NHS (Contracts and Conditions)

Helen Jones Excerpts

Monday 14th September 2015 Westminster Hall

[Valerie Vaz (in the Chair)]

A digital debate took place on Twitter, ahead of today’s debate. Mr Speaker has agreed that for this debate members of the public can use handheld electronic devices in the Public Gallery, provided that they are silent. Photos, however, must not be taken.

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered the e-petition relating to contracts and conditions in the NHS.

It is a pleasure to serve under your chairmanship, Ms Vaz, and, in particular, to be debating the first petition to reach the debate stage under the new system for dealing with e-petitions. The original petition on the joint Government and Parliament website called for a vote of no confidence in the Secretary of State for Health. Fortunately for him—or unfortunately, depending on how people want to look at it—the Petitions Committee does not have the power to initiate a vote of no confidence, and so we decided that the debate should be on the issue underlying the petition, which was the contracts and conditions of NHS staff.

I might be joking about motions of no confidence in the Secretary of State, but the morale of NHS staff is not a joke. It is a long time since I last saw dedicated doctors, nurses and ancillary staff so demoralised and, sometimes, despairing. If we look at the current state of the NHS we can see why. A&E departments are in crisis and missed waiting time targets for the whole of last winter. GP services are struggling to cope, and patients find it harder and harder to get appointments. Last year, the deficit across trusts was nearly £1 billion; this year, that is predicted to double.

Yet despite all that, NHS staff work miracles every day. Who could not be proud of some of the achievements of our surgeons? Who could sit in an A&E department, as I unfortunately had to during the election, seeing the endless patience of NHS staff, and not be grateful to them? Who could watch paramedics dealing with an accident or reassuring a frail and confused elderly patient and not be ever grateful for the NHS? After the Olympic opening ceremony, I remember one American reporter said, “Oh, it’s just like praising UnitedHealthcare.” No, it is not. The NHS is not like UnitedHealthcare, thankfully, and that is why we value it.

NHS staff have been badly treated by this Government. Since 2010 pay increases have been deliberately kept low and last year we saw some staff being told that they could not have even a 1% increase if they were due to get an increment as well. The Government often talk about public services as if they were a drain on the economy, but they are not. Services such as the NHS are a huge contributor to our economy. It is completely wrong that, under this Government, tax is cut for millionaires but dedicated NHS staff are not even entitled to a decent pay rise.

Indeed, in the previous Parliament the NHS was told to make £20 billion of what the Government call efficiency savings but the rest of us call cuts. That is due to rise to £30 billion by the end of this Parliament. The NHS is struggling to cope with fewer and fewer resources but more and more patients. Many of the difficulties being encountered are of the Government’s own making. Ministers criticise spending on agency staff, but the Government’s first act on coming into office in 2010 was to cut nurse training places by over 3,000 a year.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

I of course recognise the great work that NHS staff do, not least in Dorset, but is the official policy of the official Opposition now to lift pay restraint in the NHS?

[Helen Jones]

We made our policy quite clear in the last Parliament. In particular, we opposed the Government’s decision to curb 1% pay increases for NHS staff who were gaining increments. The hon. Gentleman really has to think about this: if there are fewer and fewer nurses in our hospitals—in particular, employment in the most senior grades is down by 3%—and we are spending millions on agency staff, something is going badly wrong. Hospitals are being forced to recruit nurses from abroad or spend on agency staff when we have thousands of people in this country who want to train as nurses but simply cannot get the training places that are available.

[Maria Caulfield (Lewes) (Con)]

Will the hon. Lady give way?

[Helen Jones]

In a moment. I want to make a little progress and finish this point.

That is a false economy. I make no criticism of the skills of the nurses we recruit from abroad, but it—

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

Will the hon. Lady give way?

[Helen Jones]

In a moment. The hon. Lady will have to curb her impatience for a little while.

I make no criticism at all of those nurses’ skills, but it is much better to be employing people here in this country. The only people benefiting from the current situation are the companies that supply agency staff. Indeed, one, Independent Clinical Services, saw its profits more than double, from £6.2 million in 2010 to £16.5 million in 2013. In other words, what the Government have done is a textbook example of a false economy.

[Helen Whately]

Does the hon. Lady acknowledge that between May 2010 and May 2015 the number of qualified nursing, midwifery and health visiting staff increased by 2.1%, at 6,622 additional staff?

[Helen Jones]

I am grateful to the hon. Lady for reading that out, but I referred to nurses in hospitals. The number of nurses working in hospitals has fallen under this Government, particularly in the top grades. The failure to train and recruit enough permanent staff is putting a great strain on those staff already in post, who are having to deal with agency staff all the time to make sure that they know how things work in a particular hospital or ward. That does not offer continuity of care for patients.

[Maria Caulfield]

I declare an interest as a former NHS nurse—in fact, I still work as a nurse. I do not want to be political about this, because I want progress to be made on supporting the NHS, and particularly staff, but one of the single biggest factors in demoralising nurses and leading many skilled nurses to leave the practice was the last Labour Government’s change to the skill mix. That was crucial, because we were forced to cut our budgets, particularly on the wards, and junior nurses were left in charge of wards, instead of experienced senior staff nurses and sisters—

[Maria Caulfield]

Can I just say that it is the change to the skill mix that has demoralised nurses, and that did not happen under this Government?

[Helen Jones]

I am afraid that I do not agree with the hon. Lady. What has demoralised most of the nurses I see is the cuts they have to cope with day in, day out, as well as the shortage of sometimes even basic equipment and the—

[Mary Robinson (Cheadle) (Con)]

Will the hon. Lady give way?

[Helen Jones]

In a moment. I need to make a little progress, because other people want to speak.

There is also the fact that this Government, rather than valuing NHS staff, consistently appear to undervalue them. The Government are now introducing further ideas. They want seven-day working in the NHS. I will come in a moment to what that means for hospitals, but let me look first at what is happening with general practitioners. In principle, everyone agrees that more out-of-hours care is a good idea—not least NHS staff themselves. The question is how the Government will fund and staff the extra working hours. Currently, we are increasingly short of GPs. In Warrington—on the Government’s own figures, before the hon. Member for Faversham and Mid Kent (Helen Whately) jumps up to read out her brief again—we have fewer GPs than we had—

[Mary Robinson]

Will the hon. Lady give way?

[Helen Jones]

No. I need to make a little progress, because other people want to speak.

In Warrington, we have fewer GPs than we had in 2010—those are the Government’s own figures, not mine. Nationally, the number of unfilled GP posts quadrupled in the three years from 2010 to 2013. The Royal College of General Practitioners says there are severe shortages in some parts of the country and that in some areas—it quotes Kent, Yorkshire and the east midlands—we need at least 50% more GPs over the next five years just to cope with population increases. Now, when there are not enough GPs to ensure timely access to appointments on weekdays, it is difficult to see how the Government are going to extend GPs’ working hours without recruiting more staff.

Of course, the cost is also an issue. It is estimated that the costs of extending services beyond the current contract, with one in four surgeries opening late in the evening and at weekends, would be £749 million. That would rise to £1.2 billion if one in two practices were open longer. That is far in excess of the money currently in the GP challenge fund. If the Government intend to proceed without recruiting more staff, that will simply increase the pressures on the staff working already, leading to more burn-out, and it will be a downward spiral. We already know that many GPs are thinking of retiring early.

The Secretary of State has now turned his attention to not only GPs, but hospital doctors and consultants, who he says do not work weekends. Well, I have two consultants in my family, and that is news to me, because they certainly do work weekends. In fact, the Secretary of State so provoked hospital doctors that they took to Twitter under the #iminworkJeremy, posting pictures of themselves working at weekends, often after a 70-hour, five-day week.

Now, I reiterate that everybody accepts that out-of-hours care has to improve, but the Secretary of State needs to achieve that through consultation and by showing respect for the staff we already have. At the moment, he is guilty of muddled thinking; he has deliberately confused emergency care with elective care. Specialists in emergency care do work weekends; in fact, very few consultants opt out altogether—the figure is about 0.3%. Yet, the Government tell us that there are 6,000 extra deaths among people admitted at weekends. The Minister needs to publish the research on that and to go further, because correlation and causation are not the same thing.

[Dr Sarah Wollaston (Totnes) (Con)]

May I recommend that the hon. Lady read last week’s edition of the British Medical Journal, where the issue is set out very well by Professor Freemantle?

[Helen Jones]

Yes. I thank the hon. Lady for that useful suggestion. I will do so.

People who are admitted to hospitals at the weekend are much sicker than those admitted on weekdays, because we do not have elective admissions at the weekend.

[Maria Caulfield]

Does the hon. Lady have any suggestion as to why people are sicker at the weekend? Is it perhaps because they have been unable to get hold of their GP in the evenings or on previous weekends?

[Helen Jones]

I have just said the Government should publish their research and delve deeper into the figures. [Interruption.] Look, the hon. Lady knows that people admitted at weekend are, overwhelmingly, emergencies. That is the point. Their death rates cannot be compared with death rates on weekdays, when there is elective surgery—that is a basic point, which she needs to grasp.

If the Government really believe these things are happening, they need to find out why. As I understand it, death rates are taken over 30 days, so someone can be admitted on a Sunday and die 28 days later, on a Thursday. The Government need to prove cause and effect before they can make the link between admissions at the weekend and death rates. So far, however, we have not seen that from them.

[Helen Whately]

Will the hon. Lady give way?

[Helen Jones]

No, I need to make some progress.

What, exactly, is the Secretary of State trying to do? If he is trying to bring about a seven-day fully elective service, he needs to say so. As far as I am aware, no major health system in the world has managed to do that. If he is not trying to do that, he needs to tell us clearly—perhaps the Minister will do so when he winds up—which services he thinks should operate at the weekend.

The Secretary of State also needs to recognise that, to have the service he proposes, he needs not only more doctors, consultants and nurses on the wards, but back-up staff. Doctors operate by leading teams. If they do not have the ancillary staff—the people to do the MRI scans, the radiology and the lab tests—they cannot operate properly. We need to hear how the Secretary of State will implement his proposals. Will he recruit more staff, or will he worsen the terms and conditions of staff who are already not well paid, to introduce weekend working?

It might help to improve morale in the NHS if the Secretary of State refrained from attacking staff for not working at weekends, when they do, and actually negotiated with them sensibly. Staff know what is happening at the frontline, and they can best suggest the changes that need to be made.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

We are discussing contracts and conditions. Does my hon. Friend agree that whistleblowing is another issue over which there tends to be silence? The last time there was a full debate on it in this place was 2009. It came up tangentially in 2013, in a debate on accountability and transparency, and it has appeared in statements—I think there was one last July and one earlier this year—but is it not time that we had a full and proper debate?

[Helen Jones]

Whistleblowing in the NHS, as in other areas, is an important issue. It is important to protect staff who blow the whistle to protect their patients, which is their duty. Perhaps my hon. Friend will initiate a debate on that; I am sure we would welcome that.

When the Secretary of State talks about NHS staff and doctors, let us remember that the starting salary for a junior hospital doctor is £22,636. It is not a huge amount when someone has spent years in medical school and works many hours, and often has to deal with seriously ill patients. However, the Secretary of State proposes to change their contracts to take away the extra payments for weekend working, which will effectively mean a huge pay cut. The Scottish Executive will not do that, and that will lead to the ridiculous situation in which two doctors doing exactly the same jobs in different hospitals either side of the border will be on two rates of pay.

As for consultants, I have heard complaints from the Government that Labour raised their pay rates. Yes, we did, and I am proud that we did. I will give the Minister the reason, which was set out very clearly by Frank Dobson, who was formerly my right hon. Friend the Member for Holborn and St. Pancras. In the City there are people who probably messed about for most of their time at school and played noughts and crosses at the back of the class, and who can make millions. Across the road there will be someone who was probably the cleverest kid in their class and has worked for years in training—often someone who is at the cutting edge of medical development. Yes, those people deserve a decent rate of pay for their skills, training and responsibility.

The Government also forget that consultants’ time is allocated in two blocks: direct clinical care and supporting professional activities. Those two together make up the 40-hour week. SPA time is for such things as mentoring, quality improvement and teaching. Some consultants go on to do more teaching and research, perhaps, but they are doing extra work on top of the 40-hour week, which increases their pay. Consultants’ basic pay ranges from £70,249 to £101,451, so the Secretary of State needs to explain how he can tell us that consultants are paid £118,000 a year. How does he calculate that figure, and what is included in it?

If the Government really want more consultant time on the ward, they could look at some of the things that do not need to be done by doctors, but which doctors currently do because of lack of back-up staff. The Government always talk as if non-clinical staff in hospitals are somehow superfluous and an extravagance. That is not correct. Without the right staff, doctors and nurses are forced to take time from clinical care to do some of their jobs. For example, many doctors whom I have spoken to now collect their own data for audit and input it themselves. That is a job that a competent clerk should be doing—not a consultant. I found one hospital where there is one secretary to a group of 25 consultants. Writing letters takes consultants away from clinical care.

I found one place where the IT equipment is so old that it takes six minutes to boot up, and often collapses, with the loss of the data. If the Government really want more doctor time on the wards they should consider those issues as well, and think about the other staff. As an example, if an operating theatre does not have a full complement of staff, there is no one to send out with the patient who is in recovery, and a doctor must go with them. That slows the turnaround time for theatres, and staff are told that their turnaround time is not good enough.

I say again that it takes a team of people to run the NHS, not just doctors. Let us also remember that the NHS depends on many staff who earn very low salaries. As doctors would be the first to say, those people are an essential part of the team. The NHS Pay Review Body could see a case for some adjustments to unsocial hours pay—and I have not met any staff who do not see a case for that; but it noted that both the Department of Health and NHS employers said that the cost of unsocial hours premiums makes the delivery of seven-day services prohibitive. The Minister must tell us whether the Government will try to deliver seven-day services by cutting the pay of staff again. The review body said that that could risk the morale and motivation of staff.

Recently we have had a few soundbites from the Government, but no clear mechanism showing how they will set out to do what they say they will do. They have pledged an £8 billion increase in NHS funding by 2020. Even taking them at their word—and some of us are rather sceptical—that is the bare minimum to keep existing services going. [Interruption.] If the Minister’s Parliamentary Private Secretary, the hon. Member for Winchester (Steve Brine), will stop chuntering from behind the Minister, I will wind up my remarks. [Interruption.] PPSs, as I told someone once before, are meant to be seen, not heard.

The Minister needs to make it clear what services the Government will run and what staffing arrangements they will put in place. They can put more doctors on the ward, but that will be useless without the back-up staff. It is not surprising that one surgeon in the #iminworkJeremy campaign posted a picture of himself mopping out his operating theatre at the end of the day. That was very good of him, but is it the best use of a consultant surgeon’s time? Above all, the Secretary of State and his Ministers need to stop attacking the people who work in the NHS, and to try to work with them in a climate of mutual respect. It is not hospital doctors, GPs, nurses, lab technicians or cleaners who have caused staff shortages in the NHS; it is the Government. Those staff members did not introduce the disastrous Health and Social Care Act 2012. They are not the people requiring huge cuts in our hospitals and other services. Unless the Government are prepared to recruit more nurses, doctors and ancillary staff, more and more pressure will be put on existing staff, who will suffer burnout. It will be a downward spiral.

When I worked in teaching, a wise old head teacher said to me, “People say that the first thing you have to do in a school is ensure that the children are happy; but no—the first thing you should do is ensure the staff are happy. If the staff are happy the children will be well taught.” That is something that can be applied in many areas. I tell the Minister honestly that he needs to take note of the anger among staff that generated the petition, take it on board, stop denigrating them, and deal with them properly and sensibly, to achieve what the Government have set out to achieve.

--- Later in debate ---

[Helen Jones]

What I said, if the hon. Lady was listening, was that the Government have to dig behind those figures and find out the reason for them. Correlation is not causation. That is a very basic principle when we are looking at things such as that, and I would be grateful if she did not attribute to me words that I have not said.

[Helen Whately]

The hon. Lady is correct to distinguish clearly between correlation and causation, but I did feel that the tone of her remarks seemed to question the evidence of increased mortality over weekends and out of hours. I will say that I agree with her on the need for increased investment in IT to enable the clinical workforce to spend more time on clinical work. I agree with her on that point.

I have observed over recent years that the Secretary of State has championed the NHS. He has fought for its budget to be protected at a time when many other budgets have been cut. He has secured the Chancellor’s commitment to an extra £8 billion of annual funding by 2020, and he has truly focused on patients and clinical quality over finances and structures. I wonder whether any other Secretary of State has spent as much time with his sleeves rolled up in hospitals, not just listening to the sound of bedpans but actually emptying them.

I am a supporter of the Care Quality Commission and observe that three years ago it was close to collapse, but it is now widely praised, particularly by the acute sector. I know that GPs are unhappy about the inspections, but 70% of providers say that the CQC’s inspections have given them information that has helped to improve their service. That has been supported by the Secretary of State.

Along with that focus on quality and transparency, the Secretary of State is to be applauded for trying to improve the culture of the NHS—to make it more open, supportive and connected and to ensure that NHS leaders are in touch with patients and staff.

--- Later in debate ---

[Jo Churchill]

It is a very good idea. The lack of pharmacy provision in hospitals is often cited as one obstacle to patient discharge. The cost of not discharging someone on a Friday, meaning that they use a bed on Friday, Saturday and Sunday, is £2,700, which is a lot of money.

[Helen Jones]

The hon. Lady was not in the House when we debated this Government’s change to local government finance, but at the time, many of us warned that it would hit social care and impact on our hospitals. Does she accept that hospitals are having great difficulty discharging patients, not only at weekends but during the week, because social care is not available for them?

[Jo Churchill]

I would say that it is a mixed picture. What I am picking up from care homes in my constituency is that some wards do it more effectively than others, with better services and things better locked together. Although I accept that there may be a problem, again, I look to the leadership.

I gave birth to some of my children on a Saturday and Sunday. Their entrance did not appear any less special to the obstetrician than those of my children who appeared midweek. I am not consultant-bashing; this is reality. The NHS has been delivering consultants and staff who provide outstanding service, but one cannot deny the statistic that patients’ chance of survival is less if they are admitted to a hospital at the weekend. Even if we extrapolate from those figures to account for the fact that the people admitted at the weekend are often very poorly, and often very elderly, they tell us that there is a problem. It would be remiss of this or any Government not to ask why or to investigate the situation and consider how to provide solutions.

I will not talk about people’s pay or anything else; we have done that. Instead, I shall focus on the petition, which in my view is neither constructive nor helpful. I would like the Government to learn from the best practice of consultants and their teams. Brilliant ideas are out there if we can only harness that best practice. For example, at the virtual fracture clinic at my West Suffolk hospital, a consultant told me that he has cut the number of times that patients must visit the hospital. Work can be done remotely; even discharges can be done on the phone, and those who need further specialist help can be sent on. We need to have honest conversations about the NHS. We need to use its finite resources, including staff, more sensibly if we are to survive.

We have 1.4 million great people working in our NHS, and 1.6 million people working in our social care sector. That is one tenth of this country’s population. We all agree that a seamless pathway between the two is the best future, but I leave Members with this question. If we cannot discuss a way forward that allows us to accept change, understand and develop new ways of working, we may struggle to look after the burgeoning health population, and there may be more than contracts to think about.

[Maria Caulfield (Lewes) (Con)]

Thank you, Ms Vaz, for giving me the opportunity to speak in this debate. I am a passionate supporter of a seven-day-a-week national health service. That might take many formats; it is not a one-size-fits-all situation, so what works in my constituency might be different from what works in someone else’s.

I will not repeat what many of my colleagues have already said, but I think that we need an honest debate. There are difficulties to get over; my hon. Friend the Member for Totnes (Dr Wollaston) in particular has described them. We will have to work together and compromise on certain things, but if we do not debate the issue and find a resolution, patients will die from lack of access to good out-of-hours care. We need to tackle it. To be 16% more likely to die just because of the day of the week one is admitted to hospital is not good enough in this day and age.

However, it is not just about the impact on patients and their relatives; it is also about the impact on staff. Tribute has rightly been paid in this debate to staff, senior consultants and doctors who work long hours and come in at weekends. Many of them do so unofficially because they are dedicated, but I want to represent staff who work out of hours because it is part of their contract. I have been a nurse for more than 20 years. I have worked in the community on weekends, when patients without access to a GP have needed painkillers or an urgent dressing and it is difficult to get hold of a doctor. I have been in charge of wards on weekends and nights, when patients tend to be sicker because as medicine has progressed, patients who are well are often discharged earlier, so those left in hospital are often sicker than they would have been a decade ago.

Along with the reduced skill mix that I highlighted earlier, the pressure on nurses, healthcare assistants and other ancillary staff is huge. Two or three staff on night duty with a poorly patient who is septic might have one doctor on call handling four or five other wards, who might have 10 admissions that night to see to first. The staff will have expanded their skills so that they can cannulate the patient, take their bloods and send them off to the labs, but that is the limit of what they can do. It is hugely stressful. I know from having been in charge of a team of nurses on nights how difficult it can be.

That cannot continue. It is not good for patients—we know that their mortality and morbidity rates get worse—and it is not good for staff or for their morale. I have seen nurses in tears after a busy night shift during which we could not care for a patient the way we should have, because we had no access to senior medical advice. Yes, it is possible to phone the consultant on call and have a chat with them, but nothing beats having the advice of an expert who can interpret an X-ray or blood results and who can help junior medical staff prescribe the right antibiotics.

A great example introduced in the past couple of years is the acute oncology service, which has transformed out-of-hours care for cancer patients. As a sister in a research unit not far down the road, I know what a difference that has made to my patients. For some reason, patients tend to get really poorly at half-past 4 on a Friday afternoon, come what may. I have been so pleased with that service, which is now available up and down the country and offers trained senior nurses, doctors and a whole team of people who can assess a patient and get treatment going. For conditions such as sepsis, it is life-saving. Those with spinal cord compression can have a scan urgently and be started on steroids straight away. That is the difference between a patient being able to walk during the last six months of their life and being bed-bound.

That is out-of-hours care at its best, but of course difficulties and contentious issues will arise when renegotiating contracts. It is not just about consultants and senior staff. Proper out-of-hours care will require support services such as radiologists, radiographers and pharmacists. My hon. Friend the Member for Banbury (Victoria Prentis) spoke about the perfect week; I could talk to hon. Members day in, day out about how many patients we kept in hospital over the weekend because we could not access drugs to send them home. That is not a great use of hospital resources, but more importantly that is not a great experience for patients and their relatives.

Support services make a huge difference, but my plea is that we do not use the debate as an opportunity to score political goals. We have to work together. If we do not work cross-party on this, we will be here in 10 years’ time. Patients will lose out and their families will lose loved ones if we do not make a difference. It will not be easy. Nobody will be happy about working different hours. We are not asking people to work more than 40 hours a week; we are just asking people to work differently. We are not even just talking about how we work, but about a systems change in the culture of the NHS, so that the patient at half-past 4 on a Friday afternoon does not think, “What lies ahead for me this weekend?” I urge hon. Members on both sides of the House to be as constructive as possible.

[Helen Jones]

I am grateful to the hon. Lady; she has been most generous in giving way. She says that she is not expecting NHS staff to work more than 40 hours a week; did she mean to say that? Many of them already work more than 40 hours a week. Is it now Government policy that no one in the NHS should work more than 40 hours a week?

[Maria Caulfield]

The hon. Lady is being disingenuous.

[Helen Jones]

Answer the question.

[Maria Caulfield]

Of course. I have worked more than 40 hours a week; many staff do. We are not asking staff to work more hours—we have been very clear—but we are asking staff to work differently. I do not think that there is anything wrong with that if it provides a better service for the patient and takes the pressure off those front-line staff who are without radiology support, laboratory support and senior cover support. I ask the hon. Lady to support the measures and work with us, so that we can work with healthcare professionals to achieve that. They need senior support out of hours, because they need someone to interpret test results, make decisions to discharge a patient and break bad news when results are not good, and they need senior expertise to refer to others to move the process forward. My plea is that is we all work together.

I welcome the debate this afternoon. It is good to have it. I am pleased that healthcare professionals flag up issues, because I do not want policies to be steamrollered in, as they have been in the past, and for us to sit here 10 years later reaping the results. I welcome the seven-day-a-week initiative and the move to change the culture and the system, so that ultimately patients see improvement in patient care.

--- Later in debate ---

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

It is a great pleasure to serve under your chairmanship for the first time, Mrs Gillan, as it was to serve under the previous Chair, Ms Vaz.

This is an important and exciting day because we are responding to the first e-petition under the new system. The hon. Member for Denton and Reddish (Andrew Gwynne) is quite right that it should have happened some time earlier. I hope that through what are pretty modest forays into social media we can make more popular the debates that take place in Westminster Hall, because they are often far more thoughtful and certainly more nuanced than some of the debates that one hears just a few hundred yards away.

I am grateful to the Chairman of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), for her introduction. Hers was a vigorous opening argument and certainly did what it should have done, which was to spur a good and, at many points, enlightening debate. There is much to which I would like to respond, but at times the debate turned into a general critique of the NHS, so if I tried to answer every point, Mrs Gillan, I think we would be here beyond the 7.30 pm cut-off that you and, I imagine, other Members would not like me to reach.

The debate encompassed many of the issues and problems that confront the NHS, as do all discussions of seven-day services because they touch on contract reform and how we manage the NHS workforce. At the core of the debate was what we are trying to do: deliver exceptional, world-class care to every patient coming to an NHS institution, hospital, GP or community service in England and, by extension, the other nations of this country.

I, too, pay tribute to some shadow Front Benchers. I am grateful for the words of the hon. Member for Denton and Reddish. I almost wish he had not said what he did, because I wanted to say that I hope he keeps his Front-Bench position. He has always been a very reasonable defender of the Labour party’s point of view and a strong interrogator of the Government’s policies. That is exactly what opposition should provide. I should take the opportunity to say how much I will miss his colleague, the hon. Member for Copeland (Mr Reed), with whom I sat in this Chamber a couple of days ago for his last debate as a shadow Minister. I did not have the opportunity then—the moment escaped me, and I did not have knowledge or foresight about where he would be on Saturday—to wish him well and say how much I had, in my short time as a Minister, enjoyed debating important issues in the Chamber with him.

It is also entirely right to say that the right hon. Member for Leigh (Andy Burnham) has been Secretary of State for Health, a Health Minister before that, and a shadow Secretary of State for a long time. His contribution to debates about the NHS has been very important. It is clear from how he speaks that he cares passionately about the health service, and I very much hope that he delivers the same kind of force of argument in his new position as shadow Home Secretary.

It will be good to see what the new shadow Minister, the hon. Member for Lewisham East (Heidi Alexander), brings to her role. I hope that she will enter into arguments and debates on NHS reform with the spirit of openness and decency shown by the hon. Member for Central Ayrshire (Dr Whitford), who often attends these debates, bringing a great deal of personal experience from both this country and abroad, and who makes sure—no doubt because we often feel chastised if it goes any other way—that the debate is continued with a sense of decorum and a remembrance that our discussions are held in public. We must be aware of the fact that what turns people off political discourse more than anything is a silly repetition of party political positions with no meeting in the middle or discussion of the issues at hand.

It is in that spirit that I hope to address the central point of the presentation of the petition by the hon. Member for Warrington North. I am glad that we have these petitions, although perhaps a little less glad that this particular petition contains such stridency of language. Nevertheless, at the core, what concerns me is the point made very well by the hon. Lady: words matter. That was echoed by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). We must be very careful about the words we use—not only the manner in which we say them but how they might or might not be construed.

Hon. Members may not be surprised to hear that I have read—several times, as it happens—the Secretary of State’s speech on this matter. I have also seen the coverage on it, and there is dissonance between the two. At no point did he attack NHS staff or suggest that they are not working in conditions that are often heroic, and at no point did he suggest that we have ended up at this impasse because of a wilful wish on the part of NHS staff not to work at weekends. What was construed from that speech has unfortunately meant that our debate has been about a number of words and phrases that were not used, intended or even suggested.

Turning to the core of the speech, the Secretary of State began by saying that talking about seven-day services is not news to a large number of NHS staff, because nurses, porters, cleaners and many of those working under the “Agenda for Change” contract have, for the entirety of their professional lives, been working in seven-day services. His main contention was that, given the weight of evidence on excess mortality that can be attributed to differential working patterns at weekends and on weekdays, it is at least reasonable to ask what we are doing to ensure that if someone is admitted on a Saturday or a Sunday they can expect the same quality treatment and intensity of consultant and diagnostic support as they would receive on a Wednesday. That suggestion was not plucked out of the blue.

I have two points to make. Given that the petition is an ad hominem attack on the Secretary of State, it is right to say that I have never encountered anyone in a ministerial post who has acquitted himself with as much passion about a point on which he wishes to concentrate—patient safety—as the Secretary of State. The right hon. Member for Leigh recognised that when he was shadow Secretary of State, and it is recognised even by those who often oppose the Secretary of State in the BMA and other professional representation bodies. The fact is that the Secretary of State is passionate about patient safety. He cares deeply about it, which is why he takes an intense interest in gathering evidence about differential mortality rates.

I want to run through in detail where NHS England’s thinking comes from and why the Government have decided to act as they have. As the hon. Member for Central Ayrshire knows, there have been various academic papers from the United States and some from the United Kingdom on differential mortality, and they contain many of the questions and answers that have been alluded to today. It is certainly true that people are admitted sicker at weekends, which points in part to the need to do something about community and GP services at weekends. That is part of the reason why people are being admitted sicker. If somebody with a serious acute illness is seen on a Wednesday, they will receive a level of service—both diagnostic and consultant support—that they are unlikely to receive in many hospitals on a Saturday or Sunday.

[Helen Jones]

The Minister is making a sensible point, but could he enlighten us about exactly which services the Government foresee working seven days a week? Has the Department for Health assessed how many extra staff will be required to ensure that happens? NHS staff have got to have days off sometimes, so if they are working at the weekend they will have to have a day off in the middle of the week. How many more staff will we need?

[Ben Gummer]

Those are very reasonable questions. If the hon. Lady will allow me to continue with what I was setting out, I will certainly answer them.

That assortment of academic research, together with the wide anecdotal evidence from people who have experienced poor care in good hospitals, either for themselves or for their relatives, led NHS England to conduct the Seven Days a Week forum in 2013, which gathered together clinicians to look at the challenge. It produced a clear strategy for dealing with differences in care quality at weekends, compared with the week, and set out 10 clinical standards that it believes hospitals must meet to eradicate the difference between weekday and weekend working. Many hospitals are implementing the 10 clinical standards on a variable basis during weekdays, so the work done for weekends was helpful in determining a standard clinical approach for maximising the ability to reduce avoidable deaths for weekend and weekday admittances. The product of that forum was taken forward by NHS England and incorporated into its five-year forward view, in which the NHS, separately from the Government, made a commitment to seven-day services. It did so not because of the benefits to patients—as my hon. Friend the Member for Sutton and Cheam (Paul Scully) said, that is a secondary reason for pursuing the agenda—but purely because of the need to reduce excess mortality where possible.

This is a challenge on the scale of infections in hospitals. It is our duty not only to find out precisely why excess deaths are happening—as the hon. Member for Central Ayrshire correctly said, further work is needed and the data must be understood—but to do what we can as quickly as possible to reduce them where we think they are preventable. That is why NHS England incorporated the seven-day service into its five-year forward view. NHS England asked for an additional £30 billion of spending between 2015 and 2020, of which it said £22 billion can be achieved through efficiencies within the service. It is important to point out to the hon. Member for Warrington North, who made that point, that they are not cuts but genuine efficiencies within the organisation. On top of the £22 billion of internal efficiencies though a better use of IT, to which she alluded, and better job rostering—I will turn to that in a minute—there will need to be an injection of £8 billion to make up the rest of the £30 billion. That package will implement the five-year forward view, which includes seven-day services and many other things of great importance and about which all parties agree, such as shifting resources from providers to primary care, social care and the community sector.

This programme was not invented by the Secretary of State in a speech given to annoy doctors and consultants, much as that might be the impression given by some people on Twitter. It is the policy response of a Government taking seriously the clinical evidence and advice of NHS England, led by Professor Sir Bruce Keogh. We are responding to give NHS England and the providers tools with which they can deliver a seven-day NHS service in hospitals and GP practices.

I turn to the changes in the contracts, which are at the heart of the petition and the speech of the hon. Member for Warrington North. The contract terms are based on a review by the doctors and dentists pay review body, which identified a number of areas where contract reform is needed, including the systems of opt-out and on call. It asked a completely reasonable question: why should it be that some members of the workforce, who are expected to work at weekends as part of their normal shift patterns, do not have the option of an opt-out from their contract, while others—who tend, as it happens, to be far more highly paid than those who do not have the option of an opt-out—do? It proposed a series of changes, which in our view make up a far better contract for both junior doctors and consultants. On balance, we feel that it presents a real opportunity for consultants and doctors to improve not only their working conditions but, in some cases, their pay.

To take some salient examples from the consultants’ contract, we want a far more equitable and reasonable distribution of clinical excellence awards—many consultants are privately critical of how they are awarded—within not a cut to the total consultant budget, but exactly the same existing pay framework.