Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 9 months ago)
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Sir Henry Bellingham (North West Norfolk) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
In the last four years, 29 trusts have been put into special measures; that is more than one in 10 of all NHS trusts. Of those, 12 have now come out, having demonstrated sustainable improvements in safety and quality of care. There are nearly 1,300 more doctors and 4,200 nurses working in trusts that have been put into special measures.
Sir Henry Bellingham
The Secretary of State will be aware because he visited it last year, that the Queen Elizabeth hospital in my constituency has come out of special measures. It has made excellent progress, not least by introducing Saturday lists for in-patients and putting in place numerous measures to transform the out-patients department. Will he join me in paying tribute to all staff of the hospital, particularly the chief executive, Dorothy Hosein, and the chairman, Edward Libbey, for the excellent progress that they have made?
Mr Hunt
I am very happy to do that, and I very much enjoyed my visit to the QE with my hon. Friend a couple of years ago. This is a very good example of how trusts can be transformed when they go into special measures. Since coming out of special measures, the QE has opened a state-of-the-art laparoscopic theatre, got a dedicated breast unit, and expanded its A&E. It has got 72 more nurses over the past few years. It is a good example to many other trusts in special measures, and it shows that that really can be a turning point, bringing about benefits for patients and staff.
Derek Twigg (Halton) (Lab)
The problem is that many trusts are still in a financial mess and have a deficit. If hospitals and the wider health service are to solve that, they need more funding, and councils, too, need funding for care. What is the Secretary of State doing to fight for more funding for his Department to ensure that we deal with those problems properly?
Mr Hunt
The hon. Gentleman will have noticed that in last year’s spending review the NHS got the biggest funding increase of any Government Department. We have committed to the NHS’s own plan, which asks for £10 billion more a year during the course of this Parliament in real terms. However, I do not disagree that there are still very real financial pressures in the NHS and particularly in the social care system. The trusts that are delivering the highest standards of care are those with the lowest deficits. Delivering unsafe care is one of the most expensive things people can do, which is why this is an important agenda.
Chris Green (Bolton West) (Con)
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
The Secretary of State will know that in my own area of Calderdale and Huddersfield there is a dreadful situation for the trust that has been caused by the behaviour of the clinical commissioning group and the way in which it procures. He has received a large petition from thousands of people in the Huddersfield area about the closure of the A&E. Will he look at that seriously and intervene, because the competence of local CCGs is not up to the mark?
Mr Hunt
I am well aware of that issue and have received a number of representations from hon. Members on both sides of the House. There is a mechanism by which these issues end up on my desk—they have to be referred by a local council’s overview and scrutiny committee and then I get an independent recommendation—but I will look at this carefully if that process is followed.
Mrs Maria Miller (Basingstoke) (Con)
To cope with rapid population increases in my constituency, Basingstoke has advanced plans to build a critical treatment hospital and cancer centre, with the support of more than three quarters of the population. Does my right hon. Friend expect sustainability and transformation plans to provide clear, timely direction on plans for this new model of care in the community?
Mr Hunt
I can absolutely reassure my right hon. Friend on that. One of the main purposes of STPs is to make sure that we deliver our cancer plan, which will introduce a maximum four-week wait between GP referral and ultimate diagnosis. If we get it right, that might result in around 30,000 lives a year being saved, so this is a big priority for every STP.
Colleen Fletcher (Coventry North East) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Tragically, suicide is now the biggest single cause of death in men under 50. There are 13 suicides every day, of which three quarters are men. I am currently reviewing our suicide strategy to make sure we leave no stone unturned in trying to reduce the totally unacceptable level of these tragedies.
Colleen Fletcher
Yesterday marked the launch of the mental health awareness and suicide prevention campaign called “It takes balls to talk” across Coventry and Warwickshire. The campaign is a public information programme targeted at male-dominated sporting venues, which aims to direct men to help and support when they need it to promote positive mental health and reduce the incidence of male suicide. With suicide being the single most common cause of death in men under 45, will the Secretary of State take the opportunity to welcome and support this important new campaign?
Mr Hunt
I am happy to do just that. I would like to thank the hon. Lady for bringing up this very important and difficult issue. We are making progress in reducing suicide rates, but we can do an awful lot better. The thing that troubles me most is that nearly three quarters of people who kill themselves have had no contact with specialist NHS mental health services in the previous year, even though in many cases we actually know who they are because, sadly, most of them have tried before. I am very happy to commend the “It takes balls to talk” campaign. She may want to put the campaign in touch with the national sport mental health charter, which is another scheme designed to use sport to try to boost the psychological wellbeing of men.
Helen Jones (Warrington North) (Lab)
A recent survey showed that one in four members of the emergency services experienced mental health problems, and that a number of them experienced suicidal thoughts. What is the Secretary of State doing to protect our vital paramedics and other ambulance staff, and to ensure that they get the support they need in dealing with absolutely appalling situations?
Mr Hunt
Again, I thank the hon. Lady for raising that. She will be pleased to know that the NHS has introduced a scheme, backed with funding, to encourage NHS trusts to look after the mental wellbeing of their own staff. I particularly want to pay tribute to the courage of people who work in the air ambulance service, because they see—day in, day out—some of the most difficult and distressing cases. They have to cope with the pressure of that when they take it home every day, and we all salute them.
Luke Hall (Thornbury and Yate) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Last week, I announced plans to make the NHS self-sufficient in the supply of newly qualified doctors by the end of the next Parliament. We recognise the brilliant work that is done by the many outstanding overseas doctors who work in the NHS and have made it clear that, whether or not they are from the EU, we wish that work to continue post-Brexit. However, as the fifth largest economy in the world, Britain should be training all the doctors it needs. While there will always be beneficial exchanges of doctors and researchers between countries, we have a global obligation to train enough doctors for our own needs, otherwise the inevitable consequence will be to denude poorer countries of doctors whose skills are desperately needed.
Luke Hall
Thornbury health centre is crying out for redevelopment to cater for the growing local population. Will my right hon. Friend meet me, representatives of the health centre and NHS Property Services to see how we can take a co-ordinated approach that will move the health centre forward?
Mr Hunt
I can do better than that, because I have said that I am prepared to go to the health centre. I remember a very good visit to Thornbury community hospital during the general election campaign. I understand what those at the health centre are trying to do and they are absolutely right to be thinking about how they can improve out-of-hospital services.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Secretary of State look into the creation of a sideways move for a chief executive of a trust that was criticised for failing to investigate patient deaths? Six weeks after the special recruitment exercise by Southern Health, Katrina Percy has resigned from her advisory role, with a substantial 12-month salary payoff that has been signed off by the Department of Health and the Treasury. The campaign group, Justice for LB, has called that “utterly disgraceful” and I agree. Will the Secretary of State investigate?
Mr Hunt
I agree with the hon. Lady that the way this case was handled was by no means satisfactory. The truth is that it took some time to establish precisely what had gone wrong at Southern Health. As this House knows, because we made a statement at the time—I think it was an urgent question, actually—there was a failure to investigate unexplained deaths. I do not think the NHS handled the matter as well as it should, but we now have much more transparency and we do not have a situation where people go on and get other jobs in the NHS, which happened so often in the past.
Dr Tania Mathias (Twickenham) (Con)
Mr Jeremy Hunt
I am very happy to do that. My hon. Friend is right to highlight the fact that the provision of mental health services to children is one of the biggest weak spots in NHS provision today. It is an area that we are putting a big focus on. I would be happy to talk to her about the situation in her constituency.
Danny Kinahan (South Antrim) (UUP)
Fiona Mactaggart (Slough) (Lab)
Mr Jeremy Hunt
The Conservative candidate in the Witney by-election will be saying very clearly that because of the extra funding from this Government we are aiming to have 5,000 more doctors working in general practice by the end of this Parliament, something that would not have been possible with the increase of less than half that amount promised by the Labour party.
Wendy Morton (Aldridge-Brownhills) (Con)
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I listened very closely to the Secretary of State’s comments earlier on mental health. On 9 December he stood at that Dispatch Box and said that
“CCGs are committed to increasing the proportion of their funding that goes into mental health.”—[Official Report, 9 December 2015; Vol. 603, c. 1012.]
However, my research shows that 57% of clinical commissioning groups are reducing the proportion they spend on mental health—yet another broken promise. When will we have real equality from this Government for mental health?
Mr Jeremy Hunt
I will tell the hon. Lady what this Government have done. We have legislated for parity of esteem for mental health. We are treating 1,400 more people every single day for mental health conditions compared with six years ago. We have a new plan that will see 1 million more people treated every year by 2020, including a transformation of child and adolescent mental health services. That is possible because we are putting into the NHS extra money that her party refused to commit to.
Andrew Stephenson (Pendle) (Con)
Mr Hunt
My hon. Friend is absolutely right. I find it extraordinary that the Labour party said that our plan to train more doctors was “nonsense”. We currently have 800 doctors in the NHS from Sri Lanka, 600 from Nigeria, 400 from Sudan and 200 from Myanmar. They are doing a brilliant job and I want them to continue doing that job, but we have to ask ourselves whether it is ethical for us to continue to recruit doctors from much poorer countries that really need their skills.
Margaret Greenwood (Wirral West) (Lab)
I was alarmed to read at the weekend that NHS chiefs are warning that hospitals in England are on the brink of collapse. Is it the Government’s intention to cut the public supply of healthcare in order to create demand for a private healthcare system, or will they give the NHS the additional funds it needs?
Mr Hunt
Let me remind the hon. Lady that the party that introduced the most outsourcing to the private sector was her Labour Government under the previous Health Secretary, Alan Milburn. Our view is that we should be completely neutral as to whether local doctors decide to commission their care from the public sector or private sector. We want the best care for patients.
Lucy Allan (Telford) (Con)
Local health commissioners have concluded that Telford’s brand new women and children’s centre, which serves some of the most deprived populations in the country, should be closed and moved to a more affluent area where health is better than the national average. The commissioning process has lost the confidence of local people. Will the Secretary of State intervene and ensure that local health commissioners fulfil their legal duty to reduce health inequalities?
Mr Jeremy Hunt
I thank my hon. Friend for standing up for her constituents—it is absolutely right that she should do so. She would agree that that has to be a local matter led by commissioners locally, but she can be reassured that we are always watching what is happening to ensure that people follow due process, and that the results of any changes proposed benefit patients as intended. I will therefore watch very carefully what is happening in Telford and in Shropshire more broadly.
Mr Dennis Skinner (Bolsover) (Lab)
About half a dozen times in the last hour, the Secretary of State has bragged about the extra money he is putting in to the national health service, so why is Bolsover hospital, like many others that have been referred to in the past half hour, due to close? Why are neighbouring hospitals in countless constituencies in Derbyshire closing? Why does he not use some of that money to save the Derbyshire hospitals?
Mr Hunt
The extra money we are putting in to the NHS is going to better cancer care, better mental health care and better GP provision—it is going to all the things that Members on both sides of the House know matter. It will also mean that we can support our hospitals better. With our ageing population, we will continue to have great demand for hospital care, but the best way to relieve pressure on those hospitals is to invest in better out-of-hospital care, which has not been done for many years.
Mr Philip Hollobone (Kettering) (Con)
Kettering general hospital is treating a record number of patients with increasingly world-class treatments, yet despite being located in an area of rapid population growth, due to an historic anomaly, the funding for the local clinical commissioning groups is among the worst in the country in relative terms. What can Her Majesty’s Government do to correct that?
Mr Hunt
I am happy to look at that particular funding issue for my hon. Friend. I know that Kettering hospital is under a great deal of pressure. The one thing that it could do to relieve its financial pressures is to look at the number of agency and locum staff that it employs. As with many hospitals, there are big savings to be made in that respect in ways that improve rather than decrease the quality of clinical care.
Karin Smyth (Bristol South) (Lab)
The Secretary of State will be aware that the Public Accounts Committee has questioned both the Department of Health and NHS England on the parlous state of NHS accounts this year, following the comments by the Comptroller and Auditor General. It is clear that STPs are the only plan on the table. Will the Secretary of State make clear his support to the NHS to deliver the STPs in the teeth of opposition from his own Back Benchers? If he will not, what is plan B?
Mr Hunt
I do not recognise the picture the hon. Lady paints about opposition to STPs. We need to ensure we have good plans that will deliver better care for NHS patients by bringing together and integrating the health and social care system, and improving the quality of out-of-hospital plans. While we are in a period where those plans have not been published there will obviously be a degree of uncertainty, which we will do everything we can to alleviate, but she is right to say that these plans are very important for the future of the NHS. The process has our full support.
Kevin Foster (Torbay) (Con)
The Secretary of State will be aware of the concern in my constituency about the future of Paignton hospital, which prompted hundreds to turn up to a recent meeting. Does he agree with me that it is vital the clinical commissioning group, in publishing its plans, does not just publish what it will remove but the details of what it will replace them with?
Lilian Greenwood (Nottingham South) (Lab)
Two years ago, Nottingham University Hospitals NHS trust privatised support services, including cleaning, handing them over to Carillion in an effort to save money. Since then there have been shortages of equipment, shortages of staff and an appalling decline in standards of cleanliness. Will the Secretary of State condemn Carillion for putting patients at risk? When will he ensure that hospital services in Nottingham are properly funded?
Mr Jeremy Hunt
The decision on whether to outsource services must be a matter for local hospitals. I know that that hospital has been struggling with its deficit. I have been to visit the hospital myself and I know it has been trying very hard to improve clinical care. If the contract is not working and the quality is not right, I would expect the hospital to change it, but it must be its decision.
Several hon. Members rose—
Wachter Review
Jeremy Hunt Excerpts(9 years, 10 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today an independent review has been published which makes recommendations about how to support the effective implementation of IT systems in the health system in England.
In October 2015 I asked Professor Robert Wachter, a US clinician and authority on the issues and challenges of implementing IT and digital systems in healthcare, to undertake a review of implementation of IT in the NHS, with a particular focus on the introduction of electronic health records in the acute sector. It was to draw on recent experience in both England and the US and make recommendations on how to introduce such systems more effectively in the NHS. The review started in February this year and was supported by an advisory board drawn from digital healthcare experts in the US and UK, as well as a representative from Denmark.
The independent review has now been completed and the full report is attached and available at https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs.
Healthcare, like other areas of life, needs to make effective use of technology to deliver services as efficiently and cost effectively as possible, while meeting the needs of patients and their expectations of a modern public service. If we are to deliver on our ambition to deliver the safest, most efficient healthcare possible for NHS patients we must make the most of these technologies, moving away from paper-based records to a system that provides every health care professional with the information they need, at the point of care, so that they can make safe, effective treatment decisions, and that provides patients with easy access to all the information they need to be active partners in managing their health and wellbeing.
Digital technology is increasingly in use in many parts of the NHS but there are still some organisations that have yet to embrace its use, and many more that have found the task of implementing systems very challenging. The result is that despite already making investments in digital technology, local NHS organisations are often not getting the expected benefits for patients, health care professionals or the system.
Professor Wachter’s review identified a number of critical factors for success and has made 10 recommendations that focus on:
The importance of clinical engagement and leadership to successful implementation.
The need to improve workforce capability in the use of technology in the delivery of care, in particular the need for more clinician-informaticists (clinicians with informatics expertise) to lead implementation of clinical IT systems, including for a National Chief Clinical Information Officer (CCIO).
A phased approach to funding and implementation that reflects the level of readiness and existing digital maturity of NHS Trusts with initial support for those Trusts which have already made good progress in digitising and are ready to go further, or which are demonstrably ready to make good progress.
Interoperability as a core characteristic of the system from the outset to support clinical care, innovation and research.
I am grateful to Professor Wachter and his advisory group for their work on this important area for the future development of a NHS that is sustainable and meets our expectations of a modern service.
Today I am also presenting plans to start to implement those recommendations with the announcement of:
The first Global Exemplars. These Trusts are judged to be the most advanced in the use of digital technology in England, and which we expect to move to become world leaders at an accelerated pace:
Each Global Exemplar will be supported via international partnerships and will be expected to share their learning and experience across the NHS to show how care can be enhanced across the whole health system using digital technologies. Each of these Trusts will be able to bid for up to £10 million of funding.
The creation of a group of National Exemplars. These Trusts, although not yet as advanced as our Global Exemplars, are ready to make good progress in implementing digital technology and each can bid for up to £5 million of funding.
A competition to find a UK university partner to set up a Digital Academy to provide improved workforce capability in use of technology in the delivery of care.
The first Global Exemplars will be:
City Hospitals Sunderland NHS Foundation Trust
Luton & Dunstable University Hospital NHS Trust
Oxford University Hospitals NHS Foundation Trust
Royal Free London NHS Foundation Trust
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Salford Royal Hospitals NHS Trust
Taunton and Somerset NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust
University Hospitals Bristol NHS Foundation Trust
University Hospitals Southampton NHS Foundation Trust
West Suffolk NHS Foundation Trust
Wirral University Teaching Hospital NHS Foundation Trust
NHS England has also already announced, in July, the appointment of Professor Keith McNeill as NHS Chief Clinical Information Officer. Professor McNeill will have a key role in providing national leadership for this important agenda that will increase the speed and scope of the NHS’s adoption of digital technologies to support the transformation needed to deliver NHS services fit for the future. He will act on behalf of the whole health and care system to provide strategic leadership, also chairing the National Information Board, and acting as commissioning ‘client’ for the relevant programmes being delivered by NHS Digital (previously known as the Health and Social Care Information Centre).
It can also be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-09-07/HCWS134
[HCWS134]
Junior Doctors: Industrial Action
Jeremy Hunt Excerpts(9 years, 10 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I regret to inform the House that last week the British Medical Association announced that it was initiating further rounds of industrial action over the junior doctors contract. They involve a series of week-long all-out strikes between now and Christmas, which were scheduled to start next Monday, although this afternoon the BMA delayed the first strike until 5 October. That news is of course welcome, but we must not let it obscure the fact that the remaining planned industrial action is unprecedented in length and severity and will be damaging to patients, some of whose operations will have already been cancelled.
Many NHS organisations, including NHS England, NHS Providers, the NHS Confederation and NHS Improvement, have expressed concern about the potential impact on patient safety. Indeed, this morning the General Medical Council published its advice to doctors on the strike action. While recognising a doctor’s legal right to take industrial action, it urged all doctors in training to pause and consider the implications for patients, saying:
“Given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, patients will suffer.”
Many others have also questioned whether escalating the strikes is a proportionate or reasonable response to a contract that the BMA junior doctors’ leader, Dr Ellen McCourt, personally negotiated and supported in May. She said then that the new contract was
“safer for our patients, safer for our junior doctors… and also fair.”
She said, with respect to junior doctors, that the contract
“really values their time, values them as part of the workforce, will really reduce the problem of recruitment and retention, emphasises that all doctors are equal, and has put together a really good package of things for equalities.”
We recognise that since those comments were made, the new contract has been rejected in a ballot of BMA members. However, it is deeply perplexing for patients, NHS leaders and, indeed, the Government that the reaction of the BMA leadership, which previously supported the contract, is now to initiate the most extreme strike action in NHS history, inflicting unprecedented misery on millions of patients up and down the country. We currently expect up to 100,000 elective operations to be cancelled and up to a million hospital appointments to be postponed, which will inevitably have an impact on our ability to hit the vital “18 weeks” performance standard.
Today I want to reassure the House that the Government and the NHS are working round the clock to make preparations for the strikes. All hospitals will be reviewing their rotas to ensure that critical services such as accident and emergency, critical care, neonatal services and maternity services are maintained. The priority of all NHS organisations is to ensure that patients have access to the healthcare they need and that the risks to patients are minimised, but the impact of such long strikes will severely test that. As with previous strikes, we cannot give an absolute guarantee that patients will be safe, but hospitals up and down the country will bust a gut to look after their patients in this unprecedented situation and communicate as soon as possible with people whose care is likely to be affected.
Turning to the long-term causes of the dispute, it is clear that for the BMA negotiators it has been largely about pay, but I recognise that for the majority of junior doctors there is a much broader range of concerns, including the way their training is structured, the ability to sustain family life during training periods, the gender pay gap and rota gaps. After the May agreement, we set up a structured process to look at all these concerns outside the contract and I intend that that work will continue.
Health Education England has been undertaking a range of work to allow couples to apply to train in the same area, to offer training placements for those with caring responsibilities close to their home, to introduce a new catch-up programme for doctors who take maternity leave or time off for other caring responsibilities, and to look at the particular concerns of doctors in their first year of foundation training. Today, HEE has set out further information for junior doctors about addressing these non-contractual concerns, and we are proceeding with the gender pay review that I mentioned in my last statement to the House on this issue.
We have also responded to specific concerns raised by the BMA. First, the BMA, NHS Employers and Health Education England have agreed changes to strengthen whistleblowing protections for junior doctors beyond the scope of existing legislation, so that junior doctors can take legal action against the HEE, in relation to whistleblowing, as if the HEE was their employer. Secondly, in direct response to the concerns raised by Dr McCourt over the role of the independent guardians of safe working hours, NHS Employers has written to all NHS chief executives to set out in considerable detail the expectations for the new guardian role. As of 2 September, 186 of 217 guardians had been appointed with the involvement of BMA representatives, with a further 15 interim arrangements in place, and it is expected that all will be appointed by the middle of this month.
Many junior doctors have expressed concern about rota gaps, and the new contract acknowledges and tackles this concern. The guardians of safe working hours will report to trust and foundation trust boards on the issue of rota gaps within junior doctor rotas. This will shine a light on the issue and it will be escalated, potentially to the Care Quality Commission and the General Medical Council, when serious issues are not addressed. I strongly urge all those considering taking industrial action to consider the progress being made in all these areas before making their final decision.
With respect to the broader debate about seven-day care, we recognise that many doctors have concerns about precisely what is meant by a seven-day NHS. As Sir David Dalton stated publicly last week, we offered to insert details of our seven-day plans in the May agreement, but this was rejected by the BMA, so it is very disappointing that it now says the need for more clarity over seven-day services is one of the reasons for the strike, but given that it has said that, I would like to repeat further reassurances on that front today.
First, while the changes to the junior doctors contract are cost-neutral—that is, the overall pay bill for the current cohort of junior doctors will not go up or down—our seven-day services policy is not cost-neutral, and will be funded out of the additional £10 billion provided to the NHS this Parliament. Secondly, while the pay bill for the current number of junior doctors will not increase, we do expect the overall pay bill to go up as we have committed to employing many more doctors to help to meet our commitment on seven-day services. That means that our plans are not predicated on simply stretching the existing workforce more thinly or diluting weekday cover.
Thirdly, we recognise that junior doctors already work very hard, including evenings and weekends, and while we do need to reduce weekend premium rates that make it difficult to deploy the correct levels of medical cover, we expect this policy to have greater implications for the working patterns of other workforce groups, including consultants and diagnostic staff. Finally, we have no policy to require all trusts to increase elective care at weekends. Our seven-day services policy is focused on meeting four clinical standards relating to urgent and emergency care, meaning that vulnerable patients on hospital wards at weekends will get checked more regularly in ward rounds by clinicians, and clinicians will be able to order important test results for their patients at weekends.
Despite these reassurances, there may remain honest differences of opinion on seven-day care, but the way to resolve them is through co-operation and dialogue, not confrontation and strikes which harm patients. To those who say these changes are demoralising the NHS workforce, I simply say that nothing is more demoralising or more polarising than a damaging strike. It is not too late to turn decisively away from the path of confrontation and to put patients first, and I urge everyone to consider how their own individual actions in the coming months will impact on people who desperately need the services of our NHS.
This Government will not waiver in our commitment to make the NHS the safest, highest-quality healthcare system in the world, and I commend this statement to the House.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The prospect of a rolling five-day strike by junior doctors was one of the utmost gravity. The junior doctors have suspended next week’s action, which is a step I believe the whole House welcomes, but the remaining programme of industrial action stays in place. If it eventually goes ahead, it will be the first such strike by junior doctors in the entire history of the national health service.
What the current situation shows is that there has been a complete breakdown in trust between junior doctors and the Government. The morale of junior doctors could not be lower, and that is not something for the Secretary of State to dismiss. But somehow the Secretary of State continues to take no responsibility for the current state of affairs—no responsibility for repeatedly arguing that the only problem was that doctors had “not read the contract”, no responsibility for the misleading use of statistics by claiming that thousands of patients were dying because of poor weekend care.
The president of the Royal College of Paediatrics and Child Health, Professor Neena Modi, said:
“despite concerns raised by senior officials, Jeremy Hunt persisted in using dubious evidence about the so-called ‘weekend effect’ to impose a damaging Junior Doctor contract under the bogus guise of patient safety”.
The Secretary of State still insists that the contract is about a seven-day NHS when we know now that his own officials were telling him that the NHS had too few staff and too little money to deliver what he was talking about.
The Secretary of State well knows that the public simply do not believe him in his attempt to demonise the junior doctors. Try as he might, he has failed to convince the public that somehow junior doctors are the “enemy within” or mere dupes of the BMA. Far from being manipulated, doctors voted emphatically against the new contract.
Everyone in this House will remember the 7/7 bombings and the No. 30 bus which exploded in Tavistock Square, a few yards from the headquarters of the British Medical Association. Everyone will remember the pictures of doctors, who had been in meetings and their offices, pouring out of the BMA building, heading for the 14 dead people and the 110 victims, without flinching or faltering, fulfilling their vocation of saving lives. These are the people that the Secretary of State seeks to vilify.
Today we know that the junior doctors—who, contrary to what the Secretary of State implied, have always made patient safety a top priority—have cancelled the action planned for next Monday, but if we are going to remove the threat of industrial action, there are questions that the Secretary of State has to answer. There are widespread reports of deficits and financial crises, so how can the NHS move to enhanced seven-day week working, even with the proposed £10 billion the Secretary of State mentioned in his statement, when there are not the resources to maintain the status quo?
I welcome the structural work going on outside the contract on issues such as work-life balance, the gender pay gap, the rota gaps, strengthening whistleblowing protections for junior doctors and, importantly, looking at the role of guardians of safe working hours, but the Secretary of State talked in his statement about confrontation: what could be more confrontational than seeking to impose a contract? Even at this late stage, I ask him to listen to the junior doctors’ leader, Dr Ellen McCourt, when she says:
“We have a simple ask of the Government: stop the imposition. If it agrees to do this, junior doctors will call off industrial action.”
The public are looking for the Secretary of State to try to meet the junior doctors: stop vilifying them, stop pretending they are the “enemy within”, and meet their reasonable demands.
Mr Hunt
I will respond to the hon. Lady’s comments, but she needs to be very clear to the House about the implications of Labour’s position on this. She has just said that she welcomes the suspension of next week’s industrial action, but that was not her position at the weekend. At the weekend, when the medical royal colleges, the General Medical Council and even The Observer criticised the proposed strike, what was she saying? She was saying that she would join them on the picket line—something her predecessor refused to do. The fact is that strikes cause harm, misery and despair for families up and down the country. When one of the most extreme members of the BMA junior doctors executive, Dr Yannis Gourtsoyannis, said that these strikes were
“the single most positive thing that has occurred within NHS politics in decades”,
what was Labour’s response? Did it condemn that? No. The shadow Chancellor actually invited him to advise Labour on policy. I just say this because—
Mr Speaker
We are always grateful to the hon. Member for Worthing West (Sir Peter Bottomley) for whatever counsel he might wish to proffer, even if it is done from a sedentary position.
Mr Hunt
Thank you, Mr Speaker.
The shadow Health Secretary needs to recognise that working people, the people her party claims to represent, need a seven-day NHS. The vulnerable people that Labour claims to represent get admitted to hospital at the weekends, and in industrial disputes patients should always matter more than politics. The next time she meets a constituent who has suffered because of not having a seven-day service or because their operation has been cancelled because of a strike, she and her colleagues should hang their heads in shame.
The hon. Lady has used some very strong words. She used words such as “vilifying” and “demonising” in relation to the junior doctor workforce, and that is a very serious thing to say. I challenge her to find a single piece of evidence that has come from me or anyone in the Government, and if she cannot do so, she needs to withdraw those comments and apologise to the House. The fact is that the single most demoralising thing for the NHS workforce is strikes, because they entrench and harden positions, which results in people getting very angry, and it becomes much harder to find consensus.
The hon. Lady also talked about the use of statistics. She does not have to listen to what I say—and I understand, given the sparring that goes on between us, that she might not want to—but we have had eight academic studies in the past five years that describe increased mortality rates for people admitted to hospitals at weekends. Her response to this, in a phrase she used in another context, was that there was “zero empirical evidence” for a weekend effect. I would caution her on this, because taking that approach to hard data is exactly what happened at Mid Staffs, where hard evidence was swept under the carpet year after year because it was politically inconvenient. This Government will not make that mistake.
Finally, the hon. Lady said that my civil servants had apparently advised me that this policy would not work. Not at all. What happens with every Government policy, as you would expect, is that smart civil servants kick the tyres of every aspect of the policy to enable us to understand the risks involved. She did not mention the fact that the same document to which she referred actually says that we are on track to deliver the four clinical seven-day standards to 20% of the country by next April. I think that her constituents will welcome that, even if she does not. These strikes are going to harm patients, damage the NHS and make it harder, not easier, to resolve the challenges facing junior doctors. Labour has chosen political opportunity today, but we will do the right thing for patients.
Mr Kenneth Clarke (Rushcliffe) (Con)
Does my right hon. Friend agree that it has been an indefensible anomaly for many years that the national health service so reduces its services at weekends when the patients it serves are vulnerable to urgent or emergency conditions and need the highest standards of care for chronic conditions on a seven-day basis? Will he continue to make what he has described as careful progress? Will he also make it clear that the seven-day service will not simply do routine work and that it will be introduced as resources and staffing allow in line with civilised conditions? Further, on the strange politics of the dispute that keeps coming back to haunt him, does he agree that while the BMA has always been one of our most militant trade unions and while the Labour party has been very left wing in its leadership before—most notably in the 1980s—it is almost inconceivable that at any time in the past such extreme militant action that threatens patients would have been supported by the BMA or the Labour party? They are now opposing a contract that union leaders praised as a sensible settlement, given the improvements that it offered, only two or three months ago.
Mr Hunt
As ever, my right hon. and learned Friend speaks incredibly wisely. Actually, his last comment goes to the nub of why this is totally extraordinary, unprecedented and completely unacceptable. It is true that the junior doctors have rejected the agreement that was reached in May in a ballot, and we have to accept that. There are all sorts of reasons why that might have happened, but the choice to escalate the industrial action and to call the worst strike in NHS history was made not by those junior doctors but by the BMA leaders. They made that decision about a contract that they themselves had described as being good and safer for doctors and patients only in May. How can they justify that? Is there not perhaps a desire to pick a very big fight?
We were making good progress over the summer in a whole series of dialogues in different areas to try to resolve some of the non-contractual issues that the junior doctors are worried about, but this action makes it virtually impossible to continue that progress, although we will try very hard to do so. My right hon. and learned Friend is absolutely right to say that this is completely unacceptable and damaging for patients. I am afraid that I am having to go through some of the very same battles that he had to go through when he was Health Secretary.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I know how difficult it will be for junior doctors to take part in the strikes that have been described, and I personally am really sad that we have come to this point. Does the Secretary of State recognise the anger and desperation among the junior doctors that have led us to this point? In my mailbag from junior doctors, two things stand out. One is that the threat of imposition was there right from the word go last summer, and it therefore felt like a threat rather than a negotiation. The other involves the misuse of numerical statistical data by translating it into a claim that it refers to avoidable deaths at weekends, even though there has been no evidence of avoidable deaths. The Secretary of State has not commissioned a review of cases that might show how many of those deaths were avoidable and whether a lack of junior doctors contributed to them. The real danger in the NHS at the moment is rota gaps. Doctors are being asked to do double shifts or to carry two pagers, which means that where there should be two doctors covering an area or a service, there is only one. That is a real, palpable danger right now.
The Secretary of State has said that he would employ extra junior doctors rather than spreading the same number more thinly, but where does he plan to get them from when we cannot even fill the existing posts? I welcome the focus on the four clinical standards that boil down to greater senior doctor review and access to diagnostics, but does he not think that we might have got further if we had started at that point last summer? He calls for a turn away from strikes and for getting around the table to co-operate and discuss these matters, so when is he going to meet the junior doctors to try to avert these strikes?
Mr Hunt
The hon. Lady is a doctor, and I would simply say to her, as I said to the shadow Health Secretary, that she needs to justify the claims that she constantly makes in this Chamber about a misuse of statistics. I have been very clear about when we can actually statistically say that a death is avoidable. The studies demonstrate clearly that a higher number of people are dying from weekend admissions than we would expect. What this Government will not do is sit and ignore those numbers, which are backed up in study after study. I think that we are doing the right thing, and as a doctor she should recognise that.
The hon. Lady has said time after time over the past year that the Government should lift the plans to impose the contract and get around the table and negotiate. She could today have given the Government credit for doing exactly that in May when we thought there was an opportunity to do a deal. We lifted the imposition of the contract and got around the table to negotiate a deal that turned out to be good for both sides. Having done that, the problem is that the same people with whom we negotiated the deal have decided to call the most extreme strike in NHS history, which is unacceptable.
Rota gaps are a real problem that we are trying to address by, first, ensuring that systems are in place for junior doctors to blow the whistle if they think that such gaps are unsafe for patients. That is why we have introduced guardians of safe working, and we are committed to that. Secondly, we want to ensure that there are people to fill those rota gaps by training more doctors. We are training 11,420 more doctors in this Parliament than in the previous and already have around 9,000 more doctors than in 2010. As a doctor, those are things that the hon. Lady should recognise.
Several hon. Members rose—
Dr Sarah Wollaston (Totnes) (Con)
I welcome the BMA’s suspension of next week’s damaging industrial action. It is clear from its statement that thousands of doctors had been in touch to say that they wanted to keep their patients safe. Doctors know that they cannot do so with full, rolling, five-day walkouts. Will the Secretary of State therefore join me in asking the BMA to ballot its members to hear their views before they proceed with the other proposed, damaging, five-day walkouts?
Mr Hunt
The BMA should talk to its members much more because, as far as I could tell, the consultation over the summer showed that only a minority actually wanted this extreme series of rolling one-week suspensions of labour that the BMA supported in the end. Most junior doctors are perplexed and worried about the situation and would love to find a solution. There was a bitter industrial dispute, but we actually started a process through which trust was being rebuilt on both sides. In a series of meetings, I met the junior doctors’ leader to talk through the areas of her greatest concern and we made progress in addressing two of those four outstanding areas. Building that trust means actually sitting around the table and talking, not having confrontational strikes. I think that that is what most junior doctors want.
Norman Lamb (North Norfolk) (LD)
I want to return to the critical issue of how we ensure safe cover during the week if we expect doctors to work more hours at weekends. The Secretary of State has repeated again today that he will employ more junior doctors, but what is the timescale? What will the net increase in doctors be this year, next year and in the rest of the Parliament?
Mr Hunt
I do not have figures to hand for exactly what the number will be this year—I will certainly let the right hon. Gentleman know—but around 11,500 extra doctors will be trained during the course of this Parliament.
As I said in the statement, it is important to recognise that the changes involve not only junior doctors. We need more weekend consultant cover—that is particularly important—and more people who are able to do the diagnostic tests. A whole range of people need to take part in the changes to improve standards of care at the weekends.
Michael Gove (Surrey Heath) (Con)
I congratulate my right hon. Friend on his reasonable yet resolute approach throughout the negotiations, which has been reflected in the fact that the leaders of so many royal colleges chose to criticise the decision to go on strike. The suspension of the strike action is therefore wholly welcome.
My right hon. Friend made the point that clinical standards will be improved as a direct result of the move towards a seven-day NHS. Will he enlighten the House about which particular types of patient in which circumstances will benefit as a result of his welcome drive to improve patient care?
Mr Hunt
I am happy to do that. Indeed, I am delighted to take a question from my right hon. Friend, because it is after someone has long departed an office that people actually appreciate that big, important changes were made, which was certainly the case from his tenure as Secretary of State for Education.
One of the clinical standards states that people admitted at weekends should be seen by a senior doctor—a consultant or an experienced junior doctor—within 14 hours. They will be seen by a doctor much sooner than that, but they should be seen within 14 hours by someone experienced enough to know whether there is something to worry about. That would happen in most places during the week, but it does not happen in many places over the weekend. Another standard relates to the most vulnerable patients who are at real risk of going downhill. This is not the clinical term, but doctors say that spotting people who are going downhill is one of the most important things. Such people should be checked at least twice a day by someone experienced enough.
Those are two of the four clinical standards that we want our constituents to be reassured are in place across the country. We think that that will make a big difference.
Heidi Alexander (Lewisham East) (Lab)
The Health Secretary will know that a worrying number of A&E and maternity departments were either closed or downgraded over the summer because they simply could not get the necessary number of junior doctors: Chorley, Ealing, Stafford—I could go on. If we are training more junior doctors, why do we still have that problem?
Mr Hunt
The pressures in the NHS mean that there is a need for more doctors for all sorts of reasons, and we do not have as many doctors as we need at the moment. That is why this Government are training more doctors and putting an extra £10 billion into the NHS. The manifesto that the hon. Lady stood on just over a year ago would not have put that sort of funding into the NHS and would have meant that we were unable to train that number of extra doctors. We are doing that, but it takes time and we need to ensure that services are safe while we are getting there.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend on his balanced and reasonable approach in the negotiations despite provocation from people who really should know better. Does he agree that there cannot have been a single occasion in the history of the NHS other than this in which the General Medical Council—the body responsible for professional standards—has effectively had to intervene to stop a strike? Will he also admit that we might have underscored the centrality of Sir Bruce Keogh’s four clinical standards a little more when introducing the notion of the seven-day NHS?
Mr Hunt
In response to my hon. Friend’s last point, we have been clear from the outset about what we mean by a seven-day NHS for hospital care, but a huge amount of misinformation has been put out. This time last year, for example, the BMA was telling many people that our plans were to cut pay by between 30% and 50%. That is why strikes are damaging. Positions get entrenched on both sides and misinformation sometimes gets out, as it has done, causing a lot of anxiety.
I agree with my hon. Friend about the GMC’s significant intervention. The medical regulator is completely independent of Government and has been clear that doctors have a responsibility not to take a decision under any circumstances that would lead to their patients being harmed.
Dr Rosena Allin-Khan (Tooting) (Lab)
As the Secretary of State knows, prior to taking up this office in June I was an emergency medicine junior doctor on the frontline of our NHS for the past 11 years. Today, doctors have listened and have halted strike action, putting patient safety first.
This is not the first time I have stood before the Secretary of State to say that I worry that the imposition of the contract does not put patient safety first. The Government can train all the extra doctors they want, but current junior doctors are leaving. The risk of having a contract imposed on them is causing them to move further afield to places such as Australia. I have always maintained that a safe seven-day NHS cannot be created with an overstretched five-day team and the rota gaps are proof of that. Doctors have listened today. Will the Secretary of State listen and please halt the imposition?
Mr Hunt
I thank the hon. Lady for what she did alongside many colleagues working in A&E departments over many years, but to call this an imposition is a mischaracterisation given what actually happened. The contract was not only agreed, but recommended and supported by the leaders of the BMA. Before she was elected, we had many discussions in the House about whether negotiations were possible and what I should do, and there were a range of different views. In the end, I listened—just as she has asked me to today—and sat down and negotiated a deal that was supported by the BMA’s leaders. That is why it is so incomprehensible that those same leaders—the people who represent her and her profession—have now called the most extreme strike in NHS history.
Sir Peter Bottomley (Worthing West) (Con)
I put it to my right hon. Friend that the choice for junior doctors or doctors in training is whether they have the old contract or the agreed contract. I have not yet had a letter from any of my doctors saying that they think the old contract is better for them, for the health service or for patients. May I therefore recommend that they sign up willingly to the new contract, that they start discussions with the BMA, and through the royal colleges, on what should happen in a few years’ time when the contract itself comes up for review and that they work to improve the non-contractual situation, which my right hon. Friend has provided a good lead on?
Mr Hunt
My hon. Friend is absolutely right on that. In May, the BMA leadership, with whom we were having a very open discussion, had satisfied themselves that on the concerns many junior doctors have about their working conditions, many of which I accept are wholly legitimate, we had done pretty much everything we could inside a contract and the work that needed to be done was on the extra-contractual things. I am talking about the way the training system works when people are being rotated to a different hospital every six months, the fact that some people were being sent to a different city from their partner and how bad that was for family life, and all sorts of other things that need to be sorted out. Ironically, since the introduction of the working time directive, things have got a lot worse for many people, although we do not want to go back to the excessive hours of before. Those were the things we were patiently working through, and the way that is done is through dialogue, not confrontation, which is why this action is such a step backwards.
Mr Dennis Skinner (Bolsover) (Lab)
Is it not a weakness of the Secretary of State’s argument that it is just conceivable that he is wrong about imposing a settlement on a seven-day week for the NHS? It takes two to cause a strike, which is why he should look at this proposal again. He is very airy-fairy about training these doctors for the future. He is not being clinically correct at all. He has heard from people who have recently worked there, so why does he not reassess this seven-day week, get around the table, stop imposing a settlement and come to a negotiated agreement?
Mr Hunt
With great respect to the hon. Gentleman, if I am wrong about this, so are the leaders of the BMA, because they said the contract that he says I should not impose was a good contract, safer for patients and for doctors, and good for the NHS, for equalities and for a range of things. The contract we are proceeding with is one that doctors’ leaders said was a good deal for junior doctors, so if we are going to resolve this, that is the contract we should proceed with.
Alistair Burt (North East Bedfordshire) (Con)
May I express my strong support for the Secretary of State, not only for the measured way in which he has handled today’s statement, but for the way in which he has conducted the negotiations, as shown by the 100-plus concessions that have been made to doctors’ negotiating positions over the past four years? Is not the inevitable logic of the BMA’s suspension of the strikes—I warmly welcome that—on the advice of other medical professionals that this should be applied in exactly the same way to the other strikes that have been called? The same logic would apply. Would it not be best for the BMA’s reputation to call off the rest of the strikes and to work with the Government on the other non-contractual areas that need to be dealt with, so that we can move forward from this, end this period of confrontation, get the health service that we all believe in and end some of this silly rhetoric coming from those who suggest that Conservative Members do not believe in the NHS?
Mr Hunt
I have a stunning new ministerial team, two of whom I am pleased to see here today, but I wish to take this moment to say how much I enjoyed working with my right hon. Friend last year. Then, as now, his advice and thoughts are very wise. The Government have made 107 concessions, and the BMA might like to think what signal it sends if that many concessions are made, an agreed deal is reached with the union leadership and the reaction then is for the most extreme strike in history to be called. What encouragement will that give to other Ministers to be moderate and reasonable in their negotiations with unions? The position being taken is preposterous and many other choices could have been made when dealing with losing the ballot, but he is right in what he says.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
A lack of workforce planning and weak financial management have led to staff shortages, which have been a major contributor to this dispute. The Department of Health accounts and NHS England accounts, which came out on 21 July, underlined that weakness in financial planning, with the Comptroller and Auditor General saying clearly that he had real concerns about the future sustainability of NHS funding. We have, however, heard the Secretary of State say again today that the £10 billion available is to solve the issue about the seven-day NHS, but we have also heard that money promised for many other things by the head of NHS England. Does the Secretary of State really have a plan for the financial sustainability of the NHS? If so, what is it?
Mr Hunt
We do and we are implementing it. I know that the hon. Lady has looked at this in great detail, and I simply say, in broad terms, that following the tragedy of what happened at Mid Staffs the NHS was very honest about how some of the poor care there was happening in other places and NHS trusts decided that they needed to have more staff in their hospital wards. The poor workforce planning that she talked about, which goes back many decades in the NHS, meant that the result was an explosion in the use of agency staff, the cost of which rose to more than £3.5 billion in the last financial year, which has put huge pressure on finances. The lesson that we must take away, not just for the junior doctors’ strike, but for financial sustainability, is that we need to be better at workforce planning and training up the number of doctors and nurses that we need.
Several hon. Members rose—
Dr Julian Lewis (New Forest East) (Con)
In other words, I am totally unqualified as a medical doctor. Therefore, may I ask a question about democratic mandates? I appreciate that, unlike a referendum, a general election does not give an entirely specific mandate on every proposal put forward, but will the Secretary of State take the opportunity to remind the House and the country of how central the proposal for a seven-day NHS was to the Conservative manifesto as far as his Department was concerned?
Mr Hunt
My right hon. Friend is right, as that was our only really substantive promise in terms of a commitment to the NHS at the last election. We are funding it and we have an absolute obligation to the British people to deliver on it. That is why in that short period after the last election I felt I had to be clear with the BMA that we were going to deliver on that manifesto promise. If the BMA had reflected on that, it might have perhaps behaved differently from how it did.
Diana Johnson (Kingston upon Hull North) (Lab)
In the light of the ongoing dispute and concerns about patient safety, has the Secretary of State given any consideration to the idea of compulsory independent arbitration, binding on both sides, to settle disputes where patient safety and public safety is in dispute? Will he look at that?
Michael Fabricant (Lichfield) (Con)
Last Thursday, I was at Queen’s hospital in Burton having a minor skin procedure—hence my black eye—where I met not just junior doctors and consultants, but patients. Let me tell my right hon. Friend how concerned they are about this series of strikes. They just do not understand it, as one junior doctor said to me—he may or may not have been in the minority. Dr Johann Malawana, the previous BMA representative for junior doctors, said that this was a “good deal” for junior doctors—I noted that down at the time. One point that was made to me was that this constant defence of BMA action by the Labour party and, in particular, by the Labour spokesman is regarded as being encouragement for these strikes, whether she means to do it or not. May I urge her to say, “Look, it is not good enough. It is not good enough for patients and it is not good enough for the NHS”?
Mr Hunt
My hon. Friend is absolutely right. All of us in this debate have one simple thing to consider: what is the right answer for the people we represent? They understand that there are financial constraints and that the NHS cannot do everything, but they do want us to strive to make it safer and better the whole time. It is a surprise and a disappointment that we do not hear more of that language from the Labour party.
Bill Wiggin (North Herefordshire) (Con)
My constituents who are patients do not want this strike, and I do not believe that my constituents who are doctors want this escalation in industrial action. If it is the case that only 4% of doctors support this escalation, should the BMA not again check its mandate?
Mr Hunt
It absolutely should. The BMA has been out of step with both the British public and its own members this week. My hon. Friend’s own hospital in Hereford—Hereford county hospital—is in special measures. It has a huge number of problems, which it is working really hard to sort out, and we are helping it to sort them out. Is that not what we should be focusing on in the NHS, rather than having to do contingency planning for these damaging strikes?
Alex Chalk (Cheltenham) (Con)
Does the Secretary of State agree that the actions of the BMA in warmly backing the contract in May only to condemn it in August and call for these extreme strikes have seriously damaged its credibility? On the issue of pay, which we know from the leaked WhatsApp messages is the only red line, can he confirm that no doctor working legal hours will be paid less?
Mr Hunt
Yes, I can absolutely confirm that. We have put in place pay protection to make that happen. My hon. Friend is right that this is very damaging for his constituents in Cheltenham. Given that there is so much pressure in the NHS, the junior doctors who are thinking of striking must ask themselves whether it is really going to help their organisation respond to those pressures if it has this enormous distraction—this incredible demoralisation that we get with these kinds of strikes.
Mike Wood (Dudley South) (Con)
Does my right hon. Friend share my disappointment that the BMA leader who co-authored the new contract and said that it was beneficial for our patients and for our junior doctors is now trying to whip up support for a series of strikes that every credible medical leader has said would be disproportionate and harmful to patients?
David Morris (Morecambe and Lunesdale) (Con)
The fact that these strikes are occurring and being called off is very serious, especially against the backdrop of this contract. One of my constituents, who is a doctor, the chairman of Doctors in Unite and the deputy chairman of the BMA, stated in the Sunday Times that this issue could be used to beat the Tories and make the country great again. Does my right hon. Friend agree that it is appalling that patients across the country are being used as pawns in the political game of “Corbynista-ism”?
Mr Hunt
I completely agree. I am afraid that this is where I am very, very disappointed with the Labour party. Thrilled though it might be to have so many supporters of the leader in the more extreme ranks of the BMA, it helps no one to try to use the NHS as a political pawn and to weaponise the NHS as it tried so destructively to do before the last election.
Mr Philip Hollobone (Kettering) (Con)
Kettering general hospital is under pressure on a number of fronts. Even if the industrial action does not take place, the threat of it diverts key personnel from their normal difficult task of contingency planning, filling rotas and making sure that patients stay as safe as possible. Does my right hon. Friend agree that even the threat of industrial action does huge harm to our hospitals and the NHS?
Mr Hunt
I am more than happy to agree with my hon. Friend. The staff at Kettering general hospital work extremely hard. I have been there, as he knows. It is a very busy hospital. One shudders to think what the impact would be if we removed a third of the doctor workforce in a hospital such as that.
Philip Davies (Shipley) (Con)
I was just reading an article from earlier in the year from The Guardian newspaper, which said that Saturday working is the major sticking point in the junior doctors’ dispute. Does the Secretary of State agree that any doctor who goes on strike over premium rates of pay on a Saturday, which most people in this country do not get when they work on a Saturday, should hang their heads in shame? Will he give a commitment that he will not make any further concessions, as he has already given far too many. Is it not time to look at whether we stop doctors from going on strike altogether in the NHS, as is the case with other emergency services?
Mr Speaker
It may be the first occasion upon which the hon. Member for Shipley (Philip Davies) has vouchsafed to the House that he is a Guardian reader.
Mr Hunt
I was nervous mentioning the fact that the Government have made 107 concessions when I saw that my hon. Friend might be in the Chamber because I knew that, for him, that would be 107 too many. His broader point is absolutely spot on. The working terms and conditions for Saturdays for junior doctors in this new contract are better than they are for nurses, police officers, fire officers and for those in many other parts of the economy. That is why I think it is a fair deal that everyone should recognise and welcome.
Kevin Foster (Torbay) (Con)
I know that the Secretary of State will agree that what sums up this dispute is that, under the existing contract unless the new one is brought in, we could be treated by a doctor working their 91st hour in a week. Does he agree that it is absolutely bizarre to see this level of strike action called when even the BMA’s own council was so divided over whether to support it?
Mr Hunt
That is absolutely right. What my hon. Friend is alluding to is the fact that, in the new contract, we are reducing the maximum hours that any doctor can be asked to work in any one week from 91 hours to 72 hours. There are all sorts of other safeguards that benefit safety. He is right. This should not be happening, and I urge the BMA to reconsider.
Richard Drax (South Dorset) (Con)
May I offer my support to my right hon. Friend. I have never heard him vilify the doctors, as he was accused of doing. That language was not appropriate in this debate. Is he aware—I have heard this from one chief executive—that hospitals have been told not to speak to the junior doctors to try to resolve the dispute within the hospitals and the foundation trusts themselves? If there has been such an instruction, does he agree that it will not help solve the dispute for the future?
Mr Hunt
I am very surprised to hear that. If my hon. Friend wants to pass me the details, I will happily look into it. On the ground, the management of hospitals are working very closely with not just junior doctors, but BMA representatives to try to do everything they can to keep patients safe if these strikes go ahead.
Mr Speaker
Order. I am most grateful to the Secretary of State and to colleagues. Proceedings Time for conclusion of proceedings First day New clauses, new schedules and amendments to clauses and schedules relating to corporation tax. Two hours after the commencement of proceedings on the motion for this Order. New clauses, new schedules and amendments to clauses and schedules relating to tax avoidance and evasion. Four hours after the commencement of proceedings on the motion for this Order. New clauses, new schedules and amendments to clauses relating to VAT on women’s sanitary products. Six hours after the commencement of proceedings on the motion for this Order. Second day New clauses, new schedules and amendments to clauses and schedules relating to capital gains tax. 4.30 pm New clauses, new schedules and amendments to clauses relating to insurance premium tax; remaining new clauses, new schedules and amendments to clauses and schedules; remaining proceedings on consideration. 6 pm
Finance Bill (Programme) (No. 2)
Ordered,
That the following provisions shall apply to the Finance Bill for the purpose of supplementing the Order of 11 April 2016 in the last Session of Parliament (Finance (No. 2) Bill: Programme)):
1. Paragraphs (11) and (12) of the Order shall be omitted.
2. Proceedings on Consideration shall be taken on the days shown in the following Table and in the order so shown.
3. The proceedings shall (so far as not previously concluded) be brought to a conclusion at the times specified in the second column of the Table.
4. Proceedings in Legislative Grand Committee and proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at 7 pm on the second day of proceedings on consideration.—(Jane Ellison.)
NHS England: Annual Assessment
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today, I am laying before Parliament my annual assessment of the NHS commissioning board (known as NHS England) for 2015-16. I am also laying NHS England’s annual report and accounts for 2015-16 (HC311). Copies of both documents will be available from the Vote Office and the Printed Paper Office.
NHS England’s annual report and accounts includes a self-assessment of performance which describes an organisation that has experienced a year of both progress and challenge. NHS England continues to deliver high-quality care as it progresses with implementing the vision set out in the five year forward view delivering constancy of direction, consistency of leadership and effectiveness of delivery.
In response, my annual assessment welcomes the good progress that NHS England has made against many of its objectives including managing the commissioning system. Additionally it has continued to deliver the specialised services and primary care commissioning systems and improved the operation and management of the NHS. There does, however, remain much to do in order to achieve our agreed goals by 2020. In particular, I have drawn attention to the need to address year-round performance against the standards reflected within the NHS constitution, many of which have been routinely missed this year, as well as the need to make further progress on achieving parity of esteem between physical and mental health.
Although NHS England met its objective to deliver financial balance in the commissioning system this year, the provider sector remains financially challenged. To achieve its financial objective in 2016-17, NHS England must work with its system partners and the Department of Health to jointly deliver a balanced budget across the NHS as well as delivering its share of the productivity and efficiency savings identified in the NHS five year forward view.
Overall NHS England has made progress during 2015-16 but there remains much more to do. The extra real-terms investment of £8.4 billion agreed as part of the 2015 spending review is evidence of this Government’s continuing commitment to the NHS. My Department and I will continue to work with NHS England and its partners to ensure that this investment is used to build on the good work seen so far and to deliver an NHS that provides safe, compassionate and reliable care for those who need it while living within its means.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-21/HCWS105/.
[HCWS105]
NHS Shared Business Services
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
NHS Shared Business Services (SBS) has today published a statement regarding an issue with a mail redirection service which was formerly provided by NHS SBS on behalf of NHS England as part of the Primary Care Support Service.
This matter is also referred to in my Department’s annual report and accounts, published today, copies of which are available in the Vote Office and Printed Paper Office. I will of course keep the House updated in future as investigations are carried out by NHS England and Shared Business Services and as they seek to determine the effect of this issue.
Attachments can be viewed online at: http://www.parliament. uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-21/HCWS120/.
[HCWS120]
Junior Doctors Contract
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
In May, the Government and NHS employers reached an historic agreement with the British Medical Association on the new contract for junior doctors after more than three years of negotiations and several days of damaging strike action. That agreement was strongly endorsed as a good deal for junior doctors by the leader of the BMA’s junior doctors committee, Dr Johann Malawana, and was supported publicly by the vast majority of medical royal colleges. However, it was rejected yesterday in a ratification ballot: 58% voted against the contract, so, on the basis of a 68% turnout, around a third of serving junior doctors actively voted against the agreement.
It is worth outlining key elements of the agreement that was voted on. The agreement does indeed help the Government to deliver their seven-day NHS manifesto commitment, but it also does much more. It reduces the maximum hours junior doctors can be asked to work, introduces a new post in every trust to make sure the hours asked of junior doctors are safe, makes rostering more child and family-friendly, and helps women who take maternity leave to catch up with their peers. The president of the Royal College of Physicians, who had opposed our previous proposals, stated publicly:
“If I were a trainee doctor now, I would vote ‘yes’ in the junior doctor referendum.”
Unfortunately, because of the vote, we are now left in a no-man’s land, which, if it continues, can only damage the NHS.
An elected Government whose main aim is to improve the safety and quality of care for patients have come up against a union that has stirred up anger among its own members that it is now unable to pacify. I was not a fan of the tactics used by the BMA, but, to its credit, its leader, Johann Malawana, did, in the end, negotiate a deal and work hard to get support for it. Now that he has resigned, it is not clear whether anyone can deliver the support of BMA members for any negotiated settlement.
Protracted uncertainty precisely when we grapple with the enormous consequences of leaving the EU can only be damaging for those working in the NHS and for the patients who depend on it. Last night, Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, said that the NHS and junior doctors needed to move on from this dispute and that if the Government proceed with the new contract it should be implemented in a phased way that allowed time to learn from any teething problems. After listening to this advice and carefully considering the equalities impact of the new contract, I have this morning decided that the only realistic way to end this impasse is to proceed with the phased introduction of the exact contract that was negotiated, agreed and supported by the BMA leadership.
The contract will be introduced from October this year for more senior obstetrics trainees; then in November and December for foundation year 1 doctors taking up new posts and foundation year 2 doctors on the same rotas as their current contracts expire. More specialties such as paediatrics, psychiatry and pathology, as well as surgical trainees, will transition in the same way to the new contract between February and April next year, with remaining trainees by October 2017.
This is a difficult decision to make. Many people will call on me to return to negotiations with the BMA, and I say to them: we have been talking, or trying to talk, for well over three years. There is no consensus around a new contract and, after yesterday’s vote, it is not clear whether any further discussions could create one. However, the agreement negotiated in May is better for junior doctors and better for the NHS than the original contract that we planned to introduce in March. Rather than try to wind the clock back to the March contract, we will not change any of the new terms agreed with the BMA.
It is also important to note that, even though we are proceeding without consensus, this decision is not a rejection of the legitimate concerns of many junior doctors about their working conditions. Junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends. They have many concerns, for example, about rota gaps and rostering practices. In the May ACAS agreement, NHS employers agreed to work with the BMA to monitor the implementation of the contract and improve rostering practice for junior doctors. Last month, at the NHS Confederation’s annual conference, I set out my expectation that all hospitals should invest in modern e-rostering systems by the end of next year as part of their efforts to improve the way that they deploy staff. I hope that the BMA will continue to participate in discussions about all these areas.
Furthermore, this decision is not a rejection of the concerns of foundation year doctors who often feel most disconnected in that period of their training before they have chosen a specialty. Again, we will continue to make progress in addressing those concerns under the leadership of Sheona MacLeod at Health Education England, and we will continue to invite the BMA to attend those meetings.
We will also continue with a separate process to look at how we can improve the working lives of junior doctors more broadly, which will be led by the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer). I very much hope that the BMA will continue to participate in that process as well.
We will not let up on efforts to eliminate the gender pay gap. Today, I can announce that I will commission an independent report on how to reduce and eliminate that gap in the medical profession. I will announce shortly who will be leading that important piece of work, which I hope to have initial considerations from in September.
Most importantly, this is not a decision to stop any further talks. I welcome Dr Ellen McCourt to her position as new interim leader of the junior doctors committee. I had constructive talks with her during the negotiations. Although we do need to proceed with the implementation of the new contract to end uncertainty, my door remains open to her or whoever takes over her post substantively in September. I am willing to discuss how the new contract is implemented, extra-contractual issues such as training and rostering, and the contents of future contracts.
To me personally and to everyone in this House as well as many others, it is a matter of profound regret that, at a time of so many other challenges, the BMA was unable to secure majority support for the deal that it agreed with the Government and NHS employers, but we are where we are.
I believe the course of action outlined in this statement is the best way to help the NHS to move on from this long-running contractual dispute and to focus our efforts on providing the safest, highest-quality care for patients. I commend the statement to the House.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The NHS is only as strong as the morale of its staff, and the rejection of this contract by the junior doctors sadly reveals that morale and trust in the Government are at rock bottom. Yesterday, to mark the 68th anniversary of the NHS, I visited my local hospital, Homerton University hospital, and met some of the wonderful nurses. One of their main concerns was the abolition of the bursary, but they were also genuinely worried that NHS staff were no longer valued. The Secretary of State must accept that his handling of the junior doctor dispute has exacerbated this feeling among all NHS staff.
I have sat in this Chamber and heard the Secretary of State say that junior doctors have not read the new contract, do not understand the new contract, or have been bamboozled by their leadership, but now that the junior doctors have rejected a renegotiated contract recommended by their leadership, he must begin to understand that his handling of this dispute has contributed to the impasse. There should be no suggestion that the junior doctors’ decision is somehow illegitimate. The turnout in the ballot was higher than in the general election in 2015.
I welcome the fact that the Secretary of State will not let up on efforts to eliminate the gender pay gap and that he will commission an independent report on how to reduce and eliminate that gap, and look at shared parental leave as well. That is an important concern among doctors. I also welcome the fact that the imposition of the contract will be phased, but at this time of general instability I urge the Government to reconsider imposing the contract at all.
It has not helped for the Government to treat junior doctors as the enemy within. It has not helped junior doctors’ morale that it was implied at one time that the only barrier to a seven-day NHS was their reluctance to work at weekends, when so many of them already work unsocial hours, sacrificing family life in the process. I am glad that the Secretary of State acknowledged today that junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends, but the vote to reject the contract is a rejection of the Government’s previous approach.
The Secretary of State knows that the BMA remains opposed to the imposition of any contract, believing that imposing a contract that has not been agreed is inherently unfair and an indictment of the Secretary of State’s handling of the situation. The junior doctors committee is meeting today to decide how it will proceed. Labour Members look forward to hearing the outcome of that meeting and how we can best continue to support the junior doctors.
Public opinion is not on the Government’s side. It is evident that the public will have faith in their doctors long after they have lost faith in this or any other Government. It is not too late to change course. The Government need urgently to address the recruitment and retention crisis and scrap the contract. Although I appreciate that the contract has been in negotiation for many years, the Government should give talks with the junior doctors one more chance. If they crush the morale of NHS staff, they crush the efficacy of the NHS itself.
Mr Hunt
I welcome the hon. Lady to her place for the first statement to which she has responded and welcome her on the whole measured tone, with one or two exceptions. I will reply directly to the points she made.
First, the hon. Lady maintains the view expressed by her predecessor, the hon. Member for Lewisham East (Heidi Alexander), who is in her place this afternoon, that somehow the Government’s handling of the dispute is to blame. We have heard that narrative a lot in the past year, but I say with the greatest of respect for the hon. Member for Hackney North and Stoke Newington (Ms Abbott)—I do understand that she is new to the post—that that narrative has been comprehensively disproved by the leaked WhatsApp messages that were exchanged between members of the junior doctors committee earlier this year.
We now know that, precisely when the official Opposition were saying that the Government were being intransigent, the BMA had no interest in doing a deal. In February, at the ACAS talks, the junior doctors’ aim was simply to
“play the political game of…looking reasonable”—
their words, not ours. We also know that they wanted to provoke the Government into imposing a contract, as part of a plan to
“tie the Department of Health up in knots for…months”.
In contrast to public claims that the dispute was about patient safety, we know that, in their own words,
“the only real red line”
was pay. With the benefit of that knowledge, the hon. Lady should be careful about maintaining that the Government have not wanted to try to find a solution. We have had more than 70 meetings in the past year and we have been trying to find a solution for more than four years.
The question then arises whether we should negotiate or proceed with the introduction of the new contracts. Let me say plainly and directly that if I believed negotiations would work, that is exactly what I would do. The reason I do not think they will work is that it has become clear that many of the issues upsetting junior doctors are in fact nothing to do with the contract. Let me quote a statement posted this morning by one of the junior doctors’ leaders and a fierce opponent of the Government, Dr Reena Aggarwal:
“I am no apologist for the Government but I do believe that many of the issues that are exercising junior doctors are extra-contractual. This contract was never intended to solve every complaint and unhappiness, and I am not sure any single agreement would have achieved universal accord with the junior doctor body.”
The Government’s biggest opponents—in a way, the biggest firebrands in the BMA—supported the deal and were telling their members that it was a good deal, which got rid of some of the unfairnesses in the current contract and was better for women and so on. If the junior doctors are not prepared to believe even them, there is no way we will be able to achieve consensus.
If the hon. Lady wants to stand up and say that we should scrap the contract, she will be saying that we should not proceed with a deal that reduces the maximum hours a junior doctor can be asked to work, introduces safeguards to make sure that rostering is safe and boosts opportunities for women, disabled people and doctors with caring responsibilities—a deal that was supported by nearly every royal college. If the alternative from Labour is to do nothing, we would be passing on the opportunity to make real improvements that will make a real difference to the working lives of junior doctors.
The hon. Lady and I have a couple of the more challenging jobs that anyone can do in this Chamber. She has been in the House for much longer than I have, so she will know that. The litmus test in all the difficult decisions we face is whether we do the right thing for patients and for our vulnerable constituents, who desperately need a seven-day service. The Government are determined to make sure that happens.
Dr Sarah Wollaston (Totnes) (Con)
I welcome today’s statement and thank the Secretary of State for dealing with many of the extra-contractual issues that have blighted the lives of junior doctors. I join him in regretting the outcome of the ballot. Like my right hon. Friend, I welcome Doctor Ellen McCourt to her post. I know that my right hon. Friend will work constructively with the junior doctors committee to try to resolve the outstanding issues. In proceeding in a careful, measured way with the imposition of the contract, will he work to reassure the public that if patient safety issues arise during that process, he will deal with them?
Mr Hunt
I thank my hon. Friend for her measured tone and for being an independent voice throughout the dispute. I spoke to Dr Ellen McCourt earlier this afternoon. I appreciate that she is in a very difficult situation, but I wanted to stress to her that, as I told the House this afternoon, my door remains open for talks about absolutely anything and that I am keen to find a way forward through dialogue. I had lots of discussions with Dr McCourt when we were negotiating the agreement in May, and I know that she approached those negotiations in a positive spirit.
We have set in place processes, and that is one of the reasons why Professor Bailey recommended phased implementation—so that if there are any safety concerns, we can address them as we go along. The Minister with responsibility for care quality, my hon. Friend the Member for Ipswich, is leading a process that will keep looking at the issues to do with the quality of life of junior doctors. NHS Employers is leading a process that will look in detail at how the contract is implemented. Absolutely, the point of the changes is to make care safer for patients; we will continue to keep an eye on this to make sure that it does so.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I, too, am disappointed by the outcome of the ballot yesterday. It has to be recognised that it reflects a real desperation and unhappiness among junior doctors, who are dealing with increased demand and pressure. They have felt that, at times, the tone of the negotiations has left a lot to be desired. The threat of imposition was there from the start, and they felt that hanging over them.
I welcome several things in the statement, and I absolutely welcome its very measured tone. I welcome the attempt to tackle the gender pay gap, to deal with unhappy foundationers and to limit hours. I would say that junior doctors’ biggest concern is rota gaps. In some specialties, the rate is as high as one in four, so one doctor covers the role of two. That is a real patient safety issue, and patient safety is meant to be the whole point of the contract. I welcome the fact that the contract will be phased in, and I call on the Secretary of State to ensure absolutely that, as this goes forward, he will learn, because junior doctors’ concern is about how we spread a short-staffed workforce across more days. I called for the contract to be phased in through a trial, and it is being phased in, but in a different way. We need to recognise the pain that the vote represents.
Mr Hunt
I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.
Mr Kenneth Clarke (Rushcliffe) (Con)
I congratulate the Secretary of State on taking the only responsible decision that he could take, in the interests of the service and patients, to bring this sad, extraordinarily long episode to an end. I also congratulate him on being conciliatory, because he made concessions in May to produce the final contract, and now he is phasing it in, in its negotiated form. I hope that we get back to a peaceful settlement. Does he agree that the surprising fact that so many dedicated junior doctors were prepared to take industrial action over rather ill-defined problems with the contract shows that there is a problem with morale in the service? Will he give an undertaking that the very welcome steps that he has announced today to try to address the wider issues will last not just a few months, until the dust settles on this dispute, but will be part of a continuous process to make sure that we restore to the service the morale and dedication on which we all know the NHS relies?
Mr Hunt
As ever, my right hon. and learned Friend speaks with great wisdom and experience. He is absolutely right to say that tackling the morale deficit in the NHS has to be a key priority. That is why we have to recognise that for doctors—particularly junior doctors starting out on their medical careers—the most depressing and dispiriting thing of all is when they cannot give the patients in front of them the care that they want to. That is why we are looking at a number of things to make it easier for doctors to improve the quality of care. One of the things that is particularly challenging and that we in this House have to think about and discuss a lot more is how difficult doctors and nurses find it to speak out if they see poor care, or if they or a colleague make a mistake, because they are frightened of litigation, a General Medical Council referral, or disciplinary action by their trust. The problem is that people then do not go through the learning processes necessary to prevent those mistakes from happening again. The key is creating a supportive environment, in which learning can really happen, in hospitals.
Heidi Alexander (Lewisham East) (Lab)
If I believed that the benefits for patients of pushing ahead with this contract outweighed the impact that its imposition will have on junior doctor morale, recruitment and retention, I would support the Health Secretary, but I do not believe that. Can he tell the House which clause of which Act of Parliament gives him the power to force hospitals to introduce the contract? If he cannot tell us that, can he outline the legislative basis on which Health Education England could withhold funding from trusts that choose not to proceed with it?
Mr Hunt
Health Education England is absolutely clear that it has to run national training programmes, and that is why it has to have standard contracts across the country. As the hon. Lady knows well from her previous role on the Front Bench, in reality foundation trusts have the legal right to set their own terms and conditions, but they currently follow a national contract; that is their choice, but because they do that, I used the phrase “introduction of a new contract” this afternoon. I expect, on the basis of current practice, that the contract will be adopted throughout the NHS.
I enjoyed working with the hon. Lady when she was shadow Health Secretary, but on this issue, she was quite wrong, because she saw the WhatsApp leaks, which revealed that the British Medical Association had no willingness or desire for a negotiated settlement in February, precisely when she was saying at the Dispatch Box that I was the one being intransigent. She gave a running commentary on the dispute at every stage, but when those leaks happened, she said absolutely nothing. She should set the record straight and apologise to the House for getting the issue totally wrong.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend on the patience that he has shown on this matter, and on the deal that was agreed back in May—it is a good deal. Apropos of the remarks of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who speaks for the Opposition, does the Secretary of State agree that it is indeed important to maintain morale in the health service? We need to be very careful about striking special deals for one particular part of the workforce, and the perception that that might be unfair. Would he further agree that we need to avoid the temptation of addressing every single grievance of a particular workforce? That is more properly within the bailiwick of managers locally than national contracts.
Mr Hunt
My hon. Friend obviously speaks from experience and very sensibly on this issue. In this House, of course, we think about the actions of politicians, Ministers and so on, but for doctors in a hospital, the most important component of their morale is the way that they are treated by their direct line manager. One of the things that worries me most in the NHS, looking at the staff survey, is that 19% of NHS staff talk about being bullied in the last year. That is ridiculously high. We need to think about why that is. The reality is that it is very tough on the frontline at the moment. There are a lot of people walking through the front doors of our NHS organisations, and we need to do everything that we can to try to support doctors and nurses, who are doing a very challenging job.
Paula Sherriff (Dewsbury) (Lab)
Instead of blaming the BMA, will the Secretary of State acknowledge that yesterday’s result was indicative of the fact that a significant proportion of medical staff have lost confidence in him? More than ever, running the NHS requires the good will of its staff. How does he intend to restore that confidence?
Mr Hunt
Actually, in my statement I took the trouble to praise BMA leaders. Admittedly, at the outset I did not agree with their tactics at all, but they did then have the courage to negotiate a deal and try really hard to get their members to accept it. I respect them for doing that. Part of the problem was that in the early stages of the dispute, there was a lot of misinformation going around. There were a lot of doctors who thought, for example, that their salary was going to be cut by about a third. That was never on the table and never the Government’s intention. A lot of doctors thought that they were going to be asked to work longer hours. That, too, was the opposite of what we wanted to do. I am afraid that that created a very bitter atmosphere. I simply say that, in the end, the best way to restore morale is to support doctors in giving better care to their patients, and that is what the NHS transformation plan is all about and what we are working on.
Sir Peter Bottomley (Worthing West) (Con)
Around 10 years ago the mishandled introduction of MMC—modernising medical careers—and the medical training application service started some of the problems for junior doctors. I pay tribute to the BMA who, in the discussions up to May, helped to agree with NHS England employers changes to the proposed contract, which were to the benefit of doctors in training? I say to the Secretary of State and, through him, to the employers that I hope they will pay attention to the extra-contractual issues which are of concern to doctors, and that the BMA will catch up with the rest of us in saying that we rely on them and others in hospitals to give a good, safe service to patients. They need to work together with everybody else and we will support them in doing that.
Mr Hunt
I am absolutely prepared to give that assurance and I thank my hon. Friend for his comments. He is right. We can look at MTAS and such changes. We can go even further back and look at the introduction of the European working time directive—strange to bring that up in the current context—and the shift system, which sensibly reduced some of the crazy hours that junior doctors were being asked to work, but unfortunately at the same time got rid of the “old firm” system which gave junior doctors a sense of collegiality, meant that there was a consultant whom they knew and related to, and made their training a lot more rewarding and satisfying. That was disrupted when we introduced the shift system and the maximum hours limits. We need to think about—and we are doing some very important work on this—how we could recreate some of that sense of collegiality, which is particularly missing for junior doctors in the first two years of their training, before they have joined a specialty.
Diana Johnson (Kingston upon Hull North) (Lab)
With morale among junior doctors at rock bottom, and Hull having an historic problem with recruitment and retention, what particular initiatives is the Secretary of State going to use to allow the health service in Hull to have the number of doctors that we need to function properly and provide the high-quality care that we all want to see?
Mr Hunt
There is one very good doctor in the Hull A&E department, and that is Dr Ellen McCourt, who has taken over as leader of the junior doctors committee—at least, I imagine she is very good; I have been very impressed every time I have met her. There are particular pressures at Hull, and as the hon. Lady knows we have had management changes. So far we have not seen the improvement in performance that we would like. I am aware that there are big issues with the infrastructure— the physical buildings. We will continue to work with the NHS locally and with the trust to try to improve the situation. She is right to bring it to my attention.
Sir Oliver Heald (North East Hertfordshire) (Con)
I join my right hon. Friend in expressing sadness at the decision of the vote. He will remember that on previous occasions I have raised with him some family-friendly aspects of the lives of junior doctors. Does he agree that it is important to look at the training situation, where a couple can be sent to different towns many miles apart; the rostering, which can make family life difficult; and some of the problems of returners to work, whose training perhaps needs to be properly considered? Will he confirm that he will continue to look at these issues and that, as the monitoring and phasing goes ahead, he will try to address them?
Mr Hunt
My hon. and learned Friend is correct to have raised that before and I can reassure him that we have subsequently started a very big piece of work to look at those exact issues. The difficulty is that throughout their training junior doctors are rotated every six months. That is particularly disruptive to family life or, for example, if they have a partner and one is sent to Sheffield and the other to Bristol. We are seeing what we can do to deal with that. The other issue that we are looking at is that of people who for family reasons discover that they have a caring responsibility, maybe for children or for a parent with dementia, and want to switch to a specialty that may not have quite so many unsocial hours, and whether it is possible to novate their training across from one specialty to another, which does not happen at present.
Liz McInnes (Heywood and Middleton) (Lab)
We are all congratulating each other on the measured tone of this debate, but Dr Johann Malawana has said in very measured tones:
“Given the result, both sides must look again at the proposals and there should be no transition to a new contract until further talks take place.”
Will the Health Secretary commit to hold further talks in order to avoid further conflict and the possibility that he may provoke further strike action if he does not? If he provokes further industrial action among the junior doctors, the blame will lie fairly and squarely at his open door.
Mr Hunt
Let me tell the hon. Lady the words that Dr Malawana actually said:
“I will happily state that I think this is a good deal.”
He talked about junior doctors benefiting from
“massively strengthened areas of safety precautions…equalities improvements, improvements to whistleblowing protection and appropriate pay for unsocial hours.”
He thought this deal was a big step forward. As I said, if I thought that there was any prospect of further negotiations leading to a consensus that could get the support of the BMA membership, that is what I would be doing, but my honest assessment of the situation—given that the people who most strongly opposed the Government recommended accepting this deal and still they were not listened to—is that there is no such prospect, and I therefore need to take the difficult decision that I have taken this afternoon.
Helen Whately (Faversham and Mid Kent) (Con)
There has been a negotiation, the Secretary of State has listened to the concerns of junior doctors, we now have a better contract, and we heard today that there will a phased introduction of it. Does my right hon. Friend agree that junior doctors now need to move forward and that they should take up the offer to be involved in work to improve the experience of junior doctors in training? We know that junior doctors do not feel valued. They should feel valued. They need to play their part in making sure that they are valued.
Mr Hunt
My hon. Friend is right to say that. One of the things that is clear to me is that the reason that the May deal is better than the deal that we were going to introduce in February is because of the involvement of the BMA and the BMA leaders in telling us the concerns of junior doctors at the coalface, and the specific niggles and annoyances, many of which we were able to sort out very straightforwardly. I strongly hope that junior doctors will remain in all the discussions that we have, so that we try to get even better solutions.
Steve Rotheram (Liverpool, Walton) (Lab)
At the start of his statement, the Secretary of State used sophistry to try to call into question the result of the ballot, by implying that 58% did not provide legitimacy for the rejection of the Government contract offer. Does he regret using smoke and mirrors, and does he agree that if his flawed methodology were used for other electoral processes, he would not be sitting in this House, there would not be a Tory Government, and we would still be in the EU?
Mr Hunt
The hon. Gentleman has misinterpreted what I said. I am clear on this. I said in my statement that 58% voted against the contract, and I accept that that was a majority of BMA members. I stated the fact that on a 68% turnout, around a third of serving junior doctors actively voted against the contract. That is factually correct.
Maggie Throup (Erewash) (Con)
I thank my right hon. Friend for all his efforts in agreeing a deal that was acceptable to the junior doctors’ leaders. In effect, the junior doctors have now voted against their own trade union. I welcome the way forward that the Secretary of State has outlined, but will he reassure the House that patients and their safety will always be his No. 1 priority?
Mr Hunt
I am happy to give that assurance. One of the most exciting things in the NHS, despite a lot of the doom and gloom in the headlines, is that we are seeing a transformation in safety culture. Even though we are now doing about 4,500 more operations every day, the proportion of patients being harmed is down by about a third in just three years. I think there is a transformation, but of course there is a lot more to do, as I am no doubt going to hear.
Andrea Jenkyns (Morley and Outwood) (Con)
I am shocked that we are here yet again. If we look at the history, 90% of the contract has been renegotiated. There have been years of negotiations. This contract is far safer for patients. Regardless of what the Opposition say, it cannot be laid at the Secretary of State’s door if the junior doctors decide to take strike action. We should stop using patients as pawns and put patients first. I would like to thank the Secretary of State for his perseverance. Does he agree that, through its relentless pursuit of partisan politics, the BMA has backed itself into a corner and put patients at risk?
Mr Hunt
The way patients have suffered—there have been over 20,000 cancelled operations during this process—has been very disappointing. My hon. Friend is absolutely right to campaign on issues of hygiene and cleanliness, which lead to so many tragedies when they are not properly attended to. I hope we can move on now. I do believe that, despite the disappointing rejection of this deal in the ballot, some trust has been established between the leaders of the BMA and the Government, and we have had a productive dialogue. We have made a number of changes to the May contract since announcing it—things that they suggested and that we agreed to. I would like to continue that process and build that trust.
Huw Merriman (Bexhill and Battle) (Con)
Having been somewhat of a burden on the NHS myself over the months as a result of playing football—unsuccessfully—with the hon. Member for Ellesmere Port and Neston (Justin Madders) in December, I spent an hour on the day of the all-out strike talking to the junior doctors who treated me. They asked me if I could tell the Secretary of State and the BMA that there is a need and a desire for more talks. May I thank the Secretary of State for showing flexibility? He does a difficult job extremely well, and it is appreciated on the Government Benches. I am absolutely saddened that a deal on this contract has not been brokered in the way we thought it would in May. Will he ensure that those junior doctors who move on to this contract are made well aware of how unpopular the previous contract was in the medical profession and that this contract’s terms are well sold so that junior doctors are reassured about them?
Mr Hunt
I am more than happy to do that. I think that the vast majority of junior doctors think that what has happened is a tragedy and are keen to move on. I hope they take seriously my assurances this afternoon that we will be monitoring every stage of the implementation of this contract, and if there are further things that we can improve, we will do exactly that, because we want a contract that is good for them and good for patients.
Robert Jenrick (Newark) (Con)
Weeks like the ones we have just lived through put other matters into perspective. With that in mind, I am sure the Secretary of State will agree with me that it is absolutely right for patients and the country that this dispute ends now. I was delighted to hear that he is now reluctantly going to move to phase in the imposition of the contract. Will he, in his usual conciliatory manner, now turn a page on this dispute, end it completely and build a new relationship with junior doctors and the new interim head of the BMA’s junior doctors committee?
Mr Hunt
My hon. Friend speaks very wisely. I would certainly very much like to do that. It does take two to tango, but the Government certainly want to do everything they can to work with all the leaders of the different bodies in the medical profession, partly for the reason my hon. Friend gave—that the country is very preoccupied with even bigger issues—but partly because there is so much pressure on the NHS frontline, and it is just counterproductive to exhaust so much energy on these disputes when we could talk our way around them and avoid them.
Mrs Flick Drummond (Portsmouth South) (Con)
I am always last, but I am very grateful for being asked to speak. Does the Secretary of State have any indication of how many junior doctors actually read the contract, rather than relying on the BMA or rumours? The junior doctors I have talked to have not read it, and one said it was too long.
Mr Hunt
I thank my hon. Friend for her interest—it is last but not least, for sure, in her case. Many junior doctors are now aware of the bones of the contract. I am sure some of them have not read it, just as others have. However, I think the issue has been that a lot of them have read it and have felt that it does not answer every single problem they face today as a junior doctor. Unfortunately, there is no contract that can solve every single pressure they face at the stroke of a pen, and I suspect that that is why a number of them voted to reject the contract. What I would say to them is that we have a contract that is an improvement on what they had before, so let us go with that and try to address the other issues as best and as quickly as we can.
NHS Spending
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Perhaps I will cut down my speech a bit. I give a particularly warm welcome to all my Back-Bench colleagues here; it is wonderful to see them coming out in support in such numbers. I thank the shadow Health Secretary for calling this debate. She is right to talk about the issues of NHS funding—though not particularly through this motion, which I will come on to speak about. I welcome her to her first Opposition day debate, as I welcomed her earlier to her first statement. This is a brief that she knows well, having been shadow Public Health Minister, and having campaigned on a lot of very important topics, including plain paper packaging for cigarettes. She has done a lot of work with the all-party sickle cell and thalassaemia group as well. I wish her luck in two areas. The first is with her parliamentary questions, after last week’s question to the Department for International Development about a drought in Indonesia, when it was in fact in the Philippines. Secondly, I wish her luck finding some Front-Bench colleagues, just as I need luck finding some Back-Bench colleagues in these debates.
We are in agreement on Brexit; we were both on the remain side, and I campaigned strongly with the hon. Lady. I agree with her that however much we may have disagreed with the vote, it is very important that we respect it. She and I both worried about the damage that it might do to our economy and society if we left, but we also agree that it would do incredible damage to something even more important than them—to our democracy—if the British people were to think that the Westminster establishment was trying somehow to ignore their decision.
From the reasonable tone of her comments, I know that the hon. Lady understands that Vote Leave was not speaking for the Government when it said that there would potentially be an extra £350 million for the NHS. In fairness to the Vote Leave campaigners, at various points they clarified downwards that slogan on the side of the bus and said that they were really talking about a net figure of more like £100 million that could potentially go to the NHS, rather than £350 million.
Mr Hunt
The point that many of us made in the referendum campaign is that even the net figure—the more like £100 million net contribution that we make to the EU—is not a figure that we can bank on with any certainty because, even if it did materialise after an exit from the EU, it would be negated by the very smallest of contractions in the economy, which would itself reduce the tax base and the amount of public spending available. The Institute for Fiscal Studies said that that £100 million a week would be negated by a contraction in the economy as small as 0.6%. I do not think any of the economic forecasts said that the contraction would be as small as that; all of them said that it would be much bigger than that.
Mr Jamie Reed (Copeland) (Lab)
I share the right hon. Gentleman’s concerns about—with your permission, Mr Speaker—the lie on the side of the bus. As Secretary of State for Health, will he now, on behalf of the whole country, and particularly on behalf of people who were deceived and let down by that claim, take up with the Electoral Commission why that lie was allowed to stand for so long?
Mr Hunt
I understand the hon. Gentleman’s concerns. Let me give him a challenging reply. The trouble that we have—those of us who disagree with the outcome—is that that issue was exhaustively debated and, for whatever reason, people chose to disbelieve our concerns or decided that they were not worried about it.
I understand why the shadow Health Secretary has brought the motion before the House, but the reason it is a difficult one to debate is that essentially the argument about the £350 million, or the £120 million, or the £100 million is dependent on the state of the economy. That is something that we cannot know now, only 12 days after the Brexit vote result. However worried we are about the impact of that vote, in discussions about the economy we have to be careful not to talk it down, because in the end we have a responsibility to recognise that there may be opportunities and we need to make the most of the ones that exist.
Mr Bailey
I understand the point that the right hon. Gentleman is making. On the other hand, I believe the Treasury has downgraded our prospective growth rate from 2% to 0.5%. Presumably, future spending plans will be based on that revised future growth rate. Is it not reasonable, therefore, to start making the assumptions that he has been wary of making so far?
Mr Hunt
It is perfectly reasonable to make the assumptions that the hon. Gentleman mentions, and there are plenty of reasons why we could look at some of the early impact on the economy even in the past 12 days and be concerned about the potential impact on the tax base and public spending more broadly. My nervousness as a Minister about talking those things up is that I do not want to talk down the British economy. Even though, as I say, I campaigned against the Brexit vote, I recognise that we are now going to leave the EU, I want the economy to be successful and I want us to make the most of the opportunities that face us.
On the broader issue of NHS funding, this debate indicates that there is some consensus—the Prime Minister mentioned this earlier today at Prime Minister’s questions—on the umbilical link between the health of the economy and the amount we are able to spend on the NHS. We are proud of the fact that we were able to protect spending in the last Parliament and to increase it by £10 billion in this Parliament on the back of a growing economy. Given that Health is the second biggest spending Department, we must recognise that it is vital to the NHS that we maintain that growth, despite the choppy period we are possibly about to go through.
Mike Weir (Angus) (SNP)
I understand what the Secretary of State is saying about the health of the economy, but this debate also links to the previous debate because of the number of EU nationals who work in the health service. Has he made any estimate of the cost to the health service if all these EU nationals were forced to leave the UK in the course of this Brexit?
Mr Hunt
We are currently doing the analysis the hon. Gentleman is concerned about, but I should just say to him that I accept the Home Secretary’s assurance and confidence that we will not end up in a situation where EU nationals, upon whom we absolutely depend in the health and social care system, and who do an absolutely outstanding job, would not be allowed to remain in the UK. She has said she is very confident that we will be able to negotiate a deal whereby they are able to stay here as long as they wish and to continue to make the important contribution they do, and I accept that assurance.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
Further to the point made by the hon. Member for Angus (Mike Weir), will the Secretary of State give the House an assurance that he will release that analysis and that it will be sufficiently comprehensive to allow us to see a regional breakdown of the significance of EU nationals working in our health service?
Mr Jamie Reed
On the point my hon. Friend the Member for Harrow West (Mr Thomas) has just made about having an assessment if we do end up, essentially, forcibly repatriating EU citizens in the United Kingdom, there will of course be a flip side: something like 3 million British expats in the EU would have to return to the UK as well. Many of them are, to put it politely, of pensionable age, with challenging health demands in many regards. Will the Secretary of State also provide an assessment of what effect that would have on the national health service?
Mr Hunt
I am sure that that is analysis we can do, but I cannot do it at the Dispatch Box as a direct response to the hon. Gentleman. However, as I am sure he is well aware—we made this point during the whole Brexit referendum debate—we have reciprocal health arrangements with other EU countries at the moment. Those are immensely convenient to people travelling to and visiting other European countries, because they mean those people can access healthcare completely free of charge. The bill is actually sent to the Government, and that arrangement includes pensioners who have retired to Spain and France and Italy as well. It would be very sad if, as a result of the new relationship with the EU, we lost that convenience. That is one of the reasons why I am confident that other EU countries will be happy for British pensioners to remain in them. As long as those countries are able to charge us for the healthcare costs, the burden to them should be minimal.
Dr Rosena Allin-Khan (Tooting) (Lab)
The Secretary of State spoke about NHS spending. Does he agree that cuts to local government spending on social care are putting increased financial pressures on the NHS? At St George’s hospital, a cost of £1.3 million has been attributed to inefficient discharges.
Mr Hunt
First, may I welcome the hon. Lady to her place as a doctor and as someone who knows a great deal about NHS matters? Although I am sure we will not agree on every health matter, it is always valuable and a great asset to have someone with medical experience in the House, and I am sure she will make a huge contribution in that respect. She is absolutely right to say that what happens in the social care system has a direct impact on what happens in the NHS, and that we cannot—as, in fairness, happened under Governments of both colours over many years—look at the NHS and the social care system as completely independent systems when we know that inadequate provision in the social care system has a direct impact on emergency admissions in A&E departments. She is right to make that point.
Let me make a broader point in concluding my comments. I think that there would be agreement across this House on the huge pressure on the NHS frontline at the moment, and that there is recognition of some fantastic work being done by front-line doctors and nurses to cope with that pressure. I shall give a couple of examples of the extra work that is happening, compared with six years ago. The A&E target is to see, treat and discharge people within four hours. Every day, we are managing to achieve that, within the four-hour target, for 2,500 more people than six years ago. On cancer, we are not hitting all our targets, but every single day we are doing 16,000 more cancer tests, including 3,500 more MRI scans, and treating 130 additional people for cancer. There are some incredible things happening.
However, we all recognise, and this perhaps lies behind the Opposition’s concerns in bringing this motion to the House, that in healthcare we now deal with the twin challenges of an ageing population, in that we will have 1 million more over-70s within the next five years—a trend that is continuing to grow—and of the pressure of scientific discovery, which means we have new drugs and treatments coming down the track. They are exciting new possibilities but also things that cost money. I for one, as Health Secretary, believe that as soon as economic conditions allow, we will need to start looking at a significant increase in health funding. That is why it is incredibly important, as we go through the next few years negotiating our new relationship with Europe, that we work very hard to protect the economic base that we have in this country, the economic success that we have started to see, and the jobs that do not just employ a lot of people but create tax revenues for this country. It is incredibly important that we pilot the next few years with a great deal of care, because what happens on the economy will have a huge impact on the NHS.
Mr Thomas
I am grateful to the right hon. Gentleman for giving way, and, if he will forgive me for saying so, temporarily fond of him as a result, because he is allowing me to raise a particular constituency concern. Northwick Park hospital, which serves my constituents, currently has a deficit of almost £100 million and is having to axe 140 staff posts as a result of the lack of funding for my local clinical commissioning group, by comparison with other parts of London. Will he undertake to look specifically at the issues facing Northwick Park hospital and Harrow clinical commissioning group as his further analysis of the need for additional spending in the NHS is taken forward?
Mr Hunt
I am very happy to do so. I have visited that hospital, where the challenges very much reflect what the hon. Member for Tooting (Dr Allin-Khan) said about links to the social care system. It was clear to me that the staff in the A&E department are working incredibly hard getting people through it, but struggling to discharge people from the hospital, which is why they were not hitting their target.
I have just been handed a note by a ministerial colleague, Mr Speaker, which I hope you will indulge me and let me read out, because I have never been handed such a note before. It says: “Apparently everyone wants to go and watch Wales play, so Whips happy if you felt you wanted to shorten your remarks.” On that basis, I will conclude by thanking the shadow Health Secretary for bringing this motion to the House and for her comments in support of it.
Mr Speaker
The right hon. Gentleman is not only an experienced member of the Cabinet but a very seasoned parliamentarian, and I think he is well attuned to the feeling in the House, as I am sure that other colleagues will now also be—not that I am hinting or anything.
Oral Answers to Questions
Jeremy Hunt Excerpts(10 years ago)
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Martyn Day (Linlithgow and East Falkirk) (SNP)
3. If he will make an assessment of the potential effect of the UK leaving the EU on the availability of NHS services for (a) EU nationals living, studying and working in the UK and (b) UK citizens abroad.
The Secretary of State for Health (Mr Jeremy Hunt)
Before I start, the House will want to mark an important milestone, which is that this year, alongside Arnold Schwarzenegger, Brian May, Camilla Parker Bowles and Meat Loaf, the NHS is 68 years old, and its birthday is, in fact, today. I know that we will all want to wish the NHS and all who work there a very happy birthday.
As long as the UK is subject to EU law, current arrangements remain in place. As we move to a new relationship with Europe, our guiding principle will be to get the best possible deal for British citizens who live and work in, and who visit, EU countries. An EU unit will be set up in the Cabinet Office and will report to the Cabinet, and my Department will feed into its work.
Martyn Day
I am aware that nothing will change for the next two years, but what is the Secretary of State’s proposal for reciprocity of access to healthcare within the EU, and does he envisage the £500 NHS immigration health surcharge applying to EU nationals already living in the UK?
Mr Hunt
The health surcharge that this Government have instituted for people on long-term visas to come and work and live in the UK is the right thing to do, because it is important that everyone makes a fair contribution to the cost of NHS services. In terms of future arrangements for EU nationals in the UK, that would obviously be subject to the negotiations that now happen, and a very important part of those negotiations will be access to the EU health systems for British citizens currently living in EU countries.
Mr Philip Hollobone (Kettering) (Con)
Will the Secretary of State tell the House how many EU nationals work in the national health service and how many EU nationals use the national health service? Is it not the case that the number of eastern Europeans, especially, coming to this country has simply overwhelmed GP practices and A&E centres up and down the country, and now we have got a chance to redress the balance?
Mr Hunt
Without wanting to reopen the debate that concluded on 23 June, the overwhelming view in the NHS is that we are very lucky to have the incredible support of 110,000 EU nationals working in the health and social care system. I want to put on record to this House what a fantastic job they do and how much we are all in their debt.
Norman Lamb (North Norfolk) (LD)
Very many of those 110,000 people are now acutely anxious about their future in this country, because of the despicable suggestion that they should be used as a bargaining pawn in negotiations with the EU. Will the Secretary of State ensure that the Government, as a matter of urgency, guarantee their future in this country doing their dedicated work in our NHS and care system?
Mr Hunt
I can reassure the right hon. Gentleman that we are incredibly aware of the brilliant work that EU nationals do, not just in the NHS but in the social care system, which he was responsible for, in care homes up and down the country. We recognise that, and I hope that he will be reassured by statements made by the Foreign Secretary and the Home Secretary yesterday that we want to find a way of allowing those people to stay in the UK for as long as they wish to. We recognise the incredibly valuable contribution that they make, and we are confident in the negotiations ahead that we will be able to secure the outcome that they and we all want.
Heidi Alexander (Lewisham East) (Lab)
The last time the Secretary of State and I had an exchange in this Chamber, I suggested to him that it might be the final time we would face each other over the Dispatch Box. Although I was clearly prescient, it has not quite turned out the way I thought it would.
Following the results of the referendum, will the Secretary of State say whether he still intends to introduce an NHS charges Bill as outlined in the Queen’s Speech? Does he agree that migrants give more to the NHS than they take, that their contribution should be welcomed and that our NHS simply could not survive without them?
Mr Hunt
I enjoyed our many exchanges in this House, and it is a loss on our side as well that they will not continue. I would like to welcome the hon. Lady’s successor to her post, and I hope that I will have a chance to do so again when she asks a question later.
I agree with the hon. Member for Lewisham East (Heidi Alexander). Migrants, or the people who work in the NHS who come from different countries, make an extraordinary contribution. It is fair to say that the NHS would fall over without the incredible work that they do. It is also true that the British people voted to control migration on 23 June, and we have to accept that verdict. In terms of the NHS and social care system, I did not hear, and I have not heard in my time as Health Secretary, enormous amounts of worry about the pressure of migration on NHS services, because on the whole migrants tend to be younger and fitter people. While accepting the verdict of the British people and what they said on 23 June, the important reassurance that we now need to give is to the many people from outside the UK who make a fantastic contribution to the running of our health and care system.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State may be aware that in the wake of the Brexit vote NHS commissioning bosses have delayed funding for vital medicines and services because of the fall in the value of the pound. One affected patient is Abi Longfellow, the teenager who won her battle for a wonder drug thanks to a campaign by the Sunday People. Abi currently spends 11 hours a day on a dialysis machine and was due to start on a drug that would give her a fighting chance with a kidney transplant. We were all aware that the pound might fall post referendum, so will the Secretary of State explain why no contingency plans were put in place and what he will do to ensure that, despite the Brexit vote, patients like Abi receive the lifesaving treatments and medicines that they need?
Mr Hunt
First, I welcome the hon. Lady to her position. She is the third shadow Health Secretary I have faced in less than a year, and I am beginning to worry that it may be something personal. I wish her well; she knows the brief extremely well and has campaigned on it a great deal in her long parliamentary career. I will look into the case she brought up. I would not want anyone to be deprived of vital lifesaving drugs because of exchange rate fluctuations. The whole British economy, including the NHS, will have to deal with the economic shock that we may now face as a result of the Brexit vote. But now that the decision has been taken by the British people we must look for the opportunities for the UK and the NHS, and not simply worry about the uncertainties, although there will be lots of things we have to deal with.
John Howell (Henley) (Con)
4. What plans his Department has to increase capacity in general practice and primary care.
David Warburton (Somerton and Frome) (Con)
10. What plans his Department has to increase capacity in general practice and primary care.
The Secretary of State for Health (Mr Jeremy Hunt)
We will be investing an extra £2.4 billion a year in general practice by 2020-21, a 14% increase in real terms. The General Practice Forward View, published earlier this year, sets out a package of support for general practice to boost the workforce, drive efficiencies in workload and modernise primary care infrastructure and technology.
John Howell
General practitioners in Henley have recently written a letter to all their patients pointing out the difficulties they face in fulfilling their workload. Will the Secretary of State explain what the Government are doing about that and how what they are doing will help?
Mr Hunt
I am happy to do so. I recognise the picture that my hon. Friend paints—not just in Henley but across the country—of a huge increase in GPs’ workload, which they are finding extremely challenging. What have we done? We have almost 1,300 more GPs working and training in the NHS compared with 2010. We have said that by the end of this Parliament we will seek to make available an additional 10,000 primary and community care staff, including 5,000 doctors working in general practice and 1,000 physician associates. We recognise the problem and are doing something about it.
Michael Tomlinson
Given proposals for significant increases in housing across Dorset, my constituents are rightly concerned about access to services, including to GPs. Will the Secretary of State reassure me and my constituents that housing numbers will be taken into account when assessing provision and increasing capacity of general practice in Poole and Dorset?
Mr Hunt
I am happy to give my hon. Friend that assurance. NHS England looks at areas of new housing very carefully when deciding where to invest additional resources for new GP practices. I recognise those concerns. I was in Dorset at the weekend. It is a lovely place that many people retire to, and of course older people tend to use the NHS more, so it is very important that that is reflected in our investment patterns.
David Warburton
Having met GPs, health centre managers and patient groups in Frome, Wincanton and Somerton in my constituency, I know that GP recruitment is a serious problem in Somerset. What measures is the Department putting in place to address both that issue and the additional challenge of excessive agency costs, both of which are placing a considerable strain on rural health providers?
Mr Hunt
I am happy to do that—I visited a GP practice with my hon. Friend in the run-up to the last election, and I know the close interest that he takes in this issue. As I said, we are making huge efforts to recruit more GPs during this Parliament, and to do that we must increase the number of medical school graduates to 3,250 a year. We are making progress in that direction, and we have also introduced tough new rules on the use of agencies, including maximum hourly rates for agency doctors and nurses.
Mr Dennis Skinner (Bolsover) (Lab)
Will the Secretary of State do something about the Hardwick commissioning group in north Derbyshire? I met it a week last Friday to talk about dementia care, which he knows is due to change a little, according to the local authorities and so on. Will he tell the group that the mad idea to close Bolsover hospital, and the hospital in Bakewell in Derbyshire Dales, should be stopped? Will he tell Hardwick commissioning group that it has gone beyond its terms of reference, and that those hospitals should remain open?
Mr Hunt
I recognise the important role that community hospitals play in many of our constituencies, and that role will change as we get better at looking after people at home, which is what people want. We can all be proud of significant progress on dementia in recent years. Dementia diagnosis rates have risen by about 50%—indeed, we think we have the highest diagnosis rates in the world. However, it is not just about diagnosis; it is about what happens when someone receives that diagnosis, and the priority of this Parliament will be to ensure that we wrap around people the care that they need when they receive that diagnosis.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Health Secretary has just promised 5,000 new GPs, and GP Forward View mentions recruiting 500 GPs from overseas. I understand that Lincolnshire GP leaders are looking to recruit GPs from Spain, Poland and Romania. As we have heard, EU nationals who live in the UK and work in the NHS are seen by the Home Secretary as bargaining chips, which has made them incredibly nervous about their status. How successful does the Health Secretary think that that GP recruitment will be?
Mr Hunt
This is a time when all sides of the House should be seeking to reassure many people from other countries who do a fantastic job in our NHS that we believe they will have a great future here. The Home Secretary has prioritised doctors, paramedics and nurses in the shortage occupation lists, and in all countries that have points-based systems—look at what happens in Australia or Canada—the needs of the health service and health care system are usually given very high priority.
Keith Vaz (Leicester East) (Lab)
Mr Speaker, let us note another milestone this year: your election yesterday as a freeman of the City of London. We look forward to you bringing your own flock of sheep to Westminster in future.
The Secretary of State will know that we are facing a diabetes crisis, and by 2025, 5 million people will have been diagnosed with diabetes. There are 32,000 pharmacies in the United Kingdom, with 13,000 community-based schemes. Given that 99% of the population live near a pharmacy, does the Secretary of State agree that more diabetes work should be given to pharmacies, to try to ease the burden and pressure on general practitioners?
Mr Hunt
There is a lot of potential in what the right hon. Gentleman says. The financial pressures on the NHS and general practice mean that this is the right moment to rethink the role of pharmacies, and consider whether we can be better at tapping into the incredible skills that pharmacists have as trained clinicians, which I do not think we make the most of. He is right to say that diabetes and childhood obesity is a big priority for the Government, and I hope we will be able to inform the House more about that soon.
Imran Hussain (Bradford East) (Lab)
5. How much funding he plans to make available for the proposed pharmacy access scheme.
The Secretary of State for Health (Mr Jeremy Hunt)
Since 2010, we have invested £37 million in improving the physical environment of over 140 maternity units and purchasing equipment to improve safety. We now have 2,103 more midwives in the NHS and 6,400 more in training than in 2010.
Will Quince
Expectant parents in Colchester are among the first in the UK to have hypnobirthing courses—I recently attended one myself. What consideration has the Secretary of State given to the effectiveness of hypnobirthing in improving maternity safety?
Mr Hunt
A variety of pioneering techniques, which could make a huge difference to women’s experience of birth, are emerging. I am delighted that we are seeing lots of experimentation and innovation. I would particularly like to pay tribute to my hon. Friend’s trust, which is in special measures and has been through a very difficult period. The fact that it is still managing to do this kind of innovation is wholly to be commended.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Has the Secretary of State seen the Autism Commission report on barriers to healthcare for people with autism? In maternity care and all other care there are very severe barriers that, with the right will and the right action, we can overcome. Will he read the report and talk to me about it?
Mr Hunt
I am more than happy to do so. In fact, we have a copy of the report right here, which my Minister of State has handily given to me. When I was shadow Minister for disabled people, I had a lot of contact with parents of autistic children and with people on the autistic spectrum themselves. The hon. Gentleman makes a very important point.
Peter Heaton-Jones (North Devon) (Con)
The maternity unit at North Devon district hospital in Barnstaple in my constituency is one of the services being reviewed under the current Success Regime. Can the Secretary of State reassure me and my constituents that maternity care, and the safety thereof in what is a geographically huge region, will be the first priority under this review?
Mr Hunt
I can absolutely assure my hon. Friend on that. I know there are very big national and global events happening right now, but I want to tell the House that over the next month one of my big priorities will be to do something to improve our record on maternity safety. We have made huge progress in reducing stillbirth rates and so on, but maternity safety is still not as good as it should be and certainly not as good as in other countries in western Europe. This is an absolute priority and I hope to be able to inform the House more on this before recess.
Alison Thewliss (Glasgow Central) (SNP)
As the chair of the all-party group on infant feeding and inequalities, I welcome the new guidance issued by Public Health England, in conjunction with UNICEF Baby Friendly, on the commissioning of infant feeding services. I welcome in particular the recognition of raising infant feeding at the antenatal stage. Will the Secretary of State explain what resources the Department of Health is putting in to promote the guidance and increase breastfeeding at local levels?
Fiona Mactaggart (Slough) (Lab)
8. How many staff working in the NHS have been recruited from other European countries in the last 12 months; and if he will make a statement.
William Wragg (Hazel Grove) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
As we plan a new relationship with the EU, this Government will continue to ensure that the NHS is given the priority and stability it deserves. I have already sent a message of reassurance to all NHS staff, emphasising the vital role played by the 110,000 EU nationals working in our health and care system. To be able to allow them to continue making their outstanding contribution will be a key priority in our negotiations, and we are confident they will be able to remain in this country as long as they wish. Whatever other changes are happening at a national or international level, the commitment of the British people and this Government to our NHS and its brilliant staff remains unwavering.
William Wragg
A report published yesterday by the health journal Pulse showed that last year two thirds of young people referred by their GP for mental health services received no treatment, and moreover a third were not even assessed. I am a strong supporter of this Government’s commitment to improving mental health care, so what reassurance can the Secretary of State give today that results in child and adolescent mental health services will improve rapidly?
Mr Hunt
My hon. Friend is right to draw attention to that issue. We, too, are very proud of the progress we have made on mental health, with 1,400 more people accessing mental health services every day than six years ago, but there is a particular job to do with children and young people’s mental health, and we are putting £1.4 billion into that during the course of this Parliament—and there is a specific plan for the Manchester area, which I think will help my hon. Friend’s constituents.
Justin Madders (Ellesmere Port and Neston) (Lab)
It seems that almost every day there is another report about the deteriorating condition of NHS finances. Today we hear of a survey by the Healthcare Financial Management Association that said 67% of clinical commissioning group finance officers reported a high degree of risk in achieving their financial plan for the year, so does the Secretary of State now accept that the Government need to commit more funds to the NHS?
Mr Hunt
We have accepted that, which is why in our manifesto at the last election we were committed to putting £5.5 billion more into the NHS than was being promised by the hon. Gentleman’s party, but we have to live within the country’s financial envelope, because we know that without a strong economy we will not have a strong NHS. We will continue to make sure we get that balance right.
Andrew Stephenson (Pendle) (Con)
T5. In May, the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), gave me a very encouraging answer about improving the treatment and diagnosis of Lyme disease. Will she meet me and other concerned colleagues to discuss what more can be done to tackle that terrible condition?
Mr David Davis (Haltemprice and Howden) (Con)
T9. The Royal Free London NHS Foundation Trust recently signed an agreement to share 1.6 million patient records with Google’s DeepMind subsidiary. The data include medical history, HIV status, past drug overdoses, abortions, and all pathology, radiology and visit records. It is claimed that the data are anonymised, which is impossible given the nature of the data, and no permission was obtained from patients. It is also claimed that the agreement was made under the Secretary of State’s guidelines. Will he tell the House what he is doing to protect the privacy of such information?
Mr Jeremy Hunt
I am very happy to do so. My right hon. Friend has campaigned long and hard, and rightly so, on such issues. The truth is that the guidelines under which the NHS operates for the sharing of patient-identifiable data are not as clear as they need to be. That is why I asked the Care Quality Commission to undertake an independent investigation into the quality of data protection by NHS organisations and Dame Fiona Caldicott to update her guidelines. I hope that we will have news on that soon and certainly before the summer recess, which will please my right hon. Friend.
Nick Thomas-Symonds (Torfaen) (Lab)
Happy 68th birthday to the NHS and thank you to its creator, Labour’s Aneurin Bevan.
According to research by the British Lung Foundation, the mortality rates for lung disease have not improved over the past 10 years. Will the Secretary of State take a lesson from the Welsh Government, which have put in place a specific strategy and delivery plan to tackle the issue?
Dr Sarah Wollaston (Totnes) (Con)
Prevention of ill health has to be given a higher priority if the NHS is to meet the challenges set out in the five year forward view. Central to that will of course be the childhood obesity strategy. Has the Secretary of State had any discussions with the Prime Minister about the strategy’s future? Is he in a position to take over the strategy should No. 10 become distracted?
Mr Jeremy Hunt
I welcome my hon. Friend’s close interest in ensuring that this important agenda does not get swept aside. I can assure her that we have had many discussions inside Government about what to do. There is a strong commitment to take it forward as soon as possible, and I hope that she will get some good news on that front before too long.
Ms Margaret Ritchie (South Down) (SDLP)
Will the Minister responsible for public heath confirm when a statement on contaminated blood will be made to the House, and in particular on the response to the consultation that closed in April?
Emma Reynolds (Wolverhampton North East) (Lab)
What is the Health Secretary doing to ensure that the NHS gets the £350 million a week that it was promised during the referendum campaign?
Mr Jeremy Hunt
I am a little stumped, because I was never really sure whether we would see that money. All I can say is that I am committed to successful negotiations with the EU, and I am delighted that a number of people who championed the Brexit vote have said that any extra funding should go to the NHS.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
As we celebrate the 68th birthday of the NHS—one of the Labour party’s proudest achievements—let us not forget the fact that there are thousands of people across our country with mental health conditions who continue to face stigma, discrimination and prejudice. Recent reports tell us that young people are waiting up to a decade to receive the appropriate treatment, and future plans for children and young people’s mental health are not up to scratch. Will the Minister please tell us how many more NHS birthdays will have to pass before real equality for mental health is secured?
Alison McGovern (Wirral South) (Lab)
The Secretary of State and others have sought to reassure us that nothing changes immediately with Brexit, but that is not right for the NHS. The impact on the economy is already clear, and that will have a knock-on effect on our health service. That is why I will meet local leaders in Wirral on Friday to try to formulate a Brexit plan for the NHS. Will the Secretary of State receive that plan and take all necessary steps to protect the health service in Wirral?
Mr Jeremy Hunt
Of course, and we will take every step necessary to protect the NHS throughout the country, because it remains our most important public service. I am sure that, economically, the period ahead will be difficult, but now that we have had the argument and the British people have made their decision, it is also important that we talk up the opportunities from the new relationships that we may have in the future, and the extra funding that those could generate for the NHS, and I certainly hope that that is what happens.
Defending Public Services
Jeremy Hunt Excerpts(10 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Today’s debate, chosen by the Opposition, is about defending public services, so I want to start by stating very simply that this Government do not believe in private wealth and public squalor; quite the opposite—we believe in prosperity with a purpose, and building high quality public services is perhaps the most important purpose of all. But there is a difference between the two sides of the House. Indeed, there is more than one difference. One is that we on this side are prepared to take the difficult decisions necessary to build the strong economy that will, in the end, fund those public services. A second difference is that we go further and say that securing funding from a strong economy is not enough, and that the battle for higher standards is as important as the battle for resources. Without high standards, we let down not just the taxpayers who fund our public services but the vulnerable citizens who depend on them.
So yes, we are proud to have protected schools funding since 2010, but we are even prouder that 1.4 million more children are in good or outstanding schools. Yes, we are proud to meet our 2% of GDP defence spending pledge, but we are even prouder of the professionalism of our armed forces operating in the Mediterranean today to help to find the wreckage of the tragically lost Egyptian airliner. Yes, we are proud to have protected science and research funding, but we are even prouder that this country continues to win more Nobel prizes than any other, apart from the United States. Yes, we are proud that, since 2010 and despite the deficit, we increased NHS funding by more than was promised by the Opposition at both elections. We are even prouder that failing hospitals are being turned around, that MRSA rates have halved and that cancer survival rates have never been higher.
With that, let me turn to the NHS and say up front that nowhere is the importance of the two challenges of proper funding and high standards more stark. I pay tribute to the 1.3 million staff who work in the NHS. Whatever they have thought over the years about the politicians running their service, their dedication to patients, their hard work, night and day, and their commitment to the values that the NHS stands for make up the invisible glue that has always held it together, whatever the challenge. I know that I speak for the whole House when I thank them for their service.
Let us look at what staff have achieved over the past six years. Compared with 2010, we treat 100 more people for cancer every single day. We treat 1,400 more mental health patients, 2,500 more people are seen within four hours in A&E departments, and we do 4,500 more operations. At the same time as all of that, hospital harm has fallen by a third and patients say that they have never been treated with more dignity and respect. In the wake of the tragedy of Mid Staffs, we should recognise the huge efforts of staff at the 27 trusts that have since been placed into special measures. Eleven have now come out, three of which are now officially rated as good. Neither Stafford nor Morecambe Bay nor Basildon—three of the hospitals of greatest concern—are now in special measures thanks to excellent local leadership and superb commitment from staff.
However, all NHS staff want to know about the funding of their service. The NHS’s own plan, published in October 2014, asked for a front-loaded £8 billion increase in funding not just to keep services running, but to transform them for the future. The then shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), said that the Conservative promise to deliver that funding was a cheque that would bounce, but we delivered that promise to the British people in last autumn’s spending review, and the increase was not £8 billion, but £10 billion. It was not back-loaded, as many had feared, but front-loaded with £6 billion of the £10 billion being delivered this year.
Norman Lamb (North Norfolk) (LD)
On the Secretary of State’s point about what the NHS asked for, is it not right that the forward view set out three different efficiency savings scenarios? It was not a case of the NHS asking for £8 billion. Does he really believe that the £8 billion— £10 billion including last year’s increase—will be sufficient to meet the NHS’s demands?
Mr Hunt
The right hon. Gentleman will have heard Simon Stevens being asked that question on “The Andrew Marr Show” yesterday. He was clear that £8 billion was the minimum of additional funding that he thought the NHS needed. In fact, we supplied £10 billion, which came with some important annual efficiency saving requirements. Indeed, for that £8 billion, the NHS recognises that £22 billion of annual efficiency savings are required by 2020, because even though funding is going up, demand for NHS services is increasing even faster. I will come on to talk about how we are going to make those efficiency savings. Some in this House have observed that without £70 billion of PFI debt, without £6 billion lost in an IT procurement fiasco, and without serious mistakes in the GP and consultant contracts a decade ago, the efficiency ask might have been smaller.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
We all hear what the Secretary of State is saying: it is always somebody else’s fault. However, the fact of the matter is that I have been told by senior health professionals at the highest level—I do not watch “The Andrew Marr Show” often—that only two of this country’s health trusts are not in debt. Is that right?
Mr Hunt
That is not true, but we do all accept that there is financial pressure throughout the system. The question that is always ducked by Labour Members is how much greater that financial pressure would have been under Labour’s plans, which involved giving the NHS £5.5 billion less every year than was promised by the Government. I just point out that when Labour Members condemn the £22 billion of efficiency savings as “politically motivated”, as the shadow Health Secretary did in March, they cannot have it both ways. Her manifesto offered the NHS £5.5 billion less every year compared with what this Government put forward—
Mr Hunt
The hon. Lady shakes her head, but let us consider what the King’s Fund said in the run-up to the election:
“Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view.”
It was there in black and white: Labour was committing to a £2.5 billion increase in the NHS budget, not the £8 billion that this Government committed to. The hon. Lady cannot have it both ways. If this figure was £5.5 billion, the efficiency savings needed would be not £22 billion, but £27.5 billion, which is a 25% increase. That would be the equivalent of laying off 56,000 doctors, losing 129,000 nurses or closing down about 15 entire hospitals.
John Redwood (Wokingham) (Con)
I welcome the Secretary of State’s policy that foreign visitors should be asked to pay for non-urgent treatment that they get when they are here and that European visitors should have to recoup this through their national systems. Why do we need extra legislation, and how much money does he think we can get from that?
Mr Hunt
We need extra legislation to expedite the process. I point out to my right hon. Friend that that is another policy which has been opposed by the Labour party. All the time it says we should be doing more to get a grip on NHS finances and yet it opposes every policy we put forward in order to do precisely that. The answer to his question is that the issue with the NHS is primarily that we are not very good at collecting the money to which we are entitled from other European countries, because we are not very good at measuring when European citizens are using the NHS. This legislation will help us to put those measurement systems in place so that we can get back what we hope will be about half a billion pounds a year by the end of this Parliament.
We will no doubt hear later this afternoon the charge that the Government have lost control of NHS finances, but we strongly reject that charge. The House may want to ask about the credibility of that accusation from a party that is at the same time proposing a funding cut for the NHS and criticising the difficult decisions we need to take to sort out NHS finances.
Nic Dakin (Scunthorpe) (Lab)
Two months into this financial year, can the Secretary of State say whether or not the Department of Health broke its budget for last year?
Mr Hunt
We will find out those figures when the full audit is complete. I just say to the hon. Gentleman that efficiency savings are never easy, but a party with the true interests of NHS patients at heart should support those efficiency savings, because every pound saved by avoiding waste is one we can spend improving patient care.
Let me therefore outline to the House what we are doing to deliver those efficiencies, as well as to support NHS trusts to return to financial balance. First, we are taking tough measures to reduce the cost of agency staff, including putting caps on total agency spend and limits on the rates paid to those working for agencies. So far, that has saved £290 million, with the market rate for agency nurses down 10% since October and with two thirds of trusts saying that they have benefited. Our plan is to reduce agency spend by £1.2 billion during this financial year. Secondly, we are introducing centralised procurement under the Carter reforms. Already 92 trusts are sharing, for the first time, information on the top 100 products they purchase in real time, and we expect savings of more than £700 million a year during this Parliament as a result. Thirdly, given that the pay bill is about two thirds of a typical hospital’s costs base, we are supporting trusts to improve on the gross inefficiency of the largely paper-based rostering systems used at present. This should also significantly increase flexibility and the work-life balance for staff, as we announced last week. Finally, and perhaps most critically, we will reduce demand for hospital services by a dramatic transformation of out-of-hospital care, as outlined in the five-year forward view. If we meet our ambitions, we will reduce demand by more than £4 billion a year through prevention, improved GP provision, mental health access and integrated health and social care.
Mr Kenneth Clarke (Rushcliffe) (Con)
For as long as I can remember, unfortunately, discussions about the NHS have always been reduced to simplistic arguments about whether enough money is being spent on it, and whether efficiency is being improved enough. I think that the Government, in the present financial circumstances, have increased spending and pursued efficiency at least as effectively as any of their predecessors.
Does my right hon. Friend agree that the real issues that we ought to be considering are the rapid rise in, and the changing nature of, demand on this important service? Will he have time to consider things such as moving to a seven-day service; ending the curious divisions between the hospital service, GPs, community care and local council social services; providing for an ageing population with chronic conditions; and, at the same time, giving extra emphasis to mental health and all the things that have been neglected in the past? All these exchanges such as, “You should be spending more,” and “You are cutting, and we would spend more” are the sterile nonsense pursued by every Opposition that I can recall when they cannot think of anything positive to say.
Mr Hunt
My right hon. and learned Friend speaks with great wisdom, as he did during the junior doctors’ strike. Perhaps that is based on his experience of featuring in a BMA poster, which was put up across the country, as someone who ignored medical advice, because he smoked his cigar.
My right hon. and learned Friend is absolutely right. The crucial issue for the future of the NHS is the simple statistic that by the end of this Parliament we will have 1 million more over-70s to look after in England, and their needs are very different from those of the population whom we had to look after 20, 30 or 40 years ago. In particular, their need to be looked after well at home, before they need expensive hospital treatment, is a transformation. That is why a core part of what we are doing is to transform the services offered in mental health and in general practice, which I will come on to a bit later.
Chris Leslie (Nottingham East) (Lab/Co-op)
While the Secretary of State is talking about transformation, let me say that I agree with the right hon. and learned Member for Rushcliffe (Mr Clarke) that we have to start focusing on quality. In the east midlands, for example, the ambulance service has just been judged by the Care Quality Commission to be inadequate when it comes to patient safety. Things are in a real state of difficulty in our NHS. Ambulance services need improvement; what is he going to do about it?
Mr Hunt
I absolutely agree with the hon. Gentleman. In fact, I wanted to come on to talk about that perceived tension between money and the quality of care. Until three years ago, we did not have an independent inspection regime to go around ambulance services and tell the service, the public, constituents and Members of Parliament how good the quality of care is in each area. The first step is to have that inspection regime so that we know the truth, and then things start to happen, as is beginning to be the case in ambulance services across the country.
The big point—this is precisely what I wanted to move on to—is the worry, which is shared by many people, that an efficiency ask of this scale might impact on patient care. They should listen to the chief inspector of hospitals, Professor Sir Mike Richards, who points out that financial rigour is one of the routes to excellent quality, and that there is a positive correlation between hospitals offering the best care and those with the lowest deficits. In other words, it is not a choice between good care and good finances; we need both.
Jake Berry (Rossendale and Darwen) (Con)
Before my right hon. Friend moves on, I want to draw him back to the question of charging international visitors for the use of the NHS. The Government now charges non-EU citizens £200 per person as part of their visa application. Will he tell the House why he has chosen the figure of £200, which seems extremely low? An equivalent private healthcare policy for a year would be £800, £900 or £1,000, and an equivalent level of travel insurance for the same period would be £400 or £500. Is there not an opportunity to tier this and perhaps charge people more as they get older and become more likely to rely on the NHS?
Mr Hunt
I recognise why my hon. Friend has asked that question. We do think very hard about the level at which we set that charge, which was introduced for the first time only a couple of years ago. The reason that it is set that low—I recognise that it is quite a low charge—is that a large number of people paying it are students who tend to have low health needs and be low users of the NHS. We want to ensure that we do not create an inadvertent disincentive for people coming to the UK when they can, at the same time, choose to do their studies in Australia and America. However, it is something that we keep constantly under review.
Jake Berry
My right hon. Friend will of course be aware that there is a differential charge for students—some £150 a year rather than £200. Will he go away and consider whether there is a possibility of charging high earners who come to this country more than a couple of hundred pounds a year, because the charge does seem so low? Will he also specifically look at whether there is a possibility of charging people who are older more, as they are much more likely to rely on the NHS?
Mr Hunt
Let me repeat that we do keep this matter constantly under review. The important thing is that, for the first time, we are charging people who come to the UK on a long-term basis for their use of NHS resources. That is something that did not happen before.
Let me return to the crucial issue of this link between the quality of care and good finances. Why is it that it is so important not to see this as an artificial choice between good care and good finances? Very simply, it is because poor care is about the most expensive thing that a hospital can do. A fall in a hospital will cost the NHS about £1,200, as the patient typically stays for three days longer. A bed sore adds about £2,500 to NHS costs, with a patient staying, on average, 12 days longer. Avoidable mistakes and poor care cost the NHS more than £2 billion a year. We should listen to inspiring leaders such as Dr Gary Kaplan of Virginia Mason hospital in Seattle, which is one of the safest and most efficient hospitals in the world. He said:
“The path to safer care is the same one as the path to lower costs.”
That brings me on to the second way that this Government are fiercely defending our public services, which is our restless determination to raise standards so that people on lower incomes can be confident of the same high quality provision as the wealthiest. To their credit, the last Labour Government succeeded in bringing down NHS waiting times. I hope that that decade is remembered as one when access to NHS services improved. However, because of poor care identified in many hospitals post Mid Staffs, we should surely resolve that this decade must become the one in which we transform the safety and quality of care. Mid Staffs was the lowest point in the history of the NHS, so we must make it a turning point, or a moment that we resolve to offer not just good access to care, but care itself that is the safest and the highest quality available. The record of the past three years shows that we can do just that.
The King’s Fund has given credit to the Government for their focus on safety and quality of care. Patient campaigners have said that the NHS is getting safer and the main indicators of hospital mortality and harm are going in the right direction. However, there is much more to do, so what are our plans? First, we must deliver a seven-day NHS. It should never be the case that mortality rates are higher for people admitted at weekends than for people admitted in the week. Last week’s junior doctor contract agreement was a big step forward, but we also need to reform the consultants’ contracts, improve the availability of weekend diagnostic services and increase the number of weekend consultant-led procedures.
Secondly, a seven-day NHS also means a transformation of out-of-hospital services, especially access to an integrated health and social care system that needs to operate over busy weekends as well as during the week. It also means more GP appointments at convenient times, which is why we want everyone to be able to see a GP in the evening or at weekends. We are backing general practice with a £2.4 billion increase in its budget.
Mr David Burrowes (Enfield, Southgate) (Con)
One group of people who particularly need integrated care are those who are addicted, as their life chances are most blighted. They need to be able to make a full recovery. Will the Secretary of State tell us what has been done to support that full recovery? Like me, is he looking forward to hearing the Minister for Culture and the Digital Economy, my hon. Friend the Member for Wantage (Mr Vaizey), conclude the debate, as we will perhaps hear how blighted communities are impacted by high-stakes fixed odds betting terminals? I would like to hear what is being done by the Government on that, as we need to act now to show that we have an all-round approach to improving life chances.
Mr Hunt
It is a pleasure to sit on the Treasury Bench with my hon. Friend the Minister for Culture and the Digital Economy for the first time in several years. I will leave him to respond to that point, but I will make a broader point in response to the question from my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) which is that the change we need to make in the NHS is to prevention rather than cure. If we can stop people becoming addicted in the first place, whether to drugs, alcohol or gambling, we will reduce costs for the NHS in the long term. That is the purpose of many of our plans.
Thirdly, a seven-day NHS requires a big improvement in access to 24/7 mental health crisis care, so that whenever a problem arises we are there promptly for some of our most vulnerable people. We will deliver that alongside our broader plans to enable 1 million more people with mental health problems to access support each year by 2020.
James Morris (Halesowen and Rowley Regis) (Con)
May I commend the Government for accepting the majority of the recommendations from the independent mental health taskforce and allocating £1 billion to implement them? The Secretary of State has been talking about system change within the NHS. To deliver on the taskforce’s recommendations, we need system change to make sure that we have the sort of mental health services that the people of this country deserve.
Mr Hunt
My hon. Friend speaks with great knowledge and as chairman of the all-party group on mental health. He is absolutely right to say that we need system change. The system change we need is to stop putting mental health in a silo, but instead to understand that it needs to be part of the whole picture of treatment when a person is in hospital or with their GP; it needs to be integrated with people’s physical health needs. We need to look at the whole person. We will not get all the way there in this Parliament, but I think the taskforce gives us a good and healthy ambition for this Parliament and I am confident we will realise it.
Norman Lamb
I am pleased to hear the Secretary of State acknowledge the importance of quality of care in mental health as well, but of course there are also problems in areas such as learning disability, where there are some highly vulnerable individuals. After the shocking Southern Health exposé, does he really not think that the leadership of that organisation, which presided over some dreadful events and so many unexpected deaths not being investigated, need to be held accountable and to move on?
Mr Hunt
As the right hon. Gentleman knows, the chair of that organisation has stepped down, but he is absolutely right about accountability. Accountability needs to be about not just individual organisations within the NHS, but the people commissioning mental health care and care for people with learning disabilities. That is why, from July, we will for the first time be publishing Ofsted ratings on the quality of mental health provision and of provision for people with learning disabilities by clinical commissioning groups, so that we can see where the weak areas are and sort them out.
I conclude on quality by saying that important though a seven-day NHS is, we need to go further if we really are to make NHS care the safest and highest quality in the world. According to the respected Hogan and Black analysis, we have 150 avoidable deaths in our NHS every week. That is 3.6% of all hospital deaths with a 50% or more chance that that death could have been avoided. In the United States, Johns Hopkins University said earlier this month that medical error was the third biggest killer after cancer and heart disease, causing 250,000 deaths in the United States alone every year. That is why this year England will become the first country in the world to lead a transparency revolution in which every major hospital will publish its own estimate of its avoidable deaths and its own plans to reduce them. This year, we will focus particularly on reducing maternal deaths, stillbirths and neonatal death and harm, with plans I hope to outline soon to the House.
If we are to do that, perhaps most difficult of all will be transforming a blame culture found in too many parts of the NHS that still makes it far too hard for doctors and nurses to speak openly about medical error. Among other measures, we have set up a new healthcare safety investigation branch to conduct no-blame investigations when we have tragedies. It is modelled on the highly successful air accidents investigation branch. As in the airline industry, our model for reducing avoidable death must be transparency, openness and a learning culture that supports rather than blames front-line professionals, who in the vast majority of cases are only trying to do their best. Part of that new culture of responsibility and accountability must be a return to proper continuity of care, which is why this Government have brought back named GPs for every patient, which had been abolished in 2004, and are introducing lead consultants for people who go to hospital with complex conditions.
In conclusion, for this Government defending the NHS involves higher standards of care, wise use of resources and secure funding from a strong economy. Because the challenges we face in England are the same as in Wales, Scotland and Northern Ireland— indeed, the same as in developed countries all over the world—we should exercise caution in politicising those pressures, or we simply invite scrutiny of the relative performance of the NHS in different parts of the UK, which often shows that those who complain loudest about NHS performance in England are themselves responsible for even worse performance elsewhere.
What this Government want is simple: a safer seven-day service, backed by funding from a strong economy. Already we have delivered more doctors, more nurses, more operations and better care than ever before in NHS history.
Mr Hunt
I am about to conclude, so I shall finish, if I may.
But with that achievement comes a renewed ambition that our NHS should continue to blaze a trail across the world for the quality and safety of its care, and that is how this Government will continue to defend our biggest and most cherished public service.
Mr Jeremy Hunt
I completely defend the methodology that we used to come up with our figure, but does the hon. Lady not see the irony? She is criticising a £3.8 billion increase in NHS funding this year, when Labour’s own plans at the election last year were for a £2.5 billion increase—£1.3 billion less than this Government have delivered.
Heidi Alexander
I am grateful to the Secretary of State for that intervention. He might want to rake over the last general election but he clearly does not want to talk about the crisis in NHS finances today, with a £2.45 billion deficit among hospitals at the end of this year, cuts to public health spending, and £4.5 billion coming out of the adult social care budget over the past five years. I am quite happy to debate NHS finances with him. The truth is that the NHS is getting a smaller increase this year than it got in every single year of the previous Labour Government.
The King’s Fund and the Health Foundation concluded:
“Getting public spending figures right is important, otherwise they can mislead and detract from the real issues. The fact is that the NHS is halfway through its most austere decade ever, with all NHS services facing huge pressures.”
Heidi Alexander
I would have thought better of the hon. Gentleman, but it is clear Conservative Members want to talk about anything other than their record in England. A&E performance is currently the worst since records began, taking us back to the bad old days of the 1980s, when patients were left waiting on trolleys in hospital corridors. The figures speak for themselves.
Mr Jeremy Hunt
May I ask the hon. Lady to consider again what my hon. Friend the Member for Cheltenham (Alex Chalk) said? If A&E performance is the fault of Conservative politicians in England, is it not also the fault of Labour politicians in Wales, where it is 11% worse?
Heidi Alexander
From memory, I seem to think the budget going to the NHS in Wales has been cut in Westminster.
Let us have a look at the figures. In March 2011—[Interruption.] The Health Secretary would do well to listen to these figures, because I am about to tell him the record of his term in office. In March 2011, 8,602 patients waited more than four hours on trolleys because no beds were available. Four years later, the figure was up sixfold, to 53,641. In March 2011, just one patient had to wait longer than 12 hours on a trolley. Four years later, 350 patients suffered that experience. The NHS waiting list now stands at almost 3.7 million people—the equivalent of one in every 15 people in England. Only 67% of ambulance call-outs to the most serious life-threatening cases are being responded to within eight minutes.
I could reel off more statistics, but I will instead read a letter that I received the other week:
“Dear Ms Alexander,
I recently had the misfortune of using the A&E at my local hospital in Margate. My wife feels that I was lucky to escape with my life.
My experience has convinced me that our health service has never been more under threat than since Mrs Thatcher.
The fact that I was sent home after 4 hours without seeing a doctor and returned by emergency ambulance with a now perforated appendix I blame mostly on the conflict between the Health Secretary and the Junior Doctors. Had this been resolved he would have been able to concentrate on the woeful lack of resources our NHS faces.”
Take the experience—[Interruption.] The Parliamentary Private Secretary to the Health Secretary says, “Show us the letter”. I have it here, and I got the permission of the individual who wrote to me before referring to it.
Let me refer to another example—the experience of Mr Steven Blanchard at the Swindon Great Western hospital last November. He said in an open letter to the Swindon Advertiser:
“We arrived at 6.40pm and were asked to sit with about 15 others in the unit. It became apparent this was a place of great suffering and misery…Firstly, there was a lady who was doubled up in pain who had been promised painkillers three hours before and I witnessed her mother go again and again to reception until she was begging for pain relief for her near hysterical daughter.”
Another old lady
“who had been left on her own by her son…was sat picking at a cannula in her arm trying to pull it out…A very frail and sick old man was sat in a wheelchair and he had been in the unit since 8am. He kept saying over and over ‘a cup of tea would be nice’…then I watched as urine trailed from him and fell on to the floor beneath the chair…At 10.30pm he was taken to a ward after 14 hours.”
Mr Blanchard said that he and his partner were finally seen at 1.20 am, and stated:
“Never before have I seen people crying out of desperation…I don’t know what is to blame or whether it’s lack of money or lack of staff but this place was what I can only describe as ‘hell on earth’.”
That is what is happening in our NHS in 2016, and such stories are becoming more common. Ministers may not like to hear it, but they need to start taking responsibility.
Junior Doctors Contract
Jeremy Hunt Excerpts(10 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I will make a statement on the junior doctors contract.
For the last three years there have been repeated attempts to reform the junior doctors contract to support better patient care seven days a week, culminating in a damaging industrial relations dispute that lasted for more than 10 months. I am pleased to inform the House that after 10 days of intensive discussion under the auspices of ACAS, the dispute was resolved yesterday with a historic agreement between the Government, NHS Employers—acting on behalf of the employers of junior doctors—and the British Medical Association that will modernise the contract by making it better for both doctors and patients. The new contract meets all the Government’s red lines for delivering a seven-day NHS, and remains within the existing pay envelope. We will publish an equalities analysis of the new terms alongside a revised contract at the end of the month, and it will be put to a ballot of the BMA membership next month, with the support of its leader, the chair of the junior doctors committee of the BMA, Johann Malawana.
I express my thanks to the BMA for the leadership it has shown in returning to talks, negotiating in good faith, and making an agreement possible. I also put on record my thanks to Sir Brendan Barber, the chair of ACAS, for his excellent stewardship of the process, and to Sir David Dalton for his wisdom and insight in conducting discussions on behalf of employers and the Government, both this time and earlier in the year. The agreement will facilitate the biggest changes to the junior doctors contract since 1999. It will allow the Government to deliver a seven-day NHS, improve patient safety and support much needed productivity improvements, as well as strengthening the morale and quality of life of junior doctors with a modern contract fit for a modern health service.
The contract inherited by the Government had a number of features badly in need of reform, including low levels of basic pay as a proportion of total income, which made doctors rely too heavily on unpredictable unsocial hours supplements to boost their income; automatic annual pay rises even when people took prolonged periods of leave from the NHS; an unfair banding system that triggered payment of premium rates to every team member even if only one person had worked extra hours; high premium rates payable for weekend work that made it difficult to roster staff in line with patient need; and risks to patient safety, with doctors sometimes required to work seven full days or seven full nights in a row without proper rest periods.
The Government have always been determined that our NHS should offer the safest, highest quality of care possible, which means a consistent standard of care for patients admitted across all seven days of the week. The new contract agreed yesterday makes the biggest set of changes to the junior doctors contract for 17 years, including by establishing the principle that any doctor who works less than an average of one weekend day a month—Saturday or Sunday—should receive no additional premium pay, compensated for by an increase in basic pay of between 10% and 11%; by reducing the marginal cost of employing additional doctors at the weekend by about a third; by supporting all hospitals to meet the four clinical standards most important for reducing mortality rates for weekend admissions by establishing a new role for experienced junior doctors as senior clinical decision makers able to make expert assessments of vulnerable patients admitted to or staying in hospital over weekends; and by removing the disincentive to roster enough doctors at weekends by replacing an inflexible banding system with a fairer system that values weekend work by paying people for actual unsocial hours worked, with more pay for those who work the most.
The Government also recognise that safer care for patients is more likely to be provided by well-motivated doctors who have sufficient rest between shifts and work in a family-friendly system. The new contract and ACAS agreement will improve the wellbeing of our critical junior doctor workforce by reducing the maximum hours a doctor can be asked to work in any one week from 91 to 72; reducing the number of nights a doctor can be asked to work consecutively to four, and the number of long days a doctor can be asked to work to five; introducing a new post, a guardian of safe working, in every trust to guard against doctors being asked to work excessive hours; introducing a new catch-up programme for doctors who take maternity leave or time off for other caring responsibilities; establishing a review by Health Education England to consider how best to allow couples to apply to train in the same area and to offer training placements for those with caring responsibilities close to their home; giving pay protection to doctors who switch specialties because of caring responsibilities; and establishing a review to inform a new requirement for trusts to consider caring and other family responsibilities when designing rotas.
Taken together, these changes show both the Government’s commitment to safe care for patients and the value we attach to the role of junior doctors. While they do not remove every bugbear or frustration, they will significantly improve flexibility and work-life balance for doctors, leading, we hope, to improved retention rates, higher morale and better care for patients.
Whatever the progress made with today’s landmark changes, however, it will always be a matter of great regret that it was necessary to go through such disruptive industrial action to get there. We may welcome the destination, but no one could have wanted the journey, so today I say to all junior doctors, whatever our disagreements about the contract may have been, that the Government have heard and understood the wider frustrations they feel about the way they are valued and treated in the NHS. Our priority will always be the safety of patients, but we also recognise that to deliver high-quality care we need a well-motivated and happy junior doctor workforce. Putting a new modern contract in place is not the end of the story. We will continue to engage constructively to try to resolve outstanding issues, as we proceed on our journey to tackle head on the challenges the NHS faces, and make it the safest, highest-quality healthcare system anywhere in the world. Today’s agreement shows we can make common cause on that journey with a contract that is better for patients, better for doctors and better for the NHS. I commend my statement to the House.
Heidi Alexander (Lewisham East) (Lab)
I start by putting on record our thanks to Sir Brendan Barber and ACAS for the role they have played in finding agreement between the two sides in this dispute. I also pay tribute to the Academy of Medical Royal Colleges, which proposed these further talks and encouraged both the Government and the BMA to pause and think about patients.
I have not been shy in telling the Health Secretary what I think about his handling of this dispute, but today is not the day to repeat those criticisms. I am pleased and relieved that an agreement has been reached, but I am sad that it took an all-out strike of junior doctors to get the Government back to the table. What is now clear, if it was not already, is that a negotiated agreement was possible all along. I have to ask the Health Secretary why this deal could not have been struck in February. Why did he allow his pride back then to come before sensible compromise and constructive talks?
When he stands up to reply, he may try to blame the BMA for the breakdown in the negotiations, but he failed to say what options he was prepared to consider in order to ensure that the junior doctors who work the most unsociable hours are fairly rewarded. It was a “computer says no” attitude, and that is no way to run the NHS.
Why did the Health Secretary ignore my letter to him of 7 February, in which I asked him to make an explicit and public commitment to further concessions on the issue of unsociable hours? I was clear that if he had done that then, I would have encouraged the BMA to return to talks. Why did he insist instead on trying to bulldoze an imposed contract through, when virtually everyone told him not to, and the consequences of doing so were obvious for all to see—protracted industrial action, destroyed morale and a complete breakdown in trust?
On the detail of the new contract, will the Health Secretary say a little more about the agreed changes that will undo the discriminatory effect on women of the last contract he published? Does he now accept that the previous contract discriminated against women? Will he be clear for the record that he now understands this was never “just about pay”? Can he confirm that concessions have been made not only in respect of the mechanism for enforcing hours worked and breaks taken, but in ensuring that the specialties with the biggest recruitment problems have decent incentives built into the contract?
Moving on to what happens next, can the Health Secretary tell us what he will do if junior doctors vote against this offer? Will he still impose a contract, and which version of the contract will he impose—his preferred version or this compromised one? Can he say whether the possibility of losing a case in the High Court about his power to impose a contract had anything to do with his recently discovered eagerness to return to talks? We all know that the High Court told him he had acted above the law when he tried to take the axe to my local hospital, so I can understand why he does not want that embarrassment again.
Finally, let me caution the Health Secretary on his use of language both in this Chamber and in the media. His loose words and implied criticism of junior doctors is partly the reason why this has ended up being such an almighty mess. May I suggest that a degree of humility on the part of the Secretary of State would not go amiss? May I recommend a period of radio silence from him to allow junior doctors to consider the new contract with clear minds, and without his spin echoing in their ears? I remind him that he still needs to persuade a majority of junior doctors to vote in favour of the contract for the dispute to be finally over.
I hope with all my heart that yesterday’s agreement may offer a way forward. Junior doctors will want to consider it; trust needs to be repaired, and that will take time. I hope for the sake of everyone, patients and doctors, that we may now see an end to this very sorry episode in NHS history.
Mr Hunt
The hon. Lady is wrong today, as she has been wrong throughout this dispute. In the last 10 months, she has spent a great deal of time criticising the way in which the Government have sought to change the contract. What she has not dwelt on, however, is the reason it needed to be changed in the first place, namely the flawed contract for junior doctors that was introduced in 1999.
We have many disagreements with the BMA, but we agree on one thing: Labour’s contract was not fit for purpose. Criticising the Government for trying to put that contract right is like criticising a mechanic for mending the car that you just crashed. It is time that the hon. Lady acknowledged that those contract changes 17 years ago have led to a number of the five-day care problems that we are now trying to sort out.
The hon. Lady was wrong to say that an all-out strike was necessary to resolve the dispute. The meaningful talks that we have had have worked in the last 10 days because the BMA bravely changed its position, and agreed to negotiate on weekend pay. The hon. Lady told the House four times before that change of heart that we should not impose a new contract. What would have happened if we had followed her advice? Quite simply, we would not have seen the biggest single step towards a seven-day NHS for a generation, the biggest reforms of unsocial hours for 17 years, and the extra cost of employing a doctor at weekends going down by a third. We would not have seen the reductions in maximum working hours. We would not have seen many, many other changes that have improved the safety of patients and the quality of life of doctors.
The hon. Lady was also wrong to say that the previous contract discriminated against women. In fact, it removed discrimination. Does that mean that there are not more things that we can do to support women who work as junior doctors? No, it does not. The new deal that was announced yesterday provides for an important new catch-up clause for women who take maternity leave, which means that they can return to the position in which they would have been if they had not had to take time off to have children.
The hon. Lady asked what would happen if the ballot went the wrong way. What she failed to say was whether she was encouraging junior doctors to vote for the deal. Let me remind her that on 28 October, she told the House that she supported the principle of seven-day services. As Tony Blair once said, however, one cannot will the end without willing the means. The hon. Lady has refused to say whether she supported the withdrawal of emergency care, she has refused to say whether she supports contentious changes to reform premium pay, and now she will not even say whether doctors should vote for the new agreement.
Leadership means facing up to difficult decisions, not ducking them. I say to the hon. Lady that this Government are prepared to make difficult decisions and fight battles that improve the quality and safety of care in the NHS. If she is not willing to fight those battles, that is fine, but she should not stand at the Dispatch Box and claim that Labour stands up for NHS patients. If she does not want to listen to me, perhaps she should listen to former Labour Minister Tom Harris, who said:
“Strategically Labour should be on the side of the patients and we aren’t.”
Well, if Labour is not, the Conservatives are.
Dr Sarah Wollaston (Totnes) (Con)
I congratulate both sides on returning to constructive negotiations and on reaching an agreement. I pay particular tribute to Professor Sue Bailey and the Academy of Medical Royal Colleges for their role in bringing both sides together. I welcome the particular focus, alongside the negotiations around weekend pay, on all the other aspects that are blighting the lives of junior doctors. I welcome the recognition that we need to focus on those specialties that it is hard to recruit to and on those junior doctors who are working the longest hours, as well as the focus on patient safety.
However, we are not out of the woods yet. We need junior doctors across the country to vote for this agreement in a referendum. May I add my voice to that of the Opposition spokesman on health to say that what is needed now is a period of calm reflection? We need to build relationships with junior doctors into the future. Will the Secretary of State comment on his plans for building those relationships with our core workforce?
Mr Hunt
First, I very much agree with my hon. Friend in her thanks to Professor Dame Sue Bailey for the leadership that the Academy of Medical Royal Colleges has shown in the initiative that, in the end, made these talks and this agreement possible. I know it has been a very difficult and challenging time for the royal colleges, but Professor Bailey has shown real leadership in her initiative.
I also very much agree with my hon. Friend about the need to sort out some of the issues that have been frustrations for junior doctors—not just in the last few years, but going back decades—in terms of the way their training works and the flexibility of the system of six-month rotations that they work in. This is an opportunity to look at those wider issues. We started to look at some of them yesterday. I think there is more that we can do.
It is important that this is seen not as one side winning and the other side losing, but as a win-win. What the last 10 days show is that if we sit round the table, we can make real progress, with a better deal for patients and a better deal for doctors. That is the spirit that we want to go forward in.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I absolutely welcome this agreement, and I pay tribute to the Academy of Medical Royal Colleges for bringing it about. I do wish there had been some response to the letter that I and other Members sent before the all-out strike, because it was a genuine attempt to create a space that both sides could step into. However, I am glad that we have got to that stage now.
I welcome the recognition of the equality issues, which, to us and to many junior doctors, appeared to have been dismissed in the impact assessment. On the idea of flexible training champions in each trust, I myself was a flexible training senior surgeon—indeed, the first one in Scotland—and the idea of accelerated training is important. However, one concern I have is about childcare. If women junior doctors are going to be working longer, more antisocial shifts—I remember what I had to fork out for childcare—I would like to know whether the NHS will respond to that. Will that be in the form of crèche hours or support?
I welcome the fact that the hours guardian will be linked to the director of medical education and that there will be an elected junior doctors forum. One concern of junior doctors was that they would have no voice in relation to the guardian.
I also welcome the idea of using modern technology in rota-ing. At the moment, rotas are sheets of paper, and often no one looks at the shoulder from one rota to the next, so people can end up with the very long periods on call. However, one concern that remains is rota gaps. We do not have enough junior doctors, and we do not have enough junior doctors in the most acute specialties. How is the Secretary of State planning to re-establish a relationship? How is he going to recruit people to fill that gap? That was the core fear of junior doctors: a lack of doctors, with doctors simply being spread further. How are we going to recruit and retain doctors after the painful clash that has been going on for the last year?
Mr Hunt
I welcome the tone of the hon. Lady’s comments; we might have wished for a similar tone from the shadow Health Secretary. Let me address the comments of the hon. Member for Central Ayrshire (Dr Whitford) as constructively as she made them to me. She is right about flexible training. We have to recognise that the junior doctor workforce is now majority female, and that a number of family and caring pressures need to be taken account of. We need to do that for the NHS not only because it is the right thing to do, but because we will lose people if we do not. Those people will simply leave medicine, even though they have been through very extensive and expensive training.
We have to look particularly at the responsibilities of doctors with young children. One of the things that we announced yesterday was an obligation on trusts to take account of caring responsibilities. If, for example, a doctor wanted to work fewer hours in school holidays and more hours in term time, we cannot guarantee that a hospital would always be able meet those needs—the needs of patients always have to come first—but they could at least be taken account of, in the same way as they are in many other industries that operate 24/7. The hon. Lady is absolutely right to say that modern technology is key to that. An air steward or a pilot who works for British Airways can go on to an electronic system and choose the shifts and hours that they want to work. Because we have failed to modernise the NHS, we have seen a huge growth in agency and locum work, which is partly driven by the fact that it offers precisely the flexibilities that people need. These are important changes, and we intend to take them forward.
Sir Simon Burns (Chelmsford) (Con)
My right hon. Friend’s actions and those of the Department and the BMA in reaching an agreement will be warmly welcomed and met with a sigh of relief. Does he accept that the fact that the BMA was prepared to think again on crucial issues, such as overtime at weekends, should be seen as a sign not of weakness but of maturity, in working with the Government to ensure that we have a seven-day NHS that is for the benefit of patients and patient safety?
Mr Hunt
I absolutely agree with that wise comment, and it befits someone who is experienced in working in the Department of Health. We always get further if we sit around the table and talk about such issues. The Government are determined to improve the quality and safety of care for patients, and it is important to recognise that if the Government are successful, it will be better for the morale of doctors. The happiest, most motivated doctors work in the hospitals that are giving the best care to patients. That is why it is a win-win.
I say to Labour Members that it was the refusal of the BMA for many years to talk about the issue that my right hon. Friend referred to that meant we reached a deadlock. The fact that the Government were willing to proceed with important reforms on our own if we had to meant that, in the end, everyone came together and had a sensible negotiation. We got to the right place. I am sure everyone wishes that we had not had to go on the journey we went on to get there, but now that we have got there, I think it is the time for being constructive on all sides.
Jim Shannon (Strangford) (DUP)
I also thank the Minister and the BMA for coming to an agreement. The Minister said that it was a win-win for everyone, and so it is. It is always good to talk, and dialogue brings results. That happened in Northern Ireland, and it has happened with the conclusion of this process as well. A good deal has been reached, and some 45,000 junior doctor BMA members will now be asked to vote on it.
We have had eight days of strikes since January, and some 40,000 planned non-urgent operations and 100,000 out-patient appointments have been cancelled. May I ask the Minister what will be done to catch those up, and what discussions he has had with the Northern Ireland Assembly about the agreement?
Mr Hunt
I reassure the hon. Gentleman that we are in constant touch with the devolved regions and countries to make sure that they know the changes that we are making, and to share any learning that we have from the processes that we have been through, so we will certainly do that. Across the country, we are doing everything we can to catch up with the backlog of operations, procedures and out-patient appointments—all the things that have been affected by the industrial relations dispute. Trusts will always prioritise the areas where clinical need is the greatest, but I know that that work is ongoing across the country.
Helen Whately (Faversham and Mid Kent) (Con)
I very much welcome the agreement that has been reached. We know that the Secretary of State recognises the importance of having a happy and well-motivated workforce, and this contract addresses many of the causes of unhappiness for junior doctors. It is particularly good to hear the points made today about addressing the problems of couples who are both junior doctors. However, there is clearly more to do, as has been acknowledged, especially on the reasons why junior doctors feel unsupported and often not valued by their employers. My right hon. Friend commissioned Professor Sue Bailey to carry out a review of the underlying problems experienced by junior doctors during training. Will he advise us whether the review will now proceed?
Mr Hunt
The request from the BMA was to find a new way of proceeding with that very important work, and that is what we will do. We will do so with the input of Professor Bailey, because she has a very important contribution to make. My hon. Friend is absolutely right to say that, as well as more flexible working for people with family commitments, the big issue for many junior doctors is the way in which the training process happens. In particular, the issue is about the way that continuity of training has been undermined by the new shift system—we need that system for reasons of patient safety—and that often means that someone is given advice by a different consultant on different aspects of care from one day to the next, which is frustrating. We will look at all those issues with Professor Bailey, Health Education England and the BMA to see whether we can find a better way forward.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Secretary of State aware that even my constituents struggling with the possible closure of their A&E at the hospital in Huddersfield nevertheless welcome this announcement and thank anyone and everyone who has brought it about? That includes, I must say, leaders from the Opposition parties—our health spokespeople—who have done so much to help maintain a positive spirit. Will the Secretary of State just not gloat about this, but keep a period of silence? This is part of the phenomenon of people’s deep unhappiness about the NHS. Problems will arise again because so many people working in the NHS know it is being privatised by the back door and know that the clinical commissioning system is not working. Those problems will come back again and again unless he confronts that issue.
Mr Hunt
That would have been a constructive contribution to this morning’s discussion if the hon. Gentleman had not descended into totally false slurs about this Government’s commitment to our NHS. I would just say to him that if people support and are passionate about the NHS, as this Government are, then they put in the money—we are putting in £5.5 billion more than his party promised at the last election—and make the difficult reforms necessary to ensure that NHS care is as good as or better than anything that can be provided in the private sector. That is what this Government are doing: we believe in our NHS, and we are backing it to provide the best care available anywhere in the world.
Mims Davies (Eastleigh) (Con)
I strongly welcome this important statement and the Secretary of State’s leadership, and I congratulate all those involved in the discussions. On Tuesday, I spoke at my advice surgery in Eastleigh to a constituent, a new mum who is a junior doctor and is married to a senior nurse. She is unable to fast-track into working as a GP, and part of her concerns about the negotiations involve the future childcare arrangements for her four-month-old baby. Such concerns weigh heavily on her family, particularly in relation to on-call working. May I ask that agile working and family first issues are truly taken into account for nurses and doctors who are trying to bring up families together?
Mr Hunt
My hon. Friend gives one example, but there are thousands of such examples. Such people are totally committed to the NHS, have a bright future in it and can make a huge contribution to its success by doing a good job in looking after patients, but they also have home responsibilities that are difficult to fulfil when there are very inflexible rostering systems. One of the big wins from yesterday’s agreement is that we will be able to look at the way the rostering system works to try to bring in such flexibility. If we do not do so, more and more doctors will want to be locums or to work for an agency and we will lose the continuity of care for patients, which is one of the best things about our GP system. That is why there is an urgent need—from the perspective of patients, as well as from that of doctors—to address that issue.
Mr Clive Betts (Sheffield South East) (Lab)
I am interested in the Secretary of State’s thoughts about the serious impact on morale that the dispute has had. I was talking to a junior doctor in Sheffield the other day who said that before the dispute he had never looked at his contract, he had simply got on and done what was needed, whenever it was needed. Does the Secretary of State realise that even if the dispute is now settled, as we hope, it has had a serious impact on good will in the health service, which could affect service delivery in the future?
Mr Hunt
If the hon. Gentleman looks at the latest NHS staff survey, it shows higher staff motivation, better communication and more staff recommending their organisation as a place to work or be treated. But I accept that when big changes are made to a contract such as the junior doctors contract, they can be contentious and have a short-term impact on morale. In the long run, morale goes up when doctors are able to give better care to patients, and that is what this agreement will allow.
Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)
The Secretary of State has done a good job of explaining today, but let us look at this in the cold light of day. The BMA caused a problem that should have been resolved a long time ago. It decided it would make a political point. That is fair enough, and I know we want reflection. The Opposition should have been big enough to say, “We want to cause political trouble on this.” A lot of this has been caused by political shenanigans that should not have been allowed to get to this stage, and the failure means that the junior doctors have lost prestige throughout the United Kingdom because they have been used as political pawns by two organisations. Does the Secretary of State agree?
Mr Hunt
It is a great tragedy that the dispute unfolded in the way that it did, and I am sure that people with different agendas have not played constructive roles at various points. Given that we now have an agreement, I want to move forward positively and say that the lesson of the last 10 days is that when people sit down and negotiate about all the outstanding issues with a Government who are trying to make care safer and better for patients, we get a result that is good for everyone.
Liz McInnes (Heywood and Middleton) (Lab)
It is not the time to claim victory: this negotiated agreement now has to be put to the members of the British Medical Association. Will the Secretary of State acknowledge that his own refusal to negotiate exacerbated this crisis? Will he cease referring to the British Medical Association as a militant trade union, and will he heed the call from my hon. Friend the shadow Secretary of State for a period of silence in order to avoid antagonising the junior doctors still further?
Mr Hunt
Let us be absolutely clear: there was never a refusal to negotiate on the Government’s side. We have now developed a lot of trust between the Government and the BMA leadership, but until that point it balloted for industrial action without even sitting down and talking to the Government, and it refused to discuss the issue of weekend pay premiums, which was the crucial change we needed for a seven-day NHS. It was when the BMA changed its position in those areas that we were able to have constructive talks, and that is why it deserves great credit for coming to the table and negotiating—something it had not wanted to do previously—and that led to the solution.
Lucy Allan (Telford) (Con)
I thank the Secretary of State for working so hard to bring about this resolution and for always putting users of the NHS at the heart of everything he does. Will he join me in urging junior doctors to consider the new contract with an open mind when voting, and to strip out some of the politics that we have heard? Let us consider what is best for patients, what is best for the NHS and then what is best for junior doctors.
Mr Hunt
My hon. Friend speaks wisely. I understand that in a contentious industrial relations dispute junior doctors will not necessarily look to me for advice on which way they should vote, but it was not just me doing the agreement. It was a negotiated agreement and the leader of the junior doctors committee says that it is a good agreement. He will encourage people to support it in the ballot and he thinks it is a good way forward for doctors as well as for patients. The people who have been closest to the detail of the negotiations think that it is the right step forward for junior doctors, and that is something that they will want to take account of.
Mark Durkan (Foyle) (SDLP)
I do not wish to invite the Secretary of State to provoke or pre-empt by presumption, but if the agreement changes the shape of services, it will have implications for other health professionals. Is he prepared to have the further conversations that will need to be had, and the wider conversations that will be needed with his ministerial counterparts across these islands on workforce planning, professional education and training?
Mr Hunt
We are, of course, willing to have those discussions with colleagues in other parts of the UK. The hon. Gentleman is right to say that having a seven-day service does not just involve junior doctors; it involves widespread changes across the service. I should say that nurses, healthcare assistants, porters, cleaners—other people who work in hospitals—already operate on 24/7 shifts, so the changes necessary to those contracts are much less profound than they are to some of the doctors contracts, which is why it is important that we change not just the junior doctors contract, but the consultants contract. The fact that we have been able to reach a negotiated agreement with the junior doctors bodes well for the consultants contract, which is the next step.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
I congratulate both my right hon. Friend and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer) on their hard work in dealing with this protracted dispute with the BMA. Patients up and down the country, including those in my constituency, were somewhat concerned about the cancellation of operations, and I am delighted that the Department is going to try to ensure that we catch up on that. One thing that came out of this dispute was that some senior consultants ended up getting on to the front line for the first time in a long time. What can be done to try to make sure that that happens on a regular basis, so that they are getting experience on the front line, too?
Mr Hunt
If I answer that question directly, I will dig myself into rather a deep hole. I echo my hon. Friend’s thanks to my hon. Friend the Member for Ipswich, who has done an outstanding job by my side at every stage throughout this difficult period. I can certainly say that we would not have had yesterday’s agreement without his strong help and support at every stage. It is true that there are A&E departments across the country that, in having to plan for the two-day withdrawal of emergency care, found that having consultants more visible to patients had some positive impacts. I know that studies are going on to see what lessons can be learned from that going forward.
Paula Sherriff (Dewsbury) (Lab)
I, too, welcome the opportunity for a negotiated settlement, but let us take just a moment to reflect on one of the fundamental principles of our NHS—providing high-quality patient care. Will the Secretary of State take the opportunity today to offer a heartfelt and sincere apology for the significant and severe distress caused to patients as a result of this prolonged dispute?
Mr Hunt
With the greatest of respect to the hon. Lady, it was not my decision to take industrial action—to ballot for industrial action without even being prepared to sit around the table and talk to the Government. We are seeing dramatic improvements in patient safety under this Government, as we face up to the many problems in care that we inherited, not just at Mid Staffs, but at many other places. I know that she cares about patient safety, so she should welcome the difficult changes we have made, one of which is to have a seven-day NHS.
Stephen Hammond (Wimbledon) (Con)
Like many colleagues in the House, I wrote to the Secretary of State on numerous occasions over the past six months to express the concerns of local junior doctors. May I therefore congratulate him and the BMA on reaching this deal? I hope that junior doctors in Wimbledon will wholeheartedly support it. He spoke in his statement about the role of the guardian and the ability to ensure safe working hours, on behalf of both patients and doctors. Will he give a few more details about how he expects that to work?
Mr Hunt
Yes, I am happy to do that, and I thank my hon. Friend for a lot of his correspondence. The principle here is that junior doctors want to know that there is someone independent they can appeal to if they think they are being asked to work hours that are unsafe and which mean that they cannot look after patients in the way that they would want to because they are physically or mentally too exhausted. We would all want to make that possible, but it means that they need to have someone who is not their line manager. They will go to their line manager in the first instance, but they need to have someone independent and separate. One area where we have made the most progress during the past few months, even before the past 10 days of talks, is on establishing how these guardians can work in a way that has the trust of both the hospitals and the doctors working in them.
Nic Dakin (Scunthorpe) (Lab)
The Secretary of State is absolutely right that we can always get further if we get round the table, so why, in response to the cross-party initiative back in February to get everybody around the table, did he not do exactly that and save us all this trouble, rather than trying to impose the contract?
Mr Hunt
The cross-party initiative was not to have a new contract, but to abandon plans for a new contract and to have pilots in a few limited places. If we had followed that advice, we would not now have agreed with the BMA the biggest changes in the junior doctors contract for 17 years. Our goal was to get the agreement that we secured yesterday—safer care for the NHS and a better deal for doctors. That was what we achieved, and we would not have got there if we had listened to that advice.
Sir Oliver Heald (North East Hertfordshire) (Con)
May I join the welcome for the agreement and the persistence and patience that eventually paid off? In previous statements, I have raised with the Secretary of State the problem involving married couples who are both doctors. There are difficulties with training when they are sent to different areas and with rosters that clash. Will he say a word about the progress that has been made in this important area of making work a bit more family-friendly?
Mr Hunt
I am happy to do that for my hon. and learned Friend. It is not an easy problem to solve, because junior doctor training placements operate on six-month rotations, and they are a competitive process. We get many more applicants for a number of posts than there are posts available. We must find a way of balancing the need to respect family responsibilities, which is something that we all want to do, with the need to have a fair process for the most competitive positions. We do not have the balance right yet, so we have said that Health Education England, which decides where people are to go on rotations, will now have a duty to consider family responsibilities when it makes decisions about those rotations.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
I welcome the potential resolution of this dispute and thank the Government for negotiating it. We should also thank junior doctors for having the courage to go on strike, which no one does lightly, to get a better deal for the NHS. I ask the Secretary of State to reflect on this breakthrough, to take further steps to build on his difficult relationship with NHS staff and, crucially, to stop presenting NHS policy as a false dichotomy between the interests of patients and the interests of NHS staff.
Mr Hunt
If the hon. Gentleman had listened to some of the things that I have said, he would have heard me say repeatedly that I do not think that that dichotomy exists. As he says, it is a false dichotomy because, in the end, what is right for patients is also right for doctors. The thing that demoralises doctors, nurses and everyone working in our hospitals in different parts of the NHS is when they are not able to give the care that they want or that they think is appropriate to the patients in front of them. That is why hospitals that have moved closest towards seven-day services are also some of the hospitals with the highest levels of morale in the NHS. He is right that it is a false dichotomy and that we need to do both together.
Ben Howlett (Bath) (Con)
As the Secretary of State knows, my brother and his wife were junior doctors when they made the decision to move to New Zealand a long while ago because of the long-standing cultural problems within the NHS. They will be very pleased indeed about the announcement yesterday about couples potentially being able to work together in hospitals. I have a question for the Secretary of State from my mother. She wants to know what he can do now to encourage my brother, his wife and their friends back into the NHS.
Mr Hunt
Let me say to my hon. Friend’s mother that I hope that the message of this new agreement will go right the way around the world. Any doctors who have moved to New Zealand and Australia are always welcome to come back. The thing that must unite this Government and the good doctors who work, or have worked, in the NHS is our commitment to make NHS care the safest and the best in the world. We had a terrible shock with what happened at Mid Staffs, but we are using that as a moment of decisive change in the NHS, and we are well on our way to higher standards of care than are available in many other countries.
Danny Kinahan (South Antrim) (UUP)
I congratulate the Government and everyone involved on getting this deal in place. It will have a knock-on effect in my constituency in Northern Ireland. When I went around Antrim Area hospital, the concern was to do with the number of doctors, which we have heard about from other Members, and how to get seven-days-a-week cover from everything else that needs to go into the health service. Will the Secretary of State comment on how we will deal with that, and how we will work with the devolved Parliaments?
Mr Hunt
I agree. We need more doctors and we need more nurses. By the end of this Parliament, we will have over a million more over-70s in England alone, and I know that the demographic effects in Northern Ireland will be equivalent. We have a global shortage of about 7 million doctors, so we need to train more. We are training an extra 11,420 doctors over this Parliament as part of the spending review. The training is done on a UK-wide basis, so we will need to work closely with all the devolved regions on it.
Alex Chalk (Cheltenham) (Con)
I warmly welcome this draft agreement, which will be met with some relief in Cheltenham. Whatever our deeply held concerns about the behaviour of the BMA in the past, does the Secretary of State agree that it should be our ambition that the agreement will mark the beginning of a more constructive future? Will he join me in congratulating BMA negotiators, including Dr Malawana, for being prepared to address constructively issues such as Saturday pay?
Mr Hunt
I am happy to do that. I recognise that this was not easy for those people, because it involved changing a position that they had held for more than three years. When we looked at the details, the result that we got to was not difficult for them to sign up to because they could see that it really was better for their members, as well as better for patients. The lesson here is that the NHS faces huge challenges, and it can only be right to deal with them by sitting round the table and negotiating constructively.
Christian Matheson (City of Chester) (Lab)
I, too, warmly welcome the news of the agreement, and I hope that it leads to a settlement. If it is the Secretary of State’s intention to create a seven-day NHS, that will require the participation of more than the junior doctors, so does he intend to bring forward a new contract for consultants, hospital lab workers, ambulance workers, nurses or indeed ancillary workers and catering staff?
Mr Hunt
The hon. Gentleman is right. A seven-day NHS is not just, or not even mainly, about junior doctors, although they are a very important part of the equation. We will need a new contract for consultants and we are having constructive negotiations with them. Many other people working in the NHS are already on seven-day contracts, so there will not necessarily be a contractual change, but the hon. Gentleman is right to say that we will need, for example, diagnostic services operating across seven days so that the junior doctor who works at the weekend will be able to get the result of a test back at the weekend. Those are all part of the changes that we will introduce to make the NHS safer for patients.
Dr Andrew Murrison (South West Wiltshire) (Con)
I warmly congratulate both sides on reaching this agreement. Our NHS is different at weekends, and my right hon. Friend is right to inculcate Sir Bruce Keogh’s four key clinical standards on a Sunday and a Saturday. Does he agree that it is important not simply to rely on mortality data, which are often difficult to interpret, to underpin the case for a seven-day NHS? Will he look closely at other metrics based on clinical standards for things like routine lists for upper gastrointestinal endoscopy on a Saturday and Sunday? Will he also look at palliative care, which of course does not feature in any hospital mortality data?
Mr Hunt
My hon. Friend speaks, as ever, very wisely on medical matters. I particularly agree when he talks about palliative care; it has got better, but there is a long way to go. We have recent evidence that it is particularly in need of improvement where we are not able to offer seven-day palliative support.
Norman Lamb (North Norfolk) (LD)
I welcome this settlement and thank everyone involved for securing it. However, many junior doctors remain concerned that, as the hours worked at the weekend increase, cover is inevitably reduced during the week, unless more junior doctors are employed to bridge that gap. With many rotas already left unfilled around the country during the week, how can the Secretary of State guarantee that we will not make the situation worse during the week, thereby impacting on patient safety?
Mr Hunt
I understand the concern. The short answer is that we need to increase the NHS workforce, which we are doing. We will see more doctors going into training during this Parliament, as indeed we did during the previous Parliament. More doctors in the workforce will be an important part of the solution.
Bob Blackman (Harrow East) (Con)
It appears that at the start of the recent negotiations the payment for Saturday working was the main sticking point for the BMA, but now the issue of weekend pay has been resolved. Will my right hon. Friend confirm that, now, the doctors who work extended hours over the weekend can get extra pay, and patients can get the seven-days-a-week NHS we all want?
Mr Hunt
My hon. Friend is absolutely right. This is not just a safer deal for patients, but a system that is much fairer for doctors than the current one. We are giving a pay rise of between 10% and 11%, for which we say that people are expected to work one weekend day a month, but doctors who work more than that get more, and it goes up, so more weekends worked means more extra pay. I think that is one of the reasons why the BMA was prepared to sign up to the agreement: it values the people who give up the most weekends.
Andrew Bridgen (North West Leicestershire) (Con)
I was contacted by a constituent who told me how his four-year-old daughter fell through a pane of glass, severely cutting her face. Unfortunately, the accident happened on a Friday evening, and because insufficient doctors were working over the weekend, she could not have an operation to remove any remaining glass from the wound until Monday, by which time the wound had started to heal and was misaligned. That four-year-old girl will suffer severe facial scarring for the rest of her life. Does my right hon. Friend agree that this is why we need a seven-day NHS?
Philip Davies (Shipley) (Con)
I must confess to being rather puzzled. The BMA said all along that the strike and dispute had nothing to do with weekend pay and terms, yet after negotiations limited simply to weekend pay and terms, the BMA has come to a deal and advised against strike action. Can we take it that, despite much huffing and puffing from the BMA that this was about the future of the NHS and all the rest of it, at the end of the day it was all about weekend pay and terms?
Mr Hunt
I think my hon. Friend is right that that was the big sticking point. It was the BMA’s willingness to be flexible and negotiate on that that ultimately made an agreement possible, but it is also fair to say that the Government recognise that there are many other non-contractual issues in the way that junior doctors are trained and treated by the NHS, and we want to use this opportunity to put them right.
Mark Spencer (Sherwood) (Con)
I congratulate the Secretary of State on putting patients first, but does he recognise that there are still people out there whose operations were cancelled due to industrial action? Will he look to the future and consider whether front-line medical staff should have the right to strike and so put people’s health on the backburner or postpone their medical care?
Mr Hunt
I know that that is a view that some colleagues share. Doctors have obligations even now under the Medical Act 1983 not to take action that would harm patients, and under their responsibilities to the General Medical Council; they have to be aware of those. What I hope is that that question simply does not arise again. We are now having constructive discussions with the BMA; I think that is the way forward and I hope that neither I nor any future Health Secretary has to go through what has happened in the past 10 months.
John Glen (Salisbury) (Con)
I applaud the tone and content of the Secretary of State’s remarks. I think this agreement will go down as a breakthrough in the NHS. It has been very uncomfortable to engage in dialogue with constituents who are junior doctors, who have felt aggrieved, so I particularly welcome the way my right hon. Friend has been able to look at non-contractual issues. I urge him to give serious consideration to the outcome of the Bailey review so that progress can be made on morale and the wider issues that have been raised.
Mr Hunt
I finish by saying that I completely agree with my hon. Friend. It has been a very sad dispute for all of us, because we all recognise that junior doctors are the backbone of the NHS; they work extremely hard and they often work the most weekends already. That we now have an agreement is a brilliant step forward. We all have constituents who work hard for the NHS. They are people we value, so dialogue, negotiation and constructive discussion must always be the way forward.