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Anti-TNF Treatments
5. Mr. Mark Todd (South Derbyshire): What steps he is taking to secure availability of anti-TNF treatments in line with NICE recommendations. [59122]
The Minister of State, Department of Health (Mr. John Hutton): On 22 March, the National Institute for Clinical Excellence recommended the use of anti-TNF drugs for the treatment of juvenile idiopathic arthritis and rheumatoid arthritis. Primary care trusts have been directed to provide the appropriate funding for NICE-recommended treatments. However, supplies of one of those drugs, Etanercept, have been restricted worldwide since the beginning of 2001 due to high demand and limited production capacity. I am glad to say that those capacity restrictions are now being addressed by the manufacturer, and in the meantime rheumatologists in the NHS have established arrangements that aim to ensure equitable access to the treatment for as many new patients as possible.
Mr. Todd: I thank my right hon. Friend for that answer. I am sure that it is a relief to my constituents as well as those of many other hon. Members. May I question the process by which PCTs are having to deal with the consequences of NICE judgments? One difficulty is that they have to anticipate not only when the judgment will be made but guess what it will be, and it may not be clear what the outcome of a NICE investigation will be. They also have to take account of the implications of a judgment for the financial year for which they have budgeted, and dealing with those financial consequences leads to inequity and the slow delivery of some of those judgments to our constituents.
Mr. Hutton: I am grateful to my hon. Friend for those observations. He is right; we are undertaking a new process, and when NICE issues its recommendations and guidance for new treatments, it is important that the arrangements are in place to allow primary care trusts to respond reasonably to those judgments. That is why, under the directions, we have given PCTs three months to make the appropriate funding available. The key to making the policy work is to keep the investment flowing into the national health service. That provides the practical means whereby primary care trusts can respond to the recommendations of the national institute. The simple choice facing us in the House is to build up the NHS, as the Government want to do, or run it down, which Opposition Members want to do.
Medical Training
6. Mr. James Plaskitt (Warwick and Leamington): If he will make a statement on the number of training places established for students who wish to become doctors and surgeons. [59123]
The Secretary of State for Health (Mr. Alan Milburn): Between 1999 and 2001 almost 2,150 new medical school places were announced in England, an increase of 57 per cent. over 1997 medical school intakes. That is the largest increase in medical school places since the NHS was established, and includes, as my hon. Friend knows, four new medical schools—the first for many decades.
Mr. Plaskitt: Will my right hon. Friend join me in congratulating the Leicester Warwick medical school, which was founded in March 2000 and which next year will take in 400 students, playing its part in reversing the decline in available places under the previous Government? Does my right hon. Friend agree that it is vital that there should be close links between the universities and the new structures in the NHS?
Mr. Milburn: I very much welcome the establishment of the new Leicester Warwick medical school in my hon. Friend's area. It is one of a number of medical schools that have been established. Not only will it provide an expansion in the number of doctors in the future, but the new medical schools have been innovative in the way that they are recruiting their medical students. For example, they are trying to broaden the social base of the medical students whom they take in. That means that in future the NHS will have a broader range of doctors from a broader range of backgrounds. That is good news for the NHS, but most importantly, it is good news for NHS patients.
Dr. Evan Harris (Oxford, West and Abingdon): Does the Secretary of State accept that students need teachers, and that extra medical students need extra consultants to teach them? Can he explain why, in London medical schools, academic consultant posts and other training posts are being lost because of cuts? Can he also explain why he does not use the opportunity of the extra funding to expand the number of consultant posts available to teach, by allowing doctors currently languishing in staff grade and trust grade posts—mainly ethnic minority,
black and Asian doctors—at least to apply to re-enter training to become consultants and help to train the consultants of the future?
Mr. Milburn: As the hon. Gentleman knows, there are some problems in some medical schools in some parts of London, but not in all. That comes about because of the uneven distribution of a growing resource as a consequence of the research assessment exercise that now takes place in universities, so that we get the money into the universities capable of best using it.
When we agreed with the individual medical schools—for example, the one in the area of my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt)—that they would take on extra medical students, each and every one of those schools gave an assurance that it would be able to recruit the teaching staff necessary to train properly the doctors of the future. They have fulfilled that assurance. In each and every year since 1999, the number of medical students coming into the new medical schools has exceeded the plans for each of those medical schools. That is very good news indeed.
There are some issues to consider, as the hon. Gentleman is aware. My right hon. Friend the Minister of State will be meeting the Minister for Lifelong Learning in the Department for Education and Skills and representatives of the British Medical Association to discuss some of them. If there is more that we can do, we will do it. Again, we come back to the question of investment. We believe that we should put more investment into medical student training and medical schools, and we have committed the resources for it. The question for the Opposition is whether they are prepared to match that level of investment.
Hugh Bayley (City of York): May I congratulate my right hon. Friend on choosing York and Hull universities for one of the new medical schools? They have just published their first prospectus. The university of York has consistently come in the top 10 universities for the quality of research. It already has a world-class track record in research in health economics, epidemiology and social policy, which it will integrate with the clinical studies in the medical school. May I offer my right hon. Friend an open invitation to stop off in York some time when he is on the train from London to his Darlington constituency to meet the new dean of the medical school, Professor Gillespie, and see what York will be offering?
Mr. Milburn: After that fulsome tribute, I dare not say no, so I suppose that I had better take up the offer. The Hull York medical school has a very good reputation, as my hon. Friend rightly points out, and is one of the new wave of medical schools. It has been doing a very good job so far, and I am sure that it will continue to do so. As a consequence of the expansion in the number of medical school places, almost 1,700 extra medical students are being trained as future doctors for the national health service. That is an important break with the past, when adequate investment did not go into medical schools, causing the major shortages that we still experience today. We now have an opportunity to put that right.
Tim Loughton (East Worthing and Shoreham): How can the medical profession have any confidence in the Government's headline commitment to recruit 15,000 new
doctors by 2008, when the Council of Heads of Medical Schools reports that 80 per cent. of the medical schools that it has surveyed are having to freeze the academic staff recruitment needed to train those doctors, and when the BMA has reported that there are already vacancies for 79 professors and more than 320 lecturers in those medical schools? We now hear that the Secretary of State wants a new medical educational standards board that is answerable directly to him and not to Parliament. The document containing the proposal is described by the president of the Royal College of Surgeons as
- "potentially the most sinister document to emerge from this government."
Mr. Milburn: It is true what they say: empty vessels make the most noise. This is an Opposition who have precisely nothing to say, no policy to talk about and no resources to commit. Indeed, the one policy that they have is the one that they do not want to talk about: charging patients for their care. Forget all this talk about caring, compassionate conservatism—
Mr. Speaker: Order. I want to hear about the Minister's policies.
Mr. Peter Pike (Burnley): I welcome the figures that my right hon. Friend announced a moment ago. Does he recognise that in some parts of the country, because of the failure to train enough doctors a few years ago, prior to the change of Government in 1997, we will have serious shortages of doctors until the new ones who are now training are fully qualified and take their place in the national health service? Are the Government prepared to take action, especially in areas where there are shortages, to ensure that the short-term gap is filled until the new doctors to whom he referred are on line?
Mr. Milburn: My hon. Friend is absolutely right. Figures that were, I think, published under the previous Government show that in the four or five years up to 1996–97, the number of doctors in training for family practice and to become GPs fell by about 44 per cent. That number fell for five consecutive years. Since Labour came to office, the number has grown in every single year and by 20 per cent. This is a long-term business, and as my hon. Friend rightly says, that means that there is a need in the short term. When we can get suitably qualified applicants to come to this country from abroad, that is what we should do.
I can report to the House that in respect of the effort that is being led by Sir Magdi Yacoub—there could be no better ambassador for the national health service—although we expected about 50 international fellows from Europe, America and Australia to come in the first wave and work in the national health service, 400 have applied. I think that 200 have now been through the medical royal college standard assessment process and a number of them are now being appointed to posts throughout the country. That is very good news for hospitals, but most importantly of all, it means that we can get more treatments more quickly to more NHS patients.
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