BMA (Contract Negotiations)

Helen Jones Excerpts

Monday 21st March 2016 Westminster Hall

[Sir David Amess (in the Chair)]

I call Helen Jones to move the motion.

[Helen Jones (Warrington North) (Lab)]

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

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

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

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

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

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 Much of the equipment is now out of date and there is a repairs backlog worth £4.3 billion, but the capital moneys available were cut by £1.1 billion in the Budget.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

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

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

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

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

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

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

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

[Andy Slaughter (Hammersmith) (Lab)]

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

[Helen Jones]

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

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

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

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

[Mr Andrew Smith (Oxford East) (Lab)]

I assure my hon. Friend that Oxford is certainly not only what it was, but better than it was. Therefore, the Secretary of State really ought to understand what is going on.

[Helen Jones]

I am grateful to my right hon. Friend for defending the university in his town. I am sure that he is right.

Any experienced negotiator will say that beginning negotiations by insulting the staff is never a good tactic. That is part of what the Government have attempted in muddying the waters: first, by drawing conclusions from the research that are not there, and secondly, by not being clear what they mean by a seven-day NHS. They have constantly said, “We need a seven-day NHS”. What they fail to tell us is whether they want a seven-day emergency service, which we already have but everybody accepts that it could be improved, or a seven-day elective service, which will require a huge investment not only in doctors and nurses but in diagnostics, support staff, lab technicians and so on. That failure to be clear has made doctors very wary of what the Secretary of State is trying to achieve.

[Rachael Maskell (York Central) (Lab/Co-op)]

There is also a real issue around capacity for a seven-day service. If elective surgery is increased over the weekend, where will those patients go, because hospitals are already at capacity?

[Helen Jones]

My hon. Friend makes a very good point, and she is right.

The Government need to make clear what they are trying to do, then they need to negotiate with the staff in good faith. Unfortunately, there is not much good faith around at the moment. That is why 90% of junior doctors have said they would consider leaving the NHS if the new contract is imposed on them. I do not think for one minute that 90% of junior doctors will go, but the Government have proceeded—as they do in a lot of cases—as if those junior doctors had nowhere else to go. Unfortunately, in this case they do: they can go to Scotland, or to Wales; or they can go and work abroad, where their skills are in high demand and where they will find, in many cases, they are paid more and work fewer hours than they do here. If even a small percentage of junior doctors go, what will the Government do to fill the gaps? We already have gaps in certain specialities, such as A&E, and paediatrics. What is the Government’s plan?

[Mr Andrew Smith]

I congratulate my hon. Friend on securing this debate—she is making a powerful argument—and I congratulate all the people who petitioned for it. Does not the threat—and decision—by the Government to impose the contract amount to an admission on their part that they were incapable of persuading the critical backbone of NHS clinical staff that their plans made sense? If so, is that an abject failure or an act of malevolence?

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[Helen Jones]

It is a real failure, given the commitment of doctors and other staff to the NHS.

This dispute is taking away energy and focus from dealing with the real problems facing the NHS. The NHS is under huge pressure and many trusts have big deficits, yet the service as a whole is still expected to make over £20 billion worth of so-called efficiency savings, which no one with real knowledge of the NHS thinks can be made without cutting services. One in 10 people in A&E now wait longer than four hours for treatment, which is the worst result for a decade.

There is also huge pressure from the Government’s ill-conceived cuts to local council budgets, which has led a slashing of social care and which the Government were warned at the time would have an impact on the NHS. The real problem those cuts are causing is more admissions to A&E, often of elderly people who have had falls or who have become ill because of lack of care. There is also the problem at the other end, whereby people cannot be discharged because there is no care package in place for them.

[Rachael Maskell]

I thank my hon. Friend for giving way again; she is being incredibly generous with her time. Does she agree that it causes real concern that the specialisms that require people to work longer and unsocial hours are also the ones that are most difficult to recruit for, and that the contract is therefore putting clinical safety at risk?

[Helen Jones]

My hon. Friend is quite right, and I will come on to that point later. There are staff shortages in the NHS that the contract may well make worse.

In the end, as in any dispute, the issues can be resolved only by negotiation, and in truth the two sides are not all that far apart. Huge progress was made when Sir David Dalton was brought into the talks, but there are still outstanding issues to be resolved. For instance, the Government trumpet a 13.5% increase in basic pay. What they do not say is that that increase will be paid for by cuts elsewhere. For example, payments that are made as a reward for length of service will go. I have yet to hear from the Government their assessment of what impact that change will have on retaining staff in the NHS, or how it will work for members of staff who take time out, whether for academic study—we need doctors who are both academics and good clinicians—or for maternity leave. What will happen to women who work part time, and so on? If we lose a number of women doctors in the NHS, the service will be in a great deal of difficulty.

Guaranteed pay rates when people change specialties are also going. In the past, if someone changed specialty later on in their career, their pay was guaranteed. That will not be the case any more. That change is bound to have an effect on recruitment in areas where we are already short of doctors, and I have seen no real impact assessment of that yet.

Of course, the big issue for many doctors is the change to standard time and premium time. The Government are increasing standard time from 60 hours a week to 90 hours a week. In the past, doctors were paid extra for working between 7 pm and 7 am, and for working at weekends. Standard time will now increase to run to 9 pm on weekdays and 5 pm on Saturdays. Doctors who work more than one in four weekends will get a premium payment. It is difficult to work out the effect of that change on individual doctors; it depends on how many weekends they work now, what their specialty is and so on.

The Government’s pay guarantee lasts for only three years, and given the Secretary of State’s remarks, junior doctors fear that the change is a back-door way of introducing longer hours. It certainly makes it cheaper to roster doctors at weekends. The Government say they will fine hospitals that roster people for more than a certain number of hours, but the doctors say that offer is not good enough. That is not an unbridgeable gap; it could be resolved. However, the result of what has happened and the Secretary of State’s comments is distrust and suspicion among doctors about what his real motives are. That is combined with a disastrous drop in morale in the NHS. The latest NHS staff survey shows that the percentage of junior doctors reporting stress has risen from 20% to 35% in five years. The proportion of staff saying that they feel pressurised to come into work when they are ill has gone up from 16% to a whopping 44%.

That loss of good will and drop in morale matters, because NHS staff are known for going the extra mile, working longer than they are paid for and doing things they do not have to do. That extends from the consultants who come in on their day off to see certain patients to the nurses and support staff who bring in a birthday card for an elderly person who has got no one else. I well remember that when my son was born, I was there for three shifts in the maternity department. After he was born, the registrar from the first shift came back to see me, to check that I was all right and to see whether I had had a boy or a girl. It is impossible to put a price on such things, and the Government risk losing all that and doing huge damage to the NHS if they do not solve the dispute.

[Jeff Smith (Manchester, Withington) (Lab)]

Will my hon. Friend give way?

[Helen Jones]

Yes, I will give way once more.

[Jeff Smith]

I am grateful to my hon. Friend. I met a group of junior doctors recently. For the first time, many of them are considering going abroad to work. None of them want to, but they are so demoralised by this Government’s actions that they are considering it. One of them told me how much she loved her job, but she said, “I would never let my daughter train as a junior doctor.” Does my hon. Friend agree that if the Government carry on down this route, we will not have a junior doctor workforce to rely on?

[Helen Jones]

My hon. Friend is right. That is an awful and sad thing to hear from people who are dedicated to the NHS, but yes, there has been a huge increase in the numbers of junior doctors thinking of moving abroad.

The answer is not the imposition of a contract, it is to get back into negotiations. It is about funding for weekend working, not just for doctors and nurses but for the lab staff, the diagnostic staff and the support staff that we need. It is about valuing the staff and showing that they are valued, because many junior doctors believe that the Secretary of State undervalues their work and has sought to undermine patients’ trust by implying that they are responsible for a number of deaths. That really needs to be corrected.

I have a message for the Secretary of State today: you get real. You are a member of Her Majesty’s Government —a senior Minister. Take responsibility. Yes, we need to get the BMA around the negotiating table again, but you need to make an offer that brings it there. You need to make that offer, because you are the person in charge.

It is already clear, in fact, that it is possible to improve weekend working without the new contract. There are trusts that have done that—Salford Royal is one example, as my hon. Friend the Member for Manchester, Withington (Jeff Smith) will know. There is also a rumour that the Department is close to a deal with consultants that will not require the proposed changes. Perhaps the Minister will tell us whether that is true.

To continue my message to the Secretary of State: man up. Admit that you got things wrong. Admit that you mishandled this. Make a gesture and get people back around the negotiating table. If you do not, it is not only the junior doctors who will hold you responsible. The public will hold you responsible as well—in fact, they already do.

When polls ask who is to blame for the dispute, the overwhelming answer is that it is the Government. That is not surprising, is it? If a member of the public is asked, “Who do you trust most, this nice doctor in your local hospital or Jeremy Hunt?”, it is not a difficult decision for them to make. It is time for the Government to stop heading down this road, before we end up with disastrous consequences. It is time for them to get people back around the table, because if they do not the NHS will suffer incredible damage, not simply through doctors leaving but through the loss of their good will. Both the staff of the NHS and the public in this country deserve better.

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[Helen Jones]

Will the hon. Lady give way?

[Andrea Jenkyns]

I am sorry—I am carrying on. I am talking about the millions who voted for a proper seven-day NHS in the general election. The seven-day NHS is not some distant pipe dream. Several trusts across the UK, including Northumbria’s, have established consultant-led care across seven days. The only reason the rest of the country cannot enjoy the benefits of that is the BMA’s political posturing. The Labour party’s suggestion that the Government have not negotiated well is difficult to take, when it was the party that signed off on the consultant contract in 2003 that gave an opt-out on weekend work, and gave GPs the ability to opt-out of out-of-hours care in 2004.

[Helen Jones]

Will the hon. Lady give way?

[Andrea Jenkyns]

I am going to finish. Can a policeman say that he does not want to cover a Friday night? Can a firefighter turn down a shift because it is a Sunday morning? No.

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[Ben Gummer]

I will not give way, because I know the hon. Gentleman has to go, and he intervened enough earlier.

Far from a few minor amendments, as the hon. Member for Warrington North (Helen Jones) suggested, a far greater number of changes needed to be made to the contract.

[Helen Jones]

I am afraid the Minister may be misquoting me. I was giving examples, not suggesting that they were the whole list of things wrong with the contract. When I said there were only a few issues, that was to illustrate that the Government and the BMA are not that far apart in the negotiations. Perhaps the Minister will consider what I actually said.

[Ben Gummer]

I will, and by way of return I hope that the hon. Lady will consider what the Secretary of State has actually said on a number of occasions, which—I am sure completely unintentionally—she misrepresented at numerous points. The hon. Lady said that the existing contract had moments of imperfection—I cannot remember her exact words. However, it had rather more imperfections than that, which is why the BMA recognised many years ago there was a need for significant change, and why the coalition Government entered into negotiations with the BMA early in 2013. The heads of terms were agreed between early 2013 and July 2013. The negotiations began in October 2013 and broke down a year later, with no notice to the Government. The BMA just walked out, and it took some time to explain why. It claimed, generically, that it was to do with patient safety, which was an odd thing to say given that there were doctors negotiating on the management side who were also concerned about patient safety. The negotiations were not rejoined until we involved ACAS in November last year.

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[Ben Gummer]

It is a great shame that we were unable to discuss those final things with the BMA, but as I have just explained, the BMA did not wish to discuss that final portion, even though it had agreed to do so in the heads of terms that were in front of ACAS at the end of November 2015. It was impossible to have that final discussion. That was not of the Secretary of State’s volition; it was a decision of the BMA’s junior doctors committee.

I turn to the point that my hon. Friend the Member for Morley and Outwood made, which Opposition Members discounted so quickly. At no point has the Secretary of State ever claimed that there is militancy among junior doctors as a whole, nor has he said that the BMA as a body has sought to wind up the dispute. In fact, if he had said that, it would have been entirely wrong. It is, however, true that the junior doctors committee, which is a small portion of the BMA—it is not the whole body, and we have just come to an agreement with the BMA on the general practitioners’ contract—has become radicalised in the past few years.

We know that the committee did not wish to discuss Saturday pay rates, not because of any inherent merit or otherwise in the arguments but because of the tantalisingly close prospect of an agreement with the Secretary of State—one that the committee had been fighting against. We know that that dispute existed, because even when we made a revised offer just after Christmas, the committee refused to discuss it before talking to its members and committing to a strike. There has been an impelling force within the junior doctors committee to take action, which, I am afraid, has disrupted the course of the negotiations and made it far harder to have an open and honest discussion with junior doctors.

We come to the issue of junior doctors being misled. They are very bright people who I know take an interest in the news and in the contract under which they will be working. I have no doubt about that. However, the British Medical Association—a trusted body—has claimed to its members that they are going to have a pay cut of 20% or 30%. Despite the fact that the NHS and we in this House have rejected that claim numerous times, it has been repeated. The hon. Member for Hornsey and Wood Green (Catherine West) repeated it today. That claim is untrue. It was made in the summer, and it is no wonder that BMA members were worried. If I were a junior doctor and someone told me I was going to have a 20% or 30% pay cut and would have to work longer hours, I would be extremely worried, and of course I would be angry. The fact is, however, that the claim was not true. The gravity of that untruth is such that it can still be repeated in this Chamber as if it were true.

Junior doctors, who no doubt informed the hon. Lady—I know she is not willingly misleading the House—still think they are going to have a pay cut of 20%. If we are still in an atmosphere where people believe they are going to have something that they are not, and that they will have to work more hours than they will, it will of course be difficult to come to a resolution until we allow things to calm down. That is why it is important to move to a point where junior doctors have the contract in front of them, so that they can see the effect on their working patterns and see that much of what they have been told is simply not true. We can then, I hope, move to a much better position in individual trusts where we can start discussing the existing problems that the hon. Member for Central Ayrshire mentioned, such as rotas, training schedules and the like.

I will address some of the individual points that hon. Members have made during this interesting debate. Apart from misrepresenting the shape of the negotiations as if somehow the Secretary of State had broken off talks, which he did not, the hon. Member for Warrington North questioned the research that led to the various statements that the Secretary of State and others—many of them clinicians—have made about the so-called weekend effect, or avoidable excess mortality attributable to weekend admissions. I should make absolutely clear where the link is. Almost any clinician in the NHS will recognise that we do not yet have the same consistency of care over the weekends that we do during the week in every hospital or every setting where we need it. We know that, and the hon. Member for Central Ayrshire made a similar point herself.

Our manifesto pledge was translated into the mandate that is reflected in all the contract negotiations that are going on, and it concerns one particular issue—the need to standardise urgent and emergency care—and nothing more. It is not about elective care; I have made that point several times to the hon. Lady. People who are admitted at weekends—including, to some extent, those admitted at the shoulder periods at the end of Fridays and especially on Monday mornings, because of inconsistency of care over the weekends—will then be able to expect the same standard of care, which will contribute to lower mortality rates as part of a wider package to reduce mortality attributable to weekends.

The drive for that comes from clinicians. It comes from the seven days a week forum convened by the Academy of Medical Royal Colleges, which reported at the end of 2012 and gave the Secretary of State and the whole service 10 clinical standards that it believed would help to reduce variation in weekend clinical standards. It is those standards that we seek to bring in across the service. The academy has said that four of them in particular are the most important for reducing variation. They relate to urgent and emergency care, and it is those standards that we seek to fulfil across the service.

[Helen Jones]

The Minister is once again managing to conflate two things. Everyone accepts the need to improve emergency care at weekends. What is not accepted—this is where the Secretary of State misused the research, and I was questioning his use of it, rather than the research itself—is a causal link between junior doctors’ work patterns and the deaths that occur. That is simply wrong; the research does not show that. In fact, a great deal more research is needed to find out the actual causes of the excess mortality.

[Ben Gummer]

If the hon. Lady were quoting the Secretary of State correctly, he would indeed be wrong, but he has never made a causal link precisely with junior doctors’ working hours. He has said that it is the working patterns of the NHS as a whole. One of the studies that the hon. Lady quoted in part makes it clear that the purpose of the research study was not to look at answers to the questions that were raised, but it did say that one of the areas that policy makers should look at first is staffing ratios over the weekend.

Let me ask the hon. Lady something. There is general acceptance across the service of a weekend effect. There are varying studies that, under different research scenarios, point to figures of 6,000, 8,000 and 11,000 deaths, and sometimes more—15,000, for example. Does she believe that if the number were 2,000, it would therefore not be right to deal with this problem? Would 500 be an acceptable number of deaths that we should tolerate without seeking to reform contracts? In fact, what price should we put on an avoidable death? Or is she saying that not one single death in the service is related to staffing ratios over the weekend?

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[Helen Jones]

The Minister is once again managing to conflate two different issues. Let me repeat what the researchers said:

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

That is the researchers’ comment on their own research. Of course, nobody wants to see preventable deaths, but the Secretary of State has tried to use the research to link those deaths to junior doctors’ working patterns. It simply does not prove that. He is wrong.

[Ben Gummer]

I will happily arrange for the hon. Lady to have a clinical explanation of the various studies that she has cited, because I think she will then understand why the part that she has quoted needs to be understood in context—[Interruption.] I am asking her a direct question: does she—and do other hon. Members, who are tittering about this on the Opposition Benches—really propose that there is no weekend effect? If they are saying that is the case, or if they are saying that there are 500 or 1,000 deaths and that somehow is acceptable and the Secretary of State should not address himself to it, that is a worrying statement of intent.

[Dr Whitford]

rose—

[Helen Jones]

rose—

[Ben Gummer]

I will not give way to the hon. Member for Warrington North. I give way to the hon. Member for Central Ayrshire.

[Ben Gummer]

One of the studies that the hon. Lady cites does a control for acuity, which she has raised. I know that there is an understandable change in the acuity of patients and one of the studies allows for that.

As for the point about the 10 clinical standards—and here I will just move on from the points that the hon. Member for Warrington North was making—

[Helen Jones]

Before the Minister does, will he give way? He asked me a direct question.

[Ben Gummer]

I will in a second, but hopefully I will answer the hon. Lady’s point first. She says that I am conflating two things, but I am certainly not; I am saying that there is a recognisable weekend effect. We can have a discussion about the precise numbers involved, but the key answer is that clinicians themselves understand that something needs to be done to reduce variation. I will come to junior doctors in a second, but clinicians themselves have offered the 10 clinical standards, which lie at the base of this. We are not doing anything extra beyond what clinicians are recommending. The four key clinical standards lie at the heart of our changes to urgent and emergency care to ensure consistency of standards, and it is right that one of them relates to the training of junior doctors. The standard at the moment is not as good at the weekend, because they do not have consultant cover, and that is something we are hoping to change. It is also true that the 10 clinical standards refer to senior decision makers, and there is a discussion about precisely who that might be. I will give way to the hon. Lady now, and then we will move on.

[Helen Jones]

Had the Minister listened to what I said, he would have heard me say that there is a weekend effect, even when the control for acuity is put in, and that more research is needed to find out exactly why that occurs. No one on the Opposition side wants to see preventable deaths in the NHS, but the Minister has to explain why this contract that he wishes to impose is so important in preventing them, when many trusts have already managed to improve weekend working—including Salford—without it.

[Ben Gummer]

On the issue of the response to the mounting clinical evidence of a weekend effect—I am glad that the hon. Lady recognises it—clinicians have said that we need to reduce variation by changing the clinical standards that we hold clinicians to, and that is what we are seeking to do. That is why all the contracts relating to clinicians are being reformed. It is part of a package. I have made that point in this Chamber many times before, so Members who keep repeating that somehow we are loading everything on to junior doctors are just not listening to the points that the Government are making—that it is part of a piece.

The recommendations of the DDRB—the Review Body on Doctors’ and Dentists’ Remuneration—asked for far more radical changes to Saturday working. We have moderated those in an effort to bring about negotiations and discussions with the British Medical Association, but it has refused to do that.

I will answer one more point that the hon. Lady made in her speech. She said that a point of contention was payments and reward for length of service. I think she was referring to increments. That issue was resolved with the BMA as part of the 90%, so I hope she therefore sees that it is not a substantial part of the argument, despite what she pretended.

The hon. Member for Wirral West (Margaret Greenwood) mentioned issues around psychiatry, which was a legitimate point to make. That is precisely why, as part of the new contract, flexible pay premia will be paid to psychiatrist trainees, so that we can provide an incentive to get more trainees opting for this specialism. It is clear that across the service, there are specialisms that, for decades now, have not recruited the numbers that we would all like to see going in. We have identified three where we think a particular incentive is appropriate, because of the difficulty of going into those specialisms—general practice, emergency medicine and psychiatry. This is one that we proposed. It was disagreed with and then agreed with by the BMA, and we hope, therefore, to address precisely the point that she made in her speech.

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[Helen Jones]

Sir David, I apologise for demoting you to the ranks in my opening remarks.

This has been an interesting debate, although I was disappointed by the Minister’s reply. He is normally a very reasonable man, except when he is attributing things to Opposition Members that we have not actually said. His problem is that he is being sent here time after time to defend the indefensible. It is clear that there is a deal to be done, as Opposition Members have said, but there is no movement from the Government to get people back around the table to do that deal. If the contract is so good that it provides a land of milk and honey for junior doctors, as the Minister seems to imply, one wonders why they are not dancing in the street at the prospect of it.

We have heard clearly from Opposition Members about junior doctors’ worry that the contract will lead to excess hours and that they are moving from being part of a team, where they learn and progress properly, to being just another rota of shift workers to be shifted around. We heard from my hon. Friend the Member for Bristol West (Thangam Debbonaire), whose return I too am very glad to see, about her experience in the NHS and the staff who went the extra mile for her, and we have heard about the weekends that people work.

We have also heard some extraordinary attacks from Government Members on a respected profession. I understand that the hon. Member for Morley and Outwood (Andrea Jenkyns) may have suffered a personal tragedy, but that does not in any way justify her attempts to smear all junior doctors as a bunch of militants who are endangering patient safety.

[Ben Gummer]

She did not say that. Withdraw.

[Helen Jones]

Yes, she did say they were endangering—

[Ben Gummer]

She did not say that. Withdraw.

[Helen Jones]

She did. She said they were Corbynites—

[Ben Gummer]

Withdraw!

[Helen Jones]

No, I am not going to withdraw that remark. [Interruption.]

[Sir David Amess (in the Chair)]

Order.

[Helen Jones]

And she said they were endangering patient safety. It is that attitude among Government Members that is preventing a solution to the dispute. There are constant attempts to stigmatise staff and to accuse them of things that they have not done and are not doing. The Minister, for example, says that junior doctors are misled about their contract by the BMA. That is patronising, because it implies that they are not able to look at the evidence and judge for themselves. We have heard no attempt from the Minister to outline the Government’s plan B if some doctors leave and do not sign the contract. Well, I am not surprised that the Government do not have a plan B because they do not even appear to have a plan A.

I appeal to the Government to change course and to take steps to get the BMA and junior doctors’ representatives back round the table so that the dispute can be sorted out for the benefit of patients and for the benefit of the whole NHS. If they do not do that, we are really heading towards serious problems in the future.

Question put and agreed to.

Resolved,

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