Junior Doctors Contract

Debate between Jeremy Hunt and Jonathan Reynolds

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I am happy to do that for my hon. and learned Friend. It is not an easy problem to solve, because junior doctor training placements operate on six-month rotations, and they are a competitive process. We get many more applicants for a number of posts than there are posts available. We must find a way of balancing the need to respect family responsibilities, which is something that we all want to do, with the need to have a fair process for the most competitive positions. We do not have the balance right yet, so we have said that Health Education England, which decides where people are to go on rotations, will now have a duty to consider family responsibilities when it makes decisions about those rotations.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I welcome the potential resolution of this dispute and thank the Government for negotiating it. We should also thank junior doctors for having the courage to go on strike, which no one does lightly, to get a better deal for the NHS. I ask the Secretary of State to reflect on this breakthrough, to take further steps to build on his difficult relationship with NHS staff and, crucially, to stop presenting NHS policy as a false dichotomy between the interests of patients and the interests of NHS staff.

[Mr Hunt]

If the hon. Gentleman had listened to some of the things that I have said, he would have heard me say repeatedly that I do not think that that dichotomy exists. As he says, it is a false dichotomy because, in the end, what is right for patients is also right for doctors. The thing that demoralises doctors, nurses and everyone working in our hospitals in different parts of the NHS is when they are not able to give the care that they want or that they think is appropriate to the patients in front of them. That is why hospitals that have moved closest towards seven-day services are also some of the hospitals with the highest levels of morale in the NHS. He is right that it is a false dichotomy and that we need to do both together.

Junior Doctors Contracts

Debate between Jeremy Hunt and Jonathan Reynolds

Monday 25th April 2016 Commons Chamber

[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.

Mental Health

Debate between Jeremy Hunt and Jonathan Reynolds

Wednesday 9th December 2015 Commons Chamber

[Mr Hunt]

I will proceed with my speech for a little longer, if I may.

We are seeing the prospect of very real progress, and we as a Government need to give careful thought to which areas to prioritise. We do not have a monopoly of wisdom in this area, which is why we set up the independent mental health taskforce that is led by Paul Farmer, the chief executive of Mind. We will receive its report early in the new year. It will follow a successful independent report produced by the cancer taskforce, chaired by Harpal Kumar. I think that it is a good way of uniting the Government, Members in all parts of the House, and the mental health campaigning charities, so that we can decide together on the key areas that we want to transform in the coming years.

We are still working on the detailed planning, but we have already announced the provision of £2 billion of additional mental health funding over the course of this Parliament, which will benefit CAMHS, perinatal mental health treatment, the treatment of eating disorders, and talking therapy. Some of that funding is a result of promises made by the coalition Government which we have said we will honour, and some is a result of promises that we ourselves have made.

I agree with the hon. Member for Liverpool, Wavertree that as we increase investment in mental health, we need greater transparency in respect of the way in which that money is spent. I am pleased to say that next June, following consultation with the King’s Fund, there will for the first time be independently assured Ofsted-style ratings that will tell us very simply, CCG area by CCG area, whether mental health provision in the health economy as a whole is outstanding, is good, requires improvement, or is inadequate. As far as I know, ours is the first country in the world to do that. The hospital sector underwent the same process in the wake of Mid Staffs, and, on the basis of that experience, I believe that it will lead to a dramatic reduction in variation and an improvement in care as people are given independent information about how their services compare with those of their peers. That increased transparency will also mean the development of a new mental health data set, which will enable us to collect more and better data and then share them with the House, debate them, and learn what needs to be learnt.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

rose—

[Mr Hunt]

I will give way once more.

[Jonathan Reynolds]

I recognise the thoughtful case that the Secretary of State is making in saying that things are not good enough but they are getting better, but I must say to him—in a non-partisan way—that when it comes to funding, the stories about funding in my area do not match what we are hearing from him today. There is a story on the Manchester Evening News website about a £1.5 million cut in Greater Manchester.

[Mr Hunt]

We, as a Government, make commitments and choices in terms of where we want resources to go, and we then have a duty to ensure that they are followed up locally. As we know from our experience of the health service, sometimes—under all Governments—that advice is followed, and sometimes it is not. The introduction of proper independent ratings, area by area, will enable us to expose the areas that are not making the commitment to mental health that they should be making. As has been pointed out many times by Members in all parts of the House, failing to invest what is needed in mental health is a false economy. It stores up problems for accident and emergency departments and for the providers of mental health services, because late intervention means more expensive intervention, and it is of course a very real human tragedy for the individuals concerned.

Junior Doctors’ Contracts

Debate between Jeremy Hunt and Jonathan Reynolds

Wednesday 28th October 2015 Commons Chamber

[Mr Hunt]

Yes, I am shocked. I am really shocked about the suggestion that there is a difference between what is right for patients and what is right for doctors. The shadow Secretary of State spent a lot of time talking about morale. The worst possible thing for doctors’ morale is their being unable to give their patients the care they want to give.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

Does the Secretary of State not see anything perverse in making the case for a seven-day NHS—he has repeatedly done so—while drawing up a junior doctor contract that financially penalises doctors who already work evenings and weekends? How can that make any sense?

[Mr Hunt]

The contract will not do that. The contract we are proposing will give more reward to people who work the most antisocial hours. I will explain the details of that later.

The shadow Secretary of State talked about academic studies, so let us look at what the academic studies on the weekend effect say. The Freemantle study, published in the British Medical Journal, which is owned, incidentally, by the British Medical Association, said in September that the mortality rate for those admitted to hospital on a Sunday is 15% higher than for those admitted on a Wednesday. It said the weekend effect equated to 11,000 excess deaths. Let us be clear about what that means. It does not mean that every one of those 11,000 deaths is avoidable or preventable—it would be wrong to suggest that. It means that there are 11,000 more deaths than we would expect if mortality rates were the same as they are on a Tuesday, Wednesday or Thursday. Professor Sir Bruce Keogh, the NHS England medical director, called it

“an avoidable ‘weekend effect’ which if addressed could save lives.”

It is not just one study. In the past five years, we have had six independent reviews. Another study in the British Medical Journal, by Ruiz et al, states:

“Emergency patients in the English, US and Dutch hospitals showed significant higher adjusted odds of deaths…on Saturdays and Sundays compared with a Monday admission.”

The Academy of Medical Royal Colleges—the body that represents all the royal colleges—said in 2012 that deficiencies in weekend care were most likely linked to the absence of skilled and empowered senior staff and the lack of seven-day diagnostic services.