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The Secretary of State for Health (Mr. Frank Dobson): As the £50 million is to be disbursed, according to the review body, not in this financial year but in the next financial year, how could we have implemented it this year?
Miss Widdecombe: The Secretary of State could simply have said that he accepted that recommendation and would implement it. Had he done so, the consultants would not have been so upset, and they and the British Medical Association would not have been putting out statements saying that the Government had let them down. They would have had to say that the Government were acting in tune with the review body.
The Secretary of State has a problem. It is not that the Opposition are saying these things--it is the health service personnel who are saying these things. It is they who are thoroughly disillusioned, fed up and demoralised by what the Government are doing. Is it surprising that a survey last year showed not only that morale in the health service was at an all-time low, but that only four in 100 health service employees saw a long-term future in their jobs?
Nowhere is that more important than for our junior doctors. Our new deal for junior doctors was an enormous success. In 1991, six out of 10 junior doctors were still working more than 83 hours per week. By the time of the last election, two in 10 were working more than 56 hours a week. There was still work to do, and we said that. However, we had got those substantial results and we were moving in the right direction.
This Government are moving in a different direction. They are not content with milking our doctors and nurses dry over the winter; they are not content with shipping in 1,000 overseas juniors to work unpaid in posts that would normally pay £30,000 a year. Now, the Government want our junior doctors to agree to work for 65 hours a week for the next 15 years.
It is difficult to be surprised, given the record of the Government. After all, they are happy to use the tactics of fiddle and fudge. They conned the BBC into misleading the public and exaggerating basic junior doctors' pay by £10,000. Significantly, it was not the Government who apologised, but the BBC who had been misled.
Sir Brian Mawhinney (North-West Cambridgeshire):
Does my right hon. Friend recall that when we were reducing the number of hours that junior doctors worked, providing more junior doctor posts and resources and improving the management of the use of junior doctors, it was done with Ministers very involved in the process on a regular basis--including, as I had, regular meetings with the leaders of junior doctors? Is not part of the
Miss Widdecombe:
Indeed, but this is a highly arrogant Government who dismiss the very people on whom they have to rely. We should not be surprised when this arrogant Government try to pass off an increase of nine hours a week for 15 years as a reduction in junior doctors' working hours. Perhaps the Secretary of State should try it himself. If he had to work hundreds of hours more, we might start to get some results in our health service, although on the evidence of the past two years, perhaps we should encourage him to take a long time off instead.
Mr. John Bercow (Buckingham):
My right hon.Friend referred to the way in which the Government misrepresented the position on the doctors' pay rise. Does she recall that that misrepresentation is based on the premise of junior doctors working not 56 hours a week, as the Government claim, but 72 hours a week? Does she fear that perhaps the Government have another agenda, for even longer hours, of which we have hitherto not been informed?
Miss Widdecombe:
There is no iniquity that I would not fear from the Government.
The evidence is abundantly clear. We have the Brussels document. Despite his virtual denial in the House, the Secretary of State cannot deny that the UK has proposed that junior doctors' working time threshold should be raised to 65 hours a week. How did he get out of it? He told the House that he never proposed that to the EU Commission. He did not, because it was in fact proposed to the EU Council. That shows the weaselly depths to which the Government will stoop.
If the Secretary of State had been at all concerned about junior doctors' working hours, Labour Members could have voted with us and with the Liberal Democrats last week in Committee to write the current limits into the Health Bill. If he has no problem with the current limits and does not intend to exceed them, what harm would there have been in writing them into the Bill?
Let us consider the Brussels document, which the Secretary of State tried to deny; the 72 hours on which he calculated the "basic" rate of pay; and the refusal to write 56 hours into the Health Bill. Adding up those three, one need not have a very suspicious mind to work out what the agenda is likely to be.
The Secretary of State never misses a chance to blame our doctors when a tragedy occurs but he is much less concerned with getting to the root of the problems. Take the massive manpower crisis in obstetrics. Hundreds of qualified doctors are fighting for a handful of consultant posts in that specialty, but the Health Bill lacks the detail needed to handle manpower planning issues.
By 2001 there will be 500 obstetricians chasing only 50 consultant posts a year. Hospital Doctor magazine has campaigned for a solution to that problem, which could result in hundreds of doctors leaving the profession. My hon. Friend the Member for Lichfield (Mr. Fabricant) said earlier that, according to one survey, 80 per cent.
of specialist registrars in obstetrics plan to leave the health service as a result of the Government's incompetence.
We can ill afford to lose those doctors, given that the 7,000 alleged extra doctors about whom the Secretary of State has boasted are actually the ones who were planned to come through medical school in any case and are not extra at all. Those doctors will have to be supplemented by yet more imports, yet the Government failed to support our amendments to the Health Bill, which would have allowed the Secretary of State to make regulations on manpower planning.
Had the Secretary of State swallowed his pride--which is considerable--and supported us, he could have had the powers to sort out the problems at source. Instead, he has told doctors that he will not back an NHS Executive consultant expansion plan; yet he still tells us that we will get more doctors.
The problem is most forcefully put by Fiona Kew of the British Medical Association junior doctors committee. She says:
All those problems have a huge impact on staff morale, yet the Government, who are directly responsible for increasing expectations then bringing them crashing down, seem unable or unwilling to act.
Mr. David Hinchliffe (Wakefield):
I have given the right hon. Lady prior notice of my question on at least four separate occasions in previous debates, but I have yet to get an answer. We are all aware of the shortages of doctors, consultants and nurses. The only policy that she has proposed in this Parliament for her vision of health has been to make more and more use of the private sector. We all know that the private sector recruits primarily from the health service. Her model would denude the health service of staff, who are already in short supply. What is her answer to that conundrum? I cannot make head or tail of the logic of her policy. She says that she is concerned about staff shortages, but her proposal would make the situation far, far worse.
Miss Widdecombe:
The hon. Gentleman cannot understand my policy because his own economics are those of the madhouse. In the public sector, the NHS bears the cost of training, recruitment, treatment, capital buildings, theatres, support staff and everything else. In the private sector, the NHS has contributed only the cost of training and all the rest is spent by outside sources. That is a big net addition that the NHS would otherwise have to find.
If we found it feasible to recommend a substantial expansion of the use of private resources, I would have no difficulty at all in expecting the private sector to take
some responsibility for training, and representatives of that sector have told me that they agree. I have never believed in a one-way flow.
Mr. Hinchliffe:
Will the right hon. Lady read the transcript of the Health Committee proceedings on the current inquiry into the regulation of private medicine and focus on the questions asked by the hon. Memberfor Southend, West (Mr. Amess) and my follow-up questions? She will see that when the private sector is asked where it gets its staff, the answer, every time, is the national health service.
"Babies and mothers die because there is not enough consultant input into their care. This is an ideal opportunity to use these specialists to improve the care of women in pregnancy . . . but the DoH refuse to provide more consultant posts."
Instead, the Government's fudge--taking five years through a series of pilot programmes--makes it appear as though the Secretary of State is simply pulling the covers over his head and hoping that the problems will go away--a bit like a child hiding from a nasty monster--but they do not go away.
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