11/02/2016 House of Commons


11/02/2016

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confident the ministers will do their best to ensure the regime in

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place will deal with the challenges they face in the tragic situations

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around family breakdown. On the 21st of January I asked for the Leader of

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the House to get the meeting the prime Minister promised with my

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constituents regarding the scandal of the baby Ashes. I have heard

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nothing. I also asked the Minister for Justice and the 26th of January,

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and I have not heard from her either. Politicians need to keep

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their promises, and we would like this meeting. I have checked on this

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and I think she has possibly misinterpreted the response. If the

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ministerial meeting has not come through I will follow it today. The

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flooding in your was devastating for so many because so many could not

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afford insurance. The government still have not applied for the EU

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Solidarity fund. Can we have an urgent statement as to why that has

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not taken place and what progress is being made? The government's

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approach is being trying to get finance on those who need it

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quickly, rather than complicated bidding processes. If you look at

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the amounts of money provided, I think we have done the right thing.

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Last Saturday marked the 126th anniversary of the landmark colliery

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disaster in my constituency in which a number of men and boys lost their

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lives. Can we have a debate on the sacrifices made by miners and their

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families and communities over generations? There is no doubt that

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mining communities played a huge role in this country. They provided

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the energy which kept this country going for decades. I am glad that

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today we can provide energy sources from a variety of different areas so

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we do not have too subject those workers to those conditions today.

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Order. Statement, the Secretary of State for health, Secretary Jeremy

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Hunt. Nearly three years ago today the government first sat down with

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the British Medical Association to negotiate a contract for junior

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doctors. Both sides agreed that the current arrangements drawn up in

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1999 were not fit for purpose. And that the system of paying for a

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unsociable hours was unfair. Under the existing contact, Dutch

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contract, doctors can receive different pay for different

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unsociable hours. Doctors paying nights can be paid the same as those

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who do not, and pay rise can be triggered for all doctors on a road

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if they stay past their shift length. Despite the unfairness of

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this, processing it and reforming it has been slow, with the BMA walking

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out without notice before the general election. Following the

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election, which... The committee refused point blank to reforms.

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Discussions started with ACAS in December, but we have since have two

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damaging strikes with operation cancelled. In January I asked the

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chief executive of Salford Royal to read the negotiating team for the

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government. Under his outstanding leadership, for which the whole

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House will be immensely grateful, progress has been made on almost 100

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different points of discussion, with agreement secured the BMA on

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approximately 90% of them. Despite this progress and willingness from

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the government to be flexible on the crucial issue of Saturday paid, Sir

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David wrote to me yesterday advising that a negotiated solution is not

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realistically possible. Along with other senior NHS leaders and

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supported by NHS employers, the NHS can Confederation, he has asked me

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to end the uncertainty for the service by preceding with the

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introduction of a new contract that they consider safer for patients and

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reasonable for junior doctors. I have decided to do that. Tired

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doctors risk patient safety. In a new contract, the maximum number of

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hours worked in one week will be reduced from 91, 272. The number of

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consecutive -- the maximum number of consecutive nights will be reduced

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from seven, two four. The maximum number of long days will be reduced

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from seven, 25. No doctor will ever be working to consecutive weekends.

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Banning substantial improvements to patient safety and Doctor

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well-being. We will also introduce a new guardian role who will have the

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authority to impose fines for breaches in work. A new contract

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will give additional paid to those working Saturday evenings from 5pm,

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nights from 9pm until 7am, and all day on Sunday. I said the government

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was willing to be flexible on Saturday premium paid, and we have

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been. Those working one in four or more or more Saturdays, will receive

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a paid premium of 30%, which is higher than average of that

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available to most other clinical staff. It is also a higher premium

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of that available to fire officers, police officers and those in other

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walks of life. Nonetheless it still represents a reduction compared to

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current rates. At is necessary to ensure they can afford weekend

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rostering. We do not want take on paid to go down for junior doctors,

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so I can tell the House that they will receive an increase of basic

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salary, of not 11%, but of 13.5%. No trainee working within contracted

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hours will have their pay cut. Our strong preference was also for a

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negotiated solution. Our door remained open for three years. We

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demonstrated time and again our willingness to negotiate with the

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BMA on their concerns. However the definition of negotiation is a

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discussion where both sides demonstrate flexibility and

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compromise, and the BMA proved unwilling to do this. In such a

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situation, any government must do what is right for both patients and

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doctors. We have now had eight independent studies in the last five

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years identifying higher mortality rates at the weekend to be a key

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challenge is to be addressed. Six of these say that staffing levels need

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to be investigated. Professors describe the status quo as

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unavoidable weekend affect. -- effect, which could save lives if

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addressed. They have set out ten clinical standards necessary to

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remedy this. Today we're taking one important step necessary.

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And I understand that this process has generated dismay amongst junior

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doctors, I believe that this new contract we are introducing shaped

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by Sir David Dalton and with over 90% of the measures agreed by the

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BMA through negotiation, it is one that in time can command the

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confidence of both the workforce and their employers. I do believe,

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however, that the process of negotiation has uncovered some wider

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and more deep-seated issues relating to the morale of June doctors and

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the quality of life, which must be addressed. -- junior doctors. This

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includes inflexibility around these, lack of notice about placements that

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can be a long way from home. Separation from spouses and families

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and sometimes inadequate support from employers, professional bodies

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and senior clinicians. I have asked Professor Dame Sue Bailey, president

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of the Academy of Royal colleges, alongside other senior clinicians to

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beat a review into measures outside of the contracts that can be taken

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to improve the morale of the junior doctor workforce. Further details of

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this review will be set out soon. Mr Speaker, no government or Health

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Secretary could responsibly ignore the evidence that hospital mortality

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rates are higher at the weekend or the overwhelming consensus that the

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standard of weekend services is to bowl with insufficient senior

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clinical physician 's -- decision-makers. The likes of

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Morecambe Bay and Basildon show that patients suffer when governments

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drag their feet over such high mortality rates and this covenant is

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determined our NHS should offer the safest, highest quality care in the

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world. We have committed an extra ?10 billion to the NHS this

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Parliament. But with that extra funding must, reform to deliver

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safer services across all seven days. This is not just about

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changing the contracts of doctors, we need better we can support

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services, such as physiotherapy, pharmacy and diagnostic scans as

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well as social care services over seven days, better discharging and

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primary care access to avoid problems and admissions at the

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weekends. Today this is a decisive step forward to deliver our

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manifesto commitment and I commend this statement to the House.

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Thank you, Mr Speaker. I am grateful to the Secretary of State for

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advanced sight of his statement. It would have been good to have plagued

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this exchange on Monday during the urgent question but be no that the

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secretary of state could not be bothered to turn up. Mr Speaker, you

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might also think that the House Secretary would do me the courtesy

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of responding to the two letters I have said to him in the last week,

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but you would be wrong. So much for a health service over seven days, a

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five-day elite Health Secretary would be nice! Mr Speaker, this

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whole dispute could have been handled differently. They have

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Secretary's failure to listen to junior doctors, has deeply dubious

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misrepresentation about research and care at the weekends and his desire

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to make these contract negotiations into a symbolic fight for delivery

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of services over seven days has led to a situation that has been

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unprecedented in my lifetime. Everyone, including the BMA, agrees

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with the need to reform the current contract, but hardly anyone thinks

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they need to do that is so urgent that it justifies imposition and all

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the chaos that will bring. The Health Secretary, Mr Speaker, said

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NHS leaders have asked him to end the uncertainty, but can you confirm

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that means the support imposing a new contract? One of the hospital

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chief executives, who the secretary of state claims are supporting, he

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has treated this morning. I have supported the view that the offer

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made is reasonable. I have not supported contract imposition. That

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is what he has said. For clarity, can he categorically say that the

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NHS leaders he mentioned all fully support his actions today? Can the

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Health Secretary not see that imposing a new contract which does

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not enjoy the confidence of junior doctors will destroy morale, which

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is already at rock bottom? Does he not realise that this decision could

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lead to a protracted period of industrial action, which will be

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distressing for everyone. Patients, doctors, everyone who works in or

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depends upon the NHS? Order! Far too much noise in the Chamber, let me

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say to members on both sides of the House who are shouting out, do it

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again and you will not be called. As simple as that. If members cannot

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exercise the self restraint to be quiet whilst the front benches are

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speaking, they have no business in taking part in the exchanges.

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Heidi Alexander. Grateful, Mr Speaker, what is the House secretary

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honestly think the impact of an imposed contract would be on

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recruitment and retention? A poll earlier this week found that nearly

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90% of junior doctors are prepared to be the NHS if a contract is

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imposed. How does the Health Secretary propose to deliver

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services over seven days but one tenth of the current junior doctor

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workforce? How can it possibly be right for us to be training junior

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doctors and the consultants of tomorrow only to be exporting them

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on Mars to the southern hemisphere? The Health Secretary needs to stop

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behaving like a recruiting agent for Australian hospitals and start

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acting like the Secretary of State for our NHS. Mr Speaker, I would

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also like to ask the Secretary of State what advice he has taken

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before making this decision. He may not want to respond to my letters,

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but what does he say to the volume -- Royal College of Surgeons, Royal

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College of obstetricians and an ecologist? All of whom have or is

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the Secretary of State not to impose a contract? What legal advice has

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the secretary of state taken about how an imposed contract would work

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in practice? What employment rights do junior doctors have in this

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context and what happens if they simply refuse to sign? Mr Speaker,

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the Health Secretary has been keen to present a new junior doctor

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contract as the chief watch on mocks the delivery of services over seven

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days. This is a massive oversimplification and he knows it!

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Whilst research shows a high mortality rate among patients

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admitted to hospital at the weekend, there is absolutely no evidence

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which shows a lack of junior doctors specifically causes this. Will he

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stayed for the record that he accepts that? One of the real

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barriers to more consistent services over seven days is the consultant

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contract and Tom now, at least, the BMA and the government were making

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progress in those negotiations. Could a decision to impose a new

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junior doctors' contract not put the consultant negotiations at risk and

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make the delivery of services over seven days even harder? Could the

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secular state be clear about how the definition of unsociable hours will

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need to change and other contracts in order to deliver services over

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seven days and which groups of staff will this apply to? What we have

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heard from the Secretary of State to date could amount to the biggest

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gamble in patient safety this House has ever seen. He has failed to win

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the trust of the very people who keep our hospitals running and he

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has failed to convince the public of his grounds for change. Imposing a

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contract is a sign of failure, it is about time the Secretary of State

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realise that. Secretary of State. Mr Speaker, she has made a number of

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incorrect statements that I will come to, but what the country will

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notice about her response is a straightforward. When we have an NHS

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any viewers time that runs over seven days, people will see it is

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obvious and the correct thing to do. They will remember how hard it was

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to get there but they will sadly remember the big coal that she made

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to date which was to put short-term political advantage over the

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long-term interests of patients. -- the big political call. She has

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vulnerable constituents, we all have vulnerable constituents who need a

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true NHS that runs over seven days. Those people are precisely the

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people that the NHS should be there for and sorting this out should not

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be a party issue, it should be something that unites the entire

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house. She will come to regret the line that she has taken today. Let

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me address some of our particular points. She has said today and on

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other occasions that this has been badly handled. Well, if she wants to

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know who has handled contract negotiations badly, it was the party

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that gave consultants the right to opt out from weekend work in 2003.

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Who gave GPs the right to opt out of out of hours care in 2004. Is it

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difficult to sort those problems out? Yes, will be the lecture tab

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over by those who caused them? No. She also said that she questioned

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whether there is support for imposition. Let me read to her

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exactly what the letter that I got from Sir David Dalton says. It says

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on the basis of this stalemate, I advise the government to do whatever

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it deems necessary to end uncertainty for the service and make

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sure that a new contract is in place which is as close as possible to the

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final position put forward to the DNA yesterday. What does Simon

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Stevens, the chief executive of NHS England tell us? Are the regrettable

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and avoidable circumstances, hospitals are calling for the end of

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uncertainty and the implication of the package that the Dalton team are

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recommending. She talked about the impact upon her and. Perhaps you

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would like to look at the hospitals that have commented here over seven

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days, some of which have the highest morale in the NHS because morale for

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doctors is higher when they are getting better care for patients.

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She has said that we should not impose this contract, but what she

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is telling us is that because the BNP point-blank refused to negotiate

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on patient care, we should give up on looking after vulnerable

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patients. What an extraordinary thing for a rape Shadow Secretary to

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tellers. -- BNA. She said that we were conflating this contract. Let

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us look at what the Academy of medical colleges said in 2012. They

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said that the weekend is it is likely to be 22 problems linked to

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the absence of skilled and empowered senior staff. -- BMA. Most medical

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colleges have told us that junior doctors will call the fight as

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senior staff. Mr Speaker, the NHS has made great strides in improving

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the quality of care. Since I have been Health Secretary, avoidable

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harm in hospitals has merely halfed, nearly 20% of acute hospitals have

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been put into a new special measures regime and we are turning them

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around. Record levels of the public has said that their care is safe and

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that they are treated with dignity and respect. An NHS over 70s is not

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just a manifesto commitment, it is because we are willing to fight to

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make the NHS is the safest, the highest quality health care system

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in the world. Today we have seen the party opposite is not going to have

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that fight. So it would appear that the Conservative Party is the true

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party of the NHS. Kenneth Clarke. May I congratulate my rate

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honourable friend on taking the clear and correct decision. It is

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obvious after three years that the BMA were prepared to let the whole

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thing back on with talks and days of action until he either abandoned the

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service over seven days or give them a substantial settlement to provide

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them to do it. Can I ask him in future discussions to concentrate as

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he has done, on essential public interest, which is to meet the

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rising and Moss was the man on the servers from an ageing population

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and to use the extra resources that the NHS is getting at the moment to

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deliver that better service to the patients and not allow it to be

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taken away as so often in the past, including ten years ago, orbital

:21:53.:21:58.

more than 2003, and to very large pay claims by the various staff

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unions which will lessen his ability to give us a modern NHS that he

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talks about. My right honourable friend speaks

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with great wisdom and also great experience because many people in

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this House will remember when he was Health Secretary how BMA put up

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posters of him over the country asking what you call a man who

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ignores medical advice and there was my right honourable friend smoking

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his cigar! Every Health Secretary on the website has had similar

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treatment as well, I would suggest. He makes a very important point.

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Under the new Labour administration of Tony Blair, a huge amount of

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extra resources were put into the NHS, but unfortunately because of

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the contract changes in 1999, 2003 and 2004, the impact was actually

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that it made clear at the weekend less effective, not more effective.

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We have now, thanks to the tough decisions we have taken on public

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spending and pulling the economy around, being able to give the NHS a

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funding settlement mixture which is the sixth biggest in its entire

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nearly 70 year history and we are absolutely determined that we are

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putting that extra money into the NHS, that it should come with reform

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that leads to better care for patients, that is the conservative

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week and we will not deflected from it.

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If I could pick up the secretary of state on to statements he has made.

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Can you step away from the trees increased mortality at the weekend.

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The Fremantle paper does not show that, it shows 30 day mortality for

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people admitted at the weekends. There is a lower mortality rate. The

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junior minister said that the secretary of state is careful, but

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that is twice in the statement and I think that is very misleading. I

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have to tell them that what should have happened in terms of things

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like the Fremantle papers and other papers, is trying to understand why.

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The only study that guides us a clear answer and backs up the

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Francis Report is the paper into 103 stroke units showing the single most

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important thing, the ratio of registered nurses. We should know

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what the problem is before we try to fix it and the one group of staff

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along with nurses that are there are junior doctors, they are not the

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barrier to achieving this step ten standards. I welcome the progress

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that has been made since last November. In the debate in this

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Chamber in October, the secretary of state was relatively unloving. The

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process has been made since those negotiations started and

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particularly since Sir David Dalton became involved in the last month. I

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find it incredible that with 90% of agreement, having traded at four

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minutes past eight o'clock, let's go get both sides back to the table, to

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see the next thing on the BBC that the contract is going to be imposed.

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My two concerns are that the problem around recognition of unsocial hours

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may increase the difficulty we already have in recruiting people

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for the acute specialties A, maternity and acute medicine. They

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are already struggling. This could make that worse and I have concerns

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about the problem of the junior doctor at the bottom of a hierarchy

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will have to go and complain. Then a hierarchical system, we can simply

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imagine how difficult that could be and how easily they could get

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labelled as a troublemaker. So I think there are things to begin

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with, I do welcome the progress that has been made in the last month, but

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I do not feel that this is a time to pour petrol on the fire and throw in

:25:55.:25:56.

the towel. First of all can I welcome the tone

:25:57.:26:10.

of her comments, which are more constructive than the comments we

:26:11.:26:14.

have had from other opposition spokesmen, and she is right that

:26:15.:26:19.

what the studies talk about is mortality rates for people admitted

:26:20.:26:26.

at weekends, if you include International studies, there have

:26:27.:26:29.

been eight study since 2010, and if you look at by those factors

:26:30.:26:35.

happened, she is right. You have to look at why we have these problems.

:26:36.:26:41.

Clinical standards say that when someone is admitted they should be

:26:42.:26:45.

seen by a senior decision within 14 hours of admission. They will be

:26:46.:26:51.

seen by a doctor by someone before then, but they will be seen by

:26:52.:26:59.

someone seen in badge senior within 14 hours. That is made in one and

:27:00.:27:14.

eight hospitals. Consultants are also part of this, and contract

:27:15.:27:19.

reform is therefore essential. It is also about the presence of nurses,

:27:20.:27:25.

and the terms we are offering today for junior doctors are better on

:27:26.:27:30.

average than the nurses working in the very same hospitals, better than

:27:31.:27:34.

the midwives and paramedics, which is why Sir David Dalton and many

:27:35.:27:38.

others say that this is up there and reasonable offer. With respect to

:27:39.:27:45.

accident and emergency recruitment, the impact of this contract changes

:27:46.:27:50.

that people who regularly work nights and weekends will actually

:27:51.:27:54.

see their pay go up relatively compared to the current contract.

:27:55.:28:00.

These are the people delivering a seven day NHS, and we must support

:28:01.:28:08.

them. I know that colleagues across the House would want to thank junior

:28:09.:28:17.

doctors for the work they do. I hope they will look carefully at the

:28:18.:28:25.

improvements and the safeguard that will encourage premium rates if they

:28:26.:28:34.

have to work more than one weekend. I would hope that the BMA would also

:28:35.:28:41.

recognise and welcome the very important appointment to lead the

:28:42.:28:50.

enquiry into all the other aspects that lead to discontent with junior

:28:51.:28:54.

doctors. What we now need is to move forward in a positive spirit that

:28:55.:28:58.

actually brings this dispute to an end, takes the temperature down and

:28:59.:29:02.

recognises that we all want the same thing, which is safety for patients.

:29:03.:29:10.

Can I thank her for her constructive comments. She is right, at 13.5%

:29:11.:29:17.

increase in basic pay is very significant because, unlike overtime

:29:18.:29:23.

and premium pay, it is pensionable, it helps applying for a mortgage, it

:29:24.:29:26.

aims you get more money if you are on maternity, and it is something

:29:27.:29:28.

that will be much better for junior doctors. The review that Dame Sue

:29:29.:29:34.

Bailey is doing, which was much derided IV opposition when I

:29:35.:29:40.

mentioned it, is very significant, because one of the things that has

:29:41.:29:44.

gone wrong in training is that since the implementation of the working

:29:45.:29:48.

Time directive, we have moved away from the old firm system, which

:29:49.:29:52.

means junior doctors were assigned to a consultant who had they would

:29:53.:29:56.

see on a regular basis, who would be able to coach them, on a continuous

:29:57.:30:01.

basis over weeks, months, that has been lost, and many people think

:30:02.:30:06.

that has led to lower morale, and we want to see what we can do to sort

:30:07.:30:12.

it out. I want to echo what she said about going forward with a positive

:30:13.:30:18.

and constructive spirit. When the government took the decision to

:30:19.:30:21.

proceed with implementing new contracts, we had the choice to go

:30:22.:30:26.

many different routes because essentially we can decide exact link

:30:27.:30:31.

what it is. We have chosen to implement the contract recommended

:30:32.:30:37.

by NHS Chief Executive is as being fair and reasonable. It was

:30:38.:30:40.

different to our original position. We have moved on most of the major

:30:41.:30:45.

issues a considerable distance, but it is what the NHS thinks is a fear

:30:46.:30:51.

and decent contract, and we have to move forward. The Secretary of State

:30:52.:30:57.

and sure has the grace to acknowledge that the application

:30:58.:31:00.

rate for speciality training has fallen since the government put

:31:01.:31:05.

forward the last year. But can he accept that if he gets less junior

:31:06.:31:09.

doctors, then the problem here is strong to solve would only get

:31:10.:31:16.

worse? What I would say is that we have 10,600 more doctors working in

:31:17.:31:23.

the NHS now than we did five years ago, and we are investing record

:31:24.:31:27.

amounts going forward, and I think there has been a lot of smoke and

:31:28.:31:34.

mirrors about what is actually in the contract proposals. I hope that

:31:35.:31:38.

all trainees and medical students will look at what these proposals

:31:39.:31:42.

are, they will see that independent people have looked over them and

:31:43.:31:46.

believe they are fear and reasonable, actually better for

:31:47.:31:50.

junior doctors, and we will continue to recruit more doctors into the

:31:51.:31:59.

NHS. As one gets a bit older like myself, you get to rely on the NHS

:32:00.:32:04.

more and more, and I have just had an operation and might have one

:32:05.:32:09.

coming up, so people like me get worried about strikes, and I would

:32:10.:32:12.

hope the Secretary of State would try to build on the morale of junior

:32:13.:32:19.

doctors, but can I say that the NHS is not for the Labour Party or the

:32:20.:32:23.

Conservative Party, it is for the people. And why should people like

:32:24.:32:27.

me who are admitted on Saturday have a greater chance of dying? He has to

:32:28.:32:34.

take on the vested interests and take care of the people. He is

:32:35.:32:46.

absolutely right. If you look at the change... If we want the NHS to be

:32:47.:32:51.

the best in the world, we have to be confident that we are giving

:32:52.:32:54.

patients the best care in the world. I completely agree, and there is no

:32:55.:32:59.

reason why this could not be something that the whole House could

:33:00.:33:03.

unite behind. But what we cannot do is look at eight study is in five

:33:04.:33:09.

years and say that we will do that as soon as we get a consensus in the

:33:10.:33:13.

medical profession. We have been trying to get that for over three

:33:14.:33:17.

years, you have to say enough is enough and we have got to do the

:33:18.:33:27.

right thing for patients. As someone who spent 40 years in trade

:33:28.:33:36.

disputes, can we ask how he expects industry relations to improve when

:33:37.:33:43.

he has posed a contract, accused people of lying, and now he has told

:33:44.:33:52.

us he will build into a contract the differential between the anti-social

:33:53.:33:58.

payments will be a difference between those working next to them.

:33:59.:34:04.

Did he put in the library the full list of what he believes the BMA

:34:05.:34:13.

lied? How can he get things back to an even keel? As someone who I can

:34:14.:34:23.

see has more experience of industrial relations disputes than I

:34:24.:34:28.

have, let me say this, I think it is very clear that where you are able

:34:29.:34:34.

to make progress is when you have given take from both sides, the

:34:35.:34:36.

sides are both prepared to negotiate and come to a deal in the interests

:34:37.:34:41.

of the service and the people working in the service. With respect

:34:42.:34:56.

to some of the things put out by the BMA, such as the pay calculator they

:34:57.:35:09.

put on their website, which caused a great amount of anger and dismay, I

:35:10.:35:18.

do not think it is... If I could say to him, the differential between

:35:19.:35:22.

doctors and other workers in hospitals is what the BMA is seeking

:35:23.:35:27.

to protect. It still exists, but we have reduced it because we think it

:35:28.:35:33.

is fairer that way and better for junior doctors. May I add to what my

:35:34.:35:46.

honourable friend said by delving into past history, in 1977I was

:35:47.:35:51.

knocked off a motor cycle by a careless driver on a Sunday because

:35:52.:35:57.

staff were not in the hospital -- because staff were not in the

:35:58.:36:02.

hospital, the room could not be cleaned and I got an infection. It

:36:03.:36:08.

is about the prolongation of small and routine episodes and injuries,

:36:09.:36:19.

and can we say again to the House that when we look at back again to

:36:20.:36:26.

this episode, but it took 40 years to bring about this long overdue

:36:27.:36:33.

change. He is absolutely right. X-rays illustrate the point that it

:36:34.:36:36.

is not just about Doctor presence, it is about people who are able to

:36:37.:36:44.

do x-ray scans, CT scans, get results from laboratories, there is

:36:45.:36:48.

a whole raft of things necessary for seven day care. He is also right

:36:49.:36:53.

that there are huge savings if you get this right. If someone gets an

:36:54.:37:00.

unavoidable pressure ulcer because they have not had the care that they

:37:01.:37:04.

should, they are likely to stay in hospital for over ten days longer.

:37:05.:37:09.

That will cost the NHS several thousand pounds more, which means

:37:10.:37:13.

this is the right thing to do economically and ethically. There

:37:14.:37:20.

are huge pressures everywhere in the NHS, for instance GP out-of-hours

:37:21.:37:28.

services are under strain. What is the Secretary of State doing about

:37:29.:37:30.

those pressures and the additional strain that could be triggered by an

:37:31.:37:35.

exodus of doctors following the imposition of the doctors contract?

:37:36.:37:40.

Will he entertain a commission, as my honourable friends on both sides

:37:41.:37:48.

of the House have suggested, to find a long-term solution? The problem

:37:49.:37:56.

with commissions as they take a long time to come up with solutions, and

:37:57.:37:59.

we need to sort these problems out now, which is why the Chancellor has

:38:00.:38:05.

committed to 3.8 billion next year. We want 5000 more GPs working in

:38:06.:38:09.

general practice, which will help the issues of the out-of-hours

:38:10.:38:16.

services. We have a five-year plan that the NHS is at the mentoring,

:38:17.:38:22.

has the funding to implement, which will transform

:38:23.:38:31.

Can I thank my right honourable friend for his patience in bringing

:38:32.:38:37.

this matter to a conclusion. Go see also share the real sadness that so

:38:38.:38:42.

many of us feel that these wonderful young people who come into the

:38:43.:38:47.

health service to be doctors, with such high ideals, are caught up in

:38:48.:38:51.

this terribly debilitating and damaging dispute? And can I ask him

:38:52.:39:00.

to reinforces average to re-engage directly with junior doctors and the

:39:01.:39:04.

medical profession as a whole to speak directly with and not allow

:39:05.:39:09.

the destructive behaviour of the British Medical Association destroy

:39:10.:39:13.

the relationship? He is absolutely right. There was

:39:14.:39:19.

absolutely no reason to have this dispute. The things we're trying to

:39:20.:39:25.

sort out, seven day safest care for patients, is something every doctor

:39:26.:39:31.

wants to do. They choose the medical profession for the highest ethical

:39:32.:39:37.

reasons. I share his sadness that it has come to this. Given that the

:39:38.:39:41.

counterpart is not willing to budge, we have to take action to remove

:39:42.:39:45.

uncertainty, do the right thing for patients and do the right thing for

:39:46.:39:49.

doctors. I will certainly continue doing gauge. The new commission will

:39:50.:39:57.

also look at wider issues of morality which will make a big

:39:58.:40:00.

difference. I must advise the House that so far

:40:01.:40:04.

we have got through eight questions in 14 minutes, which by the

:40:05.:40:08.

standards of the House operating at its best, is poor. That means

:40:09.:40:19.

shorter questions and pithy answers. I had an e-mail from a doctor in my

:40:20.:40:23.

constituency this morning who thanked me for forwarding replies

:40:24.:40:26.

from the department, although he did say he was disappointed with them.

:40:27.:40:32.

He did say the BMA have proposed a contract which meets the cost skills

:40:33.:40:37.

requirement of the government, although this seems to be rejected

:40:38.:40:43.

by the government. Is it true? I am going to be pithy. It is not just

:40:44.:40:47.

about cost neutrality, it is about dealing with weekend care, which is

:40:48.:40:53.

why the proposal was not accepted. May I congratulate my right

:40:54.:40:57.

honourable friend for always having at the forefront of patient care and

:40:58.:41:06.

the well-being of junior doctors. Would my right honourable friend

:41:07.:41:11.

remind the House how much extras are involved with the NHS in contrast to

:41:12.:41:17.

the opposition? He is absolutely right. There are some regrettably

:41:18.:41:21.

political elements within the BMA. The great irony is that without the

:41:22.:41:25.

austerity measures those same people opposed in the last Parliament, we

:41:26.:41:28.

would not have been able to give the NHS its sixth biggest funding

:41:29.:41:35.

increase ever. I watched the Secretary of State on the TV on

:41:36.:41:40.

Sunday. Two to -- two things struck me. One that he got more pale as the

:41:41.:41:43.

letters were read out from junior doctors. And two that the Secretary

:41:44.:41:49.

of State made clear that the point was the senior doctors not being

:41:50.:41:55.

president -- that the senior doctors not being present was a barrier. Why

:41:56.:42:01.

pick a fight with junior doctors? Senior decision-makers are the most

:42:02.:42:04.

important people in terms of delivering care. But I junior doctor

:42:05.:42:10.

with substantial training does qualify as a senior decision-makers,

:42:11.:42:14.

and that is why we need them more. BMA has taken the oversubscribed

:42:15.:42:20.

political speciality of spin doctoring to a whole new level. Can

:42:21.:42:28.

I express my admiration of the Secretary of State's ability to keep

:42:29.:42:30.

his cool under the sort of provocation he has had, and say how

:42:31.:42:37.

it is that a 13.5% increase in the pensionable pay could possibly lead

:42:38.:42:42.

to problems with recruitment and retention. My honourable friend

:42:43.:42:48.

speaks with personal knowledge of this. This is one of the things that

:42:49.:42:51.

has been wrong with the junior doctors contract for many years.

:42:52.:42:55.

Basic pay is too low. Therefore they feel under huge pressure to boost

:42:56.:43:01.

basic pay by some of the premium working. That has led to some

:43:02.:43:05.

distortions. So yes, it is a significant increase in basic pay,

:43:06.:43:10.

which is a big step forward. Mr Speaker, I spent 30 years in the

:43:11.:43:14.

world of work representing employees, conducting negotiations

:43:15.:43:19.

and solving disputes. I have seldom seen a sense of grievance so

:43:20.:43:25.

grotesquely mishandled, insulting the intelligence of junior doctors

:43:26.:43:28.

by telling them they do not understand what is on offer. Does

:43:29.:43:33.

the Secretary of State not feel a sense of shame that his handling of

:43:34.:43:40.

this dispute should have so poisoned relationships with junior doctors,

:43:41.:43:46.

the backbone of the NHS? Mr Speaker, he can do a lot better than that. We

:43:47.:43:51.

have been willing to negotiate since June. It was not me that refused to

:43:52.:43:55.

sit around the table and talk until December, it was the BMA, who before

:43:56.:44:00.

even talking to the government, balloted for industrial action. What

:44:01.:44:04.

totally irresponsible behaviour. If Labour were responsible they would

:44:05.:44:10.

be condemning it as well. I would like to thank the Minister

:44:11.:44:14.

for his statement today and for the work he is doing to deliver the

:44:15.:44:18.

truly seven-day week NHS we already want. But Willie confirmed that the

:44:19.:44:24.

BMA, the Royal colleges, government and the wider NHS, are agreed on the

:44:25.:44:30.

need to improve weekend care, which, as Professor Bruce Kehoe has said,

:44:31.:44:37.

is a clinical and moral course? She is absolutely right. There is a huge

:44:38.:44:40.

amount of support are doing the right thing for patients, and that

:44:41.:44:45.

is why it is so extraordinary that the BMA have decided to defend the

:44:46.:44:48.

indefensible, not to sit around and talk about how we can do this, and

:44:49.:44:53.

indeed to go back to the earlier question, to put out Commons that

:44:54.:45:00.

are deeply misleading to their own members that have inflamed the

:45:01.:45:02.

situation admitted for worse than it needed to be. The Royal College of

:45:03.:45:06.

GPs have reacted to the decision by saying they are shocked and

:45:07.:45:10.

dismayed. The Royal Oak of psychiatrists have also said it will

:45:11.:45:14.

exacerbate the recruitment and retention issues that the NHS is

:45:15.:45:19.

facing currently. Why does the Health Secretary ignore the concerns

:45:20.:45:23.

of these two Royal colleges? When they have had a chance to look

:45:24.:45:29.

carefully at what we are proposing, I think they will find a lot in it

:45:30.:45:35.

they can commence. Both are psychiatrists and GPs we are putting

:45:36.:45:39.

in a premium to attract more people into those specialties, which are

:45:40.:45:41.

immensely important to them and the NHS.

:45:42.:45:46.

Willie Secretary of State wrote to the attention of the Shadow

:45:47.:45:50.

secretary of state the research in the Netherlands that has shown that

:45:51.:45:55.

improved weekend working, in fact, seven day working, as cut stillbirth

:45:56.:45:59.

rates in the Netherlands dramatically and was up by 6.8%? And

:46:00.:46:05.

that seven-day working has the potential to have a real impact on

:46:06.:46:09.

survival rates for young babies. I would like to commend her for her

:46:10.:46:13.

campaigning on that. She could not be more right. We had a report by a

:46:14.:46:19.

professor before Christmas, which said the mortality rates for

:46:20.:46:24.

neonatal children were 7% higher at weekends. That just underlines why

:46:25.:46:33.

it is so important. On the 5th of December 2011 the government tried

:46:34.:46:39.

to bring in a cut to unsocial hours. Can the Secretary of State, at a

:46:40.:46:42.

time when morale is so low across the NHS, guarantee he will not bring

:46:43.:46:47.

forward cuts? The reason for that was to introduce seven-day working.

:46:48.:46:53.

We have no plans to do that but I cannot be drawn any further except

:46:54.:46:57.

to say we do have to deliver our manifesto commitments. The specific

:46:58.:47:01.

issues we have identified with respect to seven-day working, do

:47:02.:47:04.

relate to consultant and junior doctor presences.

:47:05.:47:11.

Can I thank my honourable friend for the clear way in which he has kept

:47:12.:47:15.

the House up-to-date on his progress. It is very important,

:47:16.:47:20.

surely, that not only do we actually free up beds in hospitals at

:47:21.:47:23.

weekends, but also we should be making greater use of our pharmacies

:47:24.:47:29.

to deliver better health care within the committee. Can my right

:47:30.:47:33.

honourable friend explain how that might happen? I believe my right

:47:34.:47:38.

honourable friend, the Minister of State, is actually with the

:47:39.:47:41.

pharmacists discussing that precise issue. He raises this issue

:47:42.:47:46.

regularly and rightly and they do have a very important part in the

:47:47.:47:51.

future of the NHS. On Sunday I witnessed seven-day working in a

:47:52.:47:55.

Welsh hospital where a clinic was held in Neville Hall for the

:47:56.:47:59.

convenience of patients and to get maximum use of an expensive gamma

:48:00.:48:05.

camera. Wally constantly denigrates the work of the Welsh health

:48:06.:48:10.

service, will he paused to congratulate the Welsh and Scottish

:48:11.:48:13.

governments, who avoided the misery of a strike and will also avoid the

:48:14.:48:17.

poisonous legacy of resentment that he will face from junior doctors?

:48:18.:48:25.

They may have avoided the difficult decision we are taking in the NHS in

:48:26.:48:29.

England, but I would simply say that the longer they go on avoiding that

:48:30.:48:33.

issue, the longer they will have higher mortality rates at weekends.

:48:34.:48:37.

We are determined to do something about it. I would like to thank the

:48:38.:48:43.

Secretary of State for his statement. If we do not have enough

:48:44.:48:46.

junior doctors, patient safety cannot be guaranteed. You referred

:48:47.:48:53.

to reducing the hours, the Knights, the days. Does the health minister

:48:54.:48:57.

believe this will ensure there will be no more strikes? What safeguards

:48:58.:49:02.

are in place for the medical profession if an agreement cannot be

:49:03.:49:07.

reached? It is because an agreement cannot be reached that we are taking

:49:08.:49:13.

the measures we have today. The bits of the new contract he has drawn

:49:14.:49:17.

attention to add the bits that will have the biggest impact on the

:49:18.:49:20.

morale of junior doctors, because we are saying we do not think it is

:49:21.:49:23.

right for hospitals to ask you to work five nights in a row, or to

:49:24.:49:29.

work six or seven long days in a row, and we're putting that right in

:49:30.:49:32.

the new contract. That will lead to better care for patients and less

:49:33.:49:37.

tired doctors. I met a large group of junior

:49:38.:49:40.

doctors in my constituency to discuss the new contract. They were

:49:41.:49:44.

highly professional. There were totally committed to the NHS. But

:49:45.:49:49.

for the first time some of them were considering working abroad. One said

:49:50.:49:53.

that although she loved her job, she would never let her daughter train

:49:54.:49:57.

as a junior doctor. Isn't that a demonstration that the low morale,

:49:58.:50:02.

the despair and the likely flight of junior doctors in the light of

:50:03.:50:05.

imposition, is a huge threat to the future of the NHS?

:50:06.:50:09.

I think the biggest threat to morale for doctors is if they are not able

:50:10.:50:14.

to deliver the care that they came into the profession to deliver. And

:50:15.:50:20.

that is why, that is why sorting out the proper seven-day NHS,

:50:21.:50:24.

particularly for junior doctors who work in A departments at the

:50:25.:50:27.

weekend and often do not have the support they have of the week -- in

:50:28.:50:31.

the week, that is what we are trying to put right. I appreciate it is

:50:32.:50:34.

difficult when your counterpart in the dispute does not want to

:50:35.:50:37.

negotiate. But in the end governments have to decide what is

:50:38.:50:41.

right for patients, what is right for the service and what is right

:50:42.:50:47.

for doctors. Lie Hull has traditionally struggled to recruit

:50:48.:50:53.

doctors in specialities. I'm concerned that the imposition of

:50:54.:50:56.

this contract will have a detrimental effect on staff morale

:50:57.:51:01.

and staff retention in the NHS. Isn't this going to make things even

:51:02.:51:05.

more difficult for areas like Hull that struggle to recruit in the

:51:06.:51:11.

first place? We want more doctors and more nurses in the NHS. In the

:51:12.:51:16.

end if we are putting extra money into recruit these extra doctors and

:51:17.:51:21.

nurses, it is fair to the public paying for their salaries, to have

:51:22.:51:24.

reforms that means they care gets better. That will apply to her

:51:25.:51:29.

constituents in Hull just as my constituents in Surrey.

:51:30.:51:38.

The health secretary has repeatedly and continues to mislead junior

:51:39.:51:44.

doctors. Yet 98% of them voted for industrial action. Without

:51:45.:51:47.

said the last thing they wanted to said the last thing they wanted to

:51:48.:51:51.

be doing was to be out on strike. The doctors are some of the

:51:52.:51:54.

brightest and most intelligent people we have in our country. Does

:51:55.:51:59.

the Secretary of State believe they cannot make their minds up for

:52:00.:52:03.

themselves? It is interesting because when they did that vote, the

:52:04.:52:08.

BMA had actually not sat down and talked to the government, despite

:52:09.:52:12.

repeated invitations. I personally met the leader of the junior doctors

:52:13.:52:16.

committee and invited him to talks. And despite the repeated invitation,

:52:17.:52:21.

they refused to talk. They decided to ballot for industrial action. How

:52:22.:52:26.

serious are people about reaching a negotiated settlement if that is

:52:27.:52:30.

what they do? I wonder if the Secretary of State

:52:31.:52:34.

could clarify something? He says those work doing one in four or more

:52:35.:52:41.

Saturdays will receive a pay premium of 30%, higher on average than that

:52:42.:52:45.

available to most other clinical staff. Those Clough that he sites

:52:46.:52:54.

will be employed... Those staff, if they work Saturdays, they receive

:52:55.:53:01.

30%. Can he tell me how he has calculated an average? I do not

:53:02.:53:03.

understand his mathematics. The contract gives Junior doctors

:53:04.:53:15.

who work more than one in four Saturdays, one in three Saturdays, a

:53:16.:53:19.

higher premium of 50%. On average it is a higher premium. As been pointed

:53:20.:53:26.

out by May honourable friend, the word on strikes in Wales yesterday

:53:27.:53:31.

-- were no. In response to the point, there was an increase in 10%

:53:32.:53:37.

in the budget equivalent of 135 paces pernicious training. So

:53:38.:53:41.

critical to this cover. It may have been what led to be education I had

:53:42.:53:46.

from England junior doctor to say could we have your minister for

:53:47.:53:51.

Wales please? What does this say about morale in the NHS and England

:53:52.:53:59.

went in football and rugby, the Minister has now lost the confidence

:54:00.:54:03.

of the changing and Kazakh I think that is the first time -- of the

:54:04.:54:07.

changing room. I think that is the first time a Welsh MP has got up and

:54:08.:54:11.

said they think things are better in the Welsh NHS. Look at the waiting

:54:12.:54:15.

times that people have when they want to wait for basic operations on

:54:16.:54:20.

the NHS in Wales, far far longer than England. I don't think we will

:54:21.:54:23.

take any lectures about how to run the NHS from Labour in Wales. I

:54:24.:54:31.

represent three fine hospitals, one great medical school and has spent a

:54:32.:54:35.

lot of time listening to junior doctors and medical students. The

:54:36.:54:38.

Secretary of State talks about the crisis of morale within the NHS, and

:54:39.:54:45.

junior doctors, does he not recognise his handling of the

:54:46.:54:48.

dispute has done so much to enhance that crisis and today's announcement

:54:49.:54:53.

will make it so much worse? Bottle at all. The choice I had was to do

:54:54.:54:59.

something -- not at all. To do something about mortality rates at

:55:00.:55:03.

weekends or duck the issue. On the Conservatives we don't duck the

:55:04.:55:06.

issue is about mortality rates, we do the right thing for patients.

:55:07.:55:10.

After Labour's record I would have thought he would be more

:55:11.:55:15.

circumspect. Point of order. Thank you. In an earlier exchange in deck

:55:16.:55:22.

questions, the Secretary of State said in response to a question that

:55:23.:55:27.

I posted her, large-scale solar is already subsidy free. I think she

:55:28.:55:34.

may have inadvertently misled the House as I understand that under the

:55:35.:55:38.

Government's imbibing review, the Government are proposing a subsidy

:55:39.:55:43.

of ?34 per megawatt hour in terms of subsidy. How can get the Secretary

:55:44.:55:49.

of State to correct statement? I thank him for this point of order. I

:55:50.:55:54.

was not here during deck questions but as he knows, ministers take

:55:55.:55:57.

responsibility for their own statements but has put the matter on

:55:58.:56:04.

the record. Point of order. Earlier in business questions I raised the

:56:05.:56:07.

case of my constituents Mike and Tina Trouville. I raised them in

:56:08.:56:12.

Prime Minister questions on November four and the Prime Minister promised

:56:13.:56:16.

a meeting with my constituents. I raised it with Leader of the House

:56:17.:56:19.

because it is now the user of February and it is very difficult to

:56:20.:56:23.

get that meeting. The Leader of the House said I misinterpreted the

:56:24.:56:26.

response from the Prime Minister. I went back and checked Hansard on the

:56:27.:56:35.

4th of November. I specifically say, will be Prime Minister agreed to

:56:36.:56:38.

meet Mike and Tina to discuss why we need a national and local enquiry

:56:39.:56:43.

into what happened to baby as is in such cases? His responses, I quote,

:56:44.:56:49.

I am happy to arrange that meeting. I don't quite understand how I

:56:50.:56:53.

misinterpreted that and more to be point my constituents who have now

:56:54.:56:55.

been meeting three months for a meeting with the Prime Minister of

:56:56.:57:00.

misinterpreted how could I assist -- take this forward Kazakh I think she

:57:01.:57:10.

has already taken this forward. I am sure it they will take this further

:57:11.:57:14.

and perhaps she will be risen to at least. We come now to two Select

:57:15.:57:20.

Committee statements. Mr Clive Betts will speak to his subject up to ten

:57:21.:57:26.

minutes. No interventions may be taken. After his statement I will

:57:27.:57:30.

call members to put questions on the subject of the statement and called

:57:31.:57:34.

Mr Clive Betts to respond to these in turn. This is very long. Members

:57:35.:57:39.

can expect to be called only once, and a vengeance should be questions

:57:40.:57:42.

and be brief. The front bench may take part in questioning, the same

:57:43.:57:46.

procedure will be followed for the second Select Committee statement, I

:57:47.:57:50.

called Beach Arabic Communities and Local Government Committee, Clive

:57:51.:57:56.

Betts. -- the chairman. I would like to thank the chance to prevent a

:57:57.:58:03.

report on houses and right to buy. -- present. I thank them for their

:58:04.:58:11.

help in producing a report. There is clearly a housing crisis in the

:58:12.:58:14.

country. They wanted to look at one of the key policies in greater

:58:15.:58:18.

detail. Extending the right to buy pretence of us housing association.

:58:19.:58:20.

This was a Conservative manifesto commitment. The Committee did not

:58:21.:58:25.

question whether this Committee should be appointed, but as is

:58:26.:58:28.

appropriate for select committees, scrutinised how it was being

:58:29.:58:32.

invited. We also looked at other government policies such as the 1%

:58:33.:58:36.

reduction in social rents, paid to stay and started homes which will

:58:37.:58:39.

have an impact on the provision of social housing on housing

:58:40.:58:43.

associations. We had a very large response to for evidence will stop

:58:44.:58:48.

over 175 written submissions. We heard from a range of witnesses

:58:49.:58:52.

including housing association chiefs across England, Scotland, Wales,

:58:53.:58:57.

council leaders, representatives of tenants and model that lack of

:58:58.:58:59.

mortgage lenders. Three of investigations we found a great deal

:59:00.:59:02.

of uncertainty in relation to the key point, a lack of detail. The

:59:03.:59:07.

funding model of the right by is extremely question. We call on the

:59:08.:59:13.

Government to look at the programme is a matter of urgency. There was a

:59:14.:59:18.

deal to extend the right to write on a voluntary basis restricting the

:59:19.:59:21.

Government and the National Housing Federation. Recognise a voluntary

:59:22.:59:24.

deal is a way of delivering a key policy from the Government's

:59:25.:59:28.

manifesto while maintaining the independence of housing

:59:29.:59:30.

associations. In the circumstances, is the best way forward for both.

:59:31.:59:34.

However there remains much uncertainty in the wording of the

:59:35.:59:38.

agreement. A minority associations but are against it and so much then.

:59:39.:59:42.

We don't know yet how the race to buy will be imposed upon them. And

:59:43.:59:46.

how binding the terms of the voluntary agreement will be. Another

:59:47.:59:50.

issue is how much discretion each association will have to decline the

:59:51.:59:53.

sales, can they for example choose not to sell any of their homes in a

:59:54.:59:58.

certain area or will it be the case of a case-by-case basis? What is the

:59:59.:00:02.

appeal process for tenants who are refused to break the bank was buy?

:00:03.:00:05.

Extended right to buy is designed to increase home ownership and increase

:00:06.:00:09.

housing supply. We support his aspirations and the principal giving

:00:10.:00:13.

people the opportunity to own their own home. Providing a home sold on

:00:14.:00:16.

the motorbike replaced on a one-to-one basis, housing continues

:00:17.:00:21.

to be delivered across all tenders to meet the country's housing needs.

:00:22.:00:25.

The field there are unresolved issues and remain concerned the

:00:26.:00:27.

policies could have a detrimental affect on the prison of accessible

:00:28.:00:34.

and affordable housing across all places including rented homes. We

:00:35.:00:37.

looked in particular at houses in rural areas weather often is a

:00:38.:00:41.

demand. The did supply of land availability means it can be

:00:42.:00:45.

challenging to build new homes. In order of our rural committees to

:00:46.:00:49.

thrive it is important that young people and those on low incomes can

:00:50.:00:53.

afford to live on them. The terms include ability of housing

:00:54.:00:56.

associations to offer a portable discount in place of selling a home.

:00:57.:01:00.

Given that national parks can be large, it remains to be seen how

:01:01.:01:05.

this work in practice. We are also concerned that extending right to

:01:06.:01:08.

buy could hinder the provision of specialist and supporting housing

:01:09.:01:10.

schemes. They are expensive to build and can be harder to replace but

:01:11.:01:13.

provide essential services to those living in them. We believe to avoid

:01:14.:01:19.

confusion or possible legal challenges, restrictive covenants on

:01:20.:01:22.

the stricken sites and properties built using charitable funds should

:01:23.:01:26.

be explicitly exempt from the extended right to buy. We found that

:01:27.:01:30.

large numbers of homes sold through the statutory right to ride to

:01:31.:01:34.

council tenants had in its short space of time become rental

:01:35.:01:37.

properties in the private sector. This is a concern to us because of

:01:38.:01:41.

private rented sector is often more expensive than

:01:42.0:54:45

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