BMA SRM and negotiating with the enemy

The British Medical Association held a Special representative meeting (BMA SRM) for the first time in nearly 20 years. This demonstrates the strength of feeling over a health bill that has been condemned by almost everyone qualified to give an opinion.

Their statement released today said:

In a meeting today (16/3/11), the day after the Special Representative Meeting (SRM) – convened to debate the Health and Social Care Bill – BMA Council confirmed its intention to step up its opposition to the most damaging parts of the Bill.  Council also considered a variety of options that would be necessary to achieve these aims. The role that competition, and in particular Monitor – as the economic regulator – will play in planning and running health care, is a key concern. “

The meeting yesterday carried motion after motion including the strongly worded:

That this Meeting deplores the government’s use of misleading and inaccurate information to denigrate the NHS, and to justify the Health and Social Care Bill reforms, and believes that:-
i) the Health Bill is likely to worsen health outcomes as a result of fragmentation and competition;
ii) the NHS needs to respond to the challenges presented by altered patient demographics, and by development of medical technology and medical care provision;
iii) the NHS needs national planned and coordinated strategies and frameworks to improve health outcomes.

As an example of the deplorable abuse of misleading and innacurate information, David Cameron in Prime Minister’s questions today said people in England were twice as likely to die from a heart attack as they are in France, despite this being thoroughly refuted. He omitted to add that if you collapse and die suddenly in France and you are at high risk of a heart attack, without a post mortem you will be coded as dying from ‘unknown causes’, but in England you will be much more likely to be coded as having died from a heart attack since it is the most likely cause of sudden death. Consequently in France they have twice the number of deaths from unknown causes. I’ve addressed this and the abuse of cancer outcomes on a leaflet you can download here. You should make sure your MP knows this so that they don’t sound as absurd as Lansley and Cameron when they repeat these canards in public.

At the SRM the meta-motion and (anti) climax of the meeting came at 5pm with number 175:

That this Meeting:
i) believes the BMA stance of “critical engagement” with the government failed, and
ii) calls on the BMA to oppose the Bill in its entirety;
iii) calls on the BMA to publicise and oppose the damaging elements of the Bill;
iv) calls for the BMA to consider what form of action should be taken by the medical profession.

Proposing the motion was Dr Jackie Davis (here explaining the health white paper on youtube)

The huge round of applause when she took to the stage was by far the loudest of the day and she had a standing ovation after her speech in which she said that the health and social care bill without privatisation was like a ham sandwich without ham, in other words, the health bill cannot be separated from the dismantling and privatisation of the NHS.

It was a surprise then when parts i and ii were narrowly rejected. The vote by a majority of 54% to 44%, with 2% abstaining, came after BMA chair Dr Hamish Meldrum urged his colleagues not to ‘tie our negotiating hands’.

One GP at the meeting said:

it was a set up…all out opposition to every motion in the bill and then wham some powerful speakers like Dr Mark Porter and BMA chair Hamish Meldrum in favour of negotiations after setting up a medical student to speak after Dr Davis …
hmm… the conservative profession

I am sympathetic with Hamish Meldrum who I suspect would agree with the following,

Sustainable peace has to be rooted in a willingness at a local level to find ways to coexist in a manner that will allow trust to develop over time between the warring parties. The failure to understand and therefore to address the aspirations, prejudices and fears of either party, no matter how misguided these may appear to be, is to put them beyond diplomacy, and by so doing so to sow the seeds of potential conflict down the line.

Oliver McTernan, Violence in God’s Name. Oliver McTernan has been involved for over 30 years in conflict resolution in Russia, Northern Irelland, the Balkans and the Horn of Africa.

After the meeting Dr Meldrum said,

“Ministers can no longer continue to cite the often reluctant and pragmatic decision by GPs to get involved in commissioning groups as endorsement of their NHS reforms. Following yesterday’s SRM, the government should not be left in any doubt about the strength of feeling among the medical profession; many doctors recognise the need to change how the NHS is run but have serious concerns about scale and nature of the planned reforms which are hugely risky and, potentially, highly damaging.”

The BMA leadership need to be supported to take a firm stand. I believe it is consistent to have no confidence in Andrew Lansley and to completely oppose the health and social care bill and yet still commit to continue to engage.

What is also certain is that this will not be enough. I’ve just come back from South Africa and seen that it took a broad range of tactics to overthrow apartheid. Its the same with every serious political struggle. Change will need public action as well as BMA negotiations and things will have to get pretty messy if Lansley and Cameron are to back down.