The NHS doesn’t produce widgets to be sold on the widget market. It has sick people coming through the doors. Yet one of the consequences of the government’s commercialisation of the NHS is that efficiency is measured by the balance sheet rather than the quality of the work done. The market system which the government has introduced not only makes planning more difficult, owing to “patient choice”, but in some instances it appears designed to ‘incentivise’ Trusts to do less work, even when it is socially necessary!
According to Health Service Journal the Department of Health has announced that Trusts will be penalised for doing “too much” work, so far as emergency procedures are concerned. Emergency procedures, you may well think, are the product of, well…emergencies. People have an accident, or they fall ill. Yet the problem with sick people is that they don’t fall ill according to some pre-ordained timetable, nor do they take into account the budgetary circumstances of their local Trust. ‘Market conditions’ do not determine how many people need emergency procedures at any given time. But so far as the government is concerned if the number of emergency procedures that a Trust carries out is more than planned for then this can only be deemed to be ‘inefficient’. So the government has decided that any activity above the volumes carried out in 2008-9 will only receive 30% of the money that would normally receive for the tariff (the price determined by the Department of Health) of each procedure.
This obviously means that Trusts will lose money by carrying out this work, so they will have to cut the amount they spend on non-emergency procedures. So they are being penalised not for “inefficiency” but as a result of more people requiring emergency procedures from one year to the next; a situation completely beyond their control.
The irony of this is that the rationale of the government’s ‘health market’ is that the money will “follow the patients”. If you have had a coronary, a stroke, or some life threatening illness, you are not interested in ‘choice’. If you are conscious you just want to be taken to the nearest hospital to be dealt with quickly. Yet here the government determines that the more people a hospital treats (beyond 2008-9 levels) then the more money it will lose! This sums up the irrationality of New Labour’s market system which fundamentally undermines the rationale of the NHS and socialised medicine.
Martin Wicks 