Secretary of State for Health explain doctors contracts and 7 day working

29th October 2015

RE: Junior Doctors’ Contract – not a single junior doctor will see their pay cut compared to their current contract

As you know, this Government was elected on a mandate to deliver a 7-day NHS and ensure NHS care is the same quality across the week.

Independent research published in the British Medical Journal is clear that there are 11,000 excess deaths in our hospitals every year – the ‘weekend effect’. We are determined to change this by ensuring that hospitals can staff their hospitals properly 7 days a week to ensure that patients get the care they need whenever they fall ill. There’s a significant body of academic and clinical evidence backing this up.

• Professor Sir Bruce Keogh, the NHS Medical Director, has said there is a ‘weekend effect which if addressed could save lives’.
•  The BMJ published study found that patients admitted on a Sunday have a 15% greater risk of mortality compared to those admitted on Wednesday. The authors said this ‘raises challenging questions about reduced service provision at weekends’.
• A 2012 study – Freemantle et el – found that the day of admission was associated with increased risk of death in seven of the ten most common clinical conditions. Patients admitted on a Sunday with renal failure, for example, had a 37% greater risk of death compared with those admitted on a Wednesday.
• The Academy of Medical Royal Colleges said in 2012 that the weekend effect was very likely to be attributable to deficiencies in care processes because of a lack of skilled senior staff and a system that doesn’t provide full diagnostic and support services 7 days.
•  In 2010, Aylin et al found that mortality rates are higher for patients admitted at weekends compared to weekdays.

Changing this means reforming contracts – put in place by Labour – for junior doctors in 2000 and for consultants in 2003. Yesterday in the Commons, I gave a guarantee on behalf of the Government that not a single junior doctor will see their pay cut compared to their current contract. This was actually a deal I said to the British Medical Association I hoped we could reach by negotiated settlement back in September – but sadly instead they chose to whip up fear amongst junior doctors.

You’ll have seen that the doctors’ union, the BMA, has been misleading its members in saying junior doctors will get pay cuts of 30 per cent, and be forced to work longer hours. As I have made very clear, the opposite is true, and in fact we are offering a better deal for doctors that allows us to deliver an NHS that provides the same excellent quality of care every day of the week. In summary, we want –

• The same pay for junior doctors as they receive under their current contracts;
• Shorter hours, with a reduction in the maximum number of hours that can be worked in any one week;
• An end to unsafe working.

I have already given the BMA firm assurances on the junior doctors’ contract in advance of the Government’s formal proposal, which still stand. I’ll be setting out more detail in the coming days, but – as the BMA themselves have admitted – the best deal will be reached by negotiation, so we continue to urge the Junior Doctors’ Committee to come back to the table. Many independent and clinical voices are doing the same – including the Royal College of Surgeons, the Royal College of Emergency Medicine, the Academy of Medical Royal Colleges and NHS Providers.

• Firstly, this is not a cost cutting exercise. We are not seeking to save a penny from the junior doctors’ pay bill.
• Secondly, I want the new contract to improve patient safety by better supporting a seven day NHS. For junior doctors, this means some increase in hours which aren’t payable as overtime, but backed up with a significant increase in basic pay. We will still pay staff for antisocial hours, junior doctors will get the same pay on average, and we want to discuss from when on a Saturday overtime is payable.
• Thirdly, I believe that our ambition for the NHS to be the safest health care system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. Junior doctors already work seven days and are the backbone of medical care in hospitals at weekends and at night. There is no question that thiirdly, I believe that our ambition for the NHS to be the safest health care system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. Junior doctors already work seven days and are the backbone of medical care in hospitals at weekends and at nis contract will impose longer hours. In fact, it is the current contract which provides a perverse incentive for juniors to work unsafe hours by paying those who breach safe hours up to 100% of their basic pay.
• Finally, I can now give an absolute guarantee that no-one will lose out compared to their current contract. I have already given the BMA my assurances there will be pay protection for doctors who change to shortage specialities and to support agreed academic work.

The negotiations on the new contract began on the basis of a shared view between the BMA and the Government that the current contract had served its purpose and needed reform. In fact, the BMA accepted that point as far back as 2007.

We are absolutely clear that – as well as being better for patients – this is a fairer deal for doctors. The new contract will mean no junior is required to work more than an average of 48 hours per week, with tougher limits on unsafe hours including a new maximum working week of 72 hours, and a new maximum shift pattern of four consecutive night shifts and five long day shifts, compared with the current contract which permits more than 90 hours a week, 7 consecutive night shifts and 6 long day shifts. It will also better reward pay progression based on achievement and experience.

Finally, there’s a broader lesson from Labour’s time in Government we’re determined to learn. They didn’t take action to address shockingly poor care – and patients at Mid Staffs, Morecambe Bay, Basildon, Tameside and several other hospitals suffered as a result. Since, our tough new special measures process is turning places where care is poor around. We will continue to focus on that – and must never again allow academic debates on the statistical methodology around mortality rates to become a substitute for action to prevent human tragedies unfolding.

Rt. Hon. Jeremy Hunt MP
Secretary of State for Health