Junior Doctors: Industrial Action
Debate between Jeremy Hunt and Diane Abbott(7 years, 8 months ago)
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Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The prospect of a rolling five-day strike by junior doctors was one of the utmost gravity. The junior doctors have suspended next week’s action, which is a step I believe the whole House welcomes, but the remaining programme of industrial action stays in place. If it eventually goes ahead, it will be the first such strike by junior doctors in the entire history of the national health service.
What the current situation shows is that there has been a complete breakdown in trust between junior doctors and the Government. The morale of junior doctors could not be lower, and that is not something for the Secretary of State to dismiss. But somehow the Secretary of State continues to take no responsibility for the current state of affairs—no responsibility for repeatedly arguing that the only problem was that doctors had “not read the contract”, no responsibility for the misleading use of statistics by claiming that thousands of patients were dying because of poor weekend care.
The president of the Royal College of Paediatrics and Child Health, Professor Neena Modi, said:
“despite concerns raised by senior officials, Jeremy Hunt persisted in using dubious evidence about the so-called ‘weekend effect’ to impose a damaging Junior Doctor contract under the bogus guise of patient safety”.
The Secretary of State still insists that the contract is about a seven-day NHS when we know now that his own officials were telling him that the NHS had too few staff and too little money to deliver what he was talking about.
The Secretary of State well knows that the public simply do not believe him in his attempt to demonise the junior doctors. Try as he might, he has failed to convince the public that somehow junior doctors are the “enemy within” or mere dupes of the BMA. Far from being manipulated, doctors voted emphatically against the new contract.
Everyone in this House will remember the 7/7 bombings and the No. 30 bus which exploded in Tavistock Square, a few yards from the headquarters of the British Medical Association. Everyone will remember the pictures of doctors, who had been in meetings and their offices, pouring out of the BMA building, heading for the 14 dead people and the 110 victims, without flinching or faltering, fulfilling their vocation of saving lives. These are the people that the Secretary of State seeks to vilify.
Today we know that the junior doctors—who, contrary to what the Secretary of State implied, have always made patient safety a top priority—have cancelled the action planned for next Monday, but if we are going to remove the threat of industrial action, there are questions that the Secretary of State has to answer. There are widespread reports of deficits and financial crises, so how can the NHS move to enhanced seven-day week working, even with the proposed £10 billion the Secretary of State mentioned in his statement, when there are not the resources to maintain the status quo?
I welcome the structural work going on outside the contract on issues such as work-life balance, the gender pay gap, the rota gaps, strengthening whistleblowing protections for junior doctors and, importantly, looking at the role of guardians of safe working hours, but the Secretary of State talked in his statement about confrontation: what could be more confrontational than seeking to impose a contract? Even at this late stage, I ask him to listen to the junior doctors’ leader, Dr Ellen McCourt, when she says:
“We have a simple ask of the Government: stop the imposition. If it agrees to do this, junior doctors will call off industrial action.”
The public are looking for the Secretary of State to try to meet the junior doctors: stop vilifying them, stop pretending they are the “enemy within”, and meet their reasonable demands.
Mr Hunt
I will respond to the hon. Lady’s comments, but she needs to be very clear to the House about the implications of Labour’s position on this. She has just said that she welcomes the suspension of next week’s industrial action, but that was not her position at the weekend. At the weekend, when the medical royal colleges, the General Medical Council and even The Observer criticised the proposed strike, what was she saying? She was saying that she would join them on the picket line—something her predecessor refused to do. The fact is that strikes cause harm, misery and despair for families up and down the country. When one of the most extreme members of the BMA junior doctors executive, Dr Yannis Gourtsoyannis, said that these strikes were
“the single most positive thing that has occurred within NHS politics in decades”,
what was Labour’s response? Did it condemn that? No. The shadow Chancellor actually invited him to advise Labour on policy. I just say this because—
Junior Doctors Contract
Debate between Jeremy Hunt and Diane Abbott(7 years, 10 months ago)
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Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The NHS is only as strong as the morale of its staff, and the rejection of this contract by the junior doctors sadly reveals that morale and trust in the Government are at rock bottom. Yesterday, to mark the 68th anniversary of the NHS, I visited my local hospital, Homerton University hospital, and met some of the wonderful nurses. One of their main concerns was the abolition of the bursary, but they were also genuinely worried that NHS staff were no longer valued. The Secretary of State must accept that his handling of the junior doctor dispute has exacerbated this feeling among all NHS staff.
I have sat in this Chamber and heard the Secretary of State say that junior doctors have not read the new contract, do not understand the new contract, or have been bamboozled by their leadership, but now that the junior doctors have rejected a renegotiated contract recommended by their leadership, he must begin to understand that his handling of this dispute has contributed to the impasse. There should be no suggestion that the junior doctors’ decision is somehow illegitimate. The turnout in the ballot was higher than in the general election in 2015.
I welcome the fact that the Secretary of State will not let up on efforts to eliminate the gender pay gap and that he will commission an independent report on how to reduce and eliminate that gap, and look at shared parental leave as well. That is an important concern among doctors. I also welcome the fact that the imposition of the contract will be phased, but at this time of general instability I urge the Government to reconsider imposing the contract at all.
It has not helped for the Government to treat junior doctors as the enemy within. It has not helped junior doctors’ morale that it was implied at one time that the only barrier to a seven-day NHS was their reluctance to work at weekends, when so many of them already work unsocial hours, sacrificing family life in the process. I am glad that the Secretary of State acknowledged today that junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends, but the vote to reject the contract is a rejection of the Government’s previous approach.
The Secretary of State knows that the BMA remains opposed to the imposition of any contract, believing that imposing a contract that has not been agreed is inherently unfair and an indictment of the Secretary of State’s handling of the situation. The junior doctors committee is meeting today to decide how it will proceed. Labour Members look forward to hearing the outcome of that meeting and how we can best continue to support the junior doctors.
Public opinion is not on the Government’s side. It is evident that the public will have faith in their doctors long after they have lost faith in this or any other Government. It is not too late to change course. The Government need urgently to address the recruitment and retention crisis and scrap the contract. Although I appreciate that the contract has been in negotiation for many years, the Government should give talks with the junior doctors one more chance. If they crush the morale of NHS staff, they crush the efficacy of the NHS itself.
Mr Hunt
I welcome the hon. Lady to her place for the first statement to which she has responded and welcome her on the whole measured tone, with one or two exceptions. I will reply directly to the points she made.
First, the hon. Lady maintains the view expressed by her predecessor, the hon. Member for Lewisham East (Heidi Alexander), who is in her place this afternoon, that somehow the Government’s handling of the dispute is to blame. We have heard that narrative a lot in the past year, but I say with the greatest of respect for the hon. Member for Hackney North and Stoke Newington (Ms Abbott)—I do understand that she is new to the post—that that narrative has been comprehensively disproved by the leaked WhatsApp messages that were exchanged between members of the junior doctors committee earlier this year.
We now know that, precisely when the official Opposition were saying that the Government were being intransigent, the BMA had no interest in doing a deal. In February, at the ACAS talks, the junior doctors’ aim was simply to
“play the political game of…looking reasonable”—
their words, not ours. We also know that they wanted to provoke the Government into imposing a contract, as part of a plan to
“tie the Department of Health up in knots for…months”.
In contrast to public claims that the dispute was about patient safety, we know that, in their own words,
“the only real red line”
was pay. With the benefit of that knowledge, the hon. Lady should be careful about maintaining that the Government have not wanted to try to find a solution. We have had more than 70 meetings in the past year and we have been trying to find a solution for more than four years.
The question then arises whether we should negotiate or proceed with the introduction of the new contracts. Let me say plainly and directly that if I believed negotiations would work, that is exactly what I would do. The reason I do not think they will work is that it has become clear that many of the issues upsetting junior doctors are in fact nothing to do with the contract. Let me quote a statement posted this morning by one of the junior doctors’ leaders and a fierce opponent of the Government, Dr Reena Aggarwal:
“I am no apologist for the Government but I do believe that many of the issues that are exercising junior doctors are extra-contractual. This contract was never intended to solve every complaint and unhappiness, and I am not sure any single agreement would have achieved universal accord with the junior doctor body.”
The Government’s biggest opponents—in a way, the biggest firebrands in the BMA—supported the deal and were telling their members that it was a good deal, which got rid of some of the unfairnesses in the current contract and was better for women and so on. If the junior doctors are not prepared to believe even them, there is no way we will be able to achieve consensus.
If the hon. Lady wants to stand up and say that we should scrap the contract, she will be saying that we should not proceed with a deal that reduces the maximum hours a junior doctor can be asked to work, introduces safeguards to make sure that rostering is safe and boosts opportunities for women, disabled people and doctors with caring responsibilities—a deal that was supported by nearly every royal college. If the alternative from Labour is to do nothing, we would be passing on the opportunity to make real improvements that will make a real difference to the working lives of junior doctors.
The hon. Lady and I have a couple of the more challenging jobs that anyone can do in this Chamber. She has been in the House for much longer than I have, so she will know that. The litmus test in all the difficult decisions we face is whether we do the right thing for patients and for our vulnerable constituents, who desperately need a seven-day service. The Government are determined to make sure that happens.
NHS Spending
Debate between Jeremy Hunt and Diane Abbott(7 years, 10 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Perhaps I will cut down my speech a bit. I give a particularly warm welcome to all my Back-Bench colleagues here; it is wonderful to see them coming out in support in such numbers. I thank the shadow Health Secretary for calling this debate. She is right to talk about the issues of NHS funding—though not particularly through this motion, which I will come on to speak about. I welcome her to her first Opposition day debate, as I welcomed her earlier to her first statement. This is a brief that she knows well, having been shadow Public Health Minister, and having campaigned on a lot of very important topics, including plain paper packaging for cigarettes. She has done a lot of work with the all-party sickle cell and thalassaemia group as well. I wish her luck in two areas. The first is with her parliamentary questions, after last week’s question to the Department for International Development about a drought in Indonesia, when it was in fact in the Philippines. Secondly, I wish her luck finding some Front-Bench colleagues, just as I need luck finding some Back-Bench colleagues in these debates.
We are in agreement on Brexit; we were both on the remain side, and I campaigned strongly with the hon. Lady. I agree with her that however much we may have disagreed with the vote, it is very important that we respect it. She and I both worried about the damage that it might do to our economy and society if we left, but we also agree that it would do incredible damage to something even more important than them—to our democracy—if the British people were to think that the Westminster establishment was trying somehow to ignore their decision.
From the reasonable tone of her comments, I know that the hon. Lady understands that Vote Leave was not speaking for the Government when it said that there would potentially be an extra £350 million for the NHS. In fairness to the Vote Leave campaigners, at various points they clarified downwards that slogan on the side of the bus and said that they were really talking about a net figure of more like £100 million that could potentially go to the NHS, rather than £350 million.
Oral Answers to Questions
Debate between Jeremy Hunt and Diane Abbott(7 years, 10 months ago)
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Mr Hunt
I enjoyed our many exchanges in this House, and it is a loss on our side as well that they will not continue. I would like to welcome the hon. Lady’s successor to her post, and I hope that I will have a chance to do so again when she asks a question later.
I agree with the hon. Member for Lewisham East (Heidi Alexander). Migrants, or the people who work in the NHS who come from different countries, make an extraordinary contribution. It is fair to say that the NHS would fall over without the incredible work that they do. It is also true that the British people voted to control migration on 23 June, and we have to accept that verdict. In terms of the NHS and social care system, I did not hear, and I have not heard in my time as Health Secretary, enormous amounts of worry about the pressure of migration on NHS services, because on the whole migrants tend to be younger and fitter people. While accepting the verdict of the British people and what they said on 23 June, the important reassurance that we now need to give is to the many people from outside the UK who make a fantastic contribution to the running of our health and care system.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State may be aware that in the wake of the Brexit vote NHS commissioning bosses have delayed funding for vital medicines and services because of the fall in the value of the pound. One affected patient is Abi Longfellow, the teenager who won her battle for a wonder drug thanks to a campaign by the Sunday People. Abi currently spends 11 hours a day on a dialysis machine and was due to start on a drug that would give her a fighting chance with a kidney transplant. We were all aware that the pound might fall post referendum, so will the Secretary of State explain why no contingency plans were put in place and what he will do to ensure that, despite the Brexit vote, patients like Abi receive the lifesaving treatments and medicines that they need?
Mr Hunt
First, I welcome the hon. Lady to her position. She is the third shadow Health Secretary I have faced in less than a year, and I am beginning to worry that it may be something personal. I wish her well; she knows the brief extremely well and has campaigned on it a great deal in her long parliamentary career. I will look into the case she brought up. I would not want anyone to be deprived of vital lifesaving drugs because of exchange rate fluctuations. The whole British economy, including the NHS, will have to deal with the economic shock that we may now face as a result of the Brexit vote. But now that the decision has been taken by the British people we must look for the opportunities for the UK and the NHS, and not simply worry about the uncertainties, although there will be lots of things we have to deal with.
A and E (Major Incidents)
Debate between Jeremy Hunt and Diane Abbott(9 years, 3 months ago)
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Mr Hunt
I am aware that there have been particular pressures at Northwick Park hospital, but I am also aware that a plan is in place in north-west London to have weekend opening of GP surgeries to improve out-of-hospital provision. The pressures that are faced there are like those in the rest of the country—very severe. We are doing everything we can to support the hospitals in that area with our winter pressures plans.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State spoke about the algorithms used by 111 call handlers. Does he appreciate that a frightened mother with a sick child is not really interested in algorithms? What she wants to know is that her child can get the medical help that they need promptly. He has told the House that he has been having meetings on this winter crisis since March. Is he not a little bit embarrassed that we now have people queuing to see their GPs first thing in the morning, ambulances queuing outside hospitals, people being treated in tents outside hospitals, and old people staying in hospital longer than they need to because there is a lack of funding and no proper co-ordination between health and social care?
Mr Hunt
Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.
UK Ebola Preparedness
Debate between Jeremy Hunt and Diane Abbott(9 years, 4 months ago)
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Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
Pauline Cafferkey is a heroine and the thoughts of the whole House are with her and her family at this difficult time. Many people will be glad that the Secretary of State mentioned the hundreds of African health workers who have died fighting Ebola, showing extraordinary heroism and devotion to duty. Our constituents, including those linked to families in that region, will want to know that we will continue to give the region all the support we can in fighting Ebola long after it has dropped from the headlines.
Mr Hunt
I could not agree more with the hon. Lady. Some 382 health care workers have died of Ebola, and it is worth saying that they include not just local people from Sierra Leone, Liberia and Guinea, but people from all over Africa as well as small numbers from other parts of the world. The very least we can do is to continue to support an aid budget, which will allow them to continue to improve their local health care systems.
Mid Staffordshire NHS Foundation Trust
Debate between Jeremy Hunt and Diane Abbott(10 years, 5 months ago)
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Mr Hunt
The biggest assurance that patients will have is that the definition of success as regards how the system views a hospital will be the same as patients’ definition of success. They want to go somewhere that treats them promptly and safely and with decent, compassionate care. That has not been how the system has judged the success of a hospital or its chief executive or board. That is why it is such a profound change to have a new chief inspector and Ofsted-style ratings. I think this will make a big difference, but I do not want to underestimate how big a challenge it is and how long a process it will be fully to make the transformation we need.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State will be aware of people’s disappointment that there is still no proper system of regulation for health care assistants. Does he understand that many members of the public feel that one of the problems with general standards of care in the health service may have been the push—under a Labour Government—for an all-graduate nursing profession? There is a strongly held view among members of the public that that has led to elevating taking exams and inputting data on a computer over providing basic levels of care, which is what they really value in a nurse.
Changes to Health Services in London
Debate between Jeremy Hunt and Diane Abbott(10 years, 6 months ago)
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Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The whole House knows that all the medical directors in the hospitals involved in north-west London support the reconfiguration. Does the Secretary of State really understand the importance of bringing ordinary people with him? Londoners are especially cautious about these reconfigurations because of the historic problems with access to GPs and the many excluded communities for whom A and E is their primary care, and because these institutions are often major employers in their area and people identify with them. Does he realise that unless he brings ordinary people and patients with him on these reconfigurations, Londoners will continue to fight them and, as in the case of Lewisham, they will continue to win?
Mr Hunt
Apart from the very last sentence, I actually agree with what the hon. Lady says. It is important to carry the public with us in these reconfigurations. Governments of both parties have struggled to do that in these difficult reconfigurations, which is why the new structures that we have introduced will put doctors in the front line to argue for changes. It is not just the medical directors of trusts supporting them, but the CCG leaders, who are all local GPs, making that case. That is why there is much stronger support for these changes. All the elected representatives on the local councils, apart from Ealing, supported these changes, and that is a very big change from what we have seen previously. I agree with the hon. Lady: we need to do more work and it is very important to carry people with us.
Health Services (North-West)
Debate between Jeremy Hunt and Diane Abbott(10 years, 9 months ago)
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Mr Hunt
The other point the right hon. Member for Leigh (Andy Burnham) made was that we should not make these changes to A and E services when those in other hospitals are under pressure. It is important that I remind the House of what he did when he was Health Secretary. After 2004-05, Labour missed its A and E targets in 12 quarters but closed or downgraded 12 A and Es. Now, in Wales, the A and E target has not been met since 2009, yet Labour is embarking on a big reconfiguration programme with his full support. So it is one policy when Labour is in opposition, another when it is in power. There is one person who agrees with the right hon. Gentleman, and he was campaigning in Trafford on Friday—Len McCluskey. When it comes to a choice between supporting local doctors or the unions, the Opposition support the unions.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
On a point of order, Mr Speaker.
Mr Speaker
Order. We cannot have points of order in the middle of a statement. The Secretary of State has been asked specific questions and I know that he will now respond without any delay to those specific questions and nothing more. Other Members wish to contribute and there is other business. The Secretary of State is an extremely important man, of course, but there are a lot of other people involved, too, and we need to get on and hear them. I call the Secretary of State to respond briefly.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
On a point of order, Mr Speaker.
Mental Health (Approval Functions) Bill
Debate between Jeremy Hunt and Diane Abbott(11 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.
Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.
Ms Abbott
We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clause 2 ordered to stand part of the Bill.
The Deputy Speaker resumed the Chair.
Bill reported, without amendment.
Third Reading
Oral Answers to Questions
Debate between Jeremy Hunt and Diane Abbott(11 years, 6 months ago)
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Mr Hunt
The first thing I would say to my hon. Friend about Sherwood Forest is that I know everyone in the House will join me in saying that our hearts go out to the families of the women who were misdiagnosed for breast cancer. We expect the local NHS to come up with a serious package of measures to make sure that that kind of thing cannot happen again.
My hon. Friend is right to talk about PFI. We inherited an appalling scandal. In order to tackle the PFI debts of just seven institutions, we are having to put aside £1.5 billion over the next 25 years, but we are working with all institutions to deal with this appalling debt overhang.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
We know that the Secretary of State’s views on abortion do not have a religious basis, so does he care to share with the House the scientific evidence to support his view that abortion time limits should come all the way down to 12 weeks?
Mr Hunt
Four years ago I voted with my conscience, as I am sure she voted with hers, but I did so as a Back-Bench Member of Parliament and we have made it clear that it is not the policy of the Government to change the abortion law. My job as Health Secretary is to implement the elected will of the House, which voted in 2008 not to reduce the abortion time limits.