Increased competition in the NHS could jeopardise the quality of doctors’ training, the new leader of the UK’s 49,000 junior doctors warned on Thursday as the Blair government’s policy was defeated at the Labour Party conference.
Dr Jo Hilborne, who has been elected chairman of the BMA’s Junior Doctors Committee, expressed concerns that private companies running treatment centres will have no incentive to provide doctors with high quality training:
She said: ‘It’s not clear whether profit-making companies running treatment centres will provide training to the same standards as the NHS. Unless a mechanism is introduced to make training as important to private companies as it is to the NHS, standards are likely to drop. Junior doctors are already under pressure from changes to their working patterns and reforms to their training, and the move to private provision makes their future even more uncertain.
‘In an NHS based on competition, there will be winners and losers. How is a trainee surgeon supposed to learn how to do a hip replacement if their hospital has lost its contract to do them? Little thought seems to have been given to doctors’ training in a market-based NHS.’
Dr Jo Hilborne lives in Swansea and is currently practising as a specialist registrar in obstetrics and gynaecology at University Hospital Wales in Cardiff. She replaces Simon Eccles as chairman of the BMA’s Junior Doctors Committee.
The Blair government’s NHS privatisation policy was defeated by the trade unions on a card vote at the Labour Party’s Brighton conference.
The biggest public sector union, UNISON moved the successful resolution on Wednesday afternoon, demanding an end to the use of the private sector in the NHS Dave Prentis, general secretary, UNISON, told delegates: ‘Dave Prentis moving composite 6 and asking you to oppose composite 7 (the NEC motion backing continued ‘reform’) ‘And in moving this motion, I want to pay tribute to our public service workers. . . . Our people who through their union and their political party, have a right to have their say. Not denigrated as “a producer interest”.’
Attacking the ‘moderisers’ he added: ‘This composite isn’t about going back. Denying choice’
‘It’s about a government not consulting on fundamental change. Not talking. Not treating people with respect. Our primary care trusts. Brought in by our changemakers only three years ago. Brought in “to unleash the spirit of public sector enterprise to rival that of the private sector” – not my words, but those of Alan Milburn. PCTs – just bedding down, now booted out, told they can no longer provide services.
‘Managers who should be leading – the real changemakers – now fighting for their jobs. Health visitors, community midwives, occupational therapists, district nurses – the backbone of our local community services – threatened with transfer to the private sector. Left to the vagaries of the market.’
Prentis complained there was: ‘No debate. No discussion. No analysis. No mention of PCTs in the manifesto. Government by diktat. And conference, I’ll tell you this. It is simply not acceptable Composite 6 isn’t about returning us to the past. It’s about learning from the failed Tory policies of the past.’
Prentis said that in 1997, the Labour Party and the unions to save the NHS ‘the destructive forces of Tory competition’ from the ‘excesses of GP fundholding. Prentis reminded that the 1997 ‘manifesto promised “to end the NHS internal market. Restore the health service as a public service, working cooperatively for patients. Not a commercial business driven by competition”.’
Prentis added: ‘We’ve made the sacrifices. We’ve delivered real improvements. We’re up for it –18 major reorganisations in 18 years But now told from on high that the NHS would work better if fragmented. Hospitals competing for patients. And if an nhs hospital can’t compete, can’t win contacts, It will close.’
He insisted this was not ‘scaremongering’ but: ‘Our health secretary’s words only this summer. Telling the NHS confederation that if services aren’t attracting patients, then, yes, they may have to close.
Prentis warned now we face ‘an nhs driven not by patient need but by profitablity and markets.’
He questioned: ‘Is that really our vision? Only last year at our own policy forum at Warwick, agreed “not to see the introduction of destructive markets and competition into the NHS. As the Tories internal market demonstrated, setting hospital against hospital is not the way to improve the NHS”.
He concluded: ‘If you want to turn the public place into the market place. If you support a competitive health market where hospital competes against hospital, don’t support our composite – Vote for the other motion. If you have no concerns about the way thousands in primary care found out about the new direction – don’t support our composite, vote for the other motion.
‘If you’re prepared to risk your local NHS hospital – even your new pfI hospital –closing services because it has been destabilised by the market, don’t support our composite. But conference if you share our concerns. If you have any doubts Join us in voting for composite 6 Join us in voting for a review of the role of markets and competition in our health service – before there is any further expansion.
‘And to our government I say this: “Together we have transformed our health service. Secured real improvement. . .Work with us again. Have a proper review – Involve us – Before any further expansion. I can think of nothing more important. Nothing where the stakes are higher. The issue is too important not just for us, But for future generations.’
• The first evidence has emerged the day before Wednesday’s debate that the NHS deficits crisis is hitting senior doctor posts in England. The British Medical Association has highlighted the fact that one in four NHS trusts and strategic health authorities ran up a deficit last year, forcing half of trusts to consider recruitment freezes this financial year.
To date these have mainly been confined to nursing and administration posts. But Oxfordshire Mental Healthcare Trust announced on Tuesaday that it plans to cut seven consultant posts by March and seven junior doctor posts the following year. The Trust said it hoped to make savings by not filling empty posts, but it refused to rule out redundancies.
Meanwhile, one inpatient ward has already been closed, while out-of-hours and occupational therapy services are likely to be changed. The Trust has kept itself in the black for the last five years but has been ordered to make £5.9m of savings by the regional health authority to help reduce a the regional deficit.
Hospital trusts in several strategic health authorities across England have been asked to make ‘savings’ to help spread the burden of deficits. Julie Waldron, the Oxford trust’s chief executive, said officials had lobbied hard against cuts. She said: ‘We continue to believe that there is every need for more investment, not reductions, in mental health funding and we shall ask primary care trusts to reconsider their decision.’ She warned that the sale of the reduction meant ‘radical measures’ were needed.
A shocked deputy chairman of the British Medical Association’s consultants committee, Jonathan Fielden, said consultant post cuts have been unheard of for 20 years. He warned: ‘This is the culmination of what we have been saying for many months, the NHS is facing severe deficit problems and it will hit services.’
He said there needed to be a review of the impact the government’s new NHS funding system, payment by results, which comes into effect for most of the NHS next year.
