HC Deb 08 December 1969 vol 793 cc198-208

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

11.25 p.m.

Mr. Ifor Davies (Gower)

I welcome very much the opportunity to put before the House the case for a medical school at Swansea, covering the South-West Wales catchment area. This is not the first time that the claims of Swansea have been put forward. I would remind my hon. Friend that in 1965 I had the privilege of leading a deputation of South-West Wales Members to the then Secretary of State for Education. I was supported by my hon. Friends the Members for Swansea, East (Mr. McBride) and Swansea, West (Mr. Alan Williams) who are also most interested in this matter.

A great deal has happened since. The most significant development was the Royal Commission Report on Medical Education, published in April 1968. It was under the chairmanship of Lord Todd. The case for Swansea was put before the Commission by a Committee led by Mr. Roy Thomas, Dr. Duncan Davies and Principal F. Llewellyn Jones. I take this opportunity of paying a tribute to them for their excellent work, which I am sure, was instrumental in getting the Royal Commission to make a recommendation in favour of Swansea.

It is this recommendation which is the basis of my case. I refer to paragraph 390 of the report, which says: The medical school capacity available soon after 1975 could, we think be further increased by the establishment of a new medical school at Swansea, where conditions are very suitable. The University College there has already more than 3,000 students, most of whom come from outside Wales, and offers substantial relevant academic resources. A big new hospital, which in our view could be adapted without great difficulty for undergraduate clinical teaching, has been built immediately alongside the College and land is available for expansion; this hospital, with other hospitals in the district, could meet the needs of a reasonably large medical school on the assumption that the population drawn upon will be not only that of the immediate area (under 600,000 at present) but for many purposes that of the whole of south-west Wales, which is over 850,000 at present and is likely to expand as industrial and commercial development proceeds. I am glad to see the Minister of State, Welsh Office, in her place. I am sure, knowing her close interest in education and health, that she will agree with my argument. I am also glad to see present my hon. Friend the Member for Swansea, West, to whom I have referred. The Commission has recommended Swansea, where the conditions, to use its own words "are very suitable."

I was also very glad last Friday to be present at the opening of the Postgraduate Medical Centre at Morriston Hospital, Swansea, opened by Sir Max Rosenheim, President of the Royal College of Physicians. I was gratified to hear him express support for a medical college at Swansea. The all-important point I want to stress is that the Government's acceptance of the recommendation is now a matter of urgency because there is so much detailed advanced planning necessary, involving at least three parties.

In the first place, there is the University College. The Royal Commission had made this clear in paragraph 386. when it said: The modern medical school must be an integral part of a university which can be expected to provide in due course a full range of opportunities for instruction and research in those biological, physical and behavioural sciences which are relevant to medicine. The general scale of the university's development must be big enough to allow a medical school which is established within it to reach the desirable size without causing imbalance and distortion in the pattern of the university's activities. The University College needs to know where it stands before it can plan further its future educational policy.

Secondly, the Welsh Hospital Board, and the Glantawe Hospital Management Committee, in particular, are both deeply involved. Since the first comprehensive review of medical education by the Goodenough Committee in 1944, medical education has been accepted as an integral part of our hospital service. The Government also recognise this in the White Paper, The Hospital Building Programme, Cmnd. 3000. Paragraph 15 reads: The teaching hospitals will play an increasing part as district general hospitals serving the communities around them;". The Royal Commission has expressed the view that about 2,000 teaching hospital beds would be needed for the 150 to 200 students which it considers is the minimum required for a new medical school. That appears in paragraph 386. The Commission says that these beds need not all be found in a single hospital provided that they are located in hospitals reasonably close to the university with which they are associated. In the case of Swansea, the new Singleton Hospital, which is alongside the university, will be ideal as a base hospital. But plans for its development, as well as for that of the neighbouring hospitals, are all being held up pending the decision on the medical school, as my hon. Friend the Minister of State well knows. The hospital authorities are therefore faced with a serious problem.

There is the vital interest of the local authority, which has already been extremely helpful. I pay tribute to the authority, but it needs to know where it stands, as it is very much involved, because of such questions, among others, as location, land acquisition and access. It is, therefore, clear that the University College, the hospital authorities and the local authority are all in a state of uncertainty and cannot plan ahead.

I turn to the all-important question of manpower targets. I note that in reply to a Question on 6th February this year, the Minister stated that The establishment of further new schools will depend on decisions on manpower targets."—[OFFICIAL REPORT, 6th February, 1969; Vol. 776, c. 575.] This, it appears, is the crucial issue confronting us.

In paragraph 389 the Royal Commission recommended that the present intake of approximately 2,600 places per year be increased to 3,700 intake places up to 1975. On 14th April the Minister indicated that this target—the target raising from 2,600 intake places to 3,700 intake places by 1975—had been accepted and would be achieved by expanding the existing medical schools, together with new medical schools at Nottingham and Southampton. That is reported in column 222 of the OFFICIAL REPORT of 14th April.

Tonight, I am concerned with the target for 1975 onwards. The Royal Commission has given its views on this subject too, and these are to be found in paragraph 363, Table 5. The Commission recommends an increase in the annual intake from 3,700 a year in 1975 up to 5,000 a year over a period of 15 years. If this target is to be reached—and the Swansea recommendation is included—there is no time to lose in making the preparatory arrangements.

May I refer to the position in Wales? The situation is that 55 per cent. of our junior hospital doctors are from overseas. I do not wish to be misunderstood in this matter. I pay very sincere tribute to these doctors for their magnificent work. Indeed, our hospital service would have faced a crisis without them, but this state of affairs is clear proof that we should be doing far more to provide medical education for our own students who are desperately anxious to train as doctors.

We have only one medical school in Wales, and that in Cardiff. It has a wonderful record, but up to last year its annual intake was only 65. This figure, of course, has now been increased to about 107 by some expansion, but I can say to my hon. Friend that the number of applicants was 10 times higher than the number of places available, and that situation is not good enough. I hope that he will agree that out of the present annual intake, which is approximately 2,600 students a year throughout the United Kingdom, a figure of only 107 per year intake in Wales is completely unsatisfactory.

In this very short debate my time is very limited, but I hope that I have succeeded in convincing my hon. Friend that the time has come for a second medical school to be established in Wales as a matter of urgency. I am very glad indeed to be able to give this assurance, that on this issue, at least, Wales is united in approving the recommendations of the Royal Commission itself that Swansea, from every point of view, is ideally suitable as the best centre. I would ask the Government tonight, therefore, to give their approval without further delay, or at least to make a declaration of intent, if I may use a popular phrase.

It may be said, of course, that the delay in any announcement regarding future plans is due to the question of capital expenditure involving the universities building programme, and if it is said that the University Grants Committee, too, is involved, I must say to my hon. Friend that the Government should give some clear indication as a matter of policy. After all, we are dealing with public funds. I am second to none in my appreciation of what the Government have achieved already, despite the most difficult economic circumstances, and I agree that in any future expenditure programme the question of priorities is absolutely essential, but I am convinced that the highest possible priority should be given to the provision of medical education. This would not only be a case of money well spent, but it would be a sound investment in safeguarding the future health of the nation, as well as giving new hope to a large number of young students whose one ambition is to follow the noble profession of medicine.

I trust that my hon. Friend will provide that new hope tonight by giving a favourable reply regarding the future of a medical school in Swansea.

11.38 p.m.

The Minister of State, Department of Education and Science (Mr. Gerry Fowler)

I well know the zeal and the vigour with which my hon. Friend the Member for Gower (Mr. Ifor Davies) has campaigned for the establishment of a medical school in Swansea. He himself referred to the deputation which he led to see the then Secretary of State in 1965. With him on that occasion was the hon. Member for Swansea, West (Mr. Alan Williams), now Joint Parliamentary Secretary to the Ministry of Technology. I am delighted to see that he, too, is here tonight to support by his physical presence the plea for the provision of a medical school in Swansea and that the Minister of State, Welsh Office, is here.

I know the depth of feeling in Wales on this subject which my hon. Friend has put to the House tonight, but perhaps he will forgive me if I set this plea against the wider background of the history of the possibility of the provision of further medical schools and the need for a greater output of doctors.

Medical schools are an example of the universities' direct contribution to the community, and they are a side of the universities in which provision can be related particularly closely to ascertainable manpower needs. In this sense, they are rare birds. Much of university provision cannot be related in any direct sense to the manpower needs of the community, and university education in this way has traditionally been non-vocational, but the medical schools are different. Their growth has been related to the need for doctors.

This is the explanation of the discrepancy to which my hon. Friend pointed when he said that for a particular medical school applicants numbered ten times more than the permissible intake. I do not think he would go so far as to suggest that we should be wise to make such provision for medical education that we were grossly over-providing ourselves with doctors.

Medical schools have suffered from this special position in the university world, since for many years it has precluded them from sharing in the general expansion of university facilities and numbers. An assessment of medical manpower needs made by the Willink Committee in 1957 resulted in the universities being asked to reduce medical intake, and the Robbins Report in 1963 followed this by calling for only a minimal increase in medical places.

The best laid schemes o'mice an' men Gang aft a-gley. We are all now in favour of more modern methods of statistical forecasting. But the history of the forecasting of medical manpower needs over the past twelve years reveals the pitfalls which lie ahead if we place an excessive reliance upon such forecasting methods.

The effects of the action which followed these reports are only now being over- come in the medical schools. The position in the schools is now being vigorously retrieved as a result of the efforts of the U.G.C. and the universities, with some special funding from the Government, and the annual intake to the schools has risen from just over 2,000 in 1960 to about 2,700 this October.

May I say a word about Ministerial responsibility for medical schools. A medical school is a university faculty, and the university is responsible for financing it, with the aid of Exchequer grant, and for staffing it and running it. The pre-clinical part of the school is generally within the university precinct, built with university money, again with Government grant, as a charge on the universities' building programme as allocated by the U.G.C.

The clinical part of the school is in a teaching hospital provided for in the hospitals' building programmes controlled by the Secretaries of State for Health and Social Security, for Scotland and for Wales, although the teaching facilities in it are financed by the university with the aid of a grant from the U.G.C. A wholly new school is thus a co-operative venture, but the fundamental decision as to location is primarily an educational one dependent on U.G.C. advice.

I must stress here the part played by the U.G.C. in the decision as to the location of a new medical school, but perhaps I may put the matter in a broader context. As my hon. Friend is probably aware, the greatest headache I have inherited in the Department of Education and Science is the expansion which will be necessary in higher education as a whole for the next decade.

Decisions as to which sector should expand and where expansion should take place, and by how many, will have to be taken in the near future. I am not yet in a position to be able to take these decisions, but the whole question of medical education must, of course, be seen against this general background. One cannot take decisions about the expansion of medical education in the university sector without looking at the broader background of the expansion of university education as a whole.

I am well aware—if I had not been I would have become so considering the pressure that has been put on me in recent weeks—of the urgency of these decisions which affect, in some degree, the decisions about the further provision of medical education in the universities; and I am pressing on with the action that I deem necessary in this area as rapidly as I can.

When it became apparent that the Willink Committee had under-estimated the future numbers of doctors needed, a general effort was made to regain lost ground, but it was clear that the position was serious enough to warrant special consideration. The Royal Commission on Medical Education was, therefore, set up to define more closely the needs of the medical profession, in terms of both numbers and the nature of the education and training they received, and to examine the problems of expanding and adapting medical faculties to meet these needs. By the time the Commission reported, not one or two but 17 universities had expressed a wish to establish medical faculties.

There was then some competition for the establishment of a new medical faculty. As my hon. Friend knows, the report of the Royal Commission called for a considerable increase in medical school provision. In the first phase, it suggested, as an immediate practicable target, that the number of entry places might be increased to 3,700 by 1975, and this the Government have already accepted.

The case for an increase after 1975—the report suggested 5,000 entry places by 1990—must be looked at carefully because of its major implications for finance as well as manpower. This is a matter for my right hon. Friends the Secretaries of State for Health and Social Security, for Scotland and for Wales and also for the Chancellor of the Exchequer, bearing in mind, in the context of the national resources likely to be available, the cost not only of providing the extra medical school places, but also of employing the extra doctors who would be trained.

I am not suggesting that we should make inadequate provision for our manpower needs in the medical sphere, but I am suggesting that we must look carefully at the financial implications and ensure that we get the numbers right—flat we match provision to need—because it would be expensive if we were to over-provide.

In the matter of providing additional places, the Royal Commission made a number of suggestions and these cannot be wholly dissociated from other of its recommendations, and not least those regarding the organisation of medical faculties. It saw a case for bigger medical schools. Hitherto, many, although crammed to capacity, have been able to admit only about 100 students a year. On grounds of economy of teaching staff of facilities and of educational benefit for students, the size suggested was an annual intake of at least 150 to 200 students.

Against this background, bearing in mind the necessary expansion which the Royal Commission saw of existing medical faculties, it suggested the establishment of five new schools—in addition to the one approved at Nottingham in 1964—at Southampton, Leicester, Swansea, Keele or Hull, and Warwick. The subject of this debate is one of these, Swansea. Whilst I have every sympathy with the anxiety of those directly concerned in Swansea and elsewhere, the problem of any one cannot be considered in isolation from developments over the whole field of medical education.

As my hon. Friend knows, of these five the Commission suggested that Southampton and Leicester should start in time to contribute to the 1975 expanded intake, with the others following in the period from 1975 to 1990. By the time the report was published, the establishment of the school at Southampton had already been agreed.

Establishing a new medical school is a very costly business, and a lengthy business in terms of academic planning and provision of buildings, and the U.G.C. was satisfied that the rest of the expansion down to 1975 could be achieved more economically and speedily by expanding existing schools. In this way, it sought to bring the size of the existing schools nearer to the size suggested by the Commission. Apart from Southampton, all the new schools suggested in the report, including Leicester, are therefore related to the post-1975 period and, as I have already said, decisions as to expansion then have yet to be reached. And I have talked of some of the factors involved.

I am conscious that what I have said about length of time for planning makes it all the more desirable for any decisions about new medical schools to be given in principle as far ahead as possible, and I am very well aware of the factors to which my hon. Friend has drawn attention when he spoke of the difficulty of planning locally in other medical areas which is posed by doubt as to whether or not there will be a medical school at Swansea and, if there is to be such a medical school there, when it is to be established.

We are very well aware of this. I realise that the position is especially difficult for sonic hospitals where building is already in progress, and Swansea, of course, is a model example in this respect. But it would be wrong to attempt to reach conclusions until decisions have been taken about the scale of manpower needs in the relevant future years, and until we have the advice of the U.G.C. on how this can best be met.

So what I have to say to my hon. Friend tonight is that there is no complacency about this matter, and I can certainly assure him, and undertake, that there will be no unnecessary delay. But we have to take first things first—

Mr. Ifor Davies

I accept the argument of the difficulty of relating a medical school in Swansea to the national position in general, but I would ask him to pay special consideration to the point I emphasised, which is that there is only one medical school in Wales, with an intake of 65 last year and now 107. That is completely unsatisfactory. I know I had better reduce my estimate of ten times, but I must say that 107 for the whole of Wales is most unsatisfactory. Will he take that fact into consideration when thinking of the overall position?

Mr. Fowler

Yes. I am very well aware of that point. This is, in my view, one of the most powerful arguments for the establishment of a medical school at Swansea. I hope that we can take a decision on Swansea and other areas as rapidly as is feasible. Such decisions relate, as we know, to a later phase than the 1975 developments, but the departments which have responsibility here are now considering these longer-term developments as a matter of urgency.

I can assure my hon. Friend that I will try to instil into them a yet greater sense of urgency in taking these decisions. The Government as a whole are keenly concerned to reach the necessary decisions at the very earliest opportunity. I am determined that there shall be no unnecessary delay, and I am very grateful to my hon. Friend for drawing this most important matter to the attention of the House tonight.

Question put and agreed to.

Adjourned accordingly at six minutes to Twelve o'clock.