Pandemic Prevention, Preparedness and Response: International Agreement

Debate between Steve Brine and Justin Madders

Monday 17th April 2023 Westminster Hall

[Steve Brine]

As a former health Minister with responsibility for the WHO, I worked with the organisation. It is supranational, but it is 100% driven by its members and we, as the second largest donor and one of its founding members, are one of the most respected members round the table, so we are designing the process. We should be proud of that. We are at the heart of that and we should submit it to scrutiny by us in this House. Does the hon. Member not agree?

[Justin Madders]

I am grateful to the Chair of the Health and Social Care Committee, who has a great deal of experience in this area. As a country, we are leaders in the field. We should be proud of our role in creating the WHO and fighting the pandemics that have happened in recent years. It is also the case that, as with all treaties, there is an opportunity for parliamentary intervention. That is already established, and the Government have committed that any subsequent domestic regulations would need to be passed before the treaty was ratified.

As we have already heard, we can, if we so decide, opt out, so there is no question that this is something that will be done to us. As a sovereign nation we have the opportunity to say no. Given the amount of time that this House has spent debating questions of national sovereignty over the past five or six years, would we do something that would give away sovereignty? There are important principles about parliamentary accountability that we need to bear in mind. It would be unfair to allow some of the wilder conspiracy theories to overshadow legitimate concerns about any potential infringement on our sovereignty and democracy.

On the specifics of the treaty, as I have said already, the key point to note is that it has not been finalised yet, but we do know the broad parameters of negotiations set out in the latest “zero draft” published in February. From that we can see that the guiding mission is:

“to prevent pandemics, save lives, reduce disease burden and protect livelihoods, through strengthening, proactively, the world’s capacities for preventing, preparing for and responding to, and recovery of health systems from, pandemics.”

I would be very surprised if anyone objected to that as a set of guiding principles, but it is reasonable to ask what the definition means in practice, what the procedure is for declaring a pandemic, and what safeguards will be in place to ensure individual liberty and rights are protected.

Those questions and that ambiguity have been seized upon by those who want to undermine global co-operation. They state fears that the treaty will restrict freedom of speech to the extent that dissenters could be imprisoned, that it will impose instruments that impede on our daily life and that it will institute widespread global surveillance without warning and without the consent of world leaders. In other words, some of the hallmarks of totalitarian Governments are to be combined with supercharged lockdown measures, which are all, of course, already in the power of the Government under the Public Health (Control of Disease) Act 1984. Under this treaty, those things will apparently be done without our Government having a say.

If those claims had any basis in fact, we would all be rightly concerned, but they do not stand up to scrutiny. Fact checkers have consistently stated that the WHO would have no capacity to force members to comply with public health measures. A WHO spokesperson said:

“As with all international instruments, any accord, if and when agreed, would be determined by governments themselves, who would take any action while considering their own national laws and regulations.”

The idea that we would allow our citizens to be imprisoned by a third party for expressing an opinion on something in this country is absurd. It is just not going to happen. We live in a liberal democracy and I know that Members from across the House are determined to keep it that way. It is those nations that want to undermine western liberal democracies and to create disarray that are pushing the narrative that there is an unaccountable, unelected, global group of people seeking to take control of our lives.

We can both protect our values of freedom and democracy and work more closely with other countries in the face of a global threat. Those two aims can be entirely consistent with one another. Creating a global treaty is an entirely reasonable and responsible course of action. One of the most important messages to emerge from covid-19 was that we need to be better prepared for the next pandemic. We have learned that global co-operation is crucial to success, whether that is by co-ordinating measures to suppress transmission or conducting vaccine roll-outs. It took the world far too long to understand that in a pandemic no one is safe until everyone is safe.

To my mind, the question is much more about whether this Parliament and this Government are up to the task of dealing with another public health emergency in a way that ensures that democratic accountability and public confidence are maintained. As someone who spent many hours dealing with public health regulations during the covid pandemic, I think there is much to be done to improve Parliament’s role. We know that, at times, decisions had to be taken quickly, but far too often covid regulations were debated weeks or even months after they were introduced. As the pandemic progressed, I felt that no effort was being made to ensure that regulations were debated before they came into force. On numerous occasions, there was no objective reason why that needed to be case. Indeed, sometimes the rules were made publicly available on the Government website only minutes before they became law. Trying to obtain clarity about which measures, individually or collectively, were considered likely to lead to an increase or decrease in transmission rates was mission impossible.

When we were able to see the minutes of meetings of the Scientific Advisory Group for Emergencies—in the early stages of the pandemic, we were not—there was often very little correlation between them and the measures being debated. Sometimes, there was no statement in the explanatory memorandum that the measures being put forward in the regulations had even been considered by a scientific adviser. Often, there were no SAGE minutes that stated that these matters had been considered either. Often, what SAGE recommended did not even make it into regulations.

I am sure that many of us can remember the contradictions and the confusion about some of the measures: around why an area was in a particular tier, the lack of clarity about how areas moved in and out of tiers, the decision to close pubs—

Fertility Treatment and Employment Rights

Debate between Steve Brine and Justin Madders

Tuesday 1st November 2022 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Sir Edward. I congratulate the hon. Member for Cities of London and Westminster (Nickie Aiken) on securing this debate and on her excellent speech. She said that there is little legal, medical, practical and emotional support for those seeking fertility treatment. That encapsulates the broad issues facing people in that situation; obviously, we are looking at a very specific issue today. I agree that IVF should not be considered on a par with cosmetic surgery—it is a very different thing altogether.

The hon. Lady really brought it home to me how far we need to go. She gave the example of her constituent who was told that she would be sacked if she undertook IVF treatment. That is the sort of thing that we would expect to have been said in the ’70s to someone who said they were pregnant. Rightly, society and the law have said that that kind of response is unacceptable. The hon. Lady summed it up well when she said that people should not be penalised for being unable to conceive naturally.

There were a lot of good speeches from Back Benchers. As always, the hon. Member for Strangford (Jim Shannon) gave a good contribution. I think everyone was pretty much in agreement about the importance of this issue.

The right hon. Member for Romsey and Southampton North (Caroline Nokes), who does an excellent job in all sorts of areas on equality in the workplace, said that we need to create a culture of openness and support for employees, and I hope this debate engenders that. She also asked about an employment Bill. The Minister is standing in today, but she may know that I have asked many previous Ministers when we can expect such a Bill. I am not expecting an answer, so to the right hon. Lady I say that I suspect it will take a Labour Government to introduce the plethora of employment legislation that this country desperately needs.

I am grateful to the hon. Member for Cities of London and Westminster for securing this debate. This issue has not traditionally received the attention it deserves because people understandably find it difficult to talk about, but we need to foster a culture of openness.

As we have heard, infertility and fertility treatment are the second most common reason for a woman to visit her GP—the most common is pregnancy. About one in seven couples are affected by infertility, which is about 3.5 million people in the UK. Since 1991, 1.3 million IVF cycles have been undertaken, resulting in 390,000 babies being born. IVF has become commonplace over those three decades: 6,700 IVF cycles took place in 1991, and 69,000 took place in 2019. I doubt that a tenfold increase in employers’ awareness has accompanied the increase in IVF treatment, which is why this debate is so important.

[Steve Brine]

It is interesting to hear those figures. There is a group who are not included in those figures, for whom all these issues around fertility challenge do not exist because they are banned from fertility treatment. Current legislation means that people living with HIV are banned from using such treatment. HIV medication is so effective these days that someone with HIV who is on it cannot pass HIV on, so their babies can be born without HIV. There is therefore no medical reason for this law to still exist. Are the Opposition aware of that situation? Do they think that law is a really brutal bit of discrimination that belongs to another age?

[Justin Madders]

I thank the hon. Gentleman for his intervention. I was not aware of that; obviously it is a matter that comes within the Department of Health’s bailiwick, so I would have to defer to my shadow colleagues in that sector. However, perhaps in a few days he will have a new role that will enable him to put a focus on this issue in a way that we have not seen so far.

We have heard a number of statistics that show why fertility treatment is such an important issue in the workplace. Fertility Network UK says that 56% of those seeking such treatment reported decreased job satisfaction; 63% admitted to reduced engagement; 36% had increased sickness absences; and 38% had seriously considered leaving their job or actually quit their job because they were trying to conceive—a statistic that should shame us all. Similarly, recent research published by Zurich found that 58% of women undergoing IVF treatment withheld that information from their employer and 12% of women left their job completely because their employer was unsupportive. These are statistics that we absolutely have to challenge and change.

It is easy to see why those undergoing fertility treatment report such experiences. Both from what we have heard today and from issues reported in the media, it is easy to see why so many people—particularly women—report feeling vulnerable and distressed about discussing these issues with their employer. I think that almost all in society are sensitive to how emotionally challenging and stigmatising seeking fertility support can be. However, having to physically administer treatment while in the workplace, and possibly while alone in a toilet stall, must be extremely difficult for those who have to do it, and fearing that a line manager might be questioning where they are while they do that can only add to the anxiety that people feel. Then there is the issue of whether someone’s treatment will negatively impact on their career, because they have an unsympathetic line manager. The experience can be very isolating. We have to change the culture to make sure that women feel supported and do not feel alone during these times.

In conclusion, the statistics that I have cited and the testimony today should give us all food for thought about whether we have got the balance right and make us consider whether there is sufficient support for those with fertility issues. The picture that has been presented today overwhelmingly suggests that we have not got that balance right at all.

Draft Medicines and Healthcare Products Regulatory Agency Trading Fund (Amendment) (EU Exit) Order 2018

Debate between Steve Brine and Justin Madders

Thursday 11th October 2018 General Committees

[Steve Brine]

I am not giving the hon. Lady that guarantee. I am saying that it is a live consultation and it would not be appropriate for me to pre-empt it. I do not share the hon. Lady’s half-full view of our ambition for the future, which the Prime Minister set out in terms of our relationship with the EMA. The EU does not have a relationship with the UK as a third country at the moment. That is why we have set out an ambitious proposal for our new relationship with the EU and its agencies, including the EMA. I am hopeful, as are the Prime Minister and the Government whom I speak on behalf of, that we will secure a good deal. We still think that that is the most likely outcome. That includes a new relationship with the EMA. We should remember that the expertise that we have in this country, and the work we do with the EMA, will not suddenly change because it is based in Amsterdam. It will still need that expertise and that relationship. I am ambitious about the future, which is why I say what I say.

The matter before the Committee today is technical, to make changes to enable the agency to function after exit day.

[Justin Madders]

The Minister is speaking with great confidence, without any basis in fact, in saying that the MHRA will not need any state handouts in the future. Will he commit to report back to Parliament, if it turns out that it is not, in future, self-financing?

[Steve Brine]

Of course, if there is any change to any arm’s length agency that the Department works with, we will come back to Parliament for that discussion. That is partly what the consultation is about at the moment. So if the hon. Gentleman wants a blank cheque to say that we would come back to the House to have discussions around any future changes, the answer is self-evidently yes.

Question put and agreed to.

Medicines Regulation

Debate between Steve Brine and Justin Madders

Tuesday 21st November 2017 Westminster Hall

[Steve Brine]

I share the hon. Lady’s concern. As I said, so much about this is still subject to negotiation. I cannot give her the exact assurance that she wants at this time.

The hon. Lady also asked about the EU exit transition. The Government are clear that we want to continue collaborating with the EU in the interest of protecting patient safety. The detail of any future relationship is, of course, subject to that negotiation. That is nothing new. We recognise completely that new arrangements can take time to implement, and we will work closely with the industry and key health system partners to ensure smooth implementation. The European Union (Withdrawal) Bill, which is going through the House at the moment, will ensure that a known legal framework is in place immediately after we leave the EU.

The hon. Lady talked about the Secretary of State “flirting” with leaving the EMA for the FDA. Earlier this year, the Secretaries of State for Health and for BEIS published a letter in the Financial Times setting out our aim to retain a close relationship in respect of medicines regulation. The FDA has been clear that it would not let another country “join” FDA processes even if we wanted to, but if we are outside EU processes, we will certainly look at how we can co-operate more closely with other global regulators.

The hon. Member for Lewisham East (Heidi Alexander) asked whether we had had contact with Australia and New Zealand. The chief executive of the MHRA chairs the International Coalition of Medicines Regulatory Authorities, and we of course have had discussions through that group on a contingency basis with Canada, Australia and others about the potential for greater collaboration once we have left the EU.

The hon. Lady asked whether I can guarantee that the adverse effects of drugs will be detected quickly. She also asked about orphan drugs and clinical trials. Increasingly, information about the adverse effects of drugs is shared at a global level. The EMA collaborates with many third countries. There is no need for a broad deal to agree to share safety information. We want to continue collaboration with the EU on orphan drugs for rare diseases, which she rightly pointed out are a subset of the wider issue. If we are outside EU processes, we will need to consider incentives for orphan drug development, and we are doing that. Clinical trials all receive national approval today, and they will receive approval under the EU clinical trials regulation, which is due to come into force in late 2019. The UK will remain a leading centre for clinical trials. There is no reason why multi-country trials cannot include the UK after Brexit.

Several Members, including the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), asked about MHRA resources. Some 90% of medicines on the UK market already have a national licence from the MHRA; fewer than 10% come via work that we do for the EMA. We have world-renowned scientific assessors at the MHRA. Some work and workloads may change post-Brexit, but I do not think that claims of fundamental change are correct. MHRA has full contingency planning in place.

[Justin Madders]

On that point, can the Minister confirm that Department of Health budgets will not be used to fund any additional MHRA costs?

Hormone Pregnancy Tests

Debate between Steve Brine and Justin Madders

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

I thank my right hon. Friend—one of my predecessors in this role—for her question. I appreciate that she will have met constituents who have been affected by this in her surgeries and that that must have been very difficult. The report’s conclusions do not detract from the suffering experienced by the families, and we recognise that the families may find those conclusions hard to accept. Birth defects occur naturally in up to four in every 100 babies, and the existence of a birth defect in a baby exposed to a medicine during pregnancy does not necessarily mean that it was caused by the medicine.

As for the question of any future parliamentary discussion of this subject, I suspect—in fact, I know—that my right hon. Friend is more than capable of seeking such opportunities.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This decision has rightly been met with disbelief by campaign groups. It has been called a whitewash, an injustice and a betrayal. It is clear from the reaction to yesterday’s report that real anger remains about the way in which the affected families have been treated. Have we learnt nothing from previous scandals and cover-ups? The chair of the campaign group, Marie Lyon, has said:

“I could go to prison if I divulge what was discussed.”

Does the Minister not agree that that is as far away as possible from transparency? How can Marie Lyon or any of the other campaigners say that their views have been properly taken into account? Will the Minister tell us what conversations he has had with the affected families about the results of the report and what further action they want to take?

A draft of the report, which was published in October, stated

“Limitations of the methodology of the time and the relative scarcity of the evidence means it is not possible to reach a definitive conclusion.”

However, that sentence was removed from the final version. It is critical that the Minister answers these questions: why was the sentence removed; why was there a delay of a month; and did he speak to the authors of the report about the sentence before its removal? The inquiry has answered a question that it was not asked to answer, and it has reached a conclusion not supported by the evidence. What is the Minister’s view of the various studies that have been referred to that show a causal connection?

When he set up the inquiry, the previous Minister for life sciences, the hon. Member for Mid Norfolk (George Freeman), said that he wanted to

“shed light on the issue and bring the all-important closure in an era of transparency”. —[Official Report, 23 October 2014; Vol. 586, c. 1143.]

The reaction that we have seen will demonstrate to the current Minister that on that measure the inquiry has failed. Will he look again at holding a full, independent review, so that families can feel they have seen justice done and we can be sure that this will never happen again?

[Steve Brine]

The hon. Gentleman referred to a “whitewash”. As I have said, this was a comprehensive, independent, scientific review of all available evidence by experts on a broad range of specialisms who, with respect, are far more qualified to consider the subject than either him or me. It was a rigorous, important and impartial review conducted over the best part of two years, and the experts were given access to all the available documents.

As for the families and issues relating to disclosure, yes, Mrs Lyon was on the panel. However, it is standard procedure for expert working groups to sign such an agreement, as all members of the panel did, in order to keep the process free from external influence and to prevent it from being constantly discussed in the media. The companies did meet the group and gave evidence to it. Having discussed the matter briefly with members of the Medicines and Healthcare Products Regulatory Agency this morning, I have to say that I think the families could have been treated a great deal better when they met the group. I thought that the layout of the room was intimidating. Not everyone is like a Minister or a Member of Parliament who can sit in front of a Select Committee and know how to handle it. I think that the process could have been handled better, and I made that very clear.

As for Ministers and meetings, my noble Friend Lord O'Shaughnessy, who ultimately has responsibility for the MHRA and whom I “shadow” in the House of Commons, has met the all-party group and the families group. He will meet them again on 6 December, now that the report has been published. The APPG is also meeting the chair of the expert working group.

The hon. Gentleman mentioned other research. He might have been referring to Dr Vargesson, an Aberdeen-based researcher who is, I believe, working on the components of Primodos in fish. He was invited to give evidence to the group, and he did so, but he did not want to leave his work and the evidence, which he said would shortly be published, with the expert working group. As far I am aware, that work has still not been published, but I know that the MHRA will be keen to look at any new work that is published.

BMA (Contract Negotiations)

Debate between Steve Brine and Justin Madders

Monday 21st March 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David.

I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on the eloquent way in which she introduced the debate on behalf of the Petitions Committee. Under her stewardship, the Committee has gathered in a short space of time a reputation for allowing issues that are important to the public to be debated in this Chamber and for some great innovations in how democracy is dealt with in this place.

My hon. Friend helpfully set out the history and the research. She characterised as “rash and misleading” the conclusions drawn from such research about higher weekend death rates and staffing levels. We rightly say it is not easy to find a link between the cause and effect, as she mentioned in her opening remarks, but, despite a wealth of evidence showing that we cannot draw straightforward conclusions on cause and effect, the Secretary of State has proceeded on that basis. The proposals, which will see dramatic changes in how the health service will be run in the future, seem to be based on evidence that does not necessarily justify the conclusions drawn.

I will refer to contributions made by other Members. I congratulate the hon. Member for Morley and Outwood (Andrea Jenkyns) on being the only Conservative Back Bencher present. I know she is genuine in her concern about patient safety, but I was sad to hear some of the comments she made. I am afraid she repeated the mistakes that have characterised the dispute by demonising the BMA, portraying it as a militant faction. Let us not forget that these people have had 40 years without a strike, so can she not see that something has gone very wrong for them to decide to take industrial action and that they do have genuine concerns about patient safety?

I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) on her contribution. She has great experience in this area and she spoke about the potential exodus of junior doctors that the proposals may mean. She rightly highlighted the serious questions about the proposals that need to be answered.

I am glad to see my hon. Friend the Member for Hammersmith (Andy Slaughter) still in his place. He spoke with great sincerity about how unhelpful the character assassination of certain members of the BMA has been and about how he believes—I believe most Members who have spoken tonight agree—that junior doctors are still willing and able to reach a compromise, but they have been met with an intractable Government.

My hon. Friend the Member for Hornsey and Wood Green (Catherine West) described what she considers to be a Government with a determination to sabotage the relationship with junior doctors. She has spoken to a number of constituents about issues of concern to them, and she was right to say—I wholeheartedly agree—that this is about valuing staff.

My hon. Friend the Member for York Central (Rachael Maskell) spoke with great personal experience and exposed the massive dichotomy at the heart of the proposals. She rightly paid tribute to the staff who, by their good will, add so much more value to the NHS than will ever show up on a balance sheet. I agree with her that the dispute causes massive anxieties about what the future holds for recruitment and retention of our staff. She is right that industrial relations is about sitting down and getting into a constructive dialogue. I hope that, as many Members have said tonight, that is still possible.

The hon. Member for Central Ayrshire (Dr Whitford) spoke with the great experience that she brings to every debate on these matters. She correctly identified the Secretary of State’s wilful conflation of statistics. She highlighted that the ratio of trained nurses is a significant issue and gave good examples of how challenges were resolved in the past by dialogue in conflict—dialogue was raised numerous times by Members. She was right to ring the alarm bells about the fact that fewer than half of junior doctors apply to stay in the NHS and she talked with great knowledge about some of the current pressures in the system on finding staff.

Finally, I pay tribute to my hon. Friend the Member for Bristol West (Thangam Debbonaire). It is so good to see her back here and to hear from her about her recent personal experience of the NHS. She spoke with great passion and sincerity about the treatments and flexibility she was afforded by those staff. It is clear that she has received excellent treatment—she was hugely impressed by staff’s willingness to go that extra mile. The three words she highlighted should be reflected on by the Government: they need to treat staff respectfully, honourably and professionally. I could not agree more with that.

I am aware that in this Chamber we strive for a note of consensus, recognising that the main Chamber is where the theatrics, which do little to enhance Parliament’s reputation, tend to take place.

[Steve Brine (Winchester) (Con)]

They are right now.

[Justin Madders]

Yes, I am sure there are plenty of theatrics going on at this very moment. I will try to be measured in my response on behalf of the official Opposition, but it is our role to point out where we believe there are shortcomings in the Government’s approach, and on this occasion I believe that the Government have been found wanting. The sad reality is that we should not be debating this matter today at all. It could have been different if the Secretary of State had demonstrated a genuine desire to listen, engage and negotiate.

We all know that from time to time an employer will want to change the terms and conditions of their workforce. As a former employment lawyer, I know that change can be sometimes be difficult to deliver, but rarely—if ever—have I seen one side approach a negotiation with such stubbornness, intransigence and provocation. Whatever legal method the Government choose to draw this dispute to a conclusion, the reality is that it is far from over, and the well of resentment that has been built up by the Government’s approach will last for years. Everyone, including the BMA, has recognised the need to reform the current contract, but we have seen a Health Secretary giving the impression that he is looking for a fight, not a solution. In the past year he has described junior doctors as “militant”; implied incorrectly that they do not work weekends; insinuated that they are in some way to blame for deaths among patients admitted at weekends; questioned their integrity by suggesting that they may not be on hand to respond to a major terrorist incident; and insulted the intelligence of some of the brightest and best minds in the country by telling them that the 99% of them who backed industrial action had been somehow misled by the BMA.

I know how important junior doctors are to the smooth running of any hospital, how they consistently go the extra mile to deliver superb care—we heard that from many Members tonight—and how vital they are to the NHS’s future success. Yet they are repaid with insults. That is no way to treat any public servant, least of all those whose good will has kept our health service afloat as it has suffered from years of mismanagement and underfunding.

The dispute, unnecessarily inflamed by the Health Secretary, reached a new low last month when he claimed support for contract imposition from NHS leaders across the country only for many of them later to come out and confirm that that was simply not the case. That was the latest in a long line of statements he has made that do not stand up to any kind of scrutiny. Contrast that rapid evaporation of support when imposition was announced with the solidarity shown by representatives from every part of the health sector who believe that contract imposition was the wrong move to make. At least 10 professional groups, from the Royal College of Midwives to the Royal College of General Practitioners, have warned about the dangers of imposing a contract on junior doctors at a time when staff morale in the NHS is at rock-bottom.

If the Health Secretary, the self-styled patients’ champion, will not listen to the doctors and nurses, perhaps he will listen to the patients instead. The chief executive of the Patients Association, Katherine Murphy, said:

“The Government’s decision to impose contract terms on junior doctors is unacceptable. The health and social care system depends entirely on the great people who work in services across the community for the benefit of patients…It is clear that the acrimonious dispute over the junior doctors’ contract is unnecessary and damaging.”

Unfortunately, it appears that he is not listening to patients, either. He has tried to point the finger of blame at the BMA for the dispute, but if he wants someone to blame he should look no further than the mirror. His actions up to the decision to impose the contract are not those of someone trying to calm things down and reach a resolution: they are the very opposite.

What is in many ways just as unacceptable and unforgivable is the Health Secretary’s complete inaction after the decision was taken to impose the contract. A few weeks ago I asked him, in a written parliamentary question,

“what steps he has taken to avert further industrial action by junior doctors”.

The answer was quite telling. The truth is that since he announced imposition, he has not picked up the phone, opened his door or lifted a finger to try to avoid the most recent industrial action. There was virtually a month from the announcement of imposition to when the Government knew perfectly well that there was going to be further industrial action, but they did absolutely nothing to avert it.

We all need to remember that the NHS is ultimately there to serve patients, and they are now suffering because the Secretary of State has sat on his hands. It has been a complete dereliction of duty. Therefore, when the Minister responds, I ask him to confirm that the Government have not taken, and do not intend to take, any steps to prevent further industrial action.

I have some further questions for the Minister. Was a risk assessment of the effect on patient safety carried out before the decision was taken to impose the new contract? What assessment has he made of the likely impact of the contract on the recruitment and retention of junior doctors, given the crisis that the health service already faces? Does he accept that imposing a new contract that does not enjoy junior doctors’ confidence will further damage morale? Is he concerned by the 10-fold surge in inquiries by doctors planning to emigrate on the very day that the Government announced imposition? What legal advice did he take about how an imposed contract would work in practice? Will he tell the House when we will see the final terms and conditions? It is important for us to see that final detail, particularly as the BMA claims that a cost-neutral proposal was personally vetoed by the Health Secretary. We have never had an answer on that, so I should be grateful if the Minister would confirm whether the assertion is correct, and what the impediment to a deal was, given that it was cost-neutral and we already know that junior doctors work seven days a week.

The Secretary of State has sought, in recent months, to present the negotiation as a symbolic battle to unlock the delivery of a seven-day NHS. If that is the case, can the Minister explain why seven-day services are not mentioned once in the original heads of terms for the negotiations set out in 2013? The truth is that the Secretary of State only decided that the issue was about seven-day services half way through the negotiations when it was clear that doctors were going to put safety first, and he was looking for a way to divert blame away from his disastrous handling of the whole affair. Given that junior doctors already work seven days and seven nights a week, I cannot see how they can be the barrier to the safety of patients. Can the Minister name a single chief executive who has told him that the junior doctor contract is the barrier to providing high quality care 24/7? Even the chief negotiator whom the Secretary of State personally appointed, Sir David Dalton, says that changes to junior doctors’ contracts will have the least impact on arriving at seven-day working.

We all want a seven-day NHS, but no evidence has been provided about how the contract will do anything to further that ambition. Nothing coming even close to a credible delivery plan has yet been provided to set out how the seven-day NHS will be delivered. The truth is that the whole dispute has been used by the Secretary of State to detract from the challenges facing the NHS; those will only be harder to overcome thanks to his industrial relations approach, which is straight out of the Thatcherite 1980s playbook. Picking a fight with a group of people who will be critical to the future of the NHS is a mistake that I believe the Government will come to regret. The Secretary of State recently announced a number of measures aimed at making the NHS more open to learning from mistakes, and we of course support him in doing that, but when will he learn from his mistakes? When will he learn how to conduct a negotiation in a measured way?

On any analysis the Secretary of State has failed. He has failed to win the trust of the very people who run our hospitals, and the support of patients and the public. The Health Secretary may be content with a legacy of failure, but the way in which he has alienated a whole generation of doctors is something we will have to live with for many years to come.