My Lords, I shall now repeat as a Statement the Answer to an Urgent Question given in another place by my right honourable friend the Minister of State for Community and Social Care on negotiations for a new junior doctors contract. The Statement is as follows.
“Three years ago negotiations began between the BMA, NHS Employers and the Department of Health. This was based on a common view that the current contract, agreed in 2000 when junior doctors were working very long hours, was outdated and needed reform. Between December 2012 and October 2014 an extensive and patient negotiation took place with an agreed target date for implementation of August 2015. These were abruptly terminated by the BMA’s unilateral withdrawal from those negotiations without warning in October 2014. This led to the independent and expert doctors’ and dentists’ review body being asked to take evidence from all parties, including the BMA, on reform of the contract and to make recommendations. This happened because of the unwillingness of the BMA to agree sensible changes to the contract and allowed an independent expert body to recommend a way forward.
The DDRB report, with 23 recommendations on the junior doctors contract, was published in July this year. The Secretary of State then invited the BMA to participate in negotiations based on those independent recommendations. Unfortunately, the Junior Doctors Committee of the BMA maintained its refusal to negotiate even though it was now on the basis of an independent report to which it had had an input. Both the Secretary of State and NHS Employers have invited the BMA repeatedly to participate in negotiations. It was made clear that there was a great deal to agree based on the DDRB recommendations.
We deeply regret that the BMA chose the path of confrontation rather than negotiation. While we continued to try to persuade it to develop a new contract with us, it instead chose to campaign against the independent DDRB’s recommendations including issuing a calculator, which it subsequently withdrew, which suggested wholly falsely that junior doctors would lose 30% of their pay. Instead the BMA issued demands, including a right of veto on any contract change, and was in effect asking us to ignore the DDRB’s recommendations, the heads of terms that were agreed back in 2013, and start again. Given the BMA’s refusal to engage and its wholly misleading statements about the impact of a new contract, NHS Employers issued a contract offer to juniors earlier this month. This offer has safety at its heart, strong contractual safeguards to ensure that no doctor is required to work more than 48 hours a week on average, and gives juniors the right to a work review when they believe hours are being exceeded. It reduces the maximum hours that a doctor can work in any week from 91 to 72. It pays doctors an 11% higher basic pay rate according to the hours that they work, including additional payments for unsocial hours. It reduces the number of consecutive nights that can be worked to four and long days to five, ending the week of nights.
The honourable lady has called for the parties to go to ACAS. The Secretary of State is not ruling out conciliation. We have always been willing to talk. The Government have repeatedly appealed to the BMA to return to the negotiating table and that offer is still open. We believe that talks not strikes are best for patients and for junior doctors. The Secretary of State has said that talks can take place without preconditions other than that an agreement should be within the pay envelope, but the Government reserve the right to make changes to contracts if no progress is made on the issues preventing a truly seven-day NHS, as promised in the manifesto and endorsed by the British people at the last election. It is regrettable that junior doctors have voted for industrial action which will put patients at risk and see between 50,000 and 60,000 operations cancelled or delayed each day. I would, therefore, call upon the honourable lady to join the Government in calling on the BMA, as it prepares for unprecedented strike action, to come back to the table for talks about the new contract for junior doctors. The Government remain firmly of the view that a strike by junior doctors is entirely avoidable and calls upon the BMA to also do all it can to avert any action that risks harm to the patients we all serve”.
My Lords, I am grateful to the noble Lord. The fact that we are here today, with 98% of junior doctors having voted to take significant industrial action for the first time in 40 years, is a matter of very serious concern to the NHS and its patients. Does the Minister agree that, over the course of the next week, everything that can be done should be done to stop the three days of planned industrial action? The Guardian this morning says that the noble Lord, Lord Prior, has urged on the Secretary of State the need for a settlement. Will the noble Lord confirm that? Will he also say why the Secretary of State appeared to dismiss the idea of independent mediation yesterday, has said today that they have not ruled out conciliation, but has again set preconditions, including the imposition of a contract? I have been bemused by the Secretary of State’s approach. Does he understand that the junior doctors are particularly angry about the way the Health Secretary has repeatedly conflated the reform of the junior doctors contract with seven-day services, including the highly selective and misleading use of statistics which has been disowned by the very authors of the research he quotes from?
Junior doctors already work weekends; they already work nights. Why on earth are the Government picking a fight with the very people who are so crucial to keeping the NHS running? There are nine days left before the first day of planned industrial action. I have one message for the Minister: it is time to talk.
My Lords, the noble Lord said that this was a serious concern. It is a tragedy that we are in this situation. Of course I want a settlement, as does the Secretary of State. The last thing we want is a strike. We want the junior doctors to come back to the negotiating table and not to go on strike. The only people who will suffer from a strike are patients. I cannot believe that there are many junior doctors who want to go on strike, so it is in all our interests to find a settlement, and the Secretary of State, myself and others are very keen that we do so. The Secretary of State has made it absolutely clear that there are no preconditions, save that we settle this issue within the existing pay envelope. The door is open to the BMA to come back for talks at any time.
My Lords, is my noble friend aware that in 1982, when I was Health Secretary, there was lengthy industrial action not involving doctors. When I went to St Thomas’ Hospital over the river, I was met by a deputation of doctors protesting at the damage that was being done to the health service. It is the successors of those very doctors who are now threatening industrial action. Should we not all, quite irrespective of party, condemn industrial action, which will damage patient care? Should we not also recognise that this action is not just against the Government? It also involves the rejection of the independent doctors’ and dentists’ remuneration review body, which is valued and respected throughout the health service and which doctors over the years have pressed to have. Surely we are faced with a failure of BMA leadership in this case, and the obvious course is to go back to the negotiating table very quickly.
I agree entirely that industrial action is the last thing that any of us want. I have worked with trade unions of one kind or another off and on since 1980—for 35 years. I think that the Junior Doctors Committee of the BMA is behaving in an extraordinary fashion.
My Lords, can the Minister say how sincerely the Government are considering going to ACAS, which, as far as I understand it, is acceptable to the BMA Junior Doctors Committee, and can he explain why there is resistance to doing that? Given the threat of terrorism that we now face, have the Government assessed the impact and the security that would be needed on the strike days both in the event of a terrorist attack on the population at large, when those who are well versed in managing it will not be working, and in the event of a terrorist attack specifically targeted at demonstrations by junior doctors, when they will be injured and the hospitals will be empty?
The Secretary of State has said that he is open to conciliation. Frankly, it would be so much better if we could sort this out ourselves rather than go to conciliation, but he has said that he is open to it. If there is a terrorist attack, speed will be of the essence if people are severely injured. Junior doctors care hugely about their patients, so I think we have to rely on junior doctors to be available in hospitals in the event of some awful terrorist outrage, even if they are on strike. I will certainly draw to the attention of COBRA and the relevant authorities the question of the impact of terrorism on a demonstration by junior doctors.
My Lords, if, as appears to be the case, the Government’s proposals discriminate against junior female doctors who take time off to have children or against doctors who devote some of their time to research, will the Government be prepared to reconsider their proposals?
I probably did not make the situation clear enough. The Secretary of State said that there are no preconditions. If there are concerns about time off to have children or to carry out research, those are absolutely the kinds of issues that should be discussed around the table.
I declare an interest as chairperson of Milton Keynes Hospital. Where in all this are we talking about patients? I am not going to enter into any discussion about who should be doing what. I spent this morning at Milton Keynes Hospital with my chief executive, medical director and all the consultants discussing this. I obviously associate myself with everybody’s plea that this does not go ahead, but if it does, how are we going to ensure that our patients get the best possible experience? I am equally surprised that the Minister has not referred to the letter from Sir Bruce Keogh, which went out to the chairman of the BMA and provided us with many opportunities. I am anxious that the Minister understands that the prime thing in this is patients. Whatever we have to do, patients need to be looked after.
I completely agree with the noble Baroness. I am not going to stand here and be sycophantic about the Secretary of State for Health, but the one thing he has prioritised above all else since he has been there is patient safety and patient quality.
My Lords, Sir Terrence English in his excellent article in the Telegraph made the point that medicine is a vocation and doctors who enter the profession should recognise that patients always come first. The Armed Forces do not go on strike and neither, I believe, should doctors. On the issue of preconditions, in response to a question from Sarah Wollaston in the other place, the Secretary of State made it clear that there are no preconditions. I have looked at Hansard, and that is what he said. There are no preconditions and the BMA should recognise that and go back to the table.
My Lords, the threshold for strike should be very high because of the vocational and professional dedication of doctors. Certainly, the threshold should be higher than it usually is for pay and conditions issues such as the one before us today.
My Lords, I deeply regret the tone of the statement. I understand that that is not the responsibility of the noble Lord, Lord Prior. I also respect very much his attitude, which is, I think, respected by the whole House. We have to say very clearly that this is an unprecedented situation. I do not think the nature of how junior doctors feel is understood. Already, there are more doctors in medical schools looking at going overseas—they are actually asking me whether they should be working in this country. The key issue is one we discussed in today’s earlier debate: the backbone of a good NHS is the good research we do. Research is massively threatened by what the Secretary of State is proposing. That has been emphasised by Jeremy Farrar, who, after all, is a very independent person as head of the Wellcome Trust. Would the Minister be kind enough to address that issue?
I agree. It is tragic that we are in this situation. My son is a medical student and I meet many of his friends; they do not want to be in this position. Concerns have been raised about whether junior doctors will have time to do research or will lose out on their progression if they do. That should be discussed and argued out with the BMA sitting around the table.