Letter

The NHS is in tiers — but who cares?

Dear healthmatters — David Hardy may be right to point out that government policy on the NHS is contradictory in developing GP fundholding at the same time as the needs-led purchasing of health authorities (Is the future fundholding?, issue 14), and he may even be right to say that these policies are on a collision course.

But what is remarkable is that the government, far from trying to produce some consistency in policy, doesn’t seem to care less.

On the contrary, the Department of Health seems happy just to sit back and see what happens. The resultant uncertainty will paralyse any sensible strategic decisions about how local services should develop.

Neither does the government seem to care that we now havea blatantly two-tier health service. This is not scaremongering, it’s just current reality. Districts where the patients of fundholding GPs are admitted to hospital in preference to the patients of the hard-up district health authority are too numerous to mention.

The government has allowed this to happen despite assurances last year that it would not, and despite guidance to trusts that they should not unfairly disadvantage the patients of one purchaser (the district) compared to another (the fundholder). Trust managers are simply playing out the logic of the internal market.

Save the NHS? We’ve lost everything worth defending already.