NHS Sustainability and Transformation Plans

Heidi Alexander Excerpts

Wednesday 14th September 2016 Commons Chamber

[Mr Dunne]

The hon. Lady is leaping much too far ahead. There are no proposals at this point—[Interruption.] I will explain the exact state of the STPs shortly. There are a number of draft ideas to try to improve the services that are delivered to patients. Looking to the future and the efficiencies that need to be provided, as part of the five-year forward view the NHS leadership asked the Government to fund £8 billion of additional cash for the NHS. We provided £10 billion; the Labour party refused to provide anything like it. In return, the NHS agreed to look for £22 billion of efficiencies up to 2020. We have assisted it through the efforts of Lord Carter, whom we asked to undertake a review of efficiencies across the NHS. He has identified 10 work streams in which clear efficiencies can be found—many of which, incidentally, have been identified by Opposition Members. The hon. Member for Hackney North and Stoke Newington herself has referred in the past to areas of the NHS in which there is waste, and a newspaper article this week by the former Chair of the Public Accounts Committee, the right hon. Member for Barking (Dame Margaret Hodge), referred to “absurdities” in the spending practices in the NHS. We are trying to put right some of the practices that have been swept under the carpet for too long.

[Heidi Alexander (Lewisham East) (Lab)]

rose—

[Mr Dunne]

I am going to make some progress.

I turn now to the timetable and the progress that has been made so far. Each area was asked to work together over the first six months to draw up its initial thinking into a first draft plan by the end of June. Those plans were individually reviewed by senior leaders from NHS England and NHS Improvement during July and August. Each area is now in the process of developing its STP, with a view to submitting a worked-up plan to NHS England in October. The plans, as one would expect, will vary in their proposals, but all are expected to demonstrate a shared understanding of where an area is in relation to the three challenges set out in the five year forward view and where they need to be by 2020-21.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful for the opportunity to speak in this debate. Sustainability and transformation plans—what are they, should the public be concerned, and are the plans good, bad or a mixture of both? As we have heard, over the last eight months or so STPs have been drawn up in 44 areas in England by a range of people involved in the running of the NHS and local government. As far as I can work out, they have come about because NHS England could see that in the chaos following the previous Government’s Health and Social Care Act 2012, there was no obvious body responsible for thinking about how best to organise NHS services at a regional and sub-regional level, so NHS staff and local government officials were tasked with assessing the health and care needs of their local populations, considering the quality and adequacy of the provision to meet those needs, and developing ideas about how those needs might be better met within available resources.

So far, so good, we might say, but there are three big problems. First, the current financial pressures on the NHS mean that the plans are likely to be all about sustainability, not transformation. Secondly, this is a standardised process to define and drive change, so we run the risk of good proposals being lumped in with bad ones, and of some plans simply focusing on the achievable, as opposed to the necessary and the most desirable. Thirdly, it is an inescapable fact that these plans are being developed when there is huge public cynicism about the motives of a Tory Government when it comes to change in the NHS. If the Government want to deliver change, the debate with the public needs to start in the right place—not behind closed doors, and not using jargon that no one understands. It needs to be focused on patients and their families, not on accountants and their spreadsheets.

I think most people understand that the NHS cannot be preserved in aspic. They understand that compared with the 1950s, we now use the NHS in a very different way. At the moment, they simply see an NHS under enormous pressure. They are waiting longer for an ambulance, to see a GP, to be treated in A&E and for operations. They see staff who are stressed out and who are on the streets in protest. When Ministers and NHS leaders talk about sustainability and transformation, the public are therefore dubious. For sustainability, they read cuts, and in some cases they will be right—it will mean cutting staff, closing services and restricting access to treatment. No matter good the plan, how thorough the analysis or how innovative the solution, we cannot escape the basic problem of inadequate funding for the NHS and social care.

[Kerry McCarthy (Bristol East) (Lab)]

In my constituency, we are very concerned because Bristol is in surplus but the footprint means that we will be going in with North Somerset and South Gloucestershire, which both have cumulative deficits. No matter what else is part of the plan, to us in Bristol it means cuts.

[Heidi Alexander]

That is the story we hear from all over the country. This is not profligate overspending on the part of NHS bosses or local government leaders; it is chronic underfunding on the part of Government. There was much fanfare associated with last year’s comprehensive spending review and what it meant for the NHS, but when we look at that financial settlement, along with the one in the last Parliament, we see a flatlining budget to deal with soaring demand.

As a country, we have a growing and ageing population. The reality is that in the last 10 years, the number of people living beyond the age of 80 has increased by half a million, and the NHS and social care are buckling under the strain. Although we should never give up on trying to organise the NHS in the most efficient and effective way possible, we have a choice. Do we want to cut services to match the funding available, or do we want to pay more to ensure that our grandparents and our mums and dads get the sort of care that we would want for them? If the NHS is to provide decent care for older people we need not only to fund social care adequately, but to find better ways of organising services to keep people out of hospital for as long as possible.

That leads me to the next problem. STPs are being used as a catch-all process to bring about change in the NHS, but many run the risk of focusing on the wrong things. They are being used as a vehicle to do different things in different places, and although some may lead to better treatment and better outcomes, the danger is that there will be knee-jerk, blanket opposition to everything. Some proposals will inevitably be controversial—the closure or downgrading of an A&E or maternity department will never be easy—but, in other cases, the plans may end up focusing on something that is not the burning issue.

Let me take my local area as example. The STP for south-east London proposes two orthopaedic elective care centres. The sites for them have yet to be decided, and the STP plan has yet to be signed off by NHS England. On the face of it, there is little wrong with the proposal to create centres of excellence so that all hip and knee replacements are done in one of two places. The problem is that when the front page of a national newspaper talks about the “secret” STP plans under which A&Es will close, my constituents fear the worst. “We’ve been here before,” they will say. They will smell a rat, even where one might not exist.

[Alex Chalk (Cheltenham) (Con)]

Will the hon. Lady give way?

[Heidi Alexander]

I will not give way. I am aware that many Members want to speak, and I wish to conclude my remarks.

My constituents ask me these questions. What happens if Lewisham is not the site of the new centre, its elective work is shifted elsewhere and the hospital then struggles to staff the emergency department? Is orthopaedic care really the burning issue in south-east London? What about the queues of ambulances outside the Queen Elizabeth hospital? What about the homeless young man who pitches up in A&E because he has nowhere to sleep and there is no support for him in the community?

Where will the money come from physically to redesign the NHS buildings that such a care centre would entail? With £l billion taken out of capital budgets and switched to revenue last year, it seems fanciful to think that there will be money lying around for such projects. The NHS is on its knees. Everyone knows that hospitals ended up £2.5 billion in deficit last year. We have all seen the reports of A&Es closing overnight because they have not got the staff. We all know that GPs are run ragged, that ambulance crews are stressed out and that nurses are demoralised, and that is before mentioning the junior doctors.

This is the main problem for the Government: if you do not fund the NHS adequately and if you do not staff it properly, do not be surprised when the public do not trust your so-called improvement plans. There is deep public cynicism when it comes to anything this Government wants to do to the NHS. People believe Ministers are trying to privatise it. They believe services are contracted out to the private sector to save money, not to improve quality, and in many cases they are right. The problem is not STPs as such, but the context in which they are being developed—inadequate funding, an inability to make the case for change, a workforce crisis that is leading to overnight closure of services and, as a result of all of these, a deep public mistrust of the Government’s intentions.

[Several hon. Members rose—]

Junior Doctors: Industrial Action

Heidi Alexander Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

I am happy to do that. Indeed, I am delighted to take a question from my right hon. Friend, because it is after someone has long departed an office that people actually appreciate that big, important changes were made, which was certainly the case from his tenure as Secretary of State for Education.

One of the clinical standards states that people admitted at weekends should be seen by a senior doctor—a consultant or an experienced junior doctor—within 14 hours. They will be seen by a doctor much sooner than that, but they should be seen within 14 hours by someone experienced enough to know whether there is something to worry about. That would happen in most places during the week, but it does not happen in many places over the weekend. Another standard relates to the most vulnerable patients who are at real risk of going downhill. This is not the clinical term, but doctors say that spotting people who are going downhill is one of the most important things. Such people should be checked at least twice a day by someone experienced enough.

Those are two of the four clinical standards that we want our constituents to be reassured are in place across the country. We think that that will make a big difference.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary will know that a worrying number of A&E and maternity departments were either closed or downgraded over the summer because they simply could not get the necessary number of junior doctors: Chorley, Ealing, Stafford—I could go on. If we are training more junior doctors, why do we still have that problem?

[Mr Hunt]

The pressures in the NHS mean that there is a need for more doctors for all sorts of reasons, and we do not have as many doctors as we need at the moment. That is why this Government are training more doctors and putting an extra £10 billion into the NHS. The manifesto that the hon. Lady stood on just over a year ago would not have put that sort of funding into the NHS and would have meant that we were unable to train that number of extra doctors. We are doing that, but it takes time and we need to ensure that services are safe while we are getting there.

Junior Doctors Contract

Heidi Alexander Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

As ever, my right hon. and learned Friend speaks with great wisdom and experience. He is absolutely right to say that tackling the morale deficit in the NHS has to be a key priority. That is why we have to recognise that for doctors—particularly junior doctors starting out on their medical careers—the most depressing and dispiriting thing of all is when they cannot give the patients in front of them the care that they want to. That is why we are looking at a number of things to make it easier for doctors to improve the quality of care. One of the things that is particularly challenging and that we in this House have to think about and discuss a lot more is how difficult doctors and nurses find it to speak out if they see poor care, or if they or a colleague make a mistake, because they are frightened of litigation, a General Medical Council referral, or disciplinary action by their trust. The problem is that people then do not go through the learning processes necessary to prevent those mistakes from happening again. The key is creating a supportive environment, in which learning can really happen, in hospitals.

[Heidi Alexander (Lewisham East) (Lab)]

If I believed that the benefits for patients of pushing ahead with this contract outweighed the impact that its imposition will have on junior doctor morale, recruitment and retention, I would support the Health Secretary, but I do not believe that. Can he tell the House which clause of which Act of Parliament gives him the power to force hospitals to introduce the contract? If he cannot tell us that, can he outline the legislative basis on which Health Education England could withhold funding from trusts that choose not to proceed with it?

[Mr Hunt]

Health Education England is absolutely clear that it has to run national training programmes, and that is why it has to have standard contracts across the country. As the hon. Lady knows well from her previous role on the Front Bench, in reality foundation trusts have the legal right to set their own terms and conditions, but they currently follow a national contract; that is their choice, but because they do that, I used the phrase “introduction of a new contract” this afternoon. I expect, on the basis of current practice, that the contract will be adopted throughout the NHS.

I enjoyed working with the hon. Lady when she was shadow Health Secretary, but on this issue, she was quite wrong, because she saw the WhatsApp leaks, which revealed that the British Medical Association had no willingness or desire for a negotiated settlement in February, precisely when she was saying at the Dispatch Box that I was the one being intransigent. She gave a running commentary on the dispute at every stage, but when those leaks happened, she said absolutely nothing. She should set the record straight and apologise to the House for getting the issue totally wrong.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Hunt]

I can reassure the right hon. Gentleman that we are incredibly aware of the brilliant work that EU nationals do, not just in the NHS but in the social care system, which he was responsible for, in care homes up and down the country. We recognise that, and I hope that he will be reassured by statements made by the Foreign Secretary and the Home Secretary yesterday that we want to find a way of allowing those people to stay in the UK for as long as they wish to. We recognise the incredibly valuable contribution that they make, and we are confident in the negotiations ahead that we will be able to secure the outcome that they and we all want.

[Heidi Alexander (Lewisham East) (Lab)]

The last time the Secretary of State and I had an exchange in this Chamber, I suggested to him that it might be the final time we would face each other over the Dispatch Box. Although I was clearly prescient, it has not quite turned out the way I thought it would.

Following the results of the referendum, will the Secretary of State say whether he still intends to introduce an NHS charges Bill as outlined in the Queen’s Speech? Does he agree that migrants give more to the NHS than they take, that their contribution should be welcomed and that our NHS simply could not survive without them?

[Mr Hunt]

I enjoyed our many exchanges in this House, and it is a loss on our side as well that they will not continue. I would like to welcome the hon. Lady’s successor to her post, and I hope that I will have a chance to do so again when she asks a question later.

I agree with the hon. Member for Lewisham East (Heidi Alexander). Migrants, or the people who work in the NHS who come from different countries, make an extraordinary contribution. It is fair to say that the NHS would fall over without the incredible work that they do. It is also true that the British people voted to control migration on 23 June, and we have to accept that verdict. In terms of the NHS and social care system, I did not hear, and I have not heard in my time as Health Secretary, enormous amounts of worry about the pressure of migration on NHS services, because on the whole migrants tend to be younger and fitter people. While accepting the verdict of the British people and what they said on 23 June, the important reassurance that we now need to give is to the many people from outside the UK who make a fantastic contribution to the running of our health and care system.

Defending Public Services

Heidi Alexander Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

That is not true, but we do all accept that there is financial pressure throughout the system. The question that is always ducked by Labour Members is how much greater that financial pressure would have been under Labour’s plans, which involved giving the NHS £5.5 billion less every year than was promised by the Government. I just point out that when Labour Members condemn the £22 billion of efficiency savings as “politically motivated”, as the shadow Health Secretary did in March, they cannot have it both ways. Her manifesto offered the NHS £5.5 billion less every year compared with what this Government put forward—

[Heidi Alexander (Lewisham East) (Lab)]

indicated dissent.

[Mr Hunt]

The hon. Lady shakes her head, but let us consider what the King’s Fund said in the run-up to the election:

“Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view.”

It was there in black and white: Labour was committing to a £2.5 billion increase in the NHS budget, not the £8 billion that this Government committed to. The hon. Lady cannot have it both ways. If this figure was £5.5 billion, the efficiency savings needed would be not £22 billion, but £27.5 billion, which is a 25% increase. That would be the equivalent of laying off 56,000 doctors, losing 129,000 nurses or closing down about 15 entire hospitals.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

I start by thanking the Health Secretary for joining us today. I know that he does not always choose to respond to me when I bring matters to this Chamber, so I am grateful to him for being here. I am conscious that, if the Cabinet deckchairs shift around after the referendum, this may be our last parliamentary exchange. If that turns out to be the case, let me put on record my best wishes for whatever he goes on to do, but may I gently suggest that a future career in resolving employment disputes may not be for him?

The topic of this debate is defending public services, and as the House would expect, I shall focus my remarks on what is happening to our health and care service. Listening to the Health Secretary today, one could be forgiven for thinking that all is well. One would have no idea that hospital finances are at breaking point, waiting lists are approaching a record high, and the NHS is facing a workforce crisis with endemic understaffing and broken morale. Put together, the triple whammy of challenges on the finances, quality of care and the workforce put the NHS in a very precarious position. Let me take each of those challenges in turn.

First, on the finances, the right hon. and learned Member for Rushcliffe (Mr Clarke) called it sterile nonsense, but it is fundamental to whether hospitals and GPs can continue to deliver the care needed for our ageing and growing population. One of the Health Secretary’s favourite soundbites recently has been to claim that the Government are giving the NHS the sixth biggest funding increase in its history. Indeed, he has made that claim six times in this Chamber over recent months, so I was surprised that it did not feature in his speech today. However, I think I may have an explanation for that omission. Last week the King’s Fund and the Health Foundation, two well-respected independent think-tanks, looked into his claim. I have a copy of their analysis, which states:

“We’re afraid to say, although perhaps not surprised . . . that we have a very different figure.”

They go on to say that, rather than being the sixth largest funding increase in NHS history,

“we find that . . . this year it is in fact the 28th largest funding increase since 1975”.

[Mr Jeremy Hunt]

I completely defend the methodology that we used to come up with our figure, but does the hon. Lady not see the irony? She is criticising a £3.8 billion increase in NHS funding this year, when Labour’s own plans at the election last year were for a £2.5 billion increase—£1.3 billion less than this Government have delivered.

[Heidi Alexander]

I am grateful to the Secretary of State for that intervention. He might want to rake over the last general election but he clearly does not want to talk about the crisis in NHS finances today, with a £2.45 billion deficit among hospitals at the end of this year, cuts to public health spending, and £4.5 billion coming out of the adult social care budget over the past five years. I am quite happy to debate NHS finances with him. The truth is that the NHS is getting a smaller increase this year than it got in every single year of the previous Labour Government.

The King’s Fund and the Health Foundation concluded:

“Getting public spending figures right is important, otherwise they can mislead and detract from the real issues. The fact is that the NHS is halfway through its most austere decade ever, with all NHS services facing huge pressures.”

[Sir Simon Burns]

May I recommend that the hon. Lady read a recently published book by Tom Bower which shows the utter failure of the Blair Government, who pumped billions of pounds into the NHS over a period of years but had no control over it and made no attempt to increase productivity, so that from 1998 performance flatlined for six years, and the then Health Secretary was forced to bring back health policies that they had abandoned in ’97?

[Heidi Alexander]

I am grateful for the reading advice from the right hon. Gentleman, but I simply say this: I am very happy to defend the record of the previous Labour Government, who trebled the NHS budget and had the highest-ever public satisfaction ratings and the lowest-ever waiting lists.

We should be crystal clear about the crisis that we face today. The decade from 2010 to 2020 is set to be marked by the biggest sustained funding squeeze on the NHS ever. As a percentage of GDP, spending on health is set to fall from 6.3% in 2009-10 to just 5.4% by the end of the decade.

[Mrs Maria Miller (Basingstoke) (Con)]

People who are listening to this debate will want some clarification. Is the hon. Lady denying the fact that if Labour were in government it would not have increased NHS spending in the way that this Government have done? I think she needs to be clear on that point.

[Heidi Alexander]

We were very clear at the last election that we would have had an emergency Budget to put every penny that the NHS needs into its funding.

I was talking about the reduction of NHS spending as a proportion of GDP. In terms of real funding, the House of Commons Library has shown that, if spending as a percentage of GDP had been maintained at Labour levels, by 2020, £20 billion more would be being spent on the NHS each year. That demonstrates the scale of underfunding that we have already seen and just how tough the coming years are going to be. That is not to mention the deep cuts to adult social care, which have piled the pressure on to hospitals, and the £22 billion-worth of so-called efficiency savings that this Government have signed up to. I have yet to meet anyone who works in the NHS who thinks that efficiencies on this scale are possible without harming patient care.

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

I do not disagree with the hon. Lady that there are big pressures on the horizon, but can she say how much, beyond Simon Stevens’ predicted costs, her party is now pledged to spend on the national health service, because so far all we have heard is prevarication?

[Heidi Alexander]

I am not going to be drawn into giving figures here at the Dispatch Box today. Yesterday the Life Sciences Minister was tweeting that we need a big public debate about funding of the NHS.

Three days ago, the scale of this crisis was laid bare. NHS Improvement, the body responsible for overseeing hospitals, published figures showing that NHS trusts ended 2015-16 with a record £2.45 billion deficit—I repeat, £2.45 billion. To give hon. Members some context, that is treble the deficit from last year. What is the key cause? It is the spiralling agency spend because of staff shortages. When this Government talk about more money going in, let us remember that, before that money gets to the frontline, the bulk of it will be spent on paying off the bills from last year.

[John Redwood]

Will the hon. Lady give us an idea of how much extra money and how many more personnel she thinks we need to deal with current levels of migration?

[Heidi Alexander]

I am grateful to the right hon. Gentleman for that intervention. I actually think that the health service benefits more from migrants than the amount migrants cost it.

I want to tell all Conservative Members that Labour Members are not going to take any lessons about NHS spending from the party that has created the biggest black hole in NHS finances in history. It has got so bad that the Health Secretary cannot even guarantee his Department will not blow its budget. It is chaos: Ministers blame hospital bosses, hospital bosses blame Ministers and all the while patients are paying the price.

Faced with this crisis, we might have thought that the NHS would get more than a passing reference in the Queen’s Speech, but that was not the case. What is the Government’s answer when it comes to the NHS? Fear not: they will introduce a Bill to crack down on health tourism. With all the problems the NHS is facing, this Government want to focus Parliament’s time on debating a Bill that risks turning NHS staff into border guards.

Let me be clear: if such measures are about getting the taxpayer a better deal and ensuring fairness in the system, we will not oppose them. However, I must ask, given everything that is happening in the NHS right now, whether Ministers’ No. 1 priority is really to introduce legislation to charge migrants and their children for going to A&E. If so, my fear is that we will see the kind of dog-whistle politics that was so rejected by the people of London earlier this month, and which I hope will be rejected again on 23 June. The truth is that the cash crisis in the NHS is not the fault of migrants; it is the fault of Ministers.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

I genuinely believe and have no doubt that the hon. Lady is committed to the NHS and I share her desire for a wider public debate, but does she agree that, to have a meaningful debate and to add value to her critique, she needs to set out what she sees as the financial requirements of the NHS, otherwise such a debate will not be very helpful?

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention, but he will just have to watch this space.

As I was saying, the truth is that the cash crisis in the NHS is the fault not of migrants, but of Ministers. Cuts to nurse training places during the last Parliament have created workforce shortages and led to a reliance on expensive agency staff. Cuts to social care have left older people without the help and support they need to remain independent at home, putting huge pressure on NHS services. The underfunding of GPs has left too many people unable to get timely appointments, which means they are often left with nowhere to turn but A&E. The financial crisis is a massive headache for NHS accountants, but we all know it can mean life or death for patients. Waiting time targets, which exist to ensure swift access to care, have been missed so often that failure has become the norm.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady is making a very political attack. In that context, would she care to explain why the performance for accident and emergency admission is far worse in Labour-run Wales than it is in England?

[Heidi Alexander]

I would have thought better of the hon. Gentleman, but it is clear Conservative Members want to talk about anything other than their record in England. A&E performance is currently the worst since records began, taking us back to the bad old days of the 1980s, when patients were left waiting on trolleys in hospital corridors. The figures speak for themselves.

[Mr Jeremy Hunt]

May I ask the hon. Lady to consider again what my hon. Friend the Member for Cheltenham (Alex Chalk) said? If A&E performance is the fault of Conservative politicians in England, is it not also the fault of Labour politicians in Wales, where it is 11% worse?

[Heidi Alexander]

From memory, I seem to think the budget going to the NHS in Wales has been cut in Westminster.

Let us have a look at the figures. In March 2011—[Interruption.] The Health Secretary would do well to listen to these figures, because I am about to tell him the record of his term in office. In March 2011, 8,602 patients waited more than four hours on trolleys because no beds were available. Four years later, the figure was up sixfold, to 53,641. In March 2011, just one patient had to wait longer than 12 hours on a trolley. Four years later, 350 patients suffered that experience. The NHS waiting list now stands at almost 3.7 million people—the equivalent of one in every 15 people in England. Only 67% of ambulance call-outs to the most serious life-threatening cases are being responded to within eight minutes.

I could reel off more statistics, but I will instead read a letter that I received the other week:

“Dear Ms Alexander,

I recently had the misfortune of using the A&E at my local hospital in Margate. My wife feels that I was lucky to escape with my life.

My experience has convinced me that our health service has never been more under threat than since Mrs Thatcher.

The fact that I was sent home after 4 hours without seeing a doctor and returned by emergency ambulance with a now perforated appendix I blame mostly on the conflict between the Health Secretary and the Junior Doctors. Had this been resolved he would have been able to concentrate on the woeful lack of resources our NHS faces.”

Take the experience—[Interruption.] The Parliamentary Private Secretary to the Health Secretary says, “Show us the letter”. I have it here, and I got the permission of the individual who wrote to me before referring to it.

Let me refer to another example—the experience of Mr Steven Blanchard at the Swindon Great Western hospital last November. He said in an open letter to the Swindon Advertiser:

“We arrived at 6.40pm and were asked to sit with about 15 others in the unit. It became apparent this was a place of great suffering and misery…Firstly, there was a lady who was doubled up in pain who had been promised painkillers three hours before and I witnessed her mother go again and again to reception until she was begging for pain relief for her near hysterical daughter.”

Another old lady

“who had been left on her own by her son…was sat picking at a cannula in her arm trying to pull it out…A very frail and sick old man was sat in a wheelchair and he had been in the unit since 8am. He kept saying over and over ‘a cup of tea would be nice’…then I watched as urine trailed from him and fell on to the floor beneath the chair…At 10.30pm he was taken to a ward after 14 hours.”

Mr Blanchard said that he and his partner were finally seen at 1.20 am, and stated:

“Never before have I seen people crying out of desperation…I don’t know what is to blame or whether it’s lack of money or lack of staff but this place was what I can only describe as ‘hell on earth’.”

That is what is happening in our NHS in 2016, and such stories are becoming more common. Ministers may not like to hear it, but they need to start taking responsibility.

[Mr Kenneth Clarke]

There are always pressures in the giant national health service as demand grows and expectations rise, and there always will be. The hon. Lady could have made this speech as an Opposition spokesman 10, 20, 30 or 40 years ago. After 20 minutes, she has not yet suggested a solitary policy proposal as an alternative to the Secretary of State’s, and she has not said whether she agrees with him about seven-day working and all the rest of it. She is describing sad incidents in which things have obviously not been ideal or as they should be, but does she have anything to suggest by way of policy that may contribute to helping the NHS in future?

[Heidi Alexander]

Having had these exchanges over the Dispatch Box for the past nine months, it strikes me that the reality of what people are experiencing in hospitals is sometimes missing from these debates, and that is why I thought it important to quote from those letters.

On workforce challenges, nothing sums up this Government’s failure on the NHS more than the way that they have treated NHS staff. We have had pay freezes, cuts to training places, and the first all-out doctors strike in 40 years—a strike that the Health Secretary did not even try to prevent; in fact he provoked it. He has spoken about seven-day services, but he said little about how he proposes to improve weekend care without the extra resources and staff that the NHS will need. We can only assume that his plan is to spread existing resources more thinly, asking staff to do even more and putting patients at risk during the week.

The Health Secretary also failed to say what experts think about his approach. For example, Professor Sir Bruce Keogh said that the NHS was making good progress towards improving weekend care, but that that became “derailed” when the Health Secretary started linking seven-day services to junior doctors. Fiona Godlee, editor of The British Medical Journal, said that, by picking a fight with doctors, the Health Secretary has set back NHS England’s established programme of work on improving services at weekends. Not only does he have no plan to deliver a seven-day NHS, but he has ripped up the plan that was already in place to improve weekend care. You couldn’t make it up, Mr Speaker.

The Health Secretary often reads out his usual list of stats on staff numbers, but to know what is really happening we must look beyond the spin. A recent survey of nurses by Unison found that almost two-thirds believe that staffing levels have got worse in the past year, and 63% said that they felt there were inadequate numbers of staff on the wards to ensure safe and dignified care—that figure was up from 45% the year before. Whether GPs, nurses or midwives, numbers of staff have not kept pace with demand.

Analysis by the House of Commons Library shows that, in the Labour Government’s last year in office, there were 70 GPs per 100,000 of the population, but that figure has now fallen to just 66. In Labour’s last year, there were 679 nurses per 100,000 of the population, but there are now just 665. No wonder that doctors and nurses feel pushed to breaking point. If we do not look after the workforce, patients will suffer. There was nothing in the Queen’s Speech to help the workforce—no U-turn on scrapping NHS bursaries, no plan to train the staff the NHS so desperately needs, and no plan to improve working conditions.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

My hon. Friend’s point about the workforce is important. Does she share my concern about those attacks on doctors and nurses, and the undermining of numbers? If we break the doctors we will in turn break the NHS, and it is a lot easier to get public support to privatise a broken NHS, than an NHS that is well, healthy and working as it should.

[Heidi Alexander]

My hon. Friend makes a good point, and motivated staff are essential to providing high-quality care.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Under the last Labour Government, new medical schools were set up—including Hull York medical school—to train the additional doctors that we knew the NHS needed. The Queen’s Speech is a missed opportunity because there is no announcement about increasing capacity in those new medical schools that Labour brought in.

[Heidi Alexander]

My hon. Friend is, as always, entirely right.

The Government have run out of answers and they have run out of people to blame. Whichever way we look at it—funding, quality of care or staffing—theirs is a record of failure. That will be the Health Secretary’s legacy. He rightly said “Never again” to Mid Staffs, but his time in office has been marked by tragedy and failure at Southern Health. He talks about patient safety, but his actions have made the NHS less safe.

The Government have failed patients and staff. They have proved the old saying true: we simply cannot trust the Tories with the NHS.

Junior Doctors Contract

Heidi Alexander Excerpts

Thursday 19th May 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I start by putting on record our thanks to Sir Brendan Barber and ACAS for the role they have played in finding agreement between the two sides in this dispute. I also pay tribute to the Academy of Medical Royal Colleges, which proposed these further talks and encouraged both the Government and the BMA to pause and think about patients.

I have not been shy in telling the Health Secretary what I think about his handling of this dispute, but today is not the day to repeat those criticisms. I am pleased and relieved that an agreement has been reached, but I am sad that it took an all-out strike of junior doctors to get the Government back to the table. What is now clear, if it was not already, is that a negotiated agreement was possible all along. I have to ask the Health Secretary why this deal could not have been struck in February. Why did he allow his pride back then to come before sensible compromise and constructive talks?

When he stands up to reply, he may try to blame the BMA for the breakdown in the negotiations, but he failed to say what options he was prepared to consider in order to ensure that the junior doctors who work the most unsociable hours are fairly rewarded. It was a “computer says no” attitude, and that is no way to run the NHS.

Why did the Health Secretary ignore my letter to him of 7 February, in which I asked him to make an explicit and public commitment to further concessions on the issue of unsociable hours? I was clear that if he had done that then, I would have encouraged the BMA to return to talks. Why did he insist instead on trying to bulldoze an imposed contract through, when virtually everyone told him not to, and the consequences of doing so were obvious for all to see—protracted industrial action, destroyed morale and a complete breakdown in trust?

On the detail of the new contract, will the Health Secretary say a little more about the agreed changes that will undo the discriminatory effect on women of the last contract he published? Does he now accept that the previous contract discriminated against women? Will he be clear for the record that he now understands this was never “just about pay”? Can he confirm that concessions have been made not only in respect of the mechanism for enforcing hours worked and breaks taken, but in ensuring that the specialties with the biggest recruitment problems have decent incentives built into the contract?

Moving on to what happens next, can the Health Secretary tell us what he will do if junior doctors vote against this offer? Will he still impose a contract, and which version of the contract will he impose—his preferred version or this compromised one? Can he say whether the possibility of losing a case in the High Court about his power to impose a contract had anything to do with his recently discovered eagerness to return to talks? We all know that the High Court told him he had acted above the law when he tried to take the axe to my local hospital, so I can understand why he does not want that embarrassment again.

Finally, let me caution the Health Secretary on his use of language both in this Chamber and in the media. His loose words and implied criticism of junior doctors is partly the reason why this has ended up being such an almighty mess. May I suggest that a degree of humility on the part of the Secretary of State would not go amiss? May I recommend a period of radio silence from him to allow junior doctors to consider the new contract with clear minds, and without his spin echoing in their ears? I remind him that he still needs to persuade a majority of junior doctors to vote in favour of the contract for the dispute to be finally over.

I hope with all my heart that yesterday’s agreement may offer a way forward. Junior doctors will want to consider it; trust needs to be repaired, and that will take time. I hope for the sake of everyone, patients and doctors, that we may now see an end to this very sorry episode in NHS history.

[Mr Hunt]

The hon. Lady is wrong today, as she has been wrong throughout this dispute. In the last 10 months, she has spent a great deal of time criticising the way in which the Government have sought to change the contract. What she has not dwelt on, however, is the reason it needed to be changed in the first place, namely the flawed contract for junior doctors that was introduced in 1999.

We have many disagreements with the BMA, but we agree on one thing: Labour’s contract was not fit for purpose. Criticising the Government for trying to put that contract right is like criticising a mechanic for mending the car that you just crashed. It is time that the hon. Lady acknowledged that those contract changes 17 years ago have led to a number of the five-day care problems that we are now trying to sort out.

The hon. Lady was wrong to say that an all-out strike was necessary to resolve the dispute. The meaningful talks that we have had have worked in the last 10 days because the BMA bravely changed its position, and agreed to negotiate on weekend pay. The hon. Lady told the House four times before that change of heart that we should not impose a new contract. What would have happened if we had followed her advice? Quite simply, we would not have seen the biggest single step towards a seven-day NHS for a generation, the biggest reforms of unsocial hours for 17 years, and the extra cost of employing a doctor at weekends going down by a third. We would not have seen the reductions in maximum working hours. We would not have seen many, many other changes that have improved the safety of patients and the quality of life of doctors.

The hon. Lady was also wrong to say that the previous contract discriminated against women. In fact, it removed discrimination. Does that mean that there are not more things that we can do to support women who work as junior doctors? No, it does not. The new deal that was announced yesterday provides for an important new catch-up clause for women who take maternity leave, which means that they can return to the position in which they would have been if they had not had to take time off to have children.

The hon. Lady asked what would happen if the ballot went the wrong way. What she failed to say was whether she was encouraging junior doctors to vote for the deal. Let me remind her that on 28 October, she told the House that she supported the principle of seven-day services. As Tony Blair once said, however, one cannot will the end without willing the means. The hon. Lady has refused to say whether she supported the withdrawal of emergency care, she has refused to say whether she supports contentious changes to reform premium pay, and now she will not even say whether doctors should vote for the new agreement.

Leadership means facing up to difficult decisions, not ducking them. I say to the hon. Lady that this Government are prepared to make difficult decisions and fight battles that improve the quality and safety of care in the NHS. If she is not willing to fight those battles, that is fine, but she should not stand at the Dispatch Box and claim that Labour stands up for NHS patients. If she does not want to listen to me, perhaps she should listen to former Labour Minister Tom Harris, who said:

“Strategically Labour should be on the side of the patients and we aren’t.”

Well, if Labour is not, the Conservatives are.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 10th May 2016 Commons Chamber

[Mr Hunt]

Perhaps I can give the hon. Lady some comfort. I recognise that there is a big mountain to move, but the changes we made last year were not just about changing the rates paid to agencies. They were also about capping the amounts agencies can pay their own staff, because we think it is incredibly divisive inside hospitals to have two nurses doing exactly the same work, but one being paid dramatically more than the other. We are also capping the total amount hospitals can spend on agency staff. The result is that the monthly spend on agency staff is now falling and we are on track to reduce the agency bill by about £1 billion in this Parliament.

[Heidi Alexander (Lewisham East) (Lab)]

Spending on agency staff has gone through the roof under this Health Secretary, and the Secretary of State’s attempt to deal with the symptoms of the problem but not the cause has left hospitals struggling to get staff at rates they are allowed to pay. In the past few weeks we have seen reports of emergency surgery suspended in Doncaster, an A&E department downgraded in Chorley and two critical care units closed in Leeds, all because of staff shortages. The Health Secretary has admitted that this will be his last big job in politics. May I urge him before he goes to get a grip on the cause of the staffing crisis? Otherwise, it will be patients who will be facing the consequences long after he has gone.

[Mr Hunt]

May I start by thanking the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous congratulations earlier, and indeed for making history himself by being the first Opposition Member I can remember to congratulate the Government on hitting a target?

I say to the hon. Lady that, as a result of the measures we have taken to deal with the agency staff issue, we think we have saved £290 million compared with what we would have spent since last October, two thirds of trusts are reporting savings and the price paid for agency nurses is 10% lower than it was in October. The root cause of the problem is, as the hon. Member for Southport (John Pugh) said, our failure in the past to recruit enough staff. One of the reasons for that is that successive Governments failed to understand the needs of nursing in wards, which is why we had the problem at Mid Staffs. Because we are addressing that, we are now able to make sure that we do not pay excessive rates for agency staff.

[Heidi Alexander]

If I may turn to another part of the staffing crisis, all Opposition Members welcome the resumption of talks on the junior doctors contract. It is in no one’s interest—not the Government’s, not junior doctors’ and certainly not patients’—for this dispute to drag on any longer. May I implore the Health Secretary to do all he can to find a reasonable compromise this week that will keep doctors in the NHS and ensure that we have a motivated, well trained and fairly rewarded workforce to continue to deliver the excellent care we all want?

[Mr Hunt]

I thank the hon. Lady for her reasonable tone and absolutely give her that assurance. We have always wanted a negotiated outcome to this dispute. That is why we paused the introduction of the new contracts last November to give talks a chance to succeed, and it is why this week I have said we will further pause the introduction of the new contracts to see whether we can get a negotiated outcome. We want a motivated workforce and we are highly cognisant of the fact that hospitals that offer seven-day care and higher standards of care for patients are the very hospitals that have some of the highest levels of morale in the NHS. It takes two to tango, and I very much hope that the British Medical Association will play ball and its part this week in helping us to deliver a safer seven-day NHS.

NHS Bursaries

Heidi Alexander Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I beg to move,

That this House recognises the contribution of student nurses, midwives, allied health professionals and other healthcare staff; has serious concerns about the potential impact of removing NHS bursaries on the recruitment and retention of staff; and calls on the Government to drop their plans to remove NHS bursaries and instead to consult on how they can best fund and support the future healthcare workforce.

I have been told that the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), will be opening this debate for the Government. Given that the Health Secretary is sitting next to him, may I ask the Minister why we will not be hearing from his boss today? If he would like to give a genuine reason I would be happy to take an intervention, but if not I will take it that the Health Secretary simply does not want to defend his policy to the House. [Interruption.]

[Mr Speaker]

Order. There is a certain amount of chirruping from the Treasury Bench and elsewhere on this matter, and I simply make two points. It is entirely for the Government to decide which Minister to field, but I say gently to the Secretary of State, and to the Deputy Leader of the House, that to sit on the Bench rather than to participate while these matters are debated, is one thing—particularly in the case of the Secretary of State—but to sit there fiddling ostentatiously with an electronic device defies the established convention of the House that such devices should be used without impairing parliamentary decorum. They are impairing parliamentary decorum, and in very simple terms the Secretary of State and the Deputy Leader of the House are being rank discourteous to the shadow Secretary of State and to the House. It is a point so blindingly obvious that only an extraordinarily clever and sophisticated person could fail to grasp it.

[Heidi Alexander]

Thank you, Mr Speaker. This is not the first time that the Health Secretary has chosen not to respond to debates that I have secured or questions that I have put. [Interruption.]

[Mr Speaker]

Order. I say to the Deputy Leader of the House: put the device away. If you do not want to put it away, get out of the Chamber. It is rude for the—[Interruption.] Order! I am not inviting a response from the hon. Lady. [Interruption.] Order! I am simply telling her that it is discourteous to behave like that—a point that most people would readily understand.

[Heidi Alexander]

Thank you, Mr Speaker. I will leave my comments on that matter there.

In the past few months, Ministers and I have had a number of exchanges across the Dispatch Box about the unnecessary and dangerous fight the Government are picking with junior doctors. You might think that having totally alienated one section of the NHS workforce, Ministers would think twice about doing it again, but you would be wrong. Not content with junior doctors, the Government are now targeting the next generation of nurses, midwives and other allied health professionals: podiatrists, physiotherapists, radiographers and many more. Instead of investing in healthcare students, and instead of valuing them and protecting their bursaries, which help with living costs and cover all their tuition fees, the Government are asking them to pay for the privilege of training to work in the NHS: scrap the bursary, ask tomorrow’s NHS workforce to rack up enormous debts, and claim that this is the answer to current staff shortages.

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

The hon. Lady is making a spending commitment. Why then, only a few months ago, did she stand on a manifesto that opposed the Government’s £10 billion investment in the NHS?

[Heidi Alexander]

The Labour party has always made it clear that it would have given the NHS every penny it needs.

Given the approach to healthcare students I have outlined, most people would think the Government had taken leave of their senses. They would be right.

[Diana Johnson (Kingston upon Hull North) (Lab)]

My constituents in Hull are baffled by the Government’s approach. At a time when our local hospitals have to recruit nurses from Spain and other European countries, stopping bursaries that enable more people to get training seems absolutely ridiculous.

[Heidi Alexander]

I absolutely agree with my hon. Friend. Indeed, the bursary acts as an incentive to get those students into training and into the NHS.

A few weeks ago, the Government launched their consultation on the technical detail of the changes—not the principle, just the detail. In his foreword, the Under-Secretary of State for Health, the hon. Member for Ipswich, claimed that the proposals were

“good for students, good for patients and good for the NHS.”

The opposite is the case.

Before I set out why the plans are so bad, it is important to remind ourselves of why our country has a nursing shortage in the first place. Shortly after the 2010 election, the coalition Government cut the number of nurse training commissions in an attempt to make short-term savings. The cuts saw nurse training places reduced from more than 20,000 a year to just 17,000, the lowest level since the 1990s. As a result, we trained 8,000 fewer nurses in the previous Parliament than we would have done had we maintained commissions at 2010 levels. At the time, experts such as the Royal College of Nursing warned that the cuts would cause

“serious issues in undersupply for years to come.”

It was right, but it was ignored by Ministers who were too focused on the short term and no doubt too distracted by their plans to launch a massive reorganisation of the NHS.

Our health service is now suffering the consequences of those decisions. New analysis by the House of Commons Library released today shows that the number of nurses per head of population fell from 6,786 per million people in 2009 to 6,645 per million people in 2015. A Unison survey published just last week found that more than two-thirds of respondents felt that staffing levels had got worse in the past year, with a further 63% saying they felt there were inadequate numbers of staff on the wards to ensure safe, dignified and compassionate care. Because of these shortages, hospitals are forced to recruit from overseas or spend vast amounts on expensive agency staff.

[Paula Sherriff (Dewsbury) (Lab)]

In the years 2014 to 2015, the NHS spent £3.3 billion on agency staff. Does the short-sighted step of removing the bursary mean that beleaguered trusts may actually be more reliant on agency staff?

[Heidi Alexander]

My hon. Friend is completely right to point out that the problem of staff shortages leads to more agency staff having to be used, and that creates an enormous black hole in hospital finances. My fear is that the proposals will put off the next generation of nurses.

It now appears that the Government are making some of the same mistakes all over again. A report sneaked out on the day the House rose for the Easter recess revealed that the Government had commissioned only one-tenth of the extra nurse training places that experts said were needed this year. The report, from the Migration Advisory Committee, states:

“We were told that HEE—

Health Education England—

“has acknowledged that, on the basis of workforce modelling alone, they would have liked to commission an additional 3,000 places in 2016-2017. Funding constraints meant that they had only commissioned an additional 331 places; one tenth of what was actually needed”.

[David Morris (Morecambe and Lunesdale) (Con)]

Does the hon. Lady not agree that by changing the way we run the NHS, especially in relation to bursaries and opening it up to more competition, we will get more nurses coming into the NHS, thus plugging the gap she describes?

[Heidi Alexander]

I do not agree with the hon. Gentleman, and later in my speech I shall explain why in some detail.

I would like to return to the Migration Advisory Committee report, because it does not make happy reading for Ministers. It goes on to say:

“It seems self-evident to us that the reduction in the number of commissioned training places between 2010 and 2013 across England, Scotland, Wales and Northern Ireland, was a significant contributing factor towards the current national shortage of nurses.”

Finally, there is the crucial sentence that sums up why we are experiencing across-the-board nursing shortages:

“Almost all of these issues relate to, and are caused by, a desire to save money. But this is a choice, not a fixed fact. The Government could invest more resource if it wanted to.”

Those are the words of the Migration Advisory Committee. Hospitals are short of nurses; mental health services are short of nurses—so, too, are care homes, hospices and primary care. We therefore have a big problem. No one in this House disputes that, but no one in this House should be under any illusion as to the cause. The question, when faced with this problem, is this: what is the right thing to do? How best can the Government work with experts to ensure that we are training enough staff and supporting those staff so that they stay motivated and stay working in the NHS?

[Richard Graham (Gloucester) (Con)]

Of course we all agree that there is a significant shortage of nurses, and the hon. Lady is absolutely right to ask what should be done. Does she therefore support the Government’s concept of associate nurses, which I believe will make a huge difference in places like my constituency where we need new nurses of this kind to increase the numbers of home-trained nursing staff?

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention. The key question we need answered with regard to nursing associates is whether the Government intend them to replace registered nurses. If that is the case, I fear the proposals would be bad for patient care.

Madam Deputy Speaker, you might think a sensible approach to trying to resolve this problem would be to sit down with the Royal College of Nursing, other trade unions, universities and healthcare providers to work out a way forward. But no, this Government seem incapable of that. Instead, in just two lines in the Chancellor’s autumn statement, they announced that they would be scrapping NHS bursaries and asking student nurses to pay tuition fees. The Minister will argue that this will allow universities to train more students, but his problem is this.

[Nic Dakin (Scunthorpe) (Lab)]

Does my hon. Friend agree that the Government should listen to the Royal College, which said that these proposals were “high risk”, potentially

“deterring prospective students from entering the nursing profession”,

and that they risked “worsening the nursing shortage”?

[Heidi Alexander]

I entirely agree with my hon. Friend. I think the Government’s problem is this: they have failed to back up their claim with any evidence and they are now faced with a breadth of opposition to this proposal, not just from Members but from the Royal College of Nursing, the Royal College of Midwives and Unison, while organisations such as MillionPlus, the association for modern universities, are also questioning the assumptions on which the Government base this policy.

[Anna Turley (Redcar) (Lab/Co-op)]

Does my hon. Friend agree with my constituent Zoe, who is training to be a nurse and is particularly concerned about mature students? She feels that about 50% of their time is spent in unpaid clinical placements in hospitals in the community, so they do not have the opportunity to do part-time work to support themselves as many others do. Will they not be disproportionately affected?

[Heidi Alexander]

I agree with my hon. Friend, and I shall make some remarks on that precise point later.

The Opposition’s purpose in calling today’s debate is that we hope the House can rally round what many would view as a straightforward and reasonable proposal— that the Government drop these plans and instead consult on how properly to fund and support the future healthcare workforce.

Let me set out why these plans are bad for students, bad for patients and bad for the NHS. The Government claim that these plans will leave healthcare students 25% better off. What they will not say is that, according to their own consultation, in order to be 25% better off, a student will have to take out a maximum maintenance and tuition fee loan for three years and would graduate with debts of between £48,000 and £59,000.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Many Members will know that I had a son born at 23 weeks’ gestation who spent six months in intensive care with a neonatal nurse, Nicola Probert, who sadly died not long after my son came out of hospital. I am frightened, as many people watching this debate will be, that people like Nicola will no longer go into the profession because of the astronomical debts that they will have to take on. Does my hon. Friend agree that this is a regressive step, and that the Government should think again about it?

[Heidi Alexander]

I completely agree with my hon. Friend. It seems that the Government’s argument is that students will be better off because they can borrow more. The simple truth is that loan repayments will hit nurses’ take-home pay—there are no two ways about it. The current starting salary for a nurse is £21,692—just above the student loan repayment threshold which, of course, has been frozen. This means that nurses will start paying off their loans as soon as they graduate. According to Unison, based on current salary levels nurses will be faced with an average pay cut of over £900 a year to meet their debt repayments. How can that possibly be justified? Even worse, the average age of a student nurse is 28, so the current 30-year repayment period means that many nurses will be paying off loans to within years of retirement. We Labour Members say it is wrong to burden the next generation of NHS staff with a lifetime of debt and wrong to expect tomorrow’s nurses to pay the price for this Government’s mis- management of the NHS.

Does the Minister not understand that student nurses, midwives and other allied health professionals are different from other students? Can he not see that it is dangerous to assume that just because application rates remain stable after the trebling of tuition fees in the last Parliament, the same will happen with his proposals? Assuming healthcare students will respond in the same way as other students to a tuition fees hike is one hell of an assumption and one hell of a risk.

Courses for nursing, midwifery and other allied health professions are substantially different from most other arts and science degrees. Courses are more onerous—there are fewer holidays, longer days and longer term times—while students are also required to spend about half their time in clinical practice. This means 2,300 hours in the case of a student nurse, including night and weekend shifts as a normal part of their studies.

[David Morris]

Will the hon. Lady give way?

--- Later in debate ---

[Heidi Alexander]

I have already given way to the hon. Gentleman, and I want to make some progress.

These changes will effectively charge students for working in the NHS. Of course, longer term times and clinical placements also make it harder for these students to get a part-time job to supplement their income in the way many other students do. It is not just the course that makes healthcare students unique; they are much more likely to be women, much more likely to be mature students, much more likely to have children and more likely to be from BME backgrounds.

Many nursing students have already completed one degree and turn to nursing in their late 20s or early 30s—indeed, the average age of a student nurse is 28. When I think of my own friends who are nurses and midwives, I find that three out of four took the decision to re-train, having done a different first degree.

The Minister probably moves in different circles from me, but I can tell him that if he wants a dose of reality, my friends would, I am sure, be more than happy to oblige. I understand that he may not have experienced the conversations that I had in my working-class family about the pluses and minuses of racking up debts to get a degree, but I can tell him that for many nurses, under his proposals, that consideration will be all too real. Does he not realise that for the one in five healthcare students with children, the fear of debt is greater than it is for carefree, privately educated history students bound for Cambridge? My concern about these proposals is that we ultimately end up with those best placed to pay becoming nurses and midwives rather than those best placed to care. That brings me on to why these proposals are bad for patients.

[Helen Whately (Faversham and Mid Kent) (Con)]

I think we are all agreed on the need for more nurses; the question is how we fund them. Will the hon. Lady tell us how much money she would take away from front-line NHS care in order to fund the expansion of nursing places that the country needs?

[Heidi Alexander]

We set out at the last election our clearly costed plans for how to recruit additional nurses, doctors and care staff to the NHS.

The NHS should have a workforce that reflects the population it serves—just as this place should, too. The mental health sector in particular relies on mature students and the additional life experience they bring to what is a very demanding environment.

A few months ago, I met Marina, a young woman who has not had an easy life, but who is now on a mission to become a mental health nurse. When Marina says that she thinks some of the people best placed to care for others are those who have experienced hardships themselves, I think she has a point; and when she says she would not have been able to start her training without the bursary, I believe her. Why is the Minister so convinced that the NHS can do without people like Marina in the future? Why does he think they should pay to train, and why will he not consider other options for increasing student numbers?

The quality of training that student nurses, midwives and other allied health professionals receive will also depend on the quality of their clinical placements. Government Ministers claim these changes could deliver up to 10,000 extra places over the course of this Parliament, so can they set out what capacity hospitals and other providers have to accommodate these extra students, and confirm whether Health Education England has sufficient funds set aside to fund these placements? Will the Minister be clear about how this 10,000 figure was arrived at? Is it the Government’s assessment of what the system needs, what Health Education England can afford to fund or simply a big-sounding number plucked out of the air at random?

An extra 10,000 compared with when? What is the baseline year on which we should judge the Minister’s policy? I have asked him that three times in written parliamentary questions, and each time I have not received an answer. Does he not understand that if his Department cannot even answer a simple question relating to one of its key claims about the policy, that does not exactly inspire confidence? There are so many questions that the Minister needs to answer that it is impossible to do all of them justice in a single speech.

[Alex Chalk (Cheltenham) (Con)]

As has been indicated, it is agreed that we need to expand the number of places. Thanks to this Government, however, an extra £10 billion has been put into GP services, acute services, cancer treatment and hospital care. Which of those services would the hon. Lady cut to fund the alternative bursary scheme that she has in mind?

[Heidi Alexander]

The hon. Gentleman does not seem to realise that that money is plugging a very big black hole in NHS finances. I am sure that when the Minister responds to my speech, he will note that many people who apply to study for nursing and other healthcare degrees are turned away, but what proportion of those unsuccessful applicants actually meet the entry criteria? How can he be sure that his new system will deliver the required numbers of different types of nurses and other healthcare professionals in the right geographical areas? What guarantees has he given to higher education institutions that the new arrangements will fully cover the costs of delivering degrees, and what assessment has he made of the amount of un-repaid student debt that will accumulate, given that, over a lifetime, some nurses will not earn enough to repay the totality of their loans plus interest?

The proposal to scrap NHS bursaries is a massive gamble at a time when the NHS needs certainty. Put simply, it will shift the costs of training nurses, midwives and other allied health professionals from the state to the individual. If we are all happy to enjoy the benefits of the NHS, why should we not all contribute to the training of those who work in it?

I was the first member of my family to go to university. My tuition fees were paid in full, and I received a full maintenance grant. What really worries me is that people like me, and people like my friends, will be put off what could be a fulfilling and important career. We should be doing all we can to inspire today’s schoolchildren to become the nurses and healthcare professionals of the future, but, sadly, the Government are making a very good job of doing the very opposite. If Ministers want to continue to import staff from overseas, they are going the right way about it. We owe a debt of gratitude to those staff, but we want home-grown staff too.

Finally, let me return to the Government’s consultation paper. One section is entitled

“Nursing, midwifery and allied health professional students deserve the same opportunities as other students”.

Labour Members say, “No, they deserve better.” Those people should be treated differently from other students, because they are the people who will look after us when we are older, care for our relatives when they are sick and staff the NHS when this shambolic Government are long gone.

The Government should drop these proposals and think again. I commend the motion to the House.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to respond to the motion, not least because I think that this is potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards. We will be able to do that because of the reform that has helped so many other students throughout the country in the last five years.

The hon. Member for Lewisham East (Heidi Alexander) entered the House at the same time as I did. In November 2010, we sat on opposite sides of the House and contributed to a debate; many of us expressed anxiety about the outcome, not least because of the enormous pressures that we were experiencing from our constituents. Members who have been here for many years will know that that was the first occasion on which a riot taking place outside the House could be heard from the Chamber. The rioters were complaining that we were going to destroy people’s ability to go to university. We were going to make it impossible for people from disadvantaged backgrounds to go there, and we were going to set back years of progress in the closing of the inequality gap in this country.

Members on both sides of the House who spoke in that debate felt very passionately about the issue. We believed that it could be resolved by different means, but over the last five years we have been able to see the effect—and, as posited by the hon. Member for Lewisham East, the evidence—of the changes that were made. That evidence is quite clear. This year, 394,380 people were given university places in this country, 35,000 more than were given places in 2010, the year of the debate. If those 35,000 were to make up a single university, it would be the fourth largest in the country: one university, the fourth largest in one year, following the expansion of opportunity that resulted from the reforms that the House passed in 2010.

The hon. Lady made the most important point, however, when she asked how the reforms extended opportunity to the people who most needed to go to university. I regret the tone that she adopted in that portion of her speech; it was, I am afraid, beneath her. It was indeed wrong that when I was at university my fees were paid for in part by nurses paying tax on low wages. That was wrong, and we accepted that it was wrong. We also accepted that the system was not helping the people who most needed to go to university in order to escape their backgrounds.

The result that we should be looking for now is the number of people from disadvantaged backgrounds who have been helped to get into university in the last five years, and I can tell the hon. Lady that it has increased by 10,150. That is a massive increase. Had someone said back in 2010 that that would be possible, I doubt whether anyone would have given 5,000:1 odds on it, but I can also tell the hon. Lady that 10,150 is the number of people at the University of Leicester. That is the number of people whom we have brought into the university sector as a result of the changes that we have made. We have the equivalent of one more university, full of people from disadvantaged backgrounds, as a result of the reforms that we enacted in 2010.

I know that the hon. Lady’s motivations back then were entirely honest and commendable. I also know that many Conservative Members felt likewise. But we have to accept when we get things wrong, and it is in that regard, I am afraid, that the hon. Lady, rather than us, is failing to learn from history. During the 2010 debate, in an intervention on one of my hon. Friends, she said that the proposed changes would force on students a “huge debt”, and that

“the huge debt that they could now face will act as a greater disincentive to go to university than it will for students from more affluent backgrounds”.—[Official Report, 9 December 2010; Vol. 520, c. 579.]

The hon. Lady has made exactly the same point in today’s debate. She was wrong then, and I humbly suggest that she is wrong on this occasion. She should listen very carefully to the evidence that has been presented, not by me but by so many institutions, about the progress that has been made in reducing inequalities, and the reasons why we need to press ahead. In this instance, for one reason alone—and I will come on to others—we need to bring about the reforms to nursing bursaries.

[Heidi Alexander]

Does the Minister not accept, though, that healthcare students have very different characteristics from other students, and that their behaviour will not necessarily be same as that of students affected by the reforms in the last Parliament?

[Ben Gummer]

I accept that there are differences—I will come to them in a second—but implied in the hon. Lady’s point is an acceptance that she was wrong in 2010, and she should therefore be more measured in her proposals, or lack of them.

--- Later in debate ---

[Ben Gummer]

Contrary to what the hon. Member for Lewisham East said, I did consult the royal colleges. I have spoken at length with the Royal College of Nursing and with Unison. As I would expect, we differ on key parts—though not every part—of the plan, but the royal college’s initial response accepted that the premise on which we were proceeding was, in significant part, correct. In the consultation, I want to find areas we can agree on and improve the proposals we have put before the public. We were open about the consultation and offered the full 12 weeks—many people said we would not do so, but we did—precisely so that we could listen to the concerns, proposals and exciting challenges from people across the sectors, and thereby improve the proposals we have put before the NHS.

The motion suggests a series of things, but not a proposal from the Opposition to do anything different. They are not offering the NHS any new money—they offered £4.5 billion less than we did at the last election—so I can only presume that the money would have to be found from cuts elsewhere in the service. The hon. Lady will have no credibility unless she tells the House that she will pay for the 10,000 additional training places out of taxpayers’ money, rather than by finding an alternative funding mechanism. I will not offer the House a series of suggestions that might or might not be better, or merely criticise proposals, rather than offering constructive improvements.

[Heidi Alexander]

Whenever I make suggestions, they’re just ignored.

[Ben Gummer]

The hon. Lady is welcome to contribute to the consultation. She is doing so now, although sadly we heard no solutions or alternative proposals. I intend to set out not suggestions, but a clear announcement of our plans, the reasons for them, and how we will enact them over the year to come.

[Ben Gummer]

The hon. Member for Ilford North (Wes Streeting), who has concerns about the proposals, has discussed the matter with me several times and offered some useful suggestions about the detail. I have accepted his points and incorporated them into our thinking. I am very willing to listen to people from across the House when they come with helpful suggestions, and I am sure that the Minister for Skills, my hon. Friend the Member for Grantham and Stamford (Nick Boles), would be interested in the hon. Gentleman’s contribution about the apprenticeship levy. The way not to do it, however, is to come to the House with a series of criticisms but not one suggestion, nor any money to provide for the increased number of training places in the plan.

We should make these changes not only for reasons of social equity, though that is the foremost reason; not only to produce 10,000 additional training places in our university system; and not only because we have a broken planning system, which otherwise would remain broken—even people as intelligent as the hon. Member for Lewisham East cannot predict how many nurses, doctors and allied health professionals we will need in 20 or 30 years, or the skills they will need. Even were it not for all those things, it would still be important to do this, because of the changes it will make to the quality of training we can provide to nursing graduates. Across the rest of undergraduate training, universities have been released to innovate and improve their courses. Satisfaction levels have gone up and drop-out rates have fallen; consequently, people are getting a better experience.

We have not, however, been able to spread those advantages to nurses, who, I am afraid, remain trapped in a system that is prescriptive and does not take account of the skills that they and their future employers will need. By releasing universities from their straitjacket, we can make significant improvements to the quality of the training they provide.

[Heidi Alexander]

That’s just an assertion.

[Ben Gummer]

It is an assertion that is backed up by the evidence of the past five years, and which has received the recommendation of Professor Dame Jessica Corner, the chancellor of the Council of Deans of Health. I can tell the hon. Member for Lewisham East, in answer to her barracking, that Professor Dame Jessica Corner said:

“We recognise that this has been a difficult decision for the government but are pleased that the government has found a way forward. Carefully implemented, this should allow universities in partnership with the NHS to increase the number of training places and also improve day to day financial support for students while they are studying. The plan means that students will have access to more day to day maintenance support through the loans system and recognises that these disciplines are higher cost, science-based subjects.”

Likewise, Universities UK has said:

“We support increasing health professional student numbers and will work with Government and the NHS to secure the sustainable funding system”

that the Government have provided. It is particularly pleased about the impact that this will have on placement training. These are the people who are providing training in our NHS, and they support our proposals because they will release the same kind of innovation that we have seen elsewhere in the university sector.

--- Later in debate ---

[Ben Gummer]

The economic impact assessment is part of the consultation, and the hon. Gentleman should consult that. It will obviously depend on the way in which the student workforce develops over the next 20 or 30 years, but this has been fully costed within the Treasury’s assumptions, and we anticipate that people working beneath the current limits will not be paying back more than they are doing at the moment. That is in the nature of the way in which student finance repayments are calculated. These measures will not land newly qualified nurses with new payments that they might otherwise not have expected.

[Heidi Alexander]

The Minister has urged me to be careful with my words, which I was, and I recognise that he is being careful with his, too. He is talking about newly qualified nurses. Can he confirm what the average repayment would be for the average nurse?

[Ben Gummer]

We do not currently have a figure for the average nurse, as the hon. Lady puts it. I cannot project where a nurse’s career path will take them 50 years into the future, for precisely the reasons that we have been discussing. The actual repayments—[Interruption.] I will come to the hon. Member for Kingston upon Hull North (Diana Johnson) in a second. The actual repayments are clearly listed in the consultation document. They are clear about the amount that will be paid back over and above what existing students would be expected to pay.

The only way in which we will be able to square the circle that the hon. Member for Kingston upon Hull North mentioned is by reforming student finance. Rather than shouting from a sedentary position, she might like to know that, contrary to her suggestion that many people in her constituency were none the wiser about this reform, I talked about the reforms to nurses in her constituency a few months ago. I also talked to them about the introduction of apprenticeships and of nursing associate grades, all of which are part of the reforms that I am outlining, and they were very excited about the changes that we are making to the nursing profession. All of this is possible only within a budget that is being carefully controlled, and in which priorities are placed on where the money is spent.

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.

Junior Doctors Contracts

Heidi Alexander Excerpts

Monday 18th April 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the imposition of a new junior doctors contract.

[The Secretary of State for Health (Mr Jeremy Hunt)]

This House has been updated regularly on all developments relating to the junior doctors contract, and there has been no change whatsoever in the Government’s position since my statement to the House in February. I refer Members to my statement in Hansard on 11 February, and to answers to parliamentary questions from my ministerial colleagues on 3 March, which set out the position clearly. Nevertheless, I am happy to reiterate those statements to the hon. Lady.

The Government have been concerned for some time about higher mortality rates at weekends in our hospitals, which is one reason why we pledged a seven-day NHS in our manifesto. We have been discussing how to achieve that through contract reform with the British Medical Association for more than three years without success. In January, I asked Sir David Dalton, the highly respected chief executive of Salford Royal, to lead the negotiating team for the Government as a final attempt to resolve outstanding issues. He had some success, with agreement reached in 90% of areas.

However, despite having agreed in writing in November to negotiate on Saturday pay, and despite many concessions from the Government on this issue, the BMA went back on that agreement to negotiate, leading Sir David to conclude that

“there was no realistic prospect of a negotiated outcome.”

He therefore asked me to end the uncertainty for the service by proceeding with the introduction of a new contract without further delay. That is what I agreed to, and what we will be doing. It will start with those in foundation year 1 from this August, and proceed with a phased implementation for other trainees as their current contracts expire through rotation to other NHS organisations.

Let me be very clear: it has never been the Government’s plan to insist on changes to existing contracts. The plan was only to offer new contracts as people changed employer and progressed through training. This is something that the Secretary of State, with NHS organisations as employers, is entitled to do according even to the BMA’s own legal advice. NHS foundation trusts are technically able to determine pay and conditions for the staff they employ, but the reality within the NHS is that we have a strong tradition of collective bargaining, so in practice trusts opt to use national contracts. Health Education England has made it clear that a single national approach is essential to safeguard the delivery of medical training and that implementation of the national contract will be a key criterion in deciding its financial investment in training posts. As the Secretary of State is entitled to do, I have approved the terms of the national contract.

The Government have a mandate from the electorate to introduce a seven-day NHS, and there will be no retreat from reforms that save lives and improve patient care. Modern contracts for trainee doctors are an essential part of that programme, and it is a matter of great regret that obstructive behaviour from the BMA has made it impossible to achieve that through a negotiated outcome.

[Heidi Alexander]

Just when we thought this whole sorry saga could not get any worse, it now appears that Government policy is in complete disarray. Despite the Health Secretary giving us all the impression back in February that he was going to railroad through a new contract, it now appears that he is simply making a suggestion—or, as his lawyers would say, approving the terms of a model contract. Last night, the Health Secretary took to Twitter to claim that this was not a change of approach, and we have heard the same again today, so, on behalf of patients, I have to ask him: what on earth is going on?

We need a straightforward answer to a simple question: is the Health Secretary imposing a new contract—yes or no? If he is not, but merely suggesting a template, why did he not make it clearer beforehand, and why, in his oral statement on 11 February, did he lead Parliament, the media, the public and, crucially, 50,000 junior doctors to believe that he was announcing imposition? The junior doctors committee took the unprecedented step of escalating its industrial action on the back of his decision to force through a contract. How can he possibly justify a situation whereby his rhetoric, underpinned by nothing but misplaced bravado and bullishness, could lead to the first ever all-out strike of junior doctors in the history of the NHS? He must get back to the negotiating table, and quickly.

We also need answers to the following questions. Do all NHS employers have free rein to amend the terms of the Health Secretary’s so-called model contract? Does this include non-foundation trusts? Is it legal for Health Education England effectively to blackmail trusts on the part of the Health Secretary by withholding funding, if that is what Government policy now is? Finally, it seems there are two basic scenarios: either he has known all along that he does not have the power to impose a new contract, and so all this is part of a cynical attempt to take on a trade union, or he was oblivious to the fact that he did not have the power, in which case, what is going on in his Department? This is no way to run the NHS. Today’s revelations call into question the motives, judgment and competence of the Health Secretary, and the House, doctors and patients deserve some answers.

[Mr Hunt]

That is a truly desperate attempt to divert attention from the single biggest question that people in this House want answered: does the Labour party support or not support a strike that will see the care of thousands of people up and down the country suffer?

Let me answer the hon. Lady’s question very directly. Yes, we are imposing a new contract, and we are doing it with the greatest of regret, because over three years—with three independent processes, 75 meetings and 73 concessions that we made in a huge effort to try to come to a negotiated settlement—the BMA refused to talk. With respect, I think Sir David Dalton, the trusted chief executive of Salford Royal, understands these things better than the hon. Lady has shown she does today. After working very hard, he concluded that a negotiated settlement was not possible. That is why I announced on 11 February that I would introduce a new contract.

As for foundation trusts, if the hon. Lady had listened to my statement she would know that it is true that foundation trusts have the freedom to introduce new contracts on pay and conditions. They can choose to exercise that freedom, but none of them has done so. She asked about non-foundation trusts. They do not have that freedom, and that is why we will be introducing a new contract for everyone.

Let me say this to the hon. Lady. There has been a lot of talk about this, but none of it as specious as the story that she planted in The Guardian this morning about the Government changing their position, which was absolute nonsense. We have not changed our position. The fact of the matter is that the Government have bent over backwards to avoid this strike. Right now, the people refusing to talk, whether it be on rota design with hospital managers or training reform with the academy, are not the Government but the BMA. Had it negotiated on Saturday pay, as it said it would, we would have had an agreement by now. Instead, we have a strike—the first ever withdrawal of emergency care in NHS history. [Interruption.]