A new system of Payment by Results (PBR) will be phased in to the NHS over four years to 2009.
The slow take-off is no doubt linked to the prospect of a General Election in the spring of 2005, since it threatens to be destabilising, and its consequences still are not clear for many Trusts and Primary Care Trusts, some of which stand to gain, and others lose.
Trusts whose costs are currently above the new fixed prices that they will be able to charge for treatments they deliver under PBR stand to lose out heavily: unless they can find ways to slash back costs, or close down lossmaking departments, they face the prospect of losing money on every patient they treat.
Primary Care Trusts (as the purchasing bodies) in these areas will recoup a windfall gain, paying out less for the same level of hospital care. But in other areas they will need to increase cash allocations to hospitals, to match the new fixed prices in Trusts which have been operating at below this level of costs.
In these cases the Trusts stand to make windfall gains, at the expense of other Trusts and the wider health care сконошу.
PBR will initially apply only to acute hospital care, leaving out mental health where standardising costs has proved even more problematic: but it already seems set to trigger a fresh stand-off between primary care and the hospital sector.
This is because Trusts will be given a fresh incentive to treat patients in hospital in order to claim the funding, while GPs will potentially be able to retain more funding for primary and community care if they keep larger numbers of patients out of hospital.
The new market-style system makes no reference to social or other inequalities, and runs the risk of funnelling an ever-larger share of the NHS budget to the bestresourced and largest Trusts and GP practices at the expense of those struggling to cope in more deprived areas.
But the new system also represents the end of 30 years of efforts to equalise allocations of NHS spending on the basis of population and local health needs.
Instead PCTs in areas where Trusts are currently delivering services below the new NHS reference costs will require additional funding to pay an increased fee - which will become a "surplus" for the Trust.
Conversely PCTs whose Trusts currently deliver relatively high-cost treatment will see their cash allocations reduced.
None of this bears any relation to social deprivation, the age profile or relative health of the population: the new market system emerges as the enemy of equality. Minister threatens closures Health Minister John Hutton has insisted that the government will not 'bottle out of tough decisions to close hospital which "tail" as a result of patient choice.
While claiming that this did not mean hospitals would be closed at the first sign of difficulty, and that efforts would be made to revive and support the stragglers, he made clear that the ultimate sanction could and would be used, and that falling hospitals could be sacriliced to force through New Labour's vision of a market system in
"We are going to be tough about it. A lot of people think we will bottle it at the last minute. We won't. It will be a very different NHS," he told a fringe meeting at Labour Conference. nurses vote to join Labour Federation An important blow was struck for workers' unity when Ontario Nurses announced on November 27 at a mass labour rally in front of the provincial Legislature in Toronto that they had just voted to join the Ontario Federation of Labour (OFL).
Overcoming decades of isolation, steeped in professional "sacrifice" and elitist Illusions, nurses recognize that the fight against ongoing health sector cutbacks will be stronger if they make common cause with the rest of the workers' movement.
Founded in 1973, the Ontario Nurses' Association (ONA) is represents 50,000 registered nurses and allied health professionals working in hospitals, long-term care facilities, public health, community agencies and industry throughout Ontario.
ONA maintains strong links with other nurses' unions across Canada, some of which have conducted lengthy and militant strikes to defend public health services and to advance their members' interests.
ONA is a member of the Canadian Federation of Nurses Unions (CFNU), and is thereby affiliated with the Canadian Labour Congress (CLC).
For several years ONA rank and file militants proposed joining the OFL.
This time the ONA Executive presented affiliation to Ontario labour on a trial basis, with the central union to pay the fees for the first year - and the ONA Convention approved it.
If the OFL follows up on the November rally with a serious fight against Ontario Liberal government "broken promises" on labour law reform and proper funding of health, education and wel fare, it should be easy to get nurses to ratity a long term