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Alan Johnson: Hansard will record that I said on numerous occasions in my speech that there are genuine concerns about this issue, that it is not easy, that it has been difficult for 10 years and that we talk to the royal colleges, the BMA and everyone else day in and day out. We are talking to them on a monthly—in fact almost weekly—basis. We must consider whether this country is somehow uniquely unable to train doctors without their working 65 to 70 hours a week. I say that that is absolutely not the case.
Norman Lamb: We are certainly not arguing that either. Our concern is about the change in August this year from 56 hours to 48. Many, including the Conservative party and the Liberal Democrats, have concerns about that and about the potential risk of the opt-out ending if the Council of Ministers were to vote in that way. I fully acknowledge that the Government are seeking to protect the opt-out, and we agree with them about that.
Mr. Alistair Carmichael (Orkney and Shetland) (LD): My hon. Friend is being very generous with his time. I hope that he will join me in welcoming the hon. Member for Moray (Angus Robertson) to the debate. Neither he nor any of his Scottish National party colleagues have been able to be with us on previous occasions when we have discussed the working time directive. I hope that my hon. Friend will not make the obvious point that when the vote was held in the European Parliament, all the other members of the group of which the SNP members are part—I believe that it is called the green and radical group—voted in the other direction. That is not a helpful way to proceed. We need proper unity, particularly in relation to the case for retained firefighters in Scotland.
Norman Lamb: I am grateful for that helpful intervention, and I am just frustrated that I am not allowed to use the word “hypocrisy” to comment further. The Liberal Democrats’ group in the European Parliament has been at the forefront in working with the Government to protect the opt-out, as the Secretary of State will know.
The irony of all this is that although the working time directive is defined as a health and safety measure, there is a risk that the imposition of a 48-hour week will put patient safety at risk. That is what we are all concerned about. I should declare an interest: I worked as an employment lawyer before I arrived in this place, and I worked with the Secretary of State on an employment Bill some years ago, which brings back happy memories. I might even declare that I know something about the subject, which is always dangerous in this place.
The first principle that we should apply is that excessive working hours are not good. We should all accept that, and I am sure that even the hon. Member for Dartford (Dr. Stoate), who clearly works excessive hours, would accept that we should work to reduce them. Exploitation of staff is unacceptable, and whenever evidence emerges that staff are under pressure to opt out, firm action should be taken against the employer concerned.
Sandra Gidley (Romsey) (LD): Does my hon. Friend share my concern that although that has been a known concern for some years, work force planning in the NHS seems totally inadequate to deal with the problem? It has not come upon us overnight. The Government have had eight, nine or 10 years to prepare, and still the medical profession does not seem ready. We were talking about this in 2001.
Norman Lamb: I agree, and all the evidence that we get from the royal colleges, contrary to what the Secretary of State says, is that the NHS is not ready and that there are real problems ahead.
There is a case for establishing limits on working time and norms that should apply generally across the work force. In fact, the last Conservative Government acknowledged that with the introduction of the new deal in 1991. They then failed to implement it, and it was only really implemented from about 2000, when financial incentives were applied to NHS employers. In principle, however, the Conservatives accepted the case for limiting doctors’ working hours.
However, it must surely be a fundamental right to opt out of a limit on working hours and to choose for oneself, not due to pressures from others, to work longer than the limit. I think that we can all agree on that, although of course it should be subject to limitations such as the 56-hour limit in the health service. People must surely have that right. As I have said, we all do it.
The importance of retaining the opt-out goes well beyond the NHS. Particularly in tough times, the business community regards it as very important. My hon. Friend the Member for Orkney and Shetland (Mr. Carmichael)—
Mr. Carmichael: You have my complete and undivided attention.
Norman Lamb: I am grateful for it. My hon. Friend secured an Adjournment debate on the subject of retained firefighters, who are important in his constituency and in my rural constituency, the whole of which depends on the work of those fine individuals who give their spare time to protect their community. It is absolutely essential that their capacity to provide that service and that contribution to their community is retained. That is why the retention of the opt-out is so important.
Mr. Alan Reid (Argyll and Bute) (LD): My hon. Friend is quite right about those individuals giving time to their community. Does he agree that it is ridiculous that, under the European Parliament’s proposals, if people got together and voluntarily operated a fire engine without pay they would not be covered by the directive, but because they are professionally trained and get a small wage they will be covered? In fact, the proposals would simply mean that we would not have paid, professional fire cover throughout large parts of the country.
Norman Lamb: That is a very good point, and it demonstrates that overly prescriptive regulations imposed from Brussels can have unintended and rather ludicrous consequences. That is why it is important to retain the opt-out, so that that professional service can be retained.
Michael Connarty:
Apart from mentioning the Liberal Democrat Member of the European Parliament who voted against the interests that the hon. Member for Argyll and Bute (Mr. Reid) has set out, may we return to a point made by the hon. Member for North Norfolk (Norman Lamb)? He said that the Royal College of Surgeons should be listened to and that it had a point. However, what it called for was a limit of 65 to 70 hours, whereas he seems to support a 56-hour limit. Is he willing to oppose the conclusions of the Royal College of Surgeons? It said that there was an “impending
disaster”—I believe that he quoted those words—if the limit was not 65 to 70 hours. Will he now contradict that and say that it is not the case?
Norman Lamb: I do not support the case made by the Royal College of Surgeons for working 65 hours. Throughout my speech I have argued that the Government should listen to its concerns about the impact on the service if the limit were reduced to 48 hours. That is the important point. One can then have a discussion with it about how best to resolve the matter. It does not mean that one has to accept its proposition as the only solution to the problem.
Let me consider the scale of the potential impact, which is frightening. Approximately 30,000 junior doctors in training will be hit by the 1 August change. That means 30,000 working days lost per week from the NHS through the reduction from 56 to 48 hours a week. If we take an average trust with 200 junior doctors, that means 200 working days or 1,600 hours of medical cover or 28 whole doctor equivalents lost in an average week. Losing 28 doctors out of 200—14 per cent. of junior medical staff—could have a massive impact on the NHS and the care that it provides. The effect is made more acute by the SiMAP and Jaeger judgments, which deal with on-call time.
What will the result be? All those in the profession who have considered the matter express genuine concern about the impact on patient care and continuity of care. They talk of the danger of multiple handovers. Contrary to what the Secretary of State said, clear evidence shows that loss of continuity of care is a key cause of avoidable medical errors. That is why the royal colleges’ concerns should be taken more seriously.
Hospital trusts that have managed to comply with the 48-hour ruling have often done so through using locums, often from outside the hospital. That causes concern because, as the Royal College of Physicians highlighted, now that the Government have acted to reduce massively the number of international medical graduates who work in the health service, it is hard to find enough locums. The survey that the Royal College of Physicians conducted raises concerns about the quality of locums who are brought in to complete shift patterns because of the reduction in working hours. It identified lower quality and reliability. All that is apart from the cost of bringing in locums, which RemedyUK suggests could be as much as £120,000 in one hospital.
There is also the problem of the thinness of the available cover if any problems arise, such as sickness or holiday absence. The Royal College of Surgeons has highlighted the risk of running out of surgeons in some parts of the country to fill gaps in the rotas. The Government should take those anxieties seriously.
We must also consider the impact on training. Almost 50 per cent. of junior doctors in the first two years of surgical training go into theatre less than three times a week. One in 15 do not go into theatre at all. If those junior doctors’ hours are reduced, their experience in theatre will be further reduced. They may pass their exams and have the tick-box competencies required to qualify, but that does not mean that we produce the best and most experienced surgeons. The royal colleges are concerned about that.
There is a danger that patient care will suffer if training suffers. We are considering a health and safety measure, yet the impact on patient safety could be negative. That is why not only the royal colleges but doctors, including junior doctors, who would supposedly benefit from the measure, oppose the 1 August changes. A majority of the doctors who are supposed to benefit do not want the imposition of that 48-hour limit. They are concerned about the resulting loss of opportunities.
There is also a serious concern about the impact on the viability of small and medium-sized district general hospitals. The president of the Royal College of Surgeons has expressed that anxiety directly to me. If we reach a point where it becomes unsafe to keep a small district general hospital open because there is insufficient cover, the Government will be responsible if they have not managed to resolve the problems. Rural areas will be most affected; the massive hospitals in our cities will be less affected. The viability of small hospitals faces a genuine challenge as a result of the changes.
Can the changes be achieved? The evidence from the surveys and the royal colleges suggests that they cannot. The Secretary of State said that the north-west was already largely compliant, but the surveys suggest that, if one examines the detail, hours are substantially under-reported and many of the hospitals that are supposedly compliant are not, in practice.
What are the solutions? The Royal College of Surgeons complaint suggests the possibility of a sectoral opt-out, to permit surgeons to work to a maximum of 65 hours. There is general opposition to that. We have heard that the Government are putting money into facilitating hospitals in coping with the change, yet there is also concern that the money is not getting through to hospitals to help them effect that change. I would be grateful if the Minister could confirm in his closing remarks whether the money that the Government have made available is getting through to the hospitals where it is needed.
The Government rely on the power of derogation, which in effect means that we can delay the inevitable for two years, reducing working hours in the interim period from 56 to 52 hours, before coming down to 48 hours in two years. However, the process is cumbersome and bureaucratic. The Department of Health has applied for a derogation, but we understand that individual hospitals will have to apply to the Department for the right to take advantage of that derogation if it is granted. We will have to wait until May before we know whether the derogation will be granted, which makes it impossible for hospitals to plan their rotas into the future. They will not know until May whether the European Union will grant the derogation. Derogation is therefore a blunt instrument and will simply delay the inevitable, without addressing concerns about the loss of continuity of care and the impact on training. Patient care will be permanently comprised.
The Government maintain that we should retain the individual opt-out and we support them on that. However, the individual opt-out is generally regarded as not an option for resolving the problem that we are discussing, because if the general rotas go down to 48 hours, how, in an organisational way, is it possible to provide for junior doctors working up to 56 hours? The process becomes a bureaucratic nightmare, and everyone ends up having to comply with the 48 hours.
As the Conservative spokesman mentioned, a company—it is called RotaGeek—has developed software that facilitates a discussion between management and individual junior doctors to organise their shift patterns and add extra slots, so that they can go up to 56 hours. That seems to be an eminently sensible way of getting the Government out of a hole and facilitating longer working hours for those junior doctors who collaboratively choose to participate in a 56-hour rota. However, when RotaGeek went to the Department and said, “We want to work with you and pilot this in a hospital to see how it will work,” it was turned away. The Department was not interested in that sort of collaborative working.
Dr. Stoate: Can the hon. Gentleman not see how divisive it would be if a manager said to a junior doctor, “I want you to ‘voluntarily’ opt out and go to the 56 hours, but if you don’t, it won’t in any way affect your career”? How is a young person supposed to accept that? What complete nonsense it would be to have a two-tier system, of those who are prepared to opt out and so sign a bit of paper, and those who are more concerned about health and safety and therefore are not prepared to sign it. How can they have a level playing field for the future?
Norman Lamb: I continue to fail to understand why the hon. Gentleman wants to impose rules on others that do not apply to himself. [ Interruption. ] He expresses amazement, but that is a fundamental point. Why should he be able to—
Dr. Stoate: I am not an employee: that is the difference.
Norman Lamb: The same rules should surely apply to an employee who chooses, of their own volition. The hon. Gentleman assumes that every manager in the NHS is an oppressive manager who will make life impossible for their employees. However, the survey evidence shows that junior doctors want the right to be able to work more than 48 hours.
Norman Lamb: The hon. Gentleman shakes his head, but a majority of junior doctors in the surveys want to do that. Why is he preventing them from doing so? That is the crazy thing.
Michael Connarty: The hon. Gentleman should be clear, because if he is arguing for a sectoral opt-out, he is arguing for a compulsory 56 hours. He seems now to be arguing against an individual opt-out, but he was previously arguing for a sectoral opt-out.
Mr. Deputy Speaker: Order. Before the hon. Gentleman responds, let me say that we have not yet had a Back-Bench speech in this debate, and time is disappearing rapidly. Perhaps all hon. Members will bear that in mind.
Norman Lamb: Thank you, Mr. Deputy Speaker.
Just to clarify this point, I support the individual opt-out. I want the Department of Health to work with those who are developing software to facilitate a discussion between management and individual employees, to enable
those who want to work more than 48 hours to do so—in contrast with the wishes of Labour Members, who seem to want to prevent people from doing what should be their right.
We have a process that could infringe an individual’s freedom to work beyond 48 hours if they want to, and that is threatening patient care here and now, as well as in the future because of the impact that it will have on training. The Government need to sort this out, because the consequences of not doing so could be disastrous.
Mr. Deputy Speaker: Order. Before I call the next hon. Member, may I tell the House that I have decided to reduce the time limit on Back-Bench speeches to eight minutes?
8.40 pm
Mr. Kevin Barron (Rother Valley) (Lab): Thank you, Mr. Deputy Speaker. Eight minutes is only just over half the time that was displayed on the Annunciator earlier today. I have prepared my speech during the past three hours, but I am not sure whether I would have come in to the debate on the basis of being able to speak for eight minutes, rather than 15. However, I shall move on.
I support the Government’s position in many areas of this debate, especially in relation to the working time directive and the health and safety benefits that it brings to workers not only in this country but in other European countries. It is primarily about health and safety. Indeed, this country’s health and safety statistics show that we do rather well—even with the opt-out. The UK has the lowest rate of work-related fatal injuries, and the third lowest rate of non-fatal injuries. The UK also has the lowest proportion of those in employment reporting that their work affects their health or that it causes them to suffer from stress.
I am pleased that the Government are committed to helping people to achieve more choice over how they work. I support the work-life balance campaign, for example. Of course, that includes the choice to work more hours as well as fewer. Many millions of people work far fewer hours than they did 15 or 20 years ago, which is a good thing, but I also believe that the individual opt-out is important.
I received an e-mail from a constituent of mine on 6 March, although it was unrelated to this debate. Mr. Bunting, who lives in the village of Whiston, said:
“Should our government agree to adopt this decision”—
the decision of the European Parliament—
“this will mean that I will no longer be able to choose to work over an average of 48 hours per week should I wish to do so.”
He lives in South Yorkshire, but I have just checked the name of the company that he works for, and it is in Tipton in Staffordshire. The world is becoming a smaller and smaller place, and people travel a long way for their work. He might not be in Tipton every day—he is a sales engineer—but it is likely that the kind of flexibility offered to him on a personal basis is what keeps him in the job that he wants and that, presumably, keeps his family well.
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