Junior Doctors’ Contracts

Norman Lamb Excerpts

Wednesday 28th October 2015 Commons Chamber

[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.

[Norman Lamb (North Norfolk) (LD)]

rose—

[Mr Hunt]

I am happy to give way to my former colleague.

[Norman Lamb]

During my travels across the country, I recently spoke with the chief executive and the chair of an acute trust. They said that they have no difficulty at all with junior doctors and ensuring that there is cover at weekends; their problem is with consultants—and the Secretary of State has just made that point. Has he not chosen the wrong target?

[Mr Hunt]

Chief executives of trusts and NHS employers have been very clear that this is about reform of contracts for both consultants and junior doctors, because the reduction in medical cover at weekends happens with both the consultant and the junior doctor workforces. Also, as I will go on to say, it puts huge pressure on junior doctors at the time when they do not have senior support and the ability to learn from it, and that is exactly what we want to sort out.

Junior doctors are not to blame for the weekend effect. The situation would actually be far worse without them, because they perform the lion’s share of medical evening, night and weekend work. In many ways, they are the backbone of our hospitals. However, the BMJ study this year showed that there is evidence that junior doctors felt clinically exposed at weekends, and nothing could be more demotivating for a doctor than not being able to give the standard of care they want for a patient.

--- Later in debate ---

[Lady Hermon (North Down) (Ind)]

rose—

[Norman Lamb]

rose—

[Mr Hunt]

I am going to make some progress before I give way again.

[Norman Lamb]

rose—

[Mr Hunt]

As the right hon. Gentleman is my former colleague, I will give way once more.

[Norman Lamb]

I want to ensure that I fully understand the commitment that the Secretary of State gave about not a single doctor losing out. I think he said that that is “provided they are working within maximum legal hours”. Does that mean people working up to 48 hours, which is the maximum working week under the working time directive? What about doctors who have opted out of that and are working 60 or 70 hours? Could they lose out?

[Mr Hunt]

It applies to all doctors working within the legal limit. If they opted out of the working time directive, it would apply up to 56 hours. For people who are working more than the legal limits, even after opting out, the right answer is to stop them working those extra hours because it is not safe for patients. But yes, that is the commitment to people even if they have opted out.

--- Later in debate ---

[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to follow the hon. Member for South West Wiltshire (Dr Murrison), who made a thoughtful and valuable speech. As a principle, we must be willing to accept the importance of debating the reform of working arrangements if we believe that there is evidence that current arrangements are undermining the best possible patient care, and I know that junior doctors absolutely accept that view. But I have to say that I am not convinced by the Government’s arguments.

I mentioned earlier that I had talked to hospital leaders, who shared their view that junior doctors’ arrangements are not the problem. It was striking, listening to the Secretary of State, that he referred to a shortage of consultants at weekends. It was notable also that when I talked to hospital leaders, they spoke of a concern that some senior consultants in some specialties make outrageous demands for additional pay for weekend work. There is a problem there, and I would support reform of that situation, but I am not convinced by the case for reform of the sort that the Government are pursuing. The Secretary of State also rightly talked about juniors being clinically exposed at weekends. Again, the issue is a shortage of consultants at weekends, not issues relating to junior doctors.

I met some junior doctors yesterday and found them all to be very passionate and completely dedicated to the NHS. I found them to be not driven and motivated by pay. I have to say to the Secretary of State and the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), that junior doctors find it frankly insulting to be told that they have been misled by the British Medical Association. They are intelligent enough to make up their own minds, and they have done. The Secretary of State should choose very carefully the arguments that he puts to them. The Government must also recognise a basic reality—the contract will work only if it is attractive to junior doctors. If it is not, they will vote with their feet and do what the daughter of the hon. Member for Totnes (Dr Wollaston) has done and go to Australia—or Scotland or the United States—to work instead of in the NHS.

The reform and extension of plain time gives rise to real concerns about its impact on emergency medicine, on acute medicine, on intensive care and on maternity services—those areas where there is a particular need for substantial evening and weekend working.

[Rehman Chishti]

I have immense respect for the right hon. Gentleman’s work on mental health. In relation to the shortage of specialists, does he agree with the Royal College of Psychiatrists that psychiatrists should be put in that category?

[Norman Lamb]

I totally agree, and I am very grateful to the hon. Gentleman for raising that point.

Will the Minister clarify what the Secretary of State said with regard to no loss of pay for individual junior doctors because I fear that those may have been weasel words? He talked about working up to the legal maximum. Is he talking about working up to 48 hours or up to 56 hours? He has given no guarantee that those doctors who may still work 60 to 70 hours in a week will not end up losing their pay. It is very important that the Government are clear on that.

The Government seek to extract too much from a limited pot of money. We all know that £10 billion is not enough to keep the NHS going until 2020. We need to work together. I repeat the Liberal Democrat call for a non-partisan commission to ensure that we achieve a new settlement for the NHS and for care, and to engage with the public and the workforce to ensure that we get this right.