Speech by the Dr Jonathan Fielden, Chairman of the Central Consultants and Specialists Committee
Consultants Conference
6 June 2007
Madam Chairman, colleagues. It has been a great honour to lead and stand up for consultants at one of the most critical periods in the history of the NHS. To shoulder the significant workload I have had excellent support from my deputies, Mark, Alan and Ian, the executive and the whole of the CCSC – for your wise council I thank you. The job is undoable without the support of the secretariat ably led by John Maingay – my thanks to you, for your dedication and ability to respond to our demands. Thank you.
This conference comes at a pivotal time: the profession is angry. You have a right to be angry, a right to answers and solutions. The old regimen has squandered our faith. As Tony Blair hands over to Gordon Brown there is a chink of light, a chance to put forward how we wish to see the future. Tony may feel “it’s been the best year ever” but we know the reality. Its time we started talking and Gordon you started listening.
We have the answers, if you are prepared to hear them. We have the skills, if you are prepared to use them. We are up to the job, and will take the responsibility that comes with it. Not only making demands, but delivering the solutions – This is what we do. As consultants we must lead the fight to return the NHS to the people.
The profession is angry, it is angry with managers, with employers, with deaneries, but most of all we are ALL angry with the government for a woeful dereliction of duty, towards patients, towards the profession and towards the future.
But why? We have had unprecedented levels of funding; we are delivering significant improvements in care. We have hard earned and well deserved salaries with our new contract. Surely this should make us content – No! The profession is angry because of this government’s mis-handling of the health service, and, to be honest, has lost all confidence that the government can solve the problems it has created.
Our agenda today shows the targets of this anger, not irrational anger, but considered anger. By a profession held in the highest regard by patients and public alike, distraught at the mis-management of what was once the world’s best health service.
How is it that our once world beating service is now pitied by our neighbours? How is it that our medical training system once the envy of the world, is now in chaos? How is it that despite unprecedented increases in funding and real improvements in care, the public, patients and the profession despise the 4th P in our game of health: politicians? This is the real handover Mr Brown, a pitch for a better future.
I passionately believe in the NHS, I passionately believe that the professions must be put back in charge of health care. Let’s face it political meddling has brought it to its knees. Unshackle the profession, give us back the health service and we will rebuild it. Fail to do so and your legacy will be to be condemned for destroying the best piece of social capital the country has ever had.
Let’s go back – ten years: a landslide victory driven by “24 hours to save the NHS”.
We were told that they would deliver “unity and purpose for the future” instead we have seen incoherent policy dividing and fragmenting. No long term strategy for sustained improvement. A bonanza for management consultants: in and out after a fast buck, taking the money and never being there to see the results or pay the price.
To quote John Tudor-Hart we have achieved progress “despite the deadweight of NHS policy and structures” The real barriers to progress are government policies – we all bare the scars on our backs from these – patients, the public and notably the profession.
They talked of the return to the public sector ethos, abandoning the market, leaving the “infernal bazaar”. Instead they went from Bazaar to the Bizarre: a messianic belief in the market, redirecting billions of pounds into poor value for money schemes. To quote back their comments when last in opposition “you should distrust these moves”. We still do distrust them and feel there is a better way forward.
This total loss of trust defines the most fundamental destruction this government has delivered. A sad result of the initial promise “to repay the nations trust a thousand fold”. We must rebuild that trust, but it is now a thousand times more difficult because of their manifest lack of desire, no ability, to listen.
We hear that the prime minister in waiting is listening well lets see action to prove it. Let’s build a cohesive dialogue at all levels to bring about the improvement we know we can deliver. The barriers to change are in government not this profession!
Brown has 21 days to go, 21 days to change direction to start building a partnership for the future. Gordon, it is time for a new team. Your team is lame, it is tired and it needs a change. It is time to move on.
Policy lacks strategic direction. Pouring out initiative after initiative. Taking good principles and tying them up with bureaucracy and political necessity, killing off the benefit and leaving a distorted skeleton behind.
Reforming the NHS should have brought an opportunity to improve how the NHS handles money. But with Payment by Results they failed to listen. Perversions rapidly developed distorting clinical priorities. Why did they not learn from abroad, why did they not involve the profession earlier? Did it really need to push internationally known institutions like the Nuffield Orthopaedic Centre to the wall? This is not professions getting in the way of change, but professions protecting against unnecessary harm.
Our criticisms are slowly being heard by some: The Lawlor review was a devastating critique. The future of PbR is out to consultation. Let’s see if there are benefits, lets see where improvements can be made. But where it does not work let us throw it out, make a better system, fit for our hospitals and fit for our patients.
The cuts in services have been excessive. The Government may trumpet the £500M surplus. But the Department of Health, under treasury zeal, has cut too far. It takes weeks to cut but years to rebuild trust and collaboration.
For too long the NHS has put finance as its number one goal. This has wrought lasting havoc. We have seen some signs of change – such as our calls for Resource Allocation Budgeting to go. But we must now see quality back at the helm to deliver finance AND safer patient care.
Reforming the NHS should have been a major opportunity to improve access, but we got Choice. Who wants Tony Blair’s idea of choice? Do we – no! Do patients? Not according to the Picker Institute. So who does? The main beneficiaries of “choice” Tony Blair style are the independent sector providers. Patients want time with their doctors, quality care, as close to home as is safe. They want a “voice” in healthcare. The politics of destruction used by this administration has done little to benefit patients and much to harm continuity and collaboration. We warned of the consequences but again they failed to listen
The weight of evidence is on our side: the governments own suppressed research, costing £77000, states choice does not deliver, is not what patients want.
Reforming the NHS should have brought improved capacity, but we got Independent Sector Treatment Centres – we said from the beginning that they would be costly, disruptive and fragment care. The Health Select Committee agreed finding little or no benefit, merely an ability to reduce the spot-price of procedures. A £5B remedy for a small problem. Let the Public Accounts Committee get its teeth into a real financial black hole!
The independent sector should only be used where the NHS needs it, not thrust into its midst like a carelessly placed hand grenade.
We are told patients want care closer to home, but at what cost? We can and should improve in some centres to match the high standards of the best, but the claims of some of the Tsars are frankly ridiculous: Do we really want hernias operated on in every GP surgery? I certainly hope not. This is not good use of GP time. Let them concentrate on what patients need them for.
The whole of the care closer to home agenda has been tarnished by government. The years of evidence based work, to improve care and efficiency are now indelibly tainted by association with government. This is a shame as much of it is well worth while, so please Gordon will you listen and learn?
If you really listen you will hear that we are not stubbornly adverse to change. Consultants lead change, consultants are the innovators; but we do not change for changes sake. We not only understand the need for change, we deliver it.
Consultants deliver high value and excellence, be it new treatments, or reaching out into communities with specific health issues. We see consultants across the world stage, be it in Tower Hamlets or, quite literally on top of the world, undertaking experiments on Everest. Consultants are worth every penny. Get off our backs, unshackle us from bureaucracy, and let us get on with what we are best at- caring for patients and making the health service work.
We will support change where it is safe, where it enhances services, where the profession is truly involved from the beginning, in partnership with patients. But we will not stand by and see you decimate hospitals for purely financial reasons. We will not stand by and let you damage patient care through rushed reforms and we will not stand by and see the Trojan horse of the independent sector rolled in to take over the health service from within. It is not better, it is not better value and above all it is not safer.
We need to radically improve commissioning with the aim to enhance collaboration across health care. This must involve both primary and secondary care. Both have roles, both are needed. That is not easy in a market driven system, neither is the quality needed for sustained long term care.
The market is an unnecessary aberration, a costly method of achieving improvements in healthcare with little if any evidence of benefit.
One of the most grievous examples of the market devouring resources in healthcare is the private finance initiative. Selling our heritage. Making money out of the contracts, selling them on, throwing crumbs back to the NHS, creaming off fat profits to satisfy share holders. The long term debt is devastating: Nuffield Orthopaedic Centre facing bankruptcy, Leicester hospitals, Patricia Hewitt’s own back yard, heavily criticised, Paddington Basin failed. It is time to consign this to history and go to a better way.
We have to turn the destructive tide this government is washing over the health service and produce a better way forward. The BMA has now produced that Rational Way Forward. I fervently believe, we must not only criticise but also lead the way forward. To do one without the latter is abrogation of our responsibilities. If we wish to take back the lead, we need a coherent way forward. I believe we have this and commend it to you.
This way forward, is clearly one for England. Our colleagues in Scotland Wales and NI look on. There is much we need to learn from devolution and make best use of it to empower us. With the changes brought by the recent elections I believe it is even more important that the BMA address the issues of devolution with renewed zest, another challenge we cannot put off.
There is one issue UK wide, above all others that has acted as a lightening rod for unprecedented anger, frustration and angst: the MTAS and MMC debacle.
The apology from the secretary of state is not enough, the minister’s apology was half hearted. The whole profession, including the BMA, should say sorry to our junior colleagues. But sorry is not enough, Juniors need solutions they need support and they need protection. We must deliver on this for them and our future. It must never happen again
We owe consultants an enormous thank you for the efforts you have gone to, to get the best doctors into post despite such a flawed system. The BMA will support you.
The BMA, like the colleges, despite strenuous efforts over the years of MMC development couldn’t prevent the high principles of MMC being hide-bound and distorted by the MMC team and DH. The price in terms of lost members has been very small: 30 consultants out of 27000; the price in terms of needing major change is enormous. I state now: The BMA must change; the BMA has changed and will change because of this.
We are meeting and working with our critics, forging a unified way forward. The BMA is rightly coined as the nation’s strongest union. We must use that strength, working together for now and for the future.
The tasks of the review group are now over and it is being wound up. Being part of solving the problem was the responsible way forward; the “difficult path”. Some may have wished us to leave the solution to the Department of Health, or just the colleges. But in all honesty would you really trust the Department of Health to be left to their own devices? With one or 2 notable exceptions, they need a guide book to organise a party in a brewery and a sense of direction to get out of a wet paper bag. What we have now may not be perfect, what they would have delivered alone would have been so so much worse.
We must radically overhaul the system for the future. That future must begin now. It is not enough for the DH to say they will consult with stakeholders. The only stake-holding to be done is the stake that should be driven into the heart of this Monster of a Medical Crisis, that is Murdering Medical Careers. Let us ditch the acronym and move on. Let us design a better system for post graduate medical training. One truly fit for purpose. One that delivers the principles the profession wants.
So go on line and tell us, come to our meetings and tell us. It is your future; help us design and deliver it. We cannot let this government squander a generation of talent.
Sir John Tooke’s independent review, fought for by the BMA, will outline what went wrong and what high principles there are for the future. But we must now build the team that designs and delivers this. I call on the Secretary of State today to state unequivocally that the profession will lead this group, released from government interference that have wrought such devastation.
This new future must have the flexibility of the old system without its problems. Move away from the once a year scheme giving the perception of no future chances. We must also be able to choose on good evidence, not who can write best prose.
There must no medical unemployment because of this process. Just one doctor made unemployed because of this process is one further nail in the coffin of care this government shows for the profession.
We must continue to push for more training posts, to add to those delivered by our demands so far. We need some expansion to achieve a consultant based service, but flooding the market with CCTs holders would force a sub-consultant grade, dumbing down the profession. We must thus overhaul workforce planning that has been woeful for too long.
The belief that there is a coordinated plan to dumb down the profession gains credence from the multiple cock-up’s perpetrated by this government. This betrays patients, it embeds a belief that mediocre is enough, that patients don’t deserve the best. I passionately believe that our patients do deserve the best. They want the best health service their taxes can buy.
Whilst we focus on our current crisis in training we must not lose sight of the whole agenda. Our next fight looming: revalidation. It is vital that self regulation remains, we must use the current tools, improved where they must be to deliver this. It will be a travesty if we produce a system, so over burdened in bureaucracy that it takes doctors away from treating patients. The current white paper proposals are perilously close to doing this. I object to diverting unnecessary resources and time, once again away from patient care. Furthermore if the government wish to take away our majority, if they remove our ability to choose some of those that judge us, then they cannot expect us to pay for it..
So in closing what can we do to help Gordon Brown?
Firstly morale is at an all time low, the vital element, the glue, the substance that has kept the health service going has been thrown away by political meddling. Morale must be rebuilt and the key to this is politicians listening, valuing and giving back leadership to the professions.
Secondly you have given us the funding, now trust the professions, as the public trusts the professions. Give us the freedom from political interference – within 4 days you freed the Bank of England and obtained your place in history. What better way to cut loose from the tainted past than and free the NHS from political meddling? Go on Gordon go for it; get your legacy in days where Tony has failed in a decade!
Thirdly we need debate on what the health service can and should deliver. I fully back the BMA position that we must remain a tax funded universal, comprehensive health care system free at the point of delivery, but we must now have a rational debate in public on what the NHS provides and what, the public feel it should not provide. Lets face up to that public debate, go on Gordon, take a risk and help define the NHS for the future. You say the NHS will be your priority – we wait to see your actions.
Now is the time for us to focus our anger into a constructive force for change. Now is the time for the profession to rise up from this dark and desolate time and lift our training, our whole health care system to a better place, now is the time to re-take the reigns of power.
The whirlwinds of revolt are shaking the foundations of health care. This is not just a profession that has had enough of current policy; this is a nation that has had enough. If we unite, if we unite with our patients we truly can regain control, we can deliver a better health service. We must talk up the health service, highlight what patients’ really want and really feel – we know that 90% say that care is good, very good or excellent. That is the message we need to drive home.
Let’s deliver a health service where quality comes first, not politically driven financial targets. Where quality outcomes are our drivers and we all aim to deliver a quality experience for our patients, be they a young single mum balancing a long term condition and child care, or a 90yr old man in good health now requiring intensive care.
They deserve it, we must deliver, we will deliver.