NHS Dentistry

Lord Birt Excerpts

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for raising this and declare my interest as my wife is a dentist, although she is not currently practising. It is accepted that we have made sensible improvements to the dental contract, but a fundamental longer-term overhaul is needed. In terms of the ability to get registered with a dentist, that is what the mobile trucks are all about. We realise that in certain areas it is difficult to get that registration. The idea is for mobile trucks to go into a neighbourhood where there is a particular shortage to resolve the problem.

[Lord Birt (CB)]

My Lords, while working at No. 10 in the early noughties, I was involved in a strategic review of the NHS and was shocked, at the time, to discover how poor the long-term workforce capacity planning was. The total number of dentists currently working in NHS England—around 25,000—has not changed by more than tens or hundreds over the last five years. In that period, more dentists have left than joined. At the same time, fewer than 1,000 dental students have been enrolled each year. Precisely how many dentists do we need to bring NHS capacity in line with demand? In what year, again precisely, will that point be reached?

[Lord Markham (Con)]

The noble Lord is correct in talking about the supply challenges. That is what the long-term workforce plan is all about, and why we are committing to a 40% increase in training places by 2030. The other issue that he rightly raises is the balance between the cost-effectiveness of providing private versus national health dentistry. The problem is that it is often seen as more lucrative for a dentist to go down the private sector route. That is why we are trying to rebalance that and have introduced an increase in the minimum charge to £28 for a unit of dental activity, and £50 for a new patient, to try to bring services back more in favour of the NHS.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Lord Birt Excerpts

Wednesday 15th December 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, as an aside, I begin with a reflection on how this debate illustrates how outdated our political frames and the arrangement of our political furniture are, with the idea that we have two sides of politics. That clearly does not reflect the way our politics is operating now. I must respond to the noble Lord, Lord Dobbs, who asked how many deaths there have been from omicron; he appears to have learned nothing from the past two years about the exponential spread of viruses and the delay between infection, hospitalisation and death.

I caught the No. 29 bus down this morning. I saw, as I have seen pretty well throughout the last two years, the public in advance of where the Government thought they might be. The bus was largely empty. Everyone on it was wearing a mask properly. I was seeking to speak after the noble Lord, Lord Thomas of Gresford, because I wanted to say how honoured I would have been to do so and to express my respect for his presence and speech today. It is an utter rebuttal to the claim of the noble Lord, Lord Robathan, that we are all free to make our own decisions. None of us is free to choose whether or not to breathe. We all have to breathe the air in this Chamber and wherever we go.

That brings me to the first of my two points. We could be debating some very different SIs today, ones based on both the science and a response I had from the noble Lord, Lord Bethell, in July, when he was sitting where the Minister is now. The noble Lord said then that

“ventilation is critical—but it is also challenging.”—[Official Report, 21/7/21; col. 335.]

Instead of these SIs, we could be debating SIs that allowed for an emergency scheme for entertainment premises—concert halls and theatres—to have on the door, as restaurants do for food health, a rating for ventilation. People would be able to choose which venues they went into based on the real measure of risk that they presented. We could see another SI that would have an emergency programme, as the National Education Union has for many months been calling for, of installation in schools of not just carbon dioxide meters but ventilation and filtration systems. We are seeing isolated trials popping up, but not those things.

However, we cannot see emergency SIs such as those because such long-term schemes would take many months to implement. But they are long-term schemes that should have been implemented many months ago. I turn to a British Medical Journal editorial from July, which says that

“workplaces, healthcare facilities and education providers”

must

“pay greater attention to the cleanliness of the air”.

This editorial was written by world-leading microbiologists and engineers.

Over the past two years we have seen a public who have done amazing things, shown an amazing grasp of reality and adapted their behaviour accordingly. Sadly, we have seen a Government which have not lived up to their responsibilities and have been totally focused on one prong of defence—vaccination. I absolutely support and agree with the huge drive for vaccination, like many Members of your Lordships’ House; my booster is booked for next Monday. I am holding out for that and hoping to survive until that point.

I turn to the other SI, on vaccine passports. The noble Baroness, Lady Walmsley, and the noble Lord, Lord Scriven, made some very powerful points about the medical faults in this. I will pick up another concern, which I raised yesterday when we were talking about vaccination for deployment in health and care. If we send a message to people that vaccination is something that we have to force them to do, it risks building resistance and being counterproductive. We want to get to a situation where every person for whom it is medically possible is vaccinated, and has chosen to be. That requires a fairly large ask—trust in the Government—but above all it requires a programme of education and outreach, which we have clearly not seen nearly enough of.

In the other place, the Green MP Caroline Lucas, while expressing great reluctance, voted with those opposing the vaccine passport SI before us. I must admit I feel rather torn at the moment, because I think the SI is dangerous and counterproductive, but I feel extremely uncomfortable with people making different arguments grouped in the same space, so I have not quite decided what to do. But I want to see a Government allowing people to keep themselves safe by taking on what the noble Lord, Lord Bethell, accepted was crucial in July, which is ventilation.

I also pick up the point from the noble Baroness, Lady Hayman, on global scale. No one is safe until everyone is safe. The Government are not doing nearly enough to get vaccines around the world, so we will see more risks. In picking up on how people can keep themselves safe, whatever the Government pass, we will see people not going to entertainment venues and rearranging their lives. That means that people and businesses will need public support, on which I agree with the noble Lord, Lord Blencathra. We also need people to be able to keep other people safe, which means proper and full sickness payments when they have to self-isolate, as they should.

[Lord Birt (CB)]

My Lords, this is overwhelmingly a public health issue and, at heart, not a complex one. We all agree that we should constrain our freedoms only for a good reason. Not drinking and driving at the same time would be a good reason. The good reason here is the overwhelming nature of the scientific advice. I have participated, as have many of your Lordships, in the briefings we have had from all the leading scientists who advise the Government. The airwaves are full of professors who know their stuff and who also advise, and there is a real scientific consensus about the problem we face.

It is simple at heart: this particular variant of the virus is much more transmissible than any variant we have seen before, and the scientists are clear that they do not yet know how severe its symptoms will be. We can all be hopeful; there is some evidence from South Africa that the symptoms are mild, but the scientists tell us not to jump to conclusions, because you cannot easily translate the South African experience to our own. Its population is far younger and has hitherto been much more infected by other forms of the virus. We cannot assume that what has happened in South Africa will happen here.

We have used the word “exponential”; it is a powerful word. It means, as the scientific modelling has demonstrated, that the numbers double every few days. You do not need more than O-level maths to know that, after not many days, you get to a very large number indeed. If the symptoms turn out to be severe, the combination of those large numbers and more severe symptoms would be devastating and the NHS would be overwhelmed. That is why this action is prudential. It is not definitive, but is prudential and entirely justified. I support the Government.

[The Lord Bishop of Leeds]

My Lords, in one sense I hesitate to contribute to this debate, which has been very interesting for lots of reasons. We sit in a Chamber where we contribute to the making of law, which is precisely about the infringement of people’s freedoms—that is what law is—so I struggle with the arguments about freedom. Yesterday or the day before we talked about infringing people’s freedoms regarding the right to protest, for example. I hope to hear the same arguments about the importance of freedom when we get to some of those very restrictive debates.

Health and Care Bill

Lord Birt Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Birt (CB)]

My Lords, I have finally reached the head of the long queue to, like other noble Lords, congratulate the noble Lord, Lord Stevens, on his trailblazer of a maiden speech. As we all know, he has been at the forefront of health reform for decades. He signalled today that he has lost none of his vim and vigour, it has not abated and he will continue his lifetime’s work in your Lordships’ House. We are lucky to have him.

I declare an interest as chair of a company that supplies services to the care sector as well as to other sectors. Like some others, I broadly welcome the Bill and its companion piece—this month’s White Paper on adult social care. Indeed, the White Paper is notably impressive; I have not found myself saying that many times in this House. It is absent of political rhetoric and plainly the result—as has been made clear today—of a long and sensitive consultation both with providers and with those for whom they care. It sets out a truly daunting challenge, making clear the sheer complexity of the conditions that can strike any of us, or our families, at any moment, as well as the sheer scale of current demand. Last year, a fraction under 2 million requests were made for care support. Nearly 850,000 people are currently receiving state-funded long-term care. I make three sets of observations.

First, on front-line integration, I strongly welcome the introduction of the new bodies that will ensure proper integration of the services provided by many categories of public and private suppliers of care at local level; and I welcome the plan that that these new bodies, and local authority providers, will be regulated by the CQC. However, both the Bill and the White Paper are silent on how this integration will be achieved. Almost all large organisations—I have worked in many—struggle with the task of providing a seamless experience for the users of the services they offer, in both the public and the private sector. Which of us has not spent fruitless hours on helplines, passed from pillar to post? How will the integrated care partnerships operate and their success be measured? Will the multiple parties that provide care share a common technology platform? How will user data be shared? Will there be common measures of success? How will good practice be syndicated? That point was made by the noble Baroness, Lady Cavendish. In the last months of my father’s life, the help he received in navigating the multiple parts of the health and care system was well-meaning but chaotic. Will there be a nominated personal navigator for those with complex care needs to help them steer the best path through?

Secondly—many have raised this point—the workforce in adult social care is of a staggering size. Currently, 1.7 million people work in the sector. The White Paper fully recognises the contribution made by those who work in care, but does it go far enough? Do we not need to celebrate the increasing skills now needed in the social care sector? Do we not need a clear career progression with a status and a hierarchy something akin to those deservedly enjoyed by those who nurse? When I worked in government, I was struck—very much like the noble Baroness, Lady Harding—by how poor workforce planning had been in the health system. The elephant in the room is that, plainly, the Treasury bears considerable responsibility for that. There are already chronic worker shortages in care. In the next 20 years, the number of over-85s is projected to increase by nearly 1 million. Like many of your Lordships, I am hoping that I will be among their number. The forecast is that, by 2035, we will need one-third more care workers than we employ now. We will need to transform our approach to strategic workforce planning to bring that about. Will the Government do that?

Thirdly, on the social care contribution cap—which, again, many have mentioned—I recognise that the Government’s new proposal is an improvement on the old, but it has an utterly disproportionate impact on those with little wealth. I urge the Government to think again, to design a scheme where everyone with assets makes a contribution to their care costs, but which is progressive, where those of greater means assume a greater burden.

Overall, though, I welcome the Bill, and the social care White Paper, as real steps forward.

Social Care in England

Lord Birt Excerpts

Thursday 14th October 2021 Lords Chamber

[Lord Birt (CB)]

My Lords, I declare an interest as the chair of a company, listed in the register, that supplies services to the care and other sectors.

The real cost of care is of the order of £700 to £900 per person per week, yet some local authorities pay as little as £500 a week and the average appears to be around £600, well below the cost of providing the service. This is a truly shameful way for the public sector to treat business suppliers. Half of our 12,000 care homes have fewer than 40 beds, and many are SMEs. Around 3,000 are significantly undercapitalised and lack en suite or wet room provision. All face significant problems over pay and recruitment. Prices for care will need to rise, not fall. I hope I have this figure right, but I say from memory to the noble Lord, Lord Sikka, that only 13% of care homes are owned by the major corporations he focused his remarks on. Many are much smaller businesses and struggle.

Will the Minister assure us that paying suppliers less than the cost of provision will end once new funding comes on stream? There has been much debate about funding and far too little about our failure to meet the significant organisational challenges of ensuring a humane and seamless experience for individuals in the last years of their lives. I expect that many of us in this Chamber have seen through our families just how chaotic, unsatisfactory and distressing this experience can be. I echo the noble Lords, Lord Astor and Lord Bichard: surely “holistic” is the critical word.

I hope the Government will create a framework of governance and regulation to ensure that the principal players—and there are many: hospitals, GPs, local authorities, social workers, district nurses and hospices—work together collaboratively with appropriate processes, common systems and performance measurement to capture and share best practice and to identify under-performance. I suspect this can happen only if the Government set an ambitious expectation and, further, if they create some new independent leadership at local level to foster collaboration and sufficient funding to ensure effective administrative oversight. Will the Government set out a plan for transforming the effectiveness of how care is delivered as well as how it will be funded?

--- Later in debate ---

[Lord Kamall (Con)]

Thank you. Noble Lords will have to forgive the new boy. Now someone is saying I have two minutes—there we are.

There are many questions I wanted to go through in detail, so I hope noble Lords will accept my apologies for being too verbose in many ways and not answering the detailed issues. I will write to noble Lords on any particular points. Clearly, I do not have a realistic estimate of my speaking time—let us put it that way.

Once again, I thank the noble Baroness, Lady Pitkeathley—

[Lord Birt (CB)]

The Minister has, understandably, focused largely on the funding issues. However, does he accept that unless there is fundamental organisational reform at the front line, we will not continue, whatever the level of funding, to deliver services in the most appropriate way?

[Lord Kamall (Con)]

I thank the noble Lord, Lord Birt, for his question. Yes, I agree.

The Government have provided support to our fantastic social care sector; many will debate whether it is enough and what more can be done, and we recognise that. However, we want to continue to address the many challenges. We will work with stakeholders on the plans for reform that we have set out, publishing more details in a White Paper later this year, when I hope we will have more discussions and debates.

I have spoken far too slowly but, finally, I know that we are all deeply committed to supporting the social care sector. I think we would all want to join together, whatever our views on various parts of the debate, in thanking all the amazing people on the front line providing care, who go the extra mile each day, week, month and year, some for those they love and others because it is a noble profession. As we have an ageing population, it is important that we tackle this issue, which has, as I say, been kicked down the road for many generations. Not all proposals will be perfect and any proposal will of course have its critics —that is the nature of political debate. However, I hope very much that in producing the proposals—and producing something rather more than a blank sheet of paper—that we can all debate, I will learn from the expertise and the points made in today’s debate from across the House to make the forthcoming Bill a more successful and more appropriate Bill that recognises the hard work and dedication of all care workers, whether paid or unpaid.

Covid-19: Obesity

Lord Birt Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

I do agree with my noble friend that the answer to this issue is sustained action. This is not something where snazzy initiatives are going to have the necessary impact. But the key to our efforts is creating cross-governmental co-ordination—that very difficult thing to achieve. We are working extremely hard with other departments, particularly with DCMS and DCLG, in order to address the kind of housing, cultural, advertising and nutritional issues at the heart of this problem.

[Lord Birt (CB) [V]]

My Lords, the UK has among the highest rates of obesity in the whole world— 28% compared with the benchmark, Japan, at 4%. We know, however, that payback on public health investment is high—witness our historic success with cigarettes, safety belts and AIDS. All of us are painfully aware of how difficult it is to control our weight, but does the Minister not agree that we need a massive and truly transformative programme of public health and education to reverse this deadly trend?

[Lord Bethell (Con)]

As the noble Lord rightly points out, the cost is enormous: £27 billion is the estimated cost to society, and 64% of people are classified as overweight. The challenge is enormous. We have to strike the right balance between government action and personal agency. The noble Lord is right that the return on investment is huge, but the Government cannot lose weight for people on their behalf. No amount of government initiative will shed the pounds. We have to get people to change their behaviours. We are trying to understand what the right measures are to give people the inspiration and information they need to take the right steps.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020

Lord Birt Excerpts

Tuesday 1st December 2020 Lords Chamber

[Lord Birt (CB) [V]]

My Lords, I support the regulations. We understand well that neither this Government nor their predecessors prepared adequately for a pandemic of this nature, and initially the Government responded to the threat in slow motion. The result is one of the world’s highest death rates. However, I shall be more generous than others. In the last month or so, there has been a surer touch, with less bombast, more measured decision-making and a sense, at last, that the many cogs of the public sector—public health, local authorities, the Armed Forces and the NHS—are now finally meshing. As one who has been responsible for many challenging projects in the course of my career in both the public and private sectors, I do not underestimate this achievement.

There are those who bridle at the constraints that the Government impose on their freedom, like the man I encountered last Friday evening, who joined me in an orderly, rules-compliant takeaway queue and stood two feet away from me, breathing squarely in my face, defiantly maskless. To him and others like him, I say that we all value our freedom and, thankfully, we live in a country that over centuries fought for it and won it, but we also agree to constrain our freedoms when their exercise harms others.

The maskless man threatened my health. We do not allow cars to drive fast in pedestrian areas, we constrain freedom of expression with libel laws and we do not allow people into crowded pubs with loaded guns—and, for some, this virus can be as deadly as any gun. If you are over 75 and catch Covid, you have a one in 10 chance of dying: not great odds.

Infection rates have increased again since the summer because insufficient people have observed the rules. Swale in Kent is an area marked by lovely countryside, picturesque villages and handsome market towns, yet in November it had the second-highest infection rate in England, with 565 cases per 100,000—more than one in 20 of its population. The council’s leader, understandably, bemoaned that the rules in Swale were being “wilfully disregarded”.

The Prime Minister has acknowledged—I applaud his bluntness—that pre-lockdown tiers 1 and 2 failed to reverse the pace of growth of the virus and that even tier 3 did not succeed in reducing cases in all areas. So we must, with relief, welcome the fact that this second lockdown has put a foot on the brake and that across the country the R rate is probably now below one. But beware, my Lords: the ONS estimates that something close to 650,000 people currently have the virus, and they will not all be self-isolating.

I well understand why the Prime Minister did not want to be the Grinch that stole Christmas, but we will surely pay a price for this relaxation of holiday rules, for most certainly the virus itself will not observe a Christmas truce. Public Health England has warned that subsequently we will need five days of belt tightening for each day of Christmas loosening.

My parents lived through the Second World War—my father in the RAF, my mother working in a Liverpool Docklands canteen, bombed out of her home four times. But my mum and dad never complained. Like almost all their generation, they were stoics. With vaccines now in clear sight, we need to rekindle some of that wartime stoicism. Let us be tolerant of the inevitable anomalies created by blanket rules, and let us accept that, until a vaccine kicks in, we can surely endure a period of limited social interaction, for that short-term sacrifice will mean fewer victims of Covid, fewer deaths and fewer threats to the NHS.

If we can keep the lid on the pandemic until the vaccines ride to the rescue, more of the economy can continue to function, as we see in Asian countries. Those parts of the economy adversely affected by limiting social interaction, such as hospitality, deserve, and should receive, adequate and sufficient support to enable them to bounce back once the new normal returns, which it will.

Let us give thanks in this debate for the brilliance of our and the world’s scientists. Let us hold our nerve. There is every reason to be hopeful.

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Lord Birt Excerpts

Wednesday 4th November 2020 Lords Chamber

[Lord Birt (CB) [V]]

My Lords, all the trade-offs that the Government have to make during this pandemic are unwelcome: trade-offs between our health, our prosperity, our freedom, our future and our happiness. We would all like to maintain them all, but the rise in numbers makes a lockdown unavoidable. Noble Lords should watch Fergus Walsh’s measured and harrowing report on Monday’s “BBC News at Ten”, from the Royal Liverpool Hospital in my home city, if they need human citation to bring the stats to life.

On the eve of our second lockdown in England, however, I ask the Minister what will come after. We all pray that new vaccines and improving treatments will gradually restore normality, but what if they do not? Is there active contingency planning in government on pessimistic, as well as optimistic, assumptions for the moment when this second lockdown is lifted? How can we avoid turning a new period of relative freedom into a third wave where—in the nightmare scenario—we tumble on in this way for years, always fearing the grim reaper at the door or in the supermarket queue, while becoming significantly poorer and ever more disunited in the process?

I hope that the Government are investigating in careful detail exactly what went wrong when the first lockdown was lifted. What were the primary drivers of rising infection? Who obeyed and who ignored the guidance, whether in workplaces, social or family settings? Did those reached by test and trace quarantine when asked to? Which sanctions worked and which failed to bite? Next time, how can we better persuade every section of society that the Government do not give you the virus but other people do; and that, absent a vaccine, we have no hope of achieving a modicum of normality until we stop transmitting this dread virus to one another? In conclusion, are the Government preparing now to ensure that this will be not just our second but our last lockdown?

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Lord Birt Excerpts

Wednesday 14th October 2020 Lords Chamber

[Lord Birt (CB) [V]]

My Lords, the Government’s enormously challenging task is to balance competing public goods: our health, our wealth, our future and our happiness, which comes from social interaction with friends, colleagues and loved ones. In a pandemic, though, if you focus hard on any one you risk all the rest. The least damaging, and most beneficial, action would surely be for us all to take heed of the rules on intermingling, and of the “hands, face, space” mantra, in every aspect of our lives. However, many do not. Every speaker in this debate could cite multiple examples from their day-to-day lives of the widespread and flagrant disregarding of Covid guidance. Are we doing enough to persuade, not with earnest homilies from the Dispatch Box but with a drive on mass media, using the best creative minds and targeting every part of the community? We succeeded with seat belts and smoking; why not with masks?

Secondly, are we doing enough to dissuade? Do we not now need to focus on tighter enforcement, underpinned by sanctions? We press down on speeding and unlawful parking; why not on oversized groups, social distancing and the wearing of masks? Attacking the root behavioural causes of the spread of the virus is surely the most painless way of halting the drift towards more and more areas of the country joining my home city in tier 3.

Coronavirus

Lord Birt Excerpts

Monday 3rd February 2020 Lords Chamber

[Lord Birt (CB)]

My Lords, the Minister said that we were well prepared for this outbreak, but quite honestly it does not altogether appear so. We saw reports in the media of the first flights arriving from Wuhan. The passengers reported that there was no medical intervention and no advice offered of the kind that is in the Minister’s Statement. We are now asking people who have arrived in the last 14 days to contact the NHS immediately to inform them of recent travel, to stay indoors and to avoid contact. That advice was not offered to the first people who arrived. The delayed FCO chartered flight this week has quarantined people for 14 days, as we all know. These actions appear inconsistent. Can the Minister assure us that they are consistent and that there is some coherence and rationale behind them? There does not appear to be.

[Baroness Blackwood of North Oxford]

There is indeed. The first Urgent Question I replied to a few days ago was when we introduced the enhanced monitoring on planes, meeting each flight coming into Heathrow from Wuhan; they come in three times a week. That information and advice was given to individuals on those flights and public health officials met them from that day. If individuals came in before that day, they would not have received advice; contact tracing has been under way for those people. Subsequently, British nationals wishing to return home have been in contact with the Foreign Office and flights have been arranged to bring them home. I think that is the flight which the noble Lord is referring to. As a precautionary measure, quarantine has been arranged for those individuals for 14 days, to ensure that we manage any potential risk as effectively as possible. This is based on the advice of the Chief Medical Officer, from the data which has subsequently become available, since evidence is evolving regarding the risks associated with the Wuhan coronavirus.

Junior Doctors: Industrial Action

Lord Birt Excerpts

Monday 25th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, first, the need for a seven-day service has been recognised by the medical profession for a number of years. I remember reading the Future Hospital report four or five years ago in which the Royal College of Physicians talked about a seven-day service. Of course, it was the academy of the royal colleges that produced the 10 clinical standards that underpin a seven-day service. The issue is not whether or not there should be a seven-day service; the more serious issue that has been raised is whether we have the resources to deliver a seven-day service. We argue that we are putting enough resources into the NHS to do that. So I think that the principle of a seven-day service, certainly for urgent and emergency care, if not for elective care, is well accepted by the medical profession.

Interestingly, on the point about the number of people leaving—the resignations that the noble Lord referred to—I was pretty horrified to hear about the son of someone on the noble Lord’s Benches who had left the NHS to go to work in America two years ago, I think. He described a pretty torrid time working in the NHS as a junior doctor. To cap it all, when he went, there was no exit interview. No one was really concerned or knew that he had gone. That is just another illustration of the fact that we have not sufficiently respected or valued junior doctors in the NHS.

[Lord Birt (CB)]

My Lords, I wholly support the Government’s objective of seven-day working in every part, eventually, of the health service. However, I observe that the Government are trying to achieve these objectives, as the noble Lord, Lord Hunt, has just said, in a very economically adverse climate where health spend per head is in decline, in a country where the population is expanding very rapidly, and where we see significant bottlenecks right across the system. All of us can see how important junior doctors are to the system. I do not know how many of your Lordships saw the excellent BBC series on junior doctors a year or so ago set at the Royal Liverpool Hospital, in which their importance to the system and dedication was simply remarkable. We would all, I am sure, stand behind that. They should not be threatening to withdraw their labour, but it is amazing that a group of such dedicated workers can even consider doing such an inappropriate thing—they are not natural strikers. The question I put to the Minister is this: as I said, the Government’s objective is correct, but should they not move towards it with greater stealth in the context of moving towards a health service that is again appropriately funded?

[Lord Prior of Brampton]

My Lords, I echo the sentiments of the noble Lord. I recognise the vocational commitment of junior doctors and that they are not natural strikers. It is a tragedy that we have got into this situation. There are no winners in this dispute and only one absolutely clear loser: the thousands of patients who are now suffering. The noble Lord asked whether we could have got here with greater stealth. These discussions have been going on for three years. We have had one independent review done by the DDRB and a number of independent assessments of the impact on mortality of not working at weekends. The Government are putting £10 billion of new money into the health service over the next five years, which was asked for by the NHS. In the NHS there will always be a lack of resources: demand will always exceed supply in a system where there is no price mechanism. That is an issue that all Ministers have lived with in the NHS since 1948. However, I echo his views: it is tragic that we find ourselves in this position with junior doctors. They are not natural strikers.