I have known people spend their life’s savings in order to give private treatment to one of their relatives, believing that they were getting better service. Friend the Minister of Health said that if we were to have a State theatre, we should not have the same prices for all seats; but one cannot compare this health service with comfortable seats in a theatre. We cannot afford to have any secondrate seats in an operating theatre.
We want people to be grateful for the devoted service of nurses and the rest in hospitals. We want people to be cooperators in hospital, because a tiresome bunch of patients can do a lot to upset other patients. There has to be instilled into the whole thing the spirit of working together. Therefore, I feel it is very difficult to vote against the proposals put forward by the Minister.
For example, in the dental service the same principle will prevail. The State will provide a certain standard of dentistry free, but if a person wants to have his teeth filled with gold, the State will not provide that. Friend has raised a very important matter, and I hope that I have covered all the points which he put forward. We accept that there is some evidence, which my hon.
I feel it is difficult, because I believe the Minister seeks the cooperation of all those who are interested in the health of the country. I do not think that that cooperation should be refused. I am very much concerned about what may happen in the interim period between now and the time when the Bill becomes an Act. I must say in all fairness to the Minister that I believe the teaching hospital with which I am associated will be able to go ahead under better conditions betterdoctor api than we have ever had. I hope that between now and the Committee stage, the Minister will be able to give an assurance to everyone in the country that through some machinery of a regional character endowments which have been given to specific hospitals will be earmarked if possible for those hospitals. Everyone’s conscience would be happier if that were done. There must be more links between the teaching hospitals and the general hospitals to group them together.
At present the qualified optician is qualified by examination of his own free will, but anybody is free to give advice or supply glasses without any training or qualification at all. During the last 16 years the National Ophthalmic Treatment Board have had their clinics boosted high, yet during that time 90 per cent. of those needing treatment under the National Health Insurance Act went to qualified opticians. I would like to ask the Under-Secretary what will be the position of a very small section of hospitals, but a section which is of vital importance; I refer to the hospitals for the dying. I have personal knowledge of the work done by these hospitals. They exist usually through the charity or personal interest of people who have given or are giving money for the purpose of helping those who have not long to live, and nowhere else to spend the remaining months of their lives. I dread to think what will happen to these hospitals if they become parts of a crowd of impersonal hospitals, run by regional boards.
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Member for Woking about what the Government are intending to do about the problem. First, I will deal with the practical matter of the provision of better statistics. I am sure that it will provide us with important new information on a continuing basis and help as we review the problem in the future.
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Gentleman dispute the figure given by The Times, on 1st February, that at least 1,300 key specialists in the aerospace industry were leaving last year alone? If not, he confirms that that is a very high proportion of the whole of the brain drain.
As to the future, I agree that we do not want to run down this country. We have tremendous technical ability, but it is not helped when projects are cancelled. This Government have failed to appreciate that many scientists and engineers do not want to work in a vacuum. They want to work and see the product—whether a component or a finished product—developed and put into production and finally sold.
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133I presume that Service hospitals are not to be taken over and are to be left in the hands of the three Services. There may be reasons for this, such as military discipline and that hospitals in Service areas cannot be taken over and run as civilian hospitals. What is to happen to Government hospitals like those of the Ministry of Pensions? Are they to be taken over and included in the scheme or are they to be left in the hands of the Departments concerned and, if so, why?
- I do not want to reopen the vast question of comprehensive education.
- But it is proposed that there shall be a basic salary and that for a number of very cogent reasons.
- without enough thought in regard to its immediate impact upon the country.
- This is the time when one is prepared to go abroad.
- There were no abdom- 118inal operations, and none of the really difficult operations of today.
- As to their current attitude, the right hon. and learned Gentleman used the phrase disjecta membra, although I am not sure what they are.
of the junior staff in our hospitals come from abroad. We know that if all the overseas doctors were to return home tonight our National Health Service would collapse. It is essential that we get this subject into perspective, because it has been grossly dramatised and exaggerated by the Press and is now being exploited by the Opposition for political purposes. There is not a drain of doctors from the country—that is too drastic a description. Friend the Minister of Technology gave some figures which put this into perspective. The average net loss of doctors by emigration is 300 to 350 a year. But this is out of a total of 60,000 in the whole of Britain, and that latter figure is rarely mentioned.
Every one of us is concerned with how we can play our part in making this country more attractive so that people stay here and make their careers here. All over the world the richer nations are taking doctors from the poorer. America takes them from Europe and we take them from India and Pakistan. Countries like that have one doctor for every 150,000 inhabitants whereas in Britain we have one doctor for every 2,000 or 3,000 inhabitants. The only solution to this problem is to raise the world standard of living and prosperity so that salaries and conditions of work everywhere become comparable. Only when that situation exists will there be no such thing as an under-doctored area.
Do they prefer to pay their taxes directly from their pay packet, or as a toll on the roads, or a payment across a doctor’s surgery? I hope that the Government will carry out some research in order to see how far our present taxation methods are a disincentive to people earning higher Incomes. Why do they go—apart from a sense of adventure which seems to be absolutely natural betterdoctor api and wholly desirable? First, salaries in American industry are substantially higher than they are in this country or in Europe. Remuneration in American universities is very much higher than at equivalent levels here. It may well be that many more people with a whole range of skills and trades would go from this country if the American immigration laws did not stop them.
APIs are going to take the clinical research to another new level altogether. Sometimes the researcher is unable to draw a conclusion from the studies and this is because the subjects involved are minimal numbers. With efficient health APIs, the researcher software development agency ensures that they obtain the most accurate results via accessing the records of many patients having a particular type of diagnosis. The best part here for the patient is they can hide their personalities and can contribute to research vastly.
I am not charging the Minister with any lack of intention. I know that it is his policy to encourage hospital boards to provide resident accommodation for married staff. His Ministry has doubled the amount available in London. There were in the London teaching hospitals 33 units and 32 have been added. But this is still inadequate if we are to ease the basic problem among junior hospital staff who form the backbone of the hospital service.
There is very often extra responsibility in many American hospitals, where a registrar may do a job in five different specialties in rotation—surgery, medicine, obstetrics, gynaecology and so on—instead of concentrating on one. Of course, for the potential G.P., there are very often preferable conditions of work overseas. But I do not believe, as the right hon. and learned Member for St. Marylebone (Mr. Hogg) claims, that the reason doctors leave is that they are running away from a Labour Government or a collapsing Health Service. This sort of thing is inaccurate and unfounded and does no credit to the Opposition or to the Health Service which they purport to support.
At that meeting the committee of the past year report, and are elected or not, as the case may be, for the coming year. We are going to have a «wishy washy» form of indirect democracy, and the Bill does not make it clear how we are going to get it. If we are lucky we may get a chance to elect a member who, if he is lucky, may get the chance to get somebody on to a hospital management committee.
Friend of this particular point tonight—to press on with the work of the advisory committee which his predecessor set up to advise him on rheumatic diseases and their treatment. If I may cite an example without pleading a special cause, I would put forward the example of London. According to Clause II of the Bill, a university having a school of medicine is to be associated with the provision, by the regional hospital board, of hospital and specialist services, so far as practicable. The London University not only has 12 such schools of medicine instead of one, but it is also the natural university centre for a population of some 14 million people in South-East England. The gathering grounds of these 12 teaching schools naturally overlap, and the problem is further complicated by the post-graduate teaching hospitals in London.
Certainly, research expenditure has more than doubled in the last decade. Another piece of conversation research is that there are no jobs at the top and that is why people leave this country. The great range of people who are inclined to move out of the country for other experiences in the United States and other countries are not usually those who are at the top of a particular research project. There are exceptions, but in the main such betterdoctor api research as we have done on this suggests that people have gone because they want other experiences and want to add a new piece of material to the job that they are working at. This is quite different from suggesting that people leave this country because they cannot get to the top. This is not to say that the right hon. and learned Gentleman’s speech was not amusing. But it seems to me that he is engaged in conversation research.
Somehow or other, the Government have a responsibility. I should like to think that the Opposition feel the same, because the right hon. and learned Gentleman identified himself with that sentiment. His words were that we all have a responsibility, and I am glad to see that there are hon. Gentlemen opposite who agree with me on that point. Members opposite had sons who said, «Where can I expect to accumulate a larger amount of industrial equity for myself», would they advise them to stay here or to go overseas? Or if their son was not an entrepreneur but simply a highly talented and determined young man who wanted to play a part in a large and growing industrial concern, would they advise him to stay here if he were to ask them about stock options?
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When a doctor sells a practice he is not selling patients, he is not selling bodies, he is selling the goodwill he has earned with his patients. If he has been a diligent doctor, if he has been devoted, forgetful of himself, if he has worked his hardest in the interests of his patients, the value of that goodwill will be high. If he has 80been a bad doctor, the value of that goodwill will be low. Conversely, when a doctor is buying a practice he is not buying patients, he is only buying an opportunity to serve his patients. If he does not make use of that opportunity he loses his practice. What the Minister is doing by forbidding the buying and selling of practices is to remove one more material inducement which a doctor has to give the best service he can to his patients.
I know that in my own constituency, the Harrogate hospitals work in close touch with the Leeds University, and the research of the two parties is going on together. The Royal Baths Hospital at Harrogate may be termed the teaching hospital for rheumatics in that region. The Minister has frequently referred to the fact that under the Bill the family doctor will still be available. They look on him as a friend as well as a medical adviser. It is clever wording and I think a good many people will be taken in, but I cannot see how the family doctor will remain. The patient will attend a clinic, and he or she will have to consult the doctor on duty at the time. There is no guarantee, when doctors work on a strict rota, which doctor patients will find when they arrive at the clinics.
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Members opposite were very much vexed by what might happen to the public schools, and they came to the House and asked for the permission of the House to lay sacrilegious hands upon educational endowments centuries old. I remember protesting against it at the time—not, however, on the grounds of sacrilege. These endowments had been left to the public schools, many of them for the maintenance of the buildings, but hon. Members opposite, being concerned lest 62the war might affect their favourite schools, came to the House and allowed the diversion of money from that purpose to the payment of the salaries of the teachers and the masters. There have been other interferences with endowments. Disestablishment interfered with an enormous number of endowments. Scotland has been behaving in a most sacrilegious manner; a whole lot of endowments have been waived by Scottish Acts.
Reviewed by: Santos Gonzalez