NHS Shared Business Services

Helen Jones Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

The hon. Lady is right. That is one of the most critical questions when it comes to trying to understand whether there was any actual patient harm. Ordinarily, if a patient was waiting for a test result that did not arrive at their GP’s surgery, the GP would chase it up and get a copy, so there would be no delay in treatment. However, only by looking at the patient’s notes can we understand whether any harm is likely to have happened. So far we have not identified any patient harm, but we will continue to look.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State told the House in February that all correspondence was kept safe and secure, and he has repeated that claim today, so when did he know that 35 sacks of mail had been destroyed by staff, and why has he not mentioned it since?

[Mr Hunt]

As the hon. Lady knows, I was informed at the end of March 2016. The issue with the correspondence that was destroyed relates to procedures around what it is legitimate to do when patients have been dead for 10 years. At the moment we are not aware of any specific risk to patients as a result of those sacks of mail being destroyed, but we will continue to look at the issue very closely.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Speaker]

A question of textbook brevity and eloquence from Helen Jones.

[Helen Jones (Warrington North) (Lab)]

While digital platforms can be useful in guiding patients to the right service, does the Minister accept that there are still huge shortages of people who can carry out talking therapies, and long waits for child and adolescent mental health services? When are the Government going to stop talking about improving mental health services and actually ensure that the money is going where it is needed to recruit staff?

[Nicola Blackwood]

We are working extremely hard on increasing staff. We are not only introducing our new mental health workforce strategy, which we will publish shortly, but increasing the number of people who are seeing these services. Four million extra people have seen psychiatry services—talking therapies—and 90% of those patients are being seen within six weeks, which is exceeding our waiting time target.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

We looked at this extremely carefully, and I have a lot of sympathy with what my hon. Friend is saying. People do not have to have medical insurance if they visit countries such as America as a tourist, and we do not want to insist on that for visitors to this country because of our tourism industry here. We concluded that it was better to have a system in which people who get a visa to come and live here have to pay a surcharge. That is why we have introduced the visa health surcharge, which raises several hundred million pounds for our NHS.

[Helen Jones (Warrington North) (Lab)]

I have always supported the view that we are not running an international health service, but as well as directing his energies towards that question will the Secretary of State direct them towards stopping the waste of money that occurs elsewhere in the NHS when highly trained surgeons and theatre teams are forced to wait to operate because beds are not available for their patients and have to spend their time doing nothing? How much is wasted in that way because of the chronic underfunding that this Government have introduced?

[Mr Hunt]

The constant accusations of underfunding would have a little more credibility if Labour was actually promising any more money for the NHS. Instead, at the last election it committed to £5.5 billion less than this Government.

National Health Service Funding

Helen Jones Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jonathan Ashworth]

I am going to make a bit of progress, because I am aware that Members want to speak.

We have seen what the reality of six years of Tory underfunding and cuts in our NHS are all about, and there are more stealth cuts to come, which will add further pressures. For example—these are small things, but they all add up—cuts to the Care Quality Commission mean that it will increase its fees for NHS hospitals, other trusts and other providers. Some trusts will have to pay over £100,000 as a result of these cuts. Reductions in education and training tariffs will put more pressures on trusts and on the frontline. In the House the other week, we debated how cuts to community pharmacies will lead to increased demands on the NHS.

Only last week, news slipped out about the privatisation of NHS Professionals. A body that makes a profit for the NHS and ploughs that back into the NHS is going to be privatised, and that profit will presumably go to private companies.

The combination of all these cuts and privatisations, the utter failure to deal with the crisis in adult social care, and the lack of planning for an ageing population with complex needs will directly lead to greater demands on the NHS, bigger cuts, and deficits across the board. It is in this context that the NHS is also expected to find £22 billion of so-called efficiencies and to redesign services across England completely as part of the sustainability and transformation process.

Where sustainability and transformation plans are about transforming services in the interests of patient care, reversing fragmentation and ensuring more collaboration in geographical areas, we will consider them carefully. We will want to look at every single STP to see whether those plans are genuinely jointly owned, and whether they tackle the crisis in social care, guarantee better access to care for the long term, and are transparent and financially viable. What we know so far, though, is far from reassuring, because we can see from the 19 or so STPs that have been published that the ground has shifted. It has become obvious that what began as a project to transform services for patients and build up community services is now more about closing the financial gap:

“Of course, the driving force behind STPs is the emergence in the last two financial years of substantial deficits.”

Those are not my words, but those of Andrew Lansley just a few weeks ago. The STP areas that we have seen so far have been racking up shortfalls of about £10 billion that can be filled only by cuts to hundreds of beds, closing hospitals, downgrading A&Es, downgrading maternity wings and withdrawing treatments.

[Helen Jones (Warrington North) (Lab)]

Does my hon. Friend agree that proposals to downgrade A&E in an area such as Warrington, which is surrounded by motorways as well as containing many people who suffer from health deprivation, is a recipe for disaster? If people have to travel further for emergency care, that will not improve their care in any way.

[Jonathan Ashworth]

My hon. Friend is extremely knowledgeable about the health service and has been campaigning vigorously on the STPs. She is completely right. We will see hospitals merged in the Merseyside area and in London, hospitals lost in Durham, and efficiencies found by changing staffing levels. In fact, the STP for Cheshire and Merseyside, the area that she represents, talks enticingly of

“Exploration of a Factory Model”.

Doesn’t that sound nice?

With cuts to services and rock-bottom staff morale, we have the Sports Direct approach to the NHS, with the Secretary of State playing the part of Mike Ashley. The public deserve better than this bargain basement approach. Scaling back the acute sector while not investing in the community sector simply does not work. The Prime Minister might have ruled out extra funding—

--- Later in debate ---

[Jonathan Ashworth]

My right hon. Friend is absolutely right. Morale among GPs is at an all-time low. She identifies another problem that has emerged because of the 2012 Act. I hope that the Minister will respond to her important point.

[Helen Jones]

rose—

[Jonathan Ashworth]

I will give way to my hon. Friend, but then I will not take any more interventions.

[Helen Jones]

Is my hon. Friend aware that the Cheshire and Merseyside group has not only refused to publish details about the STP, but refused my Freedom of Information Act request for information about the meetings that were held on the STP and who was present at them? Does that not simply give rise to suspicion that this whole process is being driven by cuts rather than the need to improve care?

[Jonathan Ashworth]

My hon. Friend is absolutely right. I will now make a bit of progress because I know that other Members are anxious to speak.

The Chancellor should respond tomorrow to the growing body of evidence that the NHS has not been given the money that it needs. Tomorrow, we need an end to the scandal of crumbling hospitals. Tomorrow, the Chancellor must put right the Government’s greatest betrayal on adult social care. Tomorrow, the Government must deliver the long-overdue investment that our NHS needs.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Speaker]

That was very dextrous handling of a very broad interpretation of the question on the Order Paper, but I hope that honour has been served.

[Helen Jones (Warrington North) (Lab)]

14. The Cheshire and Merseyside sustainability and transformation plan relies heavily on more care in the community. Does the hon. Gentleman accept that this will not work while local authority social care is being cut to the bone, because it will merely send people back to their own homes, where their health will deteriorate?

[David Mowat]

The Cheshire and Merseyside STP will be published tomorrow, and we will all know better then what it says. The hon. Lady is right that there is an interaction between social care and health, but she and I, as Warrington MPs, must both be pleased that Warrington is one of the top performers in terms of delayed transfers of care, and on that we should congratulate our local authorities.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I am happy to do just that. I would like to thank the hon. Lady for bringing up this very important and difficult issue. We are making progress in reducing suicide rates, but we can do an awful lot better. The thing that troubles me most is that nearly three quarters of people who kill themselves have had no contact with specialist NHS mental health services in the previous year, even though in many cases we actually know who they are because, sadly, most of them have tried before. I am very happy to commend the “It takes balls to talk” campaign. She may want to put the campaign in touch with the national sport mental health charter, which is another scheme designed to use sport to try to boost the psychological wellbeing of men.

[Helen Jones (Warrington North) (Lab)]

A recent survey showed that one in four members of the emergency services experienced mental health problems, and that a number of them experienced suicidal thoughts. What is the Secretary of State doing to protect our vital paramedics and other ambulance staff, and to ensure that they get the support they need in dealing with absolutely appalling situations?

[Mr Hunt]

Again, I thank the hon. Lady for raising that. She will be pleased to know that the NHS has introduced a scheme, backed with funding, to encourage NHS trusts to look after the mental wellbeing of their own staff. I particularly want to pay tribute to the courage of people who work in the air ambulance service, because they see—day in, day out—some of the most difficult and distressing cases. They have to cope with the pressure of that when they take it home every day, and we all salute them.

Junior Doctors Contracts

Helen Jones Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. The truth is that being Health Secretary is never easy, whichever Government they are in, but where they have made mistakes in the past is where they have been too willing to compromise on vital issues of patient safety, and a seven-day NHS is one of those issues. When it comes to safety, Channel 4’s “FactCheck”, which is not a known supporter of the Government, has compared the new contract with the old one and said that, on the face of it, the new one is safer. That should reassure many doctors that this is the right thing for the NHS to do, and they should work with us, not against us.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State has said that this is all about patient safety. Well, the junior doctors I have met in Warrington believe that it is all about patient safety, too, and they do not believe that overtired doctors provide the best service for patients. Has he done a risk assessment on the imposition of a contract and the consequences for patient safety of lowering doctors’ morale and losing doctors from the NHS?

[Mr Hunt]

Let me gently tell the hon. Lady the facts about what the contract involves. It involves the maximum number of hours that any junior doctor can be asked to work in any week coming down from 91 to 72. It involves reducing the number of nights and long days they can work, as we discussed earlier. It is a safer contract. The reason morale is low is that, rather than negotiating sensibly, the BMA has gone for an outright win, which was a very big mistake. We could have had a negotiated solution a long time ago. In that situation, a Health Secretary has to do what is right for patients, and that is what we are doing.

Junior Doctors Contracts

Helen Jones Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

Absolutely. One of the key changes in the new contract that we hope to see is much more predictability about weekend working, and a sense for junior doctors that when they do go into work at the weekends they will get the same support around them as they would during the week; it can be incredibly stressful when junior doctors are called into work at the moment. All these things are improvements, and what has made it very difficult is that these improvements have been misrepresented by the BMA to its own members, so that people have become very suspicious about these changes. That is why we tried so hard to get a negotiated outcome, and why we have been so disappointed that that has not been possible.

[Helen Jones (Warrington North) (Lab)]

Can the Secretary of State confirm that the studies of mortality rates within 30 days of weekend admissions have in no case said that the rostering of junior doctors is a problem? Instead of talking about others negotiating, why does he not take responsibility and get around the negotiating table himself?

[Mr Hunt]

With respect, not very far away from the hon. Lady’s constituency is the Salford Royal, whose very respected chief executive concluded that a negotiated outcome was not possible. That is why I reluctantly took the decision to proceed with the new contracts. As for the studies on mortality rates, we have had eight studies in the past six years, six of which have said that staffing levels at weekends are one of the things that need to be investigated. The clinical standards say that we need senior decision makers to check people who are admitted at the weekends, and junior doctors, when they are experienced, count as senior decision makers, which is why they have a very important role to play in delivering seven-day care.

Brain Tumours

Helen Jones Excerpts

Monday 18th April 2016 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered e-petition 105560 relating to funding for research into brain tumours.

It is a great pleasure to be here under your chairmanship, Sir Edward, and to see so many colleagues present for this debate on funding for research into brain tumours, which was the subject of the first report by the new Petitions Committee.

We began this inquiry in response to a petition that was started by Maria Lester, whose brother, Stephen Realf, died following a brain tumour. It is fair to say—I think my colleagues would agree—that we began in a state of ignorance. We did not know a great deal about brain tumours or their impact, but, as we proceeded with the inquiry, we were humbled and shocked. We were humbled by the people who came forward to give evidence to us, whether in person, in writing or on the web; it is a measure of the interest in this topic that we received more than 1,100 posts on our web thread in 10 days. All those people had been either directly or indirectly affected by brain tumour and wanted to use their experience to improve other people’s chances. We were also shocked at the number of life years lost to this dreadful disease, the impact on children and the pitifully small amount of research funding devoted to it.

For that reason, we have made our report slightly different from some Select Committee reports; there are many individual stories in it and pictures of those affected. That is because we want to make it clear that this is not just a matter of statistics. Real lives, real people and real families are affected, and they are let down at almost every stage of the process, because, despite the excellent work of the doctors in this area, the system is underfunded and not properly structured, and has been so for years. That is our collective failure, because the neglect has gone on under different Governments, even though brain tumours are the biggest cause of cancers in children and in the under-40s. They account for between 15% and 25% of cancers in the under-25s and, if we look at the statistics overall for all age groups, we see that about 60% of cancers involve the brain at some stage, meaning that there has to be treatment for that if people are to recover. Because of the age groups that are generally affected, the number of life years lost to this cancer is greater than for any other cancer, and, of course, when children are involved, the situation is particularly tragic.

A number of parents came forward to tell us what had happened to their children. A number of those children suffered from a type of tumour called diffuse intrinsic pontine glioma, or DIPG, which is almost universally fatal. In this country, a child is diagnosed with one every nine days, yet few people have even heard of it. I suggest that, if they had, there would be much more pressure to increase funding for research in that area.

Those who survive, whether children or adults, face a huge burden from this disease. Many survive with serious disabilities, including physical disabilities or other things such as memory loss, personality change or cognitive disorders. Because of the huge burden of the disease, in terms of life years lost and significant disabilities among those who survive, we have made the recommendations that we have and we believe that it is time for a step change in how we deal with this most awful cancer.

That change has to begin, of course, with diagnosis, with which there are major difficulties. GPs may see only two or three cases in their professional lives, and in its early days brain tumour can mimic the symptoms of other diseases. However, 61% of people are diagnosed in A&E when they reach a crisis. We heard time and again from people who went back to their GP and went back to other doctors, often knowing that something was seriously wrong with them or with their child, but they were still not able to get a diagnosis. I suggest that we would not accept 60% being diagnosed in A&E for any other cancer and we should not be accepting it for this one.

Early diagnosis matters, because it affects the treatment options and the outcome. If we were able to diagnose people earlier, more would survive, especially among children, and there would be better outcomes for patients, with fewer survivors left with significant disabilities. That is why, I say to the Minister, we were concerned to note that the Government’s Be Clear on Cancer campaign did not include brain tumour. We understand that that is because the number of life years lost is not taken into account in deciding which cancers are included, and we believe that has to change.

There are important things happening. For example, the HeadSmart campaign, which seeks to raise awareness among GPs and lists the symptoms that can be seen in different age groups, has managed to improve the time taken between people presenting to their GP and diagnosis. Again, however, we are concerned that the guidelines issued by the National Institute for Health and Care Excellence in 2015 do not include lists of different symptoms for different age groups. We think that needs resolving.

[Derek Twigg (Halton) (Lab)]

Why does my hon. Friend think that NICE guidelines did not take that into account and include the information that we feel should be included?

--- Later in debate ---

[Helen Jones]

We simply do not know the reason for that, but we think that the Government need to look at this as a matter of urgency and raise awareness among GPs as part of their continuing professional development programme. It is very important that they understand this, because if the disease was caught in its early stages, that would help future research. More people could take part in clinical trials and more could donate tissue in the early stages of the disease. Research is extraordinarily important, and I will come back to that in a minute.

We heard from a number of experts, including Professor Geoff Pilkington from the University of Portsmouth, about the questions that GPs should be asking when people present with particular symptoms—it is not always a headache, of course. There can be lots of different symptoms, such as an odd smell or a pain in the spine. There is a range of symptoms that people need to be alert to, but the only real way to diagnose a brain tumour is with a scan. Again, we heard from many people who had tried and tried to get a scan but were not able to do so.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my hon. Friend on securing the debate. An important factor, which she has just mentioned, is the difficulty of getting scans. Why is that difficult? Is there a shortage of scanners or is there another reason?

[Helen Jones]

Again, we were given various reasons when we took evidence, and we want the Government to consider the matter carefully. There is no doubt that if we are to improve scanning procedures, we must accept that a number of scans will come back clear. The issue is, what proportion that comes back with no tumour shown is acceptable? Surely it is better to invest in a scan than to let a tumour grow, because later treatment is much more difficult, complex and costly. We want more people to have access to scanning.

Early diagnosis is important, but it will not solve the problem without more research. Despite the excellent scientists and clinicians who gave evidence to the Committee, there is no doubt that they are working in an underfunded system. The Government response to the petition said that about 1.5% of cancer spending is devoted to brain tumours, but that includes fundamental research and non-site-specific research.

The National Cancer Research Institute told us in evidence that some non-site-specific research undoubtedly benefits brain tumour research, but it was unable to put a figure on that. We heard from Professor Tracy Warr of the brain tumour research centre at the University of Wolverhampton that brain tumours are less likely than other cancers to benefit from non-site-specific research because of their complexity and location, and the blood-brain barrier, which means that drugs that work in the bloodstream do not transfer to the brain. That is an unscientific explanation, but I am sure hon. Members will know what I mean.

We found that spending records are very unclear. The Government’s own records are not clear. The National Cancer Research Institute was unhelpful when trying to find out exactly how much of the spending benefited research into brain tumours and there is no central record of spending by people who are not partners with the National Cancer Research Institute. There is no doubt that spending is low. The only figure that we can be certain of is the 3.3% of spending on site-specific research, which is about £7.7 million a year. At that rate of progress, it is estimated that it would take 100 years for the outcome for brain tumours to be as good as for many other cancers.

[Dr Julian Lewis (New Forest East) (Con)]

Does the hon. Lady agree with the assessment of my constituent, Mrs Alison Hutchman, who has been living with what she calls “this devastating disease” for the last six years, about that estimated time of 100 years? Why is this terrible disease so low down the priority order?

I saw the recent death of my friend, Richard Webster, at the age of only 50, from a brain tumour, despite the loving care of his family and his long-term partner and later husband, Jamie Norton. I know only too well, as only someone who has seen it can know, what is entailed when this disease strikes.

[Helen Jones]

I am grateful for the right hon. Gentleman’s intervention and I agree with his constituent. Brain tumours are perceived to be rare, although my argument is that they are not as rare as we think and the number of life years lost and the burden of the disease mean they have to be tackled. We know there is a correlation between the amount of money spent and survival rates in cancer. Survival rates for those with brain tumours went up by only 7.5% between 1970 and 2015. For cancer overall, they have doubled.

[Kit Malthouse (North West Hampshire) (Con)]

The hon. Lady is making some valuable points. Does she agree that a key issue is that a young researcher will look at the overall commitment and likely level of spending in this area during their career before deciding whether to specialise in it? The paucity of research spending in this area may mean that we do not get the amount and quality of research that is required.

[Helen Jones]

I agree with the hon. Gentleman and I will come to that.

Between 2000 and 2012, we spent about £35 million on brain tumour research. The Government have rightly said that such spending has increased tenfold. It has, but it has increased from a very low base. That £35 million is from a total of about £4.5 billion of spending on cancer research.

[Sir Gerald Howarth (Aldershot) (Con)]

The Brain Tumour Charity is based in Farnborough in my constituency. The hon. Lady mentioned the £35 million. Is that just public sector funding, or does it encompass private sector funding? The Brain Tumour Charity has already invested £14 million and plans to invest another £25 million by 2020.

[Helen Jones]

That £35 million includes spending from the voluntary sector. The report states that it is simply not good enough for the Government to leave decisions on such spending solely to the voluntary sector.

We welcome the decision of Cancer Research UK and Children with Cancer UK to prioritise spending on brain tumour research as a cancer of unmet need, but we are calling on the Government to identify the gaps in funding, to take action to remedy them and most important, to make it clear that they see this research as a priority. We heard evidence that creating a positive research environment with an emphasis on increasing funding would not only keep our scientists in this country, but attract scientists from elsewhere in the world. Britain has the potential to be a world leader in this sort of research but at the moment we are not.

The Government said in their reply to the petition that decisions on funding are based on a number of factors, including the size and quality of the workforce. That ignores the fact that, as the hon. Member for North West Hampshire (Kit Malthouse) said, this is a Catch-22 situation. At the moment, young trained oncologists are having to change specialties or leave this country to pursue their research. Without an increase in funding, we simply cannot attract the good PhD students and postdoctoral researchers we need to make progress and to build up the cohort of young scientists who will go on to research this disease and may make the important discoveries of the future.

There are other barriers to research. One is the difficulty of getting enough tissue to work on. Only about 30% of patients are asked whether they will donate tissue, yet polls show that up to 90% would do so if asked. We do not have enough specialist support nurses and, according to the evidence, we do not even have enough people who can transfer tissue from hospitals to laboratories.

The other problem that researchers come across—the Government really could act in this area—is that they must make applications to many local biobanks to get enough material to work on. Often, those biobanks have different procedures, application forms and so on. We urge the Government, while keeping safeguards in place, to try to tackle the problem of biobanking. Unless researchers have access to tissue, they cannot do the fundamental research that we need. The University of Southampton has started to use tissue left over from diagnosis but, again, the system is grossly underfunded. In the end, I am afraid the issue comes back to money if we want to make progress.

We also highlight other issues, such as the need for access to non-therapeutic drugs, which can improve brain surgery outcomes, and the need for access to off-patent drugs, which can be used for new indications. The Government said in response to the Off-patent Drugs Bill that they did not need a Bill to allow that. We need to make progress in that area urgently, but I will not spend too much time on it now, because we are pressed for time.

I do, however, want to say this to the Government. I said earlier that brain tumours may not be as rare as is perceived, and the reasons for that are simple. The numbers are going up. The system of recording has been changed. The experts who spoke to us said that they do not yet know the reasons for that. Secondary tumours are not recorded, yet they still have to be treated, and benign tumours are not recorded, but they can still kill. It is that, and the huge burden of the disease, that we think the Minister ought to take into account, or at least ought to get his Department to take into account, to deal with this issue. The five-year survival rate for brain tumours is only 19.8%. When it comes to cancer as a whole, 50% survive for 10 years or more. That is the difference, because of lack of funding and lack of research.

I hope that the Minister will look at the personal stories in our report. They are there for a reason. Let me remind people of some of them: Saira Ahmed, dead at the age of 6, Abbie Walker, also dead at 6, Lucy Goulding, who died at 16, and Stephen Realf, whose sister started the petition. An RAF officer who was apparently in excellent health, he was diagnosed at 19 and dead at 26. There are many more, whom I do not have time to name. There are those who died and those who survived—remarkable people such as Hannah Jones, a young woman who gave evidence to us and now devotes her time to promoting the HeadSmart campaign. And there are the families of those who died. In all my time in Parliament, I have never met such an amazing group of people. They had undergone the most appalling tragedies, but did not want to point the finger of blame. They simply wanted to use their experience to make life better for others. They deserve that we listen to what they say.

I say gently to the Minister that it is not often in ministerial life that one gets a chance to make a real difference. We know that Ministers get bogged down in the minutiae of every day and that things come down the chain to them, but this is a chance to make a difference. It is a chance to leave a mark that will be there long after he leaves ministerial office—not that I am hoping he will leave soon—long after most of us have left Parliament, in fact.

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

Will the hon. Lady give way?

[Helen Jones]

I am going to wind up my speech, if the hon. Gentleman will forgive me.

This is a real chance to save lives, so I say to the Minister: read the report and champion its recommendations in government. That way we can have world-class scientists in this country and save the lives of many people, including young people, who will have the chance to make an enormous contribution to this country. It is as simple as that. This cancer has been neglected for far too long. That now has to change. [Applause.]

[Sir Edward Leigh (in the Chair)]

Order. I know this is a sensitive subject, but I am afraid that people in the Public Gallery must not clap; I am sorry.

As I said earlier, a very large number of Members have written to Mr Speaker, and they often quote the fact that they want to speak on behalf of constituents, so my aim is to get everyone in and I will now have to impose a four-minute limit. I would be grateful if colleagues could resist the temptation to take too many interventions, because that will mean that someone at the end of the queue does not get in. I know that the first speaker will want to abide by that, because of her long experience.

--- Later in debate ---

[Helen Jones]

In the few seconds available to me I would like to thank all hon. Members who have spoken today, particularly those who were willing to share their individual stories, because that is a terribly difficult thing to do.

This debate and the inquiry that we conducted have been a vindication of the Petitions Committee process, and of our decision to take on inquiries into petitions. We have heard some encouraging words from the Minister today; we will look forward to hearing further from him. It is fair to say that we are now on the march; I hope in the future we shall continue with that.

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?

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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?

--- Later in debate ---

[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.

--- Later in debate ---

[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.