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President's view: NHS in crisis

In his last column as HCSA President, Professor John Schofield urges unity among the profession in order to confront the many challenges to come

I am reaching the end of my three- year term as HCSA President. It has been a great honour to serve the Association, and I know that I leave it in safe hands with our President Elect, Professor Ross Welch, and our talented Executive Committee and Council.

Perhaps now is the time for an overarching review of the period, reflecting on what has gone before and what still remains to do. However, we are currently engaged in one of the most bitter wars the medical profession has endured since the formation of the NHS.

Central in the battlefield, the current impasse in the junior doctors’ contract negotiations, and on the right flank the impending new consultants’ contract. The painful protracted dispute dictates that my thoughts focus on these issues, ones which go to the heart of our profession.

The government’s decision to impose contractual terms on doctors in training sets a dangerous new precedent. It is a deeply disturbing departure from good industrial relations and has sent a shockwave through the health service. The impact of this decision has reverberated in all hospitals across the country, setting the tone for industrial relations for years to come, and not just with medical practitioners.

Mutual agreement would have been a sensible outcome following the unprecedented strength of feeling currently displayed, but now there is a danger that the imposition of terms will have a disastrous impact on professional morale.

This strength of feeling was demonstrated by the massive response to a crowdfunding drive launched to raise £100,000 for a judicial review of the government’s plans – in just 48 hours, that amount was raised by a group of junior doctors. It remains to be seen whether such a judicial review process will bear fruit, but it would surely be wise for the government to heed the impact of imposition given the anger that has driven this initiative.

As I write, we await the final shape of the consultants’ contract. Against the backdrop of conflict with doctors in training, we cannot help but feel deep concern regarding its content. The question that must be posed is whether the long- term results of this strategy will affect the well-being, recruitment and retention of hospital doctors.

Crucially, will the outcome be safe for both patients and doctors? Without sufficient medical professionals including supporting staff to deliver safe services, and with increasing financial pressures on NHS trusts, there must be reasonable cause for doubt.

A wide range of clinical voices, including professional associations such as the Hospital Consultants and Specialists Association, have long agreed with the goal of seven-day services. However, the idea that this can be achieved simply by using the current resources more efficiently is one that we have always firmly rejected. Sadly, this still does appear to be part of the current strategy, albeit now with some transitional funding aimed at softening the blow for the worst affected.

Amid this period of uncertainty, cost- cutting and conflict, it is essential that hospital doctors remain vigilant. That is why the Hospital Consultants & Specialists Association, unique in its focus solely on this section of our profession, is increasing its activities and has launched a major programme of outreach in hospitals across the UK.

The number of local HCSA Hospital Representatives who play a vital role in helping to organise and publicise these events on the ground is growing, but our goal remains to achieve total coverage, as well as official recognition, in every trust. I urge all members to enhance their direct relationship with the HCSA. If your own trust does not have a Hospital Representative or a meeting planned, contact your national officer, who will be only too happy to assist.

I do not exaggerate when I state that we have reached crisis point for consultants and specialist doctors in the NHS. Whether it is trusts tackling their budget deficits and attempting to squeeze blood from a stone, or the national challenges that face us, the pressure is certainly rising.

We need to get organised and to help each other, as together we are so much stronger. More than ever before, it is vital that our profession stays unified and that our voice is heard – not in the interest of ourselves and our colleagues, but in the interests of patients and the NHS as a whole.