Working Time Directive

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Mr. Clifton-Brown: The Minister has said something helpful and I should like him to repeat it. He said that even if the court case went the wrong way, he would not expect any services in either the NHS or social services to be shut down as a result of the directive. Could he please confirm that?

Mr. Hutton: Yes, that certainly is our intention. I said earlier that we have to resolve a number of different and, to some extent, competing issues. However, my right hon. Friend the Secretary of State and I are clear that our first responsibility is to provide services for the public, in the present case for NHS patients. That is why I do not envisage services or units closing because of the directive. That is our position and what we intend to ensure happens.

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Stephen Hesford (Wirral, West) (Lab): I should like to ask my right hon. Friend about SIMAP and Jaeger in relation to doctors in training. Is not he comforted by the fact that junior surgeons, or those who wish to become junior surgeons, are likely to want to use the opt-out in order to work the hours needed to satisfy the royal colleges' training requirements? Will that not help the situation?

Mr. Hutton: The situation would certainly be helped if junior doctors took the view that my hon. Friend describes. That would shoot the fox of the hon. Member for Cotswold (Mr. Clifton-Brown) fairly squarely between the eyes, because the answer to his question would be nil. The junior doctors whom I meet have various views on the matter, as one would expect. Some say that they will want to exercise their right to opt out, for the reason that my hon. Friend described. Others may not want to do so, for other reasons. It is hard to plan for continuity in services if one cannot be sure of how one will get through such difficulties. That is why we are working with doctors, nurses, managers and others in 20 NHS sites to devise flexible staffing rotas in time for 1 August. It is important that we continue to do that and disseminate the results of that work across the NHS as a whole.

I do not want to repeat myself, but as I said earlier, the more that I have considered the issue and worked with the service, the clearer it has become that the sensible changes that we are considering making in our hospitals as a result of pressure from the directive, particularly to overnight and weekend practices, are precisely the reforms that a well managed and effectively led service should consider making in any regard. It would be difficult to find many junior doctors who would say that the on-call rotas rotas that cause difficulty under the directive allow for the work environments in which they can get meaningful and helpful training. Many juniors have told me that they do not. I take some comfort from my hon. Friend's helpful intervention, and I hope that he feels free to make more.

Several hon. Members rose—

The Chairman: Order. May I ask the three or four Members who want to ask questions to move the proceedings along quickly?

Rev. Martin Smyth: The working time directive applies to more than health workers. I will come back to them, but I was humorously thinking that it would have been interesting to see what would have been done in the Scottish Parliament, where people were kept on site to do nothing. I do not know whether they would have been within the hours.

I appreciate the concern about closures, but does the Minister agree that those who went to study medicine in 1997 in increased numbers are not yet qualified to be GPs or consultants? It takes a long time before our homespun people come on line. Does he also accept that there is growing concern about the number of nurses who are due to retire and the low numbers of new nurses? Will that not also have an impact on the provision of services if the impositions of the working time directive are strictly applied?

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Mr. Hutton: I agree that we need to keep a close eye on the issue that the hon. Gentleman has raised, although the situation may not be as dark as he and others have suggested. I know that there is a figure flying around suggesting that a quarter of all nurses are within five years of retirement. That is not strictly true, as the assessment starts from the assumption that people aged 50 will retire within five years. That is not true of the NHS and nurses in particular. We have to keep a close eye on demographic trends, but I hope that he will accept that a significant number of nurses are being trained in the United Kingdom, which is positive for the national health service.

Mr. Bellingham: I have two quick questions. First, how many junior doctors will use the individual opt-out to work longer than 48 hours if the directive is implemented as the Government imagine? Is it possible for junior doctors to do that? Secondly, other sectors will be affected by the case law of the ECJ. We have heard about offshore workers, but what will happen to police officers? I presume that there will also be problems about the timing of compensatory rest, so how many police officers are likely to be affected? Perhaps the Under-Secretary can answer the second question, and the Minister of State the first.

Mr. Hutton: I shall have a go at the first question. There are 37,000 junior doctors in training in England. With the best will in the world, I cannot tell the hon. Gentleman how many will exercise their right to an opt-out. As my hon. Friend the Under-Secretary has made clear, those are individual decisions, so sadly it is information that I cannot give the Committee today.

Mr. Sutcliffe: I admire the initiative of the hon. Member for North-West Norfolk (Mr. Bellingham) in asking two questions in one go. The issue for the police is not as important because of the shift patterns that are worked. However, I undertake that if the situation varies dramatically, I will come back to him on it.

Dr. Murrison: I have an observation, and I should appreciate the Minister's thoughts. In the 1970s, we got dentistry badly wrong. Successive Governments failed to plan properly, and we are now living with the effects. Is he confident that he is not making the same mistake? Will he also give his estimate of likely cost of the measure? I have my own views, which are based on the consultations that I have had with acute trust chief executives, who cite figures of between £500,000 and £2.5 million each. One can extrapolate that to a cost of about £300 million as a result of the directive. Does he feel that that is a reasonable guestimate?

Mr. Hutton: It is very difficult to judge, and I do not want to put a price tag on the measure because so many ifs and buts are associated with it. We have been over the issue before, and I do not dispute the fact that there will be a cost. However, it is difficult for anyone to identify specific costs related directly to the working time directive in the way that the hon. Gentleman has suggested, for the very reason that I have tried to explain. These changes will be necessary in the long term and may be helpful to the wider national health service.

It is difficult for me to respond to the point about dentists. I think that the hon. Gentleman was simply

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asking me how many dentists we will need in future. We need more than we have. We have substantially increased the number of dentists in training and we are looking at how we can further expand the dental work force.

Richard Younger-Ross: I am almost flabbergasted. The Minister says that he will win the arguments in Europe, but he cannot tell us what those arguments will be because he cannot tell us what the costs will be. How will he win that argument when he cannot work out the total costs of implementing these regulations if the argument is lost?

Mr. Hutton: The hon. Gentleman is too easily flabbergasted if that is his perception of the debate. I refer him back to the paper that we sent to the Commission last year setting out all the figures and the worst-case scenarios. I regret that he has not read that information.

Mr. Francois: If this has all been put on paper and sent to the Commission and the calculations have already been made, that saves us a lot of time and trouble. Will the Minister please tell us exactly what the financial figure is for the worst-case scenario?

Mr. Hutton: It would be hundreds of millions of pounds.

Mr. Francois: How many hundreds?

Mr. Hutton: The hon. Gentleman has made a perfectly fair debating point. There is a figure. I do not have it with me, but I am sure that by the end of the proceedings I can give it to him. We told the Commission that in the worst-case scenario we might need to recruit between 6,000 and 12,000 additional doctors. That is on the public record. I will get him the figure for the cost before the sitting ends.

Mr. Francois: We have already established that the issue is the additional cost not only of doctors, but of related nurses and support staff. Giving the figure for the cost of doctors will be helpful, but it will not give the true worst-case projection. We need the overall total likely worst-case figure. That is the figure that we all need by 4.30 pm, and I hope that the Minister will undertake to provide it.

Mr. Hutton: As is always the case in these situations, my file now has the information that I was seeking. The cost in relation to doctors would be between £380 million and £780 million if we did nothing other than respond to the directive by recruiting those additional doctors. I was right to say that the cost would be hundreds of millions of pounds. I am not sure that I can attempt a similar calculation for nurses, but I will do my best to inform the hon. Gentleman before the end of the sitting.

Mr. Clifton-Brown: I know from the discussions with my primary care trusts—the Minister will have had similar discussions—that these things are incremental. The Government have introduced new health and safety regulations requiring more staff, and they have introduced the GP contract and the consultants' contract, which will require more staff. I assume that if the directive goes through, we will need

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more junior doctors, nurses and support staff, and that the Government are planning in that regard. Presumably, we could get into a situation in which junior doctors were provided by agencies, which would cost the NHS a hugely increasing part of its budget. Has the Minister had discussions with the Treasury about a larger budget for the NHS to meet the directive if he finds he cannot live within the Chancellor's three-year expenditure plans?

 
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Prepared 24 March 2004