Doctoring the British Health Service

...Certainly some small hospitals in remote areas will be forced to shut down, requiring people to travel great distances for minor treatment...

...Escalating numbers of non-medical hospital personnel and inefficient central and regional administration drained the system further...

...In part, this is why waiting lists for surgery vary so widely in different areas...

...What they earn from the NHS depends upon how many patients they have and on NHS fees for special services like screenings and immunizations...

...the hospital will not have to bill the NHS and run the considerable risk of learning that government funds have given out before the end of the fiscal year...

...In contrast to the United States, no one in Britain has had to worry about being impoverished by hospital bills...

...Should the Tories be voted out of office in the general election that must be held no later than next June, NHS reforms of a different kind can be expected...

...For the first time, people here of all classes and means would have equal and free access to the best medical care the nation could provide...

...The problem has been that bureaucratic and accounting tangles ensnare the doctor who tries to send a patient to a hospital outside his district, so the tendency is to avoid such referrals...

...Secretary of Health William Waldegrave asserts that the NHS will continue to monitor the situation closely, that the reforms will be "bounded by rules and guidelines," and that his department will prevent any violation of the basic principle of providing everyone with the best health care free of charge...

...A relative handful of Britain's hospitals are self-governing, and many are unlikely to become so for a long while, if at all...

...They almost certainly will address the underfunding that Labor has roundly denounced...

...Complaints that GPs are overly casual, impatient or brusque have long been common here...

...GP practices in Britain range in size from one doctor to eight...

...There is no way," a surgeon there declared, "that I will put someone with varicose veins ahead of a serious gall bladder problem...

...They say, for instance, that cholesterol is worth testing only if a patient has high blood pressure, smokes heavily or is subject to other relevant risk factors...

...A GP in Hertfordshire, not far from London, is offering his patients reduced waiting periods for vasectomies...

...Moreover, the theory is that with budgetary allotments and salaries determined by the number of patients on their list, and with advertising authorized, doctors will be motivated to do the best they are capable of...

...Changes and modifications eventually were implemented, yet to little avail, leading one NHS administrator to groan that the adjustments were like "rearranging the deck chairs on the Titanic...

...But the system, financed by the taxpayer, has hardly been without serious problems...

...One hospital that entered into such an agreement has given assurances it will not push back other patients...

...Less fortunate GPs have complained that the privileged few have been "fast tracking," employing their special status to avoid the lines at hospitals by promising to pay for operations more expeditiously than is possible under the old system...

...Under the NHS, everyone is entitled to register with a local doctor who is responsible for his or her primary care...

...Like Labor, the BMA insists that they do not address the problem that has always plagued the NHS—a lack of sufficient resources...

...Using his budget, he has made arrangements for accelerated specialist treatment...

...the average is three or four...

...But the contract must be fulfilled, so doubts persist...

...At the doctor-patient level, the BMA fears the Tory plan could prove corrosive...

...One early complication, paradoxically, was caused by the NHS' success...

...Meanwhile, as part of its more comprehensive "health strategy," it has initiated a strong preventive medicine campaign...

...For the first time, GPs are required to offer complete regular checkups to their patients to detect early signs of illness...

...When specialized treatment is necessary, patients are referred to NHS hospitals...

...Though remaining part of the NHS network, they are assuming far more responsibility for managing their own affairs, including medical activities, finances and personnel...

...And the big inner-city hospitals are already having difficulty coping with the exigencies of the market...

...According to Labor's health spokesman, Robin Cook, "Never has so little been promised for so long with so much hype...

...But the new scheme makes it much easier for individuals to switch from one GP practice to another...

...The same is true of small GP practices...

...Smaller hospitals will probably never be seen as likely to benefit from controlling their own finances...

...The NHS became a political football, booted about by politicians, doctors and health administrators...

...As family doctors, GPs deal with minor or ongoing illnesses...

...To be sure, fast flowing income from private patients must tempt the selfgoverning hospitals to seek novel sources of profit...

...Besides their usual NHS check, some doctors are receiving an annual budget intended to allow them flexibility in caring for their patients...

...In time, every physician will be able to arrange treatment at the facility believed to perform an indicated therapy most quickly and effectively, for the "money will follow the patient...

...The BMA's concerns are not unwarranted...

...Thrift-minded doctors may send patients to a hospital clear across the country when equally good attention is available locally for a few extra pounds...

...Normally NHS hospitals—and they constitute the vast majority in the country—are administered by regional health authorities that adhere to national guidelines in setting policies...

...The latest available figures reveal that Britain spends $758 per person annually on health care, compared with $1,483 in Canada, $1,093 in what usedtobe West Germany, and $2,051 (mostly private money) in the United States...

...The government is convinced that Britons will get better medical care if hospitals exist in conditions that reward them when they satisfy patients' needs and penalize them when they do not...

...Norman Gelb writes regularly for The New Leader on British affairs...

...In some places this appears to be what is happening...

...All of the self-governing hospitals continue to treat NHS patients free of charge, but as businesses they have an incentive to function competitively: to be cost efficient and, in industrial terms, to be highly productive...

...The new plan is permitting a small number of hospitals to become "self-governing...

...The doctors have self-employed status...

...One option being contemplated is the closing of specific departments that fail to pay their way...

...Then there is the danger that instead of offering the best treatment possible, budget-holding GPs will after all opt for the cheapest—that they will economize on hospital referrals and cut back on services for cost-intensive elderly patients...

...Nevertheless, it is too early to attempt an informed assessment of the changes...

...Despite ever increasing allocations, the government has never been able to fund it adequately, even when the Labor Party occupied No...

...Critics worry about doctors being tempted to lower standards and save money...

...To eliminate that anomaly, a system of "budget holding" is gradually being put in place...

...Keenly sensitive to the overstretched resources of bigcity facilities, many NHS general practitioners (GPs) began hesitating to send patients for intensive exploration of complaints...

...Similarly, hospitals will no longer have to delay operations because of exhausted resources...

...Whether their reforms succeed, or in the end merely inject the Health Service with a large dose of incompatible business techniques, will not be lost on the electorate...

...Pointing to the experience in the United States, they argue that the checkups involve unnecessary, costly and sometimes painful examinations, and do not noticeably boost universal health or longevity...

...Laborites have vigorously condemned the whole enterprise...

...The NHS still provided excellent services to people in need of urgent attention, but widespread dissatisfaction with its larger workings developed...

...Extra payment notwithstanding, doctors are on the whole opposed to the campaign...

...Over the years, the NHS generally has worked well...

...It warns of the emergence of an unjust two-tier hospital service, and of facilities struggling for survival in the business jungle...

...If they send someone to the hospital, they will pay directly for the procedures requested out of their budget...

...nor has anyone had to refrain from going to the doctor because of the cost...

...Individuals forced to put off a hip replacement or a varicose vein procedure, for example, were particularly disgruntled...

...Consequently, private health insurance plans started to flourish, since they enabled anyone who could afford it to "jump the queue...

...Only 300 of Britain's9,000 practices—those with 9,000 patients or more on their list—have thus far been authorized to become budget holders...

...Vastly improved health standards meant people were living longer—and requiring more medical care...

...The reforms directed at general practitioners are similarly market oriented...

...10 Downing Street and taxes were high...

...When Margaret Thatcher's free enterprise revolution slipped into high gear during the 1980s, Britain's "socialized medicine" was rumored to be a target for elimination...

...Indeed, some budget holders have negotiated contracts with self-governing hospitals that guarantee a maximum 13-week wait for surgery...

...The Tories hope to both raise national health standards and ultimately rein in the soaring cost of maintaining the NHS...

...As budget-holding GP practices expand, the personal relationships with patients that are an important aspect of a family doctor's effectiveness could well be jeopardized...

...The ideologically driven Prime Minister, however, recognized that in spite of its imperfections the NHS had become the country's most cherished institution...

...In addition, the expenses incurred in running their practices are covered by an NHS funding body...

...They are, in effect, businesses, selling their services to GPs as well as local health authorities and raising funds in whatever other manner they wish...

...Patients had to wait months and sometimes years for nonacute operations at their local hospitals, while the wait elsewhere in the country was merely a few weeks...

...Nothing prevents a budget holder from deciding that the practice needs high-visibility signs of success like a Mercedes convertible, a couple of extra secretaries, or lavish office decoration more than expensive new drugs or the particular expertise of specialists...

...Barring a change of government in the forthcoming national elections, once the new program is fully in place the NHS will have undergone a fundamental transformation affecting virtually all Britons—to their advantage, say advocates...

...THE TORY REMEDY Doctoring the British Health Service BY NORMAN GELB London When the British National Health Service (NHS) was established after World War II, it was touted as a major advancement in social justice...

...It has nothing to do with upgrading the NHS' efficiency, they maintain, and everything to do "with the dogmatic commitment of Conservative ministers to the primacy of market forces and their distaste for public service...

...The British Medical Association (BMA), which represents most of the country's doctors, but not all of its members' views, also has strongly objected to the Conservative reforms from the moment they were proposed...

...they relied on office diagnoses and medication...

...This weighted the system's burden and compounded the difficulties of keeping up with expensive new technology and procedures...

...A third hospital in the new program has been accused of using its financial independence to invest money in a local hotel, rather than in improved medical care...

...Although an exaggeration, his quip indicated how far morale within the Service had dropped...

...to their detriment, say detractors...

...In another case, the management "trust" of a self-governing hospital approved the firing of a large number of staff not considered vital, producing charges that services will suffer...

...But the government is pressing ahead with all elements of itsoverhaul...

...Rather than privatize, her administration set in motion the machinery for producing reforms that are now being very gradually introduced by her successor, John Major, and are generating frequently bitter controversy...

...As for the self-governing hospitals, the BMA contends that independence will lead not to efficiency but to the collapse of Britain's integrated national health system...

...The two most controversial steps currently receiving a restricted debut concern the functioning of hospitals and of GPs...