Secondly, energy costs have impacted on the steel industry and will impact on all major manufacturing employers across the United Kingdom. We have been warned that as a result of green taxes that we will impose between now and 2020, electricity prices will escalate. That is a deliberate policy. The carbon price

28 Oct 2015 : Column 408

floor will take £23 billion from the pockets of electricity consumers, and on top of that we have feed-in tariffs, contracts for difference, and renewables obligations—all that is imposed on our major manufacturing industries.

There is a schizophrenic attitude in the House to energy prices. We complain when we lose jobs, yet we ask for the introduction of more green policies. If we do not have a consistent policy, many more jobs will be lost in future.

3.48 pm

Margaret Ferrier (Rutherglen and Hamilton West) (SNP): I welcome the opportunity to speak up once again on behalf of my constituents at Clydebridge as they are facing an uncertain future. I know how they must be feeling right now. All too often politicians are accused of having no real-life experience, but I know only too well how it feels to be made redundant. The wait that steelworkers at Tata Steel are currently going through to find out whether they will still have a job in a few weeks is agonising. There is never a good time to lose a job, but job losses would be utterly devastating for those workers.

The Scottish steel taskforce meets tomorrow for the first time. I will be there, and I hope that the pragmatic approach taken will help to find a buyer who can continue commercial production at those sites.

Angela Smith: Will the taskforce consider the importance of the construction of Trident submarines to keeping steel jobs in Scotland?

Margaret Ferrier: No.

The force involves multiple stakeholders of various political persuasions, as well as those of none.

Marion Fellows: Does my hon. Friend agree that the trade unions, especially Community, have been fundamental in keeping the two Scottish plants going this far, and that this has been recognised by the Scottish Government, unlike by the Conservative party, which seeks—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. That intervention is far too long. We want short interventions. We should be on to the vote by now. We have been very generous and it has been abused.

Margaret Ferrier: I thank my hon. Friend for intervening.

I welcome yesterday’s announcement from Scottish business Minister, Fergus Ewing, that Transport Scotland is reviewing all its infrastructure projects, looking at how public procurement might be utilised to help to stimulate the industry.

Steel is used to create more than 80% of the components required to build a typical wind turbine, and plate steel from Tata’s Scunthorpe and Dalzell mills is used in the fabrication of these renewables. UK Government policy on the removal of support for renewables will have an adverse impact along the supply chain, particularly on the steel industry. Plans to cut support for renewables need to be dropped now. The UK has the highest carbon tax in the world. More than half the UK power price is made up of this tax. Steel needs to be given the recognition it deserves in helping to grow the renewables sector, thus reducing carbon emissions in the long term.

28 Oct 2015 : Column 409

I welcome today’s announcement that the Government will refund energy intensive industries for the full amount of the policy costs they face as soon as the state aid judgment comes from Brussels. The Chancellor, however, must take lessons from our European neighbours who have taken matters into their own hands to support their industries, and then obtained state aid clearance retrospectively. A bold move like that could almost certainly facilitate the process of finding a buyer for the sites in Scotland.

Chinese overproduction is leading to steel being sold below market price, and this is being achieved only through Government subsidy in China. Approximately 70% of the Chinese steel industry is thought to be unprofitable. If this were the UK, the industry would have collapsed by now. In short, the European steel market is fighting with one hand tied behind its back. We have both hands bound and the playing field urgently needs to be levelled.

We need a real long-term strategy for steel. We owe it to the thousands of steelworkers across the UK and their families to support them and ensure a sustainability and security of employment. I will work with anyone to help to secure a future for the industry and the jobs of steelworkers in my constituency and right across the UK.

Saving British steel will not be easy, but we must now rise to the challenge and explore every possible option, so we can reach what should be a shared aim for all in this place. We must never give up on the steel industry and the highly skilled workers in their hour of need.

3.52 pm

Kevin Brennan (Cardiff West) (Lab): We have had a very good and, understandably under the circumstances, passionate debate. I am sorry that because the wind-ups have been truncated—the Minister and I have, I think, eight minutes each—we will not be able to refer to everybody who spoke in the debate. I think 21 Back Benchers participated in the debate. It is good that they were all able to speak and they did so with great passion. I would like to mention my hon. Friend the Member for Newport East (Jessica Morden), who represents the Llanwern area. That was where my father worked for 20 years and where I was privileged to work in the steel plant and coke ovens for six months before I went up to university. People who come from steelmaking backgrounds understand why everyone feels so passionate about this subject. I am sorry I cannot mention everybody’s contributions, but I commend the knowledge and passion the hon. Members who represent steelmaking constituencies brought to our proceedings, not just today but throughout the current crisis and long before that.

The Government cannot say that they were not warned about the crisis in the steel industry. MPs have been assiduously vocal over a long period of time. I see that the hon. Member for Stockton South (James Wharton), the so-called Minister for the northern powerhouse, has joined us. If he missed any of today’s proceedings he can read about them in TheNorthern Echo tomorrow. The efforts of my hon. Friends have been the very opposite of the showboating they were accused of. On the contrary, they have stood up for their communities, the British steel industry and its workers. They have made a substantial contribution towards forcing the

28 Oct 2015 : Column 410

Government to acknowledge that action is required, however late and inadequate it might be. It is good that the Business Secretary is finally talking to the European Commission, and it is good that he has gone to Brussels. Only last week, we found out in a parliamentary question from my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) that he had not—incredibly—until now spoken to the Commission about this. Clearly, he booked his Eurostar tickets very quickly to get over there today, and we welcome that.

It is perfectly reasonable, however, to ask why it has taken so long. Why has the Business Secretary been chasing rather than leading events? We know that when he became Business Secretary he did not want to have an industrial strategy and preferred to talk about an “industrial approach”. That hardly smacks of someone who will intervene before breakfast, lunch, tea and dinner, let alone supper, on behalf of British industry. There are echoes today of the famous row between Margaret Thatcher and Michael Heseltine over Westland.

Sir William Cash rose

Kevin Brennan: I am not going to give way, because of time.

We found out today that the Government are ordering hundreds of military vehicles and three new ships for our armed forces to be built using steel imported from Sweden. And this at the same time as Gareth Stace, of UK Steel, said that the British steel industry was “likely to die” without stronger support from the Government. He said that yesterday to the Business, Innovation and Skills Committee. We should not be surprised that the Business Secretary has until now pursued what Tata called in its briefing for this debate a laissez-faire ideology, because he has made it clear that that is what he believes in. You might not have read it, Mr Deputy Speaker, but his favourite book is “The Fountainhead”, by Ayn Rand, in which the hero blows up a poor housing estate because he does not like the design, such is his individualist approach.

The Minister for Small Business, Industry and Enterprise (Anna Soubry): Shameful.

Kevin Brennan: The Minister may say that, but my argument is that the basic cause of the Government’s slowness to respond to the steel crisis is that the Secretary of State fundamentally believes that it is not the business of Government to get involved in markets and industry. So while he is having to be seen to be doing something by going to Brussels today, he is actually in practice—[Interruption.] Government Members can chunter away as usual all they like, but in practice he has been busy planning the dismantling of his Department’s capacity to support steel and other key strategic British industries. He has volunteered to cut his Department’s budget by 40% , and this week we read in the Financial Times how investment grants to key British sectors are being converted to loans. It turns out that the much-vaunted apprenticeship levy will become a displacement tax on business and will not compensate for the cuts to the training budget.

This approach has to stop, and it is has to be replaced with a proper industrial strategy based on the consensus built up under the last Labour Government and, in fact, the last coalition Government, but which the Business Secretary does not believe in. We need a much clearer

28 Oct 2015 : Column 411

steer from the Government that they are prepared not only to say that steel is a key strategic industry, but to act to ensure it remains a key strategic industry. I again ask Ministers what they think is the minimum capacity for steelmaking in the UK below which it is not in the country’s strategic interests to go? The Minister told the Select Committee:

“I have an absolute determination to keep steel in this country”.

In her winding-up speech, will she make it absolutely clear what she means by minimum capacity for this strategic industry? What efforts are Ministers making to calculate the cost of cleaning up sites such as Redcar when they close? In a written parliamentary answer to me last week, she could not say. How can the Government decide whether closure is the right choice when they cannot even estimate the cost of cleaning up the site?

At last week’s urgent question, I urged the Business Secretary to implement the five points raised by UK Steel at the steel summit the previous week. At that time, he could not confirm that he would. Will the Minister now confirm, albeit belatedly, that the Government will do that, and will she fully implement the energy intensive industry compensation package now, not later?

Will the Government finally press hard at the EU level on anti-dumping measures? Will the Minister even admit that dumping is going on? Will she let that phrase cross her lips in her response? Will they remove plant and machinery from business rate calculations and stop gold-plating EU regulations? Will they support the use of British steel in major projects, unlike what we hear today with the staggering news about Swedish steel being used by the Ministry of Defence? Will they listen to calls from the trade unions, including Community, for a long-term strategy rather than a hand-to-mouth approach? What are the Government going to do to support skills retention and short-time working during the current crisis, if that is needed?

This has been the first major industrial test for the Business Secretary in particular and for the Conservative Government in general since the general election As I have argued, their initial response was to revert to type and do as little as possible. They were prepared, it seemed, to let a key strategic industry die without a fight. Because of the chorus of voices from local MPs, from us as Her Majesty’s loyal Opposition, from the workforce, from employers and from the public, they have had to move, albeit far too slowly and too late for thousands who have lost their jobs The steel industry is a classic example of a case where the Government need to be prepared to roll up their sleeves immediately and intervene before breakfast, lunch, tea and dinner. This Government have been slow to act. The steelworkers whose jobs have been lost know it, the British public know it and, deep down inside, Ministers know it too—it will not be forgotten.

4.1 pm

The Minister for Small Business, Industry and Enterprise (Anna Soubry): May I begin by paying tribute to all those who work in our steel industry, particularly the workforce and indeed the management? I pay particular tribute to all those—it is mainly men, but some women also work there—who have unfortunately lost their jobs, and to their families, be they at Dalzell, Clydebridge, Scunthorpe, Rotherham, Llanwern or Redcar.

28 Oct 2015 : Column 412

Nobody should ever dare to suggest that anybody on the Government Benches has taken any pleasure, happiness or anything else in the unfortunate demise we have seen over recent times of a large part of our steel industry. [Interruption.] The hon. Member for Cardiff West (Kevin Brennan) is sitting there, but he made one of the most disappointing speeches I have ever heard. He does no service whatsoever to his industry and the workers he says he seeks to support, who have come all this way to be here today. In the short time I have been in my position it has been a pleasure to attend a number of debates and even urgent questions to listen to the impassioned speeches of so many Members who speak on behalf of their constituents, and rightly so. That is their job and they do it. But, seriously and genuinely, to try to score cheap political and, in many respects, highly personal points does absolutely nothing at all. [Interruption.] The hon. Member for Middlesbrough (Andy McDonald) shouts at me, but he should know better. He knows how hard I, and others, worked to secure the future of the Redcar plant, but let us get to the facts.

The facts are as follows: the price of steel has in some instances, slab in particular, almost halved. That is the harsh reality. On the Redcar plant, it is a fact that all the time SSI was there—more than three and a half years—it lost hundreds of millions of pounds. You can have my word, Mr Deputy Speaker, that if anybody had come forward to buy the blast furnace to secure it or the coke ovens, the official receiver would have taken those offers exceedingly seriously. But the horrible truth is that no such buyers came forward, and why would they?

Sir William Cash: Will the Minister give way?

Anna Soubry: I am sorry, but I am not taking interventions. They would not, because the plant was losing hundreds of millions of pounds—even the coke ovens, which we fought so hard to secure, were losing £2 million a month. That was the harsh, awful reality.

All the steel industry asks for—and it is right to make these requests—is that we have a level playing field. It feels that its hands are tied behind its back. It makes its case, and I pay tribute to Gareth Stace, one of the first people—

Several hon. Members rose

Anna Soubry: No, I am not giving way. He was one of the first people that I met after my appointment, because I knew how much he knew about the British steel industry. It wants a level playing field, and it is right to do so. That is what this Government are doing.

Let me make it absolutely clear—

Andy McDonald: Will the Minister give way?

Anna Soubry: No.

Andy McDonald: On a point of order, Mr Deputy Speaker. We hear from the Minister that no people were coming forward to discuss projects to take over at SSI. She needs to correct that position, because there were consortiums of—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. That is not a point of order, but a point of debate. I understand that emotions are running very high.

28 Oct 2015 : Column 413

Anna Soubry: As I said, nobody came forward with an offer, and the hon. Member for Middlesbrough (Andy McDonald) knows that I held a meeting with someone who had said they were interested, but the harsh awful reality was that nobody came forward with an offer.

Andy McDonald rose—

Anna Soubry: No, I will not take any more interventions from the hon. Gentleman. I will talk to him as I always do but I do not have time for interventions.

Let me explain the actions that the Government have taken. On energy costs, we have already paid out £50 million in compensation to the steel industry. In relation to the “unfair trade”, as we put it—in simple and sharp terms “dumping”—one of the first things we did when we were elected was to take a decision and cast our vote to protect our steel industry. That had never happened before, and it was done specifically on the direction of myself and the Secretary of State for Business, Innovation and Skills. Then we turn to rebar—the investigation was started on behalf of this Government and on behalf of the steel industry after it came to us and presented us with the evidence.

Now let us look at procurement. Opposition Members, and indeed Government Members—I pay tribute to my hon. Friend the Member for Corby (Tom Pursglove) who fights as hard as he always does for his steel workforce—quite properly talk about a difficulty over procurement. Again, let us look at the evidence. The evidence is absolutely clear. We have already changed the rules for the benefit, not just of the British steel industry but for the whole of British industry, because we put into the score card of the public sector the fact that social and environmental considerations could be taken into account. That was the first time that had happened, so I am not taking any lessons from Labour Members, who had an opportunity to do that for 13 years and failed to do so. That is the sort of direct action that we have taken. We are taking this further. We have three working groups, one of which is looking specifically at how we can extend those rules further—and not just in the public sector.

Several hon. Members rose

Anna Soubry: The hon. Members for Hartlepool (Mr Wright) and for Scunthorpe (Nic Dakin) can come to see me any time. The hon. Member for Hartlepool made a really good point about the supply chains. Yes, we can chase public procurement, but we have to make sure it goes through the supply chain, which is absolutely the sort of work that the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for West Dorset (Mr Letwin) is doing—looking at how best to take those new rules all the way through the supply chain.

The Government will take further actions. We have advanced the talks with the Commission for millions more in compensation. That is why the Secretary of State for Business, Innovation and Skills is not here today; he is over in Brussels doing a brilliant job. We have already spoken to the most important Ministers about how to change things and how to secure and work with our allies in Europe to make sure that we look at the state-aid rules and how we can do more on dumping to protect our steel industry.

28 Oct 2015 : Column 414

If we look at the Crossrail contract, we find that 97% of all the materials have been placed with British companies using British materials. We know that 40,000 tonnes of steel for HMS Queen Elizabeth was made by Tata, while 95% of Network Rail’s steel is British steel. It has embarked, under this Government, on the biggest programme of railway investment that has been seen since Victorian times. If only it were as simple as—

Mr Alan Campbell (Tynemouth) (Lab): claimed to move the closure (Standing Order No.36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question put accordingly(Standing Order No. 31(2)), That the original words stand part of the Question.

The House divided:

Ayes 280, Noes 307.

Division No. 100]


4.9 pm


Abbott, Ms Diane

Abrahams, Debbie

Ahmed-Sheikh, Ms Tasmina

Alexander, Heidi

Ali, Rushanara

Allen, Mr Graham

Anderson, Mr David

Arkless, Richard

Ashworth, Jonathan

Austin, Ian

Bailey, Mr Adrian

Bardell, Hannah

Barron, rh Kevin

Beckett, rh Margaret

Benn, rh Hilary

Betts, Mr Clive

Black, Mhairi

Blackford, Ian

Blackman, Kirsty

Blackman-Woods, Dr Roberta

Blenkinsop, Tom

Blomfield, Paul

Boswell, Philip

Bradshaw, rh Mr Ben

Brake, rh Tom

Brennan, Kevin

Brock, Deidre

Brown, Alan

Brown, Lyn

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burgon, Richard

Burnham, rh Andy

Butler, Dawn

Byrne, rh Liam

Cadbury, Ruth

Cameron, Dr Lisa

Campbell, rh Mr Alan

Campbell, Mr Ronnie

Carmichael, rh Mr Alistair

Champion, Sarah

Chapman, Douglas

Cherry, Joanna

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Cooper, Julie

Cooper, rh Yvette

Corbyn, Jeremy

Coyle, Neil

Crausby, Mr David

Crawley, Angela

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cummins, Judith

Cunningham, Alex

Cunningham, Mr Jim

Dakin, Nic

David, Wayne

Davies, Geraint

Day, Martyn

De Piero, Gloria

Docherty, Martin John

Dodds, rh Mr Nigel

Donaldson, Stuart Blair

Doughty, Stephen

Dowd, Jim

Dowd, Peter

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Elliott, Julie

Ellman, Mrs Louise

Esterson, Bill

Evans, Chris

Farrelly, Paul

Fellows, Marion

Ferrier, Margaret

Field, rh Frank

Fitzpatrick, Jim

Flello, Robert

Fletcher, Colleen

Flint, rh Caroline

Flynn, Paul

Fovargue, Yvonne

Foxcroft, Vicky

Gapes, Mike

Gardiner, Barry

Gethins, Stephen

Glass, Pat

Glindon, Mary

Godsiff, Mr Roger

Goodman, Helen

Grady, Patrick

Grant, Peter

Gray, Neil

Green, Kate

Greenwood, Lilian

Greenwood, Margaret

Griffith, Nia

Gwynne, Andrew

Haigh, Louise

Hamilton, Fabian

Hanson, rh Mr David

Harman, rh Ms Harriet

Harpham, Harry

Harris, Carolyn

Hayes, Helen

Hayman, Sue

Healey, rh John

Hendrick, Mr Mark

Hendry, Drew

Hepburn, Mr Stephen

Hermon, Lady

Hillier, Meg

Hodge, rh Dame Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hopkins, Kelvin

Hosie, Stewart

Howarth, rh Mr George

Hunt, Tristram

Huq, Dr Rupa

Hussain, Imran

Irranca-Davies, Huw

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Gerald

Jones, Graham

Jones, Helen

Jones, Mr Kevan

Jones, Susan Elan

Kane, Mike

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Kerevan, George

Kerr, Calum

Kinnock, Stephen

Kyle, Peter

Lamb, rh Norman

Lammy, rh Mr David

Lavery, Ian

Law, Chris

Leslie, Chris

Lewell-Buck, Mrs Emma

Lewis, Clive

Lewis, Mr Ivan

Long Bailey, Rebecca

Lucas, Caroline

Lucas, Ian C.

MacNeil, Mr Angus Brendan

Mactaggart, rh Fiona

Madders, Justin

Mahmood, Mr Khalid

Mahmood, Shabana

Mann, John

Marris, Rob

Marsden, Mr Gordon

Maskell, Rachael

Matheson, Christian

Mc Nally, John

McCabe, Steve

McCaig, Callum

McCarthy, Kerry

McDonagh, Siobhain

McDonald, Andy

McDonald, Stewart Malcolm

McDonald, Stuart C.

McDonnell, John

McGarry, Natalie

McGovern, Alison

McInnes, Liz

McKinnell, Catherine

McLaughlin, Anne

Meale, Sir Alan

Mearns, Ian

Monaghan, Carol

Monaghan, Dr Paul

Morden, Jessica

Morris, Grahame M.

Mulholland, Greg

Mullin, Roger

Murray, Ian

Nandy, Lisa

Newlands, Gavin

Nicolson, John

O'Hara, Brendan

Onn, Melanie

Onwurah, Chi

Osamor, Kate

Oswald, Kirsten

Owen, Albert

Paterson, Steven

Pearce, Teresa

Pennycook, Matthew

Perkins, Toby

Phillips, Jess

Phillipson, Bridget

Pound, Stephen

Powell, Lucy

Pugh, John

Qureshi, Yasmin

Rayner, Angela

Reed, Mr Jamie

Reed, Mr Steve

Rees, Christina

Reynolds, Emma

Reynolds, Jonathan

Rimmer, Marie

Ritchie, Ms Margaret

Robertson, rh Angus

Robinson, Mr Geoffrey

Rotheram, Steve

Ryan, rh Joan

Salmond, rh Alex

Saville Roberts, Liz

Shah, Naz

Shannon, Jim

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheppard, Tommy

Sherriff, Paula

Shuker, Mr Gavin

Siddiq, Tulip

Simpson, David

Skinner, Mr Dennis

Slaughter, Andy

Smeeth, Ruth

Smith, rh Mr Andrew

Smith, Angela

Smith, Cat

Smith, Nick

Smith, Owen

Smyth, Karin

Starmer, Keir

Stephens, Chris

Stevens, Jo

Streeting, Wes

Stringer, Graham

Stuart, rh Ms Gisela

Tami, Mark

Thewliss, Alison

Thomas, Mr Gareth

Thomas-Symonds, Nick

Thompson, Owen

Thomson, Michelle

Thornberry, Emily

Timms, rh Stephen

Trickett, Jon

Turley, Anna

Turner, Karl

Twigg, Derek

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Watson, Mr Tom

Weir, Mike

West, Catherine

Whiteford, Dr Eilidh

Whitehead, Dr Alan

Whitford, Dr Philippa

Williams, Hywel

Williams, Mr Mark

Wilson, Corri

Wilson, Phil

Wilson, Sammy

Winnick, Mr David

Winterton, rh Ms Rosie

Wishart, Pete

Woodcock, John

Wright, Mr Iain

Zeichner, Daniel

Tellers for the Ayes:

Holly Lynch


Jeff Smith


Adams, Nigel

Afriyie, Adam

Aldous, Peter

Allan, Lucy

Allen, Heidi

Amess, Sir David

Andrew, Stuart

Ansell, Caroline

Argar, Edward

Atkins, Victoria

Bacon, Mr Richard

Baker, Mr Steve

Baldwin, Harriett

Barclay, Stephen

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Berry, James

Bingham, Andrew

Blackman, Bob

Blackwood, Nicola

Boles, Nick

Bone, Mr Peter

Borwick, Victoria

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brokenshire, rh James

Bruce, Fiona

Buckland, Robert

Burns, rh Sir Simon

Burrowes, Mr David

Burt, rh Alistair

Cairns, Alun

Carmichael, Neil

Cartlidge, James

Cash, Sir William

Caulfield, Maria

Chishti, Rehman

Chope, Mr Christopher

Churchill, Jo

Clark, rh Greg

Clarke, rh Mr Kenneth

Cleverly, James

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Costa, Alberto

Cox, Mr Geoffrey

Crabb, rh Stephen

Crouch, Tracey

Davies, Byron

Davies, Chris

Davies, David T. C.

Davies, Glyn

Davies, Dr James

Davies, Mims

Davies, Philip

Davis, rh Mr David

Dinenage, Caroline

Djanogly, Mr Jonathan

Donelan, Michelle

Dorries, Nadine

Dowden, Oliver

Drax, Richard

Drummond, Mrs Flick

Duddridge, James

Duncan, rh Sir Alan

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Ellis, Michael

Ellison, Jane

Elphicke, Charlie

Eustice, George

Evans, Graham

Evans, Mr Nigel

Evennett, rh Mr David

Fabricant, Michael

Fallon, rh Michael

Fernandes, Suella

Field, rh Mark

Foster, Kevin

Fox, rh Dr Liam

Frazer, Lucy

Freeman, George

Freer, Mike

Fuller, Richard

Fysh, Marcus

Gale, Sir Roger

Garnier, rh Sir Edward

Garnier, Mark

Gauke, Mr David

Ghani, Nusrat

Gibb, Mr Nick

Gillan, rh Mrs Cheryl

Glen, John

Goodwill, Mr Robert

Gove, rh Michael

Graham, Richard

Grant, Mrs Helen

Gray, Mr James

Grayling, rh Chris

Green, Chris

Green, rh Damian

Greening, rh Justine

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Halfon, rh Robert

Hall, Luke

Hammond, Stephen

Hancock, rh Matthew

Hands, rh Greg

Harper, rh Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Sir Oliver

Heappey, James

Heaton-Harris, Chris

Heaton-Jones, Peter

Henderson, Gordon

Herbert, rh Nick

Hinds, Damian

Hoare, Simon

Hollingbery, George

Hollinrake, Kevin

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Howarth, Sir Gerald

Howell, John

Howlett, Ben

Huddleston, Nigel

Hunt, rh Mr Jeremy

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Jayawardena, Mr Ranil

Jenkin, Mr Bernard

Jenkyns, Andrea

Jenrick, Robert

Johnson, Boris

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kennedy, Seema

Kinahan, Danny

Kirby, Simon

Knight, rh Sir Greg

Knight, Julian

Kwarteng, Kwasi

Lancaster, Mark

Latham, Pauline

Leadsom, Andrea

Lee, Dr Phillip

Lefroy, Jeremy

Leigh, Sir Edward

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Lewis, rh Dr Julian

Liddell-Grainger, Mr Ian

Lidington, rh Mr David

Lopresti, Jack

Lord, Jonathan

Loughton, Tim

Lumley, Karen

Mackinlay, Craig

Mackintosh, David

Main, Mrs Anne

Mak, Mr Alan

Malthouse, Kit

Mann, Scott

Mathias, Dr Tania

May, rh Mrs Theresa

Maynard, Paul

McCartney, Jason

McCartney, Karl

McLoughlin, rh Mr Patrick

McPartland, Stephen

Menzies, Mark

Mercer, Johnny

Merriman, Huw

Metcalfe, Stephen

Miller, rh Mrs Maria

Milling, Amanda

Mills, Nigel

Mordaunt, Penny

Morgan, rh Nicky

Morris, Anne Marie

Morris, David

Morris, James

Morton, Wendy

Mowat, David

Murray, Mrs Sheryll

Murrison, Dr Andrew

Neill, Robert

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Nuttall, Mr David

Offord, Dr Matthew

Parish, Neil

Patel, rh Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, rh Mike

Penrose, John

Percy, Andrew

Perry, Claire

Phillips, Stephen

Philp, Chris

Pincher, Christopher

Pow, Rebecca

Prentis, Victoria

Prisk, Mr Mark

Pritchard, Mark

Pursglove, Tom

Quin, Jeremy

Quince, Will

Raab, Mr Dominic

Redwood, rh John

Rees-Mogg, Mr Jacob

Robertson, Mr Laurence

Robinson, Mary

Rosindell, Andrew

Rudd, rh Amber

Rutley, David

Sandbach, Antoinette

Scully, Paul

Selous, Andrew

Shapps, rh Grant

Sharma, Alok

Shelbrooke, Alec

Simpson, rh Mr Keith

Skidmore, Chris

Smith, Chloe

Smith, Henry

Smith, Julian

Smith, Royston

Soames, rh Sir Nicholas

Solloway, Amanda

Soubry, rh Anna

Spelman, rh Mrs Caroline

Spencer, Mark

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stuart, Graham

Sturdy, Julian

Sunak, Rishi

Swayne, rh Mr Desmond

Swire, rh Mr Hugo

Syms, Mr Robert

Thomas, Derek

Throup, Maggie

Tolhurst, Kelly

Tomlinson, Justin

Tomlinson, Michael

Tracey, Craig

Tredinnick, David

Trevelyan, Mrs Anne-Marie

Tugendhat, Tom

Turner, Mr Andrew

Tyrie, rh Mr Andrew

Vara, Mr Shailesh

Vickers, Martin

Walker, Mr Charles

Walker, Mr Robin

Wallace, Mr Ben

Warburton, David

Warman, Matt

Watkinson, Dame Angela

Wharton, James

Whately, Helen

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, rh Mr John

Wiggin, Bill

Williams, Craig

Williamson, rh Gavin

Wilson, Mr Rob

Wollaston, Dr Sarah

Wood, Mike

Wragg, William

Wright, rh Jeremy

Zahawi, Nadhim

Tellers for the Noes:

Guy Opperman


Jackie Doyle-Price

Question accordingly negatived.

28 Oct 2015 : Column 415

28 Oct 2015 : Column 416

28 Oct 2015 : Column 417

28 Oct 2015 : Column 418

The Deputy Speaker declared the main Question, as amended, to be agreed to (Standing Order No. 31(2)).


That this House is concerned by the impact that recent redundancies in the steel sector could have on local communities and welcomes Government support for affected people in those communities; recognises the unprecedented global challenges currently facing the UK steel industry and agrees that all parties, including Government, opposition parties and the industry need to work together to secure a sustainable future for UK steel; and notes that the Government is in regular dialogue with the industry, including hosting a recent Steel Summit, and is taking urgent action to address both the industry's short-term and long-term concerns, including energy costs, unfair trade, the Industrial Emissions Directive and long-term procurement opportunities for the industry so as to ensure that the UK steel industry has a sustainable future.

Mr Deputy Speaker (Mr Lindsay Hoyle): I now have to announce the result of a deferred Division on the question relating to Joint Committee on Human Rights. The Ayes were 485 and the Noes were 61, so the question was agreed to.

[The Division list is published at the end of today’s debates.]

28 Oct 2015 : Column 419

Junior Doctors’ Contracts

4.21 pm

Heidi Alexander (Lewisham East) (Lab): I beg to move,

That this House notes the stalled discussions between Government and the British Medical Association (BMA) about a new junior doctors’ contract; opposes the removal of financial penalties from hospitals which protect staff from working excessive hours; urges the Government to guarantee that no junior doctor will have their pay cut as a result of a new contract; and calls upon the Government to withdraw the threat of contract imposition, put forward proposals which are safe for patients and fair for junior doctors and return to negotiations with the BMA.

It is a privilege to be opening a debate from the Opposition Dispatch Box for the first time, and I want to start in a way that is perhaps untypical for these debates. I want the Secretary of State and me to agree on something. I want him to join me in saying thank you to everyone who works in the NHS and in the care system in our country—not just the junior doctors who are the subject of today’s debate but all the staff who work day in, day out caring for our loved ones as though they were their own. So, to our doctors, nurses, porters, care workers and paramedics I say this: I know how hard you work; I know that many of you already work nights, weekends and even Christmas day, and for that we are hugely grateful.

I have called this debate today because I am deeply worried about the current stand-off between the Government and junior doctors. I am worried that a new Government-imposed employment contract will be unsafe for patients and unfair for doctors. I am worried that if the Health Secretary gets his way, he will fast become the best recruiting sergeant that the Australian health service has ever had.

Mark Spencer (Sherwood) (Con): Does the hon. Lady therefore agree that the best course of action would be to get round the negotiating table again? Will she encourage the British Medical Association to come back to the negotiating table?

Heidi Alexander: If the hon. Gentleman reads the motion, he will see that it talks about a return to the negotiating table, but the BMA and the junior doctors need to know that the Health Secretary is genuinely willing to compromise, and his performance over the past few months suggests otherwise.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): My constituency has one of the highest proportions of doctors of any in the country. My junior doctors are worried that they are being asked to work in conditions that are becoming unsafe. They also point out that they have choices, and many do not think that their future lies in this country. They will make a different choice because the damage has already been done.

Heidi Alexander: My right hon. Friend is completely right, and I will come to some of those challenges later in my speech.

When the NHS is facing unprecedented challenges, it cannot be right to pick a fight with the very people who keep our hospitals running. I come here today to ask the Secretary of State to do three things: to show that

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he is willing to compromise by withdrawing the threat of contract imposition; to guarantee that no junior doctor will be paid less to do the same, or more, than they are currently doing; and to ensure financial penalties for any hospital that forces doctors to work excessive and exhausting hours.

Sir Roger Gale (North Thanet) (Con): On that basis, given that the Secretary of State has indicated in terms that no junior doctor will be required to work more hours—rather, it is fewer hours—than at present and that they will not lose money, can the hon. Lady give me any reason why the doctors’ leader was able to say to me earlier in the week that he would not get round the negotiating table and talk?

Heidi Alexander: I am afraid that the Health Secretary has given absolutely no guarantee that no junior doctor will be paid less.

I have set out the three things that I wish the Secretary of State to do today. Anyone listening to this debate would say that they were all reasonable things to request. Anyone who wants to avoid industrial action would want the Secretary of State to step up and do the right thing.

Richard Burgon (Leeds East) (Lab): Is my hon. Friend aware that tonight in Leeds, 2,000 junior doctors are getting together to protest against this Government’s plans? Does it not come to something when 2,000 junior doctors get together in such a way? Why, despite the assurances from those on the Government Benches, does she think that that is happening?

Heidi Alexander: I am very grateful to my hon. Friend for his intervention. The junior doctors I have met are deeply concerned about patient safety and about what the proposed new contract means for them.

Several hon. Members rose

Heidi Alexander: I will not give way, because I wish to make some progress.

The Health Secretary may claim that he is doing all he can to make the contract fair and safe, but the truth is that he is not. He may say that the overall pay envelope for junior doctors will stay the same, but he will not say who the losers will be. He may say that no junior doctor will work excessively long hours, but he will not tell us that he is removing the very safeguards that were designed to prevent that. He may even say that he has some support, but he will not read out the range of independent clinical voices who have condemned his approach.

Paul Maynard (Blackpool North and Cleveleys) (Con): The hon. Lady is right to focus on the future contract, but does she recognise the inadequacies in the existing contract?

Heidi Alexander: I am not saying that the existing contract is perfect—I do not think that the British Medical Association would say that either. A few months ago, an alternative contract was being discussed, the work on which was led by the former Health Minister,

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the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). The answer is not the contract that is on the table at the moment.

Steve McCabe (Birmingham, Selly Oak) (Lab): The Secretary of State may say that the overall pay envelope remains the same, but, as far as I am aware, it has been really hard to fathom how the difference between the local education training board contribution and the individual trusts will work. It may not be the same, but even if it is, is this not an example of further administrative and organisational costs being imposed on the health service by a Tory Secretary of State?

Heidi Alexander: My hon. Friend is completely right. The lack of clarity in all these negotiations is something that I will come on to later.

The truth is that if the Secretary of State wanted to persuade junior doctors that industrial action is not the answer, he has the power to do so; it is his political choice.

Junior doctors are the lifeblood of the NHS. Two weeks ago, I spent a morning shadowing a junior doctor at Lewisham hospital. It was the single most powerful thing I have done since taking on this role. I was blown away by the skills, knowledge, humanity and professionalism I saw. The junior doctor I shadowed was working a gruelling 11-hour night shift and regularly works 60-hour weeks. I left the hospital asking myself how it could possibly be right to say to that individual, “You might be paid less for the work that you do.”

Andrew Stephenson (Pendle) (Con): I think we would all join the hon. Lady in her glowing tributes to our tireless junior doctors, working long hours across the NHS. Considering that not a penny is planned to be cut from the junior doctors’ pay bill, does she not agree that it is irresponsible for the BMA to suggest there will be pay cuts of 30% to 40% for some doctors?

Heidi Alexander: As I have already said, there is absolutely no clarity. The hon. Gentleman might do well to read the article that appeared in The Guardian on 4 October, written by the former Health Minister, who quite clearly states that he has concerns about the fact that the new contract might be used as a lever to find some of the £22 billion of efficiency savings that the NHS needs to find over the next few years.

Dr Andrew Murrison (South West Wiltshire) (Con): Will the hon. Lady give way?

Heidi Alexander: I will not give way, as I am going to make some progress.

Junior doctors are not just the first-year trainees fresh out of medical school. They are also the senior house officers and registrars with 12 or 15 years of experience. Junior doctors account for almost half of all doctors in hospitals and the vast majority already work nights and weekends. The responsibilities they carry are huge. Take the junior paediatric doctor working in accident and emergency who emailed me last week. Some of the things she does, I could never ever do. In her email, she said:

“I am in charge of teams resuscitating dying children regularly. I have had to make the decision to stop resuscitating a dying child. I have had to tell parents that their child is going to die.

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I have been the only doctor trying to stick a tiny breathing tube into a baby born 16 weeks early and weighing 600g at 3 in the morning.”

How is it right that she should face the prospect of being paid less? She is not asking to be paid more. She is just asking to be paid the same and to keep the safeguards that prevent her from being stretched even further.

Lucy Frazer (South East Cambridgeshire) (Con): I do not think that any of us dispute the fantastic work that doctors do day in, day out, but we need to debate the motion that the hon. Lady has proposed. She said there were three points that she wants to put to the Secretary of State, but she failed to mention the one in the last line of the motion, which is that she wants proposals to be put forward that are “safe for patients”. Given that there was an article just last month on 5 September in the BMJ, put together by seven experts, including three professionals, that said that there was a clear association between weekend admission and worse outcomes for patients—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. I am sorry, but hon. Members should know that interventions should be short. You cannot make a speech in an intervention, and that should be a lesson for us all. Many Members want to speak and I want to get everybody in.

Heidi Alexander: The problem with how the Government have handled the negotiations is that they have provided absolutely no clarity to junior doctors about what the proposals would mean for them individually. Everyone thinks that they are going to lose out.

The Government say that they want to reduce the number of hours defined as “unsocial” and thereby decrease the number of hours that attract a higher rate of pay. They say that they will put the rate of pay for plain time up to compensate, but there is no guarantee that the amount by which basic pay goes up will offset the loss of pay associated with fewer hours being defined as unsocial. Does the Secretary of State understand that those who work the most unsociable hours, the junior doctors who sacrifice more of their weekends and nights, feel that they have the most to lose?

Andy Slaughter (Hammersmith) (Lab): That is exactly the point, and I am glad that my hon. Friend is exposing the misleading comments of the Government, who are defending the indefensible. It is exactly those doctors—in maternity, in paediatrics, in emergency medicine—who will lose out the most and will see their pay cut by up to a third.

Heidi Alexander: My hon. Friend is right. His concern is shared by the President of the Royal College of Emergency Medicine, along with 14 other leaders of medical royal colleges and faculties, who point out that as currently proposed, the new contract would

“act as a disincentive to recruitment in posts that involve substantial evening and weekend shifts, as well as diminishing the morale of those doctors already working in challenging conditions.”

It cannot possibly be right.

Simon Hoare (North Dorset) (Con): I am grateful to the hon. Lady for giving way and I join her in the praise that she issued in her opening remarks. What advice might she give the BMA, were she asked for it? Is it better for the BMA to get back around the table, so that the very

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important points that she is raising can be sorted out, or go straight to a ballot? Is it not better to talk first, then, if the BMA does not like it, by all means ballot? It is certainly doing it in the wrong way.

Heidi Alexander: The problem is that junior doctors are not convinced that the Secretary of State is negotiating in good faith.

When one talks to junior doctors about the proposed new contract, one thing is striking: pay is less important to them than patient safety.

Ian Lavery (Wansbeck) (Lab): I was humbled, privileged and honoured, along with my hon. Friend the Member for Easington (Grahame M. Morris), to march with the junior doctors in Newcastle on Saturday—5,000 junior doctors, hardly militants or revolutionaries, who were fighting not just for the pay but in the best interests of their patients. If there are no problems, if everything in the garden is rosy, why on earth are they demonstrating?

Heidi Alexander: My hon. Friend makes an important point. The junior doctors I have met are genuinely worried that the proposals make it more likely, not less, that they will be forced to work even more punishing hours. The removal of financial penalties for hospitals that force junior doctors to work beyond their rostered hours concerns them. They are right to be concerned.

Wes Streeting (Ilford North) (Lab): A junior doctor in my constituency made precisely that point. She was an A&E doctor. My hon. Friend knows that there is an A&E crisis in London. The Health Secretary needs to understand that while there is indecision and no conclusion to the negotiations, junior doctors are making decisions about where they are going—and they are not staying in England. That is the point.

Heidi Alexander: I am grateful to my hon. Friend. He makes a very valid point about the impact on recruitment and retention of doctors in the capital.

Dr Murrison rose

Heidi Alexander: Tired doctors make mistakes. It is obvious but it is true. Nobody wants to return to the bad old days of junior doctors too exhausted to provide safe patient care. It is bad for doctors, it is bad for patients and it is bad for the NHS. So why are this Government hellbent on forcing through these unsafe changes?

The Secretary of State claims that the changes are about making it easier for hospitals to ensure that the staff needed to provide safe care at the weekends and on nights are available. Is he saying that there are not enough junior doctors on hospital wards and in A&E departments at these times currently? If so, how many more junior doctors would be present at these times as a percentage increase on current staffing levels if the new contract goes through? If the changes are about increasing the cover at weekends and nights, surely it means less cover at other times of the week unless he finds more money for more doctors.

I understand the arguments for increasing consultant cover at weekends and nights. I understand it is vital that patients who are admitted on a Sunday get to see a

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consultant as quickly as those admitted on a Tuesday, and I am pleased that the BMA’s consultants committee is negotiating with the Government on improving levels of consultant cover. Indeed, everyone in the NHS supports the principle of seven-day services. But this debate is about junior doctors. Junior doctors are already working evenings and weekends. So why has the Health Secretary tried to make this a row about seven-day services?

Let me quote some of the claims that the Secretary of State has made in recent weeks. In response to a question on the junior doctor contract from my hon. Friend the Member for Wirral South (Alison McGovern), he said:

“someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week.”

In response to a question that I asked him about junior doctors, the Secretary of State said that the overtime rates that are paid at weekends

“give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths.”

He went on to say:

“there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 150-1.]

The authors of the research that the Secretary of State has been quoting said that it would be “rash and misleading” to claim that the deaths were all avoidable. Yet the Health Secretary has got dangerously close to doing just that. Indeed, he has gone so far down that route that some people do not think that our hospitals are properly staffed at the weekend. I know of elderly patients delaying their visit to hospital because they do not think that there will be enough doctors there. That leads to more complicated treatment, longer patient recovery time, people’s lives being put in danger and a bigger bill for the NHS to cap it all off. That is appalling. Don’t get me wrong: I am as committed as anyone to high-quality care, available 24/7, 365 days a year, but the Secretary of State needs to be careful with his words. He should look in the mirror and ask himself whether his soundbites are true to the conclusions of the study he references.

Rehman Chishti (Gillingham and Rainham) (Con): Rather than quoting the Secretary of State, I quote back to the hon. Lady the words of Professor Sir Bruce Keogh, the NHS medical director, who said that if the weekend effect is addressed, it “could save lives”.

Heidi Alexander: I am very grateful to the hon. Gentleman. Let me quote the editor of the British Medical Journal, who wrote to the Secretary of State on 20 October, saying that he had

“publicly misrepresented an academic article published in The BMJ”.

She asks him to clarify the statements that he has made in relation to the article to show that he fully understands the issues involves. She further says:

“Misusing data to mislead the public is not the way to achieve”

the very best health service for patients and the public. The Health Secretary needs to be clear on exactly how reforming the junior doctor contract will deliver a seven-day NHS. He should set out how he plans to pay for seven-day services, and precisely which services he is talking about.

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Helen Hayes (Dulwich and West Norwood) (Lab): Last week I met junior doctors in my constituency, many of whom told me that they cannot afford to live in London. One reported that she was sleeping on the sofas of friends and family members in order to cover her night shifts while working in London. The doctors also reported unfilled vacancies in departments in the hospital which serve and look after the sickest patients. Does my hon. Friend agree that the recruitment and retention of junior doctors is a bigger threat to patient safety than the issues to which the Secretary of State alludes?

Heidi Alexander: I do agree. I was talking about a seven-day NHS. A truly 24/7 NHS does not just mean consultants being more readily available; it means 24/7 access to diagnostic tests, social care, occupational therapists—the list goes on. If the Secretary of State has a magic pot of money to pay for all that, bearing it in mind that the NHS can barely pay for the work that it is currently doing, I am all ears. If his plan is to deliver seven-day services by spreading existing services more thinly, he should come clean and say so.

Emily Thornberry (Islington South and Finsbury) (Lab): My hon. Friend makes a very powerful speech. I bring her back to an earlier point which needs emphasising. At the moment trusts have to provide rosters that are not only fair but safe, so that junior doctors get time off. Now it seems that trusts will no longer have to pay attention to those rules and will no longer be fined if they do not follow them.

Heidi Alexander: There are very serious concerns about the proposed new contract, and my hon. Friend is right to highlight them.

The sad thing is that it did not have to be this way. Instead of using the dispute with junior doctors to suit his own political ends, the Health Secretary should have listened. He should have understood the depth and strength of concern before it got to the point where junior doctors feel as though they are the first line of defence in a fight for the future of the NHS. Instead of telling junior doctors that the BMA was misleading them, he should have respected their intelligence and responded to their concerns. At the very least, he should have heeded the words of the present Prime Minister, who said this about junior doctors when addressing a rally in 2007:

“There’s a simple truth at the heart of this: you came into the NHS not because you wanted to get rich or famous, but because you have a vocation about curing the ill, about serving your community.”

The Prime Minister went on to say in his conference speech a few days later:

“I will never forget walking on the streets of London marching with 10,000 junior doctors who felt like they were being treated like cogs in a machine rather than professionals with a vocation to go out and save lives”.

It is time the Health Secretary started treating junior doctors like the intelligent professionals they are. When I spoke at the junior doctors rally in London 10 days ago, I delivered a message for the Health Secretary. He was not working that Saturday so I repeat it for him now: stop the high-handed demands, show you are prepared to compromise and put patients before politics.

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4.46 pm

The Secretary of State for Health (Mr Jeremy Hunt): I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“welcomes the Government’s commitment to delivering seven-day hospital services and saving lives by combating the weekend effect; notes the British Medical Association’s (BMA) decision to walk away from negotiations to reform a contract which all sides acknowledge is not fit for purpose; further notes the Government’s proposed introduction of new contractual limits which protect staff from working unsafe hours and the commitment that average junior doctors’ pay will not fall; and calls on the BMA to put patient care first, to choose talks over strikes, and to return to negotiations.”.

I warmly welcome the hon. Member for Lewisham East (Heidi Alexander) to her post at her first Opposition day debate.

One Saturday in April 2006 a 20-year-old man called John Moore-Robinson was out mountain biking with his friends in Cannock Chase when he fell off his bike and the handlebars hit his stomach. His friends dialled 999 and he was rushed to hospital. Although the paramedic who took him to hospital thought he had life-threatening internal bleeding, instead of being treated he was left for 50 minutes, apart from a brief examination. Then he was told he had bruised ribs and sent home. In fact, he had a ruptured spleen and tragically died later that Saturday night.

Tragedies happen in any healthcare system, and despite such stories I am fiercely proud of our NHS and the brilliant care given by our doctors and nurses seven days a week. The hon. Lady was right to thank each and every one of them. Anyone who uses such stories to denigrate the NHS should remember that last year the Commonwealth fund rated us the best healthcare system of 11 major countries—better than France, Germany, Australia or the US—and rated our A and E departments —[Interruption.] It was the Opposition who called this debate, so they might want to listen to some of the arguments. This is a very important issue about the lives of NHS patients, and I am saying that the tragedies and the problems we have should not be used to denigrate the NHS or our A and E departments.

Part of being the best in the world is being honest about where we need to improve, and the fact remains that in our hospitals today we have around three times less medical cover at weekends. In our manifesto in May this Government committed to a truly seven-day NHS so that we prevent a repeat of the tragedy that happened to John Moore-Robinson.

Ms Gisela Stuart: The Secretary of State is absolutely right that we need to address the fact that there seems to be less cover at the weekends. He is trying to circle that square without expanding the number of doctors and the services. He is thinning the service on Monday to Friday to bring more cover to the weekends. That does not solve the problem.

Mr Hunt: I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.

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I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. The hon. Member for Islington South and Finsbury (Emily Thornberry) may shake her head, but I expect voices in the Chamber to be a little quieter. I want to hear the Secretary of State, and I think all our constituents do. I understand that you might not agree.

Mr Hunt: Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.

Helen Whately (Faversham and Mid Kent) (Con): Is the Secretary of State shocked, as I am, that the shadow Health Secretary seemed to say that the NHS should continue as it is, and that she appears to deny the weekend effect, which means that people are dying unnecessarily?

Mr Hunt: Yes, I am shocked. I am really shocked about the suggestion that there is a difference between what is right for patients and what is right for doctors. The shadow Secretary of State spent a lot of time talking about morale. The worst possible thing for doctors’ morale is their being unable to give their patients the care they want to give.

Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): Does the Secretary of State not see anything perverse in making the case for a seven-day NHS—he has repeatedly done so—while drawing up a junior doctor contract that financially penalises doctors who already work evenings and weekends? How can that make any sense?

Mr Hunt: The contract will not do that. The contract we are proposing will give more reward to people who work the most antisocial hours. I will explain the details of that later.

The shadow Secretary of State talked about academic studies, so let us look at what the academic studies on the weekend effect say. The Freemantle study, published in the British Medical Journal, which is owned, incidentally, by the British Medical Association, said in September that the mortality rate for those admitted to hospital on a Sunday is 15% higher than for those admitted on a Wednesday. It said the weekend effect equated to 11,000

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excess deaths. Let us be clear about what that means. It does not mean that every one of those 11,000 deaths is avoidable or preventable—it would be wrong to suggest that. It means that there are 11,000 more deaths than we would expect if mortality rates were the same as they are on a Tuesday, Wednesday or Thursday. Professor Sir Bruce Keogh, the NHS England medical director, called it

“an avoidable ‘weekend effect’ which if addressed could save lives.”

It is not just one study. In the past five years, we have had six independent reviews. Another study in the British Medical Journal,by Ruiz et al, states:

“Emergency patients in the English, US and Dutch hospitals showed significant higher adjusted odds of deaths…on Saturdays and Sundays compared with a Monday admission.”

The Academy of Medical Royal Colleges—the body that represents all the royal colleges—said in 2012 that deficiencies in weekend care were most likely linked to the absence of skilled and empowered senior staff and the lack of seven-day diagnostic services.

Norman Lamb (North Norfolk) (LD) rose

Mr Hunt: I am happy to give way to my former colleague.

Norman Lamb: During my travels across the country, I recently spoke with the chief executive and the chair of an acute trust. They said that they have no difficulty at all with junior doctors and ensuring that there is cover at weekends; their problem is with consultants—and the Secretary of State has just made that point. Has he not chosen the wrong target?

Mr Hunt: Chief executives of trusts and NHS employers have been very clear that this is about reform of contracts for both consultants and junior doctors, because the reduction in medical cover at weekends happens with both the consultant and the junior doctor workforces. Also, as I will go on to say, it puts huge pressure on junior doctors at the time when they do not have senior support and the ability to learn from it, and that is exactly what we want to sort out.

Junior doctors are not to blame for the weekend effect. The situation would actually be far worse without them, because they perform the lion’s share of medical evening, night and weekend work. In many ways, they are the backbone of our hospitals. However, the BMJ study this year showed that there is evidence that junior doctors felt clinically exposed at weekends, and nothing could be more demotivating for a doctor than not being able to give the standard of care they want for a patient.

Mary Creagh (Wakefield) (Lab): The right hon. Gentleman has prayed in aid the weekend effect and quoted Sir Bruce Keogh, his own NHS medical director. Is he aware that Professor Keogh has also said that

“it is not possible to ascertain the extent to which these excess deaths may be preventable; to assume they are avoidable would be rash and misleading”?

Mr Hunt: Yes, and I agree with that, but it would be equally rash and misleading to say there are no avoidable deaths. Professor Keogh was saying that lives could be saved if we tackled this. All these studies are saying that 15% more people die than we would expect if we had

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the same level of cover at weekends as we have during the week. Therefore, as he says, the moral case for action is unanswerable.

Jeremy Lefroy (Stafford) (Con): The hospital to which my right hon. Friend referred earlier is in my constituency. The accident and emergency department has improved hugely over the past few years—well over 95% of patients are seen within four hours—and one reason for that is that it has consultant cover all the time. It is not open 24/7—we want it to be—but for the 14 hours a day that it is open, it has consultant cover all the time.

Mr Hunt: My hon. Friend is absolutely right. The fact is that this is a package designed to ensure that we eliminate the weekend effect, and it involves both junior doctors and consultants, because they both have their part to play.

Emily Thornberry: Will the Secretary of State give way?

Mr Hunt: I am going to make some progress before taking any further interventions.

The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.

Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.

For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.

Mark Spencer (Sherwood) (Con): Given the Secretary of State’s assurance, is there any reason why the BMA should not come back to the table and negotiate with him to solve this problem so that patients are safer at weekends?

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Mr Hunt: There is no reason whatsoever. What was strikingly absent from the shadow Health Secretary’s comments was an entreaty to the BMA asking it to come and negotiate. Labour Members can play a constructive role in this, but so far they have declined to do so.

Emily Thornberry: Is the right hon. Gentleman going to continue with his plan to change the rules so that trusts that insist on doctors working unsafe hours can no longer be fined for doing so? It will help if he can assure us that those rules will continue and trusts will be fined if they break them.

Mr Hunt: They are not fines; they are perverse incentives to doctors to work unsafe hours. We want to go one better than that. We propose to stop hospitals requiring doctors to work five nights in a row or six long days in a row, and to bring down the maximum number of hours that hospitals can ask a doctor to work in any one week. On top of that, we have imposed the toughest hospital regime of any country anywhere in the world that comes down very hard on hospitals that are not providing safe care.

Lady Hermon (North Down) (Ind) rose—

Norman Lamb rose—

Mr Hunt: I am going to make some progress before I give way again.

Norman Lamb rose

Mr Hunt: As the right hon. Gentleman is my former colleague, I will give way once more.

Norman Lamb: I want to ensure that I fully understand the commitment that the Secretary of State gave about not a single doctor losing out. I think he said that that is “provided they are working within maximum legal hours”. Does that mean people working up to 48 hours, which is the maximum working week under the working time directive? What about doctors who have opted out of that and are working 60 or 70 hours? Could they lose out?

Mr Hunt: It applies to all doctors working within the legal limit. If they opted out of the working time directive, it would apply up to 56 hours. For people who are working more than the legal limits, even after opting out, the right answer is to stop them working those extra hours because it is not safe for patients. But yes, that is the commitment to people even if they have opted out.

Lady Hermon: Will the Secretary of State give way?

Mr Hunt: I am going to make some progress, if I may.

As well as reducing the maximum hours a doctor can be asked to work from 91 to 72 in any week—a significant reduction—and banning hospitals from requiring doctors to work five nights in a row or six long days in a row, as hospitals can currently make them do, we propose to ban the routine use of fixed leave arrangements that mean that some doctors have to give up to three months’ notice before taking leave, meaning that they miss out on vital family or personal occasions.

We did not, and do not, seek to impose a new contract; rather, we invited the BMA to negotiate a new contract so that we could end up with a solution that

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was right for doctors and right for patients. However, because we had recently won an election in which a seven-day NHS was a manifesto commitment, we said that having tried to negotiate this unsuccessfully for two and a half years, we would ask trusts to introduce new contracts if we were unable to succeed in negotiations.

Lady Hermon: I have a specific point about Northern Ireland. Of course, health is devolved to the Northern Ireland Assembly, but I can assure the Health Secretary that junior doctors in Northern Ireland are absolutely furious about the proposed changes to their contracts. It would help if he could confirm that he is in regular direct dialogue with the Health Minister in the Stormont Assembly, Simon Hamilton MLA. I ask him not to reply that officials talk to each other regularly, because “Minister to Minister” is what I would like to hear.

Mr Hunt: We do have regular dialogue. I suggest that the reason doctors in Northern Ireland might be angry is that they have been listening to misinformation about what the Government in England are proposing, which has, very disappointingly, made doctors all over the UK very angry. I hope that the assurances I am giving, which I gave to the BMA last month and the month before, face to face and in letters, will encourage the hon. Lady to report to the doctors she mentions that the right thing for the BMA to do is to come and talk to the Government. Regrettably, the BMA’s junior doctors committee has refused to negotiate since last June. Instead, it put up a pay calculator on its website that scared many doctors by falsely suggesting that their pay could be cut by between 30% and 50%. It has now taken that pay calculator down, but the damage to morale as a result of it continues.

Rachael Maskell (York Central) (Lab/Co-op): Will the Secretary of State give way?

Mr Hunt: I will make some progress. Some people say that this is a battle between the interests of patients and those of doctors, but that is profoundly wrong. Doctors who are happy and supported in their jobs provide better care to patients, and the link between a motivated workforce and high-quality care is proven in many studies, as well as in hospitals such as that in Northumbria, where staff have become the greatest advocates for seven-day services since their introduction. Our proposed new system is intended to provide better support to doctors who work weekends, and make seven-day diagnostics more widely available across the NHS.

Simon Hoare: Given the clarity with which my right hon. Friend has addressed the principal concerns of junior doctors, does he expect the BMA’s junior doctors Committee to change its stance, come to the Department and restart negotiations, or will it continue to stall?

Mr Hunt: If the BMA is serious about wanting to do the right thing for doctors and patients, there is no reason for it not to negotiate with the Government to get the right solution. This is a test of how serious it is—my hon. Friend’s point is well made.

Rachael Maskell: This debate is reminiscent of 12 months ago and the “Agenda for Change”, when the Government refusal to negotiate with 1 million NHS staff caused

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industrial action and a strike. The same thing seems to be happening again. Will the Secretary of State take the shackles off the negotiations and enable the professionals to put their case on the table? Will he listen to them and let them lead negotiations?

Mr Hunt: That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.

Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.

Rehman Chishti: The Secretary of State said that we are open to problems being highlighted. May I thank him for what he did by putting hospitals into special measures? Medway Maritime hospital had the seventh highest mortality rate in 2005, yet nothing was done. Support is now being given to that hospital to turn it around. We are highlighting problems, but we are also introducing measures to fix those problems.

Mr Hunt: I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.

I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional

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case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.

Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.

Mr Deputy Speaker (Mr Lindsay Hoyle): There will be a four-minute limit on Back Bench speeches.

5.11 pm

Dr Philippa Whitford (Central Ayrshire) (SNP): The hon. Member for Lewisham East (Heidi Alexander) described what a junior doctor is, and that is really important. Many people think that being a junior doctor is just for the first couple of years, and isn’t it character-forming to work a bit hard and not have a lot of money? However, in the NHS, which is quite a hierarchical beast, a junior doctor is a junior doctor all the way until they are not a junior doctor and they become a senior doctor: either a consultant, as I was for the past 19 years, or a GP. That means we are talking about people who might be in their 30s, with children, families and mortgages. They are not youngsters who are able to move around flexibly and have very few financial commitments. It is important that we remember that.

It is obviously quite some time since I started as a junior doctor. More than 30 years ago, in 1982, we had absolutely no limits on hours. My light week was 57 hours; my heavy week was 132 hours. You just had no idea what your name was by the end of a weekend. It took more than 10 years of my career before the first new deal started to come in, in the early 1990s, and trusts or hospitals had to pay an additional premium to junior staff if they worked excessive hours. The definition of excessive hours at that time was still pretty lax, but it was the first step. It was tightened up in 2003, when the European working time directive came in. The Secretary of State talks about taking away those safeguards, but that he will replace them with something else. But with what? They have served us well. When trusts are in financial difficulties, the pressure on them to save money is likely to outweigh completely any little safeguard. The 48-hour working time directive does not come with punitive safeguards, and the financial one was important.

It is important to remember that the basic pay is already for 7 o’clock in the morning to 7 o’clock at night, Monday to Friday. That is a pretty long day for most people. It is proposed that the time covered by basic pay should be extended to 7 o’clock in the morning to 10 o’clock at night and include Saturday. What many

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people do not know is that a junior doctor starts at under £23,000 a year—below the benefit cap we have been arguing about. The salary is made up largely of out-of-hours.

Mr Jim Cunningham (Coventry South) (Lab): Does the hon. Lady not agree that in any other walk of life that would be intolerable, yet we put up with this situation in the national health service? Secondly, does she agree we still have not seen the £8 billion the Government promised, during the general election, to put into the NHS?

Dr Whitford: I totally agree with that.

As mentioned on both sides of the House, people do not work in an NHS hospital to make a lot of money. It is not high up the list of ways for the smartest people in our country to make money; it is a vocation, which means we have a responsibility not to exploit them. The Secretary of State says that no one will lose money, but what will happen to the people who start next August? After the first hours change, when I started my surgical career in Belfast, the “two in three” rota—every third evening off and no weekends off for a year—was no longer legal, and the hospital henceforth considered extra hours to be voluntary service. The NHS is a hierarchical organisation, bullying exists within it, and the junior doctor is in a weak position. These safeguards have worked well for a long time, and I would be reluctant to see them go.

Catherine West (Hornsey and Wood Green) (Lab): Does the hon. Lady agree that across the piece—nurses, doctors, everybody—there is a huge loss of morale in the NHS? It is down to us to stand up for the workforce and put them at the heart of our thoughts, rather than concerns about how it might look politically.

Dr Whitford: I totally agree. I also agree with the Secretary of State about patient safety. There is no one in the profession who does not want a seven-day emergency service that is strong and responsive to the needs of unwell patients, but we keep moving from people who are ill to routine services. He has said we must not call them avoidable, yet he just referred to 200 avoidable deaths a week, which is exactly what Bruce Keogh described as “rash and misleading”, and people object to that. There are no excess deaths at the weekend; the issue is with people admitted at the weekend, usually for radiology or investigation. Scotland has been moving on this for the last decade, by working with the profession, not pulling out the pin and throwing a grenade.

Mr Jeremy Hunt: For the sake of clarity, the 200 avoidable deaths are not about the weekend effect specifically, but come from the Hogan and Black analysis, which found that 3.6% of hospital deaths in England had at least a 50% greater chance of having been avoidable, which is separate from the weekend effect—the higher mortality rate among people admitted at weekends. None the less, where there are avoidable deaths—where death rates look higher than they should be—we have an obligation to do something.

Dr Whitford: I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed

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by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.

Andy Slaughter: I am grateful to the hon. Lady for busting this myth about weekend death rates—these might be sick people admitted at weekends who die within the 30 days. In fact, fewer people die in hospitals on Saturdays and Sundays than on other days. The Secretary of State is not giving the right impression of the figures.

Dr Whitford: I agree.

Since coming here, I have heard stories of people unable to access diagnostic imaging or to work up patients, but there is no argument about that from the profession. That is what we need to focus on, yet a lot of this seems to be about routine. There are fewer doctors at weekends because we do not do routine work. We have teams of people doing toenail and blood pressure clinics in the week. Professor Jane Dacre estimates that doing those at weekends would require 40% more doctors. We cannot do that. We need to make sure that hospitals at weekends have enough people and the right people to be secure, but junior doctors are already there—it is not they who are missing—and emergency services already have a consultant on call. We might need more discussion about their being physically in, but that is a discussion to have with the profession, whereas what we heard on 16 July, which gave the public the impression that senior doctors only worked 9 to 5, Monday to Friday, was very hurtful to the entire profession.

Grahame M. Morris (Easington) (Lab): The hon. Lady is making some extremely powerful and relevant arguments. I wish to make a point about the importance of junior doctors in my region, having spoken to some of them at the demonstration on Saturday. They are essential to the functioning of the service. They have the option of going not only to the Antipodes but to Scotland, where these contracts do not apply. If we lose these valued staff, it could hurt my region more.

Dr Whitford: We will roll out a red carpet somewhere on the M74 and welcome them with open arms. The progression and migration in Scotland towards robust seven-day emergency care has been happening through a dialogue, not through a threat to impose a contract.

There are other things in this, such as the plan to change pay progression, which is currently on an annual basis, to recognise experience. That will be replaced with just six pay grades. Such a move will affect women in particular, because they tend to take a career break and they tend to work part-time, so they will get stuck at a frozen level for much longer. It may also be a disincentive to people to go into research, because they will be stuck on the same rung of the ladder for longer. We do not want that disincentive. We need to make sure that we are valuing how people develop and the experience they accrue along the way.

Mark Spencer: The hon. Lady is making a powerful case for dialogue. Will she join the Secretary of State in calling for the BMA to come back to the negotiating table or join the shadow Secretary of State in refusing to call for it to do so? Which will she do?

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Dr Whitford: There is no doubt that we require dialogue, but it must involve sitting down at a table without preconditions. What we had in July and through the summer was a threat of imposing a contract, instead of proper negotiation. That is where we should be trying to get to: both sides negotiating in good faith across a blank sheet of paper. The threat of imposition is what has hurt the junior doctors.

There has also been talk of taking away the guaranteed income protection of GP trainees, there to try to keep them at the same level as they were, and replacing it with a discretionary payment. Such a payment can be taken away at any time—it can be cut and it can be changed. The Secretary of State aspires to have 5,000 extra GPs by 2020. We know from the BMA that one third of GPs—10,000 out of just over 30,000—are planning to leave, which means we need to find 15,000 extra GPs. Anything that is a disincentive for people to go into that profession is not serving the NHS.

Dawn Butler (Brent Central) (Lab): Does the hon. Lady think the Secretary of State is an incentive or a disincentive to junior doctors?

Dr Whitford: Sorry, I did not hear that. [Interruption.]

Dawn Butler: Conservative Members do not want me to repeat the question. Does the hon. Lady think the Secretary of State is an incentive or a disincentive to doctors?

Dr Whitford: I think that how this has been handled is a total disincentive, but that could change. We could simply take the decision to move to negotiations without preconditions—without the threat of imposition. We are talking about a threat to impose changes to the terms and conditions of people who, in the past, routinely worked more than 100 hours a week, as I did. That is a ghost that haunts the NHS and it really frightens junior doctors.

Rehman Chishti rose

Dr Whitford: I will give way one last time, but I need to make progress; otherwise nobody else will get to speak.

Rehman Chishti: I have a huge amount of respect for the hon. Lady. She talks about her experience of working long hours. Does she think that what the Secretary of State has just said about introducing new limits on junior doctors’ working hours is the right way forward?

Dr Whitford: What the Secretary of State has not explained is how, within the same pay envelope, there will be more people at weekends, but not working extra hours—and not having fewer during the week. At the moment, we have a circle that cannot be squared. We need to see the detail of how that can be done. If the vision is to have more routine work at the weekend, that would result in a massive uplift in the number of doctors, which we simply cannot afford. We are already haemorrhaging doctors. Acute physicians describe 48% of junior places as unfilled, with the figure for obstetrics being 25%. They can go anywhere. We heard that over 1,500 of them registered for certification for overseas work just last week. We need to be careful that we are

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attracting them to stay. They are the brightest and best in our society; they have chosen a vocation. We need to bring them to the table, but by offering to start with a blank sheet of paper—not threatening them. As has been said, they are not radicals, but people who want to do the best for their patients.

I suggest that the Secretary of State and those working with him look at how they have spoken to both senior and junior doctors over this summer. Frankly, being new to this House, I found that to be quite shocking and quite disgraceful. We should draw a line under that and try to change the tone. We need to go forward and find a solution that is fair to junior doctors, fair to patients and safe—one that is not exploiting people and not threatening people.

5.25 pm

Dr Sarah Wollaston (Totnes) (Con): I start by declaring a relevant personal interest in that my daughter is a junior doctor, and one of many hundreds who have moved to Australia to work. Because of that very clear conflict of personal interests, I shall abstain in this evening’s vote. I want to speak, however, because I have relevant personal experience, as before I came to this place I taught junior doctors and medical students for 11 years.

I can tell the House that this dispute is about far more than pay. It is about junior doctors feeling valued. The junior doctors I used to teach, including F2 foundation year doctors, felt that they were not being supported at the weekends, disliked the inability sometimes to work in the same county as their partner and disliked obstructive attitudes about rostering. That presents us with an opportunity to bring all those issues into the negotiations in this current dispute.

One thing I do know is that young people do not go into medicine because they are motivated by pay. I hope that the House sends a very clear message to junior doctors that we value what they do and are grateful for what they do on behalf of patients. What we must do is avoid a strike at all costs. A strike would be immensely damaging for patients. I would say to junior doctors that there is no meaningful industrial action that they can take that would not harm their patients. I urge them to step back from such a move. A strike would be damaging not only for patients, but for the professional reputation of doctors, and of course politically. That should not be the consideration. Our main consideration should be how we encourage junior doctors to walk back through the door of the Secretary of State’s office, as he has stated. The best way to do that would be to start again.

Many elements of the dispute feel similar to the one we had in 2007, when I was teaching junior doctors, over the medical training application service—or MTAS, as it was known. It was a very unloved, unlovely scheme that collapsed, after a much-needed apology, in 2007. The Government of the day went back to the drawing board and started again. I think it would be right to do so on this occasion. We need to remove the barricades that are preventing junior doctors from walking back through the door. It would be right to take away the preconditions, the red lines and the threat to impose—and start again, looking at all the issues in the round.

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Junior doctors share many of the Government’s objectives. They want to improve care for patients; they recognise that shortage specialties in the NHS are a real issue and that if we are going to put patients first, we need to incentivise entry to specialties such as accident and emergency, general practice, psychiatry and so forth. We need mechanisms to make that happen. They recognise, too, the need to address variation across the NHS, including with respect to weekends, but we need to look at that in the round. It is not just about senior and junior doctors either; it is about nursing, access to diagnostics, being an outlier on a ward that someone should not be in because the hospital is over-full.

Kevin Foster (Torbay) (Con): I am sure that my hon. Friend would agree that one thing about which junior doctors want certainty is no longer having whole weeks of nights or having to work beyond 72 hours. The Government need to be clear about how they will achieve that.

Dr Wollaston: I thank my hon. Friend for his intervention. There is much to be welcomed in the new contract, but we need honesty about some of this. I am very pleased that the Secretary of State has given an assurance today that no junior doctor will be worse off, but I hope that when he sums up the debate, he will tell us what will happen to a junior doctor working 70 hours a week, perhaps in a specialty such as accident and emergency or anaesthetics. If the pay envelope is the same and some junior doctors will be better off, the maths indicates that some will be worse off and we need to clarify which ones. We need much more clarity, not just about whether an individual will be no worse off as a result of changing from one job to the next over the transition period, but about what will happen to the pay for that post over the coming years.

While I welcome many of the elements of the junior contract, I feel that, because the debate has become rather toxic, we should take the opportunity to begin again to examine all the issues in the round, and ask junior doctors themselves to work with the Secretary of State in establishing how we can achieve our common aims on behalf of patients. We should also take the opportunity once more to welcome junior doctors and value everything that they do.

5.30 pm

Mr Andrew Smith (Oxford East) (Lab): It is a pleasure to follow two such thoughtful speeches, and, in particular, the powerful speech made by my hon. Friend the Member for Lewisham East (Heidi Alexander). I congratulate her on her appointment, and on the vigour with which she put the argument.

Three weeks ago, I went to a “keep in touch” meeting with doctors at the John Radcliffe hospital in Oxford. Two hundred and fifty doctors turned up, and their anger at the Government’s threatened imposition of this contract had to be seen to be believed. They were so alienated that I had a hard job trying to persuade them that it was just the Secretary of State’s incompetence which was to blame, and not a malevolent wish on his part to dismantle the NHS.

At a time when doctors, like other staff in the NHS, are working under such pressure, and when the Secretary of State knows that he needs to carry staff with him if further reform and efficiencies are to be delivered—including

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the better seven-day hospital services that we all want to see—it is beyond belief that he has simply stumbled into picking a fight with the core clinical work force in our hospitals, threatening to impose a contract that will leave some of them earning significantly less and many vulnerable to working significantly longer hours, thus risking a return to the dangers of the past.

No one, including doctors themselves, wants to see this degenerate into industrial action, but, as with other groups of workers whom we do not expect to strike, a particular responsibility is imposed on employers and the Government to listen, to be fair, and to negotiate in good faith. That is why it is so damaging that the Secretary of State gives such a strong impression of doing the opposite: threatening when he should be listening, and using weasel words when he should be showing how assurances can be delivered. As the public well understand, the success of the NHS is hugely dependent on the dedication, good will and trust of its staff. By mishandling the contract in this way, the Secretary of State is putting all those at risk, and, once lost, they could be hard to win back.

No one should be under any illusion about the damage that the contract—were it to be imposed in the way that the Government want—could do to patient care, and would certainly do to recruitment and retention in the English NHS, especially in high-cost areas such as Oxford. I already know of local GPs who have moved away, including one who found that he had a better quality of life as a locum than as member of a practice, and then found that it would be better still in Canada than in our NHS. At my meeting with doctors at the John Radcliffe, a show of hands was taken to find out how many of those who qualified would move to other parts of the UK or abroad if the contract were imposed. A sea of hands went up.

If the Government want to make good the damage that they have been inflicting and settle the issue of this contract, it should not be hard. In his letter to the chair of the BMA junior doctors committee, the Secretary of State said:

“I share exactly the same aims for the new contract as you do.”

If that is the case, the way forward is clear. First, the Secretary of State should reopen negotiations, without preconditions, lifting the imposition of the contract. Secondly, he should keep the financial penalties that protect staff from working excessive hours. Thirdly, he should show flexibility on the reimbursement for Saturday working. Fourthly, he should give a clear guarantee that no junior doctor’s pay will be cut as a result of the contract. That is what our motion calls for: it would deliver a new contract with safety for patients and fairness for doctors. It is what the Government would do if they had any sense, it is what the public wants, and I urge the House to vote for it.

5.34 pm

Charlotte Leslie (Bristol North West) (Con): I welcome this debate brought by the hon. Member for Lewisham East (Heidi Alexander) as a chance to offer some light, as opposed to the heat that has sadly dominated so much of this debate.

The House has often heard me quote the thinker and poet T. S. Eliot when he warns of the folly of trying to devise

systems so perfect that no one will need to be good.

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This speaks extraordinarily to the NHS. The NHS is not a system; it is the people who work in it. That is why it is so important that we nurture and value our NHS staff in the ways so brilliantly expounded by my hon. Friend the Member for Totnes (Dr Wollaston)—those staff who work day in, day out, and, as the daughter of a surgeon I can vouch, at weekends and on Christmas days, too.

I was extremely concerned to hear the British Medical Association’s claims that this modernisation of the junior doctor contract would lead to dangerously long working hours and less pay for our junior doctors—cuts of 30%, it said. I began to look into this more closely. I noticed that the pay calculator had been taken down, but when I looked at the detail I became very surprised. In the proposals I could not see the kind of longer hours and the less pay scenario I had heard from the BMA with such certainty and to which many junior doctors, completely understandably, have been reacting with such worry and concern. I could not see anything approaching the authoritarian and draconian measures the BMA had led me to believe my own Government were imposing.

At most, I think there are areas where we need very careful negotiation and clarity with a doctor membership body so that we can work with doctors—that is incredibly important. I would have thought the BMA junior doctors committee would be very concerned for that to happen.

I cannot find evidence that the Government are imposing longer hours on doctors. What I did note was the new absolute limit on overtime worked, which is preventing dangerously long hours and those awful weeks of nights, and the current situation where doctors routinely work over the 48-hour working time directive often slightly off the record to get in the training that they need. I would have thought measures to tackle that would have been welcomed.

I know that huge numbers of people work during Saturday daytimes, but there needs to be further discussion on the agreement of what constitutes antisocial hours for doctors on a Saturday. Again, I would have thought the junior doctors committee would have valuably contributed towards that, and in fact the Government say the same.

To read the BMA submission we would think that less pay was a key aim of the whole exercise, but the plans make clear that there will not be an overall pay cut and that average earnings will remain the same. Yes, the distribution will be different to overcome the obvious unfairnesses in the system where a doctor working normal hours will get paid more than a doctor working antisocial hours, but I am not sure that is something to complain about. Yes, there will be a reward for progress as opposed to the time the doctor has been in training, but that is in line with many professions and I am just not sure that someone who takes longer in training to reach the same standard as a high-flyer should get paid more.

Helen Whately: I support my hon. Friend on that point. It is uncomfortable but true that in almost any profession outside the NHS if someone takes time out for parental leave the clock stops on their career progression. They gain other skills; they do not just press on with their career, but they can go back to it afterwards.

Charlotte Leslie: My hon. Friend is absolutely right. In addition, I am just not sure it should be possible for supervisors with more responsibility to be paid less than those they are supervising. I am slightly confused

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about the BMA stance on this. When I spoke to it about the European working time directive, it assured me that it was not just time spent in training that mattered, but the quality of that training. Now in its submission it seems to have completely reversed that position and says that it is just time spent on the job that matters. That confuses me.

As the Government accept, there is a need for discussion on how doctors moving between different specialities can have their pay protected, but that is again something on which we must absolutely enter into discussion with junior doctors. I plead with the BMA to come to the table. The consultants committee in the BMA has done that and I applaud it for doing so. A part of the drive to get more consultants in at weekends is to improve the quality of junior doctor training which has suffered under the European working time directive.

I also note that one paragraph in the BMA’s submission states:

“Much of the subsequent detail that has been discussed in the news was never fully outlined as part of the previous negotiation process.”

That demonstrates that the Government are still completely open to talking about many things, yet the BMA almost seems to lament that fact. In the light of this, I simply do not understand why the BMA will not return to the table. I celebrated the BMA’s “No More Games” campaign. We do need to de-politicise the NHS, but I am really concerned that the junior doctors committee is bringing that laudable aim by the BMA, and the work on that which the BMA does, into disrepute.

5.40 pm

Lyn Brown (West Ham) (Lab): Countless junior doctors have been in touch with me to say that they are worried and in despair about the Government’s threat to impose an unfair contract on them. They tell me that the dangerously long hours that the contract will introduce will be a threat to patient safety. Doctors tell me that rostered hours are not a realistic gauge of total working hours, and that reducing them will not prevent dangerous increases in working time.

Sofia, an anaesthetist in my constituency, says:

“A ‘normal’ rostered day starts at 7.45am and finishes at 5.45pm. In reality there is no such thing as a ‘normal’ day, because the clock strikes 5.45pm and it is impossible to walk out the door with an operation ongoing.”

Doctors like Sofia are content to work longer hours out of a sense of duty, but they are deeply concerned by plans to remove the financial penalties placed on hospitals to prevent dangerously long hours. She describes the Health Secretary’s assurances as follows:

“It’s a bit like trying to stop speeding on a busy road by lowering the speed limit, but at the same time getting rid of all the speed cameras, police and speeding fines.”

What does all this mean for patient safety? I was contacted by another doctor, Keir, a paediatrician in a neonatal intensive care unit in West Ham. He cannot see how his team could be spread more thinly during the week in order to provide more doctors on Saturdays. He is rightly concerned that doctors would be at risk of exhaustion. He says:

“High intensity specialties are particularly affected from a safety point of view. You don’t want any delay putting a three-month

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premature baby on life support. Putting in a breathing tube, getting a tiny line into tiny veins—all require skill and concentration. Any tiredness affects the swiftness and accuracy of these procedures.”

Doctors like Keir are aghast at what the Government are telling them.

Doctors are also deeply disheartened by the Government’s handling of the new contracts. One doctor, Simi, has told me:

“The mood is grim in hospital at the moment. We feel under-appreciated and undervalued. We are not being misled by the BMA. We can read the facts and analyse them for ourselves.”

Whatever the Health Secretary has said today, it is evident that some doctors will lose out financially. This uncertainty over pay is causing anxiety. Sofia says:

“Come August 2016, I have no idea how much I will be paid, whether I will be able to afford to pay my bills or even spend time with my children.”

I agree with Oliver, another West Ham doctor, who says:

“Not one doctor should be taking home less pay than they do now.”

This will have serious consequences for staff retention. Doctors are making plans to leave the NHS. Nick, a medical student in West Ham, says:

“I studied medicine to become not just a doctor but an NHS doctor. Under the proposed contract, I’ll be left in the sad situation of being forced elsewhere.”

That will be this Health Secretary’s legacy. Kirsty, a histopathologist, says:

“The health secretary has been nothing but belittling and demeaning. He has suggested we have lost our sense of vocation. Imposing a contract on us and treating us like children rather than professionals is so wearing.”

We trust these doctors with our lives and with our loved ones. Our NHS staff are truly phenomenal. They deserve nothing but the utmost respect, and they certainly do not deserve to have an unfair, unjust contract imposed upon them. The people in this country love the NHS. For their sake, the Government must put forward fair proposals, withdraw the threat of contract imposition and return to negotiations with the BMA.

5.44 pm

Mike Freer (Finchley and Golders Green) (Con): Finchley and Golders Green is served by Barnet general hospital and the Royal Free hospital, which is just across the border in the constituency of the hon. Member for Hampstead and Kilburn (Tulip Siddiq). In particular, the Royal Free is the largest hospital serving my constituency, and it is one of the largest and safest acute hospitals in London. It has the high security infectious diseases unit, which has recently been in the news for treating Ebola, and it is a major centre for research into immunology and transplants. Not surprisingly, it is a major teaching hospital.

Many junior doctors who live in my constituency have contacted me and despite my best efforts, using the information provided by NHS employers and the Department of Health’s online pay model, they continue to be confused and believe that their pay will be cut. I have no doubt that the selective information from the BMA has not helped. I welcome the reforms in principle and the commitment to introduce a new absolute limit on the number of extra hours that junior doctors can work. Bringing an end to the week of nights and capping the extra hours are welcome, but most junior doctors in my constituency are simply not aware that that is what we propose.

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In fact, most of the junior doctors that I have seen believe that the reforms will increase their working week, leading to more fatigue and therefore jeopardising, not improving, patient safety. They believe that this will hamper the Secretary of State’s quite-right drive to improve weekend mortality rates. I say to my colleagues in the Department of Health that something is going wrong in the communication of this welcome reform.

Let me turn now to a couple of issues that have been raised by junior doctors and that echo some of the concerns mentioned by the hon. Member for Central Ayrshire (Dr Whitford). On retention, the Royal Free is a major centre for research and yet Dr Renee Hoenkampf, who wrote to me, is concerned that those doctors who seek to go into research and to step away from the frontline will be penalised by being held back on their progression pay. Those doctors who choose to have a career break to raise a family will also be penalised. Both those concerns will impact on women more than on men.

Dr Murrison: On that point, the BMA is making a case for current increments on the basis of experience gained. A career break will probably mean that there will not be any experience accrued. Does he therefore agree that the BMA needs to get its logic right?

Mike Freer: My hon. Friend is right that just getting pay progression for time served is not the right thing to do, and most organisations have scrapped it. However, we must avoid accidental penalties acting as a disincentive for women joining the workforce. We should not encourage this idea that women, or any person, should be penalised for taking career breaks or for stepping away from the frontline by taking part in valuable research. I gently ask the Minister to look again at that matter.

When I met Dr Joseph Machta, a junior doctor in paediatrics, he said that, after consulting the Department of Health’s pay model, his pay would reduce by 15%. Like many junior doctors living in my patch—it is not a cheap part of London—he was concerned that he would no longer be able to pay his mortgage. Will the Minister look into that matter? I suspect that London’s junior doctors rely more than most on premium payments. While average pay across the UK may be neutral under the compensatory increase in basic pay, that may not be true in London. I would be interested to hear whether the Department of Health has done an impact assessment on London’s junior doctors and the amount of premium pay that takes up the wage bill in London hospitals. If many junior doctors in London are over reliant on premium payments to pay their bills—that may be a wrong thing to do because they are working too many hours, but that is a different issue—it is a matter that needs to be considered.

It is not unusual to want to have contract terms changed to meet current needs. On that basis, I support the reforms, but I ask the Minister to look into those two issues that I specifically raised.

5.49 pm

Joan Ryan (Enfield North) (Lab): I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this important debate and on her powerful opening speech. As she will know, health services in my constituency have already suffered greatly

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at the hands of the Conservatives. Two years ago they downgraded Chase Farm hospital, axing both our accident and emergency and maternity services and breaking every promise they made to local people.

Now they are seeking to implement changes to contracts that I believe are unfair on doctors and pose significant risks to patients, both in Enfield and across the country. That view has been reinforced by the number of doctors from Enfield North who have contacted me to express their serious concerns. Dr Irene Gafson is one of my constituents and has been a junior doctor for eight years. She took part in the march in London earlier this month and carried a sign bearing Nye Bevan’s famous words that the NHS

“will last as long as there are folk left with the faith to fight for it.”

Many Members may have seen the thought-provoking and insightful article she wrote for The Daily Telegraph after the event. Two things in particular struck me when I read her piece. The first was the deep sense of privilege she and her colleagues feel about being doctors. It is not just a job, but a vocation. These are hard-working, dedicated professionals who care passionately about what they do.

Paula Sherriff (Dewsbury) (Lab): I spent some time in a busy city hospital last week with doctors who told me that many junior doctors now feel so demoralised that there has been a flood of applications to receive the certification to go and work overseas, so much so that the department that deals with that process has had to take on extra staff just to deal with the number of applications. Does my right hon. Friend agree that that is very worrying indeed?

Joan Ryan: Absolutely.

The second point Dr Gafson highlighted was the level of disillusionment in the medical profession with the Government’s plans. She said:

“Whilst the sense of solidarity and unity amongst junior doctors”

on the march

“was tangible to all, there was a much sadder force underpinning our mood...People who have invested years of passion into their work are feeling demoralised. This unique day that brought so many doctors together in one place really served to illustrate how dangerously low levels of morale amongst junior doctors have sunk.”

Dr Gafson voiced her strongest criticism for the way in which these contracts had not been negotiated with doctors and how the proposals threatened the safeguards on working hours. Significantly, she voted for the Conservatives at the last election:

“I trusted them with the NHS and I feel let down. I actually feel embarrassed”.

Dr Gafson is not the only one. Another local doctor who does not wish to be named contacted me to express her grave concerns at how the changes could impact on the NHS as a whole. She said that in a meeting last week a significant number of her colleagues were discussing alternative career plans and many were considering a move abroad to practise in another country. She said:

“If these reforms go through then the frontline specialties such as Accident and Emergency, General Practice and acute medicine will be hardest hit, and these areas are already undersubscribed”.

She went on to say:

“I am gravely concerned that if these changes go through they will signify the start of the dismantlement of the NHS.”

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The Secretary of State should heed those words. They are an indictment of how the entire situation has been handled. If what is being offered is a “good and fair deal”, as he has described it previously, how does he account for the upset and concern the offer has caused? Is he willing to publish in full the financial models being used to calculate the proposed changes to contracts so that doctors can know exactly what they can expect to be paid? If he is not willing to do that, junior doctors working evenings and weekends have every right to be concerned that they face a possible pay cut.

Finally, is he willing to accept that removing the safeguards that penalise hospitals that force junior doctors to work in excess of their contract hours has the potential to overburden doctors and compromise patient safety?

I therefore urge the Secretary of State to stop his continued and unwarranted attacks on the BMA and to get back to the negotiating table and offer a deal that is fair to doctors and safe for patients in the context of talks without preconditions.

5.54 pm

Dr Andrew Murrison (South West Wiltshire) (Con): I declare my interest as a doctor, and a veteran of truly awful rotas of the 1980s, involving one in two very often—that is every other weekend, every other night on duty, as well as a normal working day, which I would not recommend to either patients or practitioners. Thankfully, they are a thing of the past.

I welcome very much the Health Secretary’s statement today and the guarantees that he has given. On that basis, I am more than happy to support the Government this evening. However, I would say that we need to insist on evidence-based policy making. It is important to understand the difference between a causal effect and an association. My worry is that perhaps the Front Bench has been more influenced by Euclidean theorem than a proper understanding of statistics. My reading of the Freemantle paper and Professor Sutton’s remarks lead me to conclude that no causal link has been established between doctors’ rostering and excess weekend deaths. If we are serious about reducing weekend deaths, and reducing the difference in health outcomes between this country and countries with which we could reasonably be compared, which I know that my colleagues on the Front Bench are, we need to properly understand what are the drivers of those differences, and I do not think that junior doctors’ hours are a principal driver in the problem that we are trying to address today.

I think it is also right to appreciate that we are heavily dependent on the good will of all doctors—consultant grades and junior doctors. Most doctors that I know work well beyond their contracted hours—I know I certainly used to when I was in hospital medicine—and in dealing with them and in communicating with them, we need to keep that in mind and not take that good will for granted.

I very much regret the BMA action, and I very much regret the ballot on 5 November on strike action. The last time such action was taken was in 2012 on, ironically, the subject of pensions. It ended ignominiously and the only outcome was a reduction in the esteem in which the public held the medical profession. I would urge the

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BMA, armed with the assurances we have had today, to think again. I say “ironically” because, of course, the proposals, as I understand them to be, would increase core hours, which are pensionable—out-of-hours are not—and I have yet to see the BMA make any comment on that, or indeed reflect it in its pay calculator. Maybe a belated understanding of that has meant that it has chosen to take it down.

In trying to reduce weekend deaths and in trying to reduce that gap between our health outcomes in this country and those in the rest of Europe, we need to be focused much more broadly than on junior doctors’ hours. I know the Health Secretary is trying to work out how we can best configure the health service of the future. It is a dynamic thing; it never is fixed in one place. In my opinion, part of that means looking at our NHS estate all the time to make sure that we are getting the best from our assets. In my opinion, it means concentrating our specialist services in larger, regional and sub-regional centres. Those centres find it much easier to roster junior doctors and to concentrate expertise in one place. I am talking about stroke, heart attack and upper gastrointestinal bleeding—all things where we do less well in this country than in countries with which we should be comparable.

John Glen (Salisbury) (Con): I am grateful to my hon. Friend and parliamentary neighbour for giving way. Does he agree that in the rural communities in south Wiltshire that we both represent, there does need to be a certain minimum proximity in order for patients to be able to access their hospital with confidence?

Dr Murrison: I agree with that, which is where networks come into our national health service, and making sure that we have specialist centres that can deliver the right outcomes for people, and that there are protocols to ensure that ambulance services take people to the right place at the right time, so that they can receive the treatment they need. What we cannot do is continue with the current situation, in which our constituents can expect lower life expectancy and health in later life than, say, French or German patients. That is not sustainable and it is not right. It means looking again at how we configure our national health service. It may mean some difficult decisions in some parts of our NHS, but that should not be a barrier to making sure that we do it right.

What I would say to my right hon. and hon. Friends on the Front Bench is that this is not really about junior doctors; this is about consultant grades, who deliver the therapeutics and diagnostics in relation to upper GI bleeds, heart attacks and strokes. They are now, in our new NHS of the 21st century, at the coalface of delivery in a way that they previously were not. So, if I may say so, I would like a greater focus on consultant grades, perhaps at the expense of some of our junior doctors who are the principal subject of our debate today.

Several hon. Members rose