THE NHS AND NATIONAL POLICY
- The NHS should be viewed as an asset needing to be developed rather than a problem requiring the latest fashion in management, or the "disciplines" of market forces.
- Every effective treatment should be free at the point of delivery.
- The NHS should be democratically accountable at all levels.
- The NHS should be funded from central government as the fairest and most efficient method.
- Only if delay improves the chances of successful treatment or reduces risk should patients have to wait.
- The continued artificial separation into purchaser and provider is not appropriate to the NHS. It has led to a wasteful bureaucracy and opened the door to fragmentation and privatization.
- Each new policy initiative should be fully assessed and before general introduction. Its effects should be monitored with particular reference to wider and longer term consequences.
PRIVATE CAPITAL FUNDING
Private finance initiative (PFI) etc.
Using the private sector to fund capital developments is more expensive because of higher interest rates and shareholder profit. There is no evidence that it is more efficient than adequately funded NHS initiatives.
PRIVATE SECTOR PROVISION
Independent sector treatment centres (ISTCS, CATS) etc There is no evidence that the enforced purchase of services from private institutions provides more efficient or effective healthcare than would investing the same funds in the NHS It does, however, attract key staff from existing public institutions in the UK, and from hard-pressed healthcare systems overseas. It increases the cost and complexity of care remaining within NHS institutions, threatens their stability and restricts the training opportunities therein. The increasing use of competitive market systems such as Payment by Results emphasizes episodic elective work to the detriment of other. equally important forms of care and disadvantages "costly" patients.
The public's first choice is adequately resourced local healthcare services rather than the offer of more distant facilities, other than for highly specialized treatment. NHSCA believes that such offers of 'choice' are no more than an expensive and inefficient diversion of effort and that the artificial imposition of market forces in healthcare is now proven to be counterproductive. Health care provision should be properly planned.
NHSCA welcomes local responsibility and accountability for health services. It believes that local health services should be managed by a locally elected non-executive board which is responsible for the actions of professional managers it appoints and is itself accountable to the local population. Such local control must, however, operate within national standards, nationally equitable resourcing and ultimate government accountability.
Properly resourced, adequately empowered public health departments should be responsible to local health boards for prioritising local primary and secondary healthcare services, in the context of national policies developed by professionals and independent of politically motivated targets and initiatives. These departments should have the right and responsibility to express the public health advocacy needs of their local population at all political levels from the local neighbourhood to the European Union.
In order to use its staff as efficiently as possible the NHS should accommodate the needs of those who wish to work flexibly. The principles of the "Improving Working Lives" initiative should be implemented across the NHS. We deplore the unfair treatment of International Medical Graduates.
Doctors should be enabled to concentrate on medical practice, teaching and research to the highest possible standards. Their contribution to management should depend on inclination and training. Involvement in activities such as appraisal, quality assessment and audit should be balanced against the inevitable loss of time for direct patient care. Data should only be collected if it will be used for specific agreed purposes. All information should be available to the public unless relating to individual patients or staff.
The roles of doctor, nurse and other health professionals should evolve as needs and methods change but should continue to reflect the important differences in the training and ethos of the professions. The reallocation of tasks and functions should be strictly for the benefit of patients rather than imposed to save money.
EUROPEAN WORKING TIME DIRECTIVE
Attempts to limit sensibly the time commitments of doctors - trainee and career grade - are in the interest of patients if supported by adequate workforce expansion and remodelling. However. the rigidity with which the EWTD has been applied is unnecessary and currently detrimental to the service.
The importance of working with Primary Care is recognized. The commercial division between primary and secondary care, as embodied in health care commissioning must be resisted: within the current structure, Strategic Health Authorities and Primary Care Trusts must press for greater integration at local level.
The NHS should aim to make private practice redundant for UK citizens. Until it has done so, there should be clear definition of the separate contributions of senior doctors to NHS and private work and clear identification of possible conflicts of interest. A consultant involved in both should afford equal clinical priority to private and NHS patients . A career devoted exclusively to the NHS should be promoted and recognized as a viable and attractive alternative to private practice.
The NHS executives (in England and Wales, Scotland and Northern Ireland) and associated centralised committees have allowed risk avoidance, rather than risk control, to govern many important (but often occult) prioritisation decisions. Public and professional education about risk and its avoidance would save much anxiety and reduce the practice of 'defensive medicine'.
RATIONING HEALTH CARE
The aims of healthcare interventions have become distorted by political expediency and unfounded assumptions about public perception. The need for healthcare is finite and not a bottomless pit. Public "want" and public "need" are not necessarily congruent and in this area there is urgent need for informed public debate. This would free funds to improve the comprehensive service that NHSCA members aim for.
TEACHING AND RESEARCH
The importance of academic medicine to the NHS should receive greater recognition, with more generous provision for clinical teaching and research. An academic career should be a viable alternative to an NHS Consultant post. NHS staff with a teaching commitment should have recognition of this in job plans. There should also be recognition of the particular financial hardships faced by medical students as this makes a medical career less accessible for poorer families.
The Scottish Parliament and Welsh Assembly have powers to alter health service provision. Variations should be within a framework ensuring equity of access and standards of care throughout the UK. Lessons can already be learned from the increasingly distinct policies of the NHS in Scotland and in Wales. Where innovations in one country are proved to be beneficial, all should be encouraged to adopt them.