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Andy Jones: Sort this mess out, Patricia

The new year is a time for resolutions, and I have some for Patricia Hewitt who has now been in post for six months.

The new year is a time for resolutions, and I have some for Patricia Hewitt who has now been in post for six months.

First, sort out the NHS's financial chaos. Despite spending being boosted in the past year by £7 billion to £76 billion, the health service is facing deepening debts, last quantified as £760 million. A quarter of NHS organisations are overspent, and in fact the situation feels much worse than this. PCTs have employment freezes, and beds have been cut by secondary care attempting to rationalise costs to avert the threat of commissioning. The trouble being that the NHS works, at best, with an 85 per cent efficiency ratio, and around 55p in the pound spent on health care is swallowed up by staff costs and pensions.Second, follow the advice of a surgeon I once worked for who told me 'When operating, suppress all initiative'. What he meant was avoid too much experiment, complexity and change ­ a sort of clinical equivalent of too many cooks spoiling the broth.

'Care Outside Hospitals' will be the 38th upheaval of the NHS since its inception. Many earlier plans are working so badly, the last thing we need at the moment is more innovation. Too often politicians sound off with new ideas long before the fine detail has come anywhere near a piece of paper. If you don't believe me, look at the skimpy technical guidance on practice-based commissioning!

Third, apologise for the chaos that has been inflicted on PCTs this year. Since announcing PCT reconfiguration, there has been paralysis of decision making, as choices have been impossible until the new bodies have been determined. All difficult considerations have been deferred to the next financial year. Community staff were told they would have new names at the top of their pay cheques, only for that decision to be reversed. The Department of Health would do well to remember that frontline and administrative staff have families and mortgages just like everyone else. As a result, some very good people have left to work elsewhere.

In my view PCTs have been critically undermined in the past nine months at a time crucial to practice-based commissioning.Finally, end medical treatment by media. I don't want to see patients having to beg for treatment in the press. We need to appraise new treatments and technology properly and, if they gain approval, they should then be made available to everyone. It is not the job of politicians or PCTs to offer treatment as a result of heart-wrenching headlines.We are the fourth largest economy in the world. Let's reflect that in the quality of health care in 2006. Happy New Year.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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