Cookies: We use cookies to give you the best possible experience on our site. By continuing to use the site you agree to our use of cookies. Find out more.

House of Commons Hansard

BMA (Contract Negotiations)

21 March 2016
Volume 607

  • I call Helen Jones to move the motion.

  • Thank you, Mr Amess. It is a great pleasure to serve under your chairmanship. I beg to move,

    That this House has considered e-petition 121262 relating to contract negotiations with the BMA.

    This is one of a number of petitions on the website about the junior doctors’ dispute, including the perennial favourite “Consider a vote of No Confidence in Jeremy Hunt”. We have chosen this one for debate because it was begun after the Government’s decision to impose the contract, and therefore relates to the position that we are in now.

    It takes a lot to make doctors go on strike; their nature and their years of training mean they are inclined to stay with their patients. So, when facing the first doctors’ strike in 40 years, it is fair to ask how we reached this position and what can be done to resolve it. I am sorry to say that I think most of the blame lies with the Secretary of State and the atmosphere that he has created. In saying that, I want to make it clear that I do not think the current contract is perfect by any means. It is too complicated, and it throws up some anomalies in pay. However, it has proved impossible to negotiate changes to that contract properly, due to the atmosphere of mistrust and suspicion that has been created by some of the comments made by the Secretary of State.

    That atmosphere goes back some years, but it reached its lowest point in July last year, when the Secretary of State said that the NHS had a “Monday to Friday culture”. I have read since that he has never actually visited a hospital at the weekend. If that is true, perhaps he should, because he would find that many staff are working. So incensed were they at the idea that they did not work weekends that they took to posting pictures on Twitter with the hashtag “#ImInWorkJeremy”.

    The Secretary of State then went further by telling doctors to “get real”. I think that people who make life-and-death decisions every day, care for terribly sick patients, work with emergencies in accident and emergency while putting up with drunks and insults, work in special care baby units, and care for frail, elderly, often confused people know what reality is. They do so in a national health service under huge pressure. Much of the equipment is now out of date and there is a repairs backlog worth £4.3 billion, but the capital moneys available were cut by £1.1 billion in the Budget. Doctors are working with out-of-date scanners and computers that crash, and because the Government see all support staff as inessential bureaucrats, doctors are mopping their own operating theatres or doing data input that any competent clerk could do. I think that they know the reality of what they face. To be told that by someone whose gilded path to ministerial office went through Charterhouse, Oxford and management consultancy is beyond parody.

    The Secretary of State, again, had to say more than that. He looked at weekend death rates, and jumped to the conclusion that they were caused by staffing levels. He said clearly:

    “Around 6,000 people lose their lives every year because we do not have a proper seven-day service”.

    He later used the figure of 11,000. Again, he said that was

    “because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 151.]

    I will spend a few minutes on the research quoted by the Secretary of State, because it does not actually prove that at all. The research paper that reached the conclusion that there were 11,000 extra deaths considered admissions from Friday to Monday, not just at the weekend, and considered death rates within 30 days of admission. Anyone who designs research will say that it is almost impossible to allow for all the things that could happen in 30 days. The researchers themselves did not draw the conclusion drawn by the Secretary of State. What they said was:

    “It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

    In fact, being rash and misleading is exactly what the Secretary of State was doing.

  • I thank my hon. Friend for her exposition of the petition. She is exposing behaviour by the Secretary of State that is not only insulting but misleading. This has been said to him time and time again, including by hon. Members in the Chamber. Does she draw the same conclusion as me? The Secretary of State knows what he is doing. He knows when he quotes those figures that he is quoting them wrongly, and that they do not prove what he says they prove.

  • My hon. Friend makes a fair point. First, the research has its critics, and various bits of research done on deaths following weekend admissions have reached different numbers: 3,000; 4,400; 6,000. The problem is that it is difficult to ascertain cause and effect. If the research is adjusted for the fact that we admit different kinds of patient at the weekend—people are sicker and there are more emergencies, and not many elective patients in most trusts—there remains a slight increase in the death rate. The problem is that ascertaining the cause is difficult. As the hon. Member for Totnes (Dr Wollaston) pointed out in a previous debate on this issue, when hospitals look back at such deaths, it is difficult for them to find out what could have been done differently in those 30 days.

    When a complaint was made to the UK Statistics Authority about the use of those data, it said:

    “We are speaking with Department of Health officials to ask that future references to this article are clear about the difference between implying a causality that the article does not demonstrate, and describing the conclusions reached by the authors.”

    The reason is that although the research shows us that something is going on that we need to investigate, it does not show exactly what is causing it. I do not know whether the Secretary of State understands that. If he does not, I must say that Oxford is probably not what it was. However, I suspect that he understands it very well.

  • I assure my hon. Friend that Oxford is certainly not only what it was, but better than it was. Therefore, the Secretary of State really ought to understand what is going on.

  • I am grateful to my right hon. Friend for defending the university in his town. I am sure that he is right.

    Any experienced negotiator will say that beginning negotiations by insulting the staff is never a good tactic. That is part of what the Government have attempted in muddying the waters: first, by drawing conclusions from the research that are not there, and secondly, by not being clear what they mean by a seven-day NHS. They have constantly said, “We need a seven-day NHS”. What they fail to tell us is whether they want a seven-day emergency service, which we already have but everybody accepts that it could be improved, or a seven-day elective service, which will require a huge investment not only in doctors and nurses but in diagnostics, support staff, lab technicians and so on. That failure to be clear has made doctors very wary of what the Secretary of State is trying to achieve.

  • There is also a real issue around capacity for a seven-day service. If elective surgery is increased over the weekend, where will those patients go, because hospitals are already at capacity?

  • My hon. Friend makes a very good point, and she is right.

    The Government need to make clear what they are trying to do, then they need to negotiate with the staff in good faith. Unfortunately, there is not much good faith around at the moment. That is why 90% of junior doctors have said they would consider leaving the NHS if the new contract is imposed on them. I do not think for one minute that 90% of junior doctors will go, but the Government have proceeded—as they do in a lot of cases—as if those junior doctors had nowhere else to go. Unfortunately, in this case they do: they can go to Scotland, or to Wales; or they can go and work abroad, where their skills are in high demand and where they will find, in many cases, they are paid more and work fewer hours than they do here. If even a small percentage of junior doctors go, what will the Government do to fill the gaps? We already have gaps in certain specialities, such as A&E, and paediatrics. What is the Government’s plan?

  • I congratulate my hon. Friend on securing this debate—she is making a powerful argument—and I congratulate all the people who petitioned for it. Does not the threat—and decision—by the Government to impose the contract amount to an admission on their part that they were incapable of persuading the critical backbone of NHS clinical staff that their plans made sense? If so, is that an abject failure or an act of malevolence?

  • It is a real failure, given the commitment of doctors and other staff to the NHS.

    This dispute is taking away energy and focus from dealing with the real problems facing the NHS. The NHS is under huge pressure and many trusts have big deficits, yet the service as a whole is still expected to make over £20 billion worth of so-called efficiency savings, which no one with real knowledge of the NHS thinks can be made without cutting services. One in 10 people in A&E now wait longer than four hours for treatment, which is the worst result for a decade.

    There is also huge pressure from the Government’s ill-conceived cuts to local council budgets, which has led a slashing of social care and which the Government were warned at the time would have an impact on the NHS. The real problem those cuts are causing is more admissions to A&E, often of elderly people who have had falls or who have become ill because of lack of care. There is also the problem at the other end, whereby people cannot be discharged because there is no care package in place for them.

  • I thank my hon. Friend for giving way again; she is being incredibly generous with her time. Does she agree that it causes real concern that the specialisms that require people to work longer and unsocial hours are also the ones that are most difficult to recruit for, and that the contract is therefore putting clinical safety at risk?

  • My hon. Friend is quite right, and I will come on to that point later. There are staff shortages in the NHS that the contract may well make worse.

    In the end, as in any dispute, the issues can be resolved only by negotiation, and in truth the two sides are not all that far apart. Huge progress was made when Sir David Dalton was brought into the talks, but there are still outstanding issues to be resolved. For instance, the Government trumpet a 13.5% increase in basic pay. What they do not say is that that increase will be paid for by cuts elsewhere. For example, payments that are made as a reward for length of service will go. I have yet to hear from the Government their assessment of what impact that change will have on retaining staff in the NHS, or how it will work for members of staff who take time out, whether for academic study—we need doctors who are both academics and good clinicians—or for maternity leave. What will happen to women who work part time, and so on? If we lose a number of women doctors in the NHS, the service will be in a great deal of difficulty.

    Guaranteed pay rates when people change specialties are also going. In the past, if someone changed specialty later on in their career, their pay was guaranteed. That will not be the case any more. That change is bound to have an effect on recruitment in areas where we are already short of doctors, and I have seen no real impact assessment of that yet.

    Of course, the big issue for many doctors is the change to standard time and premium time. The Government are increasing standard time from 60 hours a week to 90 hours a week. In the past, doctors were paid extra for working between 7 pm and 7 am, and for working at weekends. Standard time will now increase to run to 9 pm on weekdays and 5 pm on Saturdays. Doctors who work more than one in four weekends will get a premium payment. It is difficult to work out the effect of that change on individual doctors; it depends on how many weekends they work now, what their specialty is and so on.

    The Government’s pay guarantee lasts for only three years, and given the Secretary of State’s remarks, junior doctors fear that the change is a back-door way of introducing longer hours. It certainly makes it cheaper to roster doctors at weekends. The Government say they will fine hospitals that roster people for more than a certain number of hours, but the doctors say that offer is not good enough. That is not an unbridgeable gap; it could be resolved. However, the result of what has happened and the Secretary of State’s comments is distrust and suspicion among doctors about what his real motives are. That is combined with a disastrous drop in morale in the NHS. The latest NHS staff survey shows that the percentage of junior doctors reporting stress has risen from 20% to 35% in five years. The proportion of staff saying that they feel pressurised to come into work when they are ill has gone up from 16% to a whopping 44%.

    That loss of good will and drop in morale matters, because NHS staff are known for going the extra mile, working longer than they are paid for and doing things they do not have to do. That extends from the consultants who come in on their day off to see certain patients to the nurses and support staff who bring in a birthday card for an elderly person who has got no one else. I well remember that when my son was born, I was there for three shifts in the maternity department. After he was born, the registrar from the first shift came back to see me, to check that I was all right and to see whether I had had a boy or a girl. It is impossible to put a price on such things, and the Government risk losing all that and doing huge damage to the NHS if they do not solve the dispute.

  • Will my hon. Friend give way?

  • Yes, I will give way once more.

  • I am grateful to my hon. Friend. I met a group of junior doctors recently. For the first time, many of them are considering going abroad to work. None of them want to, but they are so demoralised by this Government’s actions that they are considering it. One of them told me how much she loved her job, but she said, “I would never let my daughter train as a junior doctor.” Does my hon. Friend agree that if the Government carry on down this route, we will not have a junior doctor workforce to rely on?

  • My hon. Friend is right. That is an awful and sad thing to hear from people who are dedicated to the NHS, but yes, there has been a huge increase in the numbers of junior doctors thinking of moving abroad.

    The answer is not the imposition of a contract, it is to get back into negotiations. It is about funding for weekend working, not just for doctors and nurses but for the lab staff, the diagnostic staff and the support staff that we need. It is about valuing the staff and showing that they are valued, because many junior doctors believe that the Secretary of State undervalues their work and has sought to undermine patients’ trust by implying that they are responsible for a number of deaths. That really needs to be corrected.

    I have a message for the Secretary of State today: you get real. You are a member of Her Majesty’s Government —a senior Minister. Take responsibility. Yes, we need to get the BMA around the negotiating table again, but you need to make an offer that brings it there. You need to make that offer, because you are the person in charge.

    It is already clear, in fact, that it is possible to improve weekend working without the new contract. There are trusts that have done that—Salford Royal is one example, as my hon. Friend the Member for Manchester, Withington (Jeff Smith) will know. There is also a rumour that the Department is close to a deal with consultants that will not require the proposed changes. Perhaps the Minister will tell us whether that is true.

    To continue my message to the Secretary of State: man up. Admit that you got things wrong. Admit that you mishandled this. Make a gesture and get people back around the negotiating table. If you do not, it is not only the junior doctors who will hold you responsible. The public will hold you responsible as well—in fact, they already do.

    When polls ask who is to blame for the dispute, the overwhelming answer is that it is the Government. That is not surprising, is it? If a member of the public is asked, “Who do you trust most, this nice doctor in your local hospital or Jeremy Hunt?”, it is not a difficult decision for them to make. It is time for the Government to stop heading down this road, before we end up with disastrous consequences. It is time for them to get people back around the table, because if they do not the NHS will suffer incredible damage, not simply through doctors leaving but through the loss of their good will. Both the staff of the NHS and the public in this country deserve better.

  • Thank you, Sir David, for calling me to speak in this incredibly important debate.

    There is no denying that this strike is totally unprecedented. No group of doctors has ever before been willing to walk out and put patient safety at risk over a dispute about pay, which is essentially what the dispute is about. It is about pay, about unsociable hours at weekends, about working the sort of hours that other people across the public and private sectors work every week. That is not to do down the incredible work that our junior doctors do. They work incredibly hard and entirely selflessly to keep us fit and healthy and I thank them for that but, like any other body of workers, doctors are not infallible.

    Like the rest of us, doctors are driven by considerations of making enough to get by and to support their families, and of getting a fair reward for the work they do. Historically, they have got a pretty good deal, and like any other body of workers they have the right, through their union, to seek a better deal in pay and conditions. Seeking that better deal requires, as the petition notes, a meaningful negotiation between both sides in the debate.

    I would like to cite the definitions of the two words that are so crucial in today’s debate. Meaningful is defined as “serious, important or worthwhile” and a negotiation is a “discussion aimed at reaching an agreement”. My argument is that it is the British Medical Association, and not the Secretary of State, the Department of Health or any of their negotiating team, that has failed in its duty to hold a proper, meaningful negotiation.

    The history of the dispute is littered with resentment and half-truths. The BMA has repeatedly had the chance to negotiate with the Government and come to an agreement that is acceptable to all sides and, most importantly, that is safe for patients. Patient safety should be at the centre of the debate but, unfortunately, it has fallen by the wayside in the BMA’s entirely partisan quest to defeat the Government.

    For many months we heard from the BMA that it was the Government and not the union who were not willing to come to the negotiating table. That is untrue, and it is backed up by the House of Commons Library’s account of the dispute, which I will not rehash in the short time we have available. Time and again the BMA has walked away from the negotiating table and balloted for industrial action, while the Department of Health negotiators have offered it the chance to come back to talks. The BMA even balloted for industrial action on the basis of the Government’s being unwilling to talk, when the Government had set a clear deadline for the BMA to come back to the table or risk imposition of the new contract. The BMA knew that imposition was a possibility, yet time and again did as little as it could to avoid it, all because it is driven by a desire, according to one of the doctors involved, to

    “be the first crack in the edifice of austerity”.

    Again, I do not want to go over old ground, but it is well documented that the BMA’s senior medics are Corbynites of the most militant kind. [Laughter.] Dr Chand, the association’s deputy chair, tweeted:

    “Goebbels must be turning in his grave when he hears the lies and propaganda of Cameron.”

    Dr Tom Dolphin congratulated the right hon. Member for Islington North (Jeremy Corbyn) on his victory and told him to take the fight to the Tories—if that is not partisan, I do not know what is. The BMA so misled its members when it put an utterly wrong pay calculator on its website, suggesting that doctors were in line to lose thousands of pounds, that the tool had to be taken down. Does that suggest that the BMA is taking the negotiation seriously? I would say that it does not. All the while, the Secretary of the State waited, and appointed the head of Salford’s trust to lead the negotiations, to ensure they were being led as well as possible by an expert in the field.

  • Is the hon. Lady aware that 98% of junior doctors supported the BMA’s decision, and that her rather desperate attempt to portray the BMA as some sort of Scargill–like extremist organisation simply makes her look risible?

  • I thank the hon. Gentleman. I think he needs to learn his facts. I think that it was 98% of BMA junior doctors, not junior doctors in their entirety.

    The imposition of the contract is not something that the Health Secretary wanted. He wanted to reach a meaningful resolution. He wanted the union, which got 90% of the things it asked for, to put its political gripes to one side, do what was best for patient safety and follow the will of the millions.

  • Will the hon. Lady give way?

  • I am sorry—I am carrying on. I am talking about the millions who voted for a proper seven-day NHS in the general election. The seven-day NHS is not some distant pipe dream. Several trusts across the UK, including Northumbria’s, have established consultant-led care across seven days. The only reason the rest of the country cannot enjoy the benefits of that is the BMA’s political posturing. The Labour party’s suggestion that the Government have not negotiated well is difficult to take, when it was the party that signed off on the consultant contract in 2003 that gave an opt-out on weekend work, and gave GPs the ability to opt-out of out-of-hours care in 2004.

  • Will the hon. Lady give way?

  • I am going to finish. Can a policeman say that he does not want to cover a Friday night? Can a firefighter turn down a shift because it is a Sunday morning? No.

  • I thank the hon. Lady for giving way. I want to point out that the opt-out clause for consultants is for routine work at the weekend. If they run an emergency service they are not allowed to opt out of emergency care.

  • I thank my hon. Friend for that. We work together closely on many matters. At the end of the day, life has moved on from the time when the NHS was set up. Life has got to change.

    Moving on to my next point, firefighters cannot turn down shifts. They are public servants, just like doctors. The new contract proposed by the Government is safe and fair. No doctor working legal hours will get a pay cut thanks to the 13.5% increase in basic pay and the unsociable hours pay for nights, Saturday evenings and Sundays. The NHS must adjust to the modern world if it is to survive. Seven-day working is vital to that, and the BMA needs to recognise that. The Government and the Secretary of State have gone out of their way to talk to the BMA and to accommodate its demands. A negotiation in which someone gets 90% of what they want would seem pretty successful to me, and it is a shame that the BMA does not see it that way.

  • It is a pleasure to serve under your chairmanship, Sir David. Today we are here to consider the e-petition that calls on

    “Jeremy Hunt to resume meaningful contract negotiations with the BMA.”

    This is a matter of the utmost urgency. We have an unprecedented situation in our country: the Secretary of State for Health has turned what should have been constructive negotiations into a battle with junior doctors—the highly skilled and committed professional people on whom we all rely. The last strike by junior doctors was 40 years ago. This strike is one that nobody wants and to which everyone wants to see a resolution.

    In the autumn last year I met a group of junior doctors in my constituency. They came to visit me at my office in Hoylake. They spoke in great detail about the problems they had with the new contracts. Their stand-out concerns were: the impact on patient safety; the effect the new contracts would have on the ability of doctors to have a family life of their own; the damage the contracts would do to the prospects of those professionals who seek to pursue different specialisms as their careers progress; and the impact they would have on the careers of women in particular and in turn the impact that would have on the NHS.

    One junior doctor who came to speak to me was nearly in tears—in fact, she told me that she had been in tears—as she described how she had wanted to be a doctor since the age of 10. She loves her job, but she also loves her children. She feels she is being forced to choose between being a doctor and being a mum, and that is an impossible decision for any woman. Her children need to see her on Saturdays, and she needs to see them, too.

    The period for which doctors are paid at the standard rate, or plain time, is currently Monday to Friday, 7 am to 7 pm. Under the new contract, plain time will be extended to Monday to Friday, 7 am to 9 pm, and will include Saturdays from 7 am to 5 pm. Those are considerable changes that interfere with the prospects of junior doctors enjoying their weekends. They should be entitled to spend at least some of their weekends with their families.

    That meeting happened last autumn, and we are more than six months further down the line. Instead of listening to the concerns of junior doctors, as so many MPs have, the Secretary of State has decided to impose a contract that the vast majority do not wish to sign up to. A couple of weeks ago I received an email from Charlotte, a junior doctor in Wirral. She told me:

    “Since the announcement of the imposition juniors are scared, confused and do not know what the future holds for them…Junior doctors are angry that the government has failed to recognise and value the workforce through this imposition. Due to this, there is a big and real risk of exacerbating a recruitment and retention crisis as demoralised and demotivated doctors leave the profession or leave the country to work abroad.”

    Of course, Charlotte is right. The threat of the NHS losing many junior doctors to Wales, Scotland and as far away as Australia is real. In the 10 days after the Government first announced their intention to impose a new contract, the General Medical Council received 3,468 requests for a certificate of current professional status, the paperwork needed to register and practise medicine outside the UK. In more stable times, the GMC might normally expect to receive 250 such requests at most. If there is indeed an exodus of junior doctors from the NHS in England, that will deliver a real blow to the operational capacity of the NHS and will come on top of the crisis in nurse training places.

    Charlotte made other important points, and I assured her that I would raise them with the Minister. She said:

    “The proposals governing non-resident on call (NROC) availability have not been properly worked out. The concerns are that the very low availability of allowance may contribute to recruitment problems (especially in psychiatry)”.

    That is a real concern now that we are all agreed that we should have parity of esteem between physical and mental health. She also said that

    “the allowance does not reflect how busy NROC can be and the means of pay would be an estimate for hours worked...Pay protection on changing specialty is also an issue.”

    That is something I have heard from other junior doctors in my constituency. She continued:

    “At the moment if someone choses to train in another specialty (eg GP to A&E) the pay remains the same as a recognition that skills are transferable and that the doctor has beneficial experience that they can take with them…I myself spent a year in surgery before I realised it was not for me and transferred to A&E. Under the new contract if you transferred to another specialty, your pay would go back down to the lowest pay point which would be very problematic.”

    I think we can all see how someone who has experience in surgery and who then decides to change course will be so much more useful in the new path that they choose.

    Charlotte continued:

    “Indeed, many juniors do not understand how to work out what their pay is likely to be under the new contract and it is likely to be after imposition in August that we find this out. Many doctors—an estimate of over 50%—do not follow a straight, continuous path through training. Maternity leave…time out for academic or other training, changes of specialty, or alterations to training mean that it is unclear to many what training or experience will or will not be recognised in the new contract…The failure to recognise the work junior doctors do throughout the 7 day week is another factor. We are not objecting to working weekends and indeed most juniors already do, but we just want the opportunity cost of doing so to be recognised in pay. It is disappointing that junior doctors are being seen as the barrier to seven-day services without the government defining what this means or adequately resourcing the whole multi-disciplinary team.”

    Charlotte is right: the truth of the matter is that we already have a seven-day NHS. It operates 24 hours a day, seven days a week, and junior doctors regularly work at weekends and accept that as part of the job. That is not in dispute. In fact, the report by Sir Bruce Keogh into a 24/7 NHS acknowledged that and instead focused on the availability of consultants and diagnostic staff such as radiologists or phlebotomists, not junior doctors. The report said:

    “our junior doctors feel clinically exposed and unsupported at weekends”.

    Another junior doctor told me that he felt that the attack on junior doctors was just the start of the Government’s plans for NHS staff. He said:

    “If they manage to force the junior doctors to take unsafe and unfair contracts, the rest of NHS staff will fall like skittles.”

    It seems then that the Secretary of State has lost the trust of the profession, and that has to be of real and serious concern.

    My hon. Friend the Member for Warrington North (Helen Jones) has ably raised the questions around what the Government mean by a 24/7 NHS, but it is important that we also consider the funding crisis facing the NHS. In the past couple of days, worrying news seems to be emerging that the Prime Minister knew in the last Parliament that the financial situation in the NHS was far worse than was being claimed. Simon Stevens, the chief executive of NHS England, calculated that the NHS needed £16 billion more over the course of this Parliament, but was ordered by Downing Street to halve the size of his cash demands. I would be very interested if the Minister could comment on that. If the Prime Minister did know that, it raises serious questions about what the Government’s stated ambition to expand NHS services at weekends is all about. Is it realistic and costed? Is it rash or is it something else? I would appreciate an answer on those points. The issue of trust has been raised yet again.

    There cannot be a single Member of the House who has not at some time in their life had reason to thank our junior doctors. We put our trust in them. They are there at difficult births and when people die, and the level of commitment and expertise that we receive at their hands—free at the point of need and paid for through taxation—is the envy of the world. We cannot let the mishandling of the negotiations lead to catastrophic damage to our most treasured institution. No one wants to see the Government inflict such a blow on the capacity of our national health service, and I urge the Minister to row back from the imposition of junior doctors’ contracts and to get back to the negotiating table.

  • It is a pleasure to be here under your chairmanship this afternoon, Sir David. I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on her speech. In introducing the petition, which a large number of members of the public feel strongly about, she managed to explain in just a few minutes how the Government have put forward an entirely false perspective on the dispute from the beginning and continue to do so. I am sure that many more Members would be here for this debate this afternoon were it not for events in the main Chamber. I know that many people want to be present as witnesses or contributors to the dissolution of the Conservative party—not least members of the Conservative party—so perhaps the timing of the debate is unfortunate.

  • I understand what my hon. Friend says about what is going on in the main Chamber, but is it not striking that only one Conservative Back Bencher has turned up to defend the Government’s handling of the dispute?

  • I agree with my right hon. Friend, but I think that what the hon. Member for Morley and Outwood (Andrea Jenkyns) said was even more striking in its own way. I felt I could forgo the entertainment in the main Chamber because I feel so strongly about this issue, not least because my constituency hosts two of the main teaching hospitals in the Imperial College Healthcare NHS Trust, and because many thousands of junior doctors from that trust and other trusts live in my constituency. I have therefore followed the dispute with increasing anxiety and depression. I have met not only individual junior doctors but groups of them at Charing Cross hospital, and I have spoken to them at the BMA. The image of them put forward by the Secretary of State, and what we have heard from the governing party today, does no credit to that party. The slurs on junior doctors are extraordinary, and it is perhaps time to pause and consider matters again.

    Are we seriously being asked to accept that junior doctors are some sort of militant clique looking to undermine the Government? That is pure fantasy. Anybody who has spent time with junior doctors will have seen exactly what is going on. The speech by the hon. Member for Morley and Outwood was tragic in many ways, but in some ways it was quite brave, because I suspect that any of her constituents who read it will begin to think, “What have I done in electing her last year?”

  • First, the Select Committee on Health is on an away day today, otherwise there would have been more Members here. I should have been on the away day, but this is an important debate and I wanted to be here.

    On the allegation that I have accused all junior doctors of being Corbynites, I said that key members of the BMA are strongly linked to the Leader of the Opposition. I was talking about not junior doctors but people on the BMA council.

  • I will move on, because when someone is in a hole, they should really stop digging.

  • I could not let the comment made by the hon. Member for Morley and Outwood (Andrea Jenkyns) pass. Jeremy Corbyn is the leader of the Opposition, and the Conservative party is in turmoil today in the face of his leadership. Being a Corbynite and a member of the BMA is no bad thing—I just wanted to clear that up.

  • I will try to put an end to this exchange, but it is tragic that a party of the stature of the Conservative party should turn its guns on the profession and on a representative body such as the BMA in this despicable way. It is extraordinary. I will go further and praise those in the BMA who have had their positions undermined and suffered character assassination and being idly quoted in tittle-tattle on Twitter. Last week the hon. Member for Central Ayrshire (Dr Whitford) hosted an open session for Members at which I was pleased to renew an acquaintance with Dr Johann Malawana, who has been a particular target of insidious and malicious personal attacks, supported by the jackals in the right-wing press. Is that really how a Government should behave in dealing with any industrial dispute, particularly one as serious as this?

    Depending on when the debate ends, I may have to leave for a constituency engagement—I have said that to you, Sir David, and I apologise to you and to the Front Benchers—so I will make my comments brief to give other Members time to make theirs. I simply want to say to the Minister, who can no doubt take the message from this debate back to the Secretary of State, that there is nothing dishonourable about continuing negotiations in this dispute. There is an attitude of despair among junior doctors, which has led to some of the statistics we have already heard about those who now wish to leave the profession or move to other jurisdictions where they would be more appreciated.

    The Government were initially resistant to going to ACAS, but in the end they agreed. Progress was made at ACAS, but at the end there were still matters outstanding. Everything that I have learned from talking to junior doctors suggests that not only do they not want to take industrial action, and not only do they want to continue serving their patients to the best of their ability, but they are prepared to sit down and compromise. However, they are faced with a wholly intractable Government.

    Is the best that we can get from the Secretary of State the misappropriation of statistics to prove something that is clearly false on two levels? It is false because the so-called weekend deaths are not as he has presented to the public, and it is false to say that we do not have a seven-day emergency service now. Of course we do. I strongly believe that we need to restore trust and faith in the relationship between the NHS and junior doctors, and the Government have an important role to play in that. Unfortunately, individual trusts are under such financial pressure, and their management under such strain, that it is tempting for them to exploit junior doctors.

    On the guardianship system, we know about the assurances that have been given and the protections in the existing contracts. I do not think there has been a previous example of a contract being imposed on the NHS in this way. I simply urge the Government to think again. There is a deal to be done, there really is. The fact that they are not even prepared to sit down and negotiate again implies that they do not want a deal to be done. They want to play hardball, and they want to get something that is completely different from what they say. They already have their emergency service and they already have junior doctors working the way they want, and they say they do not wish to save money. They have different motives from those that they are expressing. They therefore need to return to the negotiating table. They need a pragmatic solution, and they need to step back and calm down.

    I will read the Front Benchers’ speeches tomorrow if I am not here for them, but I hope we will hear a better spirit of conciliation than we have heard so far.

  • It is a pleasure to serve under your chairmanship, Sir David.

    When someone decides to become a doctor, they do not expect it to be easy—there are years of study, huge student debts, antisocial working hours, and the pressure of knowing that the decisions they make every day can be the difference between life and death—but they have a right to expect that the Government will value and appreciate their training and dedication. Our NHS needs more doctors, not fewer. When we or our loved ones get sick, we all want the comfort of knowing that the brightest and best are providing their care, so the fact that we are having this debate means that today is a sad day. Although I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on introducing the debate, it is a pity that we have to have it. The Department seems determined to sabotage the relationship with junior doctors and is handling the negotiations poorly.

    The contract has been described as unsafe and unfair. When I have met junior doctors from the Muswell Hill and Crouch End area we have spoken about how expensive childcare is, how they hope to be able to move out of their mothers’ and fathers’ houses, and how they hope to have a career and serve in the NHS. However, they feel that all of that is at risk. They are working every hour God gives them, but they feel that there is no genuine respect and that they will eventually find it very difficult to remain in London, purchase a home and continue to serve in the NHS. They are even thinking of trying to work abroad. There is a real risk that the Government’s approach will take us back to the bad old days of overworked doctors who are too exhausted to provide safe patient care.

    One doctor told me that they had £40,000 of student debt after six years of training and were just starting out on a salary of £22,600. They said that the reclassification of unsocial hours would see them lose about 30% of their salary and leave them struggling to pay their rent and bills. The new contract that has been imposed will see incomes fall by 20%—

  • If it is not true, I look forward to clarification from the Minister. We would not like to see a couple who are junior doctors having to leave their jobs because the cost of childcare is more than it pays to work as a doctor.

    The situation is turning into a shambles. I hope that the Secretary of State for Education is watching, so that last week’s big announcement about the reorganisation of education does not end up in a similar situation in a year or two. First millions of pounds was wasted on an unnecessary top-down reorganisation, then staff and patients were made to pay the price of the Government’s financial mismanagement. Will the Minister clarify whether 75% or 80% of trusts are currently in deficit? We are already in the middle of a workforce crisis, so the last thing we need is more doctors leaving. I have heard that 1,644 physicians have registered with the General Medical Council for certificates to allow them to work overseas; will the Minister clarify the exact number? The GMC normally receives only about 20 applications a day, but since Christmas, with the Government’s disastrous handling of the situation, the number has shot up.

    I have written to the Secretary of State to urge him to get on and sort out the situation. The Government have to accept that compromise is necessary. As my hon. Friend the Member for Hammersmith (Andy Slaughter) said, there is a deal to be done. Why put patient safety at risk when it is really not necessary? I was proud to stand in solidarity with the fantastic junior doctors at my local hospital, Whittington hospital, as well as those at North Middlesex hospital on the other side of my constituency. There really does seem to be a lot of willingness to talk; I just hope that that is reflected in the approach of Ministers.

    The Government’s current approach is wrong. They should be much more flexible, and they should want to open negotiations and talk rather than impose things. Junior doctors are vital to the future of the NHS, and it is clear that if we want to move towards a seven-day NHS and improve patient care, we have to ensure that the staff we rely on are supported and valued. It is deeply worrying that the BMA has described the contract as “unsafe and unfair”, and that the Royal College of Paediatrics and Child Health has stated that it could be

    “gravely damaging to the health and wellbeing of children”

    and could

    “adversely affect recruitment, retention and the morale”

    of junior doctors. I look forward to hearing the Minister clarify those points.

  • It is a pleasure to serve under your chairmanship, Sir David.

    It is a privilege to be able to say that I worked in the NHS as a physiotherapist for 20 years—I remain on the professional register—and to bring that experience to the debate. The service that I worked on was changed to cover seven days. The complement of staff was the same, but spread over the whole week. To provide a full seven-day service with every specialism in place would require a massive investment of resources on a scale nothing like what the Government are talking about, given that they are set on making £22 billion of efficiency savings. Before being elected to Parliament I had a dual career, because I was also head of health at Unite, representing more than 100,000 health workers. I therefore have real experience of dealing with the Government and of how the Department of Health handles disputes.

    On 5 December 2011, proposals were introduced to cut unsocial hours for all “Agenda for Change” staff. The proposals were discussed with NHS employers throughout the country and with the trade unions. We sat around tables and discussed the proposals, and they were turned away, but the fear is that they could be coming back on to the table. The NHS Pay Review Body report said that the Department of Health and NHS employers recognise that

    “the cost of the unsocial hours premia makes the delivery of seven-day services prohibitive”.

    That is why the whole NHS is worried: the real prize for the Government is the savings they will make from cutting unsocial hours throughout the NHS.

    If the Government are planning to expand services to cover seven days, if only in name, they will need more people to work at weekends. The cost of having more people working at weekends cannot currently be met, so if the service is to be expanded, obviously the prize the Government are after is the NHS’s “Agenda for Change” staff, who are often very low paid. According to a survey I conducted of these professional NHS employees, they are giving eight hours of unpaid overtime to the NHS every week, doing the many things we have already heard that NHS staff do. Why? Because they care, because they are professional, and because that is what happens in the NHS.

    I do not recognise at all the caricature painted by the hon. Member for Morley and Outwood (Andrea Jenkyns). What she described is not my experience of some of the most highly professional people in our land. They deserve our respect and awe, not to be degraded as she degraded them today and as the Secretary of State has previously. I am ashamed to have heard her comments. I had a meeting with junior doctors in my constituency on Friday and listened to their concerns. They are seriously concerned about recruitment and retention in the medical profession, particularly in accident and emergency, where there is a serious recruitment and retention problem in my local hospital.

    They explained to me that as junior doctors are leaving they are being replaced by locums. That destabilises the multi-professional team. It destabilises the ability of clinicians to work in teams where clinicians know one another, which is the safest way to operate. All the tutoring, mentoring and other input that staff so value and need—learning on the job right through their professional careers—is lessened by that destabilisation. They are seriously concerned about recruitment and retention because they want to get the best professional development so that they can give the best service to patients. That is why we are seeing junior doctors applying to work overseas: they want to ensure that their careers are enriched so that they can give patients the best care.

    We should be really concerned that there are such problems with recruitment and retention in many of the specialisms that require weekend working and are involved in emergency services. We are not discussing some of those services that, frankly, could operate according to clinical need during a Monday-to-Friday service because the demand is not there for such professionals to be there at the weekend. We should be very worried, as should the public, because the reality is that if doctors are not in A&E, who is going to care for us in our time of need? That is the reality of what is happening.

    Psychiatry is another profession that is currently finding it difficult to recruit, as are other areas of emergency medicine and the intensive therapy unit at my local hospital. They face real challenges, and they have concerns about the new regime that is being introduced to try to deter hospitals from making doctors work long hours—the new guardian of safe working role. They are concerned because the new regime is like the trust marking its own homework. If doctors report that they are working excessive hours, the trust will be fined, but the fines will go into a training and development fund, so we will just see less money going into that fund in the first place. It is a case of playing with the accounts and shuffling the deckchairs on the Titanic as it is sinking under the proposal.The reality is that it will not be an effective measure for preventing people from working longer hours, and doctors have real concerns about it.

  • I, too, have concerns about the hours guardian, because it will require junior doctors to complain. The NHS is a hierarchical system, and those doctors, who are often on the lowest rung of the ladder, will have to step up and make a noise. Something that depends on their whistleblowing on their own hours will not provide strong protection.

  • The hon. Lady is absolutely right. Although Government Members say that the NHS has a much more open culture, the reality on the ground is that it is difficult to raise concerns in the NHS. Shopping the boss if they are making someone work longer hours will be difficult. The hon. Lady makes an excellent point.

    We want to maintain the best in our NHS; we do not necessarily want to give that gift to the world. That is why it is so important that we return to the negotiating process. There was pressure from the Opposition to ensure that there was a process of independent arbitration so the talks could be resumed. When Sir David Dalton became involved, the dynamic of the dialogue changed, so a deal could be brokered and progress could be made. All that we ask—hundreds of thousands of people who understand industrial relations have written to us about this—is for professional dialogue with professionals to ensure a proper negotiating process so we can find a solution to this dispute. That is how negotiations work. That is the process of industrial relations. It is about sitting around a table and working through the difficult issues before us. When great minds come together, solutions can always be found.

    I urge the Minister not to impose the contract and to withdraw from that position. Of course it is possible to do that. Anything is possible if the will is there. Withdraw, calm down, stand back and let some dialogue continue. We need to find a solution that is good for NHS employers, for our doctors—do they not deserve a solution to this dispute?—for the rest of the NHS, for patients and for the public. Why not make that small concession and open talks immediately?

  • Thank you, Sir David, for allowing me to make my first speech on my return to Parliament after a nine-month absence in the care of the NHS. [Applause.] Thank you. Forgive me if I am a little unsure of the procedure. I thank my hon. Friend the Member for Warrington North (Helen Jones) for making an excellent opening speech and other colleagues for their contributions. My constituents asked me to speak in this debate on behalf of patients, junior doctors and other NHS professionals in Bristol West, and I am grateful for the opportunity to do so.

    Junior doctors in my constituency told me that they already work in a seven-day NHS, and so do other NHS professionals. Although the subject of this debate pertains to junior doctors, it is relevant to mention other NHS professionals. As other Members have said, pushing this contract onto junior doctors appears to be a proxy for pushing for a fully seven-day NHS—indeed, that is what Government Members seem to be hinting at—so it will affect all NHS professionals.

    I have had a lot of opportunity recently to observe at first hand, and at close quarters, over nine months how hard NHS professionals, including junior doctors, work and how dedicated they are to all of their patients. During my treatment for breast cancer, the radiology department found just after Christmas that it was under severe pressure. There was a backlog of patients who all needed daily radiotherapy. I was one of them. People cannot just wait for radiotherapy to happen; it has to happen when it needs to happen. The staff worked out a way of meeting patient needs by offering extra appointments at evenings and weekends. Indeed, I went for my radiotherapy at 8 o’clock in the morning on a Saturday, such was my dedication to my treatment.

    Much more important than my approach was what the staff did. The doctors went out of their way to help and advise me and other cancer patients. For instance, I received text messages from my surgeon over a weekend and inquiries on my progress following an infection from a breast cancer nurse in the evenings. All the staff seemed to me, and to the breast cancer and other cancer patients around me, to routinely go out of their way to meet patient needs.

    All of that is by way of explaining to Government Members that my experience and that of other patients is that NHS professionals are dedicated, professional, caring and willing to be flexible about working over seven days. As other hon. Members have said, there already is seven-day care for patients. The junior doctors I met individually in Bristol West confirmed that that was the case, and the BMA representatives I consulted told me that they wanted a negotiated settlement. The Secretary of State appears not to understand that there are more than 56 medical specialties, each with different work patterns. They all need rostering, and they do not all work in the same way. Lab technicians, nurses and others, such as receptionists and cleaners, would all need to work weekends for the proposal to work. I have not seen any sign from the Conservative party that the Government would provide funding for that. If they would, I urge the Minister to tell us about it.

    My overwhelming conclusion is that the Government do not seem to be aware of where they are starting from or where they are going to. They definitely do not know how to work respectfully and honourably with the people they need to work with professionally to make the changes they want to make, whatever they are.

  • My hon. Friend is making an excellent speech. On the delivery of a seven-day service, where are the professionals going to go, as we have a recruitment crisis and have to use agency staff?

  • I thank my hon. Friend for that excellent point. The Opposition are only too aware of that.

  • May I say that my hon. Friend is making a moving and eloquent speech? I am almost tearful that she is so well and back with us. Were it not for the NHS and its wonderful staff, she might not be with us today. I thank her for being here and for making such a beautiful speech.

  • I thank my hon. Friend for her support. I will try not to get too emotional, although I find it difficult when I think of the impact that NHS staff have had on my life and what a difference it would make to have a Government who are truly dedicated to meeting the needs of patients. My hon. Friend reminded me of something that I did not write in my notes. In 2000, the Labour Government introduced the first ever national cancer strategy, to which I owe my life.

    I met professionals in Southmead hospital, just outside my constituency, where I was treated, and in Bristol royal infirmary, in the heart of my constituency. I have met professionals individually and I received letters from them in my constituency postbag. They want only the best for their patients, of whom I am still one. They go out of their way seven days a week—evenings, daytime and weekends—to do that. I do not have command of the full statistics, facts and figures; I can only argue from the heart. I urge the Secretary of State to get back to the negotiating table. Most importantly, please go there to negotiate, not to dictate. Our NHS, NHS professionals and, most importantly, NHS patients—of whom we will all be one some day—deserve nothing less.

  • We seem to have been negotiating this topic relentlessly since last summer. The Secretary of State has cited multiple papers showing the “weekend effect”, as it is described. Twice in his statement on 11 February—the day he imposed the contract—he talked about increased deaths at weekends. That is clearly not the case—it is increased deaths among those admitted at weekends. Despite being pulled up on that in the Chamber, he used exactly the same phrase on “Newsnight” the same evening.

    I am very uncomfortable about the conflation of what the problem is and what the cause is. The papers show a statistical excess of deaths among those admitted at weekends. We know that those people are sicker: any patient admitted electively on a Sunday is considerably sicker. Studies of elective patients only show that anyone admitted electively at the weekend has a 92% increased chance of death. Frankly, in the modern NHS we do not get to admit our patients the day before, so they have to have a lot wrong with them and a lot of morbidity.

    What has not been done is to dig into that to discover what the issue is. Some of the papers that the Secretary of State cites discuss excess mortality and have no relationship to a weekend effect at all. Ozdemir’s paper clearly identifies—it is categorical—the fact that excess deaths do not relate statistically to the deployment of junior doctors, yet those doctors are described as a blockage to the achievement of seven-day services. We have not had a proper definition of what is meant, and we keep waxing and waning, going from one track to the other: do we mean to strengthen urgent and emergency care, which no doctor would argue against, or do we mean routine? That keeps slipping in.

    Patients shop in Tesco seven days a week, and some shops are 24 hours—the NHS should be the same. As I have said in debates before, if someone goes to Tesco at 2 o’clock in the morning, the fresh bakery counter is not open, nor is the alcohol counter or the fish slab—it is not exactly the same. The NHS is comparable: the reason we have more doctors and more things happening Monday to Friday is that we do elective work. Quantitatively, that totally overwhelms the numbers on emergencies.

    Some papers suggest that the biggest issue, as identified in the Francis report, is the ratio of trained nurses to patients. Other issues were also identified by our Scottish Audit of Surgical Mortality, which looked at every single surgical death in the ’90s and early noughties. It identified the fact that some patients were operated on by surgeons who were too junior. That was discussed with the profession, and it changed. A couple of years later, the audit showed that we had consultant surgeons in, but that the anaesthetist was too junior for certain very sick patients, so that changed. That is what can be achieved through dialogue and development.

    In Scotland, we have a seven-day care taskforce, but we are not imposing a contract—we are doing it through dialogue. Two of our biggest hospitals, the Edinburgh Royal in Edinburgh and the new Queen Elizabeth in Glasgow, already have seven-day working. In my own hospital, we have consultant radiologists all day Saturday and all day Sunday, but not through shifts. It can be achieved without the all-out battle we seem to have had for the past nine months.

    The standards produced for the Government identified increased consultant involvement—in assessment, review and, if necessary, consultant-led intervention. There should be more diagnostics and more radiology. Those things relate to senior medical staff and to support staff such as radiographers and laboratory technicians, not to junior doctors, who are already there. Another problem is the flow of patients through hospital and back out into the community. That is why A&E gets so backed up. The problem cannot be solved in A&E; people have to be moved out to the community. We need physio- therapists, rehabilitation and the ability to discharge. None of that is junior doctors’ work.

    As we have touched on before, the term, “junior doctors”, describes people up to their mid-30s. Senior doctors and senior trainees may be committed to a place and may not move, but very junior doctors are not; they rotate every year, and they can easily go overseas, as mentioned—or if they want to come up the M74, we will welcome them with open arms, roll out the red carpet and bring them in. In 2011, 71% of foundationers—people at the end of their first two years—were applying for a post in the NHS to continue training. That figure has dropped every single year: last year it was 52%; and now, just after closure, 47%. Less than half of England’s junior trainees are applying to stay on in the NHS, which is a catastrophe.

    Not recognising antisocial hours means that the very specialties that involve a large proportion of antisocial working time will become even more unattractive. Will the Minister tell us why consideration was not given to the BMA proposal? It was cost-neutral and had a lower basic rise, but it kept a stronger recognition of antisocial hours. It would allow antisocial jobs such as those in psychiatry, A&E, obstetrics and gynaecology, and general surgery to remain at least accommodated by salary.

    We already have rota gaps. We are short of 4,500 doctors. I have read articles in the Health Service Journal that describe a rota in Basildon that should include 22 doctors, but has 13, so it has been decided that only one doctor will be on duty at night, instead of two. Social media is full of people who are carrying two pagers—the senior pager and the junior pager. What happens if they become busy?

    For the Secretary of State, the biggest issue is the attack on junior doctors. He seems to be claiming that he is the only person in England who cares about patient safety. I am sorry, but I have been a doctor for 34 years, and every single doctor, nurse and member of the NHS is working to deliver care and to protect patient safety. It is insulting to imply that they are not.

    How do we move on from where we are now? I agree that the imposition needs to be stopped. After Sir David Dalton had made so much progress in just a month, I was really shocked, the morning after the strike, having tweeted to say, “Great, let’s get back to the table”, to find a couple of minutes later on the BBC that the Secretary of State was imposing the contract. If Sir David Dalton got that close in four weeks, why could that process not continue? Why could consideration not be given to the junior doctors’ own cost-neutral solution?

    We need research to understand the issue. Do we require more senior nurses, or better nursing ratios? Do we not need to ensure that it is consultants and, in particular, radiologists who are available? The problem is that with the rota gaps that we already have, we are endangering patients, because people are constantly being emailed or texted, “Can you do another shift?”, “Can you do a split shift?”, or “Can you stay on tonight?” Exhausted doctors are dangerous. I am asking Ministers to step back, to cool things down, to remove the imposition, and to allow both sides to come back to the table. That is important for patients and the NHS itself.

    The situation is not unsolvable. A decision was made simply to raise the temperature, which has created a desperate attitude among junior doctors. To describe them as radicals or lefties—no insult to Labour Members —is flippant. Doctors are not generally known for being particularly radical, and this was the first junior doctors’ strike in four decades. I went through my entire career without ever seeing a junior doctors’ strike. It is not something that people have embarked on lightly. We need a change of direction and a massive change of tone. Do not insult the junior doctors. They are the people who already provide a lot of seven-day work; they are not the obstruction.

    People cite Salford Royal and Sir David Dalton, but I was there this morning, and he is clear that what he means by seven-day work is urgent and emergency work—and he is managing it on the existing contract. Let us be a bit more imaginative and get a solution.

  • It is a pleasure to serve under your chairmanship, Sir David.

    I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on the eloquent way in which she introduced the debate on behalf of the Petitions Committee. Under her stewardship, the Committee has gathered in a short space of time a reputation for allowing issues that are important to the public to be debated in this Chamber and for some great innovations in how democracy is dealt with in this place.

    My hon. Friend helpfully set out the history and the research. She characterised as “rash and misleading” the conclusions drawn from such research about higher weekend death rates and staffing levels. We rightly say it is not easy to find a link between the cause and effect, as she mentioned in her opening remarks, but, despite a wealth of evidence showing that we cannot draw straightforward conclusions on cause and effect, the Secretary of State has proceeded on that basis. The proposals, which will see dramatic changes in how the health service will be run in the future, seem to be based on evidence that does not necessarily justify the conclusions drawn.

    I will refer to contributions made by other Members. I congratulate the hon. Member for Morley and Outwood (Andrea Jenkyns) on being the only Conservative Back Bencher present. I know she is genuine in her concern about patient safety, but I was sad to hear some of the comments she made. I am afraid she repeated the mistakes that have characterised the dispute by demonising the BMA, portraying it as a militant faction. Let us not forget that these people have had 40 years without a strike, so can she not see that something has gone very wrong for them to decide to take industrial action and that they do have genuine concerns about patient safety?

    I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) on her contribution. She has great experience in this area and she spoke about the potential exodus of junior doctors that the proposals may mean. She rightly highlighted the serious questions about the proposals that need to be answered.

    I am glad to see my hon. Friend the Member for Hammersmith (Andy Slaughter) still in his place. He spoke with great sincerity about how unhelpful the character assassination of certain members of the BMA has been and about how he believes—I believe most Members who have spoken tonight agree—that junior doctors are still willing and able to reach a compromise, but they have been met with an intractable Government.

    My hon. Friend the Member for Hornsey and Wood Green (Catherine West) described what she considers to be a Government with a determination to sabotage the relationship with junior doctors. She has spoken to a number of constituents about issues of concern to them, and she was right to say—I wholeheartedly agree—that this is about valuing staff.

    My hon. Friend the Member for York Central (Rachael Maskell) spoke with great personal experience and exposed the massive dichotomy at the heart of the proposals. She rightly paid tribute to the staff who, by their good will, add so much more value to the NHS than will ever show up on a balance sheet. I agree with her that the dispute causes massive anxieties about what the future holds for recruitment and retention of our staff. She is right that industrial relations is about sitting down and getting into a constructive dialogue. I hope that, as many Members have said tonight, that is still possible.

    The hon. Member for Central Ayrshire (Dr Whitford) spoke with the great experience that she brings to every debate on these matters. She correctly identified the Secretary of State’s wilful conflation of statistics. She highlighted that the ratio of trained nurses is a significant issue and gave good examples of how challenges were resolved in the past by dialogue in conflict—dialogue was raised numerous times by Members. She was right to ring the alarm bells about the fact that fewer than half of junior doctors apply to stay in the NHS and she talked with great knowledge about some of the current pressures in the system on finding staff.

    Finally, I pay tribute to my hon. Friend the Member for Bristol West (Thangam Debbonaire). It is so good to see her back here and to hear from her about her recent personal experience of the NHS. She spoke with great passion and sincerity about the treatments and flexibility she was afforded by those staff. It is clear that she has received excellent treatment—she was hugely impressed by staff’s willingness to go that extra mile. The three words she highlighted should be reflected on by the Government: they need to treat staff respectfully, honourably and professionally. I could not agree more with that.

    I am aware that in this Chamber we strive for a note of consensus, recognising that the main Chamber is where the theatrics, which do little to enhance Parliament’s reputation, tend to take place.

  • They are right now.

  • Yes, I am sure there are plenty of theatrics going on at this very moment. I will try to be measured in my response on behalf of the official Opposition, but it is our role to point out where we believe there are shortcomings in the Government’s approach, and on this occasion I believe that the Government have been found wanting. The sad reality is that we should not be debating this matter today at all. It could have been different if the Secretary of State had demonstrated a genuine desire to listen, engage and negotiate.

    We all know that from time to time an employer will want to change the terms and conditions of their workforce. As a former employment lawyer, I know that change can be sometimes be difficult to deliver, but rarely—if ever—have I seen one side approach a negotiation with such stubbornness, intransigence and provocation. Whatever legal method the Government choose to draw this dispute to a conclusion, the reality is that it is far from over, and the well of resentment that has been built up by the Government’s approach will last for years. Everyone, including the BMA, has recognised the need to reform the current contract, but we have seen a Health Secretary giving the impression that he is looking for a fight, not a solution. In the past year he has described junior doctors as “militant”; implied incorrectly that they do not work weekends; insinuated that they are in some way to blame for deaths among patients admitted at weekends; questioned their integrity by suggesting that they may not be on hand to respond to a major terrorist incident; and insulted the intelligence of some of the brightest and best minds in the country by telling them that the 99% of them who backed industrial action had been somehow misled by the BMA.

    I know how important junior doctors are to the smooth running of any hospital, how they consistently go the extra mile to deliver superb care—we heard that from many Members tonight—and how vital they are to the NHS’s future success. Yet they are repaid with insults. That is no way to treat any public servant, least of all those whose good will has kept our health service afloat as it has suffered from years of mismanagement and underfunding.

    The dispute, unnecessarily inflamed by the Health Secretary, reached a new low last month when he claimed support for contract imposition from NHS leaders across the country only for many of them later to come out and confirm that that was simply not the case. That was the latest in a long line of statements he has made that do not stand up to any kind of scrutiny. Contrast that rapid evaporation of support when imposition was announced with the solidarity shown by representatives from every part of the health sector who believe that contract imposition was the wrong move to make. At least 10 professional groups, from the Royal College of Midwives to the Royal College of General Practitioners, have warned about the dangers of imposing a contract on junior doctors at a time when staff morale in the NHS is at rock-bottom.

    If the Health Secretary, the self-styled patients’ champion, will not listen to the doctors and nurses, perhaps he will listen to the patients instead. The chief executive of the Patients Association, Katherine Murphy, said:

    “The Government’s decision to impose contract terms on junior doctors is unacceptable. The health and social care system depends entirely on the great people who work in services across the community for the benefit of patients…It is clear that the acrimonious dispute over the junior doctors’ contract is unnecessary and damaging.”

    Unfortunately, it appears that he is not listening to patients, either. He has tried to point the finger of blame at the BMA for the dispute, but if he wants someone to blame he should look no further than the mirror. His actions up to the decision to impose the contract are not those of someone trying to calm things down and reach a resolution: they are the very opposite.

    What is in many ways just as unacceptable and unforgivable is the Health Secretary’s complete inaction after the decision was taken to impose the contract. A few weeks ago I asked him, in a written parliamentary question,

    “what steps he has taken to avert further industrial action by junior doctors”.

    The answer was quite telling. The truth is that since he announced imposition, he has not picked up the phone, opened his door or lifted a finger to try to avoid the most recent industrial action. There was virtually a month from the announcement of imposition to when the Government knew perfectly well that there was going to be further industrial action, but they did absolutely nothing to avert it.

    We all need to remember that the NHS is ultimately there to serve patients, and they are now suffering because the Secretary of State has sat on his hands. It has been a complete dereliction of duty. Therefore, when the Minister responds, I ask him to confirm that the Government have not taken, and do not intend to take, any steps to prevent further industrial action.

    I have some further questions for the Minister. Was a risk assessment of the effect on patient safety carried out before the decision was taken to impose the new contract? What assessment has he made of the likely impact of the contract on the recruitment and retention of junior doctors, given the crisis that the health service already faces? Does he accept that imposing a new contract that does not enjoy junior doctors’ confidence will further damage morale? Is he concerned by the 10-fold surge in inquiries by doctors planning to emigrate on the very day that the Government announced imposition? What legal advice did he take about how an imposed contract would work in practice? Will he tell the House when we will see the final terms and conditions? It is important for us to see that final detail, particularly as the BMA claims that a cost-neutral proposal was personally vetoed by the Health Secretary. We have never had an answer on that, so I should be grateful if the Minister would confirm whether the assertion is correct, and what the impediment to a deal was, given that it was cost-neutral and we already know that junior doctors work seven days a week.

    The Secretary of State has sought, in recent months, to present the negotiation as a symbolic battle to unlock the delivery of a seven-day NHS. If that is the case, can the Minister explain why seven-day services are not mentioned once in the original heads of terms for the negotiations set out in 2013? The truth is that the Secretary of State only decided that the issue was about seven-day services half way through the negotiations when it was clear that doctors were going to put safety first, and he was looking for a way to divert blame away from his disastrous handling of the whole affair. Given that junior doctors already work seven days and seven nights a week, I cannot see how they can be the barrier to the safety of patients. 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? Even the chief negotiator whom the Secretary of State personally appointed, Sir David Dalton, says that changes to junior doctors’ contracts will have the least impact on arriving at seven-day working.

    We all want a seven-day NHS, but no evidence has been provided about how the contract will do anything to further that ambition. Nothing coming even close to a credible delivery plan has yet been provided to set out how the seven-day NHS will be delivered. The truth is that the whole dispute has been used by the Secretary of State to detract from the challenges facing the NHS; those will only be harder to overcome thanks to his industrial relations approach, which is straight out of the Thatcherite 1980s playbook. Picking a fight with a group of people who will be critical to the future of the NHS is a mistake that I believe the Government will come to regret. The Secretary of State recently announced a number of measures aimed at making the NHS more open to learning from mistakes, and we of course support him in doing that, but when will he learn from his mistakes? When will he learn how to conduct a negotiation in a measured way?

    On any analysis the Secretary of State has failed. He has failed to win the trust of the very people who run our hospitals, and the support of patients and the public. The Health Secretary may be content with a legacy of failure, but the way in which he has alienated a whole generation of doctors is something we will have to live with for many years to come.

  • It is a pleasure to serve under your chairmanship, Sir David, and it has been a pleasure to hear some of the contributions to the debate, which have included measured speeches, as ever, by the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), and the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). However, it disappoints me as much as it does many other hon. Members that we need to be here today. We would all have wanted the issue to be concluded some time ago. I hope that in the next few minutes I can describe why we are in this position and what we plan to do about it.

    I will start by discussing something that the hon. Member for Hammersmith (Andy Slaughter) touched on, because I know he wants to leave early. I want to make these comments before he does. We are all here because we are interested in the future of the NHS, but, among various silly outbursts and fits of laughter, he described the speech of my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) as tragic. There is indeed tragedy behind my hon. Friend’s interest in patient safety, and that is that her father died as a result of a failure of patient safety. It is no coincidence that she is here today and that she cares so much about this important issue. It behoves hon. Members, and especially the hon. Gentleman, who is barely able to contain himself on matters of this kind, to pay a little attention to the motivations of Members, on whichever side of the House they sit, and the reasons why they feel strongly about the matter. That includes the Secretary of State, who considers it to be a question of patient safety through and through. A portion of that is about the delivery of seven-day services, but more broadly, to reflect on the wise words of the hon. Member for Central Ayrshire, it is about the fact that tired doctors who work bad rotas are dangerous. That is at the core of our reasons for wanting to change the contract.

    It was not just the present Government who decided that it would be right to change the contract. It was the British Medical Association that confirmed, in 2008, that the contract was not fit for purpose, just a few years after the Labour party had introduced it.

  • I will not give way, because I know the hon. Gentleman has to go, and he intervened enough earlier.

    Far from a few minor amendments, as the hon. Member for Warrington North (Helen Jones) suggested, a far greater number of changes needed to be made to the contract.

  • I am afraid the Minister may be misquoting me. I was giving examples, not suggesting that they were the whole list of things wrong with the contract. When I said there were only a few issues, that was to illustrate that the Government and the BMA are not that far apart in the negotiations. Perhaps the Minister will consider what I actually said.

  • I will, and by way of return I hope that the hon. Lady will consider what the Secretary of State has actually said on a number of occasions, which—I am sure completely unintentionally—she misrepresented at numerous points. The hon. Lady said that the existing contract had moments of imperfection—I cannot remember her exact words. However, it had rather more imperfections than that, which is why the BMA recognised many years ago there was a need for significant change, and why the coalition Government entered into negotiations with the BMA early in 2013. The heads of terms were agreed between early 2013 and July 2013. The negotiations began in October 2013 and broke down a year later, with no notice to the Government. The BMA just walked out, and it took some time to explain why. It claimed, generically, that it was to do with patient safety, which was an odd thing to say given that there were doctors negotiating on the management side who were also concerned about patient safety. The negotiations were not rejoined until we involved ACAS in November last year.

  • When we had a debate about the issue in October, the Secretary of State was reluctant to go to ACAS, yet only when the negotiations went to ACAS was some progress made. The BMA wanted the contract changed to include recognition of quality training. The junior doctors are future consultants and leaders, and at the moment, while they hold multiple pagers and cover rota gaps, they feel that they are getting no training at all.

  • I will come on to the hon. Lady’s sensible points about rota gaps, which have persisted for many years and need to be addressed as a separate issue, and about training. However, the negotiations have been going on for more than two years. There is an idea that the Secretary of State somehow ended them peremptorily, but throughout the period of the negotiations there was a serious attempt to engage with the BMA. Progress was very slow, and the BMA unilaterally broke off the negotiations in October 2014. It did not come back to the table until the offer was made to go to ACAS.

    On why the Secretary of State took the stance that he did, I have a different interpretation from the hon. Lady, because I was with him through that whole process. We were very keen to return to negotiations via ACAS, but we needed to ensure that the BMA would give its representatives full negotiating powers.

  • Will the Minister give way?

  • I will in a second; I will just answer this point.

    From that point, as many Members have pointed out, considerable progress was made through the negotiations that we had under ACAS from December 2015 to February 2016—far more progress than in the previous negotiating period, partly because the BMA knew that an imposition would have to come if there could be no agreement. As the shadow Minister will understand, at some point an employer needs to move both on issues where there is agreement and on those where there might not be.

    The fact that the Secretary of State chose Sir David Dalton to lead negotiations undermines the argument that somehow he was not trying to come to a negotiated settlement. He asked one of the very best chief executives in the NHS to lead the negotiations on his behalf. Even Sir David Dalton was unable to come to a final conclusion of the negotiations with the BMA, because the BMA refused to discuss the last remaining substantive issue—the rates of Saturday pay.

    Herein lies the rub: in the heads of terms of the talks it began through ACAS, the BMA had agreed to discuss Saturday pay rates, yet it withdrew that agreement at the end. Sir David Dalton was therefore forced to write to the Secretary of State saying that in his judgment, there was no prospect of agreement on the remaining matters because the BMA was refusing to discuss them. When the Secretary of State or any negotiator has no counterparty with whom to negotiate, it is impossible to negotiate.

    Far from the title of the e-petition, which suggests that the Secretary of State has somehow been unwilling, he has been negotiating in good faith all through the period since 2013. It was the BMA, right at the last minute and at previous moments that has refused to do that. I myself have called on it a number of times, both personally and in public, to come back to the negotiating table.

  • Will the Minister give way?

  • I will not, because I know that the hon. Gentleman needs to go. I said that I would give way to the shadow Minister.

  • The Minister is correct that considerable progress has been made in negotiations since the start of this year. The consensus seems to be that 90% of the contract was agreed. Does he not agree that it was therefore a great shame that a decision was made to impose the contract when just 10% of the issues were outstanding?

  • It is a great shame that we were unable to discuss those final things with the BMA, but as I have just explained, the BMA did not wish to discuss that final portion, even though it had agreed to do so in the heads of terms that were in front of ACAS at the end of November 2015. It was impossible to have that final discussion. That was not of the Secretary of State’s volition; it was a decision of the BMA’s junior doctors committee.

    I turn to the point that my hon. Friend the Member for Morley and Outwood made, which Opposition Members discounted so quickly. At no point has the Secretary of State ever claimed that there is militancy among junior doctors as a whole, nor has he said that the BMA as a body has sought to wind up the dispute. In fact, if he had said that, it would have been entirely wrong. It is, however, true that the junior doctors committee, which is a small portion of the BMA—it is not the whole body, and we have just come to an agreement with the BMA on the general practitioners’ contract—has become radicalised in the past few years.

    We know that the committee did not wish to discuss Saturday pay rates, not because of any inherent merit or otherwise in the arguments but because of the tantalisingly close prospect of an agreement with the Secretary of State—one that the committee had been fighting against. We know that that dispute existed, because even when we made a revised offer just after Christmas, the committee refused to discuss it before talking to its members and committing to a strike. There has been an impelling force within the junior doctors committee to take action, which, I am afraid, has disrupted the course of the negotiations and made it far harder to have an open and honest discussion with junior doctors.

    We come to the issue of junior doctors being misled. They are very bright people who I know take an interest in the news and in the contract under which they will be working. I have no doubt about that. However, the British Medical Association—a trusted body—has claimed to its members that they are going to have a pay cut of 20% or 30%. Despite the fact that the NHS and we in this House have rejected that claim numerous times, it has been repeated. The hon. Member for Hornsey and Wood Green (Catherine West) repeated it today. That claim is untrue. It was made in the summer, and it is no wonder that BMA members were worried. If I were a junior doctor and someone told me I was going to have a 20% or 30% pay cut and would have to work longer hours, I would be extremely worried, and of course I would be angry. The fact is, however, that the claim was not true. The gravity of that untruth is such that it can still be repeated in this Chamber as if it were true.

    Junior doctors, who no doubt informed the hon. Lady—I know she is not willingly misleading the House—still think they are going to have a pay cut of 20%. If we are still in an atmosphere where people believe they are going to have something that they are not, and that they will have to work more hours than they will, it will of course be difficult to come to a resolution until we allow things to calm down. That is why it is important to move to a point where junior doctors have the contract in front of them, so that they can see the effect on their working patterns and see that much of what they have been told is simply not true. We can then, I hope, move to a much better position in individual trusts where we can start discussing the existing problems that the hon. Member for Central Ayrshire mentioned, such as rotas, training schedules and the like.

    I will address some of the individual points that hon. Members have made during this interesting debate. Apart from misrepresenting the shape of the negotiations as if somehow the Secretary of State had broken off talks, which he did not, the hon. Member for Warrington North questioned the research that led to the various statements that the Secretary of State and others—many of them clinicians—have made about the so-called weekend effect, or avoidable excess mortality attributable to weekend admissions. I should make absolutely clear where the link is. Almost any clinician in the NHS will recognise that we do not yet have the same consistency of care over the weekends that we do during the week in every hospital or every setting where we need it. We know that, and the hon. Member for Central Ayrshire made a similar point herself.

    Our manifesto pledge was translated into the mandate that is reflected in all the contract negotiations that are going on, and it concerns one particular issue—the need to standardise urgent and emergency care—and nothing more. It is not about elective care; I have made that point several times to the hon. Lady. People who are admitted at weekends—including, to some extent, those admitted at the shoulder periods at the end of Fridays and especially on Monday mornings, because of inconsistency of care over the weekends—will then be able to expect the same standard of care, which will contribute to lower mortality rates as part of a wider package to reduce mortality attributable to weekends.

    The drive for that comes from clinicians. It comes from the seven days a week forum convened by the Academy of Medical Royal Colleges, which reported at the end of 2012 and gave the Secretary of State and the whole service 10 clinical standards that it believed would help to reduce variation in weekend clinical standards. It is those standards that we seek to bring in across the service. The academy has said that four of them in particular are the most important for reducing variation. They relate to urgent and emergency care, and it is those standards that we seek to fulfil across the service.

  • The Minister is once again managing to conflate two things. Everyone accepts the need to improve emergency care at weekends. What is not accepted—this is where the Secretary of State misused the research, and I was questioning his use of it, rather than the research itself—is a causal link between junior doctors’ work patterns and the deaths that occur. That is simply wrong; the research does not show that. In fact, a great deal more research is needed to find out the actual causes of the excess mortality.

  • If the hon. Lady were quoting the Secretary of State correctly, he would indeed be wrong, but he has never made a causal link precisely with junior doctors’ working hours. He has said that it is the working patterns of the NHS as a whole. One of the studies that the hon. Lady quoted in part makes it clear that the purpose of the research study was not to look at answers to the questions that were raised, but it did say that one of the areas that policy makers should look at first is staffing ratios over the weekend.

    Let me ask the hon. Lady something. There is general acceptance across the service of a weekend effect. There are varying studies that, under different research scenarios, point to figures of 6,000, 8,000 and 11,000 deaths, and sometimes more—15,000, for example. Does she believe that if the number were 2,000, it would therefore not be right to deal with this problem? Would 500 be an acceptable number of deaths that we should tolerate without seeking to reform contracts? In fact, what price should we put on an avoidable death? Or is she saying that not one single death in the service is related to staffing ratios over the weekend?

  • The Minister is once again managing to conflate two different issues. Let me repeat what the researchers said:

    “It is not possible to ascertain the extent to which these…deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

    That is the researchers’ comment on their own research. Of course, nobody wants to see preventable deaths, but the Secretary of State has tried to use the research to link those deaths to junior doctors’ working patterns. It simply does not prove that. He is wrong.

  • I will happily arrange for the hon. Lady to have a clinical explanation of the various studies that she has cited, because I think she will then understand why the part that she has quoted needs to be understood in context—[Interruption.] I am asking her a direct question: does she—and do other hon. Members, who are tittering about this on the Opposition Benches—really propose that there is no weekend effect? If they are saying that is the case, or if they are saying that there are 500 or 1,000 deaths and that somehow is acceptable and the Secretary of State should not address himself to it, that is a worrying statement of intent.

  • I will not give way to the hon. Member for Warrington North. I give way to the hon. Member for Central Ayrshire.

  • The problem here is about exactly what it is the paper shows. What do any of these papers show? They show a statistical excess of deaths. We know that 25% more of the people are in the sickest category. We know that 15% more of them die on a Sunday. Maybe the NHS did an absolutely amazing job in saving the other 10%. We do not know the answer, so we do not know how many are avoidable. However, I would point out to the Minister, who referred to the standards, that the only mention of junior doctors in the 10 standards is with regard to review of outcome and focus on training. Not one of the 10 standards says there should be a change in how junior doctors work.

  • One of the studies that the hon. Lady cites does a control for acuity, which she has raised. I know that there is an understandable change in the acuity of patients and one of the studies allows for that.

    As for the point about the 10 clinical standards—and here I will just move on from the points that the hon. Member for Warrington North was making—

  • Before the Minister does, will he give way? He asked me a direct question.

  • I will in a second, but hopefully I will answer the hon. Lady’s point first. She says that I am conflating two things, but I am certainly not; I am saying that there is a recognisable weekend effect. We can have a discussion about the precise numbers involved, but the key answer is that clinicians themselves understand that something needs to be done to reduce variation. I will come to junior doctors in a second, but clinicians themselves have offered the 10 clinical standards, which lie at the base of this. We are not doing anything extra beyond what clinicians are recommending. The four key clinical standards lie at the heart of our changes to urgent and emergency care to ensure consistency of standards, and it is right that one of them relates to the training of junior doctors. The standard at the moment is not as good at the weekend, because they do not have consultant cover, and that is something we are hoping to change. It is also true that the 10 clinical standards refer to senior decision makers, and there is a discussion about precisely who that might be. I will give way to the hon. Lady now, and then we will move on.

  • Had the Minister listened to what I said, he would have heard me say that there is a weekend effect, even when the control for acuity is put in, and that more research is needed to find out exactly why that occurs. No one on the Opposition side wants to see preventable deaths in the NHS, but the Minister has to explain why this contract that he wishes to impose is so important in preventing them, when many trusts have already managed to improve weekend working—including Salford—without it.

  • On the issue of the response to the mounting clinical evidence of a weekend effect—I am glad that the hon. Lady recognises it—clinicians have said that we need to reduce variation by changing the clinical standards that we hold clinicians to, and that is what we are seeking to do. That is why all the contracts relating to clinicians are being reformed. It is part of a package. I have made that point in this Chamber many times before, so Members who keep repeating that somehow we are loading everything on to junior doctors are just not listening to the points that the Government are making—that it is part of a piece.

    The recommendations of the DDRB—the Review Body on Doctors’ and Dentists’ Remuneration—asked for far more radical changes to Saturday working. We have moderated those in an effort to bring about negotiations and discussions with the British Medical Association, but it has refused to do that.

    I will answer one more point that the hon. Lady made in her speech. She said that a point of contention was payments and reward for length of service. I think she was referring to increments. That issue was resolved with the BMA as part of the 90%, so I hope she therefore sees that it is not a substantial part of the argument, despite what she pretended.

    The hon. Member for Wirral West (Margaret Greenwood) mentioned issues around psychiatry, which was a legitimate point to make. That is precisely why, as part of the new contract, flexible pay premia will be paid to psychiatrist trainees, so that we can provide an incentive to get more trainees opting for this specialism. It is clear that across the service, there are specialisms that, for decades now, have not recruited the numbers that we would all like to see going in. We have identified three where we think a particular incentive is appropriate, because of the difficulty of going into those specialisms—general practice, emergency medicine and psychiatry. This is one that we proposed. It was disagreed with and then agreed with by the BMA, and we hope, therefore, to address precisely the point that she made in her speech.

  • Will the Minister clarify whether the protection for GP registrars has been re-established? We obviously do not have access to the terms and conditions that have been agreed, because they have not been published. However, one of their concerns was that they had pay protection when they became GP registrars, and that was going to be taken away.

  • All trainees working within legal hours will have pay protection and that includes GP registrars. That was one of the bottom lines of our negotiations all the way through the process and precisely why we are so disappointed that the BMA consistently misrepresented our position.

    I have addressed the point the hon. Member for Hornsey and Wood Green raised about the 20% fall in income. She asked me to say expressly whether that is right or wrong. It is wrong. No one will see a fall in their income if they are working the legal hours. Indeed, we think that 75% of doctors will see an increase through the course of this pay contract.

    The hon. Lady raised the issue of maternity and cited a doctor who claimed that they were earning £22,600. I would be interested to know the detail of that because the foundation year one minimum pay rate is £23,768, which is slightly above the figure she quoted. She made an entirely valid point about the need to make sure that women especially, but I hope under shared parental arrangements, women and men in the service have the flexibility to be able to take time out of the service to bring up children. That is why the increased base rate of pay is particularly good because it will increase the parental pay, as we should now call maternity pay, under shared parental leave when people take time out to look after children.

    The hon. Member for York Central (Rachael Maskell), who is no longer in her seat, talked about guardians, but was factually wrong to claim that there would be no payment to junior doctors. They will be able to get one and a half times their salary as part of the payment fines made to guardians. The guardians will not, as the hon. Lady suggested, just respond to complaints. They will have an overall duty to maintain the wellbeing of junior doctors. Theirs will be a critical position in trusts and I hope it will grow into being a substantial one, making sure juniors have the opportunities for training they wish for and the levels of welfare to which they are entitled.

    The hon. Lady spoke about whistleblowing, and her comments concerned me because this is precisely an area where we should be asking juniors to speak up. If working longer hours is dangerous—we all agree with that—like any other patient safety issue, not only should they morally speak up to their guardian, but they are under a duty to do so under GMC guidelines.

  • Does the Minister recognise that if someone is the most junior person in a very hierarchical system, it is difficult and harder for them to complain about something they perceive is being done to them as opposed to something they see concerning a patient?

  • I recognise that speaking up is difficult in the current NHS culture. It is precisely what lies at the heart of Sir Robert Francis’s second report. That is why we need to change that culture. It is also the reason why we said that guardians, in receiving proactive complaints from juniors, should have an overall duty of care for the juniors in their trust and make sure they are treated properly. That is why this is an exciting role. It is a tutorial role in sense with a responsibility, especially for the youngest trainees, to make sure they are in the right place and supported in what can be difficult times.

  • May I ask the Minister again about not having the chance to see the details? One concern of junior doctors is that they would not have a voice or a role within the guardianship. They asked to have a representative as part of that function. Has that changed, or are they still excluded from that?

  • They are not excluded. It is important that that person does not become a BMA nominee, but we want the guardian to make sure they command the respect not only of the junior doctor workforce, but the trust itself. It is important to make sure that person gets that degree of buy-in from both sides, and I hope that the final solution we arrive at will satisfy that.

  • Does the Minister agree that, traditionally, whistleblowers have not been treated respectfully and that perhaps the current approach of imposing things is not the right step forward in changing the culture?

  • There has been a problem for decades with whistleblowers being listened to. That is what gave rise in part to the tragedy at Mid Staffs and the Secretary of State is trying desperately to do something about it. He cares passionately about it and his recent speech, which the hon. Member for Lewisham East (Heidi Alexander) welcomed, was about trying to create those safe spaces within trusts so that people feel they can speak openly. Indeed, recently at the social partnership forum, which I chair and where we hear contributions from trade unions, I heard of a very effective scheme recently developed in Somerset which showed a good way of getting people of all grades in a trust able to speak up.

    I, too, am delighted that the hon. Member for Bristol West (Thangam Debbonaire) has been able to take her seat again. She has come back at an exciting time in politics—one that may be more exciting for her than the last six months. She asked about the funding for seven-day services. All I would say is that within the five-year forward view are two parts that are connected. The first is the commitment to have seven-day services in urgent and emergency care, which is reflected in our mandate for the service, our manifesto pledge at the last election and the request for £8 billion of cash funding connected with the £22 billion of efficiency savings in the service. That is the funding that is being provided to achieve not only that commitment, but everything else in the five-year forward view. Hon. Members have questioned whether that money is sufficient and I point them to the statement by NHS England today in which it was very clear that that is the amount that was asked for and that is the amount that they were glad to get.

    The hon. Member for Central Ayrshire spoke about the opt-out, and I want to give clarification for the record to ensure that we are clear about it. In parts of the emergency care pathway, the opt-out has an effective impact and indeed affects part of the urgent care pathway. Ensuring the opt-out is removed is one of the areas we are keen to progress and was the origin of the Secretary of State’s statement, which related to that and not to junior doctors at the beginning of this process. It is important that we do that specifically around urgent and emergency care, and other hospital services, but we have never, ever wanted to extend by the process of our negotiations elective care at weekends. That is not part of our commitment, which has always been squarely about ensuring consistency of standards in urgent and emergency care.

  • I am afraid that I have sat in the House and listened to the Secretary of State talking about having elective services across seven days and how great that would be for patients. Of course it would be great, but we would need thousands more doctors whom we have absolutely no chance of finding. It has not been clear. In Salford Royal today, Sir David Dalton again said one crucial thing is for the Government to define exactly what they mean by seven days. Doctors have not objected to strengthening urgent and emergency care.

  • The hon. Lady, in repeating that, as have other hon. Members, makes it harder for us to state again—she knows I have done so on numerous occasions—that this is to do with urgent and emergency care. It is true that some hospitals—Salford Royal is one—do elective work at weekends. I have no doubt her hospital might do some elective work at weekends. That is part of the trust’s decision-making. It is for the hospital to make that decision. Our key in changing these contracts has been to concentrate on urgent and emergency care. That is the focus of the contract changes.

    The hon. Lady also spoke about the tenor of the language that has been used and I know that she cares deeply about this, for understandable reasons. I, too, enormously regret the way this has been portrayed. Although to a lesser degree than the Secretary of State, I have been on the other end of language that one would hope professional doctors would not wish to use.

    The whole debate has become intemperate in an extremely unfortunate way, but I have sat through every single speech that the Secretary of State has made on this matter and every single press utterance—I have also made a number myself—and never once has he attacked junior doctors as a body. He has only the utmost respect for them, not least because, like everyone else in this Chamber, he has been the beneficiary of their care. But it is true that they have been let down by their trade union.

    I repeat—I know that the Opposition Front Benchers know this—that the BMA has let down its members, because first, it has allowed a series of statements to persist that it knows to be untrue, and secondly, the junior doctors committee has not engaged in meaningful negotiations in the way that it should have done and in the way that other parts of the BMA have been happy to do, and they have concluded better contracts as a result.

    That brings me to the points that the shadow Minister, the hon. Member for Ellesmere Port and Neston, made. He asked quite a lot of questions, and I commit to giving a full answer later to the ones that I do not answer today.

    The hon. Gentleman asks whether there will be any further steps to avoid industrial action. We will do whatever we can to ensure that junior doctors understand the nature of the contract, and we hope that they will therefore not feel the need to go on strike. We have contended all the way through that that is a needless endangering of patient safety. It is certainly a massive inconvenience to patients, many thousands of whom have now seen their operations cancelled as a result. The contract dispute does not have anything to do with safety, as the BMA itself has implicitly accepted. It is to do with Saturday pay rates. The BMA and its members really have to think about whether they wish to take the dispute about Saturday pay on to the street time and time again.

    The hon. Gentleman asked whether there has been a risk assessment on patient safety. We have risk-assessed that at every single stage, and the way in which we have dealt with the industrial action has been concentrated solely on the effect that it has on patient safety, but the best way of ensuring patient safety is for the BMA to cease its unnecessary action.

    In relation to an assessment of recruitment and retention, the whole contract has been framed to try to ensure that doctors have a better work-life balance. That is precisely why we have reduced the number of consecutive long days, consecutive long nights and consecutive weekends, and it is why the contract is better for junior doctors and why we hope that it will aid recruitment and retention in the long term. However, we are conscious of the fact that there are ongoing morale issues that go all the way back to 1999 and beyond. In fact, when the previous contract was negotiated, precisely the same points were made about morale as are being made now, so clearly the old contract did not fix those issues. That is why we have asked Professor Dame Sue Bailey to look at wider issues of training and morale in the service as they pertain to junior doctors, to see what else needs to be done to ensure that they are getting the training opportunities that they require, the welfare standards that they expect and the quality of work-life balance that they rightly wish to have.

    The hon. Gentleman asked about the BMA’s proposal that it claimed was cost-neutral. Our judgment was that it was not cost-neutral, and given that the BMA was refusing to negotiate on the contract that was on the table and had been worked on for several years, it was rather odd—and, one might think, a political gesture—to throw an entirely new idea on to the table, knowing it not to be cost-neutral. I would say that that was more for effect than to actually try to further the aims with which everyone approached the contract renegotiation.

    In short, I am afraid that I reject the premise of the petition, because the Secretary of State has attempted at every stage in the process, over a period of nearly three years, to have meaningful contract negotiations with the BMA. At every point at which contract negotiations have broken down, it has been the instigator of that breakdown, so the petition would better serve itself by being addressed to the junior doctors committee of the British Medical Association, which has broken off meaningful contract negotiations not just once but three times. It is with that committee that the responsibility lies for the failure to find a solution to the final 10% of the contract negotiation, as Sir David Dalton concluded.

  • I am grateful to the Minister for giving way; I could tell that he was about to reach a crescendo. He has set out what he intends to do to reduce the temperature and avoid further industrial action. I have to say that I think his response was inadequate, but his central contention was that he hopes to persuade the majority of the BMA’s membership that the new contract is beneficial for them. To that end, can he confirm when the full details will be publicly available?

  • I expect the full details to be available shortly. The Secretary of State is studying, and will continue to study, the draft final terms, together with the equality impact assessment. It is important that when he has studied that assessment, he can make a judgment about whether any changes are necessary. Once that process has concluded, the final offer will be made, and that will be the point at which we proceed with the implementation of the contract. I hope very shortly to be able to give the hon. Gentleman a timetable for that. It is in my interests as well as his to see it happen as soon as possible, and I hope to be able to provide junior doctors with the reassurance that the contract will provide—that this is not the tragedy that they have been led to believe it is.

    This has, none the less, been a difficult period for the service and, in particular, for junior doctors, who have been led to have unnecessary worry as a result of a series of misrepresentations by their union. I hope that in the next few weeks and months we can allay their concerns, and I hope that we can then get on with the job that we are all mindful of the need to achieve, which is better quality of care whatever the day of the week, a reduction in avoidable mortality whatever the cause, and an improvement in our national health service.

  • Sir David, I apologise for demoting you to the ranks in my opening remarks.

    This has been an interesting debate, although I was disappointed by the Minister’s reply. He is normally a very reasonable man, except when he is attributing things to Opposition Members that we have not actually said. His problem is that he is being sent here time after time to defend the indefensible. It is clear that there is a deal to be done, as Opposition Members have said, but there is no movement from the Government to get people back around the table to do that deal. If the contract is so good that it provides a land of milk and honey for junior doctors, as the Minister seems to imply, one wonders why they are not dancing in the street at the prospect of it.

    We have heard clearly from Opposition Members about junior doctors’ worry that the contract will lead to excess hours and that they are moving from being part of a team, where they learn and progress properly, to being just another rota of shift workers to be shifted around. We heard from my hon. Friend the Member for Bristol West (Thangam Debbonaire), whose return I too am very glad to see, about her experience in the NHS and the staff who went the extra mile for her, and we have heard about the weekends that people work.

    We have also heard some extraordinary attacks from Government Members on a respected profession. I understand that the hon. Member for Morley and Outwood (Andrea Jenkyns) may have suffered a personal tragedy, but that does not in any way justify her attempts to smear all junior doctors as a bunch of militants who are endangering patient safety.

  • She did not say that. Withdraw.

  • Yes, she did say they were endangering—

  • She did not say that. Withdraw.

  • She did. She said they were Corbynites—

  • No, I am not going to withdraw that remark. [Interruption.]

  • And she said they were endangering patient safety. It is that attitude among Government Members that is preventing a solution to the dispute. There are constant attempts to stigmatise staff and to accuse them of things that they have not done and are not doing. The Minister, for example, says that junior doctors are misled about their contract by the BMA. That is patronising, because it implies that they are not able to look at the evidence and judge for themselves. We have heard no attempt from the Minister to outline the Government’s plan B if some doctors leave and do not sign the contract. Well, I am not surprised that the Government do not have a plan B because they do not even appear to have a plan A.

    I appeal to the Government to change course and to take steps to get the BMA and junior doctors’ representatives back round the table so that the dispute can be sorted out for the benefit of patients and for the benefit of the whole NHS. If they do not do that, we are really heading towards serious problems in the future.

    Question put and agreed to.

    Resolved,

    That this House has considered e-petition 121262 relating to contract negotiations with the BMA.

  • Sitting adjourned.