Full scale of Labour's NHS cutbacks revealed

The full scale of impending hospital closures was laid bare last night as it emerged that three out of four trusts are already restricting patients' access to treatment as they battle soaring deficits. Fears about the number of closures intensified as Patricia Hewitt, the Health Secretary, sent NHS managers a guide on how best to handle decisions to shut down hospitals and units - a document that opposition politicians immediately branded a "spin" blueprint.

At the same time, a survey of NHS trust chief executives revealed the impact of the health service's financial crisis on front-line care.

The survey, published in today's Health Service Journal, shows that 73 per cent of primary care trusts, which run GP clinics and health centres, are already restricting access to treatments. Half are also delaying operations.

Seven out of 10 chief executives said "patient care will suffer" as a result of short-term financial decisions to cut deficits, while 61 per cent of acute hospital trusts said they were already closing wards.

Almost half of all trusts said that they had made, or intended to make, redundancies this year.

Morale appears to be at rock bottom, with 86 per cent saying that managers were "battered and bruised" by endless reorganisations.

Miss Hewitt published her guide on closures amid growing panic in Whitehall about the looming public backlash as trusts across the country announce plans to cut services over the coming months.

But the opposition immediately accused ministers of "a cynical exercise" in spin as it emerged that the guide includes proposals on "media handling" and urges trusts to use words such as "adapting" or "evolving" services when talking about cuts.

Dozens of accident and emergency units, maternity units and community hospitals are facing the threat of being shut down or downgraded as part of the Government's plans to "reconfigure" the health service.

Many Labour MPs fear the cutbacks will cost them their seats, prompting four Cabinet ministers to join local protests against planned closures in their own constituencies.

In a covering letter to the guide - which has been sent to all 10 Strategic Health Authorities in England - David Nicholson, the NHS chief executive, said it was vital that managers did not "shy away from major service changes that address financial difficulties".

Miss Hewitt's new blueprint on closures, written by Sir Ian Carruthers, the former chief executive of the NHS, stresses that trust managers must do more to sell their closure plans to local people. The report conceded that closures would "lead to a loss of public confidence" and that reconfiguration had "become a euphemism for closures and downgrading of hospitals".

It argued that NHS managers could limit the damage by developing clear media strategies, using the right language and trying to get some senior doctors to back their plans.

Managers are warned that the media can often run "damaging" stories on closure plans.

"Effective media handling plans, regular engagement of local journalists, care in explaining the case for change and a strong local voice to challenge misleading media stories that worry patients unnecessarily can help mitigate this," it said.

Language is crucial and managers are urged to use words such as "adapting, developing, evolving and specialising. If a service is changing to improve the health outcomes for patients and save lives, this isn't a downgrading of the service."

Managers are also advised to argue that closures will be compensated for by better services in local health centres or GP clinics.

The new spin guide was condemned last night by the Conservatives and Liberal Democrats.

Andrew Lansley, the shadow health secretary, said: "Nothing in this long-winded document will offer any comfort. It is all about advising NHS bureaucracy how it can better sell decisions. It offers no real evidence for how services can and should be improved.

"The Department of Health should be less concerned with spin and more concerned with substance."

Norman Lamb, the Liberal Democrat health spokesman, said: "This is a cynical exercise and their cover has been blown. It demonstrates that despite claims that decisions are made locally, everything is driven from the centre. Even the spin is sent down from Whitehall."

Dr Mark Porter, the deputy chairman of the British Medical Association's consultants' committee, said changes in services needed to be about improving patient care.

"The BMA is not opposed to reconfiguration if it is done for good, sound clinical reasons. But we have been worried that finances and not patients' needs have been the driving force behind some plans," he said.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/01/nhosi01.xml

At the beginning of the new year (3 Jan 07) Health Direct warned that there were signs of NHS hospitals told to delay operations to ease health service's debt underfunding

The New Year has only just begun but it is clear that the next three months are not a good time to become ill as the NHS can not cope with Labour's underfunding of the health services as patients in some parts of the National Health Service are for the first time facing minimum waits to be seen and treated as managers attempt to balance their books.

Suffolk, Hertfordshire, North Yorkshire and Kingston are all imposing various forms of minimum wait, with some primary care trust chiefs saying their organisations may follow suit as the NHS battles to recover from last year's £536m plus overspend.

Only a week later (10 Jan 07) Health Direct posted that Maternity wards are having their cash cut amid boom in birthrate, say midwives

The NHS is responding to a boom in the birthrate by cutting spending on maternity services, the Royal College of Midwives said after a survey of more than 100 heads of midwifery in hospital trusts across Britain.

It found that two thirds of maternity units were understaffed and most were trying to save money by employing fewer qualified midwives and taking on maternity support workers instead.

Then on (1 Feb 07) Health Direct posted that Dental patients hit as dentists funding fails to add up

Dentists are turning away patients because miscalculations by the Department of Health have resulted in local health authorities running out of money in the dental budget. The problem has arisen because dentists have been treating more patients who are exempt from dental charges than had been anticipated under the new dental contract which came into force last April.

Then on Valentine's Day (14 Feb 07) Health Direct posted that it was the turn of the suppliesr to feel the financial squeeze- NHS paying bills late in struggle to balance books, say suppliers

The National Health Service is delaying paying bills and cutting orders for supplies as it tries to balance its books, according to the trade associations whose members supply the service with everything from scanners to diagnostic tests.

Ray Hodgkinson, director-general of the British Healthcare Trades Association, said that while the picture was highly variable "some of our members are having real trouble getting money out of NHS trusts".

More recently Labour's NHS Cash crisis hits sexual health STD clinics, then confirmation that MRSA and Clostridium difficile deaths up by half in year and cancer patients were also cut back in Hospitals told not to operate until cancer patients have waited 20 weeks


Only last week (Feb 22 07) Health direct warned that More trusts expect deficits as NHS spending cuts bite when around a quarter of primary care trusts are setting minimum waiting times for patients or otherwise slowing treatment, at least until the start of the new financial year.

Mr David Nicholson, the NHS chief executive, acknowledged that patients had been affected. But he said the service was still treating more people, and training cuts would be restored next year.

However, Andrew Lansley, the Conservative health spokesman, said "the surplus they have generated is a sham". More organisations were saddled with worse deficits than last year, he said, adding that "Patricia Hewitt's skin is being saved only by savage cuts to centrally held budgets".

The NHS Confederation argued that half the overspend was in just 6 per cent of organisations. It urged the health department to end the "double whammy" caused by a set of accounting rules it said were being applied inappropriately to some hospitals, causing them to enter an inescapable spiral of debt.