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Central Consultants & Specialists Committee Annual Report 2007

11 June 2007

Chairman's Message
As I write my first annual report, both the British political landscape and the medico-political landscape are in a state of major flux: first, the Government confirms a change in Prime Minister then our own Chairman of Council resigns. This means new beginnings and opportunities to take new directions. Consultants are innovators and leaders in the health service, and so we must grasp those opportunities and lead those new directions. The value we all add to patient care is one of our strongest cards and the time has come to play that card much more forcefully.

The theme running through the past year has been the fight to regain control: control of training, of reconfiguration, of the health agenda in general. We have had to remain aware of this bigger picture while addressing the many incoherent strands of government policy. There is a fine line between active engagement with the Government and other stakeholders on the one hand and remaining in touch with the needs and wants of our members on the other. I walk that line with care with the help of my deputies and committee members but always guided by the needs of the wider membership. It is only by maintaining our active involvement with you and you with us, that we can retain political influence while using it to remain effective and relevant to you.

For many consultants, unemployment and hospital reconfiguration have loomed large as significant threats to their professional lives. This has undermined their morale, their belief in the NHS and their trust in the Government. We have actively opposed any reconfiguration undertaken solely on the basis of finance. Our case has not been one of static, stubborn opposition, rather a more carefully–crafted, evidence-based approach: yes, some service redesign is important, but it must be led by doctors (particularly consultants) with and on behalf of patients. Our principles, laid out later in this report, are being pushed in many areas of the country, stopping some poorly planned reconfigurations and supporting others where clinicians and managers are in agreement on what must drive service change. These principles were also mirrored by Sir Ian Carruthers in his review of service change and should now be the guidelines for future service change.

Trusts in the North West and Manchester in particular found themselves at the frontline of the reform programme and their futures cast into doubt as proposals for CATS (Capture, Assess Treat, Support) and ICATs (Integrated Care Assessment and Treatment services) schemes were introduced, with little if any real consultation. Sterling local work in opposing the follies of these schemes by Alan Russell (CCSC deputy Chairman for Policy), JS Bamrah (Chairman of the CCSC Psychiatric subcommittee), North Western RCSC, BMA regional services and other unions raised the profile of this issue to national notice. The main lesson of the CATS/ICATS episode has been the need for us to improve and enhance dialogue with local GPs. It is by working together that we enhance our care for patients and improve our working lives.

The need to promote collaborative practice and coherent, integrated healthcare is most sharply highlighted by the development of Payment by Results. Our main attack on this aspect of the Government’s reform programme has been its cost and bureaucracy, the lack of clinical input and its inability to reflect the subtleties of specialist and longer-term care. The Lawlor Report, published in early 2006, backed many of these concerns. The future of PbR is now out for consultation and we will have a significant contribution to make to it.

Consultation itself has developed a bad name under this Government. It repeatedly pays lip service to the idea of consultation on its reforms only then to continue undeterred on its chosen course. Our forceful but logical criticisms of the pace, desirability and evidence-base for these reforms have received significant coverage, much greater than any other union or similar body. Our key criticisms have gained support: PbR, inability of PBC to cope with the perversions of PbR, the long-term detriment of PFI to the health service, the lack of benefit of ISTCs, patient choice being little more than a political sound bite and not actually what patients want. This is a start but we need to step up our criticisms of Government policy unless there is a meaningful change of direction soon.

To be heard and to exert influence we needed to move from the easy ground of criticism to the much harder path of solutions. The publication of the BMA’s “A rational way forward for the NHS in England: a discussion paper outlining an alternative approach to health reform” is a good start. It builds a strong case for returning healthcare to professional leadership in partnership with patients. We need to eliminate political interference by boosting the service’s independence and having an honest debate about what the NHS can and should provide; care that is universal, broadly comprehensive, free at the point of use and funded from general taxation. As this Government claims to listen to the profession we must now make it act on this agenda.

Listening is pointless unless it evolves into meaningful action. We have been deeply involved in trying to sort out the debacle of MTAS, defining the optimum number of training posts for the future and wresting back control of MMC. The original high principles of MMC have been compromised on far too many fronts. My aim throughout this process has been to support the JDC to get the best practical deal for their members in dreadful circumstances, whilst protecting the additional burdens for consultants. We must protect and support our trainees within the limits of what consultants can deliver and, most importantly, what is safe for patients now and in the future. As I write we are escalating our demands to minimise further damage and obtain more resources. We are also building our case for redesigning the future of training and working closely with the JDC and others to deliver the necessary improvements. This time it must be professionally-led.

Professional leadership is also required to take the green-tinged white paper “Trust Assurance and Safety: the regulation of healthcare professionals” and deliver what it is supposed to do. There is a danger that this could end up buried under a burden of restrictive bureaucracy and fear. We have many tools in place that can and should, with the necessary changes, deliver revalidation a fair and acceptable revalidation process to all.

As this report outlines, there are a challenging array of issues facing the CCSC which it must address if it is to truly represent the profession. While the Government persists in pushing the market model of health care we must do all we can to demonstrate the difficulties and dangers of this approach while at the same time giving you the tools to help you provide the best quality care for your patients.

Consultants add value to the health service way in excess of the remuneration the new contract gives them. Despite the climate of uncertainty and the distraction of constant change, their professionalism still leads them and the service to provide excellence in health care and this deserves due reward. I am determined to press home how valuable that professionalism is to all who will listen (and even those who won’t) and that message is reinforced by a unified profession demonstrating its value.

Your input to the CCSC’s work, be it an occasional email, an impassioned campaign or involvement with the committee, will help us to be representative, responsive and strong in this difficult time.

Follow this link, for information on how to get involved info@ccsc.bma.org.uk.