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NHS: Junior Doctors’ Contract

Volume 773: debated on Wednesday 6 July 2016

Private Notice Question

Asked by

To ask Her Majesty’s Government what action they propose to take in view of the decision by junior doctors to reject the terms negotiated on the proposed new contract.

My Lords, in May after nearly three years of talks, several days of damaging strike action and following conciliation through ACAS, the Government, NHS employers and BMA leaders reached agreement on a new, safer contract for junior doctors. The Government decided that to help deliver their manifesto commitment for a seven-day NHS, they will now proceed with the phased introduction of the new, safer contract, which is supported by the BMA leadership.

My Lords, I am grateful to the Minister for that statement. It is clearly a matter of great regret that the issue of the new contract for junior doctors has not been resolved satisfactorily and that the Government are intent on imposing the contract. What legal power do the Government have to impose that contract? Can he tell me whether the Government have any plans to resume discussions with the junior doctors? At the heart of the dispute is a lack of trust in the Government on the part of those junior doctors. What plans do the Government have to restore that trust and the trust of patients in the NHS?

My Lords, it is certainly a matter of regret on all sides that this dispute has not been resolved in an amicable, satisfactory way; I agree with the noble Lord on that. The Secretary of State plans to introduce the new contract with NHS employers in a phased way beginning in November. He has said that in terms of how the contract is implemented and any extra-contractual issues that arise, his door is always open; he is willing to talk to the BMA and junior doctors.

My Lords, is it not entirely inappropriate for the Secretary of State for Health to claim that a 16% majority on a 68% turnout is undemocratic, especially when he represents a Government who are in power with the votes of less than one in four of the electorate? Has he now become a supporter of proportional representation? Is it not entirely irresponsible to try to impose on junior doctors this contract, which they are so against, at a time of great danger to the NHS because of the referendum result?

My Lords, 40% of junior doctors voted against this contract. That is a fact, but it does not alter the fact that it is disappointing and sad that so many junior doctors feel obliged to vote against. I am not downgrading that at all. I have not heard it said that it is not democratic. A significant minority of junior doctors have voted against the contract. We have a huge need to rebuild trust between the Government and the junior doctors. The vast majority of junior doctors are committed to their profession and the NHS and we want to rebuild with them the level of trust that always existed in the past.

Do the Government recognise that the unrelenting pressures on junior doctors are reflected in this vote and that it is essential to restore relationships and demonstrate outreach to restore some trust, and therefore that an open mind towards negotiating even minor areas of adjustment such as timetabling of introduction would go a long way to restore deeply damaged and fractured relationships?

It is worth noting that the Royal College of Surgeons and the Royal College of Physicians, and I think most of the other royal colleges, have supported this contract. Many of the leaders of the BMA supported this contract. As I said, the Secretary of State has specifically said in a statement today that his door is always open when it comes to issues around implementation. The plan is to implement this contract after the first foundation year 1, when doctors complete their first four-month rotation in October and November.

My Lords, is it not worth pointing out at this time of great economic uncertainty that there are many people in this country whose jobs are at risk, and there are other people whose pensions are uncertain, as we have seen particularly in the case of BHS? Is it not, therefore, the case that junior doctors should reflect on the fact that they have no fear of redundancy and that their pensions are safe?

My Lords, I am sure that junior doctors will reflect on the new economic situation in which we find ourselves, and I hope very much that they will not resort to the strike action that has been taken in the past.

My Lords, what assessment has been made of the number of resignations there might be from the health service arising out of imposition?

The noble Lord refers to resignations. Does he refer to the resignation of the chairman of the junior doctors committee?

My Lords, is it not the case that there is an application before the High Court to be adjudicated upon, I believe on 11 July, seeking a declaration as to whether the Minister now has or ever did have the power of diktat to impose this upon the junior doctors? If it be the case that the junior doctors are successful in their application, does it not cast this issue in a wholly different mode?

My Lords, the strong advice that we have is that the Secretary of State does have the power to introduce the new contract along with the NHS employers.

My Lords, the Government must realise how disillusioned junior hospital doctors are now. This has gone on for far too long. Is it not time that we had a new Secretary of State for Health, and that the present one should resign?

No, I do not agree with that. Where I do agree with the noble Baroness is that this has gone on for far too long. We have been in discussion on this issue for nearly four years. It has got to come to a resolution, so the Secretary of State is absolutely right to introduce this new contract.

My Lords, what would the Government do if large numbers of junior doctors decided to resign rather than accept the new contract?

There is no indication that large numbers of junior doctors are resigning because of the introduction of this new contract. If it does happen, we will have to address that issue when it occurs.

My Lords, how much of a safety issue is this? Does the noble Lord agree that there are not enough doctors as it is?

Safety was clearly a major consideration in the minds of junior doctors when the original contract was negotiated, but the leadership of the BMA agreed with us that their safety concerns had been fully taken into account in the new contract. As far as numbers of doctors are concerned, we have plans to train a further 5,000 GPs over the next four years, but unquestionably there are gaps in many rotas around the country, and we do rely heavily on doctors from overseas to fill those gaps.

There has been much made of the fact that the junior doctors are extremely disillusioned. I think that is undeniable. It is perhaps not so well recognised that “junior doctors” includes a large number who are well into their 30s, who are very well trained and on whom the NHS relies entirely.

One fact that has come over very loudly to me during the past year is that the whole definition of “junior doctors” is an absurd one. Many junior doctors have been in training for many years and we rely on them to deliver much of our front-line care. It is just another reason why it is so important, as other noble Lords have mentioned, that we rebuild the trust of junior doctors.

My Lords, will the Minister reflect that there is not a great deal of merit in telling us that the Secretary of State’s door is always open if his mind remains closed?

I do not agree with the noble Lord. There has been considerable movement on the part of the Secretary of State between the contract that was originally put to the BMA in March and the one that was agreed with the BMA in May. There is plenty of evidence to suggest that the Secretary of State’s mind has been open.