Saturday, September 21, 2024

UK

SHA motions at Labour Party Conference

By the Socialist Health Association

SEPT. 20, 2024

The Socialist Health Association has submitted two motions to the Conference Arrangements Committee (CAC). The first is a contemporary motion on physician associates (Replacing Qualified Doctors – A Threat to Patient Safety). The second is an emergency motion (Act Now to Ease NHS Winter Pressures) on NHS pay and conditions.

Physician associates

Physician associates (PAs) and other ‘medical substitutes’ were originally introduced in the US in the 1980s to cut costs by employing cheaper, less skilled staff to carry out specific medical procedures, thereby freeing up expensive medical staff to carry out the most complex aspects of their work. They did jobs like sewing up surgical incisions or putting up drips.

Delegating some medical tasks is accepted and established here – for example phlebotomists who only take blood. However, in the last 20 years there has been an enormous growth of medical assistants such as physician associates, anaesthesia associates and surgical care practitioners. They are science graduates with a two-year postgraduate training qualification. While the intention is that they should always act under medical supervision, it has recently become apparent that this is often not the case. There have been particular problems in general practice, where the Tory government offered GPs incentives to employ PAs under a scheme whereby they were supplied to GP practices at no cost.

This led to a large expansion in the numbers of PAs in primary care, especially in poorer areas that find it harder to attract qualified doctors. In recent years there have been examples of avoidable deaths and other medical harm caused by PAs working beyond their competence and without adequate supervision. There has also been major disruption to the training of junior doctors as a result of PAs being given priority.

Many of the medical royal colleges, as well as the British Medical Association, have carried out surveys and asked the Tory and Labour governments to take urgent action in the face of a rapidly developing two tier health service.

That is also the aim of the SHA motion, which calls for an immediate freeze in the recruitment of these staff and the courses that train them, followed by a phased elimination of these roles from the NHS. In order to support this, the government should undertake an urgent review of the regulation, training and practice of PAs. Following the above, these staff should be retitled medical assistants and employed only in defined, restricted and properly supervised work.

 However, it now seems that the SHA motion may not reach the Conference floor. The CAC has placed the motion in a group called Patient Safety; as this group does not include many of the major NHS issues it is unlikely to get through Sunday’s priorities ballot. The SHA appealed against its categorisation but the appeal was rejected.

NHS pay and conditions

The text of our emergency motion speaks for itself: Act now to ease NHS winter pressures. Here is the short motion in full.

Conference notes that on the 16th September the British Medical Association Junior Doctors’ Committee accepted the government’s pay offer, thereby ending their long-running industrial action. We also note the recent result of the Unite ballot to accept the latest pay offer.

We welcome this first step towards full pay restoration for junior doctors. This should be fully funded but not at the expense of already insufficient NHS reserves. Salaries for essential workers such as these should never again be allowed to fall below inflation.

However, the NHS continues to face an unprecedented staffing crisis, across all cadres of its workforce. This pay award alone will not solve this. On the eve of another difficult winter, and with waiting lists at a record high, a comprehensive plan to drastically improve recruitment and retention of NHS staff is urgently needed.

Conference urges the government to take all necessary steps, including prioritising the necessary funding, to safeguard our NHS staff and patients this winter.

Prospects for our NHS

Emergency motions must be restricted to a single theme. If our motion is accepted for debate, there is much more to be said about the government’s management of the NHS. Most obvious is the need to challenge its commitment to sustaining the privatisation and Americanisation which we have lived with for the last 25 years. What needs to be understood is that physician associates are not in any sense an isolated project, designed to improve NHS efficiency. They are a systematic element of the ‘new care models’ imported from the US by NHS England and designed not to enhance but to undermine the NHS.

Replacing doctors with these underqualified staff in insurance-friendly community ‘hubs’ is part of the plan developed over the last ten years and legislated by the 2022 Health and Care Act, to undermine the traditional pattern of GPs and District General Hospitals.

Every Conference from 2016-22 voted to reinstate a comprehensive, publicly provided NHS (in 2023 the CAC instituted its policy of splitting up NHS motions in order to make it more difficult for them to succeed in the priorities ballot). Sadly, there was little if any response to these Conference motions from the then shadow front bench. Hopefully the need to reinstate a fully comprehensive, universal, publicly provided NHS in England will emerge in this year’s conference debate.

Please ask your CLP, union and affiliate delegates to vote for Patient Safety in the Priorities Ballot.

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