Interview: Recognition where it’s due

Professor Ross Welch reflects on an eventful three years as HCSA president

Looking back at your time as President, what are the highlights that stand out?
I think the most significant highlight was finally achieving national recognition for collective bargaining with NHS Employers and government. This was something that so many previous presidents and executive members had pursued for so many years that I feel really privileged to have been in post when it came to fruition.

It has been followed by two years of tortuous negotiating on a new consultant contract, which to be honest is not much further forward. The employers’ side have very clear aims and objectives, principally that of not spending anything more on medical salaries, but also to remove the Consultant opt-out clause on elective out of standard hours working in the pursuit of a seven-day normal working week. We have battled hard to secure protections for staff from management bullying and manipulation. Although the employers and the BMA reached agreement on local CEAs, we did not and we are still very much of the opinion that the interim scheme, and the performance-related pay scheme that will replace it from 2021, is a very bad deal not just for the Consultants of today but for those doctors currently in training who will soon face the new system.

It has been very pleasing since we achieved national bargaining rights for all grades of hospital doctors to see how many Trusts have signed formal recognition deals with us, allowing the Association to negotiate collectively on behalf of members at a local level. This will become even more crucial if NHS Employers get their way on future contracts, as nearly all aspects would then be open to local variation in pay and terms.

Many Trusts have already begun the process of establishing revised Joint Local Negotiating Committees to include representatives of the BMA, HCSA and non-unionised doctors of all grades. Other employers are more hesitant, often because of inaccurate claims that Local Negotiating Committees, the democratic mechanism for all medical staff, are a “BMA-only” body. This is something that our legal advisers have said is contrary to trade union law.

Elsewhere, HCSA and the BMA do co-operate successfully, underlining what can be achieved when we work together to represent the common interests of medical staff. It is to my regret, therefore, that the BMA maintains its position of separate negotiations at a national level.

Structurally, HCSA has increased the numbers of our extremely able National Officers (NOs), enhancing the individual member support we provide. We are also implementing changes to backroom hardware and software with a greater focus on organising and communication. The fruits of this will become increasingly visible to members.

In order to meet the challenges of recognition and increase our campaigning capacity we have grown our Policy committee, which has led campaigns such as around the case of Hadiza Bawa-Garba and Gross Negligence Manslaughter and is currently very active around the inequalities of the pension scheme. We will continue to run these campaigns, supported where needed by research to ensure we reflect members’ thinking – we fundamentally wish to be evidence-based and confident in representing these views to employers and all the “arm’s length” NHS organisations that affect clinical decision-making.

One of the greatest delights has been the rapid growth in trainee numbers in the HCSA and we are starting to get them involved in Council and Executive as they are our future. We want many, many more trainee members and hope our current members will play a part in this.

We reached our 70th anniversary last October and held a very successful conference at the Royal College of Physicians, combined with an anniversary dinner. Two senior BMA officers joined us, and we very much hope it signals the start of a new phase in our relationship.

Has your term as President changed your view of HCSA’s role as an organisation?
When I took up the presidency, I was determined that the views we presented as a professional association should be member-based, not the thoughts of a small group who held office or held representative positions. The willingness of so many members to share their opinions has confirmed my hope that we were a representative association.

My experience of most committee work, both inside and outside the NHS, had led me to believe that plans were often made not as a result of wide consultation, as this made things too complex, but through poor decisions by less-than-well-informed small groups. I was very pleased to see that the HCSA was not like that.

Did anything come as a surprise over your three years in the role?
How quickly trainees joined us when we changed the rules! More, please!

Is there anything you wish you could have achieved but haven’t?
I am very sad that we have not achieved a better working relationship with the BMA. We have had good interactions with their senior team, but their complicated representative structure makes it almost impossible to get things changed easily and quickly.

Two heads are usually better than one, and I am absolutely certain that we represent a different core group to the BMA and that those individuals a) need representation at the top tables and b) have a legitimate voice that needs to be heard.

What future do you see for HCSA in years to come?
If we can get the trainees in in large numbers, and we can keep them as members as they become seniors, then the HCSA has a great future. Numbers matter and the more you have, the more influence you can have both locally and nationally.

Do you think the main challenges facing hospital doctors have changed over the past few years?
Hugely! The NHS is no longer primarily a care provider but a business. This is devastating for patient care which is why most of us went into the profession. Doctors at all grades, but particularly Consultants, spend far too much time trying to control the overzealous management culture when they should be doing what they have trained for.

This is driving hospital doctors to leave the profession. With almost 20 per cent of medical students not completing two years of foundation training before they leave the profession or the country, combined with the huge exodus of seniors leaving early – often burnt out, bruised and damaged by the daily fight to maintain standards – I do have serious concerns for those left behind, too young to retire and too old to really consider a change of direction.

What will your involvement be in HCSA when your term as President ends?
I will become the “immediate past president”! As such I will still sit on the Executive committee and involve myself with the running of the Association. I hope to continue being useful to the association and its members. Most of all I hope to support our most excellent new president.

Have you got a message for your successor as President, and is there anything you’d like to say to members?
I think the best advice I can give Claudia is simply to do your best. As HCSA’s first female president, I hope she will use the platform to bring support to and further the progression of women in medicine.

To members, my message is simple: get others to join, get involved as a local hospital rep, by standing for Council, in surveys – but whatever else, participate in your HCSA.