Education And Debate

OxDONS syndrome: the inevitable disease of the NHS reforms

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7019.1559 (Published 09 December 1995) Cite this as: BMJ 1995;311:1559
  1. C B T Adams, consultant neurosurgeona
  1. Department of Neurological Surgery, Radcliffe Infirmary NHS Trust, Oxford OX2 6HE

    The financial demise of Oxford's department of neurosurgery (OxDONS) was precipitated by the financial rules of the reformed NHS. In particular it was produced by the failure of “resources to follow patients”; the requirement that “prices have to follow costs”; and the use of private income for revenue expenditure, not capital expenditure. This process will eventually affect all hospital departments, but it affected the unit in Oxford sooner as it started as “efficient”—that is, underresourced—and has depended on income from extracontractual referrals and private work. Current NHS accounting rules act as a disincentive to private income being generated in NHS hospitals, and consultants should be aware of this.

    Oxford's department of neurological surgery (OxDONS) has, I believe, a reputation for excellent care of patients, attracting them from all parts of Britain and elsewhere. Until 1994 it had no waiting list, and between 1972 and 1994 the numbers of patients treated increased from 600 to 2500 (fig 1). It has always been “efficient,” mainly because of inadequate resources. For instance, in Winyard et al's analysis of neurosurgical bed needs in England in 1981 we had the doubtful distinction of having the fewest facilities (table).1 Our situation reflected the difficulty of a regional specialty trying to obtain resources from a local health authority that was not particularly interested in regional services. Appeals to the region were met with the claim that the region gave the necessary finance to the local health authority—though without specifically earmarking them.

    Fig1

    Increase in patients treated since 1972 by Oxford's department of neurosurgery

    View this table:

    Provision and use of neurosurgical beds in Oxford in 1978 compared with the average for England

    We therefore welcomed the proposals in the government white paper that “resources would follow patients.” If we were successful in attracting more patients then more resources would presumably …

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