Policy Review

Review of the Role of the NHSCA in the 21st Century

The setting up of this review was originally discussed at the 2006 AGM. The Association was established in 1977 by a group of consultants who, seeing that some of the original principles of the NHSCA appeared to be under threat, decided to establish an Association committed to their protection, and to ensure that a nationally provided hospital service would continue to provide the best possible specialist care, provided by consultant-led specialist teams, employed on a salaried basis.

It was not unnatural that, in the subsequent years of repeated NHS reorganisations, especially those introduced by the Thatcher Government which brought market mechanisms into healthcare, most NHSCA members came to regard almost all proposed changes and developments in the NHS in a negative light. However, understandings and concepts of health, public and patient expectations of the NHS, population health needs, modes of delivery of care, and new treatments previously unavailable, have all resulted in a healthcare scene – not only in the UK, but throughout the developed world – of a completely different nature to that experienced by NHS doctors and others 30 years ago. UK governments and other authorities have introduced many reforms and new policies and programmes in response to this changing scene, many of which could be shown to be damaging to the maintenance of the original principles of the NHS, and which have been rightly opposed by the NHSCA. However, not all changes introduced to healthcare in the UK over the last 10 years or so are in themselves damaging, and some have clearly been beneficial, both in terms of improved care of patients, and in terms of benefits to NHS staff. Moreover, we now have four NHSs operating in the UK, working nowadays in very different ways, and we should be able to learn lessons from this. The difficulty faced by the NHSCA (with its very limited resources) and its members is the problem of identifying those reforms which should be supported by the Association, as being consistent with its aims, and those which should be opposed.

Hence it is necessary to review, on a fundamental basis, how best to apply the original principles of the NHSCA in the changed circumstances of the 21st century, and to develop positive policies to support appropriate development of the NHS on this basis. At the 2006 AGM, in response to points made in debate of these matters at that time, the following terms of reference for a review were suggested:

"Taking account of the heritage of NHSCA, being an association on NHS consultants committed to the preservation of the original Bevanite principles of the NHS, and to developments consistent with this tradition, to:

  • review current challenges facing health services in developed European countries in the 21st century, and to identify the general strategic directions which such health services might take in response to these,
  • identify, in the context of such strategic alternatives, which are the more likely to promote optimal development of health services in relation to demonstrated need, in the context of the Bevanite tradition referred to above, and the likely role of NHS consultants in the context of such strategic alternatives,
  • identify, within this context, what should be the main thrusts of NHSCA policy over the next 5 - 10 years,
  • consider whether or not any "rebranding" of the Association may be desirable, or not, and
  • consider whether or not, in the light of the above considerations, it may be desirable to make changes in the constituency within which membership is possible (including possible widening of this).”

POLICY CONFERENCE to consider the future role, structure and activities of NHSCA

To be held on April 25th 2009 in York

Possible areas for debate

(A) Structure Is there a case for some more localised structure as well as the EC eg committees for Scotland and Wales in view of the different situations in those countries but also for the English regions, to make it easier for members to become involved through more local meetings?

(B) Membership This has been raised on a number of occasions. Currently NHSCA membership is available to consultants including those in Public Health and Academic Medicine and to Associate Specialists. Specialist registrars may join as Associate Members at a reduced sub.
Is there a case for including GPs – if so how would it be done and what are the consequential changes which would be needed?

(C) Objectives What should be the objectives of the Association over the next 5-10 years?
How can we best achieve these?

(D) Policy Do we need to work out position statements on a number of key topics? eg Foundation Trusts.
What others?