My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Hubris – the BMA and coming negotiations with the new Government

Filed Under (GPs, Trades Unions) by Paul on 07-06-2010

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One of the more interesting interactions for the new Secretary of State for Health will be with the BMA. As with any opposition the Conservatives and the Liberal Democrats had spent time and effort courting the BMA. This is always an easy experience since almost by definition in their role as the doctors’ trade union, they don’t get on with the Government. The Government, in the case of the NHS and the Secretary of State for Health, are ‘the bosses’ and therefore over a few years the BMA fall out with them. So it’s easy for an opposition to get on with them. They agree – and this is after all an opposition party’s core task – that the Government is “up to no good” and the opposition, if elected, will of course be different.

Alongside this general stance, one of the Conservative’s main politics before the election was to becomevery good friends with the BMA so that they could assure them of their new found rapport with the basic principles of the NHS. But it will be no surprise to the BMA or to politics that yesterday’s “friend” (in opposition) now becomes today’s “boss” in Government. How will this new relationship pan out?
Within eight days of the election the BMA was taking part in a breakfast at the House of Commons with the interesting title of “BMA and NHS reform, drawing a line in the sand.” This phrase represents a negotiating ploy and assumes that the BMA has the power to draw such a line. (I don’t know for sure but I would expect if I had a closer appreciation of the way in which the wilder fringes of the trades unions worked in the mid 1980s, that Arthur Scargill might have given a similarly titled talk within a few days of Margaret Thatcher’s election in 1983. The BMA rather like the macho sound of being Britain’s toughest trades union, but they probably haven’t followed the last 20 years of the history of the NUM as closely as they should have)

The line they are “drawing in the sand” in terms of reform is, amongst other things, to stop the development of competition and the private sector for NHS patients. I will return to the rather odd sight of the Chairman of the BMA Council, who as a GP is himself a small businessman, being against the private sector. History sometimes offers up such rich fare to digest that they are best savoured slowly. But for the moment it’s worthwhile to think about how they are going to enforce the drawing of the line. All three main political parties promised more competition in the NHS. They talked about it in different way – the Lib Dems promising a level playing field for the NHS in competing with the private sector – the Conservatives promising a level playing field for the private sector in competing with the NHS. But overall leaving aside UKIP and the BNP over 22 million voters voted for increased competition in the NHS. And now the BMA are going to draw a line in the sand against 14 million of those votes

(By the way, one of the iconic places where the line in the sand was drawn was at the Alamo. That brave band of backwoodsman was asked if they wanted to leave. All they had to do was to walk across the line in the sand. Legend has that none of them did. What the BMA should note however is that in the next few days they were all slaughtered)
But the posturing of small business people against the introduction of a market is of less significance than the main battle lines they were drawing at this breakfast. They seamlessly moved from an organisation of small businesses to a militant public sector trades union. The report of this discussion is interesting:

“The three bullets:
• The economic challenge – the NHS was in a privileged position relative to other public services and that would temper clinical resistance to change, although maintenance of the status quo appeared to be the favoured position.
• Working with the government – there was a commitment to engage on change in the NHS, but clinical evidence for a larger role for the independent sector and on a shift to community delivery was judged to be largely inadequate.
• Harnessing clinicians – it was ludicrous and damaging not to have clinicians more substantially engaged in policy and management. The Coalition Government had pledged to change that.
The economic challenge and the dividing lines The BMA leadership would aim to steer a path between what appeared the right course of action and what members wanted. In real terms the healthcare deficit will grow, despite the supposed protection of healthcare budgets, driven by demographics, health inflation, raised patient expectations and absolute cuts in social care.
The BMA resistance points would be pay and clinical staff cuts, targets, a greater role for the independent sector and a market in provision. As a counterbalance, the BMA would embrace evidence-based policies and clinical leadership, improved outcomes data, public health and prevention.”

The main show therefore is the definition of the BMA resistance points and that starts unsurprisingly with pay and clinical staff cuts. So in truth the BMA enters into its meetings with the new Secretary of State with same agenda as every other public sector union. They recognise that there is an economic crisis but do not expect their members to have to pay a penny towards resolving it. In this way – like other public sector trades unions – they have missed the point of the 14 million votes that the coalition received. The public sector will pay a price. There is a further rather important point – that the BMA represents members who on average are amongst the very best paid staff in the country. Better-off people in the public sector will pay a higher price.

The BMA argue all the time that they are in the public sector. They need to note the right wing press view of well-off people in the public sector. As they resist their well-off members paying a price I would predict there will be even more media investigations into GP and consultant pay. I would expect that, within the next few weeks, the Daily Mail will have a very long list of doctors who are receiving much more pay than the Prime Minister.

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