Welfare of Doctors

16:00:00

I beg to move, That this House has considered the welfare of doctors. It is a pleasure to serve under your chairmanship, Sir John. Our NHS is described as “broken”. Gigantic waiting lists; ambulance delays; collapsed confidence that the NHS is there when we need it; poor access to general practice, dentistry and pharmacy; and, disgracefully, falling life expectancy in some places—these are all failures of the last Government, who could not look after the NHS despite record funding. Labour must mend the NHS; we have no choice. We invented the NHS. We fixed it before and we will fix it again. In this debate, I speak about the people who work in the NHS. There are nearly 1.5 million of them, all contributing in their own way, but let me speak specifically about our doctors. Doctors in this country are in crisis. They are leaving the profession, retiring too soon and emigrating. Who is looking after our doctors? I come to this place as a surgeon. I am one of the very few surgeons ever elected to Parliament. My dad was an RAF medic, who served in Aden in world war two before joining the newly invented NHS in 1948. He became a consultant physician in Teesside, where I grew up, and then a professor of geriatric medicine in Melbourne. He wrote an excellent account of his life called “New Ideas for Old Concerns”, which is full of fascinating accounts of his medical experiences during the war and later in the new NHS. It was a time of such hope and optimism, and I sincerely wish that we will be able to recreate that hope today.

I spoke to the hon. Gentleman beforehand about bringing up an issue that I think is important. I commend him on securing this debate, as the welfare of doctors is so important. He will be aware that GPs in Northern Ireland pay the highest indemnity costs in the United Kingdom, and that adds to the primary workforce pressures. The Medical Defence Union is working with the Government in Northern Ireland to find a long-term solution. Does the hon. Gentleman agree that support would help the Northern Ireland Executive to address this issue and get our GPs and doctors in Northern Ireland on par with those here?

I will speak of general practice shortly. My son is an A&E doctor here in London, and I am therefore one of three generations of doctors who have served the NHS continuously since it began; the welfare of doctors is personal for me. This Government have already done much for doctors, who are on the frontline and not the picket line for the first time in several years, but burnout, fatigue and stress are still very real problems that threaten to undermine the efficacy of our NHS. Today’s new doctors graduate into the profession with debts of nearly £100,000. They immediately enter a lottery to be appointed to their first jobs as pre-registration doctors, sometimes ending up miles away from family and friends in places they have never visited before. Now that reminds me of another job that I just started. Young doctors are left immediately responsible for life-and-death decisions, sometimes with insufficient support. They are left scrabbling at the very last minute for somewhere to live—the on-call accommodation that my generation remembers has disappeared—and I have known several of them to sleep in their cars. It has not escaped my notice that the new name for junior doctors is “resident doctors”. Resident doctors? That is the very last thing they are. If they are lucky, there is a place for them to rest, but many a time I have arrived to find a young doctor fast asleep from exhaustion at an office desk.

Given the desperate need for more doctors in the NHS, does my hon. Friend agree that we need to be looking after doctors’ welfare to encourage more people to enter the medical profession?

I agree with my hon. Friend, as he will see. There are odd shifts, night duties without hot food, and days and weeks that go by without an opportunity to meet supervising consultants. Short clinical attachments mean that the relationships previously created with senior mentors are rare. Just last week, I received an email from a surgeon who was my consultant in 1986. He had noticed in a surgical journal that I had become an MP, and I remembered him as the brilliant surgeon that he was. These are the relationships that make people feel as if they belong within a wider profession, but I doubt whether the young trainees of today would have the chance to make such lasting connections. There is little security of employment, because doctors are obliged to apply every year or two for another post, probably in another place. The doctors’ mess used to be a place where young doctors could find a sort of surrogate family in an unfamiliar place, but that is now sadly a thing of the past. According to research from the British Medical Association, fewer than 10% of UK trusts or health boards offer hot food after 11 o’clock at night. The demands of the job affect relationships. Many young doctors are in relationships with fellow doctors, but lucky indeed are the couple who can work and live in the same place, or even contemplate raising a young family together. Sadly, relationship difficulties and breakdowns are commonplace. Holidays must be taken at odd times, and rotas are inflexible. Doctors are left unable to take a day off to attend a wife’s graduation, a sister’s wedding or even their own wedding—all true. Progression in a chosen career depends on a multitude of competitive interviews and hugely costly professional exams. There is no security of employment. In a survey called “Fight Fatigue” conducted by the Royal College of Anaesthetists, 50% of respondents said that they had had an accident or a near miss when driving home after a night shift—I recall fatalities like this in my own hospital; 84% were too tired to drive home after a night shift; and only 64% had access to any rest facilities. What would we say if the same were true of airline pilots, to whom anaesthetists are sometimes compared?

Last week I met with a GP in my constituency, and she described very much what the hon. Gentleman is talking about: at the end of the day, after blitzing through 25 patients, back to back, she sometimes found herself sitting in her car, simply too tired to drive home for half an hour. Does he agree that we are expecting too much of our medical staff in relying on their dedication to go beyond the call of duty?

I agree with exactly what the hon. Gentleman said. In a recent survey, 29% of hospital doctors said they were unable to take any breaks at all during the working day; for GPs, the figure rose to 40%. That is simply not safe, for either doctors or patients. In a 2023 survey conducted by the Royal College of Surgeons, half of respondents cited poor working conditions as the main challenge in their job. It is no wonder that so many colleagues are retiring too soon. The average age for a radiologist to leave the NHS is now 56, yet we are desperately short of these vital specialists. This is happening across many specialties. Just in 2023, 23,000 English doctors left the profession prematurely. We cannot afford to lose our most experienced doctors. Too often they are discouraged from continuing in practice by a bureaucratic and costly appraisal and revalidation process, and they simply throw in the towel. Their experience is a vital asset to the NHS, and we must think carefully about how we retain them or return them to the workforce. One solution will be to create simple routes for experienced doctors to practise flexibly.

The hon. Gentleman is making a powerful speech. Langport surgery, in my constituency, is in the all too common position of struggling to attract and retain staff because of stretched budgets that limit its ability to offer attractive terms and conditions to those working in these challenging roles. Does he agree that the recruitment and retention crisis—particularly facing rural GPs—is negatively impacting doctors’ welfare, and that urgent steps must be taken to address that?

I agree completely with the hon. Member, which will be no surprise. The training of doctors is under threat. I spoke in the House about how cash-strapped universities are issuing redundancy notices to clinical professors, with no real plan on how to teach the increasing number of medical students or to continue the vital medical research for which our country has such a strong reputation. There was a 31% decline in the number of clinical academics in the country between 2004 and 2022. Something must be done about that. Our GPs are under pressure as never before. Who is looking out for them? They face massive lists of patients and huge demands. We know that we must support them, for they are the front door of our NHS.

I thank the hon. Member for his articulate and persuasive statement. In my constituency, we have surgeries such as the Al-Shafa medical centre, which has more than 6,000 patients. Given the pressure on the NHS, more work, such as basic analysis and experiments relating to cardiovascular disease and so forth, now needs to be done in local surgeries. Does the hon. Member agree that when such GP practices have the additional burden of paying increased national insurance, there need to be more methods, or maybe redirection of income, so that they can sustain their great work in constituencies?

I agree that we must put resources into general practices to deal with the Government’s plan to move care from the hospital out into the community. I am sure that needs to be addressed. The partnership model, which has served us so well, is now surely threatened as fewer young GPs are prepared to take on the responsibility or the financial risk of general practice.

I thank the hon. Member for securing this important debate, which I feel could have been easily extended beyond a mere 30 minutes. On the pressure and responsibility for GPs looking to become partners, I cite the example of Silverdale practice in Burgess Hill in my constituency. In December and January, it had a problem with the sewers being blocked up, which resulted in contaminated water coming up into the surgery and car park. The point is that it has taken weeks to get support from the NHS; the pressure on those GP partners and practice managers must be huge. Does the hon. Member agree that there needs to be more support for GPs who are prepared to take on the responsibilities of a partnership?

I do agree. I believe that the Government intend to do something about the somewhat terrible state of GP premises; the Health Secretary confirmed that only yesterday. There are serious questions about the support that individual GPs receive, especially for mental health. At present, GPs rely on the NHS practitioner health service for addiction and mental health support.

We should not be looking to the old saying “Physician, heal thyself” within our national health service. It is critical that the practitioner health service should be available across all parts of the United Kingdom; the hon. Member may not be aware that it is not currently available in Northern Ireland. Would he encourage the Government to work with the Northern Ireland Executive to ensure that all our health professionals get the same standard of care that they want to give their patients?

I was not aware that the practitioner health service was not available in Northern Ireland; I certainly agree that it ought to be. The practitioner health service was designed to be used by only 0.5% of GPs, but in fact it is accessed by 10 times that number. Ensuring that such services are fully funded will be important. There is alcohol and drug abuse, loneliness, depression, insomnia, anxiety and, sadly, suicide—including two of those who I graduated with from Sheffield, both in their very first year of medicine; and two doctors, a psychiatrist and a neurosurgeon, from my own road in Norwich. One of my own trainees was rescued at the last minute from a very serious attempt. All doctors know of this problem, but few speak of it. Last week, I informed the House of my former student who described the terrible flashbacks and post-traumatic stress disorder of the young clinical intensive therapy unit staff who witnessed 40 or 50 covid admissions die at a hospital in Yorkshire, and the complete lack of support they received. Many are reluctant to seek help and do not know where to turn. Itinerant junior doctors not registered with GPs are known to self-medicate. We simply cannot leave them on their own. In conclusion, I will respectfully make some suggestions, which have little or no cost implications. In making them, I am thinking especially of our resident doctors. They include to provide identified mentors, not simply people called educational supervisors; simplified contracts, transferable across trusts and between hospitals; clear, early information for doctors about what they will be paid and their rotas, timetables and holidays; hot food at night, and places to rest and sleep; to cover exam fees and make examinations fair and achievable; and to provide parking at the hospital and, crucially, a GP for every doctor and simple access to mental health support. Medicine is a brilliant career—satisfying, interesting and rewarding. Let us look after the doctors who look after us.

May I ask the Minister to finish a little before 4.30 pm so that I can put the Question?

16:16:00

I will of course adhere to your instruction, Sir John. I am grateful to my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for bringing this important topic to the House. I know it is close to his heart, as a working doctor. I thank him for his continued dedication to the NHS, as a surgeon and an MP, and I thank his family, too, for their dedication to it. We welcome the knowledge and expertise that he has already brought us, and he has done so again powerfully today. What a lovely memento he has of his own father’s service. I thank my hon. Friend for highlighting the incredible role that resident doctors play in our NHS. We absolutely recognise the challenges that they face as they progress through postgraduate training. We are committed to giving them the support that they need to develop and thrive in the NHS. My hon. Friend spoke passionately about the welfare of doctors. Let me acknowledge, as I know he would, the tireless professionalism and dedication that all health professionals show across the NHS daily. The NHS is broken, but we have a plan to fix it. In his investigation into the state of the NHS last year, Lord Darzi identified that this Government have inherited an NHS that is in serious trouble, with record waiting lists, people struggling to see their GP, and quality of care often lagging behind other countries. He found that too many staff are disengaged, that levels of sickness absence are worryingly high, and that many people working in the system are still exhausted from the pandemic and its aftermath, which has resulted in “a marked reduction in discretionary effort across all staff groups.” The Government completely agree with that assessment. We are on a mission to fix our broken NHS by driving fundamental reform to bring our analogue health service to the digital age. Through our 10-year health plan, we will cut waiting lists, reduce waiting times and get the health service delivering for patients and staff once again. Those ambitions will be possible only thanks to the hard-working staff, so it is essential that doctors and others are properly valued, supported and looked after at work. Employers across the NHS play a pivotal role in looking after doctors. Strong and effective leadership is fundamental to building a healthy organisational culture and too many NHS organisations are falling short in that regard. I have been shocked to hear stories, some of which we have heard again today, about the lack of support received by resident doctors, whether on shift patterns and rota changes, access to rest breaks while on duty, or really basic things that we should expect from any employer, such as hydration and the provision of decent food. We have heard about people sleeping in cars and not being able to go to a close relative’s wedding or to be the best person at their best friend’s wedding. It is unbelievable, really, and it cannot continue. It has to improve. We expect better from trusts and employers and we will make sure that that happens. We brought an end to the industrial action by resident doctors that was impacting the NHS’s ability to deliver a good-quality service and having such a corrosive effect on the morale of the workforce. As part of that deal, resident doctors and dentists in training received an average uplift of just over 4% into the 2023-24 pay scales, on top of the average 8.8% uplift they received for 2023-24. The Government have committed to improve the current exception reporting process, and to work in partnership with the BMA and other health organisations to review the current system of training, as my hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted, and rotational placements. That is in addition to the work being undertaken by NHS England to improve working lives. We want to work with the unions on the key issues that doctors face on the frontline, and improve their working lives. That applies to all NHS staff. For example, we are working at the moment with the BMA resident doctors committee to improve the exception reporting process. We know that is important to residents, and we agreed to address it as part of their pay deal. It is vital that we look after the health and wellbeing of the whole NHS workforce. High-quality care and support for patients cannot be effectively provided without a compassionate and inclusive working environment. My hon. Friend listed a number of actions, some of which are more easily addressed than others. We would expect many of them to be included as part of a supportive culture in trusts. I accept that some are more challenging and involve discussions with NHS England, the Government and trusts, but I do not think that many are beyond local trusts and systems, working with the profession, to resolve. The mental health of doctors and all NHS staff is incredibly important. We saw the strain and trauma placed on staff during the pandemic. They do so much for patients, and we owe it to them to ensure that they are properly supported in return. The NHS offers occupational health and wellbeing services for staff when they need them, but provision can be patchy. There is a drive to improve the quality of those services across the NHS. Not only can that reduce sickness absence and improve retention, but proactive and preventive occupational health can lead to improvements in productivity and, in the long run, save taxpayers money. Access to specialist mental health support is important. I know that services such as the practitioner health programme, which we have heard about this afternoon, are highly valued by many doctors. NHS England is currently reviewing the mental health and wellbeing support available across the NHS, and looking at how it can be made more equitable and sustainable. There is no doubt that we need to continue to improve the mental health support available to NHS staff, and I look forward to seeing the outcome of that review. NHS England is also moving forward with a joint initiative with NHS charities to invest £10 million in health and wellbeing initiatives for staff. That will provide grants for better facilities and invest in improved wellbeing support. I want to make a point about violence, which I do not think my hon. Friend particularly highlighted in his speech. Sadly, the threat of violence in the workplace is another thing that NHS staff are dealing with, as we saw in last week’s horrific assault in Oldham—I extend my wishes to the nurse and her family for a speedy recovery, as I know we all do. I reiterate that the Government take a zero-tolerance approach to that type of behaviour. Doctors, nurses and all healthcare workers are the backbone of our NHS and should be able to care for patients without any fear of violence or abuse. At a national level, NHS England is focused on improving workplace experience, with the NHS people promise and the NHS retention programme addressing the issues that matter to staff, whether that be improving opportunities for flexible working, tackling racism and discrimination, preventing and reducing violence in the workplace, or improving facilities so that staff have the basic opportunity to rest and recover. Resident doctors face many challenges as they progress through postgraduate medical training, as my hon. Friend outlined. Expanding access to less than full-time training, rationalising and reforming statutory and mandatory training, and increasing choice and flexibility in rota management are just some of the things we are looking to do to improve their working lives. We are also working with NHS England to support the GP workforce, including with measures to boost recruitment, to address the reasons why doctors are leaving the profession and to encourage them to return to practise. The NHS is working to address training bottlenecks, so that there are enough GPs for the future and patients can get the care they need. We have provided £82 million of additional funding for 2024-25 to address GP unemployment and support the recruitment of more than 1,000 new GPs. In conclusion, through the 10-year plan, we are engaging widely with staff, patients and the public and listening to their views on how we need to reform and modernise the NHS. That applies equally to the NHS as an employer. Our ambition is for the NHS to become a modern, innovative and supportive employer. That is a necessity if we are to continue to attract and retain skilled and experienced professionals, give them the support they deserve as they care for the nation, and build a robust and resilient NHS. I look forward to working with NHS England. My hon. Friend the Member for Bury St Edmunds and Stowmarket will bring great expertise to this work in the House, as will Members more broadly, to make it a reality. Question put and agreed to.

16:24:00