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A SERIOUS blow has been dealt by doctors to health secretary Alan Milburn's methods of trying to significantly reduce waiting lists by the next election. NHS consultants voted decisively to reject their new contract, along with its 19 percent pay rise. Two thirds of doctors voted against and, significantly, 84 percent of junior doctors just about to become consultants voted no.
The main issue was not pay. Two key issues lay behind the rejection. The first was private practice, and the second was rejection of a massive productivity deal. When the NHS was founded the consultants were allowed to keep large private practices in addition to well paid NHS contracts and pensions. Top surgeons can easily earn between £50,000 and £250,000 on top of their NHS work.
Milburn's new attempt to tackle the issue involved the new contract placing major restrictions on new consultants' rights to do private practice, and consultants rejected these restrictions. But if the new contract had only been about getting rid of private practice and forcing consultants to work full time for the NHS it would have been voted through.
This was what happened in Scotland, where there is much less private practice because NHS provision is much better. Even in England only 25 percent of consultants do a significant amount of private practice, so the majority don't. The second issue was the government's attempt to get consultants to agree to round the clock operating at basic pay rates to clear waiting lists before the next election.
New consultants would have been forced to run outpatient clinics and routine operating lists up to 10pm at night and on Saturday and Sunday mornings as part of the regular working week. Junior doctors, already fed up with long hours, voted against this. The heart of the problem lies in the NHS's major shortage of doctors, nurses, and indeed all professional staff.
So Gordon Brown is now prepared to spend extra money on the NHS, but Milburn is finding there is simply not the physical capacity, beds or manpower to turn things round fast enough.
If operating theatres lie empty much of the time, it is not the fault of consultants, many of whom work far beyond their contracted hours. It is lack of skilled nurses, operating theatre assistants and technicians. Now the government will try to force the new changes through by giving hospital trusts the power to renegotiate individual contracts at local level.
In many ways this also suits Milburn, who wants to change the NHS from being a national service into a semi-privatised two-tier one, with independent foundation hospitals being given freedoms to break away. The lesson for the rest of us is that the same treatment is coming our way and, like the consultants, we will end up resisting it.