Heal thyselves

Public service before self-interest

Leader
guardian.co.uk, Sunday November 3 2002 08.48 GMT

Few professionals could imagine rejecting a pay deal that would see their salaries at senior level increase to £85,000. So the rejection by hospital doctors in England and Wales of a pay deal worth £310 million becomes more mystifying the more it is scrutinised. Consultants would have received an increase of between 9 per cent and 24 per cent for no more work than they undertake at present, a package that, in their own sector, nurses and managers would greet with enthusiasm. Health Secretary Alan Milburn had, in the words of Nye Bevan, 'stuffed their mouths with gold'. In Northern Ireland and Scotland, the same offer has been accepted and the new rates and contracts will go ahead.

So why have consultants south of the border rejected it? The sticking point has not been pay but whether managers should be able to plan a doctor's working day. Consultants have traditionally been left to organise their surgery or clinics as they see fit. They are reluctant to find themselves at the beck and call of a chief executive who, they argue, may be more concerned with clearing waiting-lists than with patient care. A factor for some may also be the restrictions new contracts would place on consultants undertaking private work, a stronger tradition in England and Wales.

The Health Secretary should, and probably will, emerge victorious from this battle. In any other profession, it would be unthinkable for highly paid staff to insist they operate without management of their efficiency or output. Of course consultants should be protected from improper pressure to deliver rushed treatment, but, in an age where you can even use banks 24 hours a day, it remains a disgrace that too many hospital consultants collude with the inefficiencies widespread in the NHS.