A new contract for consultants has cost the NHS in Scotland an extra £235m in its first three years but clear evidence of its benefits has yet to emerge.
An Audit Scotland report published today, Implementing the NHS consultant contract in Scotland, says the new contract offers an opportunity to improve patient care by planning consultants’ work better, but it is not yet being used to its full potential.
The Scottish Executive, health boards and consultants need to work together so that the contract achieves benefits for patients. The Executive can also learn lessons from the implementation of this contract for the management of other large scale projects.
The contract was implemented across the UK in April 2004, and pay was backdated to April 2003. It allows health boards to plan consultants’ work around the needs of patients and the health service. It is also intended to limit consultants’ working hours, improve recruitment and retention and increase pay for most consultants.
Robert Black, the Auditor General for Scotland, said: “The contract is 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 last three years.”
He added:” 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.”
The Scottish Executive significantly underestimated the cost of the contract, making it difficult for boards to plan for it properly. This uncertainty has added to the cost pressures NHS boards face.
The new contract has increased the overall consultant pay bill for the NHS in Scotland by 38 per cent over the first three years. Audit Scotland concludes that it is difficult to identify whether this extra spending has so far improved patient care. This is partly because much of the first two years has been taken up with implementing the contract.
Boards have focused more on transferring consultants to the new contract than on using it to improve services.
There is little evidence so far of boards planning how to use the new contract to improve patient care.
The report says the Scottish Executive could have done more to set clear targets for boards, laying out what it wanted from the contract. The Executive is still in the process of creating a system to monitor whether boards are achieving the contract’s expected benefits.