Letter: Girl B is victim of the internal market's climate of mistrust

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Sir: There are three very good reasons for believing that the decision of the Cambridge and Huntingdon commissioning agency to refuse an operation to "Girl B" was based upon financial rather than clinical criteria.

1. The question the agency had to decide was whether or not it would fund an extra contractual referral (an ECR in NHS managerial speak). It follows, therefore, that a request must have been made for such a referral. If the clinicians involved did not make the request, then who did? Surely it is essential for these clinicians to speak out (that is, if they are allowed to).

2. According to press reports, lawyers for the agency continuously used the term "funding" as opposed to "providing" in relation to the treatment.

3. Other clinicians are prepared to go ahead with the treatment and, therefore, it must at the very least be considered as a reasonably clinical alternative.

In the days before the internal market ruined the NHS, such a very serious and difficult clinical situation as in this case would have been discussed between the parties involved in a spirit of complete trust. Under those circumstances, if it was the opinion of the clinician that it would be in the overall interest of the patient not to proceed with the treatment (but that if the relatives wished it could be given), it is highly likely that the advice given would have been graciously accepted. In the current climate, the spirit of complete trust has gone, because clinicians in their day-to-day work are being forced to take cost into account in formulating a treatment plan.

While accepting that health care funding must ultimately have a limit, in this country we are nowhere near that limit. In the UK, we only spend £582 per person per year on health, compared with the OECD average of £966 (OHE, 1992).

Do we want life and death decisions being made by quangos who are unaccountable? Is it not time that this awful experiment was brought to an end and the spirit of competition be replaced by a spirit of cooperation.

Yours sincerely,



12 March