Saturday 28 January 2012

1/20 - How the autocrats of the Royal College of Surgeons let down the profession and the NHS

1/20 - How the autocrats of the Royal College of Surgeons let down the profession and the NHS

Tuesday 24th January 2012 was a momentous day for the NHS. The Academy of Medical Royal Colleges (AoMRC),which is the umbrella organisation that represents the main 20 UK medical Colleges and Faculties, met to discuss the Health and Social Care Bill.

They had produced a joint statement that was leaked to the Guardian, which stated:

"The Medical Royal Colleges and Faculties of the AoMRC continue to have significant concerns over a number of aspects of the health bill and are disappointed that more progress has not been made in directly addressing the issues we have raised......"

"....unless the proposals are modified the academy believes that bill may widen rather than lessen health inequalities and that unnecessary competition will undermine the provision of high quality integrated care to patients.”

"The Academy is deeply concerned that the upheaval caused by the changes in the bill will distract the NHS from the huge task of meeting the current financial challenges."

"The Academy and Medical Royal Colleges are not able to support the bill as it currently stands”

This statement had been agreed by 19/20 of the organisations represented by the AoMRC. Only the Royal College of Surgeons of England (RCSE), led by Professor Norman Williams refused to sign the letter. This was expected to happen because despite having some concerns, Williams has been a longstanding proponent of the reforms, having previously stated that:
 “The College largely supports the aims of the reforms to modernise the healthcare system”

Unfortunately, this lack of solidarity with the rest of the profession provided the chink in the armour of a united front of professional opposition to the bill. The 19/20 organisations backing the statement, soon collapsed to 0/20, triggered by the Royal College of Obstetrics and Gynaecology pulling out, and catalysed by a frantic Health Secretary ringing around the College Presidents to apply some hefty political pressure. The statement was never officially released.
This collapse in solidarity was a gift to Mr Lansley, and it was widely reported in the national media including BBC headlines: Government escapes rebellion by medics over NHS

This was possibly the moment when the NHS was lost to the English public, in terms described in the Lancet recently (Fulltext reproduced here). I am convinced that a united front of opposition from the Colleges would have been enough to finish off the bill. Many commentators suggest that the reality of the Parliamentary maths would suggest otherwise, but I would them to consider the following situation:
A press conference with the BMA, Royal College of Nursing, Royal College Midwives, and the Academy of Medical Royal Colleges, all sat together signing a letter opposing the Health and Social Care Bill and calling for it to be withdrawn. This would be absolutely devastating for Lansley. Cameron’s pollsters would be calling time on the bill. They are twitched enough about it already.

This is what is so disappointing. The bill had been brought to its knees by sustained campaigning and professional evidence based criticism, and just needed the Royal Colleges to deliver the final blow, as I have explained before. Instead, Norman Williams and his College of Surgeons performed life saving surgery on it. I’m sure Mr Lansley will be very grateful. The extent of this surgery can be seen by the RSCE’s press statement on their current position on the bill:
“The College believes that the Bill should be implemented without unnecessary delays, as otherwise procrastination, without an alternative cogent plan, will lead to further chaos and be to the detriment of patients.”

This position of the College is based the views of the College Officers alone, because they have not surveyed the opinions of their paying members and fellows. This is the autocracy of the surgical establishment in action. Why they would support such a bill is an interesting topic for discussion and I recommend this interesting blog article, which goes into some the issues.
Despite the complete lack of solidarity shown by the Surgeons to the rest of the medical profession, all is not lost. If we can get back to a situation where the majority of the Royal Colleges make individual statements about opposing the bill, this could actually be even more powerful. There is a big opportunity to put the surgeons out in the cold over this. If 19 Colleges signed a joint letter, there is no reason why this cannot happen again on an individual basis. In addition, the Colleges can hardly use the claim of being “apolitical” anymore, especially following the frantic antics of Lansley, and the desire of some College Presidents to meet senior Ministers for more discussions!
The process for this to happen is already in train. The UK Faculty of Public Health have had an Emergency General Meeting and voted overwhelmingly for the bill to be withdrawn. Since the Academy meeting, The College of Emergency Medicine has now stated that:
The College of Emergency Medicine has significant concerns over a number of aspects of the Bill and is not able to support it in its current form”

The Royal College of  Radiologists has now issued this statement, which said:
“Given our widespread concerns over many serious and as yet unresolved issues, The Royal College of Radiologists cannot support, and must continue to oppose, the passage of the Health and Social Care Bill in its current form”
It has also called for an Extra-Ordinary General Meeting of Fellows to debate the bill and form policy.

The Royal College of Physicians has also been forced to have an Extra-Ordinary General Meeting by it Fellows and will be making a statement next week.
Other ordinary College fellows and members are working on the Colleges too. A College lobbying website for members and fellows has also been set up.

Next week is going to be a big week for the NHS. The damage caused by the Royal College of Surgeons of England can be repaired, but only if the other Colleges wake up the reality that the bill is unamendable. They must realise that they cannot support this bill, especially when the issues surrounding Clause 1 and related Clauses have not been resolved, and the risk register is being held back. I have been campaigning against this bill for a long time and have witnessed Lansley use every trick in the book to force this bill through. The so called “major concessions” on the bill so far are mainly cosmetic and simply do not protect the NHS from increasing commercialisation and privatisation. There is simply too little Parliamentary time to allow for proper scrutiny of more concessions because of the complexity of the bill. The true meaning of any new changes and their knock on effects with other parts of the bill can take weeks to sort out. In addition the potential for unintended consequences is much greater with complex legislation.  

So it is now time for the College Presidents to stand up for the public interest, the NHS and patients. They should listen to the majority view of the medical profession, and the views of the academic health policy community, and call for the bill to be withdrawn. It is too dangerous for the NHS to allow this bill to pass into law.

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