Doctors

HC Deb 27 January 1969 vol 776 cc916-20

10. Sir G. Sinclair

asked the Secretary of State for Social Services, in view of the evidence in Command Paper No. 3569, paragraph 358, of the annual needs of the United States of America for between 2,000 and 3,000 doctors from outside and the developing emigration to the United States of America of young doctors qualified in the United Kingdom medical schools, what steps he proposes to take to attract more of them to stay here either by reorganisation of the National Health Service or by improvements in their pay and conditions of service.

20. Mr. Fortescue

asked the Secretary of State for Social Services what plans he has to improve the recruitment of doctors into the Hospital Service and to lessen its dependence on immigrant doctors.

Mr. Crossman

A number of important improvements in the working conditions of hospital doctors were agreed in 1967 and further proposals have been made with a view to improving career planning and prospects of junior doctors. As regards general practice, I would refer the hon. Members to the reply given by the former Minister of Health to my hon. Friend the Member for Newark (Mr. Bishop) on 5th February last.—[Vol. 758, c. 13–14.] My aim is to improve still further in consultation with representatives of the profession, working conditions throughout the National Health Service as the best means of encouraging doctors to remain in this country.

Sir G. Sinclair

But does the right hon. Gentleman not realise that the proposals in his Green Paper, by making the Hospital Service more bureaucratic, tend to make it less attractive?

Mr. Crossman

My Green Paper, which is an independent Paper, produced by my predecessor, is a basis for discussion: the hon. Member would be wrong to assume that it will remain as a basis for action.

Mr. Fortescue

Would the right hon. Gentleman not agree that an effective way to improve the pay and equipment of doctors would be to give every possible encouragement, particularly by such things as tax incentives, to private health and hospital schemes?

Mr. Crossman

No, Sir. I should have thought that that was a very dubious idea. It would not necessarily be true that, if we stimulated the private sector of medicine, we should improve the salaries in the service.

Mr. Will Griffiths

But if my right hon. Friend is successful in this recruitment, how does he propose to improve the salaries of these doctors, since a previous Answer indicated that establishments can- not be filled at the moment because the regional boards cannot pay the doctors?

Mr. Crossman

My hon. Friend will appreciate that the subject of doctors' remuneration is a very different question from the one that I was asked.

11. Sir G. Sinclair

asked the Secretary of State for Social Services in view of the conclusions of the Royal Commission, Command Paper No. 3569, regarding the reliance of the National Health Service on reinforcements of doctors from overseas and the need to reduce such reliance, what steps he proposes to take.

38. Mrs. Renée Short

asked the Secretary of State for Social Services what steps he intends to take to reduce the number of doctors coming from overseas, in view of the Royal Commission's Report on medical education.

Mr. Crossman

I am in sympathy with the Royal Commission's comments on this subject and am taking them into account in reviewing future needs both for overseas and for British doctors.

Sir G. Sinclair

I welcome that reply, but would the right hon. Gentleman consider it to be in the interests of this country, as well as of the developing countries, to ensure that, when medical reinforcements come in from outside, they are on the basis of being trainees or students, rather than on work vouchers, which carry with them the right of permanent settlement?

Mr. Crossman

I am not prepared to go as far as that, and I repeat that I am in entire sympathy with the Royal Commission's comments. I think that they have pointed to what could be a danger to the long-term recruitment of doctors in this country. If the hon. Gentleman will put down another question later, I hope to be able to give him a more concrete answer.

Mrs. Short

Is my right hon. Friend aware that senior consultants, with their merit awards, all oppose dilution, that is, the appointment of more consultants, yet they are quite happy to allow dilution at the lower end of the hospital and medical service? Does he not think that it is absolutely immoral that we should take trained doctors from underdeveloped countries—people in whom they have invested a large share of their national resources—when we should be training more doctors here and helping them to train doctors?

Mr. Crossman

We are training more doctors here and there is emigration from this country to other countries, as well as immigration to this country from others. I do not think all movement of doctors is bad, but we do regard the emigration to the United States, as my hon. Friend knows, as something which we should be actively trying to reduce. Equally, we are considering carefully and critically the dependence on doctors from the Commonwealth, both from our own point of view and from that of the Commonwealth countries themselves.

Mr. Maurice Macmillan

In view of the obvious importance of these matters and all other matters which are the subject of the Todd Committee's Report, does the right hon. Gentleman intend to publish a statement about the Report?

Mr. Crossman

It could not be done in a single statement but would require a series of statements. A number of the matters concerned are not the responsibilities of my Department but those of the Department of Education and Science. However, I am hoping in the relatively near future to make a statement about medical manpower and the Todd recommendations.

13. Mr. Montgomery

asked the Secretary of State for Social Services what is the average length of service in Great Britain after completion of training of foreign doctors who have trained in this country.

Mr. Ennals

This information is not at present readily available but studies are in progress with a view to obtaining more data about doctors born overseas and working in this country, including their length of stay.

Mr. Montgomery

May we have an assurance that we will be given this information as soon as possible? Is the hon. Gentleman aware of the tremendous shortage of doctors in certain industrial areas? What are the Government planning to do to try to get people who train in this country to stay on and work in the National Health Service on completion of their training?

Mr. Ennals

This has in part been dealt with by my right hon. Friend in his previous Answer. It is true that, in some parts of the country, there is a shortage of doctors. Executive councils are doing what they can and the degree of shortage is not nearly as much as it was some years ago. I can give the hon. Gentleman the assurance for which he asks. The data concerning the actual movements in and out of doctors is not nearly as good as we should like, and this is why we are urgently looking at means of improving our statistics.

Mr. Frank Allaun

Will my hon. Friend accept from me that there are many young hospital doctors, English and overseas, working up to 120 hours a week, working day, night and the next day, without going to bed at all, and that therefore if it were not for these doctors from overseas, our wives and families would not receive the attention that they might need?

Mr. Ennals

This is absolutely true. As to the extent to which junior hospital doctors are working, my hon. Friend is right. When he refers to the dependence that we have on doctors who come from other parts of the world, especially from the Commonwealth, I agree that it would be extremely difficult for us to maintain our hospital services were it not for those who have trained in other countries and have come to give their services here in Britain.

Sir G. Nabarro

Is it not a fact that the egress of doctors from this country is larger than the intake of doctors from overseas and that it is not a matter of conditions of service, as the Minister said, but largely of the lack of pecuniary rewards and the invidious comparison with the United States, where a trained doctor can earn 40,000 or 50,000 dollars a year?

Mr. Ennals

The question of pecuniary rewards is not one that I can answer at present. I doubt whether the hon. Member is right concerning the flow of doctors leaving this country compared with those coming in, but I cannot give him a precise answer. Our statistics do not show whether doctors leaving this country were trained in Britain or overseas.