asked Her Majesty's Government:
In view of the shortage in the United Kingdom of junior doctors, consultants and other trained medical staff, whether they will delay the implementation of the European working time directive for United Kingdom doctors in training.
My Lords, the United Kingdom successfully negotiated transitional arrangements which permit phasing in the introduction of the 48-hour average weekly working time limit by a staged reduction of hours, from 58 in 2004 to 48 in 2009. If difficulties still remain, the UK may defer full implementation of the 48-hour working week for up to a further three years, at 52 hours, until 2012.
My Lords, I thank the Minister for that Answer, which is better than I had hoped. I thought that we might not be able to do anything. Nevertheless, the Government's NHS Plan, which was intended to bring us many more doctors, either home produced or from overseas, is falling way behind. Both the Royal College of Physicians and the BMA are concerned that with the introduction of even parts of the scheme in 2004, we shall end up with not enough doctors to deal with patients in hospital. They think that that is an acute problem. What are the Government doing to produce more doctors?
My Lords, I recognise the pressures on the National Health Service to implement the working time directive. We are working hard with the NHS, the royal colleges and the BMA to ensure that the NHS gets as much help and support as is necessary. We also have pilot schemes which are looking at new forms of rosters and shift systems in order to tackle some of the issues that are involved. As regards medical workforce planning and numbers, we have seen increases in the number of consultants and other doctors employed in the NHS over the past five years. Of particular significance is the expansion in medical school intakes. In 1997–98, the figure stood at 3,749, but by 2002–03, the provisional figure shows an intake of 5,292. That is a significant increase.
My Lords, the working time directive will have a major impact on hospital trusts, yet the Government appear to be giving no guidance on compensatory rest for junior doctors. Why are they leaving it up to individual hospital trusts and not issuing national guidance?
Because, my Lords, the noble Lord has been telling me for the past three years that the Government try to micromanage the health service. It is much better that we give advice and encourage working relationships between NHS trusts and employees, but at the end of the day, it is up to them to come up with their own solutions.
My Lords, the Minister is no doubt aware that because of concerns on the part of the medical profession, I tabled a Question on this very topic one day after the noble Baroness, Lady Gardner of Parkes, tabled hers, and therefore withdrew it. Is it not the case that the problem arises as a result of the horizontal amending directive, passed by the European Union, which would modify the implementation of the European working time directive as from 2004? This would be a serious problem in reducing certain working hours which at the moment the Royal College of Physicians feels could not be carried out because of shortage of doctors, as the noble Baroness has indicated, and would therefore have a serious and detrimental effect upon clinical care.
My Lords, I do not quite agree with the noble Lord. I certainly understand the concerns in the health service and among the medical profession about the impact of the working time directive. But the horizontal amendment resulted from pressure from this and other governments to give many more years to implement the directive. So although I recognise the pressures, the horizontal amending directive has been helpful to the UK.
My Lords, is my noble friend aware that, contrary to what has been stated by the noble Baroness, Lady Gardner of Parkes, although it may be true that the proposal for postponement has the support of the Royal College of Physicians, it does not have the support of the British Medical Association. I talked to the association this morning and have its briefing note in my hand. The BMA deals with terms and conditions. It points out that one-third of England's junior doctors work more than 56 hours a week at present and that more than half of them are outside the current new deal hours limits.
My Lords, I understand the BMA's position. At the end of the day, there are two points to be made. First, requiring junior doctors to work too many hours is hardly good for patients, so the general direction in which the directive takes us is welcome. Secondly, on current hours of work, we already have the new deal agreement. My understanding is that 95 per cent of pre-registration house officers are in new deal compliant posts. Of course, further progress needs to be made with other junior doctor grades, but we should recognise that a great deal of progress has been made by the NHS in the past couple of years.
My Lords, I am always deeply concerned about the difficulties of the French Government in healthcare matters. They will have to consider the issues, as we do. But when it came to seeking a horizontal amendment, the UK received support from a number of European countries which were similarly concerned about the implications.
My Lords, at the risk of being called naive by two Ministers in two days, why did the Department of Health not recognise five years ago that the working time directive would be coming into force and take steps to ensure that enough medical staff would start to be trained then so that they would be available now? That was the answer I received yesterday when I asked about engine drivers.
My Lords, my noble friend is not naive. On preparing for the implementation of the directive, it is worth recalling that the Council directive was issued in November 1993. There are Members in other parts of the House who might have to answer the charge of lack of preparation. When we came into office, we set about increasing the number of medical training places with great vigour. The fact that in 2002–03 we have an intake of 5,292, compared with 3,749 in 1997–98, tells a very convincing story.
My Lords, do the Government accept the general proposition that if junior doctors are to work fewer hours, we shall need commensurately more of them in the health service? If they do, has the Minister estimated how many more junior doctors are required for the health service to meet the requirements of the European working time directive?
My Lords, taking the time factor and assuming that we had to fill the time reduction currently being worked by juniors with new junior doctor appointments, a rough estimate is that between 7,000 and 10,000 new junior doctors would be required. While increasing the medical workforce is one of the ways in which we will respond to the issue, there is no doubt that the work being undertaken with the BMA and the royal colleges in reorganising out-of-hours work and shift systems, and improving and enhancing the way in which junior doctors are involved in the health service, will be key in answering this problem.