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NHS: Junior Doctors’ Pay

Volume 768: debated on Wednesday 27 January 2016


Asked by

To ask Her Majesty’s Government what assessment they have made of the remuneration of junior doctors.

My Lords, the review body on doctors’ and dentists’ remuneration stated, in its 2015 report, that total pay for junior doctors compares favourably with comparator groups. This will remain the case under the proposed new contract. Average total earnings range from £31,000 in the early stages of training to £53,000 for those in the later stages when they have specialised.

My Lords, I thank the Minister for his Answer and declare a personal interest with a wife and son who are doctors. As the Minister will know, medical students do three years after they graduate before they obtain their first job at the age of 24, at which point they will have accumulated between £100,000 and £120,000-worth of debt, and their starting salary will be about £20,000 a year. I heard recently of somebody newly graduated being offered a job in computers for £60,000 a year, and another person newly graduated—at the age of 20 or 21—being offered £60,000 for a job in management consulting. Do the Government agree that there is something fundamentally out of balance in this system, and is the Minister convinced that the Government are doing all they can to ensure that junior doctors get a fair settlement, not just for themselves but for the whole future of the NHS?

My Lords, I should also declare a personal interest, as my son is in his fourth year as a medical student. It is actually two years after undergraduate training when you qualify fully. The base salary is about £23,000—the noble Lord said £20,000—but the average is more like £30,000, when you take into account the supplementary pay that they receive. I, too, see what other people are being paid in other sectors, but the fact of the matter is that, when a young man or woman opts to go into medicine, pay is not their main motivation: there are all kinds of other things as well. One has to take into account the whole package that is offered, not just the salary.

Is not the reason why young doctors and not-so-young doctors are threatening to go on strike not so much the pay but because this is the last straw in a continuing series of alienation, and of feeling undervalued and underappreciated by the management from the Secretary of State down?

I agree. I do not think that this dispute is fundamentally about pay; it is much more profound than that. It is about a feeling among many junior doctors, which is shared by many senior doctors as well, that they are not properly valued and fully appreciated. That is the underlying cause of the problems we are facing.

Can my noble friend say what the Secretary of State, his Ministers and the senior members of the department are doing to promote the morale of junior doctors in the light of what he has just said? There must be a very important job to be done in that connection.

My Lords, yes; the Secretary of State takes this matter incredibly seriously, and as part of the contract that is under negotiation with the BMA at the moment we are looking very much at the number of hours that junior doctors have to work. Many have worked for too many hours in the past and we want to put a cap on the number of hours they will work in future.

My Lords, I declare an interest as in 1950 I was elected chairman of the BMA’s Registrars Group, the predecessor of the present Junior Doctors Committee. I express the fervent hope that the current negotiations between the BMA and the Government will quickly be concluded to the satisfaction of both parties. In my view and in the view of many doctors it is a matter of considerable concern that there is a suggestion of further industrial action, which is inimical to the ethos of a caring profession. Will the Minister accept my view that the alleged threat by the Secretary of State to impose a new contract of employment on all junior doctors without agreement is outrageous?

My Lords, I think the whole House will agree with the noble Lord that we all very much hope to avoid another strike. The Secretary of State has asked David Dalton, the very distinguished chief executive of Salford Royal—the noble Lord, Lord Turnberg, will know him extremely well—to head up those negotiations with the BMA, and we are very hopeful that a conclusion to this dispute will be reached before there is any more strike action.

My Lords, I am sorry to intervene, but I know that the noble Lord cannot see that the noble Baroness, Lady Brinton, is trying to get in.

I am very grateful to the noble Lord for giving way. Pay is only part of the problem for our doctors in this country at the moment. The NHS is increasingly kept afloat by overseas-trained doctors and over 40% of our hospital doctors are now from overseas. In certain specialities such as obstetrics and gynaecology the number is currently over 56%. Can the Minister say what the Government are doing to understand why some specialities struggle to attract enough UK-trained doctors, and, further, what they are doing to increase the number of medical training places for UK-based students?

The noble Baroness raises a very important point that we are highly dependent in a whole range of medical specialties on overseas doctors and of course overseas nurses as well. Health Education England is expanding the number of training places, in particular for GPs; we hope to have an extra 5,000 GPs in place by the end of this Parliament.

My Lords, I apologise for interrupting the noble Baroness. The Government’s stated objective is essentially to cover NHS hospitals 24/7—that is, with weekend working. Many hospital managers—for example, those in Birmingham—have pointed out that they are perfectly able to staff their hospitals fully under the existing contract. Can the Minister tell us how many NHS hospitals in the United Kingdom have closed as a result of inadequate staffing at weekends?

My Lords, it is not a question of hospitals closing at weekends because of inadequate staffing; it is a question of whether hospitals are able to offer high-quality care throughout the weekend. Some hospitals can but some cannot. We have seen, for example, the reorganisation of stroke care in London. Providing high-quality seven-day services for stroke care can have a significant impact on the quality of patient care. This seven-day issue is not just about junior doctors by any means; it is a question of having diagnostics, senior doctors and a whole range of other specialties on duty over the weekend.

My Lords, I, too, declare that I have a daughter who is a junior doctor. She is in her fourth year since qualification. To get to the level of remuneration that the noble Lord mentioned—from £23,000—junior doctors have to work jolly long and unsocial hours. But my specific question is: what is the comparator with other developed western countries for the remuneration of our younger doctors?

My Lords, I cannot answer that question as fully as I would like but I shall certainly write to the right reverend Prelate on that. I think that from 2004 to 2007 British doctors were extremely well remunerated by any international comparison but that, over time, that has eroded. But I will write to the right reverend Prelate with those comparisons.

My Lords, I think that the House will have been very interested to hear the Minister say, in terms, that seven-day working is not just about junior doctors but about a lot of other healthcare professionals who also need to be able to bring their services to bear at those times. Does he not think that it is a great pity that the dispute, as it has been conducted politically, has focused entirely on junior doctors and that this point has not been brought out? Will he do his best to make sure that it is brought out hereafter?

My Lords, discussions are going on with senior doctors and consultants at the same time, so I can assure the noble Baroness that it is not just with junior doctors that we are having these discussions.