ARM 2023 welcome address

Chair, RB. Good morning.

We’ve often stood together to discuss the direction of our association and the future of our profession.

But as we look at our health service today, we see hospitals falling apart and ambulances stacked outside emergency departments. We look patients in the eye and apologise when we have not been able to provide the care and treatments we’ve been trained to give. All around us the NHS is collapsing.

Where we are today is not the result of the pandemic, nor due to new economic challenges precipitated by war in Europe. We’ve been warning of catastrophe for ten years - it has now arrived.

This devastation has been wrought by successive UK Governments.

A year ago you asked the BMA to find our collective strength and collective will to say enough is enough.

And the torment unleashed by the monumental failures of this Government has let slip a renewed struggle, grasped with both hands, by all doctors.

Together we are fighting back.

We have become what Governments fear most – an association undaunted by their threats and false narratives. Willing to do what it takes for our profession and for our patients. And we will strike to the next general election – and beyond – if that is what it takes.

But this can be averted. Today I have written again to the Prime Minister asking his Government to agree to ACAS facilitated talks to break the deadlock and reach a settlement with junior doctors.

Today I want us to start by recognising a simple truth; that our greatest strength is our unity. And I ask all of you to commit to that unity which will guide us to better days ahead.

In one year over 24 thousand more doctors have joined the BMA - 186,000 members is a historic high.

A year of balloting and organising. A year of action. A year of renewal. A year that we will all remember. The year our association became a force of nature.

The struggles we are engaged with in each nation of the United Kingdom are not just for all our members but for future generations.

We are on a precipice. To lose these battles is to accept and assent to the exodus of doctors from this country. It is to allow the managed decline of our once great health service and our profession. It is to reconcile ourselves to year-upon-year of pay erosion and the casual disregard for our expertise.

But that has not been my experience of the BMA – we are not ready to settle. We will not stand idly on the sidelines while others malign our great profession. Or permit Governments of any colour to take for granted our expertise and dedication.

And we are no longer shying away from that most fundamental question – what are you worth?

“There isn’t a high enough amount”, said the London cabbie to me last week, for treating his cancer and saving the life of his little granddaughter. And I’m sure you have similar experiences of the fantastic care given free of charge every day in our hospitals, in general practice and across all our health services.

It is with vigor and spirit that junior doctors in England have led the way to the picket lines. I’m inspired by them for the stand they have taken. For the mass participation in industrial action. For their courage and the unwavering support that SAS doctors, consultants and GPs have given in uniting behind them.

It is thanks to our organisation on the ground that the BMA achieved the biggest turnout and vote for action of any union in modern times.

And not just once - junior doctors in Scotland also smashed their ballot.

And consultants in England just days ago secured a massive 86% yes vote for industrial action.

Listening to their stories, as I have, it soon becomes clear how many junior doctors are struggling every day with student debt, the costs of being shoved around the country in a training lottery. The price of exams rising as the bills stack up – housing and energy costs going through the roof.

We’re the 6th richest economy in the world and this is their reality.

But a meaningful negotiation needs a credible offer. To disregard the DDRB last year showed contempt for junior doctors in England. To pitch an offer below the DDRB recommendation this year would be obscene.

Our doctors have told you what they are worth - they are not worth less now than 2008. We are prepared to negotiate in good faith, but this government is not.

I want to repeat our clear message to Westminster. Throughout the junior doctors dispute we have always said we will meet without preconditions anytime, anywhere, to resolve our issues. This offer still holds.

Meanwhile, consultants have suffered the biggest decline in pay of any branch of practice. They are joining the fight to ensure we do not lose our most senior and expert doctors – those who will train the next generation.

Our SAS colleagues in England are considering their next steps after seeing pay fall by over a quarter over the last 15 years.

And the public is on our side. The latest polls show that the majority support doctors in this fight.

But rather than negotiate, the UK Government puts its efforts into attacking people’s ability to win change with their anti-worker Bill. The UK already has some of the toughest trade union laws in Europe. And now the Secretary of State wants unprecedented powers to define minimum staffing levels.

I’ll tell you what I’m concerned about. It’s safe staffing 365 days of the year. And the Secretary of State already has all the powers he needs to fix this. This is nothing but a thinly veiled attack on workers' rights.

I promise the BMA will not back down from protecting its members. We will fight for its repeal. This is another stick that this government wields to try to beat you into submission. It won’t work.

And GPs in England are beginning the process of entering dispute - starting with preparations for an indicative ballot in the coming months if the UK Government fails to negotiate a new contract that is fit for purpose. Imposition is not negotiation.

I’m married to a GP partner. My son is a salaried GP. I know GPs have had enough of being scapegoated for a conscious policy of chronic underinvestment, picking up the pieces of failed Government preparedness for the pandemic and waiting lists that were already the worst in history prior to 2020.

General practice is not the dumping ground for the failures and inefficiencies in secondary care – nor should it be. General practice is the cornerstone of a cost effective and efficient health service. The unbelievable expertise they bring to managing risk will be lost at our peril. If we lose general practice, we lose the NHS. The anti-GP narrative – from both major parties – HAS to stop.

RB at this rate, the whole of the medical profession will be in dispute at the next general election.

The tragedy is that, with access to a Treasury that could easily – easily – fund Full Pay Restoration across the 4 nations, the UK Government persists in its denial of a workforce crisis.

It is ignoring the workforce crisis as the Australian Government drives billboards to picket lines to advertise a better life for junior doctors.

It is ignoring the crisis when over 7 million patients languish on waiting lists in England alone.

It is ignoring the crisis as both junior doctors and consultants take to the picket lines.

In Northern Ireland, hospitals and general practices are collapsing, and our Northern Irish colleagues are moving their work south of the border.

Is it any wonder that so many are heading where the grass is greener, the beaches are sandier.

So what’s the solution from UK Government? Last week they announced this country’s greatest ever investment - in the future Australian healthcare workforce.

Yes, thank you for a costed workforce plan at last, but this ignores that the crisis is NOW; the crunch is today.

Who will train the workforce? Who will teach medicine when there are no medics and academics left? Investing in medical school places while refusing to reverse years of pay erosion is illogical. And we saw the Prime Minister unable to answer questions about why pay wasn’t part of their retention strategy.

How have we got to a situation where the Australian Government understands our workforce better than our own?

But the Government CAN listen when we are loud enough. Earlier this year the painstaking work of the BMA Pensions Committee - and the threat of consultants taking industrial action - resulted in changes that mean most senior doctors will no longer be penalized for working extra hours. An outstanding achievement.

RB, this week the NHS celebrates its 75th anniversary. I remain immensely proud to work as a doctor in an organisation I truly believe in. But as we know, waiting lists have never been higher. Cancer targets are missed. Emergency departments are overwhelmed. Sleeping in a corridor or chair is frighteningly common. Those needing mental health support are cruelly sent across the country. This Government said that practice would stop by now, yet another failed promise.

It’s hardly surprising. It’s the same Government that said it would expand GP numbers by 5,000. Instead, we have over 2,000 fewer Full Time Equivalent GPs than in 2015, while patient numbers soar. In England, we are almost 50,000 doctors short of the OECD EU nation average. The new NHS modelling says we are already 150,000 full-time equivalents short across services. And yet they tell us the NHS is safe with Rishi?

Almost every metric for understanding what is happening is flashing red right now. What’s the Government’s response? Heap more work on an already burnt-out workforce. Repeat lines to the press about how much they value doctors, while simultaneously cutting the value of pay. Taking the nurses’ union to court – shameful.

This government takes pride in beating the very workers who care for the people of this country.

This NHS is far removed from the one we want to be celebrating at 75. It’s birthday threatens to be a wake. But I’m not prepared to let that happen, and I know you aren’t either.

The NHS isn’t perfect – there is so much to do when we settle our pay disputes. As well as standing up for the institution, we must also stand up for those who call it out when it fails. I promise you, today, that the BMA will not stand by as employers try to silence those who raise concerns.

The culture of fear in the NHS that the BMA has warned against is a clear and present danger. Inadequate resources and crippling vacancies affect the quality and safety of patient care -- 97% of our members have found this; yet only 40% feel content to report errors.

In the face of this, there are brave doctors who take a stand and speak out in this chaos. Yet, whistleblowers are continuously undermined or disciplined or sacked. They are pilloried because some NHS organisations believe that the reputational hit is more dangerous than unsafe care.

Over the last year I have had the privilege to meet with many whistleblowers who all share similar experiences. After raising concerns their employers turn on them, reduce their opportunities, launch phony investigations into their professional or clinical conduct to intimidate them. All the while the serious patient safety issues they raised are ignored. How many more scandals need to surface ? Often, long after a career has been ruined.

This year we saw one of our most significant wins. A 3.2-million-pound settlement for Dr Rosalind Ranson, the medical director for the Isle of Man during the outbreak of the pandemic. Dr Ranson’s expert advice was blocked; she faced bullying, harassment, humiliation and abuse from civil servants and politicians. An exceptionally dedicated doctor who moved to the Isle of Man to improve their healthcare system was destroyed by a cosy establishment.

Government departments and the health provider shredded evidence, Dr Ranson was subjected to vexatious referrals to the GMC, politicians refused to give evidence under oath, the Attorney General’s defence was, according to the Tribunal, ‘a travesty of the truth’, ‘based on a lie’, ‘false and misleading’. If a doctor was guilty of any of this their career would be over. Yet there is no accountability for those who run health services.

I am in no doubt that some NHS employers are guilty of the same tactics. And they need to know that the BMA won’t allow this anymore. If regulators won’t hold you accountable, we will call you out for the safety issues you have sought to hide. We will take you on locally, and in the courts if we must, to end this victimisation. We won’t just talk about the need for a just culture, we will hold you accountable for delivering one.

We MUST have a system that welcomes being told what is wrong so that it can put it right. And don’t think that driving care into the private sector will obscure wrongdoing or that we will stand idle while staff are abused with shoddy contracts.

This year we joined with the Doctors Association to highlight the plight of Resident Medical Officers in private hospitals. International Medical Graduates brought to the UK and employed for just over minimum wage. Trapped in unsafe hours and poor accommodation by the jeopardy of visa rules. Let us be clear that IMGs are welcome colleagues and an asset to this country; they deserve our respect, our thanks and our support at a time when they are most vulnerable and open to appalling treatment.

And RB we have not forgotten our role as a world leading professional association.

Over ten years ago Michael Marmot published his landmark report Fair Society, Healthy Lives. A blueprint to improve population health. Since then, we have had a government policy of austerity; the slashing of public health budgets, the biggest squeeze on NHS resources since its creation. By the time he published 10 Years On with the Health Foundation not much had changed.

Not simply a lost decade, but a dark decade. We are going backwards.

Now people can expect to spend more of their lives in poor health.

Improvements to life expectancy have stalled and declined. The health gap has grown between the richest and the poorest. That is shameful for our country. If ever the message was clear – the disinvestment, running down and fragmentation of public health, academic medicine and occupational health has been a disaster and must be reversed.

And what response have we seen from the architects of austerity? Flat-out denial in front of the COVID inquiry from both David Cameron and George Osborne. They refused to admit that their actions have made our country sicker and our health services less prepared to withstand a fatal pandemic; a shameful abdication of accountability.

As core participants in the COVID-19 inquiry the BMA will do all it can to ensure that lessons are learnt and that those responsible are not allowed to shy away from scrutiny. Just as the BMA did all it could to protect doctors during the pandemic, supporting doctors on the frontline and challenging all 4 Governments every step of the way. So we will do all we can in front of the inquiry to hold those responsible accountable. We must NEVER expose future generations to this again.

Without the BMA, we would not have exposed deficiencies in preparation, PPE and the appalling inequalities suffered by so many of our colleagues. I want to thank all the staff and members who steered us, assessed new data as it came in and reassessed lessons from the past. But I particularly want to recognize Chaand’s leadership – he was the right doctor, at the right time, in the right place, for the job.

We all coped with the brutality & trauma of providing treatment and juggling who lived or died because the capacity to cope just wasn’t planned for. Don’t tell me that doctors aren’t experts when my lasting image is of my ITU colleagues calculating the physics of oxygen flow through pipes, painstakingly working out if we could get oxygen to more places in the hospital.

And what did Jeremy Hunt say to the COVID inquiry? That he had to stop during a pandemic planning exercise because he was too traumatized to make the decisions doctors then faced every day - too many patients and being made to prioritise those judged most likely to survive. Only for us it wasn’t a simulation, it was real human lives in front of us. That’s the difference between us and them – we did our duty, took the hard decisions and have lived with sometimes tragic consequences, but we were accountable.

For too many, COVID isn’t over; they bear scars, the memories, and the moral injury – some continue to suffer debilitating symptoms of long COVID. We must also acknowledge that the public inquiry may trigger and reignite great distress for many – so please - please - take time to care for each other. And we’ve put up help and support contact details if you need to speak to someone.

RB, last year you passed a motion instructing the BMA to condemn and take action on the human rights violations against the Uyghur population in China. Thanks to the tireless diplomacy of our outgoing President, Martin McKee, the international, ethics and human rights teams, the World Medical Association Council has adopted a resolution asking the Chinese Medical Association to acknowledge and condemn medical complicity in these abuses. This is the first time the WMA has been pressured successfully to hold national bodies accountable for human rights violations. It’s a watershed moment demonstrating our leadership on the international stage.

I would also like to thank all the BMA staff involved in the evacuation of doctors from Sudan. They worked to facilitate conversations between the Department of Health and the Sudanese Junior Doctors Union to identify stranded doctors in the region and enable their evacuation. Thanks to their successful advocacy work the Government made a U-turn on its policy regarding those NHS doctors without a UK passport. You saved lives. That’s your BMA, in action.

The BMA is doing what you have also asked of us – to not be insular, but to play a part in the wider world. Being a world leading professional association lends credibility and inclusion to our being a strong trade union. Our diversity is our strength.

With Emma, Latifa, Trevor, Rachel & Neeta, we are the most diverse & inclusive chief officer & executive team ever. But the seeds of this were planted by previous chief officers to whom we owe much thanks. This team has inherited recommendations tackling issues in the ‘too difficult’ box; and we are committed to taking concrete action on sexism, racism, bullying and harassment, within the BMA and beyond.

We inherited the ambitious motion passed at last year’s ARM to rebuild the BMA from the ground up.

We will shift towards a more traditional branch structure in your workplace with active reps. Make no mistake, this is transformative, and represents the biggest structural and cultural change for the BMA in over 50 years. We need to get this right, for all doctors, which is why we are launching a consultation on proposals for how this will work.

Our goal is clear: to become an even more powerful trade union and professional association, where members together deliver and reap the benefits of their collective endeavour. Where you can recognise the BMA in your workplace, region or nation. Where you can count on your union to be unafraid of your employer to fight for your rights at work.

I want to return though to that fundamental question I posed at the beginning. What are you worth?

You know it. You are invaluable.

The patients we save and care for know what we’re worth.

This country knows what we are worth.

So let’s send a clear message to those in Government who cannot ignore us any longer. We will not stay silent about what needs to change.

The BMA is not going anywhere.

We are ready for this fight. We will strike for as long as it takes.

So RB. Let's stand together as one profession.

Let's organise together as one workforce.

Let’s stick together as one BMA.

With head, and heart, and hand this is your time.

And this is just the beginning.

Thank you.