conference focus: Far from being a 'quick fix' for short-term problems, European and American clinical teams are set to become a permanent part of the NHS, the NHS Confederation conference heard

Published: 30/05/2002, Volume II2, No. 5807 Page 12 13

Health secretary Alan Milburn signalled a fundamental shift in the nature of the UK healthcare system when he announced that overseas clinical teams were to become a 'permanent feature' of the NHS.

In his closing speech to the NHS Confederation conference, Mr Milburn said: 'We are now in discussions with a number of major overseas providers to bring in clinical teams - in particular extra surgeons and other doctors - to this country. I will be meeting personally with prospective providers from both Europe and the US over the next few months to encourage them to invest in Britain. They will concentrate on elective surgery in hard-pressed specialties in those parts of the country where capacity constraints are greatest.'

He continued: 'I expect to see a growing number of these new providers in place late this year.

These new providers will become a permanent fixture of the new NHS landscape.'

Later at a press conference, he explained why permanence was an important part of the relationship with overseas clinical teams.

'You're not going to be able to get these teams here unless they think There is work coming, It is actually quite a big risk for them.

You have got to have some kind of guarantee that this is for the long term, rather than the short term.'

Mr Milburn sketched out two scenarios: 'One is that you bring an overseas team of clinicians, to undertake elective surgery, into an existing NHS facility. The other scenario is where an overseas company not only brings its staff here, but decides to invest in new facilities.'

Asked how many overseas teams he thought were needed, he said: 'The more we can get the better.'

Asked where they would go, he remarked that capacity constraints tended to be greater in the South.

Recruitment of overseas teams is to be handled 'in the first instance' by the Department of Health, said Mr Milburn. 'I think it is a pointless sort of exercise for hard-pressed trusts to have to negotiate a contract with a potential supplier.'

The arrival of overseas teams was a fundamental change in how the NHS is organised, said Mr Milburn. 'NHS healthcare no longer needs to be always delivered exclusively by line-managed NHS organisations. The task of managing the NHS becomes one of overseeing a system, not running an organisation.'

Speaking directly of the overseas clinical teams, he said: 'If they're coming here and they're providing services, then they're part of the NHS.'

NHS Confederation vice-chair Trevor Campbell Davis welcomed the announcement.

He also welcomed the fact that there were ongoing discussions about the way in which the schemes could be made to work.

He said: 'I think what managers look for is capacity and support.

What they then expect is good support for the development of their own services.

'I think the language is changing to give more certainty to some other players in Europe.'

Mr Campbell Davis said the intention was to have competition in provision even when, after a number of years, there was sufficient capacity in the NHS.

NHS Confederation chief executive Gill Morgan said the government was now defining the NHS as 'a set of principles', rather than as an organisation. She suspected that this would mean the DoH looking for partners who shared the same ethos, such as not-for-profit independent hospitals.

She added that the Confederation would consult members over bringing overseas help into the organisations and would look at the issues concerning its charitable status, which might at present prevent it.

Mr Milburn also announced that the programme which allowed heart patients waiting for more than six months to choose to move to another hospital would be extended to other conditions. A number of regional pilots will be established 'later this year'.Mr Milburn said that conditions with the longest waiting times, such as orthopaedics, ophthalmology and ENT, would be given priority.

And in a bid to reduce the number of directives and circulars, the health secretary said a panel of senior managers would be set up to 'act as a firebreak' to vet communications between the DoH and local health services, 'so they are limited to those that are absolutely necessary'.