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Next steps to secure real advances for hospital doctors

The snap general election was an excellent opportunity for HCSA to set out its policy vision – now to build on it

Amid the political frenzy of the snap general election HCSA published its first Manifesto for Hospitals and the Clinicians Who Work in Them.

It reflects another new phase in the history of the association. Since achieving recognition in England, increasingly our focus – for so long fixed on the prize of negotiating rights for our members – has been able to turn outwards.

HCSA continues to press for recognition in Wales and Scotland, while similar efforts in Northern Ireland have been delayed by political impasse in the six counties.

As the only professional association and trade union dedicated to hospital doctors, it has an important role to play in advocating solely for the clinical workforce.

Nationally in England reconfigurations such as those planned through the Sustainability and Transformation Plans are poised to fundamentally shift relationships between hospitals as NHS units and the rest of the health economy. Elsewhere in Scotland and Wales plans are also being laid that reflect the demographic and financial challenges facing health services.

Hospital doctors will inevitably be affected locally, and if such plans are mishandled this will undoubtedly serve to compound existing concerns over shortages, pressure and morale.

As the Manifesto foreword notes, “Our current hospital workforce reports continuing low morale and high levels of stress and sickness.

“Relentless pressures to meet targets and to squeeze more from the same or fewer members of staff threatens to have a disastrous outcome with an exodus of our most experienced hospital doctors into early retirement.

“Illogical measures designed to cut costs in other parts of the service have piled ever more pressure on hospitals. Our hospital services are themselves underfunded and our hospital doctors are being stretched too thinly. Yet we believe that as professionals we have a great deal to offer in delivering innovation and safeguards on our health services.”

This latter point is a crucial one. To our managerial health “leaders,” STPs and similar reorganisations are an example of “bottom up” rather than “top down.” Whether one agrees with this or not depends heavily on one’s perspective of where the “top” begins.

To many clinicians, although there is considerable local and regional variation, the current pervasive culture remains top down, with clinicians’ voices often drowned out due to other competing priorities.

While aspirational, the 2017 Manifesto document forms an initial baseline from which HCSA intends to develop policy, with the assistance of a stronger policy and communications team, that will make a real difference to the day-to-day position of clinicians and, as a result, their patients. Over coming months the intention is to expand on its themes, bringing existing and original research to the table.

HCSA members will have an important part to play in shaping and directing this work, not just in exposing the frustrations and constraints within which hospital doctors must sometimes work, but crucially to help the association put forward positive and constructive proposals that will enhance both clinicians’ working lives and the effectiveness and quality of healthcare.

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