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Medical Profession: Emigration
The Earl of Munster asked Her Majesty's Government:
- What statistics they have regarding graduates from British medical schools emigrating abroad.
Baroness Jay of Paddington: Evidence of doctors going abroad is available from studies published in 1991 by Professor James Parkhouse. This gives the results of surveys of doctors who qualified in 1974, 1977, 1980 and 1983. The department has commissioned further cohort studies of doctors' careers by the Medical Careers Research Group at the Oxford Unit of Health-Care Epidemiology. These are examining career patterns of doctors who qualified in 1988, 1993 and 1996, as well as some of the cohorts surveyed originally by Professor Parkhouse. The studies, which collect data via questionnaires, continue to look at wastage from the medical profession including reasons why doctors choose to go abroad.
NHS Consultants and Doctors: Staff Retention
The Earl of Munster asked Her Majesty's Government:
- What measures are undertaken to retain both trainee doctors and the most highly qualified consultants within the National Health Service.
Baroness Jay of Paddington: The Government are committed to tackling the concerns of National Health Service staff and bringing back a more co-operative culture by listening to staff and taking an evolutionary approach to change. The new approach is based on a combination of fairness, flexibility, and efficiency. In September 1997, a consultation exercise on managing human resources in the NHS, a service wide approach, was launched in England. A key aim of this strategy is to provide sufficient experienced, knowledgeable,
skilled, well trained and highly motivated staff to deliver health services. In Scotland, a similar consultation exercise to develop a human resource strategy was launched in October 1997. Good recruitment and retention practice in trusts is being identified for sharing with the service. Annual planning guidance issued to the NHS, stresses the need for employers to improve retention for all staff.NHS Doctors
The Earl of Munster asked Her Majesty's Government:
- How the terms and conditions of National Health Service doctors compare with those of doctors in
(a) France;
(b) Germany;
(c) Canada; and
(d) the US.
Baroness Jay of Paddington: The structure of healthcare provision and the employment arrangements of doctors differ between the countries listed. It is therefore not possible to make meaningful comparisons.
Parental Discipline
Baroness David asked Her Majesty's Government:
- In view of the Department of Health press notice of 7 November entitled Government to clarify the Law on Parental Discipline, whether they intend to defend the case of A v. the United Kingdom at the European Court of Human Rights.
Baroness Jay of Paddington: No. My honourable friend the Parliamentary Under-Secretary of State for Health made it clear in his press statement of 7 November that the Government intend to consult widely on the law relating to parental discipline. We will then decide how the law should be clarified.
Vitamin B6 Toxicity in Animals: Studies
The Countess of Mar asked Her Majesty's Government:
- Whether they will list any published studies of vitamin B6 toxicity in animals of which they are aware and which specifically concluded that 50 mg per day should be the safety limit for human vitamin B6 supplementation; and whether they will summarise any representations which they have received on this matter from the authors of published papers relating to vitamin B6 toxicity in animals, indicating in each case the specific daily safety limits which such authors have advocated.
Baroness Jay of Paddington: The lists of studies which were considered by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT), including both animal and human studies, have been placed in the Library. At a meeting on 8 September 1997, an edited transcript of which has been sent to the Government, Dr. Ian Munro, the author
of an experimental study on vitamin B6 toxicity in dogs, suggested that 100 mg per day would not produce adverse effects in humans. This information did not cause the COT to change its advice.Meningococcal and Pneumococcal Vaccines
Lord HolmPatrick asked Her Majesty's Government:
- Whether they consider that there is adequate progress being made in the new meningococcal A & C vaccine; and when it will be introduced into the general immunisation programme.
Baroness Jay of Paddington: Following preliminary work commissioned by the Department of Health in 1995, on 3 November this year the department announced an extension of work to evaluate meningococcal and pneumococcal vaccines in United Kingdom children. The study is being funded by the department at a total cost of over £1 million and is being carried out by the Public Health Laboratory Service in collaboration with the National Institute for Biological Standards and Controls, the Centre for Applied Microbiology and Research and the Institute for Child Health. Good progress is being made and these studies have shown very encouraging results already for Group C. Early indicators for Group B are also encouraging. There are reasonable prospects that these vaccines will eventually be able to induce long term immunity although more research is needed before their suitability for widespread use can be considered. The work in progress on accelerated development of conjugate vaccines puts the UK in a world leading position.
Group A vaccine is recommended for those travelling to areas where this strain is prevalent; it is very rare in this country.
The Department of Health looks to its independent expert committee, the Joint Committee on Vaccination and Immunisation (JCVI), to advise on the appropriate method and timing of the introduction of new vaccines. The results of the studies set out above will allow JCVI to make an assessment of the efficacy and safety of new meningococcal vaccines and their potential place in the UK immunisation programme.
Lord HolmPatrick asked Her Majesty's Government:
- Whether, in the light of the recent increase in cases of meningococcal meningitis type C amongst the student population of United Kingdom colleges and universities, they will consider making available now the meningococcal A & C vaccine to all first year students and those living in halls of residence, and
Whether, in the light of the recent increase in cases of meningococcal meningitis type C amongst the student population of United Kingdom colleges and universities, they will consider making standard practice for all first year students to receive meningococcal A & C vaccine in the first two weeks of the Autumn term.
Baroness Jay of Paddington: The current policy on the use of meningococcal C vaccine is based on the recommendations of independent experts, including the Joint Committee on Vaccination and Immunisation. These experts have considered the possible more widespread use of the existing meningococcal vaccine, but concluded that the vaccine had problems (set out as follows) which made such use unsuitable.
The presently available Group C vaccine only offers about 80 per cent. protection for those in older age groups, this immunity is relatively short lived and the vaccine offers no protection at all against the most common strain of meningococcal disease, Group B.
There is some preliminary evidence that those who receive the existing Group C vaccine may develop immune tolerance for further exposure, a risk as yet unresolved. Someone who has had the existing vaccine may not have a very good level of immunity when given the new, more effective vaccine under development, or potentially when exposed to the meningococcal organism.
The vital message is to be aware of the signs and symptoms of the disease and to be alert. These remain the best general protection. The Health Education Authority's "Look out for your mate" campaign, together with the information provided by the Meningitis Research Foundation and the National Meningitis Trust, seeks to ensure students are aware and alert.
It should also be remembered that rates of meningococcal infection are highest in under fives. If the existing vaccine were suitable for more widespread use these and other age groups would also have to be considered.
Meningitis Awareness: Students
Lord HolmPatrick asked Her Majesty's Government:
- Whether they consider that public funds spent on student meningitis awareness campaigns by the Department of Health would be better spent on medical research, given the fact that there are well-established meningitis charities running their own awareness campaigns.
Baroness Jay of Paddington: The Department of Health first asked the Health Education Authority to develop material for students in 1996 as the department was aware of the lack of information specifically aimed at this group. The meningitis charities have since also produced information aimed at students independently of the department's information strategy. The department reviews annually its information strategies and will be consulting with the two meningitis charities about next year's student awareness campaigns.
The main agency through which the Government support medical and clinical research is the Medical Research Council (MRC). The council is always willing to consider support for soundly based new scientific proposals in competition with other applications. As
regards research into meningitis, the MRC is currently providing support for two MRC units and funding 12 research grants at a cost of £2.3 million in 1995/6.
In addition work to evaluate meningococcal and pneumococcal vaccines in United Kingdom children is being funded by the department at a total cost of over £1 million. Early indications from this work are encouraging and puts the UK in a world leading position. The department provides funding to both the National Meningitis Trust and the Meningitis Research Foundation to support their work.
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