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Mr. Stephen Dorrell (Charnwood) (Con): Every Member in the House would agree that doctors working in the NHS must be employed on terms that ensure high-quality care to patients, and that their hours of work are part of that equation. That is uncontroversial. The question for the Minister is whether his task, as the representative of the doctors' employer, has been made easier or more difficult by the introduction of the European working time directive as interpreted through the two judgments. As an employer seeking to deliver agreed objectives, is his task easier or more difficult?
Mr. Hutton: It has been made immeasurably more difficult. I have acknowledged that on previous occasions, as the right hon. Gentleman, who reads all my press releases on the Department's website, would confirm. There is nothing new about that. I shall develop my concerns about the SIMAP/Jaeger judgments in a few moments, but it is obvious for anyone who observes these issues that the European Court's interpretations of the definition of working time—and, crucially, in the Jaeger case, of when compensatory rest should be taken—have made matters immeasurably worse. In fact, on the Jaeger case, the UK Government made representations to the European Court, arguing for precisely the opposite interpretation of the directive. Sadly, we lost that argument in the Court, but I do not believe that we have lost it in the wider court of opinion among the Council of Ministers and the Commission—a point to which I shall return.
It is clear not only from today's debate but from all previous debates on these matters that there is a disagreement between Government and Opposition about the terms of the directive and whether we should provide for these rights in law at all. The hon. Member for South Cambridgeshire has made it clear that he believes that we should not. For the sake of making progress on the substantive issues, I shall not develop arguments about that particular issue today, although it is worth pointing out that all the negotiations surrounding the wording of the directive took place under the leadership—if that is the right word—of the previous Conservative Administration.
On at least one point, however, there is likely to be general agreement across the House and outside it—that implementing the European working time directive in the light of recent decisions of the European Court of Justice presents a very considerable challenge to the NHS and particularly to specialties such as paediatrics and obstetrics. The NHS is taking action at a number of different levels to respond to that challenge. In the course of my remarks, I want to set out how we are attempting to achieve that in more detail, but it might be helpful if I first set out the general principles that we have been following.
First, our priority must be to implement the directive in a way that maintains both the quality and accessibility of NHS services. Our response will not be based on the assumption that we will have to restrict access to vital health care services, which would be contrary to the wider public interest, and disproportionate. That is why we have ruled out that approach.
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We are committed instead to maintaining and improving local access to services and have published guidance aimed at ensuring that that principle is fully reflected in local NHS decision making. The focus of the guidance is on redesigning services—not relocating them—around the needs of local populations. The NHS, in implementing the directive, needs fully to develop the contributions of different hospitals and primary, intermediate and social care providers as part of a sensible and integrated approach.
Secondly, in implementing the directive, we must not substitute tired consultants for tired junior doctors because that would benefit neither doctors nor patients. Instead, we need to look carefully, as we have, at the contribution that the whole NHS work force can make in helping to reduce the hours that junior doctors currently work. The EWTD is not therefore just about the hours that doctors work, but goes much wider and deeper.
Thirdly, as we make progress in implementing the directive—and we are—we need to maintain and, where possible, improve the quality of junior doctor training, helping to ensure that the doctors of the future are as well equipped as possible to meet the challenges of a lifetime of professional practice. So in meeting the requirements of the directive—clearly the obligation of the NHS—we must be careful not to compromise on the standards of medical education and training. That, too, would not be in the long-term interests of doctors or patients.
In all those areas, work is already well advanced and I will spell out the progress that has been made. I reject the Opposition's suggestion that little or nothing has been done. They would say that, but the opposite is true. The Department has worked closely with the Academy of the Medical Royal Colleges, individual royal colleges, the BMA—whom I met again this morning to discuss the issue—the NHS Confederation and other organisations to put in place the necessary reforms to help the NHS to implement the directive sensibly. We will continue to do so, working closely with the professions to effect sensible and effective solutions to the very real challenges posed by the directive. Those measures have been backed up by additional investment to help accelerate the necessary changes.
It is true that we do not accept the interpretation that the European Court has recently placed on the meaning of the directive, either in relation to the definition of working time or when periods of compensatory rest should be taken. As I said earlier when the right hon. Member for Charnwood (Mr. Dorrell) asked me to confirm it—I do so freely again—the decisions of the Court in both cases have made implementing the directive considerably more onerous and difficult for the NHS. That is true not just of the NHS in Britain, but for every health care provider across the EU. The SIMAP decision will have a particularly serious impact on the NHS, as it directly affects the pattern of resident on-call rotas worked by junior doctors. It does so, as the hon.
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Member for South Cambridgeshire rightly said, by requiring periods of time spent asleep but on call to count as working time.
Mr. McLoughlin : The Minister acknowledges that the judgment has made it worse for all health services in the EU, so why cannot and has not the Council of Ministers changed it?
Mr. Hutton: We are working precisely to achieve that. If the hon. Gentleman can hold on to his hat for a moment, I will set out precisely the level of progress made at the European Commission and Council of Ministers level.
As I was saying, the judgment has a particularly serious impact on resident on-call time. Given the existing pattern of resident on-call working in the NHS, it will be difficult to comply with that interpretation unless we employ thousands of additional doctors and radically change working practices and on-call rota arrangements. On the Jaeger case, I agree completely with the BMA that, in relation to when compensatory rest should be taken, the ruling is unworkable and unnecessary. Again, we argued in the European Court for a different outcome.
As I have said, these cases have raised concerns right across the European Union. It is not just Britain and the NHS that will face difficulties in implementing the decisions. With the exception of Greece and Lithuania, all member states and all the accession countries have expressed their support for a review of those aspects of the directive. Together with the Health Ministers of Sweden, Denmark and the Netherlands, I raised our concerns over the impact of the rulings with the Commission last July.
In January, the Commission began a consultation on amending the directive to deal with, among other things, the impact of the SIMAP/Jaeger rulings. On 4 March, European Employment Ministers, at their meeting in Brussels, recognised the need for changes to the directive on both of those matters. The Irish presidency concluded that
"the key message from our discussions today is that an urgent European Union solution is needed to address the impact of the recent European Court of Justice rulings."
On 17 March, Commissioner Dimas wrote to my right hon. Friend the Secretary of State, referring expressly to the SIMAP/Jaeger judgments. He commented:
"I am aware of the practical difficulties experienced by the health sector in particular. As the commission indicated at the March Employment Council, I intend to bring forward legislative proposals on the working time directive before the summer."
We very much welcome that acceptance on the part of the Commission that the directive needs to be amended.
We have responded to the Commission giving details of the changes that we are seeking to the directive, and many other member states have done the same. Copies of these documents are available in the Library, and I assume that the hon. Member for West Derbyshire (Mr. McLoughlin) has familiarised himself with them. We will clearly need the support of other member states who have expressed their concerns over the two recent rulings. The proposals for change need to be taken
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forward as quickly as possible, because 1 August is looming. We will keep the House fully informed of developments in that area.
In the meantime, good progress has been made in reducing junior doctors' hours. Our strategy has been twofold. We have sought first to develop an employment contract for doctors in training that reflects the requirements of the Directive and, secondly, to increase the size of the workforce substantially. We have achieved both.
The new contract for doctors in training was successfully negotiated with the medical profession and put into effect in December 2000. The arrangements limit the maximum weekly working hours of doctors in training to 56, which is less than the 58 hours specified in the directive—
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