I beg to move,
That this House
opposes the forthcoming blanket imposition in Britain of the 48- hour working week under the European Working Time Directive in August 2009;
welcomes improvements in the workplace which improve safety and general wellbeing but does not believe that the further implementation of the Directive is necessary to deliver this;
notes in particular the potential impact on patient safety arising from reduced and inflexible working hours for NHS doctors;
recognises the additional constraints imposed on the NHS by the SiMAP and Jaeger judgements;
is disturbed by the negative impact of the Directive on medical training and on the viability of some frontline services;
further notes that the New Deal for Doctors in 1991 would have secured the necessary reduction in junior doctors' hours;
regrets a series of missed opportunities to amend the worst aspects of the Directive since 2003;
expresses solidarity with other member states who are finding the Directive impracticable, including the 15 countries that currently depend on derogation;
further notes that the loss of the opt-out and the distinction between active and inactive on-call time would also be deeply damaging to British business and other public services such as those provided by retained fire-fighters;
fully agrees with the Secretary of State for Business, Enterprise and Regulatory Reform that the UK should stand firm in support of the opt-out;
deeply regrets that most Labour Members of the European Parliament (MEPs) have failed to support the Government's position;
advises Labour MEPs to support the retention of the opt-out;
and urges the Government to give full consideration to alternative solutions.
We have given up waiting for the Government to allow Parliament to debate the issues that will have most impact on the health service, so I am very glad that my colleagues have once again allowed us to raise an issue that is timely and important as regards the management of the national health service. I hope that we have not gone beyond the point at which the Government can do something to remedy the problems. The timing is important.
I will in a moment; I have not begun yet— [ Interruption. ] Perhaps I will give way to the hon. Gentleman, since he might be eager to go to dinner.
I am eager to hear the hon. Gentleman's words, especially as there is considerable concern in the health service about the impact on training and on the development of doctors. The motion should go wider, however. There is great concern in the north-east of Scotland about the future of the retained fire brigade service and the working time directive. I wanted to add that important focus to his introductory remarks.
I am afraid that the hon. Gentleman has neglected to read the motion that I have just moved, which
"further notes that the loss of the opt-out and the distinction between active and inactive on-call time would also be deeply damaging to British business and other public services such as those provided by retained fire-fighters".
We did raise that matter, but if the hon. Gentleman wants to make a point later about retained firefighters I am sure that my colleagues would welcome it.
No, I will make some progress. Let me at least explain why I think that this motion is timely. From the health service's point of view, it is just four months until the introduction at the beginning of August of the 48-hour limit on junior doctors' hours. However, the long-term future of the working time directive lacks clarity.
I am grateful to the hon. Gentleman for giving way so early. He talked about the important vote in the European Parliament. Is he as concerned as I am that the only Liberal Democrat MEP from Scotland voted to end the opt-out? Why do we get questions from Liberal Democrats here when their MEPs voted differently in Brussels?
The hon. Gentleman makes an interesting point. We will have to find out why the Government have pursued a line that does not appear to be supported by their MEPs. Perhaps the Liberal Democrat spokesman will tell us why that party appears to be pursuing a line not supported by theirs, but I am happy to say that at least Conservative Members have taken a view on these issues that is supported by our MEPs.
If I may, Mr. Deputy Speaker, I shall focus on the issues as they affect the NHS. Later, I hope that my hon. Friend Mr. Francois will have an opportunity to talk about some of the wider issues raised by the European working time directive. However, the health service issues illustrate the impact that inappropriate and unthinking legislation can have on the delivery of public services and, by extension, private sector services and production.
I shall begin with some of the background to a problem that Opposition Members have found very frustrating. As far back as 1991, the excessive hours worked by junior doctors were clearly unacceptable. The problem needed to be tackled, and that is why the new deal for junior doctors was introduced in that year. Its objective was to bring us to the point where junior doctors worked a maximum of 56 hours a week, and we reached that position three years ago. That measure was introduced domestically by the UK Government for UK purposes. When the working time directive was introduced in 1993, it was recognised that there was a need for exemptions, and doctors in training were exempted.
When the directive was extended in 2000, it was recognised that there needed to be a substantial transition period. The 2003 regulations implementing the changes to the directive in this country specified a maximum working week of 58 hours from
I thank my hon. Friend for his remarks so far, but is it not extraordinary that our employment policies depend on contorted negotiations in Brussels with other member states, many of which have every interest in imposing more and higher employment costs on the UK economy? Will he confirm that it is our party's policy to repatriate employment policies back to this country from the EU, so that we can decide these matters ourselves?
My right hon. Friend will know, as will my other colleagues, that our intention is to secure national control over social and employment legislation. I know that my hon. Friend the Member for Rayleigh will want to expand on that, but I entirely concur with what my right hon. Friend Mr. Heathcoat-Amory has said about the absurdity—the perversity, as it were—of seeking to introduce European legislation that is applied in ways that go far beyond the original intention. We know that that has happened, because we are about to debate the further tightening—from 56 to 48 hours—of restrictions on working hours for junior doctors. There is no good evidence that that would have any meaningful impact on the health and safety of those employees—the ostensible purpose of the regulation—but, as I hope to go on to explain in detail, it would have damaging effects on the management of the NHS, as well as serious implications for patient safety and the delivery of services for patients.
Will my hon. Friend join me in pointing out to the Secretary of State that his predecessor had helpful advice from many doctors, including from some in my constituency? They said then that the Modernising Medical Careers and Medical Training Application Service systems would not work, and neither would the NHS IT system, and they are saying now that the working time directive will not work and that it is bad to have surgeons without enough work experience becoming consultants. I was a junior Minister involved with European legislation when this matter was first discussed in 1984. I have asked every Commissioner whom I have met since then, "Do you work more than 48 hours? Do you find that it affects your health? How many days do you have off work?" However, none of them seems to go sick, or say that 48 hours is enough. If the directive is not good enough for Commissioners, why should it be forced on other people who want to work?
My hon. Friend makes a good point. Indeed, the Opposition are beginning to see some striking parallels with how some quarters of the medical professions warned the Government about the disastrous implementation of MMC and MTAS. The Government simply did not listen. Some two years ago, the Royal College of Surgeons was warning about what was going to happen, and offering some solutions. Today, it is again expressing warnings and offering ideas and solutions to the Secretary of State. It is incumbent on Ministers to respond to those ideas, and not simply ignore them.
However, the challenge issued by my hon. Friend Peter Bottomley is interesting. Perhaps the Secretary of State worked more than 48 hours last week: if so, will he tell the House at what point his judgment and decision-making capacity were impaired?
No. I said that our policy was to secure national control over social employment legislation. That is how we have expressed it, and that is what we will aim to do. The question for this debate is how the Government will secure their policy and our national interests in the next few months. Perhaps the Secretary of State has shifted his position so completely that he now thinks that the only issue is what the next Government are going to do. If so, that is fine: by all means let us have a debate about that, in recognition of the fact that we will be taking over these responsibilities. Unless and until we do, however, our task is to challenge the Government about how they are discharging their responsibilities to deliver our national interests now and over the four months before the working time directive is implemented.
I will give way in a moment, of course, but it is important to recognise that although the regulations were implemented to achieve a progressive reduction in working hours, the way that the European Court of Justice chose to interpret them also had a substantial impact.
The SiMAP and Jaeger judgements are relevant in this regard. The SiMAP judgment treated time spent as a resident on call as working time, regardless of whether the people involved were actively engaged in work. The Jaeger judgment reinforced that, and also applied the interpretation that compensatory rest for time worked should be achieved before the next scheduled work period. Both judgments, of course, had a substantial impact on junior doctors' ability to fulfil their obligations in operating rotas and the like. They also effectively ended the resident-on-call status that until then had been a substantial part of their service contribution to the NHS.
I am grateful to the hon. Gentleman for giving way. Earlier, he seemed to agree with the suggestion from Mr. Heathcoat-Amory that the working time directive was some dastardly European plot imposed on us from Strasbourg and Brussels. I stand second to none in my scepticism about many things European, but I am not aware that any foreign firms are seeking to deliver the retained fire service in Scotland or parts of the NHS in England. That is a daft suggestion. When the 56-hour and 48-hour working week were being trialled, it is true that there were gaps in provision, but surely they could be filled by locums if we were able to train enough of them. The health and safety—
In 2004, the European Commission, reviewing the working time directive, proposed to retain the individual opt-out and to redefine inactive time and compensatory rest in ways that would have been helpful, from our point of view. Unfortunately, as Ministers subsequently admitted in debates, they were unable, even during the UK presidency, to deliver that through the Employment Council. In June last year, a common position was reached in the Council; again, that would have been helpful from our point of view, but the European Parliament has voted against it. None of that impacts on the possibility of providing additional flexibility through the directive to provide a derogation beyond 48 hours to 52 hours through to 2012, so that the 48 hours does not apply to junior doctors in 2009. That is all by way of background.
What I find remarkable in all that is that the response of Government seems to have been so weak when it came to our national interests. Mr. Hutton, who was Minister of State at the Department of Health at the time, was in January 2004 so misguided as to say:
"Complying with the working time directive need be neither costly nor a burden."
People across the national health service know that it is an enormous burden, even in the pilot projects, which have sought to put the most charitable interpretation on the matter. There are enormous costs, and there are implications for rota design, staff arrangements, and in particular, the recruitment of additional locum and consultant staff. In recognition of that—it is scarcely full recognition—the Government are providing £110 million this financial year and £200 million next financial year to compensate. So we know that compliance is costly.
Is that not typical of this Government, whose approach to Europe is always supine? They try to find out what the answer will be first, and then they say that that is the answer that they want. They have never stood up for British interests on anything and seen it through to a successful conclusion. They gave the money away, and now they are giving the working rights away.
Yes, my right hon. Friend is absolutely right. Interestingly, even two months after the right hon. Member for Barrow and Furness made the statement that I quoted, he recognised that there were problems with the working time directive. He said:
"Both the retention of the individual opt out and a solution for the problems caused by the SiMAP/Jaeger judgments remain key priorities for the UK".—[ Hansard, 10 March 2006; Vol. 443, c. 1820W.]
They may have been key priorities, but they were not achieved; I am afraid that the Government have consistently failed on the issue.
Interestingly, in January this year, when we raised the issue in the course of a debate on emergency care, the Secretary of State said, in apparent contradiction of the Government's intentions:
"We have decided...that the national health service will have a 48-hour working week with no opt-out."—[ Hansard, 21 January 2009; Vol. 486, c. 774.]
He did not qualify that. For a start, does he actually intend that consultants in the NHS should have no opt-out? Is he actually contending that he wants to get rid of the individual opt-out? Is he contending that there is no scope for derogations? It all appears to be completely contrary to the Government's stated policy intention. The Secretary of State is all over the shop on that subject.
The working time directive is a piece of health and safety legislation. Can the hon. Gentleman tell me of two other pieces of health and safety legislation that allow the individual employee simply to opt out of something that is there to protect his or her health?
That is a curious intervention. It is ostensibly the policy of the hon. Gentleman's Government that there should be an individual opt-out, but he appears to be arguing that that is strange and anomalous. We are in favour of retaining the opt-out, even if Government Members—not only Members of the European Parliament but Members in this Parliament—appear not to have understood, or to support, anything that the Government tell them. What I find really curious is that although the Secretary of State told the House that the limit would be 48 hours and that was that, nine days later he sent the European Commission notification of the fact that there would be a derogation. Unfortunately, he wrote that on the basis that the derogation would relate only to
"doctors in training who are delivering 24 hour immediate patient care, in some supra specialist areas or in small, remote, or rural" areas. He did not give the opportunity for a wider derogation—something that the Royal College of Physicians, for example, is very keen to have.
My hon. Friend is making a very good speech on health matters, but of course there is also the question of business as a whole. Has he noticed that in this time of economic crisis, the number of countries seeking derogation has risen to 15 and is growing, precisely because countries now appreciate that they need that flexibility, particularly for small and medium-sized businesses? To do otherwise in an economic crisis is pure Alice in Wonderland.
Yes, it is interesting; 15 member states, including ourselves, make use of the opt-out. It is astonishing that throughout the process, the European Union, through its decision-making processes, appears to have been able to resist what, on the face of it, was the common position of most of the member states of the European Union, represented in the Council of Ministers. The way in which decision making is structured in the European Union gives one pause for thought. I shall say no more on that; it is not my place to do so.
I shall make some progress, but I will give way in a minute. I do not want to lose sight of the nature of the problems that the issue creates for the NHS. This is not a theoretical debate about European policy, or the merits or otherwise of reducing working hours for junior doctors. As I said, in the absence of the working time directive, we would none the less have enforced a 56-hour limit on working hours for junior doctors, to prevent them from having an excessive work load.
I am grateful to the hon. Gentleman. Does he agree that derogation, which would still involve a four-hour reduction to the current number of hours allowed, does not solve the fundamental problems? It does not address concerns about patient safety or the impact on training; it simply delays the inevitable for two years.
Yes, I agree with that, and I will come on to some possible solutions, although I fear—I know that some of my colleagues would say this—that the directive imposes a legislative straitjacket that limits our potential, even given the common position taken by the Council of Ministers.
Let me be clear about what the problems are for the NHS. First, the Government are proceeding on the basis that there is a much higher level of compliance than there really is. Ministers are working on the basis of compliance with the new deal for junior doctors, not with the working time directive directly. When the Royal College of Surgeons went to the north-west region, which the Government had said was already 97 per cent. compliant with the obligations for this August, it found that one third of those units in the north-west were not compliant, and about a third of those who were not compliant thought that they still would not be compliant by August.
Are the data that we see reliable? The Association of Surgeons in Training, which surveyed its surgical trainees, found that only a quarter of them had contracts and human resources department data that were an accurate reflection of the real hours that they were working, so we may not be getting proper data. Worryingly, 55 per cent. of members of the Association of Surgeons in Training went on to say that they were pressured falsely to declare their actual hours worked, and 80 per cent. of surgical trainees supported an opt-out from the European working time directive to protect their training.
The second problem is that a reduction in trainees' hours reduces the time available for training. We knew that that was happening—Modernising Medical Careers and the new deal did that—but what is proposed goes even further. It means that doctors are moving to shift working, instead of operating as a firm and taking collective responsibility. Most of us, in so far as we know about the way in which junior doctor training works—many of us do—have always thought in terms of a consultant and his or her "firm", but that will have to go if all the changes are made, because junior doctors simply will not be able to be there for enough time, and will not get enough contact with their consultant, to make that happen.
Junior doctors will lose continuity of learning. They will not be able to admit a patient, see them through their course of treatment and see what happens to them when they leave to the same extent as they once did. Continuity in relation to patients is a very important aspect of learning. The cumulative experience of trainees in the course of their medical education is absolutely vital. We know that the reduction from 10,000 hours of contact and direct experience of the treatment of patients to 7,000 hours will have a significant impact. As Professor Janet Grant from the Open university said, the difference between competent and expert is 10,000 accumulated hours of experience. Do we want specialists who have the ticks in the boxes when it comes to their training qualifications, but who do not have sufficient practical, supervised experience in the procedures with which they will be involved? I do not and patients do not, and the Secretary of State has a letter from the lay group advising the Royal College of Surgeons on the matter. The medical profession does not want that. The surgeons in training do not want it. So why does the directive and why will the Department prejudice the safety of patients for no initial gain for doctors?
Given that the working time directive is, in essence, a health and safety measure, can it be healthy or safe that the future generation of consultants will have less than half the clinical exposure that the current generation has?
That is exactly right. What are we gaining in health and safety terms for junior doctors by prejudicing in this way their capacity to undertake the necessary training in order for them to become not only qualified specialists, but excellent in the services that they provide?
Some of the studies have made it clear that the change does not make much difference. For instance, a study in the Journal of Occupational and Environmental Medicine last year reported:
"Our results challenge the assumption that each hour of work above 40 hours steadily increases health and safety risks and reduces productivity. In fact, no adverse effects were found until the 60-hour per week mark".
Another study published by the university of Maryland said:
"Studies show that the risk of an incident associated with long work hours may be influenced more by the precise work schedule, including the length and timing of the duty periods, and the provision of breaks, than by compliance or lack of compliance with the arbitrary benchmark of 48 working hours."
Many junior doctors say that the shift system often leads to negative impacts on their sense of well-being and their work-life balance, and one of the surveys by the Royal College of Physicians showed exactly that—a negative effect on their work-life balance.
In its position statement in January this year, the Association of Surgeons in Training said that
"it is necessary to return to a working week of approximately 65 hours".
Does the hon. Gentleman agree with that?
No. In any case, under the new deal for junior doctors, it would not be possible to go beyond 56 hours. That was introduced by us, not by the present Government, but it does not mean that there is not considerable scope. For example, RemedyUK, which has honourably been involved in telling the Government some of the things they should have done on Modernising Medical Careers and the Medical Training Application Service, has made it clear to the Government that there could, for example, be a process by which junior doctors collectively made a decision to opt out from 48 hours and opt for up to 56 hours. That would enable many of the rotas currently operated in our hospitals to be maintained.
As a consequence of MMC and MTAS and the loss of junior doctors resulting from reactions to them, we are seeing a considerable increase in the vacancy rate among junior doctors. A specialist hospital reports a 30 per cent. vacancy rate, whereas three years ago it had 40 applicants for each post. How did we get to such a situation? Two years ago we had an excess of junior doctors. The Government have spent considerable amounts of taxpayers' money increasing the number of medical students, and lo and behold, where have we arrived? Across the hospital sector, rotas cannot be filled, junior doctors are not applying, and the shortfall has to be covered by extending the hours of consultants, who could opt out up to 78 hours if they had to, and by internal locums probably not properly supervised to protect the interests of those junior doctors.
No, I shall conclude, if the hon. Gentleman will forgive me.
We need a way ahead. We need to know from the Government that we will retain the individual opt-out, and we need the Government to explain how they will secure a policy objective that they have talked about for five years but have not secured. We need an explanation from the Government of how they will achieve that in the European Union.
As solutions to the problem, junior doctors must continue to be able to opt out from 48 hours and go up to as much as 56 hours, in the way that RemedyUK has suggested to the Government, although they do not seem to be engaging with the issue. Inactive time on call should not be treated as working time, so that rotas can be given the proper flexibility. We need to explore the scope for collective agreements under the directive, which the Royal College of Surgeons has pressed upon Ministers and which would allow some of the definitions of night-time working and rest breaks to be more flexible.
As an immediate response, the Government should send to the Commission a much wider notification of derogation that would allow surgical specialties and, if necessary, paediatrics, obstetrics and anaesthesia to retain 52 hours, even if at this stage we do not have the individual opt-out that would allow us to go to 56 hours.
No, I am concluding, if my hon. Friend will forgive me.
Interestingly, the Government's amendment signals some movement. It states that the Government recognise
"that a solution is required in order to bring back much needed flexibility to the treatment of on-call time and compensatory rest time".
The problem is that they have not achieved that. As my hon. Friend the Member for Rayleigh will make clear in his winding-up speech, if we achieve that flexibility, the retention of the opt-out and the ability to amend the directive, we will be able to support greater labour market flexibility and competitiveness generally. The burden of compliance with the working time directive has been enormous, but the benefit has been far too limited by comparison.
We have had years of promises from Ministers, but they have failed. It is time for action by the Government and for clarity about the long-term future of the working time directive. The Government are always claiming influence in Europe. It turns out that they cannot even influence their own Members of the European Parliament. The time has come for MEPs who will promote British interests, and the elections in June will take care of that. The time has also come for a Government who have impact in securing our interests in Europe. That will come at the next general election, through a change of Government.
Several hon. Members rose—
Order. With the number of hon. Members who have by now indicated that they wish to take part in the debate at 15 minutes per head, we would have to start now, which would be a little unfair to the Secretary of State and Norman Lamb, so I give notice that I shall reduce the time limit on Back-Bench speeches to 10 minutes.
I beg to move an amendment, to leave out from "House" to the end of the Question and add:
"agrees it is right that no worker should be required to work longer than 48 hours per week averaged over 26 weeks unless he or she freely chooses to do so;
notes the Government's manifesto commitment to maintaining the individual opt-out from the European Working Time Directive;
further notes the importance of the individual opt-out which is used by the UK along with 14 other EU member states;
recognises that maintaining the individual opt-out is a key part of the UK's flexible labour market and of particular importance during the current economic climate;
understands the particular concerns related to the working of excessive hours in the medical professions and welcomes the significant progress that has been made in the NHS to reduce junior doctors' hours;
further notes the challenges faced as a result of the SiMAP and Jaeger judgements;
further recognises that a solution is required in order to bring back much needed flexibility to the treatment of on-call time and compensatory rest time;
welcomes the significant progress made in introducing the Working Time Directive across all clinical and staff groups within the NHS;
further recognises that an extended derogation is necessary for a limited number of specialties and isolated, rural locations in order to ensure the efficient implementation of the Directive;
and supports the continuing action to work with staff, clinicians, the British Medical Association and the Royal Colleges to ensure the workable implementation of the Working Time Directive to the benefit of patients and staff."
This debate provides a timely opportunity to remind the House of the principles behind the European working time directive. The philosophy behind the motion was, I believe, something to do with the Conservative Whips, who wanted to get a bigger turnout on their Benches. If "European" is mentioned in the same line as "working time", all sorts of people come out of the woodwork. It is extremely important to ensure the proper implementation of the directive.
I am grateful to the right hon. Gentleman for allowing me to intervene so early. Does he agree that it seems from the motion that the Tories are tinkering with the issue, and that the only sustainable way forward is to renegotiate the European Communities Act 1972? That is the only way that we will solve these European problems, and it is in line with what the majority of the British people want us to do.
From the Conservative speeches and interventions, it sounded to me as though that is precisely what the Opposition intend to do, which would, of course, mean renegotiating the treaty of Rome.
The directive is, above all, about protecting employees from exploitation. It gives employees the right not to work beyond a maximum of 48 hours a week. It also gives British workers a statutory entitlement to holidays and rest breaks which have been common in most other European countries for many years. At the same time, it reflects the right of individuals to opt out of the weekly limit if they so choose. The common position agreed at the Council of Ministers last June made it clear that the right to opt out should remain, as well as setting out how we could resolve the difficulties that many member states, including the UK, are experiencing as a result of the SiMAP and Jaeger judgments
Does the Secretary of State agree that, in the light of his remarks about the need to protect people from exploitation, it is slightly odd that many of my constituents who are doctors have written to me saying that they should be allowed to work more than 48 hours? Is that not an odd state of affairs?
They can work more than 48 hours; the individual opt-out would allow them to do that. I shall come to the issue with doctors in a moment. [Hon. Members: "What about junior doctors?"] And the issue of junior doctors. Junior doctors have the right of an individual opt-out.
I shall come to the health provisions in a second, but this issue is about the European working time directive. There is an awful lot about the directive itself, and not its application to health, that I need to address. In December 2008, the European Parliament voted through a number of hostile amendments to the common position, including abolishing the opt-out. I want to make it absolutely plain, including to the Scottish Liberal Democrats who voted for that position, that that is not the end of the process. The directive is, of course, subject to co-decision, and this is the latest step in a complex negotiation between the European Parliament and member states. The UK Government will continue to defend the opt-out, working with many other EU states, as we enter the next phase of conciliation.
In its motion, the Conservative party
"welcomes improvements in the workplace which improve...general well-being."
That is indeed a Damascene conversion. When it was in government, the Conservative party opposed the European working time directive for the same reasons it opposed the national minimum wage. We all remember its version of patriotism: it was to position the UK as the sweatshop of Europe, boasting of its long-hours, low-wage economy. It was not at all perturbed by the high proportion of the UK work force who—never mind working hours—had no entitlement at all to paid holidays. Among working women with dependent children, the proportion was 15 per cent. The Conservative Government voted against the directive being adopted in 1993, and then spent the next three years, and millions of pounds of taxpayers' money, mounting an unsuccessful challenge in the European Court of Justice, which ruled unanimously against them in November 1996.
The UK work force whose "general well-being" the Conservatives welcome so much in the motion today had to wait for a Labour Government to have their rights protected. When in 1998 the directive was finally introduced in the UK, the 48-hour maximum working week was applied immediately to the vast majority of NHS staff, including consultants and nurses.
In his continuing negotiations in Europe and in the context of his remarks about protection and well-being, what would the Secretary of State say to the constituents of Ludlow, not a single one of whom has anyone other than retained firefighters to protect their well-being, if, as a result of the loss of this opt-out, we have no fire protection cover in Shropshire?
This is the position. The retained firefighters need the opt-out. We have protected the opt-out since 1998, and against the most vehement criticism from other member states. The reason why SiMAP and Jaeger could not be sorted out—and this is a negotiation, of course—is that some member states put the solution of those judgments together with the opt-out. They then said to the UK and other member states, "You can get a solution to SiMAP and Jaeger only if you give up your opt-outs."
We have got to a common position that we all support and that would resolve SiMAP and Jaeger and maintain the opt-out; what the Conservative party now asks us to do is to go back and say, "We want the opt-out, SiMAP and Jaeger, and a sectoral opt-out"—incidentally, the European working time directive does not allow for that, but I will come to that in a second—"for all junior doctors who are involved in surgery." What a brilliant negotiating stance. It is a "Janet and John" way of negotiating an agreement. That is the difference between the Conservative and Labour parties. The Conservatives never had any intention of reaching agreements on issues such as protecting workers' rights—all they saw was "European"; they did not go on to see "working time directive".
My right hon. Friend well illustrates the fact that the Opposition motion is false and a posture. The intervention of Mr. Dunne showed that they do not understand. What would threaten retained firefighters has nothing to do with the opt-out; it is the fact that they are on call, that their on-call time would be counted and that they would therefore have no time in which to do their jobs. We need negotiations with the European Parliament about the opt-out, to get the changes to the rulings. It is the rulings, not the principle of the opt-out, that are blocking common sense.
According to my conversations with fire brigade members, Michael Connarty is wrong in that they work full time in other jobs. They are retained firefighters who turn out at the call of a pager to save people's lives. According to their argument, it is the opt-out to the working time directive that they need to keep, not Jaeger and SiMAP. I am afraid that the hon. Gentleman was wrong on that.
My hon. Friend Michael Connarty was right because in negotiations people put all kinds of things together. [Interruption.] "Ah," says the Conservative party. The first basis of trying to negotiate a deal is that other people bring to the table the changes that they want. SiMAP and Jaeger are inextricably linked to the issue; that is why it is surprising that Liberal Democrat MEPs voted against the opt-out.
The directive initially excluded junior doctors, along with those working in the air, on rail, on the roads and at sea, because of particular difficulties associated with those professions. Such difficulties included the need for increased resources, or, in the case of HGV drivers, the need for even more rigorous regulation of working hours than the directive provided for. An amendment made in 2000 applied the directive to junior doctors and all other sectors that had previously been exempt, but introduced special, transitional measures by which junior doctors' hours could be gradually reduced to 48. It also allowed countries to apply further derogations to ease transition where necessary.
In August 2004, the maximum working week for junior doctors was reduced from an average of 72 hours to 58 hours. In 2007, it came down to 56 hours. By August this year, it will come down to 48 hours for the vast majority of junior doctors.
Is the Secretary of State aware of the report published recently by the Royal College of Physicians? It suggests that the move towards compliance with the new working week has resulted in a reduction of quality not only in clinical care but in the training of junior doctors. Does he agree? If he does, what is he going to do about it?
I reject it completely, for reasons that I shall come to in a second.
The Government supported the amendment to the directive and its gradual implementation, not least because there is irrefutable evidence that tired doctors present a risk to patient safety. The Government never want a return to a situation that many established doctors will remember only too well. It was common for trainees to work through the weekend until Monday evening, with no provision for any breaks—a continuous shift of 90 hours. They would then return to work on Tuesday morning for another shift of at least 36 hours.
I should point out that there is another doctor in the House. On a serious point, I was one of the doctors who had to work many more hours than is currently legal. Is the Secretary of State aware of a report by Warwick and Harvard universities that showed that doctors who worked 56 hours made 30 per cent. more mistakes than those working 48 hours? Even relatively few extra hours significantly increases the risk of making an error.
Not only am I aware of that research, but I intend to quote it chapter and verse later.
In acute disciplines, a working week of over 100 hours was the norm, with most of that time spent directly caring for and even operating on patients, with often the most critically ill patients being initially seen by the least trained staff. That is why it is even more important that there are sensible limits to the number of hours staff work to break that culture once and for all and to ensure that no medical professional is required or expected to work dangerously long hours again. For this reason and many others, the British Medical Association is supporting the full implementation of the directive for all junior doctors.
There is no question but that it has been challenging to work towards full compliance. The NHS has over 46,000 doctors in training at any one time. Incidentally, there is no vacancy problem, as Mr. Lansley suggested. On the last set of figures, we had a 95 per cent. fill rate; there is absolutely no vacancy problem anywhere in the country that I know of. This is a service that by its very nature has to operate for 24 hours a day, seven days a week. Trainee doctors need to train and work in as many medical disciplines as possible to become good doctors. Hospitals have had to make dramatic changes to how staff work. So, yes, it has been difficult, but it is simply not true to say that the NHS is ill prepared to achieve full compliance by August this year. We have provided substantial financial support to the NHS to help it to meet the requirements of the directive—£110 million in the current financial year, rising to £310 million for the year to come.
We are working closely with the royal colleges, including the Royal College of Surgeons, and with the BMA and all strategic health authorities, to ensure that we have as accurate a picture as possible of how well prepared trusts are for full implementation. At present, two thirds of junior doctors are working no more than 48 hours per week, and many trusts, including almost all those in the north-west, are already fully compliant with the directive. In December, we agreed a quality assurance process with the SHAs and the royal colleges to examine potential difficulties and ensure that there are action plans to secure full compliance. The first quality assurance return was received at the end of January, the next is due towards the end of this month, and they will then be received monthly until August. The content is routinely shared with the Academy of Medical Royal Colleges and the National Reference Group, on which the Royal College of Surgeons, the Royal College of Anaesthetists, the Royal College of Paediatrics and Child Health, the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians, the BMA and the SHAs are all represented. There is a rigorous process to ensure that this is being implemented successfully.
There are, of course, still some areas that are struggling: in specialisms such as surgery and 24-hour immediate patient care; or in more isolated, rural parts of the country where there is a shortage of trainee doctors. We have therefore notified the European Commission of our intention to derogate for these areas. It needs to be made clear that the derogation does not mean opting out of the directive: it will mean a maximum working week, for certain disciplines, of 52 hours; and within three years, full compliance with the directive must be achieved.
The Secretary of State said that the individual opt-out could not be used for junior doctors, as has been proposed by RemedyUK. What did he mean by that? It seems to me that as long as the individual opt-out applies, it is as applicable to the health service as it is to anywhere else.
Yes, the individual opt-out does apply. The mistake is in thinking that there is an ability to get a sectoral opt-out for a complete sector of the working population. I will come to that in a moment.
The Royal College of Surgeons recently argued that there should be a sector-wide opt out for trainee surgeons, who should be granted the right to work a maximum week of 65 to 70 hours—a position that the hon. Member for South Cambridgeshire has said the Opposition disagree with. I met John Black, the president of the RCS, and his colleagues, a few weeks ago to explain that I could not accept their demands even if I agreed with them, which I do not. My reasons are threefold.
First, even if a sector-wide opt-out from the maximum 48-hour working week were desirable, it is not possible under the terms of the directive. The only opt-out allowed by the directive is not sectoral but individual. Even if a sectoral opt-out were possible, it would not be practical to consider surgical care or any one discipline separate from other specialisms. However, the right to the individual opt-out is not automatic under the directive. The directive does not directly entitle anyone to opt out. It gives EU member states the option to legislate that individuals can opt out—a course that we have followed in the United Kingdom—or to deal with the issue via collective agreements in order to enshrine the same individual rights. In Germany, for instance—this has been cited by the RCS—unions and industry representatives have collective agreements to use the opt-out in specific professions, including doctors, enabling those covered by the agreement to work 54 to 60 hours a week—but within those agreements staff are still required to make an individual decision to opt out.
The RCS has claimed that there are sectoral exemptions for employees working in the armed forces, the fire service and the police. That is incorrect. The police and the armed forces are exempt only in times of national emergency.
Will the Secretary of State consider the proposal—it came from RemedyUK but moves in the direction that the RCS is looking for—to have, in effect, a collective agreement to allow junior doctors individually to opt for a 56-hour working week?
The hon. Gentleman misunderstands. Getting a sectoral agreement that allows individuals to opt out would put us in exactly the same position as we are now. We took the legislation route; the Germans, because of their history—they do not even have a national minimum wage, but use collective agreements—took the collective agreement route. The result is exactly the same. Any individual, including junior doctors, has the right to opt out enshrined in the legislation.
Let us cut to the chase. At the moment, the NHS, under the instructions sent by the NHS chief executive to the trusts, does not offer to retain 56 hours. It goes to 48 hours and that is it—an absolute commitment, in the words of the chief executive, presumably at the Secretary of State's behest. Will the Secretary of State therefore say that that is no longer the Government's policy for the NHS, and that the NHS is in fact willing to discuss with the BMA, the royal colleges and the associations the implementation of 56 hours based on individual opt-out?
There are three reasons I disagree with the RCS. The first is the fact that this cannot be done under the agreement; I will explain later why it should not be done even if it could be. In any case, in the situation that the hon. Gentleman raises, the individual opt-out will be available, but individual workers cannot be coerced into taking it up. It would be wrong for the chief executive of the NHS, or any other organisation, to write to people saying that the 56-hour week is still available. If an individual wants to opt out, anyone can choose to do so under the directive.
My hon. Friend makes a really important point. There were serious allegations that that was happening in the early days of the working time directive, but it has not happened since.
I was talking about the emergency services. Normal emergency service activities that can be planned in advance would not allow for the opt-out; it is only there for emergency services when there is a national emergency.
The second reason I cannot accept the Royal College of Surgeons' recent demands, or indeed the policy proposed by the hon. Member for South Cambridgeshire, is that I reject the argument that reducing the hours worked by junior doctors will reduce the quality of their training. There is no evidence that with the gradual reduction in junior doctors' hours over the past 10 years, training is any less effective. The number of junior doctors who fail their training has remained static. We have gone from 72 hours down to 58 hours and on to 56 hours, with the same Jeremiahs saying that that would prejudice proper training, but there is not a single smidgeon of evidence that that is the case. The number of junior doctors who fail their training has remained static. No junior doctor who fails to demonstrate the competencies required is allowed to progress, and we still have one of the most intensive training regimes for junior doctors in Europe.
Having trainee surgeons working longer hours and spending regular periods as a resident on call at night does not afford more opportunities for training, or necessarily mean better training. Very little training takes place in the dead of night, when only very urgent surgery is carried out. Surgery is a technical skill and the way in which surgeons train is evolving. Developments in new technology such as virtual reality surgical simulators mean that there is increasingly and thankfully less need for inexperienced trainee surgeons to practise their skills directly on patients.
No, I am not giving way. In some parts of the country where the directive has already been implemented, teams of trainee surgeons work on a shift system with senior trainees on call to deal with surgical emergencies. Others have split elective and surgical work so trainees get to experience both.
My third and final reason for rejecting the call by the Royal College of Surgeons is that I completely reject the claim that a reduction in the working week of trainee surgeons will jeopardise the safety of patients. Those who make this argument—including the Opposition in their motion—claim that to have shorter working hours reduces cover in hospitals. But hospitals are addressing that by organising trainee teams and rotas differently, and it is beyond doubt that doctors who are required to work long hours are more likely to make mistakes that could threaten the lives of patients. As long ago as 1998, my noble Friend the eminent surgeon, Lord Darzi, published a paper in The Lancet on the effect of sleep deprivation on surgical trainees, which showed that being deprived of sleep for 24 hours had the same impact on surgeons' performance as a blood alcohol level higher than the legal limit for driving.
Most recently, a study by Warwick university medical school—referred to by my hon. Friend Dr. Stoate—on trainees working in Coventry and Warwickshire university hospitals compared the number of errors made by junior doctors working no more than 48 hours with those working no more than 56 hours, and it showed that those working fewer hours made 30 per cent. fewer clinical errors. In the US, where junior doctors work around 80 hours a week, 50 per cent. admit that they have made errors because of fatigue. That reflects the study published in the British Medical Journal in 2001, which showed that surgical trainees were much more likely to make mistakes during the daytime after being on call at night. To complete the process, a study by the Harvard work hours, health and safety group published in The Joint Commission Journal on Quality and Patient Safety shows that junior doctors who have worked traditional shifts of more than 24 hours have a greatly increased risk of crashing their car driving home from work, as well as of making a serious, even fatal, medical error.
Over the past 10 years, the NHS has put considerable effort into preparing for full implementation of the European working time directive. It is worth pointing out—this would have been my fourth reason if I had thought of it earlier—that longer hours particularly disadvantage women. Some 60 per cent. of medical students are women. All the professional bodies agreed with the objective when this agreement was signed in 1999-2000. I have no idea why the Conservative party wants to be the champion of long hours and staff exploitation. I hope that the House leaves its arguments where they belong: in the last century. I commend the amendment to the House.
I welcome the debate. It comes at a timely point in the build-up to the change in August and it is important because of the massive potential problems that are emerging. I am conscious of an extraordinary gap between what the Secretary of State says about the potential risks involved in the changes and what the professionals working in the service have said, loud and clear. The Secretary of State ought to listen a bit more carefully to the royal colleges, because their analysis of the risks we face as a result of the changes is different to his. He ought to listen to the people working in hospitals, who have experience of the way in which the reduction in hours impacts on patient care.
My hon. Friend rightly draws attention to the comments of the president of the Royal College of Surgeons, John Black, of which the Secretary of State has been rather dismissive. Does my hon. Friend agree that for the president of the Royal College of Surgeons to have used language such as "an impending disaster" and to say that these moves would "devastate" medical training and lead to
"dangerous lapses in patient care", means that he was making serious criticisms of the proposals, which ought not to be dismissed quite so lightly by the Secretary of State?
The hon. Gentleman is very generous with his time. I would like to quote the British Medical Association:
"The BMA is strongly supportive of the August deadline. Although the 11-year transitional phase for trainees was crucial in ensuring health service delivery was not put at risk unduly, we consider it is now time that junior doctors receive the same level of protection of their health and safety as all other workers in the UK."
The BMA is in favour of the 48-hour week.
Interestingly, when the BMA surveyed its members, they disagreed with the BMA. If we follow the hon. Gentleman's analysis, we reach the assumption that he is dangerous when providing medical care because, presumably, he is working substantially more than 48 hours in combining this job with that job. He ought to give up his second job on the basis of his analysis of the risks of excessive working hours. There is a great hypocrisy in this place and elsewhere—all of us, by and large, work substantially more than 48 hours a week.
On hypocrisy, will the hon. Gentleman allow me?
Order. Before the hon. Gentleman intervenes, I should say that "hypocrisy" is not a word we like to bandy about in the Chamber.
I am grateful to the spokesman for the Liberal Democrats for taking an intervention on this point, because he will be able to clarify the concerns echoed by those of all other parties who have spoken this evening. Why is it, when we have all shared concerns about retained firefighters and the problems that getting rid of the opt-out would cause, that the only Liberal Democrat Member of the European Parliament from Scotland voted to get rid of the opt-out? Please could the hon. Gentleman take this opportunity to explain why. Did his colleague disagree with the policy or did she just press the wrong button?
The hon. Gentleman appears to be stuck in a groove—he has repeated himself rather a lot on that point. There are always occasions when people do not vote with their party. I suspect that he will even find that in his Stalinist party in Scotland.
I was going back to much less contentious territory, thank you very much. I gave three reasons why I was against the proposal of the Royal College of Surgeons that we should seek a sectoral derogation for a 65 to 70-hour week. I also said that we are working with all the royal colleges and listening to them intently. Is the hon. Gentleman now saying that it is Liberal Democrat policy to support the Royal College of Surgeons in its efforts to get a 65 to 70-hour sectoral opt-out?
No, I am not saying that. The point that I made earlier, which the Secretary of State might not have heard clearly enough, is that he appeared to dismiss the concerns that have been expressed by the Royal College of Surgeons and the Royal College of Physicians about the risks to patient care. He shakes his head in a rather dismissive way. Will he listen to those concerns? We all want him to acknowledge that he should do that. Does he wish to intervene to confirm that he will?
Hansard will record that I said on numerous occasions in my speech that there are genuine concerns about this issue, that it is not easy, that it has been difficult for 10 years and that we talk to the royal colleges, the BMA and everyone else day in and day out. We are talking to them on a monthly—in fact almost weekly—basis. We must consider whether this country is somehow uniquely unable to train doctors without their working 65 to 70 hours a week. I say that that is absolutely not the case.
We are certainly not arguing that either. Our concern is about the change in August this year from 56 hours to 48. Many, including the Conservative party and the Liberal Democrats, have concerns about that and about the potential risk of the opt-out ending if the Council of Ministers were to vote in that way. I fully acknowledge that the Government are seeking to protect the opt-out, and we agree with them about that.
My hon. Friend is being very generous with his time. I hope that he will join me in welcoming Angus Robertson to the debate. Neither he nor any of his Scottish National party colleagues have been able to be with us on previous occasions when we have discussed the working time directive. I hope that my hon. Friend will not make the obvious point that when the vote was held in the European Parliament, all the other members of the group of which the SNP members are part—I believe that it is called the green and radical group—voted in the other direction. That is not a helpful way to proceed. We need proper unity, particularly in relation to the case for retained firefighters in Scotland.
I am grateful for that helpful intervention, and I am just frustrated that I am not allowed to use the word "hypocrisy" to comment further. The Liberal Democrats' group in the European Parliament has been at the forefront in working with the Government to protect the opt-out, as the Secretary of State will know.
The irony of all this is that although the working time directive is defined as a health and safety measure, there is a risk that the imposition of a 48-hour week will put patient safety at risk. That is what we are all concerned about. I should declare an interest: I worked as an employment lawyer before I arrived in this place, and I worked with the Secretary of State on an employment Bill some years ago, which brings back happy memories. I might even declare that I know something about the subject, which is always dangerous in this place.
The first principle that we should apply is that excessive working hours are not good. We should all accept that, and I am sure that even Dr. Stoate, who clearly works excessive hours, would accept that we should work to reduce them. Exploitation of staff is unacceptable, and whenever evidence emerges that staff are under pressure to opt out, firm action should be taken against the employer concerned.
Does my hon. Friend share my concern that although that has been a known concern for some years, work force planning in the NHS seems totally inadequate to deal with the problem? It has not come upon us overnight. The Government have had eight, nine or 10 years to prepare, and still the medical profession does not seem ready. We were talking about this in 2001.
I agree, and all the evidence that we get from the royal colleges, contrary to what the Secretary of State says, is that the NHS is not ready and that there are real problems ahead.
There is a case for establishing limits on working time and norms that should apply generally across the work force. In fact, the last Conservative Government acknowledged that with the introduction of the new deal in 1991. They then failed to implement it, and it was only really implemented from about 2000, when financial incentives were applied to NHS employers. In principle, however, the Conservatives accepted the case for limiting doctors' working hours.
However, it must surely be a fundamental right to opt out of a limit on working hours and to choose for oneself, not due to pressures from others, to work longer than the limit. I think that we can all agree on that, although of course it should be subject to limitations such as the 56-hour limit in the health service. People must surely have that right. As I have said, we all do it.
The importance of retaining the opt-out goes well beyond the NHS. Particularly in tough times, the business community regards it as very important. My hon. Friend Mr. Carmichael—
I am grateful for it. My hon. Friend secured an Adjournment debate on the subject of retained firefighters, who are important in his constituency and in my rural constituency, the whole of which depends on the work of those fine individuals who give their spare time to protect their community. It is absolutely essential that their capacity to provide that service and that contribution to their community is retained. That is why the retention of the opt-out is so important.
My hon. Friend is quite right about those individuals giving time to their community. Does he agree that it is ridiculous that, under the European Parliament's proposals, if people got together and voluntarily operated a fire engine without pay they would not be covered by the directive, but because they are professionally trained and get a small wage they will be covered? In fact, the proposals would simply mean that we would not have paid, professional fire cover throughout large parts of the country.
That is a very good point, and it demonstrates that overly prescriptive regulations imposed from Brussels can have unintended and rather ludicrous consequences. That is why it is important to retain the opt-out, so that that professional service can be retained.
Apart from mentioning the Liberal Democrat Member of the European Parliament who voted against the interests that Mr. Reid has set out, may we return to a point made by Norman Lamb? He said that the Royal College of Surgeons should be listened to and that it had a point. However, what it called for was a limit of 65 to 70 hours, whereas he seems to support a 56-hour limit. Is he willing to oppose the conclusions of the Royal College of Surgeons? It said that there was an "impending disaster"—I believe that he quoted those words—if the limit was not 65 to 70 hours. Will he now contradict that and say that it is not the case?
I do not support the case made by the Royal College of Surgeons for working 65 hours. Throughout my speech I have argued that the Government should listen to its concerns about the impact on the service if the limit were reduced to 48 hours. That is the important point. One can then have a discussion with it about how best to resolve the matter. It does not mean that one has to accept its proposition as the only solution to the problem.
Let me consider the scale of the potential impact, which is frightening. Approximately 30,000 junior doctors in training will be hit by the
What will the result be? All those in the profession who have considered the matter express genuine concern about the impact on patient care and continuity of care. They talk of the danger of multiple handovers. Contrary to what the Secretary of State said, clear evidence shows that loss of continuity of care is a key cause of avoidable medical errors. That is why the royal colleges' concerns should be taken more seriously.
Hospital trusts that have managed to comply with the 48-hour ruling have often done so through using locums, often from outside the hospital. That causes concern because, as the Royal College of Physicians highlighted, now that the Government have acted to reduce massively the number of international medical graduates who work in the health service, it is hard to find enough locums. The survey that the Royal College of Physicians conducted raises concerns about the quality of locums who are brought in to complete shift patterns because of the reduction in working hours. It identified lower quality and reliability. All that is apart from the cost of bringing in locums, which RemedyUK suggests could be as much as £120,000 in one hospital.
There is also the problem of the thinness of the available cover if any problems arise, such as sickness or holiday absence. The Royal College of Surgeons has highlighted the risk of running out of surgeons in some parts of the country to fill gaps in the rotas. The Government should take those anxieties seriously.
We must also consider the impact on training. Almost 50 per cent. of junior doctors in the first two years of surgical training go into theatre less than three times a week. One in 15 do not go into theatre at all. If those junior doctors' hours are reduced, their experience in theatre will be further reduced. They may pass their exams and have the tick-box competencies required to qualify, but that does not mean that we produce the best and most experienced surgeons. The royal colleges are concerned about that.
There is a danger that patient care will suffer if training suffers. We are considering a health and safety measure, yet the impact on patient safety could be negative. That is why not only the royal colleges but doctors, including junior doctors, who would supposedly benefit from the measure, oppose the
There is also a serious concern about the impact on the viability of small and medium-sized district general hospitals. The president of the Royal College of Surgeons has expressed that anxiety directly to me. If we reach a point where it becomes unsafe to keep a small district general hospital open because there is insufficient cover, the Government will be responsible if they have not managed to resolve the problems. Rural areas will be most affected; the massive hospitals in our cities will be less affected. The viability of small hospitals faces a genuine challenge as a result of the changes.
Can the changes be achieved? The evidence from the surveys and the royal colleges suggests that they cannot. The Secretary of State said that the north-west was already largely compliant, but the surveys suggest that, if one examines the detail, hours are substantially under-reported and many of the hospitals that are supposedly compliant are not, in practice.
What are the solutions? The Royal College of Surgeons complaint suggests the possibility of a sectoral opt-out, to permit surgeons to work to a maximum of 65 hours. There is general opposition to that. We have heard that the Government are putting money into facilitating hospitals in coping with the change, yet there is also concern that the money is not getting through to hospitals to help them effect that change. I would be grateful if the Minister could confirm in his closing remarks whether the money that the Government have made available is getting through to the hospitals where it is needed.
The Government rely on the power of derogation, which in effect means that we can delay the inevitable for two years, reducing working hours in the interim period from 56 to 52 hours, before coming down to 48 hours in two years. However, the process is cumbersome and bureaucratic. The Department of Health has applied for a derogation, but we understand that individual hospitals will have to apply to the Department for the right to take advantage of that derogation if it is granted. We will have to wait until May before we know whether the derogation will be granted, which makes it impossible for hospitals to plan their rotas into the future. They will not know until May whether the European Union will grant the derogation. Derogation is therefore a blunt instrument and will simply delay the inevitable, without addressing concerns about the loss of continuity of care and the impact on training. Patient care will be permanently comprised.
The Government maintain that we should retain the individual opt-out and we support them on that. However, the individual opt-out is generally regarded as not an option for resolving the problem that we are discussing, because if the general rotas go down to 48 hours, how, in an organisational way, is it possible to provide for junior doctors working up to 56 hours? The process becomes a bureaucratic nightmare, and everyone ends up having to comply with the 48 hours.
As the Conservative spokesman mentioned, a company—it is called RotaGeek—has developed software that facilitates a discussion between management and individual junior doctors to organise their shift patterns and add extra slots, so that they can go up to 56 hours. That seems to be an eminently sensible way of getting the Government out of a hole and facilitating longer working hours for those junior doctors who collaboratively choose to participate in a 56-hour rota. However, when RotaGeek went to the Department and said, "We want to work with you and pilot this in a hospital to see how it will work," it was turned away. The Department was not interested in that sort of collaborative working.
Can the hon. Gentleman not see how divisive it would be if a manager said to a junior doctor, "I want you to 'voluntarily' opt out and go to the 56 hours, but if you don't, it won't in any way affect your career"? How is a young person supposed to accept that? What complete nonsense it would be to have a two-tier system, of those who are prepared to opt out and so sign a bit of paper, and those who are more concerned about health and safety and therefore are not prepared to sign it. How can they have a level playing field for the future?
The same rules should surely apply to an employee who chooses, of their own volition. The hon. Gentleman assumes that every manager in the NHS is an oppressive manager who will make life impossible for their employees. However, the survey evidence shows that junior doctors want the right to be able to work more than 48 hours.
The hon. Gentleman should be clear, because if he is arguing for a sectoral opt-out, he is arguing for a compulsory 56 hours. He seems now to be arguing against an individual opt-out, but he was previously arguing for a sectoral opt-out.
Order. Before the hon. Gentleman responds, let me say that we have not yet had a Back-Bench speech in this debate, and time is disappearing rapidly. Perhaps all hon. Members will bear that in mind.
Thank you, Mr. Deputy Speaker.
Just to clarify this point, I support the individual opt-out. I want the Department of Health to work with those who are developing software to facilitate a discussion between management and individual employees, to enable those who want to work more than 48 hours to do so—in contrast with the wishes of Labour Members, who seem to want to prevent people from doing what should be their right.
We have a process that could infringe an individual's freedom to work beyond 48 hours if they want to, and that is threatening patient care here and now, as well as in the future because of the impact that it will have on training. The Government need to sort this out, because the consequences of not doing so could be disastrous.
Order. Before I call the next hon. Member, may I tell the House that I have decided to reduce the time limit on Back-Bench speeches to eight minutes?
Thank you, Mr. Deputy Speaker. Eight minutes is only just over half the time that was displayed on the Annunciator earlier today. I have prepared my speech during the past three hours, but I am not sure whether I would have come in to the debate on the basis of being able to speak for eight minutes, rather than 15. However, I shall move on.
I support the Government's position in many areas of this debate, especially in relation to the working time directive and the health and safety benefits that it brings to workers not only in this country but in other European countries. It is primarily about health and safety. Indeed, this country's health and safety statistics show that we do rather well—even with the opt-out. The UK has the lowest rate of work-related fatal injuries, and the third lowest rate of non-fatal injuries. The UK also has the lowest proportion of those in employment reporting that their work affects their health or that it causes them to suffer from stress.
I am pleased that the Government are committed to helping people to achieve more choice over how they work. I support the work-life balance campaign, for example. Of course, that includes the choice to work more hours as well as fewer. Many millions of people work far fewer hours than they did 15 or 20 years ago, which is a good thing, but I also believe that the individual opt-out is important.
I received an e-mail from a constituent of mine on
"Should our government agree to adopt this decision"— the decision of the European Parliament—
"this will mean that I will no longer be able to choose to work over an average of 48 hours per week should I wish to do so."
He lives in South Yorkshire, but I have just checked the name of the company that he works for, and it is in Tipton in Staffordshire. The world is becoming a smaller and smaller place, and people travel a long way for their work. He might not be in Tipton every day—he is a sales engineer—but it is likely that the kind of flexibility offered to him on a personal basis is what keeps him in the job that he wants and that, presumably, keeps his family well.
It is beyond doubt that doctors who are required to work long hours are more likely to make mistakes, which could threaten the lives of patients. We need to bear that in mind in this debate. My hon. Friend Dr. Stoate and the Secretary of State mentioned the recent studies by Warwick university and Harvard, which compared the number of errors made by doctors working no more than 48 hours with those made by doctors working no more than 56 hours, and showed that those working fewer hours made 30 per cent. fewer clinical errors. If you or I were party to a clinical error, that would be an important factor. We need to look carefully at the comparisons, particularly those involving surgery. A wealth of research makes it clear that long hours worked by doctors are bad for patient health.
Since 1998, when the directive was introduced, the NHS has made good progress. In 1998, the 48-hour maximum working week was introduced for the vast majority of staff, including consultants and nurses, although they of course retained their right to opt out if that was their individual choice. It is only for junior doctors that we have yet to implement the directive fully, but if we look at the NHS health care work force website, we can see that we have come a long way towards achieving that.
In August 2004, the maximum working week for junior doctors was reduced to 58 hours, in 2007 it was reduced to 56 hours, and it will come down to 48 hours in August this year for the vast majority of junior doctors—no matter what happens over the argument about whether to opt out. We have to take that into account. We are talking about specialist areas that may or may not be affected by the reduction in hours, and we should keep that very much in mind.
As my right hon. Friend the Secretary of State said, the NHS is not ill prepared to achieve virtual compliance by August this year. At present, some two thirds of junior doctors are working no more than 48 hours a week and many trusts are already fully compliant with the directive. The Government have supported the trusts in doing that. There was an argument against it from the British Medical Association—rightly so, as it is a trade union looking after its members—in December last year, questioning whether the money was getting to the front line. That is a very relevant question and if I were in the BMA's position, I would have asked it as well. I have not seen any evidence, nor have we been sent any evidence for this debate, to suggest that money has not gone to the front line to help to reduce the hours of people who cannot meet the 48-hour target.
As far as the negotiations in Europe about getting a further derogation are concerned—they start this month, I believe—I hope that they go well. Our negotiators should tell the Commission, and the Parliament, that when 15 member states are arguing for some form of opt-out, that should send a message that the Commission has got this wrong—and I think that in some areas, they have. But I would not go for a massive opt-out; in some sectors, such as long-distance lorry driving, it would be quite dangerous not to reduce the hours over time.
The Health Committee is currently carrying out an inquiry into patient safety. We took evidence on the issue from the Royal College of Surgeons. I see that I have little time left, but I want to mention one important point. I received a copy of the survey by the Royal College of Surgeons the other day, and we asked Sir John Black to give evidence to us. We are talking about a response rate of 32 per cent.; this is the Royal College of Surgeons contacting its fellows, so these are not independent surveys. I have to say that it is the same for the Royal College of Physicians. I should add that I am now an honorary fellow of the Royal College of Physicians; I was made a fellow last year, along with Dr. Taylor, and I believe we are the only two in the House now. The RCP was also contacting its lead people inside each individual trust.
As I say, this is not necessarily the type of survey on which we in the House, whether we be in government or in opposition, should be taking decisions. It is not sufficiently independent. We see this in the media all the time. I am not saying that some of the issues raised may not be genuine. My right hon. Friend the Secretary of State dismissed the issue that training may be affected—but it is about the logistics of training. We also saw this in our ISTC—independent sector treatment centre—inquiry of a few years ago; training is very important. If people are not there to train, we could end up not getting the type of skilled surgeons that we need. That said, I would desist from using these types of survey to suggest that this is what is out there in the real world. This is what is out there in the surgeons' world, but things may be very different in other parts of the national health service—sometimes even within the same operating theatres.
I am grateful to catch your eye, Mr. Deputy Speaker, in this important debate on the European working time directive.
As has been made perfectly clear in a number of contributions, losing our opt-out from the working time directive presents a number of serious problems for the country. As the motion states, the Business Secretary is right to say that we should stand firm in support of the opt-out. It is just a pity that the Government's leadership has lost control of their MEPs who have forced us into the position where we have to debate the issue today. I ask the Business Secretary in all seriousness: what has happened to the deal brokered in June that we keep our opt-out by accepting the temporary agency workers directive? What on earth has happened to that deal?
There are some 96 fire stations in this country that are staffed by full-time firefighters, and retained firefighters are a vital part of our nation's fire protection. Indeed, as I witnessed during the summer floods of 2007, the work of firefighters in providing emergency relief to those so badly affected was vital. They are going to face great difficulties if this opt-out is abolished.
The British people have complained for many years about the nanny state. Now we are seeing the damage caused by the super-nanny state emerging from Europe. I sincerely ask the Minister for Employment Relations and Postal Affairs what the point is of the EU's Small Business Act, which is intended to improve the environment for Europe's small businesses, when we see this directive filtering through. A number of eminent people have criticised the possible loss of the opt-out, and the CBI deputy director general, John Cridland, has described it as replacing "opportunity with obstruction". The cost to the UK economy is judged to be between £47 billion and £66 billion by 2020—a terrific sum. A former director general of the CBI—Lord Jones of Birmingham, no less, who is a former Labour Minister—noted in 2006:
"The choice is simple: flexibility or stagnation. Faced with the meteoric rise of China and India, Europe has to decide between a responsive and flexible labour market or an oversupplied and restrictive one."
That is the kernel of the argument.
A chief executive from a senior FTSE 100 company told me recently that the EU will lose 20 per cent. of its share of world trade in the next 10 years if it continues down the regulatory path that it is on. When we face a record and huge balance of payments deficit, it seems crazy to heap more regulation on more regulation. An agreement to lose our opt out would be an acceptance of that decline. What will that do to the standard of living of our people?
Unfortunately, unemployment in the UK stands at 1.97 million, with the claimant count in January 2009 up 438,000 on the previous year. At the time of a huge spike in unemployment, the Government and the EU are considering abolishing our opt-out. If a man or a woman loses their job, is it not their right that their partner has the opportunity to work overtime as necessary to support them and their family? For those in the manual labour sector or unskilled workers on the minimum wage, the ability to work overtime often affords a reasonable standard of living. For those who remain in employment, it must remain their right to choose how they support themselves and their families.
What of the nation's businesses? In Britain, we have the work force and the businesses—in particular, the small and medium-sized enterprises—that will be the engine room in pulling us out of this recession. A rigidly enforced 48-hour weekly limit will damage those firms that choose to employ a core of staff whose flexibility allows them to be responsive to fluctuations in their work.
"Some 3 million workers in the UK regularly work more than 48 hours a week, and we do not have a worse health and safety record than other countries."
So, if we do not have a worse health and safety record than other countries, why on earth are we considering abolishing the opt-out? He continued, even more importantly:
"In fact, the UK has the lowest rate of work-related fatal injuries and the third-lowest rate of non-fatal injuries, according to recent surveys of EU member states."—[ Hansard, 11 February 2009; Vol. 487, c. 432WH.]
What on earth is the health and safety problem that we face, which demands that we abolish the opt-out?
The burden of regulation on business is already too high and through losing the opt-out our capacity to outperform our European neighbours will be weakened. Indeed, I would have thought that the EU wanted inter-state competition, rather than wanting to eliminate it. To have to consider complete reform of the structure of employment is the last thing that British businesses need right now, in the middle of the deepest recession in living memory. In this country, 98 per cent. of businesses employ fewer than 20 employees. Unless the Government manage to secure an opt-out for those businesses, they will face huge challenges in implementing the directive, and no doubt an army of Government inspectors enforcing the rules, taking up even more time. No doubt the British public will make their feelings known in the European and general elections.
We need to ensure that the working time opt-out is applied fairly by all and that people are not coerced into signing it. A number of measures have been set down to prevent that. It is also right that we continue to consider ways in which efficiency can be improved in the workplace and address the issues of work-life balance and the long-hours culture. Ultimately, however, legislation that affects our country should be introduced to stop abuse and to protect the health and well-being of all citizens, not to tie the hands of businesses and restrict an individual's freedom of choice.
Already, since 1997, the Government have introduced at least 18 Acts covering employment matters, along with a staggering 280 statutory instruments relating to employment law. Instead of more red tape, why are we not seeing more positive support for businesses from the Government?
"organisations employing fewer than 20 employees might be exempted from the requirements of the Directive so long as their employees themselves have the right to opt-in to a maximum 48 hour working week if they wish to do so."
We know that this decision is now the subject of conciliation procedures undertaken in Europe in an attempt to broker a deal. I expect that it will go back and forth and then end up with the Commission, where I hope it will stay at least until we have a new Commission. Can the Minister confirm that the Government will at least fight for an opt-out for small businesses in Europe?
Let me end by reminding the Minister that we are in the middle of a recession. What businesses and their workers in this country need is flexibility to enable them to survive the recession, to thrive, and to play their vital part in helping our country to recover from its present situation.
This is an important debate and I think it is good that we are airing our personal views, but let me begin by correcting Norman Lamb, who seemed to think that I wanted to impose my will on other people. That is not the case. I am not against the opt-out; what I am against is the possibility that it could be used as a measure of coercion rather than autonomy.
I am all in favour of workers' autonomy. I am worried, however, about what would happen if a hospital manager said, "The hospital is in trouble, chaps: you had better sign this piece of paper and agree, voluntarily, to a 56-hour week, or we shall all have problems and your future may be jeopardised." In my view, that would be crossing the line. I want to ensure that we do not have a two-tier system whereby a form of pressure could be put on a young doctor early in his or her training to toe the line or face the consequences. If the hon. Member for North Norfolk wishes to intervene, I shall be happy to allow him to do so.
The hon. Gentleman said earlier that long working hours were potentially dangerous for clinicians. As I said to him then, his working hours are very substantial, and I am sure he takes the view that he is entirely safe in respect of his clinical actions.
I do not wish to turn this into a personal argument. I cited, initially, what had been said by the British Medical Association. The hon. Gentleman asked the Government to take careful note of the views of the professional bodies that look after doctors' interests, such as the colleges and the BMA. I merely quoted from what the BMA had sent me—a statement, which other Members will have seen, that it is happy with 48 hours and believes it is time for junior doctors' hours to fall into line with the health and safety requirements of all workers in the country, which effectively means not having the opt-out.
I have always said that, within reason, we should ensure that we look after health and safety. Members have said today that the workers should have the right to choose what they do. If a worker found that he could work faster on piece work if he removed the safety guard from his machine, would Members be happy for him to do so, because he would be paid more to look after his family? Of course not. The guards are on machines for health and safety reasons, to protect people's lives. Health and safety legislation is there to protect individual workers, and we should respect that.
Among the EU15, only Spain has a higher percentage than Britain of workers who work for more than 48 hours a week. We are already one of the countries with the longest working hours in the EU. There is considerable evidence, including evidence from the Whitehall study conducted by Michael Marmot, that the workers who experience the most pressure on their time and the least autonomy—those who have the fewest decision-making opportunities—suffer much more ill health than those with far more autonomy and far more decision-making powers. There is a 40 per cent. difference in the rate of early death between people at the bottom of the autonomy pile and those at the top.
There is no doubt that people's working conditions make a huge difference to their overall longevity and life chances. What we are seeing in this country is a picture of hard work and falling autonomy for many workers, combined with long hours and difficulties for a significant minority. In his comprehensive review of the subject, Francis Green reported a process of work intensification in the United Kingdom during the 1980s and up to the mid-1990s. The review tells a consistent story. Employees reported significant increases in effort levels and a less striking, but nevertheless important, acceleration in the pace of work. In 1997, 40 per cent. of workers were employed in a job that required them to "work very hard", compared with 32 per cent. in 1992. Furthermore, a rising percentage of employees reported that they worked under
"a great deal of tension" all or most of the time.
Allowing people, and particularly high-earning professionals, to opt out of the directive sends out all the wrong signals. It suggests that we are not serious about creating a better balance between work and personal life in the UK. It also suggests that if people want to be successful, they will need to work long hours and sacrifice family and personal life and neglect community commitments. It entrenches pernicious social inequalities, too, which are responsible for the pronounced social gradient in health that we have in this country. It creates a gulf between "ordinary" less valuable workers who work 48 hours or less, and the elite cadre of professionals who are so valuable that they need to work more than 48 hours. The only way to dispel this unhealthy, divisive culture is to remove the opt-out—or at least to look very hard at how it works and how we are entitled to apply it.
We need to strike a difficult balance between the need for doctors to build up the necessary skills and experience and making sure that patients are properly looked after. It is beyond doubt, however, that doctors who are required to work long hours are more likely to make mistakes; we have heard evidence of that, so I do not need to rehearse the argument.
I know that other Members wish to speak, so I do not want to detain the House any longer, other than to say that this is an important issue and that we must get it right. We have to ensure that we balance the needs of training for young doctors against the needs of health and safety and the safety of patients. If we do not get that balance right, in the end the whole country, including patients, will suffer.
I thank my Front-Bench colleagues and my leadership—I am also grateful for the understanding of the Chair—for allowing me to speak from the Back Benches this evening on an issue that is very close to my heart and the hearts of my constituents: the future of the fire service in the United Kingdom.
The working time directive will have effects on numerous areas in our communities, but one of the most risky and dangerous is the future of the retained and voluntary fire service throughout the country. We have heard about the concerns of Scotland, but this is not a rural issue or a Scotland or Ireland issue; it is an issue for the whole country. We have, without any shadow of a doubt, the greatest fire service certainly in Europe, if not the world—and I must declare an interest, as I am a former firefighter. I was a full-time firefighter, and a member of the Fire Brigades Union, which was, and still is, quite anti retained firefighters. I understand the reason for that, even if it is somewhat lost in the 21st century; it is a feeling that retained firefighters take jobs from whole-time firefighters. I do not think that is true; we should come to an understanding, based on costs and analysis, of what is right for firefighting throughout this country.
The hon. Gentleman is very qualified on this matter; all Members recognise that he has a background in firefighting. What does he think firefighters will make of political parties that stand up in one Parliament and say they are concerned, and then vote a different way, as the Scottish Liberal Democrats did in the European Parliament?
The hon. Gentleman has raised his point on several occasions. All I can say is that the electorate are not stupid, and that communities that are worried about the future of their retained firefighters will know how MEPs voted. I am sure other parties will draw attention to the Liberal Democrats' record, as well as to how Labour MEPs voted in the European Parliament; they voted to wreck the situation in respect of retained firefighting.
Let us consider the types of firefighters we currently have. We have whole-time stations in London—I understand that it is the only fire authority in the country that does not allow part-timers on to its ground—and we also have whole-time retained and day-manning stations, where whole-time firefighters go home in the evenings but are on call. There are some stations that operate only from Monday to Friday. We also have retained firefighters and voluntary firefighters.
There was something I could not understand when I first looked at the problems facing us: why were we in this country being affected so badly compared with other EU countries? The reason is simple. We pay our firefighters well, whether they are whole-time or retained. It is not a huge amount of money, but they are paid and they get a pension. As a result, our firefighters are completely different from those in the rest of the European Union. Most other firefighters in the European Union who are not full-time are volunteers and they only get expenses—surprise, surprise, Europe looks at them in a different way when it comes to this legislation from how it sees UK firefighters. That is the simple situation. I have heard all the banter going back across the Chamber tonight as to what the reason is, but the facts are there—we trained them, we give them a pension and we look after them in the way that they deserve to be looked after.
There are areas of this country, particularly in Scotland, that have voluntary firefighters, where the community has come together to pay for the firefighters and the equipment to be there and the firefighters get expenses only when they are out on call. They will be exempt from this measure. What I cannot understand is the Fire Brigades Union's complete lack of understanding as to why it needs to join this campaign that the excellent Retained Firefighters Union has started. The measure will have an effect on the FBU's whole-time firefighters. I am talking not only about the ones who will be part-time firefighters in the evening or at weekends, or who will be on call on their pagers, but those firefighters who have more than one job.
I have to declare an interest, because when I was a full-time firefighter I had more than one job. At the time, it was illegal, within a whole-time firefighter's contract, to have more than one job, but we all did it—it was called fiddling. Most of the window cleaners in our communities are firefighters, as are most of the bricklayers, plumbers and so on. The contracts all got changed when a wonderful chap who came out of the Royal Marines became the world boxing champion. He was called Terry Marsh, and the contracts all got thrown out of the window because people quite liked a firefighter being the world boxing champion. In the end, the fact that firefighters should have the right to do more than one job was accepted.
This legislation will have a major effect when it comes in, and the FBU needs to understand the effects on its members as well as on some retained firefighters; the two unions should come together, bury any differences that they have had over the years in different disputes and stand up for the communities that all of these firefighters are looking after and representing. If they do not do so, the whole situation will be one of division. What I am sure every Member in this House wants is to have a firefighting capability in their community that is right and proper for that community, and which is safe and well trained. They also want the firefighters to be remunerated correctly for the services that they give to their community.
What would happen if this legislation were to go through? Why would it decimate so many of the retained firefighters in this country, particularly in the rural areas, but in the urban areas too? My constituency has only one whole-time fire station and two retained fire stations. When my whole-time pump appliances are detained at an incident, the retained firefighters are called out and they stand by at the whole-time station. We see the same thing happening all around the country; it is one of the reasons why even if a major fire is going on in someone's constituency, there will always be a red fire engine sitting inside their regular whole-time station. That happens because the retained firefighters come in to cover the community, and that is a crucial element to what they do.
What could happen if this legislation were to go through? I know that the FBU feels that we have to have more whole-time firefighters, but we do not have the money for that. No community in the country, especially those in the rural areas, could have regular, full-time firemen covering every single situation. Perhaps the Government will change the legislation again on response times. Recently, some fire stations in my constituency closed because the Government changed the modelling on response times from 10 to 12 minutes. The Bovingdon fire station, which is next to my constituency and was responsible for the second appliance that got to the Buncefield fire in my constituency, was one station that was closed. I am sure all hon. Members recall that fire, which was the largest that this country has seen since the second world war. The vast majority of the firefighters at that fire, dealing with the explosion at that depot, were retained firefighters—90 per cent. of the coverage in this country is carried out by retained, part-time firefighters. I am very worried about what would happen in rural communities and in my community, which is not so rural in parts, in respect of who would provide the cover. I think that the Government believe that the communities will rise up, as they did in past centuries, and put together the fire cover. Perhaps they think that the parishes or the town councils will rise up, as they did historically, or that local companies will provide the cover. Dickinson's, in my constituency, supplied the fire cover not just for the paper mill but for our local community in Apsley for many years, but those times have gone.
We cannot just rely on volunteers saying that they will do it for nothing if they do not get the training and the skills to work together with the whole-time firefighters. We need cohesion in the fire service in this country and the Government must get their act together and go back to the European Union to say, "Our firefighters are different. You have an excellent system in the rest of Europe that works for you, but our system is different. We pay them and give them a pension, which is right and proper, and because of that this legislation will destroy our firefighting capability in this country. That is wrong." I stress to the Minister, in a non-party political way, that he should understand how devastating the directive will be for our communities and the fire services in this country.
I call again for the FBU to join the RFU and bury the hatchet. Let us forget about the problems in the past and come together to fight this ludicrous legislation that will destroy our firefighting capabilities in this country.
First, I want to declare an interest in the Register of Members' Interests as an employer.
Whenever we debate the working time directive people think, "Well, with a bit of common sense, we can make the 48-hour working week work." However, along comes the dear old European Court, delivering judgments on such issues as waiting times that immediately colour a lot of the detail and cause problems for the national health service and many other areas.
I agree with much of what has been said in the debate. Like my hon. Friend Mike Penning I particularly want to focus on the retained fire service, Britain gets very good value for money from its fire and rescue services, particularly in rural areas. Some of the most sparsely populated areas of our country are covered by the retained fire service, which is made up of members of the local community who are compensated and who provide valuable fire cover. Some 90 per cent. of all fire cover comes from the retained fire service.
I think that this judgment will be a problem. The chief officer of Dorset fire and rescue service is very concerned about its implications, not least because most of those in the retained service have day jobs and usually train one night a week. By the time they have finished their training, they have hit the 48-hour limit without fighting any fires. The implications are that the training of our retained fire service might come under pressure if we are to recruit people to fight fires. That is a real problem for management. If one asks most chief fire officers what their key priority is for the retained firemen, they reply that it is to get them sufficiently trained, to keep them up to speed and to ensure that they turn up and cover the required number of hours to ensure that they are qualified to fight fires, which is becoming much more technical.
The retained fire service is therefore vital to our national interest. In a county such as Dorset, the bulk of the service is retained. The Government get very good value for money and the council tax payers of Dorset get very good value for money from the service. Unless we get a derogation from the directive, there is no way in which we shall be able to provide fire cover, save people's lives and give people security without employing substantially more firefighters at a substantially greater cost.
I and other Dorset Members have made representations about this year's grant to Dorset fire and rescue service. The increase this year was, I think, 0.5 per cent., which puts the service under severe pressure. We might well have to have fewer full-time engines. We will be required to rely far more on the retained fire service, and the additional consequences of the 48-hour week make the task almost impossible for our excellent chief fire officer. I hope that the Government can sort this out.
A clear message on the national health service has come from most of the royal colleges. We would not necessarily all agree with it, but there are real concerns about how we will manage the change. We have known about the problem for a long time, but I do not believe that there has been sufficient work force planning. I have had meetings with doctors and people who run hospitals, and the truth is that some hospitals are well up on the game and could work a 48-hour week, but a lot could not. The point made earlier in the debate about some of the smaller hospitals in rural areas is very important.
The Secretary of State was very robust in his response today but, given their scale, I am a little disappointed that he did not address the concerns expressed by responsible organisations. Rather than going back to first principles, I hope that he will set a pathway that will allow us to have a robust debate about how we get through this very difficult decision.
Ideally, we would want junior doctors to work shorter hours, but they must train and gain experience. That problem has come up time and again. As we have heard, the 48-hour week poses a real problem for shifts and the handover of patients, so I hope that the Minister who winds up the debate will be able to reassure us that the Government are looking into protecting our derogation when the great conciliation meeting takes place. However, August is approaching very rapidly and we need to make progress.
I have always believed in a fairly flexible labour market. As a responsible individual, of course I believe that we must have decent health and safety provisions but, as we have heard, this is a pretty safe country in which people can work and go about their ordinary business. At a time of economic strain and stress, when a lot of resources have gone into the NHS, it is a pity that we are facing problems that may impact on the service and on patients. They may also impact on people who want to provide a service and be properly trained to do the job in future years.
I am delighted to speak in this debate, and first I want to express my amazement at what seems to be quite a lot of agreement between the parties. Everyone agrees that excess hours are impossible. When I worked as a houseman at the old Westminster hospital, I crashed my car on the way home after being on duty all one night and for several nights before that. Excess hours, as we all agree, are completely unacceptable now.
We are also all against the exploitation of junior doctors. I am delighted to follow the hon. Members for Hemel Hempstead (Mike Penning) and for Poole (Mr. Syms), because retained firefighters are crucial in my area. I have one full-time station and two retained stations, and we have absolutely got to keep them.
There is also widespread agreement—certainly on the Front Benches—that the individual opt-out must be free and without any coercion. I at last understand the difference between sectoral and individual opt-outs, so that is one thing that I have gained from the debate. There is also a certain amount of agreement about applying for some derogation. The Government are limiting it to some specialties and isolated communities, but that is something that we need to work for.
There is no agreement about hours, although everyone seems to think that 65 to 70 hours a week are too many. The Royal College of Physicians has suggested 52 hours a week as a short-term compromise, and I think that that sounds very reasonable.
I wish to underline the importance of securing the free individual opt-out and the temporary derogation. Most people seem to think that doctors merely want to protect their own interests and avoid working too hard, but I genuinely believe that most approach the matter from the patient's point of view.
Quality is the watchword. When people complain to me about quality, they talk about the lack of continuity and communication, both of which have been mentioned in the debate. Continuity is crucial, but shift systems are inevitable: unfortunately, continuity will be lost unless there is really good handover when shifts change. Handover implies and needs communication. I invite hon. Members to put themselves in the position of a junior hospital doctor struggling to get through the caring work. He knows he has to leave when 5 o'clock comes, and as a result the handover is squeezed out. That is a crucial factor. I mean not only communication between doctors, but communication between the doctor and the nurse and—this is the way to prevent complaints—between the doctor and the patient and relatives.
Quite a lot has been said about training. It is worth remembering that although one can get a certain amount of training from books, lectures and seminars, certain things can be learned only by experience. From the medical point of view, specialists have to see that their diagnosis and their treatment are right. They have to be able to follow up. If they cannot see a patient for any length of time, they will miss out on that.
Surgeons put the surgical point of view very bluntly: unless one does enough cutting, one does not become a good surgeon. It is experience of operations that counts. In my day, when I worked as a house surgeon—we all had to do that, even though we were to be physicians—I did my appendicectomies in the middle of the night with a very good senior house officer holding my hand. People must have that sort of apprenticeship experience in their training.
The British Medical Association has been quoted as saying that it is fully in favour of the 48 hours, but it is right that it should attach some conditions. One condition is consultant expansion. Somebody will have to do the work if there are not enough junior doctors around, and that means that there will have to be more consultants. I am tremendously glad that I am retired, because that means that consultants will have to work at night much more than they did in my day.
I was disappointed that the Secretary of State and Mr. Barron, the Chair of the Health Committee, tended not to accept the statements from the royal colleges. I will read what the statement from the Royal College of Physicians said. I take the point that its statement is not a scientific survey, but it gives a real impression of what is happening. It says:
"Our surveys reveal a widespread consensus that the quality of patient care has declined in those hospitals that have introduced compliant working patterns, as has the quality and quantity of postgraduate medical training provided. Both have serious implications for future clinical care."
I will finish my remarks by hoping that the Government will get the derogation, and the free individual opt-out; indeed, I push them to do so. In the meantime, we must have a compromise until we have adequate consultant numbers, have worked out how to provide junior doctor training adequately, and can ensure adequate continuity of care. We must also ensure adequate time for communication, not only between doctors, and between doctors and nurses, but between doctors and patients and their relatives.
May I first say that what has happened in the European Parliament, and the way in which MEPs from the Government party voted in the European Parliament, has caused great concern to those who will be affected by the European directive? My party believes that what happens on working time should be determined nationally, and not Europe wide. That point was illustrated very well by the contribution from Mike Penning, who pointed out that there are particular circumstances affecting the United Kingdom, namely those pertaining to retained firefighters. That situation is unique in Europe, so a European directive is not suitable. There are many other examples of cases in which we need national flexibility. I welcome the assurance given by Government Front Benchers that despite what happened with the MEPs from the Government's own party, Ministers will at least fight to retain the opt-out.
I will cut my remarks short, because there is another Member who wishes to speak, but let me just put something on record first. In Northern Ireland in particular, the working time directive would cause a great problem for many of the emergency services. Of the 68 fire stations in Northern Ireland, 46 rely totally on retained firefighters. If the working time directive applied to them, large parts of Northern Ireland would be left without a local fire station. As has been pointed out, it is not an option to say, "Well, let's have full-time firefighters in all those stations." One thousand firefighters in Northern Ireland are retained firefighters and would be affected by the measure.
In my constituency the life boat would be affected, as would the coastguards. Ironically, although the directive is supposed to be applied for health and safety reasons, health and safety would be impaired by it. It is therefore important that the Government push on their commitment that the opt-out will be retained.
At a time of recession, when Northern Ireland is particularly dependent on small businesses, flexible hours will enable many businesses to remain viable and will probably enable many workers to stay in employment.
For all those reasons, I welcome the commitment that has been given from the Front Bench today, though there still appears to be some unwillingness to consider the sectoral opt-out. The Retained Firefighters Union in Northern Ireland has asked for the opt-out to apply collectively to the fire service. I do not believe that a collective or a sectoral application is impossible. That does not seem to be a problem for other European countries, so why should it not be possible for the United Kingdom?
Flexibility and the right of countries to determine their own working practices, to which individuals can sign up, are important. Rather than the super-state of Europe dictating to us, the issue should be determined by this Parliament and its Members, who are elected to reflect the needs of their constituents and their own country.
Sammy Wilson was making such an excellent speech that I am almost sorry that he cut it short to allow me to make a modest contribution to the debate. In showing that courtesy, he sets an example that certain people on the Front Benches would do well to emulate.
I did not come along to take part in the debate, as the Secretary of State implied, because it was one way to lure all the Eurosceptics out from their caves. I came not because I am a doctor—although I have that academic title, I know nothing whatsoever about medicine. I am not even an honorary physician, like Mr. Barron who, sadly, is no longer in his place.
I came because I know a man who is a doctor, or at least I received a fax from that excellent service writetothem.com from a man who is a doctor. His name is Mr. Jason Millington. He is a Fellow of the Royal College of Surgeons and he is an orthopaedic specialist currently working at the North Hampshire hospital and he lives in my constituency.
Mr. Millington has set out very pithily indeed the basis of why members of the medical profession are so concerned about the implications of the working time directive. He has done that under four headings—patient safety, training, professional status and productivity. On patient safety, he says that there is no doubt in his mind that in preparing for the directive, junior doctors' rotas are unable to sustain the mandatory 48-hour week and to provide adequate service to patients. He writes:
"We are already stretched, and further dilution of our time will make holes in the rota that have been inadequately planned for. Locum cover for these slots is inappropriate, as well as wishful thinking."
That is his understanding of the situation.
Mr. Millington says that doctors' training is largely based on experience, as we heard in the excellent contribution from Dr. Taylor, to whom the House always listens with respect on this subject. My correspondent adds that many doctors
"earn no more money by working 56 hours than 48 hours, yet still recoil from the idea of a shorter working week imposed by Europe."
That is because they are concerned about the skill base in the future. Mr. Millington asks me whether I am
"happy for Consultants of the future to be trained with less than half the clinical exposure as the current Consultants...Should this ring any warning bells?"
On professional status, he says that he is sure that I, like most professional people, work more than 48 hours a week, and goes on:
"To impose a ridiculous restriction is demeaning and demoralising. You reap what you sow".
He warns that if we want young doctors to be a "generation of clock-watchers", the directive will guarantee that that comes to pass.
Finally, on productivity, Mr. Millington says that every doctor affected by the directive
"will lose a day's productivity a week. This amounts to around 70,000 working days a week in the NHS."
He asks whether I am prepared
"to see the possible collapse of service in any of the hospitals in your constituency on the back of a one-size-fits-all European policy".
Finally, he points out that a recent Royal College of Physicians survey of the 48-hour week pilot scheme showed that 84 per cent. of the pilots created gaps in the rotas, so locums were required to cover the gaps; that 40 per cent. of the pilots had to use consultants to plug gaps in the junior rotas; and that 58 per cent. of doctors thought that patient care was worse under a 48-hour week. Mr. Millington says:
"There are a limited number of locums in the UK. Many say that the system cannot support such a change."
We politicians have little of value to say to doctors. However, Mr. Millington has shown that doctors have plenty of value to say to us politicians.
I am pleased to sum up from the Conservative Benches after this lively debate. In the time available, I shall do my best to refer to at least some of the very good speeches that we have heard during its course.
As my hon. Friend Mr. Lansley and other hon. Members have set out, the European Parliament's proposed version of the revised directive has the potential to do crippling damage to the NHS. The implementation of the existing directive has been subject to damning criticism from the Royal College of Surgeons, the Royal College of Anaesthetists and the Association of Surgeons in Training.
A British Medical Association survey of junior doctors found that almost two thirds reported that compliance with the 48-hour week would have a negative effect on their training. A recent editorial in the British Medical Journal succinctly summed the issue up:
"If the directive was meant to improve clinical care and the quality of life and training for junior medical staff, its effect has been the opposite. The changes to working hours have had a major negative effect on the working life, free time, and education of junior doctors in the NHS."
The threat to our public services from the European Parliament's proposed abolition of the opt-out and the distinction between active and inactive on-call time goes even wider than the NHS. Its effects would cause severe difficulties for a wide range of other vital public service workers, including care home workers and retained firefighters, as was rightly highlighted by my hon. Friends the Members for Hemel Hempstead (Mike Penning) and for Poole (Mr. Syms) and Sammy Wilson.
So far, so bad—but the effects of both the current legislation and the European Parliament's proposed changes go further. As the latest burdens barometer from the British Chambers of Commerce shows, the working time directive, as implemented by the Working Time Regulations 1999, is the single most expensive regulatory burden on British businesses introduced under this Government, with a total cost of £16 billion as of July last year and an annual recurring cost of almost £1.8 billion. Working time regulations on transport workers add a further annual burden of £423 million on British businesses.
So no one—Minister, Member of this House or Member of the European Parliament—should be under any doubt that the existing legislation imposes considerable cost on British enterprise. That is not to argue against all its contents—I hope that no one would disagree with the importance of statutory paid holidays, for example—but it is to emphasise the burdens that British businesses already labour under. The now threatened opt-out is crucial to British businesses' ability to remain globally competitive. The then Business Secretary, Mr. Hutton, rightly underlined how critical it was for our businesses' flexibility when he said only last June:
"That flexibility has been preserved by ensuring workers can continue to have choice over their working hours in future years."
Formal negotiations on this vital matter are due to start in less than a fortnight in the conciliation process to which several Members have referred. One would have thought that the Government would have done everything in their power to support their case for retention of the opt-out, yet Ministers have failed to carry out even an impact assessment on the loss of the opt-out. According to a study by the think-tank Open Europe, the reason, according to the Department for Business, Enterprise and Regulatory Reform, is that
"no one expected the opt-out to come up for negotiation".
Because of the Government's failure to examine the matter properly, we have to rely on third-party work.
According to the CBI, 3 million workers—10 per cent. of the British work force—take advantage of the opt-out. Open Europe's study has also found that if those workers were no longer allowed to take advantage of their right to work as they please, the cost to the British economy would be between £47 billion and £67 billion by 2020. To take the effect on just one specific part of Britain's economy, the British Constructional Steelwork Association, which represents an industry with 100,000 employees and an annual turnover of over £5 billion, has said that:
"we are seriously concerned that any negotiated deal that does anything to restrict our working hours could have serious consequences for all of us and in particular our industry which would not be able to operate without the flexibility the opt-out allows us".
It surveyed 1,000 workers in that field of industry, and the results show that 90 per cent. of them want to retain the opt-out from the working time directive.
This is not a cost that the British economy can afford, least of all when we face possibly the worst economic downturn of the past 60 years and when, thanks to this Government's economic mismanagement, the country is the worst prepared of any major developed economy. As the Institute of Directors has said, the
"irony" of the abolition of the opt-out would be
"that the people who will suffer the most will be ordinary workers. Employees who want to work beyond 48 hours a week, so that they can earn more money to pay food bills and the mortgage, will no longer be able to do so if the opt-out goes".
More broadly, the CBI has said that:
"the right of employees to work longer hours if they choose to is vital to their ability to maintain the living standards of their families during a recession. The needs of workers and businesses are aligned. Both need the flexibility to respond to changing economic circumstances. British business will depend on the 48 hour 'opt out' when the upturn comes, and urges the Government to maintain the common position previously agreed in the Council. No more compromise is possible on this point."
That is an important point which I hope Labour Members will take on board: no further compromise is possible.
If the European Parliament gets its way, our hospitals will be less safe, our doctors will be worse trained, the NHS's resources will be put under further strain, our fire service will be dangerously stretched, our economy will be less prosperous and less competitive, with the inevitable consequence that tax revenues will shrink further, and the likelihood must be that yet more businesses will go to the wall or have to shed jobs, so that even more people will find themselves out of work.
How did we find ourselves in so dangerous a situation? The Government linked the agency workers directive—that has its legal base in the old social chapter, which originally they rightly opposed—with the revised working time directive. That point was rightly highlighted in the very good speech by my hon. Friend Mr. Clifton-Brown. As the Minister for Employment Relations and Postal Affairs told a Committee in another place in October,
"we never particularly wanted these two directives to be taken as a package...but most Member States wanted it and decided that way".
Having reached an agreement on a revised version of the directive that at least preserved the opt-out and made a distinction between active and inactive on-call time, the Government made their next mistakes: ones of complacency and failure of political leadership. The Minister happily boasted to journalists, "I don't think" that the issue of the opt-out "will reappear", apparently oblivious to the fact that working time legislation is subject to co-decision with the European Parliament.
The Government have shown remarkable incompetence at the European negotiating table. By linking the two directives and then letting the agency workers directive precede the working time directive, they made the current dangerous position possible. That is Janet and John negotiating, to use the earlier phrase of the Secretary of State. But what is really inexcusable is the behaviour of Labour's MEPs. They are members of the European Parliament's Socialist group and it was down to them to make the case to their colleagues on behalf of their constituents and to give a lead. Instead, the majority voted to scrap the opt-out and the distinction between active and inactive on-call time. They were led into that vote by their then Chief Whip, Glenis Willmott, who has since been chosen as Labour's leader in the European Parliament. On her election, the Prime Minister congratulated her, saying:
"Glenis will provide excellent leadership of the European Parliamentary Labour Party".
Given her record on this directive, do Ministers stand by that today? When the Minister winds up for the Government will he say that Ms Willmott has provided excellent leadership on the working time directive? If he is reluctant to do so, I shall intervene on him and give him a definite chance to say it.
What is more extraordinary is that the Labour party has published a document called "100 Labour Achievements in Europe". I have this significant tome here. In the second boast in the document, it says that Labour MEPs have
"implemented EU wide laws on working time, limiting the length of time workers can be obliged by their employer to work to 48 hours per week".
That shows Labour MEPs boasting of their achievement, but does the Minister stand by it? Is it the Government's real policy, regardless of how long anyone wants to work, and regardless of the damage it would do to our NHS, to ban any employee from working more than 48 hours a week?
So let us be clear: Labour MEPs have let down our national health service, they have let down our firefighters and they have let down businesses struggling to make ends meet in the recession, and they are attacking British jobs. The fundamental underlying truth is that the Labour party is abandoning the centre ground of British politics. It is increasingly taking its lead from the trade unions and others on the hardcore left. Labour MEPs, like the Cabinet Ministers manoeuvring for future leadership bids, are bidding to win their favour, so instead of representing the national interest, they pursue factional interests within the Labour party. That is the symptom of a party that has forgotten that its purpose is to talk to and speak for the British nation.
If Ministers are going to go into the negotiations to preserve our opt-out with credibility, they must insist that Labour MEPs renounce their vote against our opt-out and against the rules on on-call time. Given what is at stake, I do not see how they can do anything less without fatally undermining our negotiating position. People in the European Parliament and in the Commission are asking privately how it can be that the British Government are supposedly digging in on this issue while their MEPs voted in precisely the opposite direction. If the Government's position in these vital negotiations is to have any credibility, the Minister needs to answer that question clearly tonight.
The Government must make it plain to European partners that our opt-out from the working time directive and the correction of the European Court's judgments on on-call time are red-line issues and that no further compromise is acceptable. The Government got us into this mess by linking the working time directive with the agency workers directive. Labour MEPs made a bad situation worse, and now large numbers of jobs in Britain are potentially at stake. That is unacceptable, and the Government must not give way on the working time directive. We intend to hold them to account on that in the forthcoming European elections on behalf of all those we represent in this country.
This has been a useful debate on an issue that, as we have heard, is relevant to both our national health service and the economy more widely. I thank all the right hon. and hon. Members who have taken part. As we debate the matter in the House, it is also being discussed in the European Union, most recently at the Employment and Social Affairs Council, which I attended in Brussels yesterday.
As my right hon. Friend the Secretary of State for Health said in his opening remarks, the working time directive gives workers important rights. In implementing it, this Government introduced for the first time legal default limits on working hours and a statutory entitlement to annual leave. He talked in detail about the national health service and how we will match our commitments on working time with ensuring that we have the best possible system of health care for the public. I wish to deal more generally with the position of working time for individuals and for the economy as a whole.
As the House knows, unemployment is rising, but we still have many more people in work than a decade ago, and all of them enjoy stronger employment rights, including those granted under the working time directive. They enjoy more paid leave, more maternity leave and rights to flexible working. Many of those changes were fought tooth and nail by the Opposition as we sought to create a better balance between family responsibilities and working life. We believe that the Government should support each individual's right to rest and holiday, and the right not to be forced to work excessive hours. We believe that that should apply to all workers, regardless of their employment status, including temporary and agency staff.
However, the Government also believe that choice and opportunity are important factors in the debate—choice for ourselves and the 14 other member states that use the opt-out, and choice for individual workers, who may choose to work longer hours if they so wish. Dr. Taylor said that there was broad agreement about that, and I am glad to hear it, but some have said that there should not be choice on such a matter, and that it could endanger the health and safety of workers. I agree with my right hon. Friend Mr. Barron, who pointed out that the UK has a very good health and safety record that stands comparison with that of other countries, and which we have maintained during the period for which the opt-out has been in place. In fact, according to survey evidence within the EU, the UK has the lowest rate of work-related fatal injuries and the third lowest rate of non-fatal injuries. The fourth European working conditions survey states that the UK has the lowest proportion of those in employment reporting that their work affects their health or causes them to suffer stress.
While the Minister is in the business of agreeing with people, does he agree with the Prime Minister, who seems to think that Glenis Wilmott has provided excellent leadership for the European parliamentary Labour party by voting to abolish the UK's opt-out from the working time directive?
I regret the vote in the European Parliament, but while the hon. Gentleman is tempting me, I might turn to his party's tactics in the European Parliament. When I look around for its allies who agree with the Opposition on renegotiating a ratified treaty of Lisbon, which political giants do I find? Which great statesmen support the Opposition's position? The Dutch animals party, the French Hunting, Fishing, Nature, Tradition party, Sinn Fein and a number of communist parties. Those are the hon. Gentleman's allies, and I will keep mine rather than trade them for his any day of the week.
The existence of the opt-out is not the foundation of ever-longer working hours in the UK. In fact, in the past decade the proportion of UK full-time employees working long hours has fallen from about 22 per cent. to about 17 per cent.
Although the proportion of people who work long hours has fallen, the opt-out remains an important flexibility for individuals and the economy. As my hon. Friend Dr. Stoate said, it is important that the opt-out is voluntary. We do not believe that people should be forced to work long hours against their wishes. Any worker who feels that he or she has been forced to opt out as a condition of taking a job, or is disadvantaged as a result of not opting out, can take a case to an employment tribunal.
The Government were also prepared to accept the introduction of additional safeguards when we agreed the common position on amending the directive with other member states last June. However, it would be wrong to deprive people of the right to work longer and earn more if they wish, or to deprive businesses of the flexibility that people working longer hours can bring.
At the moment, some people have either lost their jobs or are on short-time working, which may have reduced their earning capacity. The Government believe that it would be wrong to say to the partner of such a worker that we wanted to limit their choice to work longer and earn more if they can, thereby perhaps allowing them to continue to pay their mortgage and other family bills. We have made that point to fellow member states in the negotiations.
Several hon. Members, including the hon. Members for Moray (Angus Robertson), for North Norfolk (Norman Lamb), for Cotswold (Mr. Clifton-Brown), for Hemel Hempstead (Mike Penning), for Poole (Mr. Syms) and for East Antrim (Sammy Wilson) raised the important issue of retained firefighters. The value and importance of the service were rightly highlighted. I want to make it clear that, contrary to what some believe, there are no general exemptions for emergency services in the directive, so an end to the opt-out would have implications for them. In the case of retained firefighters, who give their time and effort, normally on top of doing another full-time job, it is difficult to understand how that valuable and important service, which benefits the whole community, could continue in its current form without the opt-out. Let me reassure the House that the Government fully appreciate the importance of the retained fire service. That is another reason for our belief that it is important to build into legislation the sort of flexibility that the opt-out provides.
As my right hon. Friend the Secretary of State for Health said, our policy on the NHS is guided, above all, by considerations of patient safety. We know that there is evidence of a link between long hours in the health professions—some of the surveys that have been conducted were mentioned—and the quality of care offered to patients. We are committed to ensuring sensible limits on the hours that health professionals work in the NHS. We have made sustained investment in that commitment, and two thirds of junior doctors already work no more than 48 hours a week.
Again, as my right hon. Friend the Secretary of State said, there are exceptional circumstances, in which some doctors have less choice than others to work longer hours. That is why we notified the European Commission of our intention to use an extended derogation available under the directive to retain a maximum working week of up to 52 hours for a further three years. That will be limited, but will also provide important flexibility to help make the change.
So that the general public can understand what is happening in the debate, will the Minister say whether he agrees with my analysis of the conciliation process—that a stalemate is likely and that the matter will go back to the Commission, where it will remain beyond the life of the Commission?
The hon. Gentleman has intervened at the right time, because I am about to deal with the conciliation process and update the House on the negotiations. Throughout the lengthy negotiations, the Government have had two key aims: to reach a sensible solution about on-call and rest time, which the SiMAP and Jaeger judgments raised, and to secure the future of the individual opt-out. I believe that there is broad unity in the European Council on tackling the issues of on-call and rest time. Indeed, the vast majority of member states are seeking greater flexibility on those issues, precisely because of the SiMAP and Jaeger rulings.
I stress again that the opt-out is not an issue just for the UK. Fourteen other member states make use of the opt-out and there is good support for our position in the Council. That was reflected in the common position that we agreed last June, and it continues to be reflected in discussions in the Council since then. Following the European Parliament's votes in December, we are now entering the formal process of conciliation, through which I hope that we can reach an agreement that secures our objectives. Several trialogue meetings involving the Parliament, the Commission and the Czech presidency have already taken place. The first formal conciliation meeting is scheduled for
We will know one way or the other whether the conciliation process has succeeded before the European elections.
We believe that the flexibility shown in the way that the UK has implemented the working time directive has been right. It cannot be argued that it has had a damaging effect on workers' health and safety in the UK, because our health and safety record is good, but it can be argued that it is an important element of choice for workers, businesses and the economy as a whole. As we take the negotiations forward, it is important to contrast our engagement in Europe with the policy that would be pursued by the Opposition. How they hope to achieve anything for Britain in Europe by pursuing an isolationist approach that draws away from the mainstream of European politics is completely beyond most people in mainstream thinking. That approach will not achieve for the UK; our approach can.
We believe in opportunity and in the chance to work harder to lift oneself up and make a better life for oneself and one's family. Sometimes, choosing to work longer hours is part of that. It is important to retain the opt-out, and that will be our objective in the weeks and months ahead. On that basis, I ask the House to back the amendment in the Government's name.
Question accordingly negatived.
Question put forthwith (
Question agreed to.
The Speaker declared the main Question, as amended, to be agreed to (
That this House agrees it is right that no worker should be required to work longer than 48 hours per week averaged over 26 weeks unless he or she freely chooses to do so; notes the Government's manifesto commitment to maintaining the individual opt-out from the European Working Time Directive; further notes the importance of the individual opt-out which is used by the UK along with 14 other EU member states; recognises that maintaining the individual opt-out is a key part of the UK's flexible labour market and of particular importance during the current economic climate; understands the particular concerns related to the working of excessive hours in the medical professions and welcomes the significant progress that has been made in the NHS to reduce junior doctors' hours; further notes the challenges faced as a result of the SiMAP and Jaeger judgements; further recognises that a solution is required in order to bring back much needed flexibility to the treatment of on-call time and compensatory rest time; welcomes the significant progress made in introducing the Working Time Directive across all clinical and staff groups within the NHS; further recognises that an extended derogation is necessary for a limited number of specialties and isolated, rural locations in order to ensure the efficient implementation of the Directive; and supports the continuing action to work with staff, clinicians, the British Medical Association and the Royal Colleges to ensure the workable implementation of the Working Time Directive to the benefit of patients and staff.