I read your comment on the internet, so I thought you might be interested in
a few extra details.
Most people agree that the old system has problems. Noone knew what amything
costed, resources and power were often controled by medics in particular
prestige specialties, irrespective of the general medical needs of the
community that they served. Unplanned overspends in particular areas would
always be creatively reaccounted elsewhere or elsewhen.
The new system was rapidly introduced before the Resource Management
Initiative pilot had been properly assessed, and in many areas not well
thought out. Although some aspects are positive, such as separating
Commissioning(Purchasing) and Providing, a vast layer of beauracracy was
introduced. Instead of getting a million pounds to run a Unit, thousands of
invoices for hundreds of pounds must be raised, chased, and argued about.
Free market Purchasing, rather than planning can also be wasteful, with Units
being closed or opened depending on whether they have 'won' a contract.
In primary care, GP fundholding has meant that a minority of practices in
suburban middle class areas (mainly) have been able to get preferential
treatment for their affluent patients.
For more information, read the recent Kings Fund book, assessing the reforms,
or for an alternative future , read the Labour Party Document Heath 2000
(from Labour Party Sales, Walworth Road, London)
Guy Lancaster
Greater Manchester Socialist Health Association
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