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Catherine West (Hornsey and Wood Green) (Lab)
It is a pleasure to serve under your chairmanship, Sir David.
When someone decides to become a doctor, they do not expect it to be easy—there are years of study, huge student debts, antisocial working hours, and the pressure of knowing that the decisions they make every day can be the difference between life and death—but they have a right to expect that the Government will value and appreciate their training and dedication. Our NHS needs more doctors, not fewer. When we or our loved ones get sick, we all want the comfort of knowing that the brightest and best are providing their care, so the fact that we are having this debate means that today is a sad day. Although I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on introducing the debate, it is a pity that we have to have it. The Department seems determined to sabotage the relationship with junior doctors and is handling the negotiations poorly.
The contract has been described as unsafe and unfair. When I have met junior doctors from the Muswell Hill and Crouch End area we have spoken about how expensive childcare is, how they hope to be able to move out of their mothers’ and fathers’ houses, and how they hope to have a career and serve in the NHS. However, they feel that all of that is at risk. They are working every hour God gives them, but they feel that there is no genuine respect and that they will eventually find it very difficult to remain in London, purchase a home and continue to serve in the NHS. They are even thinking of trying to work abroad. There is a real risk that the Government’s approach will take us back to the bad old days of overworked doctors who are too exhausted to provide safe patient care.
One doctor told me that they had £40,000 of student debt after six years of training and were just starting out on a salary of £22,600. They said that the reclassification of unsocial hours would see them lose about 30% of their salary and leave them struggling to pay their rent and bills. The new contract that has been imposed will see incomes fall by 20%—
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
That is not true.
Catherine West
If it is not true, I look forward to clarification from the Minister. We would not like to see a couple who are junior doctors having to leave their jobs because the cost of childcare is more than it pays to work as a doctor.
The situation is turning into a shambles. I hope that the Secretary of State for Education is watching, so that last week’s big announcement about the reorganisation of education does not end up in a similar situation in a year or two. First millions of pounds was wasted on an unnecessary top-down reorganisation, then staff and patients were made to pay the price of the Government’s financial mismanagement. Will the Minister clarify whether 75% or 80% of trusts are currently in deficit? We are already in the middle of a workforce crisis, so the last thing we need is more doctors leaving. I have heard that 1,644 physicians have registered with the General Medical Council for certificates to allow them to work overseas; will the Minister clarify the exact number? The GMC normally receives only about 20 applications a day, but since Christmas, with the Government’s disastrous handling of the situation, the number has shot up.
I have written to the Secretary of State to urge him to get on and sort out the situation. The Government have to accept that compromise is necessary. As my hon. Friend the Member for Hammersmith (Andy Slaughter) said, there is a deal to be done. Why put patient safety at risk when it is really not necessary? I was proud to stand in solidarity with the fantastic junior doctors at my local hospital, Whittington hospital, as well as those at North Middlesex hospital on the other side of my constituency. There really does seem to be a lot of willingness to talk; I just hope that that is reflected in the approach of Ministers.
The Government’s current approach is wrong. They should be much more flexible, and they should want to open negotiations and talk rather than impose things. Junior doctors are vital to the future of the NHS, and it is clear that if we want to move towards a seven-day NHS and improve patient care, we have to ensure that the staff we rely on are supported and valued. It is deeply worrying that the BMA has described the contract as “unsafe and unfair”, and that the Royal College of Paediatrics and Child Health has stated that it could be
“gravely damaging to the health and wellbeing of children”
and could
“adversely affect recruitment, retention and the morale”
of junior doctors. I look forward to hearing the Minister clarify those points.
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
It is a pleasure to serve under your chairmanship, Sir David, and it has been a pleasure to hear some of the contributions to the debate, which have included measured speeches, as ever, by the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), and the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). However, it disappoints me as much as it does many other hon. Members that we need to be here today. We would all have wanted the issue to be concluded some time ago. I hope that in the next few minutes I can describe why we are in this position and what we plan to do about it.
I will start by discussing something that the hon. Member for Hammersmith (Andy Slaughter) touched on, because I know he wants to leave early. I want to make these comments before he does. We are all here because we are interested in the future of the NHS, but, among various silly outbursts and fits of laughter, he described the speech of my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) as tragic. There is indeed tragedy behind my hon. Friend’s interest in patient safety, and that is that her father died as a result of a failure of patient safety. It is no coincidence that she is here today and that she cares so much about this important issue. It behoves hon. Members, and especially the hon. Gentleman, who is barely able to contain himself on matters of this kind, to pay a little attention to the motivations of Members, on whichever side of the House they sit, and the reasons why they feel strongly about the matter. That includes the Secretary of State, who considers it to be a question of patient safety through and through. A portion of that is about the delivery of seven-day services, but more broadly, to reflect on the wise words of the hon. Member for Central Ayrshire, it is about the fact that tired doctors who work bad rotas are dangerous. That is at the core of our reasons for wanting to change the contract.
It was not just the present Government who decided that it would be right to change the contract. It was the British Medical Association that confirmed, in 2008, that the contract was not fit for purpose, just a few years after the Labour party had introduced it.
Ben Gummer
I will not give way, because I know the hon. Gentleman has to go, and he intervened enough earlier.
Far from a few minor amendments, as the hon. Member for Warrington North (Helen Jones) suggested, a far greater number of changes needed to be made to the contract.
Helen Jones
I am afraid the Minister may be misquoting me. I was giving examples, not suggesting that they were the whole list of things wrong with the contract. When I said there were only a few issues, that was to illustrate that the Government and the BMA are not that far apart in the negotiations. Perhaps the Minister will consider what I actually said.
Ben Gummer
I will, and by way of return I hope that the hon. Lady will consider what the Secretary of State has actually said on a number of occasions, which—I am sure completely unintentionally—she misrepresented at numerous points. The hon. Lady said that the existing contract had moments of imperfection—I cannot remember her exact words. However, it had rather more imperfections than that, which is why the BMA recognised many years ago there was a need for significant change, and why the coalition Government entered into negotiations with the BMA early in 2013. The heads of terms were agreed between early 2013 and July 2013. The negotiations began in October 2013 and broke down a year later, with no notice to the Government. The BMA just walked out, and it took some time to explain why. It claimed, generically, that it was to do with patient safety, which was an odd thing to say given that there were doctors negotiating on the management side who were also concerned about patient safety. The negotiations were not rejoined until we involved ACAS in November last year.
Dr Whitford
When we had a debate about the issue in October, the Secretary of State was reluctant to go to ACAS, yet only when the negotiations went to ACAS was some progress made. The BMA wanted the contract changed to include recognition of quality training. The junior doctors are future consultants and leaders, and at the moment, while they hold multiple pagers and cover rota gaps, they feel that they are getting no training at all.
Ben Gummer
I will come on to the hon. Lady’s sensible points about rota gaps, which have persisted for many years and need to be addressed as a separate issue, and about training. However, the negotiations have been going on for more than two years. There is an idea that the Secretary of State somehow ended them peremptorily, but throughout the period of the negotiations there was a serious attempt to engage with the BMA. Progress was very slow, and the BMA unilaterally broke off the negotiations in October 2014. It did not come back to the table until the offer was made to go to ACAS.
On why the Secretary of State took the stance that he did, I have a different interpretation from the hon. Lady, because I was with him through that whole process. We were very keen to return to negotiations via ACAS, but we needed to ensure that the BMA would give its representatives full negotiating powers.
Ben Gummer
I will in a second; I will just answer this point.
From that point, as many Members have pointed out, considerable progress was made through the negotiations that we had under ACAS from December 2015 to February 2016—far more progress than in the previous negotiating period, partly because the BMA knew that an imposition would have to come if there could be no agreement. As the shadow Minister will understand, at some point an employer needs to move both on issues where there is agreement and on those where there might not be.
The fact that the Secretary of State chose Sir David Dalton to lead negotiations undermines the argument that somehow he was not trying to come to a negotiated settlement. He asked one of the very best chief executives in the NHS to lead the negotiations on his behalf. Even Sir David Dalton was unable to come to a final conclusion of the negotiations with the BMA, because the BMA refused to discuss the last remaining substantive issue—the rates of Saturday pay.
Herein lies the rub: in the heads of terms of the talks it began through ACAS, the BMA had agreed to discuss Saturday pay rates, yet it withdrew that agreement at the end. Sir David Dalton was therefore forced to write to the Secretary of State saying that in his judgment, there was no prospect of agreement on the remaining matters because the BMA was refusing to discuss them. When the Secretary of State or any negotiator has no counterparty with whom to negotiate, it is impossible to negotiate.
Far from the title of the e-petition, which suggests that the Secretary of State has somehow been unwilling, he has been negotiating in good faith all through the period since 2013. It was the BMA, right at the last minute and at previous moments that has refused to do that. I myself have called on it a number of times, both personally and in public, to come back to the negotiating table.
Ben Gummer
I will not, because I know that the hon. Gentleman needs to go. I said that I would give way to the shadow Minister.
Justin Madders
The Minister is correct that considerable progress has been made in negotiations since the start of this year. The consensus seems to be that 90% of the contract was agreed. Does he not agree that it was therefore a great shame that a decision was made to impose the contract when just 10% of the issues were outstanding?
Ben Gummer
It is a great shame that we were unable to discuss those final things with the BMA, but as I have just explained, the BMA did not wish to discuss that final portion, even though it had agreed to do so in the heads of terms that were in front of ACAS at the end of November 2015. It was impossible to have that final discussion. That was not of the Secretary of State’s volition; it was a decision of the BMA’s junior doctors committee.
I turn to the point that my hon. Friend the Member for Morley and Outwood made, which Opposition Members discounted so quickly. At no point has the Secretary of State ever claimed that there is militancy among junior doctors as a whole, nor has he said that the BMA as a body has sought to wind up the dispute. In fact, if he had said that, it would have been entirely wrong. It is, however, true that the junior doctors committee, which is a small portion of the BMA—it is not the whole body, and we have just come to an agreement with the BMA on the general practitioners’ contract—has become radicalised in the past few years.
We know that the committee did not wish to discuss Saturday pay rates, not because of any inherent merit or otherwise in the arguments but because of the tantalisingly close prospect of an agreement with the Secretary of State—one that the committee had been fighting against. We know that that dispute existed, because even when we made a revised offer just after Christmas, the committee refused to discuss it before talking to its members and committing to a strike. There has been an impelling force within the junior doctors committee to take action, which, I am afraid, has disrupted the course of the negotiations and made it far harder to have an open and honest discussion with junior doctors.
We come to the issue of junior doctors being misled. They are very bright people who I know take an interest in the news and in the contract under which they will be working. I have no doubt about that. However, the British Medical Association—a trusted body—has claimed to its members that they are going to have a pay cut of 20% or 30%. Despite the fact that the NHS and we in this House have rejected that claim numerous times, it has been repeated. The hon. Member for Hornsey and Wood Green (Catherine West) repeated it today. That claim is untrue. It was made in the summer, and it is no wonder that BMA members were worried. If I were a junior doctor and someone told me I was going to have a 20% or 30% pay cut and would have to work longer hours, I would be extremely worried, and of course I would be angry. The fact is, however, that the claim was not true. The gravity of that untruth is such that it can still be repeated in this Chamber as if it were true.
Junior doctors, who no doubt informed the hon. Lady—I know she is not willingly misleading the House—still think they are going to have a pay cut of 20%. If we are still in an atmosphere where people believe they are going to have something that they are not, and that they will have to work more hours than they will, it will of course be difficult to come to a resolution until we allow things to calm down. That is why it is important to move to a point where junior doctors have the contract in front of them, so that they can see the effect on their working patterns and see that much of what they have been told is simply not true. We can then, I hope, move to a much better position in individual trusts where we can start discussing the existing problems that the hon. Member for Central Ayrshire mentioned, such as rotas, training schedules and the like.
I will address some of the individual points that hon. Members have made during this interesting debate. Apart from misrepresenting the shape of the negotiations as if somehow the Secretary of State had broken off talks, which he did not, the hon. Member for Warrington North questioned the research that led to the various statements that the Secretary of State and others—many of them clinicians—have made about the so-called weekend effect, or avoidable excess mortality attributable to weekend admissions. I should make absolutely clear where the link is. Almost any clinician in the NHS will recognise that we do not yet have the same consistency of care over the weekends that we do during the week in every hospital or every setting where we need it. We know that, and the hon. Member for Central Ayrshire made a similar point herself.
Our manifesto pledge was translated into the mandate that is reflected in all the contract negotiations that are going on, and it concerns one particular issue—the need to standardise urgent and emergency care—and nothing more. It is not about elective care; I have made that point several times to the hon. Lady. People who are admitted at weekends—including, to some extent, those admitted at the shoulder periods at the end of Fridays and especially on Monday mornings, because of inconsistency of care over the weekends—will then be able to expect the same standard of care, which will contribute to lower mortality rates as part of a wider package to reduce mortality attributable to weekends.
The drive for that comes from clinicians. It comes from the seven days a week forum convened by the Academy of Medical Royal Colleges, which reported at the end of 2012 and gave the Secretary of State and the whole service 10 clinical standards that it believed would help to reduce variation in weekend clinical standards. It is those standards that we seek to bring in across the service. The academy has said that four of them in particular are the most important for reducing variation. They relate to urgent and emergency care, and it is those standards that we seek to fulfil across the service.
Helen Jones
The Minister is once again managing to conflate two things. Everyone accepts the need to improve emergency care at weekends. What is not accepted—this is where the Secretary of State misused the research, and I was questioning his use of it, rather than the research itself—is a causal link between junior doctors’ work patterns and the deaths that occur. That is simply wrong; the research does not show that. In fact, a great deal more research is needed to find out the actual causes of the excess mortality.
Ben Gummer
If the hon. Lady were quoting the Secretary of State correctly, he would indeed be wrong, but he has never made a causal link precisely with junior doctors’ working hours. He has said that it is the working patterns of the NHS as a whole. One of the studies that the hon. Lady quoted in part makes it clear that the purpose of the research study was not to look at answers to the questions that were raised, but it did say that one of the areas that policy makers should look at first is staffing ratios over the weekend.
Let me ask the hon. Lady something. There is general acceptance across the service of a weekend effect. There are varying studies that, under different research scenarios, point to figures of 6,000, 8,000 and 11,000 deaths, and sometimes more—15,000, for example. Does she believe that if the number were 2,000, it would therefore not be right to deal with this problem? Would 500 be an acceptable number of deaths that we should tolerate without seeking to reform contracts? In fact, what price should we put on an avoidable death? Or is she saying that not one single death in the service is related to staffing ratios over the weekend?
Helen Jones
The Minister is once again managing to conflate two different issues. Let me repeat what the researchers said:
“It is not possible to ascertain the extent to which these…deaths may be preventable; to assume that they are avoidable would be rash and misleading.”
That is the researchers’ comment on their own research. Of course, nobody wants to see preventable deaths, but the Secretary of State has tried to use the research to link those deaths to junior doctors’ working patterns. It simply does not prove that. He is wrong.
Ben Gummer
I will happily arrange for the hon. Lady to have a clinical explanation of the various studies that she has cited, because I think she will then understand why the part that she has quoted needs to be understood in context—[Interruption.] I am asking her a direct question: does she—and do other hon. Members, who are tittering about this on the Opposition Benches—really propose that there is no weekend effect? If they are saying that is the case, or if they are saying that there are 500 or 1,000 deaths and that somehow is acceptable and the Secretary of State should not address himself to it, that is a worrying statement of intent.
Ben Gummer
I will not give way to the hon. Member for Warrington North. I give way to the hon. Member for Central Ayrshire.
Dr Whitford
The problem here is about exactly what it is the paper shows. What do any of these papers show? They show a statistical excess of deaths. We know that 25% more of the people are in the sickest category. We know that 15% more of them die on a Sunday. Maybe the NHS did an absolutely amazing job in saving the other 10%. We do not know the answer, so we do not know how many are avoidable. However, I would point out to the Minister, who referred to the standards, that the only mention of junior doctors in the 10 standards is with regard to review of outcome and focus on training. Not one of the 10 standards says there should be a change in how junior doctors work.
Ben Gummer
One of the studies that the hon. Lady cites does a control for acuity, which she has raised. I know that there is an understandable change in the acuity of patients and one of the studies allows for that.
As for the point about the 10 clinical standards—and here I will just move on from the points that the hon. Member for Warrington North was making—
Helen Jones
Before the Minister does, will he give way? He asked me a direct question.
Ben Gummer
I will in a second, but hopefully I will answer the hon. Lady’s point first. She says that I am conflating two things, but I am certainly not; I am saying that there is a recognisable weekend effect. We can have a discussion about the precise numbers involved, but the key answer is that clinicians themselves understand that something needs to be done to reduce variation. I will come to junior doctors in a second, but clinicians themselves have offered the 10 clinical standards, which lie at the base of this. We are not doing anything extra beyond what clinicians are recommending. The four key clinical standards lie at the heart of our changes to urgent and emergency care to ensure consistency of standards, and it is right that one of them relates to the training of junior doctors. The standard at the moment is not as good at the weekend, because they do not have consultant cover, and that is something we are hoping to change. It is also true that the 10 clinical standards refer to senior decision makers, and there is a discussion about precisely who that might be. I will give way to the hon. Lady now, and then we will move on.
Helen Jones
Had the Minister listened to what I said, he would have heard me say that there is a weekend effect, even when the control for acuity is put in, and that more research is needed to find out exactly why that occurs. No one on the Opposition side wants to see preventable deaths in the NHS, but the Minister has to explain why this contract that he wishes to impose is so important in preventing them, when many trusts have already managed to improve weekend working—including Salford—without it.
Ben Gummer
On the issue of the response to the mounting clinical evidence of a weekend effect—I am glad that the hon. Lady recognises it—clinicians have said that we need to reduce variation by changing the clinical standards that we hold clinicians to, and that is what we are seeking to do. That is why all the contracts relating to clinicians are being reformed. It is part of a package. I have made that point in this Chamber many times before, so Members who keep repeating that somehow we are loading everything on to junior doctors are just not listening to the points that the Government are making—that it is part of a piece.
The recommendations of the DDRB—the Review Body on Doctors’ and Dentists’ Remuneration—asked for far more radical changes to Saturday working. We have moderated those in an effort to bring about negotiations and discussions with the British Medical Association, but it has refused to do that.
I will answer one more point that the hon. Lady made in her speech. She said that a point of contention was payments and reward for length of service. I think she was referring to increments. That issue was resolved with the BMA as part of the 90%, so I hope she therefore sees that it is not a substantial part of the argument, despite what she pretended.
The hon. Member for Wirral West (Margaret Greenwood) mentioned issues around psychiatry, which was a legitimate point to make. That is precisely why, as part of the new contract, flexible pay premia will be paid to psychiatrist trainees, so that we can provide an incentive to get more trainees opting for this specialism. It is clear that across the service, there are specialisms that, for decades now, have not recruited the numbers that we would all like to see going in. We have identified three where we think a particular incentive is appropriate, because of the difficulty of going into those specialisms—general practice, emergency medicine and psychiatry. This is one that we proposed. It was disagreed with and then agreed with by the BMA, and we hope, therefore, to address precisely the point that she made in her speech.
Dr Whitford
Will the Minister clarify whether the protection for GP registrars has been re-established? We obviously do not have access to the terms and conditions that have been agreed, because they have not been published. However, one of their concerns was that they had pay protection when they became GP registrars, and that was going to be taken away.
Ben Gummer
All trainees working within legal hours will have pay protection and that includes GP registrars. That was one of the bottom lines of our negotiations all the way through the process and precisely why we are so disappointed that the BMA consistently misrepresented our position.
I have addressed the point the hon. Member for Hornsey and Wood Green raised about the 20% fall in income. She asked me to say expressly whether that is right or wrong. It is wrong. No one will see a fall in their income if they are working the legal hours. Indeed, we think that 75% of doctors will see an increase through the course of this pay contract.
The hon. Lady raised the issue of maternity and cited a doctor who claimed that they were earning £22,600. I would be interested to know the detail of that because the foundation year one minimum pay rate is £23,768, which is slightly above the figure she quoted. She made an entirely valid point about the need to make sure that women especially, but I hope under shared parental arrangements, women and men in the service have the flexibility to be able to take time out of the service to bring up children. That is why the increased base rate of pay is particularly good because it will increase the parental pay, as we should now call maternity pay, under shared parental leave when people take time out to look after children.
The hon. Member for York Central (Rachael Maskell), who is no longer in her seat, talked about guardians, but was factually wrong to claim that there would be no payment to junior doctors. They will be able to get one and a half times their salary as part of the payment fines made to guardians. The guardians will not, as the hon. Lady suggested, just respond to complaints. They will have an overall duty to maintain the wellbeing of junior doctors. Theirs will be a critical position in trusts and I hope it will grow into being a substantial one, making sure juniors have the opportunities for training they wish for and the levels of welfare to which they are entitled.
The hon. Lady spoke about whistleblowing, and her comments concerned me because this is precisely an area where we should be asking juniors to speak up. If working longer hours is dangerous—we all agree with that—like any other patient safety issue, not only should they morally speak up to their guardian, but they are under a duty to do so under GMC guidelines.
Dr Whitford
Does the Minister recognise that if someone is the most junior person in a very hierarchical system, it is difficult and harder for them to complain about something they perceive is being done to them as opposed to something they see concerning a patient?
Ben Gummer
I recognise that speaking up is difficult in the current NHS culture. It is precisely what lies at the heart of Sir Robert Francis’s second report. That is why we need to change that culture. It is also the reason why we said that guardians, in receiving proactive complaints from juniors, should have an overall duty of care for the juniors in their trust and make sure they are treated properly. That is why this is an exciting role. It is a tutorial role in sense with a responsibility, especially for the youngest trainees, to make sure they are in the right place and supported in what can be difficult times.
Dr Whitford
May I ask the Minister again about not having the chance to see the details? One concern of junior doctors is that they would not have a voice or a role within the guardianship. They asked to have a representative as part of that function. Has that changed, or are they still excluded from that?
Ben Gummer
They are not excluded. It is important that that person does not become a BMA nominee, but we want the guardian to make sure they command the respect not only of the junior doctor workforce, but the trust itself. It is important to make sure that person gets that degree of buy-in from both sides, and I hope that the final solution we arrive at will satisfy that.
Catherine West
Does the Minister agree that, traditionally, whistleblowers have not been treated respectfully and that perhaps the current approach of imposing things is not the right step forward in changing the culture?
Ben Gummer
There has been a problem for decades with whistleblowers being listened to. That is what gave rise in part to the tragedy at Mid Staffs and the Secretary of State is trying desperately to do something about it. He cares passionately about it and his recent speech, which the hon. Member for Lewisham East (Heidi Alexander) welcomed, was about trying to create those safe spaces within trusts so that people feel they can speak openly. Indeed, recently at the social partnership forum, which I chair and where we hear contributions from trade unions, I heard of a very effective scheme recently developed in Somerset which showed a good way of getting people of all grades in a trust able to speak up.
I, too, am delighted that the hon. Member for Bristol West (Thangam Debbonaire) has been able to take her seat again. She has come back at an exciting time in politics—one that may be more exciting for her than the last six months. She asked about the funding for seven-day services. All I would say is that within the five-year forward view are two parts that are connected. The first is the commitment to have seven-day services in urgent and emergency care, which is reflected in our mandate for the service, our manifesto pledge at the last election and the request for £8 billion of cash funding connected with the £22 billion of efficiency savings in the service. That is the funding that is being provided to achieve not only that commitment, but everything else in the five-year forward view. Hon. Members have questioned whether that money is sufficient and I point them to the statement by NHS England today in which it was very clear that that is the amount that was asked for and that is the amount that they were glad to get.
The hon. Member for Central Ayrshire spoke about the opt-out, and I want to give clarification for the record to ensure that we are clear about it. In parts of the emergency care pathway, the opt-out has an effective impact and indeed affects part of the urgent care pathway. Ensuring the opt-out is removed is one of the areas we are keen to progress and was the origin of the Secretary of State’s statement, which related to that and not to junior doctors at the beginning of this process. It is important that we do that specifically around urgent and emergency care, and other hospital services, but we have never, ever wanted to extend by the process of our negotiations elective care at weekends. That is not part of our commitment, which has always been squarely about ensuring consistency of standards in urgent and emergency care.
Dr Whitford
I am afraid that I have sat in the House and listened to the Secretary of State talking about having elective services across seven days and how great that would be for patients. Of course it would be great, but we would need thousands more doctors whom we have absolutely no chance of finding. It has not been clear. In Salford Royal today, Sir David Dalton again said one crucial thing is for the Government to define exactly what they mean by seven days. Doctors have not objected to strengthening urgent and emergency care.
Ben Gummer
The hon. Lady, in repeating that, as have other hon. Members, makes it harder for us to state again—she knows I have done so on numerous occasions—that this is to do with urgent and emergency care. It is true that some hospitals—Salford Royal is one—do elective work at weekends. I have no doubt her hospital might do some elective work at weekends. That is part of the trust’s decision-making. It is for the hospital to make that decision. Our key in changing these contracts has been to concentrate on urgent and emergency care. That is the focus of the contract changes.
The hon. Lady also spoke about the tenor of the language that has been used and I know that she cares deeply about this, for understandable reasons. I, too, enormously regret the way this has been portrayed. Although to a lesser degree than the Secretary of State, I have been on the other end of language that one would hope professional doctors would not wish to use.
The whole debate has become intemperate in an extremely unfortunate way, but I have sat through every single speech that the Secretary of State has made on this matter and every single press utterance—I have also made a number myself—and never once has he attacked junior doctors as a body. He has only the utmost respect for them, not least because, like everyone else in this Chamber, he has been the beneficiary of their care. But it is true that they have been let down by their trade union.
I repeat—I know that the Opposition Front Benchers know this—that the BMA has let down its members, because first, it has allowed a series of statements to persist that it knows to be untrue, and secondly, the junior doctors committee has not engaged in meaningful negotiations in the way that it should have done and in the way that other parts of the BMA have been happy to do, and they have concluded better contracts as a result.
That brings me to the points that the shadow Minister, the hon. Member for Ellesmere Port and Neston, made. He asked quite a lot of questions, and I commit to giving a full answer later to the ones that I do not answer today.
The hon. Gentleman asks whether there will be any further steps to avoid industrial action. We will do whatever we can to ensure that junior doctors understand the nature of the contract, and we hope that they will therefore not feel the need to go on strike. We have contended all the way through that that is a needless endangering of patient safety. It is certainly a massive inconvenience to patients, many thousands of whom have now seen their operations cancelled as a result. The contract dispute does not have anything to do with safety, as the BMA itself has implicitly accepted. It is to do with Saturday pay rates. The BMA and its members really have to think about whether they wish to take the dispute about Saturday pay on to the street time and time again.
The hon. Gentleman asked whether there has been a risk assessment on patient safety. We have risk-assessed that at every single stage, and the way in which we have dealt with the industrial action has been concentrated solely on the effect that it has on patient safety, but the best way of ensuring patient safety is for the BMA to cease its unnecessary action.
In relation to an assessment of recruitment and retention, the whole contract has been framed to try to ensure that doctors have a better work-life balance. That is precisely why we have reduced the number of consecutive long days, consecutive long nights and consecutive weekends, and it is why the contract is better for junior doctors and why we hope that it will aid recruitment and retention in the long term. However, we are conscious of the fact that there are ongoing morale issues that go all the way back to 1999 and beyond. In fact, when the previous contract was negotiated, precisely the same points were made about morale as are being made now, so clearly the old contract did not fix those issues. That is why we have asked Professor Dame Sue Bailey to look at wider issues of training and morale in the service as they pertain to junior doctors, to see what else needs to be done to ensure that they are getting the training opportunities that they require, the welfare standards that they expect and the quality of work-life balance that they rightly wish to have.
The hon. Gentleman asked about the BMA’s proposal that it claimed was cost-neutral. Our judgment was that it was not cost-neutral, and given that the BMA was refusing to negotiate on the contract that was on the table and had been worked on for several years, it was rather odd—and, one might think, a political gesture—to throw an entirely new idea on to the table, knowing it not to be cost-neutral. I would say that that was more for effect than to actually try to further the aims with which everyone approached the contract renegotiation.
In short, I am afraid that I reject the premise of the petition, because the Secretary of State has attempted at every stage in the process, over a period of nearly three years, to have meaningful contract negotiations with the BMA. At every point at which contract negotiations have broken down, it has been the instigator of that breakdown, so the petition would better serve itself by being addressed to the junior doctors committee of the British Medical Association, which has broken off meaningful contract negotiations not just once but three times. It is with that committee that the responsibility lies for the failure to find a solution to the final 10% of the contract negotiation, as Sir David Dalton concluded.
Justin Madders
I am grateful to the Minister for giving way; I could tell that he was about to reach a crescendo. He has set out what he intends to do to reduce the temperature and avoid further industrial action. I have to say that I think his response was inadequate, but his central contention was that he hopes to persuade the majority of the BMA’s membership that the new contract is beneficial for them. To that end, can he confirm when the full details will be publicly available?
Ben Gummer
I expect the full details to be available shortly. The Secretary of State is studying, and will continue to study, the draft final terms, together with the equality impact assessment. It is important that when he has studied that assessment, he can make a judgment about whether any changes are necessary. Once that process has concluded, the final offer will be made, and that will be the point at which we proceed with the implementation of the contract. I hope very shortly to be able to give the hon. Gentleman a timetable for that. It is in my interests as well as his to see it happen as soon as possible, and I hope to be able to provide junior doctors with the reassurance that the contract will provide—that this is not the tragedy that they have been led to believe it is.
This has, none the less, been a difficult period for the service and, in particular, for junior doctors, who have been led to have unnecessary worry as a result of a series of misrepresentations by their union. I hope that in the next few weeks and months we can allay their concerns, and I hope that we can then get on with the job that we are all mindful of the need to achieve, which is better quality of care whatever the day of the week, a reduction in avoidable mortality whatever the cause, and an improvement in our national health service.
Helen Jones
Sir David, I apologise for demoting you to the ranks in my opening remarks.
This has been an interesting debate, although I was disappointed by the Minister’s reply. He is normally a very reasonable man, except when he is attributing things to Opposition Members that we have not actually said. His problem is that he is being sent here time after time to defend the indefensible. It is clear that there is a deal to be done, as Opposition Members have said, but there is no movement from the Government to get people back around the table to do that deal. If the contract is so good that it provides a land of milk and honey for junior doctors, as the Minister seems to imply, one wonders why they are not dancing in the street at the prospect of it.
We have heard clearly from Opposition Members about junior doctors’ worry that the contract will lead to excess hours and that they are moving from being part of a team, where they learn and progress properly, to being just another rota of shift workers to be shifted around. We heard from my hon. Friend the Member for Bristol West (Thangam Debbonaire), whose return I too am very glad to see, about her experience in the NHS and the staff who went the extra mile for her, and we have heard about the weekends that people work.
We have also heard some extraordinary attacks from Government Members on a respected profession. I understand that the hon. Member for Morley and Outwood (Andrea Jenkyns) may have suffered a personal tragedy, but that does not in any way justify her attempts to smear all junior doctors as a bunch of militants who are endangering patient safety.