Adrian Butler looks at the arguments in the NHS
IN THE last week, the state of the National Health Service has risen to become one of the biggest campaign issues of the coming general election.
Margaret Dixon, from Penketh, near Warrington, whose shoulder operation was repeatedly cancelled, led to days of media coverage about the government's record on health.
It was played out across television and newspapers after Mrs Dixon told her local councillor, Fiona Bruce, a prospective parliamentary candidate, who, in turn, contacted Michael Howard, resulting in last week's combative Prime Minister's Question Time.
Now health Minister Dr John Reid has said that hospitals will effectively be fined for cancelling operations and failing to offer patients a new date for their surgery.
Currently, 67,000 operations are cancelled each year, or 0.8-0.9% of the total carried out.
However, from later this year, hospitals which fail to offer a new surgery date within 28 days of a cancelled operation will see patients transferred to a different hospital, with the cash following them.
The move is the final stage of the Government's programme to introduce greater patient choice into the NHS. Until now, NHS hospitals have been able to hold onto the cash to pay for operations whether they carried out the procedure or not.
The Government claims this puts the choice back into the hands of patients. Dr Reid said: "I am introducing choice, where you say to the local hospital on cancellations or anything else: 'I don't want to take it. I'm going to go somewhere else to get a better, quicker, faster operation."
But critics say this will just lead to more bureaucracy, with more money wasted on paying people to administer the system.
They'll be putting in another lot of administrators
NO SAYS Fiona Bruce Conservative councillor for Penketh and Cuerdly
WILL Labour never learn? Instead of helping professional doctors and nurses to get on with the jobs they are trained for, Tony Blair's Government is bringing in another raft of bureaucracy with another set of targets. They will be putting in place another group of administrators to manage this.
Fining hospitals will achieve nothing. While hospitals are fined for cancelling operations, less money will go to front-line patient care.
NHS spending has risen by over 30% in the last five years from 1999 to 2003. But only 5% more patients have been treated.
I run a small business in Warrington and if I incurred 30% more overheads and produced only 5% more productivity I would be in bankruptcy.
What has happened in the NHS has been that the extra money put in - our money - has been sucked up like a sponge into bureaucracy since 1997. The money managers have been recruited at three times the rate of doctors and nurses.
In Warrington, between 2002 and 2004, the numbers of doctors and nurses actually fell by 56 and the number of bureaucrats increased by 78. In the same period, the number of cancelled operations more than doubled. Setting up a system to fine hospitals would increase the bureaucrats even more.
Margaret Dixon wanted two things. She wanted her operation, which she had been trying to get for three months, and she wanted to highlight the fact that bureaucrats are taking clinical priorities instead of medics. I rang the hospital, wrote to the hospital and met people at the hospital. I was told the problems were not the hospital's fault.
They could do nothing about it because in the middle of last year, when she first needed her operations, it was clear that Warrington hospital needed more beds, but could not allocate funding for them - they had to wait for the Government to release it.
The bureaucrats are directly affecting Mrs Dixon's life. Her daughter Lindsay told me her mother was losing the will to live.
Of course her family have every sympathy with other patients who also need those beds. What they wanted to highlight was many doctors and nurses cannot treat patients as they need treating. What are we getting for all the extra money? There are still 67,000 Margaret Dixons in the country who every year, face having operations cancelled.
The average days spent waiting for an operation have increased in the last five years. Here in Warrington, the average waiting time has gone up from 103 days in 1999 to 126 last year.
The point we are making is that for these fantastic amounts of money things are not improving.
Instead of fining hospitals for cancelling operations, patients should be offered the choice to have private treatment right from the start. Under Conservative plans, the NHS would then pay half the cost of the operation. That would not be a case of hospitals being penalised. It would be a case of hospitals supporting one another.
Cancelling operations has a huge effect on people
YES SAYS Angie Weatherby, co-chair of CARES steering committee
I SUPPORT the idea of hospitals being fined if they cancel operations, but only in certain circumstances and depending on the reasoning behind the measure.
I'm in hospital fairly regularly with my four-year-old daughter Courtney, who is disabled and who needs a lot of operations because she suffers from brittle bones.
On one occasion, she was supposed to have an operation on a Thursday evening. It was cancelled and they then said it would be Friday, so we turned up again and it was cancelled again. Finally it happened on the Saturday morning. When we complained, we got told a whole lot of different stories.
To wait once for an operation is fair enough. Things do happen and you often cannot predict something happening if an operation has been booked to take place six months in the future.
But looking at some of the situations we have seen in the news recently, the hospitals involved should have paid some form of financial penalty.
If it happens for two or three times they should have to be fined. Cancelling operations has a huge effect on people.
If you have to work you have to plan everything in advance and you have to take everything into consideration.
If you keep taking time off work for appointments which keep being broken, your employers are going to get fed up with you.
And operations do not just affect the people who are being operated on. It is surprising how many people this affects. A lot of people make plans.
If it does not go ahead there should be some sort of penalty.
Often an operation will change a person's life.
My daughter had to have an operation on her spine which was going to transform her quality of living. It involved putting a metal framework like a Meccano set inside her.
But she had her operation cancelled three times, and it was detrimental to her life.
The Government wants to move patients to different hospitals.
But you have then got to look at the financial side of it for patients. How far away is the hospital?
Often, relatives have to travel there to visit. There are a lot of factors to consider.
You have also got to take into account travelling for the after-care after the operation.
It is people being able to visit. There are all sorts of different factors.
The reason why different hospitals are built is so there is a hospital for that borough. It is there for the boundaries that it covers.
It is unrealistic for the patients to have to go to another hospital.
If it's a patient's choice and the patient asks to go to another hospital that is different but they shouldn't have be forced to travel long distances.
Often patients will be moved from one hospital to another and then to another, so they have to travel even further.
In our case, we live in Southport but we then had to travel to Ormskirk for treatment and then to Alder Hey.