Mr Speaker, I regret to inform the House that last week the British Medical Association announced they were initiating further rounds of industrial action over the junior doctors’ contract. It involves a series of week-long all out strikes between now and Christmas, which was scheduled to start next Monday, although this afternoon the BMA has delayed the first strike until 5 October.
This afternoon’s news delaying the first strike is of course welcome. But we must not let it obscure the fact that the remaining planned industrial action is unprecedented in length and severity and will be damaging for patients, some of whom will already have had operations cancelled.
Many NHS organisations including NHS England, NHS Providers, the NHS Confederation and NHS Improvement have expressed concern about the potential impact on patient safety. Indeed this morning the General Medical Council published its advice to doctors on the strike action. While recognising a doctor’s legal right to take industrial action, they urged all doctors in training to pause and consider the implications for patients, saying that, ‘given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, patients will suffer.’
Many others have also questioned whether escalating strikes is a proportionate or reasonable response to a contract that the BMA junior doctors leader, Dr Ellen McCourt, personally negotiated and supported in May. She said then the new contract was ‘safer for our patients, safer for our junior doctors… and also fair.’
She also said that with respect to junior doctors the new contract ‘really values their time, values them as part of the workforce, will really reduce the problem of recruitment and retention, emphasises that all doctors are equal, and has put together a really good package of things for equalities.’
We recognise that since those comments the new contract was rejected in a ballot of BMA members. But it is deeply perplexing for patients, NHS leaders, and indeed the government that the reaction of the BMA leadership, who previously supported the contract, is now to initiate the most extreme strike action in NHS history, inflicting unprecedented misery on millions of patients up and down the country.
We currently anticipate around up to 100,000 elective operations will be cancelled and up to a million hospital appointments will be postponed, inevitably impacting on our ability to hit the vital 18 weeks performance standard.
Today I want to reassure the House that the government and NHS is working round the clock to make preparations for the strikes. All hospitals will be reviewing their rotas to ensure critical services such as accident and emergency, critical care, neonatal services, and maternity services are maintained. The priority of all NHS organisations is to ensure patients have access to the healthcare they need and the risks to patients are minimised but the impact of such long strikes will severely test this.
As with previous strikes, we cannot give an absolute guarantee that patients will be safe. But hospitals up and down the country will bust a gut to look after their patients in this unprecedented situation and communicate with people whose care is likely to be affected as soon as possible.
Turning to the long term causes of the dispute, it is clear that for the BMA negotiators it has been largely about pay. But I recognise that for the majority of junior doctors there are a much broader range of concerns including the way their training is structured, the ability to sustain family life during training periods, the gender pay gap and rota gaps. After the May agreement we set up a structured process to look at all these concerns outside the contract and I intend this work to continue.
Health Education England (HEE) has been undertaking a range of work to allow couples to apply to train in the same area, to offer training placements for those with caring responsibilities close to their home, to introduce a new catch up programme for doctors who take maternity leave or time off for other caring responsibilities, and to look at the particular concerns of doctors in their first year of foundation training. Today HEE has set out further information for junior doctors about addressing these non-contractual concerns and we are proceeding with the gender pay review that I mentioned in my last statement to the House on this issue.
We have also responded to specific concerns raised by Dr McCourt. Firstly, the BMA, NHS Employers and Health Education England have agreed changes to strengthen whistleblowing protections for junior doctors beyond the scope of existing legislation so that junior doctors can take legal action against HEE, in relation to whistleblowing, as if HEE was their employer.
Secondly, in direct response to the concerns raised by Dr McCourt over the role of the independent guardians of safe working hours, NHS Employers has written to all NHS chief executives to set out in considerable detail the expectations for the new guardian role. As of 2 September, 186 out of 217 guardians had been appointed with the involvement of BMA representatives (with a further 15 interim arrangements in place) and it is expected that all will be appointed by the middle of this month.
Many junior doctors have expressed concern about rota gaps and the new contract acknowledges and tackles this concern. The guardians of safe working hours will report to trust and foundation trust boards on the issue of rota gaps within junior doctor rotas. This will shine a light on this issue and it will be escalated, potentially to the Care Quality Commission and the General Medical Council where serious issues are not addressed, and I would strongly urge all those contemplating taking industrial action to consider the progress that is being made in all these areas before making their final decision.
With respect to the broader debate about 7-day care, we recognise that many doctors have concerns about precisely what the government means by a 7-day NHS. As Sir David Dalton stated publicly last week, we offered to insert details of our 7-day plans into the May agreement but this was rejected by the BMA, so it is very disappointing that they now say the need for more clarity over 7-day services is one of the reasons for the strike.
Let me therefore repeat further reassurances on that front today.
Firstly, while the changes to the junior doctors’ contract are cost neutral, that is, the overall pay bill for the current cohort of junior doctors will not go up or down, our 7-day services policy is not cost-neutral, and will be funded out of the additional £10 billion provided to the NHS this Parliament.
Secondly, while the pay bill for the current number of junior doctors will not increase, we do expect the overall pay bill to go up as we have committed to employ many more doctors to help meet our commitment on 7-day services. That means our plans are not predicated on simply stretching the existing workforce more thinly, or diluting week day cover.
Thirdly, we recognise that junior doctors already work very hard, including evenings and weekends, and while we do need to reduce weekend premium rates that make it difficult to deploy the correct levels of medical cover, we expect this policy to have greater implications for the working patterns of other workforce groups, including consultants and diagnostic staff.
Finally, we have no policy to require all trusts to increase elective care at weekends. Our 7-day services policy is focused on meeting 4 clinical standards relating to urgent and emergency care, meaning vulnerable patients on hospital wards at weekends will get checked more regularly in ward rounds by clinicians, and clinicians will be able to order important test results for their patients at weekends.
Despite these reassurances, there may remain honest differences of opinion on 7-day care. But the way to resolve them is through cooperation and dialogue, not confrontation and strikes, which harm patients. To those who say these changes are demoralising the NHS workforce I say nothing is more demoralising or more polarising than a damaging strike. It is not too late to turn away from the path of confrontation and put patients first and I urge everyone to consider how their own individual actions in the coming months will impact on people who desperately need the services our NHS offers.
This government will not waver in our commitment to make the NHS the safest, highest quality healthcare system in the world and I commend this statement to the House.