The NHS should be set more ambitious targets, rather than lay off surplus staff once a maximum 18-week wait has been achieved, the British Medical Association has said.

BMA chair James Johnson made the comments following HSJ's publication of a leaked Department of Health memo, which showed the government forecasting an excess of 3,200 consultants by 2011. He accused the government of 'an appalling lack of workforce planning'.

Speaking at a press conference last Thursday, BMA chair James Johnson said: 'It's quite clear the DoH will have to put in a lot of resources to meet this target and by that I mean staff and kit.

'Once we have got to that target then, by default, we will have over-capacity.'

He added: 'Once we get into 2009, assuming we achieve the target, we may well have too many resources, unless the government brings in a 16-week target; 18 weeks is not that ambitious compared to other countries in Europe.

'If they don't manage the situation, the problem will be how to deal with over-capacity. It needs very serious workforce planning.'

At the same event, he said there was 'only one year left to save the NHS', given that next year is the last of five years of record growth.

Using a phrase which echoed Labour's warning in 1997 that there were '24 hours to save the NHS', he said that 'a very serious situation arises if we get up to 9 per cent of our GDP being spent on health and cannot make it work.'

King's Fund senior associate Tony Harrison said it was possible that the over-capacity of staff predicted in the leaked memo would not materialise, as demand on diagnostics could continue to rise.

He said: 'There are other factors at work which may take up over-capacity. Planned surgery is growing and there is no reason to think it won't continue to grow.

'That, combined with new procedures and the growing number of elderly people needing treatment, could take up the slack in surgical over-capacity.'

He also questioned how much resource the NHS should pump into reducing waits below 18 weeks.

Dr Harrison said: 'There isn't, as far as I know, any good data on what referral-to-treatment times are in any other country - although it used to be said there were none in Germany.

'If an optician sees you have a cataract and you go to hospital to have an operation, unless you have co-morbidities, it can take a couple of days - it's quite straightforward.

'Other things are not so simple and it may not be a good thing to push forward for a decrease in waiting times.

'Statistical analysis shows that people don't place a high value on waiting times shorter than three months, as long as they are treated. Is it worthwhile using more resources to reduce waiting time?'

A DoH spokesperson said: 'Eighteen weeks is ambitious. The target was arrived at after looking at best practice in other countries and asking patients how long they thought it reasonable to wait.

She added: 'The NHS has been funded to make the necessary progress towards 18 weeks in 2006-07 and 2007-08.

'Funding for 2008-09 and beyond is being considered as part of the current spending review to be announced later this year and, as part of this, capacity issues will of course be considered.'

Johnson: public health is 'going down the tubes'

The government has been accused of 'unravelling the public health system' by restructuring primary care trusts.

British Medical Association chair James Johnson told a press briefing: 'When the government cut PCTs by half, the number of public health doctors went down by half.

'Unravelling the public health system is one of the most short-sighted things any government can do. I am very worried it is going down the tubes.' He added that the situation was 'extremely disheartening'.

Association of Directors of Public Health president Tim Crayford supported the comments.

'It is hard to underestimate the amount of disruption the public health system has experienced regarding Commissioning A Patient-led NHS.

'Halving the number of public health directors has not done much to strengthen it. They have reduced capacity at a time when the government should have clearly planned to increase it.'

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