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Medical Students

Volume 776: debated on Wednesday 26 October 2016


Asked by

To ask Her Majesty’s Government whether they intend to review the number of students studying medicine.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in doing so, declare an interest in that my wife is a retired full-time GP practitioner.

My Lords, my right honourable friend the Health Secretary announced on 4 October that the Government plan to increase the number of medical school places by up to 25%. From September 2018, the Government will fund up to 1,500 additional medical school places each year. Students will be able to apply for the extra places from 2017 in order to take them up from the academic year 2018-19.

Is my noble friend clear that the Secretary of State is to be congratulated on beginning to grasp this nettle? In the last three years, we have lost 3,500 medical students, but the problem goes deeper, does it not? Today, 56% of the intake of medical students is female. Furthermore, 70% of female GPs today work part-time, and a recent survey by the King’s Fund says that 90% of all medical students in training want to work part-time. Given that it costs £200,000 to train anybody as a medical practitioner, surely the time has come to consider a minimum full-time commitment of at least four years after qualification, similar to what they do in Singapore and, indeed, in our own Armed Forces.

My noble friend is absolutely right that more than 55% of those who go to medical school are now women; that is a fantastic change that has happened over the past 20 years. It is true that more women than men tend to work part-time, as they have children and bring them up, and that is taken into account in the planning done by HEE. When my right honourable friend the Health Secretary made his announcement, he said that we will be looking in our consultation at requiring people whom we have paid to go through medical school to give at least four years back to the NHS, which I think is reasonable. The figure is actually six years if you become an Army doctor, so four years is not unreasonable.

My Lords, is the Minister aware that, although there may be enough people wanting to apply to medical school, many of the brightest and the best are now completely turned off doing medicine because of the relationship with the Secretary of State for Health? This is a very serious mistrust and, whether they are male or female, the brightest and best are often not applying. There is increasing evidence for this in most medical schools, and indeed in schools as well.

I respect the views of the noble Lord but I have looked very carefully at the number of applications coming into medical schools in 2016 compared with the previous year. In 2016, there were 20,100 applications for all medical schools, including in Scotland. The previous year the figure was 20,390, so there is no firm evidence to support the view that the noble Lord expresses. There were some rumours that St George’s was having trouble filling its places. I have investigated that and understand that it was a result not of any lack of demand but of the fact that it wanted to wait until A-level results had come through so that it could choose the best candidates based on those results. So I do not think there is any evidence to substantiate the noble Lord’s point.

My Lords, one of the objectives in Health Education England’s mandate is to reduce our dependency on temporary staff. However, the National Audit Office tells us that we are short of 50,000 clinicians, and that HEE is failing to be sufficiently proactive in addressing the,

“variations in workforce pressures in different parts of the country”.

Is the noble Lord’s department monitoring how well HEE is responding to these challenges?

My Lords, predicting the future requirement for doctors is extremely difficult. It is more a matter of prophesy than science. The fact that we are now going to fund an extra 1,500 doctor places a year, which is a 25% increase, should make a huge difference.

My Lords, I declare my interest as chairman of University College London Partners. Beyond undergraduate medical education, do the Government believe that there are sufficient opportunities for the established workforce to continue to develop itself to meet the changing needs of the population of our country?

That is a very big question, which is hard to answer. My personal view is that I do not think that the training we give to our young doctors in management, leadership and how to structure new models of care is sufficiently broad. You could argue that the curriculum at medical school is too narrow and should be broadened.

Can the Minister tell me how many overseas doctors, particularly Commonwealth doctors—if he has a figure for that—are working in our National Health Service? On a separate topic, what can be done to encourage people to go into some specialties that we are told do not attract doctors, which is why there are not sufficient numbers in them?

My Lords, overseas doctors account for about 25% of the total number of doctors employed by the NHS, which is a very high number. I do not have the breakdown for the Commonwealth countries but it is an interesting question; I will research it and write to my noble friend. She is absolutely right that there are shortages in particular specialties. General practice and psychiatry are probably the two areas where there is the biggest shortage. HEE is determined to increase the intake in those areas. Certainly, the number of doctors going into GP specialty training this year is just over 3,000. That is an increase on last year but is still not enough.

My Lords, we welcome the increase, but is it sufficient to meet the problem? I understand that about 100,000 overseas doctors, including European doctors, work in the NHS. Given an extra 1,500 places a year, it will take many years to reach the target. Why do we not make a gesture to those overseas doctors working in the health service and offer them permanent residence here?

I think it will be helpful if I quote from the Health Secretary’s speech at the Conservative Party conference, talking about overseas doctors. He said:

“They do a fantastic job and the NHS would fall over without them. When it comes to … EU nationals, we’ve been clear we want them to … stay post-Brexit”.

Let us be absolutely clear: we want overseas doctors from the EU or elsewhere to stay here post-Brexit.

My Lords, how many medical students drop out during training? How many, when qualified, do not take up medicine and go into other specialties?

My Lords, the attrition rate for students at medical school is about 5%. Some of those leave for medical reasons and come back subsequently, so the figure will be less than 5%. I do not have the drop-out rate for doctors who are further advanced in their training but I will find out and write to the noble Baroness.