BMA (Contract Negotiations)

Margaret Greenwood Excerpts

Monday 21st March 2016 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David. Today we are here to consider the e-petition that calls on

“Jeremy Hunt to resume meaningful contract negotiations with the BMA.”

This is a matter of the utmost urgency. We have an unprecedented situation in our country: the Secretary of State for Health has turned what should have been constructive negotiations into a battle with junior doctors—the highly skilled and committed professional people on whom we all rely. The last strike by junior doctors was 40 years ago. This strike is one that nobody wants and to which everyone wants to see a resolution.

In the autumn last year I met a group of junior doctors in my constituency. They came to visit me at my office in Hoylake. They spoke in great detail about the problems they had with the new contracts. Their stand-out concerns were: the impact on patient safety; the effect the new contracts would have on the ability of doctors to have a family life of their own; the damage the contracts would do to the prospects of those professionals who seek to pursue different specialisms as their careers progress; and the impact they would have on the careers of women in particular and in turn the impact that would have on the NHS.

One junior doctor who came to speak to me was nearly in tears—in fact, she told me that she had been in tears—as she described how she had wanted to be a doctor since the age of 10. She loves her job, but she also loves her children. She feels she is being forced to choose between being a doctor and being a mum, and that is an impossible decision for any woman. Her children need to see her on Saturdays, and she needs to see them, too.

The period for which doctors are paid at the standard rate, or plain time, is currently Monday to Friday, 7 am to 7 pm. Under the new contract, plain time will be extended to Monday to Friday, 7 am to 9 pm, and will include Saturdays from 7 am to 5 pm. Those are considerable changes that interfere with the prospects of junior doctors enjoying their weekends. They should be entitled to spend at least some of their weekends with their families.

That meeting happened last autumn, and we are more than six months further down the line. Instead of listening to the concerns of junior doctors, as so many MPs have, the Secretary of State has decided to impose a contract that the vast majority do not wish to sign up to. A couple of weeks ago I received an email from Charlotte, a junior doctor in Wirral. She told me:

“Since the announcement of the imposition juniors are scared, confused and do not know what the future holds for them…Junior doctors are angry that the government has failed to recognise and value the workforce through this imposition. Due to this, there is a big and real risk of exacerbating a recruitment and retention crisis as demoralised and demotivated doctors leave the profession or leave the country to work abroad.”

Of course, Charlotte is right. The threat of the NHS losing many junior doctors to Wales, Scotland and as far away as Australia is real. In the 10 days after the Government first announced their intention to impose a new contract, the General Medical Council received 3,468 requests for a certificate of current professional status, the paperwork needed to register and practise medicine outside the UK. In more stable times, the GMC might normally expect to receive 250 such requests at most. If there is indeed an exodus of junior doctors from the NHS in England, that will deliver a real blow to the operational capacity of the NHS and will come on top of the crisis in nurse training places.

Charlotte made other important points, and I assured her that I would raise them with the Minister. She said:

“The proposals governing non-resident on call (NROC) availability have not been properly worked out. The concerns are that the very low availability of allowance may contribute to recruitment problems (especially in psychiatry)”.

That is a real concern now that we are all agreed that we should have parity of esteem between physical and mental health. She also said that

“the allowance does not reflect how busy NROC can be and the means of pay would be an estimate for hours worked...Pay protection on changing specialty is also an issue.”

That is something I have heard from other junior doctors in my constituency. She continued:

“At the moment if someone choses to train in another specialty (eg GP to A&E) the pay remains the same as a recognition that skills are transferable and that the doctor has beneficial experience that they can take with them…I myself spent a year in surgery before I realised it was not for me and transferred to A&E. Under the new contract if you transferred to another specialty, your pay would go back down to the lowest pay point which would be very problematic.”

I think we can all see how someone who has experience in surgery and who then decides to change course will be so much more useful in the new path that they choose.

Charlotte continued:

“Indeed, many juniors do not understand how to work out what their pay is likely to be under the new contract and it is likely to be after imposition in August that we find this out. Many doctors—an estimate of over 50%—do not follow a straight, continuous path through training. Maternity leave…time out for academic or other training, changes of specialty, or alterations to training mean that it is unclear to many what training or experience will or will not be recognised in the new contract…The failure to recognise the work junior doctors do throughout the 7 day week is another factor. We are not objecting to working weekends and indeed most juniors already do, but we just want the opportunity cost of doing so to be recognised in pay. It is disappointing that junior doctors are being seen as the barrier to seven-day services without the government defining what this means or adequately resourcing the whole multi-disciplinary team.”

Charlotte is right: the truth of the matter is that we already have a seven-day NHS. It operates 24 hours a day, seven days a week, and junior doctors regularly work at weekends and accept that as part of the job. That is not in dispute. In fact, the report by Sir Bruce Keogh into a 24/7 NHS acknowledged that and instead focused on the availability of consultants and diagnostic staff such as radiologists or phlebotomists, not junior doctors. The report said:

“our junior doctors feel clinically exposed and unsupported at weekends”.

Another junior doctor told me that he felt that the attack on junior doctors was just the start of the Government’s plans for NHS staff. He said:

“If they manage to force the junior doctors to take unsafe and unfair contracts, the rest of NHS staff will fall like skittles.”

It seems then that the Secretary of State has lost the trust of the profession, and that has to be of real and serious concern.

My hon. Friend the Member for Warrington North (Helen Jones) has ably raised the questions around what the Government mean by a 24/7 NHS, but it is important that we also consider the funding crisis facing the NHS. In the past couple of days, worrying news seems to be emerging that the Prime Minister knew in the last Parliament that the financial situation in the NHS was far worse than was being claimed. Simon Stevens, the chief executive of NHS England, calculated that the NHS needed £16 billion more over the course of this Parliament, but was ordered by Downing Street to halve the size of his cash demands. I would be very interested if the Minister could comment on that. If the Prime Minister did know that, it raises serious questions about what the Government’s stated ambition to expand NHS services at weekends is all about. Is it realistic and costed? Is it rash or is it something else? I would appreciate an answer on those points. The issue of trust has been raised yet again.

There cannot be a single Member of the House who has not at some time in their life had reason to thank our junior doctors. We put our trust in them. They are there at difficult births and when people die, and the level of commitment and expertise that we receive at their hands—free at the point of need and paid for through taxation—is the envy of the world. We cannot let the mishandling of the negotiations lead to catastrophic damage to our most treasured institution. No one wants to see the Government inflict such a blow on the capacity of our national health service, and I urge the Minister to row back from the imposition of junior doctors’ contracts and to get back to the negotiating table.

--- Later in debate ---

[Andy Slaughter]

I will move on, because when someone is in a hole, they should really stop digging.

[Margaret Greenwood]

I could not let the comment made by the hon. Member for Morley and Outwood (Andrea Jenkyns) pass. Jeremy Corbyn is the leader of the Opposition, and the Conservative party is in turmoil today in the face of his leadership. Being a Corbynite and a member of the BMA is no bad thing—I just wanted to clear that up.

[Andy Slaughter]

I will try to put an end to this exchange, but it is tragic that a party of the stature of the Conservative party should turn its guns on the profession and on a representative body such as the BMA in this despicable way. It is extraordinary. I will go further and praise those in the BMA who have had their positions undermined and suffered character assassination and being idly quoted in tittle-tattle on Twitter. Last week the hon. Member for Central Ayrshire (Dr Whitford) hosted an open session for Members at which I was pleased to renew an acquaintance with Dr Johann Malawana, who has been a particular target of insidious and malicious personal attacks, supported by the jackals in the right-wing press. Is that really how a Government should behave in dealing with any industrial dispute, particularly one as serious as this?

Depending on when the debate ends, I may have to leave for a constituency engagement—I have said that to you, Sir David, and I apologise to you and to the Front Benchers—so I will make my comments brief to give other Members time to make theirs. I simply want to say to the Minister, who can no doubt take the message from this debate back to the Secretary of State, that there is nothing dishonourable about continuing negotiations in this dispute. There is an attitude of despair among junior doctors, which has led to some of the statistics we have already heard about those who now wish to leave the profession or move to other jurisdictions where they would be more appreciated.

The Government were initially resistant to going to ACAS, but in the end they agreed. Progress was made at ACAS, but at the end there were still matters outstanding. Everything that I have learned from talking to junior doctors suggests that not only do they not want to take industrial action, and not only do they want to continue serving their patients to the best of their ability, but they are prepared to sit down and compromise. However, they are faced with a wholly intractable Government.

Is the best that we can get from the Secretary of State the misappropriation of statistics to prove something that is clearly false on two levels? It is false because the so-called weekend deaths are not as he has presented to the public, and it is false to say that we do not have a seven-day emergency service now. Of course we do. I strongly believe that we need to restore trust and faith in the relationship between the NHS and junior doctors, and the Government have an important role to play in that. Unfortunately, individual trusts are under such financial pressure, and their management under such strain, that it is tempting for them to exploit junior doctors.

On the guardianship system, we know about the assurances that have been given and the protections in the existing contracts. I do not think there has been a previous example of a contract being imposed on the NHS in this way. I simply urge the Government to think again. There is a deal to be done, there really is. The fact that they are not even prepared to sit down and negotiate again implies that they do not want a deal to be done. They want to play hardball, and they want to get something that is completely different from what they say. They already have their emergency service and they already have junior doctors working the way they want, and they say they do not wish to save money. They have different motives from those that they are expressing. They therefore need to return to the negotiating table. They need a pragmatic solution, and they need to step back and calm down.

I will read the Front Benchers’ speeches tomorrow if I am not here for them, but I hope we will hear a better spirit of conciliation than we have heard so far.