Letter: Making NHS do the business

Sir: Further to the letter from Dr Rhidian Morris (13 July) on GP fundholding, I entered the National Health Service in 1991 when I became a fundholding manager for a first-wave fundholding practice, having spent my life before that as company secretary and accountant in industry and commerce.

I was amazed at the lack of business expertise within the NHS, and more so by the lack of basic statistical knowledge about the needs of patients. The practice could not say which of its patients were on hospital waiting lists, or for what procedures, and hospitals could not say how many people were waiting, and how the problem was being tackled. There was little evidence of information available which could be used for forward planning, establishing priorities, or writing budgets (they said "what's a budget?"), and the whole ethos of the service was that money would continue to flow from central coffers as needs emerged.

Fundholding and the establishment of NHS trust hospitals has changed all that. Proper business plans are now in place at all units, so that everyone knows what the objectives are, and how it is proposed to meet them. Complaints about a two-tier service are rubbish - if you set out to improve a service, you can't expect immediate and universal success throughout the land. What you can do is gradually introduce the changes over the longer term.

GRAHAM BLINCOW

Sheffield,South Yorkshire