Chairman's speech at consultants conference 2004

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Put patients first. That's what Mr Reid says. That's fine. Consultants do this every day. We don't need a politician to say it, like it's something we never thought of. When a consultant is working 50 hours a week despite only being paid for 35, that is putting the patient first. When a consultant is operating on an emergency patient in the middle of the night, that is putting the patient first. When a consultant is assessing a desperately mentally ill patient in a police cell out of hours, that is putting the patient first. For us, patients do come first, and always have. Perhaps it's time to put patients before personal political ambitions.

What a year this has been. At our conference last June, I called for Mr Reid- then a new Secretary of State- to rejoin us at the negotiating table. We wanted to resolve our contract difficulties, so we consultants could refocus on our patients, not politics. I said agreement was achievable and we would work very hard to get it. He agreed. We delivered.

Doing so required incredible hard work from a lot of people. I want to recognise and pay tribute to the original negotiating team who deserve a lot of credit for their work developing the principles of the new contract. I also want to recognise and thank Nizam and his team for their skill and tenacity in completing the job in horribly difficult circumstances, despite having tremendous power and pressure used against us. And I particularly want to thank the CCSC office team, led by Martin, who have walked with us every step of a very difficult year, sharing the setbacks, helping to achieve the successes. They were with us for negotiations that went on until midnight, 7.30AM breakfast meetings, regularly working late. They have been a truly fantastic team to work with, giving more for us than we have any right to ask. Thank you.

We achieved a contract which rewards consultants fairly for all the work they agree to do. Which is already delivering very significant back pay and well deserved pay rises for most consultants. And which has already begun to change the culture towards shorter hours and a more family friendly work-life balance.

Importantly, this contract is good for patients, protecting as it does time for the activities which underpin the quality of patient care we provide, but which was never fully recognised previously, except by our patients.

The contract has shocked the Department of Health. They had spent so long spinning against us that they forgot that independent surveys showed consultants working long hours for the NHS. That was a very expensive mistake by them. Now, if they want you to work 50 hours, they must pay you for 50 hours.

The contract is only fair, not excessively generous. It was won because of the marvellous unity and determination you showed in rejecting half-baked plans for local contracts, ruinous to patient care. Plans which it is perfectly obvious could not have been delivered locally and which would have caused utter chaos in the NHS, as we warned. Plans which originated in Whitehall. Plans which you defeated. You can be very proud of that achievement.

Some say this is not a professional contract.

I say, this is a contract for the work of professionals.

Some say there are too many problems.

I say, it is the Department who have the biggest problems, all of their own making.

Some say there is no money to pay us.

I say, there is only an unwillingness to pay.

But anything which is not paid for is not valued and has no future. Trusts must no longer plan patient care around consultants working for free.

There is nothing unprofessional in expecting to be paid for your professionalism.

There is nothing unprofessional in wanting to have time to spend with family and friends.

There is nothing unprofessional in learning to say "No".

What is unprofessional is the coercion, intimidation and bullying of staff, including consultants, by some senior NHS managers. Thanks to the disclosures of two ex-NHS managers from South West Oxfordshire PCT, involved in the Oxford treatment centre scandal, we now know that NHS bullying is not condemned from the top, it starts there. But we also know that bullies have to be faced down, because otherwise they don't stop. So, I call on consultants to show the same determination over contract implementation as they did over local contracts.

Insist on time for SPAs, the quality work which good patient care requires.

Insist on job plans which fairly recognise your work.

Insist on time to look after patients properly.

The BMA and CCSC also work hard for you on broader professional issues. We have met the Deputy Chief Medical Officer and officials from the Modernisation Agency over inappropriate managerial interference with clinical priorities, the "dodgy dossier". We maintain regular meetings with the NCAA regarding their work with doctors in difficulties. We keep in regular contact with College presidents, postgraduate deans, PMETB members and others. We have been talking with the medical defence organisations over proposed new disciplinary procedures for hospital doctors. Our Clinical and Medical Directors subcommittee staged an excellent conference earlier this year. We are planning an event on raising standards and preventing errors through systems approaches. With the help of our press office, we speak to and brief the press. With the Parliamentary Unit we maintain contact with MPs from all parties. These are all important in their own right, they deserve to be done. But they also establish our credibility as being about much more than just money.

And we can do much more, and better, with your help.

There are major issues beyond the contract. Modernising Medical Careers was initially a very welcome intention to improve SHO training. What a mess it has become. Medical students forced to apply for two year Foundation Programmes, before anyone has determined the content of the second year or whether it will be accredited. Ridiculous proposals for an early exit to a service grade before these young doctors are adequately experienced. Excessively shortened specialist training that will not produce doctors equipped with the skills needed for safe patient care as an NHS consultant.

We believe in better training for better standards of healthcare, not only to churn out more consultants faster. But we do believe we need more consultants and that shorter training is possible, especially at the SHO level. So is there common ground to be found? Yes there is. Shorten SHO times, improve training, develop competency based assessment. Introduce it cautiously, with piloting and monitoring of outputs, especially given the imminent introduction of the working time directive which will reduce hours. But don't lower standards or gamble with patient care. And that means the time required from consultants to teach, train, assess, mentor, coach and inspire juniors must be recognised appropriately. Trusts will have to encourage consultants to provide more time for these activities, not try to bully them out of the SPA time written into their contracts.

And time spent for the greater good of the NHS and healthcare, through the GMC, NCAA, Royal Colleges and BMA must also be recognised appropriately. Unfortunately, we know that some trusts are behaving unreasonably over this.

So, we have a common theme. In the 21st century, the 4th largest economy in the world is insisting that some NHS consultants must reduce the amount of patient care they provide, while at the same time spending many millions of pounds importing doctors from developing nations.

There are ambitious plans to shorten the training of junior doctors by making it more intensive. But consultants are being refused the time to teach the next generation of consultants.

And national activities for the wider NHS are at risk because of local penny pinching.

What price patient care? What price training? This is not joined up thinking. It is barely joined up writing. Sometimes, it seems you could walk through the deepest thoughts of the Department of Health and not get your ankles wet. They must do better and share with us a responsibility to get our contract implemented and working. They must stop preventing its appropriate implementation and must free up Strategic Health Authorities to assist progress, not hinder it.

So, is it all doom and gloom in the NHS? Far from it. But the shining lights of hope in the NHS are there despite the politicians and civil servants, not because of them. I recently had the privilege of judging some applicants for NHS awards. They included a team who provide training in life saving skills and who use the funds this generates to provide, in their own time, free of charge, a pre-hospital, emergency care team. Saving lives of injured people. I read of a consultant who has run hundreds of miles for charity, raising tens of thousands of pounds to improve the care of his patients. All around the country, consultants are going the extra mile-or hundreds of miles- for patients, giving of themselves to improve care. Consultants are doing a brilliant job for the NHS. Consultants are leading by example, innovating and developing services for patients, motivating teams. Consultants are committed to the NHS and to patients and are working long hours, bringing down waiting lists, treating patients, saving lives. Consultants are the unsung work horses of the NHS.

Consultants make the difference for patients.

As NHS fashions and reorganisations come and go with great frequency, we are constant. Our relationship with patients is vital to their care. Consultants have shown we will not forget this, or abandon it.

We have the honour of representing these colleagues. Conference, I commend to you our fellow consultants- the forgotten heroes of the NHS.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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