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Dr. Andrew Murrison (Westbury) (Con): This has been a good debate, throughout which excellent speeches have been made. I was particularly struck by the quality of the Conservative speakers, who included no fewer than three Privy Councillors.
A number of interesting points have been raised. It is a pity that the Minister was ever so slightly prickly in his opening remarks, for he had no need to be. Our motion was tabled in good faith. While we broadly support much of what has been discussed today, we have problems—problems raised with us by our constituents. It is right and proper for us to counsel caution when it comes to matters that affect a vast work force, one of the biggest in the western world. I hope that Ministers will take that in good spirit, and will do their level best to respond to the genuine concerns that have been expressed.
The Opposition believe that the health and safety of doctors and their patients should not be compromised. Doctors should not be forced to work unacceptably long hours. We have heard from two doctors today, who spoke of one-in-two and even one-in-one rotas. I worked a one-in-two rota for two years. I would like to say, in a curmudgeonly sort of way, that it did me no harm; but I will not say that, because I suspect that it did harm me, and I am sure that it did not do my patients any good at all.
I think back to 1991, when a Conservative Government produced "The New Deal for Junior Doctors". It was a good piece of work but, sadly, by March 2002 the BMA was complaining that a third of juniors were still working beyond the limits set by it. During the intervening time, we had failed to get to grips with what I consider to have been a very positive
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measure. That leaves me somewhat concerned about the future of the working time directive, and Ministers' sincere and well-meant efforts to improve things for junior doctors and, most important, the patients in their charge.
In January the Minister of State told us:
"Complying with the Working Time Directive need be neither costly nor a burden."
I trust the Minister implicitly, but I have sought a second opinion. I have written to 170 acute trust chief executives asking for their views on how things stand. I asked them what problems they envisage in the meeting of deadlines, what assistance they are being given by Government, and how they think it will all pan out in the months ahead. I have received good, if mixed, responses. As might be expected, those from people making their careers in the health service are fairly positive. In general, they constitute measured and reasonable attempts to address the big problem that all the respondents clearly face.
One word occurs time and time again—"challenging". All the respondents feel challenged by the directive. "Challenging" can mean many things, not necessarily bad, but I believe that in the context of my inquiry those people really do feel up against it. I am not surprised that no one now seriously believes that the targets that have been set will be met throughout the NHS—the Minister said as much today. It would be interesting to know where the trusts stand in terms of the penalties that may apply if they do not meet those targets; I should like to hear what the Minister thinks.
The Minister says that trusts have been given £46 million to meet the costs of compliance. I must press him on that. The matter was debated in European Standing Committee C, but, as my hon. Friend the Member for Rayleigh (Mr. Francois) pointed out earlier, we have not been given all the answers that we would like to have been given. It is all to do with quantifying the costs. Last month, in the Committee, we finally managed to elicit from the Minister the fact that compliance could cost up to £780 million and require between 6,000 and 12,000 more doctors. The upper limit exceeds even my estimate, based on my poll of acute trust chief executives. It also exceeds the BMA's estimate. If the Minister genuinely believes that the cost will reach that level, we need more details—in writing.
I was further confused by a written answer, which I received only yesterday, to a parliamentary question that I tabled 10 days ago about the methodology used by Ministers to arrive at these figures. I was told:
"Actual costs or numbers of additional staff required are not held centrally and could not in any case be disaggregated from the overall cost of NHS growth and modernisation."
That is rather odd, coming from a Government with an insatiable demand for data relating to targets they have set with a view to the generation of politically obliging headlines, which we see all the time. I really must press Ministers on whether they are sticking to the figures of up to £780 million and between 6,000 and 12,000 doctors—and, if so, on how those figures are derived.
The Minister of State made a confusing statement concerning the guidance that was issued to European Standing Committee C about the possibility that that upper figure might be shifted downward if we used alternative means of providing the cover currently
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provided by doctors. I hope that the Minister will clarify that in her closing speech because, if it is wrong, we should know about it.
Paragraph 3.1 of the guidance says:
"The cost of recruiting the several thousand extra middle grade doctors required for the UK would run into hundreds of millions of pounds per annum. This includes on costs, overheads and training costs. The alternatives to employing additional doctors as set out above are likely to cost approximately the same as recruiting more doctors."
Are we saying that £780 million is a reasonable reflection, or are we seriously saying that by changing working practices and using other health care professionals the figure can be brought down, because that is not what the Department's own written guidance says? I seek clarification from the Minister.
The Government have rightly increased the number of places at medical schools, but I would like to know how they arrived at the figures that they think are required. We have heard that they feel that between 6,000 and 12,000 more doctors will be needed to satisfy the working time directive, but I cannot believe that the number of places provided at medical schools has been calculated on an empirical basis. I hope that the directive and its strictures have been factored into the assessment that Ministers have presumably made of how many doctors we will need in the future.
An historical example emphasises the point in a cautionary way. In the 1970s, consecutive Governments predicted the number of dentists that we might need now, based on the incidence of dental caries and the fact that fluoridation was predicted to reduce it. Unfortunately, they got it wrong, and that is at the heart of our current problems with NHS dentistry. We do not want to repeat such a mistake, do we?
The working time directive was incorporated into domestic legislation in 1998, yet it was 2002 before invitations were issued to undertake pilot schemes in the NHS. It is not good enough for Ministers to say that the problem with the roll-out of those schemes has been anyone's fault but the Government's. It is unreasonable to say to trusts that they have not got their act together, as it is clear when one considers the time scales involved that the fault does not lie with them at all. Indeed, contrary to Ministers' assertions, many of them have been quite enthusiastic about the schemes. I cite in particular the hospital at night schemes, which many of them have warmly embraced, and rightly so. Of course they favour the more efficient use of human resources, but none of the ones that I consulted is under any illusion that hospital at night or any other piloted scheme could address the staffing shortfall. One trust said:
"None of the projects has achieved working time compliance and they have required central funding which may not be available when the initial project ends."
Yesterday, we saw the most extraordinary three-point turn in recent political history. The Prime Minister might have set something of a trend. If so, in the new spirit of openness, it would be refreshing to hear whether Ministers, in retrospect, are content with the way in which they have handled the implementation of the European working time directive, or whether on reflection they share the obvious concerns expressed by the trusts that I have consulted.
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As EUROSTAT has shown, our health service is fundamentally different from those in Europe. We have 1.4 junior doctors for every senior doctor, while Europe has one junior for every four seniors—it is turned on its head. We have the fewest doctors per head of population in Europe. Because of the slack in Europe and because it has proportionally far fewer juniors, it is arguably better placed to implement the directive with relative ease, while our NHS will clearly struggle with it. The NHS will clearly feel challenged by the directive; "challenging" is the word that has come across time and time again in the consultation exercise that we have undertaken.
That is surely all the more reason for the early pilot schemes that we simply have not had. There were four wasted years between the implementation of the directive in 1998 and the invitation to conduct pilots in 2002.
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