Junior Doctors’ Contracts

Debate between Rehman Chishti and Heidi Alexander

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.

Immigration

Debate between Rehman Chishti and Heidi Alexander

Thursday 18th November 2010 Commons Chamber

[Heidi Alexander]

I agree that it is very important that we discuss the matter openly and rationally. I agree entirely with the comment made earlier by the hon. Member for Canterbury (Mr Brazier) that if politicians from the mainstream parties do not discuss it, we leave a space for other parties. That is why I congratulate my right hon. Friend the Member for Birkenhead on securing the debate.

I also believe that people’s concerns about immigration are symptomatic of the other big challenges with which we are grappling, which some Members have mentioned. They include the availability of housing at a price that people can afford and of jobs that pay a salary that makes taking the work worth while. We need to address those fundamental problems at the same time as ensuring that our immigration system is, to coin a phrase, “fit for purpose”. It is to that issue that I now turn.

What frustrates me more than anything else about our immigration system is our failure—yes, I accept that it was a failure of the previous Government as much as it is of the current one—to enforce decisions in a fair and humane way. We need appropriate enforcement at the point at which decisions are taken. Given that 37% of immigration appeals are successful, there is also a problem with the right decision being made in the first place, but perhaps that is a discussion for another day. I simply say that we should learn from our mistakes and make better decisions at the outset.

I suspect that I have many constituents who were told years ago that they were liable to deportation or removal, but nothing has happened. Such people carry on their lives, which is understandable. Some might be working in the informal economy, and some will have hung on to jobs that they legally should not have done. They have started relationships and had children, and their children have started school. It is then, years down the line, that they get a visit from the enforcement officers. I do not know what it would feel like to be a six-year-old child and be taken out of school—often the only school they have ever known—and have to move to a country to which they have never been, but something tells me that it would not feel great. I accept that every case is different, and that people who have been convicted of crimes in the past should not be allowed to stay, but I question why we are so intent on causing such upheaval to families.

[Rehman Chishti]

The hon. Lady brings us back to the existing system being completely bizarre. For example, when immigration judges determine a case, they are not allowed to examine an applicant’s previous convictions because of a problem between the Association of Chief Police Officers and the Home Office. Does she agree that to improve the system immigration judges must be able to see an applicant’s previous convictions when determining whether they can stay in this country?

[Heidi Alexander]

The hon. Gentleman clearly has a degree of expertise in the matter, and his suggestion sounds sensible.

I was talking about the upheaval caused to families who have been in this country a long time who face removal or deportation proceedings, not all of them as a result of doing something that the vast majority of the population would think drastically wrong. We need a sensitive approach, and if we are to have fair immigration controls we need to deal humanely with the people who are in the country at the moment.

Enforcement is a case of needing to be firm to be fair—not aggressive, not rough, but firm, competent and timely. I do not underestimate the difficulty of getting the balance right, but I cannot help but worry that cuts in the number of UK Border Agency staff will make the problem even worse. Perhaps fewer staff will just mean fewer legacy cases being processed and more people hanging around the system waiting to get on with their lives. I do not know the answer to this question, but perhaps the Minister will enlighten us about why, at a time when his Government are talking tough on immigration, he is cutting the very staff who are needed to do the job.

My second main frustration about the cases that I see in my surgery relates to the poor quality of immigration advice that many of my constituents receive. Although many private and voluntary sector providers deliver an excellent service, there are also many so-called advisers who simply exploit vulnerable people who do not know which way to turn.