) for allowing me a few minutes in which to speak, and I am also grateful to the Minister. The first point I would make, from a rather different approach than to my hon. Friend, is that, in a sense, the Wessex Region already has a medical training school. As my hon. Friend clearly explained, we have provision for general vocational training and specialist vocational training, and, indeed, for the teaching of established doctors—that is to say, courses for doctors who have been prac- tising for many years and who attend to keep abreast of recent developments. When one takes the whole of that as a complex the only thing we are missing is the undergraduate stage, the pre-clinical and clinical training of medical students. I should, therefore, like to put forward the case on this basis of, as it were, filling the gap.

As to the postgraduate training which is going on, the Minister will certainly be aware that there are nine postgraduate training centres in the region, of which two are in Southampton itself; and that they have received capital grants totalling £120,000, of which over one-quarter has come from the Nuffield Foundation. I understand that the annual running costs of these centres amount to some £16,000. In other words, this work is being done throughout the region on a fairly substantial basis. Furthermore, the fact that this postgraduate training is spread throughout the region means that it is brought much closer to the doctors themselves since they are, naturally, spread throughout the region, both in general practice and in hospitals. As my hon. Friend has said, these centres are providing medical education for doctors at all stages of development in medicine.

In the minute that is left to me, I do not want to elaborate on the fact, which he has stressed, that there are already a number of pre-clinical facilities available at the university. But I should like to point out that the Ministry of Health has, I understand, already agreed in principle to the expenditure of some £13 million on two hospitals in Southampton up to 1979—that is, the Southampton General and the Royal South Hants—covering a whole variety of facilities and improvements into which I need not enter. But quite obviously, if these hospitals are going to be used as teaching hospitals, it is vital that a decision should be taken as soon as possible so that the planning of these improvements can take this into account.

There are other reasons why an early decision, at least in principle, is required. The first one, to which my hon. Friend referred, is that there is a large body of responsible opinion which believes that Southampton could get off the ground in this matter quicker than anywhere else. I have been told that if Southampton were to receive the go ahead now, it could be teaching before Nottingham, which got the go ahead three years ago.

Again, the existing teaching hospitals which are linked with the Wessex Region—St. Thomas's, Westminster and St. George's—are themselves so busy that they are inevitably finding it difficult to maintain close links with hospital development in the Wessex Region.

I would also point out that there is a tendency for teaching hospitals in London, where the links with the Wessex Region now are, to suggest to their young doctors, when they feel they should go away for two years' experience elsewhere, that possibly they might go elsewhere in the South-West Metropolitan Region, let us say to Guildford, because then they could do two years there without moving from the homes that they have established in London; in other words, they could commute. If they went to Southampton, they would not be able to do that.

Junior hospital staff who aspire to become consultants, are not attracted to Southamtpon because they feel that they will be cut off from a teaching hospital; this is another reason, if Southampton and the Wessex area are to attract good junior hospital staff, for a teaching hospital there.

I understand that the Minister himself has encouraged the teaching hospitals in London to increase the number of medical students that they take in. That is quite understandable, but it is far more expensive for medical students to live and work in London. If, therefore, it is possible, as I hope it will be, for a decision in principle to be taken very soon that we should fill in our medical education scheme by the establishment of an undergraduate training centre, I believe that the cost to students and, therefore, to the Exchequer would be less than if they were doing their training in London.

10.54 p.m.

The Minister of Health (Mr. Kenneth Robinson)

The hon. Member for Eastleigh (Mr. David Price) has raised tonight, in what I think was a most persuasive manner, the need for a teaching hospital in the Wessex Region, and he has been supported by his hon. Friend the Member for Southampton, Test (Sir J. Fletcher-Cooke).

He has developed his argument in support of the establishment of a medical school in the region, and that is perfectly reasonable, because one could hardly imagine a teaching hospital without an associated medical school.

Perhaps I might take a moment or two to explain to the House where the responsibility lies for providing teaching facilities for medical students. As the hon. Gentleman said, it is for the University Grants Committee in the first instance to advise my right hon. Friend the Secretary of State for Education and Science on whether and where new medical schools should be set up. In doing so, it consults closely with the health departments. My own immediate responsibility is to provide whatever facilities are needed for clinical teaching and research for the medical school and its associated hospital. But it will, I trust, be clear to everyone that unless and until a decision is made to establish a medical school in the Wessex Region, the need for a teaching hospital as such does not arise.

There are several universities which have expressed a lively interest in establishing new medical schools. In arriving at decisions on where new schools should be set up, I can assure both hon. Members that regard will be had, amongst the many factors to be considered, to the hospital facilities which are already available, or can be made available, for clinical teaching. The hon. Member for Eastleigh has sought tonight to demonstrate that so far as hospital services in the Wessex Region are concerned, the potential is there, and I would not dissent from this view.

The hon. Gentleman also referred to the national need for more doctors, and for new schools to be set up generally, and that one of them should be in the Wessex Region. Certainly we have too few doctors, and the rate at which they are currently being produced is still too low. Both these deplorable facts stem directly from the policies pursued by the party opposite when in Government, but I do not want to go into a political argument at this stage. Matters are nevertheless improving. I do not say that they are improving fast enough—we must not forget that it takes between five and six years for a doctor to qualify—but they are nevertheless improving. In 1964 the output of British based doctors was 1,511, the lowest figure for many years, last year it rose to 1,618, and we expect the numbers qualifying each year to go on increasing until by 1969 the output will be over 2,000 a year. The intake last autumn was 2,283 British based students.

But that is still not enough to meet our needs, and it is for this reason that the Government have recently announced that the U.G.C. is making provision, in the revised university building programme, for medical schools building which will increase the number of pre-clinical places by a further 500, allowing an increased intake of 250 a year, or over a 10 per cent. increase. Work on these schemes is expected to begin this year and next, and will take the form of expanding existing schools.

That reflects a decision by the U.G.C. to devote in the next two years a significant part of the total money available for investment in university expansion to the provision of more medical student places. The schemes which are being selected are those which can provide, within the resources available, the greatest number of additional places in the shortest possible time, and they will result in an increase in the intake which is in total the equivalent of at least three new medical schools. I rather thought that the figure I mentioned when in Opposition was at least three.

Mr. David Price

I think it was four.

Mr. Robinson

At any rate, we have the equivalent of at least three coming along.

The House will apreciate that this is a field in which the Royal Commission on Medical Education, whose appointment was announced by my right hon. Friend the Prime Minister last July, will be taking a very close interest, because its terms of reference are not only to review medical education, but also to consider what changes may be needed in the pattern, number, nature and location of the institutions providing medical education. The Commission is already hard at work, and we look forward to its report in due course, but it will be clear from what has been said that the Government are abiding by their declared intention, made public at the time the Royal Commission was appointed, that the appointment of the Royal Commission should not of itself delay the immediate measures needed to increase the number of doctors. We have already taken a substantial step towards bridging the gap between the need for, and the supply of, doctors, and the U.G.C. is currently carrying out a review of the scope for further expansion at existing medical schools which might be undertaken after the programme which I have just mentioned has been put in hand and also exploring the possibilities of additional new medical schools.

Before I turn to the special position of the Wessex Region, perhaps I can say a few words about the dual rôle of the teaching hospital—treating the sick and providing facilities for teaching medical students. The traditional view of medical education used to place special emphasis on the rôle in teaching and research which was played by the teaching hospital.

There was at first a tendency for the patients admitted to the teaching hospitals to be those whose treatment contributed particularly to the purposes of medical education. So, too, with the 14 hospital regions created at the start of the National Health Service, each linked with an important university centre, there was a tendency for highly-specialised treatment in such fields as neurology, and neuro-surgery, radiotherapy and thoracic surgery to be concentrated where teaching facilities were also to be found, and it was from these centres that the influence of this specialised work was disseminated.

In the past, this brought allegations of a bias in the teaching hospitals in favour of the interesting as against the routine cases. More recently it has become clear that changes are taking place in the whole underlying concept of what constitutes medical education. This can be seen in the marriage of treatment and teaching with district services provided by undergraduate teaching hospitals for the surrounding community.

I am sure that this is good for teaching because it calls for close contact with the life of the community. It is good for the students, so many of whom, we hope, will serve as general practitioners. It is good for them to see the ordinary day-to-day maladies of a cross-section of the population. It is also good for research which needs to have access to a community and which itself will increasingly be based on epidemiology and social and psychological factors which affect the cause and treatment of disease.

It is within this context that I want to look at the special position of the Wessex Region. At the start of the National Health Service, the area was part of a very large region administered by the South-West Metropolitan Regional Board. This arrangement came in for heavy criticism by the Select Committee on Estimates in 1951. The Committee felt that the area was too large for any board to cover. This was despite the degree of delegation which had been embarked upon. In its recommendation the Committee came down clearly in favour of spliting the region into two. That was not done immediately. There was further delegation, but even that did not still the pressure for a separate region for Wessex.

The hon. Member for Eastleigh wrote to my Department in 1957 saying: There is no reason why the present academic association with the University of London and with the Medical Schools of St. Thomas's, Westminster and St. George's hospitals should not be maintained. I must be fair, however and agree that he added: Furthermore, there is, I believe, the prospect that in the future a Medical School might be set up at the University of Southampton. In due course the Wessex Region was created and it is important to remember that there was close consultation with the University of London and the three medical schools I have mentioned. They all agreed that the academic association with the new region should be preserved. It is right that I should pay tribute to the services these schools and teaching hospitals have provided, not only in the teaching links but also in specialised treatment for patients in the Wessex Region.

It would be wrong, therefore, to think that there has been any failure either to provide the essential teaching links with the region or the treatment required by patients. The hon. Member mentioned a number of developments going on in the Region and to some extent I think he destroyed the other leg of his case, which was that there was an intellectual isolation in the region in the absence of a medical school. I do not think that this is true.

The hon. Member for Test mentioned the medical centres which have been opened in recent years in the area and this shows that lively development is going on despite the absence of a teaching hospital.

I have only time to add that there are in the region many courses of instruction for young doctors wishing to sit for a variety of diploma examinations. But I hope I have said enough to demonstrate the extent of medical education in the region, the availability of a comprehensive service to patients at district general hospitals and the development of those specialised regional services which, in the old days, could perhaps have been provided only at a teaching hospital.

I refer again to the current review of facilities for medical education and I assure the hon. Members that, in that review, the arguments advanced tonight in favour of a new medical school and teaching hospital in the region will not be overlooked. Perhaps I can point out to the hon. Member for that his espionage was not as good as he thought. I can assure him that no decision has been taken, apart from the Nottingham decision, to set up an additional school either at Hull or anywhere else at this moment. But again I assure him that all the arguments put forward tonight will be carefully taken into account.

Question put and agreed to.

Adjourned accordingly at five minutes past Eleven o'clock.