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The BMA has recommended an independent board of governors to run the NHS in England, to put an end to what its chairman describes as the constant “political dabbling” in the day to the day running of the health service.
Although politicians would continue to make important decisions about the health service (such as what core services should be provided across the country), set priorities, and allocate resources, it would be the board—appointed by parliament—that would implement the policies and set standards and ensure these were delivered “without any further political interference,” said James Johnson, chairman of the BMA.
“It is absolutely right that politicians should set the general direction for the NHS. But the day to day political dabbling once a topic has become hot news is not good for the service and has led to the separation of managers from clinicians,” said Mr Johnson.
Managers, whose job it is to help clinicians deliver effective health care, have in effect become “political foot soldiers” whose role it is to ensure that political targets are met, he said.
Mr Johnson added: “It cannot be good for the secretary of state to have to react to every bit of news that gets into the papers.” To have to answer questions in parliament about the latest infection rates was not the responsibility of the secretary of state but should be the responsibility of the management of the hospital concerned, explained Mr Johnson, and it is they who should be made accountable.
The BMA's proposals are the culmination of a nine month review of the NHS, which was sparked by deep unhappiness among clinicians—voiced at last summer's annual representatives' meeting—about the reforms sweeping the health service. It stresses that any future reforms should be made with greater involvement of clinicians and patients.
The document recommends a constitution for the NHS, which would contain the core values of the NHS and a charter explaining what the public can expect from the NHS, what the NHS expects of the public, and the range of available services.
However, Mr Johnson said, the team behind the proposals has “fallen over backwards not to have a wholesale reorganisation of the NHS,” taking account of what he refers to as the “reorganisation fatigue” in the NHS.
No more structural tiers should be introduced in the NHS, he said, and strategic health authorities should not be abolished. But the BMA would like to see what it calls “local health economies” running primary health services. However, rather than being based on the purchaser and provider model, with each party setting its own conditions and agenda, the new bodies would have more of a cooperative structure in which providers, commissioners, doctors, the public, and others would work together to decide what services are needed in the area.
Although the BMA says that it does not advocate rationing of treatments, it recognises that in a climate of increasingly expensive medical advances and an ageing population “it may be necessary to ration some services if society is not prepared to pay higher taxes.”
“We do believe that rationing may be inevitable,” said Hamish Meldrum, chairman of the BMA's General Practitioners Committee, “but if rationing is to take place it should be done in a consistent, open, and transparent manner that involves the public and clinicians and does not happen in the idiosyncratic way that it happens at the moment.”