From his base in the North-East, British Medical Association boss Dr Paul Miller is working hard to create a more clinically sensitive environment in an NHS increasingly run by number-crunchers.

Health Correspondent Barry Nelson reports.

IT'S not known whether they ever sat together on the early train to London but for a while the future of 27,000 medical consultants lay largely in the hands of two North-Easterners.

One of them - former Health Secretary Alan Milburn - has since stepped down from government, although he remains MP for Darlington.

The other man - Sunderland psychiatrist Dr Paul Miller who has chaired the British Medical Association's consultants committee for the last nine months - still makes that regular train journey to the capital.

And if the recent negotiations with new Health Secretary Dr John Reid result in consultants accepting a new contract then Dr Miller will have succeeded where others have failed. That contract has now gone out to every consultant and specialist in England and a ballot is expected later this year.

Dr Miller, who unusually boasts business qualifications as well as a medical degree, believes that the new contract will properly reward the hardest working consultants while giving senior doctors more control over clinical priorities - who they treat and when.

The 40-year-old Wearsider is guarded about his assessment of Alan Milburn's long stint as Health Secretary but acknowledges that the politician who grew up in Tow Law, County Durham, has secured a significant increase in funding for the NHS.

However, as a trade unionist representing 27,000 English consultants, it is clear that he believes Mr Milburn's abrupt departure has helped unblock the logjam.

"The negotiations have been very, very hard work, particularly during the first few months when we were locked into disagreement with the previous Health Secretary and there seemed no great will to find a way out of it," he says. "Since John Reid took over at the Department of Health at least there has been the prospect of achieving progress."

If anything, the intensity of negotiations between the BMA and Dr Reid over the new consultants contract has intensified, reflecting the new man's wish to get the consultants on his side.

"Clearly it was important to take the chance to make progress and to take it quickly," says Dr Miller, who believes that the new contract negotiated by his team will be attractive to consultants around the country.

One of the main drawbacks in the outline contract negotiated with Mr Milburn last year, which led to its rejection by BMA members, was the perception that the consultants' working week would be too closely controlled by a manager more interested in meeting Government targets than complex clinical priorities.

"I hope that this time around we have fixed those problems. What we have now got is a clear agreement that the workload will be scheduled by clinical managers, usually by another consultant. In the standard working week there will be much more clinically-based decisions about what needs doing," he says.

Another important concession is a more balanced appeals mechanism for consultants who are unhappy about their work schedule.

Dr Miller, who was born and bred in Sunderland and chose to return to his home city after working in London and Liverpool, seems to be optimistic about the new man in charge of health.

"We have been pressing the Government on the need not to distort clinical priorities and to give credit where credit is due Dr Reid has made noises which suggests he wants to move away form the numbers-based target culture towards something a little more clinically sensitive."

But while Dr Reid gets a qualified thumbs up for his perceived change in attitude, the New Labour fixer put into health by Prime Minister Tony Blair to finish the job started by Alan Milburn will be less pleased at some of Dr Miller's general assessment of the Government's record on health so far.

"The big question is what has happened to all the money Alan Milburn secured for the NHS?," asks Dr Miller. "It is quite clear from inside the NHS that huge amounts have been spent on extra administrative staff. Now administrative staff are absolutely crucial in some areas. I can't do my job without a good medical secretary and the NHS would grind to a halt without them but the Health Service seems to be filling up with administrative staff who don't seem to have any other contribution to make to clinical activities."

This is "inevitable" in an NHS which is dominated by a Government focus on targets, measuring and number-crunching, he claims. "It takes an awful lot of administrative input to generate all those numbers but it doesn't touch the clinical service at all," he says.

To be very blunt, Dr Miller thinks that a lot of this extra money has been "wasted" on non-productive administrative staff.

But Dr Reid can take some comfort from the Sunderland consultant's view that the Government's drive to increase the number of consultants working in the NHS has been partly successful, although not as successful as the Health Department would have wished.

"The record is pretty good by historical standards," says Dr Miller.

The trouble, though, is that the workload faced by NHS consultants has been increasing for years.

"Independent surveys have shown that despite an increase in the number of consultants this has not cut down the workload at all because of the increasing demands on the NHS," he adds. "My colleagues see a lot more resources going in but they are not feeling the benefit because half has been squandered and the rest goes on keeping pace with the increased demand."

The Cherry Knowle hospital consultant, who is married to fellow BMA activist Dr Fiona Kew of North Tees Hospital in Stockton, believes he speaks for many of his colleagues when he says that the NHS has become too tightly controlled and too politicised.

"One of the early things this Government did when it came to office was to free the Bank of England from political control. I think many doctors and NHS staff would like to see the NHS freed from being a political football all of the time," he says.

He believes that all governments have tended to make health "a rod for their own backs" and argues it would be better for everyone, including patients, doctors and politicians, if they "took a little bit of the political heat out of it" and made the NHS more independent from politics.

While he says he wants to see the politics taken out of health care Dr Miller would still like to see a proper debate about the future direction of the NHS and its relationship with the private sector.

Crude accusations from some quarters that the Government is hell-bent on privatising the NHS do not meet with Dr Miller's approval. He believes the issues at stake are more sophisticated.

"I think what they are doing is moving the NHS away from being a provider of health care to simply being a purchaser. Nobody seems concerned about where that care is provided, a typical NHS hospital, a foundation hospital, a private diagnostic and treatment centre or abroad. You can argue that is good or bad but it is a public debate which needs to take place," he says.

On a personal note, Dr Miller has no regrets at moving back to Sunderland, after training at Newcastle medical school and working in the south and Merseyside. But he would like to spend more time watching the Sunderland team he has supported since he was a boy.

"I would like to get along to see them more often but it is difficult because of my commitments. I also have two young daughters,"

He is delighted by the recent upturn in the Black Cats fortunes. "Maybe there are better things in store for the future," says Dr Miller.

No doubt his wishes are as fervent for future relations between the Government and its army of NHS consultants and specialists.