Sir, The decision by NHS managers to postpone surgery to save money (report, Dec 3; letters, Dec 6) is bizarre. It will waste money, not save it.

Most costs involve premises, equipment and staff, so the rate of spend over time is largely fixed. It follows that best value for money is attained by doing the most, not the least, with assets which have to be paid for anyway.

The additional costs of care for people waiting for treatment must also be considered, and the increased complexity and cost of eventually treating conditions which may have worsened during the wait.

If, as I suspect, the problem is due to poor accounting systems and performance measurement regimes, which distort the picture by rewarding the delaying of costs, even if they are thereby increased, then these flawed systems and conventions need to be exposed and overhauled without delay.

ED TOZER
Truro, Cornwall

Sir, Department of Health maladministration is at the root of the health service crisis. The DoH devises impossible targets; it lumbers trusts with the accumulated deficits of predecessors who had been chronically underfunded; it enters into salary agreements without consulting the trusts whether they are affordable; under the guise of “modernisation”, it constantly replans systems, bringing no benefits to patients and destroying the morale of frontline staff.

ANTHONY ROWLAND-JONES
Fulbourn, Cambs

Sir, The impact of new pay contracts was grossly underestimated by the Department of Health, which has consistently interfered with trusts in setting budgets. Central meddling with financial formulas and withdrawing funding from many established care services have reduced further local ability to deliver services.

Improved financial management is as much a function of high-quality budgeting as it is of monitoring and controlling expenditure. The quest for the solution should start in better central budgeting, rather than drastically cutting “overspending” by local managers against budgets over which they had so little influence. Better budgeting also depends on much improved local demand forecasting, which trusts must address if the “health inequalities” are to be resolved.

The current purge to cut operating costs will generate savings only if there is an irreplaceable loss of frontline carers from the people- intensive service which is the NHS. Removing the lifeblood from healthcare services bodes ill for the future of the NHS.

L. C. B. LONG
Kenley, Surrey

Sir, The founders of the NHS, dazzled by the emerging wonders of modern medicine and believing that the reason people were sick was lack of treatment, genuinely hoped that the cost would decline as the population became healthier.

The nation’s health has instead deteriorated remorselessly. We have, I believe, already passed the 1 billion NHS prescriptions-dispensed-per-year mark: 22 million citizens are on repeat prescriptions. Gridlock is inevitable.

When will it sink in that one cannot run a successful health facility based on pharmaceuticals, radiation, invasive tests and conveyor-belt surgery? How much longer before the health movement is asked to formulate a national health policy as a basis for a damage-limitation effort?

PAT RATTIGAN
Chesterfield

Explore Letters

• Feedback