Wednesday, March 23, 2005


Hospitals across the country are running up huge debts despite the billions of pounds of extra funding going into the NHS, figures seen by The Times reveal. The official government statistics show that at the end of the last financial year, nine hospital trusts had deficits of more than 10 million pounds, 14 had deficits of more than 5 million pounds, and another 39 of more than 1 million pounds. Overall, almost one third of all NHS trusts were in deficit, with the total standing at more than 350 million pounds. However, experts believe that the situation now might be even worse, with many hospitals having to cancel operations, shed staff and close wards to try to claw back money before this financial year ends.

St George's and Hammersmith hospitals, in London, have already closed beds, while Leeds Teaching Hospital announced plans to shed 230 beds and four operating theatres. Airedale trust, which is predicting a 2.9 million pounds deficit, has had to cut some non-urgent surgery while South Tees trust with a debt of 25 million pounds, admitted that it was now increasingly hard to balance the books. "In recent years we have gone from a situation of being able to balance the books year on year to one where we have to effectively borrow from next year to try and balance this year's books," managers wrote in a special staff briefing. Experts said that the deficits were the result of hospitals expanding too fast to try to cut waiting times. They also overestimated the amount of money that they would get from central government, and underestimated the cost of implementing the new consultants contract.

The disclosure has caused a political storm just a day after Gordon Brown put Labour's handling of the public services at the heart of its election campaign. "Despite the hard work of NHS staff and billions of pounds worth of taxpayer investment, resources are being wasted and swallowed up by additional bureaucracy and the pursuit of government targets," Andrew Lansley, the Shadow Health Secretary, said. "Eight years ago, Mr Blair said it would be `24 hours to save the NHS', but today more than one in three hospitals is in deficit, resulting in closed wards and cancelled operations."

The Liberal Democrat MP, Edward Davey, who received the figures as part of a parliamentary answer, added: "These startling figures show that Labour has failed to get the extra health cash to the frontline. "As hospitals struggle to break even, it is operations that are being cancelled and nurse vacancies that are not being filled."

However, a Labour spokesman said that the deficits needed to be seen within the wider perspective of NHS growth. "These deficits are a tiny proportion of overall NHS spending. The very worst thing that could happen to the NHS is if we had a Tory government which would immediately take 1.2 billion pounds and use it to subsidise the private medical insurance of the wealthy few."

The biggest deficit of all was recorded by the North Bristol NHS Trust, at 48.7 million pounds. Royal United Hospitals Bath recorded a deficit of 26.7 million pounds, while Worcestershire Acute Hospitals owed 23.8 million pounds.

Nigel Edwards, of the NHS Confederation, which represents health service managers, said that hospital deficits this year were likely to be higher, but not uniformly. He added that the crisis differed from those in the past, when there was simply not enough money. "This time it is the result of over-expansion, combined with some fierce cost pressures" he said. "Many hospitals have expanded too fast and got ahead of themselves, while others underestimated the cost of the consultants contract."

A spokeswoman for North Bristol NHS Trust said: "This is a historical deficit and a permanent solution is being sought. "In 2003-2004 the trust achieved a break-even position after making savings of 16 million pounds against the previous year's deficit. This year we plan to deliver a savings plan of more than 19 million pounds. Staff have worked extraordinarily hard to deliver these saving. The number of agency staff shifts has been cut to 200 this year, compared with 5,200 in 2002. Five per cent of services in administrative and corporate departments such as human resources have also been cut."

The hospital with the second-largest deficit, Royal United Hospitals Bath, said that it hoped to avoid any cuts to pay off the deficit. "The expectation is that this deficit will not need to be repaid," John Williams, finance director of the trust, said.

From The Times


Patients across Australia are waiting longer than ever for elective surgery, despite governments pouring hundreds of millions of dollars into the hospital system to cut waiting times. The average time to wait for some of the most common procedures, including cataract removal and hip and knee replacements, has lengthened in most states over the past two years. Figures obtained by The Australian show the average waiting time for a knee replacement increased by more than a month in South Australia and the ACT to 160 days and 204 days respectively. Surgeons are calling for the health system to be restructured, warning that more funding alone will not fix the problem. "Governments are trying to make an unworkable system look good," said Don Sheldon, associate professor of surgery at the University of Sydney.

State governments are estimated to have spent more than $240 million in the past two years to cut elective surgery waiting times. The average wait for a total hip replacement blew out from 107 to 132 days in South Australia, 136 to 154 days in the ACT, 48 to 52 days in Queensland and 113 to 127 in Victoria. In New South Wales, almost 17per cent of patients who needed surgery to repair a perforated eardrum waited more than a year; in South Australia, 23 per cent waited more than a year. Health ministers in Tasmania, Western Australia and the Northern Territory would not release the 2003-04 figures. Waiting times improved most significantly in NSW and Victoria. However, the 2003-04 statistics, which will be released in May, reveal that across most states waiting times increased more often than they fell.

Professor Sheldon said operating theatres remained closed and beds lay empty as public hospitals struggled to cope with greater demand for health services. "There's a lot of rearranging of deckchairs on the Titanic, but we need to look at what's causing the problem."

Australian Healthcare Association executive director Prue Power, whose group represents public hospitals, said waiting times would remain lengthy until the system was restructured to allow greater analysis of how money was being spent. The states and territories spend $7.5 billion a year on public hospitals. Modelling by the University of Canberra calculated that giving one tier of government sole responsibility for health would reduce duplication and save $1billion a year, Ms Power said. "While there are two levels of government (that are) funding the health system, they will always blame each other. It's not transparent and there's no way to really track the money." Ms Power said policy makers were underestimating the strain the ageing population had put on public hospitals. "People are living longer and technology is improving so that we can put prostheses into the hips and knees of elderly patients and that obviously increases costs."

University of Adelaide professor of surgery Guy Madden said older patients in particular were waiting longer for elective surgery. "The resources are being dragged into the more urgent areas, and patients waiting for elective surgery to treat degenerative conditions are waiting longer, and they are often older patients," he said. Dr Sheldon said the elderly often needed more expensive treatment than younger patients. "Now you see people in their 90s having open-heart surgery and elderly patients are more likely to end up in intensive care. A bed in intensive care costs $2000 a day to run, compared to about $1000 a day for an ordinary bed in a public hospital." Hospital administrators were trying to treat more patients with fewer resources, he said. "Many smaller hospitals have closed and in some large hospitals you've got 450 beds doing the same work that almost 2000 beds were doing 30 years ago."

Dr Madden said limited access to operating theatres, rather than a shortage of medical staff, had led to the long waiting times. "I think we have the surgical workforce there in the majority of cases, but there is bed block and theatre block. "Some surgeons have only half a day a week access to the operating theatre for elective cases and that's not enough."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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