Junior Doctors’ Contracts

Andrew Murrison Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

As I have already said, there is absolutely no clarity. The hon. Gentleman might do well to read the article that appeared in The Guardian on 4 October, written by the former Health Minister, who quite clearly states that he has concerns about the fact that the new contract might be used as a lever to find some of the £22 billion of efficiency savings that the NHS needs to find over the next few years.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Will the hon. Lady give way?

[Heidi Alexander]

I will not give way, as I am going to make some progress.

Junior doctors are not just the first-year trainees fresh out of medical school. They are also the senior house officers and registrars with 12 or 15 years of experience. Junior doctors account for almost half of all doctors in hospitals and the vast majority already work nights and weekends. The responsibilities they carry are huge. Take the junior paediatric doctor working in accident and emergency who emailed me last week. Some of the things she does, I could never ever do. In her email, she said:

“I am in charge of teams resuscitating dying children regularly. I have had to make the decision to stop resuscitating a dying child. I have had to tell parents that their child is going to die. I have been the only doctor trying to stick a tiny breathing tube into a baby born 16 weeks early and weighing 600g at 3 in the morning.”

How is it right that she should face the prospect of being paid less? She is not asking to be paid more. She is just asking to be paid the same and to keep the safeguards that prevent her from being stretched even further.

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[Heidi Alexander]

I am grateful to my hon. Friend. He makes a very valid point about the impact on recruitment and retention of doctors in the capital.

[Dr Murrison]

rose—

[Heidi Alexander]

Tired doctors make mistakes. It is obvious but it is true. Nobody wants to return to the bad old days of junior doctors too exhausted to provide safe patient care. It is bad for doctors, it is bad for patients and it is bad for the NHS. So why are this Government hellbent on forcing through these unsafe changes?

The Secretary of State claims that the changes are about making it easier for hospitals to ensure that the staff needed to provide safe care at the weekends and on nights are available. Is he saying that there are not enough junior doctors on hospital wards and in A&E departments at these times currently? If so, how many more junior doctors would be present at these times as a percentage increase on current staffing levels if the new contract goes through? If the changes are about increasing the cover at weekends and nights, surely it means less cover at other times of the week unless he finds more money for more doctors.

I understand the arguments for increasing consultant cover at weekends and nights. I understand it is vital that patients who are admitted on a Sunday get to see a consultant as quickly as those admitted on a Tuesday, and I am pleased that the BMA’s consultants committee is negotiating with the Government on improving levels of consultant cover. Indeed, everyone in the NHS supports the principle of seven-day services. But this debate is about junior doctors. Junior doctors are already working evenings and weekends. So why has the Health Secretary tried to make this a row about seven-day services?

Let me quote some of the claims that the Secretary of State has made in recent weeks. In response to a question on the junior doctor contract from my hon. Friend the Member for Wirral South (Alison McGovern), he said:

“someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week.”

In response to a question that I asked him about junior doctors, the Secretary of State said that the overtime rates that are paid at weekends

“give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths.”

He went on to say:

“there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 150-1.]

The authors of the research that the Secretary of State has been quoting said that it would be “rash and misleading” to claim that the deaths were all avoidable. Yet the Health Secretary has got dangerously close to doing just that. Indeed, he has gone so far down that route that some people do not think that our hospitals are properly staffed at the weekend. I know of elderly patients delaying their visit to hospital because they do not think that there will be enough doctors there. That leads to more complicated treatment, longer patient recovery time, people’s lives being put in danger and a bigger bill for the NHS to cap it all off. That is appalling. Don’t get me wrong: I am as committed as anyone to high-quality care, available 24/7, 365 days a year, but the Secretary of State needs to be careful with his words. He should look in the mirror and ask himself whether his soundbites are true to the conclusions of the study he references.

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[Mike Freer (Finchley and Golders Green) (Con)]

Finchley and Golders Green is served by Barnet general hospital and the Royal Free hospital, which is just across the border in the constituency of the hon. Member for Hampstead and Kilburn (Tulip Siddiq). In particular, the Royal Free is the largest hospital serving my constituency, and it is one of the largest and safest acute hospitals in London. It has the high security infectious diseases unit, which has recently been in the news for treating Ebola, and it is a major centre for research into immunology and transplants. Not surprisingly, it is a major teaching hospital.

Many junior doctors who live in my constituency have contacted me and despite my best efforts, using the information provided by NHS employers and the Department of Health’s online pay model, they continue to be confused and believe that their pay will be cut. I have no doubt that the selective information from the BMA has not helped. I welcome the reforms in principle and the commitment to introduce a new absolute limit on the number of extra hours that junior doctors can work. Bringing an end to the week of nights and capping the extra hours are welcome, but most junior doctors in my constituency are simply not aware that that is what we propose.

In fact, most of the junior doctors that I have seen believe that the reforms will increase their working week, leading to more fatigue and therefore jeopardising, not improving, patient safety. They believe that this will hamper the Secretary of State’s quite-right drive to improve weekend mortality rates. I say to my colleagues in the Department of Health that something is going wrong in the communication of this welcome reform.

Let me turn now to a couple of issues that have been raised by junior doctors and that echo some of the concerns mentioned by the hon. Member for Central Ayrshire (Dr Whitford). On retention, the Royal Free is a major centre for research and yet Dr Renee Hoenkampf, who wrote to me, is concerned that those doctors who seek to go into research and to step away from the frontline will be penalised by being held back on their progression pay. Those doctors who choose to have a career break to raise a family will also be penalised. Both those concerns will impact on women more than on men.

[Dr Murrison]

On that point, the BMA is making a case for current increments on the basis of experience gained. A career break will probably mean that there will not be any experience accrued. Does he therefore agree that the BMA needs to get its logic right?

[Mike Freer]

My hon. Friend is right that just getting pay progression for time served is not the right thing to do, and most organisations have scrapped it. However, we must avoid accidental penalties acting as a disincentive for women joining the workforce. We should not encourage this idea that women, or any person, should be penalised for taking career breaks or for stepping away from the frontline by taking part in valuable research. I gently ask the Minister to look again at that matter.

When I met Dr Joseph Machta, a junior doctor in paediatrics, he said that, after consulting the Department of Health’s pay model, his pay would reduce by 15%. Like many junior doctors living in my patch—it is not a cheap part of London—he was concerned that he would no longer be able to pay his mortgage. Will the Minister look into that matter? I suspect that London’s junior doctors rely more than most on premium payments. While average pay across the UK may be neutral under the compensatory increase in basic pay, that may not be true in London. I would be interested to hear whether the Department of Health has done an impact assessment on London’s junior doctors and the amount of premium pay that takes up the wage bill in London hospitals. If many junior doctors in London are over reliant on premium payments to pay their bills—that may be a wrong thing to do because they are working too many hours, but that is a different issue—it is a matter that needs to be considered.

It is not unusual to want to have contract terms changed to meet current needs. On that basis, I support the reforms, but I ask the Minister to look into those two issues that I specifically raised.

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[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a doctor, and a veteran of truly awful rotas of the 1980s, involving one in two very often—that is every other weekend, every other night on duty, as well as a normal working day, which I would not recommend to either patients or practitioners. Thankfully, they are a thing of the past.

I welcome very much the Health Secretary’s statement today and the guarantees that he has given. On that basis, I am more than happy to support the Government this evening. However, I would say that we need to insist on evidence-based policy making. It is important to understand the difference between a causal effect and an association. My worry is that perhaps the Front Bench has been more influenced by Euclidean theorem than a proper understanding of statistics. My reading of the Freemantle paper and Professor Sutton’s remarks lead me to conclude that no causal link has been established between doctors’ rostering and excess weekend deaths. If we are serious about reducing weekend deaths, and reducing the difference in health outcomes between this country and countries with which we could reasonably be compared, which I know that my colleagues on the Front Bench are, we need to properly understand what are the drivers of those differences, and I do not think that junior doctors’ hours are a principal driver in the problem that we are trying to address today.

I think it is also right to appreciate that we are heavily dependent on the good will of all doctors—consultant grades and junior doctors. Most doctors that I know work well beyond their contracted hours—I know I certainly used to when I was in hospital medicine—and in dealing with them and in communicating with them, we need to keep that in mind and not take that good will for granted.

I very much regret the BMA action, and I very much regret the ballot on 5 November on strike action. The last time such action was taken was in 2012 on, ironically, the subject of pensions. It ended ignominiously and the only outcome was a reduction in the esteem in which the public held the medical profession. I would urge the BMA, armed with the assurances we have had today, to think again. I say “ironically” because, of course, the proposals, as I understand them to be, would increase core hours, which are pensionable—out-of-hours are not—and I have yet to see the BMA make any comment on that, or indeed reflect it in its pay calculator. Maybe a belated understanding of that has meant that it has chosen to take it down.

In trying to reduce weekend deaths and in trying to reduce that gap between our health outcomes in this country and those in the rest of Europe, we need to be focused much more broadly than on junior doctors’ hours. I know the Health Secretary is trying to work out how we can best configure the health service of the future. It is a dynamic thing; it never is fixed in one place. In my opinion, part of that means looking at our NHS estate all the time to make sure that we are getting the best from our assets. In my opinion, it means concentrating our specialist services in larger, regional and sub-regional centres. Those centres find it much easier to roster junior doctors and to concentrate expertise in one place. I am talking about stroke, heart attack and upper gastrointestinal bleeding—all things where we do less well in this country than in countries with which we should be comparable.

[John Glen (Salisbury) (Con)]

I am grateful to my hon. Friend and parliamentary neighbour for giving way. Does he agree that in the rural communities in south Wiltshire that we both represent, there does need to be a certain minimum proximity in order for patients to be able to access their hospital with confidence?

[Dr Murrison]

I agree with that, which is where networks come into our national health service, and making sure that we have specialist centres that can deliver the right outcomes for people, and that there are protocols to ensure that ambulance services take people to the right place at the right time, so that they can receive the treatment they need. What we cannot do is continue with the current situation, in which our constituents can expect lower life expectancy and health in later life than, say, French or German patients. That is not sustainable and it is not right. It means looking again at how we configure our national health service. It may mean some difficult decisions in some parts of our NHS, but that should not be a barrier to making sure that we do it right.

What I would say to my right hon. and hon. Friends on the Front Bench is that this is not really about junior doctors; this is about consultant grades, who deliver the therapeutics and diagnostics in relation to upper GI bleeds, heart attacks and strokes. They are now, in our new NHS of the 21st century, at the coalface of delivery in a way that they previously were not. So, if I may say so, I would like a greater focus on consultant grades, perhaps at the expense of some of our junior doctors who are the principal subject of our debate today.

[Several hon. Members rose—]