HCSA President John Schofield sees the profession entering a crucial phase as policy-makers reshape the future of services
I would like to start by wishing all members a very happy new year. I have no doubt it will be a busy one for all of us.
We know that this is a crucial time in the history of the medical profession, and we all have a responsibility to contribute to decision-making about hospital doctors and hospital services to ensure improved patient care in the future.
The last few years have in England been dramatic for the NHS, with changes to the commissioning structure of services devolved from regional strategic health authorities and primary care trusts to 211 clinical commissioning groups ostensibly GP-led, but increasingly supported by corporate outsourcing companies.
Since Conservative Health Secretary Jeremy Hunt succeeded Andrew Lansley in 2012 there has been a notable change in emphasis, with NHS England chief executive Sir Simon Stevens’ Five Year Forward View setting out areas of development including new technology, seven-day services, and increasing collaboration – not just between individual hospitals but crucially between health care and social care.
At the same time, though, parts of this vision have brought the government and employers into direct conflict with the professionals who are expected to deliver this brave new world of 21st century integrated healthcare services. Developments in England will no doubt be carefully scrutinised by the devolved nations of Wales, Scotland and Northern Ireland, each of which have their own unique challenges in delivering health and social care services.
Most hospital doctors agree with the goals and aims espoused in this vision, but they do so with caveats and concerns about the availability of funding and the method by which the goals are reached. So, while it was welcome news in the Autumn Statement that the NHS is to receive additional funding to cope with rising demand and complex challenges, an increasingly acrimonious relationship between clinical staff and policy-makers threatens to undermine the goals laid out within Sir Simon’s vision.
Public-sector “pay restraint” since 2010 has caused increasing tension, leading to real-terms cuts for much of the workforce. NHS trusts are facing a record overall deficit as demand for services increases, with warnings that much of the additional funding promised will merely represent a case of “treading water” as a result. Yet at the same time we saw reports in the press in early January that some NHS chief executives and senior managers have been awarded five-figure pay rises, taking the earnings of some to extraordinary levels.
The timing of these announcements could not be worse given the backdrop of discussions around the future of terms and conditions whose outcome will fundamentally shape the direction of our health system. The government maintains that these changes, heralding a comprehensive seven-day service, must be cost neutral – an incongruous precondition given the requirement not just to keep experienced staff in post but to attract and retain the next generation of hospital consultants and specialists, and the need to enshrine patient safety at their heart.
Senior doctors, with their vast experience, have an important voice and role to play in protecting and building this brave new world. However, a confrontational approach on the part of policy-makers risks missing out on this possibility and alienating the very people who enact such world-class care in our hospitals. It is hard to feel an integral part of a movement for change within health services if our views are not actively and sufficiently sought – and, crucially, listened to.
It is here that the need for increasing organisation and representation of our profession becomes essential. The robust stand taken by junior doctors is notable, and has brought about significant concessions from policy-makers. In order that hospital consultants and specialists can bring their own views to bear in a meaningful way we too must fight our corner more effectively.
This requires HCSA representatives in every hospital in the UK, acting as eyes and ears and working together with the association’s officers to spread the message. It also means all members taking responsibility and encouraging our colleagues to become part of this association, as the only dedicated voice representing our profession of Hospital Consultants and Specialists. Certainly, as we look back on 2015 and ahead to the year to come, we need a concerted push to consolidate the association’s position.
So, in 2016 we have much to do, and it is now time to make our voice heard. It is vital, too, that as a profession we ensure that patient safety, the patient experience and patient services are at the heart of everything that we do, day in and day out.