Junior Doctors Contracts

Heidi Alexander Excerpts

Monday 25th April 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I thank the Health Secretary for the advance copy of his statement.

Tomorrow’s strike is one of the saddest days in the history of the NHS, and the saddest thing is that the person sitting opposite me could have prevented it. Yesterday the Health Secretary was presented with a genuine and constructive cross-party proposal to pilot the contract. That would have enabled him to make progress towards his manifesto commitment on seven-day services and, crucially, it could have averted this week’s strike. Any responsible Health Secretary would have grasped that opportunity immediately, or at least considered it and discussed it, but not this one. Yesterday morning he tweeted “Labour ‘plan’ is opportunism”. That was a deeply disappointing and irresponsible response.

Let me remind the Health Secretary that the proposal was not a Labour plan, but was co-signed by two of his respected former Ministers, the Conservative hon. Member for Central Suffolk and North Ipswich (Dr Poulter) and the Liberal Democrat right hon. Member for North Norfolk (Norman Lamb), and the Scottish National party’s health spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). Let me also remind him that it had the support of several medical royal colleges, including the Royal College of Surgeons, and, crucially, that the BMA had indicated it was prepared to meet the Government to discuss calling off Tuesday and Wednesday’s action.

The Health Secretary claimed yesterday that a phased imposition was the same as a pilot. Will he explain how imposition on a predetermined timescale, with no opportunity to right the wrongs of his proposed contract and no independent assessment of its impact on patient care, is the same as a pilot? Why is he so afraid of an independent evaluation? Why does he not want to know how changing the contract contributes in practice to meeting his aspirations for more consistent emergency care across the seven days of the week? And why is he so determined to railroad this contract through, with all its associated implications, instead of road-testing it and working with junior doctors and hospital bosses to bring about the changes in patient care and outcomes he wants to see?

The Health Secretary claims that any further delay means it will take longer to eliminate the so-called weekend effect, but he has failed to produce a shred of evidence to show how changing the junior doctors contract alone will deliver that aim. He will know that the very person he appointed to lead his negotiations, Sir David Dalton, has said that the staff group that needs to change its working patterns the least to deliver seven-day care is junior doctors—because they already work weekends, nights and bank holidays.

The Health Secretary rightly talked about safety. NHS England’s update today said the NHS was pulling out all the stops to minimise the risks to the quality and safety of care this week. We know that in many cases senior staff will be stepping in to provide cover and ensure the provision of essential services, but there is no escaping the fact that this is a time of unprecedented risk, and he should have thought about that yesterday, before dismissing a plan that could well have averted the strike.

The Health Secretary wants to be remembered as the person who championed patient safety, but safety is not just an issue this week; it will be an issue in the months and years ahead. Long after his tenure in Richmond House is up, it will be the people who work in the NHS who will be picking up the pieces of this dispute, and they are rightly worried about the long-term safety implications of the proposed contract. How can it be safe to impose a contract when no one knows what the impact will be on recruitment and retention but everyone fears the worst, and when he is running the risk of losing hundreds of female doctors, given the contract’s disproportionate impact on women? Even if just 1% of junior doctors decide enough is enough and leave the NHS, they will be people we can ill afford to do without.

How can it be safe to impose a contract that risks destroying the morale of junior doctors, given that the NHS does not just depend on the good will of staff going the extra mile but survives on it? The Health Secretary is breaking that good will. How can it be safe to introduce a contract when there is no guarantee that effective and robust safeguards will be in place to control hours worked and shift patterns? A pilot could have addressed these issues, which is precisely why it had the backing of so many people.

I suspect that when the Health Secretary gets back to his feet, he will launch another attack on me and the Labour party to detract attention from his culpability for tomorrow’s action. I know this because last week, instead of working to resolve this dispute, the Health Secretary was busy writing me a two-page letter that he briefed to The Sun, asking whether I would be on a picket line.

Let me deal with this matter now in the hope that we can get some constructive answers from the Health Secretary. No, I will not be on a picket line tomorrow or on Wednesday, but that is not because I do not support the junior doctors’ cause, and it is certainly not because I feel even an ounce of sympathy for the Health Secretary. It is because I think patients affected by this dispute want to see politicians working together to find a constructive solution—and that is exactly what I was doing last week, while the Health Secretary was penning his pathetic political attacks.

I am flattered that the Health Secretary attaches such significance to my actions, but the truth is that it is his actions, and his actions alone, that can stop this strike: not me, not the Labour party, but him. If he ploughs on, I warn him now that history will not be kind to him. It will show that when faced with a compromise, the Health Secretary chose a fight; that when presented with a way out, this Health Secretary chose to dig in; and that when asked to put patients first, this Health Secretary chose strikes.

The way in which the Government have handled this dispute is the political equivalent of pouring oil on to a blazing fire. Even if we put to one side the legal question about his authority to impose a contract and the detail of the contract provisions, the simple truth is this: there is no trust left between the people who work in the NHS and this Health Secretary. He can barely show his face in a hospital because he ends up being chased down the road. This is a deeply, deeply sad day for the NHS, and even at this eleventh hour, I urge him to find a way out.

[Mr Hunt]

The shadow Health Secretary can do better than that. She talked about the judgments that I have made as Health Secretary, so I will tell her what is a judgment issue—it is whether or not you back a union that is withdrawing life-saving care from your own constituents. Health Secretaries should stand up for their constituents and their patients, and if she will not, I will.

The hon. Lady also talked about the trust of the profession. The Health Secretary who loses the trust of the profession is the Health Secretary who does not take tough and difficult decisions to make care better for patients—something we have seen precious little evidence of from the hon. Lady or, if I may say so, her predecessors.

The hon. Lady also talked about putting oil on a blazing fire. What, then, does she make of the shadow Chancellor’s comments recently when he said:

“We have got to work to bring this Government down at the first opportunity…Whether in parliament, picket line, or the streets, this Labour leadership is with you”?

Yes, it is with the strikers, but also against the patients. Labour should be ashamed of such comments from the shadow Chancellor.

Let us deal with the substance of what the hon. Lady said. She talked about her proposal for pilots. If this was a genuine attempt to broker a deal between all the parties, why was it that the first the Government knew about it was when we read The Sunday Times yesterday morning? The truth is that this was about politics, not peace making. If she is saying that we should stage the implementation of this contract to make sure we get it absolutely right, I agree. That is why only 11% of junior doctors are going on to the new contract in August. She says she wants more independent studies into mortality rates at weekends, but we have already had eight in the last six years, pointing to the weekend effect. How many more studies does the hon. Lady want? Now is the time to act, to save lives, and to give our patients a safer NHS.

The hon. Lady talked about legal powers, which we discussed in the House last week. The Health Act 2006 makes very clear where my powers are to introduce a new contract, either directly or indirectly, when foundation trusts choose to follow the national contract.

I have given very straight answers today. Will the hon. Lady now tell us yes or no? Will Labour Members now tell us yes or no? Do they or do they not support the withdrawal of life-saving care from NHS patients? Last week, the hon. Lady’s answer was “no comment”. Well, “no comment” is no leadership. Labour used to stand up for vulnerable patients, but now it cares more about powerful unions. It is the Conservatives who are putting the money into the NHS, delivering a seven-day service for patients, and fighting to make NHS care the best in the world.