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House of Commons

Tuesday 13 November 2007

The House met at half-past Two o’clock

Prayers

[Mr. Speaker in the Chair]

WAYS AND MEANS


Sessional Returns

Ordered,

Oral Answers to Questions

Health

The Secretary of State was asked—

Doctors

1. Mr. David Heathcoat-Amory (Wells) (Con): What estimate he has made of the number of British-trained doctors looking for permanent placements; and if he will make a statement. [162930]

The Secretary of State for Health (Alan Johnson): The estimated number of junior doctors who will complete their specialist training in England in 2007, and who are therefore likely to be looking for permanent posts, is 5,400. That number also includes those doctors who may choose to take a voluntary break before applying for posts.

Mr. Heathcoat-Amory: The Department of Health made a complete hash of negotiating the GP contract, giving doctors a great deal of extra money for doing what they were in many cases doing already. Does the Secretary of State agree that the contract has now attracted a great many doctors from overseas with the result that home-trained doctors are now unemployed in their thousands? When is the Department going
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to acquire some commercial sense and look after taxpayers’ money properly and have better regard for doctors trained at taxpayers’ expense who now have no prospect of a permanent placement?

Alan Johnson: The right hon. Gentleman is confusing several different issues.

On the GP contract, I do not accept that it was a bad deal. The contract reversed the trend whereby we were losing GPs because, by and large, medical graduates did not want to be GPs. The latest statistics show that 100 per cent. of GP training posts have been filled. The contract also incentivised GPs to look at preventive health issues for the first time—taking patients’ blood pressure, for example—so prevention as well as cure is now their concern.

That contract has in no way led to the situation that I think that the right hon. Gentleman is getting it confused with. I accept that there is an issue about the fact that there are 10,000 international medical graduates trained as undergraduates abroad who are seeking positions in postgraduate training in this country, but we are seeking to resolve it.

David Taylor (North-West Leicestershire) (Lab/Co-op): We are in the position of having several thousand UK graduates who after seven years of training—and, in many cases, with substantial debts—are without work. They now face all the associated costs—both economic and human—that go with it. One of the worst indictments in the MTAS report related to the lack of centralised work force planning. Will the Secretary of State therefore reassure the House that he will ensure that such planning is introduced so that we never again face the scale of loss and injustice that we have seen in recent months?

Alan Johnson: Also apropos the previous question, no one will be unemployed when our employment guarantee ends on 31 December. The question from the right hon. Member for Wells (Mr. Heathcoat-Amory) was about British-trained doctors. There are 3,600 UK undergraduates who have not accepted a training post for 2007 and about 1,650 posts are still to be filled, though our undergraduates will be competing with international medical graduates. However, the sum total of all that is that, at most, we expect 100 people to be unemployed, because the vast majority of those applicants are already working in a job in the NHS. That is not to undermine the important points that my hon. Friend raised about MTAS and the distress caused to junior doctors this year.

The interim report on MTAS by Sir John Tooke—an excellent piece of work—set out a number of recommendations, which we are examining. They relate to the system in 2009 rather than in 2008, so we need to ensure that the lessons are learned for next year as well. It is a valuable piece of work and when we receive Sir John’s final report, I know that it will ensure that the problems that we faced this year are not repeated in future years.

Peter Bottomley (Worthing, West) (Con): There will be opportunities—perhaps for the Select Committee—to discover who was responsible for how the modernising medical careers initiative and the medical training
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application system developed. However, looking forward from now, will the Secretary of State make it plain who should be gathering evidence of where there are too few applicants in some specialties—as with applications for anaesthetics in London, for example?

Alan Johnson: Strategic health authorities should be doing that. The hon. Gentleman is absolutely right. In trauma and orthopaedics, there is only a 95 per cent. fill rate; in paediatrics, 95 per cent.; and in psychiatry, 94 per cent. Jobs are there if some trainees are prepared to pursue a career other than their originally intended one, but the information should be gathered by the SHA. As my hon. Friend the Member for North-West Leicestershire (David Taylor) said, we need to be much better at work force planning. If we follow Sir John Tooke’s advice, we will get to a satisfactory end. One final point to note is that John Tooke himself said:

It was not the concept of MMC that was at fault—we are now in a far better place than under the old opaque and unfair system—it is just that we need to ensure that the problems of this year are not repeated in the future.

Mr. Stephen O'Brien (Eddisbury) (Con): Until the mess that Ministers made of modernising medical careers, junior doctors were rightly accommodated free of charge in hospitals. Now we discover, after Ministers slipped it through on the sly—unannounced to MPs or to the doctors themselves—that doctors in their first year, who do not have the option of renting privately as they are required to move every few months from hospital to hospital around the country, are to be forced to pay rent to each hospital. Is there no depth to which Ministers will not sink in hammering our junior doctors?

Alan Johnson: There are many depths to which we will not sink— [Interruption.] I guarantee that they are diminishing all the time. I was unaware of the particular issue that the hon. Gentleman raises, and I will look into it. Sir John Tooke points out that the profession was also in favour of the basic principle of modernising medical careers. There was a real consensus on the need to move to a much more open system. Before that system was introduced, we had no national data telling us about shortages in differential specialties. It is the right road to pursue, but I shall look into the question of doctors being charged rent.

Mr. Brian Binley (Northampton, South) (Con): I was shocked to hear that the Secretary of State did not think that the new doctors’ contract was a bad deal. We have now learned that salaries have increased by 25 per cent. and productivity has decreased by 15 per cent. If that is not a bad deal, could the Minister tell us what is? I cannot imagine a worse situation for my constituents in Northampton.

Alan Johnson: I think that the hon. Gentleman is talking about the GPs’ contract, not MMC. Before 2004, GPs were retiring and not being replaced; medical graduates did not, by and large, want to be GPs; GPs were not incentivised in any way to look after their patients’ well-being, and the profession was not paid decent money and deserved a new contract. I completely disagree with the hon. Gentleman and his Front-Bench colleagues who believe that we should
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return to a situation in which GPs are called out at 5 o’clock in the morning out of hours, and are then expected to treat people properly at 9 o’clock in the morning. I disagree that the GP contract was a mistake, and we intend to build on it to ensure that GPs are much better incentivised to increase access to health care, which is another public priority.

Abortion

2. Ann Winterton (Congleton) (Con): What plans he has to amend the law on abortion. [162931]

The Minister of State, Department of Health (Dawn Primarolo): It is accepted parliamentary practice that proposals for changes in the law on abortion come from Back Benchers and that decisions are made on the basis of a free vote. The Government’s view is that the Abortion Act works as Parliament intended.

Ann Winterton: Bearing in mind the recent majority Select Committee report on the draft human tissue and embryos Bill recommending changes to the current law for abortion on demand, with the signature of only one doctor merely relating to the length of gestation, as well as allowing nurses to undertake the procedure, how will the Government ensure that the health of women is protected from subsequent well-documented and researched psychological damage, including higher suicide rates? Will all post-abortion sequelae be taken fully into account?

Dawn Primarolo: The requirement for two doctors signatures was believed necessary when the Abortion Act 1967 was passed, to ensure that its provisions were observed and that they safeguarded women. I note the Science and Technology Committee’s report that the British Medical Association and Royal College of Obstetricians and Gynaecologists believe that there is no need for two doctors’ signatures in the first trimester, and I am sure that Members of Parliament will want to take that into account when and if they vote on the issue in the House.

Mrs. Madeleine Moon (Bridgend) (Lab): My Bridgend constituency had a significantly higher-than-average number of abortions in 2005 among 18 to 25-year-olds. That was dealt with through improving the availability of local pregnancy advisory services and contraception and sexual health clinics to young people. Is not the need to improve the availability of advice and contraceptive services to young people rather than to amend the law?

Dawn Primarolo: I agree with my hon. Friend on the two important points that she makes. First, where access to abortion is required, it is important that that is undertaken as speedily as possible within the requirements of the Act. Some 89 per cent. of abortions are conducted under 13 weeks. She is also right that, alongside ensuring that the provisions in the Act are working as Parliament intended, it is also necessary to ensure that advice on sexual health is made available to young people and to others to ensure that they have every opportunity to control the point at which they become pregnant.


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John Bercow (Buckingham) (Con): I put it to the Minister that reducing the 24-week upper limit and insisting on directional counselling—in other words, trying to tell women what to do, lest they otherwise would not do it—would be a thoroughly retrograde step for this House to take and that a far better reform of the abortion law would be to ensure much more equitable access to first-trimester abortion across the country and a proper and prudent extension of the range of professionals who can undertake that necessary procedure.

Dawn Primarolo: I understand that feelings on this issue are held strongly by Members of Parliament, and that they have differing views. But the point that the hon. Gentleman makes is right—where access to abortion is required, it is vital that it is as speedy as possible to ensure the health of the woman. Under the present arrangements, proper counselling and advice is given to women, and any attempt to delay access to abortion further increases the pressure on the woman and her health. If the matter is debated in the House, I am sure that those matters will be given careful consideration and the Committee’s report will be looked at carefully by all Members.

Chris McCafferty (Calder Valley) (Lab): Does my hon. Friend agree that, as less than 1 per cent. of abortions take place at more than 20 weeks and that those cases are usually women in difficult and vulnerable positions, lowering the limit would not be the right way forward and would not help to reduce the number of abortions? Does she also agree—

Mr. Speaker: Order. One supplementary.

Dawn Primarolo: The studies that have been conducted on the operation of the Abortion Act, as amended in 1990, focusing specifically on the question of survival have demonstrated clearly that at 21 weeks none survive, at 22 weeks 1 per cent. survive and that at 23 weeks 11 per cent. survive. When abortion is allowed under the circumstances provided in the 1967 Act, as amended in 1990, the issue is how to ensure that the process is conducted speedily and in a way that safeguards the woman and the decisions that she has taken. I am sure that the House will give that careful consideration if and when it debates the issue.

Dr. Evan Harris (Oxford, West and Abingdon) (LD): Would the Minister accept that the best way to reduce the number of abortions in this country would be to reduce the number of unwanted pregnancies by improving access to contraception and sex education, rather than seeking to deny access to a very small number of extremely vulnerable women who present late for abortion within the current law?

Dawn Primarolo: I agree entirely. What is crucial is that information on sexual health and sex education are provided in a comprehensive fashion to ensure that every person understands the responsibilities that they will undertake in parenthood. There is also a requirement to ensure that the services that the Government provide on contraception are appropriate and widely available.


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Maternity Services

3. Norman Baker (Lewes) (LD): If he will make a statement on the level and quality of provision of maternity services in Sussex. [162932]

7. Mr. Nigel Waterson (Eastbourne) (Con): If he will make a statement on the downgrading of maternity services in (a) Eastbourne and (b) England. [162936]

The Parliamentary Under-Secretary of State for Health (Ann Keen): Proposals for the reconfiguration of services and the responsibility to provide the appropriate level of very high-quality maternity services are a matter for the NHS locally, working in conjunction with clinicians, patients and other stakeholders. The safety of mothers and babies is our top priority. In April, we published “Maternity Matters”, which sets out how we will deliver local provision of safe, high-quality maternity care for all women and their babies.

Norman Baker: Is the Minister aware that, under proposals tabled by two separate and unconnected primary care trusts, two of the three hospitals that supply maternity services to my constituents—the Eastbourne district general hospital and the Princess Royal in Haywards Heath—will see those services disappear? The third hospital, the Royal Sussex in Brighton, is already at capacity and regularly turns mothers away because it cannot handle the extra casework. Is she going to take action to intervene, or will she provide mobile facilities for mothers who cannot make it to the nearest hospital?

Ann Keen: Yesterday, I met Nick Yeo, the chief executive of both the East Sussex Downs and Weald PCT and the Hastings and Rother PCT, so I am well aware of the hon. Gentleman’s concerns. The local health overview and scrutiny committee has referred the consultation process to the Secretary of State for Health, and the Independent Reconfiguration Panel is currently considering the referral.

Mr. Waterson: But is the Minister aware that when asked about maternity services on 6 November this year on BBC Radio 2, the Secretary of State said that

Will she therefore abandon today the absurd and dangerous proposals that, in my area, will involve pregnant mothers travelling 21 miles over the extremely poor roads between Eastbourne and Hastings?

Ann Keen: I am sure that the hon. Gentleman has experience himself of remarks sometimes being taken out of context. The consultation in his constituency ended on 27 July and the PCT is evaluating the responses to that consultation. Therefore, we have to wait, but I am happy to see him at any time he wishes.


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