Consultants leader warns of morale crisis
2 November 2012
New BMA consultants committee chair Paul Flynn says government assaults on the NHS and doctors' pay, pensions and merit awards are stretching morale to breaking point.
Carpentry and teaching were careers considered by Paul Flynn in his youth. He eventually opted for medicine, after deciding it was the area in which he could most 'make a difference'.
He says: 'I'm motivated by making a difference in all aspects of what I do, whether it's medico-politics or medicine. If it's not making a difference, really I can't see the point.'
Hailing from Ireland, the Swansea consultant in obs and gynae says: 'I came to the UK for six months, and I'm still here 20 years later.'
When asked his career highlight, he jokes modestly that I should ask him in a few years' time.
But when pushed, he admits he is most proud of his work in Uganda. Each year, he visits the Kitovu Hospital in Masaka, in the south of the country, to operate on women with obstetric fistulas caused by prolonged childbirth.
It is something he became involved with through his great-aunt, who was in the Medical Missionaries of Mary, an order of nuns who undertake medical work in developing countries.
Sense of mission
He says: 'It's life-changing for [the patients], and you can really see the difference you're making with something like that. What comes across is the commitment of the staff. There's a real sense of vocation about what they do and a can-do attitude.
'To some extent, the way health workers have been treated in the NHS has damaged that sense of mission and vocation.'
This low morale among UK doctors is one of Dr Flynn's concerns.
He says: 'We expect doctors to do more than just turn up and treat patients. They always look to improve what they are doing, and look out for new techniques and technology that can make a difference to patients. Continued assaults on the profession will sap the energy needed for that extra commitment.'
It is the desire to stop these 'assaults' that led him to become involved in medico-politics as chair of the BMA Northern junior doctors committee in 1995.
He says: 'At the time, it was clear the long hours worked were no good for doctors or their patients, and it was a desire to see something done about that. [Medico-politics] does suck you in a bit. There's always another change and something else going on.'
He was inspired by his father, a secondary school English teacher who was a shop steward and trustee of his union. As a child, he helped his father fill envelopes for union elections.
'My father's view on things was that any worker who isn't in a union is asking to be exploited by their employer,' he says. 'As time's gone on I've seen the wisdom of his words.'
Dr Flynn's concern with workers' rights led him to seek the chair of the BMA consultants committee after three years as deputy chair. He replaces Yorkshire consultant in pain, anaesthesia and critical care Ian Wilson, who acted as chair after consultant obstetric anaesthetist Mark Porter left to chair the BMA council in June.
Dr Flynn believes he is up to the challenge of the turbulent times ahead. He says: 'I feel I can give the committee the leadership it needs at the moment. It's a very difficult time with a lot of changes ahead. The trade union role of the BMA is coming to the fore, and that's the aspect of it I've always been most concerned with.'
As committee chair, he intends to ensure all members have the chance to fully participate and 'have their voice heard'. To this end, he plans to attend as many regional and national consultant committees as possible.
There to listen
He says: 'As chair, you're there to listen to what the members are saying through the representatives, and to take that forward. What I would like to do is make members of the committee feel they've got a real say in what happens.
'It's important that the chair of the committee and officers don't get too focused on internal BMA things and don't forget about life outside of London.'
He believes this is particularly important at a time when life is getting harder for consultants.
'There's a real feeling that consultants have just had one thing after the other,' he says. 'It's not just a feeling; it's a reality. The pay freeze started a year earlier for consultants. We are being asked to work harder, to work more antisocial hours, and often with fewer resources than we would ideally like.'
On the subject of the pay freeze on NHS staff he says: 'We're sympathetic to the financial problems besetting the NHS but do not believe that clinical staff should have to bear the brunt of them year after year.'
The proposed NHS pension scheme changes are a looming concern, and the CC recently decided to ask BMA council to authorise a ballot of secondary care doctors on industrial action.
'Clearly, the pension dispute is very much on the minds of members. The pension so many consultants looked forward to at the end of it all is being threatened. The light at the end of the tunnel has got that bit dimmer and a bit further off.'
Another issue Dr Flynn is keen to speak out on is the fate of CEAs (clinical excellence awards), which reward consultants who contribute most towards the delivery of high-quality care to patients and improvement of NHS services.
Employers are currently not legally obliged to run CEA rounds, and some trusts have attempted not to make the awards. The DDRB (Doctors and Dentists Review Body) reviewed the scheme, but the government has not published the findings.
Dr Flynn says: 'We are still waiting for the DDRB report to be published, and I would hope that CEA rounds become something that employers are obliged to do rather than do just when they feel like it.
'It does seem odd - at a time when there's never been so much focus on the quality of care doctors deliver - to try to avoid offering the rewards that the consultants pay scheme offers for delivering that quality care. Too many employers have regarded CEAs as a form of command and control to ensure the consultants keep quiet about the failings of management.'
The main message that Dr Flynn wants to convey in his new role is that 'enough is enough'.
He says: 'You can only keep pushing people so far and continue to retain their goodwill and sense of morale. I don't think that managers realise just how much is done by doctors through goodwill alone. If that goes, they will find it extremely hard to keep the whole show on the road.'
So how does Dr Flynn balance his medico-political work and clinical practice at Abertawe Bro Morgannwg University Health Board with family life? He laughs wryly, admitting he is 'still working towards achieving balance', but that his wife might see things differently.
He has a 15-year-old daughter and two stepsons aged 20 and 22. One stepson is studying engineering at Cambridge University; the other has just graduated with a first in philosophy, politics and economics from Oxford University.
To unwind, Dr Flynn takes part in adventure races that involve a mix of cycling, orienteering, kayaking and running. Next year, he plans to take part in the Ireland coast-to-coast race, covering the country in two days.
'I'm a glutton for punishment,' he says.
Paul Flynn: Five things I've learned
- People everywhere have more things in common than they have differences
- Committees are the best way to avoid making decisions
- Cock-ups are more common than conspiracies
- Never send an email you enjoyed writing
- To trust my gut instinct.