Junior Doctors’ Contracts

Andy Slaughter Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

The problem with how the Government have handled the negotiations is that they have provided absolutely no clarity to junior doctors about what the proposals would mean for them individually. Everyone thinks that they are going to lose out.

The Government say that they want to reduce the number of hours defined as “unsocial” and thereby decrease the number of hours that attract a higher rate of pay. They say that they will put the rate of pay for plain time up to compensate, but there is no guarantee that the amount by which basic pay goes up will offset the loss of pay associated with fewer hours being defined as unsocial. Does the Secretary of State understand that those who work the most unsociable hours, the junior doctors who sacrifice more of their weekends and nights, feel that they have the most to lose?

[Andy Slaughter (Hammersmith) (Lab)]

That is exactly the point, and I am glad that my hon. Friend is exposing the misleading comments of the Government, who are defending the indefensible. It is exactly those doctors—in maternity, in paediatrics, in emergency medicine—who will lose out the most and will see their pay cut by up to a third.

[Heidi Alexander]

My hon. Friend is right. His concern is shared by the President of the Royal College of Emergency Medicine, along with 14 other leaders of medical royal colleges and faculties, who point out that as currently proposed, the new contract would

“act as a disincentive to recruitment in posts that involve substantial evening and weekend shifts, as well as diminishing the morale of those doctors already working in challenging conditions.”

It cannot possibly be right.

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[Dr Whitford]

I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.

[Andy Slaughter]

I am grateful to the hon. Lady for busting this myth about weekend death rates—these might be sick people admitted at weekends who die within the 30 days. In fact, fewer people die in hospitals on Saturdays and Sundays than on other days. The Secretary of State is not giving the right impression of the figures.

[Dr Whitford]

I agree.

Since coming here, I have heard stories of people unable to access diagnostic imaging or to work up patients, but there is no argument about that from the profession. That is what we need to focus on, yet a lot of this seems to be about routine. There are fewer doctors at weekends because we do not do routine work. We have teams of people doing toenail and blood pressure clinics in the week. Professor Jane Dacre estimates that doing those at weekends would require 40% more doctors. We cannot do that. We need to make sure that hospitals at weekends have enough people and the right people to be secure, but junior doctors are already there—it is not they who are missing—and emergency services already have a consultant on call. We might need more discussion about their being physically in, but that is a discussion to have with the profession, whereas what we heard on 16 July, which gave the public the impression that senior doctors only worked 9 to 5, Monday to Friday, was very hurtful to the entire profession.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a comprehensive and powerful debate, with 23 speakers and many more Members who would have liked to contribute if we had had more time. I would particularly like to thank my right hon. Friend the Member for Oxford East (Mr Smith), my hon. Friend the Member for West Ham (Lyn Brown), my right hon. Friend the Member for Enfield North (Joan Ryan), my hon. Friends the Members for Wakefield (Mary Creagh), for St Helens South and Whiston (Marie Rimmer), for Workington (Sue Hayman), for Bolton South East (Yasmin Qureshi), for Easington (Grahame M. Morris) and for Ealing Central and Acton (Dr Huq); the hon. Member for Central Ayrshire (Dr Whitford), the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Strangford (Jim Shannon); and the hon. Members for Totnes (Dr Wollaston), for Bristol North West (Charlotte Leslie), for Finchley and Golders Green (Mike Freer), for South West Wiltshire (Dr Murrison), for Blackpool North and Cleveleys (Paul Maynard), for Morecambe and Lunesdale (David Morris), for Vale of Clwyd (Dr Davies), for Sherwood (Mark Spencer), for Erewash (Maggie Throup), for Boston and Skegness (Matt Warman) and for Morley and Outwood (Andrea Jenkyns).

Members of all parties have spoken with great passion and praise for our junior doctors, who work tirelessly to deliver good quality services—despite the challenges they face in an NHS that is increasingly under pressure and under strain.

[Andy Slaughter]

rose—

[Andrew Gwynne]

I do not have time to give way, I am afraid.

I echo those sentiments of sincere thanks, but we have heard of junior doctors who already work weekends, already work nights, already work holidays and give their all for their patients. Despite all this, the junior doctors now face a situation that has left them feeling deflated, demoralised and devalued.

Patient safety has been a key theme of today’s debate. Some Members have valiantly leapt to the Health Secretary’s defence, but those voices have been far outnumbered by Members who are deeply concerned that this contract is unsafe for doctors and unsafe for patients.

Members have argued that the removal of the financial penalties that apply to hospitals that force junior doctors to work unsafe hours risks taking us back to the bad old days of overworked doctors, too exhausted to deliver safe care. The BMA says this safeguard, which is built into the current contract, has played an important role in bringing dangerous working hours down. Removing this financial disincentive to overworked junior doctors is extremely alarming, especially at a time when junior doctors are already coming under an enormous amount of pressure and strain. If the Health Secretary would just listen, he would hear junior doctors shouting loudly and clearly that they cannot give any more.

Many Members highlighted the protests and marches that have taken place throughout the country in recent weeks. We had only to catch a glimpse of the placards that were waved as thousands of junior doctors marched against the contract to understand that those doctors now fear for their own health and well-being. I was struck by one banner which read, “I could be your doctor tomorrow, or I could be the patient”, and those doctors’ concerns have been echoed by many Members today. How can the Secretary of State possibly say that he is acting in the interests of patient safety if the very people who work in the NHS say he is putting safety at risk?

Another argument that has been advanced today is that the contract is necessary to ensure that our NHS works seven days a week. Not only does that argument do a huge disservice to our NHS staff who already provide care seven days a week and 24 hours a day, and reveal just how out of touch some Conservative Members are with the realities of working on the frontline in our NHS, but it is wholly inaccurate. If this junior doctor contract were imposed in its current form, it would have the opposite effect, as many independent clinical voices have warned.

It is a bitter irony that the problems that the new junior doctor contract was supposed to be trying to address when it was originally proposed back in 2012—the need to introduce better pay and work-life balance—are the very problems that will be made worse should the contract go ahead in its current form. In letters to the Secretary of State, the presidents of a number of royal colleges and faculties have made it very clear that they share those concerns, but he presumably thinks that they too have been misled.

The Secretary of State said that he did not intend to cut the pay of any junior doctor, but his sums simply do not add up, and everyone can see through the spin. No one with a GCSE in maths can believe that no doctor will be worse off as a result of the new contract. Let the right hon. Gentleman come to the Dispatch Box in the minute that I have left, and answer this question. To what percentage of junior doctors currently working within the legal limits will what the Secretary of State has said today apply? Is it 50%? Less than a quarter? What is it?