Hamish Meldrum: Yes, doctors have a vested interest... in their patients and a high-quality NHS

Of course, any talk of achievement must carry with it a clear health warning. This is not a signal for triumphalism, complacency or any talk of peace in our time. There is still a lot to play for, still much detail to be devilled out, still much else we want to change – indeed we must change, but we should be careful not to make the mistake of dragging defeat from the jaws of victory.

Of course we still have to seek further changes; we have to fight for the things we believe in and we will not let up in our opposition to damaging aspects of policy.

But we also have to appreciate where we started from, what we have achieved and build on that. There is still a huge task ahead of us.

We have to ensure that the legislative changes match up to the rhetoric of the past few weeks.

Over the weekend, we have been examining the 180 Government amendments, published on Thursday evening, in minute detail, ensuring that what has been promised is being delivered, that this isn’t just a case of turning a pig’s breakfast into a dog’s dinner, but rather that it is something more palatable.

So, we will not let our guard drop.

We will continue to press for sensible and permanent arrangements that will secure the future of education and training and a medical workforce that matches the nations’ needs.

We will seek to ensure a system of public health that is independent, influential and reinvigorated.

Above all, we will continue our battle against the divisive features of the healthcare market in England.

There’s been a lot of loose talk about choice and competition and the BMA’s attitude to both. Let me be clear, the BMA is not against choice – but it has to be appropriate and proportionate choice.

Just as, in a free society, individual freedoms are constrained by the impact they have on the freedoms of others, so in a healthcare system, based on the principle of social solidarity, individual choices have to be limited so that they do not adversely affect the choices of others.

As for competition, doctors are not afraid of competition – in fact, we thrive on it. We want to know that we are working as well, if not better than our colleagues and we need fair, effective and evidence-based data on health outcomes to provide us with that information.

But that is quite different from the unfettered, free market of the industrial world, because the NHS must never be like that – and why – well, you only have to look across the Atlantic to see why, and why we will continue to resist all attempts to make it like that.

Some commentators have criticised the BMA and accused doctors of having a “vested interest” – trying to undermine the changes we have fought for by claiming we do it merely to protect our own positions.

Well, I admit it, they’re absolutely right – we do have a vested interest; a vested interest in our patients; a vested interest in the NHS and a vested interest in continuing to see it improve so that it can continue to deliver comprehensive, high-quality healthcare, free at the point of delivery for this and for future generations. So, never mind the commentators; what matters is that the public seem to trust that vested interest.

Overshadowing NHS reform is, potentially, an even bigger challenge. The challenge of ever-increasing demand, finite resources and the most difficult financial situation the NHS – in all four nations of the United Kingdom – has ever faced in its 63 years.

Yes, we can argue about extent of the savings that need to be made, we can debate the timescale over which they have to happen and we can condemn the bankers who got us into this mess in the first place (bankers, who, by the way, according to the Ipsos MORI survey have the trust of just under a third of the UK public – still someway above government ministers). But there remains an inescapable truth – the NHS – just like every other healthcare system in the world has to adapt and change.

But in recognising that, there is a huge difference between adapt and change and slash and burn, between carefully planned reorganisations and knee-jerk closures and redundancies, between partnership working amongst health professionals, managers and patients and imposed, top-down, politically motivated diktat.

Never has it been more important to build trust and for everyone to work together to find the best way forward.

Never has it been more important to tap the enormous pool of knowledge and experience that health professionals can provide.

Never has it been more important to involve patients and the public, to ensure they are an integral part of the decision-making process and make them real partners in the planning of their healthcare.

If we do all that, it won’t be easy, there will still be huge problems, but we might just avoid the disasters, the waste, the disruption – the pain – that we are already beginning to see in some parts of the country.

It does not need to happen. It must not happen. We will not let it happen.

Dr Hamish Meldrum, a Bridlington GP, is chairman of the British Medical Assocation. This is an edited version of a keynote speech that he delivered to the BMA yesterday.