Junior Doctors’ Contracts

Mark Spencer Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I beg to move,

That this House notes the stalled discussions between Government and the British Medical Association (BMA) about a new junior doctors’ contract; opposes the removal of financial penalties from hospitals which protect staff from working excessive hours; urges the Government to guarantee that no junior doctor will have their pay cut as a result of a new contract; and calls upon the Government to withdraw the threat of contract imposition, put forward proposals which are safe for patients and fair for junior doctors and return to negotiations with the BMA.

It is a privilege to be opening a debate from the Opposition Dispatch Box for the first time, and I want to start in a way that is perhaps untypical for these debates. I want the Secretary of State and me to agree on something. I want him to join me in saying thank you to everyone who works in the NHS and in the care system in our country—not just the junior doctors who are the subject of today’s debate but all the staff who work day in, day out caring for our loved ones as though they were their own. So, to our doctors, nurses, porters, care workers and paramedics I say this: I know how hard you work; I know that many of you already work nights, weekends and even Christmas day, and for that we are hugely grateful.

I have called this debate today because I am deeply worried about the current stand-off between the Government and junior doctors. I am worried that a new Government-imposed employment contract will be unsafe for patients and unfair for doctors. I am worried that if the Health Secretary gets his way, he will fast become the best recruiting sergeant that the Australian health service has ever had.

[Mark Spencer (Sherwood) (Con)]

Does the hon. Lady therefore agree that the best course of action would be to get round the negotiating table again? Will she encourage the British Medical Association to come back to the negotiating table?

[Heidi Alexander]

If the hon. Gentleman reads the motion, he will see that it talks about a return to the negotiating table, but the BMA and the junior doctors need to know that the Health Secretary is genuinely willing to compromise, and his performance over the past few months suggests otherwise.

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[Mr Hunt]

I am going to make some progress before taking any further interventions.

The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.

Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.

For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.

[Mark Spencer (Sherwood) (Con)]

Given the Secretary of State’s assurance, is there any reason why the BMA should not come back to the table and negotiate with him to solve this problem so that patients are safer at weekends?

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[Dr Whitford]

We will roll out a red carpet somewhere on the M74 and welcome them with open arms. The progression and migration in Scotland towards robust seven-day emergency care has been happening through a dialogue, not through a threat to impose a contract.

There are other things in this, such as the plan to change pay progression, which is currently on an annual basis, to recognise experience. That will be replaced with just six pay grades. Such a move will affect women in particular, because they tend to take a career break and they tend to work part-time, so they will get stuck at a frozen level for much longer. It may also be a disincentive to people to go into research, because they will be stuck on the same rung of the ladder for longer. We do not want that disincentive. We need to make sure that we are valuing how people develop and the experience they accrue along the way.

[Mark Spencer]

The hon. Lady is making a powerful case for dialogue. Will she join the Secretary of State in calling for the BMA to come back to the negotiating table or join the shadow Secretary of State in refusing to call for it to do so? Which will she do?

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[Mark Spencer (Sherwood) (Con)]

I am delighted to be able to take part in this most important of debates.

It is worth saying at the outset that the most important issue we face when talking about changing these contracts is patient safety. We do well to recognise that our No. 1 priority should always be patient safety, and about the service that the NHS delivers to the patients who require its health and assistance at the most important time of their life. In order to deliver the improvements, level of service and safety that we require, we need to have an engaged workforce who are willing and enthused about their work. It is important to recognise the challenges that NHS staff face and the long hours that they have delivered over a number of years, putting themselves at great risk, frankly, in working what would be regarded in any other industry as silly hours. We clearly need to change those working practices to make sure that patient safety is once again brought right to the top of the agenda.

It is important to recognise that these negotiations are not about cash. This is not about saving money or changing the system so that the Government can spread things thinner; it is about delivering an NHS service over seven days of the week to make sure that when someone has that moment when they need the NHS to step in to save their life or to help them, the service is there and able to deliver.

Junior doctors currently receive between four and five incremental pay rises, depending on the time they serve. In most other industries, increments in pay should be about qualifications and the way in which someone has worked through them, not simply about the amount of time they have served.

We must get to a point where we can deliver a seven-day NHS and eradicate the weekend effect. As hon. Members have mentioned, some patients are starting to change the way in which they engage with the NHS because they are concerned that, if they are admitted on a weekend, that will affect the care they receive. It is important to ensure that that does not happen. There will inevitably be changes to work patterns, and current contracts will have to change. At the same time the Government will ensure that there is extra pay for time that doctors work at weekends.