GERMAN PUBLIC HEALTH SYSTEM FALLING APART

If Germany sacked just 1% of its bureaucrats, it could afford to pay its doctors a heap more

Thousands of German doctors threatened yesterday to desert Europe’s most modern health system and work in Britain, rather than put up with declining wages and longer hours. The doctors, many wearing operating masks, marched through the centre of Berlin to besiege the Health Ministry in the first big demonstration against Angela Merkel’s coalition Government. Hospitals worked at half strength and about 50,000 doctors’ surgeries across the country were closed.

“It’s no longer bearable,” Andreas Dahmen, a 31-year-old orthopaedic surgeon, said. “I earn €2,800 [£1,920] a month here after taxes. I’m moving to England where I can earn double that amount for much less work.” In Britain, he said, he could expect to earn £3,000 a month after tax, with the promise of bonuses bringing his earnings to £4,500. The hip specialist was speaking in a sea of placards held aloft by his colleagues, announcing: “England, we’re on our way!” and “If you want to see a German doctor, come to England!”. A third of all German doctors now earn less than €2,000 (£1,373) a month after tax. Junior doctors are using cheap airlines to fly to Britain on a Thursday night, working as a locum for the weekend, and returning on Monday morning. They earn up to £2,000 — the equivalent of a month’s salary. “Recruitment agencies are already trawling our country, hunting for up to 10,000 doctors,” Jürgen-Dietrich Hoppe, the chairman of the German Doctors Association, said. “And I’m sure they’ll get them — English working conditions are so much better.”

Under NHS’s Out of Hours scheme, health trusts can fly in foreign doctors to relieve British GPs who do not want to work in the evenings and at weekends. There is also a desperate shortage in Britain of doctors in areas such as radiology and diagnostics.

The German doctors stopped work yesterday because of government reforms that seek to restrain them from prescribing expensive medicines, cap the individual budgets of surgeries and force hospital administrators to make widespread use of unpaid overtime. Medical staff worked more than €2 billion worth of unpaid overtime in German hospitals last year, and further reforms planned by the Government will put even more strain on them. Another measure would financially penalise doctors who administer costly drugs.

There are 4,127 German doctors registered in Britain, which has become their European destination of choice, ahead of Switzerland and Scandinavia. Some spend their summer holidays in Britain working as locums, others do so for about a year. Far more are weekend commuters and are drawn from across the medical spectrum. “We’re thinking of setting up a mobile anaesthetic unit,” Christof Kouidis, a demonstrator, said. “Working in Britain for a week could cover our practice costs in Germany for the rest of the month.”

The influx of British patients to Germany trying to avoid NHS queues for hip replacements has encouraged German doctors to cross the Channel. Stefan Krukenberg, from Hanover, is planning to replace hip joints in Britain on a freelance basis. “I get €65 for preparing an artificial hip joint — that’s for at least two hours work. Now I’m seriously considering going to Britain on a Friday, preparing three or four hip replacements a day over the weekend and effectively doubling my monthly income.” The only way he would be able to break even under the new tight German costing rules is by preparing 1,000 hip prostheses a month. “And that’s impossible. What we’re doing at the moment amounts in financial terms to a mere hobby. We have to earn the money to live somewhere else.”

The paradox of the German medical crisis is that doctors are now abandoning rural and eastern areas to work abroad, leaving many active but underfunded surgeries in decline. The German Doctors Association estimates that 32,000 surgeries are on the brink of bankruptcy. “We are soon going to have a real shortage of doctors,” Uwe Gremmler, a cardiologist from Peine, said. “Older doctors are taking earlier retirement because it has become impossible to make a living. The younger doctors are moving to Britain and, at the same time, as Germans live longer, there are more and more patients to be treated. The Government should act now before we all disappear to England.”

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THE BRITISH ARE CUTTING PUBLIC HOSPITAL SEVICES TOO

The spiralling cash crisis in the NHS has already forced two thirds of hospitals to close wards and will soon start directly affecting patient care, health chiefs give warning today. A survey of 117 chief executives of NHS trusts reveals the depth of concern among healthcare professionals about the destabilising impact of wide-ranging government reforms. Three quarters of them say that growing financial pressures brought on by primary and acute care restructuring will affect patient treatment. Almost half of hospital trust managers said that building and refurbishment projects were being delayed, while many trusts were also having to make staff redundant and to introduce recruitment freezes.

The Times understands that the Prime Minister is to order a shake-up of ministers and top civil servants, such is the concern in Downing Street about perceived NHS disarray. It follows six years of unprecedented rises in NHS funding. Mr Blair wants a new junior minister to fend off criticism of the Government’s faltering reform programme and to sell NHS modernisation both to the public and Labour MPs. The health service is braced for even starker financial shortfalls from 2008, when the current round of annual funding increases will stop. The poll of trust executives, conducted by Health Service Journal, comes as nursing leaders also give a bleak warning of massive NHS deficits. Their research suggests that health service debts in England will hit £1.2 billion this year, putting up to 4,000 jobs at risk.

The new minister, who will be charged with promoting the reform agenda in the media, is expected to be imposed on the Department of Health in a reshuffle due within days. The jobs of Jane Kennedy, the Minister for quality and patient safety, and Rosie Winterton, the Minister for health services, are both at risk. The Times understands that a number of senior bureaucrats will also be moved in an attempt to speed up the pace of delivery. It is hoped that the MP will be a more effective deputy to Patricia Hewitt, the Health Secretary, who has struggled to explain the benefits of reforms and had to revise plans to reform primary care trusts.

The uncertainty surrounding unforeseen knock-on effects of the Government’s reforms emerged when ministers decided to review the £1.2 billion redevelopment of Barts and the Royal London hospitals. The last-minute decision, taken after more than six years of project planning, prompted 1,000 doctors to write to The Times earlier this week. They gave warning of the serious impact on cancer and cardiac services for London if the project was downscaled.

Evidence of serious financial problems is supported by 75 per cent of hospital chief executives who said that patient care would be affected by cash shortfalls. The warning comes despite assurances from Ms Hewitt that any cuts should only affect administration. The Royal College of Nursing (RCN), which has been tracking the level of deficits and the impact on staff and services during 2005, confirmed that patient services and treatments were now being disrupted. It found that cost-cutting measures — including freezing job vacancies and use of agency staff — were now having a “direct and detrimental” effect on patients, with operations cancelled, appointments postponed and beds closed. According to documents obtained under the Freedom of Information Act, a total of 81 NHS trusts in financial difficulties have been investigated by KPMG, the acountant. This is far more than the Department of Health acknowledged when it announced the “turnaround teams” of accountants before Christmas. It said that 50 trusts with financial problems would be visited.

The disclosure, and the full list of trusts visited, was obtained by Accountancy Age. They include 20 out of the total of 28 strategic health authorities, 29 primary care trusts, and 33 hospital trusts. A Department of Health spokeswoman last night defended the NHS reform programme. She said that the RCN’s predictions were “back of-an-envelope calculations”, adding that the “turnaround teams” would help to address financial problems centred on a small number of trusts

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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