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Health: Physicians

Volume 706: debated on Thursday 18 December 2008


Asked By

To ask Her Majesty’s Government whether they will take steps to make the number of physicians per capita in the United Kingdom equivalent to the European Union average.

My Lords, I think that the noble Lord will not be surprised to learn that data from different countries on the number of physicians per capita cannot be easily compared, due to definitional issues and whether we are dealing with just NHS doctors or with private doctors, too. However, there has been unprecedented growth in the medical workforce since 1997, including a 40 per cent increase in the number of doctors employed and a 53 per cent increase in the number of doctors in training.

My Lords, I thank the Minister for that Answer. She will be aware that out of 27 countries in the European league table, we are in the bottom four or five, as far as the ratio of doctors per patient goes. We have fewer than everybody else except, I think, Romania and Poland on the last count. Is the Minister aware of the difficulties these inequalities cause to the most vulnerable parts of our communities, such as parts of Wales and the north-east of England? If she is, what is she doing to remedy that?

My Lords, health inequalities exist for a number of reasons, and access to high-quality primary healthcare, and therefore the availability of doctors, is certainly one factor. However, it also includes other issues such as diet and lifestyle. International research by the academic Barbara Starfield has demonstrated that increasing the number of primary care clinicians in areas with the greatest health needs is one of the most effective ways of improving the population’s health—the noble Lord is indeed correct—so we are investing an additional £250 million annually in new primary healthcare services. We have asked every PCT to develop a new GP-led care plan, and are establishing 112 new GP practices in those areas of the country with the fewest GPs and the greatest health needs. I cannot comment on south Wales, because that is a devolved matter.

My Lords, it is clear from the supplementary question that the questioner used the word “physicians” to mean doctors in general, because that is the table he cited. I would like to turn to the specific point about physicians, and, in particular, consultant physicians. Is the Minister aware that, as a country, we are unfortunately reaching the point that when you go to see a consultant, you are looked at as a kidney, a toe or some individual organ? There is a great need for more general consultant physicians in the UK. Will she do whatever she can to encourage the training and education of more consultant physicians?

My Lords, the noble Baroness describes being a toe or a part of a body very well indeed. We are obviously very concerned to increase the number of doctors. At the moment we have 46,783 doctors in training, including doctors who will go on to become consultants. That is an increase from 30,313 in 1997. The noble Baroness is completely right: improved patient outcomes depend on having the right staff in the right place at the right time with the right skills.

My Lords, when I was appointed a consultant neurologist in 1958, there were 134 consultant neurologists in the UK, compared with 400 in Finland, with a population of 5 million. As the Minister has said—it is welcome—there has been in the last 10 years a major increase in all specialties of the consultant establishment. But, as reports from the royal colleges have demonstrated, would she accept that we are still far short of the ideal establishment of consultants in all medical specialties which would be required to give a full and satisfactory service to the UK community as a whole?

My Lords, the noble Lord has raised a very interesting point, because, as far as we can see, there is nowhere in the world where anybody says that there is an ideal number of doctors per head of the population. I specifically asked my officials to find that out for me. But we hope that, with the restructuring and decentralisation of NHS services, there will be an increased recruitment of professionally qualified staff, including GPs and consultants. We hope that the new system of recruitment and training will produce the outcomes we want.

My Lords, on the basis that one size does not fit all, how will the Government cope with different needs in different areas?

My Lords, my noble friend is absolutely right. As proposed by my noble friend Lord Darzi in his report, we anticipate that successfully shifting services closer to home will result in services being more convenient for patients and service users. For example, with conditions like diabetes, which is increasing in the population, we anticipate that community-based services will play a more prominent role. Providing care closer to home can improve patient recovery, which ends repeated trips to hospital and gives more personalised service.

My Lords, will my noble friend agree that not only does increasing the number of general practitioners in primary care improve the health of the population, but increasing the support of other health professions in relation to medicine, such as nurses, health visitors and counsellors, does? In my professional life, I have found that it is enormously more satisfactory to work in a team that includes such people.

My Lords, my noble friend is correct. The OECD report referred to by the noble Lord recognises that in the UK we have a higher than average number of nurses, and that we have very good team working with good health outcomes.

My Lords, will the Minister concede that the problem over the past few years has been that workforce planning has been something of a mess? As my noble friend said, there is a shortage of consultants in key specialties, yet there is an oversupply of doctors who have competed their basic training but who cannot find a consultant’s job. What specific measures are the Government taking to address that?

My Lords, the workforce planning cycle coming into force begins with primary care trusts and local councils commissioning services to meet the healthcare needs of their local populations. In other words, we are no longer setting national targets. We did that some time ago to boost the number of doctors, clinicians and professionals that we needed in the healthcare service. The restructuring and decentralisation should mean that increased recruitment of professionally qualified staff, including GPs, will have an impact on the training and the number of hospital doctors who will have a sufficient case-load volume to achieve the best outcomes.