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Mr. Hutton: Yes, the new deal. The arrangements also specify necessary daily and weekly rest requirements. To support the introduction of the contract, we invested in excess of £150 million over the first three years to implement the contract.
Mr. Bellingham: What would the Minister's attitude be if junior doctors wished to opt out of the working time directive, perhaps because of shortages or particular problems in a hospital?
Mr. Hutton: Under the terms of the directive, junior doctors are able to express such a preference. It is not the job of Ministers to say to individual doctors who wish to exercise that right whether they should or should not do so. That would be contrary to the spirit, letter and intent of the directive, because it is an individual choice for members of staff in the NHS and elsewhere. I fully support the retention of an opt-out in the directive, for the reasons that I gave earlier. It preserves flexibility, which all employment protection measures need if they are to work sensibly and not place unnecessary or unforeseen burdens on business or public services. It also allows us to keep our competitive edge, which is crucial in the context of the European Union. The Government's position on the opt-out has been made clear and I hope that I have dealt with the hon. Gentleman's concern.
As a result of the new contract for junior doctors, there has been a substantial fall in the number of hours that junior doctors are working. It is also pertinent to remember that the hours that junior doctors work are self-certified, so it is not my figures—which is just as well—that show that but those of junior doctors themselves.
Rev. Martin Smyth (Belfast, South) (UUP): People who work longer hours have been required to be more open and honest, but is it possible that some junior doctors have not returned full details of the hours that they have worked out of a concern to keep the medical profession going and provide proper care for patients?
Mr. Hutton
: That is always a possibility and I would not rule that out in every individual case, but it is worth bearing it in mind that the statistics that we collect on
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the hours that junior doctors work are certified by them and they are paid a premium for working more than the minimum hours specified in the new deal. I strongly suspect that the figures are as accurate as we could hope them to be.
In March 2001, immediately after implementation of the contract began, only 55 per cent. of doctors in training were compliant with the new deal requirements. However, latest figures show that 83.6 per cent. of all junior doctor posts are now fully compliant with the new contract, with 95 per cent. of all doctors in training compliant with the weekly limit on working hours. Substantial progress has been made on the part of the directive concerning maximum working hours. Regrettably, I did not hear any acknowledgement of that in the remarks of the hon. Member for South Cambridgeshire.
We have also rapidly expanded the number of doctors working in the NHS. There are more than 7,000 more doctors in training working in the NHS today than was the case in 1997, when the right hon. Member for Charnwood (Mr. Dorrell) was in charge. The number of associate and staff grade doctors has also increased by more than 3,300.
The expansion in the NHS work force is not confined to junior doctors. The number of consultant posts has increased by more than 7,000 since 1997, which represents an increase of 34 per cent., and we are making progress on increasing the number of doctors by a further 15,000 by 2008, over the 2001 baseline figure. That means that not only are we moving rapidly towards a consultant-delivered service, but we have substantially more specialist registrars to provide high-quality services and reduce further the work load of existing doctors in training. We have also met the target for an additional 1,000 specialist registrar posts 18 months ahead of schedule, and expect more to be established over the coming months.
To maintain those increases we are also training a record number of medical students. Medical school intake in England has increased by 2,281 since 1997, representing a 60 per cent. increase. More than 6,000 students entered medical school in England in autumn 2003—the highest number ever recorded. The Government achieved their target of increasing the number of medical students by more than 2,000 places two years earlier than anticipated.
We have similarly increased the number of non-medical staff working in the NHS. Between September 1997 and 2003, the number of qualified allied health professionals rose by nearly 11,000, exceeding NHS plan targets. By the end of September 2003, more than 16,300 former nurses, midwives and health visitors had returned to work in the NHS since February 1999. In total, there are an additional 67,500 more nurses working in the NHS today than in 1997. All those increases will help the NHS in meeting its obligations under the working time directive.
I am sorry to have to say that, in relation to consultants and nurses, my amendment understates the actual numbers of additional staff that have been recruited. [Interruption.] I shall not withdraw the amendment, but at least on this occasion no one can accuse us of spin.
Rob Marris (Wolverhampton, South-West) (Lab):
My right hon. Friend has put his finger on the crux of the
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problem. The negotiations on the working time directive were concluded in early 1993 by the then Conservative Government, who messed things up. They did not foresee the problems that would be caused by the legal judgments or that would result for the training of medical staff. This Government are now sorting out those problems, given the length of time that it takes to train doctors and consultants.
Mr. Hutton: I am grateful to my hon. Friend for those remarks. I am glad that he feels that I have got to the crux of the matter, although I believe that I am about to come to that—
Mr. Hutton: The hon. Member for South Cambridgeshire took 40 minutes to reach no particular point, so if hon. Members will be patient, I may be able to score at least one home run. That is all that I hope to do.
Recruiting more doctors, although essential, will not, by itself, be enough. The rapid and extensive growth in doctor numbers represents a massive achievement for the NHS, which comes back to the point made by the hon. Member for Rochford—
Mr. Hutton: I apologise. That is where my sister lives. I do not think that she voted for the hon. Gentleman, although I had better check that. I doubt whether we could recruit the many thousands of additional doctors needed to meet the effect of the SIMAP and Jaeger rulings if our only response to the directive was to replicate existing patterns of working by junior doctors. That relates to the discussion about costings that we had in the European Standing Committee.
The costings that we provided for the European Standing Committee were based on the assumption that the response was based solely on recruiting additional junior doctors and staff-grade doctors—those who are not consultants, but are not in recognised training posts. Although one cannot be 100 per cent. accurate, the cost of employing doctors is generally higher than the costs of recruiting additional nursing staff, and that was the point made by the Under-Secretary of State for Trade and Industry, my hon. Friend the Member for Bradford, South (Mr. Sutcliffe), when he summarised the debate in the European Standing Committee.
I am sorry if the hon. Member for Rayleigh (Mr. Francois) felt that we had not provided him with the costings, but my hon. Friend was making the point that, if we need fewer doctors but more nurses, the overall cost of compliance is likely to be less than those figures, not more. By the look on the hon. Gentleman's face, I am still struggling to get that point across to him.
Mr. Lansley: If the Minister is making that argument, why does paragraph 3.1 of the UK response to the Commission on SIMAP and Jaeger say:
"The cost of recruiting several thousands of extra . . . doctors . . . would run to hundreds of millions of pounds per annum"?
"The alternatives to employing additional doctors, as set out above, are likely to cost approximately the same as recruiting more doctors."
That is completely contrary to the point that the Minister is making.
Mr. Hutton: No, with great respect to the hon. Gentleman, I do not believe that to be the case. The point that I am trying to make today—
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