§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Allen.]
10.15 pm§ Ms Joan Walley (Stoke-on-Trent, North)I am most grateful for this opportunity to make the case in the House for an undergraduate medical school at Keele university, which will be for the benefit of people in north Staffordshire and further afield. The proposal is supported by many hon. Members, some of whom are here this evening.
We want Keele university to be able to offer places to 50 undergraduate medical students by 2000. Those places will be based in north Staffordshire, and placements will be provided in areas as far afield as Shropshire, the rest of Staffordshire, Burton and Crewe. It is essential to this bid that there is a joint proposal, involving the universities of Keele and of Manchester. This is a collaborative venture.
During Prime Minister's questions today, we heard a lot about doctors' hours and the working time directive. However, the bottom line for us is that we do not have enough doctors, because the previous Government did not give them to us. Therefore, we recognise that we must recruit and train more medical staff in north Staffordshire, where the shortage is already apparent. It is worth noting that the health needs of our area are widely acknowledged to be more pressing than those of the rest of the west midlands and, indeed, of the country as a whole.
I pay tribute to the vision of my right hon. Friend the Secretary of State for Health, who has put forward proposals in response to the medical work force standing advisory committee, which has stated that an extra 1,000 medical students should be recruited every year by the year 2005. I am happy to say that my right hon. Friend will visit north Staffordshire next week, so there will be an opportunity to discuss our proposals with him at first hand. However, his vision has been equalled by that of my right hon. Friend the Chancellor of the Exchequer who, through the comprehensive spending review, has provided the additional money for the extra recruitment.
§ Mrs. Llin Golding (Newcastle-under-Lyme)Does my hon. Friend agree that one of the strengths of the Keele bid for the additional places is that work on it has been going on for many years? There has been striking co-operation with the health authorities in Manchester and Shropshire over a long period. Everything is now in place to make it possible to expand the number of available places beyond 50. Is not that one of the main reasons behind the strength of this proposal?
§ Ms WalleyI am very happy to agree with my hon. Friend, who has campaigned longer than most for this medical school. In a moment, I shall explain how we have been trying to establish a medical school at Keele university since 1965.
The vision that we share is not only for undergraduate places that at present do not exist in north Staffordshire. Our vision is for the expansion of facilities dedicated to medical education. For the first time since 1965, as a result of the comprehensive spending review, we have a real opportunity to establish a medical school in the area.
1062 That has been the dream of many people—including the medical director at the North Staffordshire hospital trust, Keith Prowse—since the 1960s.
If we look out from Westminster across the river, we can see Guys and St. Thomas's medical school. We want exactly the same facility for Shropshire, Staffordshire and Cheshire. We want a postgraduate school. As my hon. Friend the Member for Newcastle-under-Lyme (Mrs. Golding) said, the bid is led by Keele university, and it has widespread support, not least from the North Staffordshire hospital NHS trust and other trusts in the area. It is supported by local Members of Parliament. There is also support, and proven expertise, from Manchester and Liverpool universities.
The bid also has the support of chief executives from Burton hospitals NHS trust, East Cheshire NHS trust, Mid Cheshire hospitals NHS trust, Mid Staffordshire general hospitals NHS trust, the Princess Royal hospital NHS trust, the Robert Jones and Agnes Hunt orthopaedic and district hospital NHS trust, the Royal Shrewsbury hospitals NHS trust, and a range of local medical committees and primary care groups.
That wide geographical support is backed by a new spirit of partnership that is growing as a result of the area's recently created and innovative health action zone. Excellent working partnerships across the area involve schools and health partnerships. We want to build on all that. Although we are in the west midlands region, the teaching hospital for which we are bidding would look towards Manchester. We have discussed that point with colleagues in the region and see no problem arising.
No one disputes the difficulties of local recruitment of medical staff. We want to create an opportunity out of the shortage. We want permanent training places. We want 50 in the first instance, and we want to build on that figure. We want local youngsters to aim high and to take up a medical career. We also want to build a local centre of excellence to which students may come from elsewhere. They will come from outside the area to train with us and, having trained, they will stay on to practise in areas that are experiencing some of the greatest difficulties in recruiting medical staff—doctors, consultants and others.
There is a culture of learning in our area. Earlier today, my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) and I attended a presentation of the beacon awards at which Stoke-on-Trent college was presented with a certificate of excellence. There is a culture of aiming high so that we may address the traditional imbalance of underachievement.
The spin-offs of a graduate medical centre would be enormous. There would be extra research money and benefits to patients—our constituents. It would almost certainly bring extra employment over a wide area, and it would bring extra ancillary staff. It would give us an opportunity to build a centre of excellence to deal with the particular medical problems that we face. I hope that I have argued convincingly for the excellence of the bid, which will shortly be considered by my hon. Friend the Minister of State, Department of Health.
Let me turn now to the extent of ill health in the area. On key indicators, north Staffordshire performs consistently worse than the west midlands region and the United Kingdom as a whole. This is the right time to redress the imbalance, and to train and recruit personnel in an area in which they are badly needed. 1063 The figures speak for themselves. Keith Prowse, the medical director of North Staffordshire hospital NHS trust, has highlighted the seriousness of our recruitment problem. In north Staffordshire alone, there are 10 full-time general practitioner vacancies. Four further practices have hard-to-fill vacancies that have not even been advertised. Local GP training schemes have had five more vacant slots in 10 practices since last August. On behalf of all my hon. Friends present in the Chamber tonight, I ask the Minister to look favourably on our proposal for a world-class teaching hospital, based at Keele university and serving the wider region that we represent.
§ Charlotte Atkins (Staffordshire, Moorlands)I am grateful to my hon. Friend the Member for Stoke-on-Trent, North (Ms Walley) for allowing me to participate in this important debate.
Among the Government's top priorities are improving health outcomes and addressing health inequalities. The Labour Government were the first to appoint a Minister for Public Health to set out proposals to improve the health of the population as a whole, especially the worse-off. North Staffordshire wants to follow that example. As my hon. Friend says, we have significantly worse health outcomes than either the west midlands or the whole of England and Wales. On the positive side, that means that we can achieve far greater health improvements than other parts of the country, so we are faced not only with a tremendous opportunity, but with a tremendous challenge.
It is in part owing to my hon. Friend's persistence that we have achieved a health action zone, which affords us exciting opportunities. It will help to break down the cycle of unhealthy life styles, poor health outcomes and low health aspirations that has bedevilled north Staffordshire for too long. It creates exciting possibilities: healthy living centres, schemes to promote community safety and tackle teenage pregnancy and drug abuse, and opportunities to create partnerships across education, the voluntary sector, the business community, social services and local people. However, we in north Staffordshire lack the inspiration, the learning culture and the modern expertise that comes from having a local medical school.
Located between Birmingham and Manchester, north Staffordshire fails to attract and retain the high-quality health care professionals we need. It is a well-established fact that the majority of medical students will ultimately practise in the locality in which they have trained; therefore, despite the delights of the Staffordshire peak district, our area has become denuded of local GPs and hospital doctors. Today, I spoke to a local GP in Leek, Dr. Shiers, who told me of the vulnerability of market towns such as Leek. Four to five years ago, when general practice was not a popular option for newly qualified doctors, there were only two or three applicants for local vacant posts.
That does nothing to raise standards of primary health care or to encourage greater collaboration between primary and secondary care. A university medical school at Keele would create positive ripples throughout the whole service, not only in hospitals. Medical students 1064 need to experience general practice early in their training if we are to create the proper balance between primary and secondary care—an objective to which I know the Government are committed. The influx of students would have a positive impact on general practice by stimulating new ideas, boosting in-service training and encouraging better communication between local doctors.
What I find especially attractive about the Keele proposal is that it is based on partnership—building on the expertise of Manchester university while exploiting the underuse by students of north Staffordshire hospitals and community placements. It would benefit from the assured quality of the established and well-tested Manchester curriculum, and make better and more rational use of national health service training facilities. The proposal offers a cost-effective way of training more doctors and meeting the needs of an area that is crying out for greater investment in improving health care.
§ Mr. Deputy Speaker (Mr. Michael Lord)Does the hon. Lady have the permission of the hon. Member for Stoke-on-Trent, North (Ms Walley) and that of the Minister? I see that she does.
§ Mrs. GoldingI wish briefly to sum up, Mr. Deputy Speaker. Essentially, the case for a new medical school at Keele rests on the following factors: the existence of a substantial natural catchment population for major trauma, tertiary and specialist services of about 1.7 million people; the presence of well-developed primary and community services; the substantial range of health and health-related teaching and research activity already existing within the area; the commitment and support of the relevant health authorities and trusts; links with other medical schools, which are extremely strong; and Keele's traditions and strengths, which make it a particularly suitable home for a 21st century medical school.
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate my hon. Friend the Member for Stoke-on-Trent, North (Ms Walley) on obtaining the debate and on providing the opportunity to discuss the provision of additional medical student places in the United Kingdom. I acknowledge the interest of my hon. Friends the Members for Staffordshire, Moorlands (Charlotte Atkins) and for Newcastle-under-Lyme (Mrs. Golding) and thank them for their contributions to the debate. Other hon. Members have been in their places this evening to show, I am sure, support for the bid that has been made by my hon. Friend the Member for Stoke-on-Trent, North.
I hope that my hon. Friends will understand that, at this stage in the bidding process, I cannot debate the merits of any individual sites for the expansion of medical education. I know that my right hon. Friend the Secretary of State for Health is looking forward to his visit to the area concerned.
It might be helpful if I set out the background to the plan to increase medical school intake. As my hon. Friend the Member for Stoke-on-Trent, North said, the planned 1065 increase was originally a recommendation in the third report of the Medical Workforce Standing Advisory Committee. It reflected its detailed consideration of the overall long-term need for doctors in this country, taking into account the projected demand for health services, the projected numerical losses from the profession as a result of retirement and other factors. The House will note that the committee's remit was with the overall numbers of doctors needed. It was not concerned with the specialties that the new doctors might join after completing their undergraduate training.
The Government are proud that, following the comprehensive spending review, my right hon. Friend the Secretary of State for Health was, last July, able to tell the House that the intake of students to medical schools in the United Kingdom will increase by about 1,000 places per annum—by 20 per cent.—to about 6,000. This will be the biggest increase in medical education in this country in a generation. Our intention is to ensure that the national health service will have the doctors that it needs in the first part of the new century.
Statutory responsibility for the allocation of the additional student places to individual universities rests with the appropriate funding council. In England, a joint implementation group, led by the chief executive of the Higher Education Funding Council for England and the permanent secretary of my Department, is working together to allocate places and to make recommendations to the HEFCE.
Some 158 extra places have already been allocated to existing medical schools in England for the autumn 1999 intake, and work is now well advanced to allocate more than 800 further places to English universities.
We should be clear why the issue of medical education is so very important. The White Paper "The new NHS" introduced a new concept of clinical governance, which embraces a range of quality assurance processes, such as clinical audit, and acknowledges the importance of continuing professional development and lifelong learning to the delivery of quality patient care in the NHS. The expectations placed upon tomorrow's doctors will be demanding, and their preparation to meet them will begin as soon as they enter medical school.
In increasing medical student places, we want to set an agenda to drive up the standards of medical education as a whole so as to deliver real long-term benefits to the NHS, following curriculums consistent with the General Medical Council's report entitled "Tomorrow's Doctors", and working towards the principles set out in "The new NHS". That is why we have asked the joint implementation group to observe specific objectives in judging proposals from universities for the allocation of the further places in England. Those objectives reflect the Government's agenda both for the NHS and for a healthier nation.
The joint implementation group's objectives are, first, to develop new doctors who are equipped to meet the challenge of the changing health and health care needs of patients and populations into the first half of the 21st century. In short, the new doctors must have the right medical and technological skills, and must be adept at dealing with the changing health needs of a new century.
The second objective is to develop new doctors who are able to practise to a very high standard, through being able to appraise and use evidence, to become lifelong 1066 learners, to maintain professional standards and be effective team members and leaders. In the new century, as now, the public will want to know that the doctors whom they consult will be of the best, and that the service that they deliver will be characterised by excellence.
The pace at which new treatments and clinical techniques are developed means that a doctor's education and professional development cannot end with the completion of specialist or vocational training. This pace of change can only accelerate in the decades ahead. Whatever specialty doctors follow in their careers, they have a duty to maintain and continue to develop their clinical practice throughout their careers. They will continue to learn, so that they remain skilled in, and will apply, the latest knowledge in their work. The country will also rightly expect them to work to the highest professional standards, and to work together within the profession and across professional boundaries.
The third objective of the joint implementation group is to develop new doctors who are committed to, and skilled in, promoting health, preventing ill health, diagnosing and treating injury and disease, and caring for people with long-term illness and disability. More than ever before, the practice of medicine is about the promotion of health and the prevention of illness and injury, as well as the treatment of injury and disease, and long-term care. That is essential to our strategy for a healthier nation.
The fourth objective is to develop new doctors who understand the value of partnership and communication with their patients, their colleagues, and members of other professional groups. The best doctors have always worked with their patients and colleagues to ensure the very best outcomes for patients, but the skills to work together in partnership with patients and their families must be a part of the medical curriculum from the beginning.
The group's fifth objective is to provide a high-quality educational environment in which evaluation and research are fostered and which gives value for money. Medicine is not taught by rote. A high-quality research environment in a university is a major driver to the development of inquiring and innovative doctors who will learn by approaching medical problems.
The national need for trained doctors who are able to apply rapidly expanding knowledge in the biological and social sciences will remain paramount. To give just one key example, advances in human genetics will bring a revolution to health care in the next century, and the Government recognise the need to strengthen medical education in genetics at all stages of the continuum of training to ensure that tests are used and interpreted appropriately and efficiently. In so rapidly changing a field, a strong research base will be needed to underpin the development of students and their teachers alike.
As the group considers bids, it seeks to demonstrate an active commitment to the admission of students from a broad range of social and ethnic backgrounds, to reflect the patterns of populations served by the NHS. In increasing the supply of doctors, the joint implementation group wants to ensure that unnecessary and often hidden barriers to a broader mix of gifted medical students are avoided.
There are already examples of outreach, where universities and others have worked with local schools, often in areas where there has been little tradition of 1067 higher education. They have encouraged young people who might never have considered a medical career to work from an early stage of their secondary school careers towards entry to medical school. Such approaches are not simply a matter of promoting equal opportunities, critical though that is. They also help to ensure that new doctors understand, and can best work with, the communities that they serve.
Finally, the group will ensure that the distribution and patterns of training of students effectively increase the home supply of doctors, and meet the needs of the populations served by the NHS, wherever the doctors may be trained and work. It will seek to enhance quality and value for money through collaboration between universities and partnership with the NHS, consistent with the principle of different groups working together.
Using those objectives as a benchmark, the joint implementation group will be well placed to judge which universities can best and most cost effectively deliver to this agenda.
All universities were invited in the new year to submit proposals for the allocation of places. I am delighted that about 20 proposals were submitted to the joint implementation group. These include a number of proposals for collaborations between new and existing medical schools, such as the planned co-operation between the university of Manchester and the university of Keele, to set up medical education facilities on new sites drawing on the curriculums, resources and expertise of the established medical schools. The joint implementation group is now considering all the proposals, and an announcement can be expected reasonably soon.
1068 It would be quite wrong for me to debate the merits of any of the proposals in this place when they are still being considered. It is clear that the different proposals will be judged on their different qualities. Not least among those will be the likely impact on local health services of establishing new sites for medical education or of increasing the size of existing sites.
Equally, the joint implementation group will consider the quality of the medical education on offer, and that will include the capacity of the local health services to provide a broad range of suitable clinical placements in primary and secondary care settings which are easily accessible from the university. Also, and fundamentally, the group must judge how the allocation of medical school places will affect the overriding reason for the increase—the development of the right number of appropriately skilled doctors to deliver medical care in the first part of the new century, in the most cost-effective way, for the country as a whole.
My hon. Friends may be assured that Keele university's proposal to set up a joint medical school with Manchester university, which I understand that they see as a possible first step towards the establishment of a free-standing medical school, will be considered in detail alongside those of other universities and in accordance with the objectives that I have described.
Hon. Members may be assured of the Government's wish to ensure that the long-term supply of doctors best meets the needs of the country as a whole, wherever the places are situated, and that the underlying principles followed will ensure a quality, cost-effective education—not only for the students filling the additional places now being created, but for all medical students at all universities, consistent with the curricular requirements of "Tomorrow's Doctors" and the broader vision set out in the White Paper "The new NHS".
§ Question put and agreed to.
§ Adjourned accordingly at eighteen minutes to Eleven o'clock.