By the way... Give doctors control of the money

WHEN I was a junior doctor at Westminster Hospital in 1973, my team got involved in a Government research project to distribute funding more fairly, after concerns that some areas were getting a bigger slice of the cake than others.

One task was to examine whether doctors were effectively signing blank cheques as they admitted patients to hospital, ordered investigations and prescribed medicines in order to do the best for patients without consideration of costs.

A gang of clerks was assigned to our team to work out the cost of every single activity we carried out, from the consultant down to me, the most junior team member.

Every aspirin, every needle used, every dressing pack opened, even the swabs to clean the skin after an injection were given a financial value. Every Friday the entire group would meet for a presentation, where the details of our spending were revealed and we could make suggestions about how to make economies.

The bonus was that any money saved as a result was ours to reallocate for patient benefit as we chose.

For example, we decided one week not to send a routine urine test to the lab every time a patient was admitted, but instead a simple dipstick test was done on the ward by the nurse. The sample would be sent on to the lab only if any abnormalities were picked up then and there.

That week we saved £140 and the team opted to use the surplus funds to buy a TV for the male ward.

This project showed that not only was it worthwhile to make clinicians aware of what their activities were costing the NHS, but also that we could curtail some costs of our own volition within the limits imposed by the need to provide excellent care.

Nearly 50 years on, and all the professionals in the NHS are convinced that funding is inadequate to cope with the perfect storm of an increasing and ageing population, the advances of technology and the lack of trained staff.

Part of the problem is that few doctors and nurses now have any control over expenditure. Vastly expensive outside consultants do that job, despite many NHS managers having salaries far greater than that paid to the Prime Minister.

But do they do better than it was in the old days? I wonder.