Skip to main content

Junior Doctors’ Contract Negotiations

Volume 605: debated on Monday 8 February 2016

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the junior doctors’ contract negotiations.

I would be delighted to update the House on the junior doctors’ proposed industrial action. The Government were elected on a mandate to provide for the NHS the resources it asked for and to make our NHS a truly seven-day service. The provision of consistent clinical standards on every day of the week demands better weekend support services, such as physiotherapy, pharmacy and diagnostic scans; better seven-day social care services, to facilitate weekend discharging; and better primary care access, to help to tackle avoidable weekend admissions.

Consistent seven-day services also demand reform of staff contracts, including those of junior doctors, to help hospitals to roster clinicians in a way that matches patient demand more evenly across every day of the week. In October 2014, the British Medical Association withdrew from talks on reforming the junior doctors’ contract and, despite the fact that the Government asked it to return, did not start talking again until the end of November last year in talks facilitated by the Advisory, Conciliation and Arbitration Service. Throughout December we made very good progress on a wide range of issues and reached agreement on the vast majority of the BMA’s concerns.

Regrettably, we did not come to an agreement on two substantive issues, including weekend pay rates. Following strike action last month, the Secretary of State appointed Sir David Dalton, one of our most respected NHS chief executives, to take negotiations forward on behalf of the NHS. Further progress has been made under Sir David’s leadership, particularly in areas relating to safety and training. However, despite agreeing at ACAS to negotiate on the issue of weekend pay rates, Sir David Dalton has advised us that the BMA has refused to discuss a negotiated solution on Saturday pay. In his letter to the Secretary of State last week, Sir David stated:

“Given that we have made such good progress over the last 3 weeks—and are very nearly there on all but the pay points—it is very disappointing that the BMA continues to refuse to negotiate on the issue of unsocial hours payment. I note that in the ACAS agreement of 30 November, both parties agreed to negotiate on the number of hours designated as plain time and I hope that the BMA will still agree to do that.”

The Government are clear that our door remains open for further discussion, and we continue to urge the BMA to return to the table. Regrettably, the BMA is instead proceeding with strike action over a 24-hour period from 8 am this Wednesday. Robust contingency planning has been taking place to try to minimise the risk of harm to the public, but I regret to inform the House that the latest estimates suggest that 2,884 operations have been cancelled.

I hope that hon. Members from both sides of the House will join me in urging the BMA to put patients first, call off its damaging strike and work with us to ensure we can offer patients consistent standards of care every day of the week.

There is so much that could be said about this dispute that it is hard to know where to begin, so let me ask the Minister four simple questions.

First, the Health Secretary says that his door is open to further talks with the BMA. What does that mean? Specifically, can the Minister envisage a new contract where the definition of plain time working at weekends applies only to a Saturday morning?

Secondly, if a negotiated solution to a new junior doctor contract cannot be found, will the Minister today rule out imposing one? Does he not see how harmful imposition would be to patients, given its impact on staff morale, the risk of a protracted period of industrial action and the implications for future recruitment and retention?

Thirdly, can the Minister confirm that the pay protection offered to one in four junior doctors means that those doing the equivalent jobs in the future will be worse off? Should we not value the junior doctors of tomorrow as much as we value those of today?

Fourthly, and finally, throughout the dispute Ministers have repeatedly conflated the need to reform the junior doctor contract with their manifesto commitment to a seven-day NHS. 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? If junior doctors are the staff group who have to change their working patterns least to deliver this, which other groups of NHS staff will need to have the definition of unsocial hours changed in their contracts during this Parliament?

In the past year, the Health Secretary has implied that doctors do not work weekends, insinuated that juniors are somehow to blame for deaths among patients admitted on Saturdays and Sundays, and insulted professionals’ intelligence by telling them they have been misled by the BMA. If he was here, I would ask him whether he regrets the way he has handled this dispute, but he has not even got the nerve to turn up.

No one is saying the existing junior doctors’ contract is perfect, but if you speak to anyone in the NHS, they will tell you that this whole episode has been an exercise in using a sledgehammer to crack a nut. It is time now for the Government to do what is right for patients, for staff and for the NHS.

The hon. Lady wonders where to begin. I would say to her that where we begin is with the promise made to the electorate to deliver seven-day services in order to make care more consistent through the week and thereby bring down the rate of avoidable deaths. That has been the aim of this Government—pursued in the guise of the previous coalition and by the current Government—for some years. The junior doctors’ contract, about which negotiations have been going on for some years, has been framed partly in that respect during that time.

The hon. Lady asks a number of questions, and I will answer them directly. She asks whether the door is open and whether the Secretary of State is willing to see further talks. Of course it remains open. Throughout the entire process—from back in the summer, when the BMA made it a point of principle not to return to talks—we have asked the BMA to come back to the negotiating table time and again. I have done so, as has the Secretary of State, so the door remains open. I hope that, in the coming days up to the strike, such contacts will continue.

The hon. Lady asks whether there can be discussions about Saturdays. The Secretary of State has made it plain throughout the process that every aspect of the contract is open for discussion. What is not up for discussion is the ability of hospitals to roster clinicians on a consistent basis through the week. The one group of people who are refusing to negotiate about Saturdays or anything to do with the extension of plain time is the British Medical Association. Despite its assurance—in fact, its promise—at ACAS at the end of the November that it wished to discuss this issue, it has now refused to do precisely that with Sir David Dalton. We are therefore left at an impasse, where I am afraid that on the one item left to discuss, which is Saturdays, it is refusing point blank to open a discussion because of what it calls an issue of principle. For us, the principle is patient safety, and that is why we will not move.

The hon. Lady’s second question was about the introduction of a new contract. At some point, the Government will need to make a decision. Time and again, we have extended the point at which we will introduce the new contract, precisely so that we can give time for talks to proceed, even though the BMA, in a disjointed manner, refused to discuss it for several years until this point. At some point, we will have to make the changes necessary to get consistency of service over weekends. We cannot delay this any longer. No Health Secretary or Health Minister could stand in the face of the many academic studies that have shown there is an avoidable weekend effect and say that nothing should happen. Of course this should be done in concert with other contract changes—changing the availability of diagnostics, pharmacy and other services—and we have always said that it is part of the piece, but it has to be done at some point and that point is fast approaching.

The hon. Lady asks whether imposition will be harmful to patients. I ask her to consider whether avoiding changing rostering patterns to eliminate the weekend effect would not itself be harmful to patients to the number of several thousand a year.

The hon. Lady asks about pay protection. We have urged the BMA to put to its members the pay protection that we made clear right at the beginning of the process, but I am afraid that it wilfully misled its members about the pay offer that we put on the table. I ask her, therefore, to be careful in what she says. For this cohort of junior doctors, this is a very good deal. Those who are coming into the service can be assured that they will have a quality of contract that the current cohort has not benefited from: a reduction in the maximum number of consecutive nights from seven to four; a reduction in the maximum number of consecutive long day shifts from seven to five; a reduction in the maximum number of consecutive long late shifts from 12 to five; and a reduction in the maximum number of hours one can work in a week from 91 to 72. Those are considerable improvements in the contract that will protect the safety and working practices of future generations of junior doctors.

When the hon. Lady wrapped up her remarks, she asked whether we had any regrets about the way this process has proceeded. We do have regrets. We regret that the BMA wilfully misled its members at the beginning of the process, making them believe that there was going to be a cut to pay and an increase in hours, neither of which was true. We certainly regret the fact that the BMA refused to talk to us for months on end, when many of these issues could have been dealt with. We certainly regret the fact that the BMA has gone back on its promise to discuss plain time hours—a promise made at ACAS that it has now reneged upon. I am afraid that in dealing with the BMA, we have not been able to address the matter that is most important to doctors, which is protecting patient safety. That is why, in the end, we will have to come to a decision on this contract for the betterment of patients and the consistency of clinical standards through the week.

Under the current contract, too many junior doctors are forced to work excessive hours and are overstretched during the hours they work. Will the Minister, having set out that the hours will be reduced, reassure the House about what measures will be put in place to make sure that managers do not let this slip and that we do not return to the days of overworked junior doctors?

My hon. Friend is right that new measures have been introduced in the proposed contract. A new guardian role, which was proposed by NHS Employers, will help to protect the hours of junior doctors in individual trusts. That has been a point of success in the negotiation between the BMA and NHS Employers. A new fines system, which is not currently in place, will penalise trusts and ensure that the moneys that are generated by the fines go towards enhancing the general wellbeing and training of doctors within those trusts.

Obviously, I am disappointed that it is not the Secretary of State we are speaking to today. The Minister referred again to weekend deaths. I gently point out that if one studies the evidence from Freemantle, one sees that there is a lower level of deaths at weekends. Perhaps we might be a bit more precise and say that we are talking about people admitted at weekends who die within the next 30 days.

I welcome the commitment to increase diagnostics and social care, as I think will everyone in the NHS, but junior doctors already work seven days and seven nights a week, so I really do not see how they can be the barrier to the safety of patients.

I do think that, on looking back, the Secretary of State and the Minister may regret how this matter has been handled. Right from last summer, it has been so combative. In October, when we debated the junior doctors, the Secretary of State was still refusing to go to ACAS, so this cannot all be put on the BMA. Doctors are not stupid; they are capable of reading what has been offered. Many of the junior doctors who have written to me have talked about the fear of hours getting out of control. When I was a junior doctor, the hours were ridiculous and it was the automatic financial penalty on trusts that changed things. It is important that their concerns are listened to and that they are not patronised, as they were on the Marr show yesterday. That has aggravated things further, and the way in which this process has been dealt with from beginning to end has been really disappointing.

We are facing the second day of strike for the first time in 40 years—that is my entire career. What does the Minister feel will be brought to the table by the Department of Health in the next few days to try to get out of this and to try a different approach? We do not have junior doctors on the streets in Scotland. He has to ask himself why we have them on the streets here.

The hon. Lady speaks from experience, and rightly points to the fact that avoidable mortality that is attributable to weekends is different from mortality at weekends—the Secretary of State has been clear about that in his public statements. However that gap does exist, as the hon. Lady knows, and Professor Sir Bruce Keogh was clear in his statements that there is an avoidable rate of mortality. He stated:

“There is an avoidable ‘weekend effect’ which if addressed could save lives. This is something that we as clinicians should collectively seek to solve. It also strengthens the moral and professional case for concerted action.”

The way in which the hon. Lady characterised the discussions in September, October and November is not quite right. We implored the BMA to come and talk; I personally had those discussions with leaders of the BMA, and they refused to do so. It was only when they came and talked to us that we made substantive progress.

The hon. Lady is right to raise these issues, and we wanted to discuss such matters with the BMA. One issue was protection against excess hours, but we had no counterparty with whom to negotiate. Since we have had that counterparty, we have made good moments of progress, and the result is the guardian position, which she welcomed in another place. The guardian will be able to levy fines, and those fines will be remitted to the guardian. I hope—and indeed expect—that process to reduce the excess hours that we still see in a small minority of positions. We must get away from the perverse incentives for trusts and a small minority of doctors that mean that unsafe working hours are perpetuated.

Of course we all regret the course that this dispute has taken, but it would not have done so had the BMA taken a responsible position from the beginning. If people lie to their members and say that they will have their pay cut and their hours raised, of course doctors will be angry—all of us would be. The fact is that that was never true, but it has inflamed the situation. We could have had the kind of productive talks that we have had over the past three or four weeks back in August, September and October had we not had all the mess beforehand because of untruthful statements issued by the BMA.

The level of support among junior doctors for this pay dispute is at least in part because of longstanding dissatisfaction with the experience of being a junior doctor. Sir David Dalton recommended a review of those longstanding concerns in his recent letter. Do the Government intend to commission such a review?

The Government will be looking at Sir David Dalton’s recommendation and acting on it. He is right to point to the fact that the 1999 contract is imperfect—it was agreed back in 2008 that it had many failings, and that something needed to be done to fix it. That contract in its generality has helped to contribute to the lowering of morale in the junior doctor workforce, which Sir David Dalton has recognised, as has the Secretary of State. It is not just the way in which training placements are made and a whole series of other problems with the contract; it is also the fact that people have to work for long periods of consecutive nights and days, all of which is reduced in the latest proposed contract.

Is the Minister aware that it takes two sides to call a strike? It cannot happen just because one side of the argument wants a strike. The Secretary of State has been looking for a fight with the doctors ever since he got the job. Does he realise that when I came here 45 years ago, I was getting time and a half for all-day Saturday, and double time, like other miners, for Sunday? Every time the doctors are replaced by agency nurses it costs the Government and the taxpayer a small fortune. Get the matter settled, and be decent for a change.

The hon. Gentleman has long prized himself as a champion of working people, yet the current contract and the proposed contract by the BMA, which I presume the hon. Member for Central Ayrshire (Dr Whitford) supports, prefers junior doctors over porters, cleaners and junior nurses, and it gives them better rates of pay, and premium rates that could not be enjoyed by lesser paid workers under contracts negotiated by unions that the hon. Gentleman supports. Here we have it: the final morphing of the Labour party into a party that prefers professionals over porters. That, I am afraid, is the party that he is now a member of.

I very much support the Government’s stance on junior doctors, while acknowledging that most doctors—junior and senior—work well beyond their contracted hours. Does the Minister agree that it is not junior doctors but their seniors, and seniors’ terms and conditions, who really set the tempo in our national health service?

My hon. Friend also speaks from experience. We have said right from the beginning that reform of consultants’ and junior doctors’ contracts will be critical in delivering seven-day services. On consultants’ contracts, it is important to make sure that consultants are providing clinical cover over weekends, not just for the benefit of patients but for juniors, who are often covering rotas without clinical cover from consultants with and to whom they might wish to confer and refer.

Is it not at the very least odd that the Secretary of State yet again chooses to stay away and not come before the House to answer questions on this very important subject? As a former Health Minister, I know how difficult the BMA can be, but this would seem to indicate to me that it is the Secretary of State who has become the main obstacle to a sensible solution to this crisis.

The right hon. Gentleman will know that, numerically, the previous Labour Government had far more scraps with the BMA than the coalition Government and this Government have achieved so far. He will know that it is a mark of all Health Secretaries to have disputes of one kind or another with the BMA. The Secretary of State will be here tomorrow, since the right hon. Gentleman asks, to answer oral Health questions.

I am sure that nobody who toddled into the Chamber after the urgent question started would expect to be called. That would be quite out of keeping with our parliamentary traditions. I think I need say no more.

I wonder whether the Minister can help me. The messaging I have heard from the BMA is that the dispute is nothing to do with pay. We have heard the issue described as a “nut” by the shadow Secretary of State, yet it has led to a national strike for the first time in 40 years and we face industrial action again. What is going on here?

That is a question I am increasingly asking of those in the BMA’s leadership. They have agreed with Sir David Dalton that the remaining issue is about pay. Having said for several months that it was not about pay, they have now, in the end, come clean and said that it is about pay. That is what we are dealing with: pay rates for plain time and for Saturdays, where they wish for preferred rates over nurses and other “Agenda for Change” staff.

Junior doctors in my constituency are only very reluctantly taking action on Wednesday. They are supported by many of my constituents, who think that it is simply a disgrace that junior doctors are being forced to take industrial action because the Government are simply failing to address the legitimate concerns raised by the BMA. I heard the Minister say that his door is open, but what he is actually going to do to settle the dispute, and does he think it helps to denigrate the BMA in the Chamber this afternoon?

The hon. Lady says the junior doctors in her constituency had legitimate concerns. They did. Every single one has now been answered in the negotiations between Sir David Dalton and his predecessors apart from one, and that is the one the BMA refuses to open negotiations on, despite having promised to do so in November last year. Yes, our door remains open, but the BMA has first to agree to talk to us, which it is again refusing to do.

Junior doctors in Cheltenham are some of the most dedicated and hard-working people anywhere in our local community. It is therefore a concern to me that some have cited information from the BMA suggesting that the Government are proposing a pay cut. Will the Minister make the position crystal clear? Is that right?

Does the Minister ever wonder whether he has chosen the wrong target? He bases his entire argument on safety—and rightly so—yet chairs and chief executives of hospitals constantly tell me that they have no difficulty staffing their hospitals with junior doctors over weekends. At the same time, however, our GP out-of-hours services are under incredible strain and cover is threadbare in many parts of the country. That, surely, is where the real safety concerns lie.

The right hon. Gentleman will know that we are looking at the contracts for GPs, consultants and junior doctors: they are of a piece. We cannot see one clinical group in isolation, when they work together. He should know, therefore, that in concluding discussions with junior doctors, consultants and GPs, we need to ensure that we give hospitals and primary care settings the ability to roster staff consistently through seven days of the week.

I have met junior doctor colleagues over the last few weeks and months, and I know that many of them are cautious about the new contract and that strike action is the absolute last resort for them that they would rather not take. I met one of my constituents from Polegate this morning whose operation is going to be cancelled this week, thanks to the strike action. I welcome the Minister’s comment that the door is still open even at this late hour to call off the strike. Would he find it helpful if the shadow Secretary of State also condemned the strike and asked the doctors to call it off, so that patients do not become the real losers in this dispute?

My hon. Friend points to an interesting fact—that despite these many months of discussions, we have never had a clear line from the shadow Secretary of State or from the Opposition generally on whether they condemn or support the industrial action. It would be helpful if they made that clear because we would know at least whose side they are on. Are they on the side of patients, where we are trying to eliminate the weekend effect, or are they on the side of the BMA’s leadership?

I find the Minister’s language and tone in regard to the BMA and the junior doctors unfortunate. He speaks as though junior doctors do not care and do not want to help their patients, and I find that regrettable. In my time as a Unison official, when I used to represent public sector workers in health care, the BMA was hardly known for its militancy within that organisation, and the Minister needs to reflect on that. Does he really think that this whole problem is, as my hon. Friend the Member for Bolsover (Mr Skinner) denied earlier, all the blame of the BMA and doctors? Doctors care about their patients; that is why they are in this position. Does the Minister not accept any responsibility for the impact?

I entirely agree with the hon. Lady about the passion and dedication of junior doctors—and never once has the Secretary of State or I questioned that. What we have questioned are the tactics of the BMA’s leadership. I happen to agree with her, too, about her previous employer Unison. I have constructive relationships with that union. I disagree with it, and it with me—often—but we agree on many things and have a straightforward relationship. I am afraid that it is difficult to do business with the BMA, however, when it promises to talk about one thing and then refuses to do so a few weeks later, when it refuses to come to the negotiating table for months, and when it misleads its members in a way that I do not think Unison has ever done.

The residents in my constituency tell me two things: first, how much they value the work of doctors, both junior doctors and consultants; and, secondly, how disappointed they are that this House is not united in saying that the strike is not justified on safety grounds. Is the Minister as disappointed as my residents?

Yes, and I would add the 2,800 people who have had their operations cancelled. I wonder what answer they would get from the Opposition about whether they support or condemn those cancellations. As soon as we get an answer to that very simple question, it will be easier for us to know the official position of Her Majesty’s Opposition.

Yesterday, the Secretary of State for Health accused the BMA of misleading junior doctors. Today, the Minister comes to the House and accuses the BMA of lying. Is he really asking us to believe that some of the most intelligent people in the country—junior doctors—cannot see for themselves what the Government are proposing? Does he not feel that the continued abuse directed at the junior doctors’ representatives is hindering any possibility of a settlement to this dispute and that that is damaging to patients?

The hon. Lady is also an intelligent woman, so let me ask her this. If a trusted body, such as the BMA, tells its members that they will have a pay cut of 30% and an increase in hours, but that statement is incorrect, does it constitute a lie? That is the question I would put back to her.

A number of Members met representatives of the BMA in the House of Commons. We were disappointed that, despite continued questioning, they refused to go to the negotiating table, but thankfully they eventually did so, and made some progress. My constituents want a safe, seven-days-a week NHS. Is it not time to get back around the table, so that we can provide the service that NHS patients want?

It is, and that is why we need to move ahead in fairly short order. Ultimately, if staff contracts are not reformed across the service, those who will suffer most will be patients, and what will be most affected is the consistency of care that they receive at weekends.

The shadow Health Secretary asked the Minister if he could list the hospitals in which there were currently not enough junior doctors working at weekends. He could not answer that question, so I will give the Minister another chance. Will he name them for us now?

Evidence given to the Review Body on Doctors and Dentists Remuneration made clear that rostering was made more difficult by the current plain-time terms in the contract. That is why it has been on the table for several years and has been the subject of parts of our discussions with the BMA, when we have been able to have them. It is also why one of the leading chief executives in the country, Sir David Dalton, who led the latest round of talks, has pressed the BMA to come and talk about Saturdays specifically and plain time in general. The BMA has refused to speak about either.

Whatever the arguments in this case, I can think of no one more honourable, decent and honest to run the negotiations than my right hon. Friend the Secretary of State. It is reported that graduating medical students applying to be foundation year 1 and 2 junior hospital doctors are seeking work in Northern Ireland, Scotland and Wales to avoid the new contract. Is that true, and if it is, what can be done to stop this drain of our best medical students?

We do not see any particular evidence of the movement of juniors at present, but what we would most like to see for juniors is the introduction of the new contract, so that they can recognise that it will be better for their working practices than the current one. It is in everyone’s interests—not just those of juniors, but those of patients—to ensure that juniors work safe hours. That is why the new contract involves reductions in the number of consecutive nights and long days, and it is why we want to reduce, and eventually eliminate, the excessively long hours in the week.

I am sure that Ministers have a very clear idea of how their proposals will affect working practices, so may I ask this Minister on how many occasions last year a junior doctor worked 91 or more hours in a week?

We believe that last year about 500 junior doctors were operating on a band 3 payment, which equates to payments for hours of work that exceed what is specified in the working time regulations. That is a relatively small number within the NHS, but it is still significant, and for the doctors concerned, working those excessive hours is unsafe.

Will the Minister join me in thanking the junior doctors who ignored the call to strike last time, and does he agree that the lack of condemnation from the Opposition demonstrates that they are putting their support for industrial action before my constituents and their healthcare needs?

I entirely agree. Rather like an arsonist who pours petrol on a fire and then runs to offer help to put it out, the Opposition have done very little to help to get the contract into the place where it needs to be, and to stop the industrial action. I am afraid that the patients whose operations will be cancelled this week will suffer partly because of the Opposition’s failure to take a firm stand.

As the Minister will know, Wexham hospital in Slough has enormously improved the care that it gives to its patients. It has done that with the same staff, but with a leadership which says to the people who work there that it has confidence in them and shares their values. The Minister is saying that he is the only person who cares about patient safety, and that doctors do not. What does that do for morale and for doctors’ ability to improve the quality of care for patients?

I am not sure how to answer the right hon. Lady’s question, given that she has wilfully misconstrued what I said. I have never once suggested that only the Government care about patient safety. Almost every doctor out there cares for nothing other than patient safety and patient care. However, according to the 10 clinical standards of the Academy of Medical Royal Colleges, if there are to be consistent levels of care over the weekends, part of that will be achieved through reform of staff contracts. One of those is the junior doctors’ contract, which is why we must press ahead with it.

I commend my hon. Friend for all the work he is doing to deliver a truly seven-day-a-week health service for the benefit of not only my constituents but those of every other Member. I am a little surprised by the hon. Member for Lewisham East (Heidi Alexander) saying that no one thinks the existing contract is perfect. Does the Minister agree that we should all be working together in the interests of our constituents to bring this situation to a successful conclusion, rather than trying to score party political points with it?

I agree with my hon. Friend. I am afraid that this is a mark of the way in which the Labour party has changed. I suspect that a Labour party of a different era—one that was more responsible in how it dealt with industrial disputes—would have understood on whose side it should be acting at this point.

This is a Conservative Government, but to have a strike of this kind on any Government’s watch is a disgrace and a failure. I quite like the Minister actually, but he has only ever laid the blame for this elsewhere. Surely, the Government should be evaluating their own performance and saying, “We can do better than this and we should ensure that this does not happen,” even at the eleventh hour.

The hon. Gentleman tempts me with kindness, and I repay the compliment. However, having been involved in this process for some months now, I have found it incredibly frustrating. Up to the end of November, every time we asked the BMA to come and talk to us, it refused, despite personal entreaties. And when it did talk to us, we often found that we had nailed down an agreement only to find it slipping out of our fingers the next day in front of the media. This has been a hugely frustrating and difficult process for everyone concerned—not only for us but for the junior doctors, who have been left confounded and confused by the whole thing.

Does the Minister agree that most, if not all, junior doctors exceed their contracted hours and that a 72-hour limit is therefore essential? Will he also acknowledge that, even after the negotiations are complete, many junior doctors will continue to exceed their contracted hours?

Some junior doctors exceed their contractual hours. The average across the service is 48 hours, but some are working as many as 91, which is the current permitted limit outside the working time directive. We wish to stop that altogether and bring it down to an absolute maximum of 72 hours a week, which would equate to a 48-hour average over the agreed period, which is currently six months. The key is to get the number of hours down, because working excessive hours is unsafe for patients and for doctors.

The Minister has been keen to establish what he sees as the preferential terms and conditions that junior doctors enjoy, yet Sir David Dalton has said in an interview with the Health Service Journal:

“My assessment is that the staff group that will have to contribute the least above that which they are providing at the moment would be our doctors in training. Our messaging on this has got muddled”.

Does the Minister agree?

Sir David Dalton has also made it clear that we have to reform all contracts. One can place the balance where one wishes, but it is important that we reform the juniors’ and the consultants’ contracts together, so that they can fit within the service of a piece. It is wrong, for instance, to have a junior on duty taking decisions at the weekend and not be covered by consultants supervising and helping with those decisions. We need to ensure that there is consistency of rostering through the week and at the weekend involving both juniors and seniors.

I represent many junior doctors. I have met them and I have tried to represent their views to the Government, but I have always taken the view that my primary responsibility is to the patients of the NHS. One of those patients, a constituent of mine, emailed me this week to say that a consequence of the strike would be the

“cancellation of my wife’s biopsy, planned for this week, without which her already shortened life will be shorter”.

Will the Minister, the shadow Minister and the whole House join me in condemning this strike? It will achieve nothing. It is a distraction from the negotiations, which need to continue, and it will put the lives of my constituent and others across the country at risk.

I cannot possibly add to the comment made by my hon. Friend, and I just hope the shadow Secretary of State takes note.

Strike action is always a last resort, and I can say categorically, as an ex-NHS worker, that no NHS worker wants to go on strike. We have here a complete failure of negotiation. The Secretary of State’s door may be open, but the inflammatory and insulting comments he made in the media this weekend do not exactly invite people to cross that threshold and talk to him. Given that he has manifestly failed as a negotiator, is it not about time he stood aside and let a trained negotiator deal with the BMA and come to an agreement, before it is too late?

I am not sure the hon. Lady has been listening to the statements made in this House and elsewhere.

I am not sure the hon. Lady has been listening because otherwise she would have heard that the negotiations have already been taken on by leading negotiators from NHS Employers and, latterly, by Sir David Dalton, one of the leading chief executives in the country. Significant progress has been made, contrary to what she has just suggested. Negotiations have worked. We have managed to nail down—[Interruption.] The hon. Lady shakes her head, but the fact is that Sir David Dalton has managed to secure agreement on every single point of contention other than pay rates for plain time, unsocial hours and Saturdays. This dispute on Saturday and the kind of results we are going to see across the country on Wednesday will, in essence, be about pay rates on a Saturday, with the BMA wanting preferential rates over nurses, porters, cleaners and other workers in the NHS.

May I join colleagues in thanking the Minister and the Secretary of State for all their work in negotiating a contract, which is obviously a tough discussion to have? Although many of my constituents may have sympathised last year with the BMA’s case, patients and their families, including my father after a recent heart valve replacement, will be concerned that the BMA is not getting around the negotiating table and thus placing a lot of undue stress on the most vulnerable. Does the Minister agree that the BMA should seriously consider those patients as it protracts its negotiations?

If the BMA was truly representing its members, it would be thinking about patient welfare during the strikes. Just now, we heard my colleagues describe with great eloquence the kinds of effects on individuals that a strike will cause. These strikes will get us no nearer to a solution; the only way to come to a solution is by negotiation.

It is testament to the progress being made in the course of these negotiations that the BMA has cancelled some strikes and has downgraded the one we are expecting on Wednesday, but does the Minister agree that one crucial thing that would make the greater difference would be condemnation from the Opposition?

It would make a significant difference. Now that the Leader of Her Majesty’s Opposition is sitting on the Front Bench, he might like to take note of the fact that if we have a united political response condemning strikes that affect patients and their safety, it helps to bring negotiations to a more profitable end.

Hull royal infirmary is under a black alert, which means that local people have been told not to attend the hospital unless it is a matter of life and death. Will the Minister tell me how the insults the Secretary of State has been throwing around over the weekend, and those that he himself has made today about hard-working and dedicated junior doctors, will help people in Hull, who need a functioning NHS? How will those insults improve the morale of those doctors?

The hon. Lady does dangerous work if she tries to conflate the comments that I and others have made about the leadership of the BMA with the motivations of junior doctors, none of whom I have impugned. I recognise that junior doctors work incredibly hard, care passionately about their patients and have a vocational drive to do the best for the people they care for, but that is different from an organisation that refuses to talk, refuses to negotiate, lies to its members and is very slippery in the statements it puts out to the press.

Kettering general hospital is always under huge pressure, and the junior doctors there do a fantastic job. May I tell the Minister that my constituents will be extremely disturbed to hear him tell the House today that the BMA said at the ACAS talks that it would negotiate about Saturday pay but is now refusing to do so? The consequence will be a strike on Wednesday, and my constituents are appalled that 2,884 operations have already been cancelled, with that number possibly set to go even higher.

My hon. Friend is right about that. He mentions one of a number of agreements that we have come to with the BMA in the course of these discussions that have subsequently been reneged upon by that organisation. That is why this whole process has been so torturous for everyone involved.