New Year message from the BMA's Chairman of Council
Dr Hamish Meldrum, 31 December 2010
There is no doubt that 2011 will be an exceptionally testing time for the NHS, patients and the profession. Set against a backdrop of an unprecedented financial challenge, with efficiency savings of at least £20 billion being sought in England alone, the Government's is pushing ahead, at break-neck speed, with an unnecessarily ambitious programme of reform in England. The NHS is facing similar financial challenges in the devolved nations and it is only of little comfort that this is not combined with the additional burden of organisational upheaval.
As doctors and clinical leaders, your role in dealing with the current demands, protecting the quality of patient care and helping to ensure the future viability of NHS services, will be crucial. I am confident that the profession will rise to the challenge and will do its part to minimise any adverse impact on patients. However, the profession can't do it alone.
The Government's response to its consultation on the White Paper (for England), "Liberating the NHS", was a missed opportunity to demonstrate to the profession, and others, that it genuinely was listening to the concerns that many had put forward. We are not opposed to reasoned and evidence-based change, and accept that there needs to be some improvement to the way services in England are planned and run, but it is our duty to speak out when we can see the NHS we care about and work in being put at risk.
Whilst we support proposals to increase clinical involvement in the design and delivery of healthcare, enable greater public and patient involvement and put the focus on quality and outcomes, rather than crude targets, we have real concerns about other aspects of the planned reforms. In particular, the lack of detail in many areas, the increasing emphasis on competition and the market, and the significant risks created by the process of rushed and unnecessarily risky transition, particularly at a time of such financial stringency.
Despite some of our scepticism, and, more so, because of our concerns, I believe there is a continuing need for the profession to remain closely involved in how the NHS develops in putting our evidence for change forward, and in reflecting how the NHS is delivered differently across the UK.
Over recent years, we have had major concerns about the erosion of professionalism and professional values. Doctors have the skills and experience to balance clinical evidence, the views of patients and the public, and the needs and constraints of the service itself to make the best possible decisions, often in very difficult circumstances. And not just at an individual patient level but, increasingly, at an organisational and whole health system level too.
If we are to create and maintain a sustainable health service it is vital that we encourage professional values to flourish and help to break down barriers between primary and secondary care, between health and social care, between clinicians and managers and between the health service and the public. It is only by working together that we will be able to make the difficult decisions and achieve the most effective outcomes with finite resources.
Strengthening professionalism and professional values will be an important ingredient in ensuring future sustainability of the NHS.
We also need to point out, both locally and nationally, what the efficiency savings actually mean in practical terms for services, patients and their staff. This is not, as some have accused us of in the past, shroud waving; it is being open and honest with patients and helping them to share the difficult choices that will have to be made. The Government may shy away from this but we have a duty of trust to our patients to spell out the reality of their actions.
While doctors will do their bit to identify waste and lead improvements in efficiency, we expect the government to spread the responsibility fairly – which means looking again at the very high rates of PFI equity returns, the generous allowances for return on capital for pharmaceutical companies and the financial consequences of fragmentation, excessive bureaucracy and unnecessary duplication caused by unfettered markets. Simply attacking hard-working staff by limiting their pay even further, will risk undermining those professional values and alienating those who make the real difference to patients in the care they provide, day-to-day.
Instead we must be encouraged to drive innovation, building on and promoting the world-class achievements of our medical academic community, embedding evidence-based change, backed by a robust national framework for training the next generation of doctors. The NHS must have a medical workforce that can meet the challenges of the future. The
BMA will keep on demanding a more sustainable UK solution as it responds to the Government's consultation on plans for education and training.
2011 will be a defining year – one in which the NHS will be tested to the limit. The BMA will continue fighting to improve the quality of care for patients, protect the values that ensure the NHS thrives, enhance the working lives of those who work within it, and guard against the threats facing the profession at large to ensure a better future for all.
I wish you all a very happy New Year in these uncertain times.
We are continuing to seek members' views on the proposed NHS reforms in England to help us lobby on your behalf, especially as more details emerge. If you would like to have your say, please complete the feedback form
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