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NHS internal market is an ‘uncontrolled monster’

Pressure on government ministers to defend their reforms of the health service has increased significantly in recent months. Amid mounting evidence of the adverse and widely predicted consequences of the internal market, the new leadership of the British Medical Association has significantly hardened its opposition to current health service policy.

Dr Sandy Macara, a public health doctor and chair of the BMA’s ruling council, described the internal market as an ‘uncontrolled monster’ in a speech in April, and said that after three years of the new system there was no evidence of any benefits to patients.

He accused ministers of a ‘denial of the undeniable fact of twin-tracking’ and called for a reinstatement of equity as a core principle of the health service.

His call came only days after news that a 27-year old junior doctor had collapsed and died after working an 86 hour week at the Warrington Hospital Trust in Cheshire. Three years after the ‘new deal’ on junior doctors’ hours was negotiated, thousands are still working more than the recommended 72 hour week.

Meanwhile, official figures revealed in a parliamentary answer by health minister Dr Brian Mawhinney showed that GPs were spending 40 per cent more time on paperwork than before the NHS reforms.

Dr Mawhinney said that surveys had shown that GPs spent 1.78 hours on administration in 1985/86, 2.48 hours in 1989/90 and 3.53 hours in 1993/94.

Labour was quick to point out that the increase had come despite a 34 per cent increase in the number of practice managers from 1990 to 1992.

‘Increasing paperwork for doctors means they are seeing fewer patients or seeing patients for less time’, said Labour’s shadow health minister Dawn Primarolo. ‘Neither result can be anything but a damning indictment of Virginia Bottomley’s stewardship of the NHS.’

The financial soundness of NHS trusts has also moved up the political agenda in the wake of a report from business advisers Newchurch and Company. The fourth Newchurch guide to NHS trusts examined the ability of first and second wave trusts to meet their financial targets in 1992/93, and found that half had failed to meet one or more targets.

Kingsley Manning, managing director of Newchurch, said: ‘Ten per cent of trusts may be unviable financially in their ability to support assets and costs. ’

‘In one sense the changes have been a success in getting virtually all hospitals to be trusts. But there is no evidence at the moment they are delivering higher quality or lower cost care. ’