The NHS is employing far more hospital doctors than it should be, the health secretary for England, Patricia Hewitt, has told the parliamentary select committee on health.
Staffing levels were above what had been proposed in the NHS workforce plans, she said at a hearing this week on deficits in the NHS.
The Department of Health had estimated that the number of hospital doctors employed by 2007 in England should be 74 590.
“Already the NHS has employed more hospital doctors than it was intended to by 2007,” she said.
“In fact, by 2004 the NHS employed 78 000 hospital doctors, and by 2005 [the number] had risen to 82 000.”
The NHS had spent more of its money for growth on extra staffing than had been planned and had taken on “significantly more” hospital doctors and nurses and “somewhat more” GPs than had been intended. This was happening even in trusts that were heading for deficit, she said.
“That's why [trusts] are having to make very difficult decisions in some cases to get to a position where they employ the right number of staff that they can afford. That's clearly a reason why some organisations are in real financial problems.”
Ms Hewitt said some NHS trusts were failing to adopt new approaches to delivering care—such as using day surgery—that would enable them to treat more patients with fewer doctors than traditionally needed for overnight stays.
Also, changes in medicine meant that some clinics would not need as many doctors as before, she said.
She referred to the deficit at the Royal Cornwall Hospital, which despite its financial crisis took on an extra 250 staff last year. She said, “They could not afford them, and now they are in a position of having to consider redundancies.” The amount of day case surgery there was below the average for England, although using it would enable the hospital to give better care with fewer staff, she said.
The Labour MP Sandra Gidley said it seemed that NHS staff were being hit because the focus of reform had moved away from reducing waiting lists and was now on finance.
And members of the Health Select Committee found it hard to understand how the situation could have got so out of control. Ms Hewitt said the health department did not run the NHS “Soviet style,” with central control. “The recruitment is down to individual hospital trusts and PCTs [primary care trusts]. It [the deficit] comes down to trusts not having a good understanding of their own financial situation,” she said.
Ms Hewitt accepted that some difficult decisions would have to be made with regard to training of all staff in the NHS, including nurses and non-medical staff. Although the number of training posts for qualifying doctors would not suddenly be cut halfway through their training, post-qualifying training would be cut.
“Certainly there are doctors who had hoped to go on a short term specialist course, and that is not happening this year,” she said.
She also accepted that newly qualified healthcare staff were the most vulnerable when posts were being cut. “Where you have an organisation making compulsory redundancies, clearly they are not in a position to take on newly qualified staff.”
She said that the 2005-6 budget for consultants was overspent by £90m (€130m; $170m) and that the Agenda for Change programme to modernise the NHS pay system cost £180m more than expected, although the GP overspend was “something rather less.”
“But these are a very small proportion of a large pay bill,” the minister said.
She said savings in the NHS's drug bill would balance some of these costs and that from these savings an additional £150m would go into primary care trusts' budgets this year.
She defended the cost of units built under the private finance initiative and refuted the suggestion from the Labour MP Howard Stoate that they were likely to result in high deficits.
Had they been built with public funds, the projects would have run over time and would inevitably have cost more, she argued. And they offered flexibility in meeting changes in clinical practice in coming years, she said, by ensuring that hospitals weren't locked into provision that became outdated.