HC Deb 23 March 1988 vol 130 cc362-3 3.47 pm
Mr. Jacques Arnold (Gravesham)

I beg to move, That leave be given to bring in a Bill to transfer the contracts of hospital consultants from the regional to the district health authorities: and to amend and redefine the contractual terms of hospital consultants. I present this Bill because of my concern over a series of events that have led to an unfortunate reorganisation of hospitals in my constituency, and also because of an extensive catalogue of incidents in the constituencies of other hon. Members which suggest that we have our structure wrong. In my own case, local hospitals, including Gravesend hospital, were reorganised as a reaction to pressure from the Royal College of Surgeons of England. This was apparently in response to internal politics by certain local consultants. Under the threat of derecognition of junior posts, the district health authority caved in. The interests of the consultants were served at the expense of the public for whom the National Health Service exists.

Consultants' contracts are held in most cases by the regional health authorities, and by the teaching districts and the boards of governors of postgraduate hospitals in the minority of cases. It is the contracts with the regions that are of most concern. The whole thrust of modern-day management of the NHS depends on the effective use of resources at district level. The Select Committee on Social Services considered this very point. In its report on medical education, it said : Consultants are a most important resource. If DHAs are truly to exercise discretion in determining which problems should receive priority and which services should be developed, they should not have to rely on the regions, any more than is necessary to plan and manage this very basic resource. It went on to recommend, that the DHAs should be the employing authority for consultants. In their reply, the Government said: virtually no medical professional body was in favour of District employment. Well, they would, wouldn't they? The Government said that they feared "an apprehensive and unhappy profession". They have settled for happy consultants at the expense of effective DHAs.

The reason why most DHAs provide effective local hospital services is that most consultants are dedicated, hard-working professionals. However, the DHAs are largely defenceless against a tiny minority of troublesome, under-performing or incompetent consultants. That must be changed.

Yet another sector for reform is that of merit awards. The average consultant earns £60,000 a year from the National Health Service. On top of that amount, he can receive up to a further £30,000 from distinction awards. In practice, they are awarded on the recommendation of a national committee of consultants meeting in secret conclave. The Committee advises the DHSS of its awards, which instructs the respective DHAs to pay ad infinitum.

One can imagine the qualifications for such awards. Studies have shown how they favour male consultants in the more glamorous faculties. Local district budgets have the costs unilaterally loaded on to them—a cost of £60 million nationwide in consultants' merit awards. If DHAs have funds for merit awards, they should be paid for patient care, operations performed or other local service criteria.

Last, I raise the potential conflict of interest for consultants who work in the National Health Service and who operate in the private sector. The temptations are only too clear. It is absurd to make consultants the potential beneficiaries of National Health Service waiting lists that are under their own influence.

The Bill raises important matters that are vital to the National Health Service. It is a case of a minority of unscrupulous consultants versus the people. The only reason why our hospitals work as well as they do is that most consultants are a credit to our community.

I ask for the support of all hon. Members because there is nothing that those people would like better than for the politicians to squabble with each other rather than unitedly fight the abuses being committed against the patients of our National Health Service.

Question put and agreed to.

Bill ordered to be brought in by Mr. Jacques Arnold, Mrs. Gillian Shephard, Mr. Michael Fallon, Miss Ann Widdecombe, Mr. Michael Brown, Mr. Jerry Hayes, Mr. Robert B. Jones, Mr. John Marshall, Mr. Andrew Rowe, Mr. Nicholas Bennett, Mr. Neil Thorne, and Mr. Malcolm Moss.

Mr. Jacques Arnold accordingly presented a Bill to transfer the contracts of hospital consultants from the regional to the district health authorities: and to amend and redefine the contractual terms of hospital consultants: And the same was read the First time; and ordered to be read a Second time upon Friday 29 April and to be printed. [Bill 131.]