Last year, I worked as a locum A+E junior doctor. I saw the fragmentation of the internal market and Health & Social Care Act first hand and soon realised who benefits from the coalition’s privatised healthcare designs – the privileged, not patients.
The overall spend on locum doctors is at an all-time high. It is particularly high in A&E departments and worsening. Spend on agency staff to fill medical rotas across hospitals has risen ‘exponentially’, Department of Health officials have told MPs on the influential Public Accounts Committee (PAC). The PAC’s new report released today reveals last year alone, agency spend jumped from £2.1billion to £2.6 billion.
It costs the public purse an average of £400,000 to train an emergency consultant, according to Margaret Hodge, Chair of the PAC.
Yet every year a hundred A&E consultants are now leaving the NHS to work abroad. Those that remain increasingly work for locum agencies - which profit by charging the NHS an extra 30% for my work.
I became an A&E locum because I needed flexibility. I faced two choices: locum ad-hoc through specific NHS trusts or via an external agency. I chose both routes.
In my case, this publicly funded agency fee went ultimately to the private equity firm the Blackstone Group, whose chairman is so concerned with our nation’s health that he’s also on the board of British American Tobacco.
The scale of the profit is highlighted in the offer of a referral bonus of 50p per hour of every hour another doctor works if I get them to work through them. Thus the NHS subsidises an ever increasing amount of stakeholders who profit from privatisation.
The one chance for a centralised NHS locum agency, “NHS professionals”, is itself now being privatised.
You can see the temptation for the private interests circling. Hospital human resources departments have already been cut to a skeleton staff, firefighting the needs of departments who do not have enough medical staff employed to start with, let alone spare capacity for sickness or study leave. NHS human resources administration is essentially being outsourced to these agencies. We’re told its efficiency, but in truth these same tasks are repeated, sometimes in triplicate, merely adding another layer of corporate bureaucracy for all involved.
And its quality and investment in staff that suffers. I worked in ten departments in total over the year, each one taking a large amount of time to get to know properly. In A+E, time matters. This short-term approach inevitably leads to less commitment towards development and training.
It’s the same story with NHS Trust Chief Executives, who spend an average of just two and a half years in post. The same pool of applicants rotating around from one trust to another regardless of performance. So much for stable leadership or a stable workforce - though this merry-go-round is great for the head-hunting agencies.
Today’s headlines scream with outrage at the idea that locum’s are paid £110/hour. Look beneath the surface though and these rates are traded for rights; maternity, sick, holiday, training and pension pay all gone. If the unexpected happens it is the state that picks up the bill, not the agency.
Yet it only gets worse for the British tax-payer. Through an agency I became the encouraged norm, my own Limited Company. Just another NHS subcontractor. I also had a zero hour contract with the NHS, yet had no fear of not being able to pay my heating, feeding my family or finding work.
Tax receipts are reduced via Ltd Company status, enabling higher rate tax payers to “efficiently” pay a larger proportion of their earnings via a lower corporation tax rate. Legal, encouraged and celebrated, I have calculated this loss of tax revenue for my earnings alone in one part-time year to be at least £600.
But then, private health firms attempting to reduce their tax payments is not new, and if they’re doing it why don’t others join the race to the bottom?
The College of Emergency Medicine have launched a campaign entitled “STEP” to address the “challenges” the specialty faces. The “S” stands for staff. The percentage of locums working in A+Es is rising. The decline in our doctors going abroad or leaving the specialty has been well documented ; causes are multi-factoral but if staffing conditions were improved, so would retention. This might go to the root of the problem, but it is not radical.
Other countries have tackled the staffing problem by investing in them. In Australia more doctors are employed than actually needed for the hospital, they “float” and fill rota gaps. In contrast, the UK has one of the lowest doctor per population ratios.
It is not the need for a flexible workforce that is a problem, locums have a role. It is the flow of cash that has been designed to leave our NHS and into the hands of shareholders, to put profit before patients and competition before quality.
This, in turn, is increasing health inequities and fuels the very real crisis A+E is facing.
I refuse to be a part of the race to the bottom. It’s time to reinstate the NHS.
Dr Paul Teed is a junior A+E doctor. As part of this article, he has donated £600 (the amount of tax “efficiently” saved) to OurNHS, Keep Our NHS Public and Dorothy House Hospice.