THE British Medical Association’s Annual Representative Meeting (BMA’s ARM), June 2006 turned into a struggle between the leadership, which supports the government’s privatisation reforms, and the representatives who were opposed to them.
On the one side were martialed all the evasive arguments and double-meaning double-talk of the BMA hierarchy plus its bureaucratic ‘machine’.
On the other, were representatives, including new medical students worried about their student debts and careers, junior doctors angry about the loss of their hospital training posts, SAS doctors and consultants starting to face redundancies and GPs concerned about being pushed out by health centres owned by multinational companies.
This concern was reflected in the six-fold increase in the number of resolutions on health service reform, up from 25 in 2005 to 156 in 2006.
They were mainly opposed to the privatisation reforms and addressed issues such as funding cuts, ISTCs (Independent Sector Treatment Centres), private provision, healthcare outside hospitals, payments by results, practice based commissioning, ‘patient choice’, targets and disrespect for professionals.
The leadership circulated its policy in advance of the ARM, in BMA Chairman James Johnson’s 10 points, the Chairman’s letter and HPERU documents.
On day one, Monday June 26, the meeting expressed its view that the NHS be defended as a publicly provided service and that privatisation reforms should be stopped, in three clear motions.
Motion 19 ‘That this meeting believes that the National Health Service can and should be
(i) free at the point of use
(ii) ethically rationed by clinical priority without discriminatory values
(iii) equitably resourced.
(iv) funded out of general taxation,’ was successfully moved by Dr Robin Arnold.
The rider, ‘(v) these fundamental values cannot be maintained if the NHS is broken up and tendered to private corporations’, was moved with his agreement by Mrs Anna Athow and again overwhelmingly passed.
The rider was important, as it made the motion consistent. The NHS can only function as an integrated whole as long as funding and provision are essentially public.
Had it been left with just the four points, it would have been possible for the leadership to argue that all of these conditions can be fulfilled with the NHS delivered by private corporations, such as ISTCs.
Indeed the platform spent the rest of the week trying to lose the rider.
Motion162 from Islington Division.
‘That this meeting believes that the current BMA leadership has failed patients, the profession and the country by their failure to actively oppose the current wave of organisation and financial reforms, which are destabilising the NHS. This meeting believes that the current policy of exposure of policy defects is not powerful enough and insists that it is replaced by a policy of active opposition and proper scrutiny.’
This was passed 58 per cent for, 42 per cent against.
Motion183 part (i) mandated the BMA to affirm and support the aims and principles of the campaign group ‘Keep our NHS public’, proposed by Ms Wendy Savage and seconded by Dr Jacky Davis. It was carried.
However, the ARM voted against affiliation to the campaign.
‘Open debates’ then followed for 2 hours. In these, representatives could speak for two minutes to any of the motions in the boxes (56 in Box 1, 42 in Box 2, etc.) Individual topics were not focussed upon, with speakers for and against, and there was no voting. Conference was therefore unable to decide on important issues.
Representatives were told that a panel would derive new motions from what had been said. In fact, it was a device to move from the representative’s agenda as stated in their motions, to that of the leadership as articulated in their policy statements.
The representative were presented with a White Paper on BMA policy reform on Tuesday June 27, at 5pm.
It consisted of a preamble offering to help with the reforms, written to sound radical.
There followed:
OD1, a motion on actions the BMA could take,
OD2, to ‘receive’ motion 19, stripped of its rider,
OD3, a new motion that the BMA take a strategic view of the role of the commercial sector in providing healthcare to NHS patients,
OD4, 32 mini-resolutions, which on examination, emanated from James Johnson’s 10 points and the HPERU document.
With little time to take these in and develop amendments and formulate a response, the bemused representatives left for the night, not before some had vigorously protested the loss of the rider.
At 10.55 am Wednesday June 28, a new policy statement on health reform on pink paper was circulated.
The rider to motion 19 had been restored, but the mini-resolutions had increased to 46, and their lettering and order had been changed.
At 11am an extraordinary ‘debate’ took place, with no standing orders, the Chairman making up the rules as he went along!
OD1, now contained nine proposals for action. The chairman called leading BMA members to speak, who concentrated on damning (viii) and (ix) the only two proposals calling for any physical action.
The procedure was so unfair, that he had to allow the proposer, Mrs Anna Athow to speak for ‘(viii) Organise a day of action to demand restoration of NHS funding and an end to privatisation and job cuts’, and ‘(ix) Call on other health service unions and patients for support and calls on TUC affiliated unions to take supportive industrial action on that day.’
A substantial minority voted for these proposals.
Dr Ellie O’Sullivan then criticised the preamble as not compatible with the motions passed on Monday. She proposed an ‘Alternative Mission Statement – The profession is dismayed by the incoherence of government policies and the damage it has caused to the NHS and the delivery of patient care. The BMA actively opposes the government plans and restates its belief in the core values of the NHS which are . . .’, then the five points of Motion 19, which included the rider.
This was carried.
OD3: Representatives voted that ‘there should be no more involvement of the commercial private sector’, and to ‘Campaign to restore an integrated publicly provided health service in England’ ‘to make clear that privatised services should be restored to public ownership’.
The Chairman called the 46 mini-resolutions, the BMA’s ‘shopping list’ for the meeting with Health Secretary Patricia Hewitt the following week and said they would be taken as a reference.
There was no time to discuss or vote on them or oppose the reference back.
Thursday June 29: A new green paper called ‘The final version of policy statement agreed by the RB on 28 June 2006’ appeared.
The ‘Alternative Mission Statement’ was fundamentally altered by chopping the second sentence in half.
‘The BMA actively opposes the government plans and restates its belief in the core values of the NHS.
‘The BMA believes that care should be Free at the point of delivery’, etc. and only four points as bullet points.
This formulation re-opened the door for the BMA to welcome private provided care as ‘care’ could be private care.
As for the rider it had become disconnected from the other four bullet points and lost in the plain text at the start of the next paragraph.
Representatives recognised the change and an emergency resolution moved by Dr Emma Bywaters was passed, calling for the original wording of the Mission statement to be restored.
It also called for the 46 mini-resolutions which the green document reported had ‘commanded support’, to be changed to ‘were mentioned’.
BMA News on July 1 and the BMA website carry the discredited wording of the green paper.
The manipulation and constant attempts by the leadership to foist its policy positions on the representatives was challenged, fought off and defeated through the resolutions passed on Day one and Day three. This struggle is even partly reflected in distorted form in the final policy statement.
It is clear that the pitched battle at the 2006 ARM is the beginning of a momentous struggle in the BMA and throughout the broader trade union movement, for a new leadership and a real struggle to defend the NHS, and stop its privatisation by bringing down the Blair government and going forward to a workers government.
