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Column 368

Vaughan, Sir Gerard

Viggers, Peter

Waddington, Rt Hon David

Waldegrave, Hon William

Walden, George

Walker, A. Cecil (Belfast N)

Walker, Rt Hon P. (W'cester)

Wallace, James

Waller, Gary

Ward, John

Wardle, Charles (Bexhill)

Warren, Kenneth

Wells, Bowen

Wheeler, John

Widdecombe, Ann

Wilkinson, John

Wilshire, David

Winterton, Mrs Ann

Winterton, Nicholas

Wolfson, Mark

Wood, Timothy

Woodcock, Dr. Mike

Yeo, Tim

Young, Sir George (Acton)

Tellers for the Ayes :

Mr. Alastair Goodlad and

Mr. Tony Durant.


Barnes, Harry (Derbyshire NE)

Benn, Rt Hon Tony

Bennett, A. F. (D'nt'n & R'dish)

Brown, Ron (Edinburgh Leith)

Canavan, Dennis

Clay, Bob

Clwyd, Mrs Ann

Cohen, Harry

Cryer, Bob

Ewing, Mrs Margaret (Moray)

Fields, Terry (L'pool B G'n)

Flannery, Martin

Gordon, Mildred

Grant, Bernie (Tottenham)

Heffer, Eric S.

Hinchliffe, David

Hughes, John (Coventry NE)

Jones, Ieuan (Ynys Mo n)

Lambie, David

Lamond, James

Loyden, Eddie

Madden, Max

Mahon, Mrs Alice

Michie, Bill (Sheffield Heeley)

Mullin, Chris

Nellist, Dave

Parry, Robert

Primarolo, Dawn

Salmond, Alex

Sillars, Jim

Skinner, Dennis

Thomas, Dr Dafydd Elis

Wall, Pat

Wise, Mrs Audrey

Tellers for the Noes :

Mr. Ken Livingstone and

Mr. Jeremy Corbyn.

Question accordingly agreed to .

Resolved ,

That this House approves the Statement on the Defence Estimates 1989 contained in Cm. 675.


Ordered ,

That, during the proceedings on the matter of the National Health Service in Wales, the Welsh Grand Committee have leave to sit twice on the first day on which it shall meet, and that, notwithstanding the provisions of Standing Order No. 88 (Meetings of standing committees), the second such sitting shall not commence before 4.00 p.m. nor continue after the Committee have considered the matter for two hours at the sitting.-- [Mr. Greg Knight.]

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General Practitioners (Training)

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Greg Knight.]

10.26 pm

Rev. Martin Smyth (Belfast, South) rose --

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. Speaker : I 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. Maginnis : Further 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. Speaker : Order. 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. Maginnis : Thank you, Mr. Speaker.

Rev. Martin Smyth : In 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.

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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 discover

"what would be the revenue and manpower consequences"

of 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 up "to 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

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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

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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. 10.40 pm

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.

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