An NHS commissioning group has proposed a temporary ban on non-vital operations in a bid to tackle funding problems.
St Helens Clinical Commissioning Group (CCG) in Merseyside could suspend all non-essential hospital referrals for four months during the winter.
The CCG’s lay chair, Geoffrey Appleton, said the group recognises the move “won’t be popular” but is facing a funding gap of £12.5m this year.
Appleton stated that the plan would “support hospitals during the busy winter period and allow them to concentrate on the sickest patients.”
Explaining the group’s situation in its Financial Recovery Plan, Appleton commented thus:
“Imagine our NHS budget is your household budget and every year the cost of living goes up but your salary doesn’t increase; the result is money becomes tighter and tighter. Now imagine another relative comes to live with you and because of their health needs are unable to work and cannot contribute financially. How would you manage?”
The CCG, which was recently rated “inadequate” by NHS England, is also suggesting a two-year suspension of IVF services for people aged under 37 and stopping provision of gluten free foods and some over-the-counter medicines.
The CCG said it hopes to save at least £2.5m by pausing non-urgent referrals to hospital, and claims that it is “under-funded” compared with other areas in Cheshire and Merseyside.
Dr Richard Vautrey, deputy chair of the BMA’s GP committee, asserted that the move “highlights the incredible financial pressure facing general practice and its impact on patient care. It cannot be right that the public will be effectively denied access to healthcare because the local CCG has run out of money.”
Vautrey also called on government ministers to “step up their commitment to resolving this crisis”.
“The cost to the health service of delaying referrals could ultimately be much greater in the long term as more complex and costly problems develop as a result,” Vautrey suggested.
The NHS England regional office will review the proposals before a decision is made because of the CCG’s inadequate rating.
An NHS spokeswoman indicated that deciding how to prioritise resources is “very difficult for commissioners, but CCGs must plan and manage demand over winter. St Helens CCG is actively engaging with its local population on the best way to ensure patients have their care prioritised over the busy months for the NHS.”
The proposals are under public consultation until 5 October, but will undoubtedly be controversial, as they effectively represent the rationing of NHS services which until now have been taken for granted.
Reports indicate that officials in the NHS have decided against purchasing thousands of operations from private hospital groups.
David Hare, chief executive of NHS Partners Network, which represents independent providers, indicated that private hospitals had offered to deliver 55,000 surgical procedures and 200,000 diagnostic tests in the last quarter of 2015.
Yet the decision has been taken to respect the public ethos of the NHS and prevent further commingling between the public and private sectors.
Of course, the decision has not been met favourably by the NHS Partners Network, and Hare has written to Jeremy Hunt on the matter.
Less than 1% of the total capacity was taken up, and there is certainly an argument to have private involvement in the NHS considering that the health service is failing to meet targets on waiting times.
December figures indicated that the NHS failed to meet the requisite target in this area, while numerous other targets were missed as well concurrently.
In his letter to the Health Secretary, the aforementioned Hare states that the situation is “clearly unacceptable that patients, carers and families are left waiting longer than necessary for treatment while capacity, available to NHS patients, continues to go unused”.
And Hare further seeks the assistance of the Health Secretary in the assessment process for “blockers for using all capacity across the NHS and we want to work with you and the national NHS bodies to reverse the declining position on waiting times across many parts of the NHS”.
Those who are sceptical of the position of the Conservative government on the NHS will no doubt believe that it is likely to be receptive to pressure to embrace public sector initiatives.
But defenders of the inclusion of private sector corporations in NHS operations will point to the efficiency of the private sector, and its ability to transform performance in the health service as a whole.
Commenting on the issue, Miriam Deakin, head of policy at NHS Providers, was keen to emphasise the contribution of private sector healthcare suppliers and companies to the NHS.
Deakin also suggested that there are fundamental problems in the health service that can be addressed by partnerships between public and private sector organisations.
“It is important to recognise that the capacity of the independent sector to meet this need does vary across the country”.
However, a spokesperson from the Department of Health defended with the performance of the health service, and the decision of the government to decline of the private operations in question.
“The NHS is performing well — this year carrying out record numbers of operations and dealing with more diagnostic tests than ever.”
Statistics indicate that the target for routine operations in England – which include such procedures as working on hips and knees – has been missed for the first time since the figures have been collated.
At the end of December, 91.8% of patients on the waiting list had been waiting less than 18 weeks.
This is marginally less than the target of 92% that was put in place in April 2012.
It is possible that the junior doctors strike, which was scheduled for 1st December, had a significant impact on the figures.
Although this strike was ultimately terminated at the eleventh hour, many hospitals had already cancelled operations, and it is likely that this pushed the figure under the 92% benchmark.
The NHS England statistics show that at the end of December the number of patients waiting to start treatment for routine operations was just under 3.3 million and of those, 755 people had been waiting for longer than 52 weeks.
However, the 92% target to treat patients within 18 weeks was missed in a variety of other areas.
This is far more common than with routine operations, but will nonetheless be considered concerning for the NHS as a whole.
The targets were missed in the following medical areas:
Plastic surgery – 87%
Neurosurgery – 87%
General surgery – 88.6%
Oral – 91.2%
Ear nose and throat – 90.8%
Cardiothoracic – which relates to the heart and chest or lungs – 88.7%
Responding to the figures, an NHS England spokesman not unreasonably pointed out that the figures were actually rather good, even if they do not meet the targets set for the NHS by the government.
“Hospitals continue to treat more than nine out of 10 patients within 18 weeks of their referral. More than 1.14 million patients started consultant-led treatment in December and the total number of patients referred in 2015 is up 4.1% on the previous year.”
On the other hand, it is noticeable that there has been an increase of over 10% in delays in 2015 compared with the 2014 calendar year.
This must be seen as disappointing, and possibly could be indicative of the financial issues that the NHS is facing.
The Royal College of Surgeons drew attention to this declining situation, and its president Clare Marx indicated that fiscal causes must be addressed if the situation is to improve in the future.
“In surgery, performance has been particularly affected for operations such as hip and knee replacements. Delayed treatment is extremely distressing to all patients. It is welcome that the government has promised extra money in the comprehensive spending review but we also need a long-term sustainable plan to address the increasing numbers of patients needing surgery.”
The NHS spent over £9 million in damages over botched operations in the last 12 months, which compares extremely unfavourably with the same figure from just a few years ago.
Back in the 2010/11 financial year, the NHS paid out just £3.2 million pounds over this issue.
In total, failures by private contractors have cost taxpayers nearly £33million in damages in the past five years – almost £52 million including court costs.
The figures were uncovered by the Labour MP Roger Godsiff, who was understandably highly critical of the amount of money being paid out due to major mistakes.
“It is unacceptable people’s health and even lives are being put at risk by the failed experiment of privatisation. It is simply not possible for companies to make what they regard as an acceptable profit unless they undercut on safety standards and provision for emergency care, leaving the NHS to pick up the pieces for poor or dangerous care.”
Godsiff also suggested that the government was unduly protecting the private sector with its existing policy, and that the NHS should acquire new rights that don’t apply currently.
“The NHS should, at the very least, have the powers to recoup costs resulting from private contractors’ ineptitude.”
But the Department of Health moved to defend the current procedure, suggesting that the existing regulations are stringent.
A spokesman on behalf of the department commented that “patients deserve the safest and best care at all times, and all organisations are subject to the same strict regulatory regime.”
This issue is a particular political hot potato, as Health Secretary Jeremy Hunt has already indicated explicitly that he would prevent agencies from “ripping off the NHS” in this manner.
Yet it seems that the amount of money being paid out owing to this situation has trebled in a matter of just five years.
Agency spending is one of the biggest costs to NHS trusts and is putting increasing pressure on the health service’s finances.
In capping the amount that can be paid out to agencies via fees, Hunt claimed that he would save the NHS £1 billion by the end of the decade.
Indeed, numerous money saving schemes have been put forward over the last few years, as the NHS attempts to achieve efficiency savings of £22 billion by 2020.
The new hourly price cap was introduced for all types of agency staff, in addition to the nursing cap announced in June, ending the practice of some agencies charging up to £1,800 for a standard shift for a nurse and £3,500 for a weekend shift for a doctor.
Analysis of the NHS Litigation Authority’s (NHSLA) financial accounts for 2014/15 indicate that the NHS has earmarked over £20 billion for potentially botched operations.
The health service is forced to make millions of pounds worth of damage to patients inadvertently harmed by medics every year.
Yet even those with a working knowledge of the health service would be surprised by the vast number discovered by analysis.
It has been found that the £28.3 billion figure figure consists of £12.3 billion for outstanding claims, and £16 billion for claims expected to be brought against the NHS over the next five years and beyond.
This represents a 70% increase compared to the sum that was projected back in March 2011.
Critics of the way that the NHS operates will point to the fact that this figure is almost entirely equal to £30 billion worth of savings that the NHS has been told to target.
Considering the vast scale of the financial figures involved, it is perhaps not surprising that several organisations have been motivated to comment.
In particular, the Patients Association suggested that the huge £28 billion figure that has been set aside for clinical negligence expenditure indicated that hospital trusts across the UK have failed to learn from previous mistakes.
And Heidi Alexander MP, Labour’s shadow health secretary, also commented strongly on the issue, asserting that the £28 million figure “should ring alarm bells in the Department of Health”.
Meanwhile, Labour’s shadow health minister Justin Madders MP said the figures “provide further evidence about how patient care has gone downhill under this Tory government”.
Helen Vernon, chief executive of the NHSLA, attempted put a positive spin on the issue.
“Care in the NHS is very safe. However, occasionally things go wrong. When they do, the NHS LA’s role is to make sure that patients receive fair compensation and to help the NHS to learn from the event so that it does not happen again in the future. Sometimes, where a patient needs long term care, these costs can be very high.”
Vernon also explained why the figure associated with clinical negligence is so high, and suggested that the reports on the matter are somewhat misleading.
“The ‘provision’ of £28.3bn held for these cases represents an estimate of the cost of incidents going back to when the NHS was first formed which have yet to become claims for compensation as well as agreements to pay the costs of care for life on settlements which may stretch decades into the future.”
Nonetheless, many people will read these reports with alarm, considering that it has already been reported that the NHS will face a deficit of £2 billion by the end of this year.
With major logistical issues and staffing arguments taking place over junior doctors’ contracts and nurses’ bursaries, the last thing the government and indeed the NHS needs is another storm over clinical mistakes.
Official figures have indicated that as many as 15 operations are being cancelled by the NHS in Scotland every day.
A report into the situation suggested that the cancellations can be attributed to a lack of capacity and resources.
Research conducted by the Scottish government indicated that in the region of 3,000 operations were postponed by hospitals in the six months until October.
Commenting on the issue, the Labour Party’s Jackie Baillie suggested that the existing situation is completely unacceptable.
“Our NHS is our most valued public service and it needs to have the resources to deliver the care Scots need. These figures are absolutely shocking,” Baillie stated.
Baillie also asserted that the Scottish government had failed a health service that is hugely valued in the nation.
“Now more than ever we need a health service free at the point of use based on patient need, not the ability to pay. Our NHS is our most valued public service and it needs to have the resources to deliver the care Scots need. These figures are absolutely shocking, and point to an NHS not getting the support it needs from the SNP government.”
Despite the concerns of the Labour opposition, the Scottish government insist that operations in Scotland which feature the highest clinical need are always prioritised.
Meanwhile, those of a less serious nature are rescheduled for the earliest possible opportunity.
But there is already considerable evidence in Scotland that the NHS has insufficient resources.
The 2015 NHS staff survey, published earlier this month, showed that one-third of workers did not think they had the resources to do their jobs adequately.
Baillie made reference to this situation in her statement to the Scottish parliament.
“Earlier this month only a third of NHS staff believed they had the resources and staff to do their jobs properly. Fifteen cancelled operations per day due to a lack of capacity show the reality of those concerns.”
Figures indicated that the number of cancellations in Scotland rose on a gradual basis from June.
This should come as no surprise considering the fact that the health service is more incumbered in the latter months of the year, owing to winter backlogs.
The NHS in Scotland faces similar funding difficulties to the English health service.
Finance secretary John Swinney announced £500 million of extra funding For NHS Scotland in his most recent budget, but this merely prompted accusations that Scotland is lagging significantly behind the rest of the United Kingdom.
Yet the Scottish government claims that the number of cancellations were relatively paltry compared to the total operations conducted, and also that clinical motivations were really involved in the ultimate cancellation.
“A very small number of operations are cancelled for non-clinical reasons. Health boards work to ensure disruption to patients is always kept to an absolute minimum, and any postponed procedures will be rescheduled at the earliest opportunity. We are clear with boards that operations for patients with the highest clinical need should not be cancelled.”
It was also pointed out that patient cancellations are by far the biggest cause of operations being rescheduled.