NHS insider speaks out

A WAVE of change is sweeping through the county's NHS, as debt-ridden trusts struggle to balance their books. Consultant physician DOUGLAS SEATON worked in the NHS for 36 years, spending nearly 30 years at Ipswich Hospital before retiring in June.

A WAVE of change is sweeping through the county's NHS, as debt-ridden trusts struggle to balance their books.

Consultant physician DOUGLAS SEATON worked in the NHS for 36 years, spending nearly 30 years at Ipswich Hospital before retiring in June.

Here, he gives his view on what the spin behind the changes really means.

Having been fortunate to have worked in the hospital service for the past 36 years and having seen many changes in the NHS, both good and bad, I have a feel for what is going on at present and am now at liberty to comment without incurring the displeasure of an employer.

So, what lies behind the spin and what does the seductive jargon we hear really mean?

“Community-Based NHS”: A device intended to save money by cutting back on hospital care, which is perceived as too “hi-tech” and therefore too expensive to be generally applied.

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For marketing purposes this is packaged as what the patient wants, - much more convenient to be seen and looked after by a specialist in the GPs' surgery or at home.

The problem is that there are not enough fully qualified specialists to do this unless patients come to a centre with all the necessary facilities under one roof - but that would be the hospital - so the Government may seek to get around this by reclassifying some GPs as “specialists”, thereby reducing the input of the expensive fully trained hospital specialists.

There are also moves that may restrict the independence of a GP to refer a patient to a hospital clinic by the setting up of local Orwellian sounding “Referral Management Centres” in which GPs referral letters may be vetted and the referral redirected elsewhere.

“Patient Choice”: An attempt by Government ministers to reintroduce into the NHS those Thatcherite competitive market forces that they previously abandoned, only in a different guise.

Patients referred for a consultation by their GP are required to be offered a choice of four hospitals, “the money following the patient”, so that hospitals that attract more patients, earn more money.

So-called independent treatment centres (ITCs) can compete in this process. These organisations contract their services to the NHS for private profit and, although no charge is incurred by the patient, they may “cherry pick” the work that will be most lucrative to their organisation, while leaving NHS hospitals to bear the cost of “unprofitable” work such as caring for elderly patients with longer term illnesses.

“Local Decision Making”: Government ministers seek to distance themselves from blame for day to day problems in the NHS. “Sufficient” funds are provided to a Primary Care Trust for the health care of its local population.

Included in this sum may be a fraction of so many million pounds provided by Government nationally to be spent, for example, on sexual health clinics, but if a local cash-strapped PCT feels that it has to settle other accounts first, then too bad for sexual health, the money will be spent on some other “priority” and the minister responsible will claim that it is entirely appropriate for the PCT appointees to best determine the local needs of their own population. Similarly NHS hospitals are being encouraged to seek “Foundation Status”, with increased financial independence and responsibility to an independent regulator rather than to Government ministers.

“Private Finance Initiative”: Rather than capital sums being raised for new hospital projects from short term tax revenues, perceived by Government to be unpopular, hospital trusts enter into expensive 30 year contracts with profit-making private operators to construct and maintain new facilities, effectively on hire purchase - more expensive for the tax payer in the long run but politically more comfortable for the Government.

“Payment by Results”: A heavily bureaucratic device, introduced by the Government, by which items of hospital clinical activity are recorded and payments made according to a national tariff. This focuses the hospital on those activities that are seen to be profitable, whereas other areas of activity that attract less funding might be run down.

Contracts with PCTs may also carry time lines so that a hospital like Ipswich, with spare capacity at certain times, may be penalised for carrying out operations too quickly. GP practices are also being encouraged by financial inducements to commission their own services, being allowed to undercut the nationally fixed tariffs to which hospitals must adhere.

These changes are forcing the law of the market place onto the NHS and the Government is further flexing its muscles by insisting that hospitals with budgets that, in the face of these changes, are overspent by tens of millions of pounds should balance their books. This is causing much unhappiness, with damage to the morale of hospital personnel, as good clinical services that have taken years to develop are forced to shed trained staff and reduce the quality of the care that they provide. Meanwhile ministers forge ahead with the NHS IT project “Connecting for Health”, at an estimated cost to the tax payer of £30 billion.