Government has turned NHS into “Byzantine system” nobody wanted, Porter says

The government has driven the NHS in England “to the edge” by budget cuts and unwanted legislation, while failing to listen to doctors who are trying to deal with an unprecedented scale of demand, the BMA’s chairman of council said today.

Mark Porter, making his first speech to the BMA’s annual representative meeting since becoming chairman of the association, said that the government had built “a Byzantine system that nobody wanted” while responding to the real issues of the NHS in ways that were both inadequate and divisive.

He won the loudest applause from representatives for an attack on moves towards an NHS that was open 24 hours a day, seven days a week. “Like many doctors here I feel personally offended by the terms in which this debate has been couched,” he said.

“Like many of you I work nights and weekends as well, at times when much of the private sector is fast asleep and ministers are tucked up soundly in their beds . . . The calls we sometimes hear for a Tesco NHS, full service 24/7, are just ridiculous when the health service can barely afford its current model.”

Doctors were already trying to deal with “sheer, unparalleled scale of demand on existing services,” he said. “And we experience overwhelming frustration that we cannot achieve the changes and improvements that we can see are so necessary to deal with this pressure.”

Rather than triggering planned and thoughtful efficiency improvements, the financial pressures faced by the service were leading to too many botched, quick fixes, including some drastic cuts in staffing that left remaining staff spread far too thinly. “How can we expect this to be safe for our patients?” he asked.

“At the Norfolk and Suffolk NHS Foundation Trust, for example, there are plans to cut one third of consultant posts and 40% of staff and associate specialist doctor posts by 2016. The BMA has been very clear that the safety and quality of services is under threat . . . We simply cannot allow NHS organisations to behave like this.”

Although the government may call this a cost improvement programme, the health secretary “really does need a new thesaurus if he thinks efficiency is synonymous with cheap,” Porter said, to applause. He cited the example of the new 111 urgent telephone services, some of which had been launched in the face of warnings that they were unsafe.1

Porter said that in the aftermath of the Francis report into failings at Mid Staffordshire NHS Foundation Trust it was the duty of doctors to have the courage to express concerns and not be deterred by institutional boundaries or be fobbed off by organisations that were better at protecting themselves than their patients or to lose sight of why they became doctors.

“Many doctors express fear about the consequences, and this inhibits us from doing what we know to be right,” he said. “The answer here is not to criminalise that fear—not to introduce an individual statutory duty of candour, if you will—but to remember that for speaking up to be meaningful, employers most listen to patients’ and doctors’ concerns.

“Employers must protect those who speak up instead of punishing them, as so often happens. This more than anything will transform the organisational culture of the NHS.”