Dr Phil Hammond, broadcaster and GP returner in Bristol

H ave you had a 'please don't get ill today' letter from your local hospital? It goes something like this: 'Our hospital(s) is (are) struggling to cope with increased demand. There are high levels of sickness among medical and nursing staff, and you may, therefore, face problems admitting patients. Please consider referral to intermediate care, district nursing teams, community matrons, and specialist nurses for support during these difficult times. Yours sincerely, Clinical Co-ordinator, Medical and Elderly Re-Design Programme.'

I wish I was making this up, but PCTs really do have an elderly re-design programme, which sounds like a short skip away from involuntary euthanasia. Interesting too that staff sickness is always to blame, rather than a lack of capacity. Surely if there was a killer virus doing the rounds it would have wiped out the community care team as well as hospital staff? And even if the community team was still functioning, I doubt its members could cope with a burst appendix, stroke, heart attack, or gangrenous foot.

In the obscene haste to balance the books in time to save ministerial careers, hospitals have been shorn of beds and staff. I know this because I spoke at a meeting for hospital 'turnaround teams', which are employed by leading firms of management consultants. As one team leader put it, 'We like to go onto a burning platform.' This all sounds a bit macho to me. Instead of offering preventive financial husbandry, a hospital has to get into dire straits and then someone rides in on a charger, decreeing that everything can be treated as a day-case now so we don't need any wards. But am I being unfair?

'Not entirely. Although we're there to make sure money isn't wasted, many of our suggestions involve better use of beds and that inevitably means you need fewer beds. And that may also mean you need fewer staff, so we're not always terrifically popular.'

You don't say!

So, is the NHS in any worse shape than other health services? It's a question we'd all like the answer to, but most of us don't have time to go sniffing around Sweden or San Diego. According to my turnaround insider though, just about every health service in the world is unsustainable in its current form. Increasing demands, rising costs, uneven quality, and misaligned incentives will apparently combine to overwhelm every single one and cause devastating health problems for those who use them. And the solution? 'Send in the turnaround teams.' Now why didn't I see that coming? But I had the last laugh.

'Tell me, in your two day turnaround conference, how often have you mentioned mental illness or care of the elderly?'

'Er…. Not at all.'

As I suspected, turnaround teams prefer dealing with the easy stuff you can stick a tariff on and which drives a profit, rather than the huge complexity of morbid suffering and difficult chronic illness. Nothing can turn around the tide of long-term care of the elderly, with the possible exception of bird flu or euthanasia. And you don't need a large firm of accountants for that. Meanwhile, the GP will be left with all the stuff that hospitals no longer want to deal with (e.g. acute care, poor people, and anything vaguely non-surgical).

You think I'm exaggerating, but the more we adopt the American model, the more we experience its side-effects. The practice of 'hospital dumping', where unprofitable patients are discharged to the skid row sidewalk, often only in their socks, is apparently widespread there. If we ever start doing this, the NHS is truly deceased.G