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　　The commissioning group in Bedfordshire, for example, has bundled some 20 contracts formusculoskeletal care (treatment for things like weak knees and cracked hips) into one five-yearcontract that was won by Circle, a commercial health group. Far from fragmenting thesystem, as critics had feared, this has made Circle responsible for integrating the services oflocal providers. Patients will be told which are doing best. Circle and its partners must achievean agreed set of outcomes to receive some of their pay. Paolo Pieri, Circle's chief financial officer,expects the deal will not only improve care but save Bedfordshire some ￡30m($50m).

　　例如英格兰南部贝德福德郡的调试组，已把20余份关于肌肉骨骼保健(面向脆弱的髌骨和股骨骨折之类的治疗)的合同与一份五年期的合同相捆绑，这份合同被商业医疗集团Circle中标。批评家们曾经担心的医疗系统会分崩离析的问题使Circle必须负责，这能使Circle为本地供应商的集成服务负责。病人将会被告知哪个做的最好。Circle及其合伙人必须就后果及分利达成共识。Circle的CFO(首席财政官)保罗·皮耶里希望，这笔交易不仅仅能够改善卫生保健，还能为贝德福德郡留下约3000万英镑(约合5000万美元)的结余。

　　Not all commissioning groups are as bold. But perhaps a quarter are considering contracts likethe one in Bedfordshire, reckons Mr Pieri. Diane Bell, a doctor there, says more than 40 CCGshave contacted her group. “Every CCG I look at is doing brave and innovative work,” saysShane Gordon, who heads one inEssex.

　　并非所有调试组都能这般大胆无畏。皮耶里推测，约有四分之一的调试组正考虑像贝德福德郡那个一样签订合同。贝德福德郡的一位医生戴安娜·贝尔说，有超过40家临床调试组与她的团队签订了合同。肖恩·戈登在埃塞克斯郡领导一个调试组，他说“每个临床调试组在我看来都在从事勇敢无谓、富于创新的工作”。

　　The Labour Party—which launched a series of NHS reforms during its 13 years in power—saysthis sort of innovation was on the way anyway, and may have been delayed. Thanks to thegiant restructuring of the NHS “we lost two or three years”, says Andy Burnham, the shadowhealth secretary. He also criticises a regulatory regime that leaves many providers confused.Fair enough. But the reforms replaced bureaucrats with clinicians, which seems to haveencouraged creative thinking. Dr Bell was warned by an old hand that outcomes-basedcontracting would stir up a fight in her group. When she suggested it, though, the other GPsquickly bought in.

　　工党在其执政的13年间，曾颁布了一系列NHS改革，它称这类改革创新不管怎么说都已经在半路上了，还有可能推迟。影子卫生部长安迪·博翰讽刺，幸亏这次NHS巨大的改革让我们“浪费两三年”。他还批评监管制度让许多供应商迷惑不解。虽有道理，但是改革用临床医生代替了官僚分子，似乎还鼓励了创造性思维。贝尔医生曾被这行老手告诫这个以结果为基础的契约签订可能引起团队内讧。尽管当她提到了这个，全科医生还是被迅速引入了。

　　If Labour wins the next election, Mr Miliband might ground CCGs just as they are taking flight.Although he has no plans to restructure the NHS yet again, his laudable aim of integratinghealth and social care, which currently falls outside the NHS's remit, would probably shiftresponsibility to a different local body. Mr Burnham would also clip the wings of reformers bygiving NHS providers a built-in advantage in the competition for contracts.

　　下届大选如果工党获胜，米利班德可能搁置临床调试组，正如现在他们才刚刚起航。即使他没有再次重组NHS的计划，他值得赞赏的集成医疗社会保障计划目前还处于NHS的推迟项目，很可能把责任转移到一个不同的地方机构。博翰也会通过给予NHS供应商先天优势的方式，限制改革者在签订合同方面的竞争。

　　But the biggest threat to CCGs and what some of them are doing to improve services is notpolitics but whether they can move fast enough to keep in front of a funding squeeze, saysThomas Cawston of Reform, a think-tank. Though the NHS has been protected from the worstof austerity, it could fall short by ￡30 billion by 2020—the result of rising demand from agrowing elderly population. Sir David warns that without more cash, the service could tip intothe red next year.

　　智囊团Thomas Cawston of Reform称，对于临床实验组最大的威胁，以及其中部分改善服务所作的努力不是来自政治方面，而是他们是否可以发展的足够快是实验组一直保持在资金压力前面。尽管NHS被最糟糕的财政紧缩保护，但其资金到2020年还不到300亿英镑，这是不断增长的老龄人口日益增长的需求带来的结果。戴维·尼克尔森爵士警告道，没有更多的钱，这项服务明年就会陷入危机。

　　As money runs short, the real test will arrive. It could be an opportunity for health reformers.Or bureaucrats could panic and revert to old ways. Whatever happens, the next governmentwill not be able to duck the issue.

　　随着资金短缺，真正的考验即将来临。这对医改人士而言是一次机遇。那些官僚却可能会陷入恐慌，且想要回归老路。无论发生什么，下届政府都无法回避这一问题

　　重点讲解

　　1.seem to 似乎

　　例句:I seem to fritter my time away at coffeemornings.

　　我似乎把时间全都浪费在咖啡早茶会上了。

　　2.lead to 导致;引起;通往

　　例句:Politicians say it could lead to a dissolution ofparliament.

　　政客们说这可能会导致议会解散。

　　3.suppose to 认为是…

　　例句:You are not suppose to stay home during the weekend.

　　你不应该周末还呆在家里。

　　4.responsible for 为…负责，是造成…的原因

　　例句:I feel partly responsible for the problems we're in.

　　我觉得应为我们遭遇的问题负部分责任。

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