BMA (Contract Negotiations)

Andy Slaughter Excerpts

Monday 21st March 2016 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

Thank you, Mr Amess. It is a great pleasure to serve under your chairmanship. I beg to move,

That this House has considered e-petition 121262 relating to contract negotiations with the BMA.

This is one of a number of petitions on the website about the junior doctors’ dispute, including the perennial favourite “Consider a vote of No Confidence in Jeremy Hunt”. We have chosen this one for debate because it was begun after the Government’s decision to impose the contract, and therefore relates to the position that we are in now.

It takes a lot to make doctors go on strike; their nature and their years of training mean they are inclined to stay with their patients. So, when facing the first doctors’ strike in 40 years, it is fair to ask how we reached this position and what can be done to resolve it. I am sorry to say that I think most of the blame lies with the Secretary of State and the atmosphere that he has created. In saying that, I want to make it clear that I do not think the current contract is perfect by any means. It is too complicated, and it throws up some anomalies in pay. However, it has proved impossible to negotiate changes to that contract properly, due to the atmosphere of mistrust and suspicion that has been created by some of the comments made by the Secretary of State.

That atmosphere goes back some years, but it reached its lowest point in July last year, when the Secretary of State said that the NHS had a “Monday to Friday culture”. I have read since that he has never actually visited a hospital at the weekend. If that is true, perhaps he should, because he would find that many staff are working. So incensed were they at the idea that they did not work weekends that they took to posting pictures on Twitter with the hashtag “#ImInWorkJeremy”.

The Secretary of State then went further by telling doctors to “get real”. I think that people who make life-and-death decisions every day, care for terribly sick patients, work with emergencies in accident and emergency while putting up with drunks and insults, work in special care baby units, and care for frail, elderly, often confused people know what reality is. They do so in a national health service under huge pressure. Much of the equipment is now out of date and there is a repairs backlog worth £4.3 billion, but the capital moneys available were cut by £1.1 billion in the Budget. Doctors are working with out-of-date scanners and computers that crash, and because the Government see all support staff as inessential bureaucrats, doctors are mopping their own operating theatres or doing data input that any competent clerk could do. I think that they know the reality of what they face. To be told that by someone whose gilded path to ministerial office went through Charterhouse, Oxford and management consultancy is beyond parody.

The Secretary of State, again, had to say more than that. He looked at weekend death rates, and jumped to the conclusion that they were caused by staffing levels. He said clearly:

“Around 6,000 people lose their lives every year because we do not have a proper seven-day service”.

He later used the figure of 11,000. Again, he said that was

“because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 151.]

I will spend a few minutes on the research quoted by the Secretary of State, because it does not actually prove that at all. The research paper that reached the conclusion that there were 11,000 extra deaths considered admissions from Friday to Monday, not just at the weekend, and considered death rates within 30 days of admission. Anyone who designs research will say that it is almost impossible to allow for all the things that could happen in 30 days. The researchers themselves did not draw the conclusion drawn by the Secretary of State. What they said was:

“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

In fact, being rash and misleading is exactly what the Secretary of State was doing.

[Andy Slaughter (Hammersmith) (Lab)]

I thank my hon. Friend for her exposition of the petition. She is exposing behaviour by the Secretary of State that is not only insulting but misleading. This has been said to him time and time again, including by hon. Members in the Chamber. Does she draw the same conclusion as me? The Secretary of State knows what he is doing. He knows when he quotes those figures that he is quoting them wrongly, and that they do not prove what he says they prove.

[Helen Jones]

My hon. Friend makes a fair point. First, the research has its critics, and various bits of research done on deaths following weekend admissions have reached different numbers: 3,000; 4,400; 6,000. The problem is that it is difficult to ascertain cause and effect. If the research is adjusted for the fact that we admit different kinds of patient at the weekend—people are sicker and there are more emergencies, and not many elective patients in most trusts—there remains a slight increase in the death rate. The problem is that ascertaining the cause is difficult. As the hon. Member for Totnes (Dr Wollaston) pointed out in a previous debate on this issue, when hospitals look back at such deaths, it is difficult for them to find out what could have been done differently in those 30 days.

When a complaint was made to the UK Statistics Authority about the use of those data, it said:

“We are speaking with Department of Health officials to ask that future references to this article are clear about the difference between implying a causality that the article does not demonstrate, and describing the conclusions reached by the authors.”

The reason is that although the research shows us that something is going on that we need to investigate, it does not show exactly what is causing it. I do not know whether the Secretary of State understands that. If he does not, I must say that Oxford is probably not what it was. However, I suspect that he understands it very well.

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[Andrea Jenkyns (Morley and Outwood) (Con)]

Thank you, Sir David, for calling me to speak in this incredibly important debate.

There is no denying that this strike is totally unprecedented. No group of doctors has ever before been willing to walk out and put patient safety at risk over a dispute about pay, which is essentially what the dispute is about. It is about pay, about unsociable hours at weekends, about working the sort of hours that other people across the public and private sectors work every week. That is not to do down the incredible work that our junior doctors do. They work incredibly hard and entirely selflessly to keep us fit and healthy and I thank them for that but, like any other body of workers, doctors are not infallible.

Like the rest of us, doctors are driven by considerations of making enough to get by and to support their families, and of getting a fair reward for the work they do. Historically, they have got a pretty good deal, and like any other body of workers they have the right, through their union, to seek a better deal in pay and conditions. Seeking that better deal requires, as the petition notes, a meaningful negotiation between both sides in the debate.

I would like to cite the definitions of the two words that are so crucial in today’s debate. Meaningful is defined as “serious, important or worthwhile” and a negotiation is a “discussion aimed at reaching an agreement”. My argument is that it is the British Medical Association, and not the Secretary of State, the Department of Health or any of their negotiating team, that has failed in its duty to hold a proper, meaningful negotiation.

The history of the dispute is littered with resentment and half-truths. The BMA has repeatedly had the chance to negotiate with the Government and come to an agreement that is acceptable to all sides and, most importantly, that is safe for patients. Patient safety should be at the centre of the debate but, unfortunately, it has fallen by the wayside in the BMA’s entirely partisan quest to defeat the Government.

For many months we heard from the BMA that it was the Government and not the union who were not willing to come to the negotiating table. That is untrue, and it is backed up by the House of Commons Library’s account of the dispute, which I will not rehash in the short time we have available. Time and again the BMA has walked away from the negotiating table and balloted for industrial action, while the Department of Health negotiators have offered it the chance to come back to talks. The BMA even balloted for industrial action on the basis of the Government’s being unwilling to talk, when the Government had set a clear deadline for the BMA to come back to the table or risk imposition of the new contract. The BMA knew that imposition was a possibility, yet time and again did as little as it could to avoid it, all because it is driven by a desire, according to one of the doctors involved, to

“be the first crack in the edifice of austerity”.

Again, I do not want to go over old ground, but it is well documented that the BMA’s senior medics are Corbynites of the most militant kind. [Laughter.] Dr Chand, the association’s deputy chair, tweeted:

“Goebbels must be turning in his grave when he hears the lies and propaganda of Cameron.”

Dr Tom Dolphin congratulated the right hon. Member for Islington North (Jeremy Corbyn) on his victory and told him to take the fight to the Tories—if that is not partisan, I do not know what is. The BMA so misled its members when it put an utterly wrong pay calculator on its website, suggesting that doctors were in line to lose thousands of pounds, that the tool had to be taken down. Does that suggest that the BMA is taking the negotiation seriously? I would say that it does not. All the while, the Secretary of the State waited, and appointed the head of Salford’s trust to lead the negotiations, to ensure they were being led as well as possible by an expert in the field.

[Andy Slaughter]

Is the hon. Lady aware that 98% of junior doctors supported the BMA’s decision, and that her rather desperate attempt to portray the BMA as some sort of Scargill–like extremist organisation simply makes her look risible?

[Andrea Jenkyns]

I thank the hon. Gentleman. I think he needs to learn his facts. I think that it was 98% of BMA junior doctors, not junior doctors in their entirety.

The imposition of the contract is not something that the Health Secretary wanted. He wanted to reach a meaningful resolution. He wanted the union, which got 90% of the things it asked for, to put its political gripes to one side, do what was best for patient safety and follow the will of the millions.

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[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship this afternoon, Sir David. I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on her speech. In introducing the petition, which a large number of members of the public feel strongly about, she managed to explain in just a few minutes how the Government have put forward an entirely false perspective on the dispute from the beginning and continue to do so. I am sure that many more Members would be here for this debate this afternoon were it not for events in the main Chamber. I know that many people want to be present as witnesses or contributors to the dissolution of the Conservative party—not least members of the Conservative party—so perhaps the timing of the debate is unfortunate.

[Mr Andrew Smith]

I understand what my hon. Friend says about what is going on in the main Chamber, but is it not striking that only one Conservative Back Bencher has turned up to defend the Government’s handling of the dispute?

[Andy Slaughter]

I agree with my right hon. Friend, but I think that what the hon. Member for Morley and Outwood (Andrea Jenkyns) said was even more striking in its own way. I felt I could forgo the entertainment in the main Chamber because I feel so strongly about this issue, not least because my constituency hosts two of the main teaching hospitals in the Imperial College Healthcare NHS Trust, and because many thousands of junior doctors from that trust and other trusts live in my constituency. I have therefore followed the dispute with increasing anxiety and depression. I have met not only individual junior doctors but groups of them at Charing Cross hospital, and I have spoken to them at the BMA. The image of them put forward by the Secretary of State, and what we have heard from the governing party today, does no credit to that party. The slurs on junior doctors are extraordinary, and it is perhaps time to pause and consider matters again.

Are we seriously being asked to accept that junior doctors are some sort of militant clique looking to undermine the Government? That is pure fantasy. Anybody who has spent time with junior doctors will have seen exactly what is going on. The speech by the hon. Member for Morley and Outwood was tragic in many ways, but in some ways it was quite brave, because I suspect that any of her constituents who read it will begin to think, “What have I done in electing her last year?”

[Andrea Jenkyns]

First, the Select Committee on Health is on an away day today, otherwise there would have been more Members here. I should have been on the away day, but this is an important debate and I wanted to be here.

On the allegation that I have accused all junior doctors of being Corbynites, I said that key members of the BMA are strongly linked to the Leader of the Opposition. I was talking about not junior doctors but people on the BMA council.

[Andy Slaughter]

I will move on, because when someone is in a hole, they should really stop digging.

[Margaret Greenwood]

I could not let the comment made by the hon. Member for Morley and Outwood (Andrea Jenkyns) pass. Jeremy Corbyn is the leader of the Opposition, and the Conservative party is in turmoil today in the face of his leadership. Being a Corbynite and a member of the BMA is no bad thing—I just wanted to clear that up.

[Andy Slaughter]

I will try to put an end to this exchange, but it is tragic that a party of the stature of the Conservative party should turn its guns on the profession and on a representative body such as the BMA in this despicable way. It is extraordinary. I will go further and praise those in the BMA who have had their positions undermined and suffered character assassination and being idly quoted in tittle-tattle on Twitter. Last week the hon. Member for Central Ayrshire (Dr Whitford) hosted an open session for Members at which I was pleased to renew an acquaintance with Dr Johann Malawana, who has been a particular target of insidious and malicious personal attacks, supported by the jackals in the right-wing press. Is that really how a Government should behave in dealing with any industrial dispute, particularly one as serious as this?

Depending on when the debate ends, I may have to leave for a constituency engagement—I have said that to you, Sir David, and I apologise to you and to the Front Benchers—so I will make my comments brief to give other Members time to make theirs. I simply want to say to the Minister, who can no doubt take the message from this debate back to the Secretary of State, that there is nothing dishonourable about continuing negotiations in this dispute. There is an attitude of despair among junior doctors, which has led to some of the statistics we have already heard about those who now wish to leave the profession or move to other jurisdictions where they would be more appreciated.

The Government were initially resistant to going to ACAS, but in the end they agreed. Progress was made at ACAS, but at the end there were still matters outstanding. Everything that I have learned from talking to junior doctors suggests that not only do they not want to take industrial action, and not only do they want to continue serving their patients to the best of their ability, but they are prepared to sit down and compromise. However, they are faced with a wholly intractable Government.

Is the best that we can get from the Secretary of State the misappropriation of statistics to prove something that is clearly false on two levels? It is false because the so-called weekend deaths are not as he has presented to the public, and it is false to say that we do not have a seven-day emergency service now. Of course we do. I strongly believe that we need to restore trust and faith in the relationship between the NHS and junior doctors, and the Government have an important role to play in that. Unfortunately, individual trusts are under such financial pressure, and their management under such strain, that it is tempting for them to exploit junior doctors.

On the guardianship system, we know about the assurances that have been given and the protections in the existing contracts. I do not think there has been a previous example of a contract being imposed on the NHS in this way. I simply urge the Government to think again. There is a deal to be done, there really is. The fact that they are not even prepared to sit down and negotiate again implies that they do not want a deal to be done. They want to play hardball, and they want to get something that is completely different from what they say. They already have their emergency service and they already have junior doctors working the way they want, and they say they do not wish to save money. They have different motives from those that they are expressing. They therefore need to return to the negotiating table. They need a pragmatic solution, and they need to step back and calm down.

I will read the Front Benchers’ speeches tomorrow if I am not here for them, but I hope we will hear a better spirit of conciliation than we have heard so far.

--- Later in debate ---

[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.

[Andy Slaughter]

rose—

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[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.

[Andy Slaughter]

Will the Minister give way?

[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.