President Dr Naru Narayanan assesses the key battlegrounds for HCSA - and explains why members will be crucial to the outcome.
I begin my presidency with no illusions of the scale of the challenges we face collectively and all too often individually in a health system creaking under the strain of financial pressure and short-sighted policy.
But equally I am resolute in my belief that HCSA has a central role in pushing back.
Too often in the past we have allowed ourselves to be picked off in smaller groups: junior doctors, consultants, SAS and trust grades.
To me, what separates HCSA from others is that we view the profession as a whole, not as a collection of distinct interest groups.
The interests of senior doctors today are those of junior doctors tomorrow.
The interests of junior doctors directly impact on the teams we all work in, and for medical students on the career that lies ahead of them.
We cannot allow any part of our profession to fall behind. And as president of HCSA I am determined to lead an organisation which calls out the issues you face and speaks truth to power with neither fear nor favour.
On pay, the battle lines are rapidly being drawn. With inflation rising into the double digits, the relentless bleeding of the value of hospital doctors’ salaries is set to turn into a torrent.
Junior doctors have faced a steeper decline than the rest of us. I was proud when HCSA campaigned publicly three years ago against the four-year “ball and chain” pay deal for junior doctors in England at a time when the economic outlook was already deeply uncertain.
How right we were, and every year since they have paid a price. Understandably many junior doctors have now reached a tipping point and are pressing hard for action to reverse the tide. I am determined that HCSA shall be guided by our members as we formulate our own approach this year.
The prospect of inflation even before the Ukraine crisis led us to table a pay claim reflecting RPI plus the national insurance rise – ironically, earmarked for the NHS – and due acknowledgement of long-term erosion for all doctors.
For juniors, we have also pressed for additional rises to make up for changes to pensions contributions in England and Wales as well as compensation for the disastrous impact of their four-year pay straitjacket.
But HCSA heads into the coming period with no illusions. The government has already indicated it plans to supress wages in the public sector. This is fundamentally flawed thinking, and if it goes unchallenged we risk a drastic impact on NHS staffing.
We cannot even have faith that anyone in the corridors of power takes seriously the threat of pay decline on career decisions and the dire need to tackle this, and the punitive and perverse pensions landscape facing older hospital doctors, within a recruitment and retention strategy.
The words “NHS workforce crisis” are flung around freely on an almost daily basis. We have been told for several years that the plan to deal with it is just around the corner. Yet it has become clear – and privately this is acknowledged – that this is merely lip service. Instead the plan, if it can be called that, appears to be to muddle through in the hope that long-suffering NHS staff will simply absorb ever more pressure.
HCSA is crystal clear on our objectives.
On pensions, which affect all hospital doctors now and in future, unfair and punitive taxation is leading doctors to retire early. The government continues to turn a blind eye. We shall shine an intense light on these issues and work to ensure that inaction is no longer an option.
On workforce, we shall highlight the need to end the current farce. We will be sharply focused on pushing the powers that be to grasp the nettle and get on with it – at risk is not just our own wellbeing, but also the safety of our patients.
On pay, we have lobbied the DDRB review body to act. But the current framework is broken, and we shall be pressing home our calls for reform. We shall be consulting with you as members on the steps you wish to take on pay later this year. Rest assured, we do not consider the current situation acceptable or sustainable.
On the hostile disciplinary culture, which is overseen by the GMC and used and abused by bad employers locally, we shall be campaigning vocally for a cultural shift. The recent case of GP Dr Arora, a doctor with an unblemished record whom the GMC suspended based on a single word and the promise or otherwise of a laptop by her employer, exemplifies why hospital doctors have so little faith in the system.
On equality for all doctors, whatever their gender or ethnic background, I am determined that we shall weave this through all that we do. Imbalances around disciplinary referrals and career progression are glaring examples of the inequity which remains within our health service. Too often lip service is paid, glossy documents are published, but little is really done. Well I bluntly reject the argument that “it’s too hard” or “it’s just the way it is.” It is unacceptable in 2022 to still be talking about issues which belong in the history books.
While we shall of course retain our focus on employment support you expect from us, these “bigger picture” issues are often at the heart of the problems our members face.
HCSA was founded as a rejection of the status quo. It has always pulled no punches in targeting the root causes impacting on our profession. Under my presidency that approach will not only continue but we will be doing more to campaign for change.
But if we are to push back on all these issues we cannot just delegate responsibility to HCSA, we also need to play our roles as individuals in forging our own future. HCSA is as strong as the members within it.
We, as doctors, all need to be advocates and defenders of our collective rights as a profession.
That is the thinking behind our new Ambassador programme, which has now seen its first graduates given the basic skills of local organisation. We intend to expand this pathway so people can develop enhanced skills, and the local networks, to meet the challenges we face.
I would urge all of you to consider enrolling in this programme, but in reality every individual member already has the power to play their part on a smaller level.
I pledge to provide the leadership required to press on all the issues which impact us. As a union, HCSA will have your back.
But it is important that we all work together to make a difference. We may be smaller than other organisations, but we are deadly serious in our intent.
I hope that, in the coming months, when we make calls on all the issues which affect us, you will consider playing your part in amplifying the message.
The doctors of today and tomorrow deserve no less.