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Lord Hunt of Kings Heath: My Lords, I very much understand the noble Baroness's point. A working group has been set up to consider the introduction of silicone cosmeses coverings in artificial limb services. In addition, the NHS Purchasing and Supply Agency has set up a strategic commissioning group which brings together commissioners, providers, the industry and user representatives to inform future specification for artificial limb contracts. I hope that, as part of that process, we can take account of the point the noble Baroness raises.

Lord McColl of Dulwich: My Lords, is the Minister aware that the supply of artificial limbs in many places in developing countries in Africa is better and quicker than in this country? It is an urgent issue. What will the Government do?

Lord Hunt of Kings Heath: My Lords, I pay tribute to the noble Lord for his work over many years on this issue, in particular in relation to the artificial limb and appliance centres. We need to be careful not to suggest that everything is poor about current services. There are many examples of excellent services around the

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country. The problem is that high standards are not universal. The Government are seized of the need to ensure that best practice is adopted throughout the country. In addition, through its local inspectors, the Audit Commission will monitor what will happen at local level. Although we should always consider the experience of other countries, we can also look to our own country for experience of best practice.

Lord Clement-Jones: My Lords, the Minister is aware of the problem when medical staff, in particular occupational therapists, are faced with widely differing standards from social services departments and health authorities about the equipment which can be provided for patients on discharge from hospital. The position as regards charges made and the type of equipment provided needs urgent consideration. Can the Minister say something on that?

Lord Hunt of Kings Heath: My Lords, I do not disagree with that point. We need to bear in mind that effective investment in appropriate equipment in the long term will ensure that many people make fewer demands on the services in the future. We need to bring home to the health service and local government the message that the more effective services they can develop in this area the better the spin- off for users of the services and the services themselves.

As regards community equipment services, the Government are keen to encourage health and local authorities to work together. As regards charges, the noble Lord will know that we intend to table amendments to ensure that we can issue statutory guidance.

Lord Campbell of Croy: My Lords, will the Minister recognise that, owing to our ageing population, demand for surgical appliances is increasing but that new materials and technologies, as referred to by the noble Baroness, Lady Masham, which are becoming available, could alleviate the situation?

Lord Hunt of Kings Heath: Yes, my Lords. Part of the effective delivery of high quality services in future is the need to ensure that those in NHS health services and local authorities who commission services relating to community equipment are keeping up to date with developments and ensuring that its quality and acceptability are of the highest order. We want to encourage that.

Medical Students

2.51 p.m.

Lord Roberts of Conwy asked Her Majesty's Government:

    What progress has been made towards increasing the number of medical students in the United Kingdom.

Lord Hunt of Kings Heath: My Lords, in July 1998, the Government announced that the annual intake of

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medical students in the United Kingdom would be increased by about 1,000 places per annum by 2005. In England, the Higher Education Funding Council for England has announced the allocation of a total of 1,126 additional places. The Government are now considering a further increase in medical school intake in England. The information relating to Scotland, Wales and Northern Ireland is a matter for the devolved administrations.

Lord Roberts of Conwy: My Lords, I declare an interest as president of the University of Wales College of Medicine. I appreciate the increase of about 1,000 in the number of medical students. However, are the Government convinced that the number is adequate to meet the needs of the United Kingdom? Bearing in mind that during the past five years only 42 per cent of doctors registering each year for service in the United Kingdom have been trained here, is it not time that the Government changed their target?

Lord Hunt of Kings Heath: My Lords, an additional 1,126 places is a considerable achievement. However, I assure noble Lords that as part of our further developments within the NHS we are looking at the number of places over and above the 1,126 which we shall need. As regards the statistics which the noble Lord gave, I understand that 76 per cent of the medical workforce is UK trained. The advice given by the Medical Workforce Standing Advisory Committee in 1997, on which much of the development in medical school places is based, suggested that we needed to stabilise that proportion. I believe that the additional places we have announced will help us to do that, as will any future expansion.

Lord Cledwyn of Penrhos: My Lords, my noble friend has given us important information, but is he aware that we could do with many more trained doctors throughout Wales--in the villages, outside Cardiff and Swansea, where they are badly needed?

Lord Hunt of Kings Heath: My Lords, I am in danger of trespassing on another country's arena. I pay tribute to the high quality of medical education in Wales, of which I have experience. The new training places allow us to develop links outside traditional medical school centres, both in terms of the new medical schools--for instance, in Norwich at the University of East Anglia and at the Peninsular Medical School in the West Country--and in places where medical schools have been expanded--for instance, in Birmingham through links with other parts of the Black Country. There is no doubt that in ensuring that we have high quality doctors we have to ensure a broad-based education for medical students which enables them to experience all facets of life in the health service.

Lord Clement-Jones: My Lords, although the Government's announcement is welcome, the Minister will be aware of comments made by his honourable friend Frank Field pointing out that the number of

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doctors per head of population in France is 75 per cent greater than in this country; two and a half times greater in Spain than in this country; and three times greater in Germany. Are the Minister and his department examining the question of additional medical students in a sufficiently fundamental way?

Lord Hunt of Kings Heath: My Lords, international comparisons can often be misleading. In terms of doctors per 1,000 of population, the UK is comparable with Finland, Norway, the Netherlands and the US. But we accept that we need to do better. We need to expand the NHS workforce as a whole and doctors will be an important component of that. Furthermore, we must break down some of the working barriers between the different professions. By the sensible reordering of responsibilities we can take some of the load from doctors, nurses and other professionals in order to allow them to focus on the most important and serious elements of their work.

Baroness Young: My Lords, does the Minister recognise that we need a considerable increase in the number of doctors? Do the figures he has given mean an absolute increase over and above those who retire every year? Is what we read in the newspapers about the two new medical schools at East Anglia and Exeter true; that they will take in students with lower qualifications who will therefore require a longer training period? Can we be satisfied that they will achieve the correct standard?

Lord Hunt of Kings Heath: My Lords, medical workforce planning has proved to be a difficult art. The noble Baroness is right that a considerable number of doctors are coming up to retirement. That statistic needs to be factored into the further development of training places.

It is right that we should consider everything we can to widen access to medical education. I point to King's College, London, whose medical school is working with local schools and colleges in south London to identify potential medical students at a young age, and where alternative tests will be applied to demonstrate a suitability and general aptitude for medicine. However, I do not believe that that or other initiatives will in any way impact on the high quality of medical students and doctors in this country. I believe that the number of applications for places is at a healthy level, enabling us to ensure that high quality students enter our medical schools.

Lord McColl of Dulwich: My Lords, is the Minister aware that according to OECD figures, Britain's number of practising doctors per head of population is one of the lowest compared with the majority of OECD countries? Only Turkey, Korea and Mexico have a lower number. At the other end of the scale, will he comment on unemployment among fully trained obstetricians and on last year's cut of 33 per cent in the number of new consultants as opposed to an annual increase under the previous government of 4 per cent?

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