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Junior Doctors’ Strikes

Volume 730: debated on Thursday 30 March 2023

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of the junior doctors’ strikes and what steps he is taking to prevent further strike action.

I am grateful to the hon. Member for Ilford North (Wes Streeting) for his question. I know that colleagues and constituents will be concerned about the planned 96-hour walkout organised by unions representing junior doctors.

The hon. Gentleman asks about the impact, and we know that during the previous walkout by junior doctors earlier this month, 181,000 appointments had to be rescheduled. The disruption and risk will be far greater with this four-day walkout, not only because it lasts longer but because it coincides with extended public holidays and Ramadan, with knock-on effects on services before and after the strike action itself, and because a significant proportion of junior doctors will already be on planned absence due to the holiday period.

NHS England has stated that it will prioritise a number of areas, including emergency treatment, critical care, maternity care, neonatal care and trauma, but—[Interruption.] The hon. Gentleman asked the urgent question, so he might want to hear the answer. NHS England has been clear that it cannot fully mitigate the risk of patient harm at this time, which is concerning and disappointing. Patients should not have to face such disruption again, and I have invited the British Medical Association and the Hospital Consultants and Specialists Association to enter formal talks on pay, with the condition that they cancel strike action.

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

More than 300,000 operations and appointments have been cancelled due to industrial action in the NHS since December. The strikes planned for next month will be longer than any previous ones, with no derogations planned and they will be coming off the back of the bank holiday weekend. Patients are worried sick and consultants have written to me to say they are terrified for patients’ safety—they fear that patients will die as a result. So when is the Health Secretary going to get junior doctors back in for talks, take them seriously and stop these catastrophic strikes from wreaking havoc on patient care?

First, the Government failed to learn the lessons of the nurses’ strikes and refused to speak to junior doctors until the last minute. Then, instead of treating junior doctors with respect and sitting down for proper negotiations, Ministers took to Twitter for a mud-slinging match. The British Medical Association accused the Secretary of State of misrepresenting the truth when he tweeted that its pay demand was a “pre-condition”. The BMA has since said that it is a “starting point” for negotiations. Will he today clarify which side is correct and who was spreading fake news?

Since the beginning of these disputes, the Government have acted like a bystander when patients needed action. Never was that clearer than when the Prime Minister said that he did not want to “get in the middle” of them. We have a Prime Minister whose idea of leadership looks more like cowardice. He talks about delivery, but the NHS is still waiting. These strikes come at a time when the Government are failing to cut the NHS backlog. But it is not only the backlog that they have built up—a plethora of plans were trailed in the press in recent weeks but on the final sitting day before recess none has emerged. There is no sign of the NHS workforce plan, when the NHS is short of more than 150,000 staff. There is no sign of the general practice plan, when patients are finding it impossible to see their GP. There is no sign either of the review of integrated care services or the social care update, which reports suggest contains a stealth cut of £250 million to the social care workforce. So can the Secretary of State say whether the Government are planning to get the bad news out over recess and avoid scrutiny in this House, or is it less sinister and they just do not know what they are doing?

The urgent question was on the junior doctors—[Interruption.] I am sure I will quote—[Interruption.] There is a rare point of agreement between us. The hon. Gentleman is chuntering, but let me go through the list of things that he did raise pertaining to the junior doctors’ dispute. He said that the Government should get the junior doctors committee in for talks; we have done so—his third question made reference to the fact that we have. We have had the junior doctors in for discussions—[Interruptions.] I will run through the questions.

The hon. Gentleman questions whether there are preconditions attached to those discussions. I have checked the minutes of the meeting and there was a list of conditions —a pay restoration of 35%, and a range of other factors that were put on the table— that were preconditions that the Government had to commit to. The point is that he has said in the media that he does not support those preconditions. He says that 35% is unaffordable, so what is his position? One minute he says that he supports the junior doctors and that they should not go on strike, yet the next minute he says that he does not actually support the precondition that the junior doctors have said is the requirement for them to enter into discussion.

The reality is that the Government have taken a constructive and meaningful approach to trade union negotiations. That is why we have reached agreement with the “Agenda for Change” trade unions. It is why the Royal College of Nursing, Unison, the GMB and the Royal College of Midwives are all recommending the agreement that has been reached, covering more than 1 million staff across the NHS, to their members. The junior doctors have set a precondition on those talks which the hon. Gentleman does not agree—[Interruption.] That is a precondition. He does not seem to understand the terms the junior doctors—[Interruption.] He asked the question, he is getting the answer and the fact that it points to the contradiction in his own position is one that he seems to be having trouble with. Conservative Members are used to contradictions from those on the Opposition Front Bench. He supports the use of the independent sector, whereas his deputy does not. He wants to nationalise the GP estate, but his shadow Chancellor does not. The Opposition are full of contradictions. The reality is that there is a position in terms of the—[Interruption.] The right hon. Member for Islington South and Finsbury (Emily Thornberry) chunters again. There is a position in terms of precondition. The shadow Secretary of State asked me to confirm at the Dispatch Box whether it was a precondition of the junior doctors. Ahead of the urgent question, I checked the minutes—[Interruption.]

The Opposition do not seem to like their question being answered. The shadow Secretary of State asked me to confirm the position, for the avoidance of doubt, at the Dispatch Box. That is exactly what I am doing. I have checked the minutes. I have spoken this morning with officials to confirm, before I made the statement to the House, that it was a precondition of the talks. We were told, in terms of the pay erosion of 26.1%, that that needed to be restored at 35%, alongside other things. The reality is that he does not support that. He is facing both ways, wanting to support the junior doctors, but not actually willing to support the pay that they are demanding.

What does it do for a respected profession that, when one visits a hospital, one is confronted by a rabble chanting like a schump of rudies, particularly when they have not co-operated with hospital authorities to minimise the impact of their absence?

I would draw an important distinction between a militant group that appears to have taken over the junior doctors committee and the vast majority of junior doctors who do a hugely important job within the NHS. We recognise in Government that they have faced considerable pressures from the pandemic, and we stand ready to work constructively with them. There are, on the other hand, some within the BMA junior doctors committee who appear to have a more political agenda. Indeed, I refer hon. Members to the statements of members of that committee, who have said that they want to move the BMA to more traditional trade union activity and to pursue a more overt political agenda.

This is an urgent question, but I do not get a sense of urgency from the Secretary of State that he wants to resolve the dispute. I am afraid that standing at the Dispatch Box and traducing the junior doctors for their approach will not help to resolve this matter. I urge him to drop any preconditions on any future meetings, because the only way that this can be resolved is through negotiation. Will he do that now?

First, there is absolutely no traducing going on. In my last answer, I praised the junior doctors and recognised the fact that they have faced huge pressure from the pandemic, which is why we stand ready to work with them. Some on the BMA junior doctors committee have a different agenda, but we stand ready to work very constructively with that committee. The hon. Gentleman suggested that I drop the precondition. It is not I who set the precondition; it is the junior doctors committee that did so. I remind the House that it includes restoration to 2008 levels of all elements of pay, not just basic pay; parking fees and exam fees; and “radical” reform of the Review Body on Doctors’ and Dentists’ Remuneration. It is the junior doctors committee that set those preconditions, not the Government.

I commend my right hon. Friend for the way in which he and his team have worked to find solutions with other trade unions, particularly the nurses. None the less, the 96-hour walkout is a significant period of disruption. Can he confirm that he is doing everything he can to ensure that those needing urgent healthcare in Warrington will be able to access it despite the industrial action by the BMA?

I thank my hon. Friend for his question. Yes, the Department is working very closely with colleagues in NHS England and across the NHS to mitigate as best we can the impact of the junior doctors’ strike. He is right that we had meaningful and constructive talks with the staff council representing “Agenda for Change” staff. I am very pleased that, as a result of the constructive engagement we had, the NHS staff council was able to recommend that pay award to its members. He is right that that points to the constructive approach that we have taken. We stand ready to have that constructive engagement with junior doctors, recognising the real pressures that the profession has been under. We will mitigate as best we can, but, given the timing over the Easter period, obviously, there is a risk in terms of patient harm. We will do all we can to mitigate that.

The latest figures from January 2023 showed 7.21 million people waiting for NHS treatment. What impact does the Secretary of State think this strike will have on the extremely hard work that has been done across the NHS to reduce those waiting lists, and what plans does he have to address the impact that the strike will have on waiting lists, if he does not plan to take any action to avoid it?

I think we can see what sort of impact it will have from the previous strike, which was over three days and impacted 181,049 appointments. We can see there will be a significant impact. On mitigations, as part of our electives recovery plan, we are doing a range of things, including expanding community diagnostic hubs and the fast-tracking of surgical hubs. The NHS is responding brilliantly with things such as super Saturdays, where teams process higher volumes of treatments, particularly in certain areas. We have the Getting It Right First Time programme, led by Sir Jim Mackey and Professor Tim Briggs, which is looking at how we embed best practice. Having hit the first interim milestone of our recovery plan in the summer, the two-year wait, we are now focused on the 78-week wait target and working our way through that.

The British Medical Association’s pay demands are more than four times the size of the private sector average pay increase. Does my right hon. Friend agree that inflation is the enemy, making everyone poorer, and that public sector pay rises of over 25% will only drive inflation even higher?

I agree with my hon. Friend that we need to do both: we need to get inflation down, recognising that has an impact across the whole workforce, including for those working within the NHS itself, and we need to recognise the real pressure that junior doctors and others within the NHS have faced. That is why we stand ready to have meaningful and constructive talks with junior doctors, in exactly the same way as we have had with midwives, nurses and others within “Agenda for Change”. We must balance the wider issue of inflation and what is affordable to the economy against recognising the real pressures the NHS has faced and responding to that, including for junior doctors.

The Secretary of State cannot blame the Opposition for his mess. Nearly every day I retweet ads from the local NHS trust, which is trying desperately to recruit doctors and other staff. Does he accept that pay is a key factor in the large number of vacancies within the NHS, and will he do something to sort that out?

I accept that pay is an important factor. It is not the only factor—the estate and technology are also important. There is a range of issues. That is exactly the conversation I had with the trade unions representing “Agenda for Change”. We discussed with them both changes to pay and the non-pay measures. There are a range of factors, and we stand ready to have those discussions with junior doctors. However, they have chosen to take a more political, militant stance, in contrast with the approach that other trade unions have pursued.

I also feel that the Secretary of State’s attitude and language from the Dispatch Box this morning are not very helpful in negotiating with such a key group of people. The BMA accused the Secretary of State of misrepresenting the truth when he tweeted that its pay demand was a precondition. Does he now accept that the BMA has said its 35% demand is a starting point? Will he therefore sit down and negotiate an affordable settlement, without delay, and can he clarify which side is correct?

I have already answered that question twice, but I am very happy to repeat at the Dispatch Box the fact that I checked with my officials in the Department this morning—with people who were in the room—and have also checked the minutes. That was the position that the junior doctors set out in terms of a precondition. Indeed, they have repeatedly stated in the media that they expect a 35% pay restoration—and not simply that, but additional things such as exam fees, parking fees, reform of the DDRB and so forth. That is the position the junior doctors have set out. I repeat that we want to work constructively with junior doctors. We recognise that the profession has faced huge pressure through the pandemic and we stand ready to work constructively with them in the same way that we have with the GMB, the RCN, Unison and many other trade unions.

Junior doctors are the backbone of the NHS. I would never describe those whom I have met as “militant”; they are hard-working and of all ages. Somehow, this is the second strike that junior doctors have staged in the last 13 years—there was none in the previous 13 years, under a Labour Government. Will the Secretary of State confirm: has he not set out his own precondition, and that is that he will not meet them until they call off the strikes?

There are two different things there—one on which the hon. Gentleman is correct and one on which he is not. He is correct that we have said that a precondition for meaningful and constructive talks is that the trade union suspends strikes. That is a precondition that the other trade unions were more than willing to accept, and it is applied in other sectors such as education. We have been clear on that.

The hon. Gentleman is not correct on my point about militancy, which referred to the junior doctors committee specifically. We stand ready and recognise the real pressure that many within the junior doctors community have faced. The NHS has been under significant pressure coming out of the pandemic. We recognise that there are issues on which we want to work and have constructive engagement with them. It is just regrettable that some in the junior doctors committee of the BMA want, as they have said in media interviews, to take a more overt political agenda, rather than work with us to focus on the real issues that many junior doctors are concerned about.

I note that the Secretary of State is trying extremely hard to try to find settlements. The settlement with the Royal College of Nursing and the nurses is an example of just that, although it took a bit of time—I would have liked to see it happen sooner. Will the Secretary of State outline what support is available for junior doctors who need greater support from registrars and consultants to restore confidence—that is the whole point of the F1 and F2 process—so that they are not left to drown under the pressure of handling entire wards on the worst shift patterns possible, wondering, when they go home, whether the decisions that they have made are the wrong ones? Will the Secretary of State ensure that financial and wage negotiations will be constructive, as he did when it came to the RCN and the nurses?

I am very happy to give the hon. Gentleman reassurance about our desire to have that constructive engagement, exactly as we had with colleagues on the NHS staff council. There are a number of issues on which we are keen to work with junior doctors: rostering; which he mentioned; holidays, which are sometimes cancelled at short notice—a range of issues have been raised with me. When I go on visits to hospitals, as I do frequently, staff raise a range of issues, and I am very keen to work through them with junior doctors. I think that people can see from the approach that we took not just with “Agenda for Change”, but with the pension changes that were announced in the Budget, that the Government are working constructively with the NHS to address those issues. We stand ready to have exactly that meaningful and constructive engagement with junior doctors.