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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“I reassure the hon. Gentleman that we are in constant touch with the devolved regions and countries to make sure that they know the changes that we are making, and to share any learning that we have from the processes that we have been through, so we will certainly do that. Across the country, we are doing everything we can to catch up with the backlog of operations, procedures and out-patient appointments—all the things that have been affected by the industrial relations dispute. Trusts will always prioritise the areas where clinical need is the greatest, but I know that that work is ongoing across the country.”
“We will look at all those issues with Professor Bailey, Health Education England and the BMA to see whether we can find a better way forward.”
“The request from the BMA was to find a new way of proceeding with that very important work, and that is what we will do. We will do so with the input of Professor Bailey, because she has a very important contribution to make. My hon. Friend is absolutely right to say that, as well as more flexible working for people with family commitments, the big issue for many junior doctors is the way in which the training process happens. In particular, the issue is about the way that continuity of training has been undermined by the new shift system—we need that system for reasons of patient safety—and that often means that someone is given advice by a different consultant on different aspects of care from one day to the next, which is frustrating.”
“That would have been a constructive contribution to this morning’s discussion if the hon. Gentleman had not descended into totally false slurs about this Government’s commitment to our NHS. I would just say to him that if people support and are passionate about the NHS, as this Government are, then they put in the money—we are putting in £5.5 billion more than his party promised at the last election—and make the difficult reforms necessary to ensure that NHS care is as good as or better than anything that can be provided in the private sector. That is what this Government are doing: we believe in our NHS, and we are backing it to provide the best care available anywhere in the world.”
“My hon. Friend gives one example, but there are thousands of such examples. Such people are totally committed to the NHS, have a bright future in it and can make a huge contribution to its success by doing a good job in looking after patients, but they also have home responsibilities that are difficult to fulfil when there are very inflexible rostering systems. One of the big wins from yesterday’s agreement is that we will be able to look at the way the rostering system works to try to bring in such flexibility. If we do not do so, more and more doctors will want to be locums or to work for an agency and we will lose the continuity of care for patients, which is one of the best things about our GP system. That is why there is an urgent need—from the perspective of patients, as well as from that of doctors—to address that issue.”
“If the hon. Gentleman looks at the latest NHS staff survey, it shows higher staff motivation, better communication and more staff recommending their organisation as a place to work or be treated. But I accept that when big changes are made to a contract such as the junior doctors contract, they can be contentious and have a short-term impact on morale. In the long run, morale goes up when doctors are able to give better care to patients, and that is what this agreement will allow.”
“It is a great tragedy that the dispute unfolded in the way that it did, and I am sure that people with different agendas have not played constructive roles at various points. Given that we now have an agreement, I want to move forward positively and say that the lesson of the last 10 days is that when people sit down and negotiate about all the outstanding issues with a Government who are trying to make care safer and better for patients, we get a result that is good for everyone.”
“Let us be absolutely clear: there was never a refusal to negotiate on the Government’s side. We have now developed a lot of trust between the Government and the BMA leadership, but until that point it balloted for industrial action without even sitting down and talking to the Government, and it refused to discuss the issue of weekend pay premiums, which was the crucial change we needed for a seven-day NHS. It was when the BMA changed its position in those areas that we were able to have constructive talks, and that is why it deserves great credit for coming to the table and negotiating—something it had not wanted to do previously—and that led to the solution.”
“My hon. Friend speaks wisely. I understand that in a contentious industrial relations dispute junior doctors will not necessarily look to me for advice on which way they should vote, but it was not just me doing the agreement. It was a negotiated agreement and the leader of the junior doctors committee says that it is a good agreement. He will encourage people to support it in the ballot and he thinks it is a good way forward for doctors as well as for patients. The people who have been closest to the detail of the negotiations think that it is the right step forward for junior doctors, and that is something that they will want to take account of.”
“We are, of course, willing to have those discussions with colleagues in other parts of the UK. The hon. Gentleman is right to say that having a seven-day service does not just involve junior doctors; it involves widespread changes across the service. I should say that nurses, healthcare assistants, porters, cleaners—other people who work in hospitals—already operate on 24/7 shifts, so the changes necessary to those contracts are much less profound than they are to some of the doctors contracts, which is why it is important that we change not just the junior doctors contract, but the consultants contract. The fact that we have been able to reach a negotiated agreement with the junior doctors bodes well for the consultants contract, which is the next step.”
“If I answer that question directly, I will dig myself into rather a deep hole. I echo my hon. Friend’s thanks to my hon. Friend the Member for Ipswich, who has done an outstanding job by my side at every stage throughout this difficult period. I can certainly say that we would not have had yesterday’s agreement without his strong help and support at every stage. It is true that there are A&E departments across the country that, in having to plan for the two-day withdrawal of emergency care, found that having consultants more visible to patients had some positive impacts. I know that studies are going on to see what lessons can be learned from that going forward.”
“With the greatest of respect to the hon. Lady, it was not my decision to take industrial action—to ballot for industrial action without even being prepared to sit around the table and talk to the Government. We are seeing dramatic improvements in patient safety under this Government, as we face up to the many problems in care that we inherited, not just at Mid Staffs, but at many other places. I know that she cares about patient safety, so she should welcome the difficult changes we have made, one of which is to have a seven-day NHS.”
“One area where we have made the most progress during the past few months, even before the past 10 days of talks, is on establishing how these guardians can work in a way that has the trust of both the hospitals and the doctors working in them.”
“Yes, I am happy to do that, and I thank my hon. Friend for a lot of his correspondence. The principle here is that junior doctors want to know that there is someone independent they can appeal to if they think they are being asked to work hours that are unsafe and which mean that they cannot look after patients in the way that they would want to because they are physically or mentally too exhausted. We would all want to make that possible, but it means that they need to have someone who is not their line manager. They will go to their line manager in the first instance, but they need to have someone independent and separate.”
“The cross-party initiative was not to have a new contract, but to abandon plans for a new contract and to have pilots in a few limited places. If we had followed that advice, we would not now have agreed with the BMA the biggest changes in the junior doctors contract for 17 years. Our goal was to get the agreement that we secured yesterday—safer care for the NHS and a better deal for doctors. That was what we achieved, and we would not have got there if we had listened to that advice.”
“I am happy to do that for my hon. and learned Friend. It is not an easy problem to solve, because junior doctor training placements operate on six-month rotations, and they are a competitive process. We get many more applicants for a number of posts than there are posts available. We must find a way of balancing the need to respect family responsibilities, which is something that we all want to do, with the need to have a fair process for the most competitive positions. We do not have the balance right yet, so we have said that Health Education England, which decides where people are to go on rotations, will now have a duty to consider family responsibilities when it makes decisions about those rotations.”
“If the hon. Gentleman had listened to some of the things that I have said, he would have heard me say repeatedly that I do not think that that dichotomy exists. As he says, it is a false dichotomy because, in the end, what is right for patients is also right for doctors. The thing that demoralises doctors, nurses and everyone working in our hospitals in different parts of the NHS is when they are not able to give the care that they want or that they think is appropriate to the patients in front of them. That is why hospitals that have moved closest towards seven-day services are also some of the hospitals with the highest levels of morale in the NHS. He is right that it is a false dichotomy and that we need to do both together.”
“Let me say to my hon. Friend’s mother that I hope that the message of this new agreement will go right the way around the world. Any doctors who have moved to New Zealand and Australia are always welcome to come back. The thing that must unite this Government and the good doctors who work, or have worked, in the NHS is our commitment to make NHS care the safest and the best in the world. We had a terrible shock with what happened at Mid Staffs, but we are using that as a moment of decisive change in the NHS, and we are well on our way to higher standards of care than are available in many other countries.”
“I agree. We need more doctors and we need more nurses. By the end of this Parliament, we will have over a million more over-70s in England alone, and I know that the demographic effects in Northern Ireland will be equivalent. We have a global shortage of about 7 million doctors, so we need to train more. We are training an extra 11,420 doctors over this Parliament as part of the spending review. The training is done on a UK-wide basis, so we will need to work closely with all the devolved regions on it.”
“I am happy to do that. I recognise that this was not easy for those people, because it involved changing a position that they had held for more than three years. When we looked at the details, the result that we got to was not difficult for them to sign up to because they could see that it really was better for their members, as well as better for patients. The lesson here is that the NHS faces huge challenges, and it can only be right to deal with them by sitting round the table and negotiating constructively.”
“The hon. Gentleman is right. A seven-day NHS is not just, or not even mainly, about junior doctors, although they are a very important part of the equation. We will need a new contract for consultants and we are having constructive negotiations with them. Many other people working in the NHS are already on seven-day contracts, so there will not necessarily be a contractual change, but the hon. Gentleman is right to say that we will need, for example, diagnostic services operating across seven days so that the junior doctor who works at the weekend will be able to get the result of a test back at the weekend. Those are all part of the changes that we will introduce to make the NHS safer for patients.”
“My hon. Friend speaks, as ever, very wisely on medical matters. I particularly agree when he talks about palliative care; it has got better, but there is a long way to go. We have recent evidence that it is particularly in need of improvement where we are not able to offer seven-day palliative support.”
“I understand the concern. The short answer is that we need to increase the NHS workforce, which we are doing. We will see more doctors going into training during this Parliament, as indeed we did during the previous Parliament. More doctors in the workforce will be an important part of the solution.”
“My hon. Friend is absolutely right. This is not just a safer deal for patients, but a system that is much fairer for doctors than the current one. We are giving a pay rise of between 10% and 11%, for which we say that people are expected to work one weekend day a month, but doctors who work more than that get more, and it goes up, so more weekends worked means more extra pay. I think that is one of the reasons why the BMA was prepared to sign up to the agreement: it values the people who give up the most weekends.”
“I could not put it better myself. We all hear stories of that sort from our constituents and our families. That is why, in the end, yesterday’s agreement was a very positive step forward in that seven-day agenda.”
“I think my hon. Friend is right that that was the big sticking point. It was the BMA’s willingness to be flexible and negotiate on that that ultimately made an agreement possible, but it is also fair to say that the Government recognise that there are many other non-contractual issues in the way that junior doctors are trained and treated by the NHS, and we want to use this opportunity to put them right.”
“I know that that is a view that some colleagues share. Doctors have obligations even now under the Medical Act 1983 not to take action that would harm patients, and under their responsibilities to the General Medical Council; they have to be aware of those. What I hope is that that question simply does not arise again. We are now having constructive discussions with the BMA; I think that is the way forward and I hope that neither I nor any future Health Secretary has to go through what has happened in the past 10 months.”
“I finish by saying that I completely agree with my hon. Friend. It has been a very sad dispute for all of us, because we all recognise that junior doctors are the backbone of the NHS; they work extremely hard and they often work the most weekends already. That we now have an agreement is a brilliant step forward. We all have constituents who work hard for the NHS. They are people we value, so dialogue, negotiation and constructive discussion must always be the way forward.”
“We have taken tough measures to control unsustainable spending on agency staff, which cost the NHS more than £3 billion last year. Overall agency spend is now falling and we expect to save the NHS at least £1 billion this year as a result.”
“I think the hon. Gentleman is right that we have historically not trained enough staff to work in the NHS and been over-optimistic about the staff needs. That is why, in this Parliament, we will be training over 11,000 more doctors as a result of the spending review, and 40,000 more nurses.”
“Perhaps I can give the hon. Lady some comfort. I recognise that there is a big mountain to move, but the changes we made last year were not just about changing the rates paid to agencies. They were also about capping the amounts agencies can pay their own staff, because we think it is incredibly divisive inside hospitals to have two nurses doing exactly the same work, but one being paid dramatically more than the other. We are also capping the total amount hospitals can spend on agency staff. The result is that the monthly spend on agency staff is now falling and we are on track to reduce the agency bill by about £1 billion in this Parliament.”
“One of the reasons for that is that successive Governments failed to understand the needs of nursing in wards, which is why we had the problem at Mid Staffs. Because we are addressing that, we are now able to make sure that we do not pay excessive rates for agency staff.”
“May I start by thanking the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous congratulations earlier, and indeed for making history himself by being the first Opposition Member I can remember to congratulate the Government on hitting a target? I say to the hon. Lady that, as a result of the measures we have taken to deal with the agency staff issue, we think we have saved £290 million compared with what we would have spent since last October, two thirds of trusts are reporting savings and the price paid for agency nurses is 10% lower than it was in October. The root cause of the problem is, as the hon. Member for Southport (John Pugh) said, our failure in the past to recruit enough staff.”
“I thank the hon. Lady for her reasonable tone and absolutely give her that assurance. We have always wanted a negotiated outcome to this dispute. That is why we paused the introduction of the new contracts last November to give talks a chance to succeed, and it is why this week I have said we will further pause the introduction of the new contracts to see whether we can get a negotiated outcome. We want a motivated workforce and we are highly cognisant of the fact that hospitals that offer seven-day care and higher standards of care for patients are the very hospitals that have some of the highest levels of morale in the NHS. It takes two to tango, and I very much hope that the British Medical Association will play ball and its part this week in helping us to deliver a safer seven-day NHS.”
“Although we are not currently hitting the national A&E target, hospital A&E departments continue to perform well under great pressure. Overall they are coping with 1.9 million more attendances annually compared with 2009-10, and the average wait to see a doctor remains just 38 minutes.”
“May I reassure my hon. Friend that I am very aware of this issue, and I have had a number of meetings with hon. Members to discuss it? Patient safety has to be the utmost priority. We are working with the local trust, and we have been given an assurance that neighbouring hospitals will be able to absorb any extra activity, and that it is working hard to try to reopen the A&E department.”
“I can reassure the hon. Lady that we have been monitoring the situation closely and have provided extra capacity at the Royal Preston hospital. Her own Royal Lancaster infirmary has recently come out of special measures and done a really good job in turning round the quality of care after protracted difficulties. We continue to monitor the situation, and patient safety is our No. 1 priority.”
“As ever on health matters, my hon. Friend speaks wisely. The fundamental issue is a high level of confusion about what happens to patients when they are faced with a bewildering choice about what to do when they have an urgent health need that needs resolving. They can call 111, try to get an urgent GP appointment, go to a walk-in centre, go to A&E and many other alternatives. We need to resolve that and make it simpler for patients so that they go to the right place first time. Urgent work is happening to ensure that we do that.”
“I recognise that we have a difficult situation in Chorley and that people in that trust are working very closely together. The chief executive of the trust pointed out that the reason for the closure was that neighbouring trusts were not respecting the caps on agency staff that she was respecting. It is incredibly important that, across the NHS, we have a concerted effort to bring down the prices paid for agency staff, which I think is the root problem here. However, we are monitoring the situation closely.”
“I can reassure my hon. Friend that, although we are happy to put the local authorities in Greater Manchester in the driving seat for some major changes, including what I hope will be the first full-scale integration of health and social care across the NHS, we are monitoring the performance against national standards. We will be able to see exactly how well they do on patient safety, waiting times and so on, and whether they live up to the big promises that have been made.”
“Talks are now taking place between NHS employers and the British Medical Association to try to resolve outstanding issues around the junior doctors’ contract.”
“That is not correct. It is worth saying that the reason for the dispute is a manifesto commitment to a seven-day NHS that the Government made to the people of England and that the Scottish National party has not made to the people of Scotland. The weekend effect does not happen just in England. There are studies in Scotland, including the Handel study, which states: “The excess of admissions ending in deaths at weekends compared with those during weekdays seen elsewhere were also found in Scotland.” I gently say to the hon. Gentleman that yes, we want to improve the quality of life for junior doctors so that they can live and work in the same city as their partners, and we are looking at the solution to that problem, but that he might think about doing the same thing in Scotland.”
“My right hon. Friend speaks very wisely. Indeed, I was thinking about the talks as I spoke on my mobile phone and he was having a cigarette just outside the House yesterday morning. He is absolutely right about jaw-jaw. That is why I think that across the whole House we wish the talks well. However, for them to succeed all sides need to recognise their objective, which is a safer seven-day service for patients. I hope that, on that basis, we will be able to make progress.”
“What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.”
“The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.”
“My hon. Friend is absolutely right. In the end, the British people’s passion for, and commitment to, the NHS is based upon its offering the highest standard of care for patients. It is sometimes difficult to take these decisions and sometimes we have arguments around them. I want to reassure him that my compromising mood is not a temporary thing. We have always wanted a negotiated solution, but there is one bit that we will not compromise on: the moment that the Government start doing things that mean that we are not delivering safe care for patients is the moment that we will fundamentally shake confidence in the NHS. This Government will not allow that to happen.”
“We are making good progress in implementing the five year forward view, including £133 million invested in new models of care and 18 million people benefiting from extended GP access.”
“My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.”
“In the spirit of straight talking and honesty, which I think is an excellent thing, perhaps the hon. Gentleman might concede that those cuts and efficiencies that he is talking about would have been a great deal more if we had followed Labour’s spending plans—that is, £5.5 billion less for the NHS than this Government promised, on the back of a strong economy.”
“Last week I agreed to pause the introduction of the new junior doctors contract for five days and return to talks with the junior doctors committee. I commend the junior doctors for their decision to return to talks. They have agreed to suspend the threat of further industrial action and those talks are now in their second day. We have always been clear that we want to see a negotiated solution to this dispute, and the resumption of these talks shows that the Government’s door is and always has been open to meaningful talks.”