Junior Doctors Contract

Friday 20th November 2015 Commons Chamber

11:00

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the negotiations for a new junior doctors contract.

[The Minister for Community and Social Care (Alistair Burt)]

Three years ago, negotiations began between the British Medical Association, NHS Employers and the Department of Health. They were based on a common view that the current contract—agreed in 2000, when junior doctors were working very long hours—was outdated and needed reform. Between December 2012 and October 2014, extensive and patient negotiations took place, with an agreed target date for implementation of August 2015.

The negotiations were abruptly terminated by the BMA’s unilateral withdrawal from them, without warning, in October 2014. That led to the independent and expert Doctors and Dentists Review Body being asked to take evidence on reform of the contract from all parties, including the BMA, and to make recommendations. That happened because of the unwillingness of the BMA to agree sensible changes to the contract, and allowed an independent expert body to recommend a way forward.

The DDRB report on the junior doctors contract, with 23 recommendations, was published in July. The Secretary of State then invited the BMA to participate in negotiations based on those independent recommendations. Unfortunately, the junior doctors committee of the BMA maintained its refusal to negotiate, even though the negotiations would be on the basis of an independent report to which it had had an input. Both the Secretary of State and NHS Employers have repeatedly invited the BMA to participate in negotiations. It was made clear that there was a great deal to agree on based on the DDRB recommendations.

We deeply regret that the BMA chose the path of confrontation, rather than negotiation. While we continued to try to persuade it to develop a new contract with us, it instead chose to campaign against the independent DDRB’s recommendations, including by issuing a calculator, which it subsequently withdrew, suggesting—wholly falsely—that junior doctors would lose 30% of their pay. Instead, the BMA issued demands, including a right of veto on any contract change. In effect, it asked us to ignore the DDRB’s recommendations, the heads of terms agreed back in 2013, and to start again.

Given the BMA’s refusal to engage and its wholly misleading statements about the impact of a new contract, NHS Employers issued a contract offer to junior doctors earlier this month. This offer has safety at its heart and strong contractual safeguards to ensure that no doctor is required to work more than 48 hours a week on average, and it gives junior doctors the right to a work review when they believe hours are being exceeded. It reduces the maximum hours that a doctor can work in any week from 91 to 72 hours. It pays doctors an 11% higher basic pay rate, according to the hours that they work, including additional payments for unsocial hours. It reduces the number of consecutive nights that can be worked to four and of long days to five, ending the week of nights.

The hon. Member for Lewisham East (Heidi Alexander) has called for the parties to go to ACAS. The Secretary of State is not ruling out conciliation. We have always been willing to talk. The Government have repeatedly appealed to the BMA to return to the negotiating table, and that offer is still open. We believe that talks, not strikes, are best for patients and for junior doctors. The Secretary of State has said that talks can take place without preconditions, other than that an agreement should be within the pay envelope. However, the Government reserve the right to make changes to contracts if no progress is made on the issues preventing a truly seven-day NHS, as promised in the manifesto and endorsed by the British people at the last election.

It is regrettable that junior doctors have voted for industrial action, which will put patients at risk and see between 50,000 and 60,000 operations cancelled or delayed each day. I therefore call on the hon. Lady to join the Government in calling on the BMA, as it prepares for unprecedented strike action, to come back to the table for talks about the new contract for junior doctors. The Government remain firmly of the view that a strike by junior doctors is entirely avoidable, and we call on the BMA to do all it can to avert any action that risks harm to the patients we all serve.

[Heidi Alexander]

The fact that we are in this situation today, with 98% of junior doctors having voted to take significant industrial action for the first time in 40 years, makes me angry and sad. I say that because it did not have to be this way. The truth is that if we had had a little less posturing and a little more conversation from the Health Secretary, this whole sorry episode could have been avoided.

Does the Minister agree that, over the next week, everything that can be done should be done to stop the three days of planned industrial action? He said that the Health Secretary does not rule out going to ACAS, so why did the Secretary of State appear to dismiss the idea of independent mediation yesterday? Does that seemingly flippant rejection of the need for independent mediators to prevent industrial action not show a casual disregard for patient safety?

The way in which the Health Secretary has handled the negotiations has been appalling. Does the Minister understand that negotiation by press release is not the way to conduct discussions, nor any way to run the NHS? Does he understand that junior doctors are particularly angry about the way in which the Health Secretary has repeatedly conflated the reform of the junior doctors contract with seven-day services? Junior doctors already work weekends and they already work nights. For the record, not a single junior doctor I have met during the past few months would not drop everything to respond to a major terrorism incident. To suggest otherwise is to insult their professionalism.

The fundamental question hanging over Ministers this morning is this: why continue this fight? Hospitals are heading for a £2 billion deficit this year, mental health services are in crisis and the NHS is facing its most difficult winter in a generation, so why on earth are this Government picking a fight with the very people who keep our NHS running? There are nine days left before the first day of planned industrial action. Let me say very clearly to the Minister this morning: it is now time to talk.

[Alistair Burt]

I agree with the hon. Lady that we do not need to be in this situation. Absolutely. That is the whole point. The Secretary of State has kept his door open all the time. In seeking to conclude this, after starting negotiations three and a half years ago, the door remains open. It is for the BMA to come through it and say that it wants to continue the negotiations that it abruptly left more than a year ago.

Can and should everything be done to avert the strikes? Yes, it should. It would help if Labour Front Benchers made an unequivocal statement that they do not support strike action by doctors. I await to see whether that will be forthcoming. In the meantime, the Secretary of State has said that he is perfectly prepared to go to conciliation, but conciliation usually comes after a process of negotiations has broken down. The whole point is that the negotiations have not even kicked off again. The point is that the Secretary of State has offered such an opportunity, based on recommendations made by the independent Doctors and Dentists Review Body. That committee has made independent recommendations, including on the basis of information provided by the BMA.

For the hon. Lady to talk about a challenge to safety ill becomes the party that presided over Mid Staffs. The point is that, since he took office, the Secretary of State has, quite plainly and to everybody’s knowledge, made safety in the NHS his prime consideration. He wants a seven-day NHS to recognise the issues that have arisen at weekends. He has never said that junior doctors do not work at weekends. Of course they do—they carry the biggest burden of hospital work at weekends—but to make sure that the NHS is completely safe at weekends, as he intends, it is essential to spread out the burden and the junior doctors contract is part of that process. The hon. Lady said that it should be up to the Secretary of State to make the next move on the negotiations. I say to her that the door to negotiations is always open, as the Secretary of State has made clear.

The hon. Lady raised the issue of patient safety and the comments of Professor Sir Bruce Keogh, who is responsible for doctors in relation to emergencies. It is his role, as the national medical director, to ensure that everyone is safe. He wrote to the BMA yesterday and said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

He stated that

“patient safety is of paramount importance.”

Sir Bruce Keogh’s point in relation to an emergency situation was that although no one doubts for a second that, should there be an emergency in this capital like the one in Paris, every available doctor and member of medical staff would report for work, if it took place on the day of a strike when they were not already in the hospitals in the numbers required, it would take them time to get in. That was his concern about patient safety and it is a reasonable one.

I say again that we await a suggestion from the hon. Lady that it is not right for junior doctors to take strike action and that she will support the Secretary of State in saying that it is time to return to negotiations. The Secretary of State has been patient and fair, and he is clear that this is about safety. Negotiations should be returned to as soon as possible, and it would help if everyone said so.

[Dr Tania Mathias (Twickenham) (Con)]

For the record, I did not vote in the ballot. I urge the Minister and the BMA to return to the negotiating table, but without any preconditions. I applaud the new calculator on the Department of Health website, which is very helpful. I would be surprised if my colleagues and the people I know went on strike. I cannot imagine it. Therefore, there is an opportunity to negotiate and, if that does not succeed, to go to ACAS.

[Alistair Burt]

My hon. Friend believes, rightly, that there should be negotiations. The Secretary of State has said that. He has also said that conciliation is possible if the negotiations break down. There are no preconditions, beyond what the Secretary of State has said about his right to ensure that a manifesto commitment is delivered. My hon. Friend is right about the calculator. The initial calculator was misleading, which may have swayed some people over a period of time. She is also right to recognise, as the chief medical officer said yesterday—[Interruption.] Perhaps the hon. Member for Worsley and Eccles South (Barbara Keeley) will listen to the chief medical officer, if not to me. She said:

“I recognise the strong feeling of junior doctors and will always support them as the future of the NHS, but the severity of the action the BMA proposes is a step too far. I urge junior doctors to think about the patients that will suffer and I ask the union to reconsider its approach.”

That is a very sensible position that I think we would all endorse.

[Yvonne Fovargue (Makerfield) (Lab)]

What evidence does the Minister have that reforming the junior doctors contract and having a seven-day NHS will make the NHS safer? Will he commit to publishing that evidence?

[Alistair Burt]

The evidence is there in what has been published about the details of the contract. It was published in the press because it was not possible to get it to the BMA as it was not negotiating. It includes an upper limit of working hours of 72 hours in a seven-day period, when it was previously 91; four consecutive night shifts instead of the current seven; five consecutive day shifts instead of the current 12; and greater flexibility over rosters. That is self-evidently safer than the existing system. One reason we are where we are is that the BMA and others recognise that the old contract does not deliver the safety that is necessary. Those sort of changes will make the contract safer. That is self-evident.

[Mr Jacob Rees-Mogg (North East Somerset) (Con)]

I wonder whether my right hon. Friend saw the report in yesterday’s Daily Mail that said that under the Conduct of Employment Agencies and Employment Businesses Regulations 2003, it would be illegal to take on locums in place of striking doctors. Does he agree that if that is true, the law should be changed?

[Alistair Burt]

The Department has not yet had a chance to examine that report, but I have seen it. This all goes to emphasise that we should not be where we are. This matter can be settled. The Secretary of State’s door has been open for negotiations all the time. There is no reason why the junior doctors committee should not walk through that door, begin negotiations and end the risk to patients that is involved in strike action.

[Nic Dakin (Scunthorpe) (Lab)]

Why not just go straight to ACAS? From my constituents’ point of view, something has broken down and it needs fixing. Why not just get on with it?

[Alistair Burt]

Because of what happened the last time an independent body looked at this matter. After the negotiations broke down before, the Secretary of State sent the matter to an independent body, the Doctors and Dentists Review Body. The BMA took part in that and made its representations, but when the independent body reported, the BMA still did not do anything. Those recommendations form the basis on which negotiation can take place. If those negotiations are not successful, that is when conciliation can happen. That is exactly what the Secretary of State has offered. I hope the hon. Gentleman will support that and try to ensure that strike action does not take place.

[Sir Peter Bottomley (Worthing West) (Con)]

It is quite clear that,

“Changes to contracts must be best for patients, fair for doctors and sustainable for the NHS.”

That, in effect, is what the Minister has been saying, but those words were said by Mark Porter of the BMA. If the problem is getting together to have discussions, may I suggest that instead of saying that the BMA should come to Ministers, Ministers announce that they are prepared to go to the BMA, discuss everything and hopefully come to a conclusion on everything? It seems to me that if the BMA has got itself stuck by proposing a strike that doctors do not want and that cannot be good for patients, the best thing is to say to it, “We will come and talk with you. Let’s get this settled.”

[Alistair Burt]

I thank my hon. Friend, but I do not think that the venue of direct negotiations is of any concern to the Secretary of State. What is important is that the body that represents junior hospital doctors should negotiate directly with the NHS, as has been on offer for some time, following the process that was going on for some three and a half years before it reached this state. My hon. Friend is right that direct negotiations should recommence immediately.

[Sarah Champion (Rotherham) (Lab)]

The Minister quoted Sir Bruce Keogh. Will he tell us what Sir Bruce said about ACAS?

[Alistair Burt]

Let me see what Sir Bruce Keogh said. [Interruption.] I did not write the letter, so I will have to look through it. He said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

As far as conciliation is concerned, I have made it entirely clear that the Secretary of State has not ruled it out. I cannot see ACAS mentioned in the particular letter that I am looking at. Sir Bruce Keogh said that there must be direct negotiations between those who know most about the matter. The Secretary of State has said that if that does not work, he is open to conciliation.

The Secretary of State has reviewed the contract, published the terms and dealt with the BMA, which said first that it was a pay issue, then that it was a safety issue and then that it was an issue about imposition. At each stage, it has moved the goalposts, whereas the Secretary of State has been open about what he wishes to see. It is now up to the negotiations. We all want negotiations to happen because nobody wants to see the withdrawal of junior doctors’ work and, I suspect, neither do they.

[Mr Christopher Chope (Christchurch) (Con)]

Is not the root problem that the NHS is a monopoly employer of junior doctors? If the veterinary profession can provide 24/7 care for sick animals, why cannot junior doctors provide the same for sick people?

[Alistair Burt]

As the House is well aware, the Commonwealth Fund said recently that the NHS was the best in the world. NHS staff, by implication, are the best in the world. They do an extraordinary job and junior hospital doctors do a fantastic job. Patient satisfaction is extremely high. We want that to continue. There is no reason to believe that NHS Employers, which is also calling for negotiations to continue and for the strike action not to take place, is not in full view of what staffing it needs to create an even safer health service. Its judgment is that the contract set out by the Secretary of State to be negotiated on provides the best basis for the employment of doctors in the health service.

[Wes Streeting (Ilford North) (Lab)]

The Minister’s statements, even this morning, imply that people have been misled by the BMA. How is it conceivable that 15 heads of royal colleges and 98% of junior doctors have been so badly misled that this unprecedented strike action has been proposed? Instead of patronising people, why will he not accept that trust has broken down, cut out the middle man and go straight to ACAS, so that there can be proper negotiations and a resolution to the dispute? People do not trust the Government.

[Alistair Burt]

I take the hon. Gentleman’s point. One example of why the Secretary of State believes that he is entitled to talk about misleading is that of the pay calculator that the BMA put on its website, which indicated that all doctors would suffer a 30% to 40% reduction in their salary, or something like that. The BMA was forced to take that calculator down when it realised that it did not reflect the truth. As we have seen, the Secretary of State has said that no doctor currently working legal hours will suffer a reduction in pay. There is an 11% pay increase on basic hours, and that is why he feels that there was an element of misleading. The hon. Gentleman is right about cutting out the middle man, which is why negotiations should restart. I am delighted that he supports that approach, and if that does not work, conciliation is there.

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

Does my right hon. Friend agree that the loss of some overtime pay currently earned by junior doctors who work more than 72 hours a week should be seen firmly in the context of the safety of patients being treated by exhausted medics, and the long-term health of our junior doctors?

[Alistair Burt]

My hon. Friend is right. One difficulty with this is getting through what has built up during the course of the dispute, and getting to the heart of this issue, which is shared by everyone. There is no doctor in the land who does not want to work in safe conditions or for their patients to be treated safely. There is no Member of Parliament who does not want safety to be at the heart of this, and no one from the royal colleges or in senior executive positions in the NHS wants to compromise on safety. That is why we need to cut the number of legal hours, and ensure that doctors cannot work the number of consecutive nights or long days that they can work currently. The contract was outdated and it needs to change, and that is why people should sit down together.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Members of the Public Accounts Committee hear repeated reports about the challenges of recruiting some of the very junior doctors who will go on strike. Not only is the Government’s game of brinkmanship causing problems with morale and patient safety, it could lead to a longer term crisis in the NHS as doctors choose not to work here. Will the Health Secretary just get on with it and get around the table? It is within his gift to get talks started again and avert this strike.

[Alistair Burt]

The hon. Lady speaks with great background knowledge on this issue. She is right to say that we should all just get on with it, but she is not right to say that it is within the Secretary of State’s gift—if it was, we would not be where we are. The Secretary of State wants a negotiation based on independent recommendations and on three and a half years of work, which is not an unreasonable position. The hon. Lady’s view that this issue should be settled in a way that means negotiations continue and the strike does not happen is correct.

[Christopher Pincher (Tamworth) (Con)]

Does my right hon. Friend agree that, just as we would feel unsafe as passengers if we got on to an aeroplane that did not have a co-pilot—because not enough co-pilots work or are fit to work at the weekend—similarly we should feel unsafe because of the weekend effect in the NHS? Reasonable reform to fix that, agreed by the BMA, is necessary.

[Alistair Burt]

My hon. Friend makes a fair point. The current contract is simply not fair. It incentivises junior doctors to work long, unsafe hours, and around 500 doctors work outside legal limits at more than 91 hours a week. Safety has always been at the heart of the reasons for wanting to change the contract. People thought that the existing contract was unsafe as far back as 2008 when the BMA recognised that it did not do the job it was designed to do, and this issue has lasted from then to where we are today. One can reasonably ask what else the Secretary of State can do beyond publicising what he is doing, continuing to talk, keeping the door open, and wanting to ensure direct negotiations.

[Clive Lewis (Norwich South) (Lab)]

When the NHS is facing a winter crisis, why have the Government decided to pick a fight with the very people who will get it through that crisis?

[Alistair Burt]

The Secretary of State has not picked a fight. Three and a half years of negotiation on a new contract, publicising the offer, and being willing for negotiations—which he did not withdraw from—to restart, is a funny definition of picking a fight.

[Tom Pursglove (Corby) (Con)]

I thank the Minister for coming to the House to set out the Government’s position, and I impress on him the concern felt by my constituents about this strike. Does he agree that our constituents expect everybody to get around the negotiating table to try to sort this out, and for Members of this House to advocate that approach? That is the responsible thing to do.

[Alistair Burt]

My hon. Friend is right. In any quarter there will be puzzlement about support for action that will withdraw the work of junior doctors from their patients. We estimate that between 50,000 and 60,000 elective pieces of work are done every day in the NHS, and such work will inevitably be put off if doctors are not available. Those numbers are individual patients who will not get the care that they are looking for, and that a doctor would want and expect to give. There must be something better than this stand-off, which is why we appeal to the BMA to take up the Secretary of State’s offer and come back to negotiations.

[Anna Turley (Redcar) (Lab/Co-op)]

Given the crisis in morale in the NHS, have the Government estimated how many junior doctors might leave the NHS if they continue to impose this new contract on them?

[Alistair Burt]

No, I do not think it possible to make that sort of estimate or assessment, but the longer that doctors go on working under an unsafe contract that includes long hours, consecutive nights and long days, the more that will add to the pain and pressures of those working in the NHS. That is why a new contract with safer hours is a better option. Encouraging the BMA to return to negotiations and settle this issue, so that the threat of strike action is not hanging over us, is also important for morale.

[Philip Davies (Shipley) (Con)]

Does my right hon. Friend agree that this strike action is completely irresponsible and that such action is never an acceptable substitute for the kind of negotiations offered by the Secretary of State? Will he guarantee that the Government will not give in to this strike action, as that would be a terrible precedent for the Government to set?

[Alistair Burt]

My hon. Friend reflects well the feelings of Chief Medical Officer Professor Dame Sally Davies, who urged junior doctors to think again because the severity of the proposed action is a step too far. I find it difficult to conceive of a circumstance in which I would support a medical practitioner withdrawing their labour, and I hope that anyone would think that such things should not happen. The Secretary of State is doing everything he can to make clear the terms of the contract, the safety principles on which it is based, and to deal with misleading information. Even at this stage, he urges the BMA to come back and sit round the negotiating table and—I repeat—he has not ruled out conciliation after that.

[Andy Slaughter (Hammersmith) (Lab)]

I have hundreds of junior doctors in my constituency and I have spoken to many of them. They feel misled, but not by the BMA. Does the Minister understand that the anger that led to the 98% vote in favour of action is because junior doctors were told that they would get a pay rise, when many would get a pay cut? Disgracefully, they have been told that somehow they may be responsible for unnecessary deaths. The only way to restore trust now is independent arbitration. Will the Secretary of State agree to that without preconditions?

[Alistair Burt]

In an attempt to build on the opportunity of trust, after the BMA withdrew from negotiations last year, the work went to the independent Review Body on Doctors’ and Dentists’ Remuneration to urge an independent look at the issue and to get recommendations based on that independent review. When those recommendations appeared, the BMA still did not go into negotiations. That independent review has been sought, and the recommendations are there to talk about. When the hon. Gentleman spoke to junior doctors in his constituency—probably about misleading information that they may have had from the BMA—I hope he said clearly that he does not support strike action. It might be helpful if he told the House that that is what he said.

[Mrs Sheryll Murray (South East Cornwall) (Con)]

Many of my constituents will want to know if the Secretary of State is satisfied with the reassurances given by the BMA, which has refused to confirm it will do what is necessary to ensure patients are not hurt if the strike takes place.

[Alistair Burt]

I am quite sure I can say to my hon. Friend that no one ever wants to see anyone hurt, but, if there is a withdrawal of labour, it is not possible to say that certain procedures to relieve the discomfort of existing patients will take place. That is obviously the point of the action and why no one wishes to see it happen. I repeat that no doctor wishes to put a patient in a situation of harm. No Minister wants to see that and none of us here does. This process has been going on for three and a half years; there has been reference to independent people, recommendations that the BMA played a part in making and an open offer always to come back to negotiations. That does not seem an unreasonable position for the Secretary of State to take. That is why it should be backed by everyone sitting in the House today.

[Liz McInnes (Heywood and Middleton) (Lab)]

Negotiations have clearly reached an impasse, and winter pressures and a winter crisis in the NHS are looming. In the interests of patient safety, let us bring in ACAS. Talks have clearly stalled. If the Secretary of State is doing everything he can, will the Minister tell me where he is today?

[Alistair Burt]

The impasse was not created by the Secretary of State. The impasse was created by the BMA walking away from negotiations last year and not returning to negotiations after the recommendations of the independent body came through. That is not an impasse; that is one side deciding it does not want to take part. The Secretary of State’s response has been to say: keep the negotiations going, the door is always open.

The hon. Lady asks where the Secretary of State is today. He is working on the spending review plans for the support the NHS needs—a financial commitment the Labour party did not make at the general election. He is also working on contingency plans to make sure the NHS is safe if action takes place. I think that is pretty important work that he should be doing.

[Mr David Nuttall (Bury North) (Con)]

As the Minister previously represented my constituency for 14 years, does my right hon. Friend agree that when the Government have guaranteed no junior doctor working within legal limits will see their pay cut and that none will be required to work longer hours, the hardworking residents of Bury, Ramsbottom and Tottington will find it difficult to understand why strike action has been voted for?

[Alistair Burt]

My hon. Friend puts it very well. The people of Bury, Tottington and Ramsbottom have long experience of very good health services provided by excellent family doctors, as well as through good secondary medical care, not just in their own constituency but around and about. They will find it surprising that, with the guarantees given by the Secretary of State and mentioned by my hon. Friend, anyone should be contemplating strike action. Equally, they will find it incomprehensible that anyone from any political party is giving that strike action any support.

[Clive Efford (Eltham) (Lab)]

The Minister has just told us that the Secretary of State is across the road in his office and cannot be bothered to come here to account for an unprecedented strike by junior doctors in our national health service. That is an absolute disgrace! The Prime Minister has said that this is his miners’ strike. The doctors are prepared to go to arbitration. The public will know that if this strike goes ahead it will be because the Government will not go to arbitration. It will be the fault of the Secretary of State and the Prime Minister.

[Alistair Burt]

I think it is of primary importance for the Secretary of State to work on contingency plans this morning to make sure that we are all safe should there be a strike. That is the task he has been given by the action that has been taken. At the same time, he has repeated that he is open to negotiations to deal with the dispute. Rather than expressing anger, the hon. Gentleman should be expressing concern that a contract that makes an unsafe situation for doctors safer is not being backed more readily by those on the Opposition Front Bench, who should also be rejecting strike action.

[Craig Whittaker (Calder Valley) (Con)]

One group that has not been mentioned by the shadow Secretary of State is, of course, the patients. They receive a poor level of service at weekends, sometimes, sadly, with dire consequences. Will the Minister and the Secretary of State pledge to stand resolute in their commitment to improve weekend care, which, as Sir Bruce Keogh has said, is both a moral and clinical cause?

[Alistair Burt]

My hon. Friend gets to the heart of the matter. The clinical director of the NHS, Professor Sir Bruce Keogh, has said that the negotiations and the new contract are about safety and ensuring that a seven-day NHS is safe. They are about dealing with the issue of what happens at weekends, which is generally accepted to be a problem right across the medical world. The Secretary of State has put forward proposals to make people safer. They are backed by those in the NHS who are responsible for patient safety. The Secretary of State is perplexed, like everyone else, that the opportunity for negotiations is not being taken. That is what is needed to end the dispute. The Secretary of State has repeatedly made that clear.

[Rachael Maskell (York Central) (Lab/Co-op)]

The Secretary Of State was here last year in relation to the rest of the NHS staff. First, the DDRB is an advisory body to government, not a mediator, whereas ACAS is a mediator. Secondly, the dispute has provided an opportunity for both sides to step back and explore the issue with a blank sheet of paper. Will the Minister take that opportunity by entering into ACAS talks to explore the grounds for moving the dispute forward?

[Alistair Burt]

The hon. Lady’s commitment to the health service is very clear from her background and everything else. I ask her to recognise that the 2008 contract is outdated and challenging. By 2012, we reached the stage where people had to negotiate around it because it was unsafe. After three and a half years, we have got to where we are. The idea that the process should start again is just unfeasible and very unfair on doctors working long hours who need to be relieved of that. She talks about the DDRB as a mediator. No, it is not a mediator, but it does provide the independent basis for the recommendations, which the BMA took part in, on which to negotiate. Anyone concerned with patient safety would say the time for direct negotiations to restart and take up the Secretary of State’s offer is now.

[Kit Malthouse (North West Hampshire) (Con)]

Will the Minister remind the House how many entirely avoidable deaths occur at the weekend every year, so that Members can reflect on where their primary concern should lie?

[Alistair Burt]

Medical studies have demonstrated that there are a number of extra deaths at weekends. The disputes about that are intense, but the medical profession recognises that the absence of facilities, the absence of consultant cover on the level it ought to be at, and the absence of diagnostic tests and other things, make entry into the health service at the weekend less secure than it would be at other times of the week. It is very important to change that. That is what the public voted for at the general election and that is what they expect the Secretary of State to deliver. That that should be held up by an industrial dispute, essentially by a union digging its feet in and not taking the opportunity to negotiate, is unfortunate and bad news for the patients my hon. Friend referred to.

[Julie Cooper (Burnley) (Lab)]

Does the Minister accept that his insistence that junior doctors do not understand the conditions is deeply insulting to some of the most intelligent people in the country? Does he accept that this shabby and patronising treatment has led to a total breakdown in confidence in the Secretary of State, and that the only way forward is through ACAS, an independent body?

[Alistair Burt]

The Secretary of State has gone out of his way to seek to explain to doctors the basis of the contract, partly to deflect what was said about it originally by the BMA during the course of the industrial dispute. He will continue to do that. There is no doubt that we all value the work of junior doctors enormously and fully appreciate that they will be looking very hard at their conditions and everything else. Proper union representation is not delivered by a union that refuses to negotiate after three and a half years and after independent recommendations have been made. I urge the hon. Lady, who also has a valuable role in the NHS in relation to pharmacy and a deep interest in carers, to recognise what will happen for those 50,000 or 60,000 elective admissions that will not be able to take place, to think about those who will be involved and to continue to stress, as I know she will, that negotiations are the answer and that conciliation is available if they are not successful.

[Mr Philip Hollobone (Kettering) (Con)]

My constituents appreciate and value the work of junior doctors but are worried about the threat of strike action and its potential impact on patient treatment, and really would not want strike action to take place. For the benefit of my constituents, will the Minister tell the House what a typical junior doctor gets paid, whether that is likely to go up or down as a result of the contract and whether that typical junior doctor is likely to work more or fewer hours?

[Alistair Burt]

As we all know, the pay of a junior doctor varies. As the Secretary of State has made clear, there will be an 11% increase in basic pay; antisocial hours will still be covered; junior doctors will work fewer hours to ensure greater safety; and there will be more cover at the weekends to ensure that the burden junior doctors bear is more equally shared.

[Alex Cunningham (Stockton North) (Lab)]

As my hon. Friends have said, the absent Secretary of State has lost the confidence of almost everybody in the NHS, to the point that consultants, nurses and others support junior doctors in their fight against him. Morale is at an all-time low and the deficit runs into billions. How will Ministers get the NHS out of this very dark hole?

[Alistair Burt]

First, we will avoid the language of “fight” and the sense that this has become an industrial dispute, although there are elements of one, given how the BMA has behaved over the negotiations. As far as the public are concerned, however, this is not an industrial dispute: it concerns them very deeply. They appreciate and value their doctors, they want to have their treatment and they want to be safe. People must talk. The BMA, which withdrew arbitrarily from the negotiations, needs to take up the Secretary of State’s offer and start talking. We all know that ultimately this will be ended by talking. Whether that happens today or after 1 December is entirely up to the BMA. I repeat that the Secretary of State is right to be spending this morning dealing with the potential consequences of the action suggested, and I still wait to hear from any Opposition Member that they reject strike action by doctors.

[Robert Jenrick (Newark) (Con)]

When I was a lawyer, I was involved in a number of arbitrations and mediations. Does my right hon. Friend agree that it is highly unusual to go straight to arbitration or to ACAS if there have not been normal negotiations? In this case, as with all other negotiations, the best practice is for the parties to get around the table, and, if that fails, then to go to ACAS, but not to waste time in the interim.

[Alistair Burt]

My hon. Friend is absolutely right. As the Secretary of State has also made clear, we need to restart the negotiations, which are based on independent recommendations that the BMA looked for and took part in. As he says, the normal procedure is that, if the negotiations do not work, conciliation is available, as the Secretary of State has said. However, we cannot say negotiations have broken down if they are not taking place. I am sure that everyone in the Chamber wants the negotiations to continue and will urge junior doctors in their constituencies to recommend that the BMA restarts them immediately so that we can move this forward and end the threat of strikes that no one wants.