National Health Service

Part of the debate – in the House of Commons at 12:00 am on 27 October 1975.

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Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield 12:00, 27 October 1975

The background to the debate is a crisis within the National Health Service. Apart from the disputes which have occurred over the past month, even more fundamental problems arise. Lack of resources means that new hospitals cannot be built, that much-needed extensions cannot go ahead and that new equipment cannot be bought. Lack of resources means that medical staff are working in conditions that no one can consider ideal and that are often blatantly inadequate. Lack of resources means that nurses who finish their training are unable to find posts in the hospitals in which they have trained, not because they are not needed but because there is no money to employ them.

Let us be clear. These problems will not suddenly be cured, and it is no part of the Opposition's case to suggest that in the present economic crisis this position will be quickly changed. Regrettably, all the signs are that the position will get worse. Once again, we are dealing with the familiar problem of inflation, and inflation which should have been tackled months earlier by the Government. That inflation has stopped progress dead.

When we talk of resources within the National Health Service we are talking not merely about physical resources such as new buildings and equipment but about human resources—namely, hospital staff, including nurses, doctors and consultants. Our case against the Government is fundamentally directed at how the Government have managed these resources. The truth that we should recognise first is that the National Health Service has been kept going because of the devoted work of those working within it. If their morale is eroded, the service is put at risk. That is exactly what has taken place over the past 18 months. By the right hon. Lady's own admission, the result is that there is now widespread demoralisation.

The reasons for the demoralisation are not difficult to discover. One of the chief reasons is the overwhelming irrelevance of what the Government are doing. Let us take, for example, the manner in which the Government have handled agency nurses. These nurses fulfil a vital rôle within the service. They help staff hospitals which find it difficult to attract nurses because they are unable to offer accommodation or because the accommodation locally is expensive and poor. They help to staff crucial specialist units, such as intensive care units, where the work is particularly exacting. Those are units which sometimes find it difficult to find staff. Agency nurses provide an invaluable reserve of experience.

Faced with this situation, what has the right hon. Lady done? She has issued a circular aimed at eliminating the use of agency nurses within the service. The Government are implementing that policy by deliberately reducing their pay, a step which is not even favoured or supported by those who support the general policy. At a time of unprecedented inflation the Government have reduced the pay of the agency nurses. Of course that policy is having its effect. It is true that it is eliminating the agency nurses from the service. It is doing so for the very good reason that many of the nurses concerned are leaving the nursing profession altogether and taking other jobs.

How does the right hon. Lady justify that situation? In her circular she simply says that she appreciates that a short-term risk may have to be accepted to achieve the longer-term aim. I know of no responsible body of medical opinion that believes that that short-term risk is justified.

Even more worrying is the position within the medical profession itself. In that sector the evidence of a collapse of morale is visible for all to see. Disputes have escalated and, worse than that for the long-term future of the service, more and more doctors are considering the prospect of a career abroad.

The exact figures of medical emigration are notoriously difficult to obtain. The Department's figures operate rather like the presumption of death procedure in that only when a doctor is missing abroad for two years is he presumed to have emigrated. Even on the Department's figures, over 300 British doctors are emigrating per year. That is bad enough, but the indications are that the trend is increasing, A forward indicator is the number of doctors expressing an intention to emigrate to the Overseas Bureau of the British Medical Association in London. The figure is now up to 80 a month. If even half of those doctors put that expression into effect, we shall be in serious trouble.

What is the emigration picture? First, I think we can all agree that many young doctors are now taking their American qualifying examinations as a matter of course and that more young doctors are now considering the prospect of a career abroad than ever before in our history. Secondly, I think we can agree that not only young doctors but senior registrars and consultants are leaving. They are not merely leaving London but are leaving other provincial centres such as Birmingham. That is clear from the results of a survey in the Birmingham Post. Thirdly, I think we can agree that some specialties are particularly affected. According to the Director of Radiology at St. Mary's in a letter to The Times, in the past 18 months 23 senior registrars and eight registrars have left from London for posts abroad.