§ 32. Dr. Vaughanasked the Secretary of State for Social Services if she will make a further statement on the emigration of doctors from Great Britain.
§ Mrs. CastleI would refer the hon. Gentleman to my public statement of 8th October—[Vol. 898, c. 1051–53]—my letter to him of 20th October, and the relevant parts of my speech and that of my hon. Friend the Minister of State during the debate on the NHS on 27th October—[Vol. 898, c. 1152]—These give the latest figures available to us, and express my concern about emigration, but point out that some accounts are exaggerated. I have nothing to add at this stage but will keep the situation under review.
§ Mr. Georgeasked the Secretary of State for Social Services if she will make a statement on the junior hospital doctors' dispute.
§ Mrs. CastleThe Government have always been anxious to settle the dispute with the junior doctors as quickly as possible. We have said all along that we were willing to consider any scheme for rearranging the new contract proposals, subject to the Doctors' and Dentists' Review Body, and provided that such a rearrangement did not breach the Government's counter-inflationary policy by making extra money available this year above the 30 per cent. increase on basic salary which the juniors received last April.
The problem has been to reconcile two things: on the one hand the juniors' desire to couple the immediate introduction of the new contract, to which they attach considerable importance, with a "no detriment" provision which would have required extra money; and on the other hand the Government's insistence that their pay policy must not be breached.
On Thursday last the Government made a new offer to the juniors' representatives which is within the pay policy but which at the same time meets the juniors' very understandable claim that none of their members should be worse off. This has been achieved by proposing that the new contract should be introduced 92W gradually as juniors change their jobs. All juniors starting new appointments or changing jobs before April 1976 would move on to the new contract; the rest would stay on their existing contracts and retain their entitlement to extra duty allowances. Thus fewer doctors would move on to the new contract immediately but no doctor would lose money while in his present job.
Since the jobs of junior doctors now in post will last a relatively short time—an average of 10 months—many doctors would change on to the new contract well before April. In April 1976 it would be possible within the counter-inflation policy, subject to the Review Body's agreement, for all juniors not yet on the new contract to have the individual option of switching to the new contract or of retaining their old one for the duration of their present job, the "no detriment" element being financed out of extra money which would then be available under the pay policy. The Government's evidence to the Review Body, as is usual, would not propose any specific figures for a pay increase in April but draw attention to the requirements of the counter-inflation policy set out in the White Paper of July 1975, under which an increase of up to £6 per head may be made available for an annual pay settlement.
In addition the Government offered the juniors' representatives a number of points of clarification of the new contract which will reassure them about its operation. We offered joint examination by the professions and the Health Departments of the long hours worked by junior doctors and dentists, both in general and in particular. In order to prevent abuse of the contract arrangements, there will be no reductions in the local junior staff complement without full consultations with the professions locally. We proposed that, where a junior is requested to provide cover in emergency situations outside his own job description, he may be engaged at the standard rate of pay for a limited period. For example, sudden illness may lead to serious undermanning in another department of the hospital, such as accident and emergency, so that a locum has to be employed. At the moment health authorities cannot normally employ someone from within the same hospital in this capacity so that they have to look outside. In future a junior 93W from another department will be able to provide this cover as if on a locum basis, and will receive the standard rate.
Where it becomes clear for any reason that the contracted assessment of hours is unfair or unrealistic, in total, or in terms of the proportion of units attracting supplement at the different rates for work and on-call, there will be provision for reassessment and appeal machinery including representatives of junior staff. It would be our intention that where a colleague's sickness or similar circumstance required a junior doctor to be engaged on duties beyond his contract hours and this persisted for a period of more than two weeks he could have his own contract reassessed from then on.
Finally, the Government's proposals recognised that the starting point—in terms of weekly time—for the payment of supplements is a matter for the Review Body, but it was made clear that the Health Departments would support the reopening in the long term of the issue as to whether supplemental payments should start at 40 hours and would not oppose the professions' evidence to that effect.
In the light of this, the juniors' representatives undertook to withdraw the ballot papers already issued and to send out a new ballot incorporating the new offer. They accepted that the new offer was within the Government's interpretation of the pay policy, and I hope I convinced them that the Government have not discriminated against the junior doctors and dentists but are merely applying to them the same strict pay criteria that they are to everyone else.
I was able to point out that 1½ million workers have already accepted the pay policy, including over 200,000 workers who, before July, had already negotiated specific pay rises for the coming year, and who had had to renegotiate those existing settlements downwards, in order to bring them into line with this policy. Other groups of workers who had concluded staged pay agreements for specific amounts before the new policy was introduced and were due to have the second stage paid after 31st July will have to offset the second stage against the £6 a week limit. In other cases where final details of an agreement had not been settled before the new policy came into effect implementation has had to be suspended. 94W It was, therefore, impossible for the Government to make an exception in the case of the junior doctors and dentists.
I had to make it clear to the junior doctors' representatives whom I met on Thursday last that the Government's overriding priority must be to their counter-inflation policy, since this is the only way that the difficulties of the NHS as well as of the economy as a whole can be overcome.
I understand that distribution of the ballot papers began today. Nonetheless industrial action by junior doctors is still continuing in some parts of the country. I hope that in the interests of patients this will be called off without delay.
§ Mr. Penhaligonasked the Secretary of State for Social Services how many junior doctors are employed in NHS hospitals; and how many vacancies are currently unfilled.
§ Dr. OwenApproximately 17,000 in England and Wales. At September 1974, 131 National Health Service senior registrar posts were not occupied; there were 1,922 senior registrars in post and 40 locums. Statistics are not collected of vacancies in the registrar and house officer grades since these are short-tenure posts with a high turnover of staff.