Wednesday, December 07, 2005

Hospital Finance Shambles


The criminally patronising Patricia Hewitt has been trying to explain the hospital finance shambles. This is the deal whereby despite the eye-watering piles of cash stuffed into the NHS, many hospitals are going bust.

Ms Hewitt's first instinct is naturally to blame others, in this case hospital trusts in the "healthier and wealthier" parts of the country. "Healthier and wealthier" is clearly all of a piece with those "worried well" wasters she told us had been responsible for the run on flu jabs. These malingering hypochondriacs are the bane of health planners everywhere. And now it turns out they're wealthy as well. They are beneath contempt.

This is actually very reminiscent of the government's well rehearsed approach to the terrifying levels of crime on our streets. As we know, we may think we're being mugged, our children are getting thumped, and our cars are getting broken into, but really it's all in our minds: we have an irrational fear of crime that is not born out by the British Crime Survey (the government's own impressionistic survey of what they'd like to be going on).

But back in the hospitals, the excellent King's Fund tries to unravel what's really gone wrong. The fact is that the new system of payment by results is virtually guaranteed to force some trusts into deficit. Indeed KF reckon it could soon increase from the current 5% of trusts to 20%.
And reading between the lines, it seems highly likely that the reason why the trusts in wealthier areas are worst hit is simply because the local cost adjustments in the central payment formulae are wrong. Following the usual conventions, they almost certainly penalise trusts in Tory areas, and favour those in Labour areas. We don't actually know because the formulae are "opaque".

So what's going to happen? What are these hit squads Pat is sending in to deficit trusts going to do? Can more ops? Turn off the heating? Sack some nurses? "Dispose" of some malingering patients? Close hospitals?

Probably they'll just hire some more accountants and call in the management consultants.


PS If you hypochondriacs out there really want to sweat, check out a spendid- though scary- new blog written by an NHS GP. You can get a consultation with Dr Crippen at NHS Blog Doctor. Appointments do not seem to be required.

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