The money side of things may get a bit easier (in one respect) in future. In foundation trusts there is a move to budgets being held at department level by a clinician. Unlike at present where this is largely in name, the proposal is that the clinician will have real power to manage that budget and decide what staff mix they want.
The bad news is that the budget is going to be broadly based on PbR income minus an allowance for use of space, use of services (labs, radiology etc.) and a contribution towards general management costs. Work on the basis that you'll have about £55 to £60 per patient seen for spending on staff. It has been made clear that the amount of money being spent on emergency care will not increase significantly over the next few years.
I think that one way or another it is unlikely that there will be any new money coming in so if you want to make the case for consultant expansion you either have to make it by showing it will bring in new money (unlikely: even if you could work out a way to produce them, increases in emergency workload don't attract much money and if you wanted to do elective minor ops lists etc. you'd come up against PCTs not wanting to commission them and other specialties wanting to hang onto them. You might get somewhere though by negotiating taking on tendon repairs etc. in the department: convenient for the patient, cost the PCT less than admission, bring in more money for the hospital than they cost in terms of your time) or by making savings elsewhere. This is likely to come from staffing: non pay items in the budget (radiology etc. usually isn't in the budget) usually come to well under 10%. So basically in many hospitals increases in consultant numbers will only be possible by reducing numbers of juniors.
Matt Dunn
Warwick
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