HC Deb 15 June 1999 vol 333 cc248-55

'In paragraph 6(2) of schedule 2 to the National Health Service and Community Care Act, 1990, after subparagraph (f), there is inserted— (g) the duty to implement safe working patterns for all doctors in the training grades, including—

  1. (i) abiding by nationally agreed maximum average hours of duty, minimum periods of rest between duty periods and continuous periods off duty, and
  2. (ii) allowing sufficient time for appropriate training, formal education and study.".'—[Dr. Harris.]

Brought up, and read the First time.

Dr. Harris

I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Sir Alan Haselhurst)

With this, it will be convenient to discuss the following: New clause 28—Regulation of doctors' working hours'The Secretary of State shall, prior to 31st March in each year, make regulations which shall have effect from the following 1st January for a period of twelve months, laying down—

(a) the maximum average number of—

  1. (i)working hours, and
  2. (ii)on call hours
that may be worked by hospital doctors in the training grades;

(b) the maximum average number of—

  1. (i) working hours, and
  2. (ii) on-call hours
that may be worked by hospital consultants; and

(c) a definition of "working hours" and "on-call hours" for the purposes of paragraphs (a) and (b) above.'.

Amendment No. 180, in clause 18, page 23, line 23, at end insert—

'(1A) It is the duty of each Health Authority, PCT and NHS trust to put and keep in place arrangements for ensuring the safety and health of staff and patients.

(1B) In pursuance of the duty defined in subsection (1A) above each body shall prepare, publish and implement a plan to reduce to a safe level the hours worked by doctors in training grades and shall review the implementation of that plan annually and publish the result of that review.'.

Dr. Harris

These important new clauses go to the heart of what the health service is about. They address the problem of junior doctors' hours of work and adequate rest and training. We have also chosen to table an amendment that seeks to place a duty upon the health service in line with its health and safety requirements. The hours worked by junior doctors affect not only their own health and safety but that of patients who are in endangered by inexperienced, over-tired doctors. The well-being of inexperienced junior doctors is threatened by the length of time that they are asked to work and the intensity of that work, which is often undertaken at extremely unsocial hours.

The basis of this new clause is unarguable. It is important that patients and staff are protected from bad working conditions. The Government are failing in their efforts to reduce the hours worked by junior doctors. We must look after our health service workers. An earlier group of new clauses that we have not had time to discuss pointed to huge staff shortages in certain medical specialties. That is due partly to the low morale of junior doctors who choose to forsake the NHS for other areas of medicine and to pursue areas of professional practice other than medicine—often in other countries. The evidence is clear from research collected in Oxford and elsewhere and from polls of doctors.

Something must be done because the status quo is not adequate. By legislating in this area, the Government would stress to the health service that this issue must be a top priority. If they do not address this problem, the Government's other objectives will be unattainable. It is inadequate for the Government to respond by saying that the need to protect the NHS from a shortage of junior doctors means that it will take another nine years to implement a new deal that was agreed nearly nine years ago. One way to guarantee that there will be a shortage of junior doctors is to fail to tackle that problem.

Many hon. Members and most people in the country would agree that 56 hours work at the coal face is far too much, yet that is what we are asking of inexperienced junior doctors.

Dr. Howard Stoate (Dartford)

Will the hon. Gentleman give way?

Dr. Harris

No, I shall not. I know of the hon. Gentleman's keen interest in this matter because he went through that training too, but other hon. Members want to speak and we have only seven minutes before the debate will be guillotined.

It is critical that we recognise that even 56 hours of work are too many and that the rest periods—which are such an important part of the new deal that now seems like an old deal—are implemented as quickly as possible.

Mr. Simon Hughes

I appreciate that my hon. Friend is pressed for time, so I shall be brief. Does he accept that health and safety considerations are a particular reason why the Government should now legislate to restrict junior doctors' hours to an acceptable maximum? The health service is increasingly afflicted by claims of negligence and inadequate performance by its professional staff. The best way immediately to reduce the number of claims would be to prevent the risk of them arising by reducing doctors' hours.

Dr. Harris

That is absolutely right. In purely financial terms, the costs of litigation alone must mean that it is a false economy to work junior doctors so hard for so long, let alone the costs of training doctors who leave the NHS, often because of health concerns arising from overwork.

I should also point out that part-time trainees—who work flexibly and often because they have family commitments—work 40 hours a week, and they are paid at half-rate for many of those hours. Not only are their hours much longer than most people would consider to be part-time, but they are paid less for their work.

It is important that the Government accept the new clause because they are faced with the results of a ballot of junior doctors who, it would appear from the polls that have been taken, are intent on taking industrial action. I became a junior doctor in 1991, and laboured under the worst excesses of the previous Government. Morale was pretty bad at times then, but I never knew of a situation such as this, in which, according to some polls, 95 per cent. of junior doctors would consider industrial action.

That is not to say that the Government are failing in this area more than the previous Government did, but this Government raised expectations enormously, to the extent that when the then Minister first appeared before a junior doctors' conference, a few of them were naive enough to give him a welcoming ovation. A Minister would not now dare to put his foot in the door of the British Medical Association when the junior doctors committee was meeting there, for fear of endangering his safety.

The Minister has to act quickly; otherwise he will find that junior doctors not only vote with their feet to realise their career intentions outside the NHS, but vote to take industrial action. None of us wants that to happen.

I am conscious that time is short, but I want to make one more point. I have been a junior doctor within recent memory, and I know that there is nothing more fearful and stressful for a junior doctor than being tired and inexperienced and faced with the responsibility of looking after scores of patients at night. The Minister must not regard lightly the effect on junior doctors of years and years of such stress. They thought at first that salvation was at hand, but now find that not only have the Government done nothing to tackle the problem, but they have gone behind their backs to the Council of Ministers in Europe, seeking to increase their maximum working hours.

The Government's record on this matter is one of failure to implement the existing deal, of neglect of junior doctors' health and that of the patients whom they look after, and of letting down junior doctors by negotiating in Europe, behind their backs, longer working hours and a longer period in which to reduce those hours. On that basis, I urge the House to support the new clause.

Mr. Denham

I have just a couple of minutes to make it clear that we are firmly committed to improving junior doctors' working and living conditions under the new deal. In reaffirming that commitment, we have promised to fund the regional task force for as long as it is needed.

It is wrong for the hon. Member for Oxford, West and Abingdon (Dr. Harris) to say that we have failed. We introduced tough new standards last December to safeguard the quality of rest that juniors get. As expected, that has had a significant effect on the level of compliance with the revised new deal target. I shall say more about that in a moment.

We have issued guidance whereby the postgraduate deans will approve posts as suitable for doctors in training only if trusts are working with task forces to ensure compliance with national controls and if they are providing acceptable living conditions. We are also committed to improvements in catering and accommodation for junior doctors. We are working closely with the medical profession and NHS managers to promote higher standards in those areas.

Mr. Hammond


Mr. Denham

The hon. Member for Oxford, West and Abingdon raised some important points, to which I want to respond in the short time available to me. He tabled the lead new clause, and he has the right to a reply. It is not my fault that the hon. Member for Runnymede and Weybridge (Mr. Hammond) did not get his act together, although he now claims to speak for junior doctors.

I acknowledge that there are concerns among junior doctors. I met junior doctors last week—the second time that I have met them. We had constructive discussions. It was not a fearful meeting at all. There are issues that we want to continue to discuss with them, and one of those is continuing progress on the new deal.

The tougher standards for rest breaks that we introduced last December with the agreement of junior doctors do not mean that any doctors are necessarily working any longer. They mean that the quality of the rest period is higher. The way in which compliance is assessed has been agreed by all the signatories to the new deal, including the junior doctors committee.

We accept that there remain—

It being five hours after the commencement of proceedings on the Allocation of Time motion, MR. DEPUTY SPEAKER, pursuant to Order [this day], put forthwith the Question already proposed from the Chair.

Question put, That the clause be read a Second time:—

The House divided: Ayes 154, Noes 337.

Division No. 207] [9.32 pm
Ainsworth, Peter (E Surrey) Cable, Dr Vincent
Allan, Richard Campbell, Rt Hon Menzies (NE Fife)
Amess, David
Arbuthnot, Rt Hon James Chidgey, David
Atkinson, Peter (Hexham) Clappison, James
Baker, Norman Clark, Dr Michael (Rayleigh)
Berth, Rt Hon A J Clarke, Rt Hon Kenneth (Rushcliffe)
Bell, Martin (Tatton)
Bercow, John Clifton—Brown, Geoffrey
Beresford, Sir Paul Collins, Tim
Body, Sir Richard Cormack, Sir Patrick
Boswell, Tim Cotter, Brian
Bottomley, Peter (Worthing W) Davey, Edward (Kingston)
Bottomley, Rt Hon Mrs Virginia Davies, Quentin (Grantham)
Brady, Graham Davis, Rt Hon David (Haltemprice)
Brake, Tom Day, Stephen
Brazier, Julian Evans, Nigel
Browning, Mrs Angela Faber, David
Bruce, Ian (S Dorset) Fabricant, Michael
Bruce, Malcolm (Gordon) Fallon, Michael
Burnett, John Fearn, Ronnie
Burstow, Paul Flight, Howard
Butterfill, John Forsythe, Clifford
Foster, Don (Bath) Öpik, Lembit
Fowler, Rt Hon Sir Norman Ottaway, Richard
Fox, Dr Liam Page, Richard
Fraser, Christopher Paice, James
Garnier, Edward Paterson, Owen
Gibb, Nick Pickles, Eric
Gill, Christopher Prior, David
Gillan, Mrs Cheryl Randall, John
Gorman, Mrs Teresa Rendel, David
Gray, James Robertson, Laurence (Tewk'b'ry)
Green, Damian Roe, Mrs Marion (Broxbourne)
Greenway, John Ross, William (E Lond'y)
Grieve, Dominic Rowe, Andrew (Faversham)
Gummer, Rt Hon John Russell, Bob (Colchester)
Hammond, Philip St Aubyn, Nick
Hancock, Mike Sanders, Adrian
Harris, Dr Evan Sayeed, Jonathan
Harvey, Nick Shephard, Rt Hon Mrs Gillian
Hawkins, Nick Shepherd, Richard
Heald, Oliver Simpson, Keith (Mid-Norfolk)
Heathcoat—Amory, Rt Hon David Smyth, Rev Martin (Belfast S)
Hogg, Rt Hon Douglas Soames, Nicholas
Horam, John Spelman, Mrs Caroline
Howarth, Gerald (Aldershot) Spicer, Sir Michael
Hughes, Simon (Southwark N) Spring, Richard
Jack, Rt Hon Michael Stanley, Rt Hon Sir John
Jackson, Robert (Wantage) Steen, Anthony
Keetch, Paul Streeter, Gary
Key, Robert Stunell, Andrew
Kirkbride, Miss Julie Swayne, Desmond
Kirkwood, Archy Syms, Robert
Laing, Mrs Eleanor Tapsell, Sir Peter
Lait, Mrs Jacqui Taylor, Ian (Esher & Walton)
Lansley, Andrew Taylor, John M (Solihull)
Leigh, Edward Taylor, Sir Teddy
Letwin, Oliver Tonge, Dr Jenny
Lewis, Dr Julian (New Forest E) Trend, Michael
Lidington, David Tyler, Paul
Livsey, Richard Tyrie, Andrew
Lloyd, Rt Hon Sir Peter (Fareham) Viggers, Peter
Llwyd, Elfyn Walter, Robert
Loughton, Tim Waterson, Nigel
Lyell, Rt Hon Sir Nicholas Webb, Steve
MacGregor, Rt Hon John Wells, Bowen
MacKay, Rt Hon Andrew Welsh, Andrew
Maclean, Rt Hon David Whitney, Sir Raymond
Maclennan, Rt Hon Robert Whittingdale, John
McLoughlin, Patrick Widdecombe, Rt Hon Miss Ann
Madel, Sir David Willis, Phil
Malins, Humfrey Winterton, Mrs Ann (Congleton)
Maples, John Winterton, Nicholas (Macclesfield)
Maude, Rt Hon Francis Yeo, Tim
May, Mrs Theresa Young, Rt Hon Sir George
Michie, Mrs Ray (Argyll & Bute)
Morgan, Alasdair (Galloway) Tellers for the Ayes: Sir Robert Smith and Mr. Michael Moore.
Nicholls, Patrick
Oaten, Mark
Abbott, Ms Diane Bell, Stuart (Middlesbrough)
Ainger, Nick Benn, Hilary (Leeds C)
Ainsworth, Robert (Cov'try NE) Benn, Rt Hon Tony (Chesterfield)
Alexander, Douglas Bennett, Andrew F
Anderson, Donald (Swansea E) Bermingham, Gerald
Anderson, Janet (Rossendale) Berry, Roger
Armstrong, Rt Hon Ms Hilary Best, Harold
Ashton, Joe Betts, Clive
Atherton, Ms Candy Blackman, Liz
Atkins, Charlotte Blears, Ms Hazel
Barnes, Harry Blizzard, Bob
Barron, Kevin Blunkett, Rt Hon David
Battle, John Boateng, Paul
Bayley, Hugh Borrow, David
Beard, Nigel Bradley, Keith (Withington)
Beckett, Rt Hon Mrs Margaret Bradley, Peter (The Wrekin)
Begg, Miss Anne Bradshaw, Ben
Brinton, Mrs Helen Foster, Rt Hon Derek
Brown, Rt Hon Gordon (Dunfermline E) Foster, Michael Jabez (Hastings)
Foster, Michael J (Worcester)
Brown, Russell (Dumfries) Foulkes, George
Browne, Desmond Galloway, George
Buck, Ms Karen Gapes, Mike
Burden, Richard Gardiner, Barry
Burgon, Colin George, Bruce (Walsall S)
Butler, Mrs Christine Gerrard, Neil
Caborn, Rt Hon Richard Gibson, Dr Ian
Campbell, Alan (Tynemouth) Gilroy, Mrs Unda
Campbell, Mrs Anne (C'bridge) Godsiff, Roger
Campbell, Ronnie (Blyth V) Goggins, Paul
Campbell—Savours, Dale Golding, Mrs Lin
Cann, Jamie Gordon, Mrs Eileen
Caton, Martin Griffiths, Jane (Reading E)
Cawsey, Ian Griffiths, Nigel (Edinburgh S)
Chapman, Ben (Wirral S) Griffiths, Win (Bridgend)
Chaytor, David Grocott, Bruce
Clapham, Michael Gunnell, John
Clark, Dr Lynda (Edinburgh Pentlands) Hain, Peter
Hall, Mike (Weaver Vale)
Clark, Paul (Gillingham) Hall, Patrick (Bedford)
Clarke, Charles (Norwich S) Hamilton, Fabian (Leeds NE)
Clarke, Eric (Midlothian) Hanson, David
Clarke, Rt Hon Tom (Coatbridge) Harman, Rt Hon Ms Harriet
Clarke, Tony (Northampton S) Heal, Mrs Sylvia
Clelland, David Healey, John
Clwyd, Ann Henderson, Doug (Newcastle N)
Coaker, Vernon Henderson, Ivan (Harwich)
Coffey, Ms Ann Hepburn, Stephen
Cohen, Harry Heppell, John
Coleman, Iain Hesford, Stephen
Colman, Tony Hewitt, Ms Patricia
Connarty, Michael Hill, Keith
Corbett, Robin Hinchliffe, David
Corbyn, Jeremy Hodge, Ms Margaret
Corston, Ms Jean Hoey, Kate
Cousins, Jim Hood, Jimmy
Cranston, Ross Hoon, Geoffrey
Crausby, David Hope, Phil
Cryer, John (Hornchurch) Hopkins, Kelvin
Cummings, John Howarth, Alan (Newport E)
Cunningham, Rt Hon Dr Jack (Copeland) Howarth, George (Knowsley N)
Howells, Dr Kim
Curtis—Thomas, Mrs Claire Hoyle, Lindsay
Dalyell, Tam Hughes, Ms Beverley (Stretford)
Darling, Rt Hon Alistair Hughes, Kevin (Doncaster N)
Darvill, Keith Humble, Mrs Joan
Davey, Valerie (Bristol W) Hurst, Alan
Davidson, Ian Hutton, John
Davies, Rt Hon Denzil (Llanelli) Iddon, Dr Brian
Davies, Geraint (Croydon C) Ingram, Rt Hon Adam
Dawson, Hilton Jackson, Ms Glenda (Hampstead)
Dean, Mrs Janet Jackson, Helen (Hillsborough)
Denham, John Jenkins, Brian
Dismore, Andrew Johnson, Alan (Hull W & Hessle)
Dobbin, Jim Johnson, Miss Melanie (Welwyn Hatfield)
Dobson, Rt Hon Frank
Donohoe, Brian H Jones, Barry (Alyn & Deeside)
Doran, Frank Jones, Mrs Fiona (Newark)
Dowd, Jim Jones, Helen (Warrington N)
Drew, David Jones, Jon Owen (Cardiff C)
Drown, Ms Julia Jones, Dr Lynne (Selly Oak)
Dunwoody, Mrs Gwyneth Jones, Martyn (Clwyd S)
Eagle, Angela (Wallasey) Jowell, Rt Hon Ms Tessa
Eagle, Maria (L'pool Garston) Kaufman, Rt Hon Gerald
Edwards, Huw Keeble, Ms Sally
Efford, Clive Keen, Alan (Feltham & Heston)
Ellman, Mrs Louise Keen, Ann (Brentford & Isleworth)
Ennis, Jeff Kelly, Ms Ruth
Fisher, Mark Kennedy, Jane (Wavertree)
Fitzpatrick, Jim Khabra, Piara S
Fitzsimons, Lorna Kidney, David
Flint, Caroline King, Andy (Rugby & Kenilworth)
Follett, Barbara King, Ms Oona (Bethnal Green)
Kumar, Dr Ashok Rammell, Bill
Ladyman, Dr Stephen Reed, Andrew (Loughborough)
Lawrence, Ms Jackie Reid, Rt Hon Dr John (Hamilton N)
Laxton, Bob Robertson, Rt Hon George (Hamilton S)
Lepper, David
Leslie, Christopher Robinson, Geoffrey (Cov'try NW)
Levitt, Tom Roche, Mrs Barbara
Lewis, Ivan (Bury S) Rooker, Jeff
Lewis, Terry (Worsley) Rooney, Terry
Liddell, Rt Hon Mrs Helen Ross, Emie (Dundee W)
Linton, Martin Rowlands, Ted
Livingstone, Ken Roy, Frank
Lloyd, Tony (Manchester C) Ruane, Chris
Lock, David Ruddock, Joan
McAvoy, Thomas Russell, Ms Christine (Chester)
McCabe, Steve Ryan, Ms Joan
McCartney, Rt Hon Ian (Makerfield) Savidge, Malcolm
Sawford, Phil
Macdonald, Calum Sedgemore, Brian
McDonnell, John Shaw, Jonathan
McFall, John Sheerman, Barry
McGuire, Mrs Anne Sheldon, Rt Hon Robert
McIsaac, Shona Short, Rt Hon Clare
Mackinlay, Andrew Simpson, Alan (Nottingham S)
McNulty, Tony Skinner, Dennis
Mactaggart, Fiona Smith, Rt Hon Andrew (Oxford E)
Mallaber, Judy Smith, Angela (Basildon)
Marsden, Paul (Shrewsbury) Smith, Rt Hon Chris (Islington S)
Marshall, David (Shettleston) Smith, Jacqui (Redditch)
Marshall—Andrews, Robert Smith, John (Glamorgan)
Martlew, Eric Smith, Llew (Blaenau Gwent)
Maxton, John Snape, Peter
Meacher, Rt Hon Michael Soley, Clive
Meale, Alan Southworth, Ms Helen
Merron, Gillian Squire, Ms Rachel
Michie, Bill (Shef'ld Heeley) Steinberg, Gerry
Milburn, Rt Hon Alan Stevenson, George
Miller, Andrew Stewart, David (Inverness E)
Moffatt, Laura Stinchcombe, Paul
Moonie, Dr Lewis Stoate, Dr Howard
Moran, Ms Margaret Stott, Roger
Morgan, Ms Julie (Cardiff N) Strang, Rt Hon Dr Gavin
Morley, Elliot Straw, Rt Hon Jack
Morris, Ms Estelle (B'ham Yardley) Stringer, Graham
Morris, Rt Hon John (Aberavon) Stuart, Ms Gisela
Mountford, Kali Sutcliffe, Gerry
Mudie, George Taylor, Rt Hon Mrs Ann (Dewsbury)
Mullin, Chris
Murphy, Denis (Wansbeck) Temple—Morris, Peter
Murphy, Jim (Eastwood) Thomas, Gareth (Clwyd W)
Murphy, Rt Hon Paul (Torfaen) Thomas, Gareth R (Harrow W)
Naysmith, Dr Doug Timms, Stephen
Norris, Dan Tipping, Paddy
O'Brien, Bill (Normanton) Touhig, Don
O'Brien, Mike (N Warks) Trickett, Jon
Olner, Bill Truswell, Paul
O'Neill, Martin Turner, Dennis (Wolverh'ton SE)
Osborne, Ms Sandra Turner, Dr Desmond (Kemptown)
Palmer, Dr Nick Turner, Dr George (NW Norfolk)
Pearson, Ian Twigg, Derek (Halfon)
Pendry, Tom Twigg, Stephen (Enfield)
Pickthall, Colin Vaz, Keith
Pike, Peter L Walley, Ms Joan
Plaskitt, James Ward, Ms Claire
Pond, Chris Wareing, Robert N
Pope, Greg Watts, David
Pound, Stephen White, Brian
Powell, Sir Raymond Whitehead, Dr Alan
Prentice, Ms Bridget (Lewisham E) Wicks, Malcolm
Prentice, Gordon (Pendle) Williams, Rt Hon Alan (Swansea W)
Primarolo, Dawn
Prosser, Gwyn Williams, Alan W (E Carmarthen)
Purchase, Ken Williams, Mrs Betty (Conwy)
Quin, Rt Hon Ms Joyce Wills, Michael
Quinn, Lawrie Winnick, David
Radice, Giles Winterton, Ms Rosie (Doncaster C)
Wise, Audrey Wyatt, Derek
Wood, Mike
Woolas, Phil Tellers for the Noes: Mr. David Jamieson and Mr. Graham Allen.
Worthington, Tony
Wright, Anthony D (Gt Yarmouth)
Wright, Dr Tony (Cannock)

Question accordingly negatived.

MR. DEPUTY SPEAKER then proceeded to put forthwith the Questions necessary for to be concluded at that hour.

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