Doctors and Dentists

HC Deb 26 March 1985 vol 76 cc226-32 4.19 pm

The Secretary of State for Social Services (Mr. Norman Fowler)

With permission, Mr. Speaker, I should like to make a statement about medical and dental manpower.

Following the report of the Royal Commission on Medical Education in 1968 and the earlier McNair report on dental manpower, a decision was taken to embark on a major programme of medical and dental school expansion. The purpose of that expansion programme was to achieve a position in which we were training, in this country, enough doctors and dentists to meet our needs. The Health Service had already become heavily dependent on doctors and dentists from other countries to whom we owe a considerable debt. They have enabled us to make good the shortfall in supply which arose from the inadequate number of graduates from our own medical and dental schools.

The expansion programme begun in the late 1960s is now largely complete. The Government therefore have a responsibility to re-examine the supply of and demand for doctors and dentists. A review of dental manpower was completed in 1983 and led us to conclude that the output from dental schools was in danger of leading to an oversupply. We accordingly agreed, following discussions with the profession, to reduce the intake to dental schools by 10 per cent.

I am today publishing a report by the advisory committee for medical manpower planning, which comprised officials from the health departments and representatives of the main professional bodies. The report contains different projections of the likely future pattern of supply and demand for doctors. There are many factors which will affect the future balance, including the level of output from medical schools, the extent to which women doctors remain in active practice and the number of overseas doctors coming here. I shall want to discuss with the medical profession the implications of the report on the intake to medical schools, on the medical staffing of hospitals and on postgraduate training.

The Government have, however, concluded that it is now necessary to prepare for the position which the expansion programme was intended to achieve—that is, where the United Kingdom is essentially self-sufficient in its supply of doctors and dentists. At present, overseas doctors and dentists have almost unrestricted access to this country. We have therefore decided to bring them more into line with the immigration rules applying to other groups. But we shall wish to retain the important role which this country has traditionally fulfilled of providing postgraduate training to doctors and dentists from other countries who can come here for periods of specialist training before returning to put those specialist skills into practice.

To give effect to this policy, my right hon. and learned Friend the Home Secretary is today laying before the House a statement of the necessary changes to the immigration rules. Briefly, these changes will have the following effects from 1 April. Doctors and dentists from overseas who wish to become general medical and dental practitioners will need to comply with the relevant entry provisions for the self-employed. All other doctors and dentists, with the exception of those intending to undertake a period of postgraduate training, will be subject to normal work permit arrangements. Doctors and dentists seeking entry for the purpose of postgraduate training in hospitals will be admitted for a period of up to four years. After four years in this country they will be able to stay only if extensions of stay are granted under the normal immigration and employment provisions. A similar permit-free period for postgraduate training will be available to overseas nationals graduating here. The changes will not apply to the doctors and dentists from the European Community who have free entry to this country for employment.

The changes are, I believe, a sensible step for us to take at this stage. They do not in any way affect the position of overseas doctors and dentists currently working here. They will, however, make clear to those who come in the future the basis on which they are being admitted and they will ensure that we do not encourage doctors and dentists to come here with expectations which the Health Service cannot fulfil. They will also enable the Health Service to plan its use of medical and dental manpower more effectively.

Mr. Michael Meacher (Oldham, West)

Is the Secretary of State aware that in principle we welcome a statement on medical and dental manpower? It is long overdue, since the Government have been sitting on the report by the advisory committee on medical manpower planning for well over a year without publishing it, even though it contains information essential for resolving current manpower problems. Nearly two years ago the Minister of State promised a review of dental manpower planning for last year, but that never transpired.

Is the Secretary of State aware that the Royal Commission report in 1979 recommended regular and more frequent reviews of medical manpower—to take place about every two years? Since this is the first such review in the last six years, will the Secretary of State undertake such reviews about every two years?

On what basis does the Secretary of State plan medical manpower requirements since the Government stopped the collection of medical unemployment statistics three years ago? Will the right hon. Gentleman confirm that at least 2,000 doctors and 10,000 nurses and midwives are on the dole? If that is correct, how does he intend to remove them from the dole queues whilst steadily increasing medical schools' intake?

On the question of consultant expansion, is the right hon. Gentleman aware that the Opposition strongly support the view of the Social Services Select Committee, chaired by my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short), in its 1981 report that a much higher proportion of patient care should be provided by qualified staff?

Is the Secretary of State further aware that in 1982 the Government suggested doubling the number of consultants over the next 15 years, so creating a growth rate of 4.75 per cent. a year? How does he explain that in the year to September 1984, the last year for which we have statistics, the growth rate was only 2.3 per cent.—less than half that needed to meet the Government's own objective? Do the Government still adhere to that objective? If they do, will the Secretary of State issue an annual target for consultant expansion in each region?

In the interim, what machinery is the right hon. Gentleman setting up to deal with the severe bottleneck between the registrar and senior registrar grades due to lack of adequate consultant posts, especially in general medicine and general surgery?

The Secretary of State seeks to justify his proposals for overseas doctors on the ground that the United Kingdom is essentially self-sufficient in its supply of doctors and dentists. What is the basis for such a bland, complacent statement when, according to a parliamentary answer on 25 February this year, the number of doctors per 1,000 population is 25 per cent. higher in France than it is in the United Kingdom, 50 per cent. higher in Germany and 100 per cent. higher in Italy?

Irrespective of numbers, is the right hon. Gentleman aware of the glaring omission from his statement about the quality of training which overseas doctors receive? Is he aware that overseas doctors are severely disadvantaged by the haphazard arrangements for their postgraduate training? They are often shunted off to study unfashionable specialties in the regions and often end up not receiving the training for which they came here and which they have a right to expect.

Does the Secretary of State agree that the system needs a radical overhaul to provide a clear guarantee of the quality of training offered, and of its completion? Does he accept that without further guarantees about standards and quality—[HON. MEMBERS: "Too long."]—This is my last point and it is important — simply cutting the numbers of overseas doctors who can stay here, which is all that his statement is about, will seem discriminatory and unfair?

Mr. Fowler

The last point rather spoiled the hon. Gentleman's response. I welcomed many of his comments. I am glad to give him the assurance that the matter will be kept under continual review.

The hon. Gentleman asked about self-sufficiency. Successive Governments have aimed for self-sufficiency. We have reviewed manpower needs from time to time and the advisory committee for medical manpower planning report published today follows the dental manpower review of 1983 upon which we have already acted by reducing the intake of dental schools by 10 per cent. We are preparing for the United Kingdom being essentially self-sufficient. Without such action there is a risk of over-supply.

The hon. Gentleman asked about unemployment. At any time people are changing jobs or between jobs. That is the only problem in that respect. We have already cut the number of British dental students. It would be indefensible to allow unrestricted immigration in such circumstances.

Since 1979 the ratio of doctors to population has improved substantially. Today 6,000 more doctors are employed in the Health Service than when the Labour Government left office.

Mrs. Jill Knight (Birmingham, Edgbaston)

I thank my right hon. Friend for listening so carefully to the representations made to him on this point since there has been widespread concern in the dental and medical professions about the way in which dentists and doctors from anywhere overseas have been allowed to come into the country. Bearing in mind the severe difficulties that this has created in planning the future levels of staffing in hospitals and in the dental profession, I have no doubt that there will be a widespread wish for me to congratulate my right hon. Friend on his action today.

Mr. Fowler

I am grateful to my hon. Friend. I think that the aim for the country to become self-sufficient in the training of doctors and dentists will be one that is shared on both sides of the House. Equally, I think that it will be realised that there is no point in training doctors if at the end of training there are no jobs for them.

Mrs. Renée Short (Wolverhampton, North-East)

I, too, welcome the fact that the Secretary of State has made the statement today although, as my hon. Friend the Member for Oldham, West (Mr. Meacher) said, the Select Committee presented its report to him in 1981, and he has had plenty of time in which to discuss these important matters with the medical profession. Why has he not done so in the intervening period? Is he aware that there are still grave problems about the appointment of more consultants in many regions of the country and that as a result junior doctors continue to have to work long hours and have more UMTs placed upon them, and progress has not been made in this regard?

Why has the Secretary of State not yet published the Green Paper on general practice? Surely this will have some bearing on the numbers of doctors employed, and possibly on the numbers of medical students that we may need in future. If he is not taking on board the proposal of the Select Committee that overseas students who wish to come here to train as doctors should undertake some kind of sponsorship scheme, has he considered it, and what are his views?

Mr. Fowler

We have always made it clear that the Green Paper on the family practitioner services will be published in the summer. That remains our intent.

On the general point about training and the position of consultants, which was also raised by the hon. Member for Oldham, West, there has been an expansion in the number of consultants in the last few years, and an expansion of about 2.3 per cent. in the last year. I share the concern of the hon. Lady and, indeed, of the hon. Member for Oldham, West about training. There is concern at present that too many overseas doctors do not receive the most relevant medical training and experience. They find themselves in areas such as geriatrics and psychiatry, which are important but are not necessarily those which are most relevant to their training needs. I want to see that position improved. I have made it clear to the British Medical Association and the medical profession generally that we shall be having urgent discussions about the matter in order to ensure that better and proper training is provided.

Mrs. Edwina Currie (Derbyshire, South)

May I commend my right hon. Friend for his honest and straightforward approach to what is a difficult problem, particularly with regard to overseas doctors. Will he agree that for years we in this country have been draining the poorest nations of their ablest manpower, which has done nothing whatever to assist those countries? Will he reassure those doctors and dentists who are already settled here, and their patients, many of whom have had excellent service in cities such as Derby and throughout the country, that we have no plans to send such practitioners back from what is now their home?

Mr. Fowler

I certainly give a categorical assurance on my hon. Friend's second point. The position of those who are practising here and, indeed, of those who are in training posts here is entirely safeguarded, and there is no question of their position being worsened by what I have said today. I hope that that is recognised by doctors.

Secondly, I should like to underline the debt that we in this country owe overseas doctors. They have made a tremendous contribution. I wish to put on record my tribute to them.

Mr. Michael Meadowcroft (Leeds, West)

Is not the Secretary of State's statement a capitulation to an existing perception of resources rather than to a better definition of need? As such, would it not be difficult for those with a greater vision of the resources that we need to raise for medical services to reverse it? Is there not a desperate need in many parts of the world for doctors and dentists to whom we should make our training facilities, both primary and postgraduate, more widely available in order to help those worse off than ourselves?

Finally, will the right hon. Gentleman take on board what has already been suggested, that the implication of his statement on immigration, particularly with regard to the Indian sub-continent, would be more acceptable if it were not for the Government's mean attitude towards immigration? That inevitably encourages a certain suspicion of the Government's intentions which we ought to allay at the first possible opportunity.

Mr. Fowler

I hope that the hon. Gentleman will therefore join me in allaying any suspicions that might arise about this measure.

I do not agree with him on the first point. The work permit system gives flexible means of controlling supply. That is the essence of the work permit system. It means that a health authority can apply for a work permit for a person who has been training in this country.

As to the general case, we have increased the number of doctors, and we are planning further to increase it. The aim is for the country to become self-sufficient. I hope that that is an aim in which the hon. Gentleman will join.

Mr. Timothy Wood (Stevenage)

I thank my right hon. Friend for his statement, which I believe reflects a very encouraging position. Is it not the case not only that the number of medical practitioners is improving, but that the A-level standards achieved by those wishing to enter university to read medicine are at an all-time high?

Mr. Fowler

Yes, I think that is right. The standards have improved and are improving.

Mr. Alfred Dubs (Battersea)

Will the Secretary of State confirm that he intends to give effect to the changes in the immigration rules from 1 April? If that is the case, it gives people six days' notice. Is it the intention that he or his hon. and learned Friend the Minister of State will rush the immigration rule changes through the House before that date, or will effect be given to the measures without the changes having gone through Parliament?

Secondly, what is the position of doctors and dentists who have made plans to come here and already have posts in hospitals but will be unable to arrive before 1 April? Will there be a period of grace?

Mr. Fowler

The broad position is that any entry that has taken place before 1 April will not be affected. That difficulty always arises with the laying of an order of this kind. If the Opposition so wish, it can be prayed against within 40 days. Any alternative method of action that the hon. Gentleman might propose would be open to severe criticism and might entail disadvantage.

Mr. Den Dover (Chorley)

I recognise that the statement is about doctors and dentists. What is my right hon. Friend able to announce about the nursing numbers, particularly if the comments by the hon. Member for Oldham, West (Mr. Meacher) are correct and there are 10,000 unemployed? In particular, what action might be taken to regulate the numbers per health authority, because there are vast fluctuations between authorities?

Mr. Fowler

I am proposing no change in the entry conditions with regard to the number of nurses coming to this country. It is important to underline the fact that we are making exceptions in regard to members of the medical and dental professions coming to the country for a four-year period of training. I think that the general position of nursing takes us rather wider than the statement.

Mr. Dennis Skinner (Bolsover)

Is the Secretary of State aware that, instead of introducing this Monday Club statement and talking about restricting the numbers of doctors and dentists, he would have done well to recognise that, with waiting lists of approaching 750,000 in the country and the lack of kidney machines, artificial limbs, heart pacemakers and so on, it would make sense not to have any restriction, but to acknowledge the collapse of the National Health Service and to make sure that we increase the number of doctors in order to shorten the current long waiting lists?

Mr. Fowler

Not for the first time the hon. Gentleman is completely out of tune with everything that has been said so far by hon. Members on both sides of the House in response to my statement. There is absolutely no point in training doctors in this country if there are no jobs for them at the end of that training. We have already reduced the number of British dental students. Frankly, it would be indefensible to allow unrestricted immigration in those circumstances. If what the hon. Gentleman said represents the policy that he would wish to advocate, that is up to him, but I doubt whether many people would agree with him.

Mr. J. F. Pawsey (Rugby and Kenilworth)

Is my right hon. Friend aware that his statement will be welcome for at least two reasons, first, because it should ensure more jobs for British doctors and dentists and, secondly, because it should ensure greater standards of health care in those countries from which many doctors have come in the past?

Mr. Fowler

My hon. Friend makes an important point. That is why it is important that we should tackle the question of the training of overseas doctors who then return to their countries and put their specialist knowledge into effect.

Mr. Charles Kennedy (Ross, Cromarty and Skye)

I welcome the Minister's acknowledgement of the crucial role that overseas doctors have played. For those who will continue to come here for post-graduate training, will he be taking steps, so far as is possible and practicable, to make sure that the training they receive is geared to the skills that they will need when they return to their own countries, bearing in mind the provision that is made in, and outlay devoted to, medicine in those countries? Does he see that type of provision being directed more to hospital service or general practitioner service?

Mr. Fowler

I agree with the hon. Gentleman in general outline, as does the medical profession, with representatives of which I have discussed the matter. I shall be having further talks with them about the matters that the hon. Gentleman raises, and any improvements that can be made will, I am sure, be welcomed by all concerned.

Mr. Frank Dobson (Holborn and St. Pancras)

When does the right hon. Gentleman think that the United Kingdom will be self-sufficient in the supply of doctors, and what doctor-patient ratio is he aiming for? Is he satisfied that we shall be self-sufficient in every specialism, bearing in mind what he said earlier about many overseas doctors tending to concentrate on one or two specialisms? Does his guarantee that the proposals will not affect overseas doctors and dentists now working here apply to overseas doctors and dentists currently training here? Is he seriously asking us to believe that all the 2,000 doctors who are out of work are in the process of changing jobs? He seemed to suggest that. Can he guarantee—perhaps I should address this question to his hon. and learned Friend the Minister of State, Home Office — that once the immigration rules have been changed there will not be any police and immigration officer raids on hospitals to check whether doctors have the necessary passports to allow them to stay in the country?

Mr. Fowler

That last question was unworthy of the hon. Gentleman—[Interruption.] Come to think of it, perhaps it was entirely worthy of him. I can give him the assurance he seeks about training. I repeat that we do not intend by anything being announced today to affect the position of those already here.

In answering his question about self-sufficiency, I ask the hon. Gentleman to study the report of the advisory committee that we have published today. Many people in the medical profession would say that we have not only reached self-sufficiency but are above it. The Government are preparing for the time when the United Kingdom is essentially self-sufficient. Without action at this stage, there is a risk of over-supply. The work permit system will give us flexibility to control supply, while at the same time allowing health authorities, if there are difficulties or shortages, to apply for work permits for doctors in those areas.