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Some hospitals have five times more doctors per patient than others

Hospital chiefs have defended management of doctors following criticism by the Audit Commission.

An Audit Commission report, Medical Staffing, has found that too few consultants have job plans, many trusts have still not reduced junior doctors’ hours sufficiently and the medical workforce in some hospitals is five times bigger than others.

The report, out last month, is the latest in a series of reviews on medical staffing by the commission since 1994. Although it found some progress there were still ‘significant problems’.

The review, carried out in 88 per cent of trusts last year, reveals that numbers of doctors employed varies fivefold from 2.6 for every 1,000 admissions in some hospitals to 14.1 in others. London teaching hospitals are the most generously staffed with around twice as many doctors for patients admitted as a typical district general hospital. While the commission admits there is insufficient evidence to know whether this is justified, even within similar general hospitals staffing varies twofold for no apparent reason.

Consultants’ posts, which the government has pledged to increase by 30 per cent by 2004, have only risen by 2 per cent, the review shows.

Meanwhile, non-consultant career grade posts have expanded fourfold since 1991. Yet although these doctors now provide large amounts of care and take on significant responsibility, the jobs are regarded as career dead ends. The report calls on the Department of Health and medical profession to accept that doctors now need to take such jobs before becoming consultants.

The report found that only 14 per cent of trusts have job plans for all their consultants, despite the fact these have been required for 10 years and mandatory since April 2001. A total 8 per cent of trusts did not even know whether their consultants had job plans.

Progress in reducing junior doctors’ hours has been slow, the review found. Many trusts have still not brought hours down to the 56 weekly maximum including adequate rest breaks, it says. Only 2 per cent have fulfilled all the New Deal requirements.

But Alastair Henderson, policy manager of the NHS Confederation, defended progress on reducing hours. ‘Clearly there are areas where the figures are not as high as they should be,’ he said. ‘But it is not because people don’t want to resolve this issue. It is because there is not a simple, straightforward solution.’