Hcsa issue#79 dec13

the hospital consultant and spec ial i st

Putting patients firstJohn Schofield on the Health and Social Care Act and more

December 2013 views | people | contactsbi-monthly journal of the Hospital Consultants and Specialists Association

Meeting our challenges together: Eddie Saville looks back on 20133 Private healthcare:

Mr Chris Khoo reports 5 Legislation:Spotlight on equality8

Consultant optometrist at work © Timm Sonnenschein/reportdigital.co.uk

president’s address

2 | t h e h o s p i t a l c o n s u l t a n t & s p e c i a l i s t

the hospitalconsultant

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Editorial: Eddie Saville Nick Wright

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Putting our patients firstReflecting on the year as it comes to a close, and my first eightmonths as President, I am gratified at how much we have achievedin such a difficult period. This year has been particularlychallenging for some hospital consultants and specialists, but Ihope has also been rewarding for the majority.

We have been contacted by many of you during 2013, and I hopethat the team have provided valuable assistance, making some ofthe issues you have faced easier to overcome. The phrase ‘thankyou, you’ve been so supportive’ is one that the Overton office haveheard many times in 2013 and I can say that I am really delightedthat we have been able to continue to stand up for our members soeffectively in these difficult times.

There have been many issues of note this year, particularly theFrancis and Berwick reports, the Keogh report, debates around 7-day services, consultant contract negotiations, proposed changes tothe clinical excellence award system, and pensions. We have beenhard at work representing your views and campaigning on theseissues as we know you care about them deeply. It is for this reasonthat HCSA exists, to not only represent its members when neededbut also to take its members views to a wider audience, to gainsupport for those views and ultimately influence the outcome ofdecisions which affect us all. With that in mind, I have set myselfand the Association ambitious goals for 2014, which support ourobjective of winning greater influence, improving services,developing the consultants’ role and growing our presence. As youread the roundup of the year on page 3, you will see that we havealready made great strides towards achieving these goals. But westill need to do more, particularly in developing our local networkswithin hospitals and increasing our membership.

So, in 2014 there will be a strong focus on recruiting local hospitalrepresentatives, with the development of training and supportinformation and an opportunity for all these representatives tocome together and find out more about how they can grow theirrole. Local representatives are crucial to the development ofHCSA, and I would like to thank all local and nationalrepresentatives for the part they have played in making HCSA asuccess in 2013. We act as the patients’ advocate, and our role inensuring high quality standards of care must not beunderestimated. It sometimes puts us in a difficult position, butwe must continue to keep putting our patients first. No Christmasaddress would be complete without talking about New Year’sresolutions, so I have one for all of you. If each one of yourecruited just one new member to HCSA in 2014, we would beeven stronger and more able to influence the decisions that are sovital in shaping the future of our role. Thank you all once again forall your support this year and I hope you all enjoy a peaceful andjoyous festive season.

John Schofield

2 President

3 Eddie Saville Review of 2013

4 John SchofieldAddress to council

5 Private healthcareMr Chris Khoo on competition

7 NHSHCSA replies to Jeremy Hunt

8 LegislationSpotlight on equality

9 NoticesCouncil vacanciesCongratulations to Dr Kerri Jones and Dr Tom Goodfellow

11 Join HCSA

12 Direct Debit

Call for contributionsIf you’d like to submit an article orsuggestion for the Newsletter, we’d love tohear from you. Please get in touch [email protected].

contents

A very warm welcome to newhospital representatives: Mr HarishParmar, Consultant OrthopaedicSurgeon at Queen ElizabethHospital, Welwyn Garden City andDr Paul Cooper, ConsultantAnaesthetist at Balfour Hospital,Orkney Islands.

Vacancies remain in other areas, so if youare interested in becoming a hospitalrepresentative or joining the HCSAcouncil please get in touch with theOverton office.

Welcome

We were deeply sorry to hear of the death of Dr KatherineBradley, an HCSA fellow and consultant psychiatrist in Berkshire.The family funeral was held on 9 December, and there will be amemorial service in Spring.Anyone wishing to get in contact to express their sympathy andcondolences can do so through the HCSA office in Overton.

annual review

t h e h o s p i t a l c o n s u l t a n t & s p e c i a l i s t | 3

The year began withthe Doctors’ andDentists’ ReviewBody report into theconsultant contractand ClinicalExcellence Awards(CEA). This sparkeda major response

from HCSA members, concerned thatthis would be the start of an onslaughton consultant’s terms and conditions.

At the same time the South West Pay Cartelwas looking to introduce wide-ranging changesto terms and conditions, simply as a result ofgeography. We joined forces with otherorganisations and campaigned hard to opposeregional pay. We reported on the issue ofopen referrals, which meant patients could besent to the insurer’s choice of consultant,limiting patient choice. It was also around thistime we had to react to the government’sproposals on pension tax changes that wouldsee many of our members hit by new taxthresholds and lower allowances.

We soon then saw the publication of theFrancis report into the events at Mid Staffsand the 209 recommendations therein. Theissue of whistleblowing was high on theagenda, and the HCSA spoke out on thestresses that members experienced whenwhistleblowing became necessary. In springwe were involved in the revision of the NHSconstitution, and have promoted its use in theworkplace to ensure the NHS fulfils itspledges and commitments.

In April the HCSA launched its three yearstrategic plan. The plan set out our vision,values, principles and objectives for theAssociation in the years to come.

Our vision:“The doctor’s advocate and the trade union ofchoice for consultants and specialists”Our values and principles:● Strong leadership ● Integrity ● Fairness ● Responsiveness ● QualityOur objectives: “Winning greater influence, improving services,growing our presence, developing theconsultants role”.

This plan will see us continue to build andgrow. To support this, we increased our

Meeting our challenges together

communications capacity by creating a newrole of head of communications and webservices, this enhanced our communicationstrategy and began the process of updatingour web site.

We surveyed our members on thegovernment’s proposals to change theconsultant contract and make changes to theCEA system. The efforts of the joint unioncampaign against regional pay began to pay offas a number of trusts in the South West beganto withdraw from the cartel. The NHS staffsurvey results were released which showed amixed bag of results, some good and somevery worrying - in particular the findings onbullying, harassment and staff shortages. Wecalled on Trusts to take these findings seriously,work in real partnership with consultants andspecialists and to listen and take note of whatthey had to say. We also for the first timeattended the Women’s TUC Conference,known as the “annual parliament of women,”and successfully moved a motion on theeffects regional pay has on women.

Also in April we saw a change in theleadership of the HCSA with Dr. UmeshUdeshi completing his term of office aspresident and Dr. John Schofield elected to athree year presidential term. Prof. RossWelch was elected as the new chair of theexecutive. At the same time the HCSAattended its first meeting of the NHS StaffCouncil as we took our observer seat.

The House of Lords were to decide on akey section of the Health and Social CareAct relating specifically to competition. TheHCSA like many other organisations andtrade unions had argued that mandatorycompetition risked the fragmentation ofNHS services, and an amendment wastabled. However the Lords went on todefeat the amendment.

As the Francis report continued to be inthe spotlight, the HCSA formed part of ahigh level TUC delegation that met withRobert Francis. Around that time we wereable to renew our local trade unionrecognition agreement with Cardiff and ValeUniversity Health Board, which gave us fullnegotiating rights alongside all other NHSunions within the Health Board.

Our Council meeting in April welcomedDean Royles, leader of NHS Employers whogave a keynote speech. In July we marked the65th Birthday of the NHS attending a rally in

Manchester, with our Council memberAhmed Sadiq giving a keynote speech tothose in attendance. We also commented onthe introduction of surgical league tables andupdated members on the tripartite workinglonger review, which the HCSA are engagedwith via our seat on the wider SocialPartnership Forum. In September we wereagain active at the TUC congress, successfullymoving and seconding motions onwhistleblowing and the future of the NHS.

It was also the 65th anniversary of theHCSA this year and we were able to give abrief history of the Association which we willcontinue to research for our archives. Whilstwe were celebrating our 65th birthday,meetings were taking place far away inWashington DC. The occasion was theopening of negotiations on a free tradeagreement between the United States and theEuropean Union. The Transatlantic Trade andInvestment Partnership (TTIP) could be thebiggest bilateral trade deal ever negotiated andcould profoundly affect the future of the NHS.The year is finishing as it started with the keyissue for us being the ongoing negotiations onthe consultant contract. Though not directlyinvolved in the detail of negotiations we willmake our members views known.

Set out above are just some of thecollective regional and national issues thatthe HCSA has been involved with. These areall ongoing matters and we continue to keepa watching brief on these and the manyother issues which affect HCSA members.However, added to all of this is the day today work that we do for members in theworkplace. Supporting and representingmembers individually and collectively oncontract disputes, bullying and harassmentissues, disciplinary cases, grievances, TUPEproblems, job plan disputes, discrimination atwork and much more. For me and theexcellent team of staff at the HCSA it hasbeen a busy year - one where we haveachieved many of our objectives.

Finally, just last month we strengthenedour staffing numbers, giving us more staff inthe field to support members and organiselocally. So as we go into the New Year werenew those objectives; to grow our hospitalbased representation, to recruit moremembers and retain our existing membersby improving our service. Above allcontinuing to be the voice of our members.

HCSA chief executive Eddie Saville looks back on a year whenHCSA confidently met the challenges that members faced.

John Schofield


consultants in waiting – he said that for theHCSA to prosper the association must tapinto their enthusiasm and provide them witha reason to join.

“We currently offer membership to thosewithin two years of CCT, but this has alwaysseemed an arbitrary cut off.”

“With the rules revision currentlyunderway, I urge you to consider whetherwe should open membership to all specialistregistrars, preserving what we do well forexisting consultant and specialists, butbuilding a powerbase of young, spiritedprofessionals who represent the consultantsof the future.”

“After all, they are already specialists! Ourplans to expand the number of regionalofficers, and their remit, will give us thecapacity to provide support to those in thetransition to consultant or senior specialiststatus.”

“The HCSA has a justifiably excellentreputation in representing members indifficulty, and this is one of the main reasonsthat many of our members join us. With theissue of revalidation looming for manyconsultants, this is an important area for usto become active in,” he said.

“I am committed to developing theseaspects of our Association, and so we arecurrently in the process of recruiting twoadditional part time regional officers, allowingus to provide enhanced services to ourmembers. These officers will also be able tohelp with recruitment and provide supportto council members in furthering the aims ofthe Association. We hope to appoint a leadregional officer to help with theadministration of this expanded cohort.”

John Schofield told council while theHCSA was some way from the goal toprovide a focus in every hospital he wascommitted to finding a way to have a localrepresentative in all hospitals.

“It does not seem to be impossible toachieve, I need to find out from you what itwill take to get to this goal and together wecan do this. It builds strength and resilienceinto the organisation, and allows us tosupport more members, so rather than anincrease in membership per se, I havechosen this as my personal goal,” he said.

He continued: “We are a professionalassociation first and foremost, but we are

Good for doctors, good for the NHS and good

NHS England, the centralmanagerial body of the NHS, hasbeen separated from Public HealthEngland, which has become part ofthe Civil Service while within NHSEngland, the establishment of AreaTeams and Clinical CommissioningGroups has been completed, andfrom 1 April 2013 the formation ofStrategic Clinical Networks replacedthe pre-existing various clinicalnetworks.

A new medical education structure, theLocal Education and Training Boards, andnew research structure, the AcademicHealth Science Networks and Local ClinicalResearch Networks are being born, oftenco-terminous, and divided into around 15regions in England.

Sir Bruce Keogh has launched the clinicalsenates, councils and assemblies and thesegroups will have many functions but will beinvolved in service reconfigurations, urgentcare reviews, horizon scanning and theprocess of ‘derogation', where trusts will notbe allowed to supply services unless they candemonstrate compliance with certainrequirements.

“Some of our members are involved inclinical leadership in these new organisations,but for many it is a bewildering new world inwhich we are all having to re-learn the rulesof engagement” he said.

Speaking outThe Berwick report, following on from theexhaustive recommendations of the Francisreport, gave all professionals in healthcare apractical approach to dealing with systemfailures highlighted in Mid Staffordshire, butobviously not exclusive to that area.

“It is important” he said, “that we reflecton the conclusions and help build systemswhich do not allow any repetition of theappalling standards of care which werehighlighted in these reports.”

“It is our duty as doctors to evolve bettersystems and to speak out when we witnesspoor practice.”

The new Chief Inspector of Hospitals,Professor Sir Mike Richards, was leading theCQC to produce a more robust qualityassurance framework system for ourhospitals, and was committed to extendingthe patient focus and involvement ininspection.

“At the TUC conference, our ChiefExecutive Eddie Saville called on MikeRichards to take on a role ensuring thatclinicians and others can speak out safelywhen necessary to preserve standards ofpatient care and I am pleased to report thatMike has agreed to take this on as animportant part of his remit.”

John Schofield said that whistle blowinghad proved a punitive, arduous andadversarial task for NHS staff, and HCSAmembers had often suffered seriousconsequences when raising legitimateconcerns.

“We need to achieve an open culture, awillingness to hear constructive criticism andreact accordingly to improve services, asadvocated by Francis,” he said.

“Consultants and specialists need to be inthe vanguard in promoting high standards ofcare, and must not fear persecution foridentifying failings in the current system.”

Strengthening the HCSAUrging the council to consider openingmembership up to specialist registrars –

In a wide-ranging 'state of the union' address HCSA president JohnSchofield told the association's national council that the Health andSocial Care Act had ushered in a new era for the NHS.

President JohnSchofield

update


for patients

also a union affiliated with the TUC. It is animportant part of our heritage, and offers usone way to achieve more influence whichbenefits our members. At the same time, weneed to seek other ways to exert influenceby direct interaction with ministers, politicalparties and the Department of Health.”

“I am very pleased that we now have aprobationary seat on the Staff Council, andthat Eddie Saville has been re-elected to siton the TUC General Council.”

“Alan Shrank would have been proud ofthis moment, and it marks an important stepin the development of the HCSA”

Consultant contract“As well as our attendance at the TUCconference this year, we were pleased to beinvited to a meeting in January, hosted by theHealth Minister which launched thediscussion about a new consultant contract,looking particularly at seven day working andconsultant remuneration including CEAs.

“We were able to voice our opinionsbased on a survey monkey poll which manyof you participated in. This showed a highlevel of dissatisfaction with the currentsystem, and a desire to move to better waysof working. Following this meeting, Heads ofTerms for a new consultant contract weredeveloped, and I hope we will have theopportunity to discuss these in greater detaillater today.

“At a previous meeting we agreed ourstrategic goals as now laid out in the strategydocument and published in The HospitalConsultant and Specialist. These enable us tore-invent and move the Association forwardin the 21st century, whilst maintaining ourcore values and history.”

“I commend them to you and would addthat the power of youth should not beunderestimated, tempered with the necessityof experience.

John Schofield proclaimed HCSA was thedoctors advocate with strength in solidarity,strength in purpose and strength in numbers.

“So, 65 years on, I think we need to re-invigorate the HCSA for the modern NHS.It is important that doctors stand together.This Association is good for doctors andgood for the NHS, but most of all, good forpatients. Long may it flourish.”

Private healthcaremarketMr Chris Khoo reports on the CompetitionCommission investigation

In November the Office of Fair Trading made amarket investigation reference to theCompetition Commission (CC) in April 2012under the provisions of the Enterprise Act(2002) regarding the supply or acquisition ofprivately funded healthcare services in the UK“to decide whether any feature, or combination offeatures, of each relevant market prevents, restricts or distorts competition inconnection with the supply or acquisition of any goods or services in the UnitedKingdom or a part of the United Kingdom”

consultants (a high proportion relating toBupa). Many were from consultants, butthere were also many from policyholders.Trade bodies and some hospital operatorssupported these concerns. They found thatthe two largest PMIs at least, Bupa and AXAPPP, have buyer power in relation toconsultants, but did not think this affectedcompetition, for example, by leading to ashortage of consultants in private practice orto a reduction in innovation or quality ofconsultant services. They based this on anestimate of 22,000 consultants in privatepractice (page 253, para 7.5a).

Possible “Remedies”The CC has also published a Notice ofpossible remedies on measures which couldimprove competition, including requiringoperators to sell hospitals in areas wherethey derive significant market power fromthe ownership of local clusters; a ban onsome incentive schemes; prevention of ‘tyingor bundling’ when an operator mightrespond to a loss of business in one area byraising prices nationally; possible entryenhancing measures; and the provision ofbetter information on prices and quality forpatients.

Provisional FindingsThe CC notified its provisionalfindings on 28 August. They foundthat, at a national level, both privatehospital ownership and the provisionof private medical insurance arehighly concentrated. The five mainhospital groups account for 70% ofprivately funded healthcarerevenues in the UK, whilst the fourlargest Private Medical Insurersaccount for approximately 87% ofUK insurance premium revenue,with the two largest aloneaccounting for 65%. The provision ofconsultant services is highlyfragmented, and most consultantsworking on a stand-alone or smallgroup basis.

In their study they proposed 7 “Theories ofHarm” (ToH) including ToH4: a PMI mayhave buyer power over individual consultants,and ToH6: there may be informationasymmetries and limited information availableto patients (as well as GPs and possibly PMIs)and ToH7: there may be vertical linkages thatlead to significant harm to competition.

They received many complaints about theconduct of the PMIs in their dealings with


update

a majority self-pay practice, limited in generalto non BUPA patients.

He states that the restriction the largePMIs have imposed effectively restricts hisworking in the market, as their fee scheduledoes not adequately address his medicalindemnity and administration costs. Theimposition of a reduced-fee scheduledisadvantages him compared with thosealready in the market, and this is anti-competitive. The schedule does not allowadequate margins for forward investment ininnovative technology.

The PMI term “fee approved” suggeststhat those not approved are of low qualitywhen approval is in fact based on low price.Therefore, imposed fee reductions for newconsultants distort the market.

● http://tinyurl.com/mts9geu

Established consultantsEstablished consultants are also affected.BUPA has reduced reimbursements forprocedures by up to 60% and unilaterallyintroduced exclusions, and both of theseimpose shortfalls on subscribers.

FIPO concernsThe Federation of Independent PractitionerOrganisations has made further represent-ations to the CC, drawing attention to:

● BUPA’s threat to derecognise consultantson the sole basis of billing in top 10%

● Reminding the CC that it alreadyrecognises that derecognition by amajority PMI disrupts the whole of aconsultant’s practice.

● PMI’s, and especially BUPA’s:– Interference in referral pathways and

clinical management of patients – Unfair incentivisation • e.g. allowing premier partners to

perform outpatient diagnostic tests inprivate facilities and bill for them, whileothers have to refer to recognisedhospitals.

• offering increased commission tointermediaries to sell specific policies (egopen referral schemes).

The consequences of derecognition of ahospital or hospital group, which affect allconsultants with practising privileges, whetheror not they have been personally targeted, isan example of vertical influence (ToH 7).

Concerns and Consequences● PMI market power over consultants will

lead to uniform consultation and

procedure prices, destroying competitionin the market.

● The sustainability of independentconsultant practice is threatened.

● Policyholders are suffering from the lackof transparency about their policies.

– The CC said “companies like Bupa needto ensure that they communicate betterwith policyholders about what theirpremiums entitle them to.”

– Currently, policyholders do not knowwhat their PMIs reimburse for eachprocedure: if it is right that hospitals andconsultants should provide clarity, PMIsshould also do so.

● Policyholders should have the right to“top up” from the level of remunerationpurchased to support choice.

– CC Annotated Issues Statement,February 2013 “ It is not evident to usthat patients are disadvantaged by top-upfees if they know about them in advanceand if this would allow them to choose theconsultant they prefer. Allowing such feesmight provide greater patient choice.”

● Policyholders should have the right toportability: the ability to use their benefitswith the clinician of choice, without beingrestricted to the PMI’s chosen provider.

● FIPO is concerned that the privatemedical sector may be heading towardsan irreversible market outcome unless theCC imposes remedies to ensure theproper function of the market.

OutcomeThe Competition Commission is required topublish its final report by 3 April 2014, andconsultation on previous work and theProvisional Findings Notification of 28August 2013 closed in September 2013.

ResponsesIn September 2013 private hospitaloperators, BMI Healthcare Limited (BMI),HCA International Limited (HCA) and SpireHealthcare Group (Spire) appliedsuccessfully to the Competition AppealTribunal (CAT) seeking judicial review of theCC’s interim statement, casting doubt on thevalidity of the process (with regard to thehandling and use of confidential information).

In November, the Chief Executive of thePrivate Patients’ Forum, Don Grocott, wroteto the Competition Commission castingdoubt on the validity of the figure of 22,000consultants in private practice, as used by theCC to determine that the market is notunder threat. He drew the CC’s attention tothe National Audit Office Report (February2013) “Managing NHS Consultants” whosesurveys showed that in 2000, 16,349consultants undertook private practice andin 2012 the figure was 15,754. However asthe overall number of consultants hasincreased, the proportion of consultants inprivate practice has decreased from 67% in2000 to 39% in 2012. The WesternProvident Association’s figures accord withthis: they have approximately 14,000recognised consultant providers. The NAOstates that 97% of NHS consultants are nowon the 2003 contract, which has succeededin the aim of focussing consultant activitywithin the NHS.

Professional IndemnityA current survey of consultants has shownthat there is now less incentive to enter orundertake private practice in the face ofrising indemnity and administrative costs, andfalling, contractually-imposed, PMIreimbursements. In responding to concernsabout indemnity (page 253 para 7.5c) theCC acknowledges that the cost of obtainingprofessional indemnity can be significant.“However, many consultants have small-scaleprivate practices suggesting that the cost ofprofessional indemnity insurance is not asignificant barrier, since even small scale privatepractice appears to be viable.” This is notcorrect: small-scale private practice inspecialties such as Obstetrics andNeurosurgery is not financially viable.

A recently appointedconsultant’s responseA recently appointed consultantophthalmologist had to agree terms andconditions and accept an imposed feeschedule in order to be recognised. Thesespecified significantly lower reimbursementsthan for established consultants. He now has

HCSA were among a group oforganisations who jointly sent aletter to The Times following theinterim report into theCompetition Commission’sinvestigation into privatehealthcare.

The text of the letter and list ofsignatories is on the HCSAwebsite


NHS

This week was a major milestone forthe NHS, with our final response tothe Francis report. It comes on theback of a challenging year ofunprecedented scrutiny andtransparency. It has not been easy,but I am confident the result will be aprofound change in culture that willmake our NHS the safest healthsystem in the world.

So I wanted to write personally to all NHSstaff to explain some changes that I agonisedover for a long time on the incrediblyimportant issue of making it easier for you tospeak out if you encounter poor care.

For the first time, there will be an explicitProfessional Duty of Candour in both GeneralMedical Council and Nursing and MidwiferyCouncil regulations which makes it clear that ifthere is any avoidable, unintended orunexpected harm, doctors and nurses have aprofessional duty to tell the patient and theirorganisation (and doing so will give someprotection if there is a subsequent professionalmisconduct case).

For all staff, I also need to make sure yourbosses encourage rather than discourage you

Jeremy Hunt’s message to NHS staff, 22 November 2013The secretary of state writes... whereby reporting and acting on problems

becomes the norm and the need for whistle-blowers would vanish - but we have a long wayto go to get to this. So all organisations shouldhave systems in place for staff to reportconcerns anonymously if they do not want totell their line manager.

Also remember that to support you inraising concerns, the Department of Healthfunds a freephone helpline offering free,impartial and confidential advice to staff whowish to raise concerns, but are not sure how orwhat protections they have in law when theydo. The helpline number is 08000 724 725.

Finally, I want to thank you for your effortsin the busy run up to winter. Last week I wason the frontline at the Acute Medical Unit atKing’s (thanks to Vanessa and her team forlooking after me so well - and Linda forshowing me how to make an NHS bed to herhigh standards).

I was struck by two things: just how muchpressure everyone is under in the run up towinter. And secondly how challenging it is forhard-working staff when problems in the NHSare hitting the headlines so frequently. OurNHS is doing nearly one million moreoperations every year on broadly the samebudget. It is an incredible achievement - onlypossible because so many people are workingso hard for patients. So let me finish with a bigthank you again to everyone.

from speaking out if you become aware thatany patient is not receiving the safe andcompassionate care they deserve. So for thefirst time hospitals everywhere will have anincentive to report suspected harm quicklyand openly, or risk losing some of theirprotection against successful litigation claims.Of course, I hope no hospital ever findsthemselves in that situation, but I want Boardsto send out a clear message to everyone: if indoubt, report it.

Another big change is something we havelearned from the airline industry, where safetyis paramount, and that is the need to report‘near misses.’ These are occasions when noharm actually happened, but a mistake wasmade which meant it might have. It is asimportant to report near misses as it is actualharm because, as President Obama’s safetyexpert Professor Don Berwick says, everyorganisation must become a learningorganisation when it comes to patient safety.

One of the most inspiring people I havemet this year is Helene Donnelly, a nurse inA&E, who faced bullying and harassment whenshe spoke out about poor care at MidStaffordshire. The whole of the NHS needs aculture of openness and transparency,

HCSA responds...The HCSA has always supported the higheststandards of patient care, and welcomes theSecretary of State’s response to the FrancisReport on Stafford hospital. Patients andfamilies had received appalling care: the officialreports detailed between 400 and 1,200unnecessary deaths between 2005 and 2009,receptionists made clinical decisions, and nursesfailed to respond to basic needs. “Crueltybecame the norm and no one noticed,” saidJeremy Hunt, the Health Secretary, “the NHSis a moral being or it is nothing.”

Government plans to improve NHS safetyinclude:● Removing indemnity cover from hospitals

which mislead or conceal information (andbeing responsible for their own damagesand costs, which currently cost the NHSlitigation authority £1.2bn a year).

● NHS trusts will have to publish nursingstaffing ratios in each ward, and will besubject to immediate CQC inspection ifthey fail to meet the guidelines.

● An explicit Professional Duty of Candourin both General Medical Council and

A separate report on patient safety in theNHS by Professor Don Berwick, a formerUS presidential adviser, recognised howeverthat “fear is toxic to both safety andimprovement. To address these issues thesystem must recognise with clarity andcourage the need for wide systemic changeand abandon blame as a tool and trust thegoodwill and good intentions of the staff.”

The lessons from the airline industry arethat whilst safety is paramount, it is aresponsibility of the whole system, and is notbest achieved by pinning the blame solely onindividuals. The Foundation Trust Networkhas drawn attention to the balancerecommended by Francis between learningand openness one hand and blame andrecrimination on the other. “Medicine is amessy, difficult job to do” said GlendaCooper, writing in the Telegraph the day afterthe Commons statement, and HCSAmembers are all part of a caring profession.

Hard pressed and dedicated carerswillingly and effectively deliver the best care,but we do need to work within a caring andsupportive environment to be able toachieve the ideals which drive us.

Nursing and Midwifery Councilregulations which make it a professionalduty to tell the patient and theirorganisation if there is any avoidable,unintended or unexpected harm. Wilfulmalpractice will lead to a prison sentence.

● A return to the practice of having thename of the consultant, and now also thenurse, on every patient’s bed.

● Making “failed NHS Managers” subject toa new “fit and proper person” test beforethey are allowed to resume work.

The Secretary of State said that the speedwith which health professionals admit toserious mistakes will be a mitigating factor inany conduct hearing into their behaviour.

The Royal College of Nursing’s safe ratio isone nurse to eight patients, but this ratio willnot be mandatory, though the National QualityBoard, working with the Chief Nursing Officerwill advise on staffing ratios for safe andeffective care. NICE (The National Institute forHealth and Care Excellence) will also beinvolved, taking into consideration the size andspecialty of the ward facility and patient factors,such as age and the need for care.

equality

The Government stated that there wasno real need for this protection. The HCSAknows that this is far from the case and I amsure that many of you have personalknowledge of this happening either toyourselves or colleagues.

Statutory Discrimination Questionnaires- this allowed employees who believed thatthey have suffered discrimination to seekinformation from their employer.

This has proved to be an extremely usefuland effective tool in avoiding full tribunalclaims and facilitating early settlement ofclaims. Without sufficient information it isoften impossible to prove discrimination sothis is regarded as a move that will preventmany individuals from gaining access to realjustice.

On 15 May 2012 the Home Secretaryannounced that there would be a wideranging review of the Public Sector EqualityDuty as part of the ‘Red Tape Challenge.’The general duty, which only came into forcein April 2011, should “eliminate unlawfuldiscrimination, harassment and victimisationand other conduct prohibited by the EqualityAct 2010. Advance equality of opportunitybetween people who share a protectedcharacteristic and those who do not andfoster good relations between people whoshare protected characteristics and thosewho do not.” There are also specific dutiesaround the publication of information andobjectives.

One of the main objectives of the reviewis to examine the effectiveness of the Dutytaking into account the devolvedadministrations. It is difficult to see howmeaningful this will be after less than twoyears of operation. It is clear that some ofthe fundamental aspects of the Duty areunder threat which could again weaken theopportunities of people with currentlyprotected characteristics.

The public sector equality duty has been

Spotlight on equality legislation

The government appear to be intent on dismantling our equalityinfrastructure. Indeed the coalitiongovernment’s equality strategyBuilding a Fairer Britain states “The Government’s new approach to

tackling inequality (is) one that moves

away from treating people as groups

or ‘equality strands’ and instead

recognises that we are a nation of

62 million individuals.”

On April 25th 2013 the Enterprise andRegulatory Reform Act 2013 received royalassent and as a result the following equalitylegislation has been repealed:

Third Party Harassment Protection - thismade an employer liable for repeated racist,sexist, homophobic or other prejudice-basedharassment of staff by third parties likepatients or patient’s relatives etc., where theemployer failed to take reasonable steps toprotect them.

By Annette Mansell-GreenThe Single Equality Act was introduced in 2010 giving us astrong and coherent piece of legislation that expandedprevious protection from just covering sex, race and disabilityto prohibit age, gender reassignment, sexual orientation andreligion or belief discrimination too. The Public SectorEquality Duty was introduced and the Equality and HumanRights Commission was established with stronger powers ofinvestigation and a role in holding government to account.

significant in stopping or delaying cuts inpublic services where they have adisproportionate impact on vulnerablegroups and in mainstreaming equality intodecision making by public authorities.

A review of the role, duties and powersof the Equality and Human RightsCommission has seen their budget cut from£70 million in 2007 to core funding of only£17 million by 2015 with a 70% reduction instaff and the closure of regional offices.

These changes are significant and will havea substantial impact on individuals pursuingdiscrimination claims.

New rights for parents are due to beintroduced via the Children and Families Bill2013/14 which is currently at committeestage in the House of Lords. The main pointsof the Bill are:

● The introduction of shared parental leaveand pay

● The creation of new rights to time off andpay for parents who have children viasurrogacy

● Better paid leave for adopters● Time off for fathers and partners to

attend ante-natal appointments and timeoff for adopters to attend adoptionappointments

● The extension of the right to requestflexible working

The TUC along with other stakeholdersare actively participating in all relevantconsultations and where necessary activecampaigns are taking place. The HCSA isplaying a part in this work through itsmembership of the TUC General Counciland participation in equality structures andconsultation meetings.

It is vitally important that our member’srights at work are protected and that wecontinue to ensure that all of our collectivemembership is treated fairly.


“The public sectorequality duty has beensignificant in stopping

or delaying cuts inpublic services”


notices

The Executive Committee of the HCSAawarded Dr Tom Goodfellow, consultantradiologist at University Hospital ofCoventry and Warwickshire, the ‘HCSAMedal for Outstanding Contribution’* tothe Association.

Dr Umesh Udeshi made thepresentation at the annual dinner and gavethe short speech that follows:

Our colleague Tom Goodfellow served theHCSA and its members as County Chairmanfor ten years till 2012. He has an enviabletrack record of recruiting new members andhelping colleagues in difficulty.

He was asked to chair the Education &Standards Committee in 2006 which he veryably did for 5 years. His success in that rolewas phenomenal. He led from the front andthe committee tackled all the importantissues of the day, deliberating on policydocuments from a wide variety of sourcesincluding the GMC, the Department ofHealth, MTAS, Sir John Tooke, the NHSEmployers and others too numerous tomention. He usually used his considerablewriting talents to the great advantage of theHCSA in personally writing up thecommittee’s comments and deliberations inreports and responses.

Many of the documents that he wrotewere accepted verbatim by the organisationsthey were submitted to and I remember theGMC lifted whole sections from ourresponses into one of their documents.

One of his major successes and of theHCSA was the HCSA response to the Tookereport which he crafted personally entitled“What’s in a name? The future role of theconsultant”. This encapsulated our view of thefuture consultant career and has been used

by many other bodies in their deliberationssince. The Royal College of Obstetricians andGynaecologists invited the HCSA to giveevidence to their working party ‘Tomorrow’sSpecialist’ based on that document.

More recently Tom has helped theEducation & Standards Committee and theExecutive and Council to update and re-writethat document despite having finished histerm of office as Chairman.

He also served on the ExecutiveCommittee for 6 years and his wise counselwas very valuable to us all.

* Note: Dr Goodfellow is the first doctor toreceive the medal. This medal is awarded bythe Executive to those who are deemed tohave made an outstanding contribution tothe HCSA. It is not a regular award and onlymade in exceptional circumstances.

Bright innovations

Dr John Schofield, Dr Umesh Udeshi and Dr Tom Goodfellow

The Executive Committee ofHCSA is the central committee ofthe ruling Council. Its mainfunctions are the management ofthe business of the Associationand the control and direction ofthe policy of the Association

It consists of HCSA Council memberselected by ballot at Council meetings andincludes the elected national officers, theChief Executive Officer and other electedmembers to ensure it, where possible,reflects a balanced representation of thevarious Constituencies and specialties ofMembers of the Association.

At the moment the Executive has twospaces that we would like to fill. Themembers of the committee at the momentinclude pathologists, radiologists,paediatricians, surgeons and anaesthetists.Most geographical constituencies of the UKare represented except for the North East,North West, Northern Ireland and Wales.

We would like to fill these spaces byballot at the next Council of the HCSAon April 24th 2014 and would encouragenominations, including self nomination,from any existing Council Member. AnyCouncil member is eligible to stand fromany area but in order to fulfil theaspirations of our association constitutionwe would particularly encouragenominations from other specialties andareas than already represented.

Executive has two subcommittees,Finance and Education and Standards.Meetings of Executive happen at leastevery two months. Our custom is tomeet every month except August andDecember. Meetings are held on aWednesday afternoon in central London,but move to a Thursday immediatelybefore the two Council meetings eachyear. A very high attendance rate isessential although when necessary wefacilitate teleconferencing when individualscannot attend. Council membersconsidering nomination should feel free tocontact any of the existing executivemembers to discuss the role further.

Nominations must be received by 12March 2014 by email or in writing toSharon George, Business Manager, HCSA,1 Kingsclere Road, Overton, Basingstoke,Hants, RG25 3JA ([email protected]).

Ross WelchChair of Executive Committee

Congratulations to Dr Kerri Joneswho has been named as one of thetop 50 brightest innovators in healthby Health Service Journal (HSJ). TheHSJ list recognises people whosecontributions are making a tangibledifference to patients, colleagues, thehealthcare system or wider societyand seeks to reflect the diversity ofpioneering work and approachesacross the healthcare system.

Dr Kerri Jones is consultant anaesthetist andassociate medical director (innovation andimprovement) at South Devon HealthcareFoundation Trust. She is the former national

clinical adviser to the Department of HealthEnhanced Recovery Programme, whichfocused on a new, evidence-based model ofcare that creates fitter patients who recoverfaster from major surgery.

The judging panel were impressed by hercontinuing improvement work in Torbay,which focuses on applying the model to non-surgical patients.

What the judges said: “A medic who doesbrilliant work locally. What she’s doing now isreally innovative - she is taking enhancedrecovery and applying it to medical patients.A local clinician delivering really goodimprovement work.”

Leading role


Executive Committee

President Dr. John Schofield Chairman of Executive Professor Ross WelchImmediate Past President Dr. Umesh UdeshiHonorary Treasurer Dr. Mukhlis MadlomHonorary Secretary Mr. Gervase DawidekHonorary Secretary Dr. Bernhard HeidemannHonorary Secretary Dr. Claudia PaoloniChairman – Ed & Stan S-C Prof. Amr MohsenIndependent Healthcare Mr. Christopher Khoo

Education & Standards Sub-CommitteeActing Chairman - Dr. Bernhard HeidemannDr. Mukhlis Madlom Dr. C MorganMr. Olanrewaju Sorinola Dr. Bernhard Heidemann Dr. Umesh Udeshi Dr. Bernard ChangDr. Hiten Mehta Mr. Christopher WelchDr. T Goodfellow Dr. S Ariyanayagam

Finance Sub-CommitteeChairman Dr. M.M. MadlomMr. M.J. Kelly [Trustee] Dr. U. UdeshiMr. R.M.D. Tranter [Trustee] Dr. J. SchofieldDr. R. Loveday [Trustee] Professor R. WelchDr B. Heidemann

HCSA Officers and StaffGeneral Secretary/Chief Executive Mr. Eddie Saville [email protected] Manager, Northern Region Mr. Joe Chattin [email protected] Manager Mrs. Sharon George [email protected], Advisory Service Mr. Ian Smith [email protected] Secretary Mrs. Brenda Loosley [email protected] Regional Officer Mrs. Annette Mansell-Green [email protected] Services Adviser Mrs. Gail Savage [email protected] of Communications and Web ServicesMrs. Jenifer Davis [email protected] Mrs. Edidta Bom [email protected]

Office Telephone: 01256 771777 Facsimile: 01256 770999E-mail: [email protected]

North East Area Dr. Olamide Olukoga, FFARCSI [email protected]

North West AreaDr. Magdy Y. Aglan, FFARCSI FRCA [email protected]. Syed V. Ahmed, FRCP [email protected]. Ahmed Sadiq, MRCOphth FRCS [email protected]. Augustine T-M. Tang, FRCS [email protected] - Mr. Shuaib M. Chaudhary, FRCOphth FRCS [email protected]

Yorkshire and The Humber Area Dr. Mukhlis Madlom, FRCPCH FRCP [email protected] Professor Amr Mohsen, FRCS(T&O) PhD [email protected] Mr. Peter Moore, MD FRCS [email protected] Dr John West [email protected]

East Midlands AreaDr. Cindy Horst, MB ChB DA FRCA [email protected]. Mujahid Kamal, MRCP FRCR [email protected]

West Midlands Area Dr. A.R. Markos, FRCOG FRCP [email protected]. Pijush Ray, FRCP [email protected]. Olanrewaju Sorinola, FRCOG [email protected]. Umesh Udeshi, FRCR [email protected]

East of England Area Mr. Rotimi Jaiyesimi, FRCOG LL.M (Medical Law) [email protected]. Andrew Murray, FRCS [email protected]

London AreaMr. Gervase Dawidek, FRCS FRCOphth [email protected]. Andrew Ezsias, FDS RCS FRCS [email protected]

South East Coast Area Dr. Paul Donaldson, FRCPath [email protected]. Ayman Fouad, MB BCh MSc MD MRCOG [email protected]. John Schofield, FRCPath [email protected]. Sriramulu Tharakaram, FRCP [email protected]

South Central Area Mr. Callum Clark, FRCS(Tr&Orth) [email protected]. Paul A. Johnson, FRCS, FDSRCS [email protected]. Christopher Khoo, FRCS [email protected] Dr. Sucheta Iyengar, MRCOG [email protected]

South West Area Dr. Claudia C.E. Paoloni, FRCA [email protected] Michael Y.K. Wee, FRCA [email protected] Ross Welch, FRCOG [email protected]. Subramanian Narayanan, MRCOG [email protected]

Wales Mr. Simon Hodder, FDS FRCS [email protected]

Scotland Dr. Bernhard Heidemann, FRCA [email protected]. Sean Laverick, FDS FRCS [email protected] - Dr. David Watson, FRCA, DipHIC [email protected] [email protected]

Northern Ireland Dr. William Loan, FRCS FRCR [email protected]

Specialist Registrar National Representative Vacancy

Non-Consultant Career Grade National Representative Mr Anthony Victor Babu Bathula, MS; DNB; FRCS; Dip Lap Surg; MBA (Health Executive) [email protected]

HCSA contacts

HCSA Christmas opening hours ● Monday December 23th – office closes at noon● Tuesday December 24th – office closed● Wednesday December 25th – office closed● Thursday December 26th – office closed● Friday December 27th – office closed● Monday December 30th – office closed but

Advice Direct and Voicemail monitored● Tuesday December 31st – office closed but

Advice Direct and Voicemail monitored● Wednesday January 1st – office closed

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