Surgeons 'treating fewer patients'

Figures from the Health Services Management Centre at the University of Birmingham show that in some specialities medical productivity has dropped by 20%.

Doctors said the drop was linked to a nationwide shortage of hospital beds which prevents many surgeons from admitting patients for operations.

Productivity
Orthopaedics: down 22%
ENT: down 20%
General Surgery: down 19%
Urology: down 10%
Plastic Surgery: down 8%
Ophthalmology: up 5%

The figures come at a time when ministers are trying to get hospitals to carry out more operations and to cut waiting times for patients and despite record government spending on the health service.

They also raise questions about plans to introduce maximum waiting times of just six months for an NHS operation in England by 2005.

According to the HSMC data, the number of patients treated by a single consultant who works whole time in the NHS fell by an average of 10% in the past six years.

Sharp falls

In 1994, orthopaedic surgeons treated on average 908 patients each per year. Last year, that figure fell to just 711.

Similarly, in general surgery operations were carried out on 1,413 patients in 1994 but fell to 1,144 patients by 2001.

Only ophthalmology appears to have boosted productivity - up 5% over the same period.

Doctors say they spend more time supervising junior doctors than they did before but also that operations have become more complex. There is also more paperwork and meetings.

Mike Harley, of the HSMC who carried out the study, said the fall in productivity was significant.

"They have lost the equivalent of about a day a week in operating terms and outpatient clinic terms as well."

But Dr Peter Hawker of the British Medical Association said the fall was caused by a shortage of hospital beds.

He said: "At the moment, we have 10 surgical patients on our surgical ward. There are 10 beds on the surgical ward my surgical colleagues cannot use to get patients in to operate on."

Health economist professor Alan Maynard of York suggested the money being allocated by the government was not being spent on patient care.

He said: "They are getting money. They are spending it on cleaning and painting and on junior doctors' hours. They are not really spending it on the core of the business what is the consultant doing and is the quality good."

Government response

Health Secretary Alan Milburn said the total number of operations was increasing, waiting times were falling and quality was improving, as illustrated by a fall in death rates following surgery of 5% last year.

He said: "It would be wrong to give the impression that consultants are not working hard for the NHS. Overwhelmingly they are.

"But there is an issue about the amount of direct clinical time with patients that NHS consultants have."

Mr Milburn said it was up to ministers to relieve some of the burdens on consultants, for instance by providing better administrative and IT support.

This would help create a better balance between the quantity of patients that are being seen, and the quality of care being given.