LETTERS


3/8/11 What’s mine is yours, for a price


A researcher has raised the ques- tion today about whether we should pay people to donate their kidneys.


Among the many thorny moral issues that this throws up, a sig- nificant worry for many is that this financial incentive will only appeal to the poor, leading to exploita- tion.


Roff’s answer to this is to increase the sum offered per kidney to the equivalent of the average UK in- come, thus providing motivation for a wider socio-economic range of donors.


Yet, risking one’s health for a non- family member, or friend, is not something we normally do out of the goodness of our hearts. If we did, there would be no need to in- troduce ‘regulated paid provision’.


Thus, the reason for donating a kidney would be financial, and the people most in need of such compensation remain the poor, no matter how much you increase that amount. The people who would take part will be the ones who desperately need the money, enough to justify losing a body part.


Still, discussion of the issue can only be helpful in developing solu- tions that could work in the future. I just don’t think we’re quite there yet.


12/7/11 Affording it


Hospital trusts shackled to expen- sive, super-long-term PFI deals are struggling to deal with the necessary ‘payments’ now that the financial picture has changed and their incomes are unable to cope


As in so many other areas, this is a long way from the vision for the NHS being expounded until recently by Andrew Lansley, and reform-minded colleagues like Oliver Letwin. They look like they will just have to live with that.


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14 | national health executive Jul/Aug 11


with such a large fixed cost on top of everything else.


This is hardly new, but the situa- tion has become particularly diffi- cult this year, as the PFI payments become a bigger drag on hospital trust funds, struggling to cope with reduced NHS spending and PCTs tightening their own belts.


Professor John Appleby at the King’s Fund has suggested that long-term structural changes to the organisation and spending power of the NHS are not quite as life-or-death as ministers have suggested, saying that if economic growth occurs at expected levels, spending would only have to go up by slightly more than it has on av- erage since the NHS’ founding to cope with a £230bn by 2030.


He is suggesting that the ‘afford- ability’ of the NHS over the next two decades is a political question, rather than an economic one – a situation in which some founda- tion trusts with PFI deals would love to find themselves in. Instead, they are very much boxed in by simple economics.


6/7/11 Money worries


NHS managers clearly don’t feel particularly protected by pledges on health service spending – pri- marily because of the immediate


need to find billions of pounds in efficiency savings.


Because this money will be re-in- vested, it does not represent ‘cuts’ to NHS spending, which is suppos- edly protected in real terms (just).


But that becomes somewhat aca- demic when the end result is still managers having to close facilities, reduce services and sack staff.


Nearly half of chief executives say the financial picture in the NHS is the worst they have ever seen: but ‘austerity’ has barely even started.


5/7/11 Caring about caring


We’re disappointed but not sur- prised that ministers have hardly rushed to embrace the Dilnot re- port with open arms. The concern really does seem to be about the cost, with Cabinet figures telling journalists that they truly are hap- py with the ideas themselves.


But what on earth were they ex- pecting? The system is broken, and desperately unfair, and there needs to be a more sensible way of pooling the ‘risk’ as regards the potential costs of people’s social care. It can vary from basically nothing into the millions, and very few people can do anything sen- sible, whether through saving or through insurance, to prepare


for it. Dilnot’s proposals mean people never have to lose every- thing they own to deal with the unexpected cost of long-term care, even though those with assets will still have to contribute a sizeable amount.


He has the backing of virtually ev- eryone in the sector, it seems, and has highlighted himself how the extra few billions pounds a year needed are only a fraction of a per- cent of government spending.


The Coalition needs to find the money to do what the man says.


13/6/11 As political as it gets


Many leading commentators note this morning that Andrew Lans- ley’s dream of taking the politics out of the NHS, leaving virtually all decisions in the hands of local- ly-accountable commissioners and regulators instead of Cabinet min- isters, has been quashed.


And it has been done in a way that has turned the NHS into one of the very biggest political stories over the past few months, sidelining the Health Secretary himself and exposing further divisions in the Coalition.


Assuming that BBC political editor Nick Robinson is right and that the Health Secretary will in fact keep the legal obligation to “provide or secure” healthcare, ministers rath- er than GPs or local boards will re- main the ones accountable to the public for the major decisions on NHS care.


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