at be free to engage in other work as they see free DESTROY The BMJ Claims acceptance of the new proposals would ultimately destroy the independence of doctors in the profession"
What the consultants are really arguing about is not just the number of hours worked or even the cash serie offered. The British Medical Association admits, "that the offer made hy Mrs, Castle is so tempting that 80 per cent of the consultants will find it irresistible".
The consultants are casting envious eyes in the direction of the American medical system, where their counterparts are paid a separate fee for each operation or SUCHECTE MYSE David Owen, Mrs, Castle's deputy. actually agreed to their demands on this matter, and suggested that they should run a pilot scheme on item of service payments. Even the conciliatory Mrs. Castle could not stomach this outrageous proposition and lossed it out.
Judging by the consultants' fury one would imagine that the new proposals involved a direct threat to their privileges. In fact, none of the present consultants have to sit the new contracts, but will be allowed to operate on their old contracts until they retire.
TERMS
The terms being offered by the Labour Government are simply meant for people now being made consultants. Instead of being fulltime in the NHS and working 1T estions a week of 36 hours each, the full-time consultants will now have a contract for 10 four-hour sessions and not he allowed to do any private work.
The part-time consultants will Pd to da private work, but lots a week at four bout cach Previously they had the option of working anywhere beeween thret and nine sessions of 3% hours each.
The oripinal terms were negotiated hy the consultants when the NHS was formed in 1948. At first the consultants refused to join the NHS. It was only when Bevan, then Labour Minister for Health, cared into their demands that they be allowed to carry on with their privale practice, that they graciously agreed to join, LINE POCKETS Since then the consultants have used their position outside the NHS to line theit pockets, There have been many cases of the hardworking' consultants doing three operaLions at the same time. This prodigious effort was made possible by the fact that all three operations were performed by junior doctors working under the consuitant's jurisdiction.
Often the consultants will make sure that waiting hists are kept long so that they can offer their worried patients the chance of queuc-jumping by becoming private patients, For this "humane' service they naturally charge a fee.
A nurse telis how at an outpatients clinic in leeds the consultant would see a private patient and use NHS equipment to examine the patient. Of course the private patient got longer time-after all be or she was payins for it-whilst the NHS patients waited hours.
ON NHS TIME Another nurse, from Lancashire, reports how the consultant radiologist would tell the nurses not to book any appointments for a particular afternoon. This enabled him to get one of his private patients X-rayed using not only the time of the NHS patients, but also the time of both the radiographer and technician. This exercise would cost the NHS £40, but the money went into the consultant's pocket.
Red Weekly 9 January 1975 RITAINS HOSPITAL CONSULTANTS are incensed at the new propowis put forward by Mrs. Cistle regarding their terms of employment. The comultants" anger has been aroused because they see the new coals at interfering with their right to sell their services to the highest r. The 4 January issue of the Brinish Medical Journal complains, 'that ide the time consultants have contracted to work for the NIS they This same consultant always took a great interest in the state uf the X-ray machine, and had a rather arbitrary habit of condemning what appeated to be good equipment as scrap. Being "public spirited and not wanting the hospital to lose all its money, he would then kindly buy it back at a wreatly reduced price. installing it us his private clinic. He would then use the student radiographers to work in his clinic during their normal NHS working hours.
Inside the hospitals the consultants have been running a pood tacket around the merit award system. Hodies set up by the Royal Colleges, the Joint Consultants" Committee, the Government, and the BMA have been dishing out E10.3 million a year in merit money for what is described as outstanding work and contributions.
SECRECY
These unchected hollies, meeting in secrecy, decide in a compictely arbitrary manner who is to get the "merit moncy. When the consultants decile which consultant deserves extra money, the lucky recipient has his or her name kept secret.
Mr Castle proposed the end af the merit award system and its replacement by incroments payable Tor experience and service, At firs the Goverament Insisted that only full-time consultants doing the ten four bour shifts would be eligible for these increments.
However following protests from the consultants the Government backed down and agreed they can also be paid to part-time consultants but that they must be deducted from their private practice earnings The Government had also originally proposed that overtime would only be offered to the full-time consultants, but again have backed down and agreed that part-lime consultants will also be offered The Government has also retreated on its first insistence that the fulltime consultants could not revert to part-time status. They are now prepared to let consultants, after a number of years as full-time workers in the NHS, re-negotiate their contracks This Treans that having made their name", and boosted their possible caring power, they can leave fulltine NHS work and cash in on their status. insistence that an extra jump-sum payment above the normal fee paid for doing a session will only apply to the full-time consultants. She has abo insisted that the new ten session per week consuitanis will not he allowed to do any private practice.
PAY-BEDS
In order to reassure the consulthat it will take five years to phaseout private heds hegun on 1 January. From that date those hospitals with more than six private beds, providing that they have an occupancy rate of less than 60 per cent, must turn over 20 percent of their beds to the NIS there is a high concentration of pay beds and lots of wealthy patients, the occupancy rate is well over 60 percent. This means that in the big centres no pay-beds will be phased out. The unly beds to go will he those that are hardly ever used.
period the Government has played right into the hands of the consultants, ALARMING GROWTH As the NHS declines and its Services grow worse, there is an alarming growth of private practice Mrs. Castle is still sticking to bei tants, the Goverument has announced For three years. out pay-beds. The first moves to phase In big centres like London, where pital.
By grunting a five year phase-out and North London, outside the NHS. Now there are 35,000 beds in indepenient hospitals and hundreds of nursing homes.
But only 5,000 of these beds can deal with noute surgical cases.
However plans are underway for a rapid expansion of the building hospitals. American Medical International, who run the Harley Street Cuntie, a to build 20 private hospitals in the bext two AMI estimate that this project will cost E60 million, and say that it will be financed by money from British institutions and the pension funds of the big unions. AMI claim that their Harley Street Chnic now does more heart surgery than the Consultants" support for claims of junior doctors-seen here lobbying MPs-is cynical and manipulative BUPA also have plans for building private bospitals, and are inviting 60 hospilals to form an independene hospital group. The Florence Nightincale Hospital in London has now become the Nightingale BUPA hos INSURANCE Al present BUPA runs 24 hospitals with 750 beds. Allied Investments which is a subsidiary of the Allied Medical Group, have doctors. launched a private insurance scheme offering patients up to £10,000 a year cover in private hospitals.
Allied Investments have found a site in South London for a 120 bed hospital, and they are seeking planning permission for building other hospitals in Leeds, Manchester Many companies are moving into the lucrative field of private medicine. and BUPA say that they will need another 2,000 beds if private practice is phased out of the NHS.
With the growth of private prac tice outside the NHS and the appalIng decline inside the healch service. the danger is that the NHS will become like the old poor house. The waiting lists will grow longer, patient care will deteriorate even more, equipment will grow rainshackle and nutdated, and the staff will leave for the better-paid haven of the provare heath chinics and hospitals.
FREE ENTERPRISE
These are the issues that lie behind the row between the Government and the medical hierarchy. The consultants are delermined tu maintain the principle of "free enterprise" and insist on their right to sell to Ene highest bidder. They are quite callous ly prepared to wreak havoc on an already sick and ailing health service. and the interests of the NHS working class patients comes a poor secone to their privulcges.
Their support of the cains of the junior doctors-house-staff and registrars is cynical and manipulative They hope to use the demands of the junior doctors to get mass resignalions from the NHS in order to strengthen their own bargaining position. They conveniently ignore the lact that it is the junior scatt who invariably do the unpaid work for the consultants and ure ofter carrying out a consultant's duties while the consultant is meandering his way around some golf course or discoursing in some bar on the evils of the NHS.
The Labour Government has nol yet replied on the junior doctors claim for a 40-bour week. At present junior doctors work around eighty bours without any overtime pay Such long hours are quite clearly detrimental to their patients" health and also put a terrible strain on the OVERTIME PAY Only by meeting this demand and offering to pay overtime for al hours that they work over 40 hours can the Government begin to break the grip of the consultants. If the threat of the consultants is to he mel, then it is vital that the junior doctors are won over to the idea of delending the NHS and their service: used to break the consultants' work to tule Because the Labour Government is tied to defending the capitalist system, it is powerless in face of the offensive of the consultants. The Government sees only one way out of the crisis, and that is by restoring British capitalism back to health. The social services are swept under the carpel and finance is poured into near-bankrupt enterprises The health workers are expected to put up with poor wages and had condicions, wich leads to their demoralisation, and the working class is offered a health service that -gets worse and worse.
Janet Manure
...until recently effective conciliation and arbitration arrangements have been absent for a number of years. Under the Labour Government a good independent service is being developed and I believe workers should use it as an alternative to the strike weapon...* -Jack