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Junior Doctors Contract

Volume 603: debated on Monday 30 November 2015

With permission, Mr. Speaker, I would like to update the House on the junior doctors’ strike. Earlier this month, the union representing doctors, the British Medical Association, balloted for industrial action over contract reform. Because the first strike is tomorrow, I wish to update the House on the contingency plans being made.

Following last week’s spending review, no one can be in any doubt about this Government’s commitment to the NHS, but additional resources have to be matched with even safer services for patients. That is why, on the back of mounting academic evidence that mortality rates were higher at weekends than in the week, we made a manifesto commitment to deliver truly seven-day hospital services for urgent and emergency care. However, it is important to note that seven-day services are not just about junior doctor contract reform. The Academy of Medical Royal Colleges noted:

“The weekend effect is very likely attributable to deficiencies in care processes linked to the absence of skilled and empowered senior staff in a system which is not configured to provide full diagnostic and support services seven days a week.”

So our plans will support the many junior doctors who already work weekends with better consultant cover at weekends, seven-day diagnostics and other support services, and the ability to discharge at weekends into other parts of the NHS and the social care system. But reforming both the consultants’ and junior doctor contracts is a key part of the mix, because the current contracts have the unintended consequence of making it too hard for hospitals to roster urgent and emergency care evenly across seven days.

Our plans are deliberately intended to be good for doctors: they will see more generous rates for weekend work than those offered to police officers, fire officers and pilots; they protect pay for all junior doctors working within their legal, contracted hours, compensating for a reduction in antisocial hours with a basic pay rise averaging 11% and average pay maintained; they reduce the maximum hours a doctor can work in any one week from 91 to 72, and stop altogether the practice of asking doctors to work five nights in a row; and, most of all, they will improve the experience of doctors working over the weekend by making it easier for them to deliver the care they would like to be able to deliver to their patients.

Our preference has always been a negotiated solution, but the House knows that the BMA has refused to enter negotiations since June. However, last week I agreed for officials to meet it under the auspices of the Advisory, Conciliation and Arbitration Service—ACAS. I am pleased to report to the House that, after working through the weekend, discussions led to a potential agreement early this afternoon between the BMA leadership and the Government. This agreement would allow a time-limited period during which negotiations can take place, and during which the BMA agrees to suspend strike action and the Government agree not to proceed unilaterally with implementing a new contract. This agreement is now sitting with the BMA junior doctors executive committee, who will decide later today if it is able to support it.

However, it is important for the House to know that right now strikes are still planned to start at midnight, so I will now turn to the contingency planning we have undertaken. The Government’s first responsibility is to keep their citizens safe. That particularly applies to those needing care in our hospitals, so we are making every effort to minimise any harm or risks caused by the strike. I have chaired three contingency planning meetings to date, and will continue to chair further such meetings for the duration of any strikes. NHS England is currently collating feedback from all trusts, but we estimate that the planned action will mean up to 20,000 patients may have vital operations cancelled—these include approximately 1,500 cataracts operations, 900 skin lesion removals, 630 hip and knee operations, 400 spine operations, 250 gall bladder removals and nearly 300 tonsil and grommets operations.

NHS England has also written to all trusts asking for detailed information on the impact of the strikes planned for the 8 and 16 December, which will involve the withdrawal of not just elective care but of urgent and emergency care as well. We are giving particular emphasis to the staffing at major trauma centres and are drawing up a list of trusts where we have concerns about patient safety. All trusts will have to cancel considerable quantities of elective care in order to free up consultant capacity and beds. So far the BMA has not been willing to provide assurances that it will ask its members to provide urgent and emergency cover in these areas where patients may be at risk, and we will continue to press for such assurances.

It is regrettable that this strike was called even before the BMA had seen the Government’s offer, and the whole House will be hoping today that the strike is called off so that talks can resume. But whether or not there is a strike, providing safe services for patients will remain the priority of this Government as we work towards our long-term ambition to make NHS care the safest and highest quality in the world. I commend this statement to the House.

I thank the Secretary of State for his statement, and for advance sight of it. When we last debated junior doctors contracts in this Chamber, the Health Secretary was too busy to attend, so I am glad that he has found time to be here today.

May I start by saying that I strongly welcome what the Health Secretary has announced? Nobody wants to see industrial action, not least the junior doctors. Hopefully, common sense will prevail. However, I have a number of issues on which I wish to press the Health Secretary, including how services tomorrow might still be affected, workforce morale, and what happens next.

A week and a half ago, I wrote to the Prime Minister suggesting independent ACAS talks to resolve this dispute. My proposal was immediately supported by the Academy of Medical Royal Colleges and accepted by the British Medical Association. It took the Government a further five days to agree to enter talks. The issue is this: given that a number of operations have already been cancelled, is it not the case that if the Health Secretary had agreed to this proposal when it was first put to him, he could have avoided, or at least mitigated, any disruption to patients tomorrow?

During my urgent question in this House on Friday 20 November, the Minister of State for Community and Social Care was asked 12 times about ACAS involvement, and 12 times he refused to agree to talks. Will the Health Secretary say very clearly why it took the Government so long to agree to talks, and why Ministers initially appeared to rule out the proposal?

Secondly, the Health Secretary will know that this dispute has been deeply damaging to workforce morale. Many junior doctors will have already voted with their feet, or would have been planning to do so over the coming months. Has the Department made any estimate of the effect of the dispute on staff recruitment and retention? What action is the Secretary of State taking to stop the brain drain of our brightest medics to countries such as Australia and New Zealand?

It was clear from my conversations with junior doctors that they felt that they were the first line of defence in a fight for the future of the NHS. Whether that is right or wrong, it is a remarkable situation in which our junior doctors find themselves. Will the Health Secretary now set out his approach to negotiations with other groups of staff about pay and conditions? Does he accept that we cannot keep asking our NHS workforce to do more for less?

Finally, I say gently to the Health Secretary that his handling of these negotiations has been a lesson in precisely how not to do it. I trust that today’s announcement will mark a change in tone and approach on the part of the Government. With that in mind, let me say this to the Health Secretary: everyone in this House agrees that if someone goes to hospital in an emergency on a Sunday, they should get the same treatment as they would on a Tuesday. The Health Secretary has repeatedly failed to make the case for why reforming the junior doctor contract is essential to that aim.

I make a genuine offer to the Health Secretary today. I am prepared to work with him on a cross-party basis to do everything possible to eradicate the so-called “weekend effect” and we will support any necessary reforms to achieving that aim. In return, he needs to be absolutely clear about what needs to change in order to deliver that. As many studies have concluded, there needs to be much more research into why there is a weekend effect, so that we can ensure that we focus efforts on the actual problem. Will he today commit to commissioning new independent research into how reforming staffing arrangements at the weekend might help improve the quality of weekend services? Does he understand that part of the problem has been that he has implied that junior doctors are to blame for differential mortality among patients admitted at the weekend? What other steps will he take to ensure that we have consistent seven-day services, including ensuring that social care is available outside the working week? Will he update the House on the consultant contract negotiations, which are separate to the junior doctor negotiations and are more directly linked to seven-day services?

I welcome the fact that the Health Secretary finally agreed to ACAS talks last week and I welcome the news from those talks today. Nobody wants patients to suffer and I hope that now we can start to put this whole sorry saga behind us.

What an interesting response from someone who has never championed seven-day services and has never been prepared to stand up for patients and do the right thing, however difficult it might be.

The hon. Lady asked about ACAS, so let me respond to her comments. We did not respond immediately—incidentally, our response was not to rule it out but to say that we would consider it and that we did not rule it out—because I made a private approach to the head of the British Medical Association to see whether there was enough common ground to make an approach to ACAS worth while. I wanted to give time for that private approach to bear fruit.

The hon. Lady asked about the brain drain. I will tell her what we are doing to stop the brain drain: there will be £3.8 billion of extra resources for the NHS next year. That is £1.3 billion more than Labour promised at the last election. That is a commitment that we can make on the back of a strong economy, which all doctors know that the Labour party would never be able to deliver.

The hon. Lady has repeatedly called for the Government to remove the threat of contract imposition. Let me tell her why we cannot do that. It would give the BMA a veto over a manifesto commitment that has been endorsed by the British people—[Interruption.] She is making noises from her seat, but let me tell her what we have actually said. We will suspend proceeding to the new contracts during the period in which negotiations happen—a short, time-limited period—and in return the BMA will suspend the threat of strikes for that time-limited period. Removing the threat of imposition permanently has not been agreed in any other part of the NHS or any other part of the public sector. The Government must balance the needs of patients, doctors and taxpayers and giving one of those groups a veto over any new contract would make it impossible to make that judgment.

The hon. Lady talked about the way in which I have approached this. Being intemperate and unreasonable is a quality that I appear to share with every Minister of Health the BMA has met; those are not my words but those of Nye Bevan, the person who founded the NHS. Had he listened to the BMA, he would have not been able to set up the NHS; it would have had to be set up by the Conservative Government who followed that Labour Government.

This junior doctors contract is not the only thing we need to do to have seven-day services, but contract reform is what hospitals say is the most important thing of all. It is based on independent research. The 2013 report from the Academy of Medical Royal Colleges had 10 clinical standards, on which we have based our proposals. We have also based them on the seven studies we have now had over five years that talk about the problems of the weekend effect. We have also had the independent research by the pay review body on which we based the bulk of our proposals.

I gently want to say to the hon. Lady that when it came to the biggest issue of patient safety in the NHS in recent years she did not speak out against the strike. She did not support the Government’s moves to seven-day services and when it came to avoidable mortality she preferred to pick holes in the data rather than make the moral case for action. The British public have noticed.

I congratulate my right hon. Friend on his steady and patient pursuit of a seven-day service for patients in the face of the extraordinarily militant tactics of the BMA. As one of his predecessors, I can reassure him that the tendency to personalise any dispute against the Secretary of State is a long-standing tradition of this trade union that goes back to Lloyd George, when it resisted panel doctors. It was ferocious in its opposition to Nye Bevan and the establishment of the NHS and every Secretary of State of every party since that time has had exactly the same experience in a dispute. If my right hon. Friend succeeds in getting the negotiations under way on a time-limited basis, as he rightly said, will he approach the BMA—of course, in a reasonable way—and insist that it make it clear that it supports a seven-day service, which would be of benefit to the country, and will not turn this into a demand for large amounts of extra pay? I think the British medical profession is among the best paid in Europe, if not the best paid. Everyone should concentrate on how to raise standards of service to ordinary patients up and down the country and how to get rid of higher mortality rates at weekends?

I thank my right hon. and learned Friend for his robust support. I seem to remember that when he was Health Secretary posters were put up all over the country saying, “What do you call a man who ignores doctors’ advice”, with a picture of my right hon. and learned Friend. He knows exactly what this is all about. It is not just Conservative Health Secretaries: Nye Bevan and Alan Milburn went through this.

My right hon. and learned Friend is absolutely right: we will all be delighted if the strike is postponed. Incidentally, it begins at 8 o’clock tomorrow morning, not midnight—I must correct that. He is right: the Government’s focus is unremittingly on improving patient care. We have made it clear that any settlement has to be within the current pay envelope. The great sadness is that the vast majority of doctors are passionate about doing something about seven-day services. If only we had had the chance to negotiate from June, we could have avoided the situation we are in.

I, too, welcome the fact that the Secretary of State has been to ACAS and made the change to plain hours that would have resulted in hours between 7 o’clock to 10 o’clock on a Saturday being counted in the same way as the equivalent period during the week. That would particularly punish people who already work at weekends such as acute medical staff and doctors working in accident and emergency—the very people we need.

I welcome the fact that the Secretary of State has made that change. I should be grateful for clarification of whether the threat of imposition is there or not. The statement says that it has been removed, but in his reply to the shadow Secretary of State he implied that it has not been removed. It would be helpful if he clarified the position.

We keep talking about more people dying at the weekend. May I again stress that it is not excess deaths at weekends, implying that hospitals look like the Mary Celeste? It is excess deaths of people admitted at the weekend, who may die on any day of the week. Junior doctors already cover weekends. It is the additional services to diagnose and get people on their journey that we are discussing. We need to focus on that. Unfortunately, the Secretary of State, in previous statements, has moved from talking about excess deaths to talking about the consultant opt-out clause, which applies only to routine work—I am sorry, a toenail clinic on a Sunday will not save lives—but he needs to focus on strengthening the seven-day service for urgent cases, in which people are ill and where existing provision leads to excess deaths. Hopefully, we can make progress. I join the Secretary of State and everyone in the House in hoping that there is not a strike tomorrow.

The hon. Lady is right that this is about the excess mortality rates of people admitted at the weekend—not of people who are already in hospital at the weekend. I am afraid that she is mistaken in her characterisation of the rest of the Government position. Clinical standards are clear: people admitted at the weekend, or at any time, should be seen by a consultant within 14 hours, but that is true in only one in eight hospitals across seven days of the week, which is why sorting out the consultant contract for urgent and emergency care matters. Although the opt-out in the consultant contract applies only to elective work, half as many consultants are available in A&E on Sunday as are available during the week, although Sunday is one of the busiest days of the week, so it is not just about junior doctors. However, if we are going to make life better for junior doctors, we need to make sure that they have more senior cover and do not feel clinically exposed, which is what independent studies have said they feel.

Governments of any party must have the right to set the terms and conditions of an employment contract. That is a right that no part of the public sector has moved away from, and it is a vital right for all employers. I have simply said that I will not move towards any new contract while negotiations are happening during this time-limited period. That was what my statement clearly said, and the BMA for its part has said that if this agreement is honoured, it will remove the threat to strike during that period.

I congratulate the Secretary of State on coming here today on this very important matter. All parts of the House support him in trying to find a negotiated solution to this knotty problem. However, if the strike goes ahead—although we very much hope that the BMA will see sense and agree to the terms so far put on the table—I understand that the BMA has not been willing to provide assurances that it will ask its members to provide urgent and emergency cover in areas where patients may be at risk. What more can the Secretary of State do to encourage the BMA to make that statement? That is what will be worrying patients out there.

On the overall picture, we must be clear that this is not about asking junior doctors to work a lot of extra hours for free. We expect that as we have increased take-up of seven-day services and more people working antisocial hours, particularly on Sundays, that might lead to a higher pay bill, but we need to make sure that the proposals for the workforce that we have at present protect average pay and mean that as we move to seven-day services, they are affordable by hospitals. To answer my right hon. Friend’s question, we respect the right of doctors to strike, even though it is very disappointing when they choose to do so, but they have said on this occasion, in a way that is quite unprecedented, that they will withdraw urgent and emergency care on 8 and 16 December. All we have said to them is that if there are areas where we are not able to make alternative arrangements for urgent and emergency care by, for example, using other front-line clinicians, we would like their support in those specific areas, not across the whole country, in asking junior doctors to step in on those cases in the interests of patient safety. We have not yet had those assurances, but we very much hope we will get them.

Order. The Secretary of State is seeking to provide comprehensive and informative replies and that is appreciated. However, progress so far—and it is not entirely down to the Secretary of State, but to the length of questions—has been a bit slow. I am keen to get through everybody if possible, but I remind the House that the next debate is very heavily subscribed, so brief questions and brief answers are the order of the day. We will be led, as usual, in this matter by Gisela Stuart.

When the Secretary of State chaired his three contingency meetings, did he take account of the fact that last year we had about 43,900 excess winter deaths, which were avoidable and largely caused by almost toxic overcrowding of emergency departments? What provisions has he made to avoid the excess deaths that we had last year and to make sure that that is not made even worse by the present situation?

The hon. Lady is right to be concerned by the much higher than normal excess winter deaths that we had, but I would not characterise the reason for those excess deaths as she did. We think they were largely caused by the ineffectiveness of the flu vaccine that was recommended by the World Health Organisation last year but proved not to be as effective as it normally is. The early signs are that this year’s flu vaccine will be more effective. Those excess deaths are deaths at home and throughout the system, not just in hospitals, but of course we are doing everything this winter, as we did last winter, to make sure that we minimise the possibility of excess deaths.

I call Helen Whately—[Interruption.] Order. May I gently remind Members that it is a good idea to continue to stand? One should not stand once and assume thereafter that the Chair is psychic. I had a hunch that the hon. Lady wished to contribute, but keep standing—it helps the Chair and it is also helpful exercise.

Thank you, Mr Speaker.

I welcome the fact that the BMA is returning to talks and that there is a potential agreement on the table. The dispute has focused on pay and hours, but I think that its roots might go deeper. For instance, juniors often do not feel valued or part of the team. Does my right hon. Friend agree that the best way to improve the situation for juniors is for them to engage in talking, rather than striking, and that talking, which they are doing, is the right choice by juniors, who are the future leaders of the NHS?

I agree with my hon. Friend, who has great knowledge of NHS matters. I simply say to junior doctors that this is not just about contracts and pay; it is also about training. Having consultants more available at weekends will help improve training for junior doctors. We will also need to look at continuity of training, which I think has been undermined in recent decades. If junior doctors are looking for a visible reflection of this Government’s commitment to the NHS, they should look at last week’s spending review statement and the extra resources we are putting into the NHS in very tight circumstances. This Government are backing the NHS, and we are doing everything we can to back junior doctors as part of that.

Thank you, Mr Speaker—I was standing.

The Secretary of State referred in his statement—in the last line of page 1 of the copy we have been given—to a “time-limited period” during which negotiations will take place. Is that a day, a week or a month? Will the contract be imposed after that?

I hope that the hon. Lady will understand that, because I very much hope that the BMA’s junior doctors executive committee will agree to go ahead with the agreement we have made with its negotiators, I do not want at this stage to go into further details about its contents. Obviously, the agreement will be published as soon as it is made, but I think that I would be pre-empting that decision by going into detail. It is a reasonable period of time for negotiations to take place.

Thank you, Mr Speaker—it appears that I need to bob more often.

I am pleased to hear that all parties might be back around the table. I join the Secretary of State in hoping that the strike action is called off. Following a meeting with Bath junior doctors this weekend, it was clear to me that they, too, will be delighted. Will he confirm that safeguards will be a central part of the renegotiation?

Absolutely. We want to reduce the number of doctors working unsafe hours and make sure that we have binding ways of ensuring that hospitals cannot ignore the intention of any agreement we make and ask doctors to work extra hours that they do not want to work and that might be unsafe, or indeed to trade on the good will that means many doctors work extra hours unpaid. That is an important part of the discussions that I hope we will now be able to enter into.

I have received a number of emails from constituents about this matter. What impact does the Secretary of State believe this fiasco will have on the long-term morale of staff in the national health service?

I am afraid that I do not agree with the hon. Lady’s characterisation of the situation as a “fiasco”. We are making really important changes that will save patients’ lives by eliminating the weekend effect that we have seen in the NHS for some time, which I think any responsible Government need to deal with. The way to improve morale in the NHS is by making it easier for doctors to give their patients the care they want to give, and at the moment that is very difficult in many places at the weekend. We want to put that right.

We have heard about the 20,000 cancelled operations and the inconvenience caused to patients by the planned strikes, but I wonder whether my right hon. Friend could report to the House how serving the needs of patients features in the negotiations with junior doctors so that patients can get the same level of care seven days a week?

That is the reason we have had this whole dispute with the BMA, and it is disappointing that, rather than it negotiating with us on something that I think every doctor understands we need to address, it has come to the eleventh hour like this. In the end, my hon. Friend is absolutely right that doing the right thing for patients is also doing the right thing for doctors, because doctors go into medicine because they want to look after patients.

I thank the Secretary of State for his statement. None of us wants to see a new contract imposed on doctors; that would be the worst possible outcome. It is very important that we have the seven-day process in the NHS. The BMA represents many doctors in Northern Ireland, where health is a devolved matter, so what discussions has he had with the Health Minister in Northern Ireland to address the issue and find a solution?

We are keeping in regular contact with our counterparts in the devolved Assemblies and Parliaments. As this is a devolved matter, it is obviously up to them to decide what they do, but I hope they will be encouraged by the progress that I think we are beginning to make in the argument for seven-day services.

There are no winners on either side whenever there is a strike, so I wish the Secretary of State well with the negotiations. What answer does he have for the doctors I have met who believe that this contract change forces junior doctors to work even longer for less?

I would like to reassure categorically those doctors that that is not the intention of the changes we are making. We have made it clear that we will protect the pay of anyone working within the legal contracted hours, and in fact three quarters of junior doctors will see their pay rise as a result of these changes. We want to deliver safer care. If we are able to go ahead with the negotiations with the BMA that I hope we can in the coming weeks, I hope we will be able to put in place very strong safeguards that all sides agree will reassure my hon. Friend’s constituents.

The Secretary of State has to accept his responsibility in bringing about the cancellation of operations, because if he had been prepared to go to ACAS at the outset, all this would have been avoided. Does he accept that he is going to have to change his attitude towards negotiating with these junior doctors if we are to get the satisfactory outcome that we all want?

My attitude is very straightforward: I need to do the things that will make patients in the NHS safer, and I want to negotiate reasonably with anyone where there is a contractual issue that needs to be resolved. I think that the Government’s position has been reasonable. The vast majority of doctors will see their pay go up, and the pay for everyone else working legal contracted hours will be protected. This is a very reasonable offer that does a better job for patients, but it has been difficult to get through to the BMA. I urge the hon. Gentleman to talk to his friends at the BMA and to urge them to be reasonable and talk to the Government, whereby we could have avoided some of the problems.

I thank the Secretary of State and the BMA for their work over the past few days in bringing this matter—I hope—to a resolution, and encourage that spirit in moving forward. May I suggest that the main way in which morale can be restored is to see that both sides are acting in the interests of patients and, in particular, patient safety, which is so vital to doctors and to all of us?

No one knows more about campaigning for patients than my hon. Friend, as he has done in his constituency, and I congratulate him on that. He is right. There does not need to be an argument on a matter such as this, because it unites the Government in what we want to do to make the NHS the provider of the safest care in the world with what doctors themselves want to do. The best way forward is to put aside suspicion and for both sides to recognise that we are trying to do the right thing for patients, for doctors, and for the NHS.

The Secretary of State has failed. He has failed patients, he has failed junior doctors, and he has failed his Government. He says that people should put aside suspicion. I suspect that the reason he did not agree to meet ACAS sooner was so that he could sneak in the announcement during the autumn statement.

Let me tell the hon. Lady what the failure was: it was setting up a contract for junior doctors in 2003 that has made it impossible for hospitals to roster proper care at weekends. The duty of a Secretary of State is to put right those historical wrongs so that patients are safe.

Tomorrow I am due to go to St Helier hospital to meet some of the doctors on the picket line. I am sure that we all agree that it would be far better if tomorrow, instead, the doctors were there working and their representatives were talking to Government representatives. Does my right hon. Friend agree that in talking to the BMA, there is genuine room for negotiation and agreement on many of the details?

I have always believed that a negotiated agreement will be better for doctors, patients and the NHS, because I am sure that the BMA has value that it can add in the negotiating process to make sure that we implement the spirit and not just the letter of what the Government want to do. I agree with my hon. Friend, and I hope that we can enter into constructive, serious negotiations.

I have watched my hon. Friend the Member for Lewisham East (Heidi Alexander) fight night and day, and for seven days a week, for services in her constituency, so I would counsel the Secretary of State against saying that she has not fought for seven-day-a-week services. May I help the Secretary of State? In order to restart the process with trust, will he confirm that he has heard from junior doctors—as I have heard from junior doctors who are constituents of mine—that their primary concern is for nothing but patient safety?

I do think that that is the primary concern of the vast majority of junior doctors, which is why I think it was wrong for the BMA to refuse even to sit down and discuss with the Government how we were going to implement a manifesto commitment. I now hope we can get past that, so I will not say any more other than that I think it is now possible to get a better agreement for the NHS, and I hope we will now be able to do that.

Having been fortunate enough to hear both from junior doctors in my constituency and from the Secretary of State, it is clear to me that both parties are talking the same language but that the communication has not quite filtered through via the BMA. Once this matter is, I hope, resolved, will the Secretary of State think of ways in which dialogue can be improved directly between the Department of Health and junior doctors?

My hon. Friend is absolutely right: we have had some very unfortunate megaphone diplomacy over recent months, but I hope we can now put that behind us and that lessons will be learned. As he rightly says, we have never wanted to do anything other than what I think is good for doctors, as well as what is good for patients, and that is what the proposals were about.

It should not have come to this and, of course, there will be a cost implication as a result. I welcome the involvement of ACAS to get to this stage and I hope the strike will be averted. Could the Secretary of State assure me that the specific concerns of anaesthetists are taken into consideration, given that they are on site all the time and are essential in making sure that hospitals are safe?

Anaesthetists have an absolutely vital role to play in providing proper seven-day services. In the highest-risk operations it is obviously very important for consultant anaesthetists also to be present, to give their very important judgments. I absolutely give the hon. Gentleman that assurance.

If this disaster is avoided, we have an opportunity to move forward and the hon. Member for Lewisham East (Heidi Alexander), who represents the Opposition, has offered her support. One of the crucial failings in seven-day care is social care. Would it be possible for Members on both sides of the House to work together to find a solution to that real problem?

I hope we can do that. The Opposition have talked regularly about social care, and rightly so. The fact is that both Labour and Conservative-run councils are responsible for the social care system, and being able to discharge into the social care system is a very important part of seven-day services. We are now about to enter a period of important reform in NHS and social care integration, so I see no reason why that approach could not be bipartisan.

Last Friday, 321 consultants at Imperial College Healthcare NHS Trust gave their full support to the junior doctors. That is just the latest indication that the Secretary of State has called this dispute wrong from the start. He now has an opportunity to rebuild trust. Does he accept that that is not helped by him coming to the House and denigrating junior doctors and their representatives again, as he has done today, and by continuing to conflate routine seven-day services with mortality rates? That just is not helpful.

I am afraid the hon. Gentleman is, as ever, completely wrong. First of all, I have not denigrated junior doctors. I have spent a lot of time praising their absolutely vital contribution as the backbone of the NHS. Secondly, I have not conflated routine services with mortality rates. In fact, I have done specifically the opposite. In answer to the hon. Member for Central Ayrshire (Dr Whitford), I confirmed that we are talking about urgent and emergency care and making sure that services are consistently delivered for urgent and emergency care across the week. That is our priority and that does link to mortality rates.

As the chairman of the alternative dispute resolution all-party group, may I confirm that it is always right to identify common ground before going into a negotiation at ACAS? I do not think that anyone should underestimate the amount of common ground that the Secretary of State has achieved in getting the ACAS talks going. What will it now take to get the BMA to call off the strike?

My hon. Friend is absolutely right. What is the common ground between the Government and junior doctors? We want to make sure they are working safe hours; we do not want to cut their pay; we want safer services for patients; and we want to make sure that the many junior doctors who do work weekends get proper consultant support and training opportunities at weekends as well as during the week. I think that that is enough on which to come to a deal.

In his approach, the Health Secretary has implied that the current junior doctors contract arrangements compromise patient safety, so will he tell us which hospital chief executives have confirmed to him that that is the case?

I can tell the hon. Lady that NHS Employers, which represents all NHS hospital trusts, has said:

“Trusts are clear that the current contracts for both consultants and junior doctors must be reformed to provide modernised and safe 7 day services in our hospitals.”

What assessment has the Secretary of State made of both the cost and the wasted NHS resources that will result from any strike action?

I cannot provide my hon. Friend with that information this afternoon, because we do not yet know whether the strike will go ahead tomorrow, and how many operations will end up being cancelled in advance of it because of the late notice, but I am happy to get that information for him when we have an estimate.

This junior doctors dispute is not just about pay. We are very fortunate to have such marvellous junior doctors. My concern, and I know that it is their concern, is about the change to the training of junior doctors in the proposed imposed contract, which will have such a negative impact on the research and development that makes our national health service the greatest in the world. Will you comment on the impact that the change in the contract will have on training and research? Will that be altered, and if not, will you please look at it again, because that is absolutely essential?

I will do neither of those things, but we will soon discover whether the Secretary of State wishes to do either.

I hope that the hon. Lady will be reassured by the Government’s November offer, which has specific protection for junior doctors doing research that the NHS needs them to do to ensure that they are not disadvantaged by doing any such research. I am happy to write to her about the plans we have outlined.

Does the Secretary of State agree that, rather than treating this issue as a political football, which Labour Members appear to want to do, they should take the advice of my hon. Friend the Member for Wellingborough (Mr Bone), which is that both sides should sit down and treat the statement with a cautious welcome? Does the Secretary of State agree that my constituents in Mid Dorset and North Poole are more concerned about patient safety and ensuring adequate 24/7 care than playing politics with our NHS?

I do agree. I think that improving seven-day services across the NHS should unite both sides of the House and, indeed, should unite the Government and the medical profession. It is extremely unfortunate that we have got into this position, but there is now an opportunity to put things right and I hope that that happens.

I welcome the statement, and I very much welcome the conversations that are going on. Many vulnerable and sick people have had letters from their local hospitals today saying that their operation tomorrow has been cancelled. Should we get good news later this evening, is it too late to allow those operations to take place, bearing in mind that in many rural constituencies—and city constituencies —transport has to be arranged for those patients?

My hon. Friend is right to bring this back to patients, which we should always do in health debates. Sadly, I fear—even if the strike is called off, as I hope it is—that in the majority of cases it will be too late to rebook people for tomorrow. We in the NHS will do everything we can to rebook people as quickly as we can. He is right that this is one of the very sad things that happens if people do not sit around the table and talk.