Letters

It has been a difficult two weeks.

Totally dedicated to the concept of an NHS that provides equally for people throughout the nation, whatever their age, class or ethnic origins, I have been pleased to work with colleagues to improve services for a group of unfashionable patients in an unfashionable part of the country.

During the past five years we have kept within budget. We have recruited better staff in greater numbers, and we have demonstrated considerable improvement in the quality and quantity of delivery. We have become involved in undergraduate and postgraduate teaching and training and have begun to aspire to a modest research profile.

Over the past two years a number of additional activities have been expected of us and declared to be 'affordable' with no increase of budget. A considerable share of extra responsibilities has fallen to me, and I have done my best with them. The formula has been, 'No extra money; more additional responsibilities'.

The new arrangements for research and development funding will not make it easy for smaller trusts wanting to engage in research.

Those which currently receive no funding would appear to have no way into the new system. Those which have a very limited budget will be fortunate indeed if their established track record is deemed sufficient for their funding to be continued or increased.

The formula appears to be, 'To those who have, more will be given'.

In R&D activity, at least, the NHS will be split even more clearly into the haves and the have nots.

I have been impressed that the government is allocating massive additional money to the NHS, directed to frontline services. We were encouraged to hear that our town would be receiving£3.4m extra during the first year, and we had begun to think how we could best use our fair share to improve services. This would be done by discussion with appropriate clinicians.

In the event, there has been no consultation with clinicians. A provisional allocation, as determined by our health authority taking into account matters it deems important, gave us a 2 per cent share. Within hours of that leak we found our anger and bewilderment doused as we learned that the health authority's provisional allocation was deemed by the regional office to be entirely inappropriate. We will receive not a single penny. All available money will be used to wipe out overspends incurred in other parts of our local health service.

The per capita funding for our mental health service remains the lowest in the West Midlands, and we believe the lowest in the country. The formula appears to support the concept that the rich and profligate should be supported at the expense of the poor and prudent.

Professor D J Jolley Medical director, Wolverhampton Health Care trust Director responsible for R&D Director responsible for clinical governance Director responsible for audit Caldicott guardian Consultant in old-age psychiatry Professor of old-age psychiatry Director of the West Midlands Old-Age Psychiatry, Learning Education and Development Centre