Speech from the Chairman of Council
Dr Ian Bogle
Monday 1 July 2002
Chairman, members of the Representative Body,
Those of you who heard me speak last year will have been left in no doubt about how passionately I felt about the let downs and lost opportunities during Labour’s first four years in office, and about the dramatic and devastating effects of hostile media coverage, the hysteria surrounding medical mistakes and the manipulation of high-profile cases such as Alder Hey and Bristol to present the medical profession as complacent about poor practice and unaccountable to the public.
The frustration and fears I expressed on the opening day of last year’s meeting were reiterated and reinforced during the debates that followed on spin-driven initiatives, the NHS blame culture, workforce and funding shortages, and the government’s obsession with meaningless, politically-driven targets that suck funds away from areas of genuine need, distort clinical priorities and pressure doctors into practising conveyor belt medicine.
Our message was clear. We were not prepared to stand on the sidelines, watch the government make a mess of the health service, then carry the can when it all went horribly wrong.
The strength of feeling we demonstrated, and the forcefulness with which we demonstrated it, seemed to unsettle some sensitive souls who would I think prefer the BMA to conduct its business in a more gentlemanly manner.
I had, apparently, torpedoed the consultant contract negotiations with my ill-judged and ill-timed attack. The president of a royal college no less accused me of being too negative and told a newspaper he was ‘saddened’ by my ‘outburst’.
We, of course, had shown our true trade union colours by digging our heels in and setting ourselves against reforms that threatened our autonomy, our power base and our patriarchal hold over our patients.
Was it wise, some commentators asked, for doctors to be biting the hand that fed them so soon after the government had comfortably secured a second term and a mandate to move forward with its modernisation agenda?
Let’s look at the facts.
Within hours of last year’s opening day debates, the government conceded that the health service was in trouble and that there were no quick-fix solutions to medical workforce shortages.
Within hours of last year’s opening day debates, the Prime Minister’s office issued a conciliatory statement committing him to working with us to address our concerns.
Within a week of the meeting, government-inspired attacks on the profession had ceased - and they haven’t resurfaced.
Within a week of the meeting, all but one of the doctors referred precipitately to the GMC following the publication of the Alder Hey inquiry report had been cleared.
In the autumn, we entered into a period of intense negotiations on quality-driven contracts for consultants and GPs that I am confident will deliver proper rewards for a professional job well done.
And throughout this past year, we have been involved in meaningful discussions on NHS reform, with the government including us in the early thinking on many initiatives.
We’ve had our work cut out sifting the gimmicks and the sticking plaster solutions from the genuine efforts to bring about long-term improvements, but more often than not we have been consulted – and our views have been listened to and acted on.
| Make no mistake. We will bite, and we will bite hard and where it hurts, if that’s what it takes to make the government understand that it cannot use the NHS, those people who work in it and those people who need it as political playthings. |
I’ve got a question for you. Who do you think topped the list of the most respected professions in a recent Radio 4 poll?
Government ministers? No, they came 90th out of 92. Try again.
Journalists? No, they came 88th out of 92.
Nurses? Nice try, but they came second.
I don’t really need to tell you the answer. I don’t really need to tell you who came top. But I will tell you why.
Our patients respect us because they know their welfare is our primary concern.
Our patients respect us because they know that we will be their advocates when they can’t speak up for themselves.
Our patients respect us because they know that once the door of the consulting room closes our judgements are based on clinical need, not on political priorities or prejudices.
If we took our cue from the media, we’d have a very different image of ourselves.
Villains who bungle operations, bully vulnerable patients and resist attempts to make us more accountable one minute.
Heroes who pioneer life-saving treatments, separate Siamese twins and help mend broken metatarsals in record time the next.
Most of us, of course, are neither. What we are is committed, conscientious and caring professionals struggling to do the best we can for our patients in the face of pressures that sometimes seem insurmountable.
And our patients know that.
Let’s not kid ourselves. The media have their own agenda. If it suits them to paint us as devils incarnate they will. If it suits them to paint us as knights on white chargers they will.
This time last year, our ‘savage attacks’ and our ‘stinging criticism’ of Blair and Milburn were front page news.
A couple of months ago, when I was invited to write an article responding to the unprecedented increase in NHS funding announced in the Budget, I wrote something positive and supportive. I couldn’t get it published anywhere because I was siding with the government and that wasn’t considered newsworthy.
I have a confession to make. The BMA does take sides - frequently.
The BMA is on the side of the medical profession, on the side of patients, on the side of the NHS.
The BMA doesn’t do party politics.
The BMA doesn’t do bandwagons.
The BMA doesn’t compromise or curry favour for short-term political gain.
| The BMA is in the business of trying to achieve a better health service for patients and a better working environment for doctors. Doctors won’t be the dog the government kicks when things don’t go quite according to plan. Doctors won’t be the pawns in anyone’s political game. |
We have been fierce and forceful critics of this government’s handling of the health service, and we will continue to expose the government when it attempts to conceal its own failings and inadequacies with spin, fudge and double counting.
But we have always been willing to work with ministers to achieve the kind of health service we are striving for and our patients deserve.
I believe Chancellor Gordon Brown’s Budget statement in March was a defining moment for the NHS - and for the government itself.
For as long as I have been involved in national medico-politics the BMA has exhorted successive administrations to spend more on healthcare from general taxation. It wasn’t so long ago that my predecessor Sandy Macara was mocked by the Conservative government when he called for the NHS to be given a cash injection of £1bn a year over five years to meet its commitments at the time.
When the Conservatives left office, they left behind them a health service brought to its knees by bed closures, ward closures, hospital closures and equipment shortages, crippled by the demand for year-on-year efficiency savings, and facing deepening recruitment crises in medicine and nursing.
We were the first to criticise the Labour government for pledging to stick to Tory spending plans, and we have lobbied Labour long and hard for a massive and sustained increase in NHS funding to address decades of chronic under-investment, to solve capacity problems, to combat staff shortages and to underpin future developments.
What we now have is the promise of substantial extra funds over the next five years and a vision of sustained investment through to 2020.
The prophets of doom in the Conservative Party and the Conservative media tell us that increased health service spending in the last four years has brought little tangible improvement, that an NHS funded solely from the public purse and free at the point of delivery is no longer sustainable, and that the Chancellor’s extra billions will disappear into some huge NHS black hole.
I think I’ve discovered a new disease. I’ve called it collective Conservative amnesia – or Fox’s syndrome. That’s the only explanation I can find for why Liam Fox and his friends on the opposition front bench have wiped from their memories the damage they wreaked during their 18-year stewardship of the health service, and ignored the fact that much of the extra investment so far has been used to pay off debts and wipe out deficits built up while they ran the NHS into the ground.
So what have they got to offer after five years in opposition? As far I can tell, they are pinning their hopes on foreign trips and photo-opportunities with French GPs, and on rubbishing every move the government makes in relation to the health service to disguise their own dearth of ideas.
Dr Fox says he doesn’t believe increased funding from taxation will succeed in raising the standard of the health service and his party will look to Europe for alternatives.
The BMA has been there, done that Dr Fox. Our own healthcare funding review two years ago, which involved patients groups, health economists, health policy analysts, other health professionals and the private sector, looked at charges, social insurance and private insurance but concluded that funding from general taxation was the fairest, most efficient and most effective way of financing the NHS.
Derek Wanless, in his report on the future funding needs of the NHS, agreed.
Our findings reinforced our belief that funding from general taxation, and more of it, was the key to solving our capacity problems.
We believe in an NHS funded from general taxation and based on the principle of equal access to a universal service regardless of ability to pay.
We have got what we asked for. We have won the economic argument and we have won the government’s acknowledgement that much-needed reform will not happen without a massive injection of resources.
Now, we must prove the prophets of doom wrong.
We must play our part in persuading ministers that the extra investment must be used wisely and must be targeted at areas of genuine need, not channelled into centrally-driven initiatives.
We need more doctors, more nurses, more beds. We need enough hospital capacity to ensure elective treatment isn’t squeezed out by acute cases.
Whitehall must release its stranglehold on the service, and local providers must be involved in decisions about how local resources are deployed.
We must deliver with this money. The consequences if we don’t don’t bear thinking about.
We have acknowledged the need for reform and we have supported the government’s modernisation agenda where its aims have been to bring about long-term improvements in healthcare delivery.
But we must decide what kind of service we want. The country must decide what kind of service it wants.
Do we want this new money to help us deliver a sausage factory service based on productivity targets, which ignores the needs of individuals and the importance of time with patients? Or do we want it to help us deliver a quality service that is truly patient-focused and patient-centred?
We hear in a recent report from Birmingham University that whole-time NHS consultants are treating 10 per cent fewer patients than they were six years ago and that ‘productivity’ in some surgical specialties has fallen sharply.
| Crude productivity targets are no measure of quality. Doctors are not working on a production line. Doctors are providing individual care for individual patients with individual needs. Patients want more time with their doctors and quality care must not be compromised in favour of greater productivity. |
Politicians have promised professionals the investment they need to provide the health service their patients need. I hope they will have the sense to let the professionals get on with the job without the distraction of unnecessary hoops, hurdles, targets and wheezes from Whitehall.
For me, the most abiding image of the NHS this past year will be Rose Addis – a 94-year-old woman whose privacy and dignity were trampled over for the sake of some party political point scoring.
No-one emerged from this unsavoury and unseemly episode with any credit - not the media, not the family, and least of all the politicians whose shameless exploitation of this poor woman and her relatives for political gain was unworthy of their office.
MPs have the right to enquire about the healthcare of their constituents, and the media have the right to investigate matters that are in the public interest.
But is it too much to ask that information about a patient’s condition and treatment should be confidential and divulged only with the patient’s informed consent?
Is it too much to ask that issues surrounding an individual’s condition and treatment should not be made public before the facts have been checked?
Is it too much to ask that for those who are dissatisfied with the care they or their relatives receive from the NHS, a swift, transparent and robust NHS complaints procedure should be the preferred route to Prime Minister’s question time or the front page of a tabloid newspaper?
Is it too much to ask that politicians stop playing politics with the NHS? That they stop playing politics with people’s lives?
The NHS has become the Punch and Judy show of British politics.
That’s not the way to do it.
Some of you will call in debates later today for the NHS to be removed from direct political control and managed by an independent body. Laudable and desirable though your aims may be, they are I think ultimately unrealistic given the billions of pounds of public money at stake.
| But we have witnessed the damage wreaked by the politicisation of the NHS. We have been victims of the politicisation of the NHS. Our patients have been victims of the politicisation of the NHS. |
In matters of overwhelming national interest consensus can be achieved.
We must not allow political priorities to undermine our ethical and moral responsibilities to those in our care.
The provision of healthcare should be driven by the needs of patients, not by the changing political agenda.
Chairman, I move.