NHS Efficiency And Quality Threatened By Cuts

The health service will struggle to protect quality and find efficiency savings if cuts to the protected time senior doctors can devote to the improvement of services continue, the BMA says today.

A new British Medical Association publication, Quality Time, highlights the importance of consultants’ Supporting Professional Activities (SPAs) – protected time for work such as the development of new services, research, safety audits and training. It features 21 consultants from across the UK who have used their SPA time to take forward initiatives that have improved the quality of patient care, frequently saving the NHS money. 



All the doctors in Quality Time say their achievements would have been either impossible or less likely without protected time. However, although the model NHS contract for consultants states that their working week should typically include ten hours of SPA time, there have been widespread cuts.

Over a fifth (21%) of consultants surveyed by the BMA earlier this year said the number of SPAs in their job plan had been reduced. More than one in seven (15.1%) said their employer had reduced the standard number of SPAs for all consultants, and almost a quarter (23.8%) said their employer had reduced SPAs for newly appointed consultants.



Consultants featured in the publication include:

• Mr Hamish Brown, who worked on a re-design of breast surgery at Birmingham City Hospital, resulting in average hospital stays dropping from five days to one, and the Trust saving an estimated £300,000 a year
• Dr Catherine Ralph, an anaesthetist who trains staff to deal with obstetric emergencies, reducing the amount the Royal Cornwall Hospital in Truro has to pay to the NHS Litigation Authority
• Dr Steve Mather, co-leader of the Bristol Medical Simulation Centre, which uses the latest simulation techniques to provide high-tech training to junior doctors
• Dr Cait Searl, who introduced the “novalung” device – which aids the survival of patients with severe lung damage – at the Freeman Hospital in Newcastle
• Dr Bill Stephens, whose work on a new model of diabetes care means patients in Manchester can get rapid access to the expertise of a consultant

In the foreword to Quality Time, Dr Mark Porter, Chairman of the BMA’s Consultants Committee, said: “NHS organisations, increasingly squeezed financially and having to achieve more with less, are trying to reduce consultants’ Supporting Professional Activities in a search for ‘efficiency’. At its worst this can lead to pressure to treat patients as units of production rather than as individuals engaged in a difficult journey at a testing time.

“We believe it represents a false economy. When consultants have time to reflect on services and improve them, they frequently save the taxpayer significant sums of money. The NHS has been tasked with saving £20 billion by 2014, but this already Herculean task will become even harder if staff are denied time to stand back and consider ways of working more efficiently.

“Preventing consultants from spending time on anything other than direct clinical care would represent a betrayal of what patients deserve from the NHS. Patients value quality of care very highly, and expect it to be delivered in all NHS organisations.”

(BMcN/GK)