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Mr. Hilton Dawson (Lancaster and Wyre) (Lab): The hon. Gentleman is making some interesting and important points. I apologise for missing the first few moments of his speech, and I wonder whether he has already put his remarks in the context of the Government's unprecedented 33 per cent. improvement in investment in primary care. Will he move on to that and establish the proper context for this debate eventually?
Mr. Lansley: I am grateful for the hon. Gentleman's contribution. I have not talked about primary care yet, and I will do so later.
On investment in hospital services, the hon. Gentleman raises an important point, because all the issues that I am discussing have implications—not only the working time directive but "Agenda for Change" and the implementation of the consultants contract, which I shall mention briefly later. The combination of those changes not only imposes significant financial and managerial challenges for the NHS, but those financial challenges may obviate—this will worry Labour Back Benchers—the resources that the Government so trumpet in terms of growth in activity in the NHS. I have spoken to a number of chief executives of a range of hospital trusts, whom I have asked how much more it will cost them in this financial year, 2004–05, to deliver the same activity as in the preceding financial year. The answers vary, but the average is between 8 and 9 per cent. extra. In the context of what the hon. Gentleman asserts are unprecedented increases in the amount of money available—we agree absolutely that more money must be available for the NHS—that shows the importance of managing and introducing changes in a
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way that delivers growth in activity and investment with reform. That is what the Prime Minister says—I heard him say it again at Prime Minister's questions—but he spends the money and does not deliver the reform.
Mr. Dawson: Is it not also about delivering improvements in the quality of services and ensuring that primary care trusts manage their services much more effectively in the future?
Mr. Lansley: I have no disagreement with the hon. Gentleman, but I think that as we proceed it will become clear that managing the system depends more on enabling hospitals to make changes effectively than on relying on the Government, who have done abjectly little to help hospitals implement the working time directive in a timely fashion.
Mr. Patrick McLoughlin (West Derbyshire) (Con): Will my hon. Friend confirm that when he spoke of an 8 or 9 per cent. increase, he was referring only to the implications of the directive and not to the implications for community hospitals of the GPs' contract, which is likely to involve a further huge expenditure?
Mr. Lansley: I was talking about the increase in costs for acute trusts. As my hon. Friend will know from his constituency experience—and from his constituent Dr. Holden, who speaks for the British Medical Association on these matters—if GPs were compensated fully for their work in community hospitals and for the quality of that work, there would be a substantial additional cost. The Government do not propose to meet that cost, but it raises serious issues for community hospitals.
Dr. Howard Stoate (Dartford) (Lab): Does the hon. Gentleman think that consultants who are called out during the night and whose sleep is therefore very disturbed should have a break afterwards? Would he expect an airline pilot who has been asked to do an extra shift and fly to America to work his normal shift in the morning? Would he expect a pilot who has just flown for eight hours to fly for a further eight hours, or would he prefer that pilot to have a rest after flying across the Atlantic in the middle of the night before flying back the next morning?
Mr. Lansley: I think we should work with consultants on a flexible, agreed and negotiated basis, as has been happening increasingly. Yes, compensatory rest is desirable, but it is certainly not desirable for it to be granted as a legal requirement before the next period of work, as that would result directly in adverse consequences for operating lists and for clinics. There may be a case for it in some circumstances, but it will depend on the extent of the interruption during the night.
The whole structure in the NHS is being driven not by flexible local negotiations, as it should be, but on the basis of European Court of Justice judgments about the circumstances of an individual German doctor, which do not strike me as relevant to the way in which we manage the health service.
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Dr. Stoate: So the hon. Gentleman is saying that if a consultant surgeon has to operate in the middle of the night it is okay for him to proceed with his morning operating session, although it would certainly not be okay for an airline pilot who has flown for an extra session to fly a plane the following morning. I would not want to be the patient of a doctor who had been out in the middle of the night and was expected to carry on as normal without a proper rest period.
Mr. Lansley: I respect the hon. Gentleman's professional expertise, but he has moved the goalposts. I was talking about non-resident on-call doctors. It is very unlikely that night surgery would not have been allowed for in rotas relating to clinics or operating lists for the following day, as the hon. Gentleman probably knows from his experience.
We may all agree that the working time directive should not be imposed on us. The Government at least seem to agree with that, but what have they done about it? In a recent response to the House of Lords European Union Committee, the BMA commented that the implementation of the directive could involve the equivalent of 3,700 junior doctors from August 2004, and that the implementation of the 48-hour limit in 2009 could involve the equivalent of between 4,300 and 9,900. In its evidence to the Committee, the Royal College of Physicians said:
"in its present shape and form, compliance will have serious long-term effects for continuity of care, patient safety, and the education and training of doctors."
"The BMA considers that the requirement made in the Jaeger judgement that compensatory rest should be taken before returning to work has huge service and workforce planning implications and is likely to be unworkable and in most cases unnecessary."
In January this year—nearly four years after the agreement on junior doctors, more than three years after the SIMAP judgment and months after the Jaeger judgment—the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), told the Royal College of Surgeons:
"Complying with the Working Time Directive need be neither costly nor a burden."
That is odd, given that the Minister told the European Standing Committee on 24 March:
"We indicated at the end of last year a worst-case scenario of between 6,000 and 12,000 additional doctors"
"The cost in relation to doctors would be between £380 million and £780 million."—[Official Report, European Standing Committee C, 24 March 2004; c. 15–19.]
We must see that alongside the Government's allocation of £46 million over three years for specific action to help implement the directive.
I recall the Minister sending the NHS this message in January: "Do not worry, it is not a problem, you can do it, it will not cost much—just get on and do it." At the same time, Ministers knew that according to the worst-case scenario thousands more doctors and hundreds of millions of pounds would be required. In evidence to the Commission, they said that the implementation of the Jaeger judgment would cost tens of millions. They knew there was a problem, but they did not tell the NHS what they proposed to do about it.
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In its evidence to the House of Lords European Union Committee, the BMA said of the pilot studies:
"proposals for these pilots were not initiated until April 2002, about four years after the implementation of the EWTD and less than 2 years before the extension of the Directive to junior doctors. The final results . . . are unlikely to be in time to aid the implementation of the EWTD for junior doctors."
In fact, I suspect that the final evaluations will come in around November.
That is fine, is it not? If hospital consultant posts are to be changed in time for implementation in August 2004, design for that change should really have started in August 2003. If junior doctor rotas are to be changed and additional junior doctors recruited, the process should already have started: no less than a six-month lead time is required. We are already in the period during which hospitals should have taken action to achieve compliance with the directive.
The medical profession has done more than Ministers and the Department in initiating the "hospital at night" programme, which the Minister will no doubt describe to us. The BMA, to its credit, has been pushing for years to secure action and awareness. On 25 February, Jim Johnson, its chairman, said:
"it seems that the government has only just grasped the potential impact of these changes. Too little has been done too late."
That, I am afraid, is the sorry story of the working time directive.
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