NHS (Contracts and Conditions)

Rupa Huq Excerpts

Monday 14th September 2015 Westminster Hall

[Helen Jones]

No, I need to make some progress.

What, exactly, is the Secretary of State trying to do? If he is trying to bring about a seven-day fully elective service, he needs to say so. As far as I am aware, no major health system in the world has managed to do that. If he is not trying to do that, he needs to tell us clearly—perhaps the Minister will do so when he winds up—which services he thinks should operate at the weekend.

The Secretary of State also needs to recognise that, to have the service he proposes, he needs not only more doctors, consultants and nurses on the wards, but back-up staff. Doctors operate by leading teams. If they do not have the ancillary staff—the people to do the MRI scans, the radiology and the lab tests—they cannot operate properly. We need to hear how the Secretary of State will implement his proposals. Will he recruit more staff, or will he worsen the terms and conditions of staff who are already not well paid, to introduce weekend working?

It might help to improve morale in the NHS if the Secretary of State refrained from attacking staff for not working at weekends, when they do, and actually negotiated with them sensibly. Staff know what is happening at the frontline, and they can best suggest the changes that need to be made.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

We are discussing contracts and conditions. Does my hon. Friend agree that whistleblowing is another issue over which there tends to be silence? The last time there was a full debate on it in this place was 2009. It came up tangentially in 2013, in a debate on accountability and transparency, and it has appeared in statements—I think there was one last July and one earlier this year—but is it not time that we had a full and proper debate?

[Helen Jones]

Whistleblowing in the NHS, as in other areas, is an important issue. It is important to protect staff who blow the whistle to protect their patients, which is their duty. Perhaps my hon. Friend will initiate a debate on that; I am sure we would welcome that.

When the Secretary of State talks about NHS staff and doctors, let us remember that the starting salary for a junior hospital doctor is £22,636. It is not a huge amount when someone has spent years in medical school and works many hours, and often has to deal with seriously ill patients. However, the Secretary of State proposes to change their contracts to take away the extra payments for weekend working, which will effectively mean a huge pay cut. The Scottish Executive will not do that, and that will lead to the ridiculous situation in which two doctors doing exactly the same jobs in different hospitals either side of the border will be on two rates of pay.

As for consultants, I have heard complaints from the Government that Labour raised their pay rates. Yes, we did, and I am proud that we did. I will give the Minister the reason, which was set out very clearly by Frank Dobson, who was formerly my right hon. Friend the Member for Holborn and St. Pancras. In the City there are people who probably messed about for most of their time at school and played noughts and crosses at the back of the class, and who can make millions. Across the road there will be someone who was probably the cleverest kid in their class and has worked for years in training—often someone who is at the cutting edge of medical development. Yes, those people deserve a decent rate of pay for their skills, training and responsibility.

The Government also forget that consultants’ time is allocated in two blocks: direct clinical care and supporting professional activities. Those two together make up the 40-hour week. SPA time is for such things as mentoring, quality improvement and teaching. Some consultants go on to do more teaching and research, perhaps, but they are doing extra work on top of the 40-hour week, which increases their pay. Consultants’ basic pay ranges from £70,249 to £101,451, so the Secretary of State needs to explain how he can tell us that consultants are paid £118,000 a year. How does he calculate that figure, and what is included in it?

If the Government really want more consultant time on the ward, they could look at some of the things that do not need to be done by doctors, but which doctors currently do because of lack of back-up staff. The Government always talk as if non-clinical staff in hospitals are somehow superfluous and an extravagance. That is not correct. Without the right staff, doctors and nurses are forced to take time from clinical care to do some of their jobs. For example, many doctors whom I have spoken to now collect their own data for audit and input it themselves. That is a job that a competent clerk should be doing—not a consultant. I found one hospital where there is one secretary to a group of 25 consultants. Writing letters takes consultants away from clinical care.

I found one place where the IT equipment is so old that it takes six minutes to boot up, and often collapses, with the loss of the data. If the Government really want more doctor time on the wards they should consider those issues as well, and think about the other staff. As an example, if an operating theatre does not have a full complement of staff, there is no one to send out with the patient who is in recovery, and a doctor must go with them. That slows the turnaround time for theatres, and staff are told that their turnaround time is not good enough.

I say again that it takes a team of people to run the NHS, not just doctors. Let us also remember that the NHS depends on many staff who earn very low salaries. As doctors would be the first to say, those people are an essential part of the team. The NHS Pay Review Body could see a case for some adjustments to unsocial hours pay—and I have not met any staff who do not see a case for that; but it noted that both the Department of Health and NHS employers said that the cost of unsocial hours premiums makes the delivery of seven-day services prohibitive. The Minister must tell us whether the Government will try to deliver seven-day services by cutting the pay of staff again. The review body said that that could risk the morale and motivation of staff.

Recently we have had a few soundbites from the Government, but no clear mechanism showing how they will set out to do what they say they will do. They have pledged an £8 billion increase in NHS funding by 2020. Even taking them at their word—and some of us are rather sceptical—that is the bare minimum to keep existing services going. [Interruption.] If the Minister’s Parliamentary Private Secretary, the hon. Member for Winchester (Steve Brine), will stop chuntering from behind the Minister, I will wind up my remarks. [Interruption.] PPSs, as I told someone once before, are meant to be seen, not heard.

The Minister needs to make it clear what services the Government will run and what staffing arrangements they will put in place. They can put more doctors on the ward, but that will be useless without the back-up staff. It is not surprising that one surgeon in the #iminworkJeremy campaign posted a picture of himself mopping out his operating theatre at the end of the day. That was very good of him, but is it the best use of a consultant surgeon’s time? Above all, the Secretary of State and his Ministers need to stop attacking the people who work in the NHS, and to try to work with them in a climate of mutual respect. It is not hospital doctors, GPs, nurses, lab technicians or cleaners who have caused staff shortages in the NHS; it is the Government. Those staff members did not introduce the disastrous Health and Social Care Act 2012. They are not the people requiring huge cuts in our hospitals and other services. Unless the Government are prepared to recruit more nurses, doctors and ancillary staff, more and more pressure will be put on existing staff, who will suffer burnout. It will be a downward spiral.

When I worked in teaching, a wise old head teacher said to me, “People say that the first thing you have to do in a school is ensure that the children are happy; but no—the first thing you should do is ensure the staff are happy. If the staff are happy the children will be well taught.” That is something that can be applied in many areas. I tell the Minister honestly that he needs to take note of the anger among staff that generated the petition, take it on board, stop denigrating them, and deal with them properly and sensibly, to achieve what the Government have set out to achieve.

--- Later in debate ---

[Helen Whately]

I believe that the Secretary of State has done a good job of driving the NHS in the right direction, and I know that a large proportion of the workforce have been very supportive of him.

We are all in this room because we value the NHS, but we must not be complacent. We have to recognise when it lets people down. It is intolerable that if someone has the misfortune to get ill and be admitted to hospital at the weekend, they may be more likely to die. I am not going to repeat the statistics on that, because my hon. Friend the Member for Totnes (Dr Wollaston) helpfully updated us, and I suspect that my figures are not as recent as hers. She made a strong case, as have others, for why the NHS needs to have proper seven-day care, which must include the support services mentioned by the hon. Member for Warrington North.

The Royal College of Surgeons strongly supports seven-day care. It has said that one reason why outcomes are worse at weekends is that patients are less likely to be seen by the right mix of junior and senior staff; that such patients experience reduced access to diagnostics; and that earlier senior consultant involvement is crucial. Research from the NHS National Health Research Institute shows that 3.6 more specialists attend acutely ill patients on Wednesdays than on Sundays. More senior doctors need to be available at weekends—not just on call, as many consultants are at the moment, but present in hospitals.

The changes should not be about getting doctors to work intolerable hours, and that is not what is being proposed. As has been mentioned, only a small proportion of consultants exercise their opt-out. One could argue that the changes to the workforce, and to the consultant contract in particular, are about bringing the contract into line with what is actually happening. Looking at the terms of the workforce gives us an opportunity to ensure that there is an appropriate package for doctors in A&E, where there are large numbers of vacancies. That is the case in hospitals in and around my constituency in Kent, which is an area with a high proportion of out-of-hours work. It also gives us an opportunity to ensure that clinicians are recognised and rewarded for taking on management and leadership responsibilities. We really need clinicians to step up and take on those responsibilities. It gives us an opportunity to make sure that consultants are treated as professionals who take responsibility for their patients, their team and the whole service that they provide.

The NHS faces an incredibly tough time over the next five years. It faces rising demand for its services and rising expectations, and even with an extra £8 billion on its way, things will have to change. Senior doctors, along with senior nurses and other health professionals, will have to lead those changes. When I worked in hospitals grappling with the challenges of transformation, ideas came from everyone: junior doctors, senior doctors and patients. When it comes down to it, consultants, matrons and senior staff have to lead from the front and make things happen. They often face opposition from colleagues, so they need to be courageous and put in extra hours.

To ensure that that happens, and to get the NHS from where it is now to where we want it to be in five years’ time, there has to be a sense that we are all in it together. We cannot have a situation in which doctors blame managers and politicians, while politicians and managers point fingers at doctors. We absolutely have to move on and focus on doing what is best for patients, and what will achieve the best clinical outcomes. We have to build trust among all who are involved in healthcare and work out how we can have, and how we can afford, excellent care seven days a week, day and night. We have to support the healthcare professionals—consultants, nurses, managers and everyone else who is going to make that happen.

[Dr Huq]

Will the hon. Lady give way?

[Helen Whately]

I was just finishing.

[Dr Huq]

I just wanted to ask where the hon. Lady would place management consultants in that. The NHS in north-west London has spent, I think, £13 million this year alone on Saatchi and Saatchi, and various other groups. I just wondered where she would place that in that trajectory. Hopefully, it will be something we can all agree on.