Speech by Dr Jackie Applebee, Chair of Doctors in Unite to the BMA Annual Representative Meeting, 15 September 2020

Dr Applebee proposed the motion by TOWER HAMLETS DIVISION of the BMA: That this meeting, in response to COVID 19, demands that government:

i) ensure that workers are not under pressure to attend work either for financial or workforce reasons while they are unwell or self-isolating and at risk of inadvertently passing on the disease;

ii) provide the equivalent of day-one statutory sick pay to those on zero hours contracts;

iii) allow the NHS to requisition private health care facilities to accommodate effective COVID-19 treatment and quarantine provision if needed;

iv) ensure workers are paid in full while they are unwell or self-isolating.

With respect to point iii)

The COVID 19 pandemic has surely blown the myth that private is good and public is bad.

We have heard repeatedly today how the NHS has stepped up to the plate to deal with the crisis, though years of an unprecedented funding squeeze has led to the collateral damage that Chaand (Dr Chaand Nagpaul, Chair of the Council of BMA) referred to earlier of  those whose other health needs could not be met due to the lack of slack in the system.

On the other hand outsourcing to the likes of Deloitte and Serco has led not to the world beating test trace isolate and support system trumpeted by Boris Johnson, but a wholesale fiasco where people are having to drive miles to get a COVID test and where, despite the billions spent, the global multinationals cannot do as well with contact tracing as the very poor relation that are local public health departments.

Private hospitals were handed hundreds of millions back in March to increase capacity to deal with COVID 19 but they were largely unused, gifting a nice windfall to their shareholders at a time when their usual work had all but dried up.

Now they are likely to commissioned to help with the backlog of NHS care. Don’t get me wrong the backlog needs to be cleared, patients need their treatment, but the private sector should not be able to profit from this. They should be brought into the NHS family and their activity now should be offset against the money they were given in March. There must be value for public money spent.

The fact that the NHS had to shut down everything except dealing with COVID in March is a stark illustration of the chronic underfunding and that there has to be spare capacity inbuilt into the system to deal with crises. The extra money thrown at the system should have been thrown at the NHS not the private sector.

With respect to points i), ii) and iv):

If we are going to crush COVID, really get on top of it, we need people to be able to afford to stay at home and isolate if they are in contact with an index case. If there is enough money in the economy to subsidise eating out there is surely enough to guarantee that if someone is in quarantine that they are paid in full.

Many of the lowest paid, for example cleaners, refuse collectors and care workers, many of whom have looked after patients with COVID, often of precarious zero hours contracts, cannot work from home, and to make ends meet many of them have two jobs. They need to be reassured that they wont’ lose out financially if they stay off work otherwise they will have no choice but to go in and the virus will continue to spread.

Covid is with us but Government could do so much more to minimise it’s devastating impact.

The pandemic has surely underlined the huge value of publicly funded, publicly provided health service which is free at the point of delivery and the demonstrated the dedication of the staff who work within the NHS and Social Care.

As has been said today already, we have an opportunity to reshape the future, it’s up to us whether we grasp the nettle.

Please support this motion in all it’s parts.

The Motion was passed with overwhelming support from delegates

For-profit companies have no place administering retirees return to the NHS

We deplore the involvement of Capita in the administration of retired doctors’ return to the NHS workforce. Reported delays of over two weeks to inclusion back on the performers’ list, while NHS 111 remains overwhelmed, are unacceptable. Valuable, willing expertise is being underused at a time of national crisis. Inexperienced call handlers are being recruited at £5.82 per hour and given as little as 90 minutes training.  Senior support is badly needed.

Capita’s record in providing NHS services is a poor one. Their contract for cervical screening has already been removed after nearly 50,000 women were denied vital information. They should never have been offered this new role.

The 2012 Health and Social Care Act enshrined competition in the business of the NHS. Fragmentation and deterioration of services quickly followed, as the newly involved private sector cut costs to increase profits. 

The NHS has been subjected to systematic under-funding for over a decade. The average increase in the NHS budget before 2010 was 3.7%. Since the Conservatives came to power it has been only 1.4%. This lags behind inflation, and leaves no room to treat a growing population or invest in modern medical technologies.

This is brought to sharp focus by our response to coronavirus. Our health and social care services are struggling with a shortage of staff, beds, ventilators and personal protective equipment. Public health organisations cannot conduct the widespread testing needed to inform any meaningful preparations for an end to the lockdown.

Retired health workers began their careers in a very different NHS; one that was comprehensive, universal, and properly publicly funded. Our much applauded health service now deserves restoration to these founding principles.

The private sector needs radical reform for patients to be kept safe

Michael Walsh, a shoulder surgeon, has been sacked by Spire Healthcare and accused of subjecting scores of patients to unnecessary operations that left many in pain, traumatised and unable to work. This is a depressingly familiar story, with echoes of the case of Ian Paterson, the rogue breast surgeon who also worked for Spire. Paterson subjected more than 1,000 patients to unnecessary and damaging operations over 14 years in both private and NHS hospitals. He is serving a 20-year jail sentence imposed in 2017 for wounding with intent and unlawfully wounding nine women and one man whom he treated between 1997 and 2011.

Walsh is the latest PR disaster for Spire and has exposed it to accusations of systemic shortcomings in its 39 private UK hospitals with 7,000 doctors and surgeons on their books. Most of Walsh’s patients were in the private sector with fees paid by insurers or out of their own pocket, but others were NHS patients under the choose and book scheme which diverts patients to the independent sector for speedier operations. Given pressure on the NHS and delay or cancellation of surgery, such diversions are becoming ever more common. While the NHS Long Term Plan promotes a consumer choice agenda, it is unlikely that patients of Paterson and Walsh would agree this leads to improved patient care as claimed:

“The ability of patients to choose where they have their treatment remains a powerful tool for delivering improved waiting times and patient experiences of care. The NHS will continue to provide patients with a wide choice of options for quick elective care, including making use of available independent sector capacity… Patients will continue to have choice at point of referral and anyone who has been waiting for six months will be reviewed and given the option of faster treatment at an alternative provider, with money following the patient to fund their care.”

The recent Paterson Inquiry, lead by Bishop Graham James, should have been an opportunity to highlight failings in the private sector that consistently put patients at risk. There was however an obvious omission – a failure to tackle the hugely problematic nature of the relationship between the private sector and the NHS. This includes the sharing of consultants, the need to make profit, and the inevitable conflicts of interest that these create. As pointed out by David Rowlands (director of the Centre for Health in the Public Interest), investors in UK private hospitals must have breathed a huge sigh of relief on reading the bishop’s recommendations:

“At stake for the investors was the possibility that the Right Reverend Graham James would deem their business model so incompatible with the safety of patients that it would require fundamental reform. Yet rather than tackle the private hospital industry head-on, the bishop put forward a series of low-impact recommendations which will do nothing to prevent another Paterson, but instead leaves intact the archaic and dangerous form of medical practice that abetted him.”

And lo and behold, we now have Walsh to demonstrate the prescience of this observation.

The independent sector is lavish with payments aimed at bringing in consultant work. Just seven private hospital firms paid about £1.5 million in gifts and hospitality to consultants who referred patients to them in 2017/18. Rowlands points out that consultants, by bringing in patients, are the main source of income to a private hospital and sometimes each worth millions of pounds. There is not only a financial disincentive to challenge their practises (killing the golden goose), but more operations mean more money, and since consultants are not employees of the private hospital it can deny responsibility when things go wrong. This is even more worrying when an increasing volume of NHS work is being sent to the private sector (including one third of hip operations) under the NHS England banner of “improved patient experiences of care”.

By November 2019, over a ten year period the number of NHS patients having surgery in private hospitals nearly trebled:

“NHS figures obtained by the Guardian showed that it paid for 214,967 people in England to have an operation in a private hospital in 2009-10, Labour’s last year in power. The figure soared to 613,833 last year, a 185% rise in nine years.”

It should now be obvious that the care model in private hospitals can have long term and even tragic consequences for NHS patients, such as Peter O’Donnell who tragically died after hip replacement. The Department of Health and Social Care should also come clean, and rather than disguising it on their balance sheets as NHS spending, accept that the cost of all these operations constitutes a form of privatisation. Rowlands demands logically that:

“private hospitals should take on full legal liability for what happens in private hospitals by employing the consultants directly… and private hospitals should fundamentally reform their post-operative care arrangements and bear the full cost of any transfers to NHS hospitals.”

An analysis of Care Quality Commission reports from private providers has identified a plethora of risks. These include consultant surgeons without indemnity insurance, clinical outcomes not being monitored by the hospital, not all clinical incidents being properly reported, and inadequate pre-operative assessments (important for excluding high risk patients, since most private hospitals do not have intensive care facilities or back-up specialist teams).

It is time for the independent sector to focus on patient care rather than profit, and for its parasitic relationship with the NHS to be brought to an end. The government must realise that so-called ‘patient choice’ has its limitations, and commit to proper investment in our public health services so that there is no need for patients to take the risk of going elsewhere.

Dr John Puntis is a consultant paediatric gastroenterologist, the co-chair of Keep Our NHS Public, and a member of Doctors In Unite.