Pay consultants more at busy A&Es, say MPs

Health minister Dan Poulter says the government is looking at making a career in A&E more attractive to consultants. Photograph: Felix Clay for the Guardian

Consultants working in struggling accident and emergency departments should be offered pay increases to halt a chronic shortage in qualified and experienced staff, according to a parliamentary report.

The public accounts committee, which scrutinises the use of public money, said A&E services finding it difficult to attract and retain permanent specialists should be allowed to offer improved terms and conditions.

The MPs made the suggestion in a report released on Tuesday which criticises both the Department of Health and NHS England for not having a “clear strategy for tackling the chronic shortage of A&E consultants”.

Dan Poulter, the health minister, said that the government is considering ways of making a consultants’ career in A&E more attractive and that the issue is being addressed as part of current negotiations.

“It takes six years to train an A&E consultant, and there is no easy fix – but our long-term plans are robust, increasing the number of training places by 75 next year, and planning for all trainee doctors to spend time in A&E. We are also looking at making an A&E career more attractive as part of our negotiations on the consultant contract,” he said.

A health source refused to be drawn on whether ministers were considering increasing consultants’ pay.

The report will make difficult reading for Jeremy Hunt, the health secretary, and Sir Bruce Keogh, NHS England’s medical director, who have faced pressure to review their plans to introduce changes in accident and emergency services.

Margaret Hodge, the committee’s chair, said that any attempt to improve emergency admissions services in the NHS is being stymied by the chronic shortage of specialist A&E consultants. Nearly a fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012.

“With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service.

“Struggling hospitals, such as those placed in special measures, find it even harder to attract and retain consultants. There are currently no incentive payments to make working in these hospitals a more attractive prospect. So we raised with the department the possibility of paying consultants more to work at struggling hospitals,” she said.

The committee’s report on emergency care suggested that doctors could be enticed to work at struggling hospitals if they were paid more.

Emergency admissions to hospitals have increased by 47% in the last 15 years, according to the report. But it is not clear who is actually accountable for the delivery of local A&E services, the report said.

A tripartite group comprising NHS England, Monitor and the Trust Development Authority is intended to oversee the performance of the emergency care system. However, it is unclear under what circumstances the tripartite group would intervene at a local level, the MPs said.

The MPs welcomed government plans to provide 24/7 consultant cover in hospitals but said they were concerned about the slow pace of implementation.

Hunt’s department also drew criticism for £250m injected into the NHS last winter to help 53 struggling departments as well as a further payment of £150m. The committee said that it was not convinced the money was used to best effect.

Dr Paul Flynn, chair of the British Medical Association (BMA) consultants committee, said that consultants working in emergency medicine faced increasingly challenging, high-pressured and stressful work environments. “The government needs to urgently address issues such as workload pressures, resourcing, and work-life balance if the NHS is to attract doctors in training and the consultant numbers that are needed, not least because spending large amounts on locum doctors is not financially sustainable in the long run.”

In November, Hunt announced plans to establish a two tier accident and emergency services across Britain, with some hospitals top be downgraded as either “emergency centres”, which would assess patients and start treatment, and “major emergency centres”, which would provide specialist care such as for strokes or heart attacks.

Pay consultants more at busy A&Es, say MPs

NHS need to charge patients, say McKinsey consultants: from the archive, 24 January 1977

A important principal on which the NHS was created in 1948 was that companies would be cost-free at the stage of use. Photograph: SSPL/Getty Pictures

The management consultants who helped to layout the new structure of the Nationwide Overall health Services in 1974 say that the scheme has failed and should be scrapped.

They also propose scrapping the tradition of a totally free well being service and introducing £20 a week “hotel” fees for hospital stays, a £5 bill for every visit to a hospital casualty division and a £2 fee for each and every go to to a GP. The partners of the McKinsey management consultancy also advocate, in their proof to the Royal Commission on the NHS, scrapping two of the current tiers of administration, getting rid of most managerial obligation from the Division of Well being and Social Protection and creating an NHS commission to run the services.

The McKinsey evidence, which has but to be formally published, condemns the new NHS construction of location and regional health authorities for major to a “proliferation of paper” and a “substantial bureaucratic dilemma.”

The total NHS is in crisis, with troubles of morale, staff grievances, soaring costs, a dissatisfied public, small extended-phrase planning and so on, the McKinsey evidence says.

The McKinsey argument is a mixture of controversy and consensus. A lot of of these offering evidence to the Royal Commission are confidently expected to attack the 1974 construction of “tiers of authority.” The Society of Civil and Public Servants, representing individuals DHSS administrators who have oversight of the NHS, announced yesterday that they desired the regional well being authorities to be abolished.

The Labour Get together in opposition attacked the 1974 reorganisation scheme, and the two Labour Secretaries, Mrs Barbara Castle and Mr David Ennals, have made it plain that they are less than enthusiastic about it – but that it would be even much more unsafe to tinker yet again with a technique that is still recovering from its final overhaul.

The opposition social services spokesman, Mr Patrick Jenkins, said last night that the 1974 structure had turned out to be “somewhat a lot more cumbersome” than Sir Keith Joseph had envisaged, and surely far more than McKinsey had suggested.

The McKinsey proposals on charging for wellness amenities are very likely to be the most controversial. The British Health-related Association is thought to be nearly particular to suggest “hotel” expenses for hospital stays, but it has set its encounter against separate charges for each and every consultation of a GP. The McKinsey suggestion of an NHS commission also has its echoes amongst some aspects in the BMA, who have named for a BBC-variety public overall health corporation to “take politics out of medicine.” The BMA’s ultimate view will not be known until right after a special BMA meeting in March.

NHS need to charge patients, say McKinsey consultants: from the archive, 24 January 1977