Information Director, London Health Emergency AS AN UNUSUALLY cold winter sets in, bringing the traditional tide of broken bones, bronchial diseases and medical emergencies, Blairite policies have achieved the seemingly impossible in the
combining record spending levels with record deficits, cuts and closures.
Indeed after big improvements in the performance of many hospital Trusts fuelled by several years of increased spending and expanded numbers of nursing and medical staff, the latest cash squeeze has seen Primary Care Trusts in Suffolk and elsewhere act to slow down treatment and lenginen walling umes In order to save money and defer costs into the next financial year: as a result the 6-month
wall for urgent operations will soon also be a minimum in many areas.
A rapid-fire and relentless succession of policy initiatives from the Department of Health has left senior managers battered and confused on all sides as they struggle to meet contradictory targets, Icor callise SCIVICES and deliver more health care than Gordon Brown's budget has paid for.
Even one of the government's most servile former academic advisors, Birmingham University's Professor Chris Ham, has come out in open criticism of the "incoherence" of policies which are seeking to restructure the NHS as a health care market, expand the role of for-profit private hospitals, and drive a new round of privatisation into primary care and communty neato services.
Ham told a conference of health finance chiefs before Christmas that ministers have got their reforms "out of sync", and put too much emphasis DrOVISIOn of services and too little on commissioning.
Ham's warning came in the midst of a major reorganisation of the main NHS commissioning bodies, the Primary Care Trusts, which have been urged by NHS chief executive Nigel Crisp to separate out their commissioning from their provision of services.
Pressure from angry local campaigners had just forced government intervention to IIIS LIUCL Thames Valley Strategic Health Authority to delay its plans to hive off the £600m purchasing budget for Oxfordshire's health services to a private company, the front runner of which is the giant US corporation United healthcare.
New hit-squads of accountants will visit
the 52 most indebted
Trusts and PCTs to
drive through even
more intensive cuts
Ham went on to warn that emergency services should be protected trom the "excesses" of the LICW competitive market system that Blair and Health Secretary Hewitt are busily creating in place of the planned public but ministers are forging ahead regardless with the imposition of a new, half-baked
of "payment results" which will further destabilise Trusts and PCTs and the services they deliver.
So manic is the obsession with market mechanisms and private sector business consultants that the US company McKinsey has been invited to draw up plans to split the Department of Health itself Ino two organisalons, one dealing only with service provision and the other with commissioning. Even Nigel Crisp's job could be split into two - although clearly his salary will remain intact as the crazy and wasteful process unfolds.
Out in the real world, ministers have also been warned that the impact of their "modernising" reforms could result
the demise OTI many District General Hospitals, with a growing share of their waiting list operations hived off to private Treatment Centres, taking the money and staff with them see Socialist Resistance No 30) and pressures on Trusts to save cash through closing local units and "centralising" services across much larger catchment populations.
The drive to cutbacks and closures flows both from central targets to make £250m of "savings" through reorganisation, and from the huge imbalances within the NHS UNISON NO