Ministers are considering ‘privatising’ an NHS agency that provides 50,000 nurses and other workers to the health service.
An advert has been placed for private sector investment in NHS Professionals, a company owned by the Department of Health, which provides bank staff to fill shifts in the health service.

Unions criticised the plan saying it was privatisation and that NHS Professionals was set up to stop the NHS being ripped off by private agencies charging large sums for staff to work unfilled shifts.

NHS Professionals has 50,000 staff on its books who cover around two million shifts in 77 organisations around England.

Karen Jennings, head of health at Unison, said: “The whole reason that NHS Professionals was set up, was because private agencies were ripping off hospitals by charging them outrageous fees for recruiting or finding staff for shifts. It makes no sense at all to bring back private companies who will want their slice of the action in return.

“This proposal is purely about Tory plans to promote privatisation and hive off parts of the NHS to private companies, regardless of the consequences on patient care.”

A Department of Health spokesman said: “This is about exploring ways that the commercial skills of the independent sector can make NHS Professionals Ltd a more efficient business and save the NHS money.

“NHS Professionals Ltd is a business, not a public service, and like any business it must ensure its services are as efficient and effective as possible. We want to discuss options with potential independent sector investors that could help to achieve this, and ultimately improve services outcomes for patients.”

It comes as the Royal Berkshire Hospital Trust announced up to 600 jobs will be cut to make £60 million worth of savings in the next few years, pledging that frontline staff would not be affected.

The Royal College of Nursing said last month that thousands of NHS jobs were being cut despite Government promises to protect frontline services.

The nurses’ group said it was aware of almost 10,000 posts lost through recruitment freezes, redundancies and people not replaced when they retired, or which face cuts in the future.

From http://www.telegraph.co.uk/Ministers-accused-of-privatising-NHS-nursing-agency

The NHS in England faces a total bill of £65bn for new hospitals built under the private finance initiative (PFI)- six times more than the buildings cost.
Figures obtained by the BBC show that some NHS trusts are spending more than 10 percent of their turnover on the annual ”mortgage” repayments.

Under PFI, private companies win contracts to build and maintain new hospitals and mental health units and the NHS pays off the ”mortgage” over around 30 years.

The 103 schemes were valued at a total of £11.3bn when they were built.

But when rising fees and additional costs such as maintenance, cleaning and catering are taken into account, the NHS will have to pay back £65.1bn over the lifetime of the schemes. Some contracts are reportedly so restrictive that trusts are forced to pay hundreds of pounds just to get half a dozen pictures put up.

According to the data, the NHS currently pays back a total of £1.25bn each year but this figure is expected to increase until 2030 when it will hit £2.3bn, the BBC reported.

The final payment will not be made until 2048.

Professor John Appleby, chief economist at the King’s Fund health think-tank, said: ”It is a bit like taking out a pretty big mortgage in the expectation your income is going to rise, but the NHS is facing a period where that is not going to happen.”

Dr Mark Porter, of the British Medical Association, added: ”Locking the NHS into long-term contracts with the private sector has made entire local health economies more vulnerable to changing conditions.

”Now the financial crisis has changed conditions beyond recognition, so trusts tied into PFI deals have even less freedom to make business decisions that protect services, making cuts and closures more likely.”

Nigel Edwards, director of policy at the NHS Confederation, which represents trusts, told the BBC: ”They were planned for a different world. I’m sure that in some cases people feel their hands are tied.”

From: http://www.telegraph.co.uk/NHS-facing-65bn-mortgage-bill-for-PFI

The NHS is suffering potentially devastating cuts to jobs and patient services as the Government’s austerity drive hits the health service, doctors’ leaders have warned.Thousands of doctors and nurses face being made redundant or not replaced if they leave, while many hospitals have cut treatments, the British Medical Association has found.

Despite ministers’ assurances that the health service would not face the same cuts as other departments, many hospitals are feeling the strain, according to the BMA.

Andrew Lansley, the Health Secretary, has boasted that frontline services would be protected. But it emerged yesterday that in his Cambridge constituency, Addenbrooke’s Hospital is planning to sack 170 nurses and up to 500 staff in total over the next year.

A survey for the BMA asked 361 doctors, who between them represent committees at all of Britain’s hospital trusts and some larger primary care trusts, how the NHS was being affected by the demand to make £20billion of cuts.

It comes as the Coalition faces political pressure to reverse its pledge to ring-fence health spending.

The BMA found that 43 per cent of those who responded said there was a freeze on recruiting doctors and nurses at their trust. Almost as many, 40 per cent, said that patient treatments, including varicose vein operations and blood tests, were being rationed.

GPs in Bedfordshire said they had been told not to refer patients with certain conditions, such as skin lesions and cysts, to hospitals except in exceptional circumstances.

Nearly a quarter of those who responded said that their trust was planning to make workers redundant. Although the majority of these would not affect frontline staff, the union warned that cuts to administrative workers could force doctors and nurses to spend more time on these duties and less time with patients.

The poll – to which 92 doctors responded – represents the first real evidence of how the NHS has been hit by the cuts. It found trusts were trying to make annual savings of six per cent on average. The Government has promised to guarantee NHS spending growth in real terms but the BMA says this will be “minimal”. The association called the cuts potentially “devastating”.

Dr Hamish Meldrum, the chairman of the BMA, said: “Whilst we accept that difficult decisions need to be taken in this tight financial climate, there is a real danger that cutting back on health now will have a long-lasting impact on our ability to maintain high-quality, comprehensive and universal care in the future.”

The warning came as senior Tories broke ranks to object to plans to protect health service funding.

Lord Lawson, the former Chancellor, and Nadine Dorries, a Tory member of the Commons health select committee, said that health funding should not be ring-fenced.

Ms Dorries told the BBC’s Politics Show: “I think we need to find the political courage to accept that there is excessive waste in the NHS and that it’s unfair to expect other departments to take all the hits.”

The Royal College of Nursing said earlier this year that about 5,600 jobs were under threat across 26 hospital trusts. In a “worst case scenario”, the true figure could be as high as 30,000, it said.

A spokesman for the Department of Health said: “Alongside all the public services, the NHS will need to deliver significant savings over the coming years.

“The department is very clear that savings should be implemented in a way that does not affect the quality of services and the Secretary of State has been very clear that every penny saved will be reinvested back into patient care.”

From: http://www.telegraph.co.uk/NHS-suffering-devastating-cuts-to-jobs-and-services-warns-BMA

The NHS is facing upheaval and cutbacks as a decade of budget increases comes to an end and £20 billion of savings must be found over the next five years.

Despite pledges from Labour and the Conservatives to protect front line services, there is evidence that their promises may have come too late.

A list of cuts has already been identified – including job losses, banning certain operations, closing casualty departments, downgrading maternity services and reducing the number of junior doctors. But these have been mostly quietly ignored by the three main parties.

The Conservatives pledged to stop all closures until they could be reviewed but, with billions of pounds of savings needed to cope with growing demand, cuts and closures are almost inevitable.

David Cameron emphasised that he was personally in favour of the NHS, after his experiences with his disabled son Ivan, who died last year, to combat arguments that the health service was not safe in Tory hands. The party manifesto contained promises about dentistry and round-the-clock GP services which appear too expensive in the current climate.

Both the major parties were accused of chasing the “fear of cancer” vote. The Tories said they would fund cancer drugs turned down by Nice, the health rationing watchdog, but did not mention drugs for other illnesses such as arthritis or dementia.

Labour said cancer patients would see a specialist and have test results back within a week. The party was criticised for unveiling its manifesto at a new hospital in Birmingham. It is against the rules to use NHS premises for election events.

But Labour pointed out that the hospital was still in the hands of the private finance initiative organisation – a policy which means the NHS will be repaying billions of pounds for new hospitals for decades.

Nick Clegg refused to ring-fence NHS spending given the size of the national debt.

The Liberal Democrat campaign focused on cutting waste on managers, scrapping regional strategic health authorities and pledging more power to communities to direct the health service locally.

From: http://www.telegraph.co.uk/General-Election-2010-cuts-inevitable-as-NHS-must-make-savings

On election day Health Direct quotes this cancer specialist- The internal market has been a costly disaster. Let the professionals manage medicine.

It’s election time, and our glorious political classes are marching forward on the massed ranks of the electorate with banners that claim that their party, only their party, will save the NHS.

Politicians clamour to praise its world-class status and laud the dedication of nurses and the skill of its doctors. And all parties are united in the view that, despite the need for austerity measures, frontline staff and services will not be cut. So where are the savings planned? Watch the hand and not the mouth.

When I started in medicine, the hospital was run by about three people. Things were so much more simple when doctors and nurses treated patients, doing their best without the guidance of guidelines and targets, doing their best … yes … to make the patients better.

How did we manage without forms to fill and waiting times compliance? Quite well actually. The medical director ran the medical side of things while matron and the accountant handled the rest. It wasn’t much of a business then: it didn’t have to be, because there was no internal market to manage.

The internal market — Mrs Thatcher’s plan to introduce efficiency by having hospital compete against hospital to provide patient treatment — has wreaked havoc. It has spawned a nation of administrators, here today and gone to another post tomorrow — while doing nothing to bring costs under control.

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

And there are big problems with the billing process. For example, if a patient is seen in an outpatient clinic then there is a charge made by the hospital for his or her first attendance — but follow-up appointments are not charged. And if many treatments are given in a hospital to a patient, only the most expensive of the treatment episodes is charged.

There are savings to be made. It is alleged that there are just 75,000 administrators at work in the NHS but this figure is laughably mythological. Doctors and nurses know that there are many more than this. They look around and see the numbers increasing.

One report by the Centre for Policy Studies published in 2003 indicated that there were 250,000 administrative staff employed in the NHS: at least one administrator for every nurse. In recent times the rate of increase of admin staff within the NHS has exceeded that of nursing staff.

There is a general feeling in the NHS of disempowerment of the professionals. People can’t face up to the incredible struggle, the disapproval that faces any of them if they have the temerity to suggest that things should be run differently.

The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it. The reality is gravediggers working with a cost improvement shovel made of rust.

Over the years politicians have made dramatic changes to the way that the NHS has been run. Recent changes have caused fragmentation and not led to any cost saving. Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.

So what should we do? Let us go back to the old discipline of the NHS. Let the professionals manage medicine, empower the professionals, the doctors and nurses and shove the internal market in the bin and screw down the lid.

At this election time please let us hear from all political parties that they will ditch this absurd love-affair with the internal market. Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.

Professor Jonathan Waxman is a consultant oncologist

http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article7112167.ece

NHS bosses are earning annual bonuses of tens of thousands of pounds on top of their six figure salaries as Anna Walker, chief executive of the Healthcare Commission, got £68,000 in bonuses.

Hundreds of chief executives, departmental directors and board members of hospitals and other NHS organisations have received extra payments of as much as £32,000 – the largest single year’s bonus unearthed by freedom of information requests submitted by the Liberal Democrats.

The £32,000 bonus went in 2008-09 to Beccy Fenton, deputy chief executive of the Heart of England hospital trust, who already earns £170,000 a year. She received it after generating almost £1m of consultancy work for her employers, including private sector contracts. The trust stressed last night that the £32,000 was a one-off sum for consultancy work.

Anna Walker, who was chief executive of the Healthcare Commission until it was disbanded last year, earned the largest combined amount in the past three years – £68,150 on top of her six-figure salary. She received £22,375 in 2006-07, £23,000 in 2007-08 and £22,775 in 2008-09 for running the then NHS watchdog in England.

Norman Lamb, the Lib Dems’ health spokesman, condemned the payments as shocking. “These bonuses are utterly scandalous. People will be disgusted by the extent to which fat cats in the public sector have been enriched at a time when the NHS has denied people drugs that they need and access to treatments such as in mental health,” he said. “We thought it was just in banking, but the unacceptable bonus culture appears to be alive and kicking in the upper echelons of the NHS.”

This is the first time both the number of bonuses and their size has been disclosed. The Lib Dems sought information from every hospital trust, primary care trust (PCT), mental health trust and ambulance service in England, as well as other NHS bodies such as strategic health authorities.

While some pay no bonuses, many do. However, the figures do not reveal the full picture because some refused to disclose theirs and a few simply gave their chief executive’s salary band.

The £32,000 one-off bonus and the £68,150 over three years are large but not atypical.

Laura Roberts, chief executive of the Manchester PCT, received £25,732 extra in 2008-09, while Dr Patrick Geoghegan, her counterpart at South Essex Partnership mental health trust – who earns £170,000-180,000 – received £20,573 in the same year for helping it do well against NHS targets.

South Essex trust spokeswoman Maxine Forrest, said: “In 2008-09, to recognise the trust’s exceptional performance in national ratings, a one-off bonus was paid. Dr Patrick Geoghegan is chief executive of one of the most successful and highest-performing NHS organisations in the country.”

Paul O’Connor, a former chief executive of Birmingham Children’s Hospital, received a one-off £15,000 bonus in 2007 for helping it to achieve semi-independent foundation trust status within the NHS. He resigned late in 2008 after the Observer revealed doctors’ concerns that some care was sub-standard.

The chief executive of the Royal Berkshire hospital trust received £54,611 in bonuses over three years in 2007-09, while the chief executive of the Human Tissue Authority was given £37,895 in 2006-09.

Many chairmen, divisional directors and both executive and non-executive directors of NHS bodies also receive bonuses. The Royal Berkshire hospital trust spent £240,728 on bonuses in 2007-09, more than any other NHS body that provided figures. Eight executive directors shared another £186,117, as well as the £54,611 payment to the chief executive.

Large payments to senior figures in those three years were also made by the Healthcare Commission (£215,550), the London Ambulance Service (£130,646), the Hertfordshire Partnership mental health trust (£122,465) and Portsmouth Hospitals (£105,000).

All three main parties have pledged to slash NHS management and bureaucracy. “This is the first real analysis of the bonus culture at the top of the NHS, and it’s shocking,” said Lamb. “Bonuses of £20,000 or more are more than many NHS staff receive as their full year’s salary.”

From: http://www.guardian.co.uk/society/2010/apr/25/nhs-bonus-liberal-democrats

A survey by the RCN found thousands of jobs were already earmarked for cuts in an attempt to slash costs.

Health trusts are planning to cut thousands of staff “by stealth” to deliver £20bn of “NHS efficiencies”, according to a survey by the Royal College of Nursing. Labour reacted by promising that there would be more jobs in the health service at the end of the next Brown administration if it wins the election.

The move comes as Gordon Brown addresses the RCN’s four-day annual conference today. More than 4,000 nurses have gathered in Bournemouth for the event, which is expected to be dominated by NHS finances.

The nurses’ union has been riled by a warning from Sir David Nicholson, the chief executive of the health service, that up to £20bn of savings will have to be found by 2014.

A survey by the RCN of 26 of the 168 English health trusts revealed that 5,600 jobs were already earmarked for cuts in an attempt to slash costs. That figure could rise to more than 36,000 in a “worst-case scenario” if the trend was replicated across all hospital trusts, said Howard Catton, head of policy at the Royal College of Nursing. The loss of posts – including redundancies and staff not being replaced if they leave or retire – could happen over the next three years, he added.

In an online survey of 287 nurses earlier this month, the RCN said hospital wards were already operating with an average of 13% fewer staff than officially needed. Nine out 10 nurses said that patient care was being compromised by short staffing.

There is little doubt that the nurses’ union, which has 400,000 members, has political clout. Last year Brown became the first prime minister to speak at the conference in its 93-year history – to a warm reception by delegates.

Although health has not been a major focus of this election campaign, the issue of NHS job cuts is an explosive one for Labour. In 2006 the then health secretary Patricia Hewitt was jeered and slow-hand-clapped by nurses as she tried to address their fears about NHS deficits.

Andrew Burnham, the health secretary, told the Guardian that savings would come from wage restraint, cutting management costs by a third, and asking “some nurses and doctors to take on different roles in different locations outside of hospitals”.

“It is unlikely that we would need fewer people in five years in the health service. Labour will ensure sufficient funding to frontline NHS services so that they do not need to make any compulsory clinical redundancies and we will ask the NHS to co-operate across organisational boundaries and work towards ensuring this basic guarantee,” he went on. “Cutting doctors, nurses and frontline staff would be costly, counterproductive and would risk a return to the kind of NHS we saw under the Tories.”

The problem for Labour is that decisions on savings are being made at a local level. The RCN points out that managers at some trusts are already openly equating efficiency savings with job cuts.

In an open letter to staff, the chief executive at Salford Royal, a foundation hospital, said: “We are about to enter a financial crisis that could ruin all that we have achieved … this means reducing costs by about £16m a year [and] providing safe standards of service with about 250 fewer people for each of the next three years.”

The market reforms that Labour implemented have made it possible for hospitals to identify savings easily. Dorset county hospital, which made 28 posts redundant in March, admitted that its strategy to “attract more patients” with 300 new staff had failed, leaving a putative black hole of £11m in next year’s budget. The hospital issued a blunt press release: “These extra patients never came and so we are left with rising costs but without the income to cover them.” .

The Conservatives say that their promise to outspend Labour on the NHS insulates them against the charge that the health service is not “safe in their hands”. They say that thousands of NHS medics will lose their jobs over the next five years under Labour’s “secret” cost-cutting plans, which would see 651 fewer doctors and 2,050 fewer nurses across England.

Disclosures made under the Freedom of Information Act at the request of the Tories show half of NHS trusts that responded were planning reductions in the numbers of full-time equivalent doctors and nurses.

The shadow health secretary, Andrew Lansley, said: “We will back the NHS. Conservatives will increase funding for the NHS each year in real terms. So instead of Labour’s cuts to doctors and nurses, we will support the recruitment of staff we need, like specialist nurses, midwives and health visitors.”

From: http://www.guardian.co.uk/politics/2010/apr/26/health-trusts-planning-job-cuts

The National Health Service’s £12.7bn scheme to create an electronic patient record will “no longer provide the comprehensive solution” originally promised, says a top NHS executive.

Until now, health ministers and officials have acknowledged that the world’s biggest civilian information technology project is running four to five years late, and have said they want to make £600m savings on the £4bn-plus worth of contracts held by CSC and BT to deliver it.

Up to now, however, no one has conceded that the programme will fail to deliver everything that was promised back in 2003 when the contracts were signed.

Following a revamped deal with BT – the London supplier, which has cut £112m or about 12 per cent off its contract – Ruth Carnall, the chief executive of the London strategic health authority, has said the spending reduction means “it will no longer be possible to provide the comprehensive solution that was anticipated in 2003″.

Not all NHS organisations in London will now receive the software needed to deliver the records, Ms Carnall makes clear in a letter to London chief executives.

Meanwhile, Christine Connelly, the health department’s chief information officer, has said that only about half of London’s 32 big acute trusts will now get the full solution. Others will be able to add clinical systems to existing patient administration systems.

In place of a dedicated means of sharing records across hospitals, and between hospitals and primary care – a key goal of the programme – London will have to rely on the national summary care record, Ms Carnall says. However, this contains little other than allergies and current medication, and does not yet carry referral or discharge information.

On top of this, the Tories have said they will scrap the national record if they win the election.

BT will no longer have to deliver new systems to London’s ambulance service or GP practices. And London can afford to pay for Map of Medicine, a decision support tool for treating patients, for only one more year, says Ms Carnall.

In much of the country, installations in acute hospitals are stalled after CSC missed a deadline to get its solution running at Morecambe Bay NHS Trust. The supplier risks being fired, but is likely to sign a similar, more restricted, deal if it does hit a new deadline for a successful installation.

Glyn Hayes, president of the UK Council for Health Informatics Professions, said it had been clear for some time that the programme was to be reduced. “But this is the first official admission that there are things it will not do that it was intended to do.”

It was unclear, he said, whether the Conservatives would in fact scrap the national record if they won. “But if they do, it knocks a hole in London’s plans,” because without it the capital had no easy means of transferring patient information between settings.

From: http://www.ft.com/cms/s/0/fba8e660-436d-11df-833f-00144feab49a.html

The biggest single supplier to the £12bn NHS NPfIT white elephant programme is on the brink of being fired from a key part of its contract after failing to meet a deadline to install systems at hospitals in the north west.

CSC, which holds the contract for two-thirds of England, missed the deadline to get the Lorenzo electronic medical record product up and running at the Morecambe Bay NHS Trust’s hospitals.

CSC originally said the system would go live almost two years ago, in June 2008.

The failure is the latest crisis for the much-troubled programme which is running at least four or five years late.

CSC and BT, which covers London, had each been given a deadline to get new systems running smoothly in a big, acute, hospital, with the Department of Health warning last year that it would “look at alternative approaches” if that failed to happen.

BT has since installed a system at Kingston Hospital to the health department’s satisfaction. Christine Connelly, the department’s chief information officer, said it now needs to go through a due process under its contract with CSC which could yet see a new deadline set and met.

But if progress is not made, she told the Financial Times, the department has the option of cancelling CSC’s contract to install the systems in acute hospitals and letting hospitals choose from other suppliers.

Morecambe Bay, she said, remained keen to continue and under the contract CSC has to be given time to propose a fresh deadline for deployment, with the programme then assessing the credibility of that and whether to agree it.

“We have to walk through this step by step,” Ms Connelly said. “In a contract as large and complex as this we cannot just set a deadline and say that’s it. We have to act responsibly and not expose the department and the taxpayer to risk.”

But, she warned bluntly, “we cannot wait for ever”.

CSC has contracts worth about £3.3bn to install hospital, community, mental health and GP systems, with the latter elements progressing much better.

But Ms Connelly said if CSC’s plan was not credible the NHS had the option of cancelling the acute hospital part of the deal, thought to be worth around £1bn. CSC did not respond to attempts to contact it last night.

BT, having hit its deadline, has agreed a contract variation, signed yesterday, which the department said would save the NHS £112m, or about 12 per cent of the contract value, as part of the £600m savings the health service is seeking on the programme as a whole.

As part of the deal, BT is now signed up to install much fewer full systems in London, with about half the hospitals likely to add clinical systems to their existing IT arrangements, rather than replacing everything, Ms Connelly said.

Allowing hospitals to choose other suppliers is already starting to happen in the south of England, although the first contracts for that have yet to be signed. That should start to take place from May this year, she said.

From: http://www.ft.com/cms/s/0/6a9f7ee2-3d26-11df-b81b-00144feabdc0.html

Tens of thousands of NHS workers would be sacked, hospital units closed and patients denied treatments under labour’s secret plans for £20 billion of health cuts.

The sick would be urged to stay at home and email doctors rather than visit surgeries, while procedures such as hip replacements could be scrapped.

The plans have emerged as health chiefs draw up emergency budgets that cast doubt on pledges by Gordon Brown to protect “front line services” in the NHS.

Documents show that health chiefs are considering plans to begin sacking workers, cutting treatments and shutting wards across the country.

The proposals could lead to:
* 10 per cent of NHS staff being sacked in some areas.
* The loss of thousands of hospital beds.
* A reduction in the number of ambulance call-outs.
* Medical professionals being replaced by less qualified assistants.

The plans are contained in a series of internal NHS documents uncovered by The Daily Telegraph.

The final details of the plans are not due to be announced until the autumn, well after the country has gone to the polls for the general election.

The Conservatives and health campaigners said the public deserved to know the true extent of cuts at their local surgeries and hospitals before voting.

Last year all English health authorities were ordered by Sir David Nicholson, the NHS chief executive, to reconsider their plans after the recession forced the Government to freeze health spending from April next year.

This left a ”black hole’’ of up to £20 billion in health budgets up to 2014, prompting the drawing up of new proposals by the 10 strategic health authorities (SHAs).

They had until Friday to submit their plans to Andy Burnham, the Health Secretary. He is under pressure from the Treasury to show how money will be saved to help bring down Britain’s record £167 billion deficit.

In Wednesday’s Budget, Alistair Darling, the Chancellor, repeated that the £20 billion would come through “efficiency savings” and not key services.

Documents produced by several of the SHAs show how the cuts are, in fact, expected to fall on hospital services.

In the South East Coast region, which covers Surrey, Kent and Sussex, up to £1.6 billion must be saved.

A document marked “restricted” and circulated among SHA board members suggests 10,000 of the region’s 100,000 NHS workers may lose their jobs. “The new financial environment demands that the trend in workforce growth must be reversed,” it said, adding bosses must reduce employee numbers by 10 per cent “or further”.

The document said staffing in the acute sector, covering hospitals, “can be expected to decline faster and further” than elsewhere.

Job losses will be “starting in the coming year”, it states. Mr Brown has repeatedly promised Labour will not start making significant cuts to public spending until 2011. A spokesman for the South East Coast SHA said the document was a discussion paper and not a final plan.

In London, which faces £5 billion in cuts, documents show managers believe up to £2 billion can be saved from community care budgets, which cover GPs’ surgeries. This would include “changing how patients get in contact with and receive services, such as through greater use of the internet and email”.

An internal presentation by NHS Yorkshire and the Humber, which spans Sheffield, York, Hull and north Lincolnshire, made similar suggestions. The SHA, which is expected to make about £2 billion in cuts, proposed directing more patients to “teleservices such as NHS Direct”. Meanwhile, £450 million could be saved in London by banning clinical procedures “that have little or no benefit to those receiving them, for example some joint replacements”.

NHS North West, which oversees Greater Manchester and Liverpool, is expected to make about £2 billion savings. It is preparing to close an A&E unit in Rochdale during evenings before scrapping it altogether next year.

In the East region, covering Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk, up to £2 billion is to be cut. The SHA proposes shifting services out of hospitals and making social workers take over some treatments. It is estimated that savings of about £2.4 billion will need to be made by NHS West Midlands, £2 billion in the South West, £1.3 billion in South Central, £1 billion in the North East and £800 million in the East Midlands.

All the Department of Health spokesman could say- as a way of confirmation: “We will be clear with trusts that they must not make short term cuts that harm patient care.”

From: http://www.telegraph.co.uk/health/healthnews/7529454/Hospital-wards-to-shut-in-secret-NHS-cuts.html