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It is beyond doubt that doctors who are required to work long hours are more likely to make mistakes, which could threaten the lives of patients. We need to
bear that in mind in this debate. My hon. Friend the Member for Dartford (Dr. Stoate) and the Secretary of State mentioned the recent studies by Warwick university and Harvard, which compared the number of errors made by doctors working no more than 48 hours with those made by doctors working no more than 56 hours, and showed that those working fewer hours made 30 per cent. fewer clinical errors. If you or I were party to a clinical error, that would be an important factor. We need to look carefully at the comparisons, particularly those involving surgery. A wealth of research makes it clear that long hours worked by doctors are bad for patient health.
Since 1998, when the directive was introduced, the NHS has made good progress. In 1998, the 48-hour maximum working week was introduced for the vast majority of staff, including consultants and nurses, although they of course retained their right to opt out if that was their individual choice. It is only for junior doctors that we have yet to implement the directive fully, but if we look at the NHS health care work force website, we can see that we have come a long way towards achieving that.
In August 2004, the maximum working week for junior doctors was reduced to 58 hours, in 2007 it was reduced to 56 hours, and it will come down to 48 hours in August this year for the vast majority of junior doctorsno matter what happens over the argument about whether to opt out. We have to take that into account. We are talking about specialist areas that may or may not be affected by the reduction in hours, and we should keep that very much in mind.
As my right hon. Friend the Secretary of State said, the NHS is not ill prepared to achieve virtual compliance by August this year. At present, some two thirds of junior doctors are working no more than 48 hours a week and many trusts are already fully compliant with the directive. The Government have supported the trusts in doing that. There was an argument against it from the British Medical Associationrightly so, as it is a trade union looking after its membersin December last year, questioning whether the money was getting to the front line. That is a very relevant question and if I were in the BMAs position, I would have asked it as well. I have not seen any evidence, nor have we been sent any evidence for this debate, to suggest that money has not gone to the front line to help to reduce the hours of people who cannot meet the 48-hour target.
As far as the negotiations in Europe about getting a further derogation are concernedthey start this month, I believeI hope that they go well. Our negotiators should tell the Commission, and the Parliament, that when 15 member states are arguing for some form of opt-out, that should send a message that the Commission has got this wrongand I think that in some areas, they have. But I would not go for a massive opt-out; in some sectors, such as long-distance lorry driving, it would be quite dangerous not to reduce the hours over time.
The Health Committee is currently carrying out an inquiry into patient safety. We took evidence on the issue from the Royal College of Surgeons. I see that I have little time left, but I want to mention one important point. I received a copy of the survey by the Royal College of Surgeons the other day, and we asked Sir John
Black to give evidence to us. We are talking about a response rate of 32 per cent.; this is the Royal College of Surgeons contacting its fellows, so these are not independent surveys. I have to say that it is the same for the Royal College of Physicians. I should add that I am now an honorary fellow of the Royal College of Physicians; I was made a fellow last year, along with the hon. Member for Wyre Forest (Dr. Taylor), and I believe we are the only two in the House now. The RCP was also contacting its lead people inside each individual trust.
As I say, this is not necessarily the type of survey on which we in the House, whether we be in government or in opposition, should be taking decisions. It is not sufficiently independent. We see this in the media all the time. I am not saying that some of the issues raised may not be genuine. My right hon. Friend the Secretary of State dismissed the issue that training may be affectedbut it is about the logistics of training. We also saw this in our ISTCindependent sector treatment centreinquiry of a few years ago; training is very important. If people are not there to train, we could end up not getting the type of skilled surgeons that we need. That said, I would desist from using these types of survey to suggest that this is what is out there in the real world. This is what is out there in the surgeons world, but things may be very different in other parts of the national health servicesometimes even within the same operating theatres.
As has been made perfectly clear in a number of contributions, losing our opt-out from the working time directive presents a number of serious problems for the country. As the motion states, the Business Secretary is right to say that we should stand firm in support of the opt-out. It is just a pity that the Governments leadership has lost control of their MEPs who have forced us into the position where we have to debate the issue today. I ask the Business Secretary in all seriousness: what has happened to the deal brokered in June that we keep our opt-out by accepting the temporary agency workers directive? What on earth has happened to that deal?
There are some 96 fire stations in this country that are staffed by full-time firefighters, and retained firefighters are a vital part of our nations fire protection. Indeed, as I witnessed during the summer floods of 2007, the work of firefighters in providing emergency relief to those so badly affected was vital. They are going to face great difficulties if this opt-out is abolished.
The British people have complained for many years about the nanny state. Now we are seeing the damage caused by the super-nanny state emerging from Europe. I sincerely ask the Minister for Employment Relations and Postal Affairs what the point is of the EUs Small Business Act, which is intended to improve the environment for Europes small businesses, when we see this directive filtering through. A number of eminent people have criticised the possible loss of the opt-out, and the CBI deputy director general, John Cridland, has described it as replacing opportunity with obstruction. The cost to the UK economy is judged to be between £47 billion and £66 billion by 2020a terrific sum. A former
director general of the CBILord Jones of Birmingham, no less, who is a former Labour Ministernoted in 2006:
The choice is simple: flexibility or stagnation. Faced with the meteoric rise of China and India, Europe has to decide between a responsive and flexible labour market or an oversupplied and restrictive one.
A chief executive from a senior FTSE 100 company told me recently that the EU will lose 20 per cent. of its share of world trade in the next 10 years if it continues down the regulatory path that it is on. When we face a record and huge balance of payments deficit, it seems crazy to heap more regulation on more regulation. An agreement to lose our opt out would be an acceptance of that decline. What will that do to the standard of living of our people?
Unfortunately, unemployment in the UK stands at 1.97 million, with the claimant count in January 2009 up 438,000 on the previous year. At the time of a huge spike in unemployment, the Government and the EU are considering abolishing our opt-out. If a man or a woman loses their job, is it not their right that their partner has the opportunity to work overtime as necessary to support them and their family? For those in the manual labour sector or unskilled workers on the minimum wage, the ability to work overtime often affords a reasonable standard of living. For those who remain in employment, it must remain their right to choose how they support themselves and their families.
What of the nations businesses? In Britain, we have the work force and the businessesin particular, the small and medium-sized enterprisesthat will be the engine room in pulling us out of this recession. A rigidly enforced 48-hour weekly limit will damage those firms that choose to employ a core of staff whose flexibility allows them to be responsive to fluctuations in their work.
Some 3 million workers in the UK regularly work more than 48 hours a week, and we do not have a worse health and safety record than other countries.
In fact, the UK has the lowest rate of work-related fatal injuries and the third-lowest rate of non-fatal injuries, according to recent surveys of EU member states.[ Official Report, 11 February 2009; Vol. 487, c. 432WH.]
The burden of regulation on business is already too high and through losing the opt-out our capacity to outperform our European neighbours will be weakened. Indeed, I would have thought that the EU wanted inter-state competition, rather than wanting to eliminate it. To have to consider complete reform of the structure of employment is the last thing that British businesses need right now, in the middle of the deepest recession in living memory. In this country, 98 per cent. of businesses employ fewer than 20 employees. Unless the Government manage to secure an opt-out for those businesses, they will face huge challenges in implementing the directive,
and no doubt an army of Government inspectors enforcing the rules, taking up even more time. No doubt the British public will make their feelings known in the European and general elections.
We need to ensure that the working time opt-out is applied fairly by all and that people are not coerced into signing it. A number of measures have been set down to prevent that. It is also right that we continue to consider ways in which efficiency can be improved in the workplace and address the issues of work-life balance and the long-hours culture. Ultimately, however, legislation that affects our country should be introduced to stop abuse and to protect the health and well-being of all citizens, not to tie the hands of businesses and restrict an individuals freedom of choice.
Already, since 1997, the Government have introduced at least 18 Acts covering employment matters, along with a staggering 280 statutory instruments relating to employment law. Instead of more red tape, why are we not seeing more positive support for businesses from the Government?
organisations employing fewer than 20 employees might be exempted from the requirements of the Directive so long as their employees themselves have the right to opt-in to a maximum 48 hour working week if they wish to do so.
We know that this decision is now the subject of conciliation procedures undertaken in Europe in an attempt to broker a deal. I expect that it will go back and forth and then end up with the Commission, where I hope it will stay at least until we have a new Commission. Can the Minister confirm that the Government will at least fight for an opt-out for small businesses in Europe?
Let me end by reminding the Minister that we are in the middle of a recession. What businesses and their workers in this country need is flexibility to enable them to survive the recession, to thrive, and to play their vital part in helping our country to recover from its present situation.
Dr. Howard Stoate (Dartford) (Lab): This is an important debate and I think it is good that we are airing our personal views, but let me begin by correcting the hon. Member for North Norfolk (Norman Lamb), who seemed to think that I wanted to impose my will on other people. That is not the case. I am not against the opt-out; what I am against is the possibility that it could be used as a measure of coercion rather than autonomy.
I am all in favour of workers autonomy. I am worried, however, about what would happen if a hospital manager said, The hospital is in trouble, chaps: you had better sign this piece of paper and agree, voluntarily, to a 56-hour week, or we shall all have problems and your future may be jeopardised. In my view, that would be crossing the line. I want to ensure that we do not have a two-tier system whereby a form of pressure could be put on a young doctor early in his or her training to toe the line or face the consequences. If the hon. Member for North Norfolk wishes to intervene, I shall be happy to allow him to do so.
Norman Lamb: The hon. Gentleman said earlier that long working hours were potentially dangerous for clinicians. As I said to him then, his working hours are very substantial, and I am sure he takes the view that he is entirely safe in respect of his clinical actions.
Dr. Stoate: I do not wish to turn this into a personal argument. I cited, initially, what had been said by the British Medical Association. The hon. Gentleman asked the Government to take careful note of the views of the professional bodies that look after doctors interests, such as the colleges and the BMA. I merely quoted from what the BMA had sent mea statement, which other Members will have seen, that it is happy with 48 hours and believes it is time for junior doctors hours to fall into line with the health and safety requirements of all workers in the country, which effectively means not having the opt-out.
I have always said that, within reason, we should ensure that we look after health and safety. Members have said today that the workers should have the right to choose what they do. If a worker found that he could work faster on piece work if he removed the safety guard from his machine, would Members be happy for him to do so, because he would be paid more to look after his family? Of course not. The guards are on machines for health and safety reasons, to protect peoples lives. Health and safety legislation is there to protect individual workers, and we should respect that.
Among the EU15, only Spain has a higher percentage than Britain of workers who work for more than 48 hours a week. We are already one of the countries with the longest working hours in the EU. There is considerable evidence, including evidence from the Whitehall study conducted by Michael Marmot, that the workers who experience the most pressure on their time and the least autonomythose who have the fewest decision-making opportunitiessuffer much more ill health than those with far more autonomy and far more decision-making powers. There is a 40 per cent. difference in the rate of early death between people at the bottom of the autonomy pile and those at the top.
There is no doubt that peoples working conditions make a huge difference to their overall longevity and life chances. What we are seeing in this country is a picture of hard work and falling autonomy for many workers, combined with long hours and difficulties for a significant minority. In his comprehensive review of the subject, Francis Green reported a process of work intensification in the United Kingdom during the 1980s and up to the mid-1990s. The review tells a consistent story. Employees reported significant increases in effort levels and a less striking, but nevertheless important, acceleration in the pace of work. In 1997, 40 per cent. of workers were employed in a job that required them to work very hard, compared with 32 per cent. in 1992. Furthermore, a rising percentage of employees reported that they worked under
a great deal of tension
Allowing people, and particularly high-earning professionals, to opt out of the directive sends out all the wrong signals. It suggests that we are not serious about creating a better balance between work and personal life in the UK. It also suggests that if people want to be successful, they will need to work long hours and sacrifice
family and personal life and neglect community commitments. It entrenches pernicious social inequalities, too, which are responsible for the pronounced social gradient in health that we have in this country. It creates a gulf between ordinary less valuable workers who work 48 hours or less, and the elite cadre of professionals who are so valuable that they need to work more than 48 hours. The only way to dispel this unhealthy, divisive culture is to remove the opt-outor at least to look very hard at how it works and how we are entitled to apply it.
We need to strike a difficult balance between the need for doctors to build up the necessary skills and experience and making sure that patients are properly looked after. It is beyond doubt, however, that doctors who are required to work long hours are more likely to make mistakes; we have heard evidence of that, so I do not need to rehearse the argument.
I know that other Members wish to speak, so I do not want to detain the House any longer, other than to say that this is an important issue and that we must get it right. We have to ensure that we balance the needs of training for young doctors against the needs of health and safety and the safety of patients. If we do not get that balance right, in the end the whole country, including patients, will suffer.
Mike Penning (Hemel Hempstead) (Con): I thank my Front-Bench colleagues and my leadershipI am also grateful for the understanding of the Chairfor allowing me to speak from the Back Benches this evening on an issue that is very close to my heart and the hearts of my constituents: the future of the fire service in the United Kingdom.
The working time directive will have effects on numerous areas in our communities, but one of the most risky and dangerous is the future of the retained and voluntary fire service throughout the country. We have heard about the concerns of Scotland, but this is not a rural issue or a Scotland or Ireland issue; it is an issue for the whole country. We have, without any shadow of a doubt, the greatest fire service certainly in Europe, if not the worldand I must declare an interest, as I am a former firefighter. I was a full-time firefighter, and a member of the Fire Brigades Union, which was, and still is, quite anti retained firefighters. I understand the reason for that, even if it is somewhat lost in the 21st century; it is a feeling that retained firefighters take jobs from whole-time firefighters. I do not think that is true; we should come to an understanding, based on costs and analysis, of what is right for firefighting throughout this country.
Angus Robertson: The hon. Gentleman is very qualified on this matter; all Members recognise that he has a background in firefighting. What does he think firefighters will make of political parties that stand up in one Parliament and say they are concerned, and then vote a different way, as the Scottish Liberal Democrats did in the European Parliament?
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