Lamb: Government wrong to impose junior doctors’ contract

Norman Lamb has commented on Jeremy Hunt’s ill-advised decision to impose the controversial contract on junior doctors. He said:

It is a mistake to force a new contract on junior doctors when there is clearly still such strong opposition to its terms. There is a serious risk that large numbers of junior doctors will leave the NHS to go and work abroad, which will have serious consequences for the health service and patient safety.

Growing demand for services, coupled with a funding settlement which doesn’t keep up, are the fundamental problems facing health and care and yet the Government is refusing to take real action to address this.

What we need is a cross party commission to fundamentally review NHS and care funding, to ensure we can give a fair deal to both patients and NHS staff in years to come.

Forcing changes to the junior doctors’ contract is completely the wrong thing for the Government to be focusing on at this critical time for the future of the NHS.

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28 Comments

  • Eddie Sammon 11th Feb '16 - 1:49pm

    The BMA doesn’t want a cross-party commission. It wants their terms or pretty much nothing. The Conservatives have made a big compromise and they still won’t agree to a deal.

    Whatever the rights and wrongs of the contract, the Lib Dems need to be 100% against an emergency services strike, which could be the next card on the table if the BMA want to continue fighting this.

  • Peter Parsons 11th Feb '16 - 2:22pm

    Ian, there is a question as to how independent the chief negotiator is if, as reported, Jeremy Hunt personally vetoed an agreement the employers and the BMA had reached between themselves. Is he effectively negotiating with one hand tied behind his back because Jeremy Hunt has nailed his political reputation to the Saturday working issue?

  • Jenny Barnes 11th Feb '16 - 2:35pm

    Jeremy Hunt doesn’t want a cross-party commission. He wants his terms or pretty much nothing.

    There. fixed that for you, Eddie.

    It’s absurd to say that a deal is impossible. JH insists on Saturdays being normal working days, and the doctors won’t have that. But they do work on Saturdays, just they want to be paid for doing so. Seems very reasonable to me.
    Looks like the privatisation project is going well.

  • @Jenny – what I find odd is how the BMA have focused in on Saturday working and on maintaining a link between pay and the specific hours actually worked, as if they were temp staff being paid by the hour rather than a salary for the job.

    Yet on the BMA’s website they mention other issues, like:
    – Scrapping GP trainee supplement.
    – Scrapping pay protection for those who change specialties.
    – Fees earned for work beyond NHS entitlements no longer to be retained by doctor but to be handed over to employer.

    @Ian – Agree there is a long history of conflict: http://www.nuffieldtrust.org.uk/blog/junior-doctors-contract-row-lessons-history

    @John
    “It will be interesting to see what happens to public opinion if things escalate.”
    Well yesterday, it was noticeable that very few cars tooted their horns in support of the junior doctors outside my local hospital.

    However, much will depend on how the BMA present their case, specifically start providing substance to their soundbites. Taking a look at the list of changes being proposed – see http://www.itv.com/news/2016-02-11/junior-doctors-contract-a-guide-to-deal-being-imposed/ it is hard to see anything in that list that a typical member of the public would not tick and hence would be left wondering why the BMA is claiming the new contract will endanger patients. I fully accept that this list will have been edited and sanitised for edia and public consumption, hence why I think the BMA, who have seen the full text, need to do more to substantiate their claims.

  • Steve Comer 11th Feb '16 - 4:03pm

    I think much of the problem is that neither the Tory Government or the BMA has any real experience of how to negotiate properly. Negotiation does not mean restating previously stated position loudly and hoping the other side gives in. As for “Saturday as a normal day” well that depends on how any new contract is formulated, and how they are moving from a 5 day+ service to 5 out of 7 working.
    There are examples elsewhere in the public sector of how this change has been managed, and both introduced and ammended by negotiations. The Customs and Immigration services have both made this sort of change, in the past couple of decades, and most Fire & Rescue Services have also made it work successfully.
    Norman Lamb is right to criticise the way this has been handed by the Tory Government, still I’ve no doubt the Australian and Canadian Health service will be very pleased to find a cheap source of qualified English speaking Doctors in the months to come.

  • Eddie Sammon 11th Feb '16 - 4:13pm

    Peter Parsons, I thank you for coming on and explaining the doctor’s case. I want junior doctors to be paid more, I’m just not comfortable with strikes in the NHS. 🙂

    If Jeremy Hunt was slashing doctor’s terms and conditions big time then maybe I could understand a strike, but I want the Conservatives to suffer, not patients.

  • From a Junior Doctor….I hate this nonsense perpetuated about us losing “generous overtime” payments. We’re currently paid a salary – the basic portion is actually very low, but with a multiplier of 20-50% which makes up the full salary and depends on how much work we are required to do outside of 7am-7pm Monday to Friday. As an example, I work 1 in 10 nights (including weekend nights) and 1 in 4 weekends – I do A LOT of anti-social hours work. How many other jobs require a professional-level trained employee to be working at 3am every 10th night? The NHS already gets our time and work for far cheaper than it’s value.

    We have a LOW basic salary BECAUSE so much of our pay depends on this out of hours work. A first year doctor gets a £22,636 basic pay – approx £10.80 an hour for a 40 hour week. Remember these are highly trained professionals who often have 5 years worth of uni debt (£45000 in fees alone, double that to include living allowance loans). The average hourly salary for the UK is £13.60 an hour. Increasing basic pay by 13% will bring the hourly pay of first year doctors up to £12.20 an hour. BUT they can now be made to work on Saturday as part of that new pay and hours. Under the current system if they were rostered to regularly work on only Saturday day time they’d get at least a 20% boost to their entire salary – £12.96. In one fell swoop Hunt has delivered them a 6% pay cut.

    Ditching the Pay-banding system for this new hourly rate contract may save the NHS a little money on it’s pointless drive to 7 day services. However it will also cut Junior Doctors pay and more significantly will destroy already low morale. Also, as Junior Doctors are paid by the hour I suspect we will start working to the clock. Say goodbye to the good-will that keeps the NHS going Mr Hunt – Juniors will no longer stay late to finish work, nor will they be likely to step in to fill rota vacancies and sickness meaning more agency fees for the NHS. They will also likely demand that all the onerous requirements to stay certified – Revalidation – be done during working hours only, rather than erode our already precious free time. Mr Hunt will be remembered as the Health Secretary who destroyed the Medical Profession, and turned those that chose to remain into nothing more than clock watchers…..

    There are lots of figures/hours being thrown about BUT, given Mr. Hunt’s record on ‘honesty and openness’, I know who’s side I’d trust…

  • Ryan McAlister 11th Feb '16 - 4:50pm

    I’d have more sympathy with Norman’s concern if he had made similar statements when Teachers (to take one example) pay and conditions were steadily trashed over the last 5 years. He didn’t of course. Real terms pay cuts, higher pension costs, big chunks of the STPCD ripped out. An end to consistent salary points and scales.

    Nobody in the Lib Dems has shed a tear for those changes. Why are doctors different?

  • Peter Watson 11th Feb '16 - 5:07pm

    @Ryan McAlister “Nobody in the Lib Dems has shed a tear for those changes. Why are doctors different?”
    Because, I suspect, Lib Dems are now in opposition.

  • @Jenny
    The BMA’s website is quite educational – I hadn’t realised that Consultants contracts are also up for renegotiation after 13 years. However, what is relevant to the discussion here are the key pieces of correspondence available on the public website [1].

    Looking through these it would seem the remaining sticking point is Saturday working and the BMA’s desire to maintain a link between pay and the specific hours actually worked, as if junior doctors were temporary staff being paid by the hour rather than occupying a salaried position. Yes! agreement has been reached on the rest of the new contract! So it would seem the rhetoric being used on the media stage is for the cameras.

    @Ian – Agree there is a long history of conflict, I came across this interesting article [2].

    @John
    “It will be interesting to see what happens to public opinion if things escalate.”
    Well, it was noticeable that very few cars tooted their horns in support of the junior doctors outside my local hospital yesterday.

    Taking a look at the list of changes the government has released to the media see [3] for an example list, it is hard to see anything that a typical member of the public would not agree with and hence would be left wondering why the BMA is claiming the new contract will endanger patients. I fully accept that this list will have been edited and sanitised for media and public consumption, hence why I think the BMA, who have seen the full text, need to do more to substantiate their claims if they are to win public opinion.

    @Expats – “There are lots of figures/hours being thrown about”
    But it is necessary to ground the debate and really understand the issues.

    [1] http://www.bma.org.uk/working-for-change/junior-and-consultant-contract-home/junior-doctor-contract-negotiations-home , http://www.bma.org.uk/working-for-change/junior-and-consultant-contract-home/ddrb-recommendations-analysis-for-juniors & http://www.bma.org.uk/working-for-change/junior-and-consultant-contract-home/ddrb-recommendations-analysis-for-juniors/junior-doctors-contract-negotiations-faq
    For some reason there are any obvious links to some sections with substantive content hence why I’ve posted multiple links.

    [2] http://www.nuffieldtrust.org.uk/blog/junior-doctors-contract-row-lessons-history

    [3] http://www.itv.com/news/2016-02-11/junior-doctors-contract-a-guide-to-deal-being-imposed/

  • Mark Seaman 11th Feb '16 - 5:39pm

    ‘@Ryan McAlister “Nobody in the Lib Dems has shed a tear for those changes. Why are doctors different?”
    Because, I suspect, Lib Dems are now in opposition.’
    .. All too true i’m afraid. The conditions for much of the Civil Service were similarly attacked when Mr Lamb was part of the Government. The only posts I can remember on this site regarding that subject were very much along the lines of ‘well they can always leave and go to the private sector if they don’t like it’.

  • Peter Parsons 11th Feb '16 - 6:34pm

    “Peter Parsons, I thank you for coming on and explaining the doctor’s case. I want junior doctors to be paid more, I’m just not comfortable with strikes in the NHS. :)”

    Eddie Sammon, junior doctors won’t get paid any more overall as the changes are cost neutral, as, apparently, was the deal agreed between the NHS employers and the BMA that Jeremy Hunt is reported to have personally vetoed. Strikes are a last resort and are not desirable in any situation, the problem with this situation is that it is three-sided, the NHS employers, the BMA and the secretary of state. Personally I am uncomfortable with a politician involving themselves in what should be, IMO, a two-sided situation – the NHS employers reaching a cost-neutral agreement with the BMA without outside interference.

    Today’s announcement has made the job of managers in the NHS more difficult. UK employment law means that the contract announced today cannot be imposed on any junior doctor currently in post while they remain in that post, the new contract can only apply to new doctors graduating this year and any current junior doctor who changes post (and therefore, presumably employer) in the future as part of their training, assuming they remain in England. Therefore there will be two conflicting sets of Ts and Cs with different base pay bands, different out of hours definitions, different unsocial hours uplifts etc. for NHS managers to worry about and deal with for a few years to come. Not ideal by any means and, it would appear, avoidable if it were not for political interference.

  • nigel hunter 11th Feb '16 - 8:42pm

    When I was a ‘postie’ we had a basic wage. this was low. We made more by working overtime, we were paid for the door to door leaflets and any overtime we could get. We had to do more than just work for our basic pay to survive. The doctors are the same. If the new basic wage does not cover ALL the other things they have to do, it is a wage cut. Anger of an imposed settlement breeds resentment etc. less work satisfaction, a move to somewhere that they are valued. This can lead to poor care through dissatisfaction, leaving the service and bringing in cheaper paid foreign doctors who may not be as highly trained as Brits AND who can have language difficulties. This can lead to further public dissatisfaction and lead to calls for privatisation. This is what the Tories want. The NHS should be far more valued than it is. Not a political football.

  • LORENZO CHERIN 12th Feb '16 - 1:18am

    Well done Eddie, I agree on the strike I keep saying it , doctors should do what politicians amateur or professional do ,campaign! Martin Luther King did not strike as a minister of his church! Bevan did not strike as an MP when really nearly all of the BMA was against the NHS !

    The doctors keep avoiding explaining to us in lay terms what on earth is the detail of the problem . If the doctors are getting a raw deal ,fine get all the support by campaigning , win me over , who cannot support this strike but does support the doctors claim if properly put to me !

    Strikes for any emergency professions , medical or fire , military or police , should , in my view not even be permitted as part of the contract of employment .When your job is to help save lives , to not be present when needed is an abdication of responsibility .Is it any wonder I have become a keener constitutional monarchist than ever , when I see commitment I support it ! Irrelevant ,not a bit ,an indication just how cross it makes me that when a position is about service ,to not serve is already resignation.

    Having said all that , I think Jeremy Hunt is completely wrong to impose this contract .I somehow seem to get the impression the rest of the government do. too I believe his handling of this woefully inadequate.This is not acceptable to the doctors , they must be heard , there shall be a crisis in the NHS, if he continues , not because of pointless and iresponsible strikes ,a description I would apply , but because Hunt deserves the same description of his record on this , if this leads to mass resignations proper, meaning doctors leaving !

    Norman , get it right , please ,be a statesman not a politician .We need you , to prevent catastrophy and be a brave and moderate voice .

    Norman , our excellent spokesman for Health , from one among many who have backed you , please criticise Hunt , but urge the doctors not to strike any more , but to do that which you do well , campaign !

  • The BMA is a Trade Union. The Tories are opposed to Trade Unions after all they have successfully blamed Trade Unions for the failure of UK manufacturing. The BMA must not be allowed to win. Teflon Man Hunt must embody the spirit of Maggie.

  • .Further to my ….. 11th Feb ’16 – 4:28pm….given Mr. Hunt’s record on ‘honesty and openness’, I know who’s side I’d trust…

    ……………..Jeremy Hunt’s letter from 20 NHS bosses supporting his decision to impose new contracts on junior doctors unravelled overnight as at least half said they had never agreed to support forcing the deal………. Half of the NHS chiefs who were said to have signed the letter backing Dalton have now insisted they do not support imposition….

    Hunt misleading parliament, perhaps?

  • ” the problem with this situation is that it is three-sided, the NHS employers, the BMA and the secretary of state. “ Peter

    I think a real issue here is that the government/secretary of state is wearing multiple hats. On the one hand they represent the funding source for the various NHS trusts and hence to some extent, it doesn’t really matter what any particular trust pays it’s staff, just as long as they can provide the service to the agreed price, a relationship with similarities to the rail operators. On the other the government is acting as an industry controller and regulator – because tied up with the junior doctors contract are various considerations that impact how a trust deploys it’s staff. I therefore suspect that some of the issues are down to the incomplete devolution/’privatisaton’ of the NHS. [Aside: I use ‘privatisation’ in the sense of legal entities and delegation of responsibilities away from Westminster, NOT that the NHS trusts should become “for profit” organisations.]

    “Today’s announcement has made the job of managers in the NHS more difficult. …” Peter
    I would agree the imposition of a contract may cause problems and resentment. However, part of the deal is that the new contract will apply to new appointments commencing August 2016, with junior doctors typically on short contracts, it is envisaged that the majority will be on the new contract by August 2017.
    During this transition period, I suspect a key concern will be whether the two contracts are compatible. The impression (which may be totally wrong) is that the old contract is fully compatible with the new contract, so as from August staff can be rostered according to the new contract, without staff on existing contracts having their contracts breeched. Additionally, given an intent of the new contract is to reduce the hours worked by individuals, there is almost certainly going to be a staffing shortfall, which in the short-term may be addressed by calling upon those who are still on existing contracts that permit the working of more hours (without penalty). Longer-term the solution will be to create more training posts etc. and so reduce the number of doctors who graduate each year but are unable to find training places and so leave the profession.

    So the real question concerning the future of the NHS, is where is the funding for all these new posts going to come from…

  • LORENZO CHERIN 12th Feb '16 - 12:45pm

    John Marriot,

    On this , your comments above are not illiberal , rather ,intelligent ,we must spend vastly greater sums , a part of that needs to be on salaries that need upgrading , Reid went too far with gps , they are paid too much in relation to junior doctors .We definitely need a Health Tax and one that does not scrimp ,and is progressive.

    Most of the problem is poor planning based on supply and demand ,or , rather , not basing it on supply and demand .That means training doctors en masse , too. Effectively we need a model that is Cuba plus America !

    If there were ever an area where Liberalism could be more of use I do not know of one.A synthesis of social Liberalism ,planning ,equity, investment , and Economic Liberalism , responsibility,dynamism,replenishment, all this is about demand being met, not just managed .For too long , since Bevan put the NHS model in place , and Gaitskell was stuck with it as a difficult one to fund adequately ,the NHS has been a problem about meeting , not just managing expectations .Only Liberals , not too far left or right , and there are many of us , seem to get it ! On this issue , as on many not related to security issues , Reid and Blair were amongst that number .I am not sure Hunt is ,to say the least !

  • Hands up everyone who wants more money spent on the NHS ? Now keep your hand up if you are willing to pay more tax to fund it. (hand down boy at the back, I said do you want to pay more, not do you want someone else to pay more tax ).
    I find it hard to take sides in the present dispute. The government and the BMA’s account of the new contract are so much at odds that it seems certain that someone is being economical with the actualite. While I have a natural distrust of Jeremy Hunt, it is also true that the BMA have, as others have pointed out, opposed just about every reform to the NHS since the year dot.
    And so the NHS stumbles on, from one scandal or crisis to the next, Alder Hey, West Staffordshire, some of the worst cancer survival rates in Europe. Recently I read that only 17% of Britons get to die in their own home, in most other countries the figure is much higher. Yet every time a government tries to do something the streets are full of demonstrators with their “Save the NHS” placards.
    I don’t pretend I know the answer, but I know that Norman Lamb is right when he says we need to have a fundamental review of NHS funding. I can’t believe that we have nothing to learn from the way other countries deliver health care.

  • Dr Wendy Taylor 12th Feb '16 - 4:35pm

    Only a Tory Government could manage to completely alienate the medical profession, as they did when Kenneth Clark was the Health Secretary. As has been said, the NHS has always run on good will. Almost all doctors work many hours more than they are paid for to ensure good & safe patient care. Most hospitals already Consultants working 7 days a week, especially for acute & emergency care. It really is far too simplistic to suggest that increasing the number of doctors on call at weekends will save lives. Even an 18 year old potential medical student I interviewed last week was able to work out that many people wait till the week end before seeking medical help & may be sicker than those admitted earlier in the week. Junior doctors are highly intelligent people who have read the proposals for themselves & are not just listening to the BMA. If they think the contract will be unsafe, I believe them & so do the vast majority of my Consultant colleagues

  • Junior doctors are highly intelligent people who have read the proposals for themselves & are not just listening to the BMA. If they think the contract will be unsafe, I believe them & so do the vast majority of my Consultant colleagues

    I don’t believe them because they have so far been unable to articulate their findings and the reasoning behind their conclusions to the general public. But then that is probably because I don’t simply accept everything a doctor (or any other professional) tells me without question. Also, I don’t like not being able to reference source documents…

    Aside: For those interested there is a ‘Summary of the new 2016 contract” available here:
    http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-contract
    However, this is a summary and not the actual contract text…

  • Peter Parsons 13th Feb '16 - 9:49am

    Another twist. It seems Foundation Trusts in England are under no obligation to use the new contract:

    http://www.independent.co.uk/news/uk/politics/junior-doctors-hospitals-could-refuse-to-impose-jeremy-hunts-new-contract-a6871401.html

    “During this transition period, I suspect a key concern will be whether the two contracts are compatible. The impression (which may be totally wrong) is that the old contract is fully compatible with the new contract, so as from August staff can be rostered according to the new contract, without staff on existing contracts having their contracts breeched.”
    Roland, my original comments were more about the financial complexities introduced by having two different contracts with two different sets of normal working hours, two different pay scales, two different sets of out of hours uplifts and two different sets of rules as to when those apply rather than the rostering. I have sympathy for those charged with the responsibility for monitoring and managing NHS staff budgets over the next few years.

  • Hi Peter, probably because of work I’ve done, I’ve downplayed the financial complexities for two main reasons. Firstly, the time recording and payroll systems being used are already capable of handling the complexities of having staff on different terms. The only complexity will be setting up the new profiles on the system. From a financial management viewpoint I agree there is going to be a level of uncertainty, but will it be more than is happening at present? I suspect not; unless things go seriously wrong and hospitals have to massively increase their use of temporary personnel…

    This leads on to my second reason, the lack of any real comment from the Trusts on this aspect, although I accept they could be simply biding their time. The only thing the Trusts have come out on is, their dismay at Jeremy Hunt’s chosen course of action, taken in response to the letter, they had signed, that concluded the negotiations had gone as far as they were going to get and the next steps were back in the Secretary of State’s hands…

    I suspect that what caught everyone by surprise was the speed with which the Secretary of State acted, namely before the final offer had been published and hence read… [Aside: My analysis of the Summary (PDF) and slidedeck (PPTX) on the NHS Employers website indicate they were produced during the morning of Feb-12 and afternoon of Feb-11 respectively.]

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