§ 2. Ms. Armstrong
To ask the Secretary of State for Health what information he collects from district health authorities concerning the contracted hours of work of junior hospital doctors; and from what date such information has been collected.
§ The Minister of State, Department of Health (Mr. David Mellor)
Information has been collected each year since 1976 on the number of contracted hours of duty for each junior hospital doctor in England and Wales. Contracted hours comprise hours of work and hours on call. They fell from an average of 91.3 hours in 1976 to 85.7 hours in 1986.
§ Ms. Armstrong
In the light of the grave concerns that junior hospital doctors are expressing about their ability properly to carry out their role, what reassurance can the Minister give to patients that their lives and future are safe in those hands?
§ Mr. Mellor
The hours that junior doctors work are determined by the heads of their clinical teams. A key part of the judgment of those who determine those hours is to ensure that the doctor carrying out the duties is capable of so doing. However, the Government are dissatisfied with the situation in which a significant minority of junior hospital doctors are expected to work and to be on call for far too many hours. Last June my predecessor asked each district to set up a working party, consisting largely of doctors, to eradicate any scheduling worse than one in three. We are in the middle of that exercise, but the evidence that we are receiving from the regional health authorities suggests that further reductions are being made as a result of that initiative. The working party is on course to report fully by the end of September.
§ Dame Jill Knight
Can my hon. and learned Friend confirm that not all specialties involve long hours for junior doctors in hospitals? Some are not really very bad. Secondly, is he aware that it has been put to me by professional concerns that because doctors' qualifications often depend on the hours worked in certain specialties, if the hours are shortened the time before qualification is likely to be much longer?
§ Mr. Mellor
I am grateful to my hon. Friend for introducing into the debate certain points that have sometimes been missed. First, although junior doctors' hours are undoubtedly onerous throughout the service, it is a minority who work the hours that we all agree to be excessive. The last study carried out on the average number of hours worked in different specialties revealed that the average hours of work for a junior doctor in psychiatry were 46 hours per week, but in general surgery the figure rose to 67 hours per week, which is obviously very high. As my hon. Friend says, a key part of junior hospital doctors' training takes place on the ward, where they see difficult cases being treated. Plainly, any action taken to reduce the number of hours that junior doctors work must take into account the need for them to gain experience and to be capable when they become consultants—we hope that most will become consultants by their late thirties—of dealing with a wide range of problems.
§ Mr. Fearn
Is the Minister aware that nowhere is it laid down that junior doctors must work so many hours continuously? I stress the word "continuously". We know about the average figures, but it is the word "continuous" in which I am interested. Continuous working must detract from performance. Is the Minister taking any steps to stop continuous working?
§ Mr. Mellor
As the hon. Gentleman knows, we are in the middle of our initiative with a working party, consisting mainly of doctors, in each health district. We must see how that works out. The preliminary indications are that that is causing a reduction in the most onerous shifts in each region. The hon. Gentleman has made an interesting point about the number of hours that a person works, or during which he is on duty continuously, and whether that should be regulated. That is one of the matters that we have in our minds at present.
§ Mr. Ward
Does my hon. and learned Friend agree that the word "average" is a little suspicious because it implies that many people are working a good deal more than the average as well as the fact that others are working a good deal less? Does he agree that many constituents are complaining that some of the doctors have established their case? I hope that he will proceed with all vigour to do something about this. I should like to draw attention to an article in The Evening Standard—
§ Mr. Mellor
The last time that a major sustained effort was made to reduce the extremely onerous shift patterns of some junior doctors was in 1982 and it resulted in a 30 per cent. reduction in extreme shifts. We hope to achieve a similar result or even an enhanced rate of progress with the present initiative. My hon. Friend should be aware that some of the difficulties are structural. The NHS must offer 24-hour cover in every hospital unit throughout the land. 856 Some of the ways in which junior doctors' hours could be cut—by rationalising services in each district on to one site, for example—would lead to equal concern among hon. Members if that meant that smaller hospital units had to be closed.
§ Mr. Robin Cook
If the Minister is so dissatisfied with the excessive hours of junior hospital doctors, why do the Government propose to resist tomorrow the Bill introduced in another place to reduce those excessive hours to 72 per week, which many doctors still regard as excessive? How can it be right to limit the hours for which lorry drivers can drive and airline pilots can fly, but wrong to limit the hours during which junior doctors can carry out complex medical treatment? If the hon. and learned Gentleman expects the House to take seriously his commitment to reducing those excessive hours, will he assure the House that he will withdraw the circular that he issued only last November requiring junior doctors to cover for colleagues on sick leave and thus work even longer hours than at present?
§ Mr. Mellor
The hon. Gentleman is seriously in error if he thinks it a legitimate criticism of Ministers that we should be taking steps to prevent the expansion of a system whereby the NHS is obliged to pay £900 per week for the services of locum doctors from private agencies. The hon. Gentleman should look for a golden thread of principle to run through his representations. It does not seem to be there in this instance.
The hon. Gentleman is excessively simplistic for a man of his supposed sophistication if he thinks that a parallel can be drawn between a lorry driver who can pull off a motorway into a lay-by when his hours of duty have expired and the need for the NHS to offer 24-hour cover in every one of its hospital units. My right hon. and learned Friend the Secretary of State has made it clear that he believes that a work pattern of 72 hours is an acceptable long-term basis, but immediate statutory intervention is far too simplistic to deal with the complex problem.