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Readers' letters

Letters to Health Service Journal's editor.
  • Tariff reveals NHS savings targets for 2015-16

    28-Nov-2014 10:11 pm

    The system of pricing NHS activity is fatally flawed and needs an overhaul not simply another year of so called efficiency savings. What was the legal basis for reduced funding for emergency activity above an arbitrary "year of activity" especialy given its largely outside the control of the provider - has anyone challenged it-? perhaps its time to do so!

  • Monitor: Role for competition in new provider landscape

    28-Nov-2014 8:11 pm

    Monitor will never give up the struggle to have competition driving change in the NHS. It is part of their free market DNA. They simply refuse to believe that the NHS is not a perfect market and hang on to the mistaken mantra that choice drives up quality and drives down cost. This text book class 1.01 of economic theory warms the cockles of the hearts of the teenage regulators fresh out of McKinsey at this now deeply flawed regulator. Time Monitor asked Ms Davies to go and compete for a job in the private sector, perhaps?

  • CCG chief to lead acute hospital

    28-Nov-2014 6:24 pm

    Interesting appointment which I hope goes well. Presumably her GP practice will be getting locums paid for.....................

  • Accountable care organisations can teach the NHS about integration

    28-Nov-2014 5:33 pm

    I am trying to join up different aspects of government policy. Where do personal health budgets fit into ACOs? I imagine the idea is that the ACOs amalgamates all the personal budgets of its patients (say £2000/person/year) which then is the ACOs budget. But what happens when a person's budget is overspent? Will there be risk sharing so that high cost patients are subsidised by low cost patients as happens already in the NHS? But with a smaller pool won't this be risky? Or will people have to pay extra if they overspend their personal health budget? After all, its called a *personal* health budget which implies its a particular sum attached to an individual and therefore different from the flexible (according to need) health budget we can all deploy by virtue of being users of the NHS. If a personal health budget can be overspent then in what way is it different from what currently exists and in what way is it personal? Will people have to take out insurance in case of overspend? Will ACO try to find ways of denying care to or jettisoning costly patients?

  • Hunt takes a high risk approach to restoring hope to the service

    28-Nov-2014 5:00 pm

    If there is a funding gap i.e. a gap between what the service needs to deliver and how much it is funded to do so then that means that services will be paid less to do more. i.e. trusts' budgets are being cut by 5% year on year by reductions in tariffs for PbR. Therefore trusts have to make cuts - they may make cuts by cutting staff numbers or skill mix, or restrict provision of certain services, or reductions in the specifications for the service such as numbers of care episodes provided. There have been very real cuts to mental health services for example. So "efficiency savings" do lead to cuts and any pretence otherwise is from someone without actual experience of what is happening in healthcare on the ground.

  • Exclusive: Patient choice is not key to improving performance, says Hunt

    28-Nov-2014 4:45 pm

    Hmm... this is very puzzling. why the U turn on patient choice which, as many commentators have said was the main justification for the H&SC Act - choice and competition would drive innovation and increased quality. Now we are to accept that there can't really be choice and that what we need is large integrated care organisations. But who will run these? Will they be for-profit companies like United Health or others that run accountable care organisations in the United States for profit? Hunt has said choice may no longer have an important place, but not said that profit doesn't. Many accountable care organisations in the USA have a reputation for controlling people's access to the care they need and denying care in order to save money/make profit. Is that where we are heading? And if these integrated care organisations are to be not for profit organisations its hard to see why they can't just be NHS provider organisations - why can't we return to the NHS as the provider of care and then we could work on breaking down barriers and integrating services. Because really, the best way to integrate is to have all health services under one umbrella - called the NHS!!

  • NHS England restructure: new 'sub region' directors appointed

    28-Nov-2014 3:22 pm

    If you think this is a 'dogsmeal' you should see the chaos at HEE

  • CQC to inspect Heart of England

    28-Nov-2014 3:19 pm

    From a patient perspective Good Hope and Heartlands do not talk to each other and care is far better at Good Hope. Demerger would be best for patients who use Good Hope

  • Some trusts will not become FTs until 2018, says Flory

    28-Nov-2014 2:55 pm

    The answer to Hugh Risebrow is not many would get through the process now, possibly 20 at most

  • CCGs poised to defy pharma by switching to cheaper, unlicensed drug

    28-Nov-2014 12:55 pm

    ...many CCGs are already doing this as quietly as possible...

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