'We need more consultants' say the BMA

The Telegraph reports a BMA call for more consultants in the NHS.


This is supported by research finding that consultants, the most senior and experienced doctors, produce better results in a number of areas.  No one is going to dispute that, it seems pretty obvious that if your doctors are more experienced they will offer a better standard of care.


However, the reason why we don't have as many consultants as in other countries isn't that we've been stingy with the health service.  Funding has gone up rapidly and we now spend just about exactly at the OECD average.  It is that increases in funding have been soaked up by a healthcare system unable to turn that new money into results.


What the BMA don't mention in its discussion of the number of doctors is how expensive they have become.  While we don't have a lot of consultants, our doctors are among the best paid in the developing world.  This can be seen in the OECD's Health at a Glance 2007 statistics on physicians remuneration (XLS).  Our GPs are the third best paid of the 23 OECD countries relative to GDP per capita, our specialists are also paid well above the average (the eighth best paid).  Pay has been rising rapidly despite falling hours due to the Working Time Directive.  Unfortunately, it seems unlikely that the BMA will acknowledge that the problem isn't a lack of resources but the direction of resources into things like big pay increases instead of areas more conducive to improving results and the patient experience.  The money to pay for all this is taken from hard pressed taxpayers who have been forced to foot some extravagant bills in recent years.  If our doctors are to enjoy such high earnings there will probably have to be fewer of them than we might like.


This is just one of the pressures pushing up costs in the NHS, we identified several drivers of NHS inefficiency in our report Wasting Lives: A statistical analysis of NHS performance in a European context since 1981 (PDF).  The Kings' Fund reported that 73 per cent of additional spending in the NHS in 2004-05 was consumed by cost pressures; the number of managers and senior managers grew twice as quickly between 1999 and 2004 as the number of clinical staff; endless reforms and then reversals have been massively disruptive.  Instead of offering the rather obvious bromide that things might be better if we had more expensive consultants, it would be nice if the BMA would reflect on the fact that the NHS has seen little result from a big increase in spending and direct their campaigning attention towards seeking serious reforms in the way the health service operates.  In Wasting Lives we set out what the priorities should be: ending political management, ensuring proper competition and delivering real decentralisation.


After all, this story provides more examples of how politicians fail to effectively manage the health service.  They weren't able to properly control pay and other costs when resources were plentiful.  Spending shot up at a clearly unsustainable rate and, instead of delivering similarly radical changes in results, built up momentum in various cost pressures.  Now that money is relatively tight pay deals are going to have to be more restrained and staff are upset but still highly paid due to past profligacy - we've got the worst of both worlds.  In order to avoid a financial crunch in organisations that had got too used to plenty NHS Trusts took radical, destructive steps like cutting back on nursing (contributing to hospital infection epidemics) or freezing consultant recruitment.  This is a fiasco that patients and staff pay for every day and is the direct result of politicians, with experience in neither healthcare nor managing large organisations, believing that they could easily translate resources into results and dictate improvement via targets from the centre.

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