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The second problem is that a reduction in trainees’ hours reduces the time available for training. We knew that that was happening—Modernising Medical Careers and the new deal did that—but what is proposed goes even further. It means that doctors are moving to shift working, instead of operating as a firm and taking collective responsibility. Most of us, in so far as we know about the way in which junior doctor training works—many of us do—have always thought in terms of a consultant and his or her “firm”, but that will have to go if all the changes are made, because junior doctors simply will not be able to be there for enough time, and will not get enough contact with their consultant, to make that happen.
Junior doctors will lose continuity of learning. They will not be able to admit a patient, see them through their course of treatment and see what happens to them when they leave to the same extent as they once did. Continuity in relation to patients is a very important aspect of learning. The cumulative experience of trainees in the course of their medical education is absolutely vital. We know that the reduction from 10,000 hours of contact and direct experience of the treatment of patients to 7,000 hours will have a significant impact. As Professor Janet Grant from the Open university said, the difference between competent and expert is 10,000 accumulated hours of experience. Do we want specialists who have the ticks in the boxes when it comes to their training qualifications, but who do not have sufficient practical, supervised experience in the procedures with which they will be involved? I do not and patients do not, and the Secretary of State has a letter from the lay group advising the Royal College of Surgeons on the matter. The medical profession does not want that. The surgeons in training do not want it. So why does the directive and why will the Department prejudice the safety of patients for no initial gain for doctors?
Mr. Desmond Swayne (New Forest, West) (Con): Given that the working time directive is, in essence, a health and safety measure, can it be healthy or safe that the future generation of consultants will have less than half the clinical exposure that the current generation has?
Mr. Lansley: That is exactly right. What are we gaining in health and safety terms for junior doctors by prejudicing in this way their capacity to undertake the necessary training in order for them to become not only qualified specialists, but excellent in the services that they provide?
Some of the studies have made it clear that the change does not make much difference. For instance, a study in the Journal of Occupational and Environmental Medicine last year reported:
“Our results challenge the assumption that each hour of work above 40 hours steadily increases health and safety risks and reduces productivity. In fact, no adverse effects were found until the 60-hour per week mark”.
Another study published by the university of Maryland said:
“Studies show that the risk of an incident associated with long work hours may be influenced more by the precise work schedule, including the length and timing of the duty periods, and the provision of breaks, than by compliance or lack of compliance with the arbitrary benchmark of 48 working hours.”
Many junior doctors say that the shift system often leads to negative impacts on their sense of well-being and their work-life balance, and one of the surveys by the Royal College of Physicians showed exactly that—a negative effect on their work-life balance.
Mr. Kevin Barron (Rother Valley) (Lab): In its position statement in January this year, the Association of Surgeons in Training said that
“it is necessary to return to a working week of approximately 65 hours”.
Does the hon. Gentleman agree with that?
Mr. Lansley: No. In any case, under the new deal for junior doctors, it would not be possible to go beyond 56 hours. That was introduced by us, not by the present Government, but it does not mean that there is not considerable scope. For example, RemedyUK, which has honourably been involved in telling the Government some of the things they should have done on Modernising Medical Careers and the Medical Training Application Service, has made it clear to the Government that there could, for example, be a process by which junior doctors collectively made a decision to opt out from 48 hours and opt for up to 56 hours. That would enable many of the rotas currently operated in our hospitals to be maintained.
As a consequence of MMC and MTAS and the loss of junior doctors resulting from reactions to them, we are seeing a considerable increase in the vacancy rate among junior doctors. A specialist hospital reports a 30 per cent. vacancy rate, whereas three years ago it had 40 applicants for each post. How did we get to such a situation? Two years ago we had an excess of junior doctors. The Government have spent considerable amounts of taxpayers’ money increasing the number of medical students, and lo and behold, where have we arrived? Across the hospital sector, rotas cannot be filled, junior doctors are not applying, and the shortfall has to be covered by extending the hours of consultants, who could opt out up to 78 hours if they had to, and by internal locums probably not properly supervised to protect the interests of those junior doctors.
Dr. Howard Stoate (Dartford) (Lab): Will the hon. Gentleman give way?
Mr. Lansley: No, I shall conclude, if the hon. Gentleman will forgive me.
We need a way ahead. We need to know from the Government that we will retain the individual opt-out, and we need the Government to explain how they will secure a policy objective that they have talked about for five years but have not secured. We need an explanation from the Government of how they will achieve that in the European Union.
As solutions to the problem, junior doctors must continue to be able to opt out from 48 hours and go up to as much as 56 hours, in the way that RemedyUK has suggested to the Government, although they do not seem to be engaging with the issue. Inactive time on call should not be treated as working time, so that rotas can be given the proper flexibility. We need to explore the scope for collective agreements under the directive, which the Royal College of Surgeons has pressed upon Ministers and which would allow some of the definitions of night-time working and rest breaks to be more flexible.
As an immediate response, the Government should send to the Commission a much wider notification of derogation that would allow surgical specialties and, if necessary, paediatrics, obstetrics and anaesthesia to retain 52 hours, even if at this stage we do not have the individual opt-out that would allow us to go to 56 hours.
Mr. Geoffrey Clifton-Brown (Cotswold) (Con): Will my hon. Friend give way?
Mr. Lansley: No, I am concluding, if my hon. Friend will forgive me.
Interestingly, the Government’s amendment signals some movement. It states that the Government recognise
“that a solution is required in order to bring back much needed flexibility to the treatment of on-call time and compensatory rest time”.
The problem is that they have not achieved that. As my hon. Friend the Member for Rayleigh will make clear in his winding-up speech, if we achieve that flexibility, the retention of the opt-out and the ability to amend the directive, we will be able to support greater labour market flexibility and competitiveness generally. The burden of compliance with the working time directive has been enormous, but the benefit has been far too limited by comparison.
We have had years of promises from Ministers, but they have failed. It is time for action by the Government and for clarity about the long-term future of the working time directive. The Government are always claiming influence in Europe. It turns out that they cannot even influence their own Members of the European Parliament. The time has come for MEPs who will promote British interests, and the elections in June will take care of that. The time has also come for a Government who have impact in securing our interests in Europe. That will come at the next general election, through a change of Government.
Mr. Deputy Speaker: Order. With the number of hon. Members who have by now indicated that they wish to take part in the debate at 15 minutes per head, we would have to start now, which would be a little unfair to the Secretary of State and the hon. Member for North Norfolk (Norman Lamb), so I give notice that I shall reduce the time limit on Back-Bench speeches to 10 minutes.
7.47 pm
The Secretary of State for Health (Alan Johnson): I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“agrees it is right that no worker should be required to work longer than 48 hours per week averaged over 26 weeks unless he or she freely chooses to do so; notes the Government’s manifesto commitment to maintaining the individual opt-out from the European Working Time Directive; further notes the importance of the individual opt-out which is used by the UK along with 14 other EU member states; recognises that maintaining the individual opt-out is a key part of the UK’s flexible labour market and of particular importance during the current economic climate; understands the particular concerns related to the working of excessive hours in the medical professions and welcomes the significant progress that has been made in the NHS to reduce junior doctors’ hours; further notes the challenges faced as a
result of the SiMAP and Jaeger judgements; further recognises that a solution is required in order to bring back much needed flexibility to the treatment of on-call time and compensatory rest time; welcomes the significant progress made in introducing the Working Time Directive across all clinical and staff groups within the NHS; further recognises that an extended derogation is necessary for a limited number of specialties and isolated, rural locations in order to ensure the efficient implementation of the Directive; and supports the continuing action to work with staff, clinicians, the British Medical Association and the Royal Colleges to ensure the workable implementation of the Working Time Directive to the benefit of patients and staff.”
This debate provides a timely opportunity to remind the House of the principles behind the European working time directive. The philosophy behind the motion was, I believe, something to do with the Conservative Whips, who wanted to get a bigger turnout on their Benches. If “European” is mentioned in the same line as “working time”, all sorts of people come out of the woodwork. It is extremely important to ensure the proper implementation of the directive.
Bob Spink (Castle Point) (Ind): I am grateful to the right hon. Gentleman for allowing me to intervene so early. Does he agree that it seems from the motion that the Tories are tinkering with the issue, and that the only sustainable way forward is to renegotiate the European Communities Act 1972? That is the only way that we will solve these European problems, and it is in line with what the majority of the British people want us to do.
Alan Johnson: From the Conservative speeches and interventions, it sounded to me as though that is precisely what the Opposition intend to do, which would, of course, mean renegotiating the treaty of Rome.
The directive is, above all, about protecting employees from exploitation. It gives employees the right not to work beyond a maximum of 48 hours a week. It also gives British workers a statutory entitlement to holidays and rest breaks which have been common in most other European countries for many years. At the same time, it reflects the right of individuals to opt out of the weekly limit if they so choose. The common position agreed at the Council of Ministers last June made it clear that the right to opt out should remain, as well as setting out how we could resolve the difficulties that many member states, including the UK, are experiencing as a result of the SiMAP and Jaeger judgments
Mr. Oliver Letwin (West Dorset) (Con): Does the Secretary of State agree that, in the light of his remarks about the need to protect people from exploitation, it is slightly odd that many of my constituents who are doctors have written to me saying that they should be allowed to work more than 48 hours? Is that not an odd state of affairs?
Alan Johnson: They can work more than 48 hours; the individual opt-out would allow them to do that. I shall come to the issue with doctors in a moment. [Hon. Members: “What about junior doctors?”] And the issue of junior doctors. Junior doctors have the right of an individual opt-out.
I shall come to the health provisions in a second, but this issue is about the European working time directive. There is an awful lot about the directive itself, and not its application to health, that I need to address. In December 2008, the European Parliament voted through
a number of hostile amendments to the common position, including abolishing the opt-out. I want to make it absolutely plain, including to the Scottish Liberal Democrats who voted for that position, that that is not the end of the process. The directive is, of course, subject to co-decision, and this is the latest step in a complex negotiation between the European Parliament and member states. The UK Government will continue to defend the opt-out, working with many other EU states, as we enter the next phase of conciliation.
In its motion, the Conservative party
“welcomes improvements in the workplace which improve...general well-being.”
That is indeed a Damascene conversion. When it was in government, the Conservative party opposed the European working time directive for the same reasons it opposed the national minimum wage. We all remember its version of patriotism: it was to position the UK as the sweatshop of Europe, boasting of its long-hours, low-wage economy. It was not at all perturbed by the high proportion of the UK work force who—never mind working hours—had no entitlement at all to paid holidays. Among working women with dependent children, the proportion was 15 per cent. The Conservative Government voted against the directive being adopted in 1993, and then spent the next three years, and millions of pounds of taxpayers’ money, mounting an unsuccessful challenge in the European Court of Justice, which ruled unanimously against them in November 1996.
The UK work force whose “general well-being” the Conservatives welcome so much in the motion today had to wait for a Labour Government to have their rights protected. When in 1998 the directive was finally introduced in the UK, the 48-hour maximum working week was applied immediately to the vast majority of NHS staff, including consultants and nurses.
Mr. Philip Dunne (Ludlow) (Con): In his continuing negotiations in Europe and in the context of his remarks about protection and well-being, what would the Secretary of State say to the constituents of Ludlow, not a single one of whom has anyone other than retained firefighters to protect their well-being, if, as a result of the loss of this opt-out, we have no fire protection cover in Shropshire?
Alan Johnson: This is the position. The retained firefighters need the opt-out. We have protected the opt-out since 1998, and against the most vehement criticism from other member states. The reason why SiMAP and Jaeger could not be sorted out—and this is a negotiation, of course—is that some member states put the solution of those judgments together with the opt-out. They then said to the UK and other member states, “You can get a solution to SiMAP and Jaeger only if you give up your opt-outs.”
We have got to a common position that we all support and that would resolve SiMAP and Jaeger and maintain the opt-out; what the Conservative party now asks us to do is to go back and say, “We want the opt-out, SiMAP and Jaeger, and a sectoral opt-out”—incidentally, the European working time directive does not allow for that, but I will come to that in a second—“for all junior doctors who are involved in surgery.” What a brilliant negotiating stance. It is a “Janet and John” way of negotiating an agreement. That is the difference between the Conservative and Labour parties. The Conservatives
never had any intention of reaching agreements on issues such as protecting workers’ rights—all they saw was “European”; they did not go on to see “working time directive”.
Michael Connarty (Linlithgow and East Falkirk) (Lab): My right hon. Friend well illustrates the fact that the Opposition motion is false and a posture. The intervention of the hon. Member for Ludlow (Mr. Dunne) showed that they do not understand. What would threaten retained firefighters has nothing to do with the opt-out; it is the fact that they are on call, that their on-call time would be counted and that they would therefore have no time in which to do their jobs. We need negotiations with the European Parliament about the opt-out, to get the changes to the rulings. It is the rulings, not the principle of the opt-out, that are blocking common sense.
Alan Johnson: My hon. Friend is completely right, as so often, in saying that Conservative Members just do not understand the issue.
Sir Robert Smith: According to my conversations with fire brigade members, the hon. Member for Linlithgow and East Falkirk (Michael Connarty) is wrong in that they work full time in other jobs. They are retained firefighters who turn out at the call of a pager to save people’s lives. According to their argument, it is the opt-out to the working time directive that they need to keep, not Jaeger and SiMAP. I am afraid that the hon. Gentleman was wrong on that.
Alan Johnson: My hon. Friend the Member for Linlithgow and East Falkirk (Michael Connarty) was right because in negotiations people put all kinds of things together. [Interruption.] “Ah,” says the Conservative party. The first basis of trying to negotiate a deal is that other people bring to the table the changes that they want. SiMAP and Jaeger are inextricably linked to the issue; that is why it is surprising that Liberal Democrat MEPs voted against the opt-out.
The directive initially excluded junior doctors, along with those working in the air, on rail, on the roads and at sea, because of particular difficulties associated with those professions. Such difficulties included the need for increased resources, or, in the case of HGV drivers, the need for even more rigorous regulation of working hours than the directive provided for. An amendment made in 2000 applied the directive to junior doctors and all other sectors that had previously been exempt, but introduced special, transitional measures by which junior doctors’ hours could be gradually reduced to 48. It also allowed countries to apply further derogations to ease transition where necessary.
In August 2004, the maximum working week for junior doctors was reduced from an average of 72 hours to 58 hours. In 2007, it came down to 56 hours. By August this year, it will come down to 48 hours for the vast majority of junior doctors.
Dr. Andrew Murrison (Westbury) (Con) rose—
Alan Johnson: Sorry—I did not realise that there was a doctor in the House.
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