We can’t afford another doctors’ stitch-up

As it often does, the BMA is standing in the way of a modern health service dedicated to its patients

History is littered with the bodies of reforming health ministers beaten down by the medical unions. Even Nye Bevan, the founder of the NHS, had to fight tooth and nail against the British Medical Association (BMA) to set up the service. So when that union attacked yesterday’s proposals for ending a veto that top doctors have over working weekends, you might think it another reform to be crushed by BMA tanks. This time, however, they look to be facing an opponent with a bit more steel.

Making the case for change is Jeremy Hunt, the Health Secretary, who wants to end the weekend working veto, saying the evidence clearly shows that hospitals have higher death rates at weekends as a result. Opposing him, the BMA is a trade union established in the 1800s with a long and ugly record of reactionary opposition to even the most progressive reform.

The argument is over a situation that looks to be straight out of the Seventies. In reality it is the result of an agreement made in 2003, when the then Labour government caved in to pressure from BMA bosses and dished out a new deal for the NHS which included rights for senior doctors to opt out of working weekends – even though this is when hospitals face some of their greatest pressures.

Back then, the BMA claimed a major victory, but the consequences of that decision today are terrible. NHS figures show there are more than 6,000 unnecessary weekend deaths in hospitals every year, figures that experts link directly to the fact that fewer senior staff are around to patrol the wards.

The weekend veto not only puts patients in danger, it makes for a grotesquely unfair split between the hard-working ranks of hospital staff and the top brass above them. While junior doctors and nurses battle through on the wards all the hours God sends, those at the top of the pile are able to come and go as they please. The real slap in the face for junior staff is that some hospital consultants use this freedom to cut their NHS work down and use the time (and their years of taxpayer-funded NHS training) to pursue lucrative moonlighting deals working for private-sector firms.

This weekend opt-out simply cannot be allowed to continue. The bald fact is that if you are unfortunate enough to be admitted to hospital at a weekend, you have a 15 per cent greater chance of dying. That alone should be case enough for reform. Yet here the BMA go again, opposing progressive changes that will not only bring the NHS up to date with modern ways of working, but will also save lives too. This is why I think the medical establishment has finally run out of road.

Negotiations with the BMA have too often focused on issues the public don’t engage with, such as complex reforms to the structures of the NHS. And throughout, the BMA has been able to claim the mantle of doctors resisting government bureaucracy – an argument the public naturally tends to side with. NHS reform has been painfully slow as a result.

Now, however, government is taking them on in the right areas – asking GPs to open at more convenient times in return for more money, and asking highly paid senior doctors actually to turn up at work when they are needed. For the public, these are perfectly reasonable requests that should have been made years ago. In opposing them, the BMA is showing itself for what it is – not a doctors’ group wanting the best care for patients, but a reactionary trade union hell-bent on preserving in aspic Seventies-style conditions that are out of kilter with everybody’s idea of a modern health service.

The NHS simply has to modernise, and the key to beating down the old Left is to fight them not on the territory of technical policy, but of naked populism. It is exactly the approach Tony Blair took when, against the odds, he brought his party and its affiliated trade union movement through reforms to introduce the private sector into the NHS. This was a much-needed reform but one that was bitterly resisted by hardliners on the Left.

Blair succeeded by targeting reform to tackle very long waiting times in hospitals in the poorest areas of the country. Once the resistance of the vested interests was made to look ridiculous, the Labour Party was able systematically to push the private sector throughout the NHS, with some excellent results.

Now that Dave Prentis, boss of Unison, has this week issued veiled threats about using illegal means to subvert reforms to unions, the Government needs more than ever to learn Blair’s lessons when it comes to fighting such recalcitrant vested interests, of which there is no better example than the BMA. If Jeremy Hunt plays his hand right, the BMA may find that it has, at last, overreached itself and lost the battle for public opinion. The real winners of such a victory would be the public themselves, who would be rewarded with a health service that matches their needs.