Inside the NHS

NHS organisation, management and finances are so Byzantine in their complexity – with various parts of the organisation competing with others they are supposed to be collaborating with – that even NHS employees are bewildered. The Department of Health in

NHS organisation, management and finances are so Byzantine in their

complexity - with various parts of the organisation competing with others they are supposed to be collaborating with - that even NHS employees are bewildered.

The Department of Health in Whitehall runs a series of regional strategic health authorities (ours is now the East of England one, but until recently covered Norfolk, Suffolk and Cambridgeshire).

The SHAs oversee primary care trusts (including Cambridgeshire though, until last month, Huntingdonshire had its own acute hospital trusts, mental health services.

The PCTs do not just buy GP and NHS dental services but run other activities on hospital sites. At Hinchingbrooke, for example, Cambridgeshire PCT is responsible for the special care baby unit and the replacement for Holly, the children's ward, due to open next year. It also looks after healthcare and social care for older people.

Then there's the funding.

Parliament votes the NHS hundreds of billions of pounds every year. The money goes in the first instance to the Department of Health, which allocates it to the SHAs.

Since the number of SHAs was reduced last summer, each now covers a wider area. So the money available for healthcare in the East of England assumes that a patient in Wistow is as likely to fall ill as one in Luton. Then the SHA allocates its funds on a similarly crude, though slightly more targeted, basis.

The result is that Cambridgeshire PCT does not have enough money to pay for all the consultations and operations that take place at Addenbrooke's, Hinchingbrooke and Papworth.

But Addenbrooke's and Papworth are "foundation" hospitals, which means they get paid for whatever they do leaving non-foundation hospitals, such as Hinchingbrooke, to do the work without knowing until the year-end whether there will be enough money to pay them.