ABCs of the National Health Service?

Factual Questions
1

Inspired by this Pit thread called Bureaucracy Gone Mad, and my conclusion that I was too ignorant to make a contribution to it

I want a better understanding of it structurally. There are several entities mentioned in the article that drew One And Only Wanderers’s ire. There is:
Ipswich Hospital
East Suffolk Primary Care Trusts
Department of Health
Ipswich Hospital NHS Trust (is this just another name for the hospital, or some separate entity between the hospital and the East Suffolk trusts?)
the NHS
the government

Can you help me flesh out the paths of money and decision making? Once the taxes are collected, do they go to these trusts directly? Some higher up entity that doles it out to the trusts?

The story in the link is about a trust refusing to reimburse a hospital for expenses incurred while treating patients “too soon”. The logic suggests the Trust is envisioning the whole nation as being on one Big List for medical services, and if this local hospital runs through it’s scheduled patients, it should be calling in patients from the Big List no matter how far away or inconvenient the access. If the Suffolk hospital treats patients faster and calls in more Suffilk patients, than the folks in Norfolk are being shortchanged. The hosptial itself, of course, doesn’t even have a copy of the “Big List” – they only have a list of who they’ve already treated and what followup work is scheduled. So they call in people off their Little List if it’s a slow week, and then get hammered by the Big List, Big Picture people,

But if the funding agency itself is regional, that theory doesn’t hold a lot of water. So how am I to make sense of this? It seems there must be some some kind of structural disconnect between sevice funding and delivery. It seems like there is almost no local autonomy in the system. What’s the deal?

2

The Department of Health runs the NHS, of which all trusts are components, and from which all PCTs receive their funding. The ultimate source of the funds is the Treasury, from general taxation revenue - there’s no specific “NHS Tax”.

In turn, the East Suffolk PCT supplies funds to the Ipswich Hospital NHS Trust (among others), based on terms agreed between the two. In the story, ‘Ipswich Hospital’ is being used as shorthand for the trust running it, partly because in this case the trust only is responsible for that one specific site.

(And ‘the government’, in this context, means high-level cabinet policy & decisions.)

It’s a ludicrously-complex system which has drained funds away from healthcare. And you’re right, that the idea that people shop around for the fastest service is nonsense, particularly in rural areas. In a free-at-point-of-delivery system, people want to be treated locally and conveniently. For me, Ipswich Hospital is a fifteen-minute bus ride away, whereas if I found I could get treated faster at the Norfolk & Norwich, it would involve a three-hour round trip by car.