Junior Doctors’ Contracts

John Glen Excerpts

Wednesday 28th October 2015 Commons Chamber

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

I declare my interest as a doctor, and a veteran of truly awful rotas of the 1980s, involving one in two very often—that is every other weekend, every other night on duty, as well as a normal working day, which I would not recommend to either patients or practitioners. Thankfully, they are a thing of the past.

I welcome very much the Health Secretary’s statement today and the guarantees that he has given. On that basis, I am more than happy to support the Government this evening. However, I would say that we need to insist on evidence-based policy making. It is important to understand the difference between a causal effect and an association. My worry is that perhaps the Front Bench has been more influenced by Euclidean theorem than a proper understanding of statistics. My reading of the Freemantle paper and Professor Sutton’s remarks lead me to conclude that no causal link has been established between doctors’ rostering and excess weekend deaths. If we are serious about reducing weekend deaths, and reducing the difference in health outcomes between this country and countries with which we could reasonably be compared, which I know that my colleagues on the Front Bench are, we need to properly understand what are the drivers of those differences, and I do not think that junior doctors’ hours are a principal driver in the problem that we are trying to address today.

I think it is also right to appreciate that we are heavily dependent on the good will of all doctors—consultant grades and junior doctors. Most doctors that I know work well beyond their contracted hours—I know I certainly used to when I was in hospital medicine—and in dealing with them and in communicating with them, we need to keep that in mind and not take that good will for granted.

I very much regret the BMA action, and I very much regret the ballot on 5 November on strike action. The last time such action was taken was in 2012 on, ironically, the subject of pensions. It ended ignominiously and the only outcome was a reduction in the esteem in which the public held the medical profession. I would urge the BMA, armed with the assurances we have had today, to think again. I say “ironically” because, of course, the proposals, as I understand them to be, would increase core hours, which are pensionable—out-of-hours are not—and I have yet to see the BMA make any comment on that, or indeed reflect it in its pay calculator. Maybe a belated understanding of that has meant that it has chosen to take it down.

In trying to reduce weekend deaths and in trying to reduce that gap between our health outcomes in this country and those in the rest of Europe, we need to be focused much more broadly than on junior doctors’ hours. I know the Health Secretary is trying to work out how we can best configure the health service of the future. It is a dynamic thing; it never is fixed in one place. In my opinion, part of that means looking at our NHS estate all the time to make sure that we are getting the best from our assets. In my opinion, it means concentrating our specialist services in larger, regional and sub-regional centres. Those centres find it much easier to roster junior doctors and to concentrate expertise in one place. I am talking about stroke, heart attack and upper gastrointestinal bleeding—all things where we do less well in this country than in countries with which we should be comparable.

[John Glen (Salisbury) (Con)]

I am grateful to my hon. Friend and parliamentary neighbour for giving way. Does he agree that in the rural communities in south Wiltshire that we both represent, there does need to be a certain minimum proximity in order for patients to be able to access their hospital with confidence?

[Dr Murrison]

I agree with that, which is where networks come into our national health service, and making sure that we have specialist centres that can deliver the right outcomes for people, and that there are protocols to ensure that ambulance services take people to the right place at the right time, so that they can receive the treatment they need. What we cannot do is continue with the current situation, in which our constituents can expect lower life expectancy and health in later life than, say, French or German patients. That is not sustainable and it is not right. It means looking again at how we configure our national health service. It may mean some difficult decisions in some parts of our NHS, but that should not be a barrier to making sure that we do it right.

What I would say to my right hon. and hon. Friends on the Front Bench is that this is not really about junior doctors; this is about consultant grades, who deliver the therapeutics and diagnostics in relation to upper GI bleeds, heart attacks and strokes. They are now, in our new NHS of the 21st century, at the coalface of delivery in a way that they previously were not. So, if I may say so, I would like a greater focus on consultant grades, perhaps at the expense of some of our junior doctors who are the principal subject of our debate today.