NHS England: Annual Assessment
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today, I am laying before Parliament my annual assessment of the NHS commissioning board (known as NHS England) for 2015-16. I am also laying NHS England’s annual report and accounts for 2015-16 (HC311). Copies of both documents will be available from the Vote Office and the Printed Paper Office.
NHS England’s annual report and accounts includes a self-assessment of performance which describes an organisation that has experienced a year of both progress and challenge. NHS England continues to deliver high-quality care as it progresses with implementing the vision set out in the five year forward view delivering constancy of direction, consistency of leadership and effectiveness of delivery.
In response, my annual assessment welcomes the good progress that NHS England has made against many of its objectives including managing the commissioning system. Additionally it has continued to deliver the specialised services and primary care commissioning systems and improved the operation and management of the NHS. There does, however, remain much to do in order to achieve our agreed goals by 2020. In particular, I have drawn attention to the need to address year-round performance against the standards reflected within the NHS constitution, many of which have been routinely missed this year, as well as the need to make further progress on achieving parity of esteem between physical and mental health.
Although NHS England met its objective to deliver financial balance in the commissioning system this year, the provider sector remains financially challenged. To achieve its financial objective in 2016-17, NHS England must work with its system partners and the Department of Health to jointly deliver a balanced budget across the NHS as well as delivering its share of the productivity and efficiency savings identified in the NHS five year forward view.
Overall NHS England has made progress during 2015-16 but there remains much more to do. The extra real-terms investment of £8.4 billion agreed as part of the 2015 spending review is evidence of this Government’s continuing commitment to the NHS. My Department and I will continue to work with NHS England and its partners to ensure that this investment is used to build on the good work seen so far and to deliver an NHS that provides safe, compassionate and reliable care for those who need it while living within its means.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-21/HCWS105/.
[HCWS105]
NHS Shared Business Services
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
NHS Shared Business Services (SBS) has today published a statement regarding an issue with a mail redirection service which was formerly provided by NHS SBS on behalf of NHS England as part of the Primary Care Support Service.
This matter is also referred to in my Department’s annual report and accounts, published today, copies of which are available in the Vote Office and Printed Paper Office. I will of course keep the House updated in future as investigations are carried out by NHS England and Shared Business Services and as they seek to determine the effect of this issue.
Attachments can be viewed online at: http://www.parliament. uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-21/HCWS120/.
[HCWS120]
Junior Doctors Contract
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
In May, the Government and NHS employers reached an historic agreement with the British Medical Association on the new contract for junior doctors after more than three years of negotiations and several days of damaging strike action. That agreement was strongly endorsed as a good deal for junior doctors by the leader of the BMA’s junior doctors committee, Dr Johann Malawana, and was supported publicly by the vast majority of medical royal colleges. However, it was rejected yesterday in a ratification ballot: 58% voted against the contract, so, on the basis of a 68% turnout, around a third of serving junior doctors actively voted against the agreement.
It is worth outlining key elements of the agreement that was voted on. The agreement does indeed help the Government to deliver their seven-day NHS manifesto commitment, but it also does much more. It reduces the maximum hours junior doctors can be asked to work, introduces a new post in every trust to make sure the hours asked of junior doctors are safe, makes rostering more child and family-friendly, and helps women who take maternity leave to catch up with their peers. The president of the Royal College of Physicians, who had opposed our previous proposals, stated publicly:
“If I were a trainee doctor now, I would vote ‘yes’ in the junior doctor referendum.”
Unfortunately, because of the vote, we are now left in a no-man’s land, which, if it continues, can only damage the NHS.
An elected Government whose main aim is to improve the safety and quality of care for patients have come up against a union that has stirred up anger among its own members that it is now unable to pacify. I was not a fan of the tactics used by the BMA, but, to its credit, its leader, Johann Malawana, did, in the end, negotiate a deal and work hard to get support for it. Now that he has resigned, it is not clear whether anyone can deliver the support of BMA members for any negotiated settlement.
Protracted uncertainty precisely when we grapple with the enormous consequences of leaving the EU can only be damaging for those working in the NHS and for the patients who depend on it. Last night, Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, said that the NHS and junior doctors needed to move on from this dispute and that if the Government proceed with the new contract it should be implemented in a phased way that allowed time to learn from any teething problems. After listening to this advice and carefully considering the equalities impact of the new contract, I have this morning decided that the only realistic way to end this impasse is to proceed with the phased introduction of the exact contract that was negotiated, agreed and supported by the BMA leadership.
The contract will be introduced from October this year for more senior obstetrics trainees; then in November and December for foundation year 1 doctors taking up new posts and foundation year 2 doctors on the same rotas as their current contracts expire. More specialties such as paediatrics, psychiatry and pathology, as well as surgical trainees, will transition in the same way to the new contract between February and April next year, with remaining trainees by October 2017.
This is a difficult decision to make. Many people will call on me to return to negotiations with the BMA, and I say to them: we have been talking, or trying to talk, for well over three years. There is no consensus around a new contract and, after yesterday’s vote, it is not clear whether any further discussions could create one. However, the agreement negotiated in May is better for junior doctors and better for the NHS than the original contract that we planned to introduce in March. Rather than try to wind the clock back to the March contract, we will not change any of the new terms agreed with the BMA.
It is also important to note that, even though we are proceeding without consensus, this decision is not a rejection of the legitimate concerns of many junior doctors about their working conditions. Junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends. They have many concerns, for example, about rota gaps and rostering practices. In the May ACAS agreement, NHS employers agreed to work with the BMA to monitor the implementation of the contract and improve rostering practice for junior doctors. Last month, at the NHS Confederation’s annual conference, I set out my expectation that all hospitals should invest in modern e-rostering systems by the end of next year as part of their efforts to improve the way that they deploy staff. I hope that the BMA will continue to participate in discussions about all these areas.
Furthermore, this decision is not a rejection of the concerns of foundation year doctors who often feel most disconnected in that period of their training before they have chosen a specialty. Again, we will continue to make progress in addressing those concerns under the leadership of Sheona MacLeod at Health Education England, and we will continue to invite the BMA to attend those meetings.
We will also continue with a separate process to look at how we can improve the working lives of junior doctors more broadly, which will be led by the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer). I very much hope that the BMA will continue to participate in that process as well.
We will not let up on efforts to eliminate the gender pay gap. Today, I can announce that I will commission an independent report on how to reduce and eliminate that gap in the medical profession. I will announce shortly who will be leading that important piece of work, which I hope to have initial considerations from in September.
Most importantly, this is not a decision to stop any further talks. I welcome Dr Ellen McCourt to her position as new interim leader of the junior doctors committee. I had constructive talks with her during the negotiations. Although we do need to proceed with the implementation of the new contract to end uncertainty, my door remains open to her or whoever takes over her post substantively in September. I am willing to discuss how the new contract is implemented, extra-contractual issues such as training and rostering, and the contents of future contracts.
To me personally and to everyone in this House as well as many others, it is a matter of profound regret that, at a time of so many other challenges, the BMA was unable to secure majority support for the deal that it agreed with the Government and NHS employers, but we are where we are.
I believe the course of action outlined in this statement is the best way to help the NHS to move on from this long-running contractual dispute and to focus our efforts on providing the safest, highest-quality care for patients. I commend the statement to the House.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The NHS is only as strong as the morale of its staff, and the rejection of this contract by the junior doctors sadly reveals that morale and trust in the Government are at rock bottom. Yesterday, to mark the 68th anniversary of the NHS, I visited my local hospital, Homerton University hospital, and met some of the wonderful nurses. One of their main concerns was the abolition of the bursary, but they were also genuinely worried that NHS staff were no longer valued. The Secretary of State must accept that his handling of the junior doctor dispute has exacerbated this feeling among all NHS staff.
I have sat in this Chamber and heard the Secretary of State say that junior doctors have not read the new contract, do not understand the new contract, or have been bamboozled by their leadership, but now that the junior doctors have rejected a renegotiated contract recommended by their leadership, he must begin to understand that his handling of this dispute has contributed to the impasse. There should be no suggestion that the junior doctors’ decision is somehow illegitimate. The turnout in the ballot was higher than in the general election in 2015.
I welcome the fact that the Secretary of State will not let up on efforts to eliminate the gender pay gap and that he will commission an independent report on how to reduce and eliminate that gap, and look at shared parental leave as well. That is an important concern among doctors. I also welcome the fact that the imposition of the contract will be phased, but at this time of general instability I urge the Government to reconsider imposing the contract at all.
It has not helped for the Government to treat junior doctors as the enemy within. It has not helped junior doctors’ morale that it was implied at one time that the only barrier to a seven-day NHS was their reluctance to work at weekends, when so many of them already work unsocial hours, sacrificing family life in the process. I am glad that the Secretary of State acknowledged today that junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends, but the vote to reject the contract is a rejection of the Government’s previous approach.
The Secretary of State knows that the BMA remains opposed to the imposition of any contract, believing that imposing a contract that has not been agreed is inherently unfair and an indictment of the Secretary of State’s handling of the situation. The junior doctors committee is meeting today to decide how it will proceed. Labour Members look forward to hearing the outcome of that meeting and how we can best continue to support the junior doctors.
Public opinion is not on the Government’s side. It is evident that the public will have faith in their doctors long after they have lost faith in this or any other Government. It is not too late to change course. The Government need urgently to address the recruitment and retention crisis and scrap the contract. Although I appreciate that the contract has been in negotiation for many years, the Government should give talks with the junior doctors one more chance. If they crush the morale of NHS staff, they crush the efficacy of the NHS itself.
Mr Hunt
I welcome the hon. Lady to her place for the first statement to which she has responded and welcome her on the whole measured tone, with one or two exceptions. I will reply directly to the points she made.
First, the hon. Lady maintains the view expressed by her predecessor, the hon. Member for Lewisham East (Heidi Alexander), who is in her place this afternoon, that somehow the Government’s handling of the dispute is to blame. We have heard that narrative a lot in the past year, but I say with the greatest of respect for the hon. Member for Hackney North and Stoke Newington (Ms Abbott)—I do understand that she is new to the post—that that narrative has been comprehensively disproved by the leaked WhatsApp messages that were exchanged between members of the junior doctors committee earlier this year.
We now know that, precisely when the official Opposition were saying that the Government were being intransigent, the BMA had no interest in doing a deal. In February, at the ACAS talks, the junior doctors’ aim was simply to
“play the political game of…looking reasonable”—
their words, not ours. We also know that they wanted to provoke the Government into imposing a contract, as part of a plan to
“tie the Department of Health up in knots for…months”.
In contrast to public claims that the dispute was about patient safety, we know that, in their own words,
“the only real red line”
was pay. With the benefit of that knowledge, the hon. Lady should be careful about maintaining that the Government have not wanted to try to find a solution. We have had more than 70 meetings in the past year and we have been trying to find a solution for more than four years.
The question then arises whether we should negotiate or proceed with the introduction of the new contracts. Let me say plainly and directly that if I believed negotiations would work, that is exactly what I would do. The reason I do not think they will work is that it has become clear that many of the issues upsetting junior doctors are in fact nothing to do with the contract. Let me quote a statement posted this morning by one of the junior doctors’ leaders and a fierce opponent of the Government, Dr Reena Aggarwal:
“I am no apologist for the Government but I do believe that many of the issues that are exercising junior doctors are extra-contractual. This contract was never intended to solve every complaint and unhappiness, and I am not sure any single agreement would have achieved universal accord with the junior doctor body.”
The Government’s biggest opponents—in a way, the biggest firebrands in the BMA—supported the deal and were telling their members that it was a good deal, which got rid of some of the unfairnesses in the current contract and was better for women and so on. If the junior doctors are not prepared to believe even them, there is no way we will be able to achieve consensus.
If the hon. Lady wants to stand up and say that we should scrap the contract, she will be saying that we should not proceed with a deal that reduces the maximum hours a junior doctor can be asked to work, introduces safeguards to make sure that rostering is safe and boosts opportunities for women, disabled people and doctors with caring responsibilities—a deal that was supported by nearly every royal college. If the alternative from Labour is to do nothing, we would be passing on the opportunity to make real improvements that will make a real difference to the working lives of junior doctors.
The hon. Lady and I have a couple of the more challenging jobs that anyone can do in this Chamber. She has been in the House for much longer than I have, so she will know that. The litmus test in all the difficult decisions we face is whether we do the right thing for patients and for our vulnerable constituents, who desperately need a seven-day service. The Government are determined to make sure that happens.
Dr Sarah Wollaston (Totnes) (Con)
I welcome today’s statement and thank the Secretary of State for dealing with many of the extra-contractual issues that have blighted the lives of junior doctors. I join him in regretting the outcome of the ballot. Like my right hon. Friend, I welcome Doctor Ellen McCourt to her post. I know that my right hon. Friend will work constructively with the junior doctors committee to try to resolve the outstanding issues. In proceeding in a careful, measured way with the imposition of the contract, will he work to reassure the public that if patient safety issues arise during that process, he will deal with them?
Mr Hunt
I thank my hon. Friend for her measured tone and for being an independent voice throughout the dispute. I spoke to Dr Ellen McCourt earlier this afternoon. I appreciate that she is in a very difficult situation, but I wanted to stress to her that, as I told the House this afternoon, my door remains open for talks about absolutely anything and that I am keen to find a way forward through dialogue. I had lots of discussions with Dr McCourt when we were negotiating the agreement in May, and I know that she approached those negotiations in a positive spirit.
We have set in place processes, and that is one of the reasons why Professor Bailey recommended phased implementation—so that if there are any safety concerns, we can address them as we go along. The Minister with responsibility for care quality, my hon. Friend the Member for Ipswich, is leading a process that will keep looking at the issues to do with the quality of life of junior doctors. NHS Employers is leading a process that will look in detail at how the contract is implemented. Absolutely, the point of the changes is to make care safer for patients; we will continue to keep an eye on this to make sure that it does so.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I, too, am disappointed by the outcome of the ballot yesterday. It has to be recognised that it reflects a real desperation and unhappiness among junior doctors, who are dealing with increased demand and pressure. They have felt that, at times, the tone of the negotiations has left a lot to be desired. The threat of imposition was there from the start, and they felt that hanging over them.
I welcome several things in the statement, and I absolutely welcome its very measured tone. I welcome the attempt to tackle the gender pay gap, to deal with unhappy foundationers and to limit hours. I would say that junior doctors’ biggest concern is rota gaps. In some specialties, the rate is as high as one in four, so one doctor covers the role of two. That is a real patient safety issue, and patient safety is meant to be the whole point of the contract. I welcome the fact that the contract will be phased in, and I call on the Secretary of State to ensure absolutely that, as this goes forward, he will learn, because junior doctors’ concern is about how we spread a short-staffed workforce across more days. I called for the contract to be phased in through a trial, and it is being phased in, but in a different way. We need to recognise the pain that the vote represents.
Mr Hunt
I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.
Mr Kenneth Clarke (Rushcliffe) (Con)
I congratulate the Secretary of State on taking the only responsible decision that he could take, in the interests of the service and patients, to bring this sad, extraordinarily long episode to an end. I also congratulate him on being conciliatory, because he made concessions in May to produce the final contract, and now he is phasing it in, in its negotiated form. I hope that we get back to a peaceful settlement. Does he agree that the surprising fact that so many dedicated junior doctors were prepared to take industrial action over rather ill-defined problems with the contract shows that there is a problem with morale in the service? Will he give an undertaking that the very welcome steps that he has announced today to try to address the wider issues will last not just a few months, until the dust settles on this dispute, but will be part of a continuous process to make sure that we restore to the service the morale and dedication on which we all know the NHS relies?
Mr Hunt
As ever, my right hon. and learned Friend speaks with great wisdom and experience. He is absolutely right to say that tackling the morale deficit in the NHS has to be a key priority. That is why we have to recognise that for doctors—particularly junior doctors starting out on their medical careers—the most depressing and dispiriting thing of all is when they cannot give the patients in front of them the care that they want to. That is why we are looking at a number of things to make it easier for doctors to improve the quality of care. One of the things that is particularly challenging and that we in this House have to think about and discuss a lot more is how difficult doctors and nurses find it to speak out if they see poor care, or if they or a colleague make a mistake, because they are frightened of litigation, a General Medical Council referral, or disciplinary action by their trust. The problem is that people then do not go through the learning processes necessary to prevent those mistakes from happening again. The key is creating a supportive environment, in which learning can really happen, in hospitals.
Heidi Alexander (Lewisham East) (Lab)
If I believed that the benefits for patients of pushing ahead with this contract outweighed the impact that its imposition will have on junior doctor morale, recruitment and retention, I would support the Health Secretary, but I do not believe that. Can he tell the House which clause of which Act of Parliament gives him the power to force hospitals to introduce the contract? If he cannot tell us that, can he outline the legislative basis on which Health Education England could withhold funding from trusts that choose not to proceed with it?
Mr Hunt
Health Education England is absolutely clear that it has to run national training programmes, and that is why it has to have standard contracts across the country. As the hon. Lady knows well from her previous role on the Front Bench, in reality foundation trusts have the legal right to set their own terms and conditions, but they currently follow a national contract; that is their choice, but because they do that, I used the phrase “introduction of a new contract” this afternoon. I expect, on the basis of current practice, that the contract will be adopted throughout the NHS.
I enjoyed working with the hon. Lady when she was shadow Health Secretary, but on this issue, she was quite wrong, because she saw the WhatsApp leaks, which revealed that the British Medical Association had no willingness or desire for a negotiated settlement in February, precisely when she was saying at the Dispatch Box that I was the one being intransigent. She gave a running commentary on the dispute at every stage, but when those leaks happened, she said absolutely nothing. She should set the record straight and apologise to the House for getting the issue totally wrong.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend on the patience that he has shown on this matter, and on the deal that was agreed back in May—it is a good deal. Apropos of the remarks of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who speaks for the Opposition, does the Secretary of State agree that it is indeed important to maintain morale in the health service? We need to be very careful about striking special deals for one particular part of the workforce, and the perception that that might be unfair. Would he further agree that we need to avoid the temptation of addressing every single grievance of a particular workforce? That is more properly within the bailiwick of managers locally than national contracts.
Mr Hunt
My hon. Friend obviously speaks from experience and very sensibly on this issue. In this House, of course, we think about the actions of politicians, Ministers and so on, but for doctors in a hospital, the most important component of their morale is the way that they are treated by their direct line manager. One of the things that worries me most in the NHS, looking at the staff survey, is that 19% of NHS staff talk about being bullied in the last year. That is ridiculously high. We need to think about why that is. The reality is that it is very tough on the frontline at the moment. There are a lot of people walking through the front doors of our NHS organisations, and we need to do everything that we can to try to support doctors and nurses, who are doing a very challenging job.
Paula Sherriff (Dewsbury) (Lab)
Instead of blaming the BMA, will the Secretary of State acknowledge that yesterday’s result was indicative of the fact that a significant proportion of medical staff have lost confidence in him? More than ever, running the NHS requires the good will of its staff. How does he intend to restore that confidence?
Mr Hunt
Actually, in my statement I took the trouble to praise BMA leaders. Admittedly, at the outset I did not agree with their tactics at all, but they did then have the courage to negotiate a deal and try really hard to get their members to accept it. I respect them for doing that. Part of the problem was that in the early stages of the dispute, there was a lot of misinformation going around. There were a lot of doctors who thought, for example, that their salary was going to be cut by about a third. That was never on the table and never the Government’s intention. A lot of doctors thought that they were going to be asked to work longer hours. That, too, was the opposite of what we wanted to do. I am afraid that that created a very bitter atmosphere. I simply say that, in the end, the best way to restore morale is to support doctors in giving better care to their patients, and that is what the NHS transformation plan is all about and what we are working on.
Sir Peter Bottomley (Worthing West) (Con)
Around 10 years ago the mishandled introduction of MMC—modernising medical careers—and the medical training application service started some of the problems for junior doctors. I pay tribute to the BMA who, in the discussions up to May, helped to agree with NHS England employers changes to the proposed contract, which were to the benefit of doctors in training? I say to the Secretary of State and, through him, to the employers that I hope they will pay attention to the extra-contractual issues which are of concern to doctors, and that the BMA will catch up with the rest of us in saying that we rely on them and others in hospitals to give a good, safe service to patients. They need to work together with everybody else and we will support them in doing that.
Mr Hunt
I am absolutely prepared to give that assurance and I thank my hon. Friend for his comments. He is right. We can look at MTAS and such changes. We can go even further back and look at the introduction of the European working time directive—strange to bring that up in the current context—and the shift system, which sensibly reduced some of the crazy hours that junior doctors were being asked to work, but unfortunately at the same time got rid of the “old firm” system which gave junior doctors a sense of collegiality, meant that there was a consultant whom they knew and related to, and made their training a lot more rewarding and satisfying. That was disrupted when we introduced the shift system and the maximum hours limits. We need to think about—and we are doing some very important work on this—how we could recreate some of that sense of collegiality, which is particularly missing for junior doctors in the first two years of their training, before they have joined a specialty.
Diana Johnson (Kingston upon Hull North) (Lab)
With morale among junior doctors at rock bottom, and Hull having an historic problem with recruitment and retention, what particular initiatives is the Secretary of State going to use to allow the health service in Hull to have the number of doctors that we need to function properly and provide the high-quality care that we all want to see?
Mr Hunt
There is one very good doctor in the Hull A&E department, and that is Dr Ellen McCourt, who has taken over as leader of the junior doctors committee—at least, I imagine she is very good; I have been very impressed every time I have met her. There are particular pressures at Hull, and as the hon. Lady knows we have had management changes. So far we have not seen the improvement in performance that we would like. I am aware that there are big issues with the infrastructure— the physical buildings. We will continue to work with the NHS locally and with the trust to try to improve the situation. She is right to bring it to my attention.
Sir Oliver Heald (North East Hertfordshire) (Con)
I join my right hon. Friend in expressing sadness at the decision of the vote. He will remember that on previous occasions I have raised with him some family-friendly aspects of the lives of junior doctors. Does he agree that it is important to look at the training situation, where a couple can be sent to different towns many miles apart; the rostering, which can make family life difficult; and some of the problems of returners to work, whose training perhaps needs to be properly considered? Will he confirm that he will continue to look at these issues and that, as the monitoring and phasing goes ahead, he will try to address them?
Mr Hunt
My hon. and learned Friend is correct to have raised that before and I can reassure him that we have subsequently started a very big piece of work to look at those exact issues. The difficulty is that throughout their training junior doctors are rotated every six months. That is particularly disruptive to family life or, for example, if they have a partner and one is sent to Sheffield and the other to Bristol. We are seeing what we can do to deal with that. The other issue that we are looking at is that of people who for family reasons discover that they have a caring responsibility, maybe for children or for a parent with dementia, and want to switch to a specialty that may not have quite so many unsocial hours, and whether it is possible to novate their training across from one specialty to another, which does not happen at present.
Liz McInnes (Heywood and Middleton) (Lab)
We are all congratulating each other on the measured tone of this debate, but Dr Johann Malawana has said in very measured tones:
“Given the result, both sides must look again at the proposals and there should be no transition to a new contract until further talks take place.”
Will the Health Secretary commit to hold further talks in order to avoid further conflict and the possibility that he may provoke further strike action if he does not? If he provokes further industrial action among the junior doctors, the blame will lie fairly and squarely at his open door.
Mr Hunt
Let me tell the hon. Lady the words that Dr Malawana actually said:
“I will happily state that I think this is a good deal.”
He talked about junior doctors benefiting from
“massively strengthened areas of safety precautions…equalities improvements, improvements to whistleblowing protection and appropriate pay for unsocial hours.”
He thought this deal was a big step forward. As I said, if I thought that there was any prospect of further negotiations leading to a consensus that could get the support of the BMA membership, that is what I would be doing, but my honest assessment of the situation—given that the people who most strongly opposed the Government recommended accepting this deal and still they were not listened to—is that there is no such prospect, and I therefore need to take the difficult decision that I have taken this afternoon.
Helen Whately (Faversham and Mid Kent) (Con)
There has been a negotiation, the Secretary of State has listened to the concerns of junior doctors, we now have a better contract, and we heard today that there will a phased introduction of it. Does my right hon. Friend agree that junior doctors now need to move forward and that they should take up the offer to be involved in work to improve the experience of junior doctors in training? We know that junior doctors do not feel valued. They should feel valued. They need to play their part in making sure that they are valued.
Mr Hunt
My hon. Friend is right to say that. One of the things that is clear to me is that the reason that the May deal is better than the deal that we were going to introduce in February is because of the involvement of the BMA and the BMA leaders in telling us the concerns of junior doctors at the coalface, and the specific niggles and annoyances, many of which we were able to sort out very straightforwardly. I strongly hope that junior doctors will remain in all the discussions that we have, so that we try to get even better solutions.
Steve Rotheram (Liverpool, Walton) (Lab)
At the start of his statement, the Secretary of State used sophistry to try to call into question the result of the ballot, by implying that 58% did not provide legitimacy for the rejection of the Government contract offer. Does he regret using smoke and mirrors, and does he agree that if his flawed methodology were used for other electoral processes, he would not be sitting in this House, there would not be a Tory Government, and we would still be in the EU?
Mr Hunt
The hon. Gentleman has misinterpreted what I said. I am clear on this. I said in my statement that 58% voted against the contract, and I accept that that was a majority of BMA members. I stated the fact that on a 68% turnout, around a third of serving junior doctors actively voted against the contract. That is factually correct.
Maggie Throup (Erewash) (Con)
I thank my right hon. Friend for all his efforts in agreeing a deal that was acceptable to the junior doctors’ leaders. In effect, the junior doctors have now voted against their own trade union. I welcome the way forward that the Secretary of State has outlined, but will he reassure the House that patients and their safety will always be his No. 1 priority?
Mr Hunt
I am happy to give that assurance. One of the most exciting things in the NHS, despite a lot of the doom and gloom in the headlines, is that we are seeing a transformation in safety culture. Even though we are now doing about 4,500 more operations every day, the proportion of patients being harmed is down by about a third in just three years. I think there is a transformation, but of course there is a lot more to do, as I am no doubt going to hear.
Andrea Jenkyns (Morley and Outwood) (Con)
I am shocked that we are here yet again. If we look at the history, 90% of the contract has been renegotiated. There have been years of negotiations. This contract is far safer for patients. Regardless of what the Opposition say, it cannot be laid at the Secretary of State’s door if the junior doctors decide to take strike action. We should stop using patients as pawns and put patients first. I would like to thank the Secretary of State for his perseverance. Does he agree that, through its relentless pursuit of partisan politics, the BMA has backed itself into a corner and put patients at risk?
Mr Hunt
The way patients have suffered—there have been over 20,000 cancelled operations during this process—has been very disappointing. My hon. Friend is absolutely right to campaign on issues of hygiene and cleanliness, which lead to so many tragedies when they are not properly attended to. I hope we can move on now. I do believe that, despite the disappointing rejection of this deal in the ballot, some trust has been established between the leaders of the BMA and the Government, and we have had a productive dialogue. We have made a number of changes to the May contract since announcing it—things that they suggested and that we agreed to. I would like to continue that process and build that trust.
Huw Merriman (Bexhill and Battle) (Con)
Having been somewhat of a burden on the NHS myself over the months as a result of playing football—unsuccessfully—with the hon. Member for Ellesmere Port and Neston (Justin Madders) in December, I spent an hour on the day of the all-out strike talking to the junior doctors who treated me. They asked me if I could tell the Secretary of State and the BMA that there is a need and a desire for more talks. May I thank the Secretary of State for showing flexibility? He does a difficult job extremely well, and it is appreciated on the Government Benches. I am absolutely saddened that a deal on this contract has not been brokered in the way we thought it would in May. Will he ensure that those junior doctors who move on to this contract are made well aware of how unpopular the previous contract was in the medical profession and that this contract’s terms are well sold so that junior doctors are reassured about them?
Mr Hunt
I am more than happy to do that. I think that the vast majority of junior doctors think that what has happened is a tragedy and are keen to move on. I hope they take seriously my assurances this afternoon that we will be monitoring every stage of the implementation of this contract, and if there are further things that we can improve, we will do exactly that, because we want a contract that is good for them and good for patients.
Robert Jenrick (Newark) (Con)
Weeks like the ones we have just lived through put other matters into perspective. With that in mind, I am sure the Secretary of State will agree with me that it is absolutely right for patients and the country that this dispute ends now. I was delighted to hear that he is now reluctantly going to move to phase in the imposition of the contract. Will he, in his usual conciliatory manner, now turn a page on this dispute, end it completely and build a new relationship with junior doctors and the new interim head of the BMA’s junior doctors committee?
Mr Hunt
My hon. Friend speaks very wisely. I would certainly very much like to do that. It does take two to tango, but the Government certainly want to do everything they can to work with all the leaders of the different bodies in the medical profession, partly for the reason my hon. Friend gave—that the country is very preoccupied with even bigger issues—but partly because there is so much pressure on the NHS frontline, and it is just counterproductive to exhaust so much energy on these disputes when we could talk our way around them and avoid them.
Mrs Flick Drummond (Portsmouth South) (Con)
I am always last, but I am very grateful for being asked to speak. Does the Secretary of State have any indication of how many junior doctors actually read the contract, rather than relying on the BMA or rumours? The junior doctors I have talked to have not read it, and one said it was too long.
Mr Hunt
I thank my hon. Friend for her interest—it is last but not least, for sure, in her case. Many junior doctors are now aware of the bones of the contract. I am sure some of them have not read it, just as others have. However, I think the issue has been that a lot of them have read it and have felt that it does not answer every single problem they face today as a junior doctor. Unfortunately, there is no contract that can solve every single pressure they face at the stroke of a pen, and I suspect that that is why a number of them voted to reject the contract. What I would say to them is that we have a contract that is an improvement on what they had before, so let us go with that and try to address the other issues as best and as quickly as we can.
NHS Spending
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Perhaps I will cut down my speech a bit. I give a particularly warm welcome to all my Back-Bench colleagues here; it is wonderful to see them coming out in support in such numbers. I thank the shadow Health Secretary for calling this debate. She is right to talk about the issues of NHS funding—though not particularly through this motion, which I will come on to speak about. I welcome her to her first Opposition day debate, as I welcomed her earlier to her first statement. This is a brief that she knows well, having been shadow Public Health Minister, and having campaigned on a lot of very important topics, including plain paper packaging for cigarettes. She has done a lot of work with the all-party sickle cell and thalassaemia group as well. I wish her luck in two areas. The first is with her parliamentary questions, after last week’s question to the Department for International Development about a drought in Indonesia, when it was in fact in the Philippines. Secondly, I wish her luck finding some Front-Bench colleagues, just as I need luck finding some Back-Bench colleagues in these debates.
We are in agreement on Brexit; we were both on the remain side, and I campaigned strongly with the hon. Lady. I agree with her that however much we may have disagreed with the vote, it is very important that we respect it. She and I both worried about the damage that it might do to our economy and society if we left, but we also agree that it would do incredible damage to something even more important than them—to our democracy—if the British people were to think that the Westminster establishment was trying somehow to ignore their decision.
From the reasonable tone of her comments, I know that the hon. Lady understands that Vote Leave was not speaking for the Government when it said that there would potentially be an extra £350 million for the NHS. In fairness to the Vote Leave campaigners, at various points they clarified downwards that slogan on the side of the bus and said that they were really talking about a net figure of more like £100 million that could potentially go to the NHS, rather than £350 million.
Mr Hunt
The point that many of us made in the referendum campaign is that even the net figure—the more like £100 million net contribution that we make to the EU—is not a figure that we can bank on with any certainty because, even if it did materialise after an exit from the EU, it would be negated by the very smallest of contractions in the economy, which would itself reduce the tax base and the amount of public spending available. The Institute for Fiscal Studies said that that £100 million a week would be negated by a contraction in the economy as small as 0.6%. I do not think any of the economic forecasts said that the contraction would be as small as that; all of them said that it would be much bigger than that.
Mr Jamie Reed (Copeland) (Lab)
I share the right hon. Gentleman’s concerns about—with your permission, Mr Speaker—the lie on the side of the bus. As Secretary of State for Health, will he now, on behalf of the whole country, and particularly on behalf of people who were deceived and let down by that claim, take up with the Electoral Commission why that lie was allowed to stand for so long?
Mr Hunt
I understand the hon. Gentleman’s concerns. Let me give him a challenging reply. The trouble that we have—those of us who disagree with the outcome—is that that issue was exhaustively debated and, for whatever reason, people chose to disbelieve our concerns or decided that they were not worried about it.
I understand why the shadow Health Secretary has brought the motion before the House, but the reason it is a difficult one to debate is that essentially the argument about the £350 million, or the £120 million, or the £100 million is dependent on the state of the economy. That is something that we cannot know now, only 12 days after the Brexit vote result. However worried we are about the impact of that vote, in discussions about the economy we have to be careful not to talk it down, because in the end we have a responsibility to recognise that there may be opportunities and we need to make the most of the ones that exist.
Mr Bailey
I understand the point that the right hon. Gentleman is making. On the other hand, I believe the Treasury has downgraded our prospective growth rate from 2% to 0.5%. Presumably, future spending plans will be based on that revised future growth rate. Is it not reasonable, therefore, to start making the assumptions that he has been wary of making so far?
Mr Hunt
It is perfectly reasonable to make the assumptions that the hon. Gentleman mentions, and there are plenty of reasons why we could look at some of the early impact on the economy even in the past 12 days and be concerned about the potential impact on the tax base and public spending more broadly. My nervousness as a Minister about talking those things up is that I do not want to talk down the British economy. Even though, as I say, I campaigned against the Brexit vote, I recognise that we are now going to leave the EU, I want the economy to be successful and I want us to make the most of the opportunities that face us.
On the broader issue of NHS funding, this debate indicates that there is some consensus—the Prime Minister mentioned this earlier today at Prime Minister’s questions—on the umbilical link between the health of the economy and the amount we are able to spend on the NHS. We are proud of the fact that we were able to protect spending in the last Parliament and to increase it by £10 billion in this Parliament on the back of a growing economy. Given that Health is the second biggest spending Department, we must recognise that it is vital to the NHS that we maintain that growth, despite the choppy period we are possibly about to go through.
Mike Weir (Angus) (SNP)
I understand what the Secretary of State is saying about the health of the economy, but this debate also links to the previous debate because of the number of EU nationals who work in the health service. Has he made any estimate of the cost to the health service if all these EU nationals were forced to leave the UK in the course of this Brexit?
Mr Hunt
We are currently doing the analysis the hon. Gentleman is concerned about, but I should just say to him that I accept the Home Secretary’s assurance and confidence that we will not end up in a situation where EU nationals, upon whom we absolutely depend in the health and social care system, and who do an absolutely outstanding job, would not be allowed to remain in the UK. She has said she is very confident that we will be able to negotiate a deal whereby they are able to stay here as long as they wish and to continue to make the important contribution they do, and I accept that assurance.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
Further to the point made by the hon. Member for Angus (Mike Weir), will the Secretary of State give the House an assurance that he will release that analysis and that it will be sufficiently comprehensive to allow us to see a regional breakdown of the significance of EU nationals working in our health service?
Mr Jamie Reed
On the point my hon. Friend the Member for Harrow West (Mr Thomas) has just made about having an assessment if we do end up, essentially, forcibly repatriating EU citizens in the United Kingdom, there will of course be a flip side: something like 3 million British expats in the EU would have to return to the UK as well. Many of them are, to put it politely, of pensionable age, with challenging health demands in many regards. Will the Secretary of State also provide an assessment of what effect that would have on the national health service?
Mr Hunt
I am sure that that is analysis we can do, but I cannot do it at the Dispatch Box as a direct response to the hon. Gentleman. However, as I am sure he is well aware—we made this point during the whole Brexit referendum debate—we have reciprocal health arrangements with other EU countries at the moment. Those are immensely convenient to people travelling to and visiting other European countries, because they mean those people can access healthcare completely free of charge. The bill is actually sent to the Government, and that arrangement includes pensioners who have retired to Spain and France and Italy as well. It would be very sad if, as a result of the new relationship with the EU, we lost that convenience. That is one of the reasons why I am confident that other EU countries will be happy for British pensioners to remain in them. As long as those countries are able to charge us for the healthcare costs, the burden to them should be minimal.
Dr Rosena Allin-Khan (Tooting) (Lab)
The Secretary of State spoke about NHS spending. Does he agree that cuts to local government spending on social care are putting increased financial pressures on the NHS? At St George’s hospital, a cost of £1.3 million has been attributed to inefficient discharges.
Mr Hunt
First, may I welcome the hon. Lady to her place as a doctor and as someone who knows a great deal about NHS matters? Although I am sure we will not agree on every health matter, it is always valuable and a great asset to have someone with medical experience in the House, and I am sure she will make a huge contribution in that respect. She is absolutely right to say that what happens in the social care system has a direct impact on what happens in the NHS, and that we cannot—as, in fairness, happened under Governments of both colours over many years—look at the NHS and the social care system as completely independent systems when we know that inadequate provision in the social care system has a direct impact on emergency admissions in A&E departments. She is right to make that point.
Let me make a broader point in concluding my comments. I think that there would be agreement across this House on the huge pressure on the NHS frontline at the moment, and that there is recognition of some fantastic work being done by front-line doctors and nurses to cope with that pressure. I shall give a couple of examples of the extra work that is happening, compared with six years ago. The A&E target is to see, treat and discharge people within four hours. Every day, we are managing to achieve that, within the four-hour target, for 2,500 more people than six years ago. On cancer, we are not hitting all our targets, but every single day we are doing 16,000 more cancer tests, including 3,500 more MRI scans, and treating 130 additional people for cancer. There are some incredible things happening.
However, we all recognise, and this perhaps lies behind the Opposition’s concerns in bringing this motion to the House, that in healthcare we now deal with the twin challenges of an ageing population, in that we will have 1 million more over-70s within the next five years—a trend that is continuing to grow—and of the pressure of scientific discovery, which means we have new drugs and treatments coming down the track. They are exciting new possibilities but also things that cost money. I for one, as Health Secretary, believe that as soon as economic conditions allow, we will need to start looking at a significant increase in health funding. That is why it is incredibly important, as we go through the next few years negotiating our new relationship with Europe, that we work very hard to protect the economic base that we have in this country, the economic success that we have started to see, and the jobs that do not just employ a lot of people but create tax revenues for this country. It is incredibly important that we pilot the next few years with a great deal of care, because what happens on the economy will have a huge impact on the NHS.
Mr Thomas
I am grateful to the right hon. Gentleman for giving way, and, if he will forgive me for saying so, temporarily fond of him as a result, because he is allowing me to raise a particular constituency concern. Northwick Park hospital, which serves my constituents, currently has a deficit of almost £100 million and is having to axe 140 staff posts as a result of the lack of funding for my local clinical commissioning group, by comparison with other parts of London. Will he undertake to look specifically at the issues facing Northwick Park hospital and Harrow clinical commissioning group as his further analysis of the need for additional spending in the NHS is taken forward?
Mr Hunt
I am very happy to do so. I have visited that hospital, where the challenges very much reflect what the hon. Member for Tooting (Dr Allin-Khan) said about links to the social care system. It was clear to me that the staff in the A&E department are working incredibly hard getting people through it, but struggling to discharge people from the hospital, which is why they were not hitting their target.
I have just been handed a note by a ministerial colleague, Mr Speaker, which I hope you will indulge me and let me read out, because I have never been handed such a note before. It says: “Apparently everyone wants to go and watch Wales play, so Whips happy if you felt you wanted to shorten your remarks.” On that basis, I will conclude by thanking the shadow Health Secretary for bringing this motion to the House and for her comments in support of it.
Mr Speaker
The right hon. Gentleman is not only an experienced member of the Cabinet but a very seasoned parliamentarian, and I think he is well attuned to the feeling in the House, as I am sure that other colleagues will now also be—not that I am hinting or anything.
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years, 5 months ago)
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Martyn Day (Linlithgow and East Falkirk) (SNP)
3. If he will make an assessment of the potential effect of the UK leaving the EU on the availability of NHS services for (a) EU nationals living, studying and working in the UK and (b) UK citizens abroad.
The Secretary of State for Health (Mr Jeremy Hunt)
Before I start, the House will want to mark an important milestone, which is that this year, alongside Arnold Schwarzenegger, Brian May, Camilla Parker Bowles and Meat Loaf, the NHS is 68 years old, and its birthday is, in fact, today. I know that we will all want to wish the NHS and all who work there a very happy birthday.
As long as the UK is subject to EU law, current arrangements remain in place. As we move to a new relationship with Europe, our guiding principle will be to get the best possible deal for British citizens who live and work in, and who visit, EU countries. An EU unit will be set up in the Cabinet Office and will report to the Cabinet, and my Department will feed into its work.
Martyn Day
I am aware that nothing will change for the next two years, but what is the Secretary of State’s proposal for reciprocity of access to healthcare within the EU, and does he envisage the £500 NHS immigration health surcharge applying to EU nationals already living in the UK?
Mr Hunt
The health surcharge that this Government have instituted for people on long-term visas to come and work and live in the UK is the right thing to do, because it is important that everyone makes a fair contribution to the cost of NHS services. In terms of future arrangements for EU nationals in the UK, that would obviously be subject to the negotiations that now happen, and a very important part of those negotiations will be access to the EU health systems for British citizens currently living in EU countries.
Mr Philip Hollobone (Kettering) (Con)
Will the Secretary of State tell the House how many EU nationals work in the national health service and how many EU nationals use the national health service? Is it not the case that the number of eastern Europeans, especially, coming to this country has simply overwhelmed GP practices and A&E centres up and down the country, and now we have got a chance to redress the balance?
Mr Hunt
Without wanting to reopen the debate that concluded on 23 June, the overwhelming view in the NHS is that we are very lucky to have the incredible support of 110,000 EU nationals working in the health and social care system. I want to put on record to this House what a fantastic job they do and how much we are all in their debt.
Norman Lamb (North Norfolk) (LD)
Very many of those 110,000 people are now acutely anxious about their future in this country, because of the despicable suggestion that they should be used as a bargaining pawn in negotiations with the EU. Will the Secretary of State ensure that the Government, as a matter of urgency, guarantee their future in this country doing their dedicated work in our NHS and care system?
Mr Hunt
I can reassure the right hon. Gentleman that we are incredibly aware of the brilliant work that EU nationals do, not just in the NHS but in the social care system, which he was responsible for, in care homes up and down the country. We recognise that, and I hope that he will be reassured by statements made by the Foreign Secretary and the Home Secretary yesterday that we want to find a way of allowing those people to stay in the UK for as long as they wish to. We recognise the incredibly valuable contribution that they make, and we are confident in the negotiations ahead that we will be able to secure the outcome that they and we all want.
Heidi Alexander (Lewisham East) (Lab)
The last time the Secretary of State and I had an exchange in this Chamber, I suggested to him that it might be the final time we would face each other over the Dispatch Box. Although I was clearly prescient, it has not quite turned out the way I thought it would.
Following the results of the referendum, will the Secretary of State say whether he still intends to introduce an NHS charges Bill as outlined in the Queen’s Speech? Does he agree that migrants give more to the NHS than they take, that their contribution should be welcomed and that our NHS simply could not survive without them?
Mr Hunt
I enjoyed our many exchanges in this House, and it is a loss on our side as well that they will not continue. I would like to welcome the hon. Lady’s successor to her post, and I hope that I will have a chance to do so again when she asks a question later.
I agree with the hon. Member for Lewisham East (Heidi Alexander). Migrants, or the people who work in the NHS who come from different countries, make an extraordinary contribution. It is fair to say that the NHS would fall over without the incredible work that they do. It is also true that the British people voted to control migration on 23 June, and we have to accept that verdict. In terms of the NHS and social care system, I did not hear, and I have not heard in my time as Health Secretary, enormous amounts of worry about the pressure of migration on NHS services, because on the whole migrants tend to be younger and fitter people. While accepting the verdict of the British people and what they said on 23 June, the important reassurance that we now need to give is to the many people from outside the UK who make a fantastic contribution to the running of our health and care system.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State may be aware that in the wake of the Brexit vote NHS commissioning bosses have delayed funding for vital medicines and services because of the fall in the value of the pound. One affected patient is Abi Longfellow, the teenager who won her battle for a wonder drug thanks to a campaign by the Sunday People. Abi currently spends 11 hours a day on a dialysis machine and was due to start on a drug that would give her a fighting chance with a kidney transplant. We were all aware that the pound might fall post referendum, so will the Secretary of State explain why no contingency plans were put in place and what he will do to ensure that, despite the Brexit vote, patients like Abi receive the lifesaving treatments and medicines that they need?
Mr Hunt
First, I welcome the hon. Lady to her position. She is the third shadow Health Secretary I have faced in less than a year, and I am beginning to worry that it may be something personal. I wish her well; she knows the brief extremely well and has campaigned on it a great deal in her long parliamentary career. I will look into the case she brought up. I would not want anyone to be deprived of vital lifesaving drugs because of exchange rate fluctuations. The whole British economy, including the NHS, will have to deal with the economic shock that we may now face as a result of the Brexit vote. But now that the decision has been taken by the British people we must look for the opportunities for the UK and the NHS, and not simply worry about the uncertainties, although there will be lots of things we have to deal with.
John Howell (Henley) (Con)
4. What plans his Department has to increase capacity in general practice and primary care.
David Warburton (Somerton and Frome) (Con)
10. What plans his Department has to increase capacity in general practice and primary care.
The Secretary of State for Health (Mr Jeremy Hunt)
We will be investing an extra £2.4 billion a year in general practice by 2020-21, a 14% increase in real terms. The General Practice Forward View, published earlier this year, sets out a package of support for general practice to boost the workforce, drive efficiencies in workload and modernise primary care infrastructure and technology.
John Howell
General practitioners in Henley have recently written a letter to all their patients pointing out the difficulties they face in fulfilling their workload. Will the Secretary of State explain what the Government are doing about that and how what they are doing will help?
Mr Hunt
I am happy to do so. I recognise the picture that my hon. Friend paints—not just in Henley but across the country—of a huge increase in GPs’ workload, which they are finding extremely challenging. What have we done? We have almost 1,300 more GPs working and training in the NHS compared with 2010. We have said that by the end of this Parliament we will seek to make available an additional 10,000 primary and community care staff, including 5,000 doctors working in general practice and 1,000 physician associates. We recognise the problem and are doing something about it.
Michael Tomlinson
Given proposals for significant increases in housing across Dorset, my constituents are rightly concerned about access to services, including to GPs. Will the Secretary of State reassure me and my constituents that housing numbers will be taken into account when assessing provision and increasing capacity of general practice in Poole and Dorset?
Mr Hunt
I am happy to give my hon. Friend that assurance. NHS England looks at areas of new housing very carefully when deciding where to invest additional resources for new GP practices. I recognise those concerns. I was in Dorset at the weekend. It is a lovely place that many people retire to, and of course older people tend to use the NHS more, so it is very important that that is reflected in our investment patterns.
David Warburton
Having met GPs, health centre managers and patient groups in Frome, Wincanton and Somerton in my constituency, I know that GP recruitment is a serious problem in Somerset. What measures is the Department putting in place to address both that issue and the additional challenge of excessive agency costs, both of which are placing a considerable strain on rural health providers?
Mr Hunt
I am happy to do that—I visited a GP practice with my hon. Friend in the run-up to the last election, and I know the close interest that he takes in this issue. As I said, we are making huge efforts to recruit more GPs during this Parliament, and to do that we must increase the number of medical school graduates to 3,250 a year. We are making progress in that direction, and we have also introduced tough new rules on the use of agencies, including maximum hourly rates for agency doctors and nurses.
Mr Dennis Skinner (Bolsover) (Lab)
Will the Secretary of State do something about the Hardwick commissioning group in north Derbyshire? I met it a week last Friday to talk about dementia care, which he knows is due to change a little, according to the local authorities and so on. Will he tell the group that the mad idea to close Bolsover hospital, and the hospital in Bakewell in Derbyshire Dales, should be stopped? Will he tell Hardwick commissioning group that it has gone beyond its terms of reference, and that those hospitals should remain open?
Mr Hunt
I recognise the important role that community hospitals play in many of our constituencies, and that role will change as we get better at looking after people at home, which is what people want. We can all be proud of significant progress on dementia in recent years. Dementia diagnosis rates have risen by about 50%—indeed, we think we have the highest diagnosis rates in the world. However, it is not just about diagnosis; it is about what happens when someone receives that diagnosis, and the priority of this Parliament will be to ensure that we wrap around people the care that they need when they receive that diagnosis.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Health Secretary has just promised 5,000 new GPs, and GP Forward View mentions recruiting 500 GPs from overseas. I understand that Lincolnshire GP leaders are looking to recruit GPs from Spain, Poland and Romania. As we have heard, EU nationals who live in the UK and work in the NHS are seen by the Home Secretary as bargaining chips, which has made them incredibly nervous about their status. How successful does the Health Secretary think that that GP recruitment will be?
Mr Hunt
This is a time when all sides of the House should be seeking to reassure many people from other countries who do a fantastic job in our NHS that we believe they will have a great future here. The Home Secretary has prioritised doctors, paramedics and nurses in the shortage occupation lists, and in all countries that have points-based systems—look at what happens in Australia or Canada—the needs of the health service and health care system are usually given very high priority.
Keith Vaz (Leicester East) (Lab)
Mr Speaker, let us note another milestone this year: your election yesterday as a freeman of the City of London. We look forward to you bringing your own flock of sheep to Westminster in future.
The Secretary of State will know that we are facing a diabetes crisis, and by 2025, 5 million people will have been diagnosed with diabetes. There are 32,000 pharmacies in the United Kingdom, with 13,000 community-based schemes. Given that 99% of the population live near a pharmacy, does the Secretary of State agree that more diabetes work should be given to pharmacies, to try to ease the burden and pressure on general practitioners?
Mr Hunt
There is a lot of potential in what the right hon. Gentleman says. The financial pressures on the NHS and general practice mean that this is the right moment to rethink the role of pharmacies, and consider whether we can be better at tapping into the incredible skills that pharmacists have as trained clinicians, which I do not think we make the most of. He is right to say that diabetes and childhood obesity is a big priority for the Government, and I hope we will be able to inform the House more about that soon.
Imran Hussain (Bradford East) (Lab)
5. How much funding he plans to make available for the proposed pharmacy access scheme.
The Secretary of State for Health (Mr Jeremy Hunt)
Since 2010, we have invested £37 million in improving the physical environment of over 140 maternity units and purchasing equipment to improve safety. We now have 2,103 more midwives in the NHS and 6,400 more in training than in 2010.
Will Quince
Expectant parents in Colchester are among the first in the UK to have hypnobirthing courses—I recently attended one myself. What consideration has the Secretary of State given to the effectiveness of hypnobirthing in improving maternity safety?
Mr Hunt
A variety of pioneering techniques, which could make a huge difference to women’s experience of birth, are emerging. I am delighted that we are seeing lots of experimentation and innovation. I would particularly like to pay tribute to my hon. Friend’s trust, which is in special measures and has been through a very difficult period. The fact that it is still managing to do this kind of innovation is wholly to be commended.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Has the Secretary of State seen the Autism Commission report on barriers to healthcare for people with autism? In maternity care and all other care there are very severe barriers that, with the right will and the right action, we can overcome. Will he read the report and talk to me about it?
Mr Hunt
I am more than happy to do so. In fact, we have a copy of the report right here, which my Minister of State has handily given to me. When I was shadow Minister for disabled people, I had a lot of contact with parents of autistic children and with people on the autistic spectrum themselves. The hon. Gentleman makes a very important point.
Peter Heaton-Jones (North Devon) (Con)
The maternity unit at North Devon district hospital in Barnstaple in my constituency is one of the services being reviewed under the current Success Regime. Can the Secretary of State reassure me and my constituents that maternity care, and the safety thereof in what is a geographically huge region, will be the first priority under this review?
Mr Hunt
I can absolutely assure my hon. Friend on that. I know there are very big national and global events happening right now, but I want to tell the House that over the next month one of my big priorities will be to do something to improve our record on maternity safety. We have made huge progress in reducing stillbirth rates and so on, but maternity safety is still not as good as it should be and certainly not as good as in other countries in western Europe. This is an absolute priority and I hope to be able to inform the House more on this before recess.
Alison Thewliss (Glasgow Central) (SNP)
As the chair of the all-party group on infant feeding and inequalities, I welcome the new guidance issued by Public Health England, in conjunction with UNICEF Baby Friendly, on the commissioning of infant feeding services. I welcome in particular the recognition of raising infant feeding at the antenatal stage. Will the Secretary of State explain what resources the Department of Health is putting in to promote the guidance and increase breastfeeding at local levels?
Fiona Mactaggart (Slough) (Lab)
8. How many staff working in the NHS have been recruited from other European countries in the last 12 months; and if he will make a statement.
William Wragg (Hazel Grove) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
As we plan a new relationship with the EU, this Government will continue to ensure that the NHS is given the priority and stability it deserves. I have already sent a message of reassurance to all NHS staff, emphasising the vital role played by the 110,000 EU nationals working in our health and care system. To be able to allow them to continue making their outstanding contribution will be a key priority in our negotiations, and we are confident they will be able to remain in this country as long as they wish. Whatever other changes are happening at a national or international level, the commitment of the British people and this Government to our NHS and its brilliant staff remains unwavering.
William Wragg
A report published yesterday by the health journal Pulse showed that last year two thirds of young people referred by their GP for mental health services received no treatment, and moreover a third were not even assessed. I am a strong supporter of this Government’s commitment to improving mental health care, so what reassurance can the Secretary of State give today that results in child and adolescent mental health services will improve rapidly?
Mr Hunt
My hon. Friend is right to draw attention to that issue. We, too, are very proud of the progress we have made on mental health, with 1,400 more people accessing mental health services every day than six years ago, but there is a particular job to do with children and young people’s mental health, and we are putting £1.4 billion into that during the course of this Parliament—and there is a specific plan for the Manchester area, which I think will help my hon. Friend’s constituents.
Justin Madders (Ellesmere Port and Neston) (Lab)
It seems that almost every day there is another report about the deteriorating condition of NHS finances. Today we hear of a survey by the Healthcare Financial Management Association that said 67% of clinical commissioning group finance officers reported a high degree of risk in achieving their financial plan for the year, so does the Secretary of State now accept that the Government need to commit more funds to the NHS?
Mr Hunt
We have accepted that, which is why in our manifesto at the last election we were committed to putting £5.5 billion more into the NHS than was being promised by the hon. Gentleman’s party, but we have to live within the country’s financial envelope, because we know that without a strong economy we will not have a strong NHS. We will continue to make sure we get that balance right.
Andrew Stephenson (Pendle) (Con)
T5. In May, the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), gave me a very encouraging answer about improving the treatment and diagnosis of Lyme disease. Will she meet me and other concerned colleagues to discuss what more can be done to tackle that terrible condition?
Mr David Davis (Haltemprice and Howden) (Con)
T9. The Royal Free London NHS Foundation Trust recently signed an agreement to share 1.6 million patient records with Google’s DeepMind subsidiary. The data include medical history, HIV status, past drug overdoses, abortions, and all pathology, radiology and visit records. It is claimed that the data are anonymised, which is impossible given the nature of the data, and no permission was obtained from patients. It is also claimed that the agreement was made under the Secretary of State’s guidelines. Will he tell the House what he is doing to protect the privacy of such information?
Mr Jeremy Hunt
I am very happy to do so. My right hon. Friend has campaigned long and hard, and rightly so, on such issues. The truth is that the guidelines under which the NHS operates for the sharing of patient-identifiable data are not as clear as they need to be. That is why I asked the Care Quality Commission to undertake an independent investigation into the quality of data protection by NHS organisations and Dame Fiona Caldicott to update her guidelines. I hope that we will have news on that soon and certainly before the summer recess, which will please my right hon. Friend.
Nick Thomas-Symonds (Torfaen) (Lab)
Happy 68th birthday to the NHS and thank you to its creator, Labour’s Aneurin Bevan.
According to research by the British Lung Foundation, the mortality rates for lung disease have not improved over the past 10 years. Will the Secretary of State take a lesson from the Welsh Government, which have put in place a specific strategy and delivery plan to tackle the issue?
Dr Sarah Wollaston (Totnes) (Con)
Prevention of ill health has to be given a higher priority if the NHS is to meet the challenges set out in the five year forward view. Central to that will of course be the childhood obesity strategy. Has the Secretary of State had any discussions with the Prime Minister about the strategy’s future? Is he in a position to take over the strategy should No. 10 become distracted?
Mr Jeremy Hunt
I welcome my hon. Friend’s close interest in ensuring that this important agenda does not get swept aside. I can assure her that we have had many discussions inside Government about what to do. There is a strong commitment to take it forward as soon as possible, and I hope that she will get some good news on that front before too long.
Ms Margaret Ritchie (South Down) (SDLP)
Will the Minister responsible for public heath confirm when a statement on contaminated blood will be made to the House, and in particular on the response to the consultation that closed in April?
Emma Reynolds (Wolverhampton North East) (Lab)
What is the Health Secretary doing to ensure that the NHS gets the £350 million a week that it was promised during the referendum campaign?
Mr Jeremy Hunt
I am a little stumped, because I was never really sure whether we would see that money. All I can say is that I am committed to successful negotiations with the EU, and I am delighted that a number of people who championed the Brexit vote have said that any extra funding should go to the NHS.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
As we celebrate the 68th birthday of the NHS—one of the Labour party’s proudest achievements—let us not forget the fact that there are thousands of people across our country with mental health conditions who continue to face stigma, discrimination and prejudice. Recent reports tell us that young people are waiting up to a decade to receive the appropriate treatment, and future plans for children and young people’s mental health are not up to scratch. Will the Minister please tell us how many more NHS birthdays will have to pass before real equality for mental health is secured?
Alison McGovern (Wirral South) (Lab)
The Secretary of State and others have sought to reassure us that nothing changes immediately with Brexit, but that is not right for the NHS. The impact on the economy is already clear, and that will have a knock-on effect on our health service. That is why I will meet local leaders in Wirral on Friday to try to formulate a Brexit plan for the NHS. Will the Secretary of State receive that plan and take all necessary steps to protect the health service in Wirral?
Mr Jeremy Hunt
Of course, and we will take every step necessary to protect the NHS throughout the country, because it remains our most important public service. I am sure that, economically, the period ahead will be difficult, but now that we have had the argument and the British people have made their decision, it is also important that we talk up the opportunities from the new relationships that we may have in the future, and the extra funding that those could generate for the NHS, and I certainly hope that that is what happens.
Defending Public Services
Jeremy Hunt Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Today’s debate, chosen by the Opposition, is about defending public services, so I want to start by stating very simply that this Government do not believe in private wealth and public squalor; quite the opposite—we believe in prosperity with a purpose, and building high quality public services is perhaps the most important purpose of all. But there is a difference between the two sides of the House. Indeed, there is more than one difference. One is that we on this side are prepared to take the difficult decisions necessary to build the strong economy that will, in the end, fund those public services. A second difference is that we go further and say that securing funding from a strong economy is not enough, and that the battle for higher standards is as important as the battle for resources. Without high standards, we let down not just the taxpayers who fund our public services but the vulnerable citizens who depend on them.
So yes, we are proud to have protected schools funding since 2010, but we are even prouder that 1.4 million more children are in good or outstanding schools. Yes, we are proud to meet our 2% of GDP defence spending pledge, but we are even prouder of the professionalism of our armed forces operating in the Mediterranean today to help to find the wreckage of the tragically lost Egyptian airliner. Yes, we are proud to have protected science and research funding, but we are even prouder that this country continues to win more Nobel prizes than any other, apart from the United States. Yes, we are proud that, since 2010 and despite the deficit, we increased NHS funding by more than was promised by the Opposition at both elections. We are even prouder that failing hospitals are being turned around, that MRSA rates have halved and that cancer survival rates have never been higher.
With that, let me turn to the NHS and say up front that nowhere is the importance of the two challenges of proper funding and high standards more stark. I pay tribute to the 1.3 million staff who work in the NHS. Whatever they have thought over the years about the politicians running their service, their dedication to patients, their hard work, night and day, and their commitment to the values that the NHS stands for make up the invisible glue that has always held it together, whatever the challenge. I know that I speak for the whole House when I thank them for their service.
Let us look at what staff have achieved over the past six years. Compared with 2010, we treat 100 more people for cancer every single day. We treat 1,400 more mental health patients, 2,500 more people are seen within four hours in A&E departments, and we do 4,500 more operations. At the same time as all of that, hospital harm has fallen by a third and patients say that they have never been treated with more dignity and respect. In the wake of the tragedy of Mid Staffs, we should recognise the huge efforts of staff at the 27 trusts that have since been placed into special measures. Eleven have now come out, three of which are now officially rated as good. Neither Stafford nor Morecambe Bay nor Basildon—three of the hospitals of greatest concern—are now in special measures thanks to excellent local leadership and superb commitment from staff.
However, all NHS staff want to know about the funding of their service. The NHS’s own plan, published in October 2014, asked for a front-loaded £8 billion increase in funding not just to keep services running, but to transform them for the future. The then shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), said that the Conservative promise to deliver that funding was a cheque that would bounce, but we delivered that promise to the British people in last autumn’s spending review, and the increase was not £8 billion, but £10 billion. It was not back-loaded, as many had feared, but front-loaded with £6 billion of the £10 billion being delivered this year.
Norman Lamb (North Norfolk) (LD)
On the Secretary of State’s point about what the NHS asked for, is it not right that the forward view set out three different efficiency savings scenarios? It was not a case of the NHS asking for £8 billion. Does he really believe that the £8 billion— £10 billion including last year’s increase—will be sufficient to meet the NHS’s demands?
Mr Hunt
The right hon. Gentleman will have heard Simon Stevens being asked that question on “The Andrew Marr Show” yesterday. He was clear that £8 billion was the minimum of additional funding that he thought the NHS needed. In fact, we supplied £10 billion, which came with some important annual efficiency saving requirements. Indeed, for that £8 billion, the NHS recognises that £22 billion of annual efficiency savings are required by 2020, because even though funding is going up, demand for NHS services is increasing even faster. I will come on to talk about how we are going to make those efficiency savings. Some in this House have observed that without £70 billion of PFI debt, without £6 billion lost in an IT procurement fiasco, and without serious mistakes in the GP and consultant contracts a decade ago, the efficiency ask might have been smaller.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
We all hear what the Secretary of State is saying: it is always somebody else’s fault. However, the fact of the matter is that I have been told by senior health professionals at the highest level—I do not watch “The Andrew Marr Show” often—that only two of this country’s health trusts are not in debt. Is that right?
Mr Hunt
That is not true, but we do all accept that there is financial pressure throughout the system. The question that is always ducked by Labour Members is how much greater that financial pressure would have been under Labour’s plans, which involved giving the NHS £5.5 billion less every year than was promised by the Government. I just point out that when Labour Members condemn the £22 billion of efficiency savings as “politically motivated”, as the shadow Health Secretary did in March, they cannot have it both ways. Her manifesto offered the NHS £5.5 billion less every year compared with what this Government put forward—
Mr Hunt
The hon. Lady shakes her head, but let us consider what the King’s Fund said in the run-up to the election:
“Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view.”
It was there in black and white: Labour was committing to a £2.5 billion increase in the NHS budget, not the £8 billion that this Government committed to. The hon. Lady cannot have it both ways. If this figure was £5.5 billion, the efficiency savings needed would be not £22 billion, but £27.5 billion, which is a 25% increase. That would be the equivalent of laying off 56,000 doctors, losing 129,000 nurses or closing down about 15 entire hospitals.
John Redwood (Wokingham) (Con)
I welcome the Secretary of State’s policy that foreign visitors should be asked to pay for non-urgent treatment that they get when they are here and that European visitors should have to recoup this through their national systems. Why do we need extra legislation, and how much money does he think we can get from that?
Mr Hunt
We need extra legislation to expedite the process. I point out to my right hon. Friend that that is another policy which has been opposed by the Labour party. All the time it says we should be doing more to get a grip on NHS finances and yet it opposes every policy we put forward in order to do precisely that. The answer to his question is that the issue with the NHS is primarily that we are not very good at collecting the money to which we are entitled from other European countries, because we are not very good at measuring when European citizens are using the NHS. This legislation will help us to put those measurement systems in place so that we can get back what we hope will be about half a billion pounds a year by the end of this Parliament.
We will no doubt hear later this afternoon the charge that the Government have lost control of NHS finances, but we strongly reject that charge. The House may want to ask about the credibility of that accusation from a party that is at the same time proposing a funding cut for the NHS and criticising the difficult decisions we need to take to sort out NHS finances.
Nic Dakin (Scunthorpe) (Lab)
Two months into this financial year, can the Secretary of State say whether or not the Department of Health broke its budget for last year?
Mr Hunt
We will find out those figures when the full audit is complete. I just say to the hon. Gentleman that efficiency savings are never easy, but a party with the true interests of NHS patients at heart should support those efficiency savings, because every pound saved by avoiding waste is one we can spend improving patient care.
Let me therefore outline to the House what we are doing to deliver those efficiencies, as well as to support NHS trusts to return to financial balance. First, we are taking tough measures to reduce the cost of agency staff, including putting caps on total agency spend and limits on the rates paid to those working for agencies. So far, that has saved £290 million, with the market rate for agency nurses down 10% since October and with two thirds of trusts saying that they have benefited. Our plan is to reduce agency spend by £1.2 billion during this financial year. Secondly, we are introducing centralised procurement under the Carter reforms. Already 92 trusts are sharing, for the first time, information on the top 100 products they purchase in real time, and we expect savings of more than £700 million a year during this Parliament as a result. Thirdly, given that the pay bill is about two thirds of a typical hospital’s costs base, we are supporting trusts to improve on the gross inefficiency of the largely paper-based rostering systems used at present. This should also significantly increase flexibility and the work-life balance for staff, as we announced last week. Finally, and perhaps most critically, we will reduce demand for hospital services by a dramatic transformation of out-of-hospital care, as outlined in the five-year forward view. If we meet our ambitions, we will reduce demand by more than £4 billion a year through prevention, improved GP provision, mental health access and integrated health and social care.
Mr Kenneth Clarke (Rushcliffe) (Con)
For as long as I can remember, unfortunately, discussions about the NHS have always been reduced to simplistic arguments about whether enough money is being spent on it, and whether efficiency is being improved enough. I think that the Government, in the present financial circumstances, have increased spending and pursued efficiency at least as effectively as any of their predecessors.
Does my right hon. Friend agree that the real issues that we ought to be considering are the rapid rise in, and the changing nature of, demand on this important service? Will he have time to consider things such as moving to a seven-day service; ending the curious divisions between the hospital service, GPs, community care and local council social services; providing for an ageing population with chronic conditions; and, at the same time, giving extra emphasis to mental health and all the things that have been neglected in the past? All these exchanges such as, “You should be spending more,” and “You are cutting, and we would spend more” are the sterile nonsense pursued by every Opposition that I can recall when they cannot think of anything positive to say.
Mr Hunt
My right hon. and learned Friend speaks with great wisdom, as he did during the junior doctors’ strike. Perhaps that is based on his experience of featuring in a BMA poster, which was put up across the country, as someone who ignored medical advice, because he smoked his cigar.
My right hon. and learned Friend is absolutely right. The crucial issue for the future of the NHS is the simple statistic that by the end of this Parliament we will have 1 million more over-70s to look after in England, and their needs are very different from those of the population whom we had to look after 20, 30 or 40 years ago. In particular, their need to be looked after well at home, before they need expensive hospital treatment, is a transformation. That is why a core part of what we are doing is to transform the services offered in mental health and in general practice, which I will come on to a bit later.
Chris Leslie (Nottingham East) (Lab/Co-op)
While the Secretary of State is talking about transformation, let me say that I agree with the right hon. and learned Member for Rushcliffe (Mr Clarke) that we have to start focusing on quality. In the east midlands, for example, the ambulance service has just been judged by the Care Quality Commission to be inadequate when it comes to patient safety. Things are in a real state of difficulty in our NHS. Ambulance services need improvement; what is he going to do about it?
Mr Hunt
I absolutely agree with the hon. Gentleman. In fact, I wanted to come on to talk about that perceived tension between money and the quality of care. Until three years ago, we did not have an independent inspection regime to go around ambulance services and tell the service, the public, constituents and Members of Parliament how good the quality of care is in each area. The first step is to have that inspection regime so that we know the truth, and then things start to happen, as is beginning to be the case in ambulance services across the country.
The big point—this is precisely what I wanted to move on to—is the worry, which is shared by many people, that an efficiency ask of this scale might impact on patient care. They should listen to the chief inspector of hospitals, Professor Sir Mike Richards, who points out that financial rigour is one of the routes to excellent quality, and that there is a positive correlation between hospitals offering the best care and those with the lowest deficits. In other words, it is not a choice between good care and good finances; we need both.
Jake Berry (Rossendale and Darwen) (Con)
Before my right hon. Friend moves on, I want to draw him back to the question of charging international visitors for the use of the NHS. The Government now charges non-EU citizens £200 per person as part of their visa application. Will he tell the House why he has chosen the figure of £200, which seems extremely low? An equivalent private healthcare policy for a year would be £800, £900 or £1,000, and an equivalent level of travel insurance for the same period would be £400 or £500. Is there not an opportunity to tier this and perhaps charge people more as they get older and become more likely to rely on the NHS?
Mr Hunt
I recognise why my hon. Friend has asked that question. We do think very hard about the level at which we set that charge, which was introduced for the first time only a couple of years ago. The reason that it is set that low—I recognise that it is quite a low charge—is that a large number of people paying it are students who tend to have low health needs and be low users of the NHS. We want to ensure that we do not create an inadvertent disincentive for people coming to the UK when they can, at the same time, choose to do their studies in Australia and America. However, it is something that we keep constantly under review.
Jake Berry
My right hon. Friend will of course be aware that there is a differential charge for students—some £150 a year rather than £200. Will he go away and consider whether there is a possibility of charging high earners who come to this country more than a couple of hundred pounds a year, because the charge does seem so low? Will he also specifically look at whether there is a possibility of charging people who are older more, as they are much more likely to rely on the NHS?
Mr Hunt
Let me repeat that we do keep this matter constantly under review. The important thing is that, for the first time, we are charging people who come to the UK on a long-term basis for their use of NHS resources. That is something that did not happen before.
Let me return to the crucial issue of this link between the quality of care and good finances. Why is it that it is so important not to see this as an artificial choice between good care and good finances? Very simply, it is because poor care is about the most expensive thing that a hospital can do. A fall in a hospital will cost the NHS about £1,200, as the patient typically stays for three days longer. A bed sore adds about £2,500 to NHS costs, with a patient staying, on average, 12 days longer. Avoidable mistakes and poor care cost the NHS more than £2 billion a year. We should listen to inspiring leaders such as Dr Gary Kaplan of Virginia Mason hospital in Seattle, which is one of the safest and most efficient hospitals in the world. He said:
“The path to safer care is the same one as the path to lower costs.”
That brings me on to the second way that this Government are fiercely defending our public services, which is our restless determination to raise standards so that people on lower incomes can be confident of the same high quality provision as the wealthiest. To their credit, the last Labour Government succeeded in bringing down NHS waiting times. I hope that that decade is remembered as one when access to NHS services improved. However, because of poor care identified in many hospitals post Mid Staffs, we should surely resolve that this decade must become the one in which we transform the safety and quality of care. Mid Staffs was the lowest point in the history of the NHS, so we must make it a turning point, or a moment that we resolve to offer not just good access to care, but care itself that is the safest and the highest quality available. The record of the past three years shows that we can do just that.
The King’s Fund has given credit to the Government for their focus on safety and quality of care. Patient campaigners have said that the NHS is getting safer and the main indicators of hospital mortality and harm are going in the right direction. However, there is much more to do, so what are our plans? First, we must deliver a seven-day NHS. It should never be the case that mortality rates are higher for people admitted at weekends than for people admitted in the week. Last week’s junior doctor contract agreement was a big step forward, but we also need to reform the consultants’ contracts, improve the availability of weekend diagnostic services and increase the number of weekend consultant-led procedures.
Secondly, a seven-day NHS also means a transformation of out-of-hospital services, especially access to an integrated health and social care system that needs to operate over busy weekends as well as during the week. It also means more GP appointments at convenient times, which is why we want everyone to be able to see a GP in the evening or at weekends. We are backing general practice with a £2.4 billion increase in its budget.
Mr David Burrowes (Enfield, Southgate) (Con)
One group of people who particularly need integrated care are those who are addicted, as their life chances are most blighted. They need to be able to make a full recovery. Will the Secretary of State tell us what has been done to support that full recovery? Like me, is he looking forward to hearing the Minister for Culture and the Digital Economy, my hon. Friend the Member for Wantage (Mr Vaizey), conclude the debate, as we will perhaps hear how blighted communities are impacted by high-stakes fixed odds betting terminals? I would like to hear what is being done by the Government on that, as we need to act now to show that we have an all-round approach to improving life chances.
Mr Hunt
It is a pleasure to sit on the Treasury Bench with my hon. Friend the Minister for Culture and the Digital Economy for the first time in several years. I will leave him to respond to that point, but I will make a broader point in response to the question from my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) which is that the change we need to make in the NHS is to prevention rather than cure. If we can stop people becoming addicted in the first place, whether to drugs, alcohol or gambling, we will reduce costs for the NHS in the long term. That is the purpose of many of our plans.
Thirdly, a seven-day NHS requires a big improvement in access to 24/7 mental health crisis care, so that whenever a problem arises we are there promptly for some of our most vulnerable people. We will deliver that alongside our broader plans to enable 1 million more people with mental health problems to access support each year by 2020.
James Morris (Halesowen and Rowley Regis) (Con)
May I commend the Government for accepting the majority of the recommendations from the independent mental health taskforce and allocating £1 billion to implement them? The Secretary of State has been talking about system change within the NHS. To deliver on the taskforce’s recommendations, we need system change to make sure that we have the sort of mental health services that the people of this country deserve.
Mr Hunt
My hon. Friend speaks with great knowledge and as chairman of the all-party group on mental health. He is absolutely right to say that we need system change. The system change we need is to stop putting mental health in a silo, but instead to understand that it needs to be part of the whole picture of treatment when a person is in hospital or with their GP; it needs to be integrated with people’s physical health needs. We need to look at the whole person. We will not get all the way there in this Parliament, but I think the taskforce gives us a good and healthy ambition for this Parliament and I am confident we will realise it.
Norman Lamb
I am pleased to hear the Secretary of State acknowledge the importance of quality of care in mental health as well, but of course there are also problems in areas such as learning disability, where there are some highly vulnerable individuals. After the shocking Southern Health exposé, does he really not think that the leadership of that organisation, which presided over some dreadful events and so many unexpected deaths not being investigated, need to be held accountable and to move on?
Mr Hunt
As the right hon. Gentleman knows, the chair of that organisation has stepped down, but he is absolutely right about accountability. Accountability needs to be about not just individual organisations within the NHS, but the people commissioning mental health care and care for people with learning disabilities. That is why, from July, we will for the first time be publishing Ofsted ratings on the quality of mental health provision and of provision for people with learning disabilities by clinical commissioning groups, so that we can see where the weak areas are and sort them out.
I conclude on quality by saying that important though a seven-day NHS is, we need to go further if we really are to make NHS care the safest and highest quality in the world. According to the respected Hogan and Black analysis, we have 150 avoidable deaths in our NHS every week. That is 3.6% of all hospital deaths with a 50% or more chance that that death could have been avoided. In the United States, Johns Hopkins University said earlier this month that medical error was the third biggest killer after cancer and heart disease, causing 250,000 deaths in the United States alone every year. That is why this year England will become the first country in the world to lead a transparency revolution in which every major hospital will publish its own estimate of its avoidable deaths and its own plans to reduce them. This year, we will focus particularly on reducing maternal deaths, stillbirths and neonatal death and harm, with plans I hope to outline soon to the House.
If we are to do that, perhaps most difficult of all will be transforming a blame culture found in too many parts of the NHS that still makes it far too hard for doctors and nurses to speak openly about medical error. Among other measures, we have set up a new healthcare safety investigation branch to conduct no-blame investigations when we have tragedies. It is modelled on the highly successful air accidents investigation branch. As in the airline industry, our model for reducing avoidable death must be transparency, openness and a learning culture that supports rather than blames front-line professionals, who in the vast majority of cases are only trying to do their best. Part of that new culture of responsibility and accountability must be a return to proper continuity of care, which is why this Government have brought back named GPs for every patient, which had been abolished in 2004, and are introducing lead consultants for people who go to hospital with complex conditions.
In conclusion, for this Government defending the NHS involves higher standards of care, wise use of resources and secure funding from a strong economy. Because the challenges we face in England are the same as in Wales, Scotland and Northern Ireland— indeed, the same as in developed countries all over the world—we should exercise caution in politicising those pressures, or we simply invite scrutiny of the relative performance of the NHS in different parts of the UK, which often shows that those who complain loudest about NHS performance in England are themselves responsible for even worse performance elsewhere.
What this Government want is simple: a safer seven-day service, backed by funding from a strong economy. Already we have delivered more doctors, more nurses, more operations and better care than ever before in NHS history.
Mr Hunt
I am about to conclude, so I shall finish, if I may.
But with that achievement comes a renewed ambition that our NHS should continue to blaze a trail across the world for the quality and safety of its care, and that is how this Government will continue to defend our biggest and most cherished public service.
Mr Jeremy Hunt
I completely defend the methodology that we used to come up with our figure, but does the hon. Lady not see the irony? She is criticising a £3.8 billion increase in NHS funding this year, when Labour’s own plans at the election last year were for a £2.5 billion increase—£1.3 billion less than this Government have delivered.
Heidi Alexander
I am grateful to the Secretary of State for that intervention. He might want to rake over the last general election but he clearly does not want to talk about the crisis in NHS finances today, with a £2.45 billion deficit among hospitals at the end of this year, cuts to public health spending, and £4.5 billion coming out of the adult social care budget over the past five years. I am quite happy to debate NHS finances with him. The truth is that the NHS is getting a smaller increase this year than it got in every single year of the previous Labour Government.
The King’s Fund and the Health Foundation concluded:
“Getting public spending figures right is important, otherwise they can mislead and detract from the real issues. The fact is that the NHS is halfway through its most austere decade ever, with all NHS services facing huge pressures.”
Heidi Alexander
I would have thought better of the hon. Gentleman, but it is clear Conservative Members want to talk about anything other than their record in England. A&E performance is currently the worst since records began, taking us back to the bad old days of the 1980s, when patients were left waiting on trolleys in hospital corridors. The figures speak for themselves.
Mr Jeremy Hunt
May I ask the hon. Lady to consider again what my hon. Friend the Member for Cheltenham (Alex Chalk) said? If A&E performance is the fault of Conservative politicians in England, is it not also the fault of Labour politicians in Wales, where it is 11% worse?
Heidi Alexander
From memory, I seem to think the budget going to the NHS in Wales has been cut in Westminster.
Let us have a look at the figures. In March 2011—[Interruption.] The Health Secretary would do well to listen to these figures, because I am about to tell him the record of his term in office. In March 2011, 8,602 patients waited more than four hours on trolleys because no beds were available. Four years later, the figure was up sixfold, to 53,641. In March 2011, just one patient had to wait longer than 12 hours on a trolley. Four years later, 350 patients suffered that experience. The NHS waiting list now stands at almost 3.7 million people—the equivalent of one in every 15 people in England. Only 67% of ambulance call-outs to the most serious life-threatening cases are being responded to within eight minutes.
I could reel off more statistics, but I will instead read a letter that I received the other week:
“Dear Ms Alexander,
I recently had the misfortune of using the A&E at my local hospital in Margate. My wife feels that I was lucky to escape with my life.
My experience has convinced me that our health service has never been more under threat than since Mrs Thatcher.
The fact that I was sent home after 4 hours without seeing a doctor and returned by emergency ambulance with a now perforated appendix I blame mostly on the conflict between the Health Secretary and the Junior Doctors. Had this been resolved he would have been able to concentrate on the woeful lack of resources our NHS faces.”
Take the experience—[Interruption.] The Parliamentary Private Secretary to the Health Secretary says, “Show us the letter”. I have it here, and I got the permission of the individual who wrote to me before referring to it.
Let me refer to another example—the experience of Mr Steven Blanchard at the Swindon Great Western hospital last November. He said in an open letter to the Swindon Advertiser:
“We arrived at 6.40pm and were asked to sit with about 15 others in the unit. It became apparent this was a place of great suffering and misery…Firstly, there was a lady who was doubled up in pain who had been promised painkillers three hours before and I witnessed her mother go again and again to reception until she was begging for pain relief for her near hysterical daughter.”
Another old lady
“who had been left on her own by her son…was sat picking at a cannula in her arm trying to pull it out…A very frail and sick old man was sat in a wheelchair and he had been in the unit since 8am. He kept saying over and over ‘a cup of tea would be nice’…then I watched as urine trailed from him and fell on to the floor beneath the chair…At 10.30pm he was taken to a ward after 14 hours.”
Mr Blanchard said that he and his partner were finally seen at 1.20 am, and stated:
“Never before have I seen people crying out of desperation…I don’t know what is to blame or whether it’s lack of money or lack of staff but this place was what I can only describe as ‘hell on earth’.”
That is what is happening in our NHS in 2016, and such stories are becoming more common. Ministers may not like to hear it, but they need to start taking responsibility.
Junior Doctors Contract
Jeremy Hunt Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I will make a statement on the junior doctors contract.
For the last three years there have been repeated attempts to reform the junior doctors contract to support better patient care seven days a week, culminating in a damaging industrial relations dispute that lasted for more than 10 months. I am pleased to inform the House that after 10 days of intensive discussion under the auspices of ACAS, the dispute was resolved yesterday with a historic agreement between the Government, NHS Employers—acting on behalf of the employers of junior doctors—and the British Medical Association that will modernise the contract by making it better for both doctors and patients. The new contract meets all the Government’s red lines for delivering a seven-day NHS, and remains within the existing pay envelope. We will publish an equalities analysis of the new terms alongside a revised contract at the end of the month, and it will be put to a ballot of the BMA membership next month, with the support of its leader, the chair of the junior doctors committee of the BMA, Johann Malawana.
I express my thanks to the BMA for the leadership it has shown in returning to talks, negotiating in good faith, and making an agreement possible. I also put on record my thanks to Sir Brendan Barber, the chair of ACAS, for his excellent stewardship of the process, and to Sir David Dalton for his wisdom and insight in conducting discussions on behalf of employers and the Government, both this time and earlier in the year. The agreement will facilitate the biggest changes to the junior doctors contract since 1999. It will allow the Government to deliver a seven-day NHS, improve patient safety and support much needed productivity improvements, as well as strengthening the morale and quality of life of junior doctors with a modern contract fit for a modern health service.
The contract inherited by the Government had a number of features badly in need of reform, including low levels of basic pay as a proportion of total income, which made doctors rely too heavily on unpredictable unsocial hours supplements to boost their income; automatic annual pay rises even when people took prolonged periods of leave from the NHS; an unfair banding system that triggered payment of premium rates to every team member even if only one person had worked extra hours; high premium rates payable for weekend work that made it difficult to roster staff in line with patient need; and risks to patient safety, with doctors sometimes required to work seven full days or seven full nights in a row without proper rest periods.
The Government have always been determined that our NHS should offer the safest, highest quality of care possible, which means a consistent standard of care for patients admitted across all seven days of the week. The new contract agreed yesterday makes the biggest set of changes to the junior doctors contract for 17 years, including by establishing the principle that any doctor who works less than an average of one weekend day a month—Saturday or Sunday—should receive no additional premium pay, compensated for by an increase in basic pay of between 10% and 11%; by reducing the marginal cost of employing additional doctors at the weekend by about a third; by supporting all hospitals to meet the four clinical standards most important for reducing mortality rates for weekend admissions by establishing a new role for experienced junior doctors as senior clinical decision makers able to make expert assessments of vulnerable patients admitted to or staying in hospital over weekends; and by removing the disincentive to roster enough doctors at weekends by replacing an inflexible banding system with a fairer system that values weekend work by paying people for actual unsocial hours worked, with more pay for those who work the most.
The Government also recognise that safer care for patients is more likely to be provided by well-motivated doctors who have sufficient rest between shifts and work in a family-friendly system. The new contract and ACAS agreement will improve the wellbeing of our critical junior doctor workforce by reducing the maximum hours a doctor can be asked to work in any one week from 91 to 72; reducing the number of nights a doctor can be asked to work consecutively to four, and the number of long days a doctor can be asked to work to five; introducing a new post, a guardian of safe working, in every trust to guard against doctors being asked to work excessive hours; introducing a new catch-up programme for doctors who take maternity leave or time off for other caring responsibilities; establishing a review by Health Education England to consider how best to allow couples to apply to train in the same area and to offer training placements for those with caring responsibilities close to their home; giving pay protection to doctors who switch specialties because of caring responsibilities; and establishing a review to inform a new requirement for trusts to consider caring and other family responsibilities when designing rotas.
Taken together, these changes show both the Government’s commitment to safe care for patients and the value we attach to the role of junior doctors. While they do not remove every bugbear or frustration, they will significantly improve flexibility and work-life balance for doctors, leading, we hope, to improved retention rates, higher morale and better care for patients.
Whatever the progress made with today’s landmark changes, however, it will always be a matter of great regret that it was necessary to go through such disruptive industrial action to get there. We may welcome the destination, but no one could have wanted the journey, so today I say to all junior doctors, whatever our disagreements about the contract may have been, that the Government have heard and understood the wider frustrations they feel about the way they are valued and treated in the NHS. Our priority will always be the safety of patients, but we also recognise that to deliver high-quality care we need a well-motivated and happy junior doctor workforce. Putting a new modern contract in place is not the end of the story. We will continue to engage constructively to try to resolve outstanding issues, as we proceed on our journey to tackle head on the challenges the NHS faces, and make it the safest, highest-quality healthcare system anywhere in the world. Today’s agreement shows we can make common cause on that journey with a contract that is better for patients, better for doctors and better for the NHS. I commend my statement to the House.
Heidi Alexander (Lewisham East) (Lab)
I start by putting on record our thanks to Sir Brendan Barber and ACAS for the role they have played in finding agreement between the two sides in this dispute. I also pay tribute to the Academy of Medical Royal Colleges, which proposed these further talks and encouraged both the Government and the BMA to pause and think about patients.
I have not been shy in telling the Health Secretary what I think about his handling of this dispute, but today is not the day to repeat those criticisms. I am pleased and relieved that an agreement has been reached, but I am sad that it took an all-out strike of junior doctors to get the Government back to the table. What is now clear, if it was not already, is that a negotiated agreement was possible all along. I have to ask the Health Secretary why this deal could not have been struck in February. Why did he allow his pride back then to come before sensible compromise and constructive talks?
When he stands up to reply, he may try to blame the BMA for the breakdown in the negotiations, but he failed to say what options he was prepared to consider in order to ensure that the junior doctors who work the most unsociable hours are fairly rewarded. It was a “computer says no” attitude, and that is no way to run the NHS.
Why did the Health Secretary ignore my letter to him of 7 February, in which I asked him to make an explicit and public commitment to further concessions on the issue of unsociable hours? I was clear that if he had done that then, I would have encouraged the BMA to return to talks. Why did he insist instead on trying to bulldoze an imposed contract through, when virtually everyone told him not to, and the consequences of doing so were obvious for all to see—protracted industrial action, destroyed morale and a complete breakdown in trust?
On the detail of the new contract, will the Health Secretary say a little more about the agreed changes that will undo the discriminatory effect on women of the last contract he published? Does he now accept that the previous contract discriminated against women? Will he be clear for the record that he now understands this was never “just about pay”? Can he confirm that concessions have been made not only in respect of the mechanism for enforcing hours worked and breaks taken, but in ensuring that the specialties with the biggest recruitment problems have decent incentives built into the contract?
Moving on to what happens next, can the Health Secretary tell us what he will do if junior doctors vote against this offer? Will he still impose a contract, and which version of the contract will he impose—his preferred version or this compromised one? Can he say whether the possibility of losing a case in the High Court about his power to impose a contract had anything to do with his recently discovered eagerness to return to talks? We all know that the High Court told him he had acted above the law when he tried to take the axe to my local hospital, so I can understand why he does not want that embarrassment again.
Finally, let me caution the Health Secretary on his use of language both in this Chamber and in the media. His loose words and implied criticism of junior doctors is partly the reason why this has ended up being such an almighty mess. May I suggest that a degree of humility on the part of the Secretary of State would not go amiss? May I recommend a period of radio silence from him to allow junior doctors to consider the new contract with clear minds, and without his spin echoing in their ears? I remind him that he still needs to persuade a majority of junior doctors to vote in favour of the contract for the dispute to be finally over.
I hope with all my heart that yesterday’s agreement may offer a way forward. Junior doctors will want to consider it; trust needs to be repaired, and that will take time. I hope for the sake of everyone, patients and doctors, that we may now see an end to this very sorry episode in NHS history.
Mr Hunt
The hon. Lady is wrong today, as she has been wrong throughout this dispute. In the last 10 months, she has spent a great deal of time criticising the way in which the Government have sought to change the contract. What she has not dwelt on, however, is the reason it needed to be changed in the first place, namely the flawed contract for junior doctors that was introduced in 1999.
We have many disagreements with the BMA, but we agree on one thing: Labour’s contract was not fit for purpose. Criticising the Government for trying to put that contract right is like criticising a mechanic for mending the car that you just crashed. It is time that the hon. Lady acknowledged that those contract changes 17 years ago have led to a number of the five-day care problems that we are now trying to sort out.
The hon. Lady was wrong to say that an all-out strike was necessary to resolve the dispute. The meaningful talks that we have had have worked in the last 10 days because the BMA bravely changed its position, and agreed to negotiate on weekend pay. The hon. Lady told the House four times before that change of heart that we should not impose a new contract. What would have happened if we had followed her advice? Quite simply, we would not have seen the biggest single step towards a seven-day NHS for a generation, the biggest reforms of unsocial hours for 17 years, and the extra cost of employing a doctor at weekends going down by a third. We would not have seen the reductions in maximum working hours. We would not have seen many, many other changes that have improved the safety of patients and the quality of life of doctors.
The hon. Lady was also wrong to say that the previous contract discriminated against women. In fact, it removed discrimination. Does that mean that there are not more things that we can do to support women who work as junior doctors? No, it does not. The new deal that was announced yesterday provides for an important new catch-up clause for women who take maternity leave, which means that they can return to the position in which they would have been if they had not had to take time off to have children.
The hon. Lady asked what would happen if the ballot went the wrong way. What she failed to say was whether she was encouraging junior doctors to vote for the deal. Let me remind her that on 28 October, she told the House that she supported the principle of seven-day services. As Tony Blair once said, however, one cannot will the end without willing the means. The hon. Lady has refused to say whether she supported the withdrawal of emergency care, she has refused to say whether she supports contentious changes to reform premium pay, and now she will not even say whether doctors should vote for the new agreement.
Leadership means facing up to difficult decisions, not ducking them. I say to the hon. Lady that this Government are prepared to make difficult decisions and fight battles that improve the quality and safety of care in the NHS. If she is not willing to fight those battles, that is fine, but she should not stand at the Dispatch Box and claim that Labour stands up for NHS patients. If she does not want to listen to me, perhaps she should listen to former Labour Minister Tom Harris, who said:
“Strategically Labour should be on the side of the patients and we aren’t.”
Well, if Labour is not, the Conservatives are.
Dr Sarah Wollaston (Totnes) (Con)
I congratulate both sides on returning to constructive negotiations and on reaching an agreement. I pay particular tribute to Professor Sue Bailey and the Academy of Medical Royal Colleges for their role in bringing both sides together. I welcome the particular focus, alongside the negotiations around weekend pay, on all the other aspects that are blighting the lives of junior doctors. I welcome the recognition that we need to focus on those specialties that it is hard to recruit to and on those junior doctors who are working the longest hours, as well as the focus on patient safety.
However, we are not out of the woods yet. We need junior doctors across the country to vote for this agreement in a referendum. May I add my voice to that of the Opposition spokesman on health to say that what is needed now is a period of calm reflection? We need to build relationships with junior doctors into the future. Will the Secretary of State comment on his plans for building those relationships with our core workforce?
Mr Hunt
First, I very much agree with my hon. Friend in her thanks to Professor Dame Sue Bailey for the leadership that the Academy of Medical Royal Colleges has shown in the initiative that, in the end, made these talks and this agreement possible. I know it has been a very difficult and challenging time for the royal colleges, but Professor Bailey has shown real leadership in her initiative.
I also very much agree with my hon. Friend about the need to sort out some of the issues that have been frustrations for junior doctors—not just in the last few years, but going back decades—in terms of the way their training works and the flexibility of the system of six-month rotations that they work in. This is an opportunity to look at those wider issues. We started to look at some of them yesterday. I think there is more that we can do.
It is important that this is seen not as one side winning and the other side losing, but as a win-win. What the last 10 days show is that if we sit round the table, we can make real progress, with a better deal for patients and a better deal for doctors. That is the spirit that we want to go forward in.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I absolutely welcome this agreement, and I pay tribute to the Academy of Medical Royal Colleges for bringing it about. I do wish there had been some response to the letter that I and other Members sent before the all-out strike, because it was a genuine attempt to create a space that both sides could step into. However, I am glad that we have got to that stage now.
I welcome the recognition of the equality issues, which, to us and to many junior doctors, appeared to have been dismissed in the impact assessment. On the idea of flexible training champions in each trust, I myself was a flexible training senior surgeon—indeed, the first one in Scotland—and the idea of accelerated training is important. However, one concern I have is about childcare. If women junior doctors are going to be working longer, more antisocial shifts—I remember what I had to fork out for childcare—I would like to know whether the NHS will respond to that. Will that be in the form of crèche hours or support?
I welcome the fact that the hours guardian will be linked to the director of medical education and that there will be an elected junior doctors forum. One concern of junior doctors was that they would have no voice in relation to the guardian.
I also welcome the idea of using modern technology in rota-ing. At the moment, rotas are sheets of paper, and often no one looks at the shoulder from one rota to the next, so people can end up with the very long periods on call. However, one concern that remains is rota gaps. We do not have enough junior doctors, and we do not have enough junior doctors in the most acute specialties. How is the Secretary of State planning to re-establish a relationship? How is he going to recruit people to fill that gap? That was the core fear of junior doctors: a lack of doctors, with doctors simply being spread further. How are we going to recruit and retain doctors after the painful clash that has been going on for the last year?
Mr Hunt
I welcome the tone of the hon. Lady’s comments; we might have wished for a similar tone from the shadow Health Secretary. Let me address the comments of the hon. Member for Central Ayrshire (Dr Whitford) as constructively as she made them to me. She is right about flexible training. We have to recognise that the junior doctor workforce is now majority female, and that a number of family and caring pressures need to be taken account of. We need to do that for the NHS not only because it is the right thing to do, but because we will lose people if we do not. Those people will simply leave medicine, even though they have been through very extensive and expensive training.
We have to look particularly at the responsibilities of doctors with young children. One of the things that we announced yesterday was an obligation on trusts to take account of caring responsibilities. If, for example, a doctor wanted to work fewer hours in school holidays and more hours in term time, we cannot guarantee that a hospital would always be able meet those needs—the needs of patients always have to come first—but they could at least be taken account of, in the same way as they are in many other industries that operate 24/7. The hon. Lady is absolutely right to say that modern technology is key to that. An air steward or a pilot who works for British Airways can go on to an electronic system and choose the shifts and hours that they want to work. Because we have failed to modernise the NHS, we have seen a huge growth in agency and locum work, which is partly driven by the fact that it offers precisely the flexibilities that people need. These are important changes, and we intend to take them forward.
Sir Simon Burns (Chelmsford) (Con)
My right hon. Friend’s actions and those of the Department and the BMA in reaching an agreement will be warmly welcomed and met with a sigh of relief. Does he accept that the fact that the BMA was prepared to think again on crucial issues, such as overtime at weekends, should be seen as a sign not of weakness but of maturity, in working with the Government to ensure that we have a seven-day NHS that is for the benefit of patients and patient safety?
Mr Hunt
I absolutely agree with that wise comment, and it befits someone who is experienced in working in the Department of Health. We always get further if we sit around the table and talk about such issues. The Government are determined to improve the quality and safety of care for patients, and it is important to recognise that if the Government are successful, it will be better for the morale of doctors. The happiest, most motivated doctors work in the hospitals that are giving the best care to patients. That is why it is a win-win.
I say to Labour Members that it was the refusal of the BMA for many years to talk about the issue that my right hon. Friend referred to that meant we reached a deadlock. The fact that the Government were willing to proceed with important reforms on our own if we had to meant that, in the end, everyone came together and had a sensible negotiation. We got to the right place. I am sure everyone wishes that we had not had to go on the journey we went on to get there, but now that we have got there, I think it is the time for being constructive on all sides.
Jim Shannon (Strangford) (DUP)
I also thank the Minister and the BMA for coming to an agreement. The Minister said that it was a win-win for everyone, and so it is. It is always good to talk, and dialogue brings results. That happened in Northern Ireland, and it has happened with the conclusion of this process as well. A good deal has been reached, and some 45,000 junior doctor BMA members will now be asked to vote on it.
We have had eight days of strikes since January, and some 40,000 planned non-urgent operations and 100,000 out-patient appointments have been cancelled. May I ask the Minister what will be done to catch those up, and what discussions he has had with the Northern Ireland Assembly about the agreement?
Mr Hunt
I reassure the hon. Gentleman that we are in constant touch with the devolved regions and countries to make sure that they know the changes that we are making, and to share any learning that we have from the processes that we have been through, so we will certainly do that. Across the country, we are doing everything we can to catch up with the backlog of operations, procedures and out-patient appointments—all the things that have been affected by the industrial relations dispute. Trusts will always prioritise the areas where clinical need is the greatest, but I know that that work is ongoing across the country.
Helen Whately (Faversham and Mid Kent) (Con)
I very much welcome the agreement that has been reached. We know that the Secretary of State recognises the importance of having a happy and well-motivated workforce, and this contract addresses many of the causes of unhappiness for junior doctors. It is particularly good to hear the points made today about addressing the problems of couples who are both junior doctors. However, there is clearly more to do, as has been acknowledged, especially on the reasons why junior doctors feel unsupported and often not valued by their employers. My right hon. Friend commissioned Professor Sue Bailey to carry out a review of the underlying problems experienced by junior doctors during training. Will he advise us whether the review will now proceed?
Mr Hunt
The request from the BMA was to find a new way of proceeding with that very important work, and that is what we will do. We will do so with the input of Professor Bailey, because she has a very important contribution to make. My hon. Friend is absolutely right to say that, as well as more flexible working for people with family commitments, the big issue for many junior doctors is the way in which the training process happens. In particular, the issue is about the way that continuity of training has been undermined by the new shift system—we need that system for reasons of patient safety—and that often means that someone is given advice by a different consultant on different aspects of care from one day to the next, which is frustrating. We will look at all those issues with Professor Bailey, Health Education England and the BMA to see whether we can find a better way forward.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Secretary of State aware that even my constituents struggling with the possible closure of their A&E at the hospital in Huddersfield nevertheless welcome this announcement and thank anyone and everyone who has brought it about? That includes, I must say, leaders from the Opposition parties—our health spokespeople—who have done so much to help maintain a positive spirit. Will the Secretary of State just not gloat about this, but keep a period of silence? This is part of the phenomenon of people’s deep unhappiness about the NHS. Problems will arise again because so many people working in the NHS know it is being privatised by the back door and know that the clinical commissioning system is not working. Those problems will come back again and again unless he confronts that issue.
Mr Hunt
That would have been a constructive contribution to this morning’s discussion if the hon. Gentleman had not descended into totally false slurs about this Government’s commitment to our NHS. I would just say to him that if people support and are passionate about the NHS, as this Government are, then they put in the money—we are putting in £5.5 billion more than his party promised at the last election—and make the difficult reforms necessary to ensure that NHS care is as good as or better than anything that can be provided in the private sector. That is what this Government are doing: we believe in our NHS, and we are backing it to provide the best care available anywhere in the world.
Mims Davies (Eastleigh) (Con)
I strongly welcome this important statement and the Secretary of State’s leadership, and I congratulate all those involved in the discussions. On Tuesday, I spoke at my advice surgery in Eastleigh to a constituent, a new mum who is a junior doctor and is married to a senior nurse. She is unable to fast-track into working as a GP, and part of her concerns about the negotiations involve the future childcare arrangements for her four-month-old baby. Such concerns weigh heavily on her family, particularly in relation to on-call working. May I ask that agile working and family first issues are truly taken into account for nurses and doctors who are trying to bring up families together?
Mr Hunt
My hon. Friend gives one example, but there are thousands of such examples. Such people are totally committed to the NHS, have a bright future in it and can make a huge contribution to its success by doing a good job in looking after patients, but they also have home responsibilities that are difficult to fulfil when there are very inflexible rostering systems. One of the big wins from yesterday’s agreement is that we will be able to look at the way the rostering system works to try to bring in such flexibility. If we do not do so, more and more doctors will want to be locums or to work for an agency and we will lose the continuity of care for patients, which is one of the best things about our GP system. That is why there is an urgent need—from the perspective of patients, as well as from that of doctors—to address that issue.
Mr Clive Betts (Sheffield South East) (Lab)
I am interested in the Secretary of State’s thoughts about the serious impact on morale that the dispute has had. I was talking to a junior doctor in Sheffield the other day who said that before the dispute he had never looked at his contract, he had simply got on and done what was needed, whenever it was needed. Does the Secretary of State realise that even if the dispute is now settled, as we hope, it has had a serious impact on good will in the health service, which could affect service delivery in the future?
Mr Hunt
If the hon. Gentleman looks at the latest NHS staff survey, it shows higher staff motivation, better communication and more staff recommending their organisation as a place to work or be treated. But I accept that when big changes are made to a contract such as the junior doctors contract, they can be contentious and have a short-term impact on morale. In the long run, morale goes up when doctors are able to give better care to patients, and that is what this agreement will allow.
Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)
The Secretary of State has done a good job of explaining today, but let us look at this in the cold light of day. The BMA caused a problem that should have been resolved a long time ago. It decided it would make a political point. That is fair enough, and I know we want reflection. The Opposition should have been big enough to say, “We want to cause political trouble on this.” A lot of this has been caused by political shenanigans that should not have been allowed to get to this stage, and the failure means that the junior doctors have lost prestige throughout the United Kingdom because they have been used as political pawns by two organisations. Does the Secretary of State agree?
Mr Hunt
It is a great tragedy that the dispute unfolded in the way that it did, and I am sure that people with different agendas have not played constructive roles at various points. Given that we now have an agreement, I want to move forward positively and say that the lesson of the last 10 days is that when people sit down and negotiate about all the outstanding issues with a Government who are trying to make care safer and better for patients, we get a result that is good for everyone.
Liz McInnes (Heywood and Middleton) (Lab)
It is not the time to claim victory: this negotiated agreement now has to be put to the members of the British Medical Association. Will the Secretary of State acknowledge that his own refusal to negotiate exacerbated this crisis? Will he cease referring to the British Medical Association as a militant trade union, and will he heed the call from my hon. Friend the shadow Secretary of State for a period of silence in order to avoid antagonising the junior doctors still further?
Mr Hunt
Let us be absolutely clear: there was never a refusal to negotiate on the Government’s side. We have now developed a lot of trust between the Government and the BMA leadership, but until that point it balloted for industrial action without even sitting down and talking to the Government, and it refused to discuss the issue of weekend pay premiums, which was the crucial change we needed for a seven-day NHS. It was when the BMA changed its position in those areas that we were able to have constructive talks, and that is why it deserves great credit for coming to the table and negotiating—something it had not wanted to do previously—and that led to the solution.
Lucy Allan (Telford) (Con)
I thank the Secretary of State for working so hard to bring about this resolution and for always putting users of the NHS at the heart of everything he does. Will he join me in urging junior doctors to consider the new contract with an open mind when voting, and to strip out some of the politics that we have heard? Let us consider what is best for patients, what is best for the NHS and then what is best for junior doctors.
Mr Hunt
My hon. Friend speaks wisely. I understand that in a contentious industrial relations dispute junior doctors will not necessarily look to me for advice on which way they should vote, but it was not just me doing the agreement. It was a negotiated agreement and the leader of the junior doctors committee says that it is a good agreement. He will encourage people to support it in the ballot and he thinks it is a good way forward for doctors as well as for patients. The people who have been closest to the detail of the negotiations think that it is the right step forward for junior doctors, and that is something that they will want to take account of.
Mark Durkan (Foyle) (SDLP)
I do not wish to invite the Secretary of State to provoke or pre-empt by presumption, but if the agreement changes the shape of services, it will have implications for other health professionals. Is he prepared to have the further conversations that will need to be had, and the wider conversations that will be needed with his ministerial counterparts across these islands on workforce planning, professional education and training?
Mr Hunt
We are, of course, willing to have those discussions with colleagues in other parts of the UK. The hon. Gentleman is right to say that having a seven-day service does not just involve junior doctors; it involves widespread changes across the service. I should say that nurses, healthcare assistants, porters, cleaners—other people who work in hospitals—already operate on 24/7 shifts, so the changes necessary to those contracts are much less profound than they are to some of the doctors contracts, which is why it is important that we change not just the junior doctors contract, but the consultants contract. The fact that we have been able to reach a negotiated agreement with the junior doctors bodes well for the consultants contract, which is the next step.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
I congratulate both my right hon. Friend and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer) on their hard work in dealing with this protracted dispute with the BMA. Patients up and down the country, including those in my constituency, were somewhat concerned about the cancellation of operations, and I am delighted that the Department is going to try to ensure that we catch up on that. One thing that came out of this dispute was that some senior consultants ended up getting on to the front line for the first time in a long time. What can be done to try to make sure that that happens on a regular basis, so that they are getting experience on the front line, too?
Mr Hunt
If I answer that question directly, I will dig myself into rather a deep hole. I echo my hon. Friend’s thanks to my hon. Friend the Member for Ipswich, who has done an outstanding job by my side at every stage throughout this difficult period. I can certainly say that we would not have had yesterday’s agreement without his strong help and support at every stage. It is true that there are A&E departments across the country that, in having to plan for the two-day withdrawal of emergency care, found that having consultants more visible to patients had some positive impacts. I know that studies are going on to see what lessons can be learned from that going forward.
Paula Sherriff (Dewsbury) (Lab)
I, too, welcome the opportunity for a negotiated settlement, but let us take just a moment to reflect on one of the fundamental principles of our NHS—providing high-quality patient care. Will the Secretary of State take the opportunity today to offer a heartfelt and sincere apology for the significant and severe distress caused to patients as a result of this prolonged dispute?
Mr Hunt
With the greatest of respect to the hon. Lady, it was not my decision to take industrial action—to ballot for industrial action without even being prepared to sit around the table and talk to the Government. We are seeing dramatic improvements in patient safety under this Government, as we face up to the many problems in care that we inherited, not just at Mid Staffs, but at many other places. I know that she cares about patient safety, so she should welcome the difficult changes we have made, one of which is to have a seven-day NHS.
Stephen Hammond (Wimbledon) (Con)
Like many colleagues in the House, I wrote to the Secretary of State on numerous occasions over the past six months to express the concerns of local junior doctors. May I therefore congratulate him and the BMA on reaching this deal? I hope that junior doctors in Wimbledon will wholeheartedly support it. He spoke in his statement about the role of the guardian and the ability to ensure safe working hours, on behalf of both patients and doctors. Will he give a few more details about how he expects that to work?
Mr Hunt
Yes, I am happy to do that, and I thank my hon. Friend for a lot of his correspondence. The principle here is that junior doctors want to know that there is someone independent they can appeal to if they think they are being asked to work hours that are unsafe and which mean that they cannot look after patients in the way that they would want to because they are physically or mentally too exhausted. We would all want to make that possible, but it means that they need to have someone who is not their line manager. They will go to their line manager in the first instance, but they need to have someone independent and separate. One area where we have made the most progress during the past few months, even before the past 10 days of talks, is on establishing how these guardians can work in a way that has the trust of both the hospitals and the doctors working in them.
Nic Dakin (Scunthorpe) (Lab)
The Secretary of State is absolutely right that we can always get further if we get round the table, so why, in response to the cross-party initiative back in February to get everybody around the table, did he not do exactly that and save us all this trouble, rather than trying to impose the contract?
Mr Hunt
The cross-party initiative was not to have a new contract, but to abandon plans for a new contract and to have pilots in a few limited places. If we had followed that advice, we would not now have agreed with the BMA the biggest changes in the junior doctors contract for 17 years. Our goal was to get the agreement that we secured yesterday—safer care for the NHS and a better deal for doctors. That was what we achieved, and we would not have got there if we had listened to that advice.
Sir Oliver Heald (North East Hertfordshire) (Con)
May I join the welcome for the agreement and the persistence and patience that eventually paid off? In previous statements, I have raised with the Secretary of State the problem involving married couples who are both doctors. There are difficulties with training when they are sent to different areas and with rosters that clash. Will he say a word about the progress that has been made in this important area of making work a bit more family-friendly?
Mr Hunt
I am happy to do that for my hon. and learned Friend. It is not an easy problem to solve, because junior doctor training placements operate on six-month rotations, and they are a competitive process. We get many more applicants for a number of posts than there are posts available. We must find a way of balancing the need to respect family responsibilities, which is something that we all want to do, with the need to have a fair process for the most competitive positions. We do not have the balance right yet, so we have said that Health Education England, which decides where people are to go on rotations, will now have a duty to consider family responsibilities when it makes decisions about those rotations.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
I welcome the potential resolution of this dispute and thank the Government for negotiating it. We should also thank junior doctors for having the courage to go on strike, which no one does lightly, to get a better deal for the NHS. I ask the Secretary of State to reflect on this breakthrough, to take further steps to build on his difficult relationship with NHS staff and, crucially, to stop presenting NHS policy as a false dichotomy between the interests of patients and the interests of NHS staff.
Mr Hunt
If the hon. Gentleman had listened to some of the things that I have said, he would have heard me say repeatedly that I do not think that that dichotomy exists. As he says, it is a false dichotomy because, in the end, what is right for patients is also right for doctors. The thing that demoralises doctors, nurses and everyone working in our hospitals in different parts of the NHS is when they are not able to give the care that they want or that they think is appropriate to the patients in front of them. That is why hospitals that have moved closest towards seven-day services are also some of the hospitals with the highest levels of morale in the NHS. He is right that it is a false dichotomy and that we need to do both together.
Ben Howlett (Bath) (Con)
As the Secretary of State knows, my brother and his wife were junior doctors when they made the decision to move to New Zealand a long while ago because of the long-standing cultural problems within the NHS. They will be very pleased indeed about the announcement yesterday about couples potentially being able to work together in hospitals. I have a question for the Secretary of State from my mother. She wants to know what he can do now to encourage my brother, his wife and their friends back into the NHS.
Mr Hunt
Let me say to my hon. Friend’s mother that I hope that the message of this new agreement will go right the way around the world. Any doctors who have moved to New Zealand and Australia are always welcome to come back. The thing that must unite this Government and the good doctors who work, or have worked, in the NHS is our commitment to make NHS care the safest and the best in the world. We had a terrible shock with what happened at Mid Staffs, but we are using that as a moment of decisive change in the NHS, and we are well on our way to higher standards of care than are available in many other countries.
Danny Kinahan (South Antrim) (UUP)
I congratulate the Government and everyone involved on getting this deal in place. It will have a knock-on effect in my constituency in Northern Ireland. When I went around Antrim Area hospital, the concern was to do with the number of doctors, which we have heard about from other Members, and how to get seven-days-a-week cover from everything else that needs to go into the health service. Will the Secretary of State comment on how we will deal with that, and how we will work with the devolved Parliaments?
Mr Hunt
I agree. We need more doctors and we need more nurses. By the end of this Parliament, we will have over a million more over-70s in England alone, and I know that the demographic effects in Northern Ireland will be equivalent. We have a global shortage of about 7 million doctors, so we need to train more. We are training an extra 11,420 doctors over this Parliament as part of the spending review. The training is done on a UK-wide basis, so we will need to work closely with all the devolved regions on it.
Alex Chalk (Cheltenham) (Con)
I warmly welcome this draft agreement, which will be met with some relief in Cheltenham. Whatever our deeply held concerns about the behaviour of the BMA in the past, does the Secretary of State agree that it should be our ambition that the agreement will mark the beginning of a more constructive future? Will he join me in congratulating BMA negotiators, including Dr Malawana, for being prepared to address constructively issues such as Saturday pay?
Mr Hunt
I am happy to do that. I recognise that this was not easy for those people, because it involved changing a position that they had held for more than three years. When we looked at the details, the result that we got to was not difficult for them to sign up to because they could see that it really was better for their members, as well as better for patients. The lesson here is that the NHS faces huge challenges, and it can only be right to deal with them by sitting round the table and negotiating constructively.
Christian Matheson (City of Chester) (Lab)
I, too, warmly welcome the news of the agreement, and I hope that it leads to a settlement. If it is the Secretary of State’s intention to create a seven-day NHS, that will require the participation of more than the junior doctors, so does he intend to bring forward a new contract for consultants, hospital lab workers, ambulance workers, nurses or indeed ancillary workers and catering staff?
Mr Hunt
The hon. Gentleman is right. A seven-day NHS is not just, or not even mainly, about junior doctors, although they are a very important part of the equation. We will need a new contract for consultants and we are having constructive negotiations with them. Many other people working in the NHS are already on seven-day contracts, so there will not necessarily be a contractual change, but the hon. Gentleman is right to say that we will need, for example, diagnostic services operating across seven days so that the junior doctor who works at the weekend will be able to get the result of a test back at the weekend. Those are all part of the changes that we will introduce to make the NHS safer for patients.
Dr Andrew Murrison (South West Wiltshire) (Con)
I warmly congratulate both sides on reaching this agreement. Our NHS is different at weekends, and my right hon. Friend is right to inculcate Sir Bruce Keogh’s four key clinical standards on a Sunday and a Saturday. Does he agree that it is important not simply to rely on mortality data, which are often difficult to interpret, to underpin the case for a seven-day NHS? Will he look closely at other metrics based on clinical standards for things like routine lists for upper gastrointestinal endoscopy on a Saturday and Sunday? Will he also look at palliative care, which of course does not feature in any hospital mortality data?
Mr Hunt
My hon. Friend speaks, as ever, very wisely on medical matters. I particularly agree when he talks about palliative care; it has got better, but there is a long way to go. We have recent evidence that it is particularly in need of improvement where we are not able to offer seven-day palliative support.
Norman Lamb (North Norfolk) (LD)
I welcome this settlement and thank everyone involved for securing it. However, many junior doctors remain concerned that, as the hours worked at the weekend increase, cover is inevitably reduced during the week, unless more junior doctors are employed to bridge that gap. With many rotas already left unfilled around the country during the week, how can the Secretary of State guarantee that we will not make the situation worse during the week, thereby impacting on patient safety?
Mr Hunt
I understand the concern. The short answer is that we need to increase the NHS workforce, which we are doing. We will see more doctors going into training during this Parliament, as indeed we did during the previous Parliament. More doctors in the workforce will be an important part of the solution.
Bob Blackman (Harrow East) (Con)
It appears that at the start of the recent negotiations the payment for Saturday working was the main sticking point for the BMA, but now the issue of weekend pay has been resolved. Will my right hon. Friend confirm that, now, the doctors who work extended hours over the weekend can get extra pay, and patients can get the seven-days-a-week NHS we all want?
Mr Hunt
My hon. Friend is absolutely right. This is not just a safer deal for patients, but a system that is much fairer for doctors than the current one. We are giving a pay rise of between 10% and 11%, for which we say that people are expected to work one weekend day a month, but doctors who work more than that get more, and it goes up, so more weekends worked means more extra pay. I think that is one of the reasons why the BMA was prepared to sign up to the agreement: it values the people who give up the most weekends.
Andrew Bridgen (North West Leicestershire) (Con)
I was contacted by a constituent who told me how his four-year-old daughter fell through a pane of glass, severely cutting her face. Unfortunately, the accident happened on a Friday evening, and because insufficient doctors were working over the weekend, she could not have an operation to remove any remaining glass from the wound until Monday, by which time the wound had started to heal and was misaligned. That four-year-old girl will suffer severe facial scarring for the rest of her life. Does my right hon. Friend agree that this is why we need a seven-day NHS?
Philip Davies (Shipley) (Con)
I must confess to being rather puzzled. The BMA said all along that the strike and dispute had nothing to do with weekend pay and terms, yet after negotiations limited simply to weekend pay and terms, the BMA has come to a deal and advised against strike action. Can we take it that, despite much huffing and puffing from the BMA that this was about the future of the NHS and all the rest of it, at the end of the day it was all about weekend pay and terms?
Mr Hunt
I think my hon. Friend is right that that was the big sticking point. It was the BMA’s willingness to be flexible and negotiate on that that ultimately made an agreement possible, but it is also fair to say that the Government recognise that there are many other non-contractual issues in the way that junior doctors are trained and treated by the NHS, and we want to use this opportunity to put them right.
Mark Spencer (Sherwood) (Con)
I congratulate the Secretary of State on putting patients first, but does he recognise that there are still people out there whose operations were cancelled due to industrial action? Will he look to the future and consider whether front-line medical staff should have the right to strike and so put people’s health on the backburner or postpone their medical care?
Mr Hunt
I know that that is a view that some colleagues share. Doctors have obligations even now under the Medical Act 1983 not to take action that would harm patients, and under their responsibilities to the General Medical Council; they have to be aware of those. What I hope is that that question simply does not arise again. We are now having constructive discussions with the BMA; I think that is the way forward and I hope that neither I nor any future Health Secretary has to go through what has happened in the past 10 months.
John Glen (Salisbury) (Con)
I applaud the tone and content of the Secretary of State’s remarks. I think this agreement will go down as a breakthrough in the NHS. It has been very uncomfortable to engage in dialogue with constituents who are junior doctors, who have felt aggrieved, so I particularly welcome the way my right hon. Friend has been able to look at non-contractual issues. I urge him to give serious consideration to the outcome of the Bailey review so that progress can be made on morale and the wider issues that have been raised.
Mr Hunt
I finish by saying that I completely agree with my hon. Friend. It has been a very sad dispute for all of us, because we all recognise that junior doctors are the backbone of the NHS; they work extremely hard and they often work the most weekends already. That we now have an agreement is a brilliant step forward. We all have constituents who work hard for the NHS. They are people we value, so dialogue, negotiation and constructive discussion must always be the way forward.
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
John Pugh (Southport) (LD)
5. What plans he has to reduce agency staffing expenditure in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
We have taken tough measures to control unsustainable spending on agency staff, which cost the NHS more than £3 billion last year. Overall agency spend is now falling and we expect to save the NHS at least £1 billion this year as a result.
Mr Hunt
I think the hon. Gentleman is right that we have historically not trained enough staff to work in the NHS and been over-optimistic about the staff needs. That is why, in this Parliament, we will be training over 11,000 more doctors as a result of the spending review, and 40,000 more nurses.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
In the Public Accounts Committee, which I sit on with the hon. Member for Southport (John Pugh), we have repeatedly come to this question about agency staffing. The key thing is, as he says, that the establishment level for acute hospitals is always under par, because the budget set from the centre is never enough to meet it. Will the Secretary of State go and take a serious look at this issue, and stop this myth that it is just down to the rates paid? That is part of the problem, but it is not the main problem.
Mr Hunt
Perhaps I can give the hon. Lady some comfort. I recognise that there is a big mountain to move, but the changes we made last year were not just about changing the rates paid to agencies. They were also about capping the amounts agencies can pay their own staff, because we think it is incredibly divisive inside hospitals to have two nurses doing exactly the same work, but one being paid dramatically more than the other. We are also capping the total amount hospitals can spend on agency staff. The result is that the monthly spend on agency staff is now falling and we are on track to reduce the agency bill by about £1 billion in this Parliament.
Heidi Alexander (Lewisham East) (Lab)
Spending on agency staff has gone through the roof under this Health Secretary, and the Secretary of State’s attempt to deal with the symptoms of the problem but not the cause has left hospitals struggling to get staff at rates they are allowed to pay. In the past few weeks we have seen reports of emergency surgery suspended in Doncaster, an A&E department downgraded in Chorley and two critical care units closed in Leeds, all because of staff shortages. The Health Secretary has admitted that this will be his last big job in politics. May I urge him before he goes to get a grip on the cause of the staffing crisis? Otherwise, it will be patients who will be facing the consequences long after he has gone.
Mr Hunt
May I start by thanking the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous congratulations earlier, and indeed for making history himself by being the first Opposition Member I can remember to congratulate the Government on hitting a target?
I say to the hon. Lady that, as a result of the measures we have taken to deal with the agency staff issue, we think we have saved £290 million compared with what we would have spent since last October, two thirds of trusts are reporting savings and the price paid for agency nurses is 10% lower than it was in October. The root cause of the problem is, as the hon. Member for Southport (John Pugh) said, our failure in the past to recruit enough staff. One of the reasons for that is that successive Governments failed to understand the needs of nursing in wards, which is why we had the problem at Mid Staffs. Because we are addressing that, we are now able to make sure that we do not pay excessive rates for agency staff.
Heidi Alexander
If I may turn to another part of the staffing crisis, all Opposition Members welcome the resumption of talks on the junior doctors contract. It is in no one’s interest—not the Government’s, not junior doctors’ and certainly not patients’—for this dispute to drag on any longer. May I implore the Health Secretary to do all he can to find a reasonable compromise this week that will keep doctors in the NHS and ensure that we have a motivated, well trained and fairly rewarded workforce to continue to deliver the excellent care we all want?
Mr Hunt
I thank the hon. Lady for her reasonable tone and absolutely give her that assurance. We have always wanted a negotiated outcome to this dispute. That is why we paused the introduction of the new contracts last November to give talks a chance to succeed, and it is why this week I have said we will further pause the introduction of the new contracts to see whether we can get a negotiated outcome. We want a motivated workforce and we are highly cognisant of the fact that hospitals that offer seven-day care and higher standards of care for patients are the very hospitals that have some of the highest levels of morale in the NHS. It takes two to tango, and I very much hope that the British Medical Association will play ball and its part this week in helping us to deliver a safer seven-day NHS.
Mark Durkan (Foyle) (SDLP)
6. What steps he is taking to improve the outcomes of people with rarer cancers.
Chris Green (Bolton West) (Con)
9. What steps his Department is taking to ensure provision of good quality A&E services.
The Secretary of State for Health (Mr Jeremy Hunt)
Although we are not currently hitting the national A&E target, hospital A&E departments continue to perform well under great pressure. Overall they are coping with 1.9 million more attendances annually compared with 2009-10, and the average wait to see a doctor remains just 38 minutes.
Chris Green
I thank my right hon. Friend for his answer. Many of my constituents are concerned about the temporary closure of the Chorley A&E department, which now only operates as an urgent care service. What assurance can he give my constituents on A&E cover in and around the Bolton West constituency?
Mr Hunt
May I reassure my hon. Friend that I am very aware of this issue, and I have had a number of meetings with hon. Members to discuss it? Patient safety has to be the utmost priority. We are working with the local trust, and we have been given an assurance that neighbouring hospitals will be able to absorb any extra activity, and that it is working hard to try to reopen the A&E department.
Cat Smith (Lancaster and Fleetwood) (Lab)
The temporary closure of A&E services at Chorley hospital has had a knock-on effect on hospitals across Lancashire, and anecdotally I hear of many more people turning up at Preston Royal. What reassurances can the right hon. Gentleman give my constituents and residents across Lancashire that he is doing everything he can to make sure that the staffing issues at Chorley are fixed and that Chorley A&E is open again?
Mr Hunt
I can reassure the hon. Lady that we have been monitoring the situation closely and have provided extra capacity at the Royal Preston hospital. Her own Royal Lancaster infirmary has recently come out of special measures and done a really good job in turning round the quality of care after protracted difficulties. We continue to monitor the situation, and patient safety is our No. 1 priority.
Mr Steve Baker (Wycombe) (Con)
Following centralisation and specialisation processes to drive up the quality of clinical care, we now have patients presenting at minor injuries units and urgent care centres with conditions that need to be treated elsewhere. Will my right hon. Friend take steps to ensure that those centres own the patients’ experience once they have presented, so that we never again have a patient with a serious illness being sent out to make their own way to A&E?
Mr Hunt
As ever on health matters, my hon. Friend speaks wisely. The fundamental issue is a high level of confusion about what happens to patients when they are faced with a bewildering choice about what to do when they have an urgent health need that needs resolving. They can call 111, try to get an urgent GP appointment, go to a walk-in centre, go to A&E and many other alternatives. We need to resolve that and make it simpler for patients so that they go to the right place first time. Urgent work is happening to ensure that we do that.
Christian Matheson (City of Chester) (Lab)
The closure of the A&E unit at Chorley and South Ribble district general hospital has ramifications across the north-west. I am informed that North West Ambulance Service has taken on three private ambulances at a cost of £70,000 each a month to provide the extra cover that is required. Does the Secretary of State accept that it is a false economy when he allows A&E units to close on his watch? He simply passes on the costs to other parts of the fractured NHS over which he presides.
Mr Hunt
I recognise that we have a difficult situation in Chorley and that people in that trust are working very closely together. The chief executive of the trust pointed out that the reason for the closure was that neighbouring trusts were not respecting the caps on agency staff that she was respecting. It is incredibly important that, across the NHS, we have a concerted effort to bring down the prices paid for agency staff, which I think is the root problem here. However, we are monitoring the situation closely.
Mr David Nuttall (Bury North) (Con)
But how will my right hon. Friend’s powers to ensure good quality accident and emergency provision in hospitals across Greater Manchester be affected by the devolution of health and social care responsibilities to Greater Manchester councils?
Mr Hunt
I can reassure my hon. Friend that, although we are happy to put the local authorities in Greater Manchester in the driving seat for some major changes, including what I hope will be the first full-scale integration of health and social care across the NHS, we are monitoring the performance against national standards. We will be able to see exactly how well they do on patient safety, waiting times and so on, and whether they live up to the big promises that have been made.
John Nicolson (East Dunbartonshire) (SNP)
11. What steps he is taking to resolve the industrial dispute with junior doctors.
The Secretary of State for Health (Mr Jeremy Hunt)
Talks are now taking place between NHS employers and the British Medical Association to try to resolve outstanding issues around the junior doctors’ contract.
John Nicolson
In his recent letter to the head of the BMA, the Secretary of State offered to discuss improving work-life balance, especially for people with family responsibilities. How exactly does he plan to do that with a contract that the Government’s own quality impact assessment has identified as especially disadvantaging women?
Mr Hunt
That is not correct. It is worth saying that the reason for the dispute is a manifesto commitment to a seven-day NHS that the Government made to the people of England and that the Scottish National party has not made to the people of Scotland. The weekend effect does not happen just in England. There are studies in Scotland, including the Handel study, which states:
“The excess of admissions ending in deaths at weekends compared with those during weekdays seen elsewhere were also found in Scotland.”
I gently say to the hon. Gentleman that yes, we want to improve the quality of life for junior doctors so that they can live and work in the same city as their partners, and we are looking at the solution to that problem, but that he might think about doing the same thing in Scotland.
Sir Simon Burns (Chelmsford) (Con)
Will my right hon. Friend bear it in mind that Secretary of State Dean Rusk always said that jaw-jaw was better than war-war, and that it is welcome that the negotiations have resumed with the BMA on this difficult problem? Does he also accept that everyone wishes the talks well so that we can get a meaningful agreement that ensures a seven-day NHS for the benefit of patients and their safety?
Mr Hunt
My right hon. Friend speaks very wisely. Indeed, I was thinking about the talks as I spoke on my mobile phone and he was having a cigarette just outside the House yesterday morning. He is absolutely right about jaw-jaw. That is why I think that across the whole House we wish the talks well. However, for them to succeed all sides need to recognise their objective, which is a safer seven-day service for patients. I hope that, on that basis, we will be able to make progress.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I too am glad that the Secretary of State has reopened talks with the junior doctors, but I am a little concerned by the claim that the only issue is Saturday pay, whereas the doctors tell me that they fear the danger of exhaustion. Has he seen the analysis by Cass Business School suggesting that it is impossible to avoid high levels of fatigue under the new contract?
Mr Hunt
What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.
Dr Whitford
I would just say that stating it does not make it happen. Junior doctors have looked at the rotas that have been put out as exemplars, and they will not be able to avoid high levels of fatigue. Does the Secretary of State not recognise that, now that we have more data suggesting that the weekend effect may just be statistical, we actually require clinical research because he does not know exactly what the problem is that he is trying to fix?
Mr Hunt
The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.
Mr Nigel Evans (Ribble Valley) (Con)
18. I am fully signed up to the national health service, and that is why I want to see the reopening of Chorley A&E as soon as possible. Many of my constituents use it.In his compromising mood, will my right hon. Friend ensure that, as he talks to the junior doctors, whom I value greatly, the one thing that he will not compromise on is delivering a full service seven days a week?
Mr Hunt
My hon. Friend is absolutely right. In the end, the British people’s passion for, and commitment to, the NHS is based upon its offering the highest standard of care for patients. It is sometimes difficult to take these decisions and sometimes we have arguments around them. I want to reassure him that my compromising mood is not a temporary thing. We have always wanted a negotiated solution, but there is one bit that we will not compromise on: the moment that the Government start doing things that mean that we are not delivering safe care for patients is the moment that we will fundamentally shake confidence in the NHS. This Government will not allow that to happen.
Several hon. Members rose—
Helen Whately (Faversham and Mid Kent) (Con)
14. What progress his Department has made on delivery of the NHS five year forward view.
The Secretary of State for Health (Mr Jeremy Hunt)
We are making good progress in implementing the five year forward view, including £133 million invested in new models of care and 18 million people benefiting from extended GP access.
Helen Whately
It is estimated that a third of patients in acute hospitals could be better treated elsewhere, for instance at home, and in east Kent our vanguard aims to address this with new models of care, but it is early days. Will my right hon. Friend advise us of what he is doing to drive progress on new models of care, bringing together health and social care so that more people are cared for in the right place?
Mr Hunt
My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.
Andrew Gwynne (Denton and Reddish) (Lab)
Yesterday the Health Secretary admitted to the Health Committee that “we didn’t protect the entire health budget” in the last comprehensive spending review. I am pleased that he appears to have adopted a bit of straight-talking, honest politics, so in that spirit will he now admit that the very real cuts to public health budgets over the next few years will make it harder to deliver the “radical upgrade” in public health that his five year forward view called for?
Mr Hunt
In the spirit of straight talking and honesty, which I think is an excellent thing, perhaps the hon. Gentleman might concede that those cuts and efficiencies that he is talking about would have been a great deal more if we had followed Labour’s spending plans—that is, £5.5 billion less for the NHS than this Government promised, on the back of a strong economy.
Chris Davies (Brecon and Radnorshire) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
Last week I agreed to pause the introduction of the new junior doctors contract for five days and return to talks with the junior doctors committee. I commend the junior doctors for their decision to return to talks. They have agreed to suspend the threat of further industrial action and those talks are now in their second day. We have always been clear that we want to see a negotiated solution to this dispute, and the resumption of these talks shows that the Government’s door is and always has been open to meaningful talks.
Chris Davies
Last Friday I met my constituent Lisa Cass whose son Ben was recently diagnosed with type 1 diabetes. Ben had been showing signs of the four T’s of type 1 diabetes—toilet, thirst, tired and thinner—and Lisa took him to her local GP for an appointment. No test was done on the day at the surgery and a blood test was booked for the following week. The following day Ben was back at his GP’s surgery after a rapid decline which could have been fatal, and the air ambulance was called. Thankfully—credit is due to the excellent medical professionals who treated Ben—he is now doing well and is managing his condition. However, this case shows the need for awareness of type 1 diabetes to be improved right across the country. Will my right hon. Friend meet me and my constituent to see what more we can do to raise awareness of type 1 diabetes and its symptoms among health professionals and the wider public?
Mr Hunt
Of course I am happy meet my hon. Friend and his constituents. A close friend of mine who wanted to take a place in this House ended up dying tragically early because he had type 1 diabetes and was not able to get the care that he needed, so I am very aware of those issues. What we are doing in England, which is different from Wales, is publishing transparent indicators of the quality of diabetes care CCG by CCG. Those data will be published before the summer recess and will enable us to look at the disparities in care. I am sure there is more we can do.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Research published yesterday by NHS Providers and the Healthcare Financial Management Association showed that half of mental health trusts had not had an increase in their budget in 2015-16 and just a quarter of providers are confident that they will receive a funding increase for this financial year, 2016-17. Will the Secretary of State finally admit that the supposed additional investment in mental health that he talks about so often has not materialised for the patients and services that need it most? What is he going to do about it?
Paula Sherriff (Dewsbury) (Lab)
T2. During March, at one of my local trusts the A&E ambulance target was missed for 937 patients, and more than 4,000 patients waited for more than four hours in A&E. Staff and management agree that this is a trust in crisis, with many wards staffed to less than half the minimum safe staffing levels. Patient safety is being compromised every day. Will the Secretary of State please stop passing the buck and act to stop the downgrade of Dewsbury and Huddersfield hospitals, because it is clear that our local healthcare is in absolute crisis?
Mr Jeremy Hunt
The hon. Lady mentioned to me yesterday that she would raise this issue today. We are absolutely not passing the buck; the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), had a very productive meeting with her and local representatives to address these issues. She is right to have concerns about some of the safety indicators, but it is also true that summary hospital-level mortality for the trust has improved, and there are encouraging improvements in morale, as recorded through the NHS staff survey. However, there are worrying things, and we will continue to monitor them closely.
Henry Smith (Crawley) (Con)
T4. Last month, Coperforma took on the patient transport contract for Sussex. Unfortunately, since then there have been unacceptable and serious delays for some very sick and elderly patients. May I have assurances that the Department of Health will follow up this issue?
John Mann (Bassetlaw) (Lab)
T6. Other EU countries charge us £650 million a year more for the health treatment of our citizens abroad than we do for the treatment of their citizens here. Is that because we cannot charge them, or because we have not got our act together?
Mr Jeremy Hunt
The answer, regrettably, is that for many years we have not got our act together. That is why I have changed the system of incentives for trusts to make sure that they get a premium for identifying EU nationals they treat and that we can then recharge the treatment to their home countries. We are, as a result, now seeing significant increases in the amount we are reclaiming from other countries.
Dr Sarah Wollaston (Totnes) (Con)
Community hospitals are immensely valued by the communities they serve. Will the Secretary of State meet me to discuss the proposals for south Devon, which will particularly affect my constituents living in Dartmouth and in Paignton?
Yvonne Fovargue (Makerfield) (Lab)
T7. Wigan A&E is expected to take a third of the patients turned away from Chorley A&E owing to Chorley’s unplanned closure, yet it has a similar ratio of staffing vacancies. What extra resources are being given to Wrightington, Wigan and Leigh NHS Foundation Trust to help it to cope with this crisis?
Peter Heaton-Jones (North Devon) (Con)
The success regime review in Devon is causing real concern about the future of acute services at North Devon District Hospital. Does the Minister recognise that the unique geographical circumstances of Barnstaple mean that the reduction of any of those services will, for some of my constituents, mean a round journey of more than 120 miles to access them?
Bob Blackman (Harrow East) (Con)
My right hon. Friend will be well aware that the business case for the rebuilding of the Royal National Orthopaedic Hospital has been dragging on within the NHS for more than six years. We now seem to have a decision for the Trust Development Authority to make. Will he put pressure on the TDA to approve this business case so that work can begin this summer?
Mr Jeremy Hunt
As my hon. Friend knows, I have done a shift as a porter in that hospital and seen for myself just how much it needs the extra investment to transform its facilities. I will happily look into the matter for him, and I am keen to see it progress as fast as possible.
Ian Blackford (Ross, Skye and Lochaber) (SNP)
The Minister will be aware that mortality rates in England and Wales have increased by 5.4% in 2015—the biggest increase in the death rate for decades. She will also be aware that mortality rates have been rising since 2011. Has she done any analysis of what has been behind those trends? Specifically, with the Cridland review starting, what will her Department do to negotiate with Cridland on the increase in the pensionable age to take account of the recent changes taking place?
Lucy Allan (Telford) (Con)
I thank the Secretary of State for working so tirelessly to get the BMA back to the negotiating table. Will he confirm that Saturday pay for junior doctors will be at a 30% premium, which is above that for any of the hard-working midwives, nurses, firefighters, paramedics and so on in my constituency?
Mr Jeremy Hunt
I thank my hon. Friend for her question. She makes the important point that the proposals on the table in the new contract are incredibly generous compared with the terms of the other people working in hospitals. That is why it is very important that we have some flexibility from the BMA on Saturday pay so that we can deliver the seven-day service that we all want. It is a very good deal for junior doctors, and I think that if they look at it objectively, we should be able to come to an agreement this week, but it will take flexibility on both sides.
Junior Doctors Contracts
Jeremy Hunt Excerpts(8 years, 8 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
We have many choices in life, but one thing over which we have no control is the day of the week that we get ill. That is why the first line on the first page of this Government’s manifesto said that if elected we would deliver a seven-day NHS, so we can promise NHS patients the same high-quality care every day of the week. We know from countless studies that there is a weekend effect showing higher mortality rates for people admitted to hospital at weekends. The British public know that, too. Today, we reaffirm that no trade union has the right to veto a manifesto promise voted for by the British people. We are proud of the NHS as one of our greatest institutions, but we must turn that pride into actions. A seven-day service will help us to turn the NHS into one of the safest, highest-quality healthcare systems in the world.
This week, the British Medical Association has called on junior doctors to withdraw emergency care for the first time ever. I will update the House on the extensive measures being taken up and down the country to try to keep patients safe. But before I do so I wish to appeal directly to all junior doctors not to withdraw emergency cover, which creates particular risks for A&Es, maternity units and intensive care units.
I understand the frustration that many junior doctors feel that, because of pressures on the NHS frontline, they are not always able to give patients the highest quality of care that they would like to. I understand that some doctors may disagree with the Government about our seven-day NHS plans and, in particular, the introduction of a new contract. I also understand that doctors work incredibly hard, including at weekends, and that strong feelings exist on the single remaining disagreement of substance: Saturday premium pay. However, the new contract offers junior doctors who work frequently at weekends more Saturday premium pay than nurses, paramedics and the assistants who work in their own operating theatres, and more than police officers, firefighters and nearly every other worker in the public and private sectors.
Regrettably, over the course of this pay dispute 150,000 sick and vulnerable people have seen their care disrupted. The public will rightly question whether this is appropriate or proportionate action by professionals whose patients depend on them. Taking strike action is a choice. If they will not listen to the Health Secretary, I urge them to listen to some of the country’s most experienced doctors—Professor Sir Bruce Keogh, Professor Dame Sally Davies and former Labour Health Minister Lord Darzi—who have all urged doctors to consider the damage it will cause to both patients and the reputation of the medical profession.
Let me today address some of the concerns raised by junior doctors: first, that a seven-day NHS might spread resources too thinly. The Government’s financial commitment to the NHS has already seen a like-for-like increase of 10,700 more hospital nurses and 10,100 more doctors. Despite the pressure on national finances, last year’s spending review committed the Government to a £10 billion real-terms increase in the annual NHS budget by 2020. I can today tell the House that by the end of the Parliament the supply of doctors trained to work in the NHS will have increased by a further 11,420. While it is true that pressures on the NHS will continue to increase on the back of an ageing population, we are not saying that the current workforce will have to bear all the strain of delivering a seven-day service, even though, of course, they must play their part.
Secondly, there is a concern that the Government may want to see all NHS services operating seven days a week. Let me be clear: our plans are not about elective care, but about improving the consistency of urgent and emergency care at evenings and weekends. To do this, the Academy of Medical Royal Colleges has prioritised four key clinical standards that need to be met. These are: making sure patients are seen by a senior decision maker no more than 14 hours after arrival at hospital; seven-day availability of diagnostic tests with a one-hour turnaround for the most critically ill patients; 24-hour access to consultant-directed interventions, such as interventional radiology or endoscopy; and twice daily reviews of patients in high dependency areas such as intensive care units. About one quarter of the country will be covered by trusts meeting these standards from next April, rising to the whole country by 2020.
Thirdly, there is the concern that proper seven-day services need support services for doctors in the weekends and evenings, as much as doctors themselves. Less than half of hospitals are currently meeting the standard on weekend diagnostic services, meaning patients needing urgent or emergency tests on a Saturday or Sunday, such as urgent ultrasounds for gallstones or diagnostics for acute heart failure, face extra hours in hospital at weekends or even days of anxiety waiting for weekday tests. Our new standards will change this, with senior clinician-directed diagnostic tests available seven days a week for all hospitals by 2020.
Finally, there is a legitimate concern that a seven-day NHS needs to apply to services offered outside hospitals if we are properly to reduce the pressure on struggling A&E departments. So, as announced last week, the Government’s seven-day NHS will also see transformed services through our GPs. We are committing an extra £2.4 billion a year for GP services by 2020-21, meaning that spending will rise from £9.6 billion last year to over £12 billion by 2021—a 14% real-terms increase. Thanks to this significant investment, patients will see a genuine transformation in how general practice services operate in England. By 2020, everyone should have easier and more convenient access to GP services, including at evenings and weekends. We will not be asking all GP practices to open at weekends to deliver this commitment, but instead using networks of practices to make sure that people can get an evening or weekend appointment, even if not at their regular practice. We have committed to recruiting an additional 5,000 doctors to work in general practice to help meet this commitment, and we will support GPs in this transformation by harnessing technology to reduce bureaucratic burdens.
Returning to the strikes, the impact of the next two days will be unprecedented, with more than 110,000 out- patient appointments and more than 12,500 operations cancelled. However, the NHS has made exhaustive preparations to try to make sure that patients remain safe, and I want to thank those many people in NHS England, NHS Improvement and every trust in the country who have been working incredibly hard over this weekend to that effect.
I have chaired a series of contingency planning meetings, bringing together the operational response across the entirety of the NHS and social care systems. From this, NHS England has worked with every trust to ensure that they have plans in place to provide safe care, with particular focus on their emergency departments, maternity units, cardiac arrest teams and mental health crisis teams. As part of their duties for civil contingency preparedness, trusts also have major incident plans in place which are ready to be enacted if required. NHS England has also asked GP practices and other primary care providers in some areas to extend their opening hours so that patients can continue to get the important but non-emergency care that they need, such as follow-ups and assessments.
Finally, we have set up a dedicated strike page on the NHS website to provide as much information as possible to the public on local alternatives to hospital care, where these alternatives are, and when they are open. This website is now live and can be reached at www.nhs.uk/strike. The NHS 111 system will also work as normal during the strike, and has been provided with additional staff to cope with expected increased demand. We would encourage people who are concerned that they may need urgent care to visit this website, and call 111 in advance of showing up at an A&E department.
The NHS is busting a gut to keep the public safe. However, we should not lose sight of the underlying reason for this dispute, namely this Government’s determination to be the first country in the world to offer a proper patient-focused seven-day health service. To help deliver this, the NHS will this year receive the sixth biggest funding increase in its history. But it is not just about money, as we know from the mistakes of previous Governments. It is also about taking the tough and difficult decisions necessary to make sure that we really do turn our NHS into the safest, highest-quality healthcare system in the world. This Government will not duck that challenge. I commend this statement to the House.
Heidi Alexander (Lewisham East) (Lab)
I thank the Health Secretary for the advance copy of his statement.
Tomorrow’s strike is one of the saddest days in the history of the NHS, and the saddest thing is that the person sitting opposite me could have prevented it. Yesterday the Health Secretary was presented with a genuine and constructive cross-party proposal to pilot the contract. That would have enabled him to make progress towards his manifesto commitment on seven-day services and, crucially, it could have averted this week’s strike. Any responsible Health Secretary would have grasped that opportunity immediately, or at least considered it and discussed it, but not this one. Yesterday morning he tweeted “Labour ‘plan’ is opportunism”. That was a deeply disappointing and irresponsible response.
Let me remind the Health Secretary that the proposal was not a Labour plan, but was co-signed by two of his respected former Ministers, the Conservative hon. Member for Central Suffolk and North Ipswich (Dr Poulter) and the Liberal Democrat right hon. Member for North Norfolk (Norman Lamb), and the Scottish National party’s health spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). Let me also remind him that it had the support of several medical royal colleges, including the Royal College of Surgeons, and, crucially, that the BMA had indicated it was prepared to meet the Government to discuss calling off Tuesday and Wednesday’s action.
The Health Secretary claimed yesterday that a phased imposition was the same as a pilot. Will he explain how imposition on a predetermined timescale, with no opportunity to right the wrongs of his proposed contract and no independent assessment of its impact on patient care, is the same as a pilot? Why is he so afraid of an independent evaluation? Why does he not want to know how changing the contract contributes in practice to meeting his aspirations for more consistent emergency care across the seven days of the week? And why is he so determined to railroad this contract through, with all its associated implications, instead of road-testing it and working with junior doctors and hospital bosses to bring about the changes in patient care and outcomes he wants to see?
The Health Secretary claims that any further delay means it will take longer to eliminate the so-called weekend effect, but he has failed to produce a shred of evidence to show how changing the junior doctors contract alone will deliver that aim. He will know that the very person he appointed to lead his negotiations, Sir David Dalton, has said that the staff group that needs to change its working patterns the least to deliver seven-day care is junior doctors—because they already work weekends, nights and bank holidays.
The Health Secretary rightly talked about safety. NHS England’s update today said the NHS was pulling out all the stops to minimise the risks to the quality and safety of care this week. We know that in many cases senior staff will be stepping in to provide cover and ensure the provision of essential services, but there is no escaping the fact that this is a time of unprecedented risk, and he should have thought about that yesterday, before dismissing a plan that could well have averted the strike.
The Health Secretary wants to be remembered as the person who championed patient safety, but safety is not just an issue this week; it will be an issue in the months and years ahead. Long after his tenure in Richmond House is up, it will be the people who work in the NHS who will be picking up the pieces of this dispute, and they are rightly worried about the long-term safety implications of the proposed contract. How can it be safe to impose a contract when no one knows what the impact will be on recruitment and retention but everyone fears the worst, and when he is running the risk of losing hundreds of female doctors, given the contract’s disproportionate impact on women? Even if just 1% of junior doctors decide enough is enough and leave the NHS, they will be people we can ill afford to do without.
How can it be safe to impose a contract that risks destroying the morale of junior doctors, given that the NHS does not just depend on the good will of staff going the extra mile but survives on it? The Health Secretary is breaking that good will. How can it be safe to introduce a contract when there is no guarantee that effective and robust safeguards will be in place to control hours worked and shift patterns? A pilot could have addressed these issues, which is precisely why it had the backing of so many people.
I suspect that when the Health Secretary gets back to his feet, he will launch another attack on me and the Labour party to detract attention from his culpability for tomorrow’s action. I know this because last week, instead of working to resolve this dispute, the Health Secretary was busy writing me a two-page letter that he briefed to The Sun, asking whether I would be on a picket line.
Let me deal with this matter now in the hope that we can get some constructive answers from the Health Secretary. No, I will not be on a picket line tomorrow or on Wednesday, but that is not because I do not support the junior doctors’ cause, and it is certainly not because I feel even an ounce of sympathy for the Health Secretary. It is because I think patients affected by this dispute want to see politicians working together to find a constructive solution—and that is exactly what I was doing last week, while the Health Secretary was penning his pathetic political attacks.
I am flattered that the Health Secretary attaches such significance to my actions, but the truth is that it is his actions, and his actions alone, that can stop this strike: not me, not the Labour party, but him. If he ploughs on, I warn him now that history will not be kind to him. It will show that when faced with a compromise, the Health Secretary chose a fight; that when presented with a way out, this Health Secretary chose to dig in; and that when asked to put patients first, this Health Secretary chose strikes.
The way in which the Government have handled this dispute is the political equivalent of pouring oil on to a blazing fire. Even if we put to one side the legal question about his authority to impose a contract and the detail of the contract provisions, the simple truth is this: there is no trust left between the people who work in the NHS and this Health Secretary. He can barely show his face in a hospital because he ends up being chased down the road. This is a deeply, deeply sad day for the NHS, and even at this eleventh hour, I urge him to find a way out.
Mr Hunt
The shadow Health Secretary can do better than that. She talked about the judgments that I have made as Health Secretary, so I will tell her what is a judgment issue—it is whether or not you back a union that is withdrawing life-saving care from your own constituents. Health Secretaries should stand up for their constituents and their patients, and if she will not, I will.
The hon. Lady also talked about the trust of the profession. The Health Secretary who loses the trust of the profession is the Health Secretary who does not take tough and difficult decisions to make care better for patients—something we have seen precious little evidence of from the hon. Lady or, if I may say so, her predecessors.
The hon. Lady also talked about putting oil on a blazing fire. What, then, does she make of the shadow Chancellor’s comments recently when he said:
“We have got to work to bring this Government down at the first opportunity…Whether in parliament, picket line, or the streets, this Labour leadership is with you”?
Yes, it is with the strikers, but also against the patients. Labour should be ashamed of such comments from the shadow Chancellor.
Let us deal with the substance of what the hon. Lady said. She talked about her proposal for pilots. If this was a genuine attempt to broker a deal between all the parties, why was it that the first the Government knew about it was when we read The Sunday Times yesterday morning? The truth is that this was about politics, not peace making. If she is saying that we should stage the implementation of this contract to make sure we get it absolutely right, I agree. That is why only 11% of junior doctors are going on to the new contract in August. She says she wants more independent studies into mortality rates at weekends, but we have already had eight in the last six years, pointing to the weekend effect. How many more studies does the hon. Lady want? Now is the time to act, to save lives, and to give our patients a safer NHS.
The hon. Lady talked about legal powers, which we discussed in the House last week. The Health Act 2006 makes very clear where my powers are to introduce a new contract, either directly or indirectly, when foundation trusts choose to follow the national contract.
I have given very straight answers today. Will the hon. Lady now tell us yes or no? Will Labour Members now tell us yes or no? Do they or do they not support the withdrawal of life-saving care from NHS patients? Last week, the hon. Lady’s answer was “no comment”. Well, “no comment” is no leadership. Labour used to stand up for vulnerable patients, but now it cares more about powerful unions. It is the Conservatives who are putting the money into the NHS, delivering a seven-day service for patients, and fighting to make NHS care the best in the world.
Dr Sarah Wollaston (Totnes) (Con)
There are only losers in this bitter dispute, but those who have the most to lose are patients and their families. Tomorrow people will visit hospitals to see those whom they care about more than anything in the world, and will ask themselves why the doctors on the picket line are not inside looking after the people they love. May I ask the British Medical Association directly whether it will show dignity, put patients first, and draw back from this dangerous escalation? May I ask all sides, whatever provocation they may feel, to put patients first in this dispute?
Mr Hunt
My hon. Friend has spoken very wisely. She recently wrote, in The Guardian, something with which I profoundly agree: she wrote that there could have been a solution to this problem back in February, when a very fair compromise was put on the table in relation to the one outstanding issue of substance, Saturday pay.
I understand that this is a very emotive issue. The Government initially wanted there to be no premium pay on Saturdays, but in the end we agreed to premium pay for anyone who works one Saturday a month or more. That will cover more than half the number of junior doctors working on Saturdays. It was a fair compromise, and there was an opportunity to settle the dispute, but unfortunately the BMA negotiators were not willing to take that opportunity. I, too, urge them, whatever their differences with me and whatever their differences with the Government, to think about patients tomorrow. It would be an absolute tragedy for the NHS if something went wrong in the next couple of days, and they have a duty to make sure that it does not.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I welcome the absolute commitment that the Secretary of State has given today that this is only about seven-day emergency care, because in the past he has often seemed to move between elective and emergency care. However, Sir Bruce Keogh has criticised the imposition of the contract, and has said that what has lost consensus across the profession has been the conflation of the need for a robust emergency service over seven days with the junior doctors’ contract, when junior doctors already work seven days.
I think that people have also been upset by the use of statistics without analysis. It is not a case of extra deaths at the weekend, which suggests poor care, but a case of extra deaths among people who were admitted at weekends within 30 days. That is quite an odd formula, but we can think of factors that might contribute.
I support the four standards that the Secretary of State mentioned, but none of them relates to junior doctors. Number one is probably access to diagnosis: people lie in hospital over the weekend with no access to scans, and their whole pathway is delayed. When we conducted an in-depth audit of surgical mortality in Scotland, it identified issues such as the insufficient seniority of an operating surgeon and, later, the insufficient seniority of an operating anaesthetist. However, part of the problem is that we have not worked out what the problem is. The Secretary of State may go on about the four standards—about a senior review, 24/7 access to interventional care, and access to diagnostics—but that will not be changed by the junior doctors’ contract.
The Secretary of State calls on the BMA to listen to leaders. What about the 11 royal colleges that have written to him? In his letter to the leader of the BMA over the weekend, he highlighted the things that still need to be sorted out, and that means that there is a need to talk. There has been no talking for five weeks. Surely we should stop the imposition, get rid of the strike, go back to the table, and complete the talking.
Mr Hunt
I agree with the hon. Lady on one point: it is a total tragedy when the Health Secretary ends up with no other choice but to impose. Had we had sensible negotiations, that would have not have been necessary. She talked about the royal colleges. They say that the withdrawal of emergency care should not happen. Clare Marx, the president of the Royal College of Surgeons, has said that she personally would not and could not strike. I have tried to be very clear this afternoon about exactly what we are trying to do, and we have been clear on many occasions that this does not apply to elective care.
If the hon. Lady is concerned about the statistics, I would encourage her to read some of the 15 international studies covering stroke, cancer, emergency surgery and paediatric care, including the very thorough Fremantle study published last September. She is right to suggest that many of them talk about senior decision-makers being present. That could be a consultant, but it could also be an experienced junior doctor. As she knows, the term “junior doctor” is something of a misnomer because someone could have been a doctor for seven years and still be a junior doctor.
The hon. Lady also asked about the link with the junior doctor contract. The single outstanding issue is Saturday pay rates, as the BMA has confirmed in private emails that it has sent out. We need to make it possible for doctors to roster more people at weekends, and Saturday pay rates are obviously connected to that. What I have tried to do today is to show that the supply of trained doctors into the NHS will be going up during this Parliament, so we will not be depending on the current workforce to supply the additional Saturday cover in its entirety. There will be more doctors going into the NHS, which will spread the burden, and that is the way that we will get the safe NHS that we want.
John Redwood (Wokingham) (Con)
I support the vision of a seven-day NHS and a safer NHS that my right hon. Friend is so energetic about. However, for the benefit of all those uncommitted people listening to our debate who just want the NHS to work, will he tell us how big the gap is over that remaining issue, and how he sees it being resolved as quickly as possible?
Mr Hunt
My right hon. Friend is right to draw attention to the difficult paradox that we face. Earlier this year, we came close to an agreement and, had there been a willingness to negotiate rather than what I fear was the BMA’s desire to settle for nothing less than a full Government climb-down, we could have had a deal. The outstanding issues were about pay for antisocial hours and particularly about Saturday hours pay. That is where the main difference lay. We proposed a sensible compromise on that but, as Sir David Dalton, the chief executive at Salford Royal, said, we had to decide quickly what we were going to do because the contracts are coming in this August and there is a process we have to go through. So that will be in the new contracts from this August, but we are very willing to talk to all parties, including the BMA, about the implementation of these contracts, about the contents of future contracts and about anything to ensure that this contract works, because we would much rather have a negotiated agreed solution and it is a great tragedy that we were not able to do that this time.
Mr Dennis Skinner (Bolsover) (Lab)
When the Secretary of State came into the Chamber today, I do not know whether he realised that there was a smirk and an arrogance about him that almost betrayed the fact that he is delighted to be taking part in this activity. He could start negotiations today, wipe that smirk off his face and get down to some serious negotiations. It has had to be done in the past, but instead he comes here to try and blame the Opposition for what is taking place. This strike can only be caused by two sides: the junior hospital doctors and the Government. He is almost giving the impression that he is revelling in standing up to the junior hospital doctors. Start negotiating now and sort the matter out!
Mr Hunt
The hon. Gentleman has made many memorable contributions in the House, but that was unworthy of his track record. Let me tell him exactly what the Government have been trying to do to solve the issue. We have been talking to the BMA for over three years. We have had three independent processes. We have had 75 meetings to try to resolve the issues. He may be interested to know that we made 74 concessions in those meetings. There has been a huge effort. It is about not just talking, but both sides compromising to reach a solution. The BMA’s junior doctors committee was not willing to have constructive discussions, which is why we face the tragic situation that we face now. When the hon. Gentleman says that it takes “two sides”, I hope he recognises that we need a counterparty with which we can have sensible negotiations. We have not had that this time.
Mrs Anne Main (St Albans) (Con)
I met some junior doctors on Saturday morning, and they said that they wanted to go back to talking, which perhaps means that the union is not representing doctors as well as it could—I do not know. They also said that they had genuine concerns about a couple of issues apart from pay. Will the Secretary of State look at concerns relating to rostering and timing and whether a daytime shift should finish at 1.30 am or 2 am with the next day continuing as normal? Some issues are open to discussion, and my doctors want those discussions to happen, so perhaps the union is not being as helpful as it could be.
Mr Hunt
I am afraid that junior doctors, who work incredibly hard and are the backbone of the NHS, have not been well represented by their union. The BMA is currently telling junior doctors not to co-operate with trusts in any discussions about the implementation of the new contract. The kinds of issues mentioned by my hon. Friend are exactly those that we want to sit down and talk to the BMA about. I wrote to Mark Porter, the chair of the BMA’s council—in fact, I talked to him earlier this afternoon—about the possibility of talks to go through all those extra-contractual issues and the contract itself to ensure that we implement it in the best possible way. That is the kind of dialogue that the Government are willing to have and that we would welcome, but we need another party to come to the table if we are to succeed in doing so.
Mr Ben Bradshaw (Exeter) (Lab)
The Health Secretary knows well that seven-day working has absolutely nothing to do with his proposed new contract. The Health Committee recently visited Salford Royal hospital, to which he referred earlier and which is already running a seven-day service on the existing contract. His petulant rejection of the all-party proposals to pilot the contract shows that tomorrow will be his responsibility and his alone.
Mr Hunt
Let us be absolutely clear. The people who are responsible for the strike tomorrow are those who choose to do the BMA’s urging and withdraw emergency care for patients. That is where the responsibility lies.
Let me deal with the right hon. Gentleman’s point directly. There are a couple of trusts in the country that have been good at introducing seven-day standards in urgent and emergency care, but my judgment, and that of the Government, is that it would not be possible under the current contractual structures to roll that out across the whole NHS. Those trusts happen to have some of the NHS’s most outstanding leaders, and we need to learn from what they have done, but we also need to make it possible for those same things to happen at all hospitals, including the right hon. Gentleman’s own.
Dr Liam Fox (North Somerset) (Con)
Those of us who have served our time as junior doctors understand the hard work and very long hours that they do in a system that has had too few doctors since its inception. Many of us believe that there is no dispute about pay and conditions that justifies putting patients’ lives at risk.
There has been some confusion about what the Government have meant by a seven-day NHS. There has always been a seven-day emergency service, but it is too patchy across the country, which needs to be addressed. That is different, however, from a seven-day elective service, which simply cannot be achieved by doctors alone and requires bacteriologists, haematologists, and radiographers. Might my right hon. Friend get the Government’s case to be more clearly defined in future so that we know what we are trying to achieve? There is little difference between what the Government and doctors want, notwithstanding the fact that the BMA has behaved rather badly.
Mr Hunt
My right hon. Friend is right; the tragedy here is that what the Government want, which is to eliminate the weekend effect, whereby there are higher mortality rates for those admitted at weekends, is exactly what every doctor wants. We should be sitting around the table discussing how we can achieve a proper, consistent, seven-day service for urgent and emergency care. When it comes to elective provision, that is not part of our plans, although some trusts are operating elective care on a seven-day basis—that is their choice. We are trying to reduce the higher mortality rates for weekend admissions, and that will be at the heart of our vision for a true seven-day NHS.
Thangam Debbonaire (Bristol West) (Lab)
Can the Health Secretary name a single medical college that backs his decision to impose this contract?
Mr Hunt
All I would say is that every medical college agrees with me that doctors should not withdraw emergency care in tomorrow’s strike, because, as one of my right hon. Friends said, this is a line the medical profession has not crossed before. I do not think it should cross it tomorrow either.
Mr Speaker
May I say, on behalf of Members on both sides of the House, how good it is to see the hon. Member for Bristol West (Thangam Debbonaire) back in her seat and, I hope, now in very good health?
Mr Hunt
My hon. and learned Friend is right about that, which is why when we announced our decision to proceed with the current contracts we also said that we would set up a process to look at all the quality of life issues that could make a difference to the current junior doctor workforce and to their morale. One of those issues is that it is currently too difficult for doctors who are partners to work in the same city, because of the processes we have—we want to reform that. There are many other things we could do in terms of improving the predictability and reliability of shift patterns, but to do that we need the BMA to co-operate with the Bailey review, which we have set up and which is led by the president of the Academy of Medical Royal Colleges. We could then sort out these problems, but at the moment we do not have that co-operation, which is why we are not making the progress we want.
Norman Lamb (North Norfolk) (LD)
May I say to the Secretary of State that it is because I have very real anxieties about the impact on patients of a strike involving emergency services, not because of political opportunism, that I signed that letter? I urge him, even at this eleventh hour, to meet all of us to discuss this in a reasonable and rational way. Ultimately, we all have a responsibility to try to avert this strike.
Mr Hunt
I absolutely agree with that, but I gently say to the right hon. Gentleman that if that was the case, he has my mobile phone number and he could have contacted me, and he did not need The Sunday Times to be the first place I saw his proposal. If the people involved were genuinely serious about brokering a deal, that was not the way to go about it. We all have a duty to do everything we can to avert tomorrow’s strike, but his proposal to change the Government’s plans into pilots would mean, as he knows perfectly well, that seven-day care would get kicked into the long grass and would probably not happen. That would be wrong. As he well knows, we have a responsibility to patients to deliver our manifesto promises, and that is what we are going to do.
Sir Roger Gale (North Thanet) (Con)
I wonder whether my right hon. Friend can refresh my memory. Is it not the case that under the new contract those who are going to strike tomorrow—it is by no means all junior doctors—putting patients’ lives at risk, will be earning more, rather than less, and for fewer hours, rather than more? Would he also remind me of any other public sector employee who gets time and a half for working on a Saturday morning?
Mr Hunt
My hon. Friend makes an important point. The deal on the table is fair for junior doctors; there is higher premium pay for people who work regular Saturdays than there is for nurses, paramedics, healthcare assistants in their own operating theatres, fire officers, police officers and pretty much anyone else in the public or private sector. Under the new contract we are bringing down premium rates for Saturday pay, but we are making sure we compensate that with a 13.5% increase in the basic pay—to my knowledge, that is not being offered anywhere else in the public sector. That will mean take-home pay goes up for 75% of junior doctors. It is a very fair deal. It is designed to make sure that they are not out of pocket as we make changes that are safer for patients, which is why we should be talking about these changes and not having these strikes.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
A phased implementation is not the same as having a pilot with an independent evaluation to assess the effects of this contract on the workforce, and on safety and quality of care. Why will the Health Secretary not accede to the wholly reasonable proposal to pilot the new contract, which will break the current deadlock?
Mr Hunt
We have had eight studies in the past six years—those were independent studies, not commissioned by the Government, and they covered areas such as paediatric and cancer care, emergency surgery and a whole range of other areas. Six of those eight studies mentioned staffing levels at weekends as something that seriously needs to be investigated. Today there are higher mortality rates for weekend admissions, and the Government have a responsibility to do something, not to commission further studies. That is why we are determined to press ahead.
Dr Julian Lewis (New Forest East) (Con)
May I reiterate my concern that there appears to have been no ballot of junior doctors specifically on the question of withdrawal of emergency care? Does the Secretary of State share my fear that if, despite his best efforts, people die as a result of this withdrawal of emergency cover, public demand for a legislative change to ensure that that can never happen again will become irresistible?
Mr Hunt
My right hon. Friend is right to say that the public will be extremely disappointed that professionals are putting patients at risk in such a way, and it is extremely tragic that they are doing so. I am afraid that I think this is a crossing of the Rubicon—crossing a line in a way that has not happened before. I think it is totally tragic, and I support the concern of my right hon. Friend.
Valerie Vaz (Walsall South) (Lab)
In his statement, the Secretary of State said that this was “in our manifesto”. This is about ideology, not about the NHS. If he cares about the NHS, will he hear the will of the House, contact the BMA straight after this statement and negotiate?
Mr Hunt
If by “ideology”, the hon. Lady means a commitment to make the NHS the safest, highest quality health care system in the world, I plead guilty to ideology. That is the NHS that I want, and that means a seven-day NHS in which we do not have higher mortality rates for people admitted at weekends. There was a time when the Labour party would have been prepared to take tough and difficult decisions to make things better for patients, but that day has passed.
Dame Angela Watkinson (Hornchurch and Upminster) (Con)
Many professions and occupations require seven-day working in the public and private sectors. Given that all but one of the points of difference between the BMA and the Government have been resolved, does my right hon. Friend agree that this drastic strike action on the remaining issue of Saturday pay is wholly unjustified?
Mr Hunt
It is wholly unjustified because the offer on the table for Saturday pay is extremely generous, and in some ways more generous than that available to pretty much any other professional in the public or private sectors. This is a very extreme step as far as patients are concerned, and the BMA must recognise that this Government are as committed to the NHS as it is. When the Government want to learn the lessons of Mid Staffs, turn around our struggling hospitals, and ensure that our care is safe every day of the week, it is right to sit around the table, negotiate and talk, but that is not what we have had from the BMA. We must not be deflected from taking difficult decisions even if we have that opposition, because our ultimate responsibility is to patients.
Yvonne Fovargue (Makerfield) (Lab)
I recently visited the Royal Albert Edward Infirmary in Wigan and met many junior doctors, all of whom told me that every day they work two or three hours longer than their contracted hours, without pay and out of concern for their patients. Is it not folly not to pilot this contract and to risk losing the good will and services of those dedicated people? Surely that will decrease, not increase, patient safety.
Mr Hunt
What is devastating to the morale of junior doctors is when they are represented by an organisation that constantly feeds them misinformation about the contents of the new contract. First, the BMA told them that it was going to mean that their pay was cut. Then it told them that they were going to be asked to work longer hours. In fact, the reverse is true on both those things. The way that we raise morale among the very important junior doctor workforce is by the BMA saying that it is prepared to take a constructive approach to sensible negotiations, not refuse to budge, as we saw in February.
Sir Peter Bottomley (Worthing West) (Con)
It is important to be both rational and reasonable. It is reasonable for registrars to be earning, on average, £53,000 a year and, when fully established, more than £100,000. It is rational for junior doctors’ leaders to accept that rostering should be a matter of discussion, as there is a right and a wrong level. The remaining issue is some of the premium pay for Saturdays. It seems that it would be a good idea if those behind the BMA negotiators came out into the open and explained in detail to my patients and the patients of the 649 other MPs, or the MPs in England anyway, what the issue is that is stopping it calling off the strikes, getting people back to talks and making agreements.
Mr Hunt
As ever, my hon. Friend is absolutely right. When I have spoken to junior doctors who are protesting, they have not wanted to bring up issues in the new contract, as much of it is very good for them. I am talking about the fact that they cannot be asked to work six consecutive nights, which they can be at the moment; the fact that they cannot be asked to work more than six long days in a row, which they can be currently; and the fact that the maximum hours that they can be asked to work is going down from 91 to 72. There are many things that are good in this new contract, which is why the sensible and rational thing for them to do is to sit down and discuss it with the Government and not to set their face against it at any cost.
Naz Shah (Bradford West) (Lab)
This morning, Dr Ben White resigned as a trainee doctor. He said it was
“to fight the contract on behalf of his patients and on behalf of the NHS.”
I also met junior doctors over the weekend, and their morale is really low. Does the Health Secretary believe that it can be safe for patients to impose a contract that risks destroying the morale of junior doctors and impacting on staff retention?
Mr Hunt
I will tell the hon. Lady what is unsafe for patients. It is not standing up to the BMA when it behaves in a totally unreasonable way with a Government who are determined to make NHS care safer. With the greatest respect to her, because she is new to the House, she should appreciate that previous Labour Governments did not stand up to the BMA, and that is why we are left with many of the problems that we face today.
Dr Andrew Murrison (South West Wiltshire) (Con)
The Health Secretary is doing the right thing for patients, and I welcome his statement. However, does he accept that there is more to be done in contractual terms for the NHS workforce if Sir Bruce Keogh’s 10 clinical standards are to be implemented? Although he may not wish to reflect on it at this particular point in time, what does he think can be done to improve contracts for non-training grades and consultants in the NHS?
Mr Hunt
My hon. Friend speaks very wisely and also from experience on these issues. He is right. I have tried to make the point in my statement that a seven-day NHS is not just about junior doctors—it is about the whole range of services; it is about consultants, diagnostic services, general practice. As we seek to move towards a seven-day NHS, we will also be expanding the NHS workforce to ensure that the current workforce does not bear all the strain by itself. This is an opportunity. We have had lots of comments today about morale. I simply say this: the way to improve morale for doctors is to enable them to give the safest possible care to patients. At the moment, much of the frustration from doctors is that they do not feel able to give the safe care they would want to. We want to change that and to work with the BMA to make that possible.
Peter Kyle (Hove) (Lab)
So far the Secretary of State has not grabbed the opportunity presented to him from across the House—I am talking about a cross-party solution—with both hands. If patients were at the centre of his thinking, he would have done so. He has told the House that he has not done so, because he read about it in The Times rather than getting a phone call. If the right hon. Member for North Norfolk (Norman Lamb) agrees to call his mobile and tell him anything that he wants to hear—whisper sweet nothings into his ear—will he agree to have the conversation and call off this strike?
Mr Hunt
I have to say that the right hon. Gentleman never whispered sweet nothings in my ear, and he certainly has not done so since being in opposition. With regard to doing what it takes, let me tell the hon. Gentleman directly that we have been trying to solve this problem for three years, with 75 meetings, 74 concessions and three independent processes. We have been doing everything we possibly can to solve this problem. What we have is a very intransigent and difficult junior doctors committee of the BMA, which has refused to negotiate sensibly. In that situation, the Health Secretary has a simple choice: to move forward or to give up. When it comes to patient safety, we are moving forward.
Andrea Jenkyns (Morley and Outwood) (Con)
Patient safety is a matter close to my heart. Tomorrow, doctors will shout that this strike is not about pay or Saturday working, but about patient safety. They will march under banners declaring the contract to be unsafe and unfair. Will the Secretary of State reassure the House that there is absolutely no prospect of the Government giving into this naked attempt by the doctors’ union to hold vulnerable patients as hostage in a row over pay? Patients must always come first.
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.
Mr Steve Baker (Wycombe) (Con)
I have long found that the BMA is not universally admired by doctors, perhaps because of its long history of putting doctors’ interests ahead of patients’ interests. Will the Secretary of State ensure that he does not inadvertently drive doctors into the arms of the BMA, and will he look into adopting some of the old left ideas of mutuality, which would reconnect doctors to the interests of their patients?
Mr Hunt
My hon. Friend and I have discussed that recently, and I do think that the mutual structure is something we should be open-minded about. When junior doctors go on to the new contracts, which will happen in stages starting this August, they will find that it is safer and better and that they have more predictable shift patterns. It will enable them to have a better quality of life. Then they will realise just how badly represented they have been by the BMA.
Richard Burgon (Leeds East) (Lab)
I am worried about the potential consequences of the Secretary of State having people believe that if they are ill on the day of strike action there will be no A&E for them to go to. If they do not go and there are consequences, I believe that the consequences will be his responsibility, so could he now clear this matter up for the British public and confirm that there will be A&E cover on the days of these strikes, if they go ahead?
Mr Hunt
We do believe we will be able to keep all A&E departments open tomorrow and the next day, during the days of the strike, but that does not mean there will not be huge pressure on hospitals, which is why we are urging people to go to A&E only if they really need to. I would simply say to the hon. Gentleman that this disruption is the responsibility of the people who are choosing to withdraw emergency care for the first time in the history of the NHS.
Andrew Bridgen (North West Leicestershire) (Con)
Can I ask my right hon. Friend to stick to his guns and not to give in to the unreasonable demands of the BMA? Doctors are among the most highly remunerated of our public servants—far better remunerated than members of the police or the armed services, who are essential workers and who are barred by law from taking strike action. Can I urge my right hon. Friend to review the situation with regard to A&E medics?
Mr Hunt
Interestingly, A&E departments will benefit from the new contract because there are special premiums to encourage more people to go into A&E as a specialty. However, on his broader point, I agree: when someone is paid a high salary, that comes with the responsibilities of a profession. That is why, however much people disagree with the new contract, and however much they may not agree with the Government’s plans for a seven-day NHS, it is totally inappropriate to withdraw emergency care in the way that will happen tomorrow and the next day. That is why doctors should be very careful about the impact this will have on their status in the country.
Alison McGovern (Wirral South) (Lab)
The Secretary of State said in his statement: “Taking strike action is a choice”. However, when someone’s back is against the wall, and the person in charge will not listen, it never feels like a choice. A month ago, the Secretary of State could not answer my question about how big the NHS provider deficit would be in the last financial year—it was about £3 billion—so will he answer my question now, because money is at the heart of this? What will the NHS provider deficit be in the next financial year?
Mr Gary Streeter (South West Devon) (Con)
I commend my right hon. Friend for the way he is conducting himself in this matter. Will he remind the House of when the BMA’s junior doctors negotiating committee first refused to meet him because it wanted to achieve a political outcome rather than a resolved settlement?
Mr Hunt
Regrettably, there has not been only one occasion. In the October before the election, the junior doctors committee walked out of talks after extensive efforts to negotiate a new contract. We then had the independent pay review body process. Then—this was the most shocking thing of all—we had the decision of the committee to ballot for strike action before it had even been prepared to sit down and talk to me about what the new contract involved. That has been at the heart of so many misunderstandings about this contract and has led to so much disappointment on all sides. If the committee had sat down and talked to us, it would have discovered that we all want the same thing: a safer, seven-day NHS.
Joan Ryan (Enfield North) (Lab)
The Secretary of State tells us he has spent over three years on this matter—three years, and he has brought us to this unprecedented state of affairs. May I gently suggest to him that it is not the junior doctors who are the problem, but him? My constituents—hundreds of whom have written to me—overwhelmingly feel that he has been irresponsible and intransigent. He needs to get back to the negotiating table, lift the imposition and put the people who need A&E—in the next few days and beyond —first.
Mr Hunt
If the right hon. Lady is asking whether I will compromise in my pursuit of a safer NHS for her constituents and my constituents, the answer is I will not. I am the Health Secretary who had to deal with Mid Staffs and with a huge number of hospitals up and down the country that the Labour party, when in power, did nothing to turn around. We dealt with that. We put 27 hospitals into special measures. We have dramatically increased the number of doctors and nurses in our hospital wards because we care about a safer NHS. When there are issues about weekend care, the right thing to do is to address those issues, not to duck them.
Philip Davies (Shipley) (Con)
I think the Secretary of State can be criticised in this dispute, and my criticism is that he has been far too generous to junior doctors. Despite their understandable embarrassment at admitting it, this is a good old-fashioned pay and terms strike by an old-fashioned trade union. As far as I am concerned, it is an absolute disgrace to withdraw emergency cover on the basis of what premiums are paid on a Saturday when most of my constituents, who are much more poorly paid, go out to work on a Saturday as a normal day without any premiums whatsoever. No Government should ever give in to this kind of industrial action. Will he give a firm commitment that, despite the bluster from the Labour party, he will stick to his guns on this issue?
Mr Hunt
I absolutely give my hon. Friend that commitment. He is absolutely right to say that professionals should not withdraw emergency care in pursuance of a pay dispute. It is totally and utterly inappropriate. It is not just me saying that; it is what very experienced doctors such as Professor Bruce Keogh are saying. This is the wrong way to go about this dispute. In the end, the public recognise a simple truth: you cannot choose which day of the week you get ill. If we are to have the best health service in the world, we need to reflect that in the medical cover we provide at the weekends as well as during the week.
Diana Johnson (Kingston upon Hull North) (Lab)
I have previously raised with the Secretary of State the problems with recruitment and retention in Hull and East Yorkshire. I would like an undertaking from him. If he moves forward with the imposition of the new contract and evidence comes to light that retention and recruitment are going to be difficult, will he stop the imposition and think again?
Mr Hunt
We are constantly monitoring what will happen with the new contract, and we want to make sure that we get it absolutely right. If the hon. Lady makes such a plea to me, she should also talk to the BMA and say that the way to make sure we implement this contract correctly is to sit down with the Government and talk about how to make it successful, rather than to refuse to talk to us, which is what is happening at Hull Royal infirmary and many other hospitals.
Jeremy Lefroy (Stafford) (Con)
I briefly attended a medical conference over the weekend, where doctors said they were hugely concerned about the impact on the vast majority of junior doctors who neither wish to strike nor believe that the contract is satisfactory, for the reason given by my hon. Friend the Member for St Albans (Mrs Main), when she was in the Chamber. They are being put in an impossible position. I really urge the BMA to withdraw the threat of strike action and the Secretary of State to make it quite clear that he will do whatever it takes in sitting down to resolve this issue for the sake of all our patients and their safety.
Mr Hunt
I am absolutely prepared to talk about anything that could be improved in the contract that will be introduced and, indeed, extra-contractual things such as the way in which rota gaps are filled and the training process. However, at the moment we do not have such a dialogue, and that has been the problem. The imposition of a new contract is the last thing in the world that we wanted as a Government. It followed 75 meetings—it was a totally exhaustive process—but in the end we found that our counterparty was not interested in sitting down to talk about this; it just wanted a political win. We had to make an absolutely invidious choice about doing the right thing to make patients safer. I wish we had not got to that point. We have got to it and we need to carry on, but the door is always open for further talks and discussions.
Rachael Maskell (York Central) (Lab/Co-op)
The Secretary of State is the one person who can stop this strike. Why will he not now take a step back, engage the services of ACAS—specialists in negotiations—remove the conditionality and address the remaining issues? Proper dialogue will get a resolution.
Henry Smith (Crawley) (Con)
I am grateful to my right hon. Friend for visiting my constituency earlier this month. In the last decade, the previous Labour Government removed medical services from Crawley hospital; now, we have a 24/7 urgent treatment service and a doctors out-of-hours service. Does my right hon. Friend share the dismay of my local patients that the BMA is essentially asking junior doctors to go against their Hippocratic oath?
Mr Hunt
I think many people inside and outside the medical profession are deeply upset that that is happening. I really enjoyed my visit to my hon. Friend’s constituency, and we will continue to invest in his local health services. I think that his constituents will be upset by the fact that the pay and conditions many of them have for working at weekends go nowhere near what is being offered to junior doctors under the new contract. In that sense, it is totally disproportionate to withdraw emergency care, which is such an extreme measure and has never happened before.
Nic Dakin (Scunthorpe) (Lab)
I welcome the Secretary of State’s recognition that junior doctors are the backbone of the NHS and his expression of willingness to talk about the implementation of the contract. Those words are great, but I urge him to take actions to match them and take the opportunity of the cross-party initiative to pilot this contract. If he does not do that and ploughs on regardless, he will jeopardise patient safety.
Mr Hunt
I welcome any genuine attempt to try to resolve this issue, but Health Education England has said that it does not believe that that cross-party approach is workable. As I have said to the hon. Gentleman before, having pilots of seven-day care and new junior doctor contracts would mean that we took too long to deliver a key manifesto promise.
Rebecca Pow (Taunton Deane) (Con)
Farmers in Taunton Deane, as well as retail workers, journalists and bus drivers, all work across the week, and we need the NHS to do so as well. We cannot choose which day our children fall sick, and it makes absolute sense for the NHS to operate seven days a week for the sake of patients. It is crucial for the BMA to join the Government and resolve these well-thought-out plans. I urge the Secretary of State to keep up the good work.
Mr Hunt
I thank my hon. Friend, who eloquently makes the point that this is a moment of opportunity for the NHS. We have been through some terrible problems at Mid Staffs and a number of other hospitals where there were serious issues with the quality of care, and now we are going on a journey to make the NHS one of the safest healthcare systems in the world. That means facing up to these problems, not ducking them, and that is what is going to happen for the time that I am Health Secretary.
Liz McInnes (Heywood and Middleton) (Lab)
The junior doctors I have spoken to are concerned about unsafe staffing levels and unworkable rotas as a result of the imposition of this contract. They ask me to make it clear to patients and to the public that the two strike days are nine hours in length and will last from 8 am until 5 pm, and that emergency care will be provided by consultants. The solution is in the Health Secretary’s hands: withdraw the imposition of this contract and get back round the negotiating table.
Mr Hunt
As I have said many times, were we to do that we would be giving the BMA a veto over a manifesto commitment, and no union should have a veto over what an elected Government do. I hope that what I said in my statement will give comfort to the hon. Lady and some of her constituents that we are increasing staffing levels in the NHS to deal with the extra pressures. With regard to unworkable rotas, perhaps she will go and tell the BMA to sit round the table and talk to its local trust managements so that we can get those rotas to work, because the way to sort out these problems is to sit down and discuss them.
Antoinette Sandbach (Eddisbury) (Con)
Will the Secretary of State join me in thanking the consultants and nurses at Leighton hospital and Countess of Chester hospital who will be working extra hours in order to give as much patient cover as they can? Does not the recent leak of emails from members of the junior doctors committee last week show that they utterly reject any compromise and that any offer at this stage is simply not a serious offer?
Mr Hunt
I thank my hon. Friend for what she says about consultants in her local trust and, indeed, up and down the country, as well as nurses, paramedics and many other people who will be working to keep the public safe. I salute all of them. She is absolutely right: those leaked emails show that those on the junior doctors committee know that had they been prepared to negotiate on Saturday pay we would not have had an imposed contract, so it was completely in their hands to avoid this outcome. They chose not to do that; they wanted war. That was a totally irresponsible thing to do. They need to recognise that the way we will build a safer NHS is by sitting round and talking to a Government who want to create it.
John Woodcock (Barrow and Furness) (Lab/Co-op)
Why does the Secretary of State suspect the motives of his former ministerial colleague, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter)? Why has he taken to Twitter to accuse him of political opportunism?
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
To take pressure off GPs, A&E units and junior doctors, may I urge my right hon. Friend to make full use of the pharmacy network and ensure that it can play its full part in a seven-day national health service?
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
Whatever the Government’s aspiration, the fact is that we cannot run a health service on any day of the week without doctors who are willing to work in it. The reality is that the doctors I speak to in my constituency are exasperated. They are angry. They feel as though they have no choice. The Conservative party is kidding itself if it thinks that this is about the BMA making a political fight. There is a genuine strength of feeling about the way in which these people have been treated. That is shared by consultants and nurses, which is why they are willing to cover for their colleagues. The idea that the Government have no responsibility for the single biggest industrial dispute in the history of the NHS is, frankly, pathetic. People want to know why, if there is just one issue left to settle, imposition is necessary. Why can that not be taken off the table, so that negotiations can begin again and the strike avoided?
Mr Hunt
Because on that one issue—Saturday pay—the BMA said in writing last November that it would negotiate, but it tore up that agreement and said that it was not prepared to negotiate even one iota. That was why the agreement fell apart. The BMA could easily, had it stuck to its word, have negotiated an agreement and we would not have a strike today. The Government have been totally reasonable and fair throughout. The BMA has not. It is the BMA’s choice to call these strikes. It should think again, because this is the wrong thing for patients and the wrong thing for the NHS.
Christopher Pincher (Tamworth) (Con)
Many of our constituents will be concerned, and indeed angry, at the thought that some of the most vulnerable people in our society—the old, the young and the sick—are being put at risk by what they will see as some of the most advantaged people in our society. Does my right hon. Friend agree that this could do tremendous reputational harm to the medical profession, and that that will do more to damage the morale of the medical profession than any bluster from the Opposition or the BMA?
Mr Hunt
I totally agree with my hon. Friend. Medicine is a profession. It has very important values attached to it, the most famous of which are the Hippocratic oath and “do no harm”. It is a step too far to say that in pursuance of a pay dispute and more pay on a Saturday, you are prepared to withdraw emergency care from vulnerable patients. That is the wrong call for the medical profession, when the alternative on the table is to sit down and talk with a Government who want to work with the medical profession to provide safer NHS care.
David Morris (Morecambe and Lunesdale) (Con)
A doctor who is a constituent and on the board of the BMA said in 2014 that he became politicised in the 1990s because he once crashed a car as a result of the gruelling hours he worked as a junior doctor. Does my right hon. Friend agree that with all the revisions to the proposals for doctors’ hours, this should be a thing of the past?
Mr Hunt
I totally agree with that. That is why, since then, junior doctors’ hours have been reduced, and under the new contract we are reducing yet again the maximum hours that junior doctors can be asked to work. Every doctor should welcome the new agreement, but because, unfortunately, the BMA has not chosen to negotiate sensibly despite exhaustive efforts, we are left with the very difficult decision as to whether we proceed with our plans for a seven-day NHS or whether we give up. I think that elected Governments should never give up on manifesto promises.
Bob Blackman (Harrow East) (Con)
Junior doctors went into medicine to save lives, not to place them at risk. Does my right hon. Friend agree that by striking, junior doctors are putting people at risk? Can he confirm what the position would be if he had allowed contracts to lapse, and what the effect would be on the national health service?
Mr Hunt
I agree that the strikes are putting patients at risk. I think that what my hon. Friend means by the second part of his question is: what would have happened if we had just allowed the current contracts to roll over? The answer is that we would not have made progress towards a safer seven-day NHS, which will be of enormous benefit to his constituents and mine.
Mark Spencer (Sherwood) (Con)
Will the Secretary of State use the Dispatch Box this afternoon to appeal directly to junior doctors to ignore the militant BMA, to turn up to work tomorrow, to acknowledge that the Government have met the BMA over 70 times and made more than 70 concessions round the negotiating table, and to put patients first and make sure that my constituents get the level of health service, seven days a week, that they so deserve?
Mr Hunt
My hon. Friend speaks extremely wisely. I say to every junior doctor in the country that what they want from our NHS—safe service and safe care for patients across every day of the week—is what we want as well. This Government are committed to the NHS. We are this year putting the sixth biggest increase in resources into the NHS in its history, so we are putting our money where our mouth is. We want to sit down with the medical profession and make this work for patients.
Mr Philip Hollobone (Kettering) (Con)
Will my right hon. Friend tell me whether my understanding of the Saturday pay dispute is correct? On the one hand the BMA wants time and a half throughout a Saturday. On the other, Her Majesty’s Government are offering time and a half between midnight on Friday and 7 on a Saturday morning, time plus 30% between 7 o’clock in the morning and 5 o’clock in the afternoon for those who have worked more than one in four Saturdays, time plus 30% between 5 o’clock in the afternoon and 9 o’clock, and time and a half between 9 o’clock and midnight. My constituents in Kettering had sympathy for the junior doctors but are totally opposed to the withdrawal of lifesaving emergency care, especially when the difference between the doctors’ position and that of the Government is so narrow.
Mr Hunt
My hon. Friend speaks wisely, as ever, on this. The fact is that we have moved a very long way to meet one of the BMA’s biggest concerns: that there should still be premium pay on Saturdays. For doctors who work regularly at weekends this is a very good deal—better than that for pretty much anyone else in the public sector. That is why we think that the reasonable thing to do would have been to accept the deal and not to call these wholly unnecessary strikes.
Kevin Foster (Torbay) (Con)
I know my right hon. Friend will agree that a dispute over pay cannot justify a threat to withdraw emergency cover. Will he confirm that after the new contract comes in no doctor will be treating patients while working their 91st hour in the same week, and that he will be looking at the availability not just of junior doctors but of other support services that are needed to deliver the seven-day services we have pledged to provide?
Mr Hunt
Absolutely. My hon. Friend is quite right to point out that the seven-day NHS vision is not just about junior doctors but about support services for junior doctors that will make the provision of care to their patients at weekends not just better for those patients but much more rewarding for them. It is immensely frustrating for doctors not to be able to get diagnostic tests back quickly because it is the weekend. We want to sort out all those problems. That will be better for doctors and better for patients.
Alex Chalk (Cheltenham) (Con)
Whatever the objections to this contract, and however sincerely they are held, withdrawing emergency care for seriously ill patients cannot be on the list of options. On Saturday pay, will the Secretary of State bring absolute clarity to something that may have been misrepresented, or at least misunderstood: will doctors who work regular Saturdays —that is, more than one in four—continue to receive a pay uplift?
Mr Hunt
Yes, they will. That is the main outstanding issue of a very small handful of issues that were not resolved. We went a very long way towards what the BMA wanted. We are reducing premium rates for Saturday pay, but are making up for that with a 13.5% increase in basic pay. That will mean that hospitals can roster more doctors at weekends and that the doctors who work the most weekends will continue to get premium pay for that extra work. It is a good thing for doctors and for patients.
Junior Doctors Contracts
Jeremy Hunt Excerpts(8 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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Heidi Alexander (Lewisham East) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the imposition of a new junior doctors contract.
The Secretary of State for Health (Mr Jeremy Hunt)
This House has been updated regularly on all developments relating to the junior doctors contract, and there has been no change whatsoever in the Government’s position since my statement to the House in February. I refer Members to my statement in Hansard on 11 February, and to answers to parliamentary questions from my ministerial colleagues on 3 March, which set out the position clearly. Nevertheless, I am happy to reiterate those statements to the hon. Lady.
The Government have been concerned for some time about higher mortality rates at weekends in our hospitals, which is one reason why we pledged a seven-day NHS in our manifesto. We have been discussing how to achieve that through contract reform with the British Medical Association for more than three years without success. In January, I asked Sir David Dalton, the highly respected chief executive of Salford Royal, to lead the negotiating team for the Government as a final attempt to resolve outstanding issues. He had some success, with agreement reached in 90% of areas.
However, despite having agreed in writing in November to negotiate on Saturday pay, and despite many concessions from the Government on this issue, the BMA went back on that agreement to negotiate, leading Sir David to conclude that
“there was no realistic prospect of a negotiated outcome.”
He therefore asked me to end the uncertainty for the service by proceeding with the introduction of a new contract without further delay. That is what I agreed to, and what we will be doing. It will start with those in foundation year 1 from this August, and proceed with a phased implementation for other trainees as their current contracts expire through rotation to other NHS organisations.
Let me be very clear: it has never been the Government’s plan to insist on changes to existing contracts. The plan was only to offer new contracts as people changed employer and progressed through training. This is something that the Secretary of State, with NHS organisations as employers, is entitled to do according even to the BMA’s own legal advice. NHS foundation trusts are technically able to determine pay and conditions for the staff they employ, but the reality within the NHS is that we have a strong tradition of collective bargaining, so in practice trusts opt to use national contracts. Health Education England has made it clear that a single national approach is essential to safeguard the delivery of medical training and that implementation of the national contract will be a key criterion in deciding its financial investment in training posts. As the Secretary of State is entitled to do, I have approved the terms of the national contract.
The Government have a mandate from the electorate to introduce a seven-day NHS, and there will be no retreat from reforms that save lives and improve patient care. Modern contracts for trainee doctors are an essential part of that programme, and it is a matter of great regret that obstructive behaviour from the BMA has made it impossible to achieve that through a negotiated outcome.
Heidi Alexander
Just when we thought this whole sorry saga could not get any worse, it now appears that Government policy is in complete disarray. Despite the Health Secretary giving us all the impression back in February that he was going to railroad through a new contract, it now appears that he is simply making a suggestion—or, as his lawyers would say, approving the terms of a model contract. Last night, the Health Secretary took to Twitter to claim that this was not a change of approach, and we have heard the same again today, so, on behalf of patients, I have to ask him: what on earth is going on?
We need a straightforward answer to a simple question: is the Health Secretary imposing a new contract—yes or no? If he is not, but merely suggesting a template, why did he not make it clearer beforehand, and why, in his oral statement on 11 February, did he lead Parliament, the media, the public and, crucially, 50,000 junior doctors to believe that he was announcing imposition? The junior doctors committee took the unprecedented step of escalating its industrial action on the back of his decision to force through a contract. How can he possibly justify a situation whereby his rhetoric, underpinned by nothing but misplaced bravado and bullishness, could lead to the first ever all-out strike of junior doctors in the history of the NHS? He must get back to the negotiating table, and quickly.
We also need answers to the following questions. Do all NHS employers have free rein to amend the terms of the Health Secretary’s so-called model contract? Does this include non-foundation trusts? Is it legal for Health Education England effectively to blackmail trusts on the part of the Health Secretary by withholding funding, if that is what Government policy now is? Finally, it seems there are two basic scenarios: either he has known all along that he does not have the power to impose a new contract, and so all this is part of a cynical attempt to take on a trade union, or he was oblivious to the fact that he did not have the power, in which case, what is going on in his Department? This is no way to run the NHS. Today’s revelations call into question the motives, judgment and competence of the Health Secretary, and the House, doctors and patients deserve some answers.
Mr Hunt
That is a truly desperate attempt to divert attention from the single biggest question that people in this House want answered: does the Labour party support or not support a strike that will see the care of thousands of people up and down the country suffer?
Let me answer the hon. Lady’s question very directly. Yes, we are imposing a new contract, and we are doing it with the greatest of regret, because over three years—with three independent processes, 75 meetings and 73 concessions that we made in a huge effort to try to come to a negotiated settlement—the BMA refused to talk. With respect, I think Sir David Dalton, the trusted chief executive of Salford Royal, understands these things better than the hon. Lady has shown she does today. After working very hard, he concluded that a negotiated settlement was not possible. That is why I announced on 11 February that I would introduce a new contract.
As for foundation trusts, if the hon. Lady had listened to my statement she would know that it is true that foundation trusts have the freedom to introduce new contracts on pay and conditions. They can choose to exercise that freedom, but none of them has done so. She asked about non-foundation trusts. They do not have that freedom, and that is why we will be introducing a new contract for everyone.
Let me say this to the hon. Lady. There has been a lot of talk about this, but none of it as specious as the story that she planted in The Guardian this morning about the Government changing their position, which was absolute nonsense. We have not changed our position. The fact of the matter is that the Government have bent over backwards to avoid this strike. Right now, the people refusing to talk, whether it be on rota design with hospital managers or training reform with the academy, are not the Government but the BMA. Had it negotiated on Saturday pay, as it said it would, we would have had an agreement by now. Instead, we have a strike—the first ever withdrawal of emergency care in NHS history. [Interruption.]
Mr Speaker
Order. Opposition Members should calm themselves. The Secretary of State is responding, and everybody will be heard.
Mr Hunt
Rather than try to fabricate some story about the Government changing their position, which the hon. Lady knows perfectly well they are not, she might think about the words that do need to be said in this Chamber this week—about whether or not it is appropriate for the BMA to be telling people to deny life-saving care to patients.
Some people in the NHS have shown great courage in speaking out, even against their own profession: Professor Sir Bruce Keogh, the NHS England medical director, Lord Darzi, the former Labour Minister, and Dame Sally Davies, the chief medical officer. But there is one person on the public stage who has not had the courage to condemn those emergency strikes, and that is the shadow Health Secretary. I hope that, for the sake of her constituents and the reputation of the Labour party, she will say at the earliest opportunity that withdrawing emergency care in pursuance of a pay dispute is wrong, disproportionate and inappropriate, and that the right thing to do now is to show courage to reform these contracts for the benefit of patients and a seven-day NHS.
Mr Kenneth Clarke (Rushcliffe) (Con)
The BMA has always been a very militant trade union. It has had bitter political battles with just about every Secretary of State that the national health service has had since it started. It has, however, never previously contemplated strike action, withdrawing urgent services in pursuit of what is essentially a pay claim. I do not believe that before this year the Labour party would ever have supported the BMA if it had done so. Does my right hon. Friend agree that as the pressures on the NHS are obviously mounting, with the ageing population and the rising level of demand, it is urgent to move towards a fuller seven-day service, and that it would be totally wrong for him to delay that in the face industrial action or nit-picking legalisms from a shadow Secretary of State who has just discovered what the legal status of foundation hospitals actually is?
Mr Hunt
My right hon. and learned Friend speaks with huge wisdom and experience. He makes a point about what happened under previous Labour Governments. He might also have said that those were the same Governments that gave us the current badly flawed contracts. Because those previous Labour Governments did not stand up to the BMA and because they ducked difficult decisions, we saw the pay bill balloon and some shocking failures of care. Leadership is not just about talking and negotiating; it is also about acting. That is what Ministers have to do, and in this situation we have a very simple decision to make after three years of talks: do we proceed with the measures necessary to deliver a seven-day NHS and better care for patients, or do we duck those decisions? This Government choose to act.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Yet again, I must pull up the Secretary of State. It is not a case of excess deaths at weekends; it is a case of people admitted at weekends dying within 30 days. He said the same thing again today, and it is being repeated over and over.
The Secretary of State has described, within the same pay envelope, having more doctors at weekends, not fewer during the week, and reducing a maximum of 91 hours to 72 hours. I do not see how the maths of that can possibly add up. We are not managing to cover the rotas that we have, and those rota gaps pose a danger to patients.
I was very disappointed that the equality impact assessment dismissed the impact on women and other people who train less than full-time as acceptable collateral damage. We are facing the first ever all-out strike next week, and I cannot believe that we are not in negotiations. We should be at the table trying to prevent that strike. May I ask the Secretary of State how he plans to get us out of this? He should come back to the table, because that is the only way in which an impasse can ever end.
Mr Hunt
Let me gently ask the hon. Lady how long she expects us to sit round the table. We have been trying to discuss this for three years. She asked how the maths added up. I will tell her how the maths adds up. It adds up because we are putting an extra £10 billion, in real terms, into the NHS over the course of this Parliament. Conservatives put money into the NHS. The Scottish National party, incidentally, takes money out of the NHS.
The hon. Lady referred to the equality impact assessment selectively. She normally pays very good attention to detail, but the paragraphs from which she quoted related to changes that were agreed to by the BMA. What she did not quote was paragraph 95, which says that the overall assessment of the new contract is that it is “fair and justified” and will promote “equality of opportunity”. Why is that? Because shorter hours, fewer consecutive nights and fewer consecutive weekends make this a pro-women contract that will help people who are juggling important home and work responsibilities.
Sir Simon Burns (Chelmsford) (Con)
Does my right hon. Friend agree that, notwithstanding the appalling nature of the decision that, for the first time during strike action, junior doctors may not provide life-saving care for young children and other vulnerable patients, that decision is also totally incomprehensible, given that the doctors’ own leader has said that it is indefensible to take such action?
Mr Hunt
It is totally incomprehensible, and I know that many doctors will be wrestling with their consciences. However, I think that, in the context of the House, this could be an occasion for us to put aside party differences. I think that there was a time when Members in all parts of the House would have condemned the withdrawal of life-saving care in a pay dispute, but that day has sadly passed, and it is the Conservatives who must now show leadership in this regard. As we heard from my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), the NHS faces huge challenges, but we will not tackle those challenges if we allow obstructive unions to hold a gun to the Government’s head and refuse to allow us to proceed with really important changes—modern contracts that will allow safer care for patients and better terms for doctors. We are determined to do the right thing for the NHS, and, indeed, to be the party of the NHS.
Mr Dennis Skinner (Bolsover) (Lab)
If the Secretary of State wanted to do a deal with anybody, does he not think it is a bit unwise to say to my hon. Friend the Member for Lewisham East (Heidi Alexander) that she planted a story in a newspaper? That is accusing her of reprehensible conduct. I think he ought to be looking at withdrawing that. I am an expert on this subject. Somebody said to me on the picket line, “Do you know what sums up this Government, Dennis? ‘When first they practise to deceive’”—I had better not finish it. [Interruption.] “Oh what a magic web they weave, when first they practise to deceive.” That is what they are.
Mr Hunt
Well, if planting a story in a newspaper is reprehensible, I do not think many Members of this House would survive the scrutiny of the hon. Gentleman’s very high code of moral conduct for long. Let me say this to him and to all Labour Members: we should be honest about the problems we face in the NHS, whatever those problems might be, and we should not sweep them under the carpet. One problem that we face—not the only one—is the excess mortality rates for people admitted at weekends. There was a time when Labour Members would have recognised that their own constituents were the people who depended most on services such as the NHS and who had the most to gain from a full seven-day NHS. Labour Members should be supporting us, not opposing us.
Dr Sarah Wollaston (Totnes) (Con)
We are eight days away from an unprecedented full walkout of junior doctors, including the withdrawal of emergency care. Our constituents want to know whether they will be safe on the strike days. Will the Secretary of State and the shadow Secretary of State join me in calling on the BMA at least to exempt casualty departments and maternity units from this walkout? We know that, even with goodwill arrangements in place to bring people back in when hospitals are overwhelmed, the delays will cost lives.
Mr Hunt
As ever, my hon. Friend speaks very constructively on this issue. She is absolutely right to say that the departments at most risk are emergency departments, maternity departments and intensive care units. Those are the areas that we are most keen to ensure will maintain critical doctor cover over the two strike days that are planned. I really hope that the BMA will co-operate with NHS England as we identify where we think the gaps might be. We will share that information with the BMA and I hope very much that it will help us to plug those gaps with junior doctors, because in the end no one wants there to be any kind of tragedy. We all have a responsibility to work to ensure that that happens.
Stella Creasy (Walthamstow) (Lab/Co-op)
The Secretary of State will be aware that, when it comes to a medical diagnosis, words and clarity matter. The same applies to us as politicians. He has said today that he is imposing a contract, in contrast with what his legal team are saying to the doctors. For the avoidance of doubt, will he set out explicitly what legal powers he thinks he has to do that?
Mr Hunt
I am very happy to do so. We are introducing a new contract from this August, and it will be for all junior doctors. It will go progressively through the different ranks of junior doctors and, over the course of the next year, the vast majority of new doctors will move on to the new contracts. The reason that we did not use the word “impose” in the original statement was not a matter of semantics. We are proceeding with this new contract and everyone will move on to it, which is the gist of what most people mean by this. What we are not doing is changing existing contracts, so when people move trust or move to a new position, they will move on to a new contract. That is why we have used the term “introduction” of new contracts. However, it would have been much better if the introduction of the new contracts had been done through a negotiated process. That is why we took such trouble: we went to 75 meetings and made 73 different concessions in order to try to do this on a negotiated basis. Very regrettably, that proved not to be possible, which is why we took the difficult decision to proceed with these new contracts anyway.
Andrea Jenkyns (Morley and Outwood) (Con)
Does the Secretary of State agree that it is totally unjustified for doctors to demand higher premium rates at weekends when almost all other NHS workers, and indeed most other working people across the economy, do not get them? It is completely disrespectful for the BMA to suggest that doctors’ lives are somehow uniquely disproportionately inconvenienced by Saturday shifts and that those of other people are not.
Mr Hunt
It is true that the BMA rejected Saturday premium pay that was more generous than the Saturday premium pay offered to nurses, healthcare assistants or paramedics working in the same hospitals and operating theatres as those doctors. Many people will ask whether that was a reasonable position to take, given that the doctors’ overall pay was protected. I think they will also ask whether, even if the doctors disagreed with the Government on that point, it was appropriate or proportionate for them to withdraw life-saving emergency care from patients in the pursuance of their disagreement. I wonder whether that is something that will shape many people’s confidence in what the NHS stands for.
Angela Rayner (Ashton-under-Lyne) (Lab)
I have been disappointed by the Secretary of State, and by his language and tone, during this urgent question. Looking at how he has responded here, we can understand why the discussions and talks have ended up as they have done. He asked how long we should do this for; I would say, “As long as it takes.” The problem with the negotiations so far has been the Government’s failure to respond to the BMA and to work with junior doctors, who do care about their patients and do want to provide a good quality of care.
Mr Hunt
I think that sums up the difference between the two parties. It is true that Labour would take “as long it as takes” to negotiate the changes, which is why we ended up with poor contracts in 1999, 2003 and 2004. After three years of trying to get reforms to contracts to make the NHS safer for patients and better for doctors, we need to proceed with a manifesto commitment. Ministers have to decide and act as well as talk. We did not choose this outcome and tried hard for a negotiated decision, but when the hon. Lady says that talks should go on for “as long as it takes”, she is actually saying that the other party has a veto over change. No one should have a veto over an elected Government’s manifesto commitments.
Sir Nicholas Soames (Mid Sussex) (Con)
One thing that the whole House can agree on is that the postponement of treatment or operations is never cost-free for patients. Every hospital has an ethics committee, so does my right hon. Friend agree that all striking doctors should consult their hospital’s ethics committee? Does he agree that the removal of emergency cover by any doctor for industrial reasons would be unlikely to meet with the approval of any medical ethic committee? Finally, does he agree that it is unacceptable for any doctor to act unethically, and that that would place him or her in serious jeopardy?
Mr Hunt
My right hon. Friend speaks wisely. A whole chorus of senior doctors, from Professor Sir Bruce Keogh to Dame Sally Davies to Lord Darzi, have urged doctors to think hard about the ethics involved. My right hon. Friend is absolutely right to say that consulting the ethics committee in the trust is a wise thing to do. Doctors might also take note of what the General Medical Council said about it being increasingly difficult to justify the withdrawal of emergency care and about the ethics involved. In the end, this is a personal decision for doctors, and it is about whether it is right to withdraw emergency care from patients in an industrial dispute about pay. This is a bridge that the NHS has never crossed before. It is a very big decision, not only for the NHS, but for every single doctor inside it.
John Cryer (Leyton and Wanstead) (Lab)
On the basis of the Secretary of State’s previous comments, and particularly his opening comments, is he absolutely confident that he has the legal power to impose the new contract?
Mike Freer (Finchley and Golders Green) (Con)
In November, the BMA promised to negotiate on Saturday pay. Has it kept that promise?
Mr Hunt
No, it has not. If it had, I do not think that we would be having a strike. I think we would have a negotiated settlement, and the NHS would be able to proceed with the contracts, which have important benefits for doctors, such as reducing the number of consecutive nights or consecutive long days that they can be asked to work. The refusal to negotiate on the crucial issue of Saturday pay, which is not a reduction in take-home pay because the reduction in Saturday premiums was made up for with an increase in basic pay, was what led Sir David Dalton to say that a negotiated settlement was not possible. It is a matter of huge regret, but I am afraid that it leaves the Government with no option but to proceed in the way that we are doing.
Jack Dromey (Birmingham, Erdington) (Lab)
A senior executive at Babcock once said to me that there are employers who could pick a fight with themselves. During 30 years in the world of work, I cannot remember a legitimate sense of grievance so grotesquely mishandled. Does the Secretary of State not recognise that he is poisoning relationships with a generation of junior doctors? Will he not get back to the negotiating table and stay there until the dispute is resolved?
Mr Hunt
Without going over the previous points about the three years we have been around the negotiating table, I just say this to the hon. Gentleman: I think there are legitimate grievances for junior doctors, and they extend well beyond the contract. There are some big issues with the way training has changed over the years, and there are some serious issues we need to address about the quality of life for junior doctors—sometimes they have a partner working in a different city and they are unable to get training posts nearby to each other. We want to address those issues, which is why we set up a review, led by Professor Dame Sue Bailey, the president of the Academy of Medical Royal Colleges. Who is refusing to talk to that review, and refusing to co-operate with it? It is the BMA. That is why it is so important that people get around the table and start to talk about how we resolve these problems, rather than remaining in entrenched positions.
Maggie Throup (Erewash) (Con)
Can my right hon. Friend confirm that the new contract provides a far better work-life balance than the current contract, which doctors tell me cannot even help them to provide and plan for important family events?
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.
Dr Julian Lewis (New Forest East) (Con)
I know that the BMA very properly balloted its members before embarking on a policy of industrial action, but has it yet balloted junior doctors on the specific question of withdrawing emergency cover?
Tom Brake (Carshalton and Wallington) (LD)
Does the Secretary of State accept that we need closure on the junior doctors’ strike, for patients and for doctors, to enable the NHS to concentrate on issues such as the projected £8 billion shortfall in the NHS; the GP out-of-hours services, which are under real pressure; the worst ever NHS performance in the first month of this year; and the long-term threat to the financial viability of our whole health and social care system?
Mr Hunt
We do face many challenges; the right hon. Gentleman is absolutely right to say that we need to focus on those, and so the sooner we resolve this dispute with the BMA, the better. I simply say to him that if we were to carry on negotiations that were clearly not going anywhere at all, this dispute would go on for even longer. We have been trying to resolve these issues for a very, very long time, and in the end one has to decide if one is going to do what it takes to move forward.
Sir Peter Bottomley (Worthing West) (Con)
Mr Speaker, if every one of the 650 MPs came to you and said that one of their constituents was dying unnecessarily every five weeks—that is the lower estimated number of excess deaths; it would be once every two weeks at the higher estimated number—I would hope that you would grant this kind of debate every day until we had a system that was safer for patients and junior doctors, and until we brought into the open the nameless characters behind the BMA negotiators. They refuse to come out into the open and argue their case on its merits, and to say why they will not discuss Saturday pay.
Mr Hunt
My hon. Friend is absolutely right. Part of the hallmark of this Government’s approach to the NHS has to be honesty about where we have too many avoidable deaths, and where there is the weekend effect for people admitted to hospital at the weekends. We have a big responsibility in that regard. The reason why we discharge that responsibility is that we believe in the NHS. We want the NHS to be the safest, highest-quality system in the world. Just as this Government have pioneered reforms that have dramatically improved the quality of state education, so too we need equal reforms in the NHS. That is why it is absolutely right to say that we have to focus on these things and debate them in this House. We should not automatically say that there is someone who must be blamed when we are dealing with these difficult situations. Unfortunately, one of the things that has led to feelings running high in this dispute has been the sense of blame being tossed around, when what the Government want to do is try to solve the problem.
Mike Gapes (Ilford South) (Lab/Co-op)
May I tell the Secretary of State about my admission to hospital in the early hours of a Saturday morning? I spent five and a half weeks in intensive care. I had many conversations with doctors during the time I was in St Mary’s hospital, Paddington. I ask him to look at the circumstances of those doctors today, as they do work weekends. We do have a weekend NHS. It is not true to say that the lives of people like me who are admitted at the weekend are not saved, because it is the doctors who make it possible for us to survive. Will he stop talking down the medical profession and start defending the doctors?
Mr Hunt
With respect, that precisely encapsulates the problem. The hon. Gentleman has interpreted the fact that I want to do something about excess mortality rates, which mean that a person admitted at the weekend has an 11% to 15% higher chance of death than if they were admitted in the week—that is proven in a very comprehensive study—as an attack on the medical profession. Nothing could be further from the truth. It was actually the medical profession—the royal colleges and Professor Sir Bruce Keogh—that first pointed out this problem of the weekend effect. We are simply doing something about it.
Dr Andrew Murrison (South West Wiltshire) (Con)
The Health Secretary rightly mentioned the excellent Salford Royal, which the BMA has used to suggest that the new contract is not necessary, because of the progress that it has made on seven-day working and on Sir Bruce Keogh’s clinical standards. However, is it not the case that what might be right in a large hospital in a densely urban centre might not be applicable right across our national health service? Is that not why the very radical changes to working practices that he is rightly prosecuting are necessary?
Mr Hunt
Yes, there are some hospitals that have managed to eliminate the difference between weekend and weekday mortality under the current contracts, but there are only a few. Having talked more widely with the medical profession, it is clear that we need a sustained national effort—contract reform is part of that effort—if we are to promise uniformly across the NHS that we will provide every patient with the same high-quality care, every day of the week. Part of that is having a modern contract for junior doctors that deals with the anomalies that they themselves recognise in the current contract; that is why this is the moment for wider reforms.
Jenny Chapman (Darlington) (Lab)
This is clearly a fight that the Secretary of State went looking for because he expected to put himself on the side of the patients. The trouble is that it has not worked out like that, because the patients, such as my hon. Friend the Member for Ilford South (Mike Gapes), use these services and know that junior doctors are in work at the weekend; it is some other procedures that are sometimes not available. Their feelings now will be fear and anxiety that they, their children or their elderly relatives will get sick, fall or need help on strike day. They will be seriously, seriously worried about that. Does the Secretary of State take any responsibility for the situation that he has caused?
Mr Hunt
On the contrary, I take full responsibility for delivering a safer NHS for patients. That is my job. If the hon. Lady wants to talk about patients, perhaps she might listen to the comments of one of the most famous patient safety campaigners in the country, James Titcombe, who tragically lost his son because of mistakes made at Morecambe Bay. He said that there has been
“much progress towards a safer NHS in recent years”,
but that there is
“much more to do to reverse the cover-up culture that flourished under Labour.”
Andrew Bridgen (North West Leicestershire) (Con)
Can my right hon. Friend confirm that on the last occasion that the BMA called on junior doctors to take strike action, that call was rejected by 47% of junior doctors? Now the BMA wants junior doctors to remove emergency cover. What does he think it will say about the BMA’s mandate for future action if fewer than half of junior doctors support its call for further strikes?
Mr Hunt
That is a very important point to make. On the BMA’s mandate for the current strike action, many hon. Members have said today that we should get round the negotiating table. They may not be aware that the BMA decided to ballot for strike action before even sitting down to talk to the Government about our plans. It decided to go straight to a ballot for industrial action on a false prospectus of the Government’s planned changes. That sowed many of the misunderstandings in the current dispute.
Greg Mulholland (Leeds North West) (LD)
Like most hon. Members, I have had many doctors coming to my constituency surgery—not junior doctors, but registrars, on whom our hospitals rely. They have sometimes been in tears. They have asked me if the Secretary of State will define exactly what he means by a seven-day NHS, because clearly there is seven-day care. Is it just an ideological mantra?
Mr Hunt
I am not sure what the hon. Gentleman’s definition of “ideological” is. If “ideological” is giving safer care to patients, it is an ideology that we can all share, but I will tell him exactly the answer to his question, which he can relay to his constituents. What we want to do is reduce the difference between the mortality rates for people admitted in the week and at weekends. We have identified four key clinical standards that we believe are necessary to do that. It is by making sure that we can deliver those four clinical standards across the NHS that we will deliver this strategy.
Christopher Pincher (Tamworth) (Con)
Can my right hon. Friend imagine the distress and the anxiety felt by constituents who have come to see me over the past six years because they are concerned about the treatment of their relatives admitted at the weekend, when they see the BMA and the Labour party appearing to use them and other patients as hostages in a long-running dispute that must come to an end?
Mr Hunt
My hon. Friend is right. What patients want is a safe NHS where it does not matter on which day of the week they are admitted if something goes badly wrong. The big surprise here is that this is not something that the whole House can unite behind. It is something that people who believe in the NHS, as I think we all do, should strongly support. We are standing up for those patients, and I hope Labour, the party that founded the NHS, might do the same.
Valerie Vaz (Walsall South) (Lab)
I would be grateful if the Secretary of State could update the House on any legal action against the Department, and on whether the Department will be defending it.
Maria Caulfield (Lewes) (Con)
I, too, have been contacted by a number of junior doctors who are increasingly disillusioned by the way that the BMA is handling the dispute, and especially by the militant tendency, which has been hell-bent on strike action for many months. Will the Secretary of State meet other groups of junior doctors who want to resolve the dispute, recognise that a reformed contract is needed, and want to get back to looking after patients?
Mr Hunt
Of course I am delighted to engage with junior doctors, and I have been talking to a number of them over recent months. I agree with my hon. Friend. My observation from talking to junior doctors is that most of the time I am with them, they are not talking about things they do not like about the new contracts. They are concerned about things to do with their training and quality of life—things that I think we can sort out outside the current contractual negotiations. As my hon. Friend has correctly been passing on to them, there are many things in the new contract that will benefit junior doctors, and we should make sure that everyone knows about them.
Margaret Greenwood (Wirral West) (Lab)
How can the Secretary of State claim that he is motivated by a desire for a seven-day NHS when he and others in the coalition Government legislated to allow hospitals to make up to 49% of their money from private patients? If hospitals achieve that 49%, what impact will that have on mortality rates for NHS patients?
Mr Hunt
The difference between those of us on the Government side of the House and those on the Opposition side is that we do not have an ideological view about a trust wanting to offer some private treatment in order to benefit its NHS patients. That is what some trusts are doing, within very strict constraints. I think that most people know that all the scare stories that were put out about the Health and Social Care Bill in 2012 have not materialised. We are finding that trusts are being very sensible about making sure they get that balance right. Indeed, in certain circumstances it makes a big difference to improving NHS care.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
The key thing is looking after patient safety, so will my right hon. Friend consider changing the law so that hospitals such as Derriford hospital can make use of dedicated military doctors to fulfil that service if it is needed?
Mr Hunt
My hon. Friend always makes important suggestions that can benefit his constituency, and rightly so. I do not think that there is a need to change the law for that to happen; if military help were needed, I think the military would stand ready to offer it. At the moment, we are making contingency plans by drawing on the consultant workforce, who are not involved in industrial action, and our hope is that A&E departments throughout the country will be covered by that extra support.
Jim Shannon (Strangford) (DUP)
If the Health Secretary is unable to impose the original contract, how can people be expected to abide by a new contract that is not legally binding? Does he agree that maintaining a constant approach is absolutely vital, particularly in a fifth walkout, which could involve everyone? What actions is he taking to restore faith in the NHS among both the staff and the general public?
Mr Hunt
Just to be absolutely clear, the new contract is legally binding and it will apply to all junior doctors in the NHS. On restoring confidence, obviously morale is low at the height of an industrial relations dispute. I think the real way to restore confidence is to point out to the doctors who work incredibly hard inside the NHS that the Government are this year giving the NHS the sixth biggest funding increase in its history, that we are committed to making the NHS the safest and highest-quality system in the world, and that we believe that if that happens it will also be a better place for them to work. I believe that all those things will come together, but obviously there is a very difficult period that we have to get through first.
Mr Philip Hollobone (Kettering) (Con)
Against the background of Kettering general hospital being under huge pressure, there is a great deal of local sympathy for junior doctors, but increasingly people are bemused as to what the strike is about, given that the contract involves a reduction in hours from 91 to 72 and a 13.5% increase in basic pay. My constituents are opposed to strike action, and they are completely opposed to any strike action that involves the withdrawal of emergency cover.
Mr Hunt
My hon. Friend is absolutely right, and I am sure that that position is shared by many members of the public. I think people are very perplexed, because both sides in the January negotiations concluded that there was only one area of outstanding difference, which was Saturday pay. I adopted a compromise position on Saturday pay, which I thought was the fairest thing to do, but the BMA was not prepared to countenance any flexibility on that whatsoever. I therefore had to make the very difficult decision of whether we go forward, or whether we do not address the big issues that we need to address for a seven-day NHS. I share his concern about whether the strikes are really worth it, and I am concerned about the impact on the residents of Kettering.
Jo Stevens (Cardiff Central) (Lab)
If the Secretary of State is correct that he has the legal power to impose contracts, can he tell the House from where that power derives? Can he also explain why the Government’s legal team failed to argue that case?
Mr Hunt
I hope the hon. Lady understands that I am not going to go into the details of the legal cases that we are currently arguing. However, let me make it clear that the Secretary of State does have that power and that we are using it correctly, and we will argue that case very strongly in the High Court.
Helen Whately (Faversham and Mid Kent) (Con)
Many hundreds of operations were cancelled during the last strike. The next strike will see the unprecedented step of emergency cover being withdrawn, and many junior doctors are themselves worried about that. Does my right hon. Friend agree that it is time for the BMA’s leaders, who are calling for the strike, to heed the worries of those junior doctors and of patients, and to call it off?
Mr Hunt
I absolutely agree. It is entirely legitimate to disagree with the Government of the day about contract reform—we have tried to make the case as to why that reform is important—but it is wrong for patients to pay the price for that disagreement. While the NHS can cope with the withdrawal of labour for elective care, it is a much bigger deal when emergency care is withdrawn, and people throughout the NHS are extremely worried about the impact of that. Doctors should also worry about how the public will view their profession if they proceed with this wholly unnecessary step.
Liz McInnes (Heywood and Middleton) (Lab)
I am glad the Secretary of State has come to the Chamber to answer the urgent question—I witnessed for myself his eagerness to get here as he sprinted across Portcullis House.
There is a real lack of clarity in this debate. “Agenda for Change” staff get paid a premium rate for working unsocial hours. Foundation trusts’ freedom to set rates allows them only to improve conditions and pay, not to diminish them. May I add that 98% of those who voted in the BMA’s ballot supported industrial action, including the full withdrawal of labour? May I suggest that the Secretary of State arm himself with the facts and get back round the negotiating table?
Mr Hunt
The hon. Lady is right that I sprinted here—I was a little concerned that Defence questions might not last the full hour, although they did, and I am sure Mr Speaker is pleased about that. The point I would make about the ballot, which did receive the overwhelming support of junior doctors, is that it happened before they knew what the deal on the table was. On the heated issue of Saturday premium rates, we ended up with a proposal where the Government agreed to pay premium pay on Saturdays for any doctors who work one Saturday or more a month. At the moment, therefore, we have this extreme step—the withdrawal of emergency care—to boost the pay of doctors who work less than one Saturday a month. I think many members of the public will say that that is not proportionate.
Graham Evans (Weaver Vale) (Con)
Let us be clear: this is an old-fashioned wage dispute, run by one of the most militant long-standing trade unions. My constituents are asking why the highest-paid NHS workers should be paid extra for working Saturdays when some of the lowest-paid NHS workers are not.
Mr Hunt
My hon. Friend is right. Doctors who strike will need to explain that to paramedics, healthcare assistants and nurses working in their own operating theatres. In the end, that issue is why this strike is happening. The BMA said in writing in November that it would negotiate on Saturday pay; it went back on its word in February. As a result, this is the only outstanding issue, and we now have this extreme step—the withdrawal of emergency care. I find that very hard to justify.
Andy Slaughter (Hammersmith) (Lab)
At the beginning, the Secretary of State said he was publishing a model contract, which he believed trusts, including foundation trusts, would by convention implement, but he has subsequently said that there is a legal duty that he can impose. He needs to clarify that, and it would be helpful if he could publish the legal advice. That would not be a surprise in the judicial review cases, because his lawyers are presumably doing their skeleton arguments. We have a right to know the answers to these questions.
Mr Hunt
With respect, all the hon. Gentleman needs to do is look in Hansard at my response to the urgent question, which made it clear that we have the right to introduce a new contract. On the basis of the conventions that currently apply in the NHS, that contract will apply to all junior doctors. Foundation trusts do indeed have the right to set their own terms and conditions, but they choose not to do so.
Alex Chalk (Cheltenham) (Con)
This unprecedented withdrawal of emergency care seems to revolve principally around the issue of pay on Saturdays. Will the Secretary of State clarify whether pay uplifts will continue to be available to junior doctors who work regular Saturdays?
Mr Hunt
Absolutely. More to the point, any doctors who see an increase in their Saturday workload will see a significant increase in their pay, including their premium pay. The contract is designed to make sure that we reward people who work the longest and most antisocial hours, including women, but in a way that means that we can afford to deliver a seven-day NHS, which is why it is good for patients as well.
Paul Flynn (Newport West) (Lab)
Many weekend admissions are for urgent cases such as heart attacks and strokes, while many weekday admissions are for elective surgery and other non-life-threatening conditions. Is not that the main reason for the myth of excess weekend deaths?
Why will the anxiety of this strike be felt only by patients in England, while the other nations have settled? Is it because of bad negotiation or because the health service is never really safe in Tory hands?
Mr Hunt
I wonder whether the hon. Gentleman would have the courage to say that in Wales, but let me answer his question directly. The 15% increase in mortality rates for people admitted at weekends falls to 11% when we take account of the more chronic conditions, so there is a small reduction, but the mortality rate is still significant.
Toby Perkins (Chesterfield) (Lab)
May I take the Secretary of State back to the question he did not answer when it was asked by my hon. Friend the shadow Secretary of State? If the Government are now arguing that the Secretary of State does have the power to impose a contract, can he explain why Government solicitors did not argue that case in their letter of 15 April? Can he point to where it is proved that he actually has that power?
Mr Hunt
We do have that power by law. The letter we put out in defence against the legal action that has been taken against the Government explains very clearly why and how we have that power. It is all written there for the hon. Gentleman to see. I assure him that, on something as contentious and difficult as this, we take every care to make sure that we are acting within the law.
Nic Dakin (Scunthorpe) (Lab)
If I were Secretary of State for Health, I would feel personally responsible for this unprecedented action taking place on my watch, and I would do everything I could to build bridges to make sure it did not happen and that patients were not threatened in the way we all fear. What is the Secretary of State doing to build trust between himself and the NHS workforce?
Mr Hunt
I will tell the hon. Gentleman one of the things we are doing, which is turning around the hospital in his own constituency, which is no longer in special measures because the quality of care has improved dramatically. What else are we doing? Over three years, there have been 75 meetings, 73 concessions and three different independent processes. We have tried everything to get a negotiated outcome, but in the end we have to do the thing that is right for patients.
Rachael Maskell (York Central) (Lab/Co-op)
The Secretary of State needs to face reality: there is a recruitment and retention crisis of junior doctors in paediatrics, A&E, intensive therapy units and acute medicine. Those specialisms demand seven-day working and people working unsocial hours. The junior doctors know that these contracts will make the situation worse, so why is the Secretary of State not doing everything in his power to get people to sit around the table—even if that does not include him personally or David Dalton—to have negotiations to address the real issues concerning junior doctors?
Mr Hunt
That is exactly what we have been doing. Indeed, there are a number of changes in the contracts that will be beneficial for people working in A&E departments, as has been recognised by the president of the Royal College of Emergency Medicine, Cliff Mann. The difficulty we have had in terms of morale is that we have been faced with the BMA, which has consistently misrepresented the contents of the new contract to its own members. Nothing could be more damaging for morale than that. What we will need to do, I am afraid, is wait until people are on the new contracts, and then they will actually see that they are a big improvement on their current terms and conditions. That is the right thing for doctors and the right thing for patients.