Managers in NHS 'taking clinical decisions': Doctors' leader fears cost takes priority

CLINICAL decisions that directly affect patients are increasingly being taken by managers with no clinical background whatsoever, it was claimed yesterday.

Paddy Ross, retiring chairman of the Joint Consultants' Committee of the British Medical Association and medical Royal Colleges, warned that the NHS changes have produced a 'sinister' shift in decision- taking away from doctors.

'Recently I had personal experience of a business manager with no medical background who independently telephoned patients on a surgical waiting list to ask if their operation was still necessary,' Mr Ross, a surgeon at the Royal Hallamshire hospital, in Sheffield, said.

'I regard this as sinister because I do not believe that the public realises that decisions with clinical consequences are being taken more and more by such people.'

Mr Ross said in that case he 'blew a fuse' and the manager desisted. But managers were arranging operating lists and then putting only GP fund-holders' patients on them, regardless of the clinical priority of non-fundholding patients. 'I do not think patients realise that decisions on whether they get an operation or not are being made by people with no clinical experience.'

Equally the medical expertise in the health authorities which were purchasing care was limited, he said. 'It will get better. But essentially decisions about what should be purchased are being made by managers not by health professionals.'

The elevation of managerial judgements over medical ones, he said, 'is, I suspect, a deliberate policy on the part of government because the managers . . . will accept balancing the books as their number one priority, whereas the doctor will always treat the individual patient'.

Mr Ross, who is retiring a year early to become dean of clinical studies at St George's University medical school, in Grenada, said he supported doctors being cost conscious. But he said: 'I believe that making NHS doctors much more income conscious will have a corrupting influence on the profession for which we may well pay a high price - like the medical profession in the US, we will risk of losing the respect of the public.'

GP fund-holders almost doubled the savings they made on their budgets in the second year of fund- holding, figures from parliamentary answers have revealed.

Huge variations in how much practices have saved, or retained as 'surpluses', prompted Alan Milburn, Labour MP for Darlington, to call for a National Audit Office investigation into a 'misuse of public funds'.

The figures showed that in the first year of GP fund-holding, practices made savings of pounds 17m. Just pounds 2.5m of that was returned to health authorities. Last year the savings jumped to just under pounds 32m, while average savings per fund-holder varied from pounds 25,000 in the South- west to pounds 96,000 in the West Midlands. 'Some GPs are making excess profits on the back of public subsidy while hospitals are having to cut back,' Mr Milburn said.

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