In April 2004, a new contract was implemented by the Department of Health, Social Services and Public Safety for the 1,100 consultants employed by 18 hospital Trusts in Northern Ireland. According to a report published today by John Dowdall, CB, Comptroller and Auditor General, the previous contract for health service consultants had remained largely unchanged since it was agreed in 1948. Consultants are highly trained senior doctors, normally appointed following a specified programme of medical training which usually requires work as a junior doctor for at least seven years following initial qualification.
The NIAO report explains that the aims of the new contract are to: allow Trusts to plan consultants’ work around the needs of patients; limit consultants’ working hours in line with the European Working Time Directive; ensure the health service has first call on consultants' work and to reduce conflicts around private practice. Under current arrangements, consultants employed within the publicly funded health service have the opportunity to work in the private sector. Of the total annual acute health care spend of around £1 billion, in 2004-05 some £6.2 million was recovered through income in respect of private patients.
Against the background of emerging new contract arrangements, the NIAO report focuses on how the Department and Trusts have monitored and managed consultants’ in the past to ensure that they fulfilled their commitments to the health service. The report considers that drawing out lessons from recent experience under the previous contract will be of particular relevance to the Department and Trusts as they embark on the management of the new contract.
Most consultants are highly committed to their work in the health service and many of them work above and beyond their strict contractual obligations. However, the report found that, prior to the introduction of the new contract in 2004, the quality of timetabled work programmes held by Trusts was often poor and that none of them undertook any systematic or routine monitoring of compliance by consultants with their work programmes. As a result, the relationship between the work of consultants in the health service and their private practice has been overshadowed by a lack of clarity and a lack of accountability.
The new contract heralds an entirely fresh approach to managing consultants, based on the overriding principle that a consultant’s first and foremost commitment is to health service patients. This provides the basis for improving the management of consultants and Trusts need to ensure that they capitalise on the opportunity if Trusts are to provide assurance to patients and taxpayers that they are meeting modern standards and requirements of accountability.
The report also found that the present arrangements for recovering the costs of treatment provided privately in health service hospitals were not always satisfactory. There was evidence of slow recovery of costs from private insurers and a lack of basic debtor controls to gather money owed for treatment received which is not compatible with a commitment to good governance and accountability and fails to achieve value for money. In the report’s view there is, therefore, an urgent need for some Trusts to improve their cost recovery systems so that the full potential of income generation is realised and the needs of accountability are fully satisfied.