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Mr. Maginnis : The 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. Needham : I 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
Column 373not 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. Needham : I 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 Smyth : The 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. Needham : Of 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.
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