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Mr. Stephen Dorrell (Charnwood) (Con): Most of what I have to say this afternoon concerns junior doctors' hours, but before moving on to that question, I must say that I agree with almost everything that the hon. Member for Dartford (Dr. Stoate) has just said. In particular, I agree that it will be possible to develop primary care under the new general medical services contract.
One might have hoped that he would take a view back into history, to before 1997 in his remarks about making out-of-hours services more flexible so as to reflect the needs of the medical profession, as well as of the patient; the development of a more flexible local definition of what general medical services means, including local contracting through the practice management system; the development of a broader range for pharmacists; and the development of services that are available through GP surgeries. The development of primary care did not begin miraculously in 1997, or even, I hasten to add, in 1979—it has been carried through by Governments of all political complexions over a long period, and is an important success story for the national health service, whatever the political label of the Government at its head at any particular moment in time. I agree with what the hon. Gentleman said, but he is not entitled to claim exclusive credit for the process as one that started on 1 May 1997.
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That is a broadly non-partisan comment. I hope that what I am about to say about junior doctors' hours is also non-partisan, but I suspect that it will lead to rather less agreement across the Floor of the House. Anyone who has attended health service debates over many years knows that the whole subject of junior doctors' hours in the NHS is a very long-standing issue. In the period before 1990, in particular, and cumulatively over several years, it got seriously out of control. There is no argument about the fact that the position before the introduction of the new deal could not be defended in the modern world. Doctors were being asked to work in circumstances that did not provide high-quality training for them or high-quality care for their patients.
I was a junior Minister when the new deal was signed and Secretary of State for two years during its implementation. That process started in 1991 and went on regardless of the change of Government that took place in 1997. The commitment first to recognise that there was a real problem with junior doctors' hours, then to do something about it, was shared across the political divide. More importantly from the point of view of both doctor and patient, it was being addressed by the health service as employers and by doctors' representative organisations—the British Medical Association and the royal colleges—without the need for a legislative framework to oblige them to do so. The situation had clearly become insupportable—action needed to be taken, and it was.
That is why I asked the Minister whether he felt that the adoption of the legislative framework of the working time directive makes the delivery of the shared objective of better management of doctors' hours easier or more difficult. As there was a clear commitment to do something about it, and action was being taken by the employer in agreement with the profession, I genuinely do not understand why the Government see no conflict between delivering that desirable objective—which is shared across the House—and the adoption of a legislative framework that, as the Minister recognises, makes it more difficult for him to do so.
In understanding that conundrum, it is important to understand why addressing the issue of junior doctors' hours is extremely difficult for the health service management and for the training authorities of the royal colleges. If it were simply a matter of saying, "People should not work ridiculous hours—let's change the law and do something about it," it is reasonable to assume that somebody would have done something about it before the situation got as serious as it had by the late 1980s.
There are difficulties in ensuring that the medical work force have sufficiently diverse training to deal with the wide range of circumstances that they will need to be able to cope with in their professional practice. My right hon. Friend the Member for Richmond, Yorks (Mr. Hague) talked about the difficulties involved in delivering medical cover in community hospitals. That applies not only to very remote rural areas, but in relation to, for example, the delivery of maternity services and minor accident cover in community hospitals, which is an issue that regularly arises in the life of a health Minister. That is compounded by the—entirely benign—move in the medical profession towards increasingly specific sub-specialisms.
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All those factors make it hard to deliver a proper training regime for doctors alongside a commitment to reduce working hours. The fact that the issue is complex and difficult, and is recognised as such, adds extra point to the question of why it is necessary to introduce a legislative framework that complicates the delivery of a shared, if admittedly difficult, policy objective, given that the only result of introducing that framework is to make the delivery of the objective even more difficult. The Minister stressed that we should not seek to adopt a one-size-fits-all approach, but that is precisely the result of introducing an unnecessary legislative framework, because history demonstrates that the issue was being resolved before that framework, which will make it more difficult, was introduced.
As my right hon. Friend the Member for Richmond, Yorks said, the difficulty is compounded by the fact that we are talking not only about a legislative framework but about a legislative framework that is being introduced in a European context. That means that the Government as the employer cannot ultimately introduce the changes that are necessary to make the policy deliverable. It is worth remembering that the working time directive was introduced by the authorities in Brussels under the single market legislation because it was felt to be necessary to deliver a single market. It is perverse to imagine that the free movement of goods and services around the European Union is promoted by confusing the problem with the delivery of junior doctors' hours in our, or indeed anybody else's, health service. That is why I do not understand why the Government welcome the introduction of a legislative straitjacket the result of which is to make the delivery of their policy objective, which I share, more difficult.
The Government are entitled to some sympathy, given that—to employ the much-used cliché—we are where we are. We have a legislative framework, and the Government have to try to obey the law and to deliver their policy objectives within the health service. They have to try to square that circle. The hon. Member for Sutton and Cheam (Mr. Burstow) pointed out that the legislative framework has been in existence since 2000, and we are now talking about August 2004, but we have a very unclear idea about how the circle is to be squared—we are simply asked to rely on the words of the Minister, who is sure that it will be all right on the night.
It really is not good enough to say that that European working time directive might have been okay, but the problem was compounded by the SIMAP judgment. The SIMAP judgment concerned the definition of the phrase "working time" as it applies in the medical profession, and it was about a very simple question: does time that is spent on call count as working time? One does not have to know much about the history of this issue to know that that question goes to the heart of the management of doctors' hours during their training. That is what all the arguments were about throughout the 1980s and 1990s. In 2000, legislation was introduced, as far as we know without active disagreement by the Government, on the extension of the working time directive to cover the medical profession, but without having decided, and leaving it to the courts to decide, the fundamental question of whether "working time" refers to time on call or time treating patients. It is a pretty
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broad-brush measure. Although it deals with extending working time legislation to junior doctors' hours, it does not define working time.
The charge against the Government is that they were content to allow the measure to be introduced without properly considering the implications and the definition at its heart. It has been in force, complete with the interpretative judgment, for three and a half years, and we still await any clear idea about the way in which the Government intend to interpret it. They have been caught asleep on the watch during an important health service development and consequently patients are at risk.
3 pm
Mr. Adrian Bailey (West Bromwich, West) (Lab/Co-op): I welcome this debate. The issues that it raises are serious issues that local health care professionals have drawn to my attention, and we now have a welcome opportunity to discuss them in the Chamber.
Having said that, I think that the motion is alarmist and concentrates narrowly on specific aspects of the subject. It is designed not to shed light but to cloud the positive benefits that have accrued from the Government's health policies and to spread an impression of impending doom and gloom. It also reflects one significant failure in Government health policy—the inability to cure the parliamentary Conservative party's collective amnesia about its record in government.
There is a debate about the robustness of the British Medical Association statistics, but let us assume that they are robust. Conservative Members' reaction to them, as reflected in the motion, is out of all proportion when compared with the predicament in which they left the health service in 1997, when there were 224,000 fewer staff, including 60,000 fewer nurses and 19,000 fewer doctors. The amendment outlines other figures, which I am told are understated and therefore not spun. To continue the cricketing metaphor, it is a question of reverse spin. Even on the Opposition's gloomiest prognostications, the staffing and ability in the NHS to meet the challenges that the debate covers are hugely improved since the Government came to power in 1997.
Let us consider one or two specific matters. General medical services contracts and the European working time directive and its impact on junior hospital doctors' hours have been discussed. Although I do not contest the difficulties that those policies may cause in some circumstances, their overall thrust accords with recognised priorities that have existed, as some Opposition Members said, for a long time. The effect in reducing junior hospital doctors' hours and giving general practitioners betters hours, more flexible working and greater reward will hugely enhance the attractiveness of the medical profession to would-be trainees and help to realise the Government's objectives for the doctor provision that is necessary for the nation's growing health needs.
I was surprised by the weight that the Opposition attached in the motion to out-of-hours services. In my discussions with my local primary care trust, the issue has not been raised. The gloomy forebodings in the motion do not appear to be reflected in reactions on the ground. I checked with my local doctors' surgery and was told that the service would continue as it had done previously and that there would be no deterioration.
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My constituency is in a traditional inner-city area, Sandwell, which has historically suffered a range of health problems. Even now, life expectancy is considerably below average and the area has historically been provided with too few doctors. However, if one examines what is happening on the ground, the motion does no justice to the true picture in an area that has suffered from under-provision and deals with a greater range of health problems than the average. My surgery, which is less than 300 yards from where I live, is expanding. It is due to have two extra doctors, is extending its premises and will become a university training centre.
The Neptune health centre in the middle of Tipton deals with one of our most deprived communities. It intends to take on a range of services that the local acute hospital previously provided. The Tipton care organisation and the Great Bridge partnership for health have pioneered new, joined-up and flexible working, which has involved GPs working with physicians' assistants and a range of nursing support. That has meant taking on roles and responsibilities that only specialist doctors undertook hitherto. In Sandwell, there is a pioneering flexibility in the provision of health care, which, by having multi-skilled groups dealing with a much wider range of health needs than under the former model, epitomises the Government's approach.
The motion fails to convey exactly what is happening on the ground and is therefore misleading. The Minister and all hon. Members can cite statistics, but they do not do justice to what is happening, either. When talking to local health professionals in my area, I have been impressed not so much by statistics as by the almost evangelical spirit that they have displayed in meeting the sort of challenges that the area presents, and by the way in which the new structures, working methods and funding have boosted their morale. They recognise that measures such as the European working time directive are a challenge and that there are problems in recruiting doctors. Such problems have always existed in my area and the retirement of the first generation of Asian doctors will present further problems.
However, health professionals not only recognise the problems but know that they can deal with them. The potential funding exists and there is an opportunity to make the case to meet the challenges ahead. I have been hugely impressed by the way in which they have sought to embrace the Government's agenda. Consequently, health care is improving in my locality.
The European working time directive presents challenges and the European Court of Justice judgment creates difficulties. However, the extra funding, staffing, new ways of working and missionary zeal that I have noticed in so many local health care professionals means that the challenges will be met. The health care professionals are much better placed to do that through the Government's policies. We should reject the motion because it fails to recognise that that is the reality on the ground.
3.10 pm
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