If Noel Plumridge is correct and the days of ‘payment by results’ in the NHS are numbered, then watch out for unintended consequences (‘Clinical trials’, November 19).
Compared with the old cash limits, providers are now given incentives to provide health care rather than not; are covered for full costs rather than expected to provide it at a loss; and fair competition with the private and independent sector are facilitated.
There will always be questions about what the right price should be. But to throw the baby out with the bathwater will return the NHS to a ring-fenced rump capable of balancing its budgets only by putting a moat round itself and carving out local deals at the expense of the patient. The future of payment by results is not a minor technical issue but strikes at the heart of the future course of the NHS.
Roger Steer, Healthcare Audit Consultants, Gravesend, Kent
