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Junior Doctors: Industrial Action

Volume 607: debated on Thursday 24 March 2016

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what steps he is taking to avoid further industrial action by junior doctors.

Yesterday, the junior doctors committee of the British Medical Association, in continuation of their dispute over how junior doctors should be paid for working on Saturdays, announced that they would be withdrawing emergency cover during two days, 26 and 27 April. If the BMA proceeds with this action, it will be unprecedented in the history of the national health service.

Let me be clear first about the impact on patients. We will do all in our power to ensure that patients are protected. However, given that patients presenting at hospitals in an emergency are often at a point of extreme danger, the action taken by the BMA will inevitably put patients in harm’s way. That the BMA wishes to do that to continue a dispute over how junior doctors are paid on Saturdays is not only regrettable but entirely disproportionate and highly irresponsible.

The hon. Lady asks what the Government have done to avoid industrial action. Let me be clear on this also. Consistent with our promise to the British people to reduce variations in care across the seven days of the week, the Government could not have done more in their efforts to avoid industrial action. Although both the BMA and NHS Employers believe the current contract to be seriously flawed, the BMA has walked away from negotiations not once, not twice, but three times—unilaterally thwarting the efforts, made in good faith, to come to a negotiated settlement on a better contract.

Time and again, the Government have implored the BMA to return to talks. Time and again, the Government have extended deadlines. Time and again, the Government have listened and responded to the BMA’s concerns, making agreed changes to the proposed contract. The Government have provided every possible means to ensure productive talks. We have charged the most experienced negotiators in the NHS to work with the BMA. At our invitation, we have discussed the contract at ACAS not once, but twice. We have asked one of the most respected chief executives in the service, Sir David Dalton, to attempt to reach a solution. Yet, despite all this, the BMA has set itself against talks, refusing to negotiate on the few remaining points of contention, even though it had previously promised to discuss them. We are in the very odd situation of being faced with a trade union that is escalating strike action, despite having been consistent only in its refusal to negotiate on behalf of its members.

The country cannot be held to ransom like this. At some point, a democratically elected Government must be able to proceed to fulfil the promises they have made to the people. Governments cannot be held hostage by a union that refuses to negotiate. That is why, having exhausted every single option open to us with the BMA—with the BMA refusing to talk—and having listened to the advice of Sir David Dalton and others to move on from the uncertainty that this dispute was creating, the Government have, to their regret, decided to move on and implement the contract.

We will very soon be presenting the new contract directly to doctors so that they can see for themselves that the new contract is safer than the one it replaces, is fairer than the one it replaces, is better for patients than the one it replaces and is better for doctors than the one it replaces. By seeing the detail of the contract for themselves, I am confident that doctors will see the strike for what it is: disproportionate, ill-judged, unnecessary and wrong.

The Minister has spoken for a number of minutes, but he has not answered the question. I asked what further action the Government will take to avert industrial action and the escalation planned for the 26th and 27th, and there was absolutely no response.

This is a worrying time for patients and the NHS, and it is nothing short of a disgrace that, yet again, the Health Secretary has failed to turn up. If this walkout goes ahead, it will be the first time ever that junior doctors have fully withdrawn their labour. Nobody wants that to happen, so let me focus my questions on how we might find a way through this very heated and deeply distressing dispute.

Yesterday, the Health Secretary was reported to have said that “the matter is closed.” May I urge the Minister to think again? He should think about how it will look to patients if the Secretary of State spends the next four weeks sitting on his hands, instead of trying to avert this action. Was the Government’s former patient safety adviser, Don Berwick, not right to have called on Ministers to de-escalate the situation? How does describing the junior doctor element of the BMA as “radicalised”, as the Minister did on Monday, help to de-escalate things? May I gently suggest to him that his tone and choice of words are making a resolution harder, not easier, to achieve?

The Minister is an intelligent man, and I know he will be talking to the same senior NHS leaders I talk to. Deep down, he knows that this contract has nothing to do with seven-day services and everything to do with setting a precedent to save money on the NHS pay bill—change the definition of unsociable hours in this contract and pave the way for changing it for nurses, porters and a whole host of other NHS staff. Am I wrong, Minister?

Finally, may I simply ask the Government to start listening to patients? The Patients Association has said:

“The Government’s decision to impose contract terms on junior doctors is unacceptable…It is clear that the acrimonious dispute…is unnecessary and damaging.”

National Voices, which represents 160 health and care charities, said yesterday:

“We are calling on government to drop the imposition of a new contract”.

The Government have 32 days to prevent a full walkout of junior doctors. The Secretary of State may think that the matter is closed; I say that that is arrogant and dangerous in the extreme. This is an awful game of brinkmanship and the Government must press the pause button before it is too late.

I thank the hon. Lady for her detailed questions, put with her customary grace—and I mean that. She raised a number of issues, and I will deal with her first point last, if I may. She mentioned the Secretary of State’s comments to the Health Service Journal earlier this week. We have been negotiating a contract for three and a half years and have reached the point where the counter-party—the British Medical Association—refuses to discuss the remaining 10% that is not agreed, despite the best efforts of the most experienced of negotiators and one of the most respected chief executives in the NHS. In his judgment, there was no further purpose to negotiations, because the BMA refused to discuss those points. The Government are therefore faced with a choice: either they allow the BMA, with that refusal, effectively to veto a contract, or they implement the 90% of the contract that has been agreed and make a decision on Saturday pay rates, on which they have provided considerable movement from the recommendations of the independent doctors and dentists pay review body. I suggest to the hon. Lady that it is not the Government who are causing or calling industrial action, but the British Medical Association.

The hon. Lady asks both in her urgent question and from her seat about our actions. All I can say is that I personally have implored the leaders of the BMA to come to talks on a number of occasions, but there is a point at which it is not possible to continue discussions, first because the counter-party refuses to talk, and secondly because the BMA has promised to talk on so many occasions, only to renege on that promise at a future point. We have to move ahead with a contract that is better for patients and better for doctors.

The hon. Lady asked about the reasons for the contract and claimed that it has nothing to do with seven-day services and something to do with the pay bill. Not only is this contract cost neutral, but transition payment is being funded from outside the pay envelope. This has nothing to do with the pay bill; it is about recognising a core concern of the British Medical Association, the Government and NHS Employers that the current contract is not fit for purpose and needs reform.

One of the many reasons for that is to make sure that care can be delivered more consistently across seven days of the week. It introduces for junior doctors terms for Saturday working that in several senses are more generous than those afforded to “Agenda for Change” employees. It could be a judgment for the House as to whether it is equitable for that to be the case, but that was the negotiated position, as far as we reached one, with Sir David Dalton. I ask the hon. Lady and junior doctors to think carefully about resisting a pay offer that is more generous in form and in number than the one that is given to porters and nurses working in the same teams.

The hon. Lady asked whether she was wrong to say that this was part of a wider narrative to reduce the pay bill for “Agenda for Change” unions. I say to her unequivocally that she is. This has nothing to do with the form or payment of “Agenda for Change” staff. It is to do with the terms of contract and employment for junior doctors. It is about making a contract that is safer and fairer for them and better for patients.

Finally, I return to the point that the hon. Lady made at the beginning of her question. It is not the Government who have caused the industrial action. We have bent over backwards to try to avert it, and I suggest that we have done more than some previous Labour Secretaries of State to avert industrial action. The one thing that will help to stop this industrial action is clear condemnation from the Labour party. There is one remaining question in the whole debate, and that is the position of Her Majesty’s Opposition.

The hon. Lady has been assiduous in holding the Government to account. She has been right to do so, and she has done so with the decency that has earned her respect on both sides of the House, but she has not yet told us what the Opposition’s position is. I can understand that, although I do not agree with it, when industrial action is to do with elective, non-emergency care. The call for strike action on emergency care is of an altogether different order, however, and it demands a response from the Opposition, because this is about emergency cover for patients. The Opposition need to say clearly whether they support or condemn the action. If the hon. Lady remains silent on the matter, I will only be able, as will the House, to draw the conclusion that she supports the action. If that is so, it is a very sad day for the Labour party.

Order. I gently say to the Minister, whose emollient and statesmanlike tone is widely admired across the House, that briefly to refer to the stance of the Opposition is legitimate, but dilation upon it is not. I know that he is drawing his remarks to a close.

I am glad to see, Mr Speaker, that you are in agreement with the hon. Member for Bolsover (Mr Skinner).

We have mutual agreement, in that case. You were right to draw attention to this, Mr Speaker. All I will say is that the strike would be more easily averted if Her Majesty’s Opposition were to condemn it absolutely. If they do not, all that says is that Her Majesty’s Opposition are in thrall to the militants within the unions and are putting decent members of the Labour party in an impossible position.

There is much interest. I will start by calling not a medical doctor, but a generally brainy bloke, Dr Julian Lewis.

I am greatly obliged, Mr Speaker, as always. Will the Minister tell me whether, having quite rightly balloted its members on general strike action, the BMA has balloted the junior doctors on the withdrawal of emergency care?

My right hon. Friend raises an important point. I believe that the legality of the action is correct and that the BMA is within its rights to do as it is doing, but that does not change whether it is right or wrong. Many junior doctors who may have supported the BMA in the withdrawal of elective care will be profoundly worried about that escalation.

It is disappointing that, as both the Minister and the shadow Minister pointed out, negotiations are not currently ongoing. Junior doctors are rightly concerned. The Secretary of State has promised that more junior doctors will work at weekends, while, at the same time, no fewer will work during the week. The UK Government decided this week that the best way to reform disability welfare payments is to listen to disabled people. Will the UK Government now make a similar U-turn on NHS reform and concede that the best way to reform the junior doctors contract is to listen to junior doctors?

I thank the hon. Lady for her question, but I suggest that listening to junior doctors on their need to have a better work-life balance, to ensure that the contract is safer for patients and to address their legitimate complaints about the way the existing contract works is significantly different from listening to the junior doctors committee, whose actions seem to have ulterior motives. All I would say is that we have listened consistently to the concerns of junior doctors both through the negotiators they have appointed and in relation to those they have raised on the ground. That is why we have come to an agreement on 90% of the contract.

Many of the issues settled within the contract were not requested by the BMA. For instance, one of the complaints made by junior doctors for many years is the fact that they have to book leave so far in advance that they often have to miss important family events. We sought to change that, and we did so in the new contract of our own accord. It is one of myriad changes that will make this contract better for junior doctors. That is why the sooner they have it in front of them—we are working very hard to make sure that happens soon—the sooner they will see that this contract is better for them and that they have been misled.

I thank the Minister for coming to the House today to set out the Government’s position on this dangerous and irresponsible strike. Quite frankly, I am appalled by the fact that the Labour party has not condemned these strikes. Throughout the negotiation, the Government’s door has been open, and the BMA was given more than enough notice before the Government were forced to impose the contract. In this negotiation, the BMA got 90% of what it wanted, so this strike is essentially about pay for working on Saturdays. What other essential public servants, from firefighters to the police, would get such terms for working on a Saturday? Will my hon. Friend please tell me what impact the strikes will have on patient safety?

We will do everything in our power to ensure that patients are protected. We have a very robust assurance programme, conducted by NHS Improvement and NHS Employers. We will do everything we can to ensure both that the number of elective operations cancelled is as low as possible, consistent with the needs of safety, and that emergency cover is provided. Withdrawing the number of doctors that the BMA will withdraw in this action means that there is an increased risk of patient harm, and I am afraid that the BMA and its members need to consider that very carefully in the weeks ahead.

It is clear that the Government are in a very difficult position, hence the Minister’s attack on Opposition Front and Back Benchers. I have to say that, from my experience of nine years on the General Medical Council, I do not recognise the various descriptions of the doctors’ profession that the Government have given over the past few weeks, including as being radicalised. We all know that this dispute should and will be settled not by imposition but by negotiations around a table. It seems to me that instead of using, at the Dispatch Box and elsewhere, rhetoric that has fired this up, Ministers would do much better to react to what the BMA said yesterday, which is that it wants

“to end this dispute through talks”.

Why do the Government not get on with it, keep us out of it and just do what people expect them to do?

Before the Minister replies, may I remind the House that this is an urgent question, not a debate under Standing Order No. 24 or a series of speeches? There seems to be predilection among colleagues to preface whatever question they ultimately arrive at with an essay first. A number of Members say, “Oh, I have to say this.” No, Members do not have to say anything; they have to ask a question, preferably briefly. That is all we want to hear.

The right hon. Gentleman should know that we have negotiated with the BMA for more than three years. We have a choice either to cave in, which would produce a bad contract—much like the 2000 and 2003 contracts, which we are trying to correct, because everyone agrees they are wrong—or to move forward, accepting the fact that 90% of this contract has been agreed. We believe that it is in the interests of patients and doctors to do the latter.

Does my hon. Friend agree that this time the BMA has gone too far, and will he join me in calling on junior doctors to reach beyond the BMA and put their patients first and the BMA leadership second? Junior doctors are the future of the NHS, and they must play their role in constructively solving this problem.

I agree entirely with my hon. Friend, and we need this new contract to help junior doctors to achieve a better work-life balance, so that they can maintain their studies, training and experience in a better way than is currently allowed. We must also ensure that they are not exhausted by the contract, which is what happens under the current failed contract. It is in their interest for the new contract to be introduced, and I hope that in the coming weeks they will revise their view of whether this industrial action is truly necessary.

Thanks to the Welsh Assembly, my constituents will not suffer the anxiety caused by the future strike. Does the Minister expect the public to support doctors who dedicate their lives to the health service, rather than the nasty party that opposed the set-up of the health service, and whose support for it has always been half-hearted and grudging?

It is unfortunate that the hon. Gentleman needs to use such language. The Conservative party is achieving better outcomes for patients in every single metric than the Labour party in Wales, which is consistently letting down patients in the Principality—an appalling aspect for people who are in need of care in Wales.

It is hard to have any discussions on any matter with the BMA in good faith when there is an escalation to the withdrawal of emergency cover on a matter of pay only. That unprecedented situation makes our collective bargaining arrangements with the BMA very difficult.

The Minister is also on premium pay, and he would be on strike if other Ministers were getting more than him. Is he aware that nearly all patients who are in work and go to hospital to be treated by these doctors are also on premium pay at the weekend? Does he realise that the Government are not in a very strong position just about now? They have had to retreat on their Budget. Does he understand that in this world, where nearly everybody in a trade union gets premium payments on Saturday, the same should apply to those in hospital by the same amount? Then we should pay the nurses and all the rest of them an equivalent amount. That is the Minister’s problem—get weaving!

I have had this discussion with the hon. Gentleman before, and he is wrong. The Review Body on Doctors’ and Dentists’ Remuneration carefully considered this issue, and its proposals for Saturday pay for junior doctors were improved on by the Government unilaterally. We made a better offer than that in the review body’s independent report, which studied other comparable professions. This comes back to a question for the hon. Gentleman: will he really turn down better terms for junior doctors, in both term and number, than those for Agenda for Change unions? If so, that is a very sad thing for the Labour party.

Does the Minister agree that the most important people in this are the patients? They should be at the forefront of our mind, and it is for their sake that this wholly unnecessary escalation of action must come to an end.

I agree wholeheartedly with my hon. Friend, which is why it would be helpful to have an unequivocal condemnation of the strike from the Labour party, which would send a message from this House that the withdrawal of emergency care is wrong.

A junior doctor at St Helier hospital states that

“this contract is unfair, unsafe, uncosted, unevidenced, ineffective, unassessed for impact and risk, and unnecessary.”

With doctors depressed and demoralised, and with the revelation in David Laws’s book that the NHS required £15 billion to £16 billion, does the Minister agree that the failure to resolve this dispute is putting a huge amount of unnecessary pressure on the NHS, and that the Government and the BMA must settle?

This is what the Liberal Democrats have come to: quoting the books of their own losing candidates—a very odd situation. I think it sad for the right hon. Gentleman to come to this House not having read Sir David Dalton’s letter, which refutes every single one of the points he quoted at the beginning of his question. The fact is that the contract will be fairer and safer—better for patients and better for doctors.

Does my hon. Friend share the frustrations of a former Health Minister, namely Nye Bevan? The BMA battled against him when he was trying to set up the NHS, leading him to state in this place that it was not his fault he could not agree with the BMA as the Government had never appointed a Minister who could agree with the BMA.

Reading Bevan’s remarks from 1948, as from 1946, are a revelation. There is so much truth in them. The fact is that there are parts of the BMA that want to come to a good and constructive deal with the Government. The general practitioners have just done so. It is just very sad that this once-respected trade union is being dragged to this position by the junior doctors committee. It is doing great damage to the reputation of the BMA, and, in allying themselves to that part of the BMA, great damage to the reputation of the Labour party.

If the Minister really wants to avert the strike, I suggest he writes to the BMA today with a list of the sticking points and dates on which to meet.

Sir David Dalton wrote to the BMA with precisely that list. The BMA refused to reply to him. He made the judgment that there was no point in continuing negotiations because it was refusing to discuss, in any event, the remaining matters. The Government have to move ahead. We have been on this for three and a half years and it is better that we move ahead.

It was with great sadness that I learned of the BMA’s decision, which is not in the interests of patients and not in the interests of its members. I urge it to withdraw the threat of action. At the same time, will the Minister consider pausing the imposition of the contract, so there can be meaningful discussions? Those discussions have to take place in the context of a withdrawal of strike action.

I say gently to my hon. Friend that meaningful discussions require both good faith and a will to talk from both sides. That is consistently the case on the Government side, but it has not been consistently the case for the junior doctors committee of the BMA. The fact is that this contract is better for patients, the patients he seeks to represent. It is better for doctors, the same doctors he seeks to represent. Therefore, any further delay would be bad for patients and bad for doctors. That is why we must move ahead with the implementation of this contract.

The Minister’s tone, language and approach today show how and why he has failed in these negotiations. I am sure my hon. Friend the Member for Lewisham East (Heidi Alexander) could easily teach him how to negotiate and how to avert the strike. Will the Minister please explain how he proposes to have more junior doctors working at the weekends, without having fewer working during the week?

The point of the new contract has, in part, been to try to achieve fairer rostering through the week and weekend. It is in response to the doctors and dentists pay review body, which took evidence from managers and senior clinicians within the service. It is their judgment that we, as Ministers, have to respect. It is not for us to make up new terms; it is to listen to those who have experience. We have been talking for three and a half years. Part of those talks were led by Sir David Dalton, who is one of the most respected people in the NHS. If he could not achieve a conclusion, I doubt very much that I, or any other Minister, would be able to do so.

How many junior doctors are members of the BMA? If the BMA is set on this activity, I encourage my hon. Friend to start talking to those who are not members. Perhaps he could talk to other health workers, too, including pharmacists, and get them involved in trying to deal with this.

My hon. Friend is right to point out that not all junior doctors are members of the BMA. In fact, a significant minority are not, which is why fewer than half have been turning out for industrial action. The number has been decreasing with each successive strike, and I have no doubt that as we move to the withdrawal of emergency cover, most junior doctors will say, “This is not something I went into medicine to do”, and will want to show their support for patients, rather than an increasingly militant junior doctors committee.

I plead with the Minister to respond to the comments from Jeremy Taylor, chief executive of National Voices, which represents 160 health and care charities and which has called on the Government to drop imposition and on both sides to get back around the negotiating table. In his words, if they do not,

“the only people who will suffer are patients.”

I disagree with the gentleman on two points. First, we have been trying to get around the negotiating table for over three and a half years, but it requires both sides to negotiate, and I am afraid the BMA has refused to do so. When only one party is at the table, negotiations cannot continue. Secondly, it is not just bad for patients; it is also bad for doctors in terms of their careers and what they want, which is to provide the best possible care for patients. That is why I urge all doctors not to withdraw emergency cover at the end of next month.

Does the Minister agree that whatever the dispute, the threat to withdraw emergency cover is one that nobody should condone, and will he join me in urging the BMA to withdraw the threat immediately?

I will join my hon. Friend. I only hope those on the Opposition Front Bench will also join him.

The Minister has described those seeking to protect our national health service and their own work-life balance as being radicalised. Will he apologise for this insult to junior doctors and the English language and urgently seek a more consensual and inclusive resolution?

If the hon. Lady had been at the debate, she would know that I did not say that. It is important to understand that there is a wide gap between junior doctors and a few of the people who seek to represent them on the junior doctors committee, who have taken an increasingly militant view and whose motives, I would suggest, are not entirely in the interests of their members.

(North West Leicestershire) (Con): Given the BMA’s completely irresponsible announcement yesterday that it was willing to walk out on even emergency patients, which seemingly shows that the doctors union is willing to put patients’ lives at risk, will my hon. Friend look at how the law on emergency medicine could be brought into line with that for the Army and other such services to prevent emergency doctors from taking such irresponsible and appalling action in the future?

The new trade union legislation does not apply to doctors in the way my hon. Friend suggests, but I appeal to them and their consciences not to withdraw emergency cover and put patients at an increased risk of harm.

In Northern Ireland, we have become experts in compromise and reaching agreement. We have had to come to terms with difficult issues and compromise on many things. The Northern Ireland Assembly Health Minister is in talks with the BMA and junior doctors to find a tailored solution for Northern Ireland that is affordable and has patient safety at its heart. Does the Minister not agree that it is time to get round the table, meet the BMA and junior doctors and realise that compromise between all parties can and often does reach a fair solution for all?

The contract is a compromise. We have compromised in a series of areas to try and reach a settlement, and 90% of it has been agreed with the BMA, but in the absence of talks—one party refuses to discuss the remaining items on a point of principle—we have to move ahead with implementation. That train has now left the station, and we will be bringing in the new contract later this year.

Seven-day working was a clear manifesto commitment, and the BMA’s position is highly regrettable, but to implement it we will clearly need more junior doctors to backfill rosters, rotas and all that goes with it. For the avoidance of doubt, will the Minister confirm to the House that he has enough junior doctors to do that?

We are increasing the number of junior doctors and the number of other doctors, consultants and nurses over the next five year years in order to meet the increasing challenges facing our national health service.

The Minister said that he had reached agreement on 90% of matters, including some that were not on the table, and he is to be warmly congratulated on that. Perhaps he has a future at ACAS. What my constituents would like, however, is for him to go back to negotiate the other 10%. Is it not the case that the junior doctors want a resolution and have said that they will negotiate? The Minister should square the circle: he says they will not negotiate; they say they will. Will he give it one more chance?

The credit that the hon. Gentleman has kindly given me is due to Sir David Dalton, who achieved the 90% agreement on the contract. As for the remaining 10%, his judgment was that the junior doctors committee would refuse to negotiate. At that point, the Government had to make a decision about whether to proceed or to cave in. We decided to proceed, which is why we will implement the contract later this year.

I worked for the NHS for 33 years, so I know that NHS staff do not take strike action lightly. The Government’s failure to negotiate has fuelled this crisis in our NHS. The BMA said in its statement yesterday that it wanted to end the dispute through talks. I implore the Minister to get back round that table for the sake of patients and every citizen of this country.

Back in November, the BMA said that it wished to discuss Saturday pay rates, and then went back on that promise—one that it had made at ACAS. That is something that, in my experience, normal trade unions do not do. In my experience, they hold to their word when they have made a promise at ACAS. Given that repeated breach of good faith, it is hard to understand how a return to talks would achieve what the hon. Lady thinks it would. That is why it is so important to move ahead with the vast majority that has been agreed, and introduce this contract, which is better for patients and better for doctors.

What an absolutely shambles of the Government’s own making! Will the Minister accept that in view of the language he is using today and the tone that the Government have struck—not just today, but throughout this week and before that—they have given the impression to junior doctors and the country that what they really seek is a fight and a confrontation rather than the resolution that the public deserve?

The hon. Gentleman is the last person to speak from the Opposition Benches. I note that he of all people—this saddens me—also fails to condemn this withdrawal of emergency cover. I am afraid that in the absence of that condemnation, the House will only draw the conclusion that the Labour party supports the withdrawal of emergency action in this strike.

That will come after business questions, and I feel sure that the hon. Lady will be in her place, perched and ready to pounce with her point of order at the appropriate moment. We will await that prospect, I am sure, with eager anticipation.