asked the Minister of Health what representations have been made by the medical profession to the effect that many doctors have already entered into expenditure commitments as a result of the recent agreement on remuneration; and what steps he proposes to take to ensure that doctors can honour these commitments.
In common with others to whom increases have not yet been paid, hospital doctors, hospital dentists, and general medical practitioners are affected by the incomes standstill. The expenses of practitioners are, however, due to be reimbursed and the arrangements for payment during the standstill period are being designed to take fully into account any increase in those expenses overall. These arrangements will include special provision for certain expenses incurred on additional ancillary help employed in anticipation of the new methods of remuneration. I am discussing with the profession other cases of specific commitment which will result in a reduction of net income if no special arrangements are made.
Is the Minister aware that this really is not good enough? Does he not realise that doctors have been working for four months on the basis of a new contract, relying on the word of the Prime Minister in this House, and that it was only a technical difficulty which prevented them from being paid at the end of June? Will the right hon. Gentleman come clean with the House and say frankly whether he made any representations on this subject to the Prime Minister concerning what I can only describe as a shocking breach of faith?
I call the hon. Gentleman's attention to the proceedings in the Council of the British Medical Association. Of course I am conscious of the difficulties in which some doctors find themselves as a result of the incomes standstill. I should like to pay a tribute to the responsible attitude shown by the representatives of the profession in accepting, as they have done, with qualifications, the deferment of the Review Body's award in the national interest. I should also like to pay tribute to the leadership which they have shown on this occasion.
Can the Minister explain how the effective date of this award, which was first 1st April—[HON. MEMBERS: "Reading."] I am not reading—can be affected by a freeze announced on 20th July? Would the right hon. Gentleman also explain what will happen if a doctor has entered into a contract whereby a part-time worker will now work full-time for him? Will that be affected by the freeze or will the doctor get the extra money in view of the extra commitment into which he has entered?
If I have understood the hon. Gentleman's example aright, the answer is "Yes". As long as the hours have been increased, then I think that that would be covered by the sentence in the middle of my original Answer. To answer the first part of his supplementary question is perfectly simple. The Prime Minister made it clear that the incomes standstill relates to increases negotiated but not yet implemented.
Would the right hon. Gentleman explain the position of doctors who were on the point of, but have not yet started, operating group practice schemes, remembering the heavy capital expenditure involved? Since doctors may have been on the point of doing this, with the help of the Ministry's loans scheme, taking into account the higher remuneration, will such doctors be covered by the right hon. Gentleman's last reply to my hon. Friend the Member for Paddington, South (Mr. Scott) and are negotiations on these matters taking place with the profession? Can the right hon. Gentleman give a guarantee that the payment will not be deferred unduly long, so that doctors may be enabled to go ahead with their plans while waiting for the higher income?
The case mentioned by the hon. Gentleman will certainly be among those which I will be discussing with the leaders of the profession later this week. The answer to his question about implementation is quite clear. The operative date is now 1st October, and payment will now be made at the beginning of January next.
Will my right hon. Friend take particular account of the difficulties of junior hospital staff, who receive very small salaries, and who also undertook additional commitments in the belief that the pay award which was to be effective from 1st April would, in fact, be awarded?
I have very great sympathy with the position of junior doctors in hospitals. The position is that no exception to the standstill can be made, although I am looking to see whether anything can be done, consistently with the White Paper, to mitigate cases of hardship as a result of commitments having been entered into in the belief that the higher rates of pay would be forthcoming shortly, with effect from 1st April last.
Will my right hon. Friend realise that in the case of underpaid junior hospital staff there must in every case be a measure of hardship? Can he hold out any hope of mitigating the present policy of the standstill arrangements, as applied to doctors as a whole, in the case of junior staff?
I do not think that one can make any exceptions to the standstill. That was made abundantly clear. However, it is the case that the special position of junior hospital doc- tors was recognised by a very substantial increase recommended by the Review Body and accepted by the Government.