Bigger may not always be better

From the archive, first published Thursday 16th Mar 2006.

DESPITE feelings to the contrary expressed by focus groups, plus the eyebrow-raising reality that the consultation period has not yet run its course, it looks as if health chiefs have decided that a proposed major shake-up is all but done and dusted.

It is not easy for the man or woman in the street to become animated by such bureaucratic concepts as primary care trusts, yet their importance in the running of the health service should not be underestimated. For it is almost certain that this area will soon be served by a single PCT to take the place of the three existing bodies - whether or not this achieves the saving and efficiencies that the NHS is increasingly expected to deliver remains to be seen.

All this comes in the wake of Government proposals to change the way it allocates funds. The Department of Health is keen to support a system based on payment by results. There is nothing wrong with a certain element of carrot and stick in our working lives, but this newspaper is not happy about any incentive that might, in some circumstances, rebound on the patient - the person who is often literally at the sharp end. The possible loss of £13m locally due to allocation changes also fails to inspire us with confidence.

Nationally, we are told that £250m needs to saved, and this is being cited as a major argument for a single trust for Worcestershire. However, the public will ultimately be judge and jury in this matter - and the court has not even convened.

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