Saturday, 21 January 2012

The NHS is in the hands of the Medical Royal Colleges

The NHS is in the hands of the Medical Royal Colleges

The recent decision by the Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) to come in line with the policy of the BMA to oppose the Health and Social Care Bill and call for its withdrawal, was a defining moment. Andrew Lansley’s desperate attempts to claim that this was all political and related to the ongoing pensions saga clearly highlighted how serious a blow this was to his plans. This was further emphasised by the offering of further concessions on the bill as reported in the Health Service Journal.

The announcements by the RCN and the RCM were also a defining moment for the Medical Royal Colleges, who are represented by the umbrella organisation, Academy of Medical Royal Colleges (AoMRC), chaired by Professor Sir Neil Douglas.
Suddenly, the Medical Royal Colleges find themselves in a position where they are the key players in the future passage of this bill and the future of the NHS.  They are the last remaining big players representing frontline NHS professionals who remain on the fence regarding the bill. They represent the frayed fibres of a damaged rope rubbing against a rock, which Lansley is desperately clinging to for survival, as he hangs over a cliff edge. If the Colleges came out against the bill, then those final fibres would finally be severed and Lansley and his bill would fall. Even though the Government has a majority in both Houses, their public credibility would be shot to pieces if they went against a united professional coalition of the BMA, RCN, RCM, Unison, Unite and the AoMRC. It is inconceivable that the coalition would try to enact such a flawed bill against such powerful professional opposition, whilst simultaneously holding back the Risk Register. It would be a PR disaster of the highest order.
In addition, one of Lansley’s three key stated principles underpinning his reforms is “empowering frontline health professionals”. United opposition from the medical and nursing professions would make a mockery of this claim, sending a clear public message of distrust in Mr Lansely and his bill.

So the future of the NHS really does lie in the hands of the Medical Royal Colleges – and they know it. Following the RCN and RCM announcement, my own College (the Royal College of Radiologists) sent out an unprecedented urgent e-bulletin about the Health and Social Care Bill. In the bulletin, the RCR President, Dr Jane Barrett, stated:
“Next week could be a defining period for the Colleges’ views on the Health and Social Care Bill”
This refers to a number of meetings that will be going on behind the scenes next week.

The Colleges must act during this crucial week, and they must act in the interests of their members and fellows, which means calling for the withdrawal of this highly unpopular, ideological and flawed bill. They have not acted in this way to date, and they cannot continue to use the excuse that they are apolitical to remain on the fence. After all, the President of the Royal College of Paediatrics and Child Health, Professor Terence Stephenson, is a member of the Government appointed Future Forum. Furthermore, the Chairman of the AoMRC, Prof Sir Neil Douglas has already given evidence to the Bill scrutiny committee and stated that:
“...there are so many disadvantages in delaying that we have to get on with it to the best of our ability now. We will not be able to give you definitive answers on detailed questions because our members have not had a chance to respond, but we will do our best and we believe that we should be going forward at the moment.”

And Norman Williams of the Royal College of Surgeons has stated (without a mandate from his fellows) that the:
“College largely supports the aims of the reforms to modernise the healthcare system.”

In addition, the Government’s response to the Future Forum report secures a number of important roles for the Colleges in delivering and leading the reforms. These roles include the establishment of close links with the NHS Commissioning Board (para 3.55), involvement in identifying the procedures most at risk of cherry picking (para 5.42) and prioritising work on Payment by Results (para 5.42)

Just as the Government has no mandate from the electorate to push through this bill, the Royal Colleges have no mandate from their Members and Fellows to help deliver and lead the reforms. In fact, there is a solid argument that they have a clear mandate to oppose the bill, because the majority of members and fellows of Colleges are also members of the BMA, which has been mandated to oppose the bill and call for its withdrawal by its members. It is also unacceptable that the Colleges (with the notable exceptions of the RCGP and RCPsych) have not even surveyed the opinions of their members/fellows on such an important issue.

The Colleges had already been warned about the bill in an open letter from myself and well over 100 high profile co-signatories. They failed to act decisively at that point. They have another chance and they must take it. Otherwise they could end up sharing the same legacy as the Liberal Democrats in colluding with a bill that will see the demise of the NHS.
All doctors who belong to Colleges and want this bill withdrawn must now write to their Presidents ASAP. They must be made to feel the strength of opinion that is out there on the frontline.    

The other fundamentally important point is that the organisations calling for withdrawal of the bill should not back down, even if Lansley offers “significant” concessions. He is simply not to be trusted. He is after all a man who has said there would be “no top down reorganisations” and “no NHS privatisation”. The bill is far too complex and there is too little time to properly assess the impact of any new concessions. For example, the independent legal opinion on the Secretary of State’s duties and powers took weeks to put together. At this late stage, the only safe option for the NHS is for the bill to be withdrawn.

We can will this battle, but we must stand firm.

If you are a doctor, please lobby your college here


  1. How about a mass-exodus and withholding of fellowship contributions/collegiate membership unless the Royal Colleges act?

    Perhaps we should all be digging out those Direct Debit mandates and preparing to cancel?

    Come on, Colleges - show some leadership!

  2. Money speaks louder than words. Shane has it about right.

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