BMA ARM 2015: Dr Mark Porter speech in full

BMA chairman Dr Mark Porter hit out at the government's plans for general practice in his speech at the 2015 BMA annual representatives meeting. Read his speech in full below.

Dr Mark Porter: urging government to 'get real' over GP crisis (Photo: BMA)
Dr Mark Porter: urging government to 'get real' over GP crisis (Photo: BMA)

Colleagues, friends, it’s an honour to stand before you at a time when doctors and our patients are looking to us to stand together as one profession in their defence.

I think we have come here to do a job.

Our job is to cut through the layers of hype, spin and pipe dreams that threaten to smother the health service. It is to find the real NHS, and then fight to make it better.

We have four days to debate the real issues faced by doctors in general practice, in hospitals and in academia, all trying to come up with real solutions for patients.

Don’t you think it’s about time someone did that? We didn’t hear much of it in the election campaign, did we?

We all remember the election campaign.

I remember a lot of promises.

Promises set in stone – in fact, I’m sure I even remember a tombstone at one point.

Promises of a health service open all hours, staffed by a phantom army of new recruits.

You might say, what do you expect? It’s an election. You get promises.

Yes, I know they all do it. I know they always do it. But if promises were the same as pounds, and diktats the same as doctors, we really would have one hell of a health service.

The election campaign is over. We have a new government – and for everyone’s sake, we need a fresh start. We can show to the government that we are an integral part of the solution. But first we need the government to face up to the scale of the problem.

We have a government run from cloud nine rather than number 10.

The crisis is real, but their solutions show little grasp of reality.

  • A debilitating NHS deficit, to be met with a £22bn wish and a promise.
  • A pledge to expand services, with barely the detail to fill a post-it note.
  • And a crude, unrealistic attempt to marginalise patient safety in our contracts.

Colleagues, the crisis is real. For the sake of every single one of our patients, it’s time for the government to get real.

In recent weeks, we’ve been promised a massive expansion of NHS services.

Along with colleagues in other healthcare professions we deliver those services, so we’re asking: ‘how?'

Let me be absolutely clear where the BMA stands on the issue. Doctors want the care we provide for sick patients to be of the same high standard, seven days a week.

Despite the lazy caricatures, last weekend, next weekend, and every weekend since we’ve had the NHS, we already have doctors of every level of seniority working in our hospitals in acute, emergency and urgent services.

But ask any doctor and they will tell you that the NHS has never been resourced the same on Saturday and Sunday as it is from Monday to Friday. 

If the government has noticed this too, then hello and welcome. We will work with any government to improve outcomes for these vulnerable patients. Of course we want to do that.

And here’s the good news. There are doctors around the country who are improving services seven days a week. Led by patient need. Supported by good employers. Protected from working unsafe hours.

There could and should be more of this. The prime minister says that he wants us to become the ‘first country in the world to deliver a truly seven-day NHS’.

We all want our patients to have the care they need when they need it. So show us the detail of what you mean. Show us how the country will pay for it.

Show us something real, because all we’ve seen so far is the pursuit of easy headlines.

The government says we can just move a few shifts around. But what about the weekday surgeries, clinics and wards left without doctors when that’s done? We don’t hear about that.

Last Friday, we were told once again that GP surgeries will open seven days a week, twelve hours a day. They talk about GPs doing even more, when thousands already work in out-of-hours services, propping up the NHS. The government is trumpeting its 'new deal for GPs'. Who are they kidding? These proposals are neither new nor a deal, but old, repackaged ideas distracting from the central issues.

We’re promised 5,000 new GPs by 2020.

How will these new GPs be ready to start work in five years’ time when it takes 10 years to train a GP?  They don’t say.

How are they even going to recruit more GP trainees when hundreds of existing training posts are still unfilled? They don’t say.

When will they provide substance over rhetoric and recycled ideas, to focus on the detail of how they will support GPs already burnt out from overwork, in a service where more than 10,000 GPs are predicted to leave in the next five years? They don’t say.

We are in the middle of this. What it is this doing to us? What is it doing to our patients?

‘We’re living a lie.’

They’re not my words but those of a doctor on BMA Communities. He said: ‘I want to tell [my patients] there are two health services. The one that politicians say they’ll provide, and the one they actually do.’

This is urgent. The government has to get real.

It hasn’t even got real with the single greatest threat that our patients face.

We have a national health service that in Scotland, Wales, England and Northern Ireland is short of funding. Within five years, the NHS in England alone will be £30bn a year short of what it needs.

Thirty billion pounds. The government doesn’t dispute the figure, but nor does it seek to address the issue.

In England it has promised a real-terms increase of £8bn. Not now, but by the end of the five-year parliament.

Colleagues, I’m not begrudging it. It’s a lot more money than most of our public services will get – including social care, where severe cuts make patients’ lives worse, our jobs even harder and integration more difficult. Or public health services, to be slashed as now outside the NHS.

But the numbers are there for us all to see. The health service needs £30bn per year. The government has promised £8bn. So where is the remaining £22bn going to come from?

For every pound from the Treasury, three more to be found. We see waste around us at work and we try to tackle it but there’s no way this alone will make up the gap.

The government seems to think it can pull off the same trick as before.

In the last parliament, it tried to claw back £20bn. Where will that come from, we asked? Don’t worry, they said, we’ll have a war on waste!

They had a strange way of fighting waste. This was the government that inflicted upon the health service the most flagrant squandering of resources we had ever seen.

We can’t talk about waste without talking about the Health and Social Care Act.

It sucked at least £1.6bn away from patient care. It distracted and demoralised staff. It seemed almost designed to stop us working together.

And so still they searched for these weapons of mass extravagance…

For efficiencies in what is already ranked the most efficient healthcare system in the developed world by the Commonwealth Fund.

And what did they do when they made more waste than they found? They took a crude alternative.

They cut. They cut the real-terms pay of staff who are delivering more care than ever before. The people, the only people, who can make the NHS more efficient, were punished for the sake of an unreachable target. 

They cut the tariffs paid to hospitals for the work they do. Every year, hospitals in England are paid less and less for treatments that cost more and more.

Access to training, cut. Opportunities and time to improve services, cut. Every time they do this they are robbing future patients of the best quality care.

They say they’ve protected frontline services. They’ve cut them.

And general practices, year after year, have not even had their costs covered. Coming on top of a real GP recruitment and retention crisis, amidst tangles of bureaucracy and unfunded demands, it’s only the frayed but steadfast resilience of GPs that keeps the service going.

Cutting hasn’t worked. The Government has to realise that it hasn’t worked. It needs to get real.

It hasn’t made hospitals more efficient. It has driven them to a seven-fold increase in their collective deficit in a single year. To the desperate point where the chief executive of NHS Providers says, and I quote, ‘… vast chunks of the NHS will simply run out of cash’.

The 'government can’t just sweep its debts under other people’s carpets.

And it can’t fine the health service when the news isn’t convenient. Because that’s effectively what it’s doing in our emergency departments.

Any patients admitted above an arbitrary level only attract a fraction of the tariff price. There has been haggling over the figure, but it’s the simple truth that the busier the department, the more they lose.

So how, you might ask, can an emergency department control the number of patients coming into it? They can’t. So why are they paying the price for keeping the NHS afloat?

Fining emergency departments for having too many patients – well, it’s like fining the Met Office for a rainy summer.

Almost two thirds of doctors think the constant squeezing of tariffs has a negative impact on clinical quality. Less than two per cent think the impact is positive.

How have we got to this? We’ve had Mid Staffs, we’ve had Francis, and cost is still being put before quality. This is, quite simply, wrong.

These most insidious of cuts are imposed upon staff who are still suffering from a disastrous restructuring of the health service, who face an unprecedented workload, and have no clarity about the future.

It’s harming some of the doctors here today. It’s harming our friends, our colleagues and our patients.

Seventy-one per cent of doctors across the UK in a survey we publish today have suffered, are suffering or feel at risk from burnout.

Our Doctors for Doctors service gives you the chance, online, to check your risk of burnout. Since 2011, more than 15,000 people have done just that, with the vast majority finding themselves at high or very high risk.

It’s a terrible burden for those it affects, and as the Nuffield Trust has said, staff burnout puts at risk the very ability of the NHS to meet its many challenges.

This often happens where doctors can see patients being affected on top of the impact of their illness. As that doctor said in BMA Communities: ‘The most stressful thing is having to say ‘sorry’ 20 times a day for something that isn’t my fault.

‘"Your appointment has been delayed?" Sorry. "Your operation has been cancelled?" Sorry. Every day, I see my patients’ frustration with the health service and I am having to apologise.’

Why are we having to say sorry for politicians’ promises? Long after they’re made, long after they’re broken, long after they’re forgotten by those who made them, we’re having to say sorry. Sorry for a reality the government won’t accept.

And where is the government?

It has abdicated its responsibility to run a National Health Service and taken its eyes off the real solutions. It has played games with the funding of the NHS, with the public’s health and with who’s providing care.

But there is another way.

If ministers would come down from the cloud for a moment and work with us, they’ll find some solutions.

Let’s talk about how to help people live healthier lives.

A minimum price per unit of alcohol would be cheap to implement. It would save lives. That one single intervention would reduce the multi-billion pound burden that alcohol misuse has loaded on society.

The Scottish Parliament passed this after strong campaigning by the BMA. Once it clears the legal hurdles, it could and should inspire the rest of the UK.

Poor diet is estimated to cost the NHS £6bn a year, and Britain’s children are amongst the most obese in Europe. And yet we see the sugar and fat industries left largely to police themselves.

We can take heart from our outgoing president’s work in getting standardised tobacco packaging back on the agenda. Next year, the silent salesman of cigarette branding will be no more, and we will all benefit.

It’s one victory, and it will show the government that if it stands up to the corporations and their lobbyists, then it can save money, without cutting services, and improve health at the same time. You achieve that, and we may actually start to address real problems with real solutions.

If the government is looking for inspiration, it should look no further than the staff of the health service.

They are drawn from almost every country in the world.

The city of Liverpool has been enriched beyond measure by those who have come here, and so it is too with our health service.

It was on this day 67 years ago that the Empire Windrush arrived in Britain with 500 people on board.

Britain desperately needed their help in rebuilding its public services, and they answered the call.

It was only a fortnight later that the National Health Service was born, a service in which some of the people from the Windrush were to work.

And what did we hear in the election campaign, from politicians of several parties?

We were told immigrants are filling up our GP surgeries and our hospitals.

Well, they are. They’re called doctors. And nurses. And porters, and cleaners, and clinical scientists. And without them, the NHS would be on its knees.

A real focus on public health issues, and a real commitment to NHS staff. That would be a start. But there is far more the government needs to do.

  • It must free doctors from the pointless daily trial in triplicate of forms, targets, and red tape.
  • It must promote a culture in which we can learn and improve, not one where NHS staff are blamed, fired and vilified for raising concerns.
  • And it must begin to see the madness of a market-based system that pits those who care against each other, and puts those who profit at its centre.

If the Government finds itself asking why our health service is under such stress, it should look at the gulf between the resources it allocates to health and what our European neighbours do.

We spend a lower share of our national income on health than France and Germany, but also Spain and Portugal. And this share is falling.

We have fewer doctors per head than the Czech Republic, than Estonia or Hungary. In a league table of healthcare resources such as staff, beds and medical equipment, we finished 28th out of 30.

Even the Eurovision song contest was better than that…

The government needs to get real with NHS resources. And it needs to get real with how it deals with NHS staff. There can be no better, fairer NHS until they do. In the absence of clear direction and plans, hollow words about the commitment of staff won’t hack it.

We saw this during the contract talks for consultants and junior doctors. We met employers in good faith. We neither sought nor expected an overall increase in funding, but both sides saw a chance to improve patient safety, protect the quality of skills and training, and enhance the morale of doctors.

And what did we get? A constant Treasury-inspired haranguing to expand services but silence when it came to how these services would be funded. A commitment to staff doing even more, without any clarity about enabling them to do it better.

How would this improve patient care? What sorry legacy does it leave to the next generation of doctors?

We came to the talks informed by the thousands of doctors who told the BMA what they think, what they experience on a daily basis.

The employers came to the talks with good intentions, I am sure, but with a constant stream of Government ‘no, no, no’s’ flashing up on their phones.

It was even a ‘no’ to contractual protection of safe working hours for juniors and consultants.

And people wonder why the talks could not carry on under those conditions?

So now it’s the DDRB. We have used your support, your experience and your evidence to make a strong case for fairer contracts.

We need the DDRB, whose independence has so often been undermined, to challenge the Government on its so-called red lines. They’re the red lines forced on an NHS that exists only in the minds of ministers.

We’ll work with the Government on real solutions. They might not be easy, but we’re only in this mess because of the seemingly easy solutions we warned them not to take.

There was the siren call of privatisation.

At Hinchingbrooke, a private company said it would turn a troubled hospital into one of the best in the country and save more than £300 million over 10 years.

The National Audit Office said the target was ‘unprecedented’. Sir Humphrey might have called it ‘brave’. The doctors who worked there had some other words for it.

And what happened earlier this year? The private company pulled out seven years early, and last year’s deficit is likely to be £13 million.

And who’s picking up the pieces? The state-provided NHS. And who suffers when services are cut to meet the growing deficit? The patients.

So we’ll be debating these issues today, forming our policies and sending a clear message to Government.

We will consider calls to eliminate the pro-competitive duties of Monitor, foundation trusts and CCGs, ask whether contracting with private providers destabilises the NHS, and examine calls for the abolition of the purchaser-provider split in the NHS in England.

I think we’re likely to reaffirm our consistent advocacy for the collective endeavour of a state-provided National Health Service.

After that we will consider whether to advocate for some very specific legislative proposals. Whether we push for the abolition of NHS England, every CCG and every NHS trust, as part of a total structural reorganisation of the NHS in England.

We have plenty of choices to make in the days ahead, but as a profession we have many more in the years to come.

The debate over whether Britain stays in the European Union will intensify. I’d urge you to get involved. The EU has had a huge impact on our working hours, on the make-up of our medical workforce, and on public health issues like tobacco.

If these things matter to you, then so does Europe.

And just as we have put one election campaign behind us, there will be others in Scotland, Wales and Northern Ireland.

They will impact more on health in these countries than the 2015 UK general election.

The UK has one NHS idea but four different takes upon it. There may soon be even more, as Manchester gets a taste of devolution.

But we are still one profession.

We can learn from each other. We need to unite against common threats. But most of all, we will support doctors wherever they work, as we continue to increase investment in our regional structures and put more BMA boots on the ground in the places doctors work.

And our message goes to all governments of the UK. That message is to get real.

  • Get real for the sake of the thousands of doctors wanting to work differently, work better. For those breaking down the barriers between primary and secondary care, or working with charities to help vulnerable people live with dignity.

  • Get real for the doctors who are making a difference. The doctors who, at this very moment, are discovering, treating, operating and always informing, reassuring and caring.

It is truly a message for everyone across the country. As our No More Games campaign made clear, politicians from every party have been guilty of scoring cheap points from the NHS, of dragging committed staff into political rows, and making promises they know they cannot keep.

As one election passes, and with three more soon to hit us, they’ll all tell us how much they love the NHS.

Well, thanks for that, but what patients and their families need, what those of us working in the NHS need is honesty, respect and a sense of reality.  We want to see clear plans, with clear funding for delivering improvements, free of dogma and ideology.

We will work with any government that wants to truly protect and improve the NHS. You want a fresh start? We’ll start today.

Colleagues, the NHS faces a real crisis.

It affects real people.

The government must get real. With urgency, with compassion and by offering a hand, not an axe, they can get real.

Thank you.

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