THE BMA doctors’ union secured a high court victory on Friday over controversial changes made by the Tory secretary of state for health and social care to the NHS Pensions scheme in England and Wales.
In April 2019 the health secretary amended NHS pension rules in England and Wales, giving himself the power to suspend payment of pensions benefits to any doctor or NHS professional who had been charged with certain criminal offences, but not yet convicted.
Most, if not all, public sector pension schemes contain provisions for the suspension of a person’s benefits, but only after the point of conviction. Yet, if the changes were to be allowed to subsist, NHS professionals would be the only public sector workers to have the threat of forfeiture of their pension hanging over them at any time from charge.
However, in a judgment handed down last Friday, the high court agreed with the BMA’s argument that the new regulations breached Article 6 (right to a fair trial), Article 14 (protection from discrimination) and Article 1, Protocol 1 (right to peaceful enjoyment of property) of the European Convention on Human Rights and also breached the Public Sector Equality Duty under the Equality Act (in failing to have regard to the equality implications of the changes).
Handing down her judgment following a judicial review brought by the BMA against the secretary of state, Justice Andrews wrote that no explanation had been given ‘to how the scope of the power to suspend (and, indirectly, the power to forfeit) came to be expanded to cover the period between charge and conviction, or what the thinking was behind it’.
She added that the government had failed to draw a distinction between someone charged with a crime and someone convicted of a crime, despite the fundamental principle in law being that ‘every defendant to a criminal charge, however serious, and however compelling the evidence against him may appear, is presumed innocent until proved guilty to the criminal standard’.
Commenting, BMA council chair Chaand Nagpaul said: ‘Today’s judgment is a victory for natural justice for our members and for all NHS professionals across England and Wales who could have been unlawfully deprived of their pensions benefits had these rules remained in place.
‘We could not allow the government to simply disregard the fundamental principle that a person charged with a crime is presumed innocent until proven guilty. These rules assume guilt from the outset with little regard for the impact on a doctor’s well-being, career or personal life.
‘From the evidence presented it is clear the government made no assessment, or worse just disregarded, the potential effect this rule change would have on those who are retired and already drawing on their pensions and those who are older, ill or disabled.
‘We welcome today’s (Friday’s) judgment and on behalf of our members we are glad that these regulations, which should never had been approved in the first place, will now be struck from the statute book.’
Last Thursday, GP leaders voted to hold special London Medical Committees (LMC) conference after rejecting the new contract deal.
BMA member Anna Athow commented: ‘GPC, the General practitioners Committee in England, voted not to accept a contract agreement with NHSE, according to a BMA bulletin.
‘A motion was passed at GPC, for a Special Conference of English Local Medical Committees (LMCs) to debate and consider the outcome of contract negotiations.
‘It is not clear whether, this would be to consider the five year GP contract signed up to by the BMA GPC on 31. 1 2019, which agreed that GP practices should form up into Primary Care networks (PCNs), or whether this meeting is only to consider the new draft specifications for PCNs recently published on 23 December 2019.
‘Several LMCs have voiced their opposition to the proposed new requirements that they should perform fortnightly ward rounds in old people’s care homes, on top of their current workload, and have raised concerns about employing pharmacists and other paramedics to do general practice work.
‘The BMA GPC leaders sowed the seeds for this opposition by GPs, by preemptively signing a five-year framework for GP contract reform, to implement the NHS Long Term Plan on 31.1.2019, to coerce GP practices into large PCNs forming “the building blocks of Integrated Care Systems,” without a vote of the GP membership.
‘To date it seems that GPs have just woken up to the enormity of the extra workload being forced onto them.
‘However, they will have to learn fast, that ICSs are business structures based on the American model and all about making profit out of healthcare.
‘GPs should take this opportunity to refuse to sign up to another year of the Network Contract DES immediately and demand a vote to render the five-year framework agreement nul and void.’
- Almost half of hospitals have a shortage of specialist stroke consultants, new figures suggest. One charity fears ‘thousands of lives’ will be put at risk unless action is taken, with others facing the threat of a lifelong disability.
This is according to new figures from King’s College London’s 2018-19 Sentinel Stroke National Audit Programme report, 48% of hospitals in England, Wales and Northern Ireland have had at least one stroke consultant vacancy for the past 12 months or more.
This has risen from 40% in 2016 and 26% in 2014.
Even more alarmingly in a number of hospitals is the time it takes from the moment the stroke happens to the when the patient is treated has increased.
If a patient is treated within the hour after the stroke takes place, studies have shown that less damage is done to the brain and the patient has more chance of recovery.
However, there are huge pressures on the ambulance service as a direct result of Tory cuts, the massive staffing crisis in the NHS and the closure of A&Es up and down the country.
Of course when an A&E shuts, it put immense pressure on the next nearest A&E which takes longer to get to and is busier on arrival.
Patients who reach the hospital within one hour of symptoms receive a clot-busting drug twice as often as those arriving later. Researchers call the first hour of symptom onset ‘the golden hour’. The study reinforces the importance of reacting quickly to stroke symptoms because ‘time lost is brain lost’.
Separate research suggests there is a similar outlook in Scotland.
The Stroke Association charity, which analysed the data, says the UK is hurtling its way to a major stroke crisis, unless the issue is addressed.
Its head, Juliet Bouverie, is deeply concerned by the rate at which highly qualified stroke doctors are leaving the profession and the slow uptake of stroke medicine by new doctors.
She has called on the government and NHS England to ‘act now’ and make stroke medicine a more attractive proposition for junior doctors to specialise in, as well as training and developing other stroke professionals – such as specialist nurses and therapists.
The Sixth Sentinel Stroke National Audit Programme (SSNAP) Annual Report entitled: ‘Moving the Dial of Stroke Care’ states: ‘Most concerningly, there are still examples of stroke care where little or no progress has been made since 2013.
‘Prime amongst these is getting patients onto a specialist stroke unit within four hours of arrival at the hospital so that patients can receive expert multi-disciplinary care as soon as possible.
‘Stroke unit care remains the most widely applicable intervention that we have for reducing death and disability after stroke. Improving access to a stroke unit should be foremost in the minds of providers and planners.
‘It is a reasonable objective for acute sites to achieve 90% of their patients spending and 90% of their in-patient stay on a specialist stroke unit.
‘There are plenty of examples of centres where this has been consistently achieved despite the many other pressures on hospital capacity – centres where it is not should be learning from those who can.
‘Another concerning area is the lengthening of arrival times to hospital. The new SSNAP Ambulance Linkage Project will help to shine some light on variations in practice, where delays are occurring in the pre-hospital phase of care and what needs to be improved.
‘As regional reconfigurations and thrombectomy become increasingly important, so will the pre-hospital care of people with stroke. It is timely that this phase is now coming under scrutiny within the SSNAP audit.
‘Over the last 6 years door to needle times for thrombolysis have slowly improved.
‘This year is the first in which we have seen a slight increase in average door-to-needle times, and again there remains substantial variation between sites.
‘This increase may well be attributable to the greater use of CT angiography and other advanced imaging in the selection of treatment for people with ischaemic stroke. It may also be attributable to busier Emergency Departments.
‘Many patients are still left without specialist psychological support, which requires innovative thinking and investment to improve provision for people with a stroke.
‘A focus is required on assessments and outcomes six months after a stroke to highlight the needs of patients and their families and carers over the longer term.’