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For all the talk of care closer to home, hospitals always seem to nab the cash

The Department of Health's best intentions to direct resources at primary care services are being undone by its own policies

By Richard Hoey

The Department of Health's best intentions to direct resources at primary care services are being undone by its own policies

It's a little known fact that the law of unintended consequences was a phrase coined after a quick glance at Government health policy.

Or if that's not true, perhaps the Department of Health was purposely designed to demonstrate the law to be valid.

After all, a central tenet of DH policy is that services, and the resources that accompany them, should move from hospitals into the community.

Government ministers repeatedly trumpet this particular policy, even though it is being systematically - if accidentally - undermined by a number of their others.

We learn this week, for instance, that PCTs are facing overspends amounting to a startling £1.2 billion on acute hospital care.

NHS managers may have an array of targets to take into account, but one matters above all others, because jobs depend on it, and that's the need to avoid deficit.

So when trusts haemorrhage cash on acute care, you can depend on them sucking back resources from primary care, as some are already doing.

That sends resources flowing from primary to secondary care, the opposite of what is supposed to happen, but as they have done fairly relentlessly over recent years.

But why the overspend on hospital services? A good portion of the blame appears to lie with the Government's 18-week referral-to-treatment target.

Eighteen weeks was actually deliberately designed to avoid some of the unintended consequences from earlier targets that only covered part of the care pathway.

But it has nevertheless been enormously difficult and expensive to meet. Many trusts have only done so by playing some pretty imaginative games such as bans on internal referrals – forcing patients back to their GP and resetting the stopwatch back at zero.

Only, of course, that means GPs must make a new referral, and under the intricately complicated Payment by Results system the Government has created, a new referral is a new expense, and a new drain on PCT resources.

Two Government policies have conspired to render another – the shift of resources to community services – an empty aspiration.

Ministers didn't intend it to happen, but that doesn't mean it wasn't entirely predictable.

By Richard Hoey, Pulse deputy editor

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