We therefore have reservations about changes to the European working time directive. High-quality, safe patient care and the maintenance of further enhancement

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of the quality of training and education for junior doctors are important. I note the issues raised today, and specific areas must be looked at. We heard concerns about the maintenance of training standards, but patient safety must be paramount, and we should co-operate with all interested parties to develop sensible, workable and achievable solutions to the problems. If we allow a relaxation of the European working time directive for junior doctors, the danger is that we run the risk of a gradual return to their working dangerously long hours. I urge the Government to tread carefully because as the hon. Member for Bristol North West said, to be fair, some aspects of the working time directive had laudable aims. As was echoed in a number of contributions today, we do not want to see a return to the dangerous working hours worked by some doctors in the past.

Charlotte Leslie: Does the hon. Gentleman acknowledge that even if we relax the working time directive, with its detriments to the NHS, doctors would still be bound by the new deal and the 56-hour week? I see no return to the bad old days while the new deal is in place, although I think it, too, needs looking at again.

Andrew Gwynne: I shall come on to the new deal shortly, but no one would want to go back to the past with tired doctors working excessive hours. Many Members recall the very real horror stories that surfaced from time to time, in particular through the 1980s and early 1990s, when it was not uncommon for junior doctors to be working a 100-hour week, as we have heard in the debate. The hon. Member for Totnes called on her personal experience and the hon. Member for Stafford (Jeremy Lefroy) called on his domestic experiences from the past to make some reasonable points about the stress and strain that the old ways of working placed on doctors. I was reassured by their comments that they did not want to see a return to those days.

An article in the BMJ, the British medical journal magazine, looking at the effects of the working time directive, suggested that it was hard to draw firm conclusions. It also found that reducing working hours to fewer than 80 a week had not adversely affected outcomes for patients or in postgraduate training in the USA, where similar restrictions were introduced. As we heard from my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), the systematic review found the same, and that cannot be discounted because it does not necessarily fit some arguments. I do, however, take full account of today’s anecdotal evidence from Members, although it might well be wise to look at the wider, long-term implications of relaxing some of the directive’s conditions.

If we go back a number of years, to the 1990s, the new deal tried to establish that full shift working should not exceed 56 hours. Through the 1990s, compliance with the new deal was poor, so a new contract was introduced in 2000. The implementation of the Working Time Regulations for employed doctors in the training grades has helped to protect doctors from working dangerously long hours, improving patient safety.

I accept, as we have heard from several hon. Members, that press reports of locum doctors costing hospitals and the NHS some quite extortionate amounts are concerning. Some reasonable points were made by the hon. Member for Central Suffolk and North Ipswich,

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who speaks with experience on these matters, about the clocking off and clocking on culture, which is certainly a concern. Clearly, questions must be raised about spending so much public money in these financially restricted times, and we need to know what will be the knock-on effect for the quality of patient care, especially if patients are continually seeing different doctors every time.

The Minister, in answer to the hon. Member for Kingswood (Chris Skidmore), mentioned the 11% drop in the use of locums since May 2010 and the increase in the number of doctors, which is welcome. I will just make the point that those extra doctors were trained and came through the system under the previous Labour Government. It would be churlish of the current Government not to recognise that as they take some political capital. May 2010 was not month zero; those doctors were coming through the system previous to that.

This debate has been a positive step. As we have heard, a number of issues surround health workers, especially junior doctors, and I agree that they should be further examined as we seek ways to resolve the problems. However, we should approach with some caution the idea of relaxing some of the directive’s conditions in relation to junior doctors as in the longer term it might cause more problems than it solves.

In closing, I refer to the opening comments of the hon. Member for Bristol North West in which she said that we all value the expertise and professionalism of NHS staff and that the aims of the working time directive were very reasonable. Long hours were dangerous for both doctor and patient and we do not want to return to those days. She is right. Although we recognise that there are issues to consider in relation to staffing implications and the cost to the NHS, we do not want to see the positives that have been secured disappear. I look forward to hearing from the Minister an indication of the current Government’s thinking on how to strike that important balance for those working in our medical and clinical professions in the NHS. I feel a bit like Daniel in the lion’s den. I urge the Minister to tread cautiously, and I mean that with all sincerity. Yes, there are some issues, but he really should resist the knee-jerk reaction of his party’s anti-EU wing, which is probably its mainstream. He needs to look holistically at the issues, the concerns and the benefits.

5.12 pm

The Minister of State, Department of Health (Mr Simon Burns): It is a pleasure to serve under your chairmanship this afternoon, Mr Howarth. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this debate. Anyone who listened to her speech this afternoon would realise that she is an expert in this area and cares passionately about improving the current situation, which, as it will become clear during the course of my remarks, is a problem for the national health service. I have considerable sympathy with the aim of her contribution—to get improvements and changes that will aid the NHS to help those who work within it.

We have had a particularly high-level and intelligent debate in which there have been some powerful contributions—surprisingly, not from many Opposition

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Members—from my own hon. Friends and the hon. Member for North Antrim (Ian Paisley). I would like to call him an hon. Friend because of the kind things that he said about me, but protocol forbids me as he is not a paid-up member of the Conservative party. None the less, my thoughts are with him in that respect.

There was an excellent speech by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke with the authority of someone who was a consultant in a national health service hospital before coming to this place. Another powerful and highly informative speech came from my hon. Friend the Member for Totnes (Dr Wollaston), whose knowledge of the NHS has been gained through direct experience of working within it for many years before coming here.

We had a very interesting contribution from the hon. Member for Vauxhall (Kate Hoey), who cares passionately about this issue. My hon. Friend the Member for Stafford (Jeremy Lefroy) made a customarily well-informed speech based on knowledge gained partly from his experiences as an MP with the Mid Staffordshire NHS Trust in his constituency, and partly from his background interest in all health matters. I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on a very powerful contribution. She rightly holds very strong views on these issues, and they are an important part of the debate. I congratulate my hon. Friends the Members for Hastings and Rye (Amber Rudd) and for Kingswood (Chris Skidmore), who both, in their own way, fight vociferously for their own local health economies in Hastings and in Kingswood, and show an interest in health debates.

All hon. Members are aware that this issue has been simmering, in one way or another, for many years. Recent news has shown us that dealing with the EU never seems simple, regardless of what is being discussed. I can understand the impatience of a number of my hon. Friends, because I, too, am impatient when I want something to be done that I think is sensible and should be done. Sadly, as we all know from our experiences of working within the European Union and of how that organisation works, we cannot always have instant gratification.

Dr Wollaston: Does my right hon. Friend think that one of the problems with the EU’s priorities is that it is demanding a 6.8% rise in its budget, rather than dealing with more pressing problems?

Mr Burns: I am tempted to go down that path, because I have considerable sympathy with my hon. Friend. However, time is short and I do not want to upset you, Mr Howarth. I will avoid temptation and keep myself on the straight and narrow.

We could not be clearer about how we want things to move forward. In the coalition agreement almost two years ago, the Government resolved to limit the application of the working time directive in the NHS. That position has not changed. We still believe strongly that working people should be able to work the hours they want. That means they should be able to choose to opt out of the directive’s limit on working hours. However, no one wants a situation where tired doctors are working for far too long, and for that reason it is important that doctors who choose to opt out, and their employers, agree working hours that ensure that patients are not at

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risk. A common thread running through the contribution of every hon. Member was the importance and necessity of not returning to what is known as the bad old days. Nobody on this side of the House, in any shape or form, would want that to happen. However, it is equally viable and intellectually respectable to argue for more flexibility, as the current situation —as highlighted in many speeches—is causing problems for the NHS. That has to be done in an ordered way. We cannot unilaterally take any action that would compromise the legality of how the European Union works, our contribution and how we operate within the EU.

Andrea Leadsom: Does my right hon. Friend recognise that Sweden agreed legally to join the euro and has failed to do so, and so our inability to implement all our commitments might be seen by some as trivial in comparison?

Mr Burns: My hon. Friend makes an interesting point that could tempt me, but I will not be tempted. Each member state of the European Union is answerable for its decisions and behaviour. I believe that if one is a member of an organisation and has signed up and committed oneself to certain procedures and legal ways to do business, it is only right that the British Government—

George Eustice: Will the Minister give way?

Mr Burns: I will not, if my hon. Friend will forgive me, simply because I have only seven more minutes. I was hoping to address some of the points raised by my hon. Friend the Member for Bristol North West.

We have to abide by the legalities. Otherwise, chaos will ensue and we will not in the longer term achieve what we are hoping to, even if we might on that narrow issue. Until the negotiations in Europe come to a successful end we are obliged to comply with the European Court of Justice and we cannot unilaterally go against it. The Department of Health and the Department for Business, Innovation and Skills are working very closely together on how the WTD will apply to the UK health care sector. Both Departments agree that we need to keep the opt-out and it would be a grave error to surrender it or to abandon it for other concessions. That is a red line for us. We have to keep the opt-out.

We also want to solve the issue of flexible on-call time and compensatory rest that allows the NHS to work within the current constraints of the working time directive. Those are both very important issues to the Government and to the NHS, but as I said, the bottom line is that the opt-out must stay. European social partners have opened negotiations to amend the WTD. At this stage, as hon. Members will know, it is not national Governments directly who are conducting these negotiations; they are being done through what is known as the social partners. In our case, it is NHS Employers and the Local Government Association with regard to local government and the knock-on effect for social care; that is an important part of the delivery of NHS services and social care.

That process is autonomous, and operates independently of the Commission and Council. The social partners have nine months at most to reach an agreement. That takes us up to September 2012. If an agreement is

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reached, it would be submitted to the Council for approval. But if an agreement cannot be reached, it will be up to the Commission to issue a proposal to change the directive. The Government have made it patently clear to everyone that long-term, sustainable growth must be the EU’s key priority. Every decision the EU makes must be geared towards that. So we will carry on working with our partners to make sure that EU measures support labour market flexibility and do not impose unfair costs on member states or businesses, or services like the NHS, that could hold back our economy and the delivery of services.

For the NHS specifically we are keen to ensure that an amended directive provides more flexibility, particularly in the areas of on-call time and compensatory rest, provided that a workable opt-out can be maintained. Responding to concerns about how the directive is being applied, particularly with regard to medical training—an issue raised by a number of hon. Members—Medical Education England, the Government’s independent advisory body on medical education, commissioned an independent review chaired by Professor Sir John Temple. My right hon. Friend the Secretary of State for Health has asked Medical Education England to help improve our training practices in line with Sir John’s recommendations.

In response, Medical Education England has set up a programme known as Better Training Better Care, which will improve patient care by increasing the presence of consultants and by ensuring that service delivery supports training. It includes two important components: identifying, piloting, evaluating and sharing good education and training practice; and improving the curriculum so that training leads directly to safe, effective patient care. From an education and training perspective, handovers present an excellent opportunity for training. The Better Training Better Care programme includes pilots that will hopefully show how education and training practice can improve in that area and take advantage of those opportunities.

NHS trusts in England have responded very positively to this programme: 96 trusts applied for part of the £1 million available for NHS pilots in 2012-13. Following that competitive process, last month 16 projects with 16 NHS trusts were awarded funding for those pilots. I look forward to seeing what developments they come up with.

As I am running out of time, I say to my hon. Friend the Member for Bristol North West, who wants to make a contribution to end the debate, that I will write to her with answers to a number of important issues that she raised. However, I will deal briefly with two issues now.

First, my hon. Friend asked what will happen in emergency situations such as a flu pandemic. I hope I can give some reassurance on that point. In such circumstances, as long as health and safety are protected in the round and the employer has correctly judged that the circumstances are exceptional, the rest requirements of the directive can be suspended.

Secondly, my hon. Friend the Member for Kingswood and other Members raised the vital issue of locums, including the cost of locums and their number. I share the concern of my hon. Friends about the use of locums. They play an important role when there are short-term staff shortages, or when there is illness or holidays, and there may be a limited impact of the EWTD that means

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that trusts will be employing locums when they might not otherwise do so. However, the evidence about the extent of that practice is not as extensive and meaningful as we would like it to be; we would like to get a fuller picture. Nevertheless, whatever the reason for the use of locums, we are concerned across the board about their extensive use and the add-on costs that brings to the NHS. That is why we are working through our training programmes and through the Quality, Innovation, Productivity and Prevention programme to seek to minimise unnecessary use of locums and to bring down the number employed, thereby reducing costs. As I said to my hon. Friend the Member for Kingswood, there has been an 11% reduction in the employment of locums, and at the same time there has been an increase in doctors.

In conclusion, I also hope I can give some reassurance to my hon. Friends about staffing levels, particularly in specialised areas, because the situation is slightly more encouraging than they may have feared. For example, if we take the current year and general surgery—

Mr George Howarth (in the Chair): Order. I call Charlotte Leslie.

5.27 pm

Charlotte Leslie: Thank you, Mr Howarth, for allowing me to speak.

I look forward to the Minister’s further reply in writing. I should like to take this brief opportunity to thank him and hon. Members for furnishing this debate with such insight and, in many cases, experience. The hon. Member for North Antrim (Ian Paisley) used the F-word and is a true advocate of Cillit Bang for the gold-plating that this country seems to put on every piece of legislation that we have.

I am particularly grateful to my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter) and for Totnes (Dr Wollaston) for sharing their first-hand experience and knowledge. They talked

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about vocation and the meaning of that word in terms of professionalism. My hon. Friend the Member for Totnes proposed some constructive solutions about how we can mitigate the effects of the European working time directive, right here and right now.

We heard an account of first-hand experience from the hon. Member for Vauxhall (Kate Hoey), who talked about the director of St Thomas’s hospital and warned that the formal view of events is often far better than the real situation, which is often a lot worse and not always represented in formal evidence that is given.

I also give many thanks to my hon. Friend the Member for Stafford (Jeremy Lefroy), who gave yet more first-hand evidence from his wife and talked cogently about the recruitment lag that we are facing. He also gave evidence from the Association of Surgeons in Training about the two years of surgical training time that is lost.

Many other Members made extremely valuable contributions. I fear that I cannot mention them all because of the limit on time, but I must mention my hon. Friend the Member for Kingswood (Chris Skidmore), who provided a great deal of experience from the Health Committee. I know that other Members would have contributed immensely if they had been able to make a speech today, particularly my hon. Friend the Member for Camborne and Redruth (George Eustice).

I was encouraged that the hon. Member for Denton and Reddish (Andrew Gwynne) acknowledged the challenges that we face, but I am slightly cautious about the fact that he did not acknowledge the urgency of the situation or the strength of doctors’ evidence. One of the reasons why the new deal failed is that it did not bring on board the views of doctors as a whole. It failed because it did not bring doctors with it. I warn against ignoring doctors’ evidence on this front. I am very encouraged by the Minister’s remarks, but I hope that he will forgive me and other Members if we carry on campaigning and do not let this issue drop.

5.30 pm

Sitting adjourned without Question put (Standing Order No. 10(11)).