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Consultants profit too much from private work, says health secretary

BMJ 2000; 320 doi: (Published 27 May 2000) Cite this as: BMJ 2000;320:1428
  1. Helen Morant
  1. BMJ

    The health secretary, Alan Milburn, has criticised consultants for profiting excessively from private work, describing the practice as one of the perverse incentives operating in Britain's NHS. “Consultants on maximum part time contracts earn nearly as much from the private sector as…from the NHS,” he said.

    Mr Milburn, who was speaking to an audience of health service managers at the Royal College of Surgeons last week, asked: “Why is it that despite large increases in consultant numbers over the last few decades, the average time people have had to wait has remained pretty constant?”

    He expressed concern about the consultant contract, saying that it did not reward the hardest working doctors. He also attacked the culture of deference and hierarchy that was still present in the NHS. “This is an age when the consumer is king,” he said.

    Describing the weaknesses in the NHS as the “seven deadly sins,” Mr Milburn included in his list of targets the lack of preventive care; lack of flexibility between primary, secondary, and social care; and the absence of positive incentives for staff to improve the care of patients.

    He thought that major changes would take place after the government published its national plan in July. Six task forces were working on a blueprint for a new, modernised NHS (15 April, p 1027).

    “The publication of the national plan … will mark a watershed for the health service …[The plan] will set out how we can radically transform the NHS from a 20th century model of care to a 21st century health service,” he told the conference, which was organised by the Harrogate Management Centre.

    The government was not scared of change, and both NHS staff and patients were frustrated by the slow pace of improvement, he claimed.

    Hospitals would be rewarded for good performance both financially and with greater autonomy and opportunity for research, he said. In hospitals where progress was slow, the government would “increase support.”

    The plan would address waiting times by reducing the current 18 month waiting limit for all operations and by introducing variable and shorter waiting times, according to the operation. National patients' access teams would be established, which would “cut out unnecessary stages in the referral and treatment of surgical patients.”

    Mr Milburn said that cutting waiting times required “overcoming the antiquated barriers between different professions.” He thought that nurse endoscopists and physiotherapists conducting triage among orthopaedic referrals were good examples of interprofessional cooperation.

    Preventive medicine was also going to be a target for the national plan. “The need for cardiac surgery is related to the extent to which the NHS helps people control their blood pressure, cholesterol obesity, and smoking,” he explained.

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