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.