Leading article: An underlying sickness

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At a time when our health service is wrestling with a major debt crisis, it is dispiriting to learn that it is also wasting a huge amount of money on a daily basis. The Department of Health claims today that the NHS could save £2.2bn a year if local trusts improved the way they handled certain services.

While some trusts admit around 10 per cent of patients the day before their operation, others admit 60 per cent. There is no medical reason why some trusts should call so many patients into hospital early; it appears to be merely an expensive institutional custom. Likewise, some doctors are prescribing costly cholesterol-lowering statins when cheaper ones are available. And many patients continue to be sent for surgical procedures such as having their tonsils removed and hysterectomies when cheaper, non-surgical, options are available.

That such inefficiencies exist is depressing, but should come as no surprise. The Chancellor of the Exchequer, Gordon Brown, has poured a huge amount of money into the NHS since 2000. The health sector will soon enjoy an annual budget of £100bn a year. But this increased funding has not been accompanied by a demand that the manner in which health services are delivered in the UK should be fundamentally reformed. This is now looking like irresponsible government.

There has been no shortage of targets imposed by the centre for improvement in areas such as operation waiting times and waiting lists. But this is not the same thing as genuine reform. The ethos of an inefficient, monopolistic health provider has been left unchallenged. And, in fact, the efforts of trusts to hit such targets has merely led to greater inefficiencies elsewhere. For example, many have devoted resources to cutting operation waiting times, but have neglected to analyse the efficiency of their hospitals' procedures for discharging patients.

The present debt crisis in many NHS trusts is another symptom of the same underlying illness. These are not organisations used to the disciplines of delivering their services on budget, since they have always been bailed out in the past. But now that the flow of funding from the Treasury is likely to slow from 2008 onwards, they are being asked to learn to do so very quickly. It is this that has raised the spectre of 20,000 NHS job cuts next year.

It is not enough for the Government to demand that the NHS set its house in order. It must look to its own responsibility for this crisis. Until those in power take drastic action to decentralise the provision and allocation of healthcare, this wastage will continue - and the British public will continue to be denied value for money.

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