Politicians lose the NHS plot

Two letters from Thursday's Independent that sum up two different perspectives  views of Tory's  planned NHS reorganisation

The reorganisation of the NHS outlined in the White Paper is irrelevant to the needs of the health service. Its introduction will cause harm in the short term as managers and clinicians try to find out what they should be doing, and in the long term will make very little difference.

Politicians have lost the plot when it comes to NHS organisation. Once it was designed as a top-down system with the District Health Authority as the basic building block. Money came from central government and was distributed to hospitals and GP practices by the DHA according to need, based on population and disease. It worked, but was grossly underfunded.

Then in 1990, under Kenneth Clarke, it was changed to a "grocery store" type of organisation. The DHA was abolished. In its place the community, based on GPs, became purchasers and secondary services (the hospital) became providers. The internal market was supposed to improve services as competition improves grocery provision.

The reality is that patients with diseases are not as simple as selling apples and cornflakes. So when the increased funding came, as it did under Labour, much of the benefit was wasted propping up this inappropriate model. After 20 years no political party is prepared to admit they are wrong and end the failed experiment of the internal market.

Until we return to a top-down planned system, we will be spending ever more on management and less on clinical services. We need a co-operative Health Service not a competitive one.

Professor Peter D O Davies, Liverpool Heart and Chest Hospital

 

The Government's health service policy is more subtle and more dangerous than your leading article "Andrew Lansley's gamble with the nation's health" (7 December) suggests.

Passing of commercial and administrative responsibilities to the doctor will require formation of units to manage this. These commercial units will become responsible for employing doctors, and not the other way round. Doctors will become factotums of these organisations, whose main responsibility will be to make money for shareholders or cut expenditure for the Government, and in the end the patients will be related to the organisations rather than to their family doctors.

This is happening now, as I notice that the practice (now called a health hub) where I had a relationship with my doctor (retired) is now serving me with doctors who come and go, half a dozen in the space of a year.

The traditional invaluable support which the individual had from his family doctor will be lost.

Matthew Wallis, London SW6