THE British Medical Association’s (BMA) Annual Representative Meeting (ARM), which opens in Torquay today, gathers at a time of unprecedented challenges for the medical profession.
As a result of government policies, the key architects of which are Prime Minister Tony Blair and Chancellor Gordon Brown, the historic independence of the medical profession and the National Health Service (NHS) are under attack.
The General Medical Council faces being changed from an organ of self-regulation of the medical profession and its practice, into a government body having control over doctors.
The role of the Royal Colleges, as the defenders of clinical standards and the quality of medical training, has been replaced by the government-appointed Postgraduate Medical Education and Training Board (PMETB).
This has led to a situation where, through Modernising Medical Careers (MMC), and the Medical Training and Application Service (MTAS), up to 18,000 junior doctors will have no training places this year, and will have difficulty finding posts and may well be driven out of the profession.
The Department of Health’s (DoH’s) plans to ‘reconfigure’ up to 60 District General Hospitals and the government’s reform programme of marketisation of the NHS and privatisation is leading to huge job losses of healthcare staff and a deterioration in standards of care.
These are the challenges facing the BMA, the doctors’ trade union.
Last year, at the ARM the representatives voted for a set of guiding principles for the leadership to follow to defend the interests of the profession, the NHS and patient care.
This included the policy statement that: ‘The Representative Body of the British Medical Association is dismayed by the incoherence of current government policies and the damage they have 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.
‘The BMA believes that care should be:
‘• Free at the point of delivery
‘• Ethically rationed by clinical priority without discriminatory values
‘• Equitably resourced
‘• Funded out of general taxation
‘These fundamental values cannot be maintained if the NHS is broken up and tendered to private corporations . . .
‘There should be no further involvement of the commercial private sector in providing NHS care.
‘The BMA will campaign to restore an integrated publicly-provided health service in England . . .
‘The BMA will now . . .
‘• Explore and publish options for a publicly-owned English health service run without a purchaser/provider split.’
This year the ARM must examine how the BMA leadership has measured up to the task of implementing these principles.
It is clear from the experience of the past year and from the motions selected for this year’s ARM, that there have been positive and negative results.
There is an important resolution calling for the medical profession to reassert professional leadership in the interests of patients and the public because ‘recent government policies have resulted in “reforms” and proposals that are not fit for purpose and are damaging to medicine and healthcare in the UK’.
In the section on Commissioning, Motion NHS 19 states ‘that the private sector should have no role in the commissioning of public services’.
Motion 36 ‘supports the provision of fully functioning comprehensive acute district general hospitals with properly supported A&E (Accident and Emergency) services’.
Motion 64 and that from Bristol (Motion NHS 32) raises the issue of abandoning the purchaser/provider split.
The latter calls on the BMA to adopt a policy which ensures that the NHS is ‘a single organisation managed without a purchaser/provider split’.
Demand management and referral management schemes are deplored in Motion 66 because they are ‘used to ration secondary care and divert patients towards ISTCs, polyclinics and ICATs’.
Motion 92 opposes PFI and calls on the government to ‘put a halt to any further PFI schemes’.
However, in what has been a historic year for the BMA, the majority of the BMA leadership has been found wanting in standing up for the interests of the profession and defending the NHS against cuts and privatisation.
Its biggest betrayal has been that carried out against its junior doctor membership, through collaboration with the MMC/MTAS process.
As a result of this the BMA Chairman James Johnson was forced to resign.
Concern at the failure of the BMA leadership is expressed in a motion from Birmingham (Motion 504) which states: ‘That this Meeting believes that the leadership of the BMA has failed to present a suitably robust challenge to the destabilising effects of government reforms of the NHS’.
In fact, a sub-committee of BMA Council has produced a so-called Green Paper, A Rational Way Forward for the NHS in England, which rather than carry forward the principles of the 2006 ARM policy statement, embraces large parts of the government’s reform agenda.
Aspects of some BMA leaders’ acceptance of reconfiguration cuts and privatisation are expressed in a number of motions.
A motion from the consultants Emergency Medicine Sub-Committee (Motion 35) believes that ‘a measure of clinically-led reconfiguration of acute services is important to improve patient care’.
This gives a respectable cover for the real reason that the government is reconfiguring services which is political and has everything to do with transferring funding to PFI hospitals and privatised facilities.
Motion 43 on the use of the private sector demands that NHS care should only be purchased from for-profit organisations if eight conditions are met.
This is an acceptance of privatised provision and does not oppose it in principle.
There is also a dangerous motion from the Junior Doctors Forum which calls on the BMA to campaign for a board that would ‘define evidence-based minimum clinical needs’ and ‘a nationally accepted minimal provision of care’. (Motion 67)
This is a concept alien to the NHS, which has always sought to provide the highest quality care and it prepares the ground for rationing. (Motion 72)
The motion on rationing calls for minimum basic healthcare needs, with the implication that anything over and above the minimum would not be provided by the NHS.
A motion on Payments by Results from Edgware and Hendon Division (Motion 88) is equivocal.
It calls for equity in procurement from public and private sectors.
This is, in essence, an acceptance of the private sector in the NHS and does not oppose Payments by Results.
It is clear that the BMA has to take the lead in restoring professional control of medical education training and selection, and medical regulation.
It needs to develop a consistent policy of defence of the NHS as a publicly funded, owned and provided service.
This is the only way that the jobs and future of its members can be assured and high standards of patient care can be maintained.
The relationship with other health service unions and the TUC in NHSTogether needs to be developed to ensure that there is action, including industrial action, to fulfil these aims.
For this the BMA needs a leadership that will take up the fight against ‘the destabilising effects of government reforms of the NHS’, scrap them, oppose NHS privatisation all down the line, and campaign for a workers’ government that will carry out socialist policies, in place of the Brown government.