What assessment he has made of the impact on medical staffing in acute hospitals of extending the working time directive to junior doctors. 
The Department of Health has issued guidance, with the support of the medical royal colleges, that sets out a range of solutions that will enable NHS trusts to meet their statutory obligations under the working time directive. That is being supported through a programme of pilots, a strategic support fund and the increases in staff and resources announced in the NHS plan.
Does the Minister recall that the Royal College of Physicians has warned that implementation of the working time directive in August next year will lead to
? Can he comment in particular on the fact that his Department's own pilot study suggests that smaller hospitals, those with six specialist registrars or fewer, will really struggle? Can he now give the House a pledge that if there turns out to be a conflict between the working time directive and acute care in acute hospitals, it will be the patients who are put first?"a substantial risk to the safety of many hospital in-patients"
Of course that must be right, and I can certainly confirm that, and of course I am aware of the views of the Royal College of Physicians, which we take seriously. It welcomed the guidance that we issued earlier in the year and we continue to discuss its concerns with it and how we can construct the right solutions. But it is possible, working with the pilots that we have announced for the 19 trusts that are devising the cost-effective solutions to the problems that the working time directive undoubtedly poses, that we can construct effective solutions that put the patient first. It is in everyone's interests to do that, and I think that we shall be able to do precisely that. [Interruption.]
Order. There is too much conversation going on. These questions are important and we should be able to hear the answers.
Is the Minister aware that while we all welcome the reduction in junior doctor's hours, some junior doctors fear that the quality and length of their training and experience may be compromised, along with continuity of care?
Yes, I am aware of that concern. The hon. Gentleman takes a close interests in these matters and I hope that he will have seen my recent announcement about how we intend to reform medical postgraduate training in order to avoid precisely that issue. We need a more structured senior house officer training programme and that is what will come through from the foundation programme that we shall be introducing. That work is being led by the chief medical officer, who I know takes such concerns seriously, and has made it clear, as we have, that the most important thing that we must do in the circumstances is to ensure that we preserve the quality of medical training in Britain, which most people, fairly, reasonably and rightly, regard as among the best in the world.
When will that programme start and how long will it take before it is working? As additional consultants were appointed to try to relieve the pressures on junior doctors in the past, have we not succeeded?
The reforms I mentioned to postgraduate medical education will start later this year, and I hope that we will be in a position to introduce them more widely from 2004. We are doing that in full consultation with all the devolved Administrations and with the support of the chief medical officers in all four nations of the United Kingdom.
The Minister has singularly failed to answer the question asked by my hon. Friend the Member for Tunbridge Wells (Mr. Norman). Does he agree with the Royal College of Physicians that implementation of the European directive by August 2004 will be difficult or even impossible and that the level of out-of-hours medical cover in many hospitals is already worryingly thin, posing a direct and alarming threat to safe levels of patient care? Given that the number of doctors enrolling in the past five years has been worryingly low—about 350, when the Minister estimates that 7,000 to 10,000 are needed to comply with the directive—is he now prepared to put British patients' interests first by delaying implementation, or does he expect doctors to deal with even more patients in fewer hours and risk many of our hospitals collapsing, or will patients simply have to wait even longer?
We have heard it all now from the hon. Gentleman.
Answer the question.
I did answer his hon. Friend; the problem is that usually he does not like the answers that I give.We ought to be clear. The idea that we should delay implementation of the working time directive is ridiculous—that is not going to happen. No, I do not agree with the Royal College of Physicians' assessment. We have published guidance setting out how the NHS can reach compliance and how we will do that, and we are backing that with significant additional investment, which will be important. The hon. Gentleman, like the rest of his rag-tag army of clapped-out, failed Front-Bench spokesmen, has absolutely no strategy other than the usual parade of doom and gloom and cutbacks in NHS spending, which will make it impossible to do what he says we should be doing.