§ 7.7 p.m.
§ Lord Rea
My Lords, in moving that this Bill be read a third time I should like to say a few brief words before sending it on the next stage of its journey.
I refrained from moving any amendments in Committee because I was anxious to speed its progress to another place. However, for example, in Clause 3 I should have preferred the word "shall" to the word "may" as an instruction to Ministers in the future further to reduce hours from 72 to 60 hours per week in stages. I believe that the argument about the desirability of a 72-hour week is now accepted both by the department and in general. The only questions are when and how that is to be done. I am very pleased that the Minister accepted the suggestion of the BMA Junior Staffs Committee that the appointment of some of the new batch of 100 consultants mentioned in the White Paper Working for Patients will be linked with a pilot project where methods of achieving 72 hours will be worked out and put into operation.
Nevertheless, I feel that the force of legislation is still necessary in order to bring in a nationwide reduction to 72 hours a week. I believe that that must be regarded as only the first step. The achievement of a 60-hour week should be the real aim, which will mean that junior hospital doctors have something like a normal social and family life and are even allowed a little time for study. Although junior hospital doctors are supposed to be in training posts, many have no time for reflection or reading. That 1205 may be good for the coffers of the Royal Colleges as candidates may have to sit their professional examinations several times instead of once, but it benefits no one else, particularly the patients.
The noble Lord, Lord Brain, would have moved a useful amendment ensuring protected time for study but, if the Bill reaches a Committee stage in another place, that and other useful amendments could well be moved.
I believe that this Bill has already served a useful purpose in raising public awareness of the current situation but I feel that legislation is necessary to achieve the solution which we all seek. I beg to move that this Bill be now read a third time.
Moved, That the Bill be now read a third time.—(Lord Rea.)
§ Lord Ennals
My Lords, first I congratulate my noble friend on having achieved the Third Reading of this Bill. I congratulate the Government for not having raised difficulties which would have meant that the Bill did not proceed to another place. I consider it to be very satisfactory that your Lordships have passed a Bill which is very necessary.
The issue arose in its most prominent form shortly before Christmas, when I was myself in hospital. I will not say that I was talked at, but I heard the views of many junior hospital doctors. Since leaving hospital I have become increasingly aware of the need for some action to be taken. The achievement of my noble friend is that there has been some response. I do not consider the decision to appoint 100 new consultants, with the consequences that that will have for the juniors, in any way a satisfactory response. But it is clear that the Government recognise there is a serious problem that has to be tackled.
I take the same view as my noble friend. There is a need for legislation. I have watched successive governments—during the time I was Secretary of State and in the 10 years subsequent to that—endeavouring with the best will in the world but lacking the force of legislation, fail to come up with an answer. I believe that there is need for legislation, that the profession very much want it—which was not the case 10 years ago—and that the public support it. They recognise that it is not right that junior hospital doctors should be working intolerable hours.
I hope very much that the Bill will be accorded a Third Reading and that it will go with the blessing of this House to another place. What will happen in another place remains to be seen. I hope that the noble Lord who is to reply—if it is for the first time in his new post I warmly congratulate him and welcome him to our frequent health debates—will want to commend the Bill to his colleagues there. I hope that the Government will listen further and that the Bill will finally come through both Houses and become the law of the land.
§ Lord Trafford
My Lords, as one of those noble Lords who, on Second Reading, had some reservations about the Bill, I too congratulate the noble Lord, Lord Rea, on bringing the measure successfully through this House. I do not think that 1206 I can say in all honesty that I have changed my mind. It would have been better for the profession to have solved this problem in its own way.
I had prepared a number of amendments based on the detail of the Bill, some of which referred to previously, but I was not sufficiently against the principle to hinder the Bill going forward with the good wishes of the whole House. To have produced a series of amendments would have delayed the Bill and no doubt those proposals will in any case be put forward in another place. At any rate comments might be expected to be made.
There is no doubt—I do not wish it be thought there is any doubt—that it is wrong that any group of young professionals in any profession should be asked to work more than a reasonable number of hours. I am sorry that it has come to legislation. However, as we now have legislation. I certainly accept the principle. For that reason I have not tabled my amendments. I wish the Bill well in another place, and I congratulate the noble Lord, Lord Rea, on bringing it through this House.
§ Lord Butterfield
My Lords, I follow the noble Lord, Lord Trafford, in welcoming the Bill which, I sense, will receive its Third Reading. I too congratulate the noble Lord, Lord Rea, on the successful way he has negotiated the Bill through this House.
There should be no doubt in your Lordships' minds that some interesting problems can be expected while the Bill goes through the other place. One senses that there may be a need for agency doctors to work at the weekends in the same way that agency nurses have had to be brought in. There are two sides to that. It will put up costs a little, but there will also be the interesting effect of bringing people in private practice back into the hospital world. That might be to the general benefit of patients. I add my congratulations to the noble Lord, Lord Rea.
§ 7.15 p.m.
§ Lord Pitt of Hampstead
My Lords, before the Minister replies may I say that I hope that the Government will take a very generous attitude to the Bill. Ist is a difficult subject. We know that there are problems if we pass the Bill saying that people should work certain hours and that those hours are limited. There will be institutions—some small hospitals, for example—where there will be difficulties.
I hope that the Government will take a generous attitude. The Bill asks for acceptance of the fact that the hours junior doctors have to work are too long and that there must be the sort of control of their working hours that exists for certain other people, such as airline pilots and lorry drivers. That is what I hope we shall hear from the Minister.
We all know that when the Bill goes through the other place there may be different attitudes to it. But if the Government take a reasonable and generous attitude, this question of the long hours worked by junior doctors can be dealt with, and dealt with successfully. I hope that we will hear from the Minister that the Government are taking that generous attitude.
§ Lord Henley
My Lords, I thank noble Lords for their contributions to the debate. In particular I thank the noble Lord, Lord Ennals, for his kind words of welcome. Perhaps I may say how pleased I am that he is out of hospital. I hope that we will see a great deal of each other across the Dispatch Box over the coming months.
I think it would be of assistance to your Lordships if I summarised the Government's attitude to the Bill and gave some information on recent developments. As my noble friend Lord Hesketh told the House during the Second Reading debate, the Government believe that an average week of duty of 72 hours is a target which we should work towards. There were a number of reasons why the Government had grave reservations about a statutory limitation of hours. My noble friend referred, first, to the fact that the Government's initiative to reduce rotas more onerous than one in three announced last June, with the agreement of all interested parties, was not due to be completed until October this year. Secondly, the pattern of work of junior hospital doctors could not, and should not, be determined centrally. Thirdly, it was far from clear that we could recruit the large number of extra doctors in the short-term necessary to implement the Bill. Fourthly, any increase in the number of junior doctors would run entirely counter to our current efforts to reform the hospital staffing structure.
Although the Government do not believe that legislation is the right answer, we are grateful to the noble Lord, Lord Rea, for the thoughtful way in which he argued the case for the Bill at Second Reading. There was the opportunity too of hearing constructive contributions from other noble Lords who spoke in that debate. Those contributions certainly illustrated why this is such a longstanding and difficult problem.
My noble friend Lord Hesketh spoke on that occasion of the meeting that my honourable friend the Minister for Health was to have with representatives of the BMA to discuss progress on the June initiative and to consider what further action might be required. That meeting, which took place on 23rd February, was useful and constructive. It was clear to all present that many health authorities had already taken action to reduce onerous rota commitments. Methods planned or used to reduce onerous rotas included removing split site working, changing working arrangements, and the provision of cross-grade and cross-specialty cover.
However, my honourable friend wishes to ensure that progress is maintained and that corrective action is taken where appropriate. Therefore he intends to write personally to the chairmen of all regional health authorities stressing the importance he attaches to the initiative. It was encouraging that at the meeting the BMA undertook to seek to persuade the profession at large that it would pursue with vigour the opportunities for further reductions in juniors' hours.
My honourable friend said that dealing with onerous rotas worse than one in three was a very important stage in reducing the heavy commitments of some junior hospital doctors. But more would 1208 need to be done. He was very concerned at the problem of long continuous hours and in particular the practice of long weekend working when a junior doctor might be on call continuously from Friday through to Monday every third weekend. Even those on one in three rotas could be working or on call every third week for 120 hours.
He recognised that this was often because some doctors preferred this arrangement so that they could have the other two weekends off. However, the practice was unlikely to be in the interests of patients and we would be holding talks with a view to it ceasing. Finally the meeting agreed to further discussions between the BMA and the Government about the possibility of mounting pilot studies to explore ways in which junior doctors' weekly hours of duty might be reduced to 72.
In brief, the Government cannot support this Bill. But we are actively sponsoring and supporting ways of reducing the onerous commitments of some junior doctors. Useful progress has been made and further action will be pursued with vigour.
§ Lord Rea
My Lords, I should like to apologise to the noble Lord for not congratulating him in my opening speech. I am sure that we shall be meeting a lot across the Floor of the House. I also thank him for his words. The useful meeting with the BMA on the 23rd of this month might not have been quite so constructive had this Bill not been currently passing through Parliament.
I think it will do nothing but good for the topic to be gone over again and some of the arguments that we have heard here developed in another place. This is why I shall be looking at Hansard and perhaps going to the Gallery in another place and watching its progress with great interest.
On Question, Bill read a third time, and passed, and sent to the Commons.