Junior Hospital Doctors (Hansard, 29 June 1999)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)
My Lords, my right honourable friend the Minister for Health met the junior hospital doctors' representatives on 10th June and had a positive and constructive meeting, identifying areas where we can continue to make progress in improving the working lives of all doctors in training. We greatly value the commitment and dedication of junior hospital doctors to providing a quality service to NHS patients. The Government have introduced a range of progressive staffing initiatives to make sure that juniors' working lives are enhanced and that good employment practices exist in all trusts.

§ Lord Clement-Jones
My Lords, I thank the Minister for that Answer so far as it goes, but evidence of low morale among junior hospital doctors is quite clear from the facts that they are now contemplating industrial action for first time since 1975 and some one in four junior doctors are leaving the service. Does the Minister believe that £4.02 per hour for bank holiday and weekend working for junior doctors is adequate, especially over the millennium period? Is not the most straightforward way of restoring morale to junior doctors to improve their levels of pay when they work at night, weekends and on bank holidays? As the Minister mentioned that the Government have started negotiations with the junior doctors, will they now firmly commit to improving their out-of-hours pay?

§ Baroness Hayman
My Lords, the noble Lord is right that junior doctors are concerned about a number 168 of issues at the moment. He mentioned an out-of-hours hourly pay rate of £4.02, but that is the absolute minimum payable to the most junior of doctors and relates to on-call payments which are not the same as NHS overtime. That leads to a great deal of confusion. Most juniors will get considerably more than that as an hourly rate and possibly up to twice that.
The pay of junior hospital doctors is set by the doctors' independent pay review body. We have implemented in full its recommendations on junior doctors' pay. One would expect all this to be determined by a professional contract, but under the situation that we inherited, it is not. About two-thirds of their pay is a basic sum and the rest results from a complex series of calculations which resembles pay systems that went out of date in industry some 30 years ago. We are meeting junior doctors to secure practical improvements in conditions. Talks will continue. We are willing to consider with the junior doctors changes to their pay structures, if that is what they want.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that junior doctors face many more stresses than just pay? I refer to the availability of beds, access to food at night, paperwork and providing cover for consultants, among other matters.

§ Baroness Hayman
My Lords, the noble Baroness is right to draw attention to that. That is why we have set up a working group including juniors' representatives. It is looking at current New Deal guidance on living and working conditions, seeking more robust standards which can be better enforced through improved monitoring, and a stronger commitment from local employers, backed by postgraduate deans, especially as an integral part of the New Deal accreditation process. The noble Baroness is right that issues such as accommodation and lack of access to a hot meal can be the final straw for people who are working very hard.

§ Lord McColl of Dulwich
My Lords, is the Minister aware that the last government increased the number of consultant posts by 3.5 per cent every year, whereas this Government are responsible, whether they like it or not, for a cut of 33 per cent in the number of consultant obstetricians? Can the Minister offer us some reassurance? Is she going to put this terrible cut right?

§ Baroness Hayman
My Lords, the noble Lord will be aware from several exchanges across the Dispatch Box that there is a problem related to specialist registrars in obstetrics and gynaecology which we seek to address. We are looking at ways to ensure that people who come to the end of their contracts are offered advice and help in planning their future careers. We are looking at ways to improve not only the situation of that particular group of doctors but also the efficiency of workforce planning in future. As to the record of the Government, in our first year we increased the number of NHS doctors by 2,200; the CSR settlement provided 169 for 7,000 more doctors over three years; and only last week we announced 1,000 new places at medical schools.

§ Lord Campbell of Alloway
My Lords, I have listened with care to all the Minister's answers. Is the problem too few doctors, too little pay and too long hours? If so, I fail to understand from the noble Baroness's answers what on earth the Government propose to do about it.

§ Baroness Hayman
My Lords, I suggest to the noble Lord that that is something of an oversimplification, although I am sure that most people would prefer shorter hours, higher pay and more people to share the workload. There are very complicated arguments about the length of training that people must undergo in order to achieve consultant status, which is obviously the pinnacle for junior hospital doctors. Despite the lengthy training and sometimes arduous working hours, medicine remains a very attractive profession for the highest calibre students. However, the noble Lord is right to point out that, in order to meet our commitment to reduce the working hours of junior hospital doctors, we shall have to increase the medical workforce, and, as I explained in an earlier reply, we are doing that.

§ Lord McCarthy
My Lords, does the Minister agree that it is very difficult to improve the conditions of junior doctors except at the cost of the conditions of senior doctors—in particular, consultants? Does she also agree that the Government can do something about the long hours of junior doctors by making senior doctors work at weekends, and that we shall have more happy junior doctors if they are given some of the income which senior doctors earn from private practice?

§ Baroness Hayman
My Lords, I am grateful to my noble friend for an extremely constructive and useful contribution which will be read carefully by all the parties to the negotiations.

§ Lord Colwyn
My Lords, can the noble Baroness say whether there is any evidence of increasing claims for negligence against junior hospital doctors who work long hours formerly reported through the Crown Indemnity Service and now through the NHS Litigation Authority?

§ Baroness Hayman
My Lords, it is recognised that there is an increasing level of litigation throughout medicine in both the NHS and the private sector. I do not have any information as to whether that relates specifically to claims against junior doctors; nor am I sure that those details are centrally collected, but I shall look into it and write to the noble Lord.

§ Lord Ackner
My Lords, can the noble Baroness tell the House how this problem is dealt with in Europe, particularly bearing in mind restrictions in regard to long hours of work?

§ Baroness Hayman
My Lords, certainly different countries deal with the issue of workforce planning in 170 different ways. Recently, I was in Italy, where there is a large number of unemployed doctors arising from oversupply, which raises a problem of its own. The Government are committed to a reduction to a 48-hour week for all workers, but we must take time to implement that in a way which safeguards patient care. We cannot produce large numbers of doctors with a snap of the fingers.