Sir, The abolition of competition among NHS hospitals is long overdue (News, Feb 22). The “internal market” introduced within the NHS in 1991 was intended to drive down costs and increase choice, among other things. In fact it was inefficient, costly, resulted in a proliferation of managers and was potentially harmful to patients, as well as many other problems.
Smaller hospitals wanted to introduce money-raising procedures for which they had neither the staff nor equipment, procedures usually performed by larger, more experienced tertiary centres. This resulted in duplication of expensive equipment, inexperienced staff doing procedures for which they did not have enough training and ultimately a risk of patient harm. A few years ago I recall a local colleague telling me that his hospital needed to start a cardiology procedure “to balance the books”.
Fortunately, it has been realised that collaboration is highly preferable to competition. At last the damage started by the internal market is being undone. Patients can be directed to centres that are best at the task in hand, not the cheapest.
Dr David E Ward
Consultant cardiologist (ret’d)