The British Medical Association (BMA) has today called on the newly elected UK parliament for ‘an open and honest debate about the NHS, focused on six priorities’ as follows:
1. Address the funding shortfall for health
UK investment in health has slipped proportionately behind France, Germany, Denmark and Austria, and should be restored to a comparative level of GDP.
Increases in NHS funding based on unrealistic assumptions will not meet patient need. For example, an extra £8bn a year by 2020-21 overlooks the fact that an annual £22bn of efficiency savings will need to have been made by that time in order to close the £30bn funding gap on current services predicted by NHS England. There is still no credible plan, or commitment to invest enough, to enable this unprecedented scale of efficiency savings to be made. A good start would be for the government to fund NHS capital projects directly and to renegotiate existing PFI contracts to ensure a better deal for the nation, bringing our hospitals back into public ownership.
2. Remove market competition in healthcare
The Health and Social Care Act 2012 was a wasteful distraction from the real challenges in delivering healthcare and should be repealed.
A truly national health service needs an accountable leader; the health secretary’s statutory responsibilities to secure and provide universal and comprehensive healthcare must be restored and explicitly stated. The bureaucracy of competitive markets in the NHS in England hinders integration and prevents providers working together around patients’ needs. The government should use the NHS as its default provider, and not allow it to be destabilised by rival commercial providers.
3. Increase, retain and value doctors
Doctors are voting with their feet in neglected areas and services; the government has to recognise the need to improve working conditions.
Increasing the numbers of doctors in understaffed specialties such as general practice, psychiatry and emergency medicine will be impossible without this. Fair pay awards require that the independence of the Doctors’ and Dentists’ Pay Review Body (DDRB) should be restored and respected. Efficiency savings targets in the NHS should no longer be met at the expense of staff pay.
4. Maintain safeguards for patients and doctors
We must not return to the age of exhausted doctors; safeguards for patients and doctors assured by the Working Time Regulations must remain in place.
Seven-day services across the NHS should only be developed in response to clear patient demand and need, most acutely in urgent hospital care. Any proposals that dramatically change ways of working must follow rigorous analysis, have clear funding plans, and have workforce arrangements that protect both patient safety and doctors’ welfare.
5. Restore investment in general practice
General practice is the bedrock of many NHS services and the gatekeeper to the rest; it plays a vital role in all communities.
Significant investment in the workforce and facilities is overdue in order to meet rising patient need, in particular, that from older patients and those living with multiple conditions. The government must work more effectively with the profession to attract motivated doctors to work in general practice, and must invest in upgrading practice premises, delivering the ambition of true community care.
6. Prioritise health and wellbeing and strengthen ill-health prevention
Unhealthy lifestyle behaviours, such as poor nutrition, smoking and alcohol consumption, have a significant impact on quality of life and life expectancy and also place a huge burden on health services.
The government must tackle these behaviours and the industries that drive them, taking effective action to reduce health inequalities across society, improve the medical and social care of children, and develop a generation-long commitment to improve the public’s health. Health and well-being must be prioritised in all policy areas across government.