Mr. Speaker, in May the government and NHS Employers reached a historic agreement with the BMA on a new contract for junior doctors after more than three years of negotiations and several days of damaging strike action. That agreement was strongly endorsed as a good deal for junior doctors by the leader of the BMA’s Junior Doctors Committee, Dr Johann Malawana, and was supported publicly by the vast majority of Medical Royal Colleges.
However, yesterday it was rejected in a ratification ballot - 58% voted against the contract which means on the basis of a 68% turnout only around a third of serving junior doctors actively voted against the agreement.
It is worth outlining key elements of the agreement that was voted on. It does indeed help the government to deliver on its 7 day NHS manifesto commitment, but it also does much more. It reduces the maximum hours junior doctors can be asked to work, introduces a new post in every Trust to make sure the hours asked of junior doctors are safe, makes rostering more child and family-friendly and helps women who take maternity time off to catch up with their peers.
Junior doctor vote
The president of the Royal College of Physicians, who had opposed our previous proposals stated publicly: 'If I were a trainee doctor now, I would vote "yes" in the junior doctor referendum.'
Unfortunately, because of the vote we are now left in a no-man’s land that, if it continues, can only damage the NHS. An elected government whose main aim is to improve the safety and quality of care for patients has come up against a union which has stirred up anger amongst its own members it is now unable to pacify. I was not a fan of the tactics used by the BMA but to its credit their leader Dr Malawana did in the end negotiate a deal and work hard to get support for it. Now he has resigned it is not clear that there is anyone able to deliver the support of BMA members for any negotiated settlement.
Protracted uncertainty at precisely the time we grapple with the enormous consequences of leaving the EU can only be damaging for those working in the NHS and the patients who depend on it. So last night Professor Dame Sue Bailey, President of the Academy of Medical Royal Colleges, said that the NHS and junior doctors needed to move on from this dispute and that if the government proceeds with the new contract it should be implemented in a phased way that allowed time to learn from any teething problems.
After listening to this advice and further careful consideration of the equalities impact of the new contract I have this morning decided that the only realistic way to end this impasse is to proceed with the phased introduction of the exact contract that was negotiated, agreed and supported by the BMA leadership.
So it will be introduced from October this year for more senior obstetrics trainees; then in November and December for Foundation Year 1 doctors taking up new posts and Foundation Year 2 doctors on the same rotas as their current contracts expire. More specialties such as paediatrics, psychiatry and pathology, as well as surgical trainees will transition in the same way to the new contract between February and April next year, with remaining trainees by October 2017.
Mr Speaker, this is a difficult decision to make. Many people will call for me to return to negotiations with the BMA and to them I would like to say this: we have been talking or trying to talk for well over 3 years. There is no consensus around a new contract and after yesterday’s vote it is not clear that any further discussions could create one.
However, I do believe the agreement negotiated in May is better for junior doctors and better for the NHS than the original contract we planned to introduce in March. So rather than try to wind the clock back to the March contract, we will not change any of the new terms agreed with the BMA.
It is also important to note that even though we are proceeding without consensus, this decision is not a rejection of the legitimate concerns of many junior doctors about their working conditions. Junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours including many weekends.
They have many concerns, for example, about rota gaps and rostering practices. In the May ACAS agreement, NHS Employers agreed to work with the BMA to monitor the implementation of the contract and improve rostering practice for junior doctors and last month at the NHS Confederation’s annual conference I set out my expectation that all hospitals should invest in modern e-rostering systems by the end of next year as part of their efforts to improve the way they deploy staff. I hope the BMA will continue to participate in discussions around all these areas.
Nor is this decision a rejection of the particular concerns of foundation year doctors who often feel most disconnected in that period of their training before they have chosen a specialty. Again we will continue to make progress in addressing these concerns under the leadership of Sheona Macleod at Health Education England, and we will continue to invite the BMA to attend those meetings.
We will also continue with a separate process to look at how we can improve the working lives of junior doctors more broadly, led by the Minister for Care Quality and I very much hope the BMA will continue to participate in that process as well.
Nor will we let up on efforts to eliminate the gender pay gap. So today I can announce that I will commission an independent report on how to reduce and eliminate that gap in the medical profession as well. I will announce shortly who will be leading that important piece of work, which I hope to have initial considerations from in September.
Most importantly Mr Speaker this is not a decision to stop any further talks. I welcome Dr Ellen McCourt to her position as new interim leader of the Junior Doctors Committee. I had constructive discussions with her during the negotiations.
While we do now need to proceed with the implementation of the new contract to end uncertainty, my door remains open to her or whoever takes over her post substantively in September. I am willing to discuss both the way the new contract is implemented, extra-contractual issues like training and rostering, and the contents of future contracts.
To me personally and to everyone in this House as well as many others, it is a matter of profound regret that at a time of so many other challenges the BMA were unable to secure majority support for the deal they agreed with the government and NHS Employers. But we are where we are, and I believe the course of action outlined in this statement is the best way to help the NHS move on from this long-running contractual dispute and focus our efforts on providing the safest, highest quality care for patients and I commend this statement to the House.