§ 1. Mr. Chris Mullin (Sunderland, South)What assessment he has made of the effect of the proposed consultants' contract on their productivity; and if he will make a statement. [67264]
§ The Secretary of State for Health (Mr. Alan Milburn)May I say how pleased I am to see the hon. Member for Woodspring (Dr. Fox) in his place after the terrible and tragic events of the weekend? I am sure that all our thoughts are with him and all concerned.
The framework agreement that we have reached with the British Medical Association will increase the time consultants spend on direct clinical care. There will be greater rewards for those consultants who contribute most to the national health service. In crude terms, the more they do, the more they will get, so contributing to increases in NHS productivity.
§ Mr. MullinMay I put it to my right hon. Friend that, although there are many dedicated NHS consultants, the profession is notorious for its pursuit of self-interest and self-importance? What safeguards are in place to ensure that consultants deliver, and what will stop them pocketing the extra money and moving on seamlessly to their next demand?
§ Mr. MilburnA good start! I listen carefully to my hon. Friend in these and all other matters, but I have a slight difference of view with him on this issue. Most NHS consultants do a very good job of work for the NHS, and I should assure him that the new NHS consultants' 138 contract is, in essence, a something-for-something deal. Obviously NHS consultants will get more, and we are prepared to pay them more, providing they are prepared to do more for NHS patients.
The deal that we have negotiated means, for example, that in future, NHS consultants' pay will be tied to their performance against their job plans. Their job plans are part of their contract of employment and, for the first time in the history of the NHS, that means that the NHS employer will be able to define when the NHS consultant works, and that includes getting an increase in direct clinical care for patients. The more consultants are prepared to do, the more rewards they will get.
§ Mr. John Redwood (Wokingham)Is it not the case that the productivity of doctors in the hospital service will decline as shorter hours are introduced? Is it not also the case that costs will rise sharply as pay becomes more realistic? Can the Secretary of State give us some idea of how much of the extra money over the next three years will go in rising costs and lower productivity as shorter hours are introduced for all doctors?
§ Mr. MilburnI do not think that that is the case. In fact, as the right hon. Gentleman is aware from the public service agreement that we published yesterday, we expect a 2 per cent. increase each year in both efficiency and quality in the NHS as we expand it. It is certainly true that there are problems with productivity, particularly if the NHS does not expand. However, it is expanding precisely because of the choices that the Labour Government have made.
The choice that we have made is to put extra investment into our key public services, including the NHS. It is therefore incredible that the right hon. Gentleman and his hon. Friends should stand up and argue about productivity, efficiency or investment when they are committed to cutting that investment.
§ Mr. Kevin Hughes (Doncaster, North)What other group of workers wield as much power as consultants? Their so-called trade unions, the royal colleges, dictate how many consultants can be trained each year, where they can be trained and which hospitals can carry out what operations. They decide how many hours consultants work for the NHS and they keep waiting lists high so that people fork out money to jump the queue that they have created. Will my right hon. Friend tackle this closed shop, which makes Bob Crow and the RMT look like a set of woolly liberals?
§ Mr. MilburnI think that that is what is known as a friendly question. As far as tackling the issue is concerned, my hon. Friend is aware of the terms of the framework agreement that we have reached with the BMA. Obviously that will now go out to consultation, and I presume that NHS consultants will have an opportunity to have a say on what they think about it. However, it will tackle many of the problems that he has outlined.
On my hon. Friend's point about closed shops, no one in the NHS has a right to prevent patients from receiving the sort of services that they require. We must ensure that we get more doctors into the NHS and get more use of the doctors who work in the NHS. He is aware that the issue of private practice has been unresolved for many 139 years in the NHS, and the new consultants' contract of employment will resolve it once and for all by making it clear that the first call on their time and their first priority has got to be NHS patients.
§ Dr. Jenny Tonge (Richmond Park)Does the Secretary of State agree that the merit award system is one of the root causes for consultants developing the characteristics so beautifully described by the hon. Member for Sunderland, South (Mr. Mullin)? What plans does he have for revising that system?
§ Mr. MilburnThe merit, or distinction, award system needs to be reformed, and we are planning to do that, as the hon. Lady well knows. It is the next element of the reform programme and is under discussion. I want the merit awards to be precisely that: rewarding merit, especially those NHS consultants who do most for NHS patients. We trained them to do that and they are skilled experts. We have too few of them, but that will change. In the meantime, we need to ensure that we get more of their valuable time and skills for the benefit of more NHS patients.