A shameful record of exploitation throughout the history of the NHS

A shameful record of exploitation throughout the history of the NHS, with the UK reliant on other countries sending us doctors to meet our healthcare needs, was condemned today (Monday 28 June 2004) by the chairman of the British Medical Association, Mr James Johnson.

In his keynote address to the BMA Annual Conference in Llandudno, James Johnson highlighted the continuing shortage of doctors and said that over the lifetime of the NHS: "We have relied on other countries to fill our NHS manpower gaps ? both for nurses and doctors. As the fourth largest economy in the world we are still doing so ? still taking doctors away from countries like South Africa and nurses from the Philippines, who need them more than we do. It's a shameful record of exploitation.

"Surely after over half a century of the NHS we should be producing enough doctors to look after our patients."

He praised the doctors from India, Pakistan and Bangladesh who have been a mainstay of the NHS for the last 40 years receiving "scant acknowledgement" or suffering "outright discrimination... Never again" said James Johnson "must we create a career cul de sac for doctors and then compound the error by trapping our overseas trained colleagues in it."

Mr Johnson said: "We want to train more doctors, but I stress more fully trained doctors?Patients deserve fully trained doctors and we have to provide them without working them 72 hours a week."

Choice, one could hardly fail to notice was currently the only show in town. The BMA chairman called on doctors to work with patients to explore the boundaries of the "choice" agenda. He said: "choice is what we want for ourselves and our own families. But the capacity to deliver choice must be put in place. Health will never be a true market place." Exercising choice had consequence: "Exercising my choice may limit yours and the better-off, middle class patient will work the system and reap maximum benefit from it.

"Choice is good ? it's certainly good for political speeches and manifestos-in-the-making. More importantly, it is right in principle. But the capacity to deliver choice must be put in place. As doctors we can ? and should ? separate out the reality from the rhetoric."

There were some major challenges to overcome, said Mr Johnson and one of these was "to help the most vulnerable, the most disadvantaged and the chronically ill to navigate the system and exercise meaningful choice. ?We must not let "choice" mean choice for some and the devil take the rest."

A second glaring difficulty with "choice" was capacity. "Choice implies spare capacity and we are still woefully short of the doctors, nurses and health professionals we need to run a proper, 21st century service." He acknowledged the investment in the NHS and growth in doctors' numbers but warned that the impact of the European Working Time Directive for junior doctors in six weeks' time, and the changing pattern of work, meant that we would still be short of doctors.

Mr Johnson said: "We have reached a defining moment in the history of the NHS - with the two major political parties both saying that health care no longer needs to be provided by the state just because it is paid for by the state.

"The Secretary of State, John Reid reassures us that the amount of healthcare provided to the NHS from the private sector will not grow to more than 10 ? 15% of the total NHS output. But he may underestimate the speed at which markets can react when lucrative opportunities present themselves ? and the NHS will be a £100 billion market in three or four years time.

"Make no mistake about this ? whether the next Government is Labour or Tory, we face a fundamental shift in the balance between public and private provision" said Mr Johnson.

A stinging attack on the Government's record of public health came at the end of his speech. He said: "I cannot bite my tongue on two public health issues where Government has been both dilatory and disgracefully complacent ? on smoking and on sexual health.

"It was a proud moment for the BMA to see three decades of campaigning come to fruition with the ban on tobacco advertising. But the Government cannot rest on its laurels. It must take the next step and ban smoking in enclosed public places. It must provide real, sustained investment in smoking cessation programmes. It is simply not good enough for John Reid to wring his hands like a latter day Marie Antoinette and say "let the poor smoke".

"I am a vascular surgeon working in one of the most deprived areas of the country. I regularly have to amputate the legs of chronic smokers ? and they are not generally from social classes ABC1. I do not know an asthmatic child who would not benefit from a smoke-free home.

"And on sexual health, we have an avoidable scandal. Nearly 90 years ago, at the time of the Great War, we instituted a service for what was then called venereal disease that was free, rapid and totally confidential. Nearly a century later in some parts of the country patients turn up at a GUM clinic only to be given an appointment in six weeks time. What use is that? What sort of public health service is that? Mr Chairman ? where is the CHOICE in that? Our campaigning has succeeded in securing some extra cash for GUM services, but nowhere near enough. This is an area where walk-in clinics and same day service really would help."

The BMA's annual takes place at the North Wales Conference Centre, Llandudno, from today until Thursday lunchtime ( Mon 28 June to 1 July 2004).