19/05/2016 House of Commons


19/05/2016

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granted to academies in this country. There are many schools that

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are taking advantage of that particular freedom. Statement, the

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Secretary of State for Health. Secretary Jeremy Hunt.

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Thank you. For the last three years there have been repeated attempts to

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reform the junior doctor's contract to support better patient care seven

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days a week, culminating in a dispute which has lasted over 10

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months after ten days of discussion under the au pishs of ACAS, the

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dispute was resolved yesterday with an historic agreement between the

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Government, NHS employers, acting on behalf of the employers of doctors

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and the BMA which will modernise the contract making it better for

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doctors and patients. The new contract meets all the Government's

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red lines for delivering a seven-day NHS and remains within the existing

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pay envelope. We will publish an equallied analysis alongside a

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renewed contract. It will be put to a ballot of the BMA membership next

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month with the support of the leader, the chair of the committee.

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Mr Speaker, I would first of all like to express my thanks to the BMA

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for the leadership they have shown in returning to talks, negotiating

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in good faith and making an agreement possible. I would like to

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put on record my thanks to Sir Barber for his excellent stewardship

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and to Sir Dalton for his wisdom and insight.

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The agreement will facilitate the biggest changes to the junior

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doctors' contract since 1999. It will allow the Government to delive

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a seven-day NHS, improve patient safety, support productivity

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improvements and impoveing the morale of junior doctors with a

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modern contract fit for a modern health service. The contract,

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inherited by this Government, had a number of features badly in need of

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reform, including low levels of basic pay as a proportion of total

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income, making doctors rely on unpredict Kabul supplements to boost

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their income, automatic annual pay rises even when people take

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prolonged periods of leave from the NHS. An unfair banded system which

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triggers premium rates to every team member, even if only one person has

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worked the extra hours. High premium rates for weekend work which make it

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difficult tos are ter staff in line with patient need and risks to

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patient safety with doctors sometimes required to work seven

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full days or seven full nights in a row, without proper rest periods.

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This Government has always been determined that our NHS should offer

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the safest, highest quality of care possible, which means a consistent

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standard of care for patients admitted across all seven days of

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the week. So, the new contract agreed yesterday makes the biggest

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set of changes to the junior doctor's contract forren 17 years,

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including establishing the principal that any doctor who works less than

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an average of one weekend day per month, Saturday or Sunday, should

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receive no additional premium pay, compensated by an increase of basic

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pay between 10-11%. Reducing the marginal cost of employing

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additional doctors at the weekend by a third. Supporting all hospitals to

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meet the clinical standard, by establishing a new role for

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experienced junior doctors, a senior clinical decision makers, able to

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make expert assessments of vulnerable patients who may be

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admitted or staying in hospitals over weekends and removing t

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disincentive tos are ter sufficient number of doctors at the weekend by

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replacing a banding system with a fairer system which values week

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yeend work by paying social hours -- unsocial hours worked with more pay

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to those who worked the most. The Government recognises that safer

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care for patients is more likely to be provided by well-motivated

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doctors who have sufficient rest between shifts and work in a

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family-friendly system. So, the new contract and ACAS agreement will

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improve the well being of our critical junior doctor workforce by

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reducing the maximum number of hours a doctor can be asked to work in a

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week from 91-72. Reducing the number of nights a doctor can be asked to

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work in a row to four. And reducing the number of long days a doctor can

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be asked to work to five. Introducing a new post, guardian of

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safe working in every trust to guard against doctors being asked to work

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excessive hours. Introducing a new catch-up programme for doctors who

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take community leave or other time off for caring responsibilities.

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Establishing a review to see how best to allow couples to train in

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the same areand a offer training placements for those with caring

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responsibilities close to their home. Giving pay protection to

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doctors who switch specialities and establishing a review to inform a

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new requirement on trusts to consider caring and other family

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responsibilities when designing rotas. Taken together, these changes

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show the Government's commitment to safe care for patients and the value

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we attach to the role of junior doctors. Whilst they do not remove

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every bug bear or frustration, they will significantly improve

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flexibility and work life balance for doctor, leading, we hope, to

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improved retention rates, higher morale and better care for patients.

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But whatever the progress made with today's landmark changes it will

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always be a matter of great regret it was necessary to go through such

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disruptive industrial action to get there.

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We may welcome the destination, but no-one could have wanted the

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journey. Today, I say to all junior doctors, whatever our disagreements

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about the contract may have been, the Government has heard and

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understood the wider frustrations that you feel about the way you are

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valued and treated in the NHS. Our priority will always be the safety

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of patients, but we also recognise that to deliver high-quality care we

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need a well-motivated and happy junior doctor workforce, putting a

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new modern contract in place is not the end of the story. We will

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continue to engage constructively with you to try and resolve

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outstanding issues, as we proceed on our journey to tackle head on the

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journey the NHS faces and make it the highest quality health care

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system in where in the world. Today's agreement shows we can make

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common cause on that journey w a contract better for patients, for

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doctors and better for the NHS and I commend it to the House.

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I want to start by putting on record our thanks to Sir Brendan Barber and

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the cars for the role they've played in fighting agreements between the

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two sides in this dispute. -- finding agreement. I want a good

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pitch to the Academy of red medical Royal colleges who proposed these

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further talks and encourage the Government and the BMA to pause and

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think about patients. I have not been shy in telling the house

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secretary what I think about his handling of this dispute. That today

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is not the day to repeat those criticisms. I am pleased and

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relieved that an agreement has been reached, but I am sad that it took

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an all-out strike of junior doctors to get the Government back to the

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table. What is now clear, if it wasn't already, is that a negotiated

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agreement was possible all along. So I have to ask the house secretary:

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Why couldn't this deal had been struck in February? Why did he allow

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his pride back then to come before sensible compromise and constructive

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talks? When he stands up, he might try to blame the BMA for the

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negotiations breaking down, but he failed to say what options he was

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prepared to consider in order to ensure that the junior doctors who

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work the most unsociable hours are fairly awarded. It was a computer

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says no attitude and that is no way to run the NHS. Why did he ignore my

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letter to him on the 7th of February on which I asked him to make an

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explicit and public commitment to further concessions on the issue of

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unsociable hours. I was clear that if he had done that then I was

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having courage to BMA to return to talks. Why did he instead insist

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upon trying to bulldoze and impose the contract through when virtue

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everyone told him not to and the consequences of doing so were

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obvious fraud to see, protracted industrial action, destroyed morale

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and eight complete Britain in trust. -- for all to see. Can it house

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secretary say more about the changes agreed that can undo the

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discriminate effects on women of the last contract he published? Does he

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now accept the previous contract discriminated against women? Will he

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be clear for the record that he note two now understands that this was

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never just about pay, can he confirm the concessions have been made not

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only in respect of the mechanism for enforcing hours worked and breaks

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taken, but also in ensuring that those specialities with the biggest

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recruitment problems have decent incentives built into the contract.

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Moving on to what happens next, can he tell us what he will do if junior

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doctors vote against this offer? Will he still impose a contract? And

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which version of the contract will he impose? His preferred version or

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this compromise one? Can he say whether the possibility of losing a

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case in the High Court about his power to impose a contract had

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anything to do with his recently discovered eagerness to return to

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talks? We all know it High Court told him he had acted above the law

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when he tried to take the axe to my local hospital, so I can understand

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why he does not want that embarrassment again, and finally,

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can I caution him on his use of language both in this chamber and on

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the media. His loose words and implied criticism of junior doctors

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is partly the reason why this has ended up being such an almighty

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mess. Can I suggest a degree of humility on the part of the

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secretary of the state wouldn't go amiss. And can I encourage a period

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of radio silence from him to allow junior doctors to consider the new

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contract with a clear mind and without his spin echoing in their

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ears? Let me remind the house secretary that he still needs to get

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a majority of junior doctors to vote for this contract for this dispute

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to be finally over. Mr Speaker, I hope with all my heart that the

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agreement yesterday may offer a way forward. Junior doctors will want to

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consider it, trust needs to be repaired and that will take time. I

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hope for the sake of everyone patients and doctors that we might

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see an end to this very sorry episode in NHS history. Mr Speaker,

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she is wrong today as she has been wrong throughout this dispute. She

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spent a lot of time in the last ten months criticising the way the

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Government has sought to change this contract. What she did not dwell on

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was why it needed to be change in the first place, namely the four

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flawed contract put in place in 1999, we have major screamers with

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the BMA but once we agree on was Labour's contract was not fit for

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purpose. -- many disagreements. Could size and the contract right is

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like could sizing the mechanic making the car you just crashed and

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it's time she polished the contract changes -- acknowledged the contract

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changes have led to the number of the five day care problems were

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trying to sort out. She was also wrong to say that an all-out strike

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was necessary to resolve this dispute. The reason that the talks

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were not in the last ten days, the meaningful talks that we had, is

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because the BMA changed its position and agreed great goal sheet is

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wrecked to negotiate an weekend pay. She told the house four times before

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that change of heart that we should not impose a new contract. What

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would have happened if we have followed her advice? Quite simply

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today we would not have had the biggest single step towards a

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seven-day NHS for a generation. The biggest reforms Don social hours for

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17 years, with the extra cost of employing a doctor at the weekend is

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going down by one third. We would not have had the reductions in

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maximum working hours or many other changes that improve the safety for

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patients and quality of life for doctors. She was wrong to say that

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the previous contract was discriminatory against women, it

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removes discrimination, but does that mean there are a lot of things

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that we can do to support women who work as junior doctors? There are,

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and that is why the new Deal announced yesterday has an important

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and new character clause for women who take time off from maternity

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leave him they can get back to the position they would have been in if

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they had not had to take time off to have children. And she asked what

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happens if the ballot goes the wrong way. What she failed to do was to

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say whether she was encouraging junior doctors to vote for that

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ballot, and I say to her that on the 28th of October she has told this

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house that she supported the principle of seven-day services, but

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as Tony Blair once said, you cannot will the end without willing the

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means, and in this dispute shows refused to say that she was spot --

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supports the withdrawal of emergency care if you report -- supports

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contentious changes to reform we can premium pay and now she won't even

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say doctors should vote for the new agreement. Leadership is facing up

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to difficult decisions, not ducking them. I say to her this Government

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is prepared to take difficult decisions and fight battles that

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improve quality and safety of care in

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fight them that is fine, but she shouldn't stand dispatch box and

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claim Labour stands up for NHS patients. If she doesn't want to

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listen to me perhaps she should listen to former Labour Minister Tom

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Harris, who said strategically Labour should be on the side of the

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patients and we aren't. If Labour isn't, the Conservatives are! Mr

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Speaker, could I add my congratulations on both sides for

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turning to constructive negotiations and far reaching an agreement and I

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would like to pay particular tribute to Professor Sue Bailey in the

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Academy of Medical Royal Colleges for their role in bringing both

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sides together. I welcome the particular focus on all the other

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aspects that are blighting the lives of junior doctors alongside

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negotiations around weekend pay and recognising we need to focus on

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those specialties which is hard to recruit two and those of junior

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doctors who are working the longest hours of folks of patient safety.

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We're not out of the woods yet, we need junior doctors to vote for this

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in a referendum. And could I add my voice to the voices of the Leader of

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the Opposition spokesman of health to say that I think what is needed

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now is a period of calm reflection and to build relationships with

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junior doctors going into the future. I wonder if this act of

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state could comment on his plans for building a relationship with our

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core workforce? Firstly I would like to very much agree with the

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honourable lady in her thanks to Professor Dame Sue Bailey and the

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leadership the Academy of Medical Royal Colleges has shown in making

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the initiative that in the end made this detox possible and the

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agreement is possible and I know it's been a difficult and

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challenging time for the Royal colleges but I think Professor

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Bailey showed real leadership in turn should have and I also very

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much agree with her about the need to sort out some of the issues that

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have been frustrations for junior doctors, not just in the last few

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years, but going back decades in terms of the way their training work

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and in terms of the flexibility of the system of six-month rotations

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that they work in actually operates and this is an opportunity to look

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at those wider issues, think we have started looking at some of them

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yesterday and think there is more we can do and I think it is very

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important that this is seen not as one side winning and the other side

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losing, but as a win-win. But the last ten days it showed is that if

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you sit around the table you commit real progress in a better deal for

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patients and doctors and that is the spirit we want to go forward. I

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absolutely welcome this agreement and I pay tribute to the Royal

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Academy of Royal colleges for bringing this about. I do wish there

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had been some response to the latter that we sent before the all out

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strike. Simic letter. That was the attempt we were trying to make to

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create a space that both sites could step into Britain that we got to it

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now. I welcome the recognition the quality issues to us and many junior

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doctors appear to be dismissed in the impact assessment, the idea of

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flexible training champions in each trust, I myself was a flexible

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training senior surgeon, the first one in Scotland at the time, and I

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think that is really important. The idea was celebrated -- of

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accelerated training that one concern I have is the issue of

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childcare, if women, junior doctors, will be working longer shifts and

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more anti-social shifts, I remember myself when I had to fork out for

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childcare, I would like to know, will the NHS respond to that? Is

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that in question are as -- crash hours or support? I welcome the

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hours Guardian will also be linked to the Director of medical education

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and they will be an elected junior doctors for. That was one of their

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concerns that they would have no voice in relation to the Guardian. I

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also welcome the idea of using modern technology in rota creation.

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At the moment rodders are sheets of paper and often no one looks at the

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shoulder of one closer to the next and people can end up with very long

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periods on call. I do welcome that but one concern that remains is the

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issue of rota gaps, we actually don't have enough junior doctors and

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we don't have enough junior doctors in the most acute specialties. I

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would ask, how is the Secretary of State planning to re-establish a

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relationship? How will he recruit people to fill that gap? Because

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that was actually the coffee of junior doctors, lack of doctors

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simply being spread further. How will we recruit and retain after all

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of the painful clash that has been going on for the last year? I

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welcome the tone of her comments, which I might say could have been

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the tone we might have wanted from the Shadow Health Secretary. Let me

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address constructively her comments as she made them constructively to

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me that she is right about flexible training, we have to recognise that

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we have a junior doctor workforce that is now majority female, that

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has a number of family and caring pressures that need to be taken

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account of and we need to do this for the NHS as well as because it is

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the right thing to do. I think we have to look at

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particularly the east Responsibilities of doctors with

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young children and one of the things we anoinsed yesterday was an

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obligation on trusts to take account of caring responsibilities. If you

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have a doctor who wants to work less time during school holiday ands more

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and during term time. The needs of patients have to come first. It

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could be something which could be taken account of, in the way that

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many other industries which operate 24/7 do. She's right to say that

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modern technology is key for this. If you are an air steward working

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for basmt, you can go on to an electronic system yourself and

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choose the hours you wish to work. We have seen a lot of low come work

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which is partly driven because they offer the flexibilities that people

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need. These are important changes and we intend to take them forward.

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May I tell my Right Honourable friend that the actions of him and

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his department and the BMA in reaching an agreement will be warmly

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welcomed, but will be met with a sigh of relief. Will he accept that

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the fact that the BMA were prepared to think again on crucial issues

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like overtime at weekends, should not be seen as a sign of weakness,

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but of maturity in working the Government to ensure a seven-day NHS

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that is for the benefit of patients and patient safety? I agree with

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that wise comment, as befits someone who is in fact experienced and

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working in the Department of Health. You always get further if you sit

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around the table and talk about these issues and it is much better

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when you have a Government that is determined to improve the quality

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and safety of care for patients, it is also better to recognise that if

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the Government is successful that will also be better for the morale

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of doctors because the happiest, most motivated doctors are working

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in the hospitals which are giving the best care for patients. That is

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why it is a win win. It was the refusal for many wreers of the BMA

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to discuss the issue that my Right Honourable friend referred to meant

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we did reach a deadlock. It was the fact this Government was willing to

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proceed with important reforms on our own f we had to, which meant in

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the end everyone came together and got a sensible negotiation. Everyone

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would have wished we did haven't to go on the journey we did to get

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there. Now we have got there it is the time for being constructive on

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all sides. Can I thank the minister and the BMA for coming to an

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agreement. It is a win win for everyone. Talk dialogue does bring

:25:22.:25:26.

results. It happened in Northern Ireland and in the conclusion of

:25:27.:25:31.

this process as well. 45,000 junior doctor BMA members will now be asked

:25:32.:25:35.

to vote in this and a date has been reached. We've had eight days of

:25:36.:25:42.

strikes since January. A cancellation of who,000 planned

:25:43.:25:46.

operations -- 40,000 planned operations what will be done to

:25:47.:25:53.

catch up with those cancelrationlations? We are in

:25:54.:26:04.

constant touch with the devolved regions to make sure they know of

:26:05.:26:08.

the changes we are making and to share any learn from the pro-ess

:26:09.:26:12.

ises we have been through. We -- processes we have been through. We

:26:13.:26:16.

are across the country now doing everything we can to catch one the

:26:17.:26:21.

back log of all the things which have been affected by the industrial

:26:22.:26:27.

relations dispute. Trust will always priority the areas where clinical

:26:28.:26:31.

need is the greatest. I know that work is on going across the country.

:26:32.:26:36.

Thank you, Mr Speaker. I very much welcome the agreement that has been

:26:37.:26:44.

reached. We know that the Secretary of State recognises the important of

:26:45.:26:48.

having a happy and well-motivated workforce and this contract

:26:49.:26:52.

addresses many of the causes of unhappiness for junior doctors. It

:26:53.:26:57.

is particularly good to see addressing the problems of couples

:26:58.:27:00.

who are both junior doctors. There is more to do, has been

:27:01.:27:05.

acknowledged, especially on the reasons why junior doctors feel

:27:06.:27:10.

unsupported and not valued by their employers. My honourable friend

:27:11.:27:16.

commissioned a report and a review from Sue Bailey, underlining the

:27:17.:27:20.

problems of junior doctors in training. Can he advise us whether

:27:21.:27:27.

this review will proceed? The request from the BMA was to find a

:27:28.:27:31.

way of proceeding with that very important work and we will do it

:27:32.:27:36.

with the input of Professor Bailey because she has an important

:27:37.:27:39.

contribution to make. She is right to say that as well as the issue of

:27:40.:27:44.

more flexible working for people with family commitments, the big

:27:45.:27:48.

issue for many junior doctors is the way the training process happens. In

:27:49.:27:52.

particular the way that continuity of training has been undermined by

:27:53.:27:57.

the new shift system, which we need for reasons of patient safety. That

:27:58.:28:02.

often means that you can have a different consultant giving advice

:28:03.:28:06.

on different aspects of care from day-to-day. That is frustrating. We

:28:07.:28:11.

will look at all those issues with Professor Bailey, with health

:28:12.:28:13.

education England and with the BMA to see if we can find a better way

:28:14.:28:19.

forward. Will the Secretary of State be aware

:28:20.:28:26.

that even my constituents struggling the possible closure of the A in

:28:27.:28:32.

Huddersfield will otherwise welcome and say thank you to everyone who

:28:33.:28:36.

has brought this about. Including, I have to say, the leaders of the

:28:37.:28:40.

opposition parties, our spokeses people who have done so much to help

:28:41.:28:47.

a positive spirit? Will he just not glout about that or keep that period

:28:48.:28:51.

of silence because out there, this is part of the phenomenon of the

:28:52.:28:57.

deep unhappiness about the NHS and problems will arise again because so

:28:58.:29:04.

many people work in the NHS service, know it has been privatised by the

:29:05.:29:08.

back door, know that the clinical commissioning system is not working

:29:09.:29:12.

and that problems will come back again and again unless he confronts

:29:13.:29:17.

that. Weshlings it would have been a

:29:18.:29:23.

constructive contribution to this morning's debate if he had not

:29:24.:29:27.

started to descend into totally false slurs about this Government's

:29:28.:29:31.

commitment to our NHS. I say to him, if you support the NHS, if you are

:29:32.:29:35.

passionate about it as this Government is, you put the money in

:29:36.:29:40.

- ?5.5 billion more than his party was promising at the last election

:29:41.:29:44.

and you make the difficult reforms necessary to make sure that NHS care

:29:45.:29:48.

is as good or better than anything which can be provided in the private

:29:49.:29:52.

sector. That is what this Government is doing. We believe in our NHS and

:29:53.:29:57.

we are backing it to give it the best care anywhere in the world. I

:29:58.:30:01.

strongly welcome this important statement and the leadership from

:30:02.:30:04.

the Secretary of State and congratulate all those involved in

:30:05.:30:08.

the discussions. On Tuesday, in Eastly, I spoke with a constituent,

:30:09.:30:14.

a junior doctor and new mum married to a senior nurse at my advice

:30:15.:30:20.

surgery. She's unable to fast track into GP working and future care

:30:21.:30:26.

around her four-month-old baby is part of the concerns she has, and

:30:27.:30:30.

around these negotiations and it weighs heavily on this family,

:30:31.:30:34.

particularly around on-call working. Can I ask that agile working and

:30:35.:30:39.

those family first issues are truly taken into account where there are

:30:40.:30:42.

nurses and doctors trying to bring up families together?

:30:43.:30:47.

My honourable friend gives one example. I think there are thousands

:30:48.:30:52.

of examples of people like that who are totally committed to the NHS,

:30:53.:30:58.

have a bright future and can make a huge contribution to the success of

:30:59.:31:03.

the NHS in doing a good job looking after patients, but also have home

:31:04.:31:06.

responsibilities, which are difficult to fulfil when you have

:31:07.:31:11.

very inflexible Ross tering systems. This is one of -- rostering systems.

:31:12.:31:19.

We will look at how it brings in that flexibility. If we don't do

:31:20.:31:24.

that we will see more and more doctors saying they will work to

:31:25.:31:30.

work as locums or want to work for an agency. That is why we have an

:31:31.:31:35.

urgent need from the perspective of patients and doctors to address that

:31:36.:31:38.

issue. I am interested in the Secretary of

:31:39.:31:43.

State's thoughts about the serious impact on morale that this dispute

:31:44.:31:48.

has had. I was talking to a junior doctor in Sheffield this-the-other

:31:49.:31:52.

day who said priority to -- prior to the dispute he did not look at his

:31:53.:31:56.

contract, he simply got on and did whatever was needed. Does the

:31:57.:32:01.

Secretary of State realise even if this is settled there's been a

:32:02.:32:06.

serious impact on goodwill in the health service which could affect

:32:07.:32:11.

service delivery going forward? I would say to him that if he looks at

:32:12.:32:18.

the latest NHS staff survey we actually see higher staff

:32:19.:32:20.

motivation, better communication and more staff recommending their

:32:21.:32:23.

organisation as a place to work or be treated. I also do accept that

:32:24.:32:31.

when you make big changes to a contract like the junior doctor's

:32:32.:32:37.

contract they can be contentious and have an impact on morale. Morale

:32:38.:32:41.

goes up when doctors are able to give better care for patients and

:32:42.:32:47.

this is what this will require. The Secretary of State I think has done

:32:48.:32:53.

a very good job in explaining today. Look, let's look at this, the BMA

:32:54.:32:57.

caused a problem which should have been resolved a long time ago thasmt

:32:58.:33:00.

decided they would make a political point. That is fair enough.

:33:01.:33:05.

Conversely the opposition should have actually been big enough to

:33:06.:33:09.

say, look, we want to cause political trouble on this. A lot of

:33:10.:33:15.

this has been caused by political shenanigans. The failure of this is

:33:16.:33:20.

the junior doctors themselves have lost prestige throughout the UK

:33:21.:33:24.

because they were used by political pawns as two organisations. Well, I

:33:25.:33:32.

think it is a great tragedy that the dispute unfolded in the way it did.

:33:33.:33:36.

I am sure there are people with different agendas who have not

:33:37.:33:40.

played constructive roles at various points. Given we now have an

:33:41.:33:46.

agreement I want to look forward and say the lesson of the last ten days

:33:47.:33:51.

is when you sit down and negotiate about all the outstanding issues

:33:52.:33:55.

with a Government that is trying to make care better and safer for

:33:56.:33:59.

patients then you get a result which is good for everyone.

:34:00.:34:02.

It is not the time to be claiming victory. This negotiated agreement

:34:03.:34:07.

now has to be put to the members of the British Medical Association.

:34:08.:34:11.

Will the Secretary of State acknowledge that his own refusal to

:34:12.:34:20.

negotiate easts a sister baiteded this crisis? Will he heed my

:34:21.:34:24.

honourable friend, the Shadow Secretary's call for a period of

:34:25.:34:29.

silence in order to avoid antagonising the junior doctors

:34:30.:34:34.

still further? Let 's be absolutely clear there was never a refusal to

:34:35.:34:38.

negotiate on the Government's side. You know, we have now, I think,

:34:39.:34:43.

developed a lot of trust between the Government and the BMA leadership.

:34:44.:34:48.

Until that point, they balloted for industrial action without even

:34:49.:34:51.

sitting down and talking to the Government and they refused to

:34:52.:34:55.

discuss the issue of weekend pay premium, which is the crucial change

:34:56.:34:59.

we needed for a seven-day NHS. It is when they changed their position on

:35:00.:35:03.

those areas that we were able to have constructive talks and that is

:35:04.:35:08.

why they deserve great credit for coming to the table and negotiating

:35:09.:35:12.

on things they did not want to previously.

:35:13.:35:17.

I would like to say thank you to the Secretary of State for bringing hard

:35:18.:35:21.

to bring about this resolution and always putting users of the NHS at

:35:22.:35:25.

the heart of everything he does. Will he join me in urging junior

:35:26.:35:32.

doctors to consider it with an open mind and strip out some of the

:35:33.:35:36.

politics we have heard. And let's consider what is best for patients,

:35:37.:35:40.

for the NHS and then what is best for the junior doctors? She speaks

:35:41.:35:46.

very wisely. All I would say is that I understand in a very contentious

:35:47.:35:51.

industrial relations dispute that junior doctors will not necessarily

:35:52.:35:54.

look to me for advice as to which way they should vote, but it wasn't

:35:55.:36:00.

just me doing this agreement, it was a negotiated agreement and the

:36:01.:36:03.

leader of the junior doctors committee said it is a good

:36:04.:36:06.

agreement, he will support people to support it and he thinks it is a

:36:07.:36:11.

good way forward for doctors and patients T people closest to the

:36:12.:36:14.

detail, to the negotiations think it is the right step forward for junior

:36:15.:36:18.

doctors and that is something I want to take account of. Thank you, Mr

:36:19.:36:26.

Speaker. I don't wish to invite the Secretary of State to provoke by

:36:27.:36:30.

presumption. If this changes the shape of services it will have

:36:31.:36:34.

implications for other health professions. Is he prepared to have

:36:35.:36:40.

further conversation that needs to be had there and with counterparts

:36:41.:36:45.

across these nationals to professional education and training?

:36:46.:36:50.

We are of course willing to have those discussions with colleagues in

:36:51.:36:55.

other parts of the UK. But he is right that to have a seven-day

:36:56.:37:02.

service doesn't just involve junior doctors, it involves widespread

:37:03.:37:05.

changes across the service. I would say for nurses, health care

:37:06.:37:09.

assistants, porters, cleaners, others who work in hospitals, they

:37:10.:37:15.

already operate on 24/7 shifts. So the changes necessary to contracts

:37:16.:37:19.

are much less profound than they are to some of the doctors' contracts,

:37:20.:37:23.

which is why it is important that we change not just the junior doctors'

:37:24.:37:29.

contract but the consultants' contracts and the fact we have an

:37:30.:37:33.

agreement bodies well for the consultants' contract, which is the

:37:34.:37:34.

next step. Can I congratulate my honourable

:37:35.:37:44.

friend and all honourable friend the member for switch for his hard work

:37:45.:37:51.

in dealing with the dispute with the BMA. Patients up and down the

:37:52.:37:57.

country, including mine, were somewhat concerned about the

:37:58.:37:59.

cancelled operations but I'm delighted that the deployment will

:38:00.:38:04.

try and make sure this gets caught up with. -- department. One of the

:38:05.:38:09.

things come out of it was that some senior consultants had to end up on

:38:10.:38:13.

the front line for the first time in a long time and can I ask what can

:38:14.:38:17.

be done to make sure this happens on a regular basis so they are getting

:38:18.:38:20.

experience on the front line as well? Think I will dig myself into a

:38:21.:38:30.

deep old answer that directly. I would like to echo his thanks to my

:38:31.:38:38.

honourable friend the member for Ipswich, who has done an outstanding

:38:39.:38:45.

job at every stage throughout this very difficult period and I can

:38:46.:38:48.

certainly say we would not have had yesterday's agreement without his

:38:49.:38:52.

very strong help and support at every stage. I think it's true that

:38:53.:39:01.

there are A departments that have to plan for the withdrawal of

:39:02.:39:05.

emergency care and they found that having consultants more visible to

:39:06.:39:10.

patients had some positive impact and I know studies are going on to

:39:11.:39:13.

see what lessons can be learned going forward. I too welcome the

:39:14.:39:20.

opportunity for a negotiated settlement, but let us take a moment

:39:21.:39:26.

to reflect on one of the fundamental principles of the NHS about

:39:27.:39:31.

providing high quality patient care, and to that end, Woody section of

:39:32.:39:35.

state figures opportunity to offer our heartfelt and sincere apology

:39:36.:39:39.

for the significant and severe distress that has been caused to

:39:40.:39:43.

patients as a result of this prolonged dispute? With the gift

:39:44.:39:50.

greatest of respect it was not my decision to take industrial action,

:39:51.:39:56.

to ballot without him in being prepared to sit around the table and

:39:57.:40:00.

talk to the Government, and with respect to patient safety we seemed

:40:01.:40:03.

about improvements in beige and safety under this Government as we

:40:04.:40:07.

face up to the many problems in care that we inherited, not just miss

:40:08.:40:15.

staffs and many other places that option should welcome the changes

:40:16.:40:18.

we've made in one of those it have a seven-day NHS. Like many colleagues

:40:19.:40:27.

in the house, wrote visit to stick on numerous occasions over the last

:40:28.:40:31.

six months to express concerns of local junior doctors so,

:40:32.:40:34.

congratulate him on reaching this and I hope the new doctors in

:40:35.:40:37.

Wimbledon will wholeheartedly support this deal. Can I say we

:40:38.:40:40.

spoken about the Guardian and the ability of it and its role to

:40:41.:40:45.

safeguard and have safe working hours per patients and doctors. Can

:40:46.:40:51.

have more details about how that should work? I'm happy to do that

:40:52.:40:54.

and I thank him for his correspondence. The principle is

:40:55.:40:58.

that junior doctors want to know that there is someone independent

:40:59.:41:03.

that they can appeal to the think they are being asked to work hours

:41:04.:41:08.

that are unsafe the spin they cannot work -- after patients how they

:41:09.:41:11.

wanted because they're physically or mentally too exhausted. That is

:41:12.:41:15.

something we would all want to make possible but it means they need to

:41:16.:41:22.

have someone who is the -- is not their line manager, someone

:41:23.:41:25.

independent and separate. One of the areas we made the most progress in

:41:26.:41:30.

the last few months, even before the last ten days, is establishing how

:41:31.:41:34.

these guardians can work in a way that has the of the hospitals the

:41:35.:41:42.

doctors working there. The section of state is right when he says you

:41:43.:41:45.

always get further if you get around the table. I ask him why in response

:41:46.:41:51.

to the cross-party initiative back in February to get everyone around

:41:52.:41:55.

the table didn't he do that and save us all this trouble rather than

:41:56.:42:00.

finding both the contract? The cross-party initiative was in for a

:42:01.:42:03.

new contract, it was to abandon plans for a new contract and just

:42:04.:42:08.

have pilots in a few limited places and if we had followed that advice

:42:09.:42:11.

we would not now today had the biggest changes in junior doctor

:42:12.:42:17.

contracts for 17 years agreed with the BMA, and that was why the call

:42:18.:42:21.

we wanted was to get the agreement yesterday, safer carefully NHS and

:42:22.:42:26.

better deals for doctors. That is what we got and we wouldn't have if

:42:27.:42:34.

we listen to that advice? Can I join in the welcome for the agreement and

:42:35.:42:39.

the persistent and patients that eventually paid off. In previous

:42:40.:42:43.

statements I've raised with the sexual state this problem of married

:42:44.:42:50.

couples, both of whom are doctors, -- secretary of state. If they have

:42:51.:42:54.

roasters that clash, can he say a word about the progress made in this

:42:55.:42:58.

important area of making work more family friendly. I'm happy to do

:42:59.:43:10.

that. Is not easy dissolved because junior doctor at training places

:43:11.:43:15.

operate on six-month locations and are competitive. You get many more

:43:16.:43:22.

up applicants than there are posts available, so we have to find a way

:43:23.:43:27.

of balancing the need to respect family responsibility, something we

:43:28.:43:30.

would all want to do, with the need to have a fair process for the most

:43:31.:43:34.

competitive positions. I think we have not got the balance right to

:43:35.:43:41.

date, so we said cells Dott health education and where we decide people

:43:42.:43:44.

will go on rotation will have a duty to consider family response but is

:43:45.:43:47.

when they make decisions about those locations. I welcome the potential

:43:48.:43:57.

resolution, thank the Government for negotiation at the doctors having

:43:58.:44:01.

the courage to go on strike, which no one does likely to get a better

:44:02.:44:05.

deal for the NHS. I would ask the secretary of state to reflect on

:44:06.:44:11.

this and take further steps to build on his difficult relationship with

:44:12.:44:15.

NHS staff and stop resenting NHS policy and false dichotomy between

:44:16.:44:17.

the interests of patients and interests of NHS staff. If he had

:44:18.:44:26.

listened to what I said, for we said Beasley I don't think that the cost

:44:27.:44:29.

me exists, the false dichotomy as he says in the end what is right for

:44:30.:44:34.

patients is also right doctors, the thing that demoralises doctors and

:44:35.:44:38.

nurses and everyone working in hospitals and different part of the

:44:39.:44:41.

Ayrshires is when they are not able to give the care they want what they

:44:42.:44:46.

think is appropriate to the patients in front of them, which is why we

:44:47.:44:51.

see hospitals that have moved closes towards a seven-day services are

:44:52.:44:54.

also some of hospitals with the highest levels of morale in the NHS.

:44:55.:44:58.

He is right, it's not a false dichotomy and we need to do both

:44:59.:45:05.

together. As the sexual note, my brother and his wife were junior

:45:06.:45:07.

doctors when they made the decision to move over to New Zealand a long

:45:08.:45:13.

while ago. That was because of the long-standing cultural problems in

:45:14.:45:16.

the NHS. They will be pleased indeed about the announcement yesterday

:45:17.:45:22.

around the couples being able to work together in hospitals

:45:23.:45:25.

potentially. I have a question for my mother and it relates around what

:45:26.:45:33.

can you do now in order to encourage them and their friends back into the

:45:34.:45:42.

NHS? Let me say to your mother that I hope the message of this new

:45:43.:45:47.

agreement will go brightly way around the world and any doctors who

:45:48.:45:53.

have moved to New Zealand or Australia are always welcome to come

:45:54.:45:56.

back, and I think the thing that must unite this Government and the

:45:57.:46:03.

good doctors who work in the NHS is our commitment to making NHS care

:46:04.:46:07.

the safest and best in the world, and I think we had a terrible shock

:46:08.:46:11.

with what happened at mid-staffs, but we're using it as an moment of

:46:12.:46:17.

change, decisive change, NHS and were on the way to higher standards

:46:18.:46:20.

of care that are available in many other countries. Mother Howlett is

:46:21.:46:25.

satisfied, or idea we shall hear about it. -- or IDSA.

:46:26.:46:32.

Congratulations Government and everyone on getting this in place,

:46:33.:46:38.

it will have a knock-on effect in Northern Ireland into my

:46:39.:46:40.

constituency, when I went around Antrim area hospitals their concerns

:46:41.:46:45.

the number of doctors and how you get a seven day a week cover from

:46:46.:46:50.

everything else that needs to go on in the health service, which, and

:46:51.:46:53.

how we will deal with that and we will work with parliaments? I do

:46:54.:47:00.

agree, we need more doctors and more nurses and by the end of this

:47:01.:47:04.

parliament will have 1 million more over 70s in England alone and I know

:47:05.:47:08.

the demographic effect in Northern Ireland will be equivalent. Globally

:47:09.:47:12.

we have a shortage of about 7 million doctors, so we need to train

:47:13.:47:18.

more. We are training an extra 11,420 doctors over this parliament

:47:19.:47:22.

as part of the spending review. Because the training is done on the

:47:23.:47:25.

UK wide basis it is something we will need to work closely with all

:47:26.:47:31.

of the devolved regions. I warmly welcome this draft agreement and it

:47:32.:47:35.

will be met with some relief in Cheltenham. Whatever article the

:47:36.:47:38.

health concerns about the behaviour of the BMA in the past, does the

:47:39.:47:42.

Secretary of State agree it should be an admission that this should be

:47:43.:47:45.

part of the beginning of a more constructive future and will you

:47:46.:47:51.

join me in congratulating the BMA negotiations for being able to

:47:52.:47:53.

address constructively issues like Saturday pay. I'm happy to do that,

:47:54.:48:01.

and I recognised it was not easy for them because they are still

:48:02.:48:03.

involving changing the position that had for over three years. The result

:48:04.:48:09.

we got to admit that at the details was actually something that was not

:48:10.:48:12.

difficult for them to sign up to because they could see it really was

:48:13.:48:16.

better for their members as well as better for patients. I think the

:48:17.:48:20.

lesson is that the NHS faces huge challenges and can only be right to

:48:21.:48:24.

deal with these challenges by sitting around the table as

:48:25.:48:30.

negotiating constructively. I also warmly welcomed the news of the

:48:31.:48:34.

agreement and I hope it feeds into a settlement. Can I ask the Secretary

:48:35.:48:39.

of State if it is his intention to create a seven-day NHS, that will

:48:40.:48:43.

require the participation of more than just the junior doctors, will

:48:44.:48:48.

he bring forward a new contract for consultants? Or will he bring

:48:49.:48:52.

forward a new contract for hospital lab walkers or Amazon 's workers or

:48:53.:48:59.

nurses or indeed for catering staff? He is right. A seven-day NHS is not

:49:00.:49:05.

just or even mainly about junior doctors, their important part of the

:49:06.:49:09.

equation but we will need a new contract for consultants and we are

:49:10.:49:13.

having constructive negotiations with consultant about that. For

:49:14.:49:18.

other people working in the NHS, many are already or seven-day

:49:19.:49:24.

contract, so he is right to say that we are going to have to have

:49:25.:49:29.

diagnostic services operating across seven days so junior doctor working

:49:30.:49:32.

at the weekend will be up to get the result back for a diagnostic test

:49:33.:49:35.

the weekend and those are all part of the changes that we will make to

:49:36.:49:44.

make and it is safer for patients. Can I warmly congratulate both sides

:49:45.:49:48.

on reaching this agreement. Our NHS is different at weekends and my

:49:49.:49:56.

honourable friend is right to bring in the four key clinical standards

:49:57.:50:00.

on Sunday and Saturday. Would he agree it's important not simply to

:50:01.:50:05.

rely on mortality data, which are often difficult to interpret in

:50:06.:50:09.

underpinning the case for the seven-day NHS and will he look

:50:10.:50:11.

closely at other metrics based on clinical standards around things

:50:12.:50:16.

like endoscopy and routine lists on Saturday and Sunday and periods of

:50:17.:50:21.

care particularly, which does not feature in any hospital mortality

:50:22.:50:30.

data? He speaks very wisely on medical matters and I particularly

:50:31.:50:33.

agree when he speaks about palette of care, which has got better, but

:50:34.:50:38.

nonetheless there is a long way to go and we had recent evidence that

:50:39.:50:42.

it is particularly in need of improvement where we are not able to

:50:43.:50:49.

offer a seven-day part of support. I welcome this settlement and thank

:50:50.:50:55.

everyone involved for securing it. Many junior doctors remained

:50:56.:51:00.

concerned that as you increase the hours worked over a weekend you

:51:01.:51:06.

inevitably produce cover during the week -- Regis cover unless you buy

:51:07.:51:09.

more junior doctors to bridge that gap. With many rotors of ready on

:51:10.:51:15.

filter does not until around the country during the week how can he

:51:16.:51:18.

guarantee we will not make the situation worse during the week,

:51:19.:51:26.

thereby impacting on patient safety? I understand the concern and the

:51:27.:51:29.

short answer is that we need to increase the NHS workforce, which we

:51:30.:51:33.

are doing and we will see more doctors going into training during

:51:34.:51:36.

the course of this parliament, as were somewhat doctors going into

:51:37.:51:38.

training over the course of the last Parliament. More doctors in the

:51:39.:51:42.

workforce will be an important part of the solution. At the start of the

:51:43.:51:50.

recent negotiations appears that the payment for Saturday working was the

:51:51.:51:55.

main sticking point from the BMA but it appears from this negotiation now

:51:56.:52:00.

that the issue of weekend pay has been resolved, can my honourable

:52:01.:52:05.

friend confirmed that the position now is that this can lead for the

:52:06.:52:09.

doctors that are working extended hours for the weekend will get extra

:52:10.:52:14.

pay and patients can see a seven-day week NHS, which we all want to see?

:52:15.:52:21.

It is much fairer for doctors than the current system. We are giving a

:52:22.:52:29.

pay rise of between 10-11%, for which we are saying people are

:52:30.:52:32.

expected to work one weekend day a month. The doctors who work more

:52:33.:52:39.

than that get more and it goes up T more weekends you work the more

:52:40.:52:43.

extra pay you get. That is one of the reasons the BMA was prepared to

:52:44.:52:47.

sign up to this agree. It does value the people who give up the most

:52:48.:52:53.

weekends. I was contacted by a constituent,

:52:54.:52:57.

who told me how his four-year-old daughter fell through a pane of

:52:58.:53:04.

glass, severely cutting her face. Unfortunate natly this accident --

:53:05.:53:08.

unfortunately this accident had on a Friday evening because there were

:53:09.:53:13.

insufficient doctors working she could not have on operation until

:53:14.:53:18.

the Monday. That four-year-old girl will now suffer severe facing

:53:19.:53:23.

scarring for the rest of her life. Does my friend agree with me, that

:53:24.:53:28.

is the republic why we need a seven-day NHS. I couldn't have put

:53:29.:53:32.

it better myself. Those are the stories we hear from our

:53:33.:53:35.

constituents, from our families. That is why yesterday was an

:53:36.:53:39.

important step forward in terms of that seven-day agenda. I must

:53:40.:53:45.

confess to being puzzled because the BMA have said all along this strike

:53:46.:53:48.

and dispute was nothing to do with weekend pay and terms. Yet, after

:53:49.:53:54.

discussions, negotiations which were limited simply to weekend pay and

:53:55.:53:59.

terms, the BMA have now come to a deal and advised against strike

:54:00.:54:05.

action. Can we take it despite much huffing and puffing this was about

:54:06.:54:08.

the future of the NHS and the rest of it, at the end of the day it was

:54:09.:54:14.

all about weekend pay and terms? I think he is right that was the big

:54:15.:54:19.

sticking point and their willingness to be flexible and the goshiate on

:54:20.:54:25.

that which made -- and negotiate on that which made it possible. There

:54:26.:54:30.

are many other noncontractual issues in the way that doctors are trained

:54:31.:54:34.

and treated by the NHS. We want to use this as an opportunity to put

:54:35.:54:40.

that right. Can I congratulate on the Secretary of State op putting

:54:41.:54:46.

patients first. Those people who had their operations cancelled during

:54:47.:54:57.

industrial action. Looking at people on the back-burner or poss pope

:54:58.:55:04.

their medical -- or postpone their medical care? That is a view some

:55:05.:55:09.

share. Doctors have obligations now under the Medical Act not to take

:55:10.:55:15.

action which would harm patients and under their responsibilities to the

:55:16.:55:19.

General Medical Council. They have to be aware of those. What I hope is

:55:20.:55:24.

that question does not arise again, we are having constructive

:55:25.:55:27.

discussions with the BMA. It is the way forward and I hope that neither

:55:28.:55:31.

myself or any future Health Secretary has to go through what we

:55:32.:55:39.

have during the last ten months. I explored the tone and content of the

:55:40.:55:42.

remarks today. It will go down as a break through in the NHS. It has

:55:43.:55:46.

been very uncomfortable to have dialogue with constituents who are

:55:47.:55:50.

junior doctors who have felt aggrieved. So, I have particularly

:55:51.:55:54.

welcomed the way he's been able to look at noncontractual issues. I

:55:55.:55:58.

would urge him to look very strongly at the issue of -- the outcome of

:55:59.:56:04.

the Bailey review so he can move forward on morale and the wider

:56:05.:56:09.

issues which have been raised. Well, I just finish by saying I

:56:10.:56:17.

complete aagree with him. It's been a very sad dispute. We recognise

:56:18.:56:20.

that junior doctors are the back bone of the NHS. They work very

:56:21.:56:24.

hard. They often work the most weekends already. I think it is

:56:25.:56:28.

therefore a brilliant step forward that we have an agreement. But the

:56:29.:56:33.

constituents that he talks about and that we all have who work hard for

:56:34.:56:37.

the NHS are the people we want to value. Therefore, dialogue,

:56:38.:56:44.

constructive discussion must be the way forward.

:56:45.:56:51.

THE SPEAKER: In accordance with standing order 122D, I must announce

:56:52.:56:56.

the arrangements for the election of the chair of the Backbench Business

:56:57.:57:01.

Committee for the new session. If there is more than one candidate,

:57:02.:57:07.

the ballot will be held in committee room 16 from 11am to 1. 30pm on

:57:08.:57:15.

Wednesday, 25th May. Nominations must be submitted in the

:57:16.:57:20.

table office between 10am and 5pm. That is on the day before the

:57:21.:57:23.

ballot. That is to say, Tuesday 24th May. In

:57:24.:57:29.

accordance with the standing order, only members who do not belong to a

:57:30.:57:36.

party represented in her Majesty's Government may be candidates in this

:57:37.:57:40.

election. A briefs note with more details

:57:41.:57:47.

about the election will be made available to members and published

:57:48.:57:55.

on the internet. Order. Presentation of bill, Mr Javid.

:57:56.:58:02.

Second reading, what day? Tomorrow. Order, the clerk will proceed to

:58:03.:58:08.

read the orders of the day. Nanss bill, presentation Fy second

:58:09.:58:15.

reading and committal. In accordance with standing order number 80 B and

:58:16.:58:18.

the order

:58:19.:58:19.

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