THE British Medical Association (BMA) leadership had a plan for the 2007 Annual Representative Meeting (ARM) in Torquay last week.
They wanted to push through acceptance of the government’s privatisation agenda, which they had failed to manage at the 2006 ARM.
There was however a battle at the conference with the leadership suffering a series of important defeats from representatives who were prepared to defend the NHS.
A special committee of the BMA Council, produced ‘A Rational Way Forward for the NHS in England’ as a vision for the NHS.
This recommended the acceptance of the market reforms to date, and also proposed more.
They planned that the first day of the ARM would be used to drive through the main points of this report in separate motions.
They managed to get the following voted through:
Motion 25 which called for ‘core values of an integrated health service’.
A ‘patient charter’ that focussed on an ‘individual’s responsibility’ and a call for ‘National Clinical Standards for quality’ to underpin ‘local management and provision of services.’ They need the latter as they favour commissioning from the private sector locally whose standards leave much to be desired.
Motion NHS4 called for an ‘independent board of Governors for the NHS,’
A Motion 35 on ‘Reconfiguration’ said: ‘that a measure of clinically-led reconfiguration of acute services is important to improve patient care’ and then went on to call for ‘safe minimal level of services’.
However, a motion with an opposite meaning, Motion 36, was also passed.
This supported ‘the provision of fully functioning comprehensive acute district general hospitals with properly supported A&E services’ and demanded ‘that the BMA vigorously oppose money saving schemes to close A&E departments or reduce their acute services backup.’
It also insisted that ‘the BMA adopt a policy of opposition to reconfiguration, if not supported by doctors and patients.’
Motion 43 on the use of the independent sector demanded ‘that NHS care should only be purchased from for profit organisation if,’ and listed eight little clauses.
This is a move backwards from last year’s policy statement which said: ‘There should be no further involvement of the commercial private sector in providing NHS care.’
Motion 72 on ‘Rationing’ was passed, and called for ‘the BMA to lobby for the development of evidence and value-based minimum basic healthcare needs’ and that ‘healthcare resources should follow national set policies, and not be decided on a case by case basis.’
However, an opposite motion by East Kent division was also passed calling that ‘the NHS should provide a comprehensive range of services setting priorities based on need and clinical effectiveness.’
Motion 73, said ‘that consultants and GPs should be incentivised to jointly develop care pathways to promote effective practice based commissioning.’
Successful Motion 77 on ‘NHS Funding’ called for ‘trusts and commissioners to be allowed to work to longer meaningful financial timescales’, meaning greater than one year. The private sector has been calling for this.
Motion NHS 51, welcomed the report A Rational Way Forward for the NHS in England, with caveats.
ARM Chairman Michael Wilks dumped Motion 92 which called for a halt to PFI schemes.
But there were also important votes against privatisation.
Motion NHS19 declared: ‘that the private sector should have no role in the commissioning of public services.’
Motion 65 called for ‘the abandonment of the purchaser-provider split in England as it has been in Scotland’.
And Motion NHS 32 called for ‘an alternative vision of the NHS as a single organisation managed without a purchaser/provider split be made a prominent part of the final document’.
On Payments by Results (PBR), Motion 89 was amended on Monday to call for the BMA to continue to oppose PBR, but was driven back by an onslaught by Dr Miller, past Chairman of CCSC, who launched a diatribe against block finding.
But on Thursday, Motion 90 was amended and discussed as a chosen motion.
This said: ‘That PBR is a payment tool facilitating a health policy of fragmenting care into saleable bits on which a profit can be made.
‘It disadvantages NHS units providing complex and comprehensive care. This meeting calls on the BMA to oppose PBR.’
Dr Jacky Davis moved it, Dr Jonathan Fielden opposed and Mrs Anna Athow seconded it.
The motion was passed overwhelmingly.
On Tuesday, the disaster of the Medical Training and Assessment Services (MTAS) and Modernising Medical Careers (MMC) was debated.
Jo Hilborne, Chairman of the Junior Doctor Committee (JDC) blamed the colleges, the deaneries and the government and ended her speech appealing to Gordon Brown to listen to the BMA.
But the membership were critical of the BMA leadership. There was a 29-per-cent vote for resolution 595 from Birmingham, that stated: ‘In the light of their failure to honour the commitment given to JDC, not to oppose legal action by RemedyUK, this meeting calls for the resignation of the chair and deputy chair of the UK JDC.’
There was also a sub-section added to motion 255 on MTAS, which demanded the resignation of the Chairman and the Deputy Chairman of BMA Council.
The junior doctor proposing this said: ‘We have had a good cause since 2004.
‘Who has been uniting us in this time? What have we achieved? We needed strong leadership from the top . . .’
Motion 287 called for a fundamental review of the principles of MMC and opposed the move to create a sub-consultant grade.
On Wednesday, MTAS/MMC came up again in Motion 393 which said: ‘This Meeting applauds the demonstration of 12,000 doctors and their supporters on March 17, in defence of their jobs.
It called ‘for the BMA to mobilise the whole of its strength, and take industrial action to stop the redundancy of its members.’
Mrs Anna Athow said that ‘the BMA leadership sold out the juniors’ and we have to make sure that there are no more sell-outs.
She called for BMA support for a campaign to keep our district general hospitals open and appropriate industrial action with other trade unions to secure this.
A large minority voted in favour.
The Junior Members Forum actively opposed the Alternative Provider Medical Services contract for GPs in Motion 442.
GPs in the scheme ‘cannot join NHS pension schemes . . . We don’t want to work for Virgin, or Netcare and make profit for the shareholders’. Sixty five per cent voted for.
On mental health, motion 462 was unanimously passed. This called on MPs to ‘support amendments aimed at limiting the powers to the treatment of the mentally ill, who will benefit from such treatment.’
Robin Arnold proposing, said: ‘We don’t want psychiatry to be a social policeman . . . It could be used as a means of social control.’
Reports from Scotland and Wales made clear that most privatisation reforms were not in place there and that ‘supported properly the NHS can deliver’.
On Thursday, the ARM voted not to pay for the government’s revised General Medical Council, which would end professional self regulation.
On Monday morning, the ARM voted ‘no confidence in the Chief Medical Officer (CMO) for England’ and called ‘for his immediate resignation.’
The main reason for this vote were the CMO’s role in pushing through the MTAS/MMC disaster and the proposals to end professional self-regulation.
The ARM was not happy with its new leader being elected by Council only and passed an emergency motion that the franchise be widened, and that this be discussed at next year’s ARM.
It is clear that the vast majority of doctors attending the BMA ARM are opposed to hospital closures, through ‘re-configuration’ and the operation of a market in the NHS.
The WRP and its trade union arm the All Trades Union Alliance must organise them and mobilise them in the year ahead.
