:00:00. > :00:00.granted to academies in this country. There are many schools that
:00:00. > :00:10.are taking advantage of that particular freedom. Statement, the
:00:11. > :00:13.Secretary of State for Health. Secretary Jeremy Hunt.
:00:14. > :00:20.Thank you. For the last three years there have been repeated attempts to
:00:21. > :00:27.reform the junior doctor's contract to support better patient care seven
:00:28. > :00:31.days a week, culminating in a dispute which has lasted over 10
:00:32. > :00:37.months after ten days of discussion under the au pishs of ACAS, the
:00:38. > :00:42.dispute was resolved yesterday with an historic agreement between the
:00:43. > :00:47.Government, NHS employers, acting on behalf of the employers of doctors
:00:48. > :00:50.and the BMA which will modernise the contract making it better for
:00:51. > :00:54.doctors and patients. The new contract meets all the Government's
:00:55. > :01:03.red lines for delivering a seven-day NHS and remains within the existing
:01:04. > :01:05.pay envelope. We will publish an equallied analysis alongside a
:01:06. > :01:10.renewed contract. It will be put to a ballot of the BMA membership next
:01:11. > :01:15.month with the support of the leader, the chair of the committee.
:01:16. > :01:21.Mr Speaker, I would first of all like to express my thanks to the BMA
:01:22. > :01:25.for the leadership they have shown in returning to talks, negotiating
:01:26. > :01:32.in good faith and making an agreement possible. I would like to
:01:33. > :01:41.put on record my thanks to Sir Barber for his excellent stewardship
:01:42. > :01:47.and to Sir Dalton for his wisdom and insight.
:01:48. > :01:52.The agreement will facilitate the biggest changes to the junior
:01:53. > :01:59.doctors' contract since 1999. It will allow the Government to delive
:02:00. > :02:03.a seven-day NHS, improve patient safety, support productivity
:02:04. > :02:06.improvements and impoveing the morale of junior doctors with a
:02:07. > :02:11.modern contract fit for a modern health service. The contract,
:02:12. > :02:15.inherited by this Government, had a number of features badly in need of
:02:16. > :02:22.reform, including low levels of basic pay as a proportion of total
:02:23. > :02:28.income, making doctors rely on unpredict Kabul supplements to boost
:02:29. > :02:31.their income, automatic annual pay rises even when people take
:02:32. > :02:37.prolonged periods of leave from the NHS. An unfair banded system which
:02:38. > :02:43.triggers premium rates to every team member, even if only one person has
:02:44. > :02:47.worked the extra hours. High premium rates for weekend work which make it
:02:48. > :02:51.difficult tos are ter staff in line with patient need and risks to
:02:52. > :02:55.patient safety with doctors sometimes required to work seven
:02:56. > :02:59.full days or seven full nights in a row, without proper rest periods.
:03:00. > :03:04.This Government has always been determined that our NHS should offer
:03:05. > :03:07.the safest, highest quality of care possible, which means a consistent
:03:08. > :03:11.standard of care for patients admitted across all seven days of
:03:12. > :03:16.the week. So, the new contract agreed yesterday makes the biggest
:03:17. > :03:21.set of changes to the junior doctor's contract forren 17 years,
:03:22. > :03:25.including establishing the principal that any doctor who works less than
:03:26. > :03:31.an average of one weekend day per month, Saturday or Sunday, should
:03:32. > :03:38.receive no additional premium pay, compensated by an increase of basic
:03:39. > :03:41.pay between 10-11%. Reducing the marginal cost of employing
:03:42. > :03:48.additional doctors at the weekend by a third. Supporting all hospitals to
:03:49. > :03:53.meet the clinical standard, by establishing a new role for
:03:54. > :03:57.experienced junior doctors, a senior clinical decision makers, able to
:03:58. > :04:01.make expert assessments of vulnerable patients who may be
:04:02. > :04:05.admitted or staying in hospitals over weekends and removing t
:04:06. > :04:10.disincentive tos are ter sufficient number of doctors at the weekend by
:04:11. > :04:17.replacing a banding system with a fairer system which values week
:04:18. > :04:21.yeend work by paying social hours -- unsocial hours worked with more pay
:04:22. > :04:25.to those who worked the most. The Government recognises that safer
:04:26. > :04:27.care for patients is more likely to be provided by well-motivated
:04:28. > :04:32.doctors who have sufficient rest between shifts and work in a
:04:33. > :04:36.family-friendly system. So, the new contract and ACAS agreement will
:04:37. > :04:41.improve the well being of our critical junior doctor workforce by
:04:42. > :04:46.reducing the maximum number of hours a doctor can be asked to work in a
:04:47. > :04:51.week from 91-72. Reducing the number of nights a doctor can be asked to
:04:52. > :04:56.work in a row to four. And reducing the number of long days a doctor can
:04:57. > :05:00.be asked to work to five. Introducing a new post, guardian of
:05:01. > :05:06.safe working in every trust to guard against doctors being asked to work
:05:07. > :05:10.excessive hours. Introducing a new catch-up programme for doctors who
:05:11. > :05:16.take community leave or other time off for caring responsibilities.
:05:17. > :05:20.Establishing a review to see how best to allow couples to train in
:05:21. > :05:23.the same areand a offer training placements for those with caring
:05:24. > :05:29.responsibilities close to their home. Giving pay protection to
:05:30. > :05:33.doctors who switch specialities and establishing a review to inform a
:05:34. > :05:36.new requirement on trusts to consider caring and other family
:05:37. > :05:42.responsibilities when designing rotas. Taken together, these changes
:05:43. > :05:48.show the Government's commitment to safe care for patients and the value
:05:49. > :05:54.we attach to the role of junior doctors. Whilst they do not remove
:05:55. > :05:56.every bug bear or frustration, they will significantly improve
:05:57. > :06:01.flexibility and work life balance for doctor, leading, we hope, to
:06:02. > :06:07.improved retention rates, higher morale and better care for patients.
:06:08. > :06:11.But whatever the progress made with today's landmark changes it will
:06:12. > :06:14.always be a matter of great regret it was necessary to go through such
:06:15. > :06:19.disruptive industrial action to get there.
:06:20. > :06:23.We may welcome the destination, but no-one could have wanted the
:06:24. > :06:27.journey. Today, I say to all junior doctors, whatever our disagreements
:06:28. > :06:31.about the contract may have been, the Government has heard and
:06:32. > :06:37.understood the wider frustrations that you feel about the way you are
:06:38. > :06:43.valued and treated in the NHS. Our priority will always be the safety
:06:44. > :06:48.of patients, but we also recognise that to deliver high-quality care we
:06:49. > :06:51.need a well-motivated and happy junior doctor workforce, putting a
:06:52. > :06:55.new modern contract in place is not the end of the story. We will
:06:56. > :07:01.continue to engage constructively with you to try and resolve
:07:02. > :07:05.outstanding issues, as we proceed on our journey to tackle head on the
:07:06. > :07:10.journey the NHS faces and make it the highest quality health care
:07:11. > :07:14.system in where in the world. Today's agreement shows we can make
:07:15. > :07:19.common cause on that journey w a contract better for patients, for
:07:20. > :07:28.doctors and better for the NHS and I commend it to the House.
:07:29. > :07:35.I want to start by putting on record our thanks to Sir Brendan Barber and
:07:36. > :07:41.the cars for the role they've played in fighting agreements between the
:07:42. > :07:44.two sides in this dispute. -- finding agreement. I want a good
:07:45. > :07:49.pitch to the Academy of red medical Royal colleges who proposed these
:07:50. > :07:54.further talks and encourage the Government and the BMA to pause and
:07:55. > :07:59.think about patients. I have not been shy in telling the house
:08:00. > :08:03.secretary what I think about his handling of this dispute. That today
:08:04. > :08:10.is not the day to repeat those criticisms. I am pleased and
:08:11. > :08:15.relieved that an agreement has been reached, but I am sad that it took
:08:16. > :08:22.an all-out strike of junior doctors to get the Government back to the
:08:23. > :08:28.table. What is now clear, if it wasn't already, is that a negotiated
:08:29. > :08:33.agreement was possible all along. So I have to ask the house secretary:
:08:34. > :08:40.Why couldn't this deal had been struck in February? Why did he allow
:08:41. > :08:46.his pride back then to come before sensible compromise and constructive
:08:47. > :08:51.talks? When he stands up, he might try to blame the BMA for the
:08:52. > :08:58.negotiations breaking down, but he failed to say what options he was
:08:59. > :09:04.prepared to consider in order to ensure that the junior doctors who
:09:05. > :09:12.work the most unsociable hours are fairly awarded. It was a computer
:09:13. > :09:17.says no attitude and that is no way to run the NHS. Why did he ignore my
:09:18. > :09:21.letter to him on the 7th of February on which I asked him to make an
:09:22. > :09:26.explicit and public commitment to further concessions on the issue of
:09:27. > :09:31.unsociable hours. I was clear that if he had done that then I was
:09:32. > :09:40.having courage to BMA to return to talks. Why did he instead insist
:09:41. > :09:43.upon trying to bulldoze and impose the contract through when virtue
:09:44. > :09:48.everyone told him not to and the consequences of doing so were
:09:49. > :09:53.obvious fraud to see, protracted industrial action, destroyed morale
:09:54. > :09:59.and eight complete Britain in trust. -- for all to see. Can it house
:10:00. > :10:04.secretary say more about the changes agreed that can undo the
:10:05. > :10:09.discriminate effects on women of the last contract he published? Does he
:10:10. > :10:16.now accept the previous contract discriminated against women? Will he
:10:17. > :10:21.be clear for the record that he note two now understands that this was
:10:22. > :10:26.never just about pay, can he confirm the concessions have been made not
:10:27. > :10:31.only in respect of the mechanism for enforcing hours worked and breaks
:10:32. > :10:34.taken, but also in ensuring that those specialities with the biggest
:10:35. > :10:40.recruitment problems have decent incentives built into the contract.
:10:41. > :10:48.Moving on to what happens next, can he tell us what he will do if junior
:10:49. > :10:55.doctors vote against this offer? Will he still impose a contract? And
:10:56. > :11:02.which version of the contract will he impose? His preferred version or
:11:03. > :11:08.this compromise one? Can he say whether the possibility of losing a
:11:09. > :11:12.case in the High Court about his power to impose a contract had
:11:13. > :11:19.anything to do with his recently discovered eagerness to return to
:11:20. > :11:24.talks? We all know it High Court told him he had acted above the law
:11:25. > :11:28.when he tried to take the axe to my local hospital, so I can understand
:11:29. > :11:35.why he does not want that embarrassment again, and finally,
:11:36. > :11:43.can I caution him on his use of language both in this chamber and on
:11:44. > :11:49.the media. His loose words and implied criticism of junior doctors
:11:50. > :11:56.is partly the reason why this has ended up being such an almighty
:11:57. > :11:59.mess. Can I suggest a degree of humility on the part of the
:12:00. > :12:05.secretary of the state wouldn't go amiss. And can I encourage a period
:12:06. > :12:11.of radio silence from him to allow junior doctors to consider the new
:12:12. > :12:19.contract with a clear mind and without his spin echoing in their
:12:20. > :12:24.ears? Let me remind the house secretary that he still needs to get
:12:25. > :12:31.a majority of junior doctors to vote for this contract for this dispute
:12:32. > :12:38.to be finally over. Mr Speaker, I hope with all my heart that the
:12:39. > :12:41.agreement yesterday may offer a way forward. Junior doctors will want to
:12:42. > :12:48.consider it, trust needs to be repaired and that will take time. I
:12:49. > :12:54.hope for the sake of everyone patients and doctors that we might
:12:55. > :13:05.see an end to this very sorry episode in NHS history. Mr Speaker,
:13:06. > :13:12.she is wrong today as she has been wrong throughout this dispute. She
:13:13. > :13:15.spent a lot of time in the last ten months criticising the way the
:13:16. > :13:21.Government has sought to change this contract. What she did not dwell on
:13:22. > :13:25.was why it needed to be change in the first place, namely the four
:13:26. > :13:30.flawed contract put in place in 1999, we have major screamers with
:13:31. > :13:35.the BMA but once we agree on was Labour's contract was not fit for
:13:36. > :13:40.purpose. -- many disagreements. Could size and the contract right is
:13:41. > :13:47.like could sizing the mechanic making the car you just crashed and
:13:48. > :13:50.it's time she polished the contract changes -- acknowledged the contract
:13:51. > :13:52.changes have led to the number of the five day care problems were
:13:53. > :13:58.trying to sort out. She was also wrong to say that an all-out strike
:13:59. > :14:04.was necessary to resolve this dispute. The reason that the talks
:14:05. > :14:10.were not in the last ten days, the meaningful talks that we had, is
:14:11. > :14:14.because the BMA changed its position and agreed great goal sheet is
:14:15. > :14:19.wrecked to negotiate an weekend pay. She told the house four times before
:14:20. > :14:23.that change of heart that we should not impose a new contract. What
:14:24. > :14:27.would have happened if we have followed her advice? Quite simply
:14:28. > :14:32.today we would not have had the biggest single step towards a
:14:33. > :14:38.seven-day NHS for a generation. The biggest reforms Don social hours for
:14:39. > :14:42.17 years, with the extra cost of employing a doctor at the weekend is
:14:43. > :14:46.going down by one third. We would not have had the reductions in
:14:47. > :14:50.maximum working hours or many other changes that improve the safety for
:14:51. > :14:57.patients and quality of life for doctors. She was wrong to say that
:14:58. > :15:00.the previous contract was discriminatory against women, it
:15:01. > :15:06.removes discrimination, but does that mean there are a lot of things
:15:07. > :15:13.that we can do to support women who work as junior doctors? There are,
:15:14. > :15:16.and that is why the new Deal announced yesterday has an important
:15:17. > :15:19.and new character clause for women who take time off from maternity
:15:20. > :15:22.leave him they can get back to the position they would have been in if
:15:23. > :15:30.they had not had to take time off to have children. And she asked what
:15:31. > :15:34.happens if the ballot goes the wrong way. What she failed to do was to
:15:35. > :15:41.say whether she was encouraging junior doctors to vote for that
:15:42. > :15:46.ballot, and I say to her that on the 28th of October she has told this
:15:47. > :15:51.house that she supported the principle of seven-day services, but
:15:52. > :15:55.as Tony Blair once said, you cannot will the end without willing the
:15:56. > :16:00.means, and in this dispute shows refused to say that she was spot --
:16:01. > :16:04.supports the withdrawal of emergency care if you report -- supports
:16:05. > :16:08.contentious changes to reform we can premium pay and now she won't even
:16:09. > :16:13.say doctors should vote for the new agreement. Leadership is facing up
:16:14. > :16:17.to difficult decisions, not ducking them. I say to her this Government
:16:18. > :16:21.is prepared to take difficult decisions and fight battles that
:16:22. > :16:21.improve quality and safety of care in
:16:22. > :16:29.fight them that is fine, but she shouldn't stand dispatch box and
:16:30. > :16:33.claim Labour stands up for NHS patients. If she doesn't want to
:16:34. > :16:37.listen to me perhaps she should listen to former Labour Minister Tom
:16:38. > :16:42.Harris, who said strategically Labour should be on the side of the
:16:43. > :16:52.patients and we aren't. If Labour isn't, the Conservatives are! Mr
:16:53. > :16:56.Speaker, could I add my congratulations on both sides for
:16:57. > :16:59.turning to constructive negotiations and far reaching an agreement and I
:17:00. > :17:03.would like to pay particular tribute to Professor Sue Bailey in the
:17:04. > :17:07.Academy of Medical Royal Colleges for their role in bringing both
:17:08. > :17:12.sides together. I welcome the particular focus on all the other
:17:13. > :17:16.aspects that are blighting the lives of junior doctors alongside
:17:17. > :17:20.negotiations around weekend pay and recognising we need to focus on
:17:21. > :17:23.those specialties which is hard to recruit two and those of junior
:17:24. > :17:29.doctors who are working the longest hours of folks of patient safety.
:17:30. > :17:35.We're not out of the woods yet, we need junior doctors to vote for this
:17:36. > :17:40.in a referendum. And could I add my voice to the voices of the Leader of
:17:41. > :17:46.the Opposition spokesman of health to say that I think what is needed
:17:47. > :17:48.now is a period of calm reflection and to build relationships with
:17:49. > :17:53.junior doctors going into the future. I wonder if this act of
:17:54. > :17:58.state could comment on his plans for building a relationship with our
:17:59. > :18:03.core workforce? Firstly I would like to very much agree with the
:18:04. > :18:06.honourable lady in her thanks to Professor Dame Sue Bailey and the
:18:07. > :18:12.leadership the Academy of Medical Royal Colleges has shown in making
:18:13. > :18:15.the initiative that in the end made this detox possible and the
:18:16. > :18:18.agreement is possible and I know it's been a difficult and
:18:19. > :18:20.challenging time for the Royal colleges but I think Professor
:18:21. > :18:25.Bailey showed real leadership in turn should have and I also very
:18:26. > :18:29.much agree with her about the need to sort out some of the issues that
:18:30. > :18:33.have been frustrations for junior doctors, not just in the last few
:18:34. > :18:39.years, but going back decades in terms of the way their training work
:18:40. > :18:43.and in terms of the flexibility of the system of six-month rotations
:18:44. > :18:46.that they work in actually operates and this is an opportunity to look
:18:47. > :18:50.at those wider issues, think we have started looking at some of them
:18:51. > :18:55.yesterday and think there is more we can do and I think it is very
:18:56. > :18:59.important that this is seen not as one side winning and the other side
:19:00. > :19:05.losing, but as a win-win. But the last ten days it showed is that if
:19:06. > :19:09.you sit around the table you commit real progress in a better deal for
:19:10. > :19:22.patients and doctors and that is the spirit we want to go forward. I
:19:23. > :19:27.absolutely welcome this agreement and I pay tribute to the Royal
:19:28. > :19:32.Academy of Royal colleges for bringing this about. I do wish there
:19:33. > :19:37.had been some response to the latter that we sent before the all out
:19:38. > :19:42.strike. Simic letter. That was the attempt we were trying to make to
:19:43. > :19:45.create a space that both sites could step into Britain that we got to it
:19:46. > :19:51.now. I welcome the recognition the quality issues to us and many junior
:19:52. > :19:56.doctors appear to be dismissed in the impact assessment, the idea of
:19:57. > :20:01.flexible training champions in each trust, I myself was a flexible
:20:02. > :20:04.training senior surgeon, the first one in Scotland at the time, and I
:20:05. > :20:09.think that is really important. The idea was celebrated -- of
:20:10. > :20:15.accelerated training that one concern I have is the issue of
:20:16. > :20:19.childcare, if women, junior doctors, will be working longer shifts and
:20:20. > :20:24.more anti-social shifts, I remember myself when I had to fork out for
:20:25. > :20:30.childcare, I would like to know, will the NHS respond to that? Is
:20:31. > :20:34.that in question are as -- crash hours or support? I welcome the
:20:35. > :20:39.hours Guardian will also be linked to the Director of medical education
:20:40. > :20:42.and they will be an elected junior doctors for. That was one of their
:20:43. > :20:47.concerns that they would have no voice in relation to the Guardian. I
:20:48. > :20:53.also welcome the idea of using modern technology in rota creation.
:20:54. > :20:57.At the moment rodders are sheets of paper and often no one looks at the
:20:58. > :21:03.shoulder of one closer to the next and people can end up with very long
:21:04. > :21:08.periods on call. I do welcome that but one concern that remains is the
:21:09. > :21:12.issue of rota gaps, we actually don't have enough junior doctors and
:21:13. > :21:18.we don't have enough junior doctors in the most acute specialties. I
:21:19. > :21:22.would ask, how is the Secretary of State planning to re-establish a
:21:23. > :21:27.relationship? How will he recruit people to fill that gap? Because
:21:28. > :21:32.that was actually the coffee of junior doctors, lack of doctors
:21:33. > :21:37.simply being spread further. How will we recruit and retain after all
:21:38. > :21:43.of the painful clash that has been going on for the last year? I
:21:44. > :21:47.welcome the tone of her comments, which I might say could have been
:21:48. > :21:53.the tone we might have wanted from the Shadow Health Secretary. Let me
:21:54. > :21:56.address constructively her comments as she made them constructively to
:21:57. > :22:01.me that she is right about flexible training, we have to recognise that
:22:02. > :22:08.we have a junior doctor workforce that is now majority female, that
:22:09. > :22:12.has a number of family and caring pressures that need to be taken
:22:13. > :22:14.account of and we need to do this for the NHS as well as because it is
:22:15. > :22:26.the right thing to do. I think we have to look at
:22:27. > :22:29.particularly the east Responsibilities of doctors with
:22:30. > :22:36.young children and one of the things we anoinsed yesterday was an
:22:37. > :22:42.obligation on trusts to take account of caring responsibilities. If you
:22:43. > :22:46.have a doctor who wants to work less time during school holiday ands more
:22:47. > :22:51.and during term time. The needs of patients have to come first. It
:22:52. > :22:55.could be something which could be taken account of, in the way that
:22:56. > :22:59.many other industries which operate 24/7 do. She's right to say that
:23:00. > :23:07.modern technology is key for this. If you are an air steward working
:23:08. > :23:11.for basmt, you can go on to an electronic system yourself and
:23:12. > :23:19.choose the hours you wish to work. We have seen a lot of low come work
:23:20. > :23:22.which is partly driven because they offer the flexibilities that people
:23:23. > :23:28.need. These are important changes and we intend to take them forward.
:23:29. > :23:33.May I tell my Right Honourable friend that the actions of him and
:23:34. > :23:37.his department and the BMA in reaching an agreement will be warmly
:23:38. > :23:43.welcomed, but will be met with a sigh of relief. Will he accept that
:23:44. > :23:48.the fact that the BMA were prepared to think again on crucial issues
:23:49. > :23:54.like overtime at weekends, should not be seen as a sign of weakness,
:23:55. > :24:00.but of maturity in working the Government to ensure a seven-day NHS
:24:01. > :24:08.that is for the benefit of patients and patient safety? I agree with
:24:09. > :24:12.that wise comment, as befits someone who is in fact experienced and
:24:13. > :24:16.working in the Department of Health. You always get further if you sit
:24:17. > :24:21.around the table and talk about these issues and it is much better
:24:22. > :24:25.when you have a Government that is determined to improve the quality
:24:26. > :24:30.and safety of care for patients, it is also better to recognise that if
:24:31. > :24:35.the Government is successful that will also be better for the morale
:24:36. > :24:38.of doctors because the happiest, most motivated doctors are working
:24:39. > :24:47.in the hospitals which are giving the best care for patients. That is
:24:48. > :24:51.why it is a win win. It was the refusal for many wreers of the BMA
:24:52. > :24:56.to discuss the issue that my Right Honourable friend referred to meant
:24:57. > :24:59.we did reach a deadlock. It was the fact this Government was willing to
:25:00. > :25:05.proceed with important reforms on our own f we had to, which meant in
:25:06. > :25:08.the end everyone came together and got a sensible negotiation. Everyone
:25:09. > :25:12.would have wished we did haven't to go on the journey we did to get
:25:13. > :25:16.there. Now we have got there it is the time for being constructive on
:25:17. > :25:21.all sides. Can I thank the minister and the BMA for coming to an
:25:22. > :25:26.agreement. It is a win win for everyone. Talk dialogue does bring
:25:27. > :25:31.results. It happened in Northern Ireland and in the conclusion of
:25:32. > :25:35.this process as well. 45,000 junior doctor BMA members will now be asked
:25:36. > :25:42.to vote in this and a date has been reached. We've had eight days of
:25:43. > :25:46.strikes since January. A cancellation of who,000 planned
:25:47. > :25:53.operations -- 40,000 planned operations what will be done to
:25:54. > :26:04.catch up with those cancelrationlations? We are in
:26:05. > :26:08.constant touch with the devolved regions to make sure they know of
:26:09. > :26:12.the changes we are making and to share any learn from the pro-ess
:26:13. > :26:16.ises we have been through. We -- processes we have been through. We
:26:17. > :26:21.are across the country now doing everything we can to catch one the
:26:22. > :26:27.back log of all the things which have been affected by the industrial
:26:28. > :26:31.relations dispute. Trust will always priority the areas where clinical
:26:32. > :26:36.need is the greatest. I know that work is on going across the country.
:26:37. > :26:44.Thank you, Mr Speaker. I very much welcome the agreement that has been
:26:45. > :26:48.reached. We know that the Secretary of State recognises the important of
:26:49. > :26:52.having a happy and well-motivated workforce and this contract
:26:53. > :26:57.addresses many of the causes of unhappiness for junior doctors. It
:26:58. > :27:00.is particularly good to see addressing the problems of couples
:27:01. > :27:05.who are both junior doctors. There is more to do, has been
:27:06. > :27:10.acknowledged, especially on the reasons why junior doctors feel
:27:11. > :27:16.unsupported and not valued by their employers. My honourable friend
:27:17. > :27:20.commissioned a report and a review from Sue Bailey, underlining the
:27:21. > :27:27.problems of junior doctors in training. Can he advise us whether
:27:28. > :27:31.this review will proceed? The request from the BMA was to find a
:27:32. > :27:36.way of proceeding with that very important work and we will do it
:27:37. > :27:39.with the input of Professor Bailey because she has an important
:27:40. > :27:44.contribution to make. She is right to say that as well as the issue of
:27:45. > :27:48.more flexible working for people with family commitments, the big
:27:49. > :27:52.issue for many junior doctors is the way the training process happens. In
:27:53. > :27:57.particular the way that continuity of training has been undermined by
:27:58. > :28:02.the new shift system, which we need for reasons of patient safety. That
:28:03. > :28:06.often means that you can have a different consultant giving advice
:28:07. > :28:11.on different aspects of care from day-to-day. That is frustrating. We
:28:12. > :28:13.will look at all those issues with Professor Bailey, with health
:28:14. > :28:19.education England and with the BMA to see if we can find a better way
:28:20. > :28:26.forward. Will the Secretary of State be aware
:28:27. > :28:32.that even my constituents struggling the possible closure of the A in
:28:33. > :28:36.Huddersfield will otherwise welcome and say thank you to everyone who
:28:37. > :28:40.has brought this about. Including, I have to say, the leaders of the
:28:41. > :28:47.opposition parties, our spokeses people who have done so much to help
:28:48. > :28:51.a positive spirit? Will he just not glout about that or keep that period
:28:52. > :28:57.of silence because out there, this is part of the phenomenon of the
:28:58. > :29:04.deep unhappiness about the NHS and problems will arise again because so
:29:05. > :29:08.many people work in the NHS service, know it has been privatised by the
:29:09. > :29:12.back door, know that the clinical commissioning system is not working
:29:13. > :29:17.and that problems will come back again and again unless he confronts
:29:18. > :29:23.that. Weshlings it would have been a
:29:24. > :29:27.constructive contribution to this morning's debate if he had not
:29:28. > :29:31.started to descend into totally false slurs about this Government's
:29:32. > :29:35.commitment to our NHS. I say to him, if you support the NHS, if you are
:29:36. > :29:40.passionate about it as this Government is, you put the money in
:29:41. > :29:44.- ?5.5 billion more than his party was promising at the last election
:29:45. > :29:48.and you make the difficult reforms necessary to make sure that NHS care
:29:49. > :29:52.is as good or better than anything which can be provided in the private
:29:53. > :29:57.sector. That is what this Government is doing. We believe in our NHS and
:29:58. > :30:01.we are backing it to give it the best care anywhere in the world. I
:30:02. > :30:04.strongly welcome this important statement and the leadership from
:30:05. > :30:08.the Secretary of State and congratulate all those involved in
:30:09. > :30:14.the discussions. On Tuesday, in Eastly, I spoke with a constituent,
:30:15. > :30:20.a junior doctor and new mum married to a senior nurse at my advice
:30:21. > :30:26.surgery. She's unable to fast track into GP working and future care
:30:27. > :30:30.around her four-month-old baby is part of the concerns she has, and
:30:31. > :30:34.around these negotiations and it weighs heavily on this family,
:30:35. > :30:39.particularly around on-call working. Can I ask that agile working and
:30:40. > :30:42.those family first issues are truly taken into account where there are
:30:43. > :30:47.nurses and doctors trying to bring up families together?
:30:48. > :30:52.My honourable friend gives one example. I think there are thousands
:30:53. > :30:58.of examples of people like that who are totally committed to the NHS,
:30:59. > :31:03.have a bright future and can make a huge contribution to the success of
:31:04. > :31:06.the NHS in doing a good job looking after patients, but also have home
:31:07. > :31:11.responsibilities, which are difficult to fulfil when you have
:31:12. > :31:19.very inflexible Ross tering systems. This is one of -- rostering systems.
:31:20. > :31:24.We will look at how it brings in that flexibility. If we don't do
:31:25. > :31:30.that we will see more and more doctors saying they will work to
:31:31. > :31:35.work as locums or want to work for an agency. That is why we have an
:31:36. > :31:38.urgent need from the perspective of patients and doctors to address that
:31:39. > :31:43.issue. I am interested in the Secretary of
:31:44. > :31:48.State's thoughts about the serious impact on morale that this dispute
:31:49. > :31:52.has had. I was talking to a junior doctor in Sheffield this-the-other
:31:53. > :31:56.day who said priority to -- prior to the dispute he did not look at his
:31:57. > :32:01.contract, he simply got on and did whatever was needed. Does the
:32:02. > :32:06.Secretary of State realise even if this is settled there's been a
:32:07. > :32:11.serious impact on goodwill in the health service which could affect
:32:12. > :32:18.service delivery going forward? I would say to him that if he looks at
:32:19. > :32:20.the latest NHS staff survey we actually see higher staff
:32:21. > :32:23.motivation, better communication and more staff recommending their
:32:24. > :32:31.organisation as a place to work or be treated. I also do accept that
:32:32. > :32:37.when you make big changes to a contract like the junior doctor's
:32:38. > :32:41.contract they can be contentious and have an impact on morale. Morale
:32:42. > :32:47.goes up when doctors are able to give better care for patients and
:32:48. > :32:53.this is what this will require. The Secretary of State I think has done
:32:54. > :32:57.a very good job in explaining today. Look, let's look at this, the BMA
:32:58. > :33:00.caused a problem which should have been resolved a long time ago thasmt
:33:01. > :33:05.decided they would make a political point. That is fair enough.
:33:06. > :33:09.Conversely the opposition should have actually been big enough to
:33:10. > :33:15.say, look, we want to cause political trouble on this. A lot of
:33:16. > :33:20.this has been caused by political shenanigans. The failure of this is
:33:21. > :33:24.the junior doctors themselves have lost prestige throughout the UK
:33:25. > :33:32.because they were used by political pawns as two organisations. Well, I
:33:33. > :33:36.think it is a great tragedy that the dispute unfolded in the way it did.
:33:37. > :33:40.I am sure there are people with different agendas who have not
:33:41. > :33:46.played constructive roles at various points. Given we now have an
:33:47. > :33:51.agreement I want to look forward and say the lesson of the last ten days
:33:52. > :33:55.is when you sit down and negotiate about all the outstanding issues
:33:56. > :33:59.with a Government that is trying to make care better and safer for
:34:00. > :34:02.patients then you get a result which is good for everyone.
:34:03. > :34:07.It is not the time to be claiming victory. This negotiated agreement
:34:08. > :34:11.now has to be put to the members of the British Medical Association.
:34:12. > :34:20.Will the Secretary of State acknowledge that his own refusal to
:34:21. > :34:24.negotiate easts a sister baiteded this crisis? Will he heed my
:34:25. > :34:29.honourable friend, the Shadow Secretary's call for a period of
:34:30. > :34:34.silence in order to avoid antagonising the junior doctors
:34:35. > :34:38.still further? Let 's be absolutely clear there was never a refusal to
:34:39. > :34:43.negotiate on the Government's side. You know, we have now, I think,
:34:44. > :34:48.developed a lot of trust between the Government and the BMA leadership.
:34:49. > :34:51.Until that point, they balloted for industrial action without even
:34:52. > :34:55.sitting down and talking to the Government and they refused to
:34:56. > :34:59.discuss the issue of weekend pay premium, which is the crucial change
:35:00. > :35:03.we needed for a seven-day NHS. It is when they changed their position on
:35:04. > :35:08.those areas that we were able to have constructive talks and that is
:35:09. > :35:12.why they deserve great credit for coming to the table and negotiating
:35:13. > :35:17.on things they did not want to previously.
:35:18. > :35:21.I would like to say thank you to the Secretary of State for bringing hard
:35:22. > :35:25.to bring about this resolution and always putting users of the NHS at
:35:26. > :35:32.the heart of everything he does. Will he join me in urging junior
:35:33. > :35:36.doctors to consider it with an open mind and strip out some of the
:35:37. > :35:40.politics we have heard. And let's consider what is best for patients,
:35:41. > :35:46.for the NHS and then what is best for the junior doctors? She speaks
:35:47. > :35:51.very wisely. All I would say is that I understand in a very contentious
:35:52. > :35:54.industrial relations dispute that junior doctors will not necessarily
:35:55. > :36:00.look to me for advice as to which way they should vote, but it wasn't
:36:01. > :36:03.just me doing this agreement, it was a negotiated agreement and the
:36:04. > :36:06.leader of the junior doctors committee said it is a good
:36:07. > :36:11.agreement, he will support people to support it and he thinks it is a
:36:12. > :36:14.good way forward for doctors and patients T people closest to the
:36:15. > :36:18.detail, to the negotiations think it is the right step forward for junior
:36:19. > :36:26.doctors and that is something I want to take account of. Thank you, Mr
:36:27. > :36:30.Speaker. I don't wish to invite the Secretary of State to provoke by
:36:31. > :36:34.presumption. If this changes the shape of services it will have
:36:35. > :36:40.implications for other health professions. Is he prepared to have
:36:41. > :36:45.further conversation that needs to be had there and with counterparts
:36:46. > :36:50.across these nationals to professional education and training?
:36:51. > :36:55.We are of course willing to have those discussions with colleagues in
:36:56. > :37:02.other parts of the UK. But he is right that to have a seven-day
:37:03. > :37:05.service doesn't just involve junior doctors, it involves widespread
:37:06. > :37:09.changes across the service. I would say for nurses, health care
:37:10. > :37:15.assistants, porters, cleaners, others who work in hospitals, they
:37:16. > :37:19.already operate on 24/7 shifts. So the changes necessary to contracts
:37:20. > :37:23.are much less profound than they are to some of the doctors' contracts,
:37:24. > :37:29.which is why it is important that we change not just the junior doctors'
:37:30. > :37:33.contract but the consultants' contracts and the fact we have an
:37:34. > :37:34.agreement bodies well for the consultants' contract, which is the
:37:35. > :37:44.next step. Can I congratulate my honourable
:37:45. > :37:51.friend and all honourable friend the member for switch for his hard work
:37:52. > :37:57.in dealing with the dispute with the BMA. Patients up and down the
:37:58. > :37:59.country, including mine, were somewhat concerned about the
:38:00. > :38:04.cancelled operations but I'm delighted that the deployment will
:38:05. > :38:09.try and make sure this gets caught up with. -- department. One of the
:38:10. > :38:13.things come out of it was that some senior consultants had to end up on
:38:14. > :38:17.the front line for the first time in a long time and can I ask what can
:38:18. > :38:20.be done to make sure this happens on a regular basis so they are getting
:38:21. > :38:30.experience on the front line as well? Think I will dig myself into a
:38:31. > :38:38.deep old answer that directly. I would like to echo his thanks to my
:38:39. > :38:45.honourable friend the member for Ipswich, who has done an outstanding
:38:46. > :38:48.job at every stage throughout this very difficult period and I can
:38:49. > :38:52.certainly say we would not have had yesterday's agreement without his
:38:53. > :39:01.very strong help and support at every stage. I think it's true that
:39:02. > :39:05.there are A departments that have to plan for the withdrawal of
:39:06. > :39:10.emergency care and they found that having consultants more visible to
:39:11. > :39:13.patients had some positive impact and I know studies are going on to
:39:14. > :39:20.see what lessons can be learned going forward. I too welcome the
:39:21. > :39:26.opportunity for a negotiated settlement, but let us take a moment
:39:27. > :39:31.to reflect on one of the fundamental principles of the NHS about
:39:32. > :39:35.providing high quality patient care, and to that end, Woody section of
:39:36. > :39:39.state figures opportunity to offer our heartfelt and sincere apology
:39:40. > :39:43.for the significant and severe distress that has been caused to
:39:44. > :39:50.patients as a result of this prolonged dispute? With the gift
:39:51. > :39:56.greatest of respect it was not my decision to take industrial action,
:39:57. > :40:00.to ballot without him in being prepared to sit around the table and
:40:01. > :40:03.talk to the Government, and with respect to patient safety we seemed
:40:04. > :40:07.about improvements in beige and safety under this Government as we
:40:08. > :40:15.face up to the many problems in care that we inherited, not just miss
:40:16. > :40:18.staffs and many other places that option should welcome the changes
:40:19. > :40:27.we've made in one of those it have a seven-day NHS. Like many colleagues
:40:28. > :40:31.in the house, wrote visit to stick on numerous occasions over the last
:40:32. > :40:34.six months to express concerns of local junior doctors so,
:40:35. > :40:37.congratulate him on reaching this and I hope the new doctors in
:40:38. > :40:40.Wimbledon will wholeheartedly support this deal. Can I say we
:40:41. > :40:45.spoken about the Guardian and the ability of it and its role to
:40:46. > :40:51.safeguard and have safe working hours per patients and doctors. Can
:40:52. > :40:54.have more details about how that should work? I'm happy to do that
:40:55. > :40:58.and I thank him for his correspondence. The principle is
:40:59. > :41:03.that junior doctors want to know that there is someone independent
:41:04. > :41:08.that they can appeal to the think they are being asked to work hours
:41:09. > :41:11.that are unsafe the spin they cannot work -- after patients how they
:41:12. > :41:15.wanted because they're physically or mentally too exhausted. That is
:41:16. > :41:22.something we would all want to make possible but it means they need to
:41:23. > :41:25.have someone who is the -- is not their line manager, someone
:41:26. > :41:30.independent and separate. One of the areas we made the most progress in
:41:31. > :41:34.the last few months, even before the last ten days, is establishing how
:41:35. > :41:42.these guardians can work in a way that has the of the hospitals the
:41:43. > :41:45.doctors working there. The section of state is right when he says you
:41:46. > :41:51.always get further if you get around the table. I ask him why in response
:41:52. > :41:55.to the cross-party initiative back in February to get everyone around
:41:56. > :42:00.the table didn't he do that and save us all this trouble rather than
:42:01. > :42:03.finding both the contract? The cross-party initiative was in for a
:42:04. > :42:08.new contract, it was to abandon plans for a new contract and just
:42:09. > :42:11.have pilots in a few limited places and if we had followed that advice
:42:12. > :42:17.we would not now today had the biggest changes in junior doctor
:42:18. > :42:21.contracts for 17 years agreed with the BMA, and that was why the call
:42:22. > :42:26.we wanted was to get the agreement yesterday, safer carefully NHS and
:42:27. > :42:34.better deals for doctors. That is what we got and we wouldn't have if
:42:35. > :42:39.we listen to that advice? Can I join in the welcome for the agreement and
:42:40. > :42:43.the persistent and patients that eventually paid off. In previous
:42:44. > :42:50.statements I've raised with the sexual state this problem of married
:42:51. > :42:54.couples, both of whom are doctors, -- secretary of state. If they have
:42:55. > :42:58.roasters that clash, can he say a word about the progress made in this
:42:59. > :43:10.important area of making work more family friendly. I'm happy to do
:43:11. > :43:15.that. Is not easy dissolved because junior doctor at training places
:43:16. > :43:22.operate on six-month locations and are competitive. You get many more
:43:23. > :43:27.up applicants than there are posts available, so we have to find a way
:43:28. > :43:30.of balancing the need to respect family responsibility, something we
:43:31. > :43:34.would all want to do, with the need to have a fair process for the most
:43:35. > :43:41.competitive positions. I think we have not got the balance right to
:43:42. > :43:44.date, so we said cells Dott health education and where we decide people
:43:45. > :43:47.will go on rotation will have a duty to consider family response but is
:43:48. > :43:57.when they make decisions about those locations. I welcome the potential
:43:58. > :44:01.resolution, thank the Government for negotiation at the doctors having
:44:02. > :44:05.the courage to go on strike, which no one does likely to get a better
:44:06. > :44:11.deal for the NHS. I would ask the secretary of state to reflect on
:44:12. > :44:15.this and take further steps to build on his difficult relationship with
:44:16. > :44:17.NHS staff and stop resenting NHS policy and false dichotomy between
:44:18. > :44:26.the interests of patients and interests of NHS staff. If he had
:44:27. > :44:29.listened to what I said, for we said Beasley I don't think that the cost
:44:30. > :44:34.me exists, the false dichotomy as he says in the end what is right for
:44:35. > :44:38.patients is also right doctors, the thing that demoralises doctors and
:44:39. > :44:41.nurses and everyone working in hospitals and different part of the
:44:42. > :44:46.Ayrshires is when they are not able to give the care they want what they
:44:47. > :44:51.think is appropriate to the patients in front of them, which is why we
:44:52. > :44:54.see hospitals that have moved closes towards a seven-day services are
:44:55. > :44:58.also some of hospitals with the highest levels of morale in the NHS.
:44:59. > :45:05.He is right, it's not a false dichotomy and we need to do both
:45:06. > :45:07.together. As the sexual note, my brother and his wife were junior
:45:08. > :45:13.doctors when they made the decision to move over to New Zealand a long
:45:14. > :45:16.while ago. That was because of the long-standing cultural problems in
:45:17. > :45:22.the NHS. They will be pleased indeed about the announcement yesterday
:45:23. > :45:25.around the couples being able to work together in hospitals
:45:26. > :45:33.potentially. I have a question for my mother and it relates around what
:45:34. > :45:42.can you do now in order to encourage them and their friends back into the
:45:43. > :45:47.NHS? Let me say to your mother that I hope the message of this new
:45:48. > :45:53.agreement will go brightly way around the world and any doctors who
:45:54. > :45:56.have moved to New Zealand or Australia are always welcome to come
:45:57. > :46:03.back, and I think the thing that must unite this Government and the
:46:04. > :46:07.good doctors who work in the NHS is our commitment to making NHS care
:46:08. > :46:11.the safest and best in the world, and I think we had a terrible shock
:46:12. > :46:17.with what happened at mid-staffs, but we're using it as an moment of
:46:18. > :46:20.change, decisive change, NHS and were on the way to higher standards
:46:21. > :46:25.of care that are available in many other countries. Mother Howlett is
:46:26. > :46:32.satisfied, or idea we shall hear about it. -- or IDSA.
:46:33. > :46:38.Congratulations Government and everyone on getting this in place,
:46:39. > :46:40.it will have a knock-on effect in Northern Ireland into my
:46:41. > :46:45.constituency, when I went around Antrim area hospitals their concerns
:46:46. > :46:50.the number of doctors and how you get a seven day a week cover from
:46:51. > :46:53.everything else that needs to go on in the health service, which, and
:46:54. > :47:00.how we will deal with that and we will work with parliaments? I do
:47:01. > :47:04.agree, we need more doctors and more nurses and by the end of this
:47:05. > :47:08.parliament will have 1 million more over 70s in England alone and I know
:47:09. > :47:12.the demographic effect in Northern Ireland will be equivalent. Globally
:47:13. > :47:18.we have a shortage of about 7 million doctors, so we need to train
:47:19. > :47:22.more. We are training an extra 11,420 doctors over this parliament
:47:23. > :47:25.as part of the spending review. Because the training is done on the
:47:26. > :47:31.UK wide basis it is something we will need to work closely with all
:47:32. > :47:35.of the devolved regions. I warmly welcome this draft agreement and it
:47:36. > :47:38.will be met with some relief in Cheltenham. Whatever article the
:47:39. > :47:42.health concerns about the behaviour of the BMA in the past, does the
:47:43. > :47:45.Secretary of State agree it should be an admission that this should be
:47:46. > :47:51.part of the beginning of a more constructive future and will you
:47:52. > :47:53.join me in congratulating the BMA negotiations for being able to
:47:54. > :48:01.address constructively issues like Saturday pay. I'm happy to do that,
:48:02. > :48:03.and I recognised it was not easy for them because they are still
:48:04. > :48:09.involving changing the position that had for over three years. The result
:48:10. > :48:12.we got to admit that at the details was actually something that was not
:48:13. > :48:16.difficult for them to sign up to because they could see it really was
:48:17. > :48:20.better for their members as well as better for patients. I think the
:48:21. > :48:24.lesson is that the NHS faces huge challenges and can only be right to
:48:25. > :48:30.deal with these challenges by sitting around the table as
:48:31. > :48:34.negotiating constructively. I also warmly welcomed the news of the
:48:35. > :48:39.agreement and I hope it feeds into a settlement. Can I ask the Secretary
:48:40. > :48:43.of State if it is his intention to create a seven-day NHS, that will
:48:44. > :48:48.require the participation of more than just the junior doctors, will
:48:49. > :48:52.he bring forward a new contract for consultants? Or will he bring
:48:53. > :48:59.forward a new contract for hospital lab walkers or Amazon 's workers or
:49:00. > :49:05.nurses or indeed for catering staff? He is right. A seven-day NHS is not
:49:06. > :49:09.just or even mainly about junior doctors, their important part of the
:49:10. > :49:13.equation but we will need a new contract for consultants and we are
:49:14. > :49:18.having constructive negotiations with consultant about that. For
:49:19. > :49:24.other people working in the NHS, many are already or seven-day
:49:25. > :49:29.contract, so he is right to say that we are going to have to have
:49:30. > :49:32.diagnostic services operating across seven days so junior doctor working
:49:33. > :49:35.at the weekend will be up to get the result back for a diagnostic test
:49:36. > :49:44.the weekend and those are all part of the changes that we will make to
:49:45. > :49:48.make and it is safer for patients. Can I warmly congratulate both sides
:49:49. > :49:56.on reaching this agreement. Our NHS is different at weekends and my
:49:57. > :50:00.honourable friend is right to bring in the four key clinical standards
:50:01. > :50:05.on Sunday and Saturday. Would he agree it's important not simply to
:50:06. > :50:09.rely on mortality data, which are often difficult to interpret in
:50:10. > :50:11.underpinning the case for the seven-day NHS and will he look
:50:12. > :50:16.closely at other metrics based on clinical standards around things
:50:17. > :50:21.like endoscopy and routine lists on Saturday and Sunday and periods of
:50:22. > :50:30.care particularly, which does not feature in any hospital mortality
:50:31. > :50:33.data? He speaks very wisely on medical matters and I particularly
:50:34. > :50:38.agree when he speaks about palette of care, which has got better, but
:50:39. > :50:42.nonetheless there is a long way to go and we had recent evidence that
:50:43. > :50:49.it is particularly in need of improvement where we are not able to
:50:50. > :50:55.offer a seven-day part of support. I welcome this settlement and thank
:50:56. > :51:00.everyone involved for securing it. Many junior doctors remained
:51:01. > :51:06.concerned that as you increase the hours worked over a weekend you
:51:07. > :51:09.inevitably produce cover during the week -- Regis cover unless you buy
:51:10. > :51:15.more junior doctors to bridge that gap. With many rotors of ready on
:51:16. > :51:18.filter does not until around the country during the week how can he
:51:19. > :51:26.guarantee we will not make the situation worse during the week,
:51:27. > :51:29.thereby impacting on patient safety? I understand the concern and the
:51:30. > :51:33.short answer is that we need to increase the NHS workforce, which we
:51:34. > :51:36.are doing and we will see more doctors going into training during
:51:37. > :51:38.the course of this parliament, as were somewhat doctors going into
:51:39. > :51:42.training over the course of the last Parliament. More doctors in the
:51:43. > :51:50.workforce will be an important part of the solution. At the start of the
:51:51. > :51:55.recent negotiations appears that the payment for Saturday working was the
:51:56. > :52:00.main sticking point from the BMA but it appears from this negotiation now
:52:01. > :52:05.that the issue of weekend pay has been resolved, can my honourable
:52:06. > :52:09.friend confirmed that the position now is that this can lead for the
:52:10. > :52:14.doctors that are working extended hours for the weekend will get extra
:52:15. > :52:21.pay and patients can see a seven-day week NHS, which we all want to see?
:52:22. > :52:29.It is much fairer for doctors than the current system. We are giving a
:52:30. > :52:32.pay rise of between 10-11%, for which we are saying people are
:52:33. > :52:39.expected to work one weekend day a month. The doctors who work more
:52:40. > :52:43.than that get more and it goes up T more weekends you work the more
:52:44. > :52:47.extra pay you get. That is one of the reasons the BMA was prepared to
:52:48. > :52:53.sign up to this agree. It does value the people who give up the most
:52:54. > :52:57.weekends. I was contacted by a constituent,
:52:58. > :53:04.who told me how his four-year-old daughter fell through a pane of
:53:05. > :53:08.glass, severely cutting her face. Unfortunate natly this accident --
:53:09. > :53:13.unfortunately this accident had on a Friday evening because there were
:53:14. > :53:18.insufficient doctors working she could not have on operation until
:53:19. > :53:23.the Monday. That four-year-old girl will now suffer severe facing
:53:24. > :53:28.scarring for the rest of her life. Does my friend agree with me, that
:53:29. > :53:32.is the republic why we need a seven-day NHS. I couldn't have put
:53:33. > :53:35.it better myself. Those are the stories we hear from our
:53:36. > :53:39.constituents, from our families. That is why yesterday was an
:53:40. > :53:45.important step forward in terms of that seven-day agenda. I must
:53:46. > :53:48.confess to being puzzled because the BMA have said all along this strike
:53:49. > :53:54.and dispute was nothing to do with weekend pay and terms. Yet, after
:53:55. > :53:59.discussions, negotiations which were limited simply to weekend pay and
:54:00. > :54:05.terms, the BMA have now come to a deal and advised against strike
:54:06. > :54:08.action. Can we take it despite much huffing and puffing this was about
:54:09. > :54:14.the future of the NHS and the rest of it, at the end of the day it was
:54:15. > :54:19.all about weekend pay and terms? I think he is right that was the big
:54:20. > :54:25.sticking point and their willingness to be flexible and the goshiate on
:54:26. > :54:30.that which made -- and negotiate on that which made it possible. There
:54:31. > :54:34.are many other noncontractual issues in the way that doctors are trained
:54:35. > :54:40.and treated by the NHS. We want to use this as an opportunity to put
:54:41. > :54:46.that right. Can I congratulate on the Secretary of State op putting
:54:47. > :54:57.patients first. Those people who had their operations cancelled during
:54:58. > :55:04.industrial action. Looking at people on the back-burner or poss pope
:55:05. > :55:09.their medical -- or postpone their medical care? That is a view some
:55:10. > :55:15.share. Doctors have obligations now under the Medical Act not to take
:55:16. > :55:19.action which would harm patients and under their responsibilities to the
:55:20. > :55:24.General Medical Council. They have to be aware of those. What I hope is
:55:25. > :55:27.that question does not arise again, we are having constructive
:55:28. > :55:31.discussions with the BMA. It is the way forward and I hope that neither
:55:32. > :55:39.myself or any future Health Secretary has to go through what we
:55:40. > :55:42.have during the last ten months. I explored the tone and content of the
:55:43. > :55:46.remarks today. It will go down as a break through in the NHS. It has
:55:47. > :55:50.been very uncomfortable to have dialogue with constituents who are
:55:51. > :55:54.junior doctors who have felt aggrieved. So, I have particularly
:55:55. > :55:58.welcomed the way he's been able to look at noncontractual issues. I
:55:59. > :56:04.would urge him to look very strongly at the issue of -- the outcome of
:56:05. > :56:09.the Bailey review so he can move forward on morale and the wider
:56:10. > :56:17.issues which have been raised. Well, I just finish by saying I
:56:18. > :56:20.complete aagree with him. It's been a very sad dispute. We recognise
:56:21. > :56:24.that junior doctors are the back bone of the NHS. They work very
:56:25. > :56:28.hard. They often work the most weekends already. I think it is
:56:29. > :56:33.therefore a brilliant step forward that we have an agreement. But the
:56:34. > :56:37.constituents that he talks about and that we all have who work hard for
:56:38. > :56:44.the NHS are the people we want to value. Therefore, dialogue,
:56:45. > :56:51.constructive discussion must be the way forward.
:56:52. > :56:56.THE SPEAKER: In accordance with standing order 122D, I must announce
:56:57. > :57:01.the arrangements for the election of the chair of the Backbench Business
:57:02. > :57:07.Committee for the new session. If there is more than one candidate,
:57:08. > :57:15.the ballot will be held in committee room 16 from 11am to 1. 30pm on
:57:16. > :57:20.Wednesday, 25th May. Nominations must be submitted in the
:57:21. > :57:23.table office between 10am and 5pm. That is on the day before the
:57:24. > :57:29.ballot. That is to say, Tuesday 24th May. In
:57:30. > :57:36.accordance with the standing order, only members who do not belong to a
:57:37. > :57:40.party represented in her Majesty's Government may be candidates in this
:57:41. > :57:47.election. A briefs note with more details
:57:48. > :57:55.about the election will be made available to members and published
:57:56. > :58:02.on the internet. Order. Presentation of bill, Mr Javid.
:58:03. > :58:08.Second reading, what day? Tomorrow. Order, the clerk will proceed to
:58:09. > :58:15.read the orders of the day. Nanss bill, presentation Fy second
:58:16. > :58:18.reading and committal. In accordance with standing order number 80 B and
:58:19. > :58:19.the order