Letter

Following what money there is

Dear healthmatters — Do you recall Kenneth Clarke’s phrase when he was first selling the NHS reforms in 1989? He told us that ‘money would follow the patients’.

This quote seems likely to go down in NHS history alongside other great classics such as ‘we have no plans to increase presciption charges’.

The internal market has turned out to make patients follow money. But we have reached the stage where, in some cases, there isn’t enough money for patients to get a chance to follow in the first place.

Twenty weeks into the financial year, Camden and Islington Health Authority put the brakes on its contracts with UCL hospitals. Patients who already had dates for operations were told that their admission was cancelled and that ‘there is no prospect of our being able to give you a date for surgery before April 1994’.

No new appointments or non-urgent operations were to take place until the contract was ‘under control’.

The London Evening Standard, a paper which it is fair to say traditionally supports government policy, observed: ‘This is the madness and obscenity of the government’s NHS reforms... is this what we have come to?... London and national medicine are in crisis and the government’s policies have created that crisis.’

So either old Ken was misleading us, or something has gone terribly wrong. As I know healthmatters readers are open minded folk, I shall conclude the latter. But the question remains: what is the government going to do about it? Is it going to admit that the internal market has a number of fault lines and that, in its third year of operation, some further analysis is required to assess whther there have been benefits?

Or is it going to pretend that everything is fine?