Call for resources to ‘rebuild the NHS’

by Neil Hallows

BMA council chair Chaand Nagpaul has called on chancellor Rishi Sunak to fulfil his promise to give the NHS ‘whatever it needs’ in his keynote speech to the BMA annual representative meeting.

Location: UK England
Published: Tuesday 15 September 2020

Warning of an impending ‘triple whammy’ for the NHS – the non-COVID backlog, the ongoing risk of a second spike, and winter pressures – he said that ‘the citizens of this nation must no longer be punished from a failure to properly resource our health service’.

Dr Nagpaul praised doctors for the ‘leadership, flexibility and courage’ they have displayed in responding to the crisis.

He said: ‘We accepted wholesale overnight change to our lives working outside contractual arrangements. Many moved from their usual specialty to learn new skills and work in critical care. Others left their families to work in new hospitals. Our emotional resilience was tested as doctors held smartphones to patients fighting for their lives so they could see loved ones who were forbidden from visiting them. We did our duty in serving the nation.’

Deep inequalities

The Government, however, had been responsible for ‘scandalous shortages’ in PPE (personal protective equipment). The BMA had raised the issue with a parliamentary committee as early as March, secured revised guidance on PPE better reflecting international standards, and provided doctors with ethics guidance and advocacy to help them challenge their employers when they were given inadequate equipment.

He said: ‘In meeting after meeting, letter after letter and interview after interview, we have delivered one simple message: We have the nation’s back, but the Government must have ours or we will all fall down.’

Dr Nagpaul set out the support the BMA offered, including round-the-clock member services, wellbeing support extended to family members, and representation informed by the nine surveys completed by thousands of doctors.

He said the pandemic had revealed deep and longstanding inequalities. More than 90 per cent of doctors who have died have come from a BAME background.

He said: ‘Never ever again should doctors and healthcare workers fail to be adequately protected in the course of their duty.’

Dr Nagpaul had called for an urgent investigation into COVID’s disproportionate impact on BAME healthcare workers and communities, which resulted in the Government commissioning Public Health England to conduct one.

‘The PHE report depicted unambiguously just how starkly unequal our society is, driven by longstanding structural and racial discrimination,’ he said.

He added that the BMA must ‘not be unequal in our commitment to equality’, citing the work carried out in gender equality, highlighting the greater difficulties women doctors have in finding proper fit-tested masks, and holding the first ever joint conference with the Medical Women’s Federation, while also raising awareness of the issues faced by disabled doctors through a major survey which found half are not receiving the adjustments they need.

Reality check

Dr Nagpaul pointed out some of the Government’s failings in its response to the pandemic. He criticised the lack of testing of healthcare workers during the peak, leading to large numbers of doctors needlessly self-isolating. He said the app which the Government had said would be ‘world-beating’ instead ‘sank without trace’.

And he said it was not surprising that the public had not always adhered to infection control measures when the Government’s messaging had been so ‘utterly inconsistent and confusing’.

With face coverings, the Westminster Government had first rejected the BMA’s call for them, back in April, but then went on one U-turn after another, to mandate their use first in public transport, then shops, then cinemas and museums.

He said: ‘The Government is now shooting for the moon, promising to deliver mass continuous testing with a test that doesn’t yet exist at a cost nearly as much as the total NHS budget. 

‘Down here on planet Earth, we need a fit for purpose test and trace system in the here and now with capacity, agility and accessibility that doesn’t require 100-mile journeys that disadvantage some of the most vulnerable.’

Dr Nagpaul said that while the private sector had ‘mushroomed’ during the pandemic, benefited by a government which had flouted the basic norms of tendering, there had been a ‘shameful disinvestment’ in public health.

‘Change is possible’

The pandemic, said Dr Nagpaul, had vindicated many of the issues on which the BMA has been campaigning for years, such as the lack of capacity in the system. He said the NHS had been forced to become a ‘national COVID service’. Ten million fewer patients attended hospital for operations or clinic appointments between April and June.

But it also offered an opportunity to show a different kind of health service. One where transformative change is possible, having built new hospitals in weeks, and that liberated the ‘hundreds of millions spent on current clipboard inspections in favour of proportionate regulation’.

It needed to be a health service that treated staff fairly, he said.

‘After everything doctors have been through – the thousands of hours of unpaid work, the toll on wellbeing with a third of doctors reporting worsening stress, depression or burnout – the same politicians who clapped us from their doorsteps later shamefully refused to even acknowledge the work we did during the pandemic in July’s pay award. It’s a further insult to English GPs and junior doctors to receive less than all their colleagues with whom they’ve worked shoulder to shoulder through the crisis.’

The same politicians who clapped us from their doorsteps later shamefully refused to acknowledge the work we did
Dr Nagpaul

And he said it was an affront to hard-working GPs for NHS England to imply recently that they have shirked their responsibility to offer face-to-face appointments, when it was NHS England itself which had directed GPs in April to avoid such appointments unless absolutely necessary.

Dr Nagpaul said: ‘This pandemic has been a window into a different world which demands a different NHS. We can’t simply go back to a National Health Service which was so patently under-staffed, under-resourced and totally under-prepared for a difficult winter, never mind a pandemic. A country so plagued by inequality. A profession set up to fail.

‘Our vision is of an NHS which is resourced to give us the time, tools and facilities to care, where doctors feel valued and rewarded for serving the nation in a caring, supportive culture of equal opportunity.

‘It was from the ruins of the Second World War that our health service was born. From the ruins of today’s national health emergency, we must seize the chance to rebuild the NHS anew on its founding principles of being there for all at times of need.

‘That, colleagues, should be the new normal. And that is what the BMA will be fighting for.’