Managers in NHS seek costs inquiry: Independent review needed to 'identify positive benefits that buying and selling of services has brought to patients'

An independent inquiry into whether the benefits of the NHS internal market have been worth the extra costs was called for yesterday by a leading NHS manager.

The call came as Virginia Bottomley, Secretary of State for Health, admitted that the public has yet to be convinced that management costs are under control.

Peter Stansbie, the newly elected president of the Institute of Health Services Management, told its conference in Bournemouth that 'we must measure the success . . . of the changes we have created and implemented'.

Management costs had risen as a result of the buying and selling of services within the NHS, he said, and 'we need to have some positive facts which prove the benefits, especially from the patients' point of view'.

Increasingly, doctors were having to prove treatments were cost- effective, he said. 'Nothing else is acceptable in clinical affairs, and nothing else can be acceptable in organisational change of this scale.' Proving the changes had been worthwhile was 'a challenge to politicians and managers'.

Mr Stansbie's call for an inquiry came as Mrs Bottomley admitted that the public has yet to be convinced that management costs are under control. She told the conference that management costs of an NHS trust varied more than twofold from under 4 per cent of the pay bill to more than 8.5 per cent, while in health authorities the variation was fourfold.

'On the face of it, these variables seem unacceptably wide,' she said, announcing that trusts and authorities will be required to publish their management costs in future. 'The public has a strong and legitimate interest in the size of management costs. It is right that accurate and meaningful figures should be published.'

Mr Stansbie's call for an evaluation of the NHS reforms was supported by the British Medical Association. Dr Sandy Macara, its chairman of council, said: 'This is exactly what the BMA has been saying was necessary before the reforms were implemented. Perhaps now that managers themselves are saying that costs and benefits should be evaluated, government will finally listen.'

Mrs Bottomley, however, rejected the idea of a 'comprehensive top-to-tale' evaluation, insisting that the reforms had performed well. She wanted management costs to be justified, but that could be done by comparisons between organisations.

A government-appointed hospital trust chairman faced with losing staff to save money warned yesterday that continued cuts would make it impossible to maintain standards. Professor Maurice Lessof, of the Lewisham Hospital Trust, south-east London, said 'quality and quantity of service' at the hospital were under threat.

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