1 JUNE 1991, Page 23

LETTERS Doctor in distress

Sir: You appear to believe that the NHS is overmanned (Leading article, 4 May), staffed by inefficient and unskilled workers and overburdened by non-productive staff. You seem to think that the totally untried, and untested, NHS reforms will produce `financial accountability'. Odd, therefore, that when questioned by the Parliamentary Select Committee on Health on the costs of the proposed reforms the then Secretary of State could give no data whatsoever, and received a rebuke from the Chairman. The NHS reforms are based largely upon a system now operating in the USA except that the NHS will continue to be funded from taxation whereas USA health care is mostly funded from insurance premiums.

The administrative costs of NHS hospit- als in 1984 accounted for 6.9 per cent of total budget whilst United Kingdom pri- vate hospitals spent 18 per cent on adminis- tration.

The administrative costs of all health care in the United States rose by 37 per cent in real terms between 1983 and 1987 and the trend is continuing upward.

An article in the New England Journal of Medicine this week calculated that admi- nistration alone will consume one third of all health care spending in the United States by 2002. Why should any sane person with the interests of the health of the UK population want to change this?

In my own hospital (NHS), opened 10 years ago, the budget for medical records (a part of administration which includes medical secretaries) has barely risen at all in real terms whilst the numbers of duties and discharges has risen by 10 per cent every year.

It really is astonishing that you and the Government call for 'value for money' without beginning to evaluate the costs and possible benefits of the proposed reforms. The change from the present NHS costs to those necessary to implement internal mar- kets and contracts (7 to well over 20 per cent) cannot equate to less than £4 billion or £5 billion, a non productive burden clearly intended by the Government to be found our of patient care.

The NHS Reforms are untried and uncosted and are being implemented at breakneck speed. In every respect except one they are exactly like an old-style Soviet five-year plan, based on right-wing rather than Marxist dogma. No mention of a Gulag archipelago. When you read the White Paper yourself, let me know if you found it.

Roger Hole

Consultant Surgeon, Wynd House, Hutton Rudby Farm, Yorkshire