Today’s the day when the BMA holds a special meeting to discuss the Health and Social Care Bill, and whether it should move from a position of ‘critical engagement’ to one of total opposition. The BMA press team are providing updates online, which are faithfully reproduced below…
17:47 The motion expressing no confidence in the Health Secretary is lost. The SRM closes.
17:40 John Chisholm has no memory of BMA votes of no confidence achieving change. “Will passing this motion make the Secretary of State more or less likely to listen to the BMA?” he asks the conference. Hamish Meldrum shares his concern that a vote of no confidence could make it harder to engage with the government.
17:35 Ian Banks says he has nothing against the Health Secretary and doesn’t want to personalise the issue, but wants the BMA to be able to talk to people who are prepared to listen.
17:33 Self-proclaimed dinosaur (and Liberal Democrat) Dr John Stewart says a vote of no confidence would be harsh. “I understand you want to vent your spleen, but it is better to warm your heart,” he says - probably the most literary turn of phrase since the Ides of March references in the morning.
17:31 “We’re not going to have it Mr Lansley. We don’t want your Health Bill. We have no confidence in you or your business friends.” Another well-received speech from Athow.
17:29 Anna Athow proposes the last motion of the day. “It is the politics of shock therapy,” she says, as she attacks the Health Secretary for starting to implement the reforms before the Bill is passed.
17:26 Another keenly awaited debate is about to kick off - the no confidence vote in the Health Secretary Andrew Lansley.
17:22 The results are in! The part of the motion calling for outright opposition to the reforms is narrowly defeated, although the BMA is urged to “publicise and oppose the damaging elements of the Bill.”
17:20 “Kill the bill – not the NHS” concludes Dr Davis, as she awaits the vote on her motion. Palpable tension here.
17:17 Jacky Davis is “whooped” on her return to the stage. The price of engagement is high, she argues, including a “privatised NHS”
17:15 BMA Chairman Hamish Meldrum now speaking - “Please do not tie our negotiating hands. Do not stop us supporting doctors who have to deal with what this Bill might do” he urges the conference, as he argues against a policy of outright opposition.
17:12 Another speaker against the motion - Mark Porter of the Consultants Committee - says the BMA took the right course by “critically engaging” with the White Paper. He urges reps not to turn on each other - and is met with warm applause. “To measure ourselves by whether or not the Secretary of State has fallen on his sword is wrong.” More applause.
17:09 Dr John McGough supports the case for outright opposition - he’s worried that the Bill could drive a wedge between different parts of the medical profession. He says many GPs who are already involved in commissioning would be very pleased to be rid of it.
17:07 Another trainee, Simon Minkoff, describes the Bill as “bitter medicine” and wants the BMA to continue to lobby and publicise doctors’ concerns.
17:05 Junior doctor Lucy-Jane Davis believes many of the concerns the BMA raised “fell on deaf ears.” She wants more consultation and piloting. “Mr Lansley - please would you listen to us” she says.
17:03 Consultant Paul Miller takes to the stage to oppose Motion 175 in part. He argues that “critical engagement was the right policy for the BMA to adopt”
17:02 Krishna Sivakumaran, a medical student, asks if reps really believe the government will substantially amend the Bill. He calls on the SRM to support the motion and send a message “that this Bill will not do. This Bill cannot pass.”
16:58 Outright opposition would mean alienating GPs who are engaged with the reforms, she argues, as she calls on reps to think very carefully before they pass the motion. Widespread applause…
16:56 Laughs for Dr Michelle Drage, putting the case against outright opposition. She thinks it may be a career-ending move.
16:55 A great reception for Dr Davis, with many standing up as they applaud.
16:53 Applause for Dr Davis as she says the BMA can’t “pick and mix”. The whole Bill is all that is on offer to us” including privatisation. “We are the patients’ true advocates - we’ll have to deal with this mess,” she says.
16:52 Dr Jacky Davis is on the stage proposing motion 175 - calling on the BMA to oppose the Health Bill “in its entirety”.
16:51 And now for the moment many of you have been waiting for…
16:50 SRM agrees with Chaand and passes the motion opposing any relaxation on the FT private income camp.
16:46 Chaand Nagpaul argues that the cap on Foundation Trusts’ private income should not be relaxed, the concern being that “taxpayers’ money could be used to cross-subsidise private work” – “a scandalous misappropriation of public funds” he says, although consultants Stephen Millar and Derek Machin disagree.
16:35 Conference votes - almost unanimously - that “forcing all NHS trusts achieve foundation status before they are ready will impact negatively on patient care”.
16:30 On we go to plans to force all NHS trusts to achieve foundation status by 2014. Cait Searl is worried that a “preoccupation with finances” could be put before patient care.
16:29 The conference votes in favour of public heath doctors remaining in employment of the NHS.
16:22 Dr Rachel McMahon raises concerns about what the movement towards all trusts becoming Foundation trusts will mean for maintaining national terms and conditions of service for doctors. Many representatives are worried that this could erode the consistency of high quality patient care.
16:16 Conference demands that health outcomes are published and used to assess quality in NHS care rather than measurements of the process of care.
16:12 Discussion has moved on to clinical outcomes. How can we use clinical outcomes when we don’t have accurate data asks Dr Hamish Brown. Dr Clive Peedell has concerns that data could be manipulated if trusts are judged on the data.
16.06 All parts of motion 150 carried calling for a stronger role for public health doctors in the NHS.
16:00 Former BMA Chairman of Council, Sandy Macara expressing his concerns about the future of public health medicine.
15:53 Concerns about the professional status of Directors of Public Health - Steve Watkins worries that the Bill doesn’t specify the qualifications they should have.
15:46 Onto a debate on public health - will the government’s plans “lead to the fragmentation of the specialist public health workforce”? Richard Jarvis thinks so.
15:44 And the motion - which says the deaneries should remain - is carried overwhelmingly.
15:43 The concerns aren’t confined to England, or to junior doctors - Scottish consultant psychiatrist Peter Bennie says the deaneries are there to protect patient care as well as the quality of training.
15:39 Tom Dolphin of the Junior Doctors Committee gets a rousing response to a speech arguing there is “no compelling case” for changes to training structures.
15:37 Karin Purshouse, Chair of BMA Medical Students, points out that central workforce planning must be kept in place to make sure that new graduates are not left in the lurch when they graduate from medical school. Conference backs her call, supporting a motion that also calls for safeguards to stop unacceptable variations in training quality.
TWITTER @DrBenMolyneux: Proposed changes to education and training are not evidence-based; real risk to doctors and patients
15:32 No argument from the delegates present, motion passed. Hamish Meldrum signs off the debate saying that this area has been overlooked because of the rush to implement the Health Bill. Gets a cheer for saying the Bill has “quadranational” implications. Not utterly sure that is in the dictionary, but it means that despite this Bill being focused on England it will impact on the other three nations in the UK as many junior doctors move across the various borders during their training.
15:26 Moving onto the impact of the Bill on Education, Training and Worforce issues, especially for junior doctors and medical students. Dr Molyneaux warns that the government is placing medical training under threat.
15:23 Motion carried overwhelming.
15:18 Dr Mark Porter, chair of BMA consultants, calls for the new proposed government regulator Monitor not to have promoting competition as its prime duty, instead that should be secondary to maintaining and extending collaboration in a cooperative health system.
15:13 Motion 120 - calling for the Bill to be amended to ensure that the Secretary of State remains fully accountable for the provision of services - gets the quick fire approval of the conference, approved in less than five minutes by delegates!
15:10 SRM agrees with Dr Balmer’s call to keep talking to the kidnappers - supporting those parts of the motion attacking remuneration links to rationing, but rejecting the element that calls for complete opposition to GP consortia.
15:08 Summing up, Hamish Meldrum, Chair of the BMA, says that he agrees with the parts of the motion ruling out remuneration payments linked to rationing services, but urges the conference to reject the final section of the motion that suggests total opposition to the creation of GP consortia is the way to solve the problem. Like Dr Balmer, agrees its best to keep talking to the government on GP consortia and focus fire on the other calamitous parts of the Bill.
15:03 But Dr Balmer from Essex suggests that while he agrees with the sentiments behind the motion (119) he believes the NHS has been “kidnapped” and that it would be wrong to stop talking to the kidnappers - basically that the BMA should keep to door open to talk to ministers about how to manage the relationship between patients and their doctors.
15:00 Dr McGough argues that the government doesn’t understand the relationship between patients and GPs. He focuses on suggestions that GPs might recieve remuneration payments depending on their rationing decisions.
14.55 We now move onto the controversially titled “Conflicts of Interest” motions, looking at potential problems that might emerge across the NHS with the introduction of greater competition.
14.52 Motion calling for greater transparency in commissioning functions is carried by the conference.
14.48 Former Liberal Democrat MP Evan Harris is cheered as he says that ‘much of this bill is unacceptable’ to his party.
14.43 Professor David Katz emphasises the importance of research and says it has been ignored by the commissioning agenda.
14.36 Doctors unanimously agree that GP commissioning consortia should hold meetings in public and publish agendas, minutes and other papers.
14.31 London salaried GP Sarita Symon urges doctors to support the inclusion of all family doctors in GP consortia regardless of their contractual arrangements.
14.27 GP commissioning consortia should hold meetings in public in the interests of transparency, says Dr Shaun Fountain.
14:21 Dr Sally Nelson says the criteria for the services that are commissioned by the board is ‘very woolly’.
14.16 GP Richard Vautrey says the National Commissioning Board poses ‘sweeping and draconian powers’. There mustn’t be political interference in the board and it should be independent, he stresses.
14:13 Doctors agree that successful and effective commissioning can only occur through close collaboration between GPs, hospital doctors and public health doctors. As medical student Emma Hodgkins points out, no one doctor can speak on behalf of the whole range of other doctors or healthcare specialists.
14:08 London consultant surgeon Anna Athow says she is in favour of the way things are done in Scotland where ‘funding, planning and delivery are in one integrated whole and in the public sector’.
14:06 Consultant paediatrician Keith Brent seeks sympathy for cutting short his holiday to attend the SRM.
14:04 An overwhelming majority backs the principles of clinician-led commissioning. Helena McKeown says increased medical participation can be achieved without the need for costly and expensive legislation.
13:59 Cumbria GP David Wrigley says doctors can oppose the bill but still support clinician-led commissioning.
13:57 BMA representative chair Steve Hajioff reminds representatives that it is important they declare their interests before speaking if it is relevant to the debate. Many GPs, some of who are already involved in pathfinders, are preparing to speak.
13:52 Salisbury GP Helena McKeown says the Health and Social Care Bill is a ‘wolf in sheep’s clothing’ - the much-needed clinician-led fleece around the privatisation body of the wolf.
12.46 Connie Fozzard proposes motion 88, that public, patients and doctors must all be involved in discussions on changes to organisation and delivery of NHS care. Government had abolished local consultation groups such as CHCs. Motion passed overwhelmingly.
12.44 Motion passed with one against.
12.42 Carol Basham of the BMA patient liasion group urges support for the motion deploring the lack of protection for patient confidentiality in the NHS and Social Care Bill.
12.36 Tony Calland opens debate on patient confidentiality and compares government undertakings on the issue to a bank saying we will only pass your details on to nice people who will use your money wisely. Patient confidentiality must be fully safeguarded.
12:35 Motion 83 carried in all parts.
12:31 “If we have commercial involvement, we must have transparency” argues Derek Machin who urges support for the motion, as does Hamish Meldrum.
12:26 Medical student Nicholas Sweetenham says the need for privacy is part of British culture, but argues patients have a right to know how their money is spent.
12:25 But John Canning speaks against Prof Savage’s motion - he doesn’t disagree but wants clarity about who is defined as an external contractor.
12:22 “There’s no place for commercial confidentiality” in a publicly funded health service – applause for Prof Wendy Savage.
12:16 The Chairman of Council agrees that price competition should be removed entirely from the bill. The amendment is not enough. Many doubts expressed by the speakers. The conference agrees and all parts of the motion are passed.
12:13 Dr Penelope Jarret from London Regional Council also speaks against price competition.
12:07 Dr George Rae from the North East proposes motion 82 - he says price competition would be a serious retrograde step, there is clear and compelling evidence that price competition means that price is the main factor when delivering healthcare and ultimately the patient suffers. Applause for what the BMA has already achieved in its lobbying efforts against price competition. But still there is huge concern about Monitor and concerns about potential involvement of the private sector.
12:06 Motion 60 is passed is passed by overwhelming majority.
12:04 Dr Andrew Mowatt talking about local experience which shows that competition does not improve quality or patient journey – he urges reps to support the motion.
11:59 Another motion against ‘Any Willing Provider’ and calls for the NHS to be preferred providers says Dr Beverley Day.
11:57 Dr Beveley Day from Birmingham takes to the stage to argue that the NHS should be “the preferred provider wherever NHS provision is accepted to be of good quality.”
11:56 Motion 59 expressing various concerns about enforced competition is carried.
11:54 Laughter as the Scottish Dr Meldrum bemoans a result at Twickenham that didn’t go his way. Like a scrum, ‘engagement’ isn’t necessarily nice.
11:53 Dr Ahmed Ali worries about the impact of any willing provider on neonatology services.
11:50 An empassioned speech by Dr Bell: “This is our moment. Let’s show that we put our patients first, that medicine is a public service - not a supermarket. Not Tescos.”
11:49 Applause for first-time speaker, Dr David Bell, who questions the belief that competition improves health outcomes in a speech for the motion.
11:48 Paul Roblin agrees he wants his local hospital to survive, but not if it means he’s left with unresponsive local providers.
11:45 We’re on to the market and ‘Any Willing Provider’. “A recipe for disaster,” says Dr Gordon Mathews.
11:38 The meeting calls for health secretary Andrew Lansley to ‘withdraw the Health and Social Care Bill’ and stop the proposed ‘top down reorganisation of the NHS.’ Doctors also back demand on Mr Lansley to ‘act on the criticisms’ of doctors leaders and ‘adopt an approach of evolution not revolution.’
11:35 Calls for a vote now on a demand to call a halt on current plans for reform because they are ‘too extreme’ and ‘too rushed’. BMA Council chairman Hamish Meldrum advises: “Practicalities of getting this bill dropped are probably remote but I’ll leave it up to you.”
11.26 The Health and Social Care Bill is an enormous mistake; withdraw the bill, says Andy Thornley. But Middlesborough GP John Canning says the outcome could be worse if doctors are not involved. BMA council member Jonathan Fielden says “radical change” is needed if NHS is to survive challenges ahead. Lively debate here.
11.21 The meeting says there is no electoral mandate for the introduction of the Health and Social Care Bill because the proposals were not in either the Conservatives or Liberal Democrat manifestos. However, there is no appetite for a public referendum.11.15 Dr Meldrum, on the stage, looks pleased by John Hyslop’s reference to a curate’s egg. The BMA’s first response to publication of the NHS white paper Equity and Excellence: Liberating the NHS, back in July 2010, was that it was a ‘curate’s egg’.
11.11 Gloucestershire’s Anthony Lynch opposes calls for a national referendum on the Health and Social Care Bill. Instead, he says the policies formed at the SRM could be ‘the medicine we want to give out’ to help heal the NHS.
11.05 Hamish Meldrum asks doctors in the room to support the first motion in its entirety. He says health secretary Andrew Lansley should not be using flawed statistics to run down the NHS. The meeting overwhelmingly agrees with him.
10.59 The debates proper are underway with London GP Chaand Nagpaul deploring the government’s use of ‘misleading and inaccurate information to denigrate the NHS’. He talks about the UK’s rates for cancer and heart disease.
10.56 TWITTER @HPIAndyCowper Very good, politically savvy speech from Meldrum, ends to warm and sustained applause. He’s got the room on his side.
10.50 Dr Meldrum closes his speech by challenging doctors to use today’s opportunity wisely.
10.49 More from Dr Meldrum’s speech, “GPs and their colleagues are being set up to fail; to take the blame when things go horribly wrong.”
10.45 “Two weeks ago we did achieve a modest but significant change to the legislation. We got rid of one of the worst features of the bill – the clauses that would have allowed price competition” says Doctor Meldrum.
10.42 I do not support this bill says Dr Meldrum to a standing ovation lasting a minute.
10.40 Chairman’s speech“Decisons made today will have a profound effect on your profession, your patients and the future shape of our NHS” says Dr Meldrum.
10.35 Preliminaries are over with as we move to the Chairman of Council’s speech.
Tags: Health policy
