Junior Doctors Contract

Debate between Heidi Alexander and Alistair Burt

Friday 20th November 2015 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 negotiations for a new junior doctors contract.

[The Minister for Community and Social Care (Alistair Burt)]

Three years ago, negotiations began between the British Medical Association, NHS Employers and the Department of Health. They were based on a common view that the current contract—agreed in 2000, when junior doctors were working very long hours—was outdated and needed reform. Between December 2012 and October 2014, extensive and patient negotiations took place, with an agreed target date for implementation of August 2015.

The negotiations were abruptly terminated by the BMA’s unilateral withdrawal from them, without warning, in October 2014. That led to the independent and expert Doctors and Dentists Review Body being asked to take evidence on reform of the contract from all parties, including the BMA, and to make recommendations. That happened because of the unwillingness of the BMA to agree sensible changes to the contract, and allowed an independent expert body to recommend a way forward.

The DDRB report on the junior doctors contract, with 23 recommendations, was published in July. The Secretary of State then invited the BMA to participate in negotiations based on those independent recommendations. Unfortunately, the junior doctors committee of the BMA maintained its refusal to negotiate, even though the negotiations would be on the basis of an independent report to which it had had an input. Both the Secretary of State and NHS Employers have repeatedly invited the BMA to participate in negotiations. It was made clear that there was a great deal to agree on based on the DDRB recommendations.

We deeply regret that the BMA chose the path of confrontation, rather than negotiation. While we continued to try to persuade it to develop a new contract with us, it instead chose to campaign against the independent DDRB’s recommendations, including by issuing a calculator, which it subsequently withdrew, suggesting—wholly falsely—that junior doctors would lose 30% of their pay. Instead, the BMA issued demands, including a right of veto on any contract change. In effect, it asked us to ignore the DDRB’s recommendations, the heads of terms agreed back in 2013, and to start again.

Given the BMA’s refusal to engage and its wholly misleading statements about the impact of a new contract, NHS Employers issued a contract offer to junior doctors earlier this month. This offer has safety at its heart and strong contractual safeguards to ensure that no doctor is required to work more than 48 hours a week on average, and it gives junior doctors the right to a work review when they believe hours are being exceeded. It reduces the maximum hours that a doctor can work in any week from 91 to 72 hours. It pays doctors an 11% higher basic pay rate, according to the hours that they work, including additional payments for unsocial hours. It reduces the number of consecutive nights that can be worked to four and of long days to five, ending the week of nights.

The hon. Member for Lewisham East (Heidi Alexander) has called for the parties to go to ACAS. The Secretary of State is not ruling out conciliation. We have always been willing to talk. The Government have repeatedly appealed to the BMA to return to the negotiating table, and that offer is still open. We believe that talks, not strikes, are best for patients and for junior doctors. The Secretary of State has said that talks can take place without preconditions, other than that an agreement should be within the pay envelope. However, the Government reserve the right to make changes to contracts if no progress is made on the issues preventing a truly seven-day NHS, as promised in the manifesto and endorsed by the British people at the last election.

It is regrettable that junior doctors have voted for industrial action, which will put patients at risk and see between 50,000 and 60,000 operations cancelled or delayed each day. I therefore call on the hon. Lady to join the Government in calling on the BMA, as it prepares for unprecedented strike action, to come back to the table for talks about the new contract for junior doctors. The Government remain firmly of the view that a strike by junior doctors is entirely avoidable, and we call on the BMA to do all it can to avert any action that risks harm to the patients we all serve.

[Heidi Alexander]

The fact that we are in this situation today, with 98% of junior doctors having voted to take significant industrial action for the first time in 40 years, makes me angry and sad. I say that because it did not have to be this way. The truth is that if we had had a little less posturing and a little more conversation from the Health Secretary, this whole sorry episode could have been avoided.

Does the Minister agree that, over the next week, everything that can be done should be done to stop the three days of planned industrial action? He said that the Health Secretary does not rule out going to ACAS, so why did the Secretary of State appear to dismiss the idea of independent mediation yesterday? Does that seemingly flippant rejection of the need for independent mediators to prevent industrial action not show a casual disregard for patient safety?

The way in which the Health Secretary has handled the negotiations has been appalling. Does the Minister understand that negotiation by press release is not the way to conduct discussions, nor any way to run the NHS? Does he understand that junior doctors are particularly angry about the way in which the Health Secretary has repeatedly conflated the reform of the junior doctors contract with seven-day services? Junior doctors already work weekends and they already work nights. For the record, not a single junior doctor I have met during the past few months would not drop everything to respond to a major terrorism incident. To suggest otherwise is to insult their professionalism.

The fundamental question hanging over Ministers this morning is this: why continue this fight? Hospitals are heading for a £2 billion deficit this year, mental health services are in crisis and the NHS is facing its most difficult winter in a generation, so why on earth are this Government picking a fight with the very people who keep our NHS running? There are nine days left before the first day of planned industrial action. Let me say very clearly to the Minister this morning: it is now time to talk.

[Alistair Burt]

I agree with the hon. Lady that we do not need to be in this situation. Absolutely. That is the whole point. The Secretary of State has kept his door open all the time. In seeking to conclude this, after starting negotiations three and a half years ago, the door remains open. It is for the BMA to come through it and say that it wants to continue the negotiations that it abruptly left more than a year ago.

Can and should everything be done to avert the strikes? Yes, it should. It would help if Labour Front Benchers made an unequivocal statement that they do not support strike action by doctors. I await to see whether that will be forthcoming. In the meantime, the Secretary of State has said that he is perfectly prepared to go to conciliation, but conciliation usually comes after a process of negotiations has broken down. The whole point is that the negotiations have not even kicked off again. The point is that the Secretary of State has offered such an opportunity, based on recommendations made by the independent Doctors and Dentists Review Body. That committee has made independent recommendations, including on the basis of information provided by the BMA.

For the hon. Lady to talk about a challenge to safety ill becomes the party that presided over Mid Staffs. The point is that, since he took office, the Secretary of State has, quite plainly and to everybody’s knowledge, made safety in the NHS his prime consideration. He wants a seven-day NHS to recognise the issues that have arisen at weekends. He has never said that junior doctors do not work at weekends. Of course they do—they carry the biggest burden of hospital work at weekends—but to make sure that the NHS is completely safe at weekends, as he intends, it is essential to spread out the burden and the junior doctors contract is part of that process. The hon. Lady said that it should be up to the Secretary of State to make the next move on the negotiations. I say to her that the door to negotiations is always open, as the Secretary of State has made clear.

The hon. Lady raised the issue of patient safety and the comments of Professor Sir Bruce Keogh, who is responsible for doctors in relation to emergencies. It is his role, as the national medical director, to ensure that everyone is safe. He wrote to the BMA yesterday and said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

He stated that

“patient safety is of paramount importance.”

Sir Bruce Keogh’s point in relation to an emergency situation was that although no one doubts for a second that, should there be an emergency in this capital like the one in Paris, every available doctor and member of medical staff would report for work, if it took place on the day of a strike when they were not already in the hospitals in the numbers required, it would take them time to get in. That was his concern about patient safety and it is a reasonable one.

I say again that we await a suggestion from the hon. Lady that it is not right for junior doctors to take strike action and that she will support the Secretary of State in saying that it is time to return to negotiations. The Secretary of State has been patient and fair, and he is clear that this is about safety. Negotiations should be returned to as soon as possible, and it would help if everyone said so.

Oral Answers to Questions

Debate between Heidi Alexander and Alistair Burt

Tuesday 2nd June 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

May I welcome my hon. Friend to his place? Among the many good reasons to go to Cornwall over the next few months will be to visit the Cornwall better care fund, which is part of the Government’s £5.3 billion better care fund, and get the opportunity to see the work of the Cornwall pioneer. Integration of social care and healthcare is extremely important, and it will be great to see it in Cornwall.

[Heidi Alexander (Lewisham East) (Lab)]

T3. For the first time in recent history, many of London’s more prestigious teaching hospitals—King’s College, University College London, Guys and St Thomas’s, and the Royal Free—are all forecasting deficit budgets. Apart from crossing his fingers and hoping the economy picks up to fund investment, what exactly is the Secretary of State going to do to tackle this problem?

Oral Answers to Questions

Debate between Heidi Alexander and Alistair Burt

Tuesday 17th April 2012 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

10. What reports he has received on the capacity of the authorities in Afghanistan to preside over free and fair presidential elections in 2014.

[The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Alistair Burt)]

When I was in Kabul about three weeks ago, officials made it clear that the forthcoming elections would create challenges, not only in relation to security. Accordingly, we are working with the United Nations Development Programme to support the capacity building of the Independent Election Commission of Afghanistan, which will have responsibility for presiding over and delivering the election in 2014.

--- Later in debate ---

[Alistair Burt]

Of course the date of presidential elections that might be triggered by a resignation must be a matter for the Afghanistan Government and the President. That he has made clear his intention to stand down is important in the context of accepting Afghanistan’s own constitution, which limits him to two terms. If an election were to come up immediately, the Independent Election Commission has said it would be difficult, but I think the sense is that the timing is likely to be co-ordinated with the Afghan Administration’s ability to hold such an election. It is a matter for them, but too soon an election might be very difficult, although the Independent Election Commission is working hard at improving its capacity to hold an election at the allotted time.

[Heidi Alexander]

I am sure the Minister will agree that for the next elections in Afghanistan to be really free and fair, women must be able to participate unrestricted in the process. What action has the embassy in Kabul taken to support women in the political process, and how confident is he that such participation will be meaningful?

[Alistair Burt]

Again, my recent visit and one I made some months ago allowed me to talk to women who are engaged in the political process. They are conscious of the difficulties in a socially conservative structure, but also of the gains they have made over the past 10 years and of their determination to make sure that the constitution, which guarantees equality for women, is adhered to. There can be no guarantees, but we are working with women’s groups and organisations throughout the country to ensure that the constitution is lived up to and to ensure the best possible opportunities for women’s representation because their full participation is indeed crucial.

Sri Lanka (Human Rights)

Debate between Heidi Alexander and Alistair Burt

Wednesday 22nd February 2012 Westminster Hall

[Alistair Burt]

I cannot. I have four minutes.

I will deal with two or three major issues raised by colleagues in the debate. First, I will deal with the deportations, which is an important issue. All asylum and human rights applications from Sri Lankan nationals are carefully considered on their individual merits, in accordance with our international obligations and against the background of the latest available country information. The situation in Sri Lanka is still evolving, and where individuals can demonstrate that they face a real risk of prosecution and/or ill treatment on return, they are granted protection. It is only when the UK Border Agency and the courts are satisfied that an individual is not in need of international protection and has no leave to remain in the UK that removal is sought. We do not routinely monitor the treatment of individual unsuccessful asylum seekers once they are removed from the UK. They are, by definition, foreign nationals who have been found, as a matter of law, not to need the UK’s protection, and it would be inconsistent with such a finding for the UK to assume an ongoing responsibility for them when they return to their own country.

The Foreign Office follows the human rights situation in Sri Lanka closely. For chartered flight operations, we currently make a small payment to enable returnees to travel to their home town or village. We also ensure that UK Government representatives are present at the airport. Every returnee, whether on scheduled or chartered flights, is provided with the contact details of the British high commission in Colombo, should they want to make contact with the migration delivery officer based there.

We are aware of media allegations that returnees are being abused. All have been investigated by the high commission, and no evidence has been found to substantiate any of them.

[Heidi Alexander]

Will the Minister give way?

[Alistair Burt]

No. I hope the hon. Lady forgives me, but I have three minutes to deal with the rest of the issues.

The hon. Member for Ealing, Southall brought up the discrepancy between scheduled and chartered flights, which I acknowledge. As I said, we give everyone the same information, and we have been able to meet chartered flights. I have now asked colleagues in Colombo to see what we can do to meet scheduled flights as well, where that is practicable. I assure the hon. Gentleman and the House that the same information is given to everyone to allow people to contact us in private—not the Sri Lankan authorities—and so far we have not been able to substantiate allegations. However, we remain open to anything that would do that, because it is essential that those returned are safe.

For the avoidance of doubt, I will also deal with the issues related to the Human Rights Council. We have raised the issue of Sri Lanka at the council under item 4, countries of concern. We also raised specifically the Channel 4 footage in the interactive dialogue with UN special reporters last June. We will continue to work with international partners to support Sri Lanka in its pursuit of enduring peace and reconciliation. We are aware that the US is preparing a draft resolution for the Human Rights Council, and we are likely to support it.

In relation to the Conservative Heads of Government—[Laughter.] If only. It was a Freudian slip. In relation to the Commonwealth Heads of Government meeting in Sri Lanka next year, it is too early for us to make the same pronouncement as the Canadians. There is much to be done before the meeting. We are conscious, as everyone in Sri Lanka is, of the importance of that meeting and its ability to stand for the highest values of the Commonwealth. No one is unaware of that position.

I conclude by repeating some earlier remarks. A number of specific issues will be answered by letter. The ongoing question is, if such things are going on, what are we going to do? We will work with the Sri Lankan Government on the implementation of LLRC and other human rights recommendations to deliver what they have declared they will deliver. We will work with international partners—Commonwealth and others—to urge action in areas where adherence to Commonwealth or human rights values is still lacking. We are conscious of the power of international bodies, such as the Human Rights Council and CHOGM, to apply pressure and to encourage the raising of standards. We are also conscious of time scales. Our activity will be both public and private, and I will regularly update colleagues. No one should doubt that there is still much to do in Sri Lanka, and no one should doubt that the UK Government recognise that.