Royal College of Radiologists Extraordinary General Meeting

RCR EGM 16th February 2012

I made following speech at the RCR EGM to support the motion below.
The motion was supported in full. The full results can be found here.
(Please note the number of abstentions for the Council's own motion)

That this meeting:

(a) welcomes the RCR statement that it cannot support, and must continue to oppose the passage of the Health and Social Care Bill in its current form;

(b) considers that the Health and Social Care Bill, if passed, will damage the NHS and widen healthcare inequalities, with detrimental effects on patient care in England;

(c) cannot support the Health and Social Care Bill without seeing the NHS reform Risk Register
(d) calls upon the RCR to publicly call for withdrawal of the Health and Social Care Bill;
(e) calls upon the RCR to seek an alliance with the BMA, RCN, RCM and other willing Royal Colleges and NHS stakeholder organisations to collectively call for the withdrawal of the Health and Social Care Bill.

(f) calls upon the RCR to hold a joint press conference with the BMA and other willing Royal Colleges and NHS stakeholder organisations, to make a joint public statement calling for the bill to be withdrawn

Speech

"I would like to thank Council and the President for calling this important meeting

I am co-chair of the NHS Consultants’ Association, a member of BMA Council and the Political Board.

This is not a party political issue. I campaigned against New Labour’s market based NHS reforms because I believe that a publicly funded, publicly provided, and publically accountable NHS is the most cost effective and equitable way of delivering healthcare to our population.

This is about defending the NHS from increasing marketisation and privatisation, which will inevitably undermine the founding principles of the NHS, leading to increasing healthcare inequalities, reduced access to care, increased healthcare expenditure, and the undermining of medical professionalism and the doctor-patient relationship

I don’t accept and I don’t think anyone accepts the status quo. I think we all realise that the NHS has problems and we would all agree that the NHS needs to continuously adapt, change and improve to meet the current and future health needs of the nation. But this has always been the case and will continue to be so. It is part of the duty of being a doctor.

However, we will hear today why the Health and Social Care Bill is not the answer to the problems of the NHS and will in fact make things worse not better. We’ll also hear why the case for such a radical change to the NHS has not been made.

Not only is the bill 3 times longer than the original bill and littered with 100s of new amendments, there is widespread recognition that something is deeply wrong with this bill. The level of opposition is unprecedented and ranges from the usual suspects of the unions, right through to members of the Cabinet of the Government. There are at least 23 professional groups in opposition including frontline staff as well as NHS managers. The highly critical joint editorial from the BMJ, HSJ and Nursing Times was a watershed moment.

Surveys of the RCGP have shown that the vast majority want the bill withdrawn.

Clare Gerada has stated:

“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”

Professor Lyndsey Davies, Chair of the UK FPH, which has just publicly called for withdrawal of the bill, has stated that: “the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”

There is also great confusion about what the bill actually means. Hamish Meldrum said it was “Hopelessly complex”. The new Chair of the NHSCB, Professor Malcolm Grant, who is a lawyer, said it was “unintelligible”.

However, experts in constitutional, public and commercial law, as well as health policy have written extensively about the bill and published their analyses in major medical journals to explain what the core underlying aim are.

There is little doubt that the intention of this bill is to denationalise the English NHS, by removing the duties and powers of the SoS of state to provide a comprehensive service.

Thus the crossbencher Lord Owen has called this the “Secratary of State abdication bill”. This explains the furore around Clause one and related clauses on the Secretary of State’s duties and powers. This is a red line he will not give up. Why not return it to the original 2006 Act wording?

In addition the bill abolishes the previous planning structures of the NHS, with creation of a regulated external market in healthcare, with public provision of healthcare increasing being replaced by private provision (through the AQP policy), driven by a competitive market. 

The Public Interest lawyer, Peter Roderick has stated:

 “The fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill.”

He goes on to state that:

“a direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided."

The number of services provided by the NHS will decline over the next few years and increasing numbers of patients will take out health insurance to widen their coverage. This process will be catalysed by the QIPP efficiency drive as services start to fail and CCGs come under enormous pressure to reduce costs. This will then place enormous financial pressure on FTs, which will need to treat increasing proportions of private patients to stay afloat. This is why Priavte Patient cap is being uplifted to 49%.

Over a 5-10 year period we will see the NHS transform in to a mixed funding system

This will all have detrimental effects on professionalism and professional standards

Markets fundamentally undermine professionalism.

The relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend.

This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. So it also strikes at the heart of this College. As Professor Kenneth Arrow recently stated about markets in healthcare “one problem we have now, is an erosion of professional standards”

It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s

Doctors intrinsically want to work collaboratively. A MORI survey of doctors showed that competition was the biggest problem they had with the reforms.

This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: “the first guiding principle is this: maximise competition…... which is the primary objective”

Another issue is that clinical leadership and clinical followership are crucial to successful healthcare reform. Mr Lansley has lost the healthcare professions. The reforms are doomed to failure

The Colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market based policies. MMC utilised a competency based tick box approach to training and it is important to note that Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. However, the professional skills of doctors are much more based on tactic and experiential knowledge.

Sir John Tooke’s report on MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence35. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB:

“… are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”

I will leave you with a quote from Arnold Relman, Emeritus Professor of Medicine of Harvard Medical School, and former editor of the New England Journal of Medicine:

“Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.”

.

In summary,

This bill is flawed. It lacks a democratic mandate. The case for such radical change has not been made. NHS productivity is increasing and patient satisfaction is at the highest levels ever recorded. Bureaucracy will be increased, not decreased. The bill lacks professional and public support (YouGov poll). We haven’t seen the risk register. It is unamendable due to the mutually reinforcing nature of the market policies, which are therefore the Coalition’s red line in the sands.

Costs will go up and not down. The service will be fragmented and the transactional nature of the new healthcare market will undermine medical professionalism and the doctor patient relationship.

The latest amendments do little address the fundamental underlying structural changes of the bill that will undermine the NHS

For these reasons, the College should continue to oppose the bill, but more that that the college should join with other professional organisations and call for withdrawal of the bill 

The fellows are ready to get behind the College to back them every step of the way. Please vote for the motion in all it parts to protect the NHS and the future interests of our fellows."