§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Greg Knight.]
10.26 pm§ Mr. Ken Maginnis (Fermanagh and South Tyrone)On a point of order, Mr. Speaker. As a member of the fourth largest party in the House, a party which is constantly being asked to participate in the business of the House, especially United Kingdom business, I draw your attention to the fact that during the defence debate 20 Conservative Members were permitted to speak for an average of 16 minutes each, and 16 contributors from the official Opposition were able to speak for an average of 18 minutes each. As a member of the fourth largest party, I wished to make a meaningful contribution to the debate, but I was cut off in mid-sentence after 10 minutes, having sat in the House for almost six hours of the debate. I find it exceedingly frustrating that the fourth largest party should be confined to one 10-minute contribution.
§ Mr. SpeakerI think that I can help the hon. Member. This has been a two-day debate. It was my understanding that the hon. Member wished to participate yesterday, when he would not have been involved in a 10-minute limit on speeches. He well knows that today, as a result of an important statement and members of his party being called to speak, we had a rather late start. With the best will in the world, I cannot change the rules to accommodate him as a member of the fourth largest party.
§ Mr. MaginnisFurther to that point of order, Mr. Speaker. If I had been aware of that, I would have been willing to speak yesterday evening. I was here to speak yesterday evening, but other hon. Members wished to speak. I was prepared to wait for the second day of the debate. It was not peculiar to that debate that the Ulster Unionist party found itself with the opportunity to make but a mere 10-minute contribution. I ask that you, Mr. Speaker, give consideration —
§ Mr. SpeakerOrder. The hon. Member should come and see me about this matter. His point of order is taking time out of the Adjournment debate led by his hon. Friend the Member for Belfast, South (Rev. Martin Smyth). The Adjournment has already been moved.
§ Mr. MaginnisThank you, Mr. Speaker.
§ Rev. Martin SmythIn the previous Adjournment debate in which I participated, the Minister promised to act speedily in the settlement of claims arising out of bomb damage at the Lisburn Road Royal Ulster Constabulary station. Three years later, some constituents are still seeking just settlement. I am therefore not unduly sanguine about the response to my raising the issue of parity of treatment for general practice trainers and trainees in Northern Ireland.
The issue affects the whole Province, not just my constituency, and the medical profession. I am not sanguine about the prospect of what I believe to be an injustice to would-be general practitioners and their trainers in Northern Ireland being settled any more quickly than was the cause of my earlier escapade into an Adjournment debate.
370 The subject has involved me for some time with the Department of Health in Northern Ireland. Lest someone suggest that I have an interest, I should declare that I am the party spokesperson on the subject and the father of a medical person. I may therefore be accused of having an interest. I declare that interest so that there can be no sniping. The issue is serious and affects different groups of people.
In my dealings with the Department of Health, as with others, I have encountered the phenomenon of moving goalposts. When we try to maintain our good education system, which is based largely on the Scottish tradition, we are told that the pattern of England and Wales is to be followed. When we try to model our general practice provision on what happens in England and Wales, Scotland is provided as our pattern. It seems that whatever pattern reduces public expenditure is chosen as the guideline in Northern Ireland.
We are lectured that, if we work together, we will be heeded. The medical profession covers all strands of religious and political opinion. The record shows that the hon. Member for Foyle (Mr. Hume) has also probed this problem. He was informed factually earlier this year that
trainers' remuneration and general practitioner trainees' allowance is made under the family practitioner services section of the Department's Health and Personal Social Services vote 1.He also tried to discoverwhat would be the revenue and manpower consequencesof allowing the Great Britain pattern to be followed in Northern Ireland. It is significant that that question was not answered.The Minister's reply confirmed that there is no parity of treatment, and that it is not proposed to introduce arrangements to allow approved trainers to act on the same basis as they do in Great Britain. The Department was prepared to follow the Fair Employment (Northern Ireland) Act 1976 and yet blatantly discriminate against Northern Ireland in regard to training would-be general practitioners. He said:
The present arrangements are designed to limit the annual number of trainees to our manpower requirements".I appreciate the fact that the same Minister is to respond to this debate. At that time, he said that a working party had been set upto review the arrangements for vocational training for general practice in Northern Ireland."—[Official Report, 11 May 1989; Vol. 152, c. 508–9.]Can the Minister give us any guidance about how far the working party has progressed?This is an important subject. I believe that we should train and equip our young people to the highest level that they can reach. They are our raw material. Young people in Northern Ireland are due that provision. If they are qualified and able to take the education or training, they should be equipped with it. We should not, and cannot, limit them according to the number of general practitioners we can employ in Northern Ireland.
Certainly in my opinion, and that of many others, article 44 of the 1972 order which makes provision for the training of persons in or for employment in the Health Service is permissive and not mandatory. However, it does not require them not to train people for work in or for the Health Service. Historically, such training was applied to those intending to work in Northern Ireland and to those who would work in Great Britain. It could certainly—especially in the light of compulsory EEC requirements 371 after 1992—apply to others. I am aware that historically it has applied to others because young people from Northern Ireland have gone into medical practice to the furthest corners of the earth and have made a tremendous contribution in Third-world countries.
It is therefore wrong to conclude that there is any legal or moral restriction to train for anticipated Northern Ireland needs only. Therefore, the only reason that exists is financial. Such financial restraints should be borne by the nation rather than by one small part of it.
This problem has many facets. Not only did Parliament not provide such a financial restraint, but this practice disadvantages Northern Ireland citizens who, as trainees, could travel to Great Britain for training and deprive their own trainers of such work. With no similar restrictions on those trained in the Republic of Ireland, it also closes openings for Northern Ireland junior doctors. Therefore, some of those young people have genuine grounds for complaint.
The Minister is aware that trainers in Northern Ireland are not fully utilised. If they were limited on the Scottish model, there would be 90 of them—in other words, the Scottish model of restraint is 10 per cent. of trainers from the number of registered general practitioners. In Northern Ireland, instead of 90, which would be 10 per cent., there are only 70, of whom 50 are being used this year. In England and Wales, the number of trainers increased from 2,704 in 1985 to 2,792 in 1987 and the corresponding number of trainees decreased in that period from 1,924 to 1,876—with a steady increase in expenditure for both. That point is important when we are told that the reduction in and restraint in Northern Ireland is to limit financial expenditure. In Northern Ireland, reduction has been the policy.
Bearing in mind that the overall provision of trainers is met by contributions from the average pay of general practitioners, is that not further discrimination? Does the Minister accept that point? If so, since general practitioners in Northern Ireland are paid only the same rate of fees, is this fair? If they are paid fees that are similar to those that pertain in Great Britain, is it fair that they should be denied the same opportunity of achieving those fees?
I ask four specific questions. First, why is funding for general practitioner training in Northern Ireland in competition with all other Health Service funding when on the mainland there appears to be specific funding for GP training independent of other Health Service funding? I have been informed by the General Medical Services Committee that that is the Department's view.
Secondly, is there, and if there is, why should there be, a manpower consideration for Northern Ireland as distinct from the United Kingdom?
Thirdly, why has the Department introduced a selection process which is number-limited and not based on those competent to be trained? They can go to England, Scotland and Wales and even, interestingly, vice versa. It is difficult for the Department in Northern Ireland to stop people coming in to be trained in Northern Ireland, although they can refuse funding for training in Northern Ireland to trainees who are graduates of Queen's university, but not limit others. Surely that drives a horse and cart through such a scheme.
Fourthly, is money allocated to trainees in competition with other Health Service funding or from other training funding. If that is so in Northern Ireland why is it not the 372 same in the rest of Great Britain? Dr. Wilson of the British Medical Association has confirmed that, since 1983, there has been
no fixed fund of money under the Vocational Training Scheme.The money in the family practitioner budget is used as needed.I believe that there is a patent case of discrimination which makes the practice in Northern Ireland different from that in the rest of the United Kingdom. It is a national Health Service. The doctors qualify under the same pattern and should be treated accordingly.
§ The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Richard Needham)The hon. Member for Belfast, South (Rev. Martin Smyth) makes a perfectly pertinent point when he says that the position in Northern Ireland is different from the rest of the United Kingdom. That is absolutely right and it is different in respects other than those he mentioned. We spend 25 per cent. more on the Health Service in Northern Ireland than we do on the NHS in the rest of the United Kingdom. I suspect that if the hon. Gentleman was making an argument for parity in spending it would be slightly different from the one that he has advanced tonight.
The limitation of access to GP vocational training in Northern Ireland has existed for many years and it is only recently that it has come under question.
§ Mr. MaginnisThe Minister has said that 25 per cent. more is spent on the NHS in Northern Ireland than in the rest of the United Kingdom. Surely that is reflected in the Health Service of Northern Ireland which is traditionally better and more efficient than elsewhere. Is the logical consequence of the Minister's argument that he would like the Health Service of Northern Ireland to regress to the state of the Health Service in Great Britain? Does he believe that it might be better if the NHS in Great Britain sought to achieve the standards of Northern Ireland?
§ Mr. NeedhamI agree entirely. We have an excellent Health Service in Northern Ireland, and one reason for that is our sensible manpower planning policy. One of the effects of that is that we are sensible and realistic about the way in which we train the number of GPs for the available posts.
For a long time it was accepted that the number of GPs trained should be limited—argument about that has developed only recently. If we were to train the number of GPs required in Northern Ireland, it would be substantially less than the 50 now trained. The number of GPs required in Northern Ireland year in, year out is certainly not 50.
The hon. Member for Belfast, South made a comparison with Scotland where a 10 per cent. limitation operates. What is the point of us training a larger additional quantity of GPs than that which we can realistically use in Northern Ireland? We do it already. Should we do it to an even greater extent?
The hon. Member for Belfast, South asked the fair question, where does the money come from? If there was a pot of money which allowed us to train more general practitioners than we require with no effect on the Northern Ireland health budget, which is rightly, as the hon. Gentleman says, in excess of that for the rest of the United Kingdom, I would accept that. However, that is 373 not so. We have to train our future general practitioners out of the Northern Ireland block, and the funding which is made available to the Health Service. If we were to train more, less money could be used elsewhere in the Health Service. That is, and always has been, the reality.
I realise that that is an argument between the General Medical Services Committee, the BMA and the Department. The hon. Member for Belfast, South and I have been involved in this discussion for much of the past two or three years. I appreciate that the other parties in the discussions do not accept that to be so, but it is so. The hon. Gentleman rightly says that there are 70 vocational trainers of whom we use only 50. If we were to do as the hon. Gentleman says, took on more trainees, used the 70 trainers and paid more to the GPs who took on the trainees—who would work as supernumeraries in the system—there would be less money for other purposes.
The hon. Member for Fermanagh and South Tyrone (Mr. Maginnis) has recently joined a health board and I am sure will be a great success in that job. He knows clearly the pressures and problems of the Health Service in his area, and the pressures on his budget. I suspect that, even though we are spending considerably more than the rest of the kingdom, the hon. Gentleman would be the first to say that if money was to be taken away to train even more general practitioners than we require, those trainees should go elsewhere. In a perfect world I would be only too keen to find additional money for training GPs. However, we do not have that money and we must be careful and sensible, although we do what we can by training more than we need.
As for the group that is being set up to discuss the way forward, I hope that the Department and the GMSC can find a way to resolve the problem by the end of the year. I realise that the GMSC feels strongly about it and that it argues that we are out of kilter with the rest of the country. The rest of the country—whether it be England or Scotland—is wrong to continue to train large numbers of young men for whom there is no immediate or obvious practice.
The vocational training of those in the Republic of Ireland and outside Northern Ireland is a matter which will be addressed in 1992 when, I understand, vocational training for all those going into general practice will become mandatory. As in so many aspects of the Northern Ireland Health Service, we have a sensible, proper and rational way forward. We are spending as much as we reasonably can and are training not only for our own needs but for outside needs. We are using the money in the Northern Ireland Health Service as sensibly as we should.
I have listened carefully to what the hon. Member for Belfast, South has said, but it would not be possible or right for us to expand the numbers which we have beyond those required without putting an unwarranted strain on the health budget in Northern Ireland. We do an excellent job which, rightly, we do differently from the rest of the country and the rest of Europe. I suggest that we continue to do that, and if the rest of the country and Europe are sensible they will follow us—
§ Mr. Dennis Canavan (Falkirk, West)How much military expenditure is going to Northern Ireland?
§ Mr. NeedhamI am talking about GPs' remuneration, and I cannot for the life of me understand what the hon. Gentleman's point has to do with the Health Service. Whatever is spent on law and order in Northern Ireland is the amount that the Government and those in Northern Ireland believe to be needed to maintain an adequate security policy.
Because of the needs of Northern Ireland, we spend considerably more than other parts of the kingdom on health care, and I hope that we shall continue to do so for as long as that need persists.
§ Rev. Martin SmythThe heart of the argument concerns whether GPs' salaries throughout the kingdom are set in the same way and whether deductions are made from them to pay for trainees' salaries. I would be the last to support waste in Northern Ireland—I want accountability—but talk of 25 per cent. more does not take into account rural problems and the remoteness of some of the work.
May there not be an addition to the health care budget in the hospital sector and the GP sector because of terrorist activity? If a GP in Northern Ireland is treated like his colleagues in England, Scotland and Wales, bearing part of the burden by deductions from his salary for trainees, should not he be entitled to earn something in return?
§ Mr. NeedhamOf course he should be entitled to earn something in relation. We are training 50 trainees whom we do not require. There is an advantage to a GP from having a trainee; he is paid a fee for having one, and he receives the trainee's assistance. I cannot tell the hon. Gentleman how the matter is evened out throughout the United Kingdom. There are anomalies in any national system of remuneration. If, as the hon. Gentleman tells me, there are 70 trainers and only 50 trainees and we should reduce the number of trainers in line with the number of trainees, the Department and the Government would be prepared to consider that.
By and large, it is right to spend the amount that we do on the Health Service in Northern Ireland. It is right to use the money that we have as effectively as we conceivably can in the interests of the Health Service.
I am not especially worried about whether we enjoy exact equality with the rest of the United Kingdom for the simple reason that we shall do what we believe to be right for the Health Service of Northern Ireland. The hon. Gentleman, the Department and the Government need to discuss how the money should be spent, and what the priorities for its use should be. The hon. Gentleman rightly pointed out that we should not waste money on training unnecessarily beyond what we can afford—that must be the criterion. That means spending the money sensibly; as a result, we can target the funds that we have directly on the needs of the patients, in acute medicine and in general practice. We need to be able to show the people of Northern Ireland that we do that regardless of the pressure that we are put under by any professional group.
§ Question put and agreed to.
§ Adjourned accordingly at six minutes to Eleven o'clock.