Finance watchdog prescribes cure for `unhealthy' NHS

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The Independent Online

Westminster Correspondent

National Health Service chiefs need to do more to improve relations between doctors and financial managers, it was claimed yesterday.

Sir David Cooksey, retiring chairman of the Audit Commission - the public finance review body - used the publication of the body's annual report to attack the way the NHS is run.

After paying tribute to efforts by staff to grapple with service reforms, he said: "What is not so healthy in today's NHS is the relationship between clinicians and managers. It is here that most effort will be required over the next few years."

Sir David said that both sides needed to pay more attention to the other. "The role of management needs to be developed in conjunction with the clinical role; clinicians need in some cases to come to terms with economic and organisational reality."

Sir David, who is also a director of the Bank of England and Wellcome Trust, pleaded: "The two groups must come together to agree protocols, to carry out meaningful clinical audit, to apply the results of research and to challenge the cost-effectiveness of both new and established procedures and treatments."

During the past year, the commission had made a series of studies into the NHS. These showed that: in some hospitals doctors spend much of their time working alone in operating theatres performing operations beyond their competence; despite efforts by the Government to wind down old, large psychiatric hospitals and to put patients into the community, many remain open with ever-increasing costs; and in the wake of scandals at Wessex and West Midlands Regional Health Authorities, the systems designed to prevent fraud within the NHS are weak.

Turning to the police, the commission called for greater integration of crime recording, analysing patterns of crime and intelligence. At present, only 11 per cent of forces had such a system but if more followed suit, said the commission, "major breakthroughs in targeting serious and prolific criminals may be possible".

Confusion still exists about the role of the CID and the type of crime it deals with. Police could do more to avoid duplicating responses to crimes such as burglary. They should make better use of information technology. Twenty per cent of police forces still do not have, and do not plan to have, computerised crime records.

In a glowing farewell to local government, Sir David appeared to counter Conservative claims that Labour-dominated councils are poor financial managers and are inefficient. Councils have coped successfully with huge reforms such as the scrapping of the rates and the introduction of the community charge and its replacement with the council tax.

"That local authorities have coped successfully with all these changes - while at the same time making great strides in improving the quality of their services, making them more customer-focused and delivering them more efficiently - says a great deal for the vitality of local government."

He acknowledged that not all authorities have embraced competitive tendering "to develop cost-effective services which respond to citizens' needs".

Councils are increasingly open to fraud. A total of 83,000 cases of fraud, worth pounds 34m, were detected in 1993/94. Of those, 98 per cent involved abuse of the housing benefits system. Other council payments are also vulnerable. Fraud involving student grants increased tenfold to pounds 2.3m and fraudulent claims of home renovation payments doubled to pounds 1.1m.