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5.23 pm

John Mann (Bassetlaw) (Lab): I am sure that there will not be any hon. Members who wish to leave the Chamber until they have had the benefit of hearing my contribution. No doubt those who do so will want to read it in the morning.

I wish to begin by declaring two interests. Of course, my family and I are users of the national health service, which we use, and will continue to use, exclusively. I am an unpaid member, too, of the editorial board of People Management, which is the leading human resources management magazine in the country.

I make the point because I note that there are two young and keenly engaged Ministers on the Front Bench. In the political traditions of this country, one of the problems faced by all Governments is that Ministers change so rapidly. That has always been the case. I have never fully understood the logic whereby successive Governments of all kinds have chosen to keep changing Ministers rapidly, with Ministers moving between different portfolios. That creates a potential problem for Ministers when they inherit the results of the actions of previous Ministers, in addition to the problem of mastering the brief. The point is not specific to the debate today. It applies to the technical issues that arise in attempting to hold the Government to account.

My suggestion to the Government and anyone else who cares to read Hansard tomorrow is that one of the big opportunities missed in the past 10 years, as it has been by successive Governments, and which I hope a change in Prime Minister will grasp, is that Ministers ought to be trained through, for example, the Henley
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Management college in effective leadership skills to equip them for the management of major Government Departments. This may be the only chance I have to put that on the record before a change of Prime Minister. It is an idea that I have held and discussed with Cranfield School of Management, Henley Management college and others. It is relevant to all parties. How we manage major Departments is fundamental to the effectiveness of Government.

My second observation is how comforting it is to have such a feeling of déj vu with respect to union organisation and strength, and the solidarity of the closed shop. It is many years since I have witnessed such good union organisation. There are rumblings outside the House—only just outside—in traditional union style, and traditional union briefings. Traditional closed shop arguments have been accepted by the Government.

That takes me back to the time when I tried to negotiate for young engineering apprentices who were doing four years of training but were not guaranteed employment by engineering companies at the end of it. How jealous we were of Fleet street, where there was an age-old tradition of a trade being passed from father to son, apprentices being guaranteed work, and jobs for life. The changes that took place in the mid-1980s were bitterly resented by those families and particularly by the young workers, who perceived entry to that trade as a vocation for life. I see some resonance with the Government’s acceptance of the arguments and their guarantees of employment for junior doctors.

Mike Penning (Hemel Hempstead) (Con): With regard to Ministers moving on too fast, the Secretary of State has been in office throughout this debacle—since the general election. If she is not up to the job, surely the senior management, the Prime Minister, should sack her.

John Mann: There is another game going on, and that is called the knock, knocking of the NHS. The Opposition’s motivation in having this debate, and the style of debating used, has been to knock the NHS and run it down, rather than look at the specific technical issues and how they may be improved, as the Liberal Democrats rather more realistically have attempted to do. The party that never really loved the NHS in the first place has a political agenda.

On every occasion the Opposition attempt to suggest that the NHS is in great crisis. The best judges of that are the patients, and my area is as good a judge of the state of the NHS as anywhere else. Since I have been a Member of Parliament, the NHS in my area as been a top performer. Two years after I became an MP it became the top performer in Britain, and remains so.

The hon. Member for North-West Norfolk (Mr. Bellingham) is no longer in his place but he referred to incompetent NHS local management. That is not what I see. In my regular meetings with management, consultants and GPs, one of whom I met to discuss some of these issues at length last week, I hear pertinent points about where they wish to see improvements, but there is pride in the fact that modern management, modern doctors and modern GPs now receive the funding that they deserve and have the tools to do the job. That is a fundamental difference from the past.


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I shall illustrate that with one of the campaigns that I ran. [ Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) from a sedentary position asked what I had had to do with improving the performance of the NHS. Along with thousands of my constituents, I have made a tiny contribution. When there was not a Government but a management move to downgrade my accident and emergency department, I led the campaign—

Mr. Deputy Speaker: Order. This is not a debate about the training of Ministers or the NHS in general; it is about modernising medical careers.

John Mann: That is precisely the point that I am leading into. The successful ballot on the accident and emergency department in my hospital was caused for only one reason, and that was that there was a perceived problem in recruiting consultants to cover that department. The issues raised in my hospital and by my GPs are the problems of attempting to recruit both specialists and generalists in a semi-rural area with a district general hospital and GP practices—

Justine Greening rose—

John Mann: I will give way in a minute, but it is important that I make this point because it is precisely on the issue of modernising medical careers in areas that have been underfunded, traditionally and historically, and which because of that have had recruitment problems for many years. The shift in allocation is one of the bravest things that the Government have done. The 11.5 per cent. increase in PCT funding last month was the biggest in the north of England— [Interruption.] This is absolutely on the subject. The subject is how my area can recruit the consultants and the GPs that it needs, and how, in an area such as Cresswell, just outside my constituency in the constituency of my hon. Friend the Member for Bolsover (Mr. Skinner), where many of my constituents worked for year upon year, the NHS had not been able to recruit GPs until last week, when a new GP practice was appointed.

Justine Greening: I am obviously listening to the hon. Gentleman’s rather long speech with interest. I presume that it is long because so few of his own Back Benchers are present to stand up for the junior doctors who face this terrible crisis. I am wondering whether he will ever start talking about the subject of the debate, which is about the junior doctors throughout the country who face redundancy having gone through an horrific recruitment process yet who still do not have an answer from the Secretary of State about what will happen next.

John Mann: The hon. Lady is choosing not to listen to the point that is being made. The question of recruitment is fundamental to the changes that are taking place in modernising medical careers. What is the point of having large numbers of junior doctors if there are not jobs? I drew an analogy with the closed shop. Many professions would like that certainty of employment in following their careers but do not get it. Equally, what if a hospital such as mine cannot get the
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consultants it requires to cover accident and emergency and questions whether it should have A and E, or if an area such as Cresswell does not have enough GPs? In the wider area of Warsop, which incorporates Mansfield, there have repeatedly been problems in getting enough GPs to cover the work that is there.

Mr. Fraser Kemp (Houghton and Washington, East) (Lab): Some years ago, we had a serious problem in the city that I represent, Sunderland—we had the lowest proportion of GPs anywhere in the UK. When we investigated, we found that in many cases, because of the funding arrangements, doctors themselves were not encouraging recruitment into practices. The health authority intervened to deal with the situation, but it was not the fault of the Government or the money going in—doctors themselves were not going out of their way to recruit more doctors in our city.

John Mann: My hon. Friend makes an excellent point.

Let me ask a couple of questions of Ministers. Under the Government’s plans, how will areas such as mine be guaranteed the consultants whom a small district general hospital requires in order to maintain core services by having staff in place and who come from the ranks of junior doctors? How will that be done, and how does it fit into the Government’s planning in the longer term?

Mr. Pelling: Will the hon. Gentleman give way?

John Mann: No; I am going to conclude in a minute because many Members wish to speak. [ Interruption . ] No doubt that includes the rude hon. Member for Hemel Hempstead, who is saying, “Thank goodness.”

How can we ensure that an area such as mine, which has top-performing NHS services and where we have moved from small one-man-band GPs to large GP practices, can get the quality of GPs to meet the new kinds of specialties that the Government rightly want to devolve down to primary care from the hospital sector? How does that fit into the vexed question of junior doctors wanting to follow traditional forms of careers when some of the new specialties that are required are in primary care, not in the hospitals sector—an issue which official Opposition Members, as is clear from their barracking, have no desire to debate.

5.38 pm

Peter Viggers (Gosport) (Con): I congratulate the hon. Member for Bassetlaw (John Mann), who made a clever job of distracting attention from the profound concern that is felt in much of the House.

We are facing the worst and most avoidable disaster to overtake young people in professional training. Thousands of young people are being plunged into uncertainty about their careers. The tragedy is that this disaster was predictable and predicted—it is unfolding like a slow-motion train crash. I am grateful for the opportunity to be able to contribute briefly on behalf of my constituents, who feel anger and disbelief about the present situation.


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The people involved in this disaster are mainly professionals. Of no professionals is so much asked, in terms of resilience and commitment, as doctors. When doctors commit to the profession of medicine, an enormous amount is asked of them as regards training, and there is an assumption that at the end of their training period they will eventually have an opportunity to work and that that will be reflected in a fulfilled sense of commitment.

There is a need for change in doctors’ training and most people agree that it was appropriate to make a change. However, in their manner of doing that, the Government are at fault not only in the detail but in the larger issues. They have been greatly at fault in three main matters: administration, computer failure leading to mismatches occurring, and the number of jobs.

The Secretary of State provided several facts when trying to explain the position. I submit that those facts did not help me—and I followed her contribution carefully—to understand the position better. Apparently, there are to be 23,000 training posts and 32,000 doctors are seeking them. However, she gave us many other numbers, seeking to lead us to believe that there was no problem.

I am afraid that there is a problem, because the Government have failed to deal with the double cohort—the two different groups of doctors who will enter training in August. Some will work under the previous system and others will work under the new system.

The Secretary of State failed to provide assurance in the case of an individual doctor in my constituency, whose mother I met today. The doctor is 28 years old, has been qualified for six years and has always wanted to specialise in intensive care. She was offered a post in August last year. It was a two-year post in anaesthetics, which would lead her to qualify in anaesthetics or go further and use her anaesthetics qualification to specialise in intensive care. Now the two-year post that she was offered in August 2006 has collapsed, leaving her with the prospect of no medical job after August this year. She is not simply a highly qualified doctor but someone who, with one other woman, rowed the Atlantic as part of her gap year.

Doctors must be given a guarantee that they will not be forced out of training. A formula must be found to permit their training to continue. The Government need to take exceptional measures and give us progress reports. The matter must be resolved by August—if necessary, by using interim measures.

5.42 pm

Mr. David Kidney (Stafford) (Lab): The county town of Stafford employs a high proportion of public sector workers because it is an administrative centre. There are workers in local government, the hospitals, the university and so on. That means that, when a problem arises in the public sector—be it last year’s efforts, which were especially bitter in Stafford, to try to deal with deficits in health trusts, or junior doctors this year struggling to find a training post and feeling that they have been badly treated—it affects not only those who work in a hospital trust or another health setting, but a large proportion of the public because of their affinity with the public sector generally. That might apply to
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the Member of Parliament who has such an affinity because of political values, the workers because they work in the public sector, and the public, who come into contact with public services perhaps more than in other areas because of Stafford’s higher than normal proportion of jobs in the public sector.

The subject of the debate is therefore generally a serious issue for Stafford. I am happy to explain that that is one of the reasons for my participation this afternoon. However, people obviously want to bring the debate to the personal level. In preparation for last week’s return to Parliament and the Secretary of State’s statement and today’s debate, I met the junior doctors’ leader in Stafford, local NHS managers and local providers of health education. Like many hon. Members, I have also met a junior doctor from my constituency who lobbied me about his personal circumstances, and representatives of the campaign that Remedy UK has organised for today. I am pleased to have an opportunity to take part in the debate to support the points that they made to me.

It is worth starting from the point of view expressed in the original words of the motion. What has been extraordinary about the history of medical training in this country is that it suffered its share of severe underfunding for decades before 1997, which led to a shortage of training places. That led, in turn, to a shortage of qualified doctors, consultants and nurses in the NHS, which created quite a challenge for the new Government, who were committed to improving the situation very quickly. Although the Government could turn on the tap for more money to pay for more doctors, nurses and consultants, there were not enough of them to recruit because the training places had been cut for years before. That is an important point for hon. Members to take into account about the history of how we came to be in the present situation.

The obvious corollary at the time was that because the money was made available and the posts were there to be filled, we recruited outside the country to fill the vacant posts. That is relevant because while people talk about the double cohort of people coming through to training posts now and the senior house officers also looking for a training post, we also have the added pressure of non-EU citizens in this country whom we recruited who still want jobs in the NHS. There was something of a failed attempt by the Government last year to squeeze them out. That in itself was hurtful to quite a large number of my constituents who came from the Indian subcontinent in order to work in this country because we needed them. All those points should be taken into account when we reflect on the situation today.

It is a good thing, is it not, that more people are in training, completing it and coming forward in greater numbers? It is also a good thing that recruitment and retention generally in the NHS has been good over the past few years. I hesitate to say that it is good now, because I am not reading a Labour party brief and want to tell it as it is. Obviously, the Government’s insistence on getting rid of deep-seated deficits, which started last year—an insistence, incidentally, that I support wholeheartedly—has led to a crash in recruitment and retention. That provides a further additional pressure—on top of the three that I have already identified—when it comes to the training
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places available for junior doctors now. It is easy to add them up and see that four pressures have all come to bear this year on the problem of the number of places available for the junior doctors who are seeking them.

The review body, comprising all the bodies that the Secretary of State described, and then Ministers, took the decision that this year is the year in which modernising medical careers for junior doctors should kick in. It is certainly a difficult year. In the looking back that the hon. Member for North Norfolk (Norman Lamb) called for, and in seeking attributions of blame for the current situation, a good question to pursue would be whether there was any opportunity to hold back from making it this year. However, it is fair to say that modernising medical careers is the right thing to do and has gained widespread support.

It is remarkable that no one in today’s debate has asked to turn back the clock and go back to the previous system. Every hon. Member has spoken about how MMC could have been introduced more effectively and how it should be improved in future years. In some areas of recruitment—before it was applied to junior doctors—it has been implemented without the sort of reaction that we are talking about today. General practitioners two years ago provide a good example of that.

When I met the leader of the Stafford junior doctors, she drew my attention to certain issues that I strongly support. First, for example, it is right to standardise training standards for junior doctors seeking specialty posts. It is also probably right in this day and age for there to be an online system. It reminds me of my adult son and daughter who use the internet, rather than pen and paper, as second nature when it comes to compiling a CV for a job application. Those aspects are right and are here to stay.

Other points that we have discussed today, however, included the scoring system, the lack of flexibility, the people who did not get acknowledgements for their online applications and felt that the applications were never read, and the doctors who felt forced to apply for jobs at the other end of the country from their families. All those personal circumstances, which I discussed with the leader of Stafford’s junior doctors, were individual tragedies.

Norman Lamb: The hon. Gentleman is making some fair points in criticising the way in which the system has operated. Are not all the features that he has described evidence and justification for the need for such a system to be piloted before being introduced?

Mr. Kidney: I agree with the hon. Gentleman. I considered whether to intervene on him earlier to say that I agreed with him on that point, but I also intend to say in my speech that developments such as these should be piloted in future. So the answer to his question is yes.


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