Published: 25/07/2002, Volume II2, No. 5816 Page 20

I was fascinated to read about the plans to bring in outside clinical assistance from overseas and allow those doctors to use what is described as spare capacity in the NHS to assist in treatment of NHS patients.

I imagine the costs are being analysed on a 'value for money' basis as many public contracts and opportunity costs are. The same hospitals taking part in the arrangement in the UK might find there is capacity elsewhere in the NHS. Instead of asking overseas hospitals to bid for the contracts they might seek bids from other NHS hospitals to offer such assistance.

You also mentioned that in some cases the overseas clinical teams would retain clinical responsibility. As a lawyer it seemed that whilst clinically the NHS body purchasing such assistance may feel their arrangement with the overseas doctors is committed to a contract, the patient will still view the provider of the care as the hospital or NHS trust where treatment is provided. Thus legally and financially the NHS will pick up the tab for any losses.

It would seem a better idea, in risk-management terms, to ask the NHS to keep clinical responsibility as well as legal and financial responsibility.

Stephen King Mills & Reeve London