Saturday, January 06, 2007

Operations cancelled as NHS runs out of money

Despite a huge but obviously mismanaged increase in funding, patients are being told to wait for routine treatment and casualty staff are being asked to turn people away

Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year, The Times can reveal. NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A&E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended.

In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under eight weeks. Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff.

The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24 million this year.

A letter from its chief executive, Janet Soo-Chung says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.

No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.

The trust also announced the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others. “We fully appreciate the difficulties that the introduction of these measures entail," Dr Soo-Chung's letter says. "However, the financial position of the PCT is such that there is absolutely no alternative to this programme if we are to avoid even more difficult decisions in the near future."

Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeks — expected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, told hospitals to work out how many patients could be deferred until next financial year, and said that the trust would not pay for elective operations on smokers until they had attended smoking clinics.

Andrew Lansley, the Conservative health spokesman, said: “The Labour project has proved utterly incapable of running our NHS. Centrally imposed initiatives and costly targets have plunged the NHS into a record deficit. The NHS needs greater freedoms at a local level to return it on a stable and sustainable financial footing.”

In a report published this week, the think-tank Reform said that NHS deficits were deepening. It called for a one-off repayment of debt followed by a more rigorous financial regime and immediate administration for failing trusts. But the idea was rejected by the Department of Health. On the delays to appointments and operations, a spokesman said it was a matter for the local NHS, provided that national targets were not breached. However, the department has not left it all to local managers but has introduced fines for hospitals that operate too fast. These can amount to millions of pounds.

Last year the NHS returned a net deficit of £512 million, a fraction of the total budget. But the scale of the problems was concealed by strategic health authorities saving large amounts of money largely by cutting education and training budgets.


37,000 job cuts needed to pay NHS salary bill

Office-workers are not separated out below but the last three categories below would contain at a guess up to half a million of them. Compare that with less than 70,000 doctors. How many sick people have office workers ever helped?

The Government is looking for ways of cutting the huge NHS salary bill to bring the service back into financial balance. Tens of thousands of job cuts and a three-year pay deal, starting with a low or zero increase for 2008-09, are strong possibilities, as the Department of Health wrestles with booming staff numbers and mismanaged pay deals.

Consultants, GPs, nurses and other NHS staff have all had pay increases, some huge, while a rise in staff numbers greatly exceeds that envisaged in the NHS Plan of July 2000.

Documents leaked to the Health Service Journal predict a sharp reduction in the workforce this year, cutting staff by 2.7 per cent, or 37,000 jobs.

Kevin Coyne, of the Amicus union, which represents many NHS staff, said: “This leaked document appears to confirm all of our worst fears. The report of job cuts runs counter to all of the Government’s claims about their commitment to the future of the National Health Service.”

NHS staff numbers have risen hugely in recent months. Patricia Hewitt, the Health Secretary, told the Commons Health Committee last year: “The NHS target for hospital doctors was to get to 74,590 by 2007. By 2004 the NHS was already employing over 78,000 hospital doctors and by 2005 over 82,000.”

Professor Nick Bosanquet, of the think-tank Reform, said: “For an organisation with a problem of financial balance and a pressing need to invest in new services, the recruitment of an additional 270,000 staff since 1999 represents a significant policy failure.”



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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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