Sir — We are unlikely to escape nonsense like the Primary Care Trust's proposal to pay doctors to reduce the number of referrals (Report, October 10) until NHS executives in the PCTs and the Strategic Health Authorities have the courage to speak up when Department of Health's instructions do not reflect the realities of providing healthcare.
For instance, Government policy allows patients to choose the hospital where they wish to be treated. In the case of orthopaedics so many choose the Nuffield Orthopaedic Centre that the PCT finds it difficult to pay the bill.
Why? Partly because the DofH requires them to pay the Independent Sector Treatment Centre, at Banbury, whether patients choose to be treated there or not. The ISTC is a well-built and well-run centre, but the department shields it from level playing field competition. It cherry-picks straightforward cases and does not have to publish infection rates.
There are other examples of confusing and contradictory practices.
Hospitals must care for patients now, train staff for the future and do research to improve patients' care. The PCT is only charged with paying for present care. Credit where it's due, the PCT has "sold off" some of Banbury's surplus capacity to the South-western SHA to reduce Oxfordshire's losses. How much better things would be if the administration of the NHS were simplified and more coherent.
Geoff Feasey, North Leigh
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