Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 10th May 2016 Commons Chamber

[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.

[John Pugh]

I thank the Secretary of State for his answer. I do not share his optimism. Is not the real problem the shortage of permanent staff and the budgetary constraints on the acute sector? Most of them are now below establishment.

[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.

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[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—]

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[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?

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[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?

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[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?

[Mr Hunt]

Yes, I am happy to do that. I have a number of community hospitals in my own area. It is really important that even as the functions and jobs that community hospitals do inevitably change, we recognise that they have a very important long-term future in the NHS.

[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?

[Mr Hunt]

We are making sure that neighbouring hospitals have the resources to deal with the temporary closure of Chorley A&E. The more patients that any hospital sees, the more resources it gets. This is none the less a very worrying situation that we are monitoring very closely.

[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?

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[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

Monday 25th April 2016 Commons Chamber

[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?

--- Later in debate ---

[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?

--- Later in debate ---

[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 Hunt]

We are taking serious action to bring that deficit down. In particular, one thing we need to do to do that is to reduce the use of agency staff. That will help with the provision of more full-time staff in the NHS, which will be good for the junior doctor workforce.

[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.

[Mr Hunt]

Had Nye Bevan given way to the BMA there would be no NHS.

[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?

[Mr Hunt]

My hon. Friend—the one Conservative who signed up to that proposal—when he was Health Minister proposed a contract that was much tougher on junior doctors than the contract we have ended up introducing. This has been a very interesting U-turn on his part.

[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?

[Mr Hunt]

No health statement would be complete without a mention by my hon. Friend of the important role that pharmacies can play in solving absolutely any problem that the NHS faces. Once again, I commend his excellent contribution.

[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

Monday 18th April 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the 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?

--- Later in debate ---

[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.

--- Later in debate ---

[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?

--- Later in debate ---

[Mr Hunt]

Yes.

[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?

[Mr Hunt]

No, it has not, and I think that is what is causing many junior members to pause for thought. Many people say that this escalation is something that the BMA should consults its members on, once again.

[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?

--- Later in debate ---

[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.

[Mr Hunt]

We have two cases ongoing, and we are defending them vigorously.

[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.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Kirsten Oswald (East Renfrewshire) (SNP)]

4. Whether the terms and conditions of the junior doctors contract were finalised before he took the decision to introduce that contract.

[The Secretary of State for Health (Mr Jeremy Hunt)]

May I start by echoing the thoughts of my the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), for the people of Brussels, with whom we stand shoulder to shoulder?

In my statement to the House on 11 February, I gave a broad outline of the new terms for doctors and dentists in training, which were recommended as fair and reasonable by Sir David Dalton. I am still reviewing the exact terms, alongside the equality impact assessment, and finalised terms will be published shortly.

[Kirsten Oswald]

When the Secretary of State declared that he was imposing the contract on junior doctors last month, he claimed the support of senior NHS leaders, many of whom subsequently denied supporting his position. Given that foundation trusts are free to offer their own terms, how does he envisage enforcing that contract?

[Mr Hunt]

We consulted widely with NHS leaders about the terms of the new contract, and they confirmed that it was fair and reasonable. Any decision to proceed with a new contract when it is not possible to have a negotiated settlement is inevitably controversial, but we wanted to ensure that independent people thought that the terms of the contract were fair. I think we have done that, and when junior doctors see their new contracts—as they will do shortly—they will realise that we were right to say that.

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

Underlying the dispute over the junior doctors contract is a long-standing problem of morale among junior doctors, and a failure to pay enough attention to their experiences in training. I welcome the Government’s decision to launch an independent review led by Professor Dame Sue Bailey, and I ask my right hon. Friend to update the House on the progress and timing of that review.

[Mr Hunt]

As ever, my hon. Friend speaks with great knowledge about NHS matters, and she is right to say that some of the underlying issues have nothing to do with contractual terms but are about very big changes in the way that training has happened over recent years, in particular the loss of the firm system and the sense of camaraderie that was part of the deal for junior doctors in training. We would like to see whether we can rectify some things that have gone in the wrong direction, but we have not yet had the co-operation of the British Medical Association for that independent review, which is led by the highly respected Professor Dame Sue Bailey. I hope that the BMA will co-operate with that, because it is a big opportunity to sort out some long-standing problems.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

There are currently 4,500 gaps for trainees in the NHS. Junior doctors often have to cover those gaps, which can mean having to do extensive extra shifts, or even covering two roles at the same time. It looks as if that situation will get worse, because fewer than half of the most junior trainees have applied for ongoing training this year. Does the Secretary of State accept that that represents a serious threat to patient safety?

[Mr Hunt]

The purpose of the changes is to improve patient safety, and particularly to deal with the issue that we have higher mortality rates for people who are admitted to hospital at weekends than for those admitted during the week. Because of the confrontational approach taken by the BMA, it has been difficult to negotiate an agreement, but we are committed to doing the right thing. What is right for patients is also right for doctors. We have been talking about morale, and the biggest way to dent doctors’ morale is to prevent them from giving the care that they want to give patients, so we must sort that issue out.

[Dr Whitford]

I suggest that what is good for doctors is also good for patients, and if people are being texted four or five times a day and asked to do a second shift to cover for a junior and a senior post at the same time, that is not good for either. On 11 February the Secretary of State said that he was imposing the contract to bring stability to the NHS, but that has not exactly gone well. What is his plan to re-establish his relationship with junior doctors and get us back out of where we are now?

[Mr Hunt]

With the greatest respect, we are trying to solve a problem that in Scotland is being ducked. We want a seven-day NHS with mortality rates that are no higher at weekends. There is no plan in Scotland to deliver that across the whole NHS. Rather than sniping, the hon. Lady should recognise that, in the interests of patient safety, we need to take difficult decisions. In the end, doctors will see that it is the right thing for them, too.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

First, on behalf of the Opposition, I associate ourselves with the comments made by Ministers about the tragic events in Brussels, and offer our condolences and solidarity to the people there.

Yesterday in Westminster Hall, there was a debate calling on the Health Secretary to resume meaningful contract negotiations with the BMA. The Health Secretary was not there—I do not know, but perhaps he was out buying a leaving present for the Chancellor—but if he had been, he would have heard his junior Minister confirm that, since the announced imposition, the Government have made no attempt to prevent further industrial action. They know more industrial action is coming. Do they not owe it to patients who would be inconvenienced by further strikes to get off their backsides and do something to prevent it?

[Mr Hunt]

The reason we made the decision to proceed with the new contracts is that we had independent advice that a negotiated settlement was not possible. On that basis, we decided that it was important to have certainty for the service by making clear what the new contract is. The contract that we decided on is one that strikes a mid-point between what the Government wanted and what the BMA asked for. It is a fair contract and a better contract for patients. The Labour party would support it if it was really on the side of patients.

[David Rutley (Macclesfield) (Con)]

5. What steps the Government is taking to improve support for children and young people with mental health problems.

--- Later in debate ---

[Kelvin Hopkins (Luton North) (Lab)]

9. How much was spent on healthcare as a proportion of GDP in (a) 2009-10 and (b) 2014-15; and what estimate he has made of the amount that will be spent on healthcare as a proportion of GDP in 2020-21.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Because in 2010 the country faced a deficit that constituted 11% of GDP, all major political parties committed to plans that reduced Government spending, including on health, as a proportion of GDP. However, because of this Government’s commitment to the NHS, health spending as a proportion of Government spending will increase from 14.2% to 15.8% over the decade.

[Kelvin Hopkins]

Former coalition Minister David Laws has recently written that under the previous Government the NHS chief executive told Ministers that the health service required an additional £30 billion, and that he was forced to cut that figure and squeeze it down to £15 billion, but was allocated only £8 billion by the Treasury. That was a savage cut of £22 billion to what the NHS really needed. Is that not the root cause of all the NHS’s problems, and does it not make utter nonsense of the Government’s claim to be protecting NHS funding?

[Mr Hunt]

What the hon. Gentleman describes as a “savage cut” was a real-terms increase of £10 billion a year, which was £5.5 billion more than his party proposed as part of the platform he stood on at the last election.

[Nigel Huddleston (Mid Worcestershire) (Con)]

16. Does my right hon. Friend agree that as well as focusing on health inputs and how much we spend on the NHS, it is also important that we focus on health outcomes?

[Mr Hunt]

My hon. Friend is absolutely right, which is why I am so proud that under this Conservative Government we have put 27 hospitals into special measures, 11 of which have now come out of special measures. We are improving the standard and quality of care, and increasing the number of people being treated across the board. Outputs matters, and that is what this Conservative Government will deliver.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary may talk a good game on funding, but the reality in A&E departments and GP surgeries tells a very different story. The whole system is on its knees, and the revelations of the former Chief Secretary to the Treasury this weekend confirmed what everyone in the NHS already knew—making £22 billion of efficiency savings over the next four years is pure fantasy. In the interests of transparency, therefore, will he now publish the full analysis explaining how NHS England arrived at the figure of £22 billion?

[Mr Hunt]

Let us look at what the chief executive of NHS England, Simon Stevens, actually said, and not what he is alleged to have done, which he denies. He said that, when it came to the spending review, the Government had listened to and actively supported the NHS’s case for spending and that he could kick-start his plan for the NHS. But it is rather academic—is it not?—because Labour refused to fund his plan at all, which all goes to show, when it comes to the NHS, that Labour writes the speeches but Conservatives write the cheques.

[Heidi Alexander]

I did not ask the Health Secretary what the chief executive of the NHS said. I asked the right hon. Gentleman to publish the analysis behind the £22 billion figure, but he will not do so because he knows that the only way to achieve these politically motivated efficiencies is by making cuts to staff and pay. The truth is that the NHS survives on the good will of its staff, yet he has pushed that good will to breaking point. How does he expect to improve current services, let alone deliver a seven-day NHS, with fewer staff and a demoralised workforce?

[Mr Hunt]

Under this Government, staff levels have actually risen: we have 11,000 more doctors and 12,000 more nurses. If the hon. Lady is worried about NHS funding, perhaps she might look in the mirror, because in 2010 her party wanted to cut funding to the NHS—in Wales, it actually did cut it—and in 2015 it wanted £5.5 billion less than the Conservatives. The NHS does not need Labour rhetoric; it needs more doctors and more nurses, which we can have only on the back of the strong economy that only the Conservatives can deliver.

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

10. What recent assessment he has made of staff morale in the NHS.

--- Later in debate ---

[John Stevenson (Carlisle) (Con)]

12. What progress his Department has made on improving the performance of hospitals in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Trusts put into special measures have recruited 1,363 more doctors and 4,190 more nurses, with one estimate saying that this has reduced mortality rates by up to 450 a year.

[John Stevenson]

In the past six years, the North Cumbria University Hospitals NHS Trust has had four chief executives, an acquisition that is going nowhere and a so-called success regime that is reporting later than intended. There are clearly tough decisions to be made in the north Cumbria health economy, and the sooner they are made, the better. Will the Secretary of State undertake to ensure that the recommendations of the success regime are implemented in full and in a timely manner?

[Mr Hunt]

I thank my hon. Friend for his persistent campaigning on behalf of his local trust. He is right that there are big issues there. He is also right generally that the NHS has too rapid a turnover of chief executives. There is a new one, Stephen Eames, who is one of the top-rate NHS chief executives. The Care Quality Commission says that things are improving and mortality rates are going down. I will support my hon. Friend in every way I can to resolve the situation as quickly as possible.

[Valerie Vaz (Walsall South) (Lab)]

As the Manor hospital is in special measures, Walsall mothers-to-be are being denied the right to choose to have their babies at that hospital. Will the Secretary of State confirm that there are safe staffing levels at the Manor and at other hospitals?

[Mr Hunt]

What I can tell the hon. Lady is that we have 83 more doctors and 426 more nurses at Walsall Healthcare NHS Trust than we did in May 2010. The trust has a quality improvement plan, and it has had an improvement director since February.

[Alex Cunningham (Stockton North) (Lab)]

13. What recent representations he has received on the future funding of mesothelioma research.

--- Later in debate ---

[Dr Andrew Murrison (South West Wiltshire) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The latest performance figures show the challenges that the NHS faces in coping with extraordinary levels of demand. Despite these pressures, however, the Government are making good progress in our ambition that NHS care should be the safest and highest quality in the world. Figures from the Health Foundation show that the proportion of patients being harmed has fallen by more than a third in the past three years, that MRSA infections have nearly halved since 2010, and that C. diff infections fell by more than a third over the same period.

[Dr Murrison]

The “Five Year Forward View” said that the NHS would need between £8 billion and £21 billion extra from the Treasury by 2021. It got a commitment of £8 billion, which was opposed by the party opposite. Can the Secretary of State say when the Stevens plan will be formally reviewed, and where in the range between £8 billion and £21 billion he expects the real requirement will be found to lie?

[Mr Hunt]

We are actually putting in £10 billion of additional public money to support the NHS over the next few years. That means that we need to find between £20 billion and £22 billion of efficiency savings. We will be reviewing the progress of the plan as we go through it, but I want to reassure my hon. Friend that I meet the chief executive of NHS England to view the progress of the plan every week and that we are absolutely determined to ensure that we roll it out as quickly as possible.

[Margaret Greenwood (Wirral West) (Lab)]

T4. I would like to express my sadness at the news that two people in my constituency lost their lives in a house fire yesterday. My thoughts are with their family and friends at this extremely sad time. The coalition Government legislated for NHS hospitals to earn up to 49% of their money from private patients. Arrowe Park hospital in my constituency is highly valued by local people for the service that it delivers, so for the sake of clarity will the Minister tell us whether he sees an increase in the number of NHS beds being used for private patients and a decrease in the number being used for NHS patients as a sign of success or a sign of failure?

[Henry Smith (Crawley) (Con)]

T3. In the last decade, under the then Labour Government, Crawley hospital saw its accident and emergency and maternity units close. However, I am pleased to say that in recent years we have seen casualty services returning, as well as the introduction of a GP out-of-hours service and a greater number of beds. Will my right hon. Friend join me in congratulating the NHS staff in my constituency who are working so hard to deliver these new services?

[Mr Jeremy Hunt]

I am absolutely delighted to join my hon. Friend in congratulating the staff in his constituency. A&E targets there have been met in the year to date: at the moment they are seeing 36,509 more people in under four hours every year compared with six years ago. The trust is meeting its 18-week target and its diagnostic waiting time target, so that is a very good performance.

[Ian Blackford (Ross, Skye and Lochaber) (SNP)]

T8. Scotland has consistently outperformed all other nations in the UK on A&E over the past year. With England’s performance dropping in every single month since weekly publication was abandoned last July, does the Secretary of State think it is time to return to more frequent analysis and to eliminate the obfuscation of the six-week delay in publication?

[Mr Hunt]

I am somewhat surprised at the complacency of the hon. Gentleman’s question after Audit Scotland identified in the autumn that performance against seven of the nine key targets for the Scottish NHS had deteriorated in the past three years, that spending since 2009 had fallen in Scotland while increasing in England, and that spending on private sector providers was increasing. The hon. Gentleman should think about that before he criticises what is happening in England.

[Dr Tania Mathias (Twickenham) (Con)]

T5. Successful cardiopulmonary resuscitation often involves people knowing where the nearest public access defibrillator is located. In my constituency, however, it is difficult to find out exactly where such defibrillators are located. Will the Minister ask the Department of Health to carry out a live mapping of public access defibrillators as well as ensuring that every workplace with a first aid point has a clear sign showing where the nearest defibrillator is located?

--- Later in debate ---

[Mr Ben Bradshaw (Exeter) (Lab)]

Given the latest, very worrying reports about goings on at the office of the Parliamentary and Health Service Ombudsman, does the Secretary of State still have confidence in the leadership of this vital regulator?

[Mr Jeremy Hunt]

I have expressed my concerns on the behalf of patients about some of the things that have been happening, but I respect the fact that it is a matter for this House and its relevant Committee, not for the Government, to deal with. I do have concerns, and it is important that patients have confidence in the ombudsman, because it is a vital, independent avenue to challenge NHS trusts when things go wrong.

[Chris White (Warwick and Leamington) (Con)]

T9. Will my right hon. Friend join me in congratulating chief executive Glen Burley and the whole team at Warwick hospital on delivering the excellent new orthopaedic ward, which I was honoured to be invited to open? Will he tell the House what support the NHS is being given for similar state-of-the-art facilities across the country?

--- Later in debate ---

[Alison McGovern (Wirral South) (Lab)]

The financial year ends next week. What does the Secretary of State expect the NHS provider budget deficit to be by then?

[Mr Jeremy Hunt]

We know that the deficit will be bigger this year, and that there is extreme pressure. Part of the reason for that is that NHS trusts have rightly said that, in the wake of what happened at Mid Staffs, they want to ensure that their wards are properly staffed, but they have done that by using unsustainable agency staff. The most important thing that we need to do is to move to permanent full-time staff rather than agency staff who are too expensive and not good for care.

[Philip Davies (Shipley) (Con)]

T10. A number of my constituents are unable to access an NHS dentist. May I ask the Minister to look at the availability of NHS dentists in my constituency and use his good offices to ensure that there is enough capacity for all of my constituents who want to use a good NHS dentist to be able to access one locally?

--- Later in debate ---

[Debbie Abrahams]

I am happy to insert “inadvertently”.

[Mr Jeremy Hunt]

The hon. Lady may inadvertently have not been listening to my previous answers. Let us look at what Simon Stevens, the chief executive of the NHS, actually said about that spending settlement. He said that the Government had listened to and “actively supported” the NHS case for public spending.

--- Later in debate ---

[Amanda Milling (Cannock Chase) (Con)]

Hednesford is a dementia-friendly town, and I am pleased that my office team, who are based on Market Street in Hednesford, will be receiving dementia-friendly training next month. Does the Minister agree that we should be encouraging more towns to become dementia-friendly?

[Mr Jeremy Hunt]

I absolutely recognise the excellent work that is happening in Hednesford, and in South Staffordshire, as a dementia-friendly community. I know that there are more than 2,000 dementia friends in Cannock Chase. Fantastic work is going on, and I thank my hon. Friend for her support.

[Mark Durkan (Foyle) (SDLP)]

When will we have a decision on the future of the human papilloma virus vaccination programme? Will it be clear, and is there due engagement with the devolved counterparts?

NHS: Learning from Mistakes

Jeremy Hunt Excerpts

Wednesday 9th March 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Madam Deputy Speaker, I would like to update the House on the steps that the Government are taking to build a safer, seven-day NHS. We are proud of the NHS and what it stands for and proud of the record numbers of doctors and nurses working for the NHS under this Government, but with that pride comes a simple ambition: our NHS should offer the safest, highest-quality care anywhere in the world. Today, we are taking some important steps to make that possible.

In December, following the problems at Southern Health NHS Foundation Trust, I updated the House about the improvements that we need to make in reporting and learning from mistakes. NHS professionals deliver excellent care to 650,000 patients every day, but we are determined to support them to improve still further the quality of that care, so this Government have introduced a tough and transparent new inspection regime for hospitals, a new legal duty of candour to patients and families who suffer harm, and a major initiative to prevent lives from being lost through sepsis. According to the Health Foundation, the proportion of people suffering from the major causes of preventable harm has dropped by a third in the last three years, so we are making progress, but we still make too many mistakes. Twice a week in the NHS we operate on the wrong part of someone’s body and twice a week we wrongly leave a foreign object in someone’s body. The pioneering work of Helen Hogan, Nick Black and Ara Darzi has estimated that 3.6% of hospital deaths have a 50% or more chance of being avoidable, equating to over 150 deaths every week.

Despite that, we should remember that our standards of safety still compare well with those in many other countries. However, I want England to lead the world in offering the highest possible standards of safety in healthcare. Therefore, today I am welcoming Health Ministers and healthcare safety experts from around the world to London for the first ever ministerial-level summit on patient safety. I am co-hosting the summit with the German Health Minister, Hermann Gröhe, who will host a follow-up summit in Berlin next year. Other guests will include Dr Margaret Chan, director general of the World Health Organisation, Dr Gary Kaplan, chief executive of the renowned Virginia Mason hospital in Seattle, Professor Don Berwick, and Sir Robert Francis QC.

We will discuss many things, but in the end all the experts agree that no change is permanent without culture change. That change needs to be about two things: openness and transparency about where problems exist; and a proper learning culture to put them right. With the new inspection regime for hospitals, GP surgeries and care homes, as well as a raft of new information now published on My NHS, we have made much progress on transparency, but as Sir Robert Francis’s “Freedom to speak up” report told us, it is still too hard for doctors, nurses and other front-line staff to raise concerns in a supportive environment.

Other industries, in particular the airline and nuclear industries, have learned the importance of developing a learning culture, not a blame culture, if safety is to be improved. Too often, the fear of litigation or professional consequences inhibits the openness and transparency we need if we are to learn from mistakes.

Following the commitment I made to Parliament at the time of the Morecambe Bay investigation, we will from 1 April set up our first ever independent healthcare safety investigation branch. Modelled on the air accidents investigation branch that has been so successful in reducing fatalities in the airline industry, it will undertake timely, no-blame investigations. As with the air accidents investigation branch, I can today announce that we will bring forward measures to give legal protection to those who speak honestly to investigators. The results of such investigations will be shared with patients and families, who will therefore get to the truth of what happened much more quickly. Unlike at present, however, those investigations will not normally be able to be used in litigation or disciplinary proceedings, for which the normal rules and processes will apply. The safe space that they will therefore create will reduce the defensive culture too often experienced by patients and families, meaning that the NHS can learn and disseminate lessons more quickly, so that we avoid repeating mistakes.

My intention is to use the reform to encourage much more openness in how the NHS responds to tragic mistakes: families will get the full truth faster; doctors will get support and protection to speak out; and the NHS as a whole will become much better at learning when things go wrong. What patients and families who suffer want more than anything else is a guarantee that no one else will have to re-live their agony. The new legal protection will help us to promise them, “Never again.” Fundamental to the change is getting a strong reporting culture in hospitals under which mistakes are acknowledged, not swept under the carpet.

Today, NHS Improvement has also published a “learning from mistakes” ranking of NHS trusts, drawing on data from the staff survey and safety incident reporting to show which trusts have the best reporting culture and which need to be better at supporting staff who want to raise concerns. It will be updated every year in a new Care Quality Commission state of hospital quality report, which will also contain trusts’ own annual estimates of their avoidable mortality rates and have a strong focus on learning and improvement. Furthermore, the General Medical Council and the Nursing & Midwifery Council guidance is now clear: where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction.

The Government remain committed to further reform to allow professional regulators more flexibility to resolve cases without stressful tribunals. The culture change must also extend to trust disciplinary procedures, so NHS Improvement will ask for a commitment to openness and learning to be reflected in all trust disciplinary procedures and ask all trusts to publish a charter for openness and transparency, so that staff can have clear expectations of how they will be treated if they report clinical errors.

Finally, from April 2018, the Government will introduce the system of medical examiners that was recommended in the Francis report, which will make a profound change to our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with an independent clinician, meaning that we get to the bottom of any systemic failings much more quickly. The NHS is one of the largest organisations in the world and learning from mistakes and becoming the world’s largest learning organisation is how we will offer the safest, highest-quality standards of care. I commend the statement to the House.

--- Later in debate ---

[Heidi Alexander]

Thank you, Madam Deputy Speaker. I ask the Health Secretary: how can he stand here and say that he wants the NHS to deliver the highest-quality care in the world when the people he depends upon to deliver that care for patients have said, “Enough is enough”? How can he talk about patient safety when he knows that his £22 billion-worth of so-called “efficiency savings” in the next four years will lead to job cuts and will heap more pressure upon a service that is about to break?

I know the Health Secretary has been shy about visiting the NHS front line in the past few months, but if we speak to anyone who has any contact with the NHS, the message we will hear is clear: the financial crisis facing the NHS is putting patient care at risk. The independent King’s Fund recently said:

“Three years on from Robert Francis’s report into Mid Staffs, which emphasises that safe staffing was the key to maintaining quality of care, the financial meltdown in the NHS now means that the policy is being abandoned”.

That is simply not good enough. For those people who have experienced failures of care and for those staff working in environments so pressurised that they fear for the quality of care they are able to deliver, the Health Secretary needs to get his head out of the sand. I say this to him: measures to investigate and identify harm are all well and good but there needs to be action to prevent harm from happening in the first place—fund the NHS adequately, staff it properly and you might just give it a fighting chance.

[Mr Hunt]

The hon. Lady had the chance to be constructive. I do welcome her commitment to a safer NHS, but we need actions and not just words from the Labour party if its conversion to improving patient care is to be believed. She mentioned the junior doctors’ strike. Patients and their families will have noticed that, when it came to the big test for Labour—whether to back vulnerable patients, who need a seven-day NHS, or the British Medical Association, which opposes it—Labour has chosen the union. She brought up the topic, so let me just remind the House of what Nye Bevan, the founder of the NHS, said about the BMA:

“this small body of politically poisoned people have decided to…stir up as much emotion as they can in the profession…they have mustered their forces on the field by misrepresenting the nature of the call and when the facts are known their forces will disperse.”—[Official Report, 9 February 1948; Vol. 447, c. 36-39.]

Bevan would have wanted high standards of care for vulnerable people across the whole week and so should she.

The hon. Lady also challenged the Government on safety, so let us look at the facts. Under this Government: MRSA down 55%; clostridium difficile down 42%; record numbers of the public saying that their care is safe; the proportion suffering from the major causes of preventable harm down by a third during my period as Health Secretary; and 11 hospitals with unsafe care put into special measures and then taken out of special measures, with up to 450 lives saved according to that programme. Before she gets on her high horse, she should compare that with Labour’s record: avoidable deaths at Mid Staffs, Morecambe Bay, Basildon and many other hospitals; care so bad we had to put 27 hospitals into special measures; the Department of Health under Labour a “denial machine”, according to Professor Sir Brian Jarman; and contracts that reduced weekend cover in our hospitals passed by the last Government. They made a seven-day NHS harder—we are trying to put that right. The hon. Lady mentioned money, but she stood on a platform to put £5.5 billion less into the NHS every year than this Government. On the back of a strong economy, we are putting more resources into the NHS. A strong NHS needs a strong economy, and Labour had better remember that.

Let me look at some of the other points the hon. Lady raised. What I said in my statement about the GMC and NMC guidance was that, having said it would change, that guidance has changed and it is now clear that people are going to be given credit in tribunals for being open and honest about things that have gone wrong. She challenged me about the timing for the introduction of medical examiners, so let me remind her of the facts: the Shipman inquiry third report recommended medical examiners in 2003, Labour failed to implement that over seven years, and in six years we are implementing it, which is what I announced today. I am confident that there will not be additional burdens on local government.

The hon. Lady talked about the issue of supporting trusts that do not have the right reporting culture, and that is exactly what we are doing today, because we have published the names of not only the trusts that do not have a good reporting culture, but the names of those that do have a good reporting culture—trusts such as Northumbria Healthcare NHS Foundation Trust, Oxleas NHS Foundation Trust and many others. The trusts that are struggling with this can learn from them.

The hon. Lady says that I need to do more, but, with respect, let me say that the measures we have taken on openness, transparency and putting quality at the heart of what the NHS does and needs to stand for go a lot further than anything we saw under the last Labour Government. I say to her that it says rather a lot that, on a day when this Government have organised a summit, with experts from all over the world, on how to make our hospitals safer, the Labour party is lining up with unions against safer seven-day services. I urge her to think again and to choose the more difficult path of backing reform that will help to make our NHS the safest healthcare system in the world.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

What a shame that the hon. Member for Lewisham East (Heidi Alexander) did not take the opportunity today to condemn the strikes. Supporting unions and not patients will not impress anyone.

May I welcome my right hon. Friend’s excellent statement, join him in paying tribute to the people who work in our NHS, and particularly welcome the setting up of the healthcare safety investigation branch and the system of medical examiners, which will contribute to better results and better outcomes in the health service?

The Secretary of State has taken a personal interest in sepsis, particularly by responding to the UK Sepsis Trust and Dr Ron Daniels, the Mead family, who tragically lost their son, William, and other relatives of patients who have died of sepsis. He knows that the ombudsman report of September 2013 contained many recommendations, including a request for a public awareness campaign, which could save lives. Will the Secretary of State tell us what progress he has made with that, because the relatives who are campaigning seem to have been waiting a long time for this public awareness campaign that they believe will help greatly?

[Mr Hunt]

I thank my right hon. Friend for her campaigning work on sepsis. Indeed, I have met the Mead family with her. She does a fantastic job with the all-party parliamentary group on sepsis. We announced a plan in January last year as this is a major area where we need to increase knowledge both inside the NHS and among the general public. As I mentioned a couple of weeks ago at a meeting organised by the all-party group, we are now looking at putting in place a public information campaign. We need to establish whether that should be about just sepsis, or whether it should be a more general public information campaign to help parents to understand when they need to worry about a fever, which is very common among small children and might be due to reasons other than sepsis, with meningitis being an obvious one. We are doing that detailed work now and we want to get this absolutely right, but I commend her persistence in ensuring that we deliver our commitments in this area.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the statement from the Secretary of State, particularly with regard to the establishment of medical examiners, which we have had in Scotland since last year. I, too, ask why there is a delay of another two years before that comes on stream. As a doctor, the thing that always seemed obvious to me was what might have made a difference with Shipman. Of all the things that have been enacted, someone reviewing deaths might have made that difference. I do not underestimate the importance of audit, and learning from routine audit, rather than depending on just whistleblowing.

In Scotland, we had an audit of surgical mortality in the 1990s. The first thing that that showed was the people dying who had not had a sufficiently senior surgeon involved in their case. That was discussed with the profession, and practice changed. Future years identified a situation with a consultant surgeon at the front line and a junior anaesthetist, but that, too, changed. The audit identified the lack of high-dependency nursing units for the sickest patients. I suggest that working with such an audit and the profession, as we have done for coming up to 20 years, would have allowed the evolution of a stronger, safer seven-day emergency service. I again call on the Secretary of State to commit to looking at a surgical approach, the things that are missing—access to scans and radiology—and perhaps more senior review and senior involvement. This is not about junior doctors and it is not blanket.

We also need to look at the ratio of staff. Francis and other research have shown the importance of nursing staff. Staff who do not have a minute to stop and think will make mistakes, and will not have time to report them. We need to make this easy. There must be a culture in which people have the time to minimise mistakes.

I have a final plea. The Secretary of State is offering more support to whistleblowers, but a review and reconciliation for those who have been badly treated in the past might give people more confidence that, if they step up and report something significant, they will not be hung out to dry, as has been the case previously.

[Mr Hunt]

I contrast the tone of the hon. Lady’s response with that of the shadow Health Secretary. Although I by no means agree with everything she said, she does make some important points.

It is not the case that we have delayed the medical examiners scheme. In the previous Parliament, we had pilots so that we could understand exactly how the examiners would work. That is relevant to the hon. Lady’s other point about audit, with which I completely agree. One thing that medical examiners will be able to do is to look for unexpected or unexplained patterns in deaths. Obviously, the vast majority of deaths are routine, predictable and expected, but those examiners will be able, looking at audit tools, to identify where there are things to worry about, which is why this is an important next step.

With respect to whistleblowers, I will reflect on what the hon. Lady says. We are trying to eliminate the need for things ever to get to the point where someone has to become a whistleblower. We want to ensure that people are supported to speak out about mistakes they have seen or made and concerns that they have, and that they are confident that they will be listened to. We are publishing a table today about the quality of the reporting culture. Much of the raw data that allow us to rank trusts on the quality of reporting data come from the NHS staff survey, which asks staff how valued they think they are, and how safe and easy it is to raise concerns. That is why this is a big step forward.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his statement and for taking forward so many of the recommendations that were made a year ago in the Public Administration Committee’s report on investigating clinical incidents in the NHS. I particularly thank him for implementing the creation of a safe space, which has been a controversial and difficult subject because some people think that this is about hiding stuff, when in fact it is about getting people to speak much more openly and freely. Will he say something about how that will be implemented without primary legislation?

[Mr Hunt]

I thank my hon. Friend for his question. He and I have talked many times and thought very hard about how we can learn lessons from the air industry. He is one of the people who came to me first to say that if we want to set up an equivalent to the air accidents investigation branch, we need to give people in the healthcare world the same legal protections that others have when they are speaking to that branch, and that is at heart of the statement that I have made to the House today.

The point about safe space is very, very important. This is not about people getting off scot free if they make a terrible mistake. There is no extra protection here for anyone who breaks the law, commits gross negligence or does something utterly irresponsible. Patients still have those protections. What they gain is the comfort that we will get to the truth and learn from mistakes much more quickly. Every single patient and bereaved family says that the most important thing is not money, but making sure that the system learns from what went wrong. We will ensure that we construct the safe space concept, and I do not rule out extending that beyond the investigations of the healthcare safety investigation branch.

[Kevin Barron (Rother Valley) (Lab)]

In welcoming the statement, may I say that, in my experience on the General Medical Council and on the Health Committee, the biggest cloud that hangs over the culture of non-reporting in the national health service is litigation? Last year it cost the British taxpayer £1.1 billion, £395 million of which went on legal costs alone. Should we not be looking at a no-fault liability scheme inside the national health service so that we can really encourage cultural change?

[Mr Hunt]

The right hon. Gentleman is absolutely right that the fear of litigation has a very pernicious effect, which we see across the NHS. Litigation is a huge drag on costs and we are reforming how it works. We have looked at what happens in other countries. In Sweden, for example, the creation of a no-blame culture has had the dramatic impact of reducing maternity and neo-natal injury. I hope that today’s statement is a step towards that, but we will consider other reforms to the litigation process as well.

[Sir Edward Garnier (Harborough) (Con)]

The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), and I had a useful debate this morning in Westminster Hall about clinical negligence cases, and what the Secretary of State has said this afternoon clearly touches on that. I might be being obtuse, but the statement seems to relate to the internal investigation of the poor or mistaken conduct of doctors by the disciplinary system, and not to the resistance to, or the conduct of, clinical negligence cases. I hope I am wrong about that, because we do not want, despite the best of intentions of the Secretary of State, as identified in the statement, to make the settlement of just clinical negligence cases more difficult, more expensive and more sclerotic. I read in the papers this morning that there would be a need for a court to give consent to the use of particular information. It might well be that this morning’s trails were inaccurate and do not reflect what the Secretary of State intends, but I wonder whether he could disentangle internal and external reactions to poor conduct.

[Mr Hunt]

I shall do my best for my right hon. and learned—and eminent—Friend. We do not want to affect the legal rights of anyone who wishes to litigate against the NHS because they feel they have been treated badly. Those rights must remain, and we will protect them, but we want to make it easier to get to the truth of what happened so that we can learn from mistakes. The information uncovered by a healthcare safety investigation branch investigation could not be used in litigation proceedings without a court order. However, my belief is that having those investigations carried out by the branch is quite likely to speed up court processes, because I think it will establish on all sides, in greater likelihood, agreement about what actually happened in any particular situation. I hope that that will be beneficial, but if anyone wants to use the evidence in litigation, they will have to re-gather it, because we are concerned that, if doctors are worried that anything that they say could be used in litigation, they may be hesitant about speaking openly, and that represents the defensive culture that we are trying to change.

[Norman Lamb (North Norfolk) (LD)]

I welcome the measures set out in the statement. The Secretary of State will not be surprised to hear that I want to focus on safety in mental health. The statement seems to be quite focused on acute hospitals. At the summit taking place today, will there be a specialist focus on safety in mental health? The Secretary of State will remember that the Government announced last February an ambition to achieve zero suicide, but he will be aware that there has been a significant increase in serious incidents and in the reporting of unexpected deaths and suicides. I do not know where that project has got to, but would he be prepared to meet me to discuss how we can develop the zero-suicide ambition, which has achieved such a reduction in deaths in the city of Detroit in the United States? The same can happen here if we have the same focus and ambition.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the Secretary of State answers that important question, I remind the House that we have a lot of business to get through today. Shorter questions and correspondingly shorter answers would be welcomed by those who are waiting to take part in other debates.

[Mr Hunt]

As ever, I commend the right hon Gentleman’s interest in mental health. May I reassure him that this is very much about what happens in mental health and also the area of learning disabilities? In fact, some of the thoughts were prompted by what happened at Southern Health. It is absolutely vital that we investigate unexpected deaths in mental health as much as we do in physical health. The measures we take will go across those areas, and I am more than happy to meet him to discuss the very laudable aim of zero suicides.

[Dr Tania Mathias (Twickenham) (Con)]

May I applaud the Secretary of State for this culture of safety and learning? Will he consider increasing the use of exit interviews in the NHS? I have worked in the NHS, aid organisations and charities, and the NHS is the only one where I have not had an exit interview. May I suggest that decreasing the use of agency and locum staff, as we hope to do, provides an opportunity to learn from good staff about sharing good practice and avoiding bad practice? I absolutely applaud the world summit on patient safety, and I very much hope the Secretary of State has invited St John of Jerusalem eye hospital, from East Jerusalem. If that was somehow forgotten, please will he ensure that it is invited to the Berlin summit next year?

[Mr Hunt]

I feel prompted by my hon. Friend’s question to investigate what I am sure is excellent practice at St John of Jerusalem eye hospital. If I may, I will take away her very good point about exit interviews. We also heard a good point about agency staff. Part of the thing that inhibits a learning culture is if a large percentage of staff are in an organisation only on a provisional or temporary basis, rather than being part of regular teams and therefore not being able to transmit lessons learned. That is why we have to deal with the virus of an over-reliance on agency staff in some parts of the NHS.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

May I gently ask that the Secretary of State, if he is going to list Morecambe Bay in a litany of things to bash the previous Government over the head with, to do so while also acknowledging that the situation continued for some time under his Government and is still taking some time to turn around?

I wholeheartedly welcome the Secretary of State’s focus on patient safety and his overall approach, and I pay tribute again to the Morecambe Bay campaigners, who have done so much to trigger this improvement. However, does he share my concerns about trusts such as Morecambe Bay being forced, for a number of reasons, including for safety, to use a large number of agency staff, and about the difficulty in changing culture when that staffing situation persists?

[Mr Hunt]

Let me commend the staff at Morecambe Bay, who have been through a very difficult patch. The trust has now exited special measures, which is a very exciting step for the trust, and there has been a huge amount of work to make that possible. It feels to me that they really have turned a corner at Morecambe Bay, and we should support the staff, who have done a great job in that respect.

The hon. Gentleman raises an important point about agency staff. In particular, it is challenging to get permanent recruitment to more geographically isolated places—we find that that is a problem not just at Morecambe Bay, but across the country. However, sometimes, it can be false comfort to get in large numbers of agency staff, as not only are they extremely expensive, but they cannot offer the continuity of care that is at the heart of a safer culture, so we have to find better ways to support places such as Morecambe Bay further to improve safety.

[David Tredinnick (Bosworth) (Con)]

I congratulate my right hon. Friend on a range of initiatives, including the independent healthcare safety investigation branch, but I remind him that some of the problems that we face are staring him in the face, not least the difficulties in Leicestershire with the ambulance service. I thank the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), for seeing the right hon. Member for Leicester East (Keith Vaz) and me to discuss the problems that occur when 15 out of 25 ambulances in the county are queuing to discharge patients. The Under-Secretary talked about bringing in troubleshooters to resolve problems. Will the Secretary of State enlighten the House on what he proposes to do about these very evident problems? They require little investigation; they require action.

[Mr Hunt]

We do have a system-wide problem in Leicestershire and we are looking into it urgently. I thank my hon. Friend for raising the issue. He is absolutely right that when we talk about safety and being open about mistakes, that has to apply to the ambulance service as much as to every other part of the NHS.

[Jim Shannon (Strangford) (DUP)]

May I also welcome the Secretary of State’s statement to the House? In particular, I welcome the commitment to building a safer, seven-day NHS. In Northern Ireland, we have just announced 1,200 new nurses, 300 new professionals, extra money for autism and mental health care and, just this week, extra money to address waiting lists to build a safer, seven-day NHS—that is what we want.

The Secretary of State referred to learning from mistakes, the need for an extension of trusts’ disciplinary procedures, openness to learning and a charter for openness and transparency. What discussions has he had with the Northern Ireland Assembly Minister, Simon Hamilton, about ensuring that that system can be replicated in Northern Ireland and by regional Assemblies and Administrations across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Mr Hunt]

My colleague, the hospitals Minister, will have those discussions with the Northern Ireland Health Minister. However, the hon. Gentleman is right that if we are going to have a learning culture, it needs to be across the UK, not just in England. That is why I welcome the discussions we have with the Scottish NHS and the Welsh NHS. There are things that we can learn from each other, and we should be very open-minded in doing so.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

We must all strive to improve safety and quality in the NHS, but the Health Foundation report that the Secretary of State referred to stated that 40% of patients said there were too few nurses to care for them—this is three years after the Francis report. The Government say that the NHS must learn more, but what are they doing to learn from the inquiries that have been held?

[Mr Hunt]

Well, quite a lot. For example, we have increased the number of nurses by more than 10,000 since the Francis report was published, to ensure that we do not have a problem with safety on our wards. We recognise that it is incredibly important not to have short-staffed wards, and we are making more reforms in this Parliament to ensure that we recruit even more nurses. It would be good to have some support from Labour on that.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend on his statement, although I hope that it draws on experience from other healthcare economies, as well as on the aerospace sector. When things go wrong, it is right that the NHS is frank about it and, where necessary, compensates people for what may be long-term management issues. Currently, negligence settlements are based on provision in the private sector and do not necessarily anticipate that people will be treated and managed in the NHS, which means that the service effectively pays twice for mistakes. As the Secretary of State seeks to close the Simon Stevens spending gap, perhaps he will reflect on that. I would be grateful if he could say to what extent he thinks that excessive negligence claims are influenced by the rather perverse way in which they are currently calculated.

[Mr Hunt]

Someone looking at our current system independently might say that some things are difficult to understand, including the point raised by my hon. Friend and the fact that we tend to give bigger awards to wealthier families because we sometimes take into account family incomes when we make them. We are considering that area, but we are cautious about reducing the legal rights of patients to secure a fair settlement when something has gone wrong. In the end, this is about doing the right thing for patients, and the most effective way of reducing large litigation bills—I know my hon. Friend will agree with this—is to stop harm happening in the first place, and that is what today is about.

[Mr Dennis Skinner (Bolsover) (Lab)]

If anybody should be learning from mistakes in the health service, it is the Secretary of State for Health. I have been down to the picket line today, as I have on every occasion, and I can tell him that it is hardening. There are more people on that picket line down at St Thomas’ today than I have seen in all the months since the strike began. I am a bit of an expert on picket lines; I know what it is like. Quite frankly, the biggest mistake that the Secretary of State has made is to think that he can get away with imposing a seven-day week on hospital doctors and everybody else who works in the health service, because he wants to avoid proper premium payments. When I worked in the coal mines, miners got double pay on Sundays, and they got time and a half all day Saturday. It is time he recognised that not just hospital doctors but nurses, radiologists and all the others who will have to work a seven-day week should be paid the proper money. Otherwise, pack the job in, and then he’ll be doing a service to the whole national health service.

[Mr Hunt]

Under our proposals, doctors will receive higher premium rates than lower paid nurses, paramedics and healthcare assistants. I thought the hon. Gentleman campaigned for the lower paid! The day that I stop this job will be the day that I stop doing the right thing for patients. He has constituents who need a seven-day NHS, as do I, and this Government will be there for them and will do the right thing.

--- Later in debate ---

[Maria Caulfield]

Thank you, Madam Deputy Speaker. People are fed up with the NHS being talked down by Labour Members, and there was a plea to showcase the good work that is taking place in our NHS today.

[Mr Hunt]

It is so good to have someone with nursing experience in the House, and I hope that my hon. Friend will make an important contribution for many years to come. She knows what it is like on the front line, and why it is important to get this culture change. She also knows how important it is not to run down the NHS, which is doing extremely well.

[Paula Sherriff (Dewsbury) (Lab)]

Last week I received an email that was frankly heartbreaking. My constituent’s 84-year-old father, a proud and dignified man, was admitted to hospital with symptoms of a stroke, and he had to wait 14 hours for a bed. She went to visit him later that day and found him in bed wearing clothes on only his top half. He needed the toilet, and she was given a bottle to help him urinate.

[Paula Sherriff]

That was no dignified way to treat that man. Will the Secretary of State agree to an urgent investigation into safe staffing levels at Mid Yorkshire Hospitals NHS Trust, because the nursing staff told my constituent that they did not have time to fulfil her father’s basic nursing needs?

[Mr Hunt]

I am more than happy to look into that case, which is exactly the kind of thing that we are trying to stop with the measures we are bringing forward today.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

I congratulate my right hon. Friend on once again ensuring that patient healthcare and outcomes are at the forefront of his thinking, and that of professional health service workers who do such a brave job and can sometimes be caught in the crossfire. Does he agree that comments from people on the front line supporting the doctors strike—such as Mr Usman Ahmed, who started a post on Facebook by saying:

“I’ve always hated the Conservatives—a complete and utter bunch of…”;

I shall leave it there as I would not like to offend you, Madam Deputy Speaker—show that they do not care about healthcare and are more interested in their own political gain?

[Mr Hunt]

This, I am afraid, is the problem with some elements in the BMA, who are putting politics ahead of patients. As we have heard today, that is the problem in the Labour party as well.

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

Action on Sir Robert Francis’s “Freedom to Speak up” review is very welcome. There are so many cases I could cite, but when a senior junior doctor reported unsafe levels of care in an intensive therapy unit, he was subject to unacceptable behaviour such as bullying and blacklisting, and now can only work as a locum. When he wrote to the Secretary of State, the Secretary of State refused to engage, listen and learn from his experience. Learning cultures have to start at the top with the Secretary of State. Will he set out how he will address retrospective cases of whistleblowing when people have been subject to discrimination?

[Mr Hunt]

I hope that the hon. Lady is not quoting selectively from my reply to the person concerned, because when people raise issues of patient safety with me, I usually refer them to the CQC, which is able to give a proper reply. I would be very surprised if I had not done that in this case. Retrospective cases are particularly difficult, and much as we want to help, it is difficult constitutionally to unpick decisions made by courts. We are trying to separate employment grievances from safety grievances and make that the way that we solve these difficult situations.

[Mr Robin Walker (Worcester) (Con)]

Like many MPs, I have come across cases where this approach would help enormously, and I thank the Secretary of State for his statement. The same CQC report that praised staff and clinicians at Worcestershire Acute Hospitals NHS Trust for their good and outstanding care, also raised concerns about the management and safety at the hospitals. That was partly a result of too many interim managers, and a lack of ability to address and learn from mistakes made. I urge the Secretary of State to do everything in his power to work with the relevant organisations to put long-term permanent management in place at that trust, so that we take things forward and make our patients safer.

[Mr Hunt]

My hon. Friend speaks very wisely. Let me say that one thing that has been a mistake of successive Governments is a short-termist approach to NHS managers. We ourselves have looked for a scapegoat when something has gone wrong—an A&E target missed or whatever—and not backed people making long-term transformations. That is something we need to think hard about.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Secretary of State for his statement and for all the work he has done on this. I pay tribute to all those who have campaigned to bring patient safety to the fore, many from tragic experiences that they have had. What work is being done to ensure that medical schools and nursing schools have patient safety right there on the curriculum?

--- Later in debate ---

[Mr Hunt]

We have looked at the curriculum very carefully. In particular, we want to make sure that people understand their responsibilities to speak out if they see mistakes or things going wrong, and to help people to understand that this may not be the prevailing culture in the hospital they go to. We are looking to a new generation of doctors and nurses to help us in changing the culture for the better.

[Amanda Milling (Cannock Chase) (Con)]

I, too, welcome my right hon. Friend’s statement. Having met the parents, he will be aware of the tragic death of three-year-old Jonnie Meek at Stafford hospital. They have been looking for answers to their questions for some time. Will he confirm that the new healthcare safety investigation branch he has announced today will give families like Jonnie’s the opportunity to find the answers they have been looking for much more quickly?

[Mr Hunt]

I thank my hon. Friend for her support for Jonnie’s parents. This is a very sad case. The independent investigator in the case talked about the closed culture he encountered at two different trusts. Indeed, that is a very good example of the change in culture we need. I have worked with them. I hope we can secure a second inquest into Jonnie’s death, so we can get to the truth. I am afraid it will be too late, but we want to get there eventually.

[Jason McCartney (Colne Valley) (Con)]

As the Secretary of State is aware, my local clinical commissioning group starts a 14-week consultation next Wednesday on proposals to downgrade A&E at Huddersfield Royal Infirmary. Does he agree that patient safety must be the priority in those decisions, not the ruinous PFI deal signed by Halifax hospital in 1998, which is the backdrop to these appalling plans?

[Mr Hunt]

No one fights harder for his constituents on healthcare matters than my hon. Friend, and I commend him for that. The process he talks about will be led by clinicians. He is absolutely right that patient safety must be of paramount importance.

[Will Quince (Colchester) (Con)]

My right hon. Friend is aware that we have one of the worst stillbirth rates in the developed world. Every stillbirth is a tragedy, and with more than 3,600 a year we must do all we can to avoid them, especially when half are preventable. I am co-chair of the new all-party group on baby loss. Does my right hon. Friend agree that it is only by looking at every single stillbirth and learning the lessons from them that we can get that number down by 20% by the end of this Parliament and by half by 2030?

[Mr Hunt]

My hon. Friend is absolutely right. I thank him for his work in this area. Maternity—stillbirths, neonatal deaths, neonatal injuries and maternal deaths—is the area where I hope we make the most rapid early progress in developing this new learning culture. There is so much to be gained. We can be the best in the world, but the truth is that we are a long way down international league tables in this area. None of us want that for the NHS. There is a real commitment to turn that around and I thank him for his support.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The prize for perseverance and patience goes to Mr Mark Spencer.

[Mark Spencer (Sherwood) (Con)]

I am grateful, Madam Deputy Speaker, even if my knees are not.

I congratulate the Secretary of State on providing a protected space for doctors, so they will be able to be honest and upfront when things go wrong, and on striking the right balance so that relatives and people who suffer wrongs in the NHS get to the bottom of what went wrong, why it went wrong and why it will not happen again.

[Mr Hunt]

I thank my hon. Friend. That is the heart of what we want to do. He of course has been very closely involved in the improvements we are trying to make at his local trust. If his knees are in pain, I can recommend a very good GP surgery in his constituency, one he very kindly showed me during the election campaign.

NHS Learning Culture

Jeremy Hunt Excerpts

Wednesday 9th March 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I would like to inform the House of the steps the Government are taking to make the NHS the safest healthcare system in the world. Perhaps the single most important thing we can do is to create a learning rather than a blame culture, so that clinicians feel supported to speak out when things go wrong.

NHS Improvement is today publishing a “Learning from mistakes league”. This draws on data from the staff survey and safety reporting data to set out a league table for NHS provider organisations. This will provide information to the providers themselves as well as to the wider public about how well different organisations are learning, and how open and honest they are. The information in the league will be published on an annual basis as part of the CQC’s report on hospital care quality.

Later this month, NHS Improvement will also publish estimates by trust of avoidable mortality, and information relating to this will then be published as part of an annual CQC report on care quality in hospitals.

In addition to greater and more intelligent transparency, a culture of learning means we need to create an environment in which clinicians feel able to speak up about mistakes. We will therefore bring forward measures for those who speak honestly to investigators from the healthcare safety investigation branch to have the kind of “safe space” that applies to those speaking to the air accident investigation branch.

The General Medical Council and the Nursing and Midwifery Council have made it clear through their guidance that where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction. The Government remain committed to legal reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals.

NHS Improvement will ask for the commitment to learning to be reflected in all trust disciplinary procedures and ask all trusts to publish a charter for openness and transparency so staff can have clear expectations of how they will be treated if they witness clinical errors.

From April 2018, the Government will introduce the system of medical examiners recommended in the Francis report. This will bring a profound change in our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with the independent clinician.

NHS England is working with the Royal College of Physicians to develop and roll out across the NHS a standardised method for reviewing the records of patients who have died in hospital.

These measures, along with the professionalism and dedication of NHS staff will help the NHS to achieve its aim of becoming the world’s largest learning organisation.

[HCWS597]

NHS Pay Review Body

Jeremy Hunt Excerpts

Tuesday 8th March 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the 29th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 9210).

Copies of the report are available to hon. Members from the Vote Office, to noble Lords from the Printed Paper Office and is also available online. I am grateful to the Chair and members of the NHSPRB for their report.

We welcome the 29th report of the NHS Pay Review Body. The Government are pleased to accept its recommendations in full.

We will take forward NHSPRB’s suggestions for how we can continue to improve our support for its important work.

Report of NHSPRB (Cm 9210) (54488 Cm 9210 NHSPRB 2016), can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-08/HCWS589/.

[HCWS589]

Doctors' and Dentists' Remuneration Report

Jeremy Hunt Excerpts

Tuesday 8th March 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the 44th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 9211). Copies of the report are available to hon. Members from the Vote Office, to noble Lords from the Printed Paper Office and is attached. I am grateful to the Chair and members of the DDRB for their report.

We welcome the 44th report of the Review Body on Doctors’ and Dentists’ Remuneration. The Government are pleased to accept the recommendations in full.

We will take forward DDRB’s suggestions for how we can continue to improve our support for its important work.

Report of the DDRB (Cm 9211) (54290 Doctors and Dentists Pay Review 2016), can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-08/HCWS590/.

[HCWS590]

Junior Doctors Contracts

Jeremy Hunt Excerpts

Thursday 11th February 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

Nearly three years ago to the day, the Government first sat down with the British Medical Association to negotiate a new contract for junior doctors. Both sides agreed that the current arrangements, drawn up in 1999, were not fit for purpose and that the system of paying for unsocial hours in particular was unfair. Under the existing contract, doctors can receive the same pay for working quite different amounts of unsocial hours; doctors not working nights can be paid the same as those who do; and if one doctor works just one hour over the maximum shift length, it can trigger a 66% pay rise for all doctors on that rota.

Despite the patent unfairness of the contract, progress in reforming it has been slow, with the BMA walking away from discussions without notice before the general election. Following the election, which the Government won with a clear manifesto commitment to a seven-day NHS, the BMA junior doctors committee refused point blank to discuss reforms, instead choosing to ballot for industrial action. Talks finally started—under the Advisory, Conciliation and Arbitration Service process—in November, but since then we have had two damaging strikes, which have resulted in about 6,000 operations being cancelled.

In January, I asked Sir David Dalton, chief executive of Salford Royal, to lead the negotiating team for the Government. Under his outstanding leadership, for which the whole House will be immensely grateful, progress has been made on almost 100 different points of discussion, with agreement secured with the BMA on approximately 90% of them. Sadly, despite this progress and willingness from the Government to be flexible on the crucial issue of Saturday pay, Sir David wrote to me yesterday advising that a negotiated solution was not realistically possible. Along with other senior NHS leaders and supported by NHS Employers, NHS England, NHS Improvement, the NHS Confederation and NHS Providers, Sir David has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors. I have therefore today decided to do that.

Tired doctors risk patient safety, so in the new contract the maximum number of hours that can be worked in one week will be reduced from 91 to 72; the maximum number of consecutive nights doctors can be asked to work will be reduced from seven to four; the maximum number of consecutive long days will be reduced from seven to five; and no doctor will ever be rostered consecutive weekends. Sir David believes that these changes will bring substantial improvements to both patient safety and doctor wellbeing. We will also introduce a new guardian role within every trust. These guardians will have the authority to impose fines for breaches to agreed working hours based on excess hours worked. These fines will be invested in educational resources and facilities for trainees.

The new contract will give additional pay to those working Saturday evenings from 5 pm, nights from 9 pm to 7 am and all day on Sunday, and plain time hours will now be extended from 7 am to 5 pm on Saturdays. However, I said that the Government were willing to be flexible on Saturday premium pay, and we have been: those working one in four or more Saturdays will receive a pay premium of 30%. That is higher on average than that available to nurses, midwives, paramedics and most other clinical staff, and also higher than that available to fire officers, police officers and those in many other walks of life.

None the less, the changes represent a reduction compared with current rates, but that is necessary to ensure that hospitals can afford additional weekend rostering, and because we do not want take-home pay to go down for junior doctors, after updated modelling, I can tell the House that these changes will allow an increase in basic salary not of 11%, as previously thought, but of 13.5%. Three quarters of doctors will see a take-home pay rise, and no trainee working within contracted hours will have their pay cut.

Our strong preference was always for a negotiated solution. Our door remained open for three years, and we demonstrated time and again our willingness to negotiate with the BMA on the concerns it raised. However, the definition of negotiation is a discussion where both sides demonstrate flexibility and compromise on their original objectives. The BMA ultimately proved unwilling to do this.

In such a situation, any Government must do what is right for both patients and doctors. We have now had eight independent studies in the last five years identifying higher mortality rates at weekends as a key challenge to be addressed. Six of these say staffing levels are a factor that needs to be investigated. Professor Sir Bruce Keogh describes the status quo as

“an avoidable weekend effect which if addressed could save lives”,

and has set out the 10 clinical standards necessary to remedy this. Today, we are taking one important step necessary to make this possible.

While I understand that this process has generated considerable dismay amongst junior doctors, I believe that the new contract we are introducing, shaped by Sir David Dalton, and with over 90% of the measures agreed by the BMA through negotiation, is one that in time can command the confidence of both the workforce and their employers. I do believe, however, that the process of negotiation has uncovered some wider and more deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life that need to be addressed.

These issues include inflexibility around leave; lack of notice about placements that can be a long way from home; separation from spouses and families; and sometimes inadequate support from employers, professional bodies and senior clinicians. I have therefore asked Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, alongside other senior clinicians, to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce. Further details of this review will be set out soon.

No Government or Health Secretary could responsibly ignore the evidence that hospital mortality rates are higher at the weekend or the overwhelming consensus that the standard of weekend services is too low, with insufficient senior clinical decision makers. The lessons of Mid Staffs, Morecambe Bay and Basildon in the last decade are that patients suffer when Governments drag their feet on high hospital mortality rates, and this Government are determined that our NHS should offer the safest, highest-quality care in the world.

We have committed an extra £10 billion to the NHS this Parliament, but with that extra funding must come reform to deliver safer services across all seven days. This is not just about changing doctors contracts. We also need better weekend support services such as physiotherapy, pharmacy and diagnostic scans; better seven-day social care services to facilitate weekend discharging; and better primary care access to help tackle avoidable weekend admissions. Today, we are taking a decisive step forward to help deliver our manifesto commitment, and I commend this statement to the House.

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[Heidi Alexander]

I am grateful to you, Mr Speaker.

What impact does the Secretary of State honestly think an imposed contract will have on recruitment and retention? Earlier this week, a poll found that nearly 90% of junior doctors would be prepared to leave the NHS if a contract were imposed. How does the Secretary of State propose to deliver seven-day services with one tenth of the current junior doctor workforce? How can it possibly be right for us to be training junior doctors and the consultants of tomorrow, only to export them en masse to the southern hemisphere? The Secretary of State needs to stop behaving like a recruiting agent for Australian hospitals, and start acting like the Secretary of State for our NHS.

What advice did the Secretary of State take before making this decision? He may not want to respond to my letters, but what does he say to the Royal College of Surgeons, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Paediatrics and Child Health, all of which have urged him not to impose a contract? What legal advice has he taken about how an imposed contract would work in practice? What employment rights do junior doctors have in this context, and what will happen if they simply refuse to sign?

The Secretary of State has been keen to present a new junior doctors contract as the key that will unlock the delivery of seven-day services, but that is a massive over-simplification, and he knows it. Although research shows that there is a higher mortality rate among patients who are admitted to hospital at weekends, there is absolutely no evidence to show that it is specifically caused by a lack of junior doctors. Will the right hon. Gentleman state, for the record, that he accepts that?

One of the real barriers to more consistent seven-day services is the consultants contract. Until now, at least, the BMA and the Government were making progress in those negotiations. Could not a decision to impose a new junior doctors contract put the consultant negotiations at risk, and make the delivery of seven-day services even harder? Will the Secretary of State also make it clear how the definition of unsocial hours will need to change in other contracts in order for seven-day services to be delivered, and which groups of staff that will apply to?

What we heard from the Secretary of State today could amount to the biggest gamble with patient safety that the House has ever seen. He has failed to win the trust of the very people who keep our hospitals running, and he has failed to convince the public of his grounds for change. Imposing a contract is a sign of failure, and it is about time the Secretary of State realised that.

[Mr Hunt]

The hon. Member for Lewisham East (Heidi Alexander) has made a number of incorrect statements with which I shall deal with later, but what the country will notice about her response is more straightforward. When we have a seven-day NHS, in a few years’ time, people will say that it was obviously necessary and the right thing to do. They will remember that it was not easy to get there, and they will also remember—sadly—the big call that she made today for short-term political advantage to be placed ahead of the long-term interests of patients.

Previous reforming Labour Governments might have done what we are doing today. Let me say to the hon. Lady that she has vulnerable constituents—we all have vulnerable constituents—who need a true seven-day NHS, and those are precisely the people that the NHS should be there for. Sorting this out should not be a party issue; it should be something that unites the whole House, and she will come to regret the line that she has taken today.

Let me address some of the hon. Lady’s particular points. She has said today and on other occasions that this has been badly handled. If she wants to know who has handled contract negotiations badly, it was the party that gave consultants the right to opt out from weekend work in 2003 and that gave GPs the right to opt out of out-of-hours care in 2004. Is it difficult to sort out those problems? Yes. Are we going to be lectured by the people who caused them? No, we are not.

The hon. Lady also questioned whether there was support for imposition. Let me just read her exactly what the letter that I got from Sir David Dalton says. He states that, on the basis of the stalemate,

“I therefore advise the government to do whatever it deems necessary to end uncertainty for the service and to make sure that a new contract is in place which is as close as possible to the final position put forward to the BMA yesterday.”

And what does Simon Stevens, chief executive of NHS England, say?

“Under these highly regrettable and entirely avoidable circumstances, hospitals are rightly calling for an end to the uncertainty, and the implementation of the compromise package the Dalton team are recommending.”

The hon. Lady talked about the impact on morale. Perhaps she would like to look at the hospitals that have implemented seven-day care, including Salford Royal, Northumbria and one or two others. They have some of the highest morale in the NHS, because morale for doctors is higher when they are giving better care for patients. She also says that we should not impose the contract, but what she is actually saying is that if the BMA refuses point blank to negotiate on seven-day care, we should give up looking after and doing the right thing for vulnerable patients. What an extraordinary thing for a Labour shadow Health Secretary to say. She also said that we were conflating the junior doctors contract with seven-day working. Well, let us look at what the Academy of Medical Royal Colleges said in 2012. It said:

“The weekend effect is very likely attributable to deficiencies in care processes linked to the absence of skilled and empowered senior staff”.

Most medical royal colleges say that junior doctors with experience qualify as senior staff.

The NHS has made great strides in improving the quality of care. Since I have been Health Secretary, avoidable harm in hospitals has nearly halved, nearly 20% of acute hospitals have been put into a new special measures regime—and we are turning them round—and record numbers of members of the public say that their care is safe and that they are treated with dignity and respect. The seven-day NHS is not just a manifesto commitment; we are doing this because we are willing to fight to make the NHS the safest, highest quality healthcare system in the world. Today we have seen that the Labour party is not prepared to have that fight. Does not this prove to the country that it is the Conservatives who are now the true party of the NHS?

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I congratulate my right hon. Friend on taking this clear and correct decision, because it is quite obvious that after three years, the BMA was prepared to let the whole thing drag on with talks and days of action until he either abandoned the seven-day service or gave the junior doctors an enormous pay settlement in order to buy their agreement to do it. In future discussions, will he keep concentrating, as he has, on the essential public interest, which is to meet the rising and remorseless demand on the service resulting from an ageing population and clinical advance? Will he also use the extra resources that the NHS is getting at the moment to deliver a better service to patients and not allow it to be taken away, as so often happened in the past—including a little more than 10 years ago in 2003—by very large pay claims by the various staff unions, as that would lessen his ability to give us the modern NHS that he is talking about?

[Mr Hunt]

My right hon. and learned Friend speaks with great wisdom and also great experience. Many Members will remember how, when he was Health Secretary, the BMA put posters of him up all over the country saying “What do you call a man who ignores medical advice?”, and there he was, smoking his cigar. I am sure that there have been Labour Health Secretaries who have had similar treatment. He makes an important point, however. Under the new Labour Administration of Tony Blair, huge amounts of extra resources were put into the NHS but, unfortunately, because of the impact of contract changes in 1999, 2003 and 2004, weekend care actually became less effective, not more effective. Now, thanks to the tough decisions we have taken on public spending and turning the economy around, we have been able to give the NHS a funding settlement next year that is the sixth biggest in its entire nearly 70-year history. We are absolutely determined that, if we are putting that extra money into the NHS, it should come with reform that leads to better care for patients. That is the Conservative way, and we will not be deflected from it.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I should like to pick the Secretary of State up on some aspects of his statement. On Monday, I challenged the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer) to step away from the term “weekend deaths”. The Freemantle paper does not show that; it shows increased 30-day mortality in people admitted at the weekend, and there is actually a lower mortality rate at weekends. The junior Minister said that the Secretary of State was really careful, but he has made that suggestion twice in his statement today, and I think that that is very misleading.

What should have come from the Freemantle paper and others is an attempt to understand why these things happen. The only study that gives a clear answer and backs up the Francis report is the Bray paper on 103 stroke units, which showed that the single most important factor was the ratio of registered nurses. We should know what the problem is before we try to fix it. The one group of staff that is there, along with the nurses, is the junior doctors. They are not the barrier to achieving the 10 standards.

I welcome the progress that has been made since last November. In a debate in this Chamber in October, the Secretary of State seemed relatively unwilling to go to ACAS, but progress has been made since the negotiations started, and particularly since Sir David Dalton became involved in the past month. I therefore found it incredible to see on the BBC this morning that, having achieved 90% agreement and following a tweet at 4 minutes past 8 saying that we should now get both sides back to the table, the Secretary of State was going to impose the contract.

The problem with the recognition of unsocial hours might increase the difficulty that we already have in recruiting people to the acute specialties: A&E, maternity and acute medicine. They are already struggling, and this might well make things worse. I also still have concerns about the role of the guardian. The problem is that a junior doctor at the bottom of a hierarchy will have to go and complain, and we can imagine how difficult that might be in a hierarchical system and how easily that doctor could be labelled a troublemaker. So there are still things to be dealt with. I welcome the progress that has been made in the last month, but this is absolutely not the time to pour petrol on the fire and then throw in the towel.

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments. I do not agree with everything that she has said, and I shall explain why, but they were immensely more constructive than the comments that we have heard from other Opposition spokesmen. She is right to say that the studies talk about mortality rates for people admitted at weekends. There have been eight studies in the past five years, or 15 since 2010 if we include international studies. She is right to say that we need to look at why we have these problems.

The clinical standards state that when someone is admitted, they should be seen by a senior decision-maker within 14 hours of admission. They will be seen by a doctor before then, but they should be seen by someone senior within 14 hours. The standards also state that vulnerable people should be checked twice a day by a senior doctor. Now, across the seven days of the week, the first of those standards is being met in only one in eight of our hospitals and the second in only one in 20. That is why it is important that junior doctors should be part of the group of people who constitute those senior decision-makers—consultants are also part of it—and that is why contract reform is essential.

The hon. Lady is right to say that this is also about nurse presence, and the terms that we are offering today for junior doctors are better on average than those for the nurses working in the very same hospitals, and better than those for the midwives and the paramedics. That is why Sir David Dalton and many others say that this is a fair and reasonable offer.

With respect to A&E recruitment, the impact of the contract change we are proposing is that people who regularly work nights and weekends will actually see their pay go up, relatively, compared to the current contract. These are the people who are delivering a seven-day NHS and we must support them every step of the way.

[Dr Sarah Wollaston (Totnes) (Con)]

I know colleagues across the House will want to join me in thanking junior doctors for the valuable work they do for patients across the NHS. [Hon. Members: “Hear, hear.”] I hope that they will look very carefully at the improvements in the offer, with a 13.5% increase in the basic rate and the very important safeguard that will discourage over-rostering at weekends by giving them premium rates if they have to work more than, or including, one in four weekends. I hope the BMA will also recognise and welcome the very important appointment of Professor Dame Sue Bailey to lead an inquiry into all the other aspects that lead to discontent with junior doctors. I wonder if the Secretary of State agrees that what we now need is to move forward in a positive spirit that brings this dispute to an end, takes the temperature down and recognises that we all want the same thing: safety for patients.

--- Later in debate ---

[Mr Hunt]

I thank my hon. Friend for her very constructive comments. She is right. A 13.5% increase in basic pay is very significant, because, unlike overtime and premium pay, it is pensionable. It will help when applying for a mortgage and will mean more money on maternity leave. I think it will be much better for junior doctors.

The review that Dame Sue Bailey is doing, which was much-derided by the Opposition when I mentioned it in my statement, is actually very significant. One of the things that has gone wrong in training is that since the implementation of the European working time directive, we have moved away from the old “firm” system, which would mean that junior doctors were assigned to a consultant, who they would see on a regular basis and who was able to coach them on a continuous basis over weeks and months. That has been lost and many people think that that has led to much lower morale. We want to see what we can do to sort that out.

Finally, I want to echo what my hon. Friend said about going forward in a positive and constructive spirit. When, as a Government, we took the decision to proceed with implementing new contracts, we had the choice of many different routes, because, essentially, we can decide exactly what to choose. We have chosen to implement the contract recommended by NHS chief executives as being fair and reasonable. That is different from our original position. We have moved a considerable distance on most of the major issues, but it is what the NHS thinks is a fair and reasonable contract and we need to move forward.

[Barry Gardiner (Brent North) (Lab)]

The Secretary of State, I am sure, has the grace to acknowledge that the application rate for specialty training has fallen since the Government put forward their proposals last year, but does he have the logic to accept that if he gets fewer junior doctors the problem he is trying to solve will only get worse?

[Mr Hunt]

We now have 10,600 more doctors working in the NHS than we did five years ago and we are investing record amounts going forward. There has been a lot of smoke and mirrors about what is actually in our contract proposals. I hope all trainees and medical students will look at the proposals and see that independent people have looked over them and believe they are fair and reasonable—actually better—for junior doctors, and that we will continue to be able to recruit more doctors into the NHS.

[Sir Edward Leigh (Gainsborough) (Con)]

As one, like myself, gets a bit older—some might say clapped out—one relies on the NHS more and more. People like me—I have just had an operation and might have another coming up—get worried about strikes. I hope the Secretary of State will try, from now on, to build the morale of junior doctors. Surely the NHS is not for the Conservative party, the Labour party, doctors or nurses, but for the people? Why should people like me, who are admitted to hospital on a Saturday, have a greater chance of dying? He has to take on the vested interests and stand up for the people.

[Mr Hunt]

My hon. Friend is absolutely right. Indeed, if we look at the change happening in global healthcare, the big movement is towards putting patients in the driving seat of their own healthcare. If we want the NHS to be the best in the world, we have to be confident that we are giving patients the best care in the world. That is why I completely agree with him and why I said in my statement that there is no reason why this could not be something the whole House can unite behind. What we cannot do, however, is look at eight studies in five years and say that we will act on this just as soon as we can get a consensus in the medical profession. We have been trying to get that consensus now for over three years. There comes a time when you have to say, “Enough is enough” and do the right thing for patients.

[Mr David Anderson (Blaydon) (Lab)]

I know the Secretary of State does not usually listen to people with a bit of experience, but, as somebody who has spent 40 years dealing with trade disputes and their aftermath, may I ask him how he expects industrial relations to improve when he has imposed a contract, accused the negotiators of lying, and effectively said that the members were fooled by their own negotiators? He has now told us today that he will build into the contract a differential between the antisocial payments paid to these professionals and those paid to other professionals working next to them. That is a recipe for disaster. Will he put in the Library a full list of what he believes are the so-called lies that were told by the leaders of the BMA? Will he explain how he expects to get things back on an even keel, something that was asked for by the Chair of the Health Committee?

[Mr Hunt]

As someone who I fully concede may have more experience of industrial relation disputes than me, let me just say this: it is very clear that we are able to progress when there is give and take from both sides; when both sides are prepared to negotiate and come to a deal that is in the interests of the service and in the interests of the people working in the service. That was not possible. It is not me who is saying that; that is was what Sir David Dalton, a highly respected independent chief executive, said in the letter he wrote to me last night.

Some of the things that the BMA put out about the offer—for example, it put up on its website a pay calculator saying that junior doctors were going to have their pay cut by 30% to 50%—caused a huge amount of upset, anger and dismay, and were completely wrong. I do not think it would be very constructive for me to put in the House of Commons Library a list of all those things, when what I want to try to do is build trust and confidence. The differential between doctors and other workers in hospitals is what the BMA was seeking to protect. It still exists, but we have reduced it from what it was before because we think it is fairer that way and better for junior doctors.

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

May I add to what my long-time comrade, my hon. Friend the Member for Gainsborough (Sir Edward Leigh) said by delving into a bit of history? In 1977, I was knocked off a motorcycle by a careless driver on a Sunday. Because staff were not in the hospital, the wound could not be cleaned until it was x-rayed and because the wound could not be cleaned, I got an infection. This is not just about increased mortality rates; it is about the prolongation and exacerbation of small or routine episodes and injuries. Will the Secretary of State, in his calm and measured way, say again to the House that when we look back on this episode people will be very surprised that it took nearly 40 years—from my accident—to bring about this long-overdue reform?

--- Later in debate ---

[Mr Hunt]

My right hon. Friend is absolutely right. He talks about x-rays, which illustrates the point that this is not just about doctor presence but the presence of those who are able to do x-rays, MRI scans, CT scans, get results back from laboratories and so on. A whole suite of things are necessary for seven-day care. He is also right to point out that there are huge savings if we get this right. For example, if someone gets an avoidable pressure ulcer because they have not had the care that they should have received over a weekend, they are likely to have to stay in hospital for over 10 days longer. That will cost the NHS several thousand pounds more and that is why, in the end, this is the right thing to do economically as well as ethically.

[Tom Brake (Carshalton and Wallington) (LD)]

There are huge pressures everywhere in the NHS. For instance, GP out-of-hours services are under an incredible strain and cover is very limited in some parts of the country. What is the Secretary of State doing about those pressures and the additional strain that could be triggered by an exodus of doctors, following the imposition of the doctors’ contract? Will he entertain the idea of a commission, as advocated by my right hon. Friend the Member for North Norfolk (Norman Lamb) and by others on both sides of the House, to find a long-term consensual solution to the growing health and care challenges that we face?

[Mr Hunt]

The trouble with commissions is that they tend to take rather a long time to come up with their conclusions, and we need to sort out these problems now. That is why the Chancellor promised an extra £3.8 billion for the NHS next year, and why we said that we want 5,000 more GPs working in general practice, which will help out-of-hours services. We have a five-year plan that the NHS has the funding to implement, and that will transform out-of-hospital services. I hope that those developments will address the right hon. Gentleman’s concerns.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his patience and resolution in bringing this matter to a conclusion. Does he share the real sadness that so many of us feel that these wonderful young people who come into the health service to be doctors with such high ideals are caught up in this terribly debilitating and damaging dispute? I ask him to reinforce his efforts to engage and speak directly with junior doctors and the medical profession as a whole and not allow the disruptive behaviour of the British Medical Association to destroy the relationship that we need to have with our doctors.

[Mr Hunt]

My hon. Friend is right. There was absolutely no reason to have this dispute, because the things that we are trying to sort out—seven-day care and safer care for patients—are what every doctor wants to happen. Indeed, they choose medicine as a profession from the highest of ethical motives, and we want to support them. I share his sadness that it has come to this, but given that the counter-party in the situation is not willing to budge, we have to take action to remove uncertainty and to do the right for patients and for doctors. I will certainly continue to engage. The new commission headed up by Professor Dame Sue Bailey will also look at wider issues of morale, which will make a big difference.

[Several hon. Members rose—]

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

I had a further email on this subject from a doctor in my constituency this morning. He thanked me for forwarding replies from the Department, although he did say that they were disappointing. He said that the BMA had proposed a contract that met the Government’s cost-neutral requirements, but that it had been rejected. Is that true?

[Mr Hunt]

I will be pithy, Mr Speaker. This is not just about cost-neutrality, but about dealing with weekend care, which is why that proposal was not accepted.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

May I congratulate my right hon. Friend on always having at the forefront patient care and the wellbeing of young doctors? Did it not give the game away when the BMA said that this was a blow against austerity? Will he remind the House how much extra money has gone into the NHS, by contrast to what happened under the Labour party?

[Mr Hunt]

My hon. Friend is absolutely right. I am afraid that, regrettably, there are some political elements inside the BMA. The great irony is that, without the austerity measures that those same people opposed in the previous Parliament, we would not have been able to give the NHS its sixth biggest funding increase ever.

[Dawn Butler (Brent Central) (Lab)]

When I watched the Secretary of State on the TV on Sunday, two things struck me: first, he got paler as the letters from junior doctors were read out; and secondly, he made it clear that it was the senior doctors not being present that was the barrier to a full seven-day NHS. Why is it then that he is picking a fight with junior doctors?

[Mr Hunt]

We need senior decision-makers to be present. They are the most important people when it comes to delivering seven-day care. Most of the medical royal colleges accept that a junior doctor who has had a substantial amount of training does qualify as a senior decision-maker, which is why we need them more.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The BMA has taken the oversubscribed political sub-speciality of spin doctoring to a whole new level. May I express my admiration for the Secretary of State for his ability to keep his cool under the sort of provocation that he has had, and ask how a 13.5% increase in pensionable pay could possibly lead to problems with recruitment and retention?

[Mr Hunt]

My hon. Friend speaks with personal knowledge. One of the things that has been wrong with junior doctors’ contracts for many years is that basic pay is too low. They therefore feel under huge pressure to boost basic pay by premium working, and that has led to some of the distortions that we see. So, yes, it is a significant increase in basic pay, which will be a very big step forward.

[Jack Dromey (Birmingham, Erdington) (Lab)]

I have spent 30 years in the world of work, representing employees, conducting negotiations and solving disputes. I have seldom seen a sense of grievance so grotesquely mishandled, insulting the intelligence of junior doctors by telling them that they do not understand what is on offer. Does the Secretary of State not feel a sense of shame that his handling of this dispute should have so poisoned relationships with junior doctors, who are the backbone of the national health service?

[Mr Hunt]

The hon. Gentleman can do a lot better than that. We have been willing to negotiate since June. It was not me who refused to sit round the table and talk until December; it was the BMA, which, before even talking to the Government, balloted for industrial action. What totally irresponsible behaviour that is. If Labour were responsible, it would be condemning it as well.

[Wendy Morton (Aldridge-Brownhills) (Con)]

I thank my right hon. Friend for his statement today and for all the work that he is doing to deliver a truly seven-day-a-week NHS, which we all really want for our constituents. Will he confirm that the BMA, the royal colleges, the Government and the wider NHS are all now agreed on the need to improve weekend care, which, as Professor Sir Bruce Keogh has said, is both a clinical and a moral cause?

[Mr Hunt]

My hon. Friend is absolutely right. There is a huge amount of support for doing the right thing for patients, which is why it is so extraordinary that the BMA has chosen to defend the indefensible, not to sit round and talk about how we can do this, as any reasonable doctor would have done and—to go back to the earlier question—to put out deeply misleading comments to its own members that have inflamed the situation and made it far worse than it needed to be.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

The Royal College of General Practitioners has reacted to the decision to impose the contract by saying that it is shocked and dismayed. The Royal College of Psychiatrists has said that the decision will exacerbate the recruitment and retention issues that the NHS currently faces. Why does the Health Secretary ignore the concerns of those two royal colleges?

[Mr Hunt]

When those colleges have had a chance to look carefully at our proposal, they will find much that they can commend. For both psychiatrists and GPs, we are putting in a premium to attract more people into those specialties, which will be immensely important both for them and for the NHS.

[Antoinette Sandbach (Eddisbury) (Con)]

Will the Secretary of State draw to the shadow Secretary of State’s attention the research in the Netherlands that has shown that seven-day working has dramatically cut stillbirth rates—by 6.8% in the Netherlands—and has the potential to have a real impact on survival rates for young babies?

[Mr Hunt]

I commend my hon. Friend for her campaigning on that issue. She could not be more right. Just before Christmas, a report by Professor Paul Aylin said that the mortality rates for neonatal children were 7% higher at weekends, which underlines just how important it is to get this right.

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

On 5 December 2011, the Government tried to cut unsocial hours for “Agenda for Change” staff. At a time when morale right across the NHS is so low, will the Secretary of State guarantee that he will not bring forward cuts, because the reason behind the unsocial hours cut that I mentioned was to introduce seven-day working?

[Mr Hunt]

We have no plans to do so, but I cannot be drawn any further, except to say that we do have to deliver our manifesto commitments. The specific issues that we have identified with respect to seven-day working relate to consultant and junior doctor presence, and that is what we are focused on putting right.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I thank my right hon. Friend for the very clear way in which he has kept the House up to date on the progress of all this. It is very important not only that we free up beds in hospitals, most certainly at weekends, but that we should be making much greater use of our pharmacies to deliver better healthcare within the community. Will he explain how that might happen?

[Mr Hunt]

I believe my right hon. Friend the Minister of State is with the pharmacists now discussing that precise issue. My hon. Friend raises this issue regularly and rightly: pharmacists have a very important part in the future of the NHS.

[Paul Flynn (Newport West) (Lab)]

On Sunday, I witnessed the seven-day working at a Welsh hospital, where a clinic was held in Nevill Hall for the convenience of patients and to get maximum use of an expensive gamma camera. The Secretary of State constantly denigrates the work of the Welsh health service, but will he pause to congratulate the Welsh and Scottish Governments, who avoided the misery of the strike and will also avoid the poisonous legacy of resentment that he will face from junior doctors?

[Mr Hunt]

The Welsh and Scottish Governments may have avoided the difficult decision that we are taking in the NHS in England, but the longer they go on avoiding the issue, the longer they will have higher mortality rates at weekends, which we are determined to do something about.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. If we do not have enough junior doctors, patient safety cannot be guaranteed. In his statement, he referred to reducing the number of hours, nights, days and rostered weekends for doctors. Does he believe that that will ensure that there will be no strike? What safeguards are in place for patients, nurses and senior doctors if an agreement cannot be reached?

[Mr Hunt]

It is because an agreement cannot be reached that we have to take the measures that we are taking today. The bits of the new contract to which the hon. Gentleman draws attention are the bits that will have the biggest impact on the morale of junior doctors, because we are saying that we do not think it is right for hospitals to ask them to work five nights in a row or to work six or seven long days in a row. We are putting that right in the new contract. That will lead to less tired doctors and better care for patients.

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

I met a large group of junior doctors in my constituency to discuss the new contract. They were highly professional and totally committed to the NHS, but for the first time some of them were considering working abroad. One of them told me that, although she loved her job, she would never let her daughter train as a junior doctor now. Does that not demonstrate that the low morale—the despair, frankly—and the likely flight of junior doctors as a consequence of imposition is a huge threat to the future of our NHS?

[Mr Hunt]

The biggest threat to morale for doctors is not being able to deliver the care that they came into the profession to deliver. That is why we are sorting out a proper seven-day NHS, particularly for junior doctors who work in A&E departments at weekends, where they often do not have the support they would get during the week and do not have as many consultants around as there would normally be. That is what we are trying to put right. I appreciate that it is very difficult when the counter-party in the dispute does not want to negotiate, but in the end Governments have to decide what is right for patients and what is right for the service, as well as what is right for doctors.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Hull has traditionally struggled to recruit doctors in specialties such as A&E, general practice and psychiatry. I am concerned about the royal colleges’ warning that the imposition of the contract will have a detrimental effect on staff morale and staff retention in the NHS. Will this not make things even more difficult for areas such as Hull, which struggle to recruit in the first place?

[Mr Hunt]

We want more doctors and more nurses in the NHS, but in the end, if we are putting extra money in to recruit these extra doctors and nurses, it is fair to the public who are paying for their salaries to have reforms that mean their care gets better. That will apply to the hon. Lady’s constituents in Hull, who want a seven-day NHS, just as my constituents in Surrey do.

[Paula Sherriff (Dewsbury) (Lab)]

The Health Secretary repeatedly accuses the BMA of misleading junior doctors, yet 98% of them voted for industrial action. Without exception, every doctor I have spoken to said that the last thing they wanted to do was to go out on strike. Doctors are some of the brightest and most intelligent people we have in our country. Does the right hon. Gentleman really believe that they cannot make up their minds for themselves?

[Mr Hunt]

It is interesting that when that vote was held, the BMA had not sat down and talked to the Government, despite repeated invitations. I personally met Johann Malawana, the leader of the junior doctors committee, and invited him to talks. Despite those repeated invitations, they refused to talk; they decided to ballot for industrial action. How serious are people about reaching a negotiated settlement if that is what they do?

[Liz McInnes (Heywood and Middleton) (Lab)]

Can the Secretary of State clarify something in his statement for me? He says that “those working one in four Saturdays or more will receive a pay premium of 30%. That is higher on average than that available to nurses, midwives, paramedics and most other clinical staff”. The staff he cites will be employed on bands 4 to 9 under “Agenda for Change” terms and conditions. If they work Saturdays, they receive plain time plus 30% for working then, so can the Secretary of State tell me how he has calculated an average? I do not understand his mathematics.

[Mr Hunt]

I am happy to do that. The contract that we are going to implement gives junior doctors who work more than one in four Saturdays—so one in three Saturdays —a higher premium of 50%, so when taken on average, it is a higher premium for working on a Saturday.

[Huw Irranca-Davies (Ogmore) (Lab)]

As has been pointed out by my hon. Friend the Member for Newport West (Paul Flynn), there were no strikes in Wales yesterday. However, on the point made by the hon. Member for Central Ayrshire (Dr Whitford), there was an increase of 10% in the budget, equivalent to 135 places for nurse training, which is so critical for cover. That may be what led to a communication that I received from a junior doctor in England who said, “Could we have your Minister for Wales, please?” What does it say about morale in the NHS in England when, in football and rugby parlance, the Minister has lost the confidence of the changing room?

[Mr Hunt]

I think that is the first time in living memory in this House that a Welsh MP has got up and said that they think things are better in the Welsh NHS. Just look at the waiting times that people face for basic operations on the NHS in Wales—far, far longer than in England. We will take no lectures about how to run the NHS from Labour in Wales.

[Paul Blomfield (Sheffield Central) (Lab)]

I represent three fine hospitals and one great medical school, and I spend a lot of time listening to junior doctors and medical students. The Secretary of State talks about the crisis in morale in the NHS among junior doctors. Does he not recognise that his handling of the dispute has done so much to enhance that crisis, and that today’s announcement will make it so much worse?

[Mr Hunt]

Not at all. The choice I had was to do something about mortality rates at weekends or to duck the issue. Under the Conservatives, we do not duck issues about mortality rates. We do the right thing for patients. After Labour’s record, I should have thought the hon. Gentleman would be a little more circumspect.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 9th February 2016 Commons Chamber

[Nigel Huddleston (Mid Worcestershire) (Con)]

12. What progress his Department has made on improving the performance of hospital trusts in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Eleven out of 27 hospitals have now exited special measures, having demonstrated sustainable improvements in the quality of care. Overall, trusts put into special measures have recruited 1,389 more doctors and 4,402 more nurses, with one estimate saying this has reduced mortality rates by 450 lives a year.

[Rehman Chishti]

Following the recent Care Quality Commission report on the Medway hospital, the staff and new chief executive are working hard to turn around long, historic and deep problems. What further support can the Secretary of State and the Government offer the hospital to help turn it around and get it out of special measures? I thank the Secretary of State and his Department for the support they have given to the hospital so far.

[Mr Hunt]

I thank my hon. Friend for his enormous support for that hospital, which has been through a very difficult patch. I had a long meeting with the chief inspector of hospitals about the Medway yesterday. My hon. Friend will be pleased to know that, over the past five years, we got 106 more doctors and 26 more nurses into the trust. We now have a link with Guy’s and St Thomas’s that is beginning to bear fruit. There is a lot more to do, but we are determined to ensure that we do not sweep these problems under the carpet and that we deal with them quickly and deliver safer care for my hon. Friend’s constituents.

[Daniel Kawczynski]

My right hon. Friend will know of some of the terrible problems experienced in Shropshire with respect to clinical commissioning groups and the trust, particularly over the future fit programme and A&E services in the county. The Royal Shrewsbury hospital covers a huge area—not just Shropshire, but the whole of mid-Wales. Will my right hon. Friend give me an assurance that he will do everything possible to support me and the residents of Shrewsbury to guarantee that A&E services remain at the Royal Shrewsbury hospital?

[Mr Hunt]

First, I thank my hon. Friend for his campaigning on behalf of the Royal Shrewsbury; no one could do more than he has over many years. I encourage him to engage carefully with the future fit programme. In the end, it is incredibly important to get the right answer for patients. My hon. Friend has been supportive of the process, but like him, I would like to see it concluded sooner rather than later.

[Nigel Huddleston]

Will the Secretary of State set out for my Worcestershire constituents what impact the putting of trusts into special measures is likely to have this year and what improvements can be expected when the trust exits special measures?

[Mr Hunt]

The advantage of the special measures programme is that we tend to make much faster progress in turning round hospitals in difficulty than used to happen in previous years. My hon. Friend will know that, in the past five years, his local trust gained nearly 50 more doctors and more than 100 more nurses. We are making progress, but we need to do it much faster. The hospital will have my full support in getting these problems dealt with quickly.

[Valerie Vaz (Walsall South) (Lab)]

Walsall NHS trust has been placed into special measures, so what immediate action can the Secretary of State take to ensure that the Manor hospital can recruit the vital staff in paediatrics and A&E that it now needs—not agency staff, but long-term fully employed staff?

[Mr Hunt]

The hon. Lady is absolutely right that one thing that can tip hospitals into special measures is having too high a proportion of staff from agencies so that a trust cannot offer the continuity of care that other trusts can. There have been an extra 83 full-time doctors at Walsall Healthcare NHS Trust over the past five years, along with 422 full-time nurses. An improvement director started this week and we are looking to find a buddy hospital, which is what I think will help most. When it comes to turning hospitals round the fastest, we have found that having a partner hospital can have the biggest effect, as with Guy’s and St Thomas’s for the Medway.

[Keith Vaz (Leicester East) (Lab)]

Despite having a football team at the top of the premier league, the hospitals of Leicester are in need of urgent assistance. The worry for Leicester is that they will slip into special measures, particularly regarding A&E. What steps can the right hon. Gentleman take to ensure that our hospitals perform as well as Leicester City football club?

[Mr Hunt]

We want to them to be as outstanding as Leicester City football club, but we recognise that there is some way to go. There is pressure on A&E departments, as the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has acknowledged in the House, and we are giving careful thought to what we can do to support them. Leicester will be one of the first trusts in the country to offer full seven-day services from March or April 2017 onwards, so important improvements are being made, but we will do all that we can to ensure that they happen quickly.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Calderdale and Huddersfield trust is not in special measures, but it is in trouble, and we are likely to lose our A&E service—in one of the biggest towns in Britain—if we follow the recommendations of the CCG. Does the Secretary of State agree that when hospitals and trusts get into trouble, it is usually because of poor management? What can we do to improve the management of hospitals, and, in particular, what can we do about people who, because they are GPs, think that they are managers?

[Mr Hunt]

The hon. Gentleman has made an important point. I think that there are some things that we just need to do differently. For instance, we should allow managers to remain in their posts for longer. If the average tenure of NHS chief executives is only about two years, their horizons will inevitably be very short-term, so we need to give them enough time to turn their organisations around. The chief executive of the latest trust to be given an “outstanding” measure, Frimley Park Hospital NHS Foundation Trust, has been there for 26 years, and I think there is a connection. We can ensure that managers have the necessary resources. I think we can also make sure that we identify their problems quickly, and give them support before those problems turn into a crisis.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

Barking, Havering and Redbridge University Hospitals NHS Trust is working extremely hard to improve its services and has already achieved considerable success, but although there are 250 spare home beds in the London borough of Havering, there are still a great many frail elderly patients in hospital who are no longer clinically ill. Has any research been done on the reasons for delayed discharge, and to what extent does patient choice play a part in it?

[Mr Hunt]

Unfortunately, it sometimes plays a part, but the main way to tackle the problem is to establish better co-ordination between what local authorities do, what the CCGs do and what the trusts do. That applies not just to my hon. Friend’s local trust, but to trusts throughout the NHS. I do, however, commend her local trust. At its last inspection, the CQC found that it had made significant progress. It has more doctors, more nurses and, in my view, an excellent chief executive, and I am very confident about its future.

[Heidi Alexander (Lewisham East) (Lab)]

Sixteen trusts across the country are currently in special measures, nine out of 10 hospitals are failing to fulfil their own safe staffing plans and waiting time targets are being missed so often that failure is becoming the norm. Does the Secretary of State think that that might explain why, as we learned yesterday, a King’s Fund survey has found that dissatisfaction with the NHS increased by eight percentage points in 2015? That is the largest single-year increase since the surveys began in 1983.

[Mr Hunt]

The hon. Lady might want to look more closely at that King’s Fund report before turning it into a political football. According to page 6, satisfaction rates in Wales—run by her party—are six percentage points lower than those in England.

Let me tell the hon. Lady exactly what is happening with the special measures regime. We are being honest about the problems and sorting them out, rather than sweeping them under the carpet, which is what caused the problems that we experienced with Mid Staffs, Morecambe Bay and a range of other hospitals. At the same time, we are putting more money into the NHS and helping it to deal with its deficits, we are treating more people, and public confidence in the safety and dignity of the care that people are given is at record levels.

[Heidi Alexander]

It is clear that the Secretary of State does not want to talk about his record in England. His own Back Benchers are queueing up to tell him about the problems in their NHS areas of Medway, Shropshire and Worcestershire, but he seems not to understand the extent of those problems.

Let us return to what the public think. Satisfaction with the NHS has fallen by five percentage points; dissatisfaction has risen by eight percentage points; satisfaction with GP services is at the lowest rate ever recorded; and satisfaction with A&E stands at just 53%. We know that the Secretary of State has lost the confidence of doctors, but is that not the clearest sign yet that he has lost the confidence of patients, too?

[Mr Hunt]

What my Back Benches are queueing up to say is, “Thank you for sorting out the problems that Labour swept under the carpet for years and years.” What did Professor Brian Jarman of Imperial College say about the Department of Health under the last Labour Government? He said that it was a “denial machine”, with all the problems in hospitals being swept under the carpet and not dealt with. What is happening under this Government? Every day, 100 more people are being treated for cancer, 2,000 more people are being seen within four hours at A&E departments and 4,400 more operations are being carried out. There are record numbers of doctors and nurses, and the NHS is safer than ever in its history. We are proud to be the party of the NHS.

[Ian Lavery (Wansbeck) (Lab)]

3. What estimate he has made of the number of patients who went to A&E after having been unable to make an appointment with their GP in the most recent period for which figures are available.

--- Later in debate ---

[Derek Twigg (Halton) (Lab)]

5. What proportion of hospital trusts are in deficit?

[The Secretary of State for Health (Mr Jeremy Hunt)]

Trusts reported a net deficit of £1.6 billion for the first half of this financial year, with 75% of trusts reporting a deficit, which is why, last week, we launched the Carter efficiency programme in which Lord Carter confirmed that hospitals can save £5 billion annually by making sensible improvements to procurement and staff rostering.

[Derek Twigg]

Almost every acute trust will be in deficit in the coming year, including Warrington and Halton Hospitals NHS Foundation Trust and Whiston and St Helens hospitals, which cover my constituency. The fact is that the Government have been slow in dealing with one of the causes of the deficit, which is the employment of great numbers of agency staff. They also want to cut the tariff, which is based on efficiency savings, leaving hospitals such as Whiston and St Helens, which are among the most efficient in the country, struggling to make greater efficiencies. Will the Secretary of State look at that matter again?

[Mr Hunt]

The hon. Gentleman should give a slightly more complete picture of what is happening in his hospitals. There are nearly 2,000 more operations every year, 7,000 more MRI scans, and 7,000 more CT scans than there were five years ago. When it comes to the issue of deficits, we are tackling the agency staff issue. That happened because trusts were responding to the Francis report into what happened in Mid Staffs. Rightly, they wanted to staff up quickly, but it needs to be done on a sustainable basis. I simply say to him that if we were putting £5.5 billion less into the NHS every year, as he stood for at the previous election, the problems would be a whole lot worse.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Does my right hon. Friend not agree that running costs in the NHS, which vary from £105 to £970 per square metre per year as highlighted by Lord Carter, are wholly unacceptable, and that the concept of a model hospital to bring the worst up to the standard of the best, which was also highlighted by Lord Carter, has great merit?

[Mr Hunt]

My hon. Friend knows about these things from his own clinical background, and he is absolutely right. We are now doing something—it is probably the most ambitious programme anywhere in the world—to identify the costs that hospitals are paying. From April, we will be collecting the costs for the 100 most used products in the NHS for every hospital. That information will be shared. We are the biggest purchaser of healthcare equipment in the world, so we should be paying the lowest prices.

[Margaret Ferrier (Rutherglen and Hamilton West) (SNP)]

Barts Health NHS Trust, the UK’s largest hospital trust, is set to run up a £135 million deficit this year. That would be by far the greatest ever overspend in the history of the NHS. When will the Minister accept the sheer scale of the austerity-driven crisis facing the NHS?

[Mr Hunt]

It is stretching things a bit to call that an austerity-driven problem when, next year, we are putting in the sixth biggest increase in funding for the NHS in its entire 70-year history. There are some severe problems at Barts, but we will tackle the deficit. We also need to ensure that we improve patient safety and patient care.

[Jeremy Lefroy (Stafford) (Con)]

The staff of the University Hospitals of North Midlands to whom my right hon. Friend entrusted the care of County Hospital in Stafford and the Royal Stoke University Hospital have done a great job both in improving the quality of care and in bringing down the deficit. Will he ensure that a long-term approach is taken to the finances of that trust so that we do not make rapid decisions that could result in difficult situations in the future?

[Mr Hunt]

As ever, my hon. Friend speaks very wisely. When we are reducing these deficits and costs, the trick is to take a strategic approach and not to make short-term sacrifices that harm patients. That is why, at the weekend, we announced a £4.2 billion IT investment programme, which will mean that doctors and nurses spend less time filling out forms and more time with their patients.

[Mims Davies (Eastleigh) (Con)]

6. What further steps he plans to take to improve access to GPs.

[The Secretary of State for Health (Mr Jeremy Hunt)]

By 2020, everyone will be able to get GP appointments at evenings and weekends. By March this year, a third of the country—18 million people—will have benefited from improved access to GP services.

[Mims Davies]

There is a concerning recruitment issue for GPs in my constituency, Eastleigh, which has led to patients experiencing significant delays in getting non-urgent appointments. Will my right hon. Friend look into promoting more agile working structures for GPs, especially women? This was highlighted by my CCG on Friday as vital for recruiting and retaining the extra GPs we need.

[Mr Hunt]

I know that West Hampshire CCG is providing extra space and capacity to take on more trainees, and across the country we plan to have 5,000 more doctors working in general practice by the end of this Parliament. This will be the biggest increase in GPs in the history of the NHS. It builds on the extra 1,700 GPs we have working in the NHS since 2010. It does take too long to get to see a GP. We are committed to sorting that out, and the record investment in the NHS five year forward view will make that possible.

[Colleen Fletcher (Coventry North East) (Lab)]

Wyken medical centre in my constituency is due to close in March. This will leave more than 2,000 of my constituents needing to find a new GP, at a time when it is practically impossible to get a prompt GP appointment, never mind register at a new GP surgery. Can the Secretary of State therefore assure me that he will co-ordinate with NHS England to ensure that it manages the situation appropriately and does all it can to assist each of my constituents affected, particularly the vulnerable and elderly, to get access to a new GP as soon as possible?

[Mr Hunt]

I am happy to do that. The hon. Lady is right to make those points. It is to care for the vulnerable people with long-term conditions that we need to see the biggest support given to GPs, because strengthening their ability to look after people proactively will mean that those people are kept out of hospital and kept healthier, and costs are kept down for the NHS.

[Kelly Tolhurst (Rochester and Strood) (Con)]

In Rochester, we are facing the closure of two single-handed GP practices owing to a retirement and a suspension, with no long-term replacements, making it more difficult for our growing population to access these vital services. Will my right hon. Friend outline the steps he is taking to maintain appropriate access to local GPs?

[Mr Hunt]

I am absolutely prepared to do that and I have met a number of GPs in my hon. Friend’s area. We are reversing the historic underfunding for general practice, with an increase of more than 4% a year in funding for primary care and general practice for the rest of this Parliament. That will give hope to the profession, whose members are vital to the NHS.

[Jim Shannon (Strangford) (DUP)]

Northern Ireland has the lowest number of GPs per capita across the United Kingdom. In order to access GPs, we need to have GPs. In the whole of the United Kingdom of Great Britain and Northern Ireland 25% of GPs are aged over 55, and that is going to get worse. What steps have been taken to train more GPs and to ensure that they stay in the NHS and do not go overseas, where there are better wages and conditions?

[Mr Hunt]

We have plans, as I mentioned, to have 5,000 more doctors working in general practice, and there is a big interviewing process. We need to increase the number of GPs going into general practice by 3,250 every year and I am happy to liaise with the Province to see how we can work together on these plans.

[Mr Speaker]

I call next the medal-wearing member of the team which won the parliamentary pancake race this morning, against the peers and against the press.

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[Rosie Cooper (West Lancashire) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Significant progress has been made in our negotiations with the British Medical Association on a new contract for junior doctors, but agreement has not been reached on the issue of Saturday pay, despite previous assurances from the BMA that it would negotiate on that point. So, regrettably, 2,884 operations have been cancelled ahead of tomorrow’s industrial action, which will affect all non-emergency services. I urge the BMA to put the interests of patients first and to reconsider its refusal to negotiate.

[Rosie Cooper]

At Prime Minister’s questions in February 2014, I raised with the Prime Minister my very serious concerns about the dangerous bullying culture at Liverpool Community Health NHS Trust. I understand that the Capsticks inquiry into parts of that is now complete, so will the Secretary of State, in the spirit of honouring his stated commitment to openness and transparency, ensure that that report is made available, perhaps via the NHS Trust Development Authority, if necessary, to the public trust board on 23 February?

[Mr Hunt]

I will happily look into that matter. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has held a round table on bullying and harassment. I thank the hon. Lady for raising the issue, because over the past decade—none of us should be proud of this—the number of NHS staff who say they are suffering from bullying and harassment has gone up from 14% to 22%. If we are going to deliver safer care, we have to make it easier for doctors and nurses on the frontline to speak out without worrying about being bullied or harassed.

[Several hon. Members rose—]

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Today’s The Independent reports that a potential deal on the junior doctor contract was put to the Government that would have resolved junior doctors’ concerns without costing any more money and potentially avoided tomorrow’s industrial action. A source close to the negotiations told the newspaper:

“The one person who would not agree was Jeremy Hunt. Even though the NHS Employers and DH teams thought this was a solution he said no”.

So let me ask the Health Secretary a very direct question: have the Government at any point rejected a cost-neutral proposal from the BMA on the junior doctor contract—yes or no?

[Mr Jeremy Hunt]

The only reason we do not have a solution on the junior doctors is the BMA saying in December that it would negotiate on the one outstanding issue—pay on Saturdays—but last month refusing to negotiate. If the BMA is prepared to negotiate and be flexible on that, so are we. It is noticeable that despite 3,000 cancelled operations, no one in the Labour party is condemning the strikes.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

T6. Will my right hon. Friend update us on the progress in decriminalising dispensing errors for pharmacists?

[Tommy Sheppard (Edinburgh East) (SNP)]

T2. The Secretary of State will be aware that Maximus is recruiting junior doctors to perform work capability assessments in the Department for Work and Pensions. The company is offering £72,000 a year, which is up to twice the salary that junior doctors would get in the health service. Is he concerned that that will result in inexperienced medical staff making judgments that relate to people’s livelihoods? Is he not also concerned that it will result in a drain of staff resources out of the NHS and out of providing general healthcare for the public?

[Mr Jeremy Hunt]

As a result of the changes the Government have made on welfare reform, we have 2 million more people in work and nearly 500,000 fewer children growing up in households where nobody works. Part of that is making important reforms, including having independent medical assessments of people who are in the benefit system. I think everyone should welcome that.

[David Tredinnick (Bosworth) (Con)]

T8. Comparative research has shown that proton therapy is as effective as radiotherapy for certain cancers, but has fewer side effects. Do Her Majesty’s Government accept the use of comparative evidence in deciding the availability on the NHS of emerging treatments such as proton therapy?

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[David T. C. Davies (Monmouth) (Con)]

T9. Has the Secretary of State seen the comments of Professor Angus Dalgleish, who is widely reported in the papers today as suggesting that EU rules are forcing us to spend billions of pounds treating health tourists and preventing us from undertaking important clinical trials? Has the Secretary of State made any assessment of Professor Dalgleish’s comments?

[Mr Jeremy Hunt]

The Government have made a huge and significant assessment of the cost of overseas people using the NHS, and we think that there are £500 million of recoverable costs that we do not currently recover. When it comes to the EU, the biggest problem that we have is that we are able to reclaim the costs of people temporarily visiting the UK, but we do not do so as much as we should because the systems in hospitals are not as efficient as they need to be. We are sorting that out.

[Liz McInnes (Heywood and Middleton) (Lab)]

T5. Despite the prevalence of pancakes in Parliament today, I am pleased to be asking a food-related question. A recent opinion poll performed by Diabetes UK showed that three quarters of British adults think food and drink manufacturers should reduce the amount of saturated fat, salt and sugar in their products. Does the Minister support introducing mandatory targets for industry to reformulate food and drink products to help people to eat more healthily, and will that form part of the Government’s childhood obesity strategy?

--- Later in debate ---

[Greg Mulholland]

Leeds has a shortage of integrated care beds and pressure on acute services. Will the Secretary of State—[Interruption.] That was a comma, Mr Speaker. Will the Secretary of State please intervene, so that Leeds Teaching Hospitals NHS Trust can open wards at Wharfedale hospital, which it wants to do, while the clinical commissioning group provides the money?

[Mr Jeremy Hunt]

I am very happy to look at that.

[Mr Speaker]

Well done.

[Andrea Jenkyns (Morley and Outwood) (Con)]

By refusing to condemn the junior doctors strike, the hon. Member for Lewisham East (Heidi Alexander) has shown that she has little regard for patient safety. [Interruption.] Will my right hon. Friend repeat his condemnation of this strike, which will seriously endanger patient safety, and assure me that he will continue to press for the new contracts, which will guarantee safer patient care and a better contract for doctors?

[Mr Hunt]

I think my hon. Friend got a bit of a reaction with those comments. The Labour party is saying that if a negotiated settlement cannot be reached, we should not impose a new contract—in other words, we should give up on seven-day care for the most vulnerable patients. There was a time when the Labour party spoke up for vulnerable patients. Now it is clear that unions matter more than patients.

[Several hon. Members rose—]