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Speech from BMA Northern Ireland council chair

Read the transcript below. 

Maidin maith a uachtarann ,a daoine uaisle agus a cairde. Cead mile failte romhibhe go leir go Beal Feirste. 

Good morning chair and conference. You’re all very welcome to Belfast.

We’re here at ARM to meet as a profession, to review policy for our members, the service for our patients and the state of the NHS in this modern world.

The world is changing rapidly, the NHS is changing, our profession is changing and society is changing. We need to embrace change and make change our friend.

We have had a very busy and productive year at BMA Northern Ireland. We have a superb team here at BMA in Belfast led by our national director Claire Armstrong. We have maintained a high profile and effective media presence and published a forward looking consultant strategy followed by roadshows.

The GP committee has accelerated the development of GP federations and MDT investment and held a series of roadshows on contingency planning. Our SAS committee has negotiated the establishment of a sub deanery to drive forward career progression. Our JD committee has had a very successful “take control” campaign, and our medical students have led the way with a fantastic widening participation programme.

This is the BMA stepping up to play its part, engaging with and leading the transformation and change in the NHS in Northern Ireland.

Like the rest of the UK we have the usual confluence in the NHS of excessive workload, an inadequate workforce and constrained resources. This is the world we have always lived in, our status quo. But; conditions have deteriorated.

We are now two and a half years without a functioning government in Northern Ireland. This has added further pressures and restrictions on what we can achieve for our members.

The mismatch between demand and resource causes stress for staff and deteriorating services for patients. Life as a doctor in the NHS has become more difficult due to the increasing needs of patients, the bureaucracy of NHS organisations, the constraints imposed by professional bodies and the continual criticism and sanction from great swathes of society who appear to be obsessed with victimising individual doctors.

This blame and sanction culture creates disrespect and mistrust. This has a price - it encourages risk avoidance behaviours in professionals, inefficient and ineffective management, increased cost for the system and deteriorating services for patients.

Mistrust is expensive.

In our member surveys in Northern Ireland 3 in 5 doctors reported that their fear of reporting a medical error has increased in the last year. The main reasons for medical errors was pressure or lack of capacity in the workplace followed by system failure and human error. 56% of doctors feared being unfairly blamed for errors due to pressures in the workplace and system failings.

This culture within the NHS has created a hostile work environment for its staff. A culture of underfunding, of rota gaps, collapsing GP practices , the Bawa Garba case and the Orwellian pensions fiasco. A culture where as doctors we have to retrospectoscope our clinical management in real time to anticipate the blame and sanction that will inevitably result if something goes wrong.

Doctors feel vulnerable to criminal and regulatory proceedings.

This creates a hostile training environment for our medical students and young doctors and a culture that senior doctors no longer want to continue to work in.

We need to point a finger of accusation at those responsible.

Politicians and government need to stop chasing unicorns and fund the NHS properly- J’accuse

Managers in the NHS need to stop prioritising targets over care and look after their staff properly- J’accuse

Society needs to understand that this profession has been pushed too far and we need to fix this hostile culture that doctors work in. J’accuse

The way forward is clear.

There is an implicit contract between society and the medical profession. We work hard and we deliver high quality services efficiently but we need the trust of the public to manage risk.

We need a more fair and just culture where investigations focus on learning not scapegoating, blame and sanction.

We need to recognize that the NHS is a system under pressure and provide better support for doctors under investigation.

We need to have enough staff and sufficient resources to meet patient needs.

We need a positive training environment for our medical students and junior doctors.

We need our senior doctors to be afforded the autonomy and flexibility to lead change in the NHS.

The BMA will continue to hold government to account to make sure that they don’t betray the vocation and commitment of future generations of doctors.

We the medical profession need to advocate for change, engage with change and lead change in the NHS.

We need to believe that we can achieve this.

As Seamus Heaney said in his poem The Cure at Troy where he talked about change and hope for the future when “ hope and history rhyme”. He said:

“Believe that further shore
Is reachable from here
Believe in the miracle
And cures and healing wells.”

Go raibh mile maith agaibh. 

Thank you.