Intended for healthcare professionals

Rapid response to:


Debt ridden trust has no cash to pay creditors

BMJ 2005; 330 doi: (Published 16 June 2005) Cite this as: BMJ 2005;330:1410

Rapid Response:

Health is not a business

Here, hidden away in a so far unremarked news story, is the problem
for national health services worldwide. This Trust has no money to pay its
creditors, but:

... the report also paints a picture of a trust that, instead of
achieving financial balance, focused on the quality of its clinical care
and achieving all clinical targets. The trust's unit costs for a wide
range of NHS treatments, such as the cost of operations, are 90% of the
national average. The trust's chief executive said that for too long its
funding had been below the cost of actually providing services.

Providing treatments is a complex matter, and it is unlikely that any
sort of costing will be appropriate in all places, even if worked out with
the best data and with the best of intentions. When you are running a
sweet factory, then the more you sell, the more money you have. When you
are providing health care, the more patients you have, the more you have
to treat, whether you have the money or not. No health system will ever
get this right, and governments - if they have any humanity - will always
have to bail out bankrupt hospitals.

Independent treatment centres deal with simpler calculations for
their simpler procedures. This will make it even more difficult for NHS
Trusts to balance their finances.

I am not a health economist. Maybe I am being simplistic, but surely
there is a way of running the finances of our hospitals so that they can
pay for their stationery without fear of having to turn patients away.

Competing interests:
None declared

Competing interests: No competing interests

23 June 2005
Neville W Goodman
Consultant Anaesthetist
Southmead Hospital, Bristol, BS10 5NB