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Junior Doctors

Volume 175: debated on Tuesday 3 July 1990

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To ask the Secretary of State for Health when he next intends to meet representatives of national health service junior doctors to discuss their terms and conditions of service.


To ask the Secretary of State for Health when he next intends to meet representatives of national health service junior doctors to discuss their terms and conditions of service.

I shall next meet the representatives formally later this summer to discuss the first report of the working group that we have set up with the key parties involved to discuss the problem of junior hospital doctors' hours.

I am disappointed by that reply. I should have thought that the Minister would seek an immediate meeting with the junior doctors. Is she aware that the British Medical Association is carrying out a survey of junior hospital doctors on industrial action over hours of work? The junior doctors want only a reduction in their hours of work to a maximum of 72 hours a week instead of the 92 hours that they are working at present, with no more than 36 hours of continuous work. In the best interests of patients and the national health service, will the Minister grant those fair demands?

I have had a series of formal and informal meetings with junior doctors, and I hope shortly to meet the new chairman of the hospital junior staff committee. For the first time, we have called together all the key players who affect junior hospital doctors' hours—the royal colleges, consultants, junior hospital doctors and management. We are determined to have further action and will take all possible steps to achieve it, but it is very much for the profession to demonstrate commitment and to make the necessary changes with us to ensure that we put an end to unreasonably long hours for junior hospital doctors.

Is not the Minister's answer a little unconvincing when we recall that her Department has found time wholly to reorganise the health service, to disrupt the relationship between the general practitioner and his patients and to pull the rug from under the national health service hospitals, while this simple problem, which has been known about for years, has still to be tackled? Junior doctors, who are an essential link in the health service, are expected to work, on average, more than 90 hours a week.

I am afraid that the hon. Gentleman is not entirely correct in his facts. The junior doctors worked more than 90 hours a week—91 hours a week—when the hon. Gentleman's party was in power. However, under this Government, their working hours are down to 83 hours a week, with about 58 hours when they are actually working. It is a complex issue because there is a difference between being on call and working. We are determined to see further progress and I am pleased to be able to inform the hon. Gentleman that, by the summer, only around one in eight junior hospital doctors will be working more than one in three onerous rotas. That is substantial progress over two years and we are determined, with those directly involved, to see further progress.

Will my hon. Friend continue to emphasise the difference between being on duty and being on call? Does she accept that, before any radical change is made, all junior doctors—not necessarily just their representatives—should be consulted, because any shortening of the number of hours would have implications for the length of time that doctors must serve before registration?

My hon. Friend is exactly right. There is a large distinction between being on call and working, which is why legislation is an irrelevance in the context. My hon. Friend also identifies another important point, which is the role of the royal colleges in approving the training places. We are at an opportune moment when, for the first time, the royal colleges, the consultants themselves—and there are, of course, 21 per cent. more consultants than there were 10 years ago—and the juniors are prepared to work with the NHS management to ensure that our junior hospital doctors can be alert as well as awake when on duty.

I welcome the obvious progress toward shorter hours for junior hospital doctors, but is my hon. Friend aware that many of us share a deep concern about the problem, especially when we read stories of such doctors falling asleep on duty? Where does the real difficulty lie? Can my hon. Friend tell the House about the obstacles?

I share my hon. Friend's deep concern. He is addressing the point about continuous hours of duty. There is a difference between the cumulative hours worked in a week and having long, continuous hours on duty. In many cases, the juniors themselves prefer to have continuous hours on duty so that they can have long weekends off duty. It is for them to sort out with the consultants in their particular locations the best way of organising the work rotas. In many cases, a move towards a team approach rather than an individual firm approach makes a difference. In other cases, other members of the health care profession, such as nurses, can substitute for doctors. It is a complex and subtle matter on which all parties are determined to make progress. Progress is in the interests not only of the junior hospital doctors, but of the patients, who are entitled to be treated in hospital by doctors who have had a good night's sleep.

Does the Minister agree that any progress made so far has been modest and slow and that the average hours worked by junior hospital doctors are still 87 a week? Any improvements have been achieved simply by shifting work from one group of overworked junior doctors to another group of overworked junior doctors. Is not the solution, as the Minister in part suggested, to look at ways of shifting work, such as giving responsibility for intravenous injections and phlebotomies to nurses and, most of all, to increase manpower, especially consultant manpower, so that they can take over some of the duties?

As I was able to inform the House a moment ago, the number of consultants has increased by 21 per cent. It is important that some of the new consultants should be prepared to cover. If the new consultants refuse to cover for the juniors, the difficulty of the juniors' hours will persist. The working practices of juniors, consultants and management alike are involved. But there has been much more substantial progress than the hon. Gentleman suggests. The number of junior doctors working such hours has fallen from one in four to one in eight over two years, and regions that have shown real determination have cut by a half the number working onerous rotas. I would mention in particular South West Thames regional health authority, Northern regional health authority and South Western regional health authority.

Like the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), I have recently been on the receiving end of the valuable services of junior hospital doctors. Will my hon. Friend take on board the suggestion that one way of relieving to some extent the burden to which junior hospital doctors are subjected would be to try to give them some clerical and secretarial assistance? In my recent experience, junior hospital doctors spend a great deal of their time engaging in such activities, which, arguably, could be dealt with by somebody else.

The discussion will soon be taken up by the working party that I have established, on precisely this subject. As my hon. Friend said, clerical skills may well play an important part. The work requirements of the consultants are important and, as my hon. Friend the Member for Shrewsbury and Atcham (Mr. Conway) said, the training requirements of the royal colleges are also involved. In many cases, a shift system could be introduced and in others juniors could be used to cover for other specialties in which they have had appropriate experience. In addition, in certain cases units can be amalgamated so that the junior can cover. What is clear is that all those involved are determined to take the necessary constructive action to bring an end to what I regard as an unacceptable problem.