THIRD REPORT
The Health Committee has agreed to the following
Report:—
CONSULTANTS' CONTRACTS
I INTRODUCTION
1. The 23,000 consultants[6]
who work in the National Health Service (NHS) are crucial to its
success or failure. As well as delivering medical care and treatment
to patients, and supervising its delivery by junior colleagues,
consultants are responsible for a range of important non-clinical
duties, such as teaching, management, clinical audit and other
responsibilities. As the King's Fund told us, "the great
majority of consultants work hard for the NHS".[7]
However, in addition to their work for the NHS, approximately
16,000 consultants maintain private practices.[8]
It is this private practice conducted alongside NHS work which
raises a number of important issues, including that of equity,
which we address below at paragraph 57.
2. It is extremely surprising that the contract managing
the work of these vitally important professionals remains, in
essence, unchanged since the formation of the NHS in 1948,[9]
especially given both the changes which have occurred in the NHS
since then, and the obvious dissatisfaction felt with them by
many interested parties. Descriptions of the contractual situation
given to us during the course of the inquiry included: "the
ineffective hand in hand with the inequitable" (Professor
John Yates);[10]
"vague and woolly" (the Consumers' Association);[11]
"a conflict of interest.... a blatant invitation to mischief"
(Professor Donald Light);[12]
"an odd situation" (Rt Hon John Denham MP, Minister
of State, Department of Health);[13]
and "the worst of all worlds" (the British Medical Association
(BMA)).[14]
3. It was because of this widespread dissatisfaction
with the contract that we decided to undertake a brief inquiry
into consultants' contracts. Such an inquiry also seemed apposite
at this stage because of the wider political context, namely:
the Government's forthcoming announcement concerning its proposed
National Plan; and the on-going contractual negotiations between
the Department of Health (DoH) and the BMA.
4. We announced our decision to undertake this inquiry
on 16 May with the following terms of reference:
To examine NHS consultants'
contracts in terms of their accountability, effectiveness and
efficiency; and in particular to establish the effectiveness of
contracts in determining the amount of work conducted by consultants
for the NHS and for the independent sector, and the impact this
has on the NHS.[15]
We then held two oral evidence sessions, taking evidence
on 15 June from the Audit Commission, The Consumers' Association,
Professor John Yates of the University of Birmingham and the NHS
Executive; and on 22 June from the BMA and the Rt Hon John Denham
MP, Minister of State, DoH. In addition we received written evidence
from a range of individuals and associations. We are very grateful
to all those who presented evidence, written and oral, to the
Committee.
6 Ev., p. 30, para. 4. Back
7
Appendix 1, para. 8. Back
8
Appendix 1, para. 24. Back
9
Ev., p. 30, para. 1. Back
10
Q 96. Back
11
Q 42. Back
12
Donald Light, "The Two Tier System Behind Waiting Lists",
British Medical Journal, 2000:320, p. 1349. Back
13
Q 287. Back
14
Q 230. Back
15
Health Committee Press Notice 1999/2000-12. Back
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