Sir Jeremy Hunt
MP for Godalming and Ash · Conservative · United Kingdom
“It is a pleasure to speak under your chairmanship, Mr Twigg. I speak today as chairman of the all-party parliamentary group for financial markets and services. I refer hon. Members to my entry in the Register of Members’ Financial Interests, which states that I accept speaking engagements from financial services companies.”
“Chief executives of banks made very ill-judged decisions to continue paying themselves large bonuses at a time when the rest of the country was suffering, and the country suffered a longer and deeper recession at that time as a result of our exposure to the financial services sector, which was much greater than that of our peers.”
“We are in a much, much better state than we were in 2008.” But I do think that it has gone slightly too far in the other direction. Sometimes we can over-correct.”
“What further action will the Government take to improve access to finance for small and medium-sized enterprises and scale-ups, which has been a particular issue in the period since the financial crisis?”
“I thank the hon. Lady for her role in helping to salvage Barings. I did not know that before. She is absolutely right to raise that issue. I do not say this in a party political way, because my party pretty much supported it at the time, but there is no doubt that, in the run-up to the financial crisis, regulation was not as tight as it n…”
“To their credit, this Government have built on those reforms with the Leeds reforms, the Pension Schemes Act 2026 and the forthcoming Financial Services and Markets Bill, all of which are extremely welcome. But, as the hon. Member for Buckingham and Bletchley said, our competitors are not standing still.”
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“My right hon. Friend is right, as that was our only really substantive promise in terms of a commitment to the NHS at the last election. We are funding it and we have an absolute obligation to the British people to deliver on it. That is why in that short period after the last election I felt I had to be clear with the BMA that we were going to deliver on that manifesto promise. If the BMA had reflected on that, it might have perhaps behaved differently from how it did.”
“I do not think that is the way forward, because the best way to solve these disputes is by an agreed solution. That is actually what we had, which is why it is so disappointing that the BMA has chosen not to work to try to implement it.”
“My hon. Friend is absolutely right. All of us in this debate have one simple thing to consider: what is the right answer for the people we represent? They understand that there are financial constraints and that the NHS cannot do everything, but they do want us to strive to make it safer and better the whole time. It is a surprise and a disappointment that we do not hear more of that language from the Labour party.”
“It absolutely should. The BMA has been out of step with both the British public and its own members this week. My hon. Friend’s own hospital in Hereford—Hereford county hospital—is in special measures. It has a huge number of problems, which it is working really hard to sort out, and we are helping it to sort them out. Is that not what we should be focusing on in the NHS, rather than having to do contingency planning for these damaging strikes?”
“Yes, I can absolutely confirm that. We have put in place pay protection to make that happen. My hon. Friend is right that this is very damaging for his constituents in Cheltenham. Given that there is so much pressure in the NHS, the junior doctors who are thinking of striking must ask themselves whether it is really going to help their organisation respond to those pressures if it has this enormous distraction—this incredible demoralisation that we get with these kinds of strikes.”
“I completely agree. I am afraid that this is where I am very, very disappointed with the Labour party. Thrilled though it might be to have so many supporters of the leader in the more extreme ranks of the BMA, it helps no one to try to use the NHS as a political pawn and to weaponise the NHS as it tried so destructively to do before the last election.”
“I am more than happy to agree with my hon. Friend. The staff at Kettering general hospital work extremely hard. I have been there, as he knows. It is a very busy hospital. One shudders to think what the impact would be if we removed a third of the doctor workforce in a hospital such as that.”
“I was nervous mentioning the fact that the Government have made 107 concessions when I saw that my hon. Friend might be in the Chamber because I knew that, for him, that would be 107 too many. His broader point is absolutely spot on. The working terms and conditions for Saturdays for junior doctors in this new contract are better than they are for nurses, police officers, fire officers and for those in many other parts of the economy. That is why I think it is a fair deal that everyone should recognise and welcome.”
“That is absolutely right. What my hon. Friend is alluding to is the fact that, in the new contract, we are reducing the maximum hours that any doctor can be asked to work in any one week from 91 hours to 72 hours. There are all sorts of other safeguards that benefit safety. He is right. This should not be happening, and I urge the BMA to reconsider.”
“I am very surprised to hear that. If my hon. Friend wants to pass me the details, I will happily look into it. On the ground, the management of hospitals are working very closely with not just junior doctors, but BMA representatives to try to do everything they can to keep patients safe if these strikes go ahead.”
“To me personally and to everyone in this House as well as many others, it is a matter of profound regret that, at a time of so many other challenges, the BMA was unable to secure majority support for the deal that it agreed with the Government and NHS employers, but we are where we are. I believe the course of action outlined in this statement is the best way to help the NHS to move on from this long-running contractual dispute and to focus our efforts on providing the safest, highest-quality care for patients. I commend the statement to the House.”
“I will announce shortly who will be leading that important piece of work, which I hope to have initial considerations from in September. Most importantly, this is not a decision to stop any further talks. I welcome Dr Ellen McCourt to her position as new interim leader of the junior doctors committee. I had constructive talks with her during the negotiations. Although we do need to proceed with the implementation of the new contract to end uncertainty, my door remains open to her or whoever takes over her post substantively in September. I am willing to discuss how the new contract is implemented, extra-contractual issues such as training and rostering, and the contents of future contracts.”
“Again, we will continue to make progress in addressing those concerns under the leadership of Sheona MacLeod at Health Education England, and we will continue to invite the BMA to attend those meetings. We will also continue with a separate process to look at how we can improve the working lives of junior doctors more broadly, which will be led by the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer). I very much hope that the BMA will continue to participate in that process as well. We will not let up on efforts to eliminate the gender pay gap. Today, I can announce that I will commission an independent report on how to reduce and eliminate that gap in the medical profession.”
“In the May ACAS agreement, NHS employers agreed to work with the BMA to monitor the implementation of the contract and improve rostering practice for junior doctors. Last month, at the NHS Confederation’s annual conference, I set out my expectation that all hospitals should invest in modern e-rostering systems by the end of next year as part of their efforts to improve the way that they deploy staff. I hope that the BMA will continue to participate in discussions about all these areas. Furthermore, this decision is not a rejection of the concerns of foundation year doctors who often feel most disconnected in that period of their training before they have chosen a specialty.”
“However, the agreement negotiated in May is better for junior doctors and better for the NHS than the original contract that we planned to introduce in March. Rather than try to wind the clock back to the March contract, we will not change any of the new terms agreed with the BMA. It is also important to note that, even though we are proceeding without consensus, this decision is not a rejection of the legitimate concerns of many junior doctors about their working conditions. Junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends. They have many concerns, for example, about rota gaps and rostering practices.”
“The contract will be introduced from October this year for more senior obstetrics trainees; then in November and December for foundation year 1 doctors taking up new posts and foundation year 2 doctors on the same rotas as their current contracts expire. More specialties such as paediatrics, psychiatry and pathology, as well as surgical trainees, will transition in the same way to the new contract between February and April next year, with remaining trainees by October 2017. This is a difficult decision to make. Many people will call on me to return to negotiations with the BMA, and I say to them: we have been talking, or trying to talk, for well over three years. There is no consensus around a new contract and, after yesterday’s vote, it is not clear whether any further discussions could create one.”
“Last night, Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, said that the NHS and junior doctors needed to move on from this dispute and that if the Government proceed with the new contract it should be implemented in a phased way that allowed time to learn from any teething problems. After listening to this advice and carefully considering the equalities impact of the new contract, I have this morning decided that the only realistic way to end this impasse is to proceed with the phased introduction of the exact contract that was negotiated, agreed and supported by the BMA leadership.”
“An elected Government whose main aim is to improve the safety and quality of care for patients have come up against a union that has stirred up anger among its own members that it is now unable to pacify. I was not a fan of the tactics used by the BMA, but, to its credit, its leader, Johann Malawana, did, in the end, negotiate a deal and work hard to get support for it. Now that he has resigned, it is not clear whether anyone can deliver the support of BMA members for any negotiated settlement. Protracted uncertainty precisely when we grapple with the enormous consequences of leaving the EU can only be damaging for those working in the NHS and for the patients who depend on it.”
“The agreement does indeed help the Government to deliver their seven-day NHS manifesto commitment, but it also does much more. It reduces the maximum hours junior doctors can be asked to work, introduces a new post in every trust to make sure the hours asked of junior doctors are safe, makes rostering more child and family-friendly, and helps women who take maternity leave to catch up with their peers. The president of the Royal College of Physicians, who had opposed our previous proposals, stated publicly: “If I were a trainee doctor now, I would vote ‘yes’ in the junior doctor referendum.” Unfortunately, because of the vote, we are now left in a no-man’s land, which, if it continues, can only damage the NHS.”
“In May, the Government and NHS employers reached an historic agreement with the British Medical Association on the new contract for junior doctors after more than three years of negotiations and several days of damaging strike action. That agreement was strongly endorsed as a good deal for junior doctors by the leader of the BMA’s junior doctors committee, Dr Johann Malawana, and was supported publicly by the vast majority of medical royal colleges. However, it was rejected yesterday in a ratification ballot: 58% voted against the contract, so, on the basis of a 68% turnout, around a third of serving junior doctors actively voted against the agreement. It is worth outlining key elements of the agreement that was voted on.”
“The litmus test in all the difficult decisions we face is whether we do the right thing for patients and for our vulnerable constituents, who desperately need a seven-day service. The Government are determined to make sure that happens.”
“Lady wants to stand up and say that we should scrap the contract, she will be saying that we should not proceed with a deal that reduces the maximum hours a junior doctor can be asked to work, introduces safeguards to make sure that rostering is safe and boosts opportunities for women, disabled people and doctors with caring responsibilities—a deal that was supported by nearly every royal college. If the alternative from Labour is to do nothing, we would be passing on the opportunity to make real improvements that will make a real difference to the working lives of junior doctors. The hon. Lady and I have a couple of the more challenging jobs that anyone can do in this Chamber. She has been in the House for much longer than I have, so she will know that.”
“This contract was never intended to solve every complaint and unhappiness, and I am not sure any single agreement would have achieved universal accord with the junior doctor body.” The Government’s biggest opponents—in a way, the biggest firebrands in the BMA—supported the deal and were telling their members that it was a good deal, which got rid of some of the unfairnesses in the current contract and was better for women and so on. If the junior doctors are not prepared to believe even them, there is no way we will be able to achieve consensus. If the hon.”
“We have had more than 70 meetings in the past year and we have been trying to find a solution for more than four years. The question then arises whether we should negotiate or proceed with the introduction of the new contracts. Let me say plainly and directly that if I believed negotiations would work, that is exactly what I would do. The reason I do not think they will work is that it has become clear that many of the issues upsetting junior doctors are in fact nothing to do with the contract. Let me quote a statement posted this morning by one of the junior doctors’ leaders and a fierce opponent of the Government, Dr Reena Aggarwal: “I am no apologist for the Government but I do believe that many of the issues that are exercising junior doctors are extra-contractual.”
“We now know that, precisely when the official Opposition were saying that the Government were being intransigent, the BMA had no interest in doing a deal. In February, at the ACAS talks, the junior doctors’ aim was simply to “play the political game of…looking reasonable”— their words, not ours. We also know that they wanted to provoke the Government into imposing a contract, as part of a plan to “tie the Department of Health up in knots for…months”. In contrast to public claims that the dispute was about patient safety, we know that, in their own words, “the only real red line” was pay. With the benefit of that knowledge, the hon. Lady should be careful about maintaining that the Government have not wanted to try to find a solution.”
“I welcome the hon. Lady to her place for the first statement to which she has responded and welcome her on the whole measured tone, with one or two exceptions. I will reply directly to the points she made. First, the hon. Lady maintains the view expressed by her predecessor, the hon. Member for Lewisham East (Heidi Alexander), who is in her place this afternoon, that somehow the Government’s handling of the dispute is to blame. We have heard that narrative a lot in the past year, but I say with the greatest of respect for the hon. Member for Hackney North and Stoke Newington (Ms Abbott)—I do understand that she is new to the post—that that narrative has been comprehensively disproved by the leaked WhatsApp messages that were exchanged between members of the junior doctors committee earlier this year.”
“Friend the Member for Ipswich, is leading a process that will keep looking at the issues to do with the quality of life of junior doctors. NHS Employers is leading a process that will look in detail at how the contract is implemented. Absolutely, the point of the changes is to make care safer for patients; we will continue to keep an eye on this to make sure that it does so.”
“I thank my hon. Friend for her measured tone and for being an independent voice throughout the dispute. I spoke to Dr Ellen McCourt earlier this afternoon. I appreciate that she is in a very difficult situation, but I wanted to stress to her that, as I told the House this afternoon, my door remains open for talks about absolutely anything and that I am keen to find a way forward through dialogue. I had lots of discussions with Dr McCourt when we were negotiating the agreement in May, and I know that she approached those negotiations in a positive spirit. We have set in place processes, and that is one of the reasons why Professor Bailey recommended phased implementation—so that if there are any safety concerns, we can address them as we go along. The Minister with responsibility for care quality, my hon.”
“In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.”
“I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS.”
“One of the things that is particularly challenging and that we in this House have to think about and discuss a lot more is how difficult doctors and nurses find it to speak out if they see poor care, or if they or a colleague make a mistake, because they are frightened of litigation, a General Medical Council referral, or disciplinary action by their trust. The problem is that people then do not go through the learning processes necessary to prevent those mistakes from happening again. The key is creating a supportive environment, in which learning can really happen, in hospitals.”
“As ever, my right hon. and learned Friend speaks with great wisdom and experience. He is absolutely right to say that tackling the morale deficit in the NHS has to be a key priority. That is why we have to recognise that for doctors—particularly junior doctors starting out on their medical careers—the most depressing and dispiriting thing of all is when they cannot give the patients in front of them the care that they want to. That is why we are looking at a number of things to make it easier for doctors to improve the quality of care.”
“Lady when she was shadow Health Secretary, but on this issue, she was quite wrong, because she saw the WhatsApp leaks, which revealed that the British Medical Association had no willingness or desire for a negotiated settlement in February, precisely when she was saying at the Dispatch Box that I was the one being intransigent. She gave a running commentary on the dispute at every stage, but when those leaks happened, she said absolutely nothing. She should set the record straight and apologise to the House for getting the issue totally wrong.”
“Health Education England is absolutely clear that it has to run national training programmes, and that is why it has to have standard contracts across the country. As the hon. Lady knows well from her previous role on the Front Bench, in reality foundation trusts have the legal right to set their own terms and conditions, but they currently follow a national contract; that is their choice, but because they do that, I used the phrase “introduction of a new contract” this afternoon. I expect, on the basis of current practice, that the contract will be adopted throughout the NHS. I enjoyed working with the hon.”
“My hon. Friend obviously speaks from experience and very sensibly on this issue. In this House, of course, we think about the actions of politicians, Ministers and so on, but for doctors in a hospital, the most important component of their morale is the way that they are treated by their direct line manager. One of the things that worries me most in the NHS, looking at the staff survey, is that 19% of NHS staff talk about being bullied in the last year. That is ridiculously high. We need to think about why that is. The reality is that it is very tough on the frontline at the moment. There are a lot of people walking through the front doors of our NHS organisations, and we need to do everything that we can to try to support doctors and nurses, who are doing a very challenging job.”
“I simply say that, in the end, the best way to restore morale is to support doctors in giving better care to their patients, and that is what the NHS transformation plan is all about and what we are working on.”
“Actually, in my statement I took the trouble to praise BMA leaders. Admittedly, at the outset I did not agree with their tactics at all, but they did then have the courage to negotiate a deal and try really hard to get their members to accept it. I respect them for doing that. Part of the problem was that in the early stages of the dispute, there was a lot of misinformation going around. There were a lot of doctors who thought, for example, that their salary was going to be cut by about a third. That was never on the table and never the Government’s intention. A lot of doctors thought that they were going to be asked to work longer hours. That, too, was the opposite of what we wanted to do. I am afraid that that created a very bitter atmosphere.”
“We need to think about—and we are doing some very important work on this—how we could recreate some of that sense of collegiality, which is particularly missing for junior doctors in the first two years of their training, before they have joined a specialty.”
“I am absolutely prepared to give that assurance and I thank my hon. Friend for his comments. He is right. We can look at MTAS and such changes. We can go even further back and look at the introduction of the European working time directive—strange to bring that up in the current context—and the shift system, which sensibly reduced some of the crazy hours that junior doctors were being asked to work, but unfortunately at the same time got rid of the “old firm” system which gave junior doctors a sense of collegiality, meant that there was a consultant whom they knew and related to, and made their training a lot more rewarding and satisfying. That was disrupted when we introduced the shift system and the maximum hours limits.”
“There is one very good doctor in the Hull A&E department, and that is Dr Ellen McCourt, who has taken over as leader of the junior doctors committee—at least, I imagine she is very good; I have been very impressed every time I have met her. There are particular pressures at Hull, and as the hon. Lady knows we have had management changes. So far we have not seen the improvement in performance that we would like. I am aware that there are big issues with the infrastructure— the physical buildings. We will continue to work with the NHS locally and with the trust to try to improve the situation. She is right to bring it to my attention.”
“My hon. and learned Friend is correct to have raised that before and I can reassure him that we have subsequently started a very big piece of work to look at those exact issues. The difficulty is that throughout their training junior doctors are rotated every six months. That is particularly disruptive to family life or, for example, if they have a partner and one is sent to Sheffield and the other to Bristol. We are seeing what we can do to deal with that. The other issue that we are looking at is that of people who for family reasons discover that they have a caring responsibility, maybe for children or for a parent with dementia, and want to switch to a specialty that may not have quite so many unsocial hours, and whether it is possible to novate their training across from one specialty to another, which does not happen at present.”
“Let me tell the hon. Lady the words that Dr Malawana actually said: “I will happily state that I think this is a good deal.” He talked about junior doctors benefiting from “massively strengthened areas of safety precautions…equalities improvements, improvements to whistleblowing protection and appropriate pay for unsocial hours.” He thought this deal was a big step forward. As I said, if I thought that there was any prospect of further negotiations leading to a consensus that could get the support of the BMA membership, that is what I would be doing, but my honest assessment of the situation—given that the people who most strongly opposed the Government recommended accepting this deal and still they were not listened to—is that there is no such prospect, and I therefore need to take the difficult decision that I have taken this afternoon.”
“My hon. Friend is right to say that. One of the things that is clear to me is that the reason that the May deal is better than the deal that we were going to introduce in February is because of the involvement of the BMA and the BMA leaders in telling us the concerns of junior doctors at the coalface, and the specific niggles and annoyances, many of which we were able to sort out very straightforwardly. I strongly hope that junior doctors will remain in all the discussions that we have, so that we try to get even better solutions.”
“The hon. Gentleman has misinterpreted what I said. I am clear on this. I said in my statement that 58% voted against the contract, and I accept that that was a majority of BMA members. I stated the fact that on a 68% turnout, around a third of serving junior doctors actively voted against the contract. That is factually correct.”
“I am happy to give that assurance. One of the most exciting things in the NHS, despite a lot of the doom and gloom in the headlines, is that we are seeing a transformation in safety culture. Even though we are now doing about 4,500 more operations every day, the proportion of patients being harmed is down by about a third in just three years. I think there is a transformation, but of course there is a lot more to do, as I am no doubt going to hear.”
“The way patients have suffered—there have been over 20,000 cancelled operations during this process—has been very disappointing. My hon. Friend is absolutely right to campaign on issues of hygiene and cleanliness, which lead to so many tragedies when they are not properly attended to. I hope we can move on now. I do believe that, despite the disappointing rejection of this deal in the ballot, some trust has been established between the leaders of the BMA and the Government, and we have had a productive dialogue. We have made a number of changes to the May contract since announcing it—things that they suggested and that we agreed to. I would like to continue that process and build that trust.”
“I am more than happy to do that. I think that the vast majority of junior doctors think that what has happened is a tragedy and are keen to move on. I hope they take seriously my assurances this afternoon that we will be monitoring every stage of the implementation of this contract, and if there are further things that we can improve, we will do exactly that, because we want a contract that is good for them and good for patients.”
“My hon. Friend speaks very wisely. I would certainly very much like to do that. It does take two to tango, but the Government certainly want to do everything they can to work with all the leaders of the different bodies in the medical profession, partly for the reason my hon. Friend gave—that the country is very preoccupied with even bigger issues—but partly because there is so much pressure on the NHS frontline, and it is just counterproductive to exhaust so much energy on these disputes when we could talk our way around them and avoid them.”
“I thank my hon. Friend for her interest—it is last but not least, for sure, in her case. Many junior doctors are now aware of the bones of the contract. I am sure some of them have not read it, just as others have. However, I think the issue has been that a lot of them have read it and have felt that it does not answer every single problem they face today as a junior doctor. Unfortunately, there is no contract that can solve every single pressure they face at the stroke of a pen, and I suspect that that is why a number of them voted to reject the contract. What I would say to them is that we have a contract that is an improvement on what they had before, so let us go with that and try to address the other issues as best and as quickly as we can.”
“She and I both worried about the damage that it might do to our economy and society if we left, but we also agree that it would do incredible damage to something even more important than them—to our democracy—if the British people were to think that the Westminster establishment was trying somehow to ignore their decision. From the reasonable tone of her comments, I know that the hon. Lady understands that Vote Leave was not speaking for the Government when it said that there would potentially be an extra £350 million for the NHS. In fairness to the Vote Leave campaigners, at various points they clarified downwards that slogan on the side of the bus and said that they were really talking about a net figure of more like £100 million that could potentially go to the NHS, rather than £350 million.”