Rest & Recuperation – Gains During Coronavirus Crisis

Author: Giancarlo Bell

National Change in Crisis

The coronavirus crisis has exposed the flimsy foundations upon which many seemingly immutable truths were built. Millions who begrudged the chore of the commute and the tyranny of the office find themselves writing emails and filling in spreadsheets from their living rooms. Accommodations long deemed impossible to find for disabled people became commonplace.  In cities across the UK, thousands of homeless people were housed overnight, albeit in temporary accommodation. After a generation of “necessary” austerity, the Conservative government has injected billions of pounds into the economy and launched the unprecedented furlough scheme, alongside several more targeted economic interventions. In light of these nationwide upheavals, as we recover from the strange and emotional experience of working through the crisis, it is useful for doctors to look at what has changed in our own workplaces, and to consider which innovations we should keep.

Glasgow Royal Infirmary

The Glasgow Royal Infirmary campus is a strange collision of imposing Victorian façades and concrete modernist monstrosities, spattered around a labyrinthine link corridor. Despite the architectural delights of the site, when I started FY1 there in August, I was bitterly disappointed by many practical aspects of the physical work environment. The hospital canteen closed at 2pm and didn’t open at all on Sundays. After 2 o’clock, there was nowhere to get hot food, or even a ready meal. The tiny WHSmith, stocked with a limited selection of expensive sandwiches, would also close in the early evening. When an unfortunate junior left their prepped meal in the fridge at home or didn’t find the time to throw food together before an on-call shift, as is often the case, the only options were vending machine crisps. In the general surgery department, where, due to the crisis, I have been working for almost a full year, the FY1 workspaces were less than ideal. A handful of computers and chairs were squeezed into cramped alcoves on the wards. In terms of rest facilities, while I have heard tell of a doctors’ mess, this is located on the opposite side of the campus, and not a practical place for a surgical FY to retreat with a pager. My medical colleagues tell me that I’m not missing anything, that the mess is a small room with a couch. In place of a mess, in surgery we only had a few small break rooms shared between nurses, healthcare assistants, catering staff, and doctors. These spaces, inevitably, became crammed at peak times.

While I have heard of and been placed on sites with superior facilities, having recently engaged in a Scottish Junior Doctors Committee (SJDC) discussion about improving break facilities across Scotland, I also know that our situation was far from extraordinary.

Looking After Staff

As rotas changed and new staff appeared on the wards, it became clear that the cramped nooks and crannies of old were not pandemic-ready; social distancing was impossible. It did not take long for management and the facilities department to take note and act. The surgical secretaries migrated from the spacious offices adjacent to the wards to the relative safety of the University’s academic building. With the blessing of management, their vacant workspaces were seized by the FY1s. These were our first offices: rooms with good IT equipment and plenty of space to distance. Here we could discuss complex cases and write discharge letters in a position both far enough from the ward to instil an atmosphere of calm but close enough for nursing staff to reach us in seconds when required.

Other changes swept across the hospital. The canteen started to open for a night-time slot. Fish and chips at midnight! Even better, local businesses and Celtic Football Club began to donate food – at the peak of the pandemic we were provided with a free high-quality hot dinner every night.

Rest & Recuperation

The centrepiece of the innovations, however, was the “R&R Area”. Break areas bearing this title were implemented across NHS Greater Glasgow & Clyde overnight. In the Royal Infirmary, this took the shape of a spacious area in the academic building manned with redeployed NHS staff and volunteer flight attendants and pilots from “Project Wingman”. It is furnished with soft seats and stocked with tea, coffee, and snacks. The space allows for social distancing, even during the mealtime rushes. In the R&R, we are not segregated by profession; everyone from porters to Advanced Nurse Practitioners has a space to relax and sip coffee alongside consultants, cleaners, and HCAs. At their peak, NHS R&R areas also provided 24 Hour, in-person psychological support and featured food and goodies donated by the public to boost staff morale. At GRI, for a time, there was even a free gym in a repurposed lecture theatre, with exercise equipment and fitness classes.

Project Wingman at Glasgow Royal Infirmary

After several weeks on my new Covid rota, I was sitting in the R&R with two colleagues during a night shift. We got to speaking about how, despite the  tone of discourse suggesting that we were making a sacrifice for the country, many things at work were better than they had ever been. We were adequately fed and well-rested. We felt looked-after. In my time as a BMA Hospital Representative (on the Local Negotiating Committee) , I had never dreamed that we could demand such comprehensive services, especially with regards to the new mental health support. We noticed that night that they had already started stripping equipment from the new staff gym. Sensing that further rollbacks were imminent, I started to feel strongly that we should fight to keep as many of our new facilities as possible.

Trade Unions can Defend Improvements

That week, I sent around emails via BMA listserver (a group email list) and put out messages on various WhatsApp groups. Employment Advisors and more senior colleagues in the BMA agreed with the sentiment of my demands . Everyone felt from their own workplaces that support services, staff facilities, and catering were all drastically improved. I was assured that this would be taken to the next Local Negotiating Committee meeting to raise with management. However, several colleagues were sceptical about the feasibility of the demands; in the Royal Infirmary, for instance, the University would need its academic space back, the restaurants and football club would eventually stop donating food, and the airline staff would have to return to the skies. I was aware of these points, but I felt that, since the pandemic had demonstrated that these amenities are possible, we should take a hard line – we should view them as essential.

I also saw that this could be a campaign which would help us to recruit and organise doctors into the BMA. If we worked with other unions, we could increase union representation for all workers in the hospital. 

Unite with Other Workers

I have been a member of Unite for a year or so now. Until recently, I had never engaged with them directly on workplace issues. However, before Covid I had been in talks with the secretary of my local Unite branch, a consultant psychiatrist and union organiser, about establishing a Doctors in Unite Glasgow division. Furthermore, in the Winter I had been elected as health rep to the Scotland Unite Youth Committee. Having seen that Unite had recently won several victories for facilities and catering staff in my hospital, I thought it could be worth tentatively reaching out.

I sent an email detailing my thoughts. Two days later, I walked into the R&R Area in the middle of the night for a break.  On the walls and scattered across every table were dozens of Unite posters demanding the retention of our new services and a post-Covid 20% discount for staff at onsite catering facilities, along with leaflets seeking to recruit new members. I texted the phone numbers on the poster. Shortly after I got home that morning, I received a phone call – it was an enthusiastic Unite organiser. He was delighted that I had reached out and thanked me for raising the issue. The branch representative had already started working on such a campaign, and my email served as impetus to put a poster together and kick things into action. The organiser strongly encouraged me to get involved with the campaign and with the grassroots work going on in the branch.

I was taken aback with the warmth and passion of this reception. A few days later, I received another phone call, this time from the branch representative, who works in one of the hospital labs. As well as thanking me for reaching out and encouraging further participation, he informed me that most of the airline staff looking after the R&R Area were Unite members. In solidarity, they had assisted in the distribution of the campaign and recruitment fliers. The rep proceeded to give me a link to a survey on staff food and rest facilities, which I promptly shared on all my FY1 networks.

The BMA had never considered such an approach.

The Campaign

The campaign is ongoing. NHS Greater Glasgow & Clyde, my local health board, has promised that the spirit of the R&R Areas will continue after the pandemic. This is not a concrete win – many of our gains will disappear as students, academics and administration staff return to the hospital site. However, having shown that at times of crisis, Glasgow can do better for health workers, it is important that we retain, or have new, facilities for rest and recuperation. We will hold this commitment in hand when negotiating in the months ahead.

This experience has taught me that, as workers, we can achieve more together than we can as individuals. The new facilities at my hospital are used by everyone, not just by doctors, and we should defend them together. We all have a stake in our workplaces and our communities; doctors could learn a lot by engaging with the wider trade union movement and striving for better conditions with a united front.

The case of the R&R Areas is one example of how workers have come together to weather the Covid-19 storm. In hospitals and other clinical settings across the UK, as well as in shops and factories, on doorsteps, and on the streets, the same thing is happening every day. It has become abundantly clear that workers on the frontline, including local managers, know how to make the NHS work best for our patients and colleagues. We made rapid and excellent changes to our workplaces when free to do so, whilst national leaders and government dithered. Together, we should run the NHS all the time.

Time to Withdraw from the Joint Statement?

Authors: Emma Runswick and Pete Campbell

On the 30th March, BMA Junior Doctors Committee and NHS Employers published a joint statement which stated that:

“the BMA agree that when not possible to implement, the working hours restrictions and rest requirements in the TCS will be suspended and that the Working Time Regulations 1998 (WTR) will be the fallback position for the duration of the pandemic.”

“Trusts should discuss proposed new patterns of work with affected trainees prior to implementation”

(emphasis ours)

Some supporters of the Broad Left, ordinary members of the BMA and the Junior Doctors Committee representatives strongly objected to this and the joint statement was rewritten reflecting some of our concerns. The up-to-date statement is available here.

We were, and continue to be, in favour of sensible flexibility during the pandemic, with the aims of providing appropriate medical cover particularly during staff sickness. However, we argued that giving employers permission to ignore our contractual rights for an undefined reason without agreement from the affected junior doctors, with no clear endpoint for that position, was dangerous.

We argued for changes, including highlighting the importance of safe working, ensuring consultation of affected trainees, and that trusts would have to prove that breaching our terms and conditions was truly a last resort.

End of “Emergency Covid-19 Measures”

On the 29th April NHS England wrote to all trusts requesting the restart of all urgent non-COVID 19 service and the gradual reintroduction of elective work. This has led to a slow withdrawal of the redeployment of junior doctors, and led us to reconsider the joint statement. The end of redeployment or restarting elective work is evidence that workload is normalising and normal TCS should be met. However, in lots of trusts, this is not happening.

“Step down” rotas are being implemented in some trusts which are designed to ‘catch up’ with delayed NHS services, some of these rotas continue to breach contractual protections with the backing of the joint NHS Employers and BMA statement. These rotas can be nothing like pre-covid rotas, with increased intensity, additional weekend working and additional hours.

Pay and Leave Arrangements

Many representatives working locally are yet to see fulfilment of the promise made by NHS Employers:

“NHS Employers is grateful for the commitment made by junior doctors and the BMA at this time and will take this into account when preparing for future negotiations once the COVID19 pandemic is resolved.”

Local trusts and Programmes are returning rapidly to old tricks, attempting to “charge” a 1.5 days of annual or bereavement leave for the new 12 hour standard day, denying leave requests and creating limits on what leave can be carried over into future rotations. Legislation aimed at allowing key workers to carry over untaken leave during the pandemic specifically excludes junior doctors.  

There is notably no national agreement on payment for untaken leave, and the new version of the contract has been withdrawn from the NHS Employers website – perhaps due to the new section on the value of a day of annual leave.

16.9       On termination of your employment, you will be entitled to pay in lieu of any outstanding entitlement accrued in the leave year in which your employment terminates or be required to repay to the Trust salary received in respect of annual leave taken in excess of entitlement. The amount of the payment or repayment shall be based on accrued salary for the leave year paid at a rate of 1/260th of your salary for each day accrued.

Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 Version 9 (withdrawn)

There also doesn’t appear to be a pay deal for >1 in 2 weekend frequency, though some local BMA reps have won excellent deals (eg at Liverpool University Teaching Hospitals).

In nursing, the government has withdrawn the deal offering payment to “aspirant nurses” (final year nursing students) leaving many in the lurch, despite thunderously clapping for carers.

We cannot trust the government, or NHS Employers, to treat us fairly or recognise our work with mealy mouthed promises. If there is a second wave, we must not be put in this position again – we need better protections and agreements on pay and training arrangements in advance.

We are shattered

Many of us have had an extremely rough few months. Some of us have lost friends, family, and colleagues to the virus. Some of us have been sick. Some have not been able to see our families – abroad, or living away for protection, or shielded. Most of us have cancelled leave, given up training plans, worked harder rotas and stepped into unfamiliar medicine to play our part in pandemic response.

Now more than ever we need contractual protections for rest and working hours, alongside other positive trade union endeavours like the Fatigue and Facilities Charter. Many of the positive aspects of the response to the pandemic are already being stripped away. If we don’t act now to allow recuperation, there won’t be anything left to give in a second wave.

The BMA must now withdraw from the joint statement and work with local representatives to ensure safe rest and hours limits are implemented across the UK.

Pay When Rotation Has Been Cancelled

Author: Emma Runswick

For many doctors, the cancellation of April rotations did not just mean loss of training, it also represented significant loss of expected pay. Those doing jobs without out-of-hours work in March would lose thousands by not moving into high-intensity jobs, through no fault of their own.

Colleagues who made financial decisions on the basis of expected pay, or reliant on this for childcare, stood to be particularly badly affected.

Several Broad Left supporters who are Local Negotiating Committee representatives* have won pay increases for trainees at multiple hospitals and we are involved in helping other reps secure this.

In these trusts, doctors are being paid the highest salary from:

  • The rota they are working
  • The rota they were expected to be working from April and had a work schedule for
  • The emergency Covid rota

For some trainees, this is worth £3700. Many more have gained over £2000.

We have argued for this on the basis of Schedule 2 of our contract.

71. Where changes to the work schedule are required by the employer and total pay would be decreased as a result, the doctor’s total pay will be protected and so remain unchanged until the end of the particular placement covered by that work schedule. This protection will not extend to any subsequent placement, including a placement where the doctor returns at a later date to the same post.

2016 Junior Doctor Contact in England, Version 8

Or 21h in the 2002 Contract, which says similar.

If you had a work schedule for April-August rotation before they announced rotation was cancelled, then you have experienced “changes to the work schedule” “required by the employer” “and total pay would be decreased as a result”. As such, you are entitled to the pay “until the end of the particular placement covered by that work schedule” (April-August).

If some trainees in your trust had a work schedule and some did not – i.e. a department didn’t get their work schedule out in line with the guidelines – then you have an argument that the department’s failure to send out work schedules should not disadvantage those trainees.

We gained support by emphasising our contractual rights, sharing the stories of doctors who were badly affected, building alliances with supportive members of management, and later by using examples of other trusts who had agreed this.

If you would like support to negotiate with your workplace or want to know more about becoming an effective BMA representative, contact us!

*Local Negotiating Committees (LNCs) are your local BMA representation. We encourage all Broad Left supporters who are hospital doctors to become LNC reps.

Abortion in Northern Ireland

Marie-Claire Bradley, a Bristol-based medical student from Northern Ireland, discusses the ongoing issue of abortion in response to debate heard at the BMA’s Annual Representative Meeting 2019, subsequent court cases and imminent legislative change.

In June this year, I listened to discussion on the above motion at BMA ARM 2019 in Belfast for the pictured motion which clarifies and sets out a framework for the implementation of BMA’s 2016 policy that abortion should be treated in line with other forms of healthcare and decriminalized across UK and Northern Ireland and policy from 1984, 1985 and 2003 which specifically supports the reform of law in Northern Ireland. The air hung thick, humidity emanating from hot palms and from under stiff collared necks.

Since then, a number of momentous legal shifts towards the fulfilment of this motion have been achieved. In July, a majority of MPs backed the bill brought by MP for Walthamstow, Stella Creasy to repeal Sections 58 and 59 of the Offences Against the Person Act 1861 – which make abortion a criminal offence in Northern Ireland. As a result, the law governing abortion in Northern Ireland, the Offences Against the Person Act 186, is due to change three days from the time of writing (on 21st October), if the devolved assembly does not re-convene before then. Interim rules currently govern the care of those seeking abortions in the meantime – these rules allow doctors to finally at least allude to the possibility of treatment in England without fear of legal reprisal. (1)

On 3rd October 2019, Sarah Ewart, (who was denied abortion despite scans definitively showing that the foetus was in viable) brought her case before the High Court in Belfast. The court considered the archaic wording of the 1861 Act – a near-blanket ban on abortion, except in cases where continuing the pregnancy would cause ‘physical and mental wreak’, as highlighted by Dr Kerr- speaker for the motion and member of Medical Students for Choice- at ARM. The court ruled that such a ban breaches the UK’s human rights commitments.

Abortion will remain a criminal offence in England, Wales and Northern Ireland, although, Northern Ireland is the only place where women and pregnant people face lifetime imprisonment for terminating a pregnancy, even in cases of rape, incest and foetal abnormality, and doctors and medical professionals also face life imprisonment for assisting. The potential for such a win for human rights in Northern Ireland is, joyously, a result of local political stalemate and governmental disregard for the region.

This departure from current archaic rules to better represent the will and the needs of Northern Irish people is particularly welcome in a time of such paralysing political uncertainty – The writer notes that the Act came into force 20 years before it was legally possible for women to own property. (2) At ARM in Belfast, Dr Kerr explained the influence that the criminalisation of abortion has had upon medical education – while the procedure affects 1 in 3 women and pregnant people, education on the subject across the UK is poor and medical students in Northern Ireland receive “little to no” training in this regard. Dr Kerr commented that the unavailability of the procedure leads to “forced pregnancy” which is “an act of violence and assault” and indeed, as Dr John Chisholm, Ethics Committee Chair, later mentioned, the UN Convention on the Elimination of Discrimination Against Women Committee condemned the law on abortion in Northern Ireland as a “grave violation of rights under the Convention”. Dr Chisholm, also echoed the words of the proposer of the motion, Dr Anthony Lempert and Dr Noel Sharkey, speaking for the motion, in stipulating, “human rights are not a devolved issue”.

There was a common preoccupation amongst speakers against the motion who feared that any such legislative overreach may impact upon the peace in Northern Ireland:-

Speaking against, Dr Dominic Whitehouse opened with the phrase, “peace is precious and fragile” and subsequently brought to the attention of ARM; the lack of an active assembly at Stormont for two years, the murder of “female journalist reporting on riots in Creggan area of Derry” and “letter bombs being delivered by dissident republicans to London airports and Waterloo station” as evidence that peace in Northern Ireland is once again dwindling and implying that the enactment of the legislative changes laid out in the motion would amount to a return to “colonial rule” and thereby threaten the peace.

The unnamed “female journalist” to whom Dr Whitehouse refers is Lyra McKee, her tragic and untimely death highlighted the pertinence of her investigative work unpicking the stories of young people left behind by the Peace Process. Lyra McKee actively campaigned for LGBTQ+ rights, was pro-choice and in favour of the decriminalisation of abortion.

Dr Rachael Pickering, also speaking against the motion, emphasised that being “from Shropshire” meant that the legislative change suggested was “imperialist”. Dr Pickering told ARM that Northern Ireland is “politically conservative”. In fact, the writer notes that the fifth Northern Ireland Peace Monitoring Report, funded by the Joseph Rowntree Trust, lists the necessity of “reform of abortion law and equal marriage” alongside the potential impact of Brexit as issues that need to be solved in order to further secure peace in Northern Ireland, citing evidence from the Northern Ireland Life and Times survey and opinion polls which show that “the majority of the population in NI support liberalizing the law on these issues”. The odd notion that the backdrop of political instability in Northern Ireland which was originally caused by Direct Rule should be an excuse for further denial of human rights in Northern Ireland is somewhat absurd.

Dr Pickering, an English Representative, was correct in saying that English Representatives probably shouldn’t dictate the consensus of Northern Irish people. The fifth Northern Ireland Peace Monitoring Report notes that the views of socially conservative political parties in Northern Ireland “are at odds with” the view of Northern Irish people. (3) Indeed, as Dr Lempert notes, 59% of people in Northern Ireland have voted in favour of decriminalisation. The consensus of Northern Irish people is for the motion.

The voice of this much needed Northern Irish perspective, came when Dr Noel Sharkey spoke in favour for the motion stressing the need for legislative change to ensure that Northern Irish people have the same human rights as people in the rest of the UK, emphatically stating that, “As a gay man I cannot marry my partner.” He explained that the lack of devolved government was not a reason to stall reform of legislation as the underlying health issues are “becoming more toxic and dangerous” as a result. Closing the debate, he powerfully stated that, the “Criminal framework is not preventative, it simply exports the problem […] it is time to trust women. Human rights is not a devolved issue. Instead of giving women in Northern Ireland air-fares, it is time to give them healthcare.”

Threatening uncertainty surrounding the border in Ireland casts a heavy shadow over economic well-being and the maintenance of the hard-won peace in the region and the right to choose hangs in the balance until Monday when Secretary of State, Julian Smith, will be forced to legalise abortion and same-sex marriage before 13 January 2020. Smith’s video tweet on 14th October urged the devolved executive to sit and discuss the law on abortion before the 21st October deadline immediately followed sit down talks between the DUP and Cabinet. Accusations ensued from MP Stella Creasy that the right to abortion is being used as a “bargaining chip” by the Government in the scramble to bend the DUP over to accept their Brexit deal. Indeed, the next day a subsequent statement from the DUP called for Stormont to sit once again to “oppose the extreme liberalisation” of the law.

BMA Council September 2019 Report

Member Support Services

We received an extended extract of the Member Support Services Review, an external look at our employment services for members. The aim is to learn and improve a range of processes, covering member experiences, ‘complex cases’, communications, and other issues. The content of the report is absolutely confidential and the discussion at Council was held ‘in private’, which means we are not allowed to share any of it with you. We are also not allowed to report what was said in the meeting. We are assured that Council will continue to have oversight of the implementation of the recommendations.

We believe that the report has evidenced many concerns that we as representatives have been highlighting for many years. It has highlighted some solutions, some of which are quick wins and others which require strategic and long-term change. We are supportive of many of these and have expressed concerns about some others. We will argue that any working groups set up to implement the findings include representatives. We are also arguing for some changes not recommended in the report:

  • Insourcing First Point of Contact
  • Recreating the Place of Work Accredited Representative role (POWARs)
  • Better local and regional staffing in Member Relations (Employment Advisors and Industrial Relations Officers, the staff that help with individual and collective cases respectively)

We consider this work to be our core trade union function and want it to link with our push for rank and file trade unionism. To that end, Emma met with the new CEO Tom Grinyer on Friday to discuss moving to an organising model of trade unionism and how that fits with the recommendations made in this report.

Pensions

Our members’ age discrimination claims are waiting for the Employment Tribunals in the four nations to work through the processes. We expect that we will get some remedy for all our members affected by pension changes in 2015.

We are also continuing to lobby on the disgraceful situation for Less Than Full Time and Locum doctors, who pay pension contributions as if they were earning a full time salary, or a locum rate for 365 days a year. We are exploring the possibility of legal cases around sex and disability discrimination to progress this issue.

The pension tax disaster rages on, as more consultants drop sessions due to the annual allowance taper. This taxes money which doctors have not received and may never receive. It also in some cases results in a tax bill larger than the additional pay earned. The only way to solve this problem decisively is to #scrapthetaper. For doctors caught by the taper, the only solution is to drop sessions, Clinical Excellence Awards or other income sources to get back under the threshold taper. Doctors are now doing this in large numbers. Wait list clinics, leadership roles and education are particularly affected. Members can access the BMA-Goldstone Modeller to work out the best course of action for them.

We have argued for increased communication with members, particularly targeted at younger members, on all of these issues.

Banding

If you were a junior doctor on the 2002 Contract in the last 6 years, and you did a monitoring exercise that used Allocate or Zircadian, you may be able to get pay for the time and money your employer didn’t pay you for. This could be thousands of pounds.

We want to help BMA members take legal cases against their employers. Read more about our first legal victory and the eligibility here.

Surveying Members’ Views on Assisted Dying

At ARM, Motion passed:

That this meeting notes the recent decision by the Royal College of Physicians to adopt a neutral stance on assisted dying after surveying the views of its members and:

  1. supports patient autonomy and good quality end-of-life care for all patients;
  2. recognises that not all patient suffering can be alleviated; and
  3. calls on the BMA to carry out a poll of its members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying. 

We were asked if the question must be as worded in the motion:

“should the BMA adopt a neutral position with respect to a change in the law on assisted dying?”

We believed that without a proposed change to the law, this question is unclear in meaning. The debate at ARM, and the RCP example in the motion, made clear that the proposers and Representative Body wanted to determine whether members believe the BMA should be neutral on Physician Assisted Dying, rather than on any changes to the law. We believe that asking the question as written would not achieve the aims and spirit of the motion, and we heard from the proposer to that effect. However, this kind of interpretation of a motion should be approached carefully. Council should not be able to substantively change the course of a proposal mandated by the democratic conference of the BMA. We should be vigilant to this and the Chair of the Representative Body (who Chairs the ARM and is the advocate and guardian of the policy book) was correct to raise the issue.

The Medical Ethics Committee will now consider all options around polling members and bring detailed proposals for Council to consider at its November meeting.

Resignation and Council Vacancy

Our colleague Yannis has had to step down from Council and Junior Doctors Committee for personal reasons. He has been an incredible asset over many years and we hope to welcome him back to activity in the future.

In cases of vacancy, Council can choose to fill the seat with the next runner up as a non-voting member, or to run a new election. The vacancy is for a Junior Doctor Branch of Practice seat. There are, due to qualification of three Council members originally elected as medical students, now more junior doctors on Council than in July 2018. In this context, an additional non-voting member appears unnecessary, and the cost of a national postal election extravagant.

Junior doctors on Council automatically get a seat on Junior Doctors Committee, where they are now the largest constituency, bigger than any regional representation. This poses a problem for the functioning of JDC.

Due to the gender constraints applied to Council, which do not allow more than two thirds of any group to be from one gender, the next elected junior would be a man. The make up of Council is almost two thirds men already.

For these reasons we voted to not fill the vacated seat immediately. We will support new elections in future if more vacancies arise. We are in favour of more frequent elections to Council.

Brexit

The BMA launched a major Brexit briefing ‘A health service on the brink: the dangers of a ‘no deal’ Brexit’ on 2nd September to coincide with Parliament’s return. The report reinforced the BMA’s concerns about the consequences of a no deal Brexit for patients, the health workforce and our health services. The report also cast significant doubt on the Government’s claims that the NHS was ready for a no deal Brexit, identifying over 40 unanswered questions on the NHS’ preparedness for this scenario. 

The BMA has also produced a member-focused resource, ‘Information for doctors if there is a no deal Brexit’ which aims to answer the questions we may have in the event of a no deal. This resource will be kept updated as developments occur and additional issues arise.

In a really positive move, the BMA joined a joint statement with 11 other health unions to warn that a no deal Brexit could devastate the NHS. We want to see more of this cross-labour-movement thinking.

Refugees – Motion not reached by ARM

According to section 89 of the ARM Standing Orders ‘should the representative meeting be concluded without all the agenda having been considered, the sponsoring constituency can request a motion to be pursued, it shall be entitled to submit a written memorandum for the consideration of the council or appropriate committee, and/or to submit oral representations.’

We were asked to consider Motion 66 from ARM on refugees:

That this meeting is appalled by the humanitarian crisis unfolding on the Greek islands, and elsewhere on Europe’s external borders, and the devastating impact this is having on the health of displaced people. We call upon the BMA to lobby nationally and internationally for:

  1. the establishment of legal routes for those seeking asylum in Europe, including the UK; 
  2. the protection of the human rights, specifically the health-related human rights, of all displaced people; 
  3. the UK to fully recognise its obligations under the 1951 Refugee Convention; 
  4. the UK to take a leading role in developing a humane international response to forced migration. 

We voted to pass this motion, to enable the BMA to lobby the UK government to use its considerable influence to establish a humane approach to migration to Europe, including by establishing safe, legal routes for seeking asylum and alternatives to immigration detention, which is damaging to health; and lobby for adequate protections for asylum-seekers who do reach the UK. 

Other Issues

We were updated on several other issues in the Chair’s Report, including that:

  • We have a new Code of Conduct support line managed by an external, independent provider which is staffed by accredited counsellors. The phone number is 033 3212 3618 and is open to both those raising concerns and those who are subject to complaints, to provide support and guidance in dealing with the situation.
  • We are taking our lobbying on a Caring, Supportive, Collaborative NHS to the party conferences in preparation for an early election.
  • The BMA is contributing to the Infected Blood Inquiry, with one Council member volunteering to work through thousands of pages of documents so that we can assist in finding the truth for those affected by infected blood.

Nationalise Care Homes – ARM

Author: Giancarlo Bell

This is the fifth of several pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.

Motion 90 ARM 2019.

Britain should nationalise its extensive network of private care homes so that the vulnerable residents of these establishments can benefit from the improved standards of care afforded by the staff and systems of the NHS. Nationalisation could also provide better regulation, improved working conditions, and higher pay for the millions of workers in the social care sector, as well as offering better integration between social care and NHS medical care processes. This was the crux of Motion 90, submitted by North East Regional Council at ARM 2019. While the Broad Left was firmly supportive of this motion, the room at ARM was divided, with many representatives questioning whether bringing social care into the NHS was the right strategy to improve falling standards. Despite the strength of the opposition presented at ARM, the Broad Left are delighted that the motion passed in all parts.

Before the recession, care homes were regarded as bulletproof investments for private equity firms. The British population was ageing, and so thousands more elderly people could be churned out into the private care system every year with a premium hanging over their heads – profit for the care home bosses. This perceived stability provoked increasingly risky financial investments and a series of reckless economic expansions, subsidised with the money of taxpayers and the savings of our elderly population. No company better embodied this story than Southern Cross, formerly the UK’s largest social care provider with a peak of 31,000 residents in 750 homes [i]. They followed the tried-and-tested pattern outlined above, with a constant cycle of buying and selling new properties and pushing into new markets. After the credit crunch, Southern Cross was hit by rising rents, decreased expenditure by councils, and falling property prices. They responded by squeezing employee pay and decreasing the quality of care provided to postpone their inevitable decline [ii].

Our elderly friends, loved ones, and colleagues should not be at the mercy of neoliberal market forces. We are a wealthy country, and we should guarantee a basic standard of living for everyone. While doctors in general, and BMA members especially, believe in a publicly funded NHS which is free at the point of delivery, these values are more contentious when it comes to social care. There has been something of a shift in the Overton window in this instance. While almost 200,000 of the half a million care home beds in the UK were operated by the NHS or local authorities in 1990, this number has dwindled to about 30,000 [i]. The public accepts the dogma that the state provides health care; while the private sector provides social care.

By bringing care homes into the public sector we can equalise the huge variation in standards of care seen across the care home industry. The private operators’ main motive is profit; the care of their residents is a secondary priority. As such, we have seen dwindling standards of care, and a growing incidence of neglect and abuse at care homes across the country [iii]. At ARM, opponents of Motion 90 argued that the care homes which scored most positively under the scrutiny of CQC review were small, privately run establishments. This may work out nicely for the people who can afford to live in such homes, but the working class are left to fend for themselves in those cheaper, often poorly run care homes with low-paid, overworked staff, because staying in a top-quality care home when nursing care is required can cost as much as £55,000/year [iv]. We would not accept such inequality in healthcare.

Employees in the care sector are at breaking point. They are working longer hours, for less pay, and with fewer benefits than their colleagues working in NHS hospitals. They also receive less training and are frequently employed on unstable zero-hour contracts with little in the way of career progression [v]. By bringing care into the NHS, we can employ care home workers on humane terms, with the pay and conditions they deserve, which will subsequently improve the standard of care they are capable of delivering.

Medical wards in NHS hospitals across the country are burdened with the complex issue of ‘acopia’ and ‘social admissions’. There has been fierce debate about the validity of these terms and about how to solve the issues underlying these admissions, but nationalising care homes could be an important step towards a solution. If care homes were provided on a universal, free basis like healthcare, and their staff were part of a wider, integrated NHS system, then elderly patients who are unable to cope at home could be admitted to somewhere to truly meet their needs, rather than taking up a costly hospital bed. This could save our NHS a significant sum of money.

Now that this motion has made it through ARM, the BMA should be unerring in its support for nationalising care homes. We must show that we believe in a humane standard of care regardless of class background, that we stand for health and social care which is comprehensive, universal, and free at the point of delivery. We must show solidarity with the workers in the care home sector. Our elderly population, and the workers looking after them, deserve better than to be treated as pawns in the games played by private equity firms.

[i] https://www.socialist.net/britains-care-homes-in-crisis-nationalise-them-now.htm

[ii] https://www.theguardian.com/business/2011/jul/16/southern-cross-incurable-sick-business-model

[iii] https://www.independent.co.uk/news/health/abuse-care-home-cqc-autism-learning-disability-whorlton-hall-police-a8969026.html

[iv] https://www.moneyadviceservice.org.uk/en/articles/care-home-or-home-care

[v] https://www.independent.co.uk/news/uk/home-news/care-home-workers-half-leave-jobs-within-year-staffing-levels-problem-report-communities-and-local-a7658281.html

Knife Crime is a Public Health Issue – ARM

Author: Adaeze Chikwe

This is the fourth of several pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.

Motion 87 ARM 2019. 87 a, b and care for reference and were not debated.

The Broad Left supported this motion which passed unanimously.

Knife crime is an ever-growing epidemic in the UK, with rates reaching record level during 2018. According to the Office for National Statistics, the number of killings due to knife crime in 2018 were 732, one of the highest rates ever recorded in the UK(1). Unfortunately, the response to this epidemic by both the government and the Home Office so far fails to combat the issue by only focusing on reactionary policing and criminalisation, rather than preventative measures.

The solution we see unsuccessfully rehashed year upon year by the government is the use of ‘stop and search’, where pedestrians are stopped by the police at random on the streets, often on the basis of preconceptions and stereotypes about the race and gender of supposed perpetrators of knife crime. According to the Home Office, black people are 40 times more likely than white people to be stopped and searched(2). Official responses and rhetoric reinforce the ignorant and damaging stereotypes already placed on the heads of black people, such as that black people are criminals and more likely to partake in violent behaviour.

Although stop and searches may be successful in the short-term, this solution does nothing to stop offenders carrying knives on the street again at a later date, and instead increases the frustration and lack of belief in the police force from particular groups of people wrongly targeted for stop and searches repeatedly.

Knife crime is a public health issue.

We recognise that to truly make a dent in this rising wall of knife crime, a more grassroots approach needs to be undertaken where organisations and charities go directly into communities to find out why some people (often young adults) feel that carrying knives on the street is their only option, and intervene in the early stages before attacks can be carried out. Furthermore, these organisations have a variety of functions such as providing positive guidance to young people who might not have had this guidance earlier on in life, providing first aid sessions that teach young people how to stem blood loss from a knife wound and helping young offenders find employment and further education when coming out of prison to prevent them from re-offending.

The motion called on the BMA, as a trade union for doctors, to recognise the role that healthcare has to play in combatting knife crime. Instead of taking a no-questions-asked approach whilst treating victims of knife crime and ushering them immediately out of the hospital doors once treated in order to free-up beds in our already over-stretched NHS, healthcare workers need the training to be able to sign-post victims towards services that can break the cycle of violence that often leads to re-attendance.

Additionally, we need further implementation of youth workers in trauma centres all around the country, such as those from the organisation ‘Redthread’ that work side by side with clinicians in hospitals to engage victims of knife crime directly from their hospital beds. Organisations like this take advantage of this time when victims are at their most vulnerable and reflective in order to have a greater effect and prevent re-attendance(3).

There is evidence that a grassroots approach to combatting knife crime is effective, as shown in Scotland. The Scottish ‘Violence Reduction Unit’ (VRU) implemented a variety of programmes that aimed to educate rather than castigate both the victims of knife crime and those at risk of partaking in knife crime. They launched a mentorship project in schools designed to educate young people about how to challenge offensive behaviour without using violence(4). The VRU have outreach teams in hospital emergency rooms to sign-post victims to services that can help them move on and rebuild their lives regardless of their circumstances. As a result of the efforts of these organisations, there has been a 39% decrease in homicides over the last decade.

If Scotland can reduce their knife crime levels, we can absolutely do the same in England and Wales.

Collectively bringing attention to this issue by promoting outreach and grassroots services will enable those at risk of partaking in knife crime to see that these programmes are available. We need to continue to pressure the government into prioritising the public health approach rather than rely solely on stop and searches. We can do this through the BMA and independently, by writing to MPs and starting petitions to have a greater proportion of money used to combat knife crime funnelled towards grassroots organisations and outreach services. Furthermore, we can raise awareness that these services are available in our communities and invite grassroots organisations to schools and youth clubs.

The knife crime epidemic, although experienced by few, needs to be acknowledged as a public health problem by all, whether you are from a community directly impacted by the effects of knife crime or not at all.

References:

  1. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/crimeinenglandandwales/yearendingdecember2018
  2. https://www.theguardian.com/law/2019/may/04/stop-and-search-new-row-racial-bias
  3. https://www.redthread.org.uk/what-we-do/#a&e
  4. https://www.bbc.co.uk/news/uk-scotland-45572691

What Union Should Medical Associate Professionals Be In?

Authors: Brocha Goode and Emma Runswick

This is the third of many pieces arising from the BMA’s Annual Representative Meeting 2019, explaining our position on the debates which occurred there.

Motion 108 ARM 2019

At the 2019 BMA ARM, supporters of the Broad Left brought forward a motion that the BMA should unionise Physician Associates (PAs), as well as other Medical Associate Professionals (MAPs), and create a branch of practice for MAPs within the BMA. It fell, save for the last part where the RB agreed to work with ‘groups’ representing PAs and MAPs in the future for the benefit of all. The main arguments against consisted of keeping the BMA a doctors’ union, and not wanting to ‘water down’ the role of the BMA in protecting the rights of doctors. Why did supporters of the Broad Left bring this motion forward?

Physician Associates and other Medical Associate Professionals

The role of the Physician Associate was created recently by the UK government as a potential solution to the workforce crisis created by the Modernising Medical Careers programme, which reduced the numbers of middle-grade doctors. University training programmes for PAs run across the UK, and they will soon join medical rotas in large numbers. We are told that in 10 years there will be 10,000 PAs working in the NHS. The role is ill-defined, but includes assessing patients, requesting investigations and creating management plans.

There is no specific trade union for PAs.

Other MAPs exist in smaller numbers in Surgery, Anaesthetics and Critical Care. Some groups have no direct entry, drawing only on highly qualified and experienced nurses. The Advanced Critical Care Practitioners are one such group. Some of these groups already have representation, many do not.

The Problem – We all need a union

It is important to separate the question of unionisation from your feelings about MAPs. It is no longer important whether you support or oppose PAs or MAPs as a concept. Individual interactions with PAs or other MAPs are irrelevant to the issue at hand. PAs exist.

They are workers. They are our colleagues. They are valued members of the Multi-Disciplinary Team. The concept of a PA comes from the USA, where it is a well-defined role separate to that of a doctor. In the UK, however, this is not the case – their roles often overlap with tasks traditionally performed by doctors. Their training, though shorter, is so similar that students share clinical skills sign-offs with medical students. NHS England has decided that their role is so similar to F1s that from August, PAs will be placed on some F1 tracks and rotas.

The current implementation of PAs by NHS managers and Universities has the potential for competition and conflict. We are already seeing concerns about training opportunities and worry about the poor differentiation of our roles by both professions. The position of the PA is also open to abuse. A person in a fluid role can be asked to take on more responsibility than they are trained or paid for. PAs have not yet been given prescribing rights or professional registration, yet they are asked to make management plans for patients. Doctors, who hold professional registration, must then ‘supervise’ and take the legal responsibility for these plans, without additional time. This situation is bad for PAs, for doctors, and for patients.

Misplaced resentment is growing between the professions, but these problems were not created by PAs. These problems were created by the poor definition of their role and poor implementation – these are problems created by the government and managers and the fault lies with them. Without representation by a strong established union, PAs may find themselves mistreated and exploited to the detriment of themselves, doctors and patients.

The Royal College of Nursing (RCN) as a Model

Similar issues were raised by nurses when Healthcare Assistants, and more recently Nursing Associates, were introduced. The Royal College of Nursing, the trade union and professional association for nurses, decided that the smartest way to deal with these issues was not to argue worker vs worker, but to fight together as union vs government. The RCN recruited these new staff groups into their union and won proper definition of those new roles. This ensured that Nursing Associates could not be asked to take on responsibility that they weren’t trained for and protected the role of the Registered Nurse.

The RCN recruit and organise Nursing Associates and Healthcare Assistants without accepting that the roles are equivalent to that of a Registered Nurse. The RCN maintains its role as a trade union and as a professional association whilst accepting members that do not have professional registration.

We should look at the RCN as a model. They know that division causes weakness, and unity gives strength. This strength allowed them to protect all groups of nursing staff. Their common needs as a nursing family trumped their differing qualifications.

Conflict and Commonality – Why the BMA?

In the BMA, we have several existing Branches of Practice with frequently conflicting views. We represent GP Partners and GP Salaried Doctors; Students and Academics; Consultants and Juniors. PAs, like these groups, are in the medical family, just like Nursing Associates are in the nursing family. Royal Colleges have accepted this. The GMC and the government both agree. We have more in common than that which divides us. Where conflicts between Branches of Practice occur, the BMA has systems to resolve that. These could be extended to include our colleagues from other professions.

 We shouldn’t leave PAs and other MAPs to seek piecemeal representation by the general unions operating in the NHS. If there was an existing union with enough MAP members for them to be effectively represented as a group, we would be advocating they join it. MAPs are currently spread across several unions, but mostly go without.

We also shouldn’t wait for years for them to form their own union with a fraction of the strength we have now, after the damage has been done. Asking MAPs to create a new union is a near impossible task and would suck up all their work for the foreseeable future. By the time they were set up and had gained negotiating rights all the big debates would be over, to the detriment of staff and patients. Furthermore, in separate unions, there would be no effective way of managing any conflicting interests between us.

That conflict has the potential to include use of one professional group against the other during industrial disputes. As it stands, PAs are a risk to doctors’ terms and conditions and doctors are a risk to PAs’. Doctors’ pay and PAs’ ability to refuse out-of-hours work could come under attack from management making unfavourable comparisons. Working together, that risk could be eliminated.

Solution

We should seek national recruitment, organisation and bargaining for Physicians Associates and other MAPs through the BMA, so we can work together for agreed and common goals including:

  • High quality training;
  • Professional registration for all members of the clinical workforce;
  • Adequate role differentiation, so one cannot be asked to do the job of the other during rota shortages or union disputes.

For many in the medical profession, this tastes bad. It tastes like an acceptance of medical understaffing, of reduction in training standards. Some argue that unionising MAPs puts the definition of a doctor, or of the BMA, at risk. The BMA was set up to define and defend the role of the registered medical practitioner. Now, the BMA needs to do so again.

How do we work to define our roles as separate on the MDT without working together? How do doctors and MAPs protect their roles and working conditions without the power of a strong well defined and well-funded union? Unionising is the right solution to the issues we face, and the only real solution right now.

The RCN has given us the model. We should be recruiting and unionising PAs. For similar reasons, we should recruit other MAPs, such as Surgical Care Practitioners or Anaesthetic Associates, that don’t have a trade union home. We cannot afford to let this snowball away.

Climate Emergency ARM

Author: Marina Politis

This is the second of many pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.

Motion 80 ARM 2019. 80a-e are for reference and were not debated.

Members of the Broad Left were in favour of this motion. We feel that it is very important for our union and the labour movement to to resist climate injustice and to take measures to halt our current climate crisis.

Between 2030 and 2050, there will be an additional 250,000 deaths a year due to malnutrition, malaria, diarrhoea and heat stress which can be attributed to climate change.[i] Since the 1960s, the annual number of natural disasters have tripled, resulting in over 60,000 deaths annually, the majority in developing countries. i Household and ambient air pollution cause a total of seven million deaths annually. i

These figures will only continue to rise. We cannot continue to sit back and be complacent when faced with a public health crisis of this magnitude. There are no innocent bystanders to ecocide.

Climate change is not the forlorn, emaciated polar bear who features as a cover star for the latest national geographic, but something that will affect all of us. It will disproportionately affect the most vulnerable members of society: children; the elderly; people with mental illness or physical disabilities; those who are less economically affluent and women. It will affect workers all over the world. Climate injustice is not just about equality for our planet, but concerns equality of all groups of people, and we must stop being silent.

The NHS is the UK’s largest public greenhouse gas emitter, which at four percent of emissions is equivalent to the UK airline industry.[ii] [iii] As our healthcare profession strives to save lives and improve quality of life, we need to make a significant contribution. Over a fifth of the NHS’ carbon footprint is contributed by pharmaceuticals, a significant proportion by Metered Dose Inhalers[iv]. Anaesthetic gases using CFCs could be switched for alternatives. The NHS has significant purchasing power which would enable it to influence change in the pharmaceutical industry and in many other sectors. Both products and practice needs to change.

In BMA lobbying and campaigning, we should consider how we can make a positive difference. The trust the public has in healthcare professionals, and the synergy between measures for public health and measures against climate change allows us to be leaders in this movement. Active travel, a reduced working week and high quality insulated housing should be on the priority list. We can also assist whilst seeking improved working conditions – could our work or university placements be organised better, to allow public or active transport? Could food provided for medical staff at night be locally sourced?

In our union, BMA expenses policies should be capped in terms of carbon emissions, rather than solely cost. The times of domestic flights to save a few hours on train journeys must end; and events such as the ARM too must reflect on the resources they use, from travel and food waste to disposable leaflets and power used for lighting.

Measures taken by the BMA, the NHS and the government must go beyond that what is currently being promised, and we can no longer say yes to tokenistic ‘tick-box’ policies and solutions. We need radical social reform instead of mere paper straws and graphic tees rebranded with “save the planet” slogans. Fundamentally, reorganisation of society is needed, with just transition for workers in the polluting industries. We must work with other trade unions to achieve this.

If change is not making us uncomfortable or challenging the way we currently go about our day-to-day lives, then we are simply not doing enough.

It is brilliant that this motion was heard, but we cannot let this close this pressing issue, but instead use it as a springboard to continue to demand more.


[i] https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

[ii] https://www.kingsfund.org.uk/reports/thenhsif/what-if-carbon-neutral-nhs/

[iii] https://sustainablehealthcare.org.uk/blog/we-work-healthcare-%E2%80%93-course-we-care-about-carbon

[iv] https://www.kingsfund.org.uk/projects/time-think-differently/trends-sustainable-services

BMJ Independence – ARM

Author: Chris Smith

This is the first of many pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.

Motion 55 ARM 2019. 55a and 55b are for reference and were not debated.

We are delighted that this motion fell. Several Broad Left members had submitted speaker slips against the motion.

The proposer argued that the BMJ was damaging the BMA by publishing information about Spousal Expenses, sexism and so on. He argued that our members saw the BMJ as the ‘official mouthpiece’ of the BMA and that we therefore needed a Memorandum of Understanding to limit their editorial independence.

We believe it is the behaviours of members and representatives that has damaged the BMA, not the reporting of these issues. These issues show how completely necessary it is for the BMJ to be empowered to investigate and report on our shortcomings and failures, both for transparency of the union and so we can reflect and change when appropriate. The free press is important: it provides the disinfectant of sunlight.

The BMJ is internationally respected, with the 4th highest impact factor in the world. It is also a great boon for our members – the surplus provided to the BMA is in the millions. If the journal is sullied around the world by a memorandum which forces it to be a vehicle for BMA propaganda it will diminish trust in the journal and trust of the association.

The BMJ is, and should remain, a critical friend. This motion argued against a free and impartial press- a right enshrined internationally by documents such as the United Nations Convention on Human Rights. We believe the integrity of the BMJ should remain intact and will continue to argue that our trade union should not be meddling with a prestigious and editorially independent publication.