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Mr. Hutton: The hon. Gentleman has just tried to make the argument that only the UK faces that particular pressure for additional doctors. I do not know whether he has read the submissions that all the other member states of the European Union have made to the Commission, itemising the difficulties that they face in implementing the directive, but if he has, he will have seen the long list of additional doctors that Germany, France, Sweden, Holland and Italy all require to meet the terms of the SIMAP and Jaeger judgments. This is not just an English problem.
Dr. Murrison: Of course it is not just an English problem. The point that I was trying to make by giving EUROSTAT statistics is that our NHS is fundamentally different from systems that operate on the continent. I am sure that the Minister accepts that and, in particular, the statistics on the ratio of junior doctors to senior doctors. Clearly this matter primarily involves junior doctors, and if the Minister cannot understand that, he merely underscores my concerns. We know that there are far more doctors per head of population in Europe than in this country. Clearly, the employment environment in the health service in this country is fundamentally different from that which applies in Europe, which makes the roll-out of the European working time directive far easier in Europe than in this country. I am sure that the Minister must admit that.
Several right hon. and hon. Members have rightly discussed cottage hospitals, and I am worried, from the Minister's remarks, that he perhaps does not fully appreciate the impact that the GP contract might have on community hospitals. I have cited my specific example and from the conversations that I have had, I am sure that it is mirrored up and down the country.
It is just not good enough to say that the new GP contract has nothing to do with any contractual arrangements that GPs may have with community hospitals. There are clearly bolt-on effects. Although I accept that there is limited direct linkage between GPs' contracts to provide out-of-hours cover to their patients and their arrangements with community hospitals, in practice, as I am sure other hon. Members will bear out, GPs facing the removal of their out-of-hours obligation
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will not then subscribe to the knock-on obligation to community hospitals to which they currently subscribe. That is the current problem for community hospitals. If the Minister does not appreciate that, he must go back and examine the matter, which is a real concern in my area and many others. We have heard about it in other contributions today.
"Keeping the NHS Local", published in February 2003, was a good document that Ministers perhaps need to dust down and remind themselves of. They need to remind themselves—I hope that they will be reminded of this in the big conversation—that people want their health care delivered locally. Will Ministers please dust down "Keeping the NHS Local" and apply it to the current problem of GPs opting out of their community hospital cover? Two of my community hospitals, in Warminster and Westbury, have already sustained closures this year, in the stroke unit and one of the general wards. Those closures are directly related to the current debate on GPs' hours.
We have heard about Saturday morning surgeries, and we might also have heard about the problems that GPs will face on Monday mornings. If there is perceived to be inadequate or patchy cover over the weekend, people might be queueing up on a Monday morning to get the treatment that they want from their doctor. I hope that Ministers are looking into that.
The Government have known since 1998, and arguably earlier, that the European working time directive would pose serious problems to the NHS. They should have known about the potentially devastating implications of the new GP contract for community hospitals. Ministers knew that staffing costs would rise, and that the supply of doctors would be insufficient for needs. They knew that any extra money for the NHS would be mopped up by some of the extra costs brought about by a series of initiatives—not only the European working time directive—introduced since 1997. Disingenuously, they have referred to extra doctors when they should have been talking about the likely reduction in doctor hours available to the service by 2009. They have over-hyped cash flow, knowing full well that much of that will not reach the front line. It is little wonder that our constituents stand aghast as Ministers deliver evermore upbeat assessments of improvements in the NHS.
3.44 pm
The Minister of State, Department of Health (Ms Rosie Winterton): In introducing this afternoon's debate, the Opposition have alleged that Ministers are somehow complacent about the implementation of the European working time directive in respect of junior doctors' hours and have failed to anticipate the effect of the new GP contract on out-of-hours cover. On the Government side, we have shown that that is plainly not the case.
The starting point of the debate is whether doctors ought to be working excessive hours. We believe that, whether they are working in hospitals or general practice, it is bad for doctors to have to take critical decisions while overtired and overworked. That was eloquently described by my hon. Friend the Member for St. Albans (Mr. Pollard).
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My fellow Minister of State made it clear in his opening contribution that on the issue of out-of-hours cover, the Opposition have ignored both the statutory duty of primary care trusts to provide it and what is actually happening on the ground. As my right hon. Friend said, at the moment only 5 per cent. of GPs provide their own out-of-hours cover. GP co-operatives and private providers already carry out most of the cover and we are continuing to work to ensure that the new arrangements work well and in the best interests of patients.
The right hon. Members for Richmond, Yorks (Mr. Hague) and for North-West Hampshire (Sir George Young) drew attention to some of the difficulties in bringing about out-of-hours cover and the right hon. Member for Richmond, Yorks particularly drew attention to what is happening in rural areas and to the challenges that they face. I was pleased that both Members drew attention to the hard work being put in to ensure that there is no reduction in services, and they received assurances that that would not be the case as more resources were going in. As my right hon. Friend said, specific allocations have been made to rural areas on top of the extra £350 million targeted to support out-of-hours services.
With regard to the working time directive and junior doctors hours, my right hon. Friend told the House that because of the recent decisions of the European Court of Justice, implementation of the directive will be very demanding for the NHS. The right hon. Member for Charnwood (Mr. Dorrell) also referred to that. We agree about the difficulties, which is why, together with other European countries, we have made clear our concerns—and the Commission has accepted that the directive needs to be amended. My right hon. Friend gave the House an assurance that he would keep it fully informed of developments in that respect.
Dr. John Pugh (Southport) (LD): Will the hon. Lady also emphasise that Ministers have constantly been in touch with the small hospitals group and that meetings have taken place with those hospitals and with the Royal College of Physicians to discuss the working time directive and the European dimension?
Ms Winterton: Yes, my right hon. Friend has certainly met them and continues to engage in discussions with them.
At the same time as successfully making representations to the Commission, we have put in train a number of measures to reduce junior doctors' hours, to increase the numbers of doctors in training, and to establish pilot schemes to look into the implementation of the working time directive. In doing so, we have made it clear that our priority is to implement the directive in a way that maintains both the quality and accessibility of NHS services—a commitment praised by the hon. Member for Wyre Forest (Dr. Taylor), who also praised the work of my right hon. Friend the Minister of State. I mention that because my right hon. Friend was not in his place at the time.
My hon. Friend the Member for West Bromwich, East (Mr. Watson) referred to new ways of working that will be necessary to ensure that we maintain service provision. For example, he highlighted in his area the
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better use of nurses' time and skills. My hon. Friend the Member for Dartford (Dr. Stoate) mentioned that as well, and referred particularly to the role that pharmacists can play. We need to consider the role that they can play under the new contract, and my hon. Friend knows that I strongly support such a move.
The hon. Member for Sutton and Cheam (Mr. Burstow) raised the issue of what would happen if trusts were not compliant. Pilots spread best practice, as we know from the results so far, and it is unlikely that the whole of a trust will be not compliant. Certain areas will have particular difficulties, including, for example, obstetrics—as the hon. Member for Wyre Forest pointed out—and, possibly, paediatrics.My right hon. Friend the Minister of State meets regularly with the BMA and others and will issue guidance on problems that may arise in such specialties.
The hon. Member for Westbury (Dr. Murrison) raised the issue of cost. As my right hon. Friend said, some £46 million has been provided to assist with compliance, but it is impossible to disentangle plans for compliance from trust plans to modernise and improve services generally, as well to meet other key NHS priorities. We have not asked trusts to quantify costs separately as that would be an added burden. Planning for working time directive compliance forms part of overall NHS planning, but in each trust the solutions will need to fit local circumstances, which will differ from place to place.
The hon. Members for Westbury, for Wyre Forest and for Sutton and Cheam raised the issue of community hospitals and out-of-hours services. I reiterate that the new general medical services contracts have no bearing on the arrangements whereby GPs provide medical cover for patients occupying beds in community hospitals. Agreements that GPs may have with a community hospital are separate from their primary medical services contracts, and PCTs should decide locally how to commission such work as part of their broader commissioning strategy. Discussions have taken place in Warminster, and continue to take place. Three months cover has now been provided, as the hon. Member for Westbury knows—we have corresponded on the matter—and the minor injuries unit has been reallocated to Westbury.
Yet again, the Opposition have shown us that they are less interested in solutions and what is best for patients, staff and those who make our health service work, and more interested in sniping about the NHS and undermining those who work in it. That is not surprising, because when they were in power the attempts they made to reduce working hours for junior doctors were too little, too late. When in power, they also cut trainee numbers. This Government have reduced the hours of doctors in training: 95 per cent. of them now work for 56 hours or fewer a week. This Government have increased work force numbers so that there are almost 7,300 more consultants and 67,500 more nurses than there were in 1997. This Government have increased the number of medical school places so that 6,030 students entered medical school in 2003.
Also, this Government's new GP contract has been welcomed by the BMA as being
"better for patients and better for everyone working in general practice".
The Government welcome the overall aims of the working time directive to ensure humane working hours for doctors, but those on the Opposition Front Bench have not learned any lessons. They have not said that they would recruit more health staff than we are recruiting already; nor have they said what reforms to contracts and working practices they would introduce. In fact, they have said very little of substance—but perhaps I am being slightly unfair, as they said that they would support the agenda for change.
Opposition Members might like to look at an article in The Times on 24 November—an interview with the hon. Member for South Suffolk (Mr. Yeo)—which says:
"The Conservative Party put itself on a collision course with doctors and nurses last night by announcing plans to scrap national pay agreements in favour of local hospital deals with staff."
"The policy has been condemned by the British Medical Association as 'divisive', while the Royal College of Nurses said that it would do nothing to solve recruitment problems."
"What we want is for hospitals to be able to reflect local conditions and have the freedom to negotiate with their staff. That is one of the characteristics of independence in our view. Clearly the more independence you bestow on an employer, the less scope there is for uniform national contracts."
Of course the Government appreciate that the Opposition are still tying down certain aspects of their health policy—in fact, most of it—but we had hoped for something more constructive and less muddled from them when they decided on the topic for today's debate.
The Government are working with patients and staff to deliver real improvements in the NHS for the benefit of everyone. Only the Conservative party does down the NHS, because it does not share our belief that the NHS is the best way to deliver decent health care to everyone in this country. That has always been the case, and we have heard today that, despite all the Conservative party's rhetoric and protestations, it really does not believe in the health service. Not only are 166 Conservative MPs sending out that message, but we now know that a whole gang of prospective parliamentary candidates, highlighted today, are also going out and undermining NHS staff.
We believe in the NHS, which is why I urge the House to vote against the Opposition motion and for the Government amendment.
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