Up to 5,000 beds facing axe in NHS cancer shake-up

The government plans to close up to 5,000 beds on cancer wards in a reorganisation of the way patients are treated, according to a report by experts in the disease. Government figures show the National Health Service aims to save up to 500m pounds a year from an “inpatient management programme” that it describes as preventing unnecessary hospital admissions and reducing the length of time patients spend in hospital. Cancer doctors and health economists say the changes could make better use of money for cancer treatment but accuse the government of hiding the extent of the bed closures from the public.

The report by Nick Bosanquet, professor of health policy at Imperial College School of Medicine, London, and Professor Karol Sikora, medical director of CancerPartnersUK, a private cancer treatment company, comes as a shake-up of NHS hospitals, led by Lord Darzi, the health minister, is expected to include widespread closures of maternity hospitals and accident and emergency units.

Bosanquet and Sikora have analysed figures published by the government as part of its Cancer Reform Strategy in December. They reveal the efficiency savings the NHS will need to make in order to pay for better radiotherapy and screening programmes. “My worry,” said Sikora, “is that the only way the Cancer Reform Strategy adds up financially is by massive bed closures to produce the funding for the huge deficits in both radiotherapy and cancer drugs. “Up to 5,000 beds will need to disappear in England to make the spreadsheet balance. How else will the money be saved? Interestingly, the financials are not in the strategy document but hidden in an obscure corner of the Department of Health website.”

The government said cancer services must change so that patients can receive chemotherapy and radiotherapy during day trips to local clinics without going to hospital. It is also centralising specialist cancer care in larger hospitals where there is the expertise to get the best results. The government has been forced to review NHS cancer treatment after studies showed that, despite spending comparable amounts on the disease as other European countries, Britain still has some of the worst survival rates.

Bosanquet, who was chairman of the Cancer Reform Strategy value for money group, said cutting beds could make better use of NHS funds but added the government should be more open about its plans. “The Department of Health has put forward aspirations that must inevitably be to lower bed use in cancer services by around 5,000,” he said. “To save 500m, which is urgently needed to build up these community centres, they will need to reduce bed use in cancer services and the best estimate is that it would be by about 5,000 beds. I would urge the Department of Health to be a lot more open about it.”

Sikora maintained that while cancer patients can receive chemotherapy and radiotherapy during daytime visits to local cancer clinics some patients will be so sick they will need to stay in hospital. He said these patients did not need high-tech beds in large hospitals, which cost about 400 pounds a day, but could be cared for by nurses in cottage hospitals.

The Department of Health denied beds on cancer wards will be closed. A spokeswoman said: “We are not planning to close beds, rather we are identifying efficiency gains by using new models of care and streamlining existing inpatient care.”

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Australia: Public hospital closures have stretched waiting lists

QUEENSLAND Health's decision to shutdown one of the state's biggest cardiac surgery units in Townsville and to stop cataract surgery in Hervey Bay has aggravated a waiting list blowout that has worsened in the past three years, doctors said yesterday. The Courier-Mail reported at the weekend that elective surgery waiting lists have blown out by 15 per cent and lists to see specialists by 50 per cent in the past 1000 days since the Government promised to fix the health system.

Don Kane, the president of Salaried Doctors Queensland, said closing the Townsville cardiac surgery unit because of infighting among staff lengthened waiting lists by at least 200 patients a year. Queensland Health estimated the unit was doing 400 procedures a year. "What happened there was a failure of management," Mr Kane said. "The situation could have been fixed up in a short period of time. Closing the unit was totally unnecessary." Since its closure in November, Queensland Health has flown dozens of patients to Brisbane for heart surgery.

A spokesman for Health Minister Stephen Robertson said the unit was closed to protect the public. "Dysfunctional interpersonal relationships between key staff threatened the safe, sustainable operation of the service," he said. "This hard decision followed several ongoing attempts by local hospital management to rectify the situation." The spokesman said Queensland Health was in final stages of negotiations with an experienced surgeon and hoped to reopen the surgery "very soon." However Mr Kane predicted it would take up to a year before the unit reopened.

In Bundaberg, optometrist Ross Fisher criticised Queensland Health for "ditching" 48 elderly patients waiting for cataract surgery at Hervey Bay hospital. The patients, who had been waiting an average of two years for the surgery, faced starting over on new waiting lists. "They certainly ditched them. They were taken off the list and told they would need to get a referral to start again on another," he said.

One of them, John Kennedy, 76, said he was told he would have to wait another 18 months beyond the year he spent waiting for a slot at Hervey Bay. "I don't know whether I'm on a list or not. I'm in limbo. I'm in the dark," he said. Queensland Health categorises cataract surgery as non-urgent elective surgery.

The minister's spokesman said he was unable to provide details about the Hervey Bay cases. "We understand the frustration of some patients who do wait longer than desirable for their surgery," he said. "Ophthalmology in particular is affected by chronic workforce shortages right around the country."

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