As the general election approaches NHS staff are more concerned than ever that they are not being listened to. As the campaign hots up to get politicians of all parties to stop 'playing games' with the NHS and to put the needs of patients first hundreds of senior hospital doctors from across the UK are gathering in London today for the BMA’s annual consultant conference.
Consultants will discuss key issues affecting the NHS including funding pressures, privatisation, the Health and Social Care Act and the challenges facing the profession from increasing workload, burnout and a recruitment and retention crisis in areas such as emergency medicine.
Speaking ahead of the conference Dr Paul Flynn, BMA consultant committee chair, said:
“Consultants have played a vital role in not just protecting, but improving the quality of patient care in the face of NHS budgets cuts. Many consultants, especially those working in emergency medicine, are working flat-out to keep up with rising patient demand, often in high pressured and challenging environments.
“While workloads are rising, doctors’ pay has been steadily chipped away at in recent years, leaving consultant pay, in real terms, back at 2003 levels. This is because billions of the Government’s so called ‘efficiency savings’ in the NHS have in fact come from cuts to front-line staff pay, leaving doctors feeling devalued and demoralised.
“With only weeks until the General Election, consultants are calling on politicians to stop playing games with the NHS and put patient care first, by listening to the concerns of senior doctors about NHS funding, creeping commercialisation of services and rising workload pressures on staff which lead to burnout.
“Staff are the beating heart of our NHS, which is the best health care system in the world1. It is vital that they feel valued and motivated rather than exploited and overlooked.”
The BMA have warned repeatedly during the last five years of the stress staff in the NHS are working under as 'efficiency cuts' bite into front line services. You cannot take £20 billion out of the NHS without consequences. The government promised there would be no reorganisation of the NHS, yet we have had one of the most disruptive organisation in the NHS history. The government promised that the NHS would be ring-fenced from cuts, yet £20 billion has been taken out of the budget in 'efficiency savings'. The idea that this would not affect the front-line was always absurd. Now NHS staff are under more pressure.
Consultants are working harder than ever before to keep up with rising demand from an ageing population with more complex medical needs. While demand on services is greater than ever before, investment is falling, leaving staff and services worryingly overstretched. Despite claims that the NHS budget has been protected, the NHS has in fact just undergone its toughest settlement in 50 years and the second toughest in its history.
The effect of rising pressure on services was laid bare in recent BMA surveys in which half of consultants described their workload as unmanageable, and identified excessive workloads as the greatest barrier to delivering the care they wanted to for patients4. Almost half of consultants reported working outside of their regular hours and satisfaction with work life balance had fallen more amongst consultants than any other group of doctors. Many consultants routinely work across seven days, with nine in 10 working evenings and weekends as part of an on call rota with a worrying seven in 10 reporting that they don’t have adequate rest periods between shifts.
Excessive workloads and stressful working environments are leading to burnout and a recruitment and retention crisis in some specialities, such as emergency medicine8, as junior doctors chose to train in other areas of medicine or existing doctors leave the NHS and work abroad.
This provides the backdrop against which more than 18 months of discussions between the BMA and NHS Employers on possible changes to consultant contracts had been taking place9. Talks stalled in October 2014 because the BMA could not accept a Heads of Agreement that didn’t provide adequate contractual protections against excessive workload and burnout, which affect patient safety and care as much as consultants’ health and wellbeing. The Government has since asked the DDRB to consider evidence relating to consultant contracts and make recommendations in the coming months.
Addressing these and other issues in his conference speech today, Dr Paul Flynn, BMA consultant committee chair issued the following warning on consultant contracts:
"Let me make this clear: if the Government wants change, they will have to offer us something in return. Consultants are not superhuman; we deserve time to rest and time with our families. Patients not only understand this, they want it. How many here would like to be treated by an exhausted consultant? Seven out of 10 consultants already report that they don’t get enough rest between duties.
Neither could we commit to accepting the blank cheque that the Department of Health offered, a blank cheque that they would fill in, and probably with a minus number for many consultants. Despite our many requests for it, no data to support realistic modelling was provided so we could not even have told consultants what they could expect to earn - or to lose - from the proposals. I say to you now, politicians cannot continue to devalue the vital role of consultants in the NHS through a relentless chipping away at pay."
Talking of he pressure on NHS staff, he calls for 'No More Games over the NHS'.
"But this pressure cannot be borne indefinitely and we have seen in some specialties like Emergency Medicine what the consequences of such a strain can be. Consultants in these specialties know that the problem will not be fixed by one-off injections of funding, funding that politicians often announce several times over. These are the people who crying out for No More Games. They know that the NHS needs more than empty gestures and posturing in the media. They don’t want the Punch and Judy of politicians bickering for our votes – they know the NHS is far too important for that. For us, the most important thing about this election campaign is not which of the parties will form the next government, but that all of them hear our call for No More Games over the NHS – No More Games with the public’s health, No More Games with NHS funding, No More Games with who provides NHS care."
He also refers to the destabilising effect of the Health and Social Care Act 'diverting money away from frontline care'.
"The NHS is emerging from, but also facing a period of further change. The Health and Social Care Act has had a destabilising effect on patients, doctors and services, diverting money away from frontline care and creating a distraction from what we know are the real challenges facing the NHS: those of rising demand and chronic underfunding. The Five Year Forward View proposes important changes to the model of care, focusing on greater integration of health and social care which will, no doubt, affect how we work. Only last week the Government announced that £6bn of healthcare spending would be devolved to local authorities in Manchester. The challenges posed by these changes are considerable, we must ensure that an already overstretched NHS budget isn’t used to prop up a woefully underfunded social care budget, and we must also ensure that, where appropriate, consultants are put back in the driving seat when it comes to decisions about changes to how care is delivered. We are on the frontline, day in day out, that makes us better placed than any politician or manager to identify how and where improvements can be made in the best interests of patients."