Doctors (Training Costs)

HC Deb 10 June 1975 vol 893 cc224-6

8. Mr. Bryan Davies

asked the Secretary of State for Social Services what she estimates to be the element of subsidy involved in the training of doctors within the NHS who subsequently practise in the private sector.

Mrs. Castle

The current identifiable revenue cost of training a doctor to qualification is about £28,000 of which rather more than half is for training in the medical school as distinct from the NHS. The capital cost of providing a new medical school place is about £12,500, not counting the NHS hospital facilities. Training within the NHS continues after qualification, but the cost is difficult to identify: it depends on how long training continues, and at this stage the doctor is providing services.

Mr. Davies

Does my right hon. Friend accept that on the basis of those staggering figures those who argue for an extension of private practice, on the whole to benefit the better-off, should admit honestly that it would involve an enormous hidden subsidy from the NHS in terms of the contribution of the ordinary taxpayer?

Mrs. Castle

The figures certainly justify our determination to put first and foremost the strengthening and the interests of the National Health Service rather than of private practice. They indicate how much on health matters we are as a society interdependent, and we should behave with a consciousness of that fact.

Dr. Vaughan

Does the Secretary of State accept that the most serious loss to this country is not from doctors going into private medicine but from doctors emigrating? What does she intend to do to encourage doctors to stay in this country?

Mrs. Castle

I am surprised that the hon. Member is so anxious to expose the lack of patriotism among certain doctors. That is a matter on which I should have thought he would do better to keep quiet and instead call on doctors to discharge the debt they owe to this country in terms of the training it has given them.

Mr. Cryer

Does my right hon. Friend realise that the Secretary of the BMA has said that the Common Market will be a device to remove the shackles of the National Health Service from doctors in this country? Will she resist any attempt to make easier the movement of doctors throughout the Common Market, thus preventing doctors going into private practice in other Common Market countries on the basis of greed instead of need until there is established throughout the EEC the sort of National Health Service that exists in Britain?

Mrs. Castle

I am aware of the statement by the Secretary of the BMA. However, I must inform my hon. Friend that under the free movement of labour and the free right of establishment provisions of the Treaty of Rome, a directive allow- ing the free movement of doctors has already been agreed.

Mr. Evelyn King

Will the Secretary of State accept that her argument cannot logically apply only to doctors? The end of the road must be that every graduate who at any time has had public help with his education must work for the State. Is that not a ludicrous proposition?

Mrs. Castle

Of course the hon. Gentleman is right that any question of, for instance, forced recovery of training fees would raise far-reaching principles and would affect not only the medical profession. Nevertheless, it is worth bringing into the light of day the sort of figures I have given this afternoon in the hope of inculcating a sense of debt towards one's country.