Mr Speaker, for the last 3 years there have been repeated attempts to reform the junior doctors contract to support better patient care 7 days a week, culminating in a damaging industrial relations dispute that has lasted over 10 months.
I am pleased to inform the House that after 10 days of intensive discussion under the auspices of ACAS, the dispute was resolved yesterday with a historic agreement between the government, NHS Employers (acting on behalf of the employers of junior doctors) and the BMA that will modernise the contract making it better for both doctors and patients. The new contract meets all the government’s red lines for delivering a 7 day NHS and remains within the existing pay envelope. We will be publishing an equalities analysis of the new terms alongside publishing a revised contract at the end of the month. It will now be put to a ballot of the BMA membership next month with the support of its leader, the Chair of the Junior Doctors’ Committee of the BMA, Johann Malawana.
Mr Speaker, I would like to first of all express my thanks to the BMA for the leadership they have shown in returning to talks, negotiating in good faith and making an agreement possible. I would also like to put on record my thanks to Sir Brendan Barber, the Chairman of ACAS, for his excellent stewardship of the process, and to Sir David Dalton for his wisdom and insight in conducting the discussions on behalf of employers and the government both this time and earlier in the year.
Reforming an outdated contract
This agreement will facilitate the biggest changes to the junior doctors’ contract since 1999. It will allow the government to deliver a 7 day NHS, improve patient safety, support much-needed productivity improvements, as well as strengthening the morale and quality of life of junior doctors with a modern contract fit for a modern health service.
The contract inherited by this government had a number of features badly in need of reform, including:
- low levels of basic pay as a proportion of total income, making doctors rely too heavily on unpredictable unsocial hours supplements to boost their income
- automatic annual pay rises even when people take prolonged periods of leave away from the NHS
- an unfair banding system which triggers payment of premium rates to every team member even if only one person has worked the extra hours
- high premium rates payable for weekend work which make it difficult to roster staff in line with patient need
- risks to patient safety with doctors sometimes being required to work 7 full days or 7 full nights in a row without proper rest periods
Seven day NHS
This government has always been determined that our NHS should offer the safest, highest quality of care possible - which means a consistent standard of care for patients admitted across all 7 days of the week. So the new contract agreed yesterday makes the biggest set of changes to the junior doctors’ contract for 17 years including:
- establishing the principle that any doctor who works less than an average of one weekend day a month (Saturday or Sunday) should receive no additional premium pay compensated by an increase in basic pay of between 10 and 11%
- reducing the marginal cost of employing additional doctors at the weekend by about a third
- supporting all hospitals to meet the 4 clinical standards most important for reducing mortality rates for weekend admissions by establishing a new role for experienced junior doctors as ‘senior-clinical decision makers’ able to make expert assessments of vulnerable patients who may be admitted or staying in hospitals over weekends
- removing the disincentive to roster sufficient numbers of doctors at weekends by replacing an inflexible banding system with a fairer system that values weekend work by paying actual unsocial hours worked with more pay to those who work the most.
A better motivated workforce
The government also recognises that safer care for patients is more likely to be provided by well-motivated doctors who have sufficient rest between shifts and work in a family-friendly system. So the new contract and ACAS agreement will improve the wellbeing of our critical junior doctor workforce by:
- reducing the maximum hours a doctor can be asked to work in any one week from 91 to 72
- reducing the number of nights a doctor can be asked to work consecutively to 4 and reducing the number of long days a doctor can be asked to work to 5
- introducing a new post, a Guardian of Safe Working, in every trust to guard against doctors being asked to work excessive hours
- introducing a new catch up programme for doctors who take maternity leave or time off for other caring responsibilities
- establishing a review by Health Education England to consider how best to allow couples to apply to train in the same area and to offer training placements for those with caring responsibilities close to their home
- by giving pay protection to doctors who switch specialties because of caring responsibilities
- establishing a review to inform a new requirement on trusts to consider caring and other family responsibilities when designing rotas.
Taken together, these changes show both the government’s commitment to safe care for patients and the value we attach to the role of junior doctors. Whilst they do not remove every bugbear or frustration they will significantly improve flexibility and work life balance for doctors, leading we hope to improved retention rates, higher morale and better care for patients.
Reflections on industrial action
But whatever the progress made with today’s landmark changes, it will always be a matter of great regret that it was necessary to go through such disruptive industrial action to get there. We may welcome the destination but no one could have wanted the journey: so today I say to all junior doctors whatever our disagreements about the contract may have been, the government has heard and understood the wider frustrations that you feel about the way you are valued and treated in the NHS.
Our priority will always be the safety of patients but we also recognise that to deliver high quality care we need a well-motivated and happy junior doctor workforce. Putting a new, modern contract in place is not the end of the story in this respect. We will continue to engage constructively with you to try to resolve outstanding issues as we proceed on our journey to tackle head on the challenges the NHS faces and make it the safest, highest quality healthcare system anywhere in the world. Today’s agreement shows we can make common cause on that journey with a contract that is better for patients, better for doctors and better for the NHS and I commend it to the House.