Coronary artery bypass grafting for the reduction of mortality: an analysis of the trials

Economies in the NHS SIR,-If Mr Fowler is keen on economies in the NHS he should look no further than the Welsh Office where before DHSS circulars are forwarded to family practitioner com- mittees, district health authorities, local medical committees, community health councils, etc, they are retyped on Welsh Office stationery.The Welsh Office also changes the reference numbers and dutifully corrects references within the circular so that it conforms to previous Welsh Office modi- fications to old DHSS circulars.The result of all this bureaucratic nonsense is unnecessary expense, delay, and chaos.We frequently learn of changes to regulations in the medical press but are then informed by the Welsh Office that these changes do not apply to Wales until the appropriate circular has been released.During reorganisation some of these circulars were delayed for up to six months.About six years ago, as an LMC secretary, I received, with a covering letter from the FPC, a photostat of a letter from the DHSS to the Welsh Office, a photostat of a letter from the Welsh Office to the FPC, and a modified Welsh Office circular, informing us that the drug tariff book would be delayed through lack of paper.The recent circular concerning the new regulations controlling barbiturate drugs, which came into effect on 1 January 1985, was not received by our FPC for redistribution until 15 January 1985.As usual, chaos reigned as pharmacists were refusing to dispense prescriptions issued before we were notified of the regulation change.As all DHSS circulars refer equally to England and Wales, there would be a resultant increase in efficiency and reduction in ex- penditure if all these circulars were sent out directly by the DHSS.No doubt similar economies could be made in Scotland and Northern Ireland.