10 March 2006
Patients have failed to benefit from a new contract for consultants which has cost the NHS in Scotland an extra £235m over three years, Audit Scotland has found.
In a highly critical report this week, the watchdog also disclosed that the Scottish Executive Health Department had underestimated the cost of implementing the contract by £171m. It said health boards and the Executive needed to improve their monitoring of its impact.
The report, Implementing the NHS consultant contract in Scotland, follows a study into the first major change to consultants' terms and conditions since 1948. Affecting 3,513 consultants in Scotland, it was part of a UK-wide move to reform pay across the NHS, with separate contracts for GPs and nurses.
It introduced new ways of working and increased the salary scale for consultants from a range of £57,370-£74,658 under the old pay scale to £69,298-£93,768. The increase was backdated to April 2003. As a result of the new contract, the overall consultant bill in Scotland increased by 38%.
Auditor general for Scotland Bob Black said the contract was an opportunity to improve patient care by better planning the work of consultants. 'There is not yet clear evidence to show if this has happened, despite the additional money that has been spent on the new contract over the past three years,' he said.
'It is essential that everywhere in Scotland, health boards and consultants work together to deliver benefits for patients. Also, health boards and the Scottish Executive need to improve the monitoring of the impact of the contract.'
According to the report, the SEHD produced cost estimates before and after the new contract was implemented. The first estimate, in March 2003, based on the UK Department of Health model, put the cumulative additional cost of the new contract at £64m for three years. However, this was an £171m underestimate – the actual figure was £235m.
The report said planning for the contract should have been more robust. The significant underestimating of the cost of the contract had made it difficult for boards to plan it properly. 'This uncertainty has added to the cost pressures NHS boards face,' the report stated.
It claimed the Scottish Executive could have done more to set clear targets for boards, laying out what it wanted from the contract. Health boards also came in for criticism for focusing more on transferring consultants to the new contract than on using it to improve services.
PFmar2006
