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Sir Robert Smith: I thank the Minister for that response. Conservative Members should examine the Cornwall and Isles of Scilly scheme. If my briefing is correct, that scheme was established in 1995-96--so there was a time when people recognised the need to break the cycle of ill health. We must not believe that we can never step outside the health service to tackle the causes of illness. We must recognise the causes if we are to break the cycle of despair about ill health that is putting such a drain on our health service. If the Minister becomes aware of health schemes, he will monitor their conduct. He will ensure that they deliver and that the quality of the nation's health improves.

I recognise that we are about to discuss other important issues, so I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

New Clause 13

Health and safety of NHS doctors

'In paragraph 6(2) of schedule 2 to the National Health Service and Community Care Act, 1990, after subparagraph (f), there is inserted--

"(g) the duty to implement safe working patterns for all doctors in the training grades, including--
(i) abiding by nationally agreed maximum average hours of duty, minimum periods of rest between duty periods and continuous periods off duty, and
(ii) allowing sufficient time for appropriate training, formal education and study.".'--[Dr. Harris.]

Brought up, and read the First time.

Dr. Harris: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Sir Alan Haselhurst): With this, it will be convenient to discuss the following: New clause 28--Regulation of doctors' working hours--

'The Secretary of State shall, prior to 31st March in each year, make regulations which shall have effect from the following 1st January for a period of twelve months, laying down--
(a) the maximum average number of--
(i) working hours, and
(ii) on call hours
that may be worked by hospital doctors in the training grades;
(b) the maximum average number of--
(i) working hours, and
(ii) on-call hours
that may be worked by hospital consultants; and
(c) a definition of "working hours" and "on-call hours" for the purposes of paragraphs (a) and (b) above.'.

Amendment No. 180, in clause 18, page 23, line 23, at end insert--

'(1A) It is the duty of each Health Authority, PCT and NHS trust to put and keep in place arrangements for ensuring the safety and health of staff and patients.
(1B) In pursuance of the duty defined in subsection (1A) above each body shall prepare, publish and implement a plan to reduce to a safe level the hours worked by doctors in training grades and shall review the implementation of that plan annually and publish the result of that review.'.

Dr. Harris: These important new clauses go to the heart of what the health service is about. They address the

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problem of junior doctors' hours of work and adequate rest and training. We have also chosen to table an amendment that seeks to place a duty upon the health service in line with its health and safety requirements. The hours worked by junior doctors affect not only their own health and safety but that of patients who are in endangered by inexperienced, over-tired doctors. The well-being of inexperienced junior doctors is threatened by the length of time that they are asked to work and the intensity of that work, which is often undertaken at extremely unsocial hours.

The basis of this new clause is unarguable. It is important that patients and staff are protected from bad working conditions. The Government are failing in their efforts to reduce the hours worked by junior doctors. We must look after our health service workers. An earlier group of new clauses that we have not had time to discuss pointed to huge staff shortages in certain medical specialties. That is due partly to the low morale of junior doctors who choose to forsake the NHS for other areas of medicine and to pursue areas of professional practice other than medicine--often in other countries. The evidence is clear from research collected in Oxford and elsewhere and from polls of doctors.

Something must be done because the status quo is not adequate. By legislating in this area, the Government would stress to the health service that this issue must be a top priority. If they do not address this problem, the Government's other objectives will be unattainable. It is inadequate for the Government to respond by saying that the need to protect the NHS from a shortage of junior doctors means that it will take another nine years to implement a new deal that was agreed nearly nine years ago. One way to guarantee that there will be a shortage of junior doctors is to fail to tackle that problem.

Many hon. Members and most people in the country would agree that 56 hours work at the coal face is far too much, yet that is what we are asking of inexperienced junior doctors.

Dr. Howard Stoate (Dartford): Will the hon. Gentleman give way?

Dr. Harris: No, I shall not. I know of the hon. Gentleman's keen interest in this matter because he went through that training too, but other hon. Members want to speak and we have only seven minutes before the debate will be guillotined.

It is critical that we recognise that even 56 hours of work are too many and that the rest periods--which are such an important part of the new deal that now seems like an old deal--are implemented as quickly as possible.

Mr. Simon Hughes: I appreciate that my hon. Friend is pressed for time, so I shall be brief. Does he accept that health and safety considerations are a particular reason why the Government should now legislate to restrict junior doctors' hours to an acceptable maximum? The health service is increasingly afflicted by claims of negligence and inadequate performance by its professional staff. The best way immediately to reduce the number of claims would be to prevent the risk of them arising by reducing doctors' hours.

Dr. Harris: That is absolutely right. In purely financial terms, the costs of litigation alone must mean that it is a

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false economy to work junior doctors so hard for so long, let alone the costs of training doctors who leave the NHS, often because of health concerns arising from overwork.

I should also point out that part-time trainees--who work flexibly and often because they have family commitments--work 40 hours a week, and they are paid at half-rate for many of those hours. Not only are their hours much longer than most people would consider to be part-time, but they are paid less for their work.

It is important that the Government accept the new clause because they are faced with the results of a ballot of junior doctors who, it would appear from the polls that have been taken, are intent on taking industrial action. I became a junior doctor in 1991, and laboured under the worst excesses of the previous Government. Morale was pretty bad at times then, but I never knew of a situation such as this, in which, according to some polls, 95 per cent. of junior doctors would consider industrial action.

That is not to say that the Government are failing in this area more than the previous Government did, but this Government raised expectations enormously, to the extent that when the then Minister first appeared before a junior doctors' conference, a few of them were naive enough to give him a welcoming ovation. A Minister would not now dare to put his foot in the door of the British Medical Association when the junior doctors committee was meeting there, for fear of endangering his safety.

The Minister has to act quickly; otherwise he will find that junior doctors not only vote with their feet to realise their career intentions outside the NHS, but vote to take industrial action. None of us wants that to happen.

I am conscious that time is short, but I want to make one more point. I have been a junior doctor within recent memory, and I know that there is nothing more fearful and stressful for a junior doctor than being tired and inexperienced and faced with the responsibility of looking after scores of patients at night. The Minister must not regard lightly the effect on junior doctors of years and years of such stress. They thought at first that salvation was at hand, but now find that not only have the Government done nothing to tackle the problem, but they have gone behind their backs to the Council of Ministers in Europe, seeking to increase their maximum working hours.

The Government's record on this matter is one of failure to implement the existing deal, of neglect of junior doctors' health and that of the patients whom they look after, and of letting down junior doctors by negotiating in Europe, behind their backs, longer working hours and a longer period in which to reduce those hours. On that basis, I urge the House to support the new clause.

Mr. Denham: I have just a couple of minutes to make it clear that we are firmly committed to improving junior doctors' working and living conditions under the new deal. In reaffirming that commitment, we have promised to fund the regional task force for as long as it is needed.

It is wrong for the hon. Member for Oxford, West and Abingdon (Dr. Harris) to say that we have failed. We introduced tough new standards last December to safeguard the quality of rest that juniors get. As expected, that has had a significant effect on the level of compliance with the revised new deal target. I shall say more about that in a moment.

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We have issued guidance whereby the postgraduate deans will approve posts as suitable for doctors in training only if trusts are working with task forces to ensure compliance with national controls and if they are providing acceptable living conditions. We are also committed to improvements in catering and accommodation for junior doctors. We are working closely with the medical profession and NHS managers to promote higher standards in those areas.

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