News of Wales - Issue 1
October 2005
How the west was won
Reflections on the Annual Representative Meeting in Manchester by our undercover reporter Dr Norman Vetter
The Monday of the ARM dawned bright and sunny. Reluctantly we dragged ourselves out of the bright sunshine into the conference hall. But we soon met up with old friends and faces we only see at the ARM. Manchester appeared to be at least quarter filled by building sites, with everything being redeveloped and nearly everything looking like something it was not; a train station was a conference centre, a school was a hotel and more canals than Venice.
There was some confusion as we tried to work out which of the three agendas we had been given was the correct one. The confounding factor was the Secretary of State. She, Patricia Hewitt, the new Minister of Health for England, had been asked to come, but against all precedent has ACCEPTED the invitation. So a space had to be made in the agenda for her. So the new green agenda had dramatic changes to let her way with us.
Then the meeting got under way; only to be interrupted by an advert for the BMA – ‘what has the BMA ever done for us?’ Well we were all disciples, so why did we need this; members of Council telling us how great the BMA is. Well they were hardly unbiased. The worst part was that if you went to the cyber café to answer or send some emails the same short programme was going on over your head. After about 30 minutes you could recite the whole thing by heart.
Then Jim Johnson spoke. A well thought out speech, ‘asking governments to evaluate policy is like asking a teenager to tidy their room’. He spoke of the lack of commitment to smoking in the English government, and a lot about the third world, especially Africa and the tendency of the West to steal skilled people, foreseeing the G8 debates. Jim is not a ranter, but he made his points well.
Then a busy day revolving around the stealthy privatisation of the NHS, and the process of educating students from the students, junior doctors and academics’ perspective. Listening to the speeches, enlivened by some nice phrases ‘Blair and the vegetables’ At one point the warning lights, warning people about the time they had left to speak showed green to starboard, red to port, just like a ship. Luckily the rostrum did not sail away.
A good open debate on overseas recruitment reflecting the two ends of the problem; on the one hand the West stealing fully trained doctors and nurses, the third world could ill afford, on the other the right of doctors to travel, better themselves and their families and send badly needed money home.
Some brave soul decided to run against David Pickersgill, the Treasurer. He seems to have been there as long as I have been going to ARMs. The trouble is that David looks like a bank manager and the finances are blooming. So the challenger lost, of course, but gained points for bravery. About this point, talking of bravery, I admitted, in front of the RB, to being on the NICE committee which advised against the existing drug therapies for Alzheimer’s. No one threw fruit. They are very open minded in the ARM this year.
The Victor Horseley lectures were, as usual, of a very high quality. Dr Nick Boon from Edinburgh made the point that everyone has plaques in their coronary arteries, so the important thing was to stop them rupturing and went through the ways of preventing that.
The afternoon was taken up with medical education from the student’s (noisy), junior doctors (earnest) and medical academics (tired) standpoints. Finishing off the afternoon with a rousing endorsement of the ‘doctor’s list’, which is under threat.
The Welsh dinner was fun, as usual with some very nice possibly Welsh lamb. Dame Deirdre Hine was guest of honour, the new president and Welsh, to boot. It was, as Dame Deirdre said afterwards, the best food of the ARM.
And so to Tuesday….
Next morning, another fine and sunny day, was buzzing because the Secretary of Stare, Patricia Hewitt was to visit. She, and we, were very aware that this was the first Health Secretary who had dared to come to an ARM. She was very charming ‘I’m an Aussie, just call me Patricia’, were her first words. She distained the formality of standing at the podium, instead standing at the front of the stage. It reminded us that our politicians are good at this. They spend a lot of time in the lion’s den – the House of Commons. Americans are always astonished by the way our politicians can manage the cut and thrust.
She gave a soothing speech – ‘the importance of frontline staff’, ‘who know what is really going on,’ to applause. But modernisation needs to happen for the sake of improving patient care.
Questions started with smoking. Why were the Celts so far ahead of England? How many lives of bar staff would be at risk, because she allowed smoking where there was no food being served? She answered well, given that the question was unanswerable. Need to go along with public opinion – no smoking three feet from the bar (at which I’m afraid I shouted ‘nonsense’). Several people had already likened not allowing smoking within three feet of a bar as like ‘only allowing peeing in the shallow end’.
Then on to questions about targets, the A&E 4-hour target and the waiting list ones. She explained that the government ‘had listened to advice’ and reduced the 4 hour target from 100% to 98% (wow). And that the overall time limits for waiting lists did not preclude prioritising patients according to clinical need ‘ but there has to be an overall limit on how long people, even with non-threatening disease have to wait’. She kept asking us to think back a couple of years to see how things had improved. And reminding us that she ‘had discussed that with Jim Johnson a couple of weeks ago’. So we felt she was chatting to the BMA
So she charmed the ARM and promised to collaborate with the BMA in future. She is, as someone said ‘no patsy’, but seemed fair.
At lunch time the Victor Horseley lecture was on a new treatment for Systemic Lupus, which is showing promise, though the randomised double blind trials were only just underway.
Assisted suicide
Then the open debate on assisted suicide. A lot of talk of Oregon, where you can evidently get a prescription for a lethal dose of something, if you feel you want to commit suicide. Only about 60 people had been given one in the first year. About two thirds had taken their dose, the others had not. Also discussion of the Lord Jeffrey Bill. Overall about two thirds of the people speaking were against assisted suicide, about a quarter for and the rest didn’t seem sure. Possibly cheering for the row of people outside the door of the Conference Centre with placards saying such things as ‘I don’t want to be killed.’
Later in the week we came to a compromise decision. This said that we would go along with what society deemed was right. Possibly a bit of a cop out, but the debate was very split between those who wanted to help people in terminal anguish and those who felt that it was not for doctors to end life.
In the evening a lot of delegates went to Manchester United football ground for a party. As a rugby enthusiast I am afraid I did not go.
Wednesdays dawns…..
Wednesday was very involved with the Mental Health Bill, complete with explanatory notes one speaker explained written by ‘Einstein’s Swahili cousin’, it was so impossible to understand. Then on to the Scots boasting about their new Bill to ban smoking in public places and the Welsh following up with their relationship with the new minister (he was a BMA member, we boasted) and the stand-off over the new contract. There were thanks from Tony Calland to the staff of the BMA Welsh Office, especially John Jenkins ‘who has been to school with everyone in Wales’.
There followed one of the most moving sessions I have been to at an ARM, on doctors and Torture with the President of the AMA speaking and stating that torture at Guantanamo Bay or anywhere else is no part of the medical profession and any doctors found taking part would not be allowed to remain as doctors.
Next the open debate on confidentiality got stuck into the proposed Centralised Electronic Care Record, with a lot of concern about confidentiality and safety.
The Installation of the President that evening had a definite Welsh flavour, with the new president being Dame Deirdre and Bryn John being honoured with the association medal for his ‘outstanding and sustained national service’ (something to do with soldiering, Bryn?). No seriously he deserves it; to think he had a full head of hair before he was chairman of Welsh Council all those years ago.
Then the last morning, some of us a little jaded by now, and onto compulsory HIV testing which the students and juniors were incandescent about, despite it not happening according to nice Susan Robson, Chair of the Occupational Health Committee. Anyway we voted against it, just in case. Best to keep on the right side of the students – they may be our doctors one day!
Then we all donned white wrist bands to ‘make poverty history’, which I have worn since, despite the comments of my wife, that I only want to look trendy – take more than a white wrist band!
The results of the open debate on abortion was to reject any change to the law, though there was disagreement about whether many more babies lived a fulfilling life if they had been born between 20 and 24 weeks gestation. The data seemed not to have been updated, so we had to depend on individual paediatric opinion and that was divided.
Then a last gasp on smoking and cycle helmets; against the first, for the second and it was the usual mixture of a rush to get away and sad partings.
In conclusion
Overall a good ARM. The secretary of State being there made it an historic occasion, with promise for closer relationships in future. But the ‘modernisation agenda’ with all its oddities remains. As a Welshman I felt pleased to be separated from ‘Choose and Book’ and Foundation hospitals and ‘Payment by Results’ and lots of other strange phrases common in England. She is certainly no patsy, but let’s hope she will at least debate new ideas with our English cousins before imposing them.