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Jonathan Fielden's speech to the Consultants Conference 2008

Chairman, Conference.
Welcome to the first conference in our new conference hall, part of the ongoing BMA redevelopment. Consultants once again leading the way, in the BMA as we do in the NHS.

I would particularly like to welcome those of you new to conference and hope that this is the start of a long and fruitful relationship. We welcome your new ideas and perspective.

The redesign of the BMA buildings is being matched by redesign of the BMA and your CCSC: All working to become more accessible, more accountable, more able to meet your needs.

Job planning seminars and contract advice with regional services. Developing new interactive ways of spreading our expertise: podcasts; a new newsletter emailed to all consultants; our work, advice and activities published online daily; lively seminars for local consultant representatives; always looking for feedback and new ideas, YOUR ideas. A comprehensive programme to improve our service to you and enhance your ability to do the job you wish to do.

This evolution is thanks to the whole team: my deputies Mark, Ian and Keith taking forward their responsibilities with care and diligence. The Secretariat, led by John Maingay, forging the way with new innovations for the BMA and CCSC and the Press and Parliamentary unit: Maintaining our strong, daily presence in the media and parliament, vital parts of our team in the fight to deliver your aspirations.

It is your aspirations, your drive that delivers the benefits of quality care to the NHS. Your drive, over and above the call of duty; as indicated once again by our survey this week showing 1 in 4 still working over 55 hours a week. Your enthusiasm has brought the NHS to its 60th anniversary and your enthusiasm will take it forward.

Reaching your 60th anniversary is meant to be especially fortunate, one of good omen; represented by the diamond – unconquerable and enduring. We should be hopeful for the future of the NHS, but can we really trust our political leaders to ensure the NHS thrives and remains unconquerable for the next 60 years?

To move forward the NHS needs 3 elements, essential to success:
Vision, Trust and Leadership – But do we have these in the NHS?

Whilst there is still much to learn any analysis shows that our NHS, and it is OUR NHS, is a massive achievement; perhaps THE MASSIVE achievement of our modern political history. Our most precious piece of social capital, one still envied by many. The NHS still gives the best value for money, equitable, universal healthcare. It is precious, we must support and promote it;
It is my passion to protect and promote it, make it yours too.

Thanks to its staff the NHS is transforming, despite the interference of government and meddling of politicians. Patients’ satisfaction with the NHS is increasing; productivity is improving; 1.5 Million patients and carers use the NHS every day. 1 in 40 of the population work in the NHS. As was stated at the beginning of the NHS:
“everyone- rich or poor, man or woman or child can use any part of it… no insurance qualifications....relieving your money worries in time of illness. A universal service one of which we should be proud.”

We are proud!

Waiting times are at record lows, delivered NOT by the private sector but by the hard work and dedication of NHS staff, led by consultants. It is your hard work, your leadership, your innovation that delivers for the NHS. We know it, our patients know it, it’s about time that ministers acknowledged it too.

So Ministers. stop wasting money on poor procurement in the private sector and invest more intelligently in the NHS. The history of contracts with the private sector is dire, even the CBI has criticised the government’s record! We have shown how well we can repay the investment; we will show how much more can be delivered.

Let’s look at their track record:
Independent Sector Treatment Centres – wasted millions, money paid for work not done, questionable outcomes; multi- million pound legacy payments, the multi-billion pound price tag of a Prime Minister’s whim. How much more could… how much more can be done with the clinicians who know how to do it better?

Private Finance Initiative – the elephant in the treasury, haunting the “golden rule”. Held off balance sheet this year; next year £33 billion debt will be added to current deficits. This will do little to raise confidence in the fiscal abilities of this government. Leaving NHS hospitals saddled with long term, expensive debts and uncertain income flows. Their future mortgaged, for a government whim. It is sanguine to note the recent announcement from Scotland of a fully government funded major hospital build in Glasgow. This will be built with the profession, with the public and for the public, using public funds. Not against the advice of the profession, despite the needs of the public, using public funds for future profits of the private sector. Who really has the correct vision here?

Commissioning: there is much talent across the NHS, a font of knowledge needing to be nurtured and focused. We don’t need to run to the private sector blinded by the lure of the management consultants, the private organisation promising the moon but only after a swift buck. For real world class commissioning you need clinicians; the best across both primary and secondary care. Patients want the best; we must promote the best for them and take up the challenge. This is a better vision.

And now, so desperate to have a story in the media today they announce they want to send in private management to sort out failing NHS trusts. How desperate are they? How much do they want to offend their backbenchers, how much do they want to demoralise the talent in the NHS that can do so much if not always played down and insulted by ministers? How little do they know of the complexities of the NHS, you can’t just fly in management. There is no evidence that private management is any better in the NHS, the last effort in the West midlands failed and the hospital was finally turned around by an NHS Trust, led by a Dr-manager. How many of us have seen our Trusts bring in the management consultants, paying through the nose, only to get a half baked solution and one that the real talent in the NHS could have delivered for less? How will this encourage NHS management, how will this aid clinical leaders to come forward? When will they learn that the private sector is after profit not quality?

Another half baked idea, from a government that has lost the plot, one that is mesmerised by the private sector, one apparently incapable of nurturing the real talent it has in the NHS. One apparently fixated on a drive to allow the private sector to take over the NHS. We will not let this Government privatise the NHS.

It is the NHS that delivers universal, equitable healthcare, not the private sector. On the day when we hear the new democratic candidate for election to the President of the US, the country where bizarrely health is a privilege but carrying a gun is a right; the country where private health rules and fails 40 million of their people. On the day when we hear him say that they must look to how they can provide universal healthcare – we look to the private sector.

The dedicated staff of the NHS, once again slapped in the face by this senseless government.

Use the talent in the NHS, promote the talent in the NHS, stop talking us down! No Vision, No Leadership, No trust.

Why won’t the government learn from having its fingers burnt? –In primary care they are once again dancing with the private sector as they throw hand grenades into the established system. It failed, in secondary care. Why do they not learn, where is their real vision?

In May last year we published our principles: Change should be clinically led, in partnership with patients; evidence based; maintain or improve services and above all be safe. Our survey of consultant opinion confirms consultants are not against change, consultants lead change. Over 80% stating that they would support reconfiguration based on good clinical evidence. But it is the lack of clinical evidence and the lack of clinical and, most importantly, public engagement that has meant this government has lost the trust of the profession and, if the polls are anything to go by, has lost the trust of the public. If your vision is wrong you lose trust.

This time last year we called for a change of English ministers: we were given a new team. Some of the old team admitted their mistakes: targets caused alienation, lack of trust, lack of ownership, drove a division between the politicians and the professions.

They were apparently listening: a professional put at the helm of health reform. Lord Darzi was part of making this government one of “all the Talents”. But already we see some of the other members of the Talent team “jumping ship”. Will Ara be the only credible one left? Or will he be left holding a fig leaf over the real government health agenda?

If we are to go forward then we first need to go back to some precious fundamentals – the NHS is best and most efficiently provided free at the point of delivery, funded by taxation, universal and equitable. There must be total transparency and openness in why and how services need change. This is the vision we need. A service clinically led in partnership with patients.

Recently we have seen the Darzi “pledges”:
Change will always be for patients’ benefit in terms of quality of care
Change will be clinically driven
All change will be locally led
People affected by proposed NHS changes will have a chance to comment, and
Existing services will not be withdrawn until new, better services are available.

Let’s use this scalpel of assessment to look at the Darzi review of London. Were all those involved, all those names, real engagement? Are these proposals were being clinically driven and locally led? Are we seeing patients being able to comment ?– well we saw a £4 million campaign – even handing out free cheese on the underground – but still 7 out of 10 patients said they had no idea of what was proposed, only 1 in 10 supported the Polyclinic model. But the Polyclinic bandwagon roles on.

The widespread view across London is that their consultation has been a charade, an expensive cloak to cover the emperor’s new plan. But London’s emperor has no clothes; the centrally enforced polyclinic plan holds no water, no benefit, no financial gain.

Why will you not listen to the profession? If you won’t listen to the profession, why not listen to the people? Build on the best of what we have and build for the future. Dump the polyclinic plan.
Work with the profession and the people. Together we will deliver the changes across the capital and the country our patients need. Breaking down the barriers between primary and secondary care; facilitating better collaboration closer to the patient.

Enforce change against all our wills and you will see a battle across every GP practice, involving every threatened DGH. We are not against change, but we know a quack theory when we see it!

Perhaps the Next stage review across the wider NHS in England is applying this Occams razor?

Our reports show widespread variation: good clinical engagement in some and absence of real involvement in others. It is clear that there has been central interference – pressure to deliver the central polyclinic model. Well if this is to be clinically driven and locally led – why is there so much central pressure for one solution? Is this a return to central command and control? Do you still want to hear a bed-pan dropped in Trafford ringing though the halls of Whitehall? The recent evidence-free call for one-off deep cleaning seemed so close to that old vision. Monitor put a shot across the bows of the Whitehall on this one – too much interference, no evidence, unhelpful extension of powers. Inadequate vision; failing leadership. There must be a better way.

This government has put too much emphasis on central political control. Let the local clinicians and patients take their vision for healthcare forward. Unshackle the professions and let them deliver. We have the vision, we have the skills, we have the knowledge, we don’t need your targets!

The public’s view of their local NHS is significantly better than the perception of the National Health Service. It is the government’s handling of the NHS that is at fault. Give it back, take your hands off, stop meddling. Let the professions lead, hand in hand with the public and you will see the progress our patients want. It is this combination that is delivering the best in the most successful hospitals, not central interference. A better vision, built on real trust.

We get sustainable changes where clinicians are working closely with their trusts or boards: implementing service line reporting; using “lean” techniques to build change from the bottom up; developing real outcomes data to inform and improve; maintaining a dialogue with their patients and their public. Let go, give the service chance to grow, have confidence that it will improve. It will do better without your interference. Have some real vision.

This vision needs national cohesion, it needs an NHS constitution. The BMA led the way with our publications last year and this year put forward our views on the NHS constitution. We await the publication of the proposed NHS constitution. This needs to be a positive step forward, a new compact with society, a clear statement of what holds the NHS together, outlining the vision and values on which we can build a sustainable future. Passing of the baton to the profession and the public. Without this independence the NHS will continue to suffer, repeatedly tainted from central political interference. Let’s face it, the public just don’t trust politicians anymore, they do trust us and they do want their own input. I challenged Gordon Brown last year to give us true independence. Let’s see that essential step now. A permanent legacy, true vision releasing true leadership.

We all have a chance to take up the challenge of service transformation. The service is looking for leaders; clinical leaders to implement the vision. We must ensure that we are those leaders. The evidence shows that it is clinicians leading, in partnership with patients that deliver the best results. I call on you all to take up the challenge of this need for leadership. Grab hold of the local visions; revive the compassion in health care this ownership brings; take your health service forward and out of the hands of political meddlers. Real vision, real leadership.

The national enabling reports from the Darzi review must endorse this direction; a clear signal that our skills and abilities as leaders will be recognised and promoted. We must ensure accurate and sensitive workforce planning, driven by better local information, guided by more informed national input. We must embed real professional leadership at the heart of this process. In England, as Sir John Tooke has said, we need the essential elements outlined as NHS Medical Education England, NHS MEE. Without this input into education and workforce planning we are unlikely to deliver the sustainable improvement we need for a truly excellent medical workforce.

The other enabling reports, tomorrows clinicians, quality and leadership, must be truly enabling, unshackling the profession to lead for the NHS, breaking down the barriers to leadership that prevent more of us taking this essential step for the improvement of the NHS and most importantly the care for our patients.

Sir John Tooke’s report was one of better outcomes from the turmoil and distress of last year’s MTAS debacle. The initial hard work of the Review group, set up the ongoing work of the programme board, showing that despite the great difficulties and stress of the circumstances the profession can work together delivering for our trainees and ultimately our patients.
It is vital that the profession finds ways, such as the programme board, to speak with one voice on crucial issues. We must graduate beyond our tendency to divide and give the “one voice” the service needs to strive towards true excellence.

This week’s survey of consultant opinion is concerning, we must ensure that we train our doctors properly for the future. We must ensure that the right people are selected; focus the best training for them; encourage them to take command of their own training and together educate, assess and enable the Certificate of Completion of Training to mean just that. On the way to this goal we should perhaps look at all posts being educational posts, remove the stigma attached to our SAS, or Speciality Doctor colleagues. All have a significant role to play here, allowing us all to Aspire to excellence. A better vision of leadership.

As Tooke has said:
If the new interpretation of the consultant role is accepted…and the new consultant contract..used as intended to facilitate pay progression..a new specialist grade is not required.
Those advocating a subconsultant grade are failing our trainees, denying long term quality. We condemn those that are so short sighted. They are abusing the fears of trainees to deliver an inferior service to patients. We will continue to put all our efforts into fighting this short-sighted trend. I call on all consultants to promote the best to our patients and for our trainees. Do not succumb to the superficial temptations of a sub consultant grade, you will be failing your trainees and more importantly failing your patients.

The current post CCT fellowship program is no better: a short sighted problem not a solution. Once again, let’s look to Scotland and promote the proleptic appointment system. We know, as our consultant expansion campaign has highlighted, that we need focused consultant expansion. The evidence is there for the numbers, the evidence shows enhancement of quality, the evidence shows value for money. With focused consultant expansion and proper attention to training we can deliver and improve the high quality of doctors for the future.

In addition to these challenges, we must define the role of the doctor.

This as a key area where CCSC is taking the lead, defining the true benefits of being a consultant and the real benefits of a consultant based service for patients. It is clear to me that the greatest benefits for patients will come from focused consultant expansion, meeting the demand. But consultants must develop their career portfolios. Whilst the expert clinical skills are of vital importance as are training and research; we must also promote our role in management and leadership.

There are many more challenges ahead for consultants and for the NHS. As we celebrate the 60th anniversary of the NHS, let us prepare for an even better future. 2008 is also the 40^th anniversary of the revolutionary summer of 1968. Let us start another revolution to deliver a future whose vision is developed by clinicians in partnership with patients, a future where the true benefits of clinical leadership are recognised and developed, a future where quality is our driver and sustainable health improvements are our goal.

We have the Vision, we have the Trust of the people and we have the skills to deliver. Our challenge, as consultants is to bring the leadership required to our joint vision. The opportunity is there, it is ours to take, now is the time for us to step up to the mark, take the positions of leadership and deliver for our patients.