Survey: Red Tape Frustrates Doctors

There is "strong dissatisfaction'' among senior doctors about the impact of managers and red tape on clinical decisions in the NHS, new research has found.

Consultants believe the health service is one of the most effective in the world but also feel it is "creaking under the strain'' of ever-rising demand.

Research by Dundee and Glasgow universities found that consultants believe that when decisions are made in the NHS the "balance has tipped too far'' towards managers and politicians.

Doctors feel that they are not listened to and are not sufficiently involved in decision-making, and they fear this could damage patient care.

The "stringent application'' of waiting-time targets was frequently cited as resulting in consultants having less discretion over who should be treated and when.

The research, which was carried out for the British Medical Association's Scottish Consultants Committee, examined the changing experience of work among consultants in NHS Scotland.

Committee chair Dr Nikki Thompson said the report revealed the "hopelessness'' consultants feel if they are unable to speak out on behalf of patients and an "over-riding sense of frustration'' about the importance political or financial priorities have in the decision-making process.

A total of 68 consultants from different areas and specialities took part in in-depth interviews while 1,058 consultants completed an online survey Professor Graeme Martin, of Dundee University, lead author of the report, said: "The consultants we spoke to complained that pressures in the system were causing significant problems for patient care.

"We also found evidence of strong dissatisfaction with the impact of non-clinical managers and bureaucracy in clinical matters.''

The research suggested consultants believe there has been a "significant change'' in what drives the decision-making process and "business-related rationale was seen to dominate decision-making rather than the rationale of medical professionalism, which consultants tended to equate with good patient care''.

The report said: "While the NHS has always had to accommodate potentially conflicting rationales, consultants felt that the balance had 'tipped too far' towards business and financial decisions dominating how work was organised and evaluated, and that such a trend was inconsistent with effective and efficient patient care.''

Doctors find the "increasing power'' of non-clinical managers as an "especially worrying development'', the research stated.

Despite these concerns, it also found the "majority of consultants regarded the NHS in a very positive light and identified strongly with the values of the NHS''.

The report said: "Most of the interviews showed that consultants regarded the NHS as among the most effective systems in the world.

"However, it was also generally felt to be creaking under the strain of having to deal with year-on-year greater 'demand inflation' unmet by proportionate increases in resources.''

Dr Thompson said: "This research shows that while consultants are overwhelmingly committed to the NHS and to our patients, there is a sense of hopelessness over how we can speak out and be heard on their behalf.

"It demonstrates the over-riding sense of frustration amongst consultants at the focus on political or financial priorities in the decision-making process.

"It is so important that the health service respects and responds to medical professional judgement, so that as consultants we are able to steer and develop the services we provide to meet the clinical needs of our patients.''

Prof Martin carried out the research with colleagues Dr Brian Howieson and Dr Stacey Bushfield from Dundee University and Dr Sabina Siebert from Glasgow University.

"Consultants continued to play a vital role in holding together a healthcare system 'caught between a rock and a hard place','' Prof Martin said.

"On the one hand, the NHS is challenged by the demands of an ageing population and ever-increasing expectations among patients and politicians. On the other, it suffers from significant resource constraints.

"As researchers, we could not be other than impressed with the levels of engagement interviewees expressed about their jobs and clinical team colleagues.

"Nevertheless, we also detected a strong note of pessimism - indeed, sometimes fatalism - over how the healthcare system could be improved for the benefit of all stakeholders.''

Prof Martin continued: "Whereas the NHS was once governed by medical professionals, who saw themselves as guardians of patient care, they now feel that the balance has tipped too far towards professional managers and politicians, who govern the service according to business and political logics.

"For example, the stringent application of waiting-time targets was frequently cited as evidence of the inappropriate reduction of consultants' discretion over who should be treated and when.

"Furthermore, as a result of the increasing demands placed on many consultants, their trust in the NHS as an employer has diminished rapidly.

"For this reason, you might expect their levels of engagement with their work also to be low but our data showed the opposite - their commitment to patients and clinical colleagues was remarkably high.''