Were we not already so blessed with rich examples, the introduction of new contracts for hospital consultants would provide a textbook example of well meaning but poorly drafted, ill-managed and ultimately self-defeating public service reform. The goal was to bind semi-autonomous consultants more closely to the NHS, and to engineer more efficient and productive use of their time for the benefit of patients. Under the quid pro quo outlined by ministers, consultants would earn more for demonstrating greater devotion to the NHS and less to their private patients. Three years on, however, consultants’ salaries have risen by more than a third with little to show in return. Rather, some are working less for the NHS while their private earnings have increased. The balanced starting point has produced an outcome of many quids and few quos.

Initial blame belongs with the Department of Health where ministers — particularly Alan Milburn, when the Health Secretary — were so consumed with the belief that consultants spent half their lives on the golf course and the other half milking private patients, that they failed to do their homework. The new contract set a benchmark for expected NHS work below the number of hours that many consultants were already putting in. In other words, the new deal guaranteed them a considerable pay rise without demanding anything in return.

Some culpability is shared, according to today’s King’s Fund report. Ministers produced contracts of sufficient complexity as to bamboozle many of the hospital managers whose job it was to implement them. Ministers set political deadlines, underestimating the scale of the task. And managers, already facing other impending and far-reaching financial changes such as payment by results, were distracted.

Critically, managers consequently viewed the contract as an ordeal rather than an opportunity to bring about change. Ministers dealt them too few cards with which to improve consultants’ productivity. Those they did have remained largely unplayed. For instance, the job plans that were supposed to deliver more consultant hours with NHS patients have been largely retrospective rather than forward-looking exercises. The contracts give trusts new powers to link pay rises to agreed objectives, but few have used them. Key principles of the new contract have therefore been negated.

Ministers cannot reprise Nye Bevan’s complaint the last time consultants contracts were thrashed out, that he had to “stuff their mouths with gold”. Certainly, consultants feared change most, yet have emerged with most and given up least. But ministerial incompetence is to blame. Patients, meanwhile, are receiving less value for the increased taxes that are financing the change. This embarrassing episode is less expensive than the bungling of GPs’ contracts, but is equally damaging to government credibility and the future of the NHS future. How much more waste is built into an institution made more powerful, and thus less flexible, by the very investment that was supposed to change its character?

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