London Eye: Paying the consultants

Without getting into the pensions issue – the handling of which seems a great way to get less productivity in the system – now seems a strange time for the British Medical Association to be flexing its muscles on pay.

Yes, medics, like the rest of the service, have worked hard over the past 30 months to keep the show on the road. Of course, the system only functions as it does with the goodwill of staff – which is fraying/gone, depending who and when you ask.

But the actual rate card set by the union for extra work is pretty steep.

One London hospital boss told London Eye: “Some of our senior docs are telling their colleagues that it’s not a good look for some of the highest paid people in the NHS to ask for more money when nurses and healthcare assistants are using food banks.”

Another said the pressure from doctors so far had been on a department-by-department basis so wasn’t a concern in quite the same way, say, a nursing strike would be.

They said: “We’ve been pretty straight with them, there is no extra money to give them”.

Both thought the issue could get worse over a difficult winter.

It might be the BMA trying to pre-empt some of the tricky decisions coming down the track for healthcare leaders, as the government moves to axe the national insurance increase that was supposed to support the NHS.

The number of consultants reducing their NHS hours to do more agency or private work has long been part of industrial relations in the sector.

St George’s University Hospitals Foundation Trust recently reported one quarter of its anaesthetics consultants and specialty doctors had left since last July. More have been recruited but even after this the service is 18 per cent under-establishment (and that establishment was already insufficient).

How are the gaps being filled in south west London? Agency locums and insourcing from Xyla. What is Xyla? An insourcing firm owned by large-scale supplier of agency staff to the NHS, Independent Clinical Services Limited, whose latest annual accounts show a 50 per cent increase in turnover year-on-year (£181m to £273m for the year ending December 2021).

Bear in mind, SWL is one of only two integrated care boards in the country to have increased inpatient elective output above pre-pandemic levels. The situation is, as ever, likely worse elsewhere.

The forthcoming budget squeezes (more agency caps anyone?) are going to run into the reality of well-that-will-lengthen-the-queue-then quite quickly.

The subsequent impact of patient safety, as ever, goes largely undiscussed.

While cancer performance is shocking enough on its own, it’s always worth remembering around a quarter of cancers are picked up after an elective referral, and these are the people whose average wait from referral to diagnosis and decision could be nudging 52-weeks this time next year.

Cancer and the private sector

Talking of cancer treatment in London, the nearly-10-per-cent-of-Royal-Marsden’s-income-comes-from-Kuwait story prompted some debate.

The cancer specialist’s argument for doing so much private work has always been that the profits go back into the NHS. The unspoken other point is that rich people will always come to London for private work, we may as well try and outcompete HCA for that business, it’s our consultants who’ll be doing the work anyway. (The Marsden have done quite well at this)

The latter point was made by the former University College London Hospitals FT chief executive Marcel Levi once about the private unit there – with the non-NHS sessions on-site, at least you know where the medics are at any given moment.

One argument for the growing amount of self-pay and insurance-funded treatment is “well, these people are no longer on a waiting list for the NHS treatment they have paid for”. On the other hand, they have received medical attention for something sooner than someone else because they are richer.

Probably none of the patients funded by £39m in Kuwaiti money coming into the Marsden will be people entitled to NHS care, so the question is whether more NHS patients are treated there more quickly than they would’ve been as a result of all its private work.

At the moment, only a few people inside the trust can know for sure.