Junior Doctors’ Contracts

Rehman Chishti Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

Tired doctors make mistakes. It is obvious but it is true. Nobody wants to return to the bad old days of junior doctors too exhausted to provide safe patient care. It is bad for doctors, it is bad for patients and it is bad for the NHS. So why are this Government hellbent on forcing through these unsafe changes?

The Secretary of State claims that the changes are about making it easier for hospitals to ensure that the staff needed to provide safe care at the weekends and on nights are available. Is he saying that there are not enough junior doctors on hospital wards and in A&E departments at these times currently? If so, how many more junior doctors would be present at these times as a percentage increase on current staffing levels if the new contract goes through? If the changes are about increasing the cover at weekends and nights, surely it means less cover at other times of the week unless he finds more money for more doctors.

I understand the arguments for increasing consultant cover at weekends and nights. I understand it is vital that patients who are admitted on a Sunday get to see a consultant as quickly as those admitted on a Tuesday, and I am pleased that the BMA’s consultants committee is negotiating with the Government on improving levels of consultant cover. Indeed, everyone in the NHS supports the principle of seven-day services. But this debate is about junior doctors. Junior doctors are already working evenings and weekends. So why has the Health Secretary tried to make this a row about seven-day services?

Let me quote some of the claims that the Secretary of State has made in recent weeks. In response to a question on the junior doctor contract from my hon. Friend the Member for Wirral South (Alison McGovern), he said:

“someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week.”

In response to a question that I asked him about junior doctors, the Secretary of State said that the overtime rates that are paid at weekends

“give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths.”

He went on to say:

“there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 150-1.]

The authors of the research that the Secretary of State has been quoting said that it would be “rash and misleading” to claim that the deaths were all avoidable. Yet the Health Secretary has got dangerously close to doing just that. Indeed, he has gone so far down that route that some people do not think that our hospitals are properly staffed at the weekend. I know of elderly patients delaying their visit to hospital because they do not think that there will be enough doctors there. That leads to more complicated treatment, longer patient recovery time, people’s lives being put in danger and a bigger bill for the NHS to cap it all off. That is appalling. Don’t get me wrong: I am as committed as anyone to high-quality care, available 24/7, 365 days a year, but the Secretary of State needs to be careful with his words. He should look in the mirror and ask himself whether his soundbites are true to the conclusions of the study he references.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Rather than quoting the Secretary of State, I quote back to the hon. Lady the words of Professor Sir Bruce Keogh, the NHS medical director, who said that if the weekend effect is addressed, it “could save lives”.

[Heidi Alexander]

I am very grateful to the hon. Gentleman. Let me quote the editor of the British Medical Journal, who wrote to the Secretary of State on 20 October, saying that he had

“publicly misrepresented an academic article published in The BMJ”.

She asks him to clarify the statements that he has made in relation to the article to show that he fully understands the issues involves. She further says:

“Misusing data to mislead the public is not the way to achieve”

the very best health service for patients and the public. The Health Secretary needs to be clear on exactly how reforming the junior doctor contract will deliver a seven-day NHS. He should set out how he plans to pay for seven-day services, and precisely which services he is talking about.

--- Later in debate ---

[Mr Hunt]

That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.

Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.

[Rehman Chishti]

The Secretary of State said that we are open to problems being highlighted. May I thank him for what he did by putting hospitals into special measures? Medway Maritime hospital had the seventh highest mortality rate in 2005, yet nothing was done. Support is now being given to that hospital to turn it around. We are highlighting problems, but we are also introducing measures to fix those problems.

[Mr Hunt]

I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.

I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.

Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.

--- Later in debate ---

[Dr Whitford]

I think that how this has been handled is a total disincentive, but that could change. We could simply take the decision to move to negotiations without preconditions—without the threat of imposition. We are talking about a threat to impose changes to the terms and conditions of people who, in the past, routinely worked more than 100 hours a week, as I did. That is a ghost that haunts the NHS and it really frightens junior doctors.

[Rehman Chishti]

rose—

[Dr Whitford]

I will give way one last time, but I need to make progress; otherwise nobody else will get to speak.

[Rehman Chishti]

I have a huge amount of respect for the hon. Lady. She talks about her experience of working long hours. Does she think that what the Secretary of State has just said about introducing new limits on junior doctors’ working hours is the right way forward?

[Dr Whitford]

What the Secretary of State has not explained is how, within the same pay envelope, there will be more people at weekends, but not working extra hours—and not having fewer during the week. At the moment, we have a circle that cannot be squared. We need to see the detail of how that can be done. If the vision is to have more routine work at the weekend, that would result in a massive uplift in the number of doctors, which we simply cannot afford. We are already haemorrhaging doctors. Acute physicians describe 48% of junior places as unfilled, with the figure for obstetrics being 25%. They can go anywhere. We heard that over 1,500 of them registered for certification for overseas work just last week. We need to be careful that we are attracting them to stay. They are the brightest and best in our society; they have chosen a vocation. We need to bring them to the table, but by offering to start with a blank sheet of paper—not threatening them. As has been said, they are not radicals, but people who want to do the best for their patients.

I suggest that the Secretary of State and those working with him look at how they have spoken to both senior and junior doctors over this summer. Frankly, being new to this House, I found that to be quite shocking and quite disgraceful. We should draw a line under that and try to change the tone. We need to go forward and find a solution that is fair to junior doctors, fair to patients and safe—one that is not exploiting people and not threatening people.

--- 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.