This was how BMA council chair Chaand Nagpaul summarised the association’s role in the national response to the pandemic and to the other challenges that have confronted the medical profession in the past year.

The right and freedom of doctors to speak up and speak out, whether in respect of an individual patient or a wider, systemic issue, are vital aspects of good medical practice.

For Dr Nagpaul, in his opening address to this year’s annual representative meeting, the BMA’s determination to live up to this principle, considering the unprecedented daily demands being faced by every member of the medical profession, has been impressive as it has been critical.

He highlighted the many examples of where the association had questioned, criticised or sought to provide leadership on aspects of the pandemic response.

These included publishing a preventive strategy following the Government’s ignoring of SAGE recommendations last autumn for a ‘circuit-breaker’ lock-down, being the first medical body to call for mandatory mask wearing by the public and lobbying for greater financial support for those having to self-isolate.

‘In the past year I’m proud the BMA has loudly said what needed to be said at each step of the way,’ Dr Nagpaul says.

‘[The] Westminster Government has been consistent only in its inconsistency – while the BMA has been consistent in speaking up for the science and the public’s health.

‘We refused to be silenced, and we did this together as one BMA family across the UK.’

In spite of the successful roll-out of vaccinations in the UK, Dr Nagpaul said the BMA would continue to call out what it saw as wrong and short-sighted decisions, such as the Government’s determination to re-open society with its 21 June ‘Freedom Day’ and dispense with social restrictions.

Highlighting that 37,000 hospitalisations and 4,000 deaths from COVID had been recorded since 19 July alone, Dr Nagpaul said ministers had effectively gambled with the nation’s health.

‘The BMA has been clear that it never was a false choice of whether to end restrictions, but a question of how to do so safely,’ Dr Nagpaul says.

‘The sad truth is that many of these infections could undoubtedly have been prevented through simple mandatory measures and would not affect reopening society one jot.’

Dr Nagpaul stressed that a determination to speak out had not detracted from doctors across all parts of the health service performing ‘magnificently’ in their duties to patients and helping to orchestrate and implement the largest and most successful vaccination programme in NHS history.

Despite this unparalleled level of dedication and sacrifice, Dr Nagpaul warned that many doctors had been let down by those in Government, from inadequate and chaotic supplies of personal protective equipment during the early stages of the pandemic, through to unacceptable abuse from sections of the public, often owing to frustration with limitations on access to non-COVID health services.

Describing this vilification of front-line staff and the frequent lack of visible support from the Government or NHS England, ‘soul destroying’, Dr Nagpaul made it clear the BMA would be tireless in its efforts to ‘champion the safety of our profession’. 

These efforts included continued speaking out against and challenging all forms of discrimination in the health service and medical profession, to tackling levels of burnout and fighting for fairness in pay and pensions, for a workforce that has done so much for the nation.

‘We demand an NHS with the staff, the facilities and the capacity, so that doctors have the time, tools and space to do their job safely,’ Dr Nagpaul says.

‘An NHS where everyone – regardless of background or characteristic – has an equal chance to be their best, progress and be fairly rewarded. An NHS which learns and doesn’t blame. Which thanks and doesn’t punish staff who raise concerns. An NHS bolstered by technology but is still fuelled by humanity.’

Dr Nagpaul added that, by continuing to speak out, the BMA sought not only to fight for a better here and now for doctors, but also to safeguard the future.

Citing the Government’s proposed Health and Care bill, he warned that with the pandemic still far from over and with a looming crisis in the form of backlogged care, doctors now faced the possibility of a fresh reorganisation of the health service at a time when they little to no capacity to engage with the detail.

‘The Health and Care Bill promises to reduce privatisation by ending competitive tendering yet allows private providers to sit on commissioning boards,’ warns Dr Nagpaul.

‘It promises local and clinical leadership but gives the Health Secretary unprecedented powers to interfere in local matters. And despite the workforce crisis in the NHS, the Bill does nothing to tangibly address staff shortages.

‘After the failure of the 2012 Health and Social Care Act, does the Government really want history to repeat itself with another rushed disoriented reorganisation?

‘As I told the Parliamentary Bill committee only last Thursday [9 September]: This is the wrong bill at the wrong time.’

As BMA chair, Dr Nagpaul has made the transformation of workplace cultures, with an emphasis on compassion and collaboration, a central part of his tenure through his ‘Caring, Supportive Collaborative’ project.

Addressing the ARM, he spoke of his determination to use the final year of his role as chair to ensure that this vision began to reach fruition and that the voices of the profession were heard.

‘We will not accept a return to the old pre-pandemic days of an NHS in perpetual crisis. Which was so patently under-staffed, under-resourced such that 9 in 10 doctors say they’re afraid of medical errors daily.

‘As doctors we’ve been at the centre of delivering care throughout the pandemic. Our experiences must be heard, and our demands must be met. Because we cannot afford not to learn the lessons. We cannot afford another disaster like the one we’ve suffered these past 18 months.’