Plans to cut the number of health boards from 14 to two are the “wrong set of reforms” that fail to demonstrate how things will be better for the patients doctors care for, BMA Scotland said today.
Dr Nóra Murray-Cavanagh, Chair of BMA Scotland, was speaking after the BMA’s Scottish Council considered the proposals that were put forward in the Programme for Government and after serious concerns were raised, voted to oppose them.
While details continue to remain in short supply of how the reforms will be implemented, the fundamental issues that were raised by members showed the very real anxiety many doctors are feeling for colleagues, patients and services in the face of this reorganisation.
Dr Murray-Cavanagh said:
“Today I can confirm that Scottish Council has voted to oppose the plans to reduce the number of health boards to just two and is urging the Scottish Government to withdraw and rethink its whole approach, with a fresh focus on steps that will benefit patients more immediately and directly.
“Our position is not one that argues NHS reform isn’t necessary – no-one thinks we can simply go on as we are. As doctors, we know better than most the precarious state of services across Scotland. But this is the wrong set of reforms, and it will set Scotland on a path of a costly, time consuming, resource-sapping reorganisation, with no serious engagement with those of us holding the service together and no clear evidence put forward on how it will benefit patients.
“In the council meeting, members set out with passion and precision the many concerns about what the reduction of boards will mean for them and the people they care for. But at the core of everything is the lack of any evidence on how these reforms will practically make care better.”
Further concerns were also raised about centralising services and governance, the impact on the medical profession and the lack of engagement with either the public, or those working in the NHS.
Dr Murray-Cavanagh continued:
“Of particular concern is the impact of the centralisation of governance and potentially services that moving to two boards covering vast swathes of the country will inevitably mean. Consolidation on this scale will weaken local accountability, and the ability to make decisions which reflect the needs of specific communities and all the complexity and nuance which comes with that.
“Services being organised on a much larger scale may mean patients have to travel further for the care they need. This could negatively impact patients in rural and remote areas, older people, those on lower incomes and those without access to private transport or wider support and runs the risk of widening already deep and pernicious health inequalities.
“There is nothing in these reforms yet to indicate that it will improve the dire situation of the medical workforce in Scotland, or as a result the care that we can provide to our patients. Instead, it risks making things worse, by potentially stretching an already thin workforce over even greater areas and asking them to do more and more to keep services running, rather than coming up with a proper workforce plan.
“The lack of engagement or consultation before the announcement creates the serious concern that these reforms will simply be bulldozed through, without proper consideration and input, both from those working in the NHS and the public. This is far too important for that to happen, and the BMA will do everything within our gift to ensure that we are able to contribute effectively to the engagement that we are promised will take place. Indeed, I have already had a constructive discussion with the Cabinet Secretary to make that point, and have received reassurances, although we wait to see what these encouraging words translate to in reality.”
Finally, Dr Murray-Cavanagh called for a change of approach, and said:
“It is our belief that when these plans are properly exposed to the scrutiny they require, the many flaws will become abundantly apparent. That is why BMA Scotland opposes them and urges the Scottish Government to wipe the slate clean and work with the representatives of organisations across the NHS and the public to design something better. Ministers need to remove the preconception that two health boards is the right approach and work with us and others with an open mind on what the most appropriate future structure for the NHS in Scotland is and how to really make a difference for patients.”
Notes to editors
The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.