The British Medical Association (BMA) Consultants Conference on Wednesday voted to oppose government targets, NHS privatisation and to promote district general hospitals.
Delegates at the conference in central London first voted overwhelmingly for Motion 5, on government targets and waiting times, from the Conference Agenda Committee.
This stated: ‘That this conference: (i) believes that widespread use of centrally imposed and clinically inappropriate targets has many unintended consequences, distorts clinical priorities and harms patients,
‘(ii) calls for NHS organisations to be driven by excellence in patient care, led by patients and doctors.’
Mover Dr Stephen Austin stressed that ‘patients are not all identical’.
He said that ‘central targets are not as simple as government would lead us to believe’.
He warned that targets for new patients often meant that existing patients ‘are not seen again’.
He insisted that ‘targets should only be used when they benefit patients, not politicians’.
Delegates went on to vote overwhelmingly for Motion 9 ‘Marketisation and Plurality of Providers’, also from the Conference Agenda Committee.
It stated that: ‘(i) the government’s costly experiment of “part privatising” the NHS by introducing private providers, a multi-provided environment, PBR, ISTCs, PFIs etc has caused the fragmentation of services and a large burden of debt within the NHS,
‘(ii) such fragmentation seriously undermines the ability to provide a high-quality full emergency 24-hour service,
‘(iii) a thorough and honest evaluation of the effectiveness of previous private sector involvement in the NHS should be undertaken,
‘(iv) the BMA should insist that the government halts the further roll out of these NHS privatisation initiatives to allow a period of consolidation, readjustment and stability in the health service; and,
‘(v) the BMA should continue in its efforts to halt this deteriorating situation.’
Mover Mr Ian McNab said: ‘In recent years, the NHS has been served an increasingly “toxic cocktail” of marketising reforms’.
He insisted that ‘we must call a halt to the further role of privatising initiatives’.
He called on delegates to support the BMA’s ‘Look After Our NHS’ campaign ‘aimed at restoring the NHS to a public service working co-operatively for patients and not a market of “commercial businesses” competing with each other’.
Delegates followed this by voting for Motion 19 from North West London Region opposing PFI.
This stated that: ‘the Private Finance Initiative for building hospitals has been demonstrably poor value for money; and,
‘(ii) the recent announcement that the Treasury will lend private companies the money for PFI projects makes a mockery of the whole initiative and is throwing good taxpayers’ money after bad
‘(iii) this method of financing new hospital buildings must be stopped.’
Mover Dr Anne Thorpe said that ‘the private consortia bidding for PFI projects are now finding it hard to raise the funds.
‘So in order to prop up this flawed system the government has decided to step in and lend them large sums of taxpayers’ money.’
She added that ‘this new manoeuvre means that public funds are being used to enable private companies to make a profit out of PFI projects, without the risk being transferred from us to them’.
She concluded: ‘It is time to unplug the ventilator and accept that building and maintaining hospitals is a core public function that should be publicly funded.’
Successful Motion 63 from the Conference Agenda Committee stated: ‘That this conference believes that the “minimum core services local hospital” (as in Healthcare for London’s “A local hospital model for London) would be clinically dangerous, because:
‘(i) a hospital without ITU and without on-site emergency surgery at night is not a safe place to accept an undifferentiated emergency to take through A&E
‘(ii) there will be an increased need for seriously ill patients to be intubated and transferred across London.
‘This meeting calls on CCSC (Central Consultants and Specialists Committee) to oppose the introduction of such hospitals and to promote the district general hospital model.’
Mover Mrs Anna Athow said that the planned model would mean: ‘The hard pressed A&E consultant, or acute physician, or junior surgeon, if there were one, would have to take responsibility for patients with acute abdominal pain or surgical other conditions.
‘They would be hard pressed as there would be few junior doctors doing work, we are told.’
She asked: ‘There would be obstetrics but no in-patient paediatrics, so who would resuscitate the sick newborn baby?’
She warned: ‘Sick patients would have to travel further to reach a hospital providing full acute services.’
Athow added that under the Darzi plan: ‘All high-volume, low-risk procedures must be removed into polyclinics and elective centres which will leave the local hospital financially unviable and dependent on what it calls “partnerships” and “joint ventures”.
‘It would appear that the rationale for these changes is not about improving healthcare but the implementation of an arbitrary plan, which sounds rather friendly to the commercial private sector.
‘There have been many years of experience with the District General Hospital.
‘The DGH contains all the main specialities on site, medicine, surgery, obs and gynae, paediatrics, A&E, anaesthetics, intensive care, diagnostic imaging and pathology.
‘This model ensures a high concentration of consultant- led services on site so that every aspect of acute care can be treated in an emergency with only a small minority of patients being sent to a tertiary centre.
‘I suggest that CCSC should defend and promote the District General Hospital as the safe model.
‘We should not bow down to the prevailing propaganda from the government, and point out that the local hospital model is not safe and we should oppose it.’
Retiring Consultants Committee Chairman Dr Johathan Fielden intervened in the debate.
He said that the motion’s ‘sentiments are clear’ but ‘there are difficulties’ as the motion ‘says promote the DGH model, but we have to move on, we have to change’.
He said ‘we need to work on an alternative model’ and called for a reference back on calling to promote the DGH model.
In reply, Athow repeated her insistence that the local hospital model is a dangerous one and that ‘the DGH is needed; all your expertise is there’.
Delegates carried the motion overwhelmingly.
In the afternoon, important issues relating to the government reforms came to the surface with the following motions passed.
Dr Anne Thorpe from the Pathology Subcommittee, moved motion 113, ‘that this conference believes that if the pathology services of NHS hospitals are privatised, the consultant pathologist should continue to be employed by the NHS.
‘This will safeguard their impartiality as advocate for patients and defend clinical quality.’ She feared that this would not be possible if they were employed by a private company.
Dr Elizabeth North from South London Regional Consultants and Specialists Committee (RCSC), explained to conference how endoscopy follow-up services had simply been removed from her hospital to the private sector, with no consultation with clinicians on the ground.
She moved motion 126 ‘that visible relevant senior clinical input should be a core component of commissioning’.
Motion 131 condemning payment by results the tariff system of payment for health procedures which has been introduced in England for surgery and many other aspects of care, came from the Northern Ireland Consultants Committee.
It stated: ‘That this conference believes that due to the fundamental flaws in the Payments by Results system in England with its adverse effects on patient care and the stability of secondary care services in hospitals and due to the small size of Northern Ireland, a Payments by Results or similar system must not be introduced in Northern Ireland.’
Mr Hamish Brown moved a motion from the W Midlands, that the ‘concept of a secure and confidential national Electronic Patient Record is an expensive and unachievable fantasy’.
He made the point that such a national record could never be confidential as it was so easily accessible by many different staff. He was in favour of a local electronic patient records which could be more secure.
The push by the department of health to incentivise GPs not to refer patients to hospital, was condemned in motion 141 from NW London RCSC.
It stated: ‘This conference believes that financial incentive schemes to dissuade GPs from referring patients to hospital for consultant consultation are unethical and will undermine patients’ trust in the NHS. The BMA should oppose the introduction of such schemes.’
The day ended with chosen motions. These are prioritised by the membership on the day of the conference.
Motion 36 from Mersey RCSC called for ‘recognition that training will need to be redesigned’ due to the impact of European Working Time Directive and suggested such measures as ‘flexibility with regard to length of training’.
Motion 97 from CCSC Surgical Specialist Committee, stated: ‘That this conference deplores the awful care for some patients at Stafford hospital and recognises that management was forced to prioritise financial considerations in order to become a Foundation Trust business.
‘We call on CCSC to campaign to restore hospitals to their original purpose of providing for the clinical needs of the patients in their catchment areas’ was moved by Mrs Anna Athow.
She said: ‘To make £10m savings, the board closed 100 beds and cut 150 nurses and doctors posts.
‘This had a direct effect on the quality of care provided.’
Athow added: ‘The legal remit of foundation trusts is primarily a financial one, to break even or make a surplus.
‘To do this they must select service lines which make a surplus at tariff.
‘They are different to the original NHS trusts which were given block funding to care for the clinical needs of the patients in their catchment area.’
She stressed: ‘The main job of an NHS hospital is to provide good care for patients as part of a public service.
‘It should not be about putting finances first and patients second.
‘It should not be about making money for competing businesses, which is what the BMA’s campaign to defend the NHS is all about.’
