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In his final ARM speech, BMA council chair Mark Porter said the under-funding of the NHS was not inevitable - it was a choice made by government, and a choice that had profound implications for the services available to patients. Here is his speech summed up in 10 quotes
'The prime minister said the election was about the Brexit negotiations. But elections, and governing this country, are about more than that.'
Not only was the general election called to give the prime minister a stronger hand in Brexit negotiations, but last week’s Queen’s Speech was dominated by Brexit-related bills.
Dr Porter said he did not under-estimate the task the Government faced, which would have major implications for the health service as well as the rest of society, but he warned the prime minister that ‘you ignore the NHS at your peril’.
He said that while the NHS treated more patients than ever before and deployed treatments of which he could only have dreamed when he qualified, and despite the extraordinary dedication of its staff, it was failing too many people, too often.
'Let them imagine what it must feel like to be that patient feeling vulnerable, frightened and in pain. Not knowing what’s wrong with them, not knowing if their life will be changed for ever. Not even knowing if they will get through the night.'
Dr Porter contrasted the remote perspective of ministers, viewing the health service from ‘high windows in Whitehall’ with that of patients forced to view it from trolleys, as they waited for admission.
He asked how many people the Government thought it was acceptable to be waiting more than four hours for admission.
‘Would 129,000 in a single year be too many?’ he asked. That was the figure five years ago, he said. Now it was more than 500,000.
'This isn’t a measure of efficiency, as it might be at the Holiday Inn.'
High rates of bed occupancy are acknowledged to be unsafe and can impact badly on NHS performance.
And yet, Dr Porter said, the average bed occupancy between January and March was at 91 per cent, and dozens of trusts had days when they hit 100 per cent.
Dr Porter highlighted a principal cause – the loss of 6,000 general and acute beds in six years.
Dr Porter added: ‘It’s a measure of how hospitals are choked as doctors try to move patients through their treatment pathway to the care they need.’
'The lack of beds, the lack of doctors, and the queues for treatment that grow and grow are not inevitable. It doesn’t have to be this way. It is the result of an explicit political choice.'
That ‘choice’ is the Government’s decision to spend a lower proportion of GDP on health than other leading European economies. If it spent the average, there would be £15bn extra investment in the NHS within five years.
This would meet most of the gap in NHS spending identified in the NHS Five Year Forward View.
But Dr Porter said it was a government that wanted a ‘world-class NHS with a third-class settlement’, and the same applied to the other main political parties, whose spending plans set out in their election manifestos would all of seen health spending fall as a proportion of GDP.
He said: ‘We’re not asking for the world. We’re asking for the average. For a fair chance to create the health service our patients need and deserve, and that we want to deliver.’
The urgency of resolving the funding crisis was highlighted by a new BMA survey which found that more than 70 per cent of doctors said it had become harder for patients to access care.
'And when it comes to the existential challenge posed by its refusal to fund the NHS adequately, it ducks, it dodges and it passes it on.'
The Government ducks responsibility for the vast NHS deficit by dumping it ‘on to the shoulders of communities who have no chance to fix it by themselves’, said Dr Porter.
So the STPs (sustainability and transformation) plans being drawn up around the country – ‘44 grim little manifestos’ – were invited to consider every option except the obvious one, that the NHS was systematically under-funded.
Even the name of STPs is misleading, he said. They claim to be about ‘sustainability’, when they have to find £26bn in cuts in health and social care, and about ‘transformation’ when they need £10bn of capital investment – more than twice the annual capital budget even before it’s raided to pay off hospital deficits.
'They were drawn by the values of the NHS and now embody those values. But they have been left with fundamental worries and doubts about their employment rights and long-term future in this country.'
A BMA survey earlier this year found 42 per cent of doctors who qualified in another EEA (European Economic Area) country were thinking of leaving after the referendum vote.
There are 10,000 such doctors working in the health service and even if a fraction of them left it could have a devastating impact on NHS staffing.
‘Closing down our borders would close down our health service,’ said Dr Porter.
He added: ‘Treating these doctors with justice and respect is not a matter of charity; it is a matter of practical necessity and of moral obligation. We simply wouldn’t have a health service without them. And even if we did, I wouldn’t want to work in it.’
He said it was right that the status of EU workers in the UK was a priority in Brexit negotiations but now ‘fine words need to be turned into actions’.
'I hear belligerent talk about who has the hardest Brexit, but while these words may be thrown around lightly in London, they will be lived in Belfast.'
The land border between Northern Ireland and the Republic of Ireland poses particular issues in the wake of Brexit.
It is not only a huge volume of goods that passes both ways, but also patients taking advantage of cross-border treatment initiatives.
As Dr Porter said: ‘Patients who have suffered heart attacks in the south have had their lives saved in the north. And patients from both countries are treated in the same, excellent cancer centre.’
All this would be put at risk with a return to ‘border controls and mutual suspicion’, he said.
'In medicine we’re trained to listen to what the patient tells us. If we ignore what we see and hear, and carry on regardless, neither we nor the patient lasts very long.'
The evidence of an over-stretched and under-resourced health service was growing overwhelming, said Dr Porter.
There were the growing number of exception reports from junior doctors, and the fact that GPs were considering whether to close patient lists because of the overwhelming pressures they faced.
They don’t need the Government to make unfunded promises or threats about extending access,’ said Dr Porter. ‘They do need the Government to listen to why they have been pushed into considering such a step.’
'Even the simplest ways to promote good health are run aground.'
Dr Porter questioned whether an English liver was worth less than a Scottish one – that being one conclusion of the Scottish Government’s energetic efforts to pursue minimum-unit pricing compared to a lack of endeavour south of the border.
He praised the efforts of doctors in BMA Cymru Wales who had campaigned successfully for health-impact assessments to become a central part of decision-making.
But he compared the childhood obesity strategy in England to a box of frosted breakfast cereal – grind it down and it’s little more than sugary dust.
As for the tobacco strategy, it was even harder to find merit – there hasn’t even been one for this crucially important public health issue since 2015.
'What, asked your predecessors in 1875, could a woman possibly know of obstetrics?'
Elizabeth Garrett Anderson, the BMA’s first female member, endured hostility and suspicion. BMA members voted to ban new female members, and it took 17 years before the ban was rescinded.
Dr Porter paid tribute to the ‘extraordinarily talented and tenacious’ Dr Garrett Anderson.
He said that while the profession is now heading towards numerical equality, it was a long way off actual equality.
He said: ‘It’s about challenging the structures that entrench inequality, but also about challenging our own behaviour and attitudes, and those we experience every day. Until we are truly equal, we are all diminished.’
Read Dr Porter's speech in full
There seems to be difficulty in recruiting GP's ? Lack of job satisfaction? Reluctant ace to work 5 days a week 40+ yrs ago practices would only appt a woman ( more choice & fewer women ) if you would offer full time or an alternative . I worked for 20+ yrs with a job share partner we both had children shared a list met most days covered each other's holidays both had hospital jobs & retired more or less together . I still believe a family Dr has job satisfaction only when offering avail ability at least 5 days a week & then it is the best job in the world
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