NHS! New! Improved?
It's finally happened. This month sees the birth of the
new NHS. Three-quarters of health money will now go straight to the new
GP-run Primary Care Trusts (PCTs). Previously, only half went to the local
docs.
It's a New Era, the usual grey minister tells Jeremy Paxman. Local health
for local people. More choice. Efficiency and accountability. Responsiveness
and flexibility. Tea and buns.
Optimists in the HIV world hope the new structure may prove more opportunity
than problem. Fewer organisations, predicts health commissioner Will Huxter
(see News), but better
ones.
Let's hope he's right, and it's not fewer and worse.
The PCTs will still get cash proportional to their positive population,
but are under no compulsion specifically to spend it on HIV. Some, we
hear, have already grabbed it for other health education, pre-natal or
aerobics classes or whatever.
But that's not the biggest issue. What's more worrying is that the new
structure may turn out to be even more jobs-for-the-boys than the old
one.
Turn back a page and read the second letter from Jacquie Johnston-Lynch,
the manager of Sahir House, Liverpool's well-regarded HIV centre. They
get four times less money per service user than they got 10 years ago.
Yet the Aids budget has not shrunk during that time.
So where's it all gone? Let's scotch one myth. It's not all gone on HIV
drugs. When combo therapy first started, hospital trusts proved beyond
all doubt that it was cost-
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effective. Keeping people healthy with pills costs less than putting them in
