BMA urges rethink on 'internal market'

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Senior doctors yesterday called on the Government to reconsider the "perverse effects of the internal market" which they claimed had exacerbated the crisis in emergency admissions.

Michael Heseltine, the Deputy Prime Minister, faced fierce questioning in the Commons from Labour over the "damning" comments by the British Medical Association and a case in which a 65-year-old man who collapsed at his GP surgery in Bradford was refused admission by 12 hospitals. A bed was eventually found 80 miles away in Scarborough where he died.

Facing protests in the Commons by John Prescott, the Labour deputy leader, Mr Heseltine said: "These are matters of concern and they will remain so until they have been dealt with."

He rejected accusations that the Government was destroying the NHS, but underlined the seriousness with which the Government is dealing with the reports of the crisis,

The Deputy Prime Minister said that the Chief Medical Officer was examining the causes of the problems confronting accident and emergency units, including an upsurge in demand, caused, according to one Tory MP, by asthma attacks and falls during the icy spell.

Gerry Malone, the health minister, last night assured NHS trusts and health authorities they could appoint extra staff for accident and emergency departments if needed.

The BMA said that bed and ward closures by NHS Trust hospitals desperate to balance their budgets had left thousands of people with limited access to emergency care.

Many trusts have run short of money as their contracts with health authorities run out with three months of the financial year left to run.

Dr Sandy Macara, chairman of the BMA, said: "The trouble is there are no central levers for the government to ensure that money goes where it's most needed, because they have set up a system where it's left up to the individual purchasers and providers."

But Mr Malone dismissed claims that Government healthcare reforms were to blame. He told The World at One on Radio 4 yesterday: "... thank goodness we now have a health service that can actually look at these things at a local level ..."

His department was aware of the problems in some areas and was investigating more flexible ways for hospitals to deal with emergency admissions.

One of the mysteries of the modern health service has been the relentless rise in emergency admissions. Several studies have investigated the phenomena but no consensus reached.

There is evidence that some of the increase is what researchers describe as "sensible". There is greater awareness among GPs of the benefits of "clot-busting" drugs immediately after a heart attack, for example, so more such patients are referred to hospital.

Similarly, GPs and parents are alert now to the need for prompt treatment for meningitis so more suspected cases - which may turn out to be something less serious - are being sent to hospital as a precaution.

In fact, a change in GP behaviour and in patient attitude has been cited as a possible cause of the growing pressure on A&E units, and indirectly, on the rise in admissions.

Patients have become more aware of their rights as consumers of healthcare; as a group they are more demanding. If they are not satisfied with the care they receive, they self-refer to accident and emergency.

Doctors are more aware of the threat of litigation and perhaps less confident in their clinical skills as a result. The rise in emergency admissions has also been attributed to demographic changes, with growing numbers of elderly patients.

Liz Hunt