BMA Council September 2019 Report

Council Reports, Reports, reflections and accountability

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.

Climate Emergency ARM

Conferences, News, Reports, reflections and accountability

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

Conferences, News, Opinion, Reports, reflections and accountability

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.

BMA Council Report May 2019

Council Reports, Reports, reflections and accountability

Apologies for the lateness of this report – Junior Doctors Conference and issues around the junior doctors’ contract and lots of student issues have slowed us down.

The meeting on 15th May was reasonably productive. There was significant anger from some members of Council at the recent leaks surrounding spousal expenses and the sexism allegations in the press. We do not share this. We applaud the bravery of those who have spoken out against poor treatment and rotten cultures in the BMA.

We received a confidential update on member support services, which the BMA is reviewing in detail. This includes the First Point of Contact, Employment Advisers and legal support given to members, which we aim to continually improve. The Broad Left welcomes the review, and hopes it will highlight solutions for the problems members face when engaging with us.

We discussed guidelines for the process of selecting members to European Medical Organisations. This aims to make it a more accountable process. The highlights are: a selection committee would select suitable candidates based on role criteria, representatives must demit office if they are no longer a member of the relevant branch of practice, and that records will be kept of meeting purpose and expense. Council approved these guiding principles with immediate effect.

The Working Together Better task group has been considering a definition of the role “Chief Officer”, which is a term frequently used in the organisation’s articles and byelaws but with no universal understanding of what this means. A definition was proposed to council in a paper, however concerns were raised as to the wording. It was also considered that it would only apply for a short time – until the completion of a review by the appointments oversight sub-committee. Some concerns were expressed that defining a “Chief Officer” beyond the actual role title could lead to power grabbing and increased control by a few senior elected members. It was resolved that the definition would be altered to reflect comments made by members, and subsequently recirculated to council for consideration at a later date.

A motion was brought to council to change the agreed process for hustings at the ARM for the roles of Treasurer, Chair of the Representative Body and Deputy RB Chair to include questions to candidates to be permitted at the hustings. The proposer explained that the motion aimed to give us a better chance of getting the best people into roles, by allowing for a more accountable and informative election process.

Several concerns were raised by council members including issues with time, and that not all candidates would perform well under questioning (and indeed this may put some people off applying). A representative from the ARM agenda committee explained that it would be very difficult to facilitate extra time for questions, and that we would potentially lose a significant amount of debates as a result. They were also concerned that long hustings may disengage representatives.
The motion was not carried, and it was decided that hustings would take place as agreed by Council in January.

Council received an oral and written update from the Audit and Risk Committee.

A discussion regarding membership of LNCs was held in private. Current rules can exclude non-BMA members from LNCs due to the BMA staff and resources they rely on. A paper presented by the Secondary Care Forum was agreed upon. We will update this report at such a time as the resolutions from this discussion are made public.

Another confidential update was made to Council about work ongoing to improve the code of conduct and resolutions processes. This is very necessary work in the context of both tight political control and increasing awareness of sexism in the BMA. Confidence must increase if the system is to work well.

Council received a brief update from Jeeves Wijesuriya, chair of JDC, about the junior doctor contract negotiations. He shared with council the successes so far which include shared parental leave, child bereavement leave, and money for junior doctor facilities. As negotiations are still ongoing there was not much more that could be shared at this time.

A discussion was had about how best to approach two unfilled council seats, following the resignation of two members. It was decided to leave the national UK seat unfilled (given that the total number of council members is comfortable above the minimum at present), and that the next highest candidate from the West Midlands region is elected as a non-voting member for the remainder of the Council term. Although we would want as many voting members representing regions as is possible, the cost of running new elections at each resignation is prohibitive.

Council received a confidential update from the board of directors, addressing matters of finance and governance. Many broad left members spoke up in support of transparency and accountability in this area and called for investigation into previous lapses in internal governance. The funding for Spousal expenses and the Lock Club has now ended, but we feel there are further questions to be asked.

We keep working hard on Council and in various other roles in the BMA. Working with some other members, we have assurances that Place of Work Accredited Representatives (POWARs) and the training for that will be reintroduced. This is one step towards the rank-and-file trade unionism we need.

Spousal Expenses – Update

Council Reports, News, Reports, reflections and accountability

We have received an update from the BMA Board of Directors on the actions that have been taken on the matter of claims for spousal travel expenses. We share it in full below. The inquiry represents progress in resolving the governance issues highlighted by the discovery of the spousal expenses payments. We are also beginning to ask questions about the Lock Club, a dinner club for ex-Chief Officers of which we were initially not aware, and are supportive of other Council members asking legitimate questions.

Update

“An inquiry of the matter is underway.  It is being conducted by Jacques Cadranel, who is a non-executive member of the BMA Audit and Risk committee.  It is planned that the findings of the inquiry will be reported back to the Board of Directors by Friday 10 May, and (through the Board) to Council by Wednesday 15 May.

The inquiry will examine the historic expense payments made by the BMA to chief officers to fund the attendance of their spouses at oversees events at which the chief officers were representing the Association.  It’s scope will include a review of:

  • relevant BMA policies to establish whether any permit/permitted spousal travel claims and, if so, who developed and approved them.
  • current expenses policies to determine if spousal travel claims are permitted or whether any previous policies that permitted them have been superseded.
  • chief officer role profiles relating to spousal expenses, including an account of any inconsistencies between them.
  • expense claims to examine compliance with policies and contracts, both by claimants and those who processed and approved claims.
  • the role of “custom and practice” in the payment of these expenses.
  • the cost to the Association resulting from the payment of these expenses, including the potential tax (and any other) liability.
  • the role of internal and external auditors in identifying liabilities and, if failings are found, recommendation for ensuring they are not repeated.
  • the decision to pay the tax liability when it was recently identified and the process that was followed.

The findings of the enquiry will feed into a wider of review into BMA policies, practices and processes that is to begin shortly.

In addition, to the inquiry, we have already taken the following actions on the matter:

  • Ceased any claims for or payments of spousal expenses.
  • Procured specialist advice on the legal basis for repayment and the associations tax liability. 
  • Written to eight past chief officers to inform them of the concerns raised and publicity and to invite them to make full or partial repayments or equivalent donations to BMA Giving.
  • Ceased funding of the Lock Club, a dinner club for past Chief Officers.”

—Update ends—

BMA Medical Students Conference Report 2019

Conferences, Reports, reflections and accountability

Author: Grace Allport

This year the BMA Medical Students Conference was hosted on the 12th and 13th of April, and an enormous number of progressive policies were passed. Organisation among Broad Left students helped us to win support for our position on several issues and ensured important motions were discussed.

Student Welfare and Finance

Conference committed to several new policies aimed at improving conditions for medical students, such as lobbying medical schools to reduce travel time to help ease time pressure, promoting communal spaces on regional placements, allocating time for physical activity and establishing mental health services for medical students. These motions are important to continuing the vital work the BMA does in supporting medical students and advocating for conditions which allow them to study medicine without compromising their mental and physical health.

A motion about performance enhancing drugs was opposed by the Broad Left. The motion called for BMA investigation into the use of illegal recreational and performance enhancing drugs, as well as the implementation of drug testing systems at medical schools. The proposal would have discriminated against students who took some drugs for medical reasons by forcing them to disclose their condition and treatments to the medical school and any agencies involved in the testing. We do not believe that the BMA should be advocating testing and punishing students in this way. After a short debate, the motion fell.

Conference also committed to lobby for maintenance loan access for students who chose to intercalate with a Master’s course rather than a Bachelors. This policy aims to increase the accessibility of intercalated Master’s degrees, especially to students from less economically privileged backgrounds. Kirush Naguleswaran, who spoke in favour of the policy, said, “Intercalation is a valuable part of a medical degree. Studying a Master’s degree equips you with additional skills and knowledge that is not necessarily covered in a Bachelors. Lack of financial support denies deserving candidates the chance to study subjects at a Master’s level.” She argued that the lack of financial access whilst a student lasted beyond university, highlighting the points awarded for Master’s degrees at specialty application.

Education

The UKMLA remains highly controversial and the Broad Left opposes its implementation in 2023. A proposal to recognise that it is too late oppose the UKMLA’s introduction was so unpopular that the conference voted, by an overwhelming majority, to have it removed from the agenda. Instead, the conference agreed to maintain its position of opposition and engagement to the UKMLA and restated its support for the red lines proposed by the Medical Students Committee.

Further policies were agreed by conference, including opposing the use of UKMLA scores in the application process for foundation training, seeking to prevent additional burdens on finals students in 2022 when the assessment will be trialled and seeking assurances that students could abstain from the trial without punishment. These are crucial to the role the BMA has of advocating for students and ensuring that their welfare is not compromised.

Equality and Access to Medicine

Unanimously, conference voted to support policies to address the Black, Asian and Minority Ethnic (BAME) attainment gap. The evidence that the gap is not due to ability, but systemic racism, has already been heard and accepted by the BMA. Majd Albakry said, “Although this matter has been addressed previously, we need a more action-specific plan as outlined by motion 52 that incites organisational and social change.” These measures included creation of an annual conference to tackle the issue, school-specific plans of action, and positive action to increase the number of BAME staff working in medical schools. The Broad Left supports these actions as part of our fight to ensure that all students receive fair education and assessment, and to end disadvantage on the grounds of race.

Conference also voted to establish liberation networks within the BMA. These networks aim to provide representation for members of minority groups. Each branch of practice would elect officers who identify as women, LGBTQ+, BAME or as living with a disability, who would then meet to discuss policy and representation. The motion was proposed by the Deputy Chair for Welfare of Medical Students Committee (MSC), Stephen Naulls, who said, “In situations where the BMA advocates for members with protected characteristics, I believe the voices of those members – and their lived experience – is pivotal to the discussions. I hope this just one step along the pathway to creating a more representative and member-led BMA.” While similar motions on liberation networks and officers have been proposed by Broad Left members in previous years, its passage now represents a win for the left and a reflection of the changing values of Medical Students Conference. The policy will now go to ARM to allow for the establishment of liberation officers across branches of practice beyond MSC.

After a passionate speech by Alessia Waller, of Swansea Medical School, conference supported lobbying the UK Foundation Programme to extend special circumstances applications to students who are pregnant or whose partner is pregnant. Although a protected characteristic, the UKFPO currently excludes pregnancy from special circumstances, which can cause a significant conflict in work-life balance of newly qualified doctors. “It negatively impacts students, mostly graduate students, and their ability to plan families,” Alessia said, “I know of two students in the year above me who’ve been affected.”

Conference voted unanimously in favour of a motion tackling sexism and sexual harassment within the BMA. This comes after sexist remarks were made by a member of the BMA towards a GP speaking at a national conference. Ella Burchill, of Kings College London, proposed the motion, giving personal examples of the sexism she has faced as a woman in medicine. “This is an issue very close to my heart,” she said, “I hope in the future, we can all be proud to work in an NHS which values the work we do as doctors and scientists, regardless of gender.”

Christine Cadman, a Bristol student, won strong support for a motion advocating Widening Participation in medicine measures for care leavers. “Care leavers face challenges that other students may not face, from financial difficulties, the lack of support from home or educational unit, to not having accommodation during summer holidays. This motion will ensure that care leavers will not only get the support and advice required to apply to medicine, but also the chance to thrive whilst studying medicine by offering information on summer time accommodation, bursaries and scholarships and summer school programmes.”

BMA and Union Policy

The conference committed to lobbying the BMA internally to affiliate with the Trade Unions council. Ciaran Kennedy, who proposed the motion, said, “I proposed the motion after seeing how the TUC lobbied for the 2007 smoking ban. I believe that with solidarity from the BMA, the TUC can further improve the health of all workers.” Despite being an organisation set up to collectively bargain for doctors and improve the conditions their employment, the BMA resisted the trade union label until 1971. The BMA has, at times, organised alongside the unions of the TUC, but it is not currently an affiliated union.

Additionally, conference voted to support recruiting physicians associates (PAs) into the BMA. Broad Left students argued in favour, recognising that unions should represent those who are alike in need, not just in qualification. Working together, we can ensure we can successfully advocate for both groups and seek safe staffing. Brocha Goode of the University of Manchester, who proposed the motion, said, “We shouldn’t leave PAs to seek piecemeal representation; we should seek national recruitment, organisation and bargaining for PAs through the British Medical Association. What we need is to work together with PAs, organising to define their role, solve problems and strengthen our union.”

Healthcare and Society

Conference committed to lobbying to ensure training of medical students to provide healthcare for the homeless, as well as lobbying health boards to ensure higher standards of care for homeless patients are introduced. The policy aims to improve the care that this highly vulnerable group in society receives. David Clayton of Glasgow University, who proposed the motion, said, “The BMA needs to be at the forefront of tackling the public health emergency of homeless deaths and healthcare exclusion and I’m glad to see the BMA support the recommendations from the Faculty for Homeless and Inclusion Health in our motion.”

Additionally, conference supported a motion which targeted homelessness more directly, supporting recognition of homelessness as a crisis manufactured by the housing industry and lobbying for more social housing, as well as taxes on the creation of luxury homes. These measures seek to end the crisis caused by the housing market, which creates an artificial scarcity of housing in order to inflate the value of property investments at the cost of the health of the economically disadvantaged.

The conference voted to support free movement for all workers, inside and beyond the EU, extending well beyond previous policy which called for maintenance of free movement for healthcare workers after Brexit only. Giancarlo Bell, whilst advocating EU free movement, told conference that the EU border was responsible for the deaths of thousands in the Mediterranean, and we should respond by making a different political choice. The policy is a significant commitment to an internationalist principle of free movement and a humanitarian response to the crises across the world. Its passage at conference reflects the increasing support the ideas of the left are gaining.

All quotations were received after the conference and represent the opinions of the individuals quoted. Not all quotes are from Broad Left members.

BMA Expenses

Council Reports, News, Reports, reflections and accountability

This post was authored by Emma Runswick

After confidential information we heard at Council was leaked to the BMJ, some members of the Broad Left were asked to comment. Chris Smith [not included by editor error] and I provided the comment included in the article.

This leak, whilst not our choice, resolves to some degree the problem in telling you about our activities on Council. You can be assured that we have asked for increased transparency with members, and we have sought information where it was lacking. We have written to the Chief Officers and Board of Directors on multiple occasions. I have been arguing for repayment of spousal expenses, and we have asked for further investigation with the aim of uncovering and tackling any other problems.

I have submitted a motion to the Annual Representative Meeting:

“This meeting agrees that senior BMA representatives should not claim expenses beyond what policy allows, including to pay for spousal or partner expenses, and instructs BMA Council and the Board of Directors to:
i) recover any such expenditure and any tax burden borne by the BMA where appropriate
ii) ensure all expenses policies exclude payments for spousal or partner expenses”

We have a track record of supporting good use of members’ money and transparency with it. Last year, I proposed a motion at the Annual Representative Meeting as detailed below. In the Treasurer’s response, he implied that I had been the only person to request to scrutinise expenses for 2 years. More recently, I have requested to view expenses and honoraria under the current system and have been unable to due to staff sickness. In my opinion the situation would be greatly improved by more, and not less, openness with members and representatives at all levels.

“ARM 2018 Motion by NORTH WEST REGIONAL COUNCIL: That this meeting instructs that:-
i) votes of committee and council members should be recorded and published for members to enable informed voting in elections;
ii) council members who wish to publish their own voting records and arguments should be free to do so;
iii) there should be a dedicated contact point for those wishing to scrutinise expenses and honoraria.”

At the 2017 ARM in Bournemouth, I supported parts i) and ii) of the composite motion below, which was proposed by Dino Motti. I argued that the expenses should be put in context (eg number of journeys and distance) for members. Dino faced a significant backlash for proposing the motion, including abuse from one of the previous senior officers.

We have ongoing concerns about governance but little information and evidence. We have submitted other motions to ARM on these issues and will continue to fight your corner at Council.

BMA Council Report March 2019

Council Reports, Reports, reflections and accountability

Four Broad Left members attended Council on Wednesday 13th March. The agenda was dominated by discussion of our legal action on pensions and a confidential item about internal governance matters. If you have any specific questions, or issues we can help you with, please contact us.

The union has continued work on Brexit and Safe Staffing which you can engage with.

Pensions

We are supportive of the BMA action on pensions, in which we are supporting members bringing age discrimination claims in an employment tribunal in respect to the discriminatory impact of the 2015 NHS Pension Scheme. Judges and firefighters have taken successful legal action over similar schemes, and the government is seeking to appeal. Our case is likely to be ‘stayed’ (delayed) pending the result of that appeal, and it is possible that if the judges and firefighters win, the whole public sector will feel the benefit without the need for further legal action.

The result would be that all doctors would benefit from 5 years accruements from the previous pension scheme, and that a new non-discriminatory pensions agreement would have to be made. This could result in a further attack on pensions by the government and we are arguing that the union and Trade Disputes Preparedness Group should be prepared for that. The letter has been very well received by members, and could contribute towards an appetite for action over pensions in future.

We also discussed the lobbying that is being undertaken to redress the pension discrimination suffered by Less Than Full Time doctors, who suffer from current annualization arrangements. The Broad Left are supportive of this also.

Some members of Council expressed concern that legal action against the government might harm the relationships built during contract negotiations. The Broad Left believes that action by the trade union on pensions, and an engaged and supportive membership, strengthens the hand of negotiators.

Confidential Item

A large proportion of the meeting was taken in private and concerned governance issues. We advocated for members’ interests as best we could. We are not delighted with the outcome, but we are confident that the issues will be resolved going forward. We have asked the Board of Directors for further information where necessary, to ensure accountability where possible, and for further investigation with the aim of uncovering and tackling any other problems. The issues seem to be known amongst some of the national branch of practice activists without us telling them. We are sorry we cannot tell you more at this stage. We will consider what we can do to resolve this.

Member Support Services Review

The BMA is undertaking a wholesale review of our member support from First Point of Contact to the legal teams. We are supportive of the review – although our BMA Employment Advisers and other staff are brilliant, there is a discrepancy between the feedback we get from members and the feedback the BMA collects internally – and look forward to seeing the results. If you have received the survey, please fill it in!

International Medical Organisations

We have been asking questions about the cost, ethics and risks of our continued membership of the World and European Medical Associations. These have now been largely answered, and oversight of who attends which international meetings and the value of each has been tightened. We have supported continued membership of the World Medical Association (WMA) on an interim basis for 1 year, whilst we push for reform. The WMA is reportedly keen for us to stay. We have offered to host the WMA General Assembly in 2021 at large cost to the association, and although we think this was a poor decision, the legal, financial and reputational costs of withdrawing are too great. We have instead supported measures to make the event more relevant to members, with fringe events taking advantage of the many international delegates from doctors’ trade unions and professional associations around the world.

. These have now been largely answered, and oversight of who attends which international meetings and the value of each has been tightened. We have supported continued membership of the World Medical Association (WMA) on an interim basis for 1 year, whilst we push for reform. The WMA is reportedly keen for us to stay. We have offered to host the WMA General Assembly in 2021 at large cost to the association, and although we think this was a poor decision, the legal, financial and reputational costs of withdrawing are too great. We have instead supported measures to make the event more relevant to members, with fringe events taking advantage of the many international delegates from doctors’ trade unions and professional associations around the world.

Regional Elections

We argued for a change to the timetable of the Regional Council elections, which in the current form would practically exclude thousands of final year medical students and rotating junior doctors from standing, being elected, voting and engaging. The argument was won and JDC is arranging for a more appropriate timetable.

The issue was raised to us by Dr Becky Acres, a member of Organisation Committee and a junior doctor working in East Midlands. If you have issues we can help with please get in touch. We will raise them and fight for you.

World Medical Association Questions

Council Reports, Reports, reflections and accountability

In light of the Canadian Medical Association’s (CMA) withdrawal from the World Medical Association (WMA), we have been asking questions about the BMA’s involvement. Our questions are detailed below, and we are now awaiting a response in the form of a report to Council. We will update the site as we have answers, and continue to press the issues we have concerns about.

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Background

The World Medical Association was established in 1947 in the wake of war crimes by doctors in Hitler’s Germany, two years after the BMA proposed the idea. It hosts biannual international meetings, lobbies significantly at UN bodies, and has a controversial history as a major contributor to issues of medical ethics.

We have a large input into the WMA, for example the BMA policy on the TTIP trade deal became the policy of the WMA, BMA work on ethical procurement is now WMA policy.

The current WMA president, Dr. Leonid Eidelman, clearly plagiarised his inaugural speech from a prior Canadian president’s speech and other sources, resulting in the CMA resignation from the WMA. The explanation, which blames speech writers, and apology of Eidelman, did not satisfy the CMA, who expected further action, perhaps including resignations and policy change. “Eidelman apologized to the WMA council and assembly, saying that he had originally written the speech in Hebrew and was unaware of any plagiarism during the translation into English. But Damji said that explanation was not convincing and did not include an apology to the CMA or Simpson, nor an acknowledgement that as president he is the arbiter of ethics for the WMA.” 

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Representatives:

The BMA is currently represented on the WMA Council by Mark Porter, who hasn’t been a Chief Officer for well over a year, and Andrew Dearden, BMA Treasurer and WMA Treasurer, who is shortly resigning his BMA post. It appears that our representatives to international medical associations, of which the WMA is just one, report to our international committee. However, the process for appointment and accountability of the representatives is unclear to us.

We are told that BMA sends Chief Officers to WMA. The 2017 WMA Council guide states that members of council are chosen by the National Medical Association (NMA) elected to occupy a particular seat.

“Members of the Council are individuals chosen by the National Medical Association (NMA) elected to occupy a particular seat. The NMA may choose to change or substitute its individual representative at its own discretion, informing the Secretary General as soon as it wishes to make a change. It is generally expected that the Council member will represent the views of his or her NMA or the region they have been elected from rather than his or her personal views, however this is a matter to be decided between the NMA and its chosen representative”

We believe that representatives do not have to be Chief Officers, but that if BMA appointments are on that basis explanation is required for deviation from policy, and accountability must be ensured. Mark Porter’s term will end in April 2019, and we should consider our processes before this date.

What was our position on the CMA resignation?

Cost to BMA:

What is the WMA membership fee paid by the BMA? Are there any other costs as a result of our membership?

What are the expenses incurred by the BMA for BMA representatives to go to WMA Council, events and conferences? Where members of the BMA hold office in the WMA (the Council or an officer role), which organisation meets the costs?

We are told that the WMA conferences have registration fees which cover travel between locations, some meals and the costs of the conference.  Representatives from BMA who are WMA Council members have travel and accommodation covered by the WMA, but the BMA pays under our usual policies for other representatives and BMA staff.

Value:

The BMA has significant influence on the WMA which produces international policy. However, it is important that we, as reps accountable to the membership, ensure this is worth the cost. From some information, provided below, you might get the impression that the WMA is a corrupt and ineffective organisation. We are very concerned our members money is being used in this way & would like reassurances.

The reputation & ethical principles of the WMA are important to consider when considering the value of our relationship. The plagiarism incident and the lack of action in the aftermath is one issue. However, it is not the first. In 2017 the BMA requested a suspension the 2016-2018 president of the WMA pending a resolution of corruption charges which were not known to Council. This was rejected & Dr Desai remained in post. His case was never heard as the government denied ‘sanction to proceed’…On this we agree with Dr David Berger: “The WMA council’s rejection of the BMA’s proposal to suspend Desai pending an investigation into his appointment shows that the organisation is not serious about ensuring the probity of its own senior officers. The WMA claims to set the global standard in medical ethics, but it is ignoring the justifiable concerns of those who believe that it is wrong to appoint a president who is disbarred from practising medicine and who has criminal charges against him for corruption. Any fair minded person can see that this casts the credibility of the WMA as the world’s peak medical body into serious doubt.”

Other issues are more longstanding, such as the concerns highlighted in this 1994 BMJ articleIt highlights membership & votes effectively being up for sale to the highest bidder, a wasteful ‘ceremonial circus’ of meetings and complete inability to communicate with the average doctor.

The WMA lists it’s important corporate partners as Bayer AG, Eli Lilly and Company, GlaxoSmithKline and Pfizer, Inc. These companies appear to sponsor projects but it unclear what they get in return. 

Advocacy for physicians’ and patients’ rights” is listed as a service of the WMA. However, we believe the average UK doctor is unaware the WMA exists. What is the WMA doing for the rights of doctors? Has this been hindered by “the registration of the WMA in New York, where it is subject to antitrust laws”? This article states it has raised problems in formulating some declarations, notably one on medical manpower.

We note with interest from the same article that the BMA has left the WMA on more than one occasion. Notably, in 1984 it “supported a breakaway group made up of the medical associations of Denmark, Finland, Iceland, Ireland, the Netherlands, New Zealand, Norway, and Sweden, joined later by Canada and Jamaica. The group met annually and flirted with the idea of establishing a rival international body before opting to campaign for four key changesfirstly, that member associations of the WMA should be truly representative of the medical profession in their country; secondly, that member associations should be politically independent of their own governmentthirdly, that the WMA should adopt a more democratic voting system; and, fourthly, that any barrier to the association adopting and publishing its statements should be removed.

We would like to see that these have been met, and that no further concerns have been raised.

 

BMA Council and more Report, September 2018

Council Reports, Reports, reflections and accountability

On 19th September the BMA UK Council convened for the second time of the 2018/19 session, with all Broad Left members in attendance. After welcomes and congratulations for newly elected members the session began earlier than usual in anticipation of the packed agenda. The first item was a presentation from the chair, Chaand Nagpaul, about the results of the BMA’s recently published all member survey. The survey was wide ranging, with topics including how meeting targets rather than patient care often drives clinical decisions, how doctors are increasingly afraid of making mistakes and that doctors want better IT systems, better levels of staffing and better pay. Emma Runswick spoke about how rota gaps and unsafe staffing levels are a composite issue: they ranked top of things affecting a doctor’s daily life (above T&C issues and pay) but these gaps do not exist in isolation or as an anomaly: they are strongly linked to poor terms and conditions, declining pay and, for non-EU nationals, issues with securing the necessary visas.

Council then discussed the issues of doctors’ pay and the BMAs response to this year’s DDRB recommendations and the wider implications of how the offer that they presented to the government should affect our relationship. This was held in a private, confidential session. Broad Left members Vicky Theakston, Emma Runswick, Yannis Gourtsoyannis and Chris Smith all contributed to the discussion in accordance with the views that we had previously expressed on Doctors Broadsheet. After considering the debate, we maintain our view that the offer was unacceptable and that the BMA needs to respond with a well resourced, comprehensive and continued comma campaign to inform members of the real-terms pay cut that has been forced on doctors over the past decade. This should be followed by an indicative ballot to gauge how members want to respond to the repeated and sustained degradation of pay across all grades and specialties. Significant time was devoted to these topics; the morning session was extended so that a range of views could be heard and the afternoon session began with continued discussion around non the DDRB and doctors’ pay.

Next, an update was given by the Trade Disputes Preparedness Group where it was discussed how they should present to Council in the event of escalating industrial action. Also discussed was the group’s responsibility to assess IA’s impact on other Branches of Practice and union as a whole, and the particular remit of each dispute committee in the event of future industrial action, including responsibility for communications planning and member mobilisation.

A shortened review of support for members was delivered to Council as the session was already overrunning, followed by an update on the independent review of the BMA’s Code of Conduct and, specifically, the resolution process therein. Council was informed of the 15 candidates for the 2 vacant South East seats and confirmed the appointment of members of the Occupational Medicine Committee.

Chris Smith and Emma Runswick co-signed a motion brought to Council stating concern with the appointment of Lord Prior to the Chair of NHS England on the grounds that there is a significant conflict of interest and that he does not show commitment to NHS values or the NHS constitution. The motion was carried nem con after discussion and a vote.

In preparation for a discussion of the BMA’s campaigning priorities to be held in November’s council session, the Director of Policy posted information on some workshops for Council members ahead of the November meeting on what made for good campaigning and how this could help council to structure the policy priorities to have maximum external impact.

After the conclusion of Council, 5 Broad Left members attended a scheduled presentation from the BMA’s legal team to receive updates and ask questions about important cases.