Leading Article: Hospitals need better treatment

VIRGINIA BOTTOMLEY won deserved praise as the junior doctors' friend. The Secretary of State for Health made it her mission to banish the practice of overworked, exhausted trainees tending the seriously ill. Britain was to have more consultants and shorter hours for juniors. As specialists took the burden from harried juniors, patients would enjoy improved care.

That pledge, made in the 1991 'New Deal', is now threatened by hospitals scrimping on salaries and consultants apparently anxious to protect private practice from newcomers. Unless Mrs Bottomley reinvigorates the agreement, she will be blamed for low morale among juniors and second-rate treatment.

Today Brian Mawhinney, Minister of State for Health, must keep Mrs Bottomley's commitments. He is to meet leaders of the medical profession and the National Health Service's top management. The agenda focuses essentially on how to break past pledges: delaying the promised 72-hour maximum working week; appointing more sub- consultant, partly trained and cheaper 'staff-grade doctors' instead of extra consultants.

It is understandable that undertakings made when the NHS was flush with pre-election largesse seem unfulfillable in more straitened times. But the 1991 New Deal is the only way to achieve all three of the Government's laudable aims: a specialist-centred hospital service, reduced pressure on junior doctors, and a professional structure that gives all of them a chance of becoming consultants.

The alternatives are variously flawed. Keeping junior doctors slaving away for 83 hours a week is unthinkable at a time when medical malpractice lawsuits are increasing. Expanding sub-consultant staff grades merely forces mid-

career doctors down a dead end and prevents them being trained to the peak of expertise. Failure to create enough consultant posts frustrates the lower ranks and destroys the dream of specialist-run hospitals. The result is a poorer deal for patients and the possible loss of lives that might have been saved by a more professional structure.

Mrs Bottomley grasped the full nature of this dilemma with her courageous commitment in 1991. Since then she has been firm in not allowing her plans to be frustrated by opposition from many quarters. Just as the NHS reforms have recognised the need for professional management, so the Health Secretary has acknowledged that hospital medical hierarchies need a shake- up. The days of an elite of all-powerful consultants devoutly followed by a retinue of juniors were supposed to be consigned to the past.

Mrs Bottomley and Mr Mawhinney must now ensure that money is available to appoint sufficient consultants. They should put their full weight behind the original New Deal, which promised so much but has delivered so little.