Examination of Witnesses (Questions 940-953)
RT HON
ALAN JOHNSON
MP, MR HUGH
TAYLOR, SIR
LIAM DONALDSON
KB, AND MS
CLARE CHAPMAN
18 FEBRUARY 2008
Q940 Dr Naysmith: It took just over
a year to ratify the new contract, did it not?
Alan Johnson: I know.
Q941 Dr Naysmith: What were you doing
in that year? That was before you even started consulting.
Alan Johnson: I wish I could tell
you a blow-by-blow account of it. Basically it was the kind of
difficulties that go on in government where you have to get clearance.
Do not forget, this was a year when we had a public sector pay
ceiling of 2% for everyone except the Armed Forces and it happened
to be the year when we came to a conclusion on this group of doctors
and it had to be related back—
Q942 Dr Naysmith: If you had come
to it a little bit quicker then you would not have got into that.
Alan Johnson: Sure.
Q943 Dr Naysmith: You could have
done it outside of that year.
Alan Johnson: Sure, that is a
fair point.
Q944 Dr Taylor: Three very broad
questions to finish with, Secretary of State. I think it was the
CMO who told us that we need more doctors because we are only
22nd in the world rating of doctors per head of population. Where
would you like to see the UK as doctors per head?
Alan Johnson: As the CMO made
the comment perhaps he would like to say where he thinks we ought
to be.
Sir Liam Donaldson: The expansion
of medical schools will start to move us up the league table.
The position is quite complex. As your colleague said, we need
to look at the whole of workforce together and look at changing
roles in healthcare and Sir John's recommendation that we have
to look specifically at the role of the doctor vis-a"-vis
other professions. It is now a wider question than just picking
a number but I am very pleased to have been associated with the
medical school expansion several years ago and it is starting
to put us on track.
Q945 Dr Taylor: Thank you. The European
Working Time Directive: obviously this is making life and training
very difficult, and we have already heard that you cannot create
more training posts just to answer that, so do you have up your
sleeve any answers to the European Working Time Directive?
Alan Johnson: What we want to
do is divorce SiMAP and Jaeger away from the issue
of the opt-out. SiMAP and Jaeger is something that
is affecting every European Union country. It is this incredible
decision where if somebody is on-call but not disturbed and sleeping
for 12 hours at night they have to another 12 hours to recover
from their 12 hours' sleep. The problem with resolving that is
it has become tied up with an argument in the European Union about
whether we should continue to have our opt-out from the 48 hour
limit, which we are very determined to protect. We have been arguing
to separate the two things away and I hope we can make some progress
on that under this Presidency or the next Presidency. Aside from
that, one of the two new recommendations in the Tooke Review was
about the European Union Working Time Directive and splitting
out training and classifying it as non-work. We are looking at
that but I dealt with this Working Time Directive in a previous
life and it is quite clear it is a health and safety directive,
it is about the time you spend on duty, if you like, and does
not differentiate between the time you spend on duty being trained
and the time you spend on duty working, you are still attending.
We will look at that but I do not think the cavalry is coming
over the hill on that one.
Q946 Dr Taylor: Is there any timescale
on SiMAP and Jaeger?
Alan Johnson: No. We live in hope
that we will get an agreement to the whole issue about Working
Time in Europe or we will get an agreement to separate away SiMAP
and Jaeger. If we separate away SiMAP and Jaeger
every European Union country will sign up to the resolution because
everyone is in the same place over that. Not everyone is in the
same place about the opt-out, which has been the confusion of
tying it in with an issue that is not related to it but, if you
like, is a negotiating trick by the European Commission.
Q947 Dr Taylor: When one is talking
about medical workforce planning one needs to know details of
what sort of doctors you want. Could we just have a brief idea
of your view of a consultant-led service as opposed to a consultant-delivered
service?
Alan Johnson: Forgive me if I
hesitate. This is all tied up with the Darzi Review and in terms
of whether we have a Health Service that is clinically-led locally-driven
and that is very much what we are looking at at the moment.
Q948 Dr Taylor: Let me try and explain
what I mean by the difference. Consultant-led is a consultant
who has a team of juniors who are doing a lot of the work whereas
consultant-delivered is the consultant who is doing most of the
work and the juniors are specifically just in training. Without
spilling the beans on the Darzi Report, and I was not aware that
came to any real pointer in that direction, I was just trying
to get your views about whether you thought that consultants should
be on-call 24 hours a day doing all the work?
Alan Johnson: We do have a Working
Time Directive! I think that the old system where people who were
not properly trained carried out a large tranche of the medical
care was not a safe, secure system. I am a big supporter of the
Working Time Directive, incidentally. I always found it amazing
20 years ago when we heard these stories of junior doctors working
120/130 hours a week, you probably did it yourself, almost as
if it was something we should be proud of, and doctors on-call
being called out at three o'clock in the morning and having to
be bright and breezy at nine o'clock at their surgery. I think
that is all wrong and it is absolutely right to tackle that as
we have tried to do. I think it should be consultant-led on the
basis that people who are in training by and large should not
be put in a position where the healthcare system relies on them
to provide medical care as if they were fully trained.
Dr Taylor: Okay. So we will wait to see
what Darzi says and you say to Darzi about it.
Q949 Mr Bone: Secretary of State,
I did not quite understand one of the answers you gave to Dr Taylor.
He asked specifically about the number of doctors per head of
population and the fact that we are very poor in the league table
on that. I know you said earlier in your evidence you had full
confidence in your Chief Medical Officer and the Chief Medical
Officer wants us to go up the table. Is it Government policy that
we are going to have significantly more doctors per head of population
to move up the league table?
Alan Johnson: We are going to
have more doctors, and have had 36,000 more doctors, but I am
not looking at it, and I think Liam said as well, as where we
are on the league table but as how many doctors do we need to
provide a proper service.
Q950 Mr Bone: How many more would
that be?
Alan Johnson: I think that depends
on a lot of things, for instance, in terms of tackling un-doctored
areas, what happens there and what comes out of the Darzi Review.
We are going to need more and we are actually planning for more
at the moment. There is no magic position that we want to be in.
These league tables could be very misleading. Number of doctors
per head of population is a bit crude.
Q951 Mr Bone: Do we need to double
the number per head of population? I am just trying to get a feel
for how you think we should go on that.
Alan Johnson: You can see where
we want to go by the number of medical school places we are making
available.
Q952 Chairman: Last question. One
thing that has come up during this inquiry is that some parts
of the country have got probably the best cohorts of junior doctors
going into their district general hospitals than ever before.
Yorkshire and Humberside, which has my constituency in it, is
one of them. The district general hospital in Rotherham has a
better cohort of junior doctors in there than ever before, but
that is not right throughout through the land. I look at Sir Liam
who has an historical link with the town.
Sir Liam Donaldson: Yes, I do,
I was brought up there. Despite the distress and anxiety caused
to the junior doctors in 2007, which we all very deeply regret
and I said so the last time I came before the Committee, I have
anecdotally heard many senior doctors around the country saying
they are very pleased with the quality of doctors they have had
appointed. I think the problem is everybody is too frightened
to say that because the minute you say anything positive about
MMC you would be attacked.
Q953 Chairman: This was not part
of the plan, was it?
Sir Liam Donaldson: It was part
of the plan to try and get the best quality doctors we could into
our training posts and to some extent the anecdotal feedback is
that has been accomplished in some parts of the country. That
does not take away from the anxiety and the damage that was caused
to many junior doctors as part of the process.
Ms Chapman: In addition to the
anecdotal feedback there is also clear evidence that some of the
hard to fill specialties have had a much better fill-rate this
year than in previous years as well.
Chairman: This just ends on a division,
Secretary of State, not a fire alarm as was the case the last
time you were here. Can I thank all of you very much indeed for
coming along and helping us with this inquiry. Probably this will
be our last session in relation to this and we will await the
outcome of your points on Tooke at the end of this month. Thank
you.
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