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Junior Doctors’ Strikes

Volume 829: debated on Thursday 30 March 2023

Commons Urgent Question

My Lords, I shall now repeat in the form of a Statement an Answer to an Urgent Question given in another place. The Statement is as follows:

“I am grateful to the honourable Member for his Question. I know that colleagues and constituents are concerned about the planned 96-hour walkout organised by unions representing junior doctors.

The honourable Gentleman asks about its impact. We know that during the previous walkout by junior doctors earlier this month, 181,049 appointments had to be rescheduled. With this four-day walkout, the disruption and the risks will be far greater not only because it lasts longer but because it coincides with extended public holidays and Ramadan, with knock-on effects before and after the strike action itself and because a significant proportion of junior doctors will already be on planned absence due to the holiday period.

NHS England has stated that it will prioritise a number of areas, including emergency treatment, critical care, maternity care, neonatal care and trauma, but has been clear that it cannot fully mitigate the risk of patient harm at this time. That is concerning and disappointing. Patients should not have to face such disruption, and I have invited the BMA and the HCSA to enter formal talks on pay, with the condition that they cancel strike action.

The BMA’s junior doctors committee’s refusal to engage in conversations unless we commit to delivering a 35% pay increase is unacceptable at a time of considerable economic pressure and suggests the leadership adopting a militant position, rather than working constructively with the Government in the interests of patients. None the less, we remain determined to find a settlement that not only prevents further strikes but, equally, recognises the important work of junior doctors within the NHS, just as we have done with the Agenda for Change trade unions in their disputes. We will continue to work in good faith, in the interest of everyone who uses the NHS.”

My Lords, junior doctors are being asked to do the work of many. The NHS is short of more than 150,000 staff, yet the long-promised NHS work plan remains just that—long promised. We are still waiting for the general practice plan, the review of integrated care services and the social care update. Do the Government intend to get those plans out over the Recess when Parliament is unable to scrutinise them? With a quarter of a million appointments and operations potentially facing postponement because of the forthcoming strikes, when will the Health Secretary get back around the table with the BMA, this time to take talks seriously to stop the damage to patient care?

We have taken the talks incredibly seriously. We have proven in other areas with the Agenda for Change unions that, with good will on all sides, we have managed to reach an agreement. I think most people would agree it is not a reasonable position to go in saying that, unless they get a 35% pay increase, they are not willing to have any further talks. That is not something that I believe many of us could support. We are always open to reasonable negotiation, as we have proved in the other cases, and we remain open to having that reasonable negotiation now.

My Lords, many hospital trusts are having to bring in more senior doctors in this period to cover the strikes, at what must be considerable expense. Given that quite a few trusts are already going into deficit due to inflationary pressures, will the Government be making provision to cover these additional and unexpected costs? We know that working as a junior doctor is physically intensive, but it is also a mentally exhausting line of work. The decision to strike will have put serious mental stress on junior doctors; they did not train for years to go on strike and cause this. So who is looking after the mental health and well-being of our junior doctors?

I think we all agree that the mental health and well-being of everyone in society is paramount. At the same time, I would hope that junior doctors did not feel the need to take this action. As I say, in other areas relating to Agenda for Change we have reached a good outcome. We sat down with the BMA junior doctors committee hoping to have the same constructive conversations around settlements that we had already reached, but unfortunately that was not forthcoming. So my main response to concerns in that space is this: please do not strike. Please sit down with us again and engage constructively.

My Lords, we know that a major cause of the strikes that we have recently seen in the health service relates to staff who are overstretched. That is the result of chronic shortages, which suggests a lack of adequate workforce planning. We have just heard that there are currently over 124,000 reported vacancies, according to the NHS Confederation. I repeat a question that was asked earlier, or shall at least reinforce it: when will the workforce plan be published? Without it, healthcare staff will continue to struggle to provide the level of care that they would like.

As I have mentioned many a time and am happy to mention again, the workforce plan will be announced shortly—soon. I wish I could give an exact date, but it is there. However, I am sorry to say that I do not believe that can be used as an excuse for the strike action that we are talking about now, which puts patients at risk. I know that, in other areas, the Agenda for Change unions have worked constructively with NHS trusts on derogations to protect patients, but I regret to inform the House that that is not the case now. There is lots that we need to do in the workforce space, and there is lots that we want to do around recruitment, motivation and making it a good place to work, but I would like to think that none of that means that the delay of a report is a reason to take this sort of action and put patients’ lives in danger. I do not think any of us would agree that that is a suitable reason.

My Lords, perhaps I could invite the Minister to respond to my first question, building on the points made by the right reverend Prelate. In addition to the NHS workforce plan, which we await, I remind the Minister that we are also waiting for the general practice plan, the review of integrated care services and the social care update. Could the Minister take this repeated opportunity to say whether the Government will be publishing these over the Recess? If this is so, it is obviously of concern that Parliament will not have the chance to scrutinise the plans.

Like all noble Lords, I absolutely agree that Parliament has to have every opportunity to fully assess, discuss, debate and scrutinise the plans. As noble Lords know, I cannot say when the report will be released, so I cannot say with all honesty whether it will be over the Recess or afterwards. I can only repeat the words “soon” and “shortly”, and say that there is not a definite plan to announce it over the Recess. What we fundamentally agree on is that these plans are being produced with stakeholders and a lot of consultation, and they will absolutely be subject to a lot of scrutiny, as we would expect. I expect to answer on the plans in this House, as I expect my ministerial colleagues in the other place to have to do as well.

My Lords, I rather cheekily snuck two questions in, and the Minister did not give me an answer to the first one, which in many ways is very important. Will the Government look at and support those trusts that risk going into deficit because of inflationary pressures?

I thank the noble Baroness for reminding me of that. I will need to confirm it but my guess is that, although trust are having to pay more for consultants to cover positions, unfortunately a lot of junior doctors will not turn up and so there will not be the same level of pay because there are far fewer consultants than there are positions to cover. I wish there was not that problem, candidly. I think we all wish there were enough consultants to cover the exact number of junior doctors. My hunch is that, because of that, the wage will end up being a bit less. I will check if I am wrong, though, and correct it.