There are a host of challenges looming for the NHS in the next 12 months.After 139 days of public hearings, the Mid Staffordshire Public Inquiry closed on 1 December. There is no date yet for the publication of the final report. But already Robert Francis QC, the head of the inquiry, has said the issue threatens to unleash a “tsunami of anger”.

The inquiry has been looking at what happened at Stafford Hospital from 2005 to 2008 during which hundreds of patients died needlessly and why it went undetected for so long. In particular, the findings promise to have major implications for regulation of the health service.

In recent months, the Care Quality Commission, which now regulates quality in the NHS after taking on responsibility for it from the Healthcare Commission in 2009, has come under criticism from the House of Commons health committee for losing sight of what it should be doing. Ominously for the quango, the prime minister was quick to give his backing to the findings.

What is more, during the inquiry the culture and vision of the regulator came under attack from its own officials, prompting the health secretary to order an investigation himself. It seems unlikely that the CQC will survive unchanged.

Politically, the government’s reform of the NHS in England may be over the worst hurdles, but that does not mean it will be an easy ride from now until the big bang in 2013 when GPs finally get control over the purse strings.

There is growing frustration among doctors who are getting involved in the new clinical commission groups. In many ways, they should be the greatest advocates of the plans as they are supposed to be getting more power than ever before.

But the Clinical Commissioning Coalition, which represents the GPs who are piloting the new arrangements, has started reporting that they are being bullied by senior managers in the health service. They say they are interfering with their structures and decision-making process – and this in turn is threatening the whole project. Expect another 12 months of arguments and controversy.

Although it is not part of the NHS, the social care system is closely linked to the fortunes of the health service. Whether it is arranging discharge from hospital or preventing falls in the home, when social services are not working as they should, the effect is felt in the NHS.

When Tony Blair came to power in 1997 he talked about improving social care. But at the end of Labour’s 13 years in power, ministers were still arguing about the best way forward.

After 13 years of labour’s dithering the system is suffering from chronic under funding.

While the NHS enjoys a budget in excess of £100 billion, adult social care has to get by on about £14 billion.

This is topped up by individual contributions – the system is means-tested – but nonetheless councils across the country are cutting back on what they can offer. And so reform will require extra money – something which is of course in short supply at the moment.

It is also likely to require cross-party consensus, but there is still some bad blood between the health secretary and his Labour opponent Andy Burnham over the death tax row which effectively scuppered the shadow health secretary’s plans to reform social care when he was in power.

The budget is increasing by an average of 0.1%, but as inflation in the health service is rising at a much quicker rate to cover costs associated with the ageing population and rising levels of obesity, savings are having to be made.

The NHS has a target of £20 billion by 2015, the equivalent of about 4% a year. That means there is pressure on jobs – unions say tens of thousands are being lost – and front-line services.

In particular, hospitals are coming under pressure. Advances in medicine and the nature of illnesses in the 21st century – many more people are suffering from chronic conditions like diabetes – means more and more can be done in the community.

It has meant an increasing number of hospitals are piling up debts because they are not getting enough patients through the door.

This in turn means managers and ministers are having to make difficult decisions about closing departments and even whole centres. The process will continue in 2012, particularly in and around London which was recently described as being in a “shocking” state by a committee of MPs.

Under Labour, an 18-week waiting time target was set for non-emergency hospital treatment, such as knee and hip operations. Within months of the coalition being formed, ministers said it was being relaxed to move away from the tick-box culture that they say had developed.

But when the government was knee-deep in criticism over its reforms the prime minister made the specific pledge that waiting times would not be allowed to slip. This has resulted in more attention than ever being given to waiting times.

And signs are emerging that hospitals are beginning to struggle to keep up with the 18-week goal. Overall, the NHS is still meeting the target – they only have to achieve it for 90% of patients to reflect the fact there are valid reasons why some wait longer.

But that masks the fact that there is a rising number of places where it is being breached, leaving the best-performers to bring the national figure up.

It means there could be growing dissatisfaction with the waits patients are facing, although it must be remembered a return to the 1990s when waits of six months and even a year were the norm for many patients is still a long, long way off.

The number of NHS patients who have to undergo emergency readmission to hospital within a month of being discharged has increased by more than three quarters over the last decade, the Daily Telegraph has disclosed.Hospitals have been accused by ministers of treating patients “like parts on a production line” after official figures suggested that hundreds of thousands of people every year are being sent home before they are well enough.

More than 660,000 people were brought back to hospital last year within 28 days of leaving, statistics show, sparking allegations that patients are being “hurried through the system” so the NHS can meet waiting-list targets.

The official figures show that some NHS trusts have seen their emergency readmission rate rise more than threefold over the past decade – while some hospitals have seen only a modest increase.

Last night, Andrew Lansley, the Health Secretary, said that the “hugely distressing” trend must stop.

“Patients have a right to expect that when they go in for treatment that they are looked after properly and that the treatment they are given helps them to recover,” he said.

“Having to be readmitted and treated all over again is hugely distressing. These figures show how Labour’s obsession with waiting time targets meant that patients were treated like parts on a production line to be hurried through the system rather than like people who need to be properly cared for.”

The Department of Health has released detailed information on the number of emergency readmissions in every area across Britain.

The figures show that 620,054 patients had to be readmitted in 2009-10 – compared to just 348,996 a decade before, a 78 per cent increase. Over the past five years, there has been a 31 per cent rise and a five per cent increase on the previous 12 months.

The data also highlights the widespread regional variations. The rate of readmission in the Kensington & Chelsea PCT area has risen by 287 per cent over the past decade to 1,582 people.

However, North Lincolnshire PCT has only experienced a 3.37 per cent rise over the same period.

Hospitals within the Hampshire PCT area readmitted 13,239 people last year. The nearby area covered by the Isle of Wight PCT only had to readmit 1,098 people.

The figures, do not include patients suffering from cancer or mental health problems or maternity patients.

Most of the areas with the highest increases in readmission numbers are in London and the south east, where pressure is greatest on the NHS. The Department of Health has analysed the social make-up of each area and concludes that the so-called “thriving London periphery” – the relatively wealthy commuter hinterland around the capital has suffered the biggest recent deterioration.

About 10 million people are admitted to hospital wards each year. Critics claim that government targets, such as the demand that patients be admitted to hospital for treatment within 18 weeks of seeing their GP, mean hospital managers are pressured into releasing patients early to make beds available.

Earlier this month, The Daily Telegraph disclosed that the Government is moving from a system of targets for hospitals based on waiting and treatment times – to a system of so-called “outcomes” which measures the success of treatment.

In a criticism of previous targets which he blames for the increase in emergency readmissions, Mr Lansley said: “Instead of focusing on the results which actually matter for patients, they focused on narrow processes to the detriment of patient care. That is why we have taken action to address these increases in emergency readmissions.

“One of the new goals we are setting the NHS is reducing emergency readmissions. In order to help achieve this we have created a re-ablement fund of £300 million and we have taken action to stop hospitals being paid when they readmit a patient after discharging them too early. These steps will turn Labour’s poor performance around.”

Under the Government scheme, hospitals will effectively be responsible for people’s care in the weeks after they return home and will be financially penalised for discharging patients too soon.

From:  http://www.telegraph.co.uk/Scandal-of-NHS-production-line-as-readmissions-soar

Andrew Lansley has called on the NHS to focus on “what really matters” as he prepares to announce plans to judge hospitals and doctors against 60 new goals that are designed to save more than 20,000 lives a year.The Health Secretary has unveiled a new system to assess success in the health service based on the quality of care patients receive – not merely the speed at which they are treated.

Comprehensive data on hospital death rates, the individual performance of GPs and surgeons and patients’ experiences under their care are to be published in an attempt to improve standards.

Mr Lansley has set out 60 benchmarks that will replace Labour’s system of targets and will be used to define success in the NHS.

These include a commitment to preventing unnecessary early deaths, a pledge to enhance the quality of life for people with long-term conditions and a drive to ensure that people have a positive experience when using the health service.

If the new standards are achieved, 24,000 early deaths a year could be prevented from cancer and other long-term conditions, Mr Lansley believes.

In addition, fewer people with long-term conditions including asthma and diabetes will be treated in hospitals, he will claim, while patients undergoing routine hip and knee operations will no longer be left in pain or unable to walk.

Access to NHS dentists will also be improved, he will say.

The Cabinet minister said the record on unnecessary early deaths varied across specialties as he urged the health service to focus on “what really matters” – the results achieved for patients and their experiences while being treated.

“If you look at the question of how many patients in this country die who could live if they got the best health care, it is literally over 10,000 patients a year if we were simply to get to a place which is better than the average across the OECD (Organisation for Economic Co-operation and Development) countries.”

In an interview with The Daily Telegraph, Mr Lansley says his tenure as Health Secretary will have been a “failure” if the 60 new “outcome” targets do not improve by the next election. He pledges that the benchmarks will now “define what the NHS is setting out to achieve”.

“We have to clear the decks and be clear this is what we are focusing on,” he says. “People say in three and a half years’ time, in 2015, at the next election, how will we know whether you’ve succeeded or not? The answer is ‘have the outcomes improved?’

“It will be my failure if we haven’t improved them and the NHS should feel that it has not succeeded, that is what we are setting out to do.”

Next week, the Government will set out current performance for each of the 60 indicators. It will then set out national targets for improvement “by the time of the next election and beyond”.

The new NHS Commissioning Board and the Care Quality Commission will also intervene directly to address problems that are highlighted by the data.

In today’s interview, Mr Lansley says that the long-running row over NHS reform must end and the health service must concentrate on improving patient care.

“We’ve really got to get into the big picture, which is delivering improvements in the results we achieve for patients right across the board,” he said. “We know that we can do it.”

The benchmarks will be monitored partly through studying clinical data – for example, to ascertain whether mortality rates for cancer, liver and heart disease are improving — and partly through surveying patients to gauge whether they were satisfied by the standard of care they received and the speed of their recovery.

The Health Secretary says: “This is literally saying to patients ‘if you were in hospital, if you were being looked after by your general practitioner was the service and experience you had good or not?’ It’s not like some other kinds of medical model where you kind of treat people and they get better. This is different.

“This is really where you begin to kind of focus on the experience of care.”

For the first time, the views of bereaved relations and even children will be surveyed so that the quality of NHS care from early years until death can be assessed.

“We’ll be undertaking a consistent national survey of the bereaved relatives of people who received end of life care,” Mr Lansley said. “Asking them, after a suitable passage of time, what was their loved one’s experience of care and how well were they looked after towards the end of life.”

From: http://www.telegraph.co.uk/Andrew-Lansley-sixty-step-plan-to-help-NHS-focus-on-what-matters

Elderly patients are increasingly being kept in hospital beds because there is no one to support them at home, or there are no places available in residential homes, figures indicate.The number of hospital bed days lost to so-called ‘bed blockers’ across NHS hospitals in England has risen by 11 per cent in the past year, official figures show.

The rise comes after years of success in tackling the problem, and illustrates growing pressures on the NHS and social services.

According to Department of Health statistics, the number of hospital bed days lost to bed blockers rose from 115,648 during September and October 2010, to 128,517 in the same two month period this year.

That comes after a sustained period of falls between 2003 and 2009, as a result of concerted ministerial action to tackle the problem.

With the average cost of providing a hospital bed for a day estimated at £255, that means the daily NHS bill for bed blockers has risen from £483,000 to £537,000.

Aside from this economic cost, it also means hospitals cannot admit new patients as quickly, which can delay waiting times for pre-planned operations.

The statistics confirm what many have been fearing for months: that reductions in local authority social care budgets would quickly lead to clogged up hospital wards.

In February Bupa warned that “chronic under-funding” of care home places would lead to an “intolerable” bed-blocking crisis in the long term, costing the NHS millions of pounds a day.

Oliver Thomas, director of UK care homes for Bupa, said last night: “If you slow down the number of people placed in residential care, because you are trying to manage your budgets better, then inevitably people will stay longer in the acute sector.”

Others described the latest figures as a “warning” of worse to come and a “pinch point”.

Jo Webber, of the NHS Confederation, which represents health service authorities, said: “This is a worrying sign of the pressure which is building in the system. Like waiting times, it is a pinch point.”

Last month The Daily Telegraph reported that government funding for nursing homes and home help for pensioners had been cut by almost a fifth, with some councils cutting spending by up to 30 per cent.

At the same time many hospitals are cutting hospital bed numbers, by up to 10 per cent, in part to meet tough efficiency saving targets.

Dr Ian Donald, of the British Geriatrics Society, said: “The trouble is hospitals operate on such tight margins. Even small delays can cause problems.”

The term ‘bed blocker’ tends to imply the patient is the cause of the problem, but Dr Donald emphasised that was not the case.

“Delayed discharges are not just statistics, but individual patients who are frail and vulnerable. “To them and their families it can feel like they are stuck and lost in the system,” he said.

The new figures follow the introduction in August 2010 of a new monthly reporting system for counting ‘delayed discharges’ – incidents when an otherwise healthy patient is kept in due to lack of community care facilities – brought in due to concerns over quality of data.

From: http://www.telegraph.co.uk/Bed-blocking-rise-of-11pc-in-last-year

NHS managers are trying to restrict access to crucial tests and scans in a move that could mean diseases being diagnosed later. 

An investigation has found that a quarter of Primary Care Trusts are either investigating how many patients individual GP practices send for examinations or looking for ways to reduce the numbers.

In addition, a handful are identifying “excessive” use of the tests or setting upper targets while others have completely stopped letting doctors have direct access to the scans.

Experts said the tactics could lead to patients being diagnosed later with diseases such as cancer, which research shows lowers survival chances.

Dr Clare Gerada, head of the Royal College of GPs, said: “This is about money and finances driving behaviour by the PCT – not about putting patients first.”

Cancer Research UK’s director of policy, Sarah Woolnough, added: “It is very worrying to hear of PCTs setting referral targets and decommissioning direct access to tests that could speed up a cancer diagnosis.”

Meanwhile, official figures show that even patients who are being referred to hospitals for tests are being forced to wait longer than a year ago.

Department of Health statistics show that 10,700 patients were waiting more than six weeks for any one of 15 key diagnostic tests at the end of July, a rise of 7,000 on the figure for the previous year.

The Government has told health service managers to improve direct access to diagnostic scans such as MRI, CT and ultrasound in order to improve early diagnosis of cancer and heart disease.

But an investigation by GP magazine suggests that many trusts want to reduce the number of patients sent directly to tests at specialist centres in order to save money.

Of the 116 Primary Care Trusts contacted, 28 per cent said they had either started looking into how many referrals GPs carried out across their area, or were planning to do so. A quarter are helping practices reduce inappropriate access.

Nine trusts said they had found surgeries that either sent too many or too few patients for tests while two are considering introducing upper and lower targets.

Five PCTs have scrapped direct access altogether to at least one type of test.

Dr Chaand Nagpaul, a leading member of the British Medical Association, said restricting access to scans risks “turning back the clock” on plans to diagnose disease early.

“An intelligent approach would be to have guidelines for appropriate use of diagnostics and incorporate them into the pathway.”

The moves are the latest example of how managers are rationing patient care in an attempt to make unprecedented efficiency savings totalling £20billion across the NHS by 2015.

From: http://www.telegraph.co.uk/NHS-managers-restricting-access-to-crucial-scans-and-tests

David Cameron will commit to “five guarantees” on the future of the National Health Service in a speech designed to reassure critics of his controversial health reforms.The Prime Minister will promise to keep waiting lists low, maintain spending, not to privatise the NHS, to keep care integrated and to remain committed to the “national” part of the health service.

Such is the concern in Downing Street at the damage the issue of NHS reform is causing the Government, that Mr Cameron will put his reputation on the line with a personal pledge to protect its core values. It represents his boldest attempt yet to assuage criticism from his Liberal Democrat Coalition partners and from many health professionals over the impact of the reforms.

In his speech, the Prime Minister will admit that he is willing to act on their concerns after listening to the “profession and patients” during a two-month exercise which was held after Mr Cameron called for a “pause” in the Health Bill’s passage.

His “five guarantees” are designed to show the Prime Minister is committed to the NHS, and “he is hearing what is being said”, according to one source. Mr Cameron’s promise on integrated care is designed to ensure patients receive continuity of treatment, without having to explain their condition from scratch each time to different doctors.

It also means that nurses and hospital professionals will retain a role in commissioning services, and that not everything is transferred to GPs.

His commitment to the “national” part of the NHS represents a pledge to keep it as a universal service, free at the point of use. But Mr Cameron will also say that “no change” is not an option.

He will echo the words of Andrew Lansley, the Health Secretary, who wrote in last week’s Daily Telegraph about the threat to the NHS if it does not reform. He warned of a £20 billion a year funding black hole without reform.

Despite ring fencing health spending, Mr Cameron is expected to make clear that NHS services will be threatened unless there is reform because of the rising costs of drugs and an increasing elderly population.

Mr Cameron is likely to say that the Coalition’s reforms will see the NHS working better. He will point out that in Europe there are health systems which work more effectively.

The speech comes as ministers prepare to rewrite much of the Health Bill. At present the plans involve abolishing two tiers of NHS management and handing control of a £60 billion-a-year budget to groups led by GPs, who can choose to buy treatment for patients from local state-run hospitals or private providers.

This week, the Royal College of Nursing is expected to renew its call for nurses to have a key role on the GP commissioning boards. Mr Lansley will not commit to such a plan until he has heard from the Future Forum, which is reporting back on possible changes to the Bill.

Tomorrow, Mr Lansley, who has been subject to rumours that he is about to resign or be sacked over the issue, faces MPs in the Commons. He will defend the reforms, although he is prepared to see them substantially watered down. However, Labour will seize on stories circulating that Cabinet colleagues had suggested he would not last the year in his post.

Downing Street polling has painted a stark picture of the problems Mr Cameron faces over the NHS and Mr Lansley’s presentation of the plans over the past 12 months is being blamed.

Last week Stephen Dorrell, who was health secretary in John Major’s government, added to speculation that he will replace Mr Lansley. Asked on BBC’s Question Time about whether he would do a better job, he said: “I am going to plead the Fifth Amendment.”

From:
http://www.telegraph.co.uk/David-Cameron-puts-reputation-on-the-line-with-five-pledges-on-the-future-of-the-NHS

The children and families minister Sarah Teather has attacked the health service for failing some of the country’s most vulnerable young people.
Sarah Teather said the chance of a child receiving much needed speech and language therapy was a postcode lottery “between low and nil”, while the wait for a wheelchair could be “really long”.

Teather, who spent most of her own secondary school days in a wheelchair after suffering from a viral infection, said the health service “has not always been good at doing its fair share for children in this position”. Families were often left as the “piggy in the middle”, she said in an interview with the Guardian.

Health workers often agreed with parents that a child needed a wheelchair, incontinence pads or a form of therapy, but “nobody pays for it” and it fails to arrive, she said. This could severely impair a child’s chances in the future, she warned: “A six-month wait for speech and language therapy can be critical; an 18-month wait can be really critical.”

In some cases, by the time a wheelchair arrives, a child has grown too big for it, she said, adding that it was a “postcode lottery” to get basic equipment.

Government proposals, published in a green paper in March, would improve life for children with special needs and disabilities and their families, she said.

At the moment, children with severe or multiple health and learning disabilities receive a statement from their local authority. This covers only the services that schools are expected to give children, rather than those they need from the health service or social services.

The green paper proposes to replace the existing statement of special educational needs with a single care plan covering schooling, health and social services from birth to the age of 25. This would mean a child’s educational, social and health needs would be dealt with together. The plan would reflect a family’s needs and ambitions for the child’s future and would be continually reviewed.

The green paper also set out plans to give parents a personal budget to spend on services such as one-to-one tuition, laptops and wheelchairs.

“Rather than a family having to go to the council trying to bang down their door to get something, [the council] are coming to you saying, this is what we normally provide. The family then has a conversation about whether it is appropriate,” Teather said.

The government also plans to introduce into all schools a programme to help children with special needs improve at a faster rate.

Researchers found the Achievement for All programme helped nine- and 10-year-olds with special needs to learn reading, writing and maths three times faster than they were expected to under the national curriculum. Under the same programme, 14- and 15-year-olds with special needs made progress in maths and English that was equivalent to having an extra term of lessons in a year.

The programme, which has been piloted in 454 schools in 10 local authorities since 2009, works by setting pupils regular targets. Teachers and parents discuss progress three times a year for a minimum of 45 minutes. Children with special needs and disabilities are strongly encouraged to join school clubs and activities outside lessons.

Sonia Blandford, director of the programme, said it could reduce by 10% the proportion of children registered as having special needs.

From: http://www.guardian.co.uk/nhs-failing-vulnerable-young-people

The NHS’ efficiency drive is already beginning to damage hospital waiting times, according to the King’s Fund think tank.
Its research found the need to achieve £20 billion of efficiency savings was increasing the difficulty of managing demand for services, meeting targets and maintaining quality.

Nearly 15% of hospital inpatients waited over the 18-week period the Labour government had made its target for treatment in February 2011 – the highest level for nearly three years.

Patients waiting over four hours in accident and emergency was up to its highest level since 2004/05, but the proportion of patients waiting more than six weeks for diagnostic services fell back in February.

“This report will provide a regular health check on the state of the NHS as it comes to terms with the new financial climate and implements the government’s reforms,” King’s Fund chief economist John Appleby said.

“It highlights significant concern among NHS finance directors – who are well placed to report on the stresses in the system – about the prospects for the year ahead.

“With hospital waiting times rising, the NHS faces a considerable challenge in maintaining performance as the financial squeeze begins to bite.”

The first instalment of the report found that nearly half of its panel identified ward closures and cuts in services as among the main ways of meeting productivity targets in their area.

David Flory, deputy chief executive of the NHS, said the health service had had a good year in spite of last year’s “exceptionally cold winter”.

He pointed out that average waiting times remained low and broadly stable and that the NHS had a healthy financial surplus “in line with its plans”.

Mr Flory added: “Despite continued good performance, the NHS is still facing pressure from growing demand and will do so for many years to come.

“This particular snapshot shows that the NHS must maintain its focus on waiting times and improving patient outcomes, while dealing with the extra demands on the service.

“Under the government’s modernisation plans, patient choice and transparent information will increasingly drive improved performance in the NHS.”

Health secretary Andrew Lansley’s proposed reforms of the NHS, which would create a market dynamic based on GP consortia being handed the bulk of commissioning powers, remain deeply uncertain, however.

Massive opposition from NHS workers, culminating in a no-confidence vote in Mr Lansley from the Royal College of Nursing earlier this month, has forced ministers to pause the health and social care bill’s progress through the Commons as the government embarks on a ‘listening exercise’.

From: http://www.politics.co.uk/health/hospital-waiting-times-highest-in-three-years

Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations or new restrictions on who qualifies for treatment.
In several areas routine surgery was put on hold for months, while in many others new thresholds for hip and knee replacements have been introduced.

The moves are part of the NHS drive to find £20bn efficiency savings by 2015.

The government said performance should be measured by outcomes not numbers.

Surgeons have described the delays faced by patients as “devastating and cruel”. Peter Kay, the president of the British Orthopaedic Association (BOA), says they’ve become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings.

“GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year while perhaps introducing thresholds for surgery.”

He says that simply delaying surgery by one means or another does not improve the outcome for patients as their condition can deteriorate.

“The double jeopardy is that patients wait longer in pain, and when they have the operation, the result might not have been as good as it otherwise would have been had they had it early. ”

The BBC asked orthopaedic surgeons through the BOA if they had seen delays to these operations as a result of measures introduced during the last financial year.

Overall, 692 surgeons in England sent the BBC information about the policy on hip and knee replacement of their local Primary Care Trust (PCT).

Between them they covered the majority of PCTs in England. In some areas no restrictions were being imposed, but in others the specialists reported delays or new thresholds for surgery.

106 surgeons told the BBC routine operations had been put on hold in their area. Others described new limits on when patients qualify for hip or knee replacements.

152 specialists said patients now have to be more disabled or in greater pain, and 118 told us hip and knee surgery had been regarded as a procedure of low priority.

The data reveals a picture of overlapping restrictions, with some surgeons reporting more than one new policy had been introduced in the same area.

A number of PCTs have been explicit about their decisions to put all routine operations on hold for several months up to April to help balance their budgets by the end of the financial year. They include Warrington, Sheffield, Eastern and Coastal Kent, Bury and Warwickshire.

Putting routine operations on hold means that GPs simply stop referring their patients for surgery. So although a patient might be waiting longer, this isn’t recorded in the official waiting statistics.

Another way of adding invisible waiting time into the system is to implement stricter new criteria which have the effect of delaying the point when a patient can be referred for treatment. An investigation by the BBC also found evidence in many PCT board papers of new thresholds being added for hip and knee replacements.

They include introducing scoring systems for patients for pain or disability, or not allowing some obese patients to be referred for surgery until they have been on a weight loss programme.

Professor John Appleby, chief economist at the Kings Fund, says it is a mystery why these operations are being targeted for savings. “I find it difficult to understand. Hip operations are quite expensive, but patients get a lot of benefit for that money. This is actually very good value for money indeed.”

These delays and restrictions are a response to the financial challenge facing the NHS in England. The scale of it was set out under the last Labour government, but the decisions on how to find those savings are being made now.

The coalition government has stopped performance managing the 18 week waiting time, although it remains a legal right under the NHS constitution.

From: http://www.bbc.co.uk/news/health-12964360

Hospitals are cutting back on routine operations like hip and knee replacements as the NHS budget freeze starts to take effect while waiting times are beginning to rise, new figures show.
A survey of more than 60 hospital trusts has found that they carried out almost 11,000 fewer planned or ‘elective’ operations in 2010 than they did in 2009.

The trusts that replied carried out 1,227 fewer knee replacements, a drop of six per cent, and 531 fewer hip replacements.

And they carried out 2,041 fewer hernia operations, down 7.25 per cent, and 1,770 fewer tonsillectomies, a drop of 11 per cent.

The figures are from Freedom of Information requests to England’s 170 NHS hospital trusts, made by the Patients Association, of which 62 responded.

The pressure group described the figures as “a disgrace” while doctors labelled them “worrying”.

The Patients Association also found that, on average, waiting times for hip replacements rose from 80 to 88 days and for knee replacements from 82 to 90 days.

The organisation undertook the research after receiving triple the number of calls in 2010 from patients saying they were having problems getting the surgery they needed, compared to 2009.

In December The Daily Telegraph reported how some trusts were postponing lower-priority procedures to save money.

Although the NHS is receiving a 0.5 per cent above inflation increase each year between now and 2014, critics say a commitment to make internal savings of up to £20 billion by then means front-line services are being affected.

Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago.”

She added: “With the NHS needing to make £20 billion of savings by 2014, we are worried that this situation is only going to get worse – how many more thousands of patients are going to be denied operations this time next year?

“This research backs up what patients are telling us every day on our helpline, less operations are being carried out, and those fortunate enough to get an operation are having to wait longer for it to take place.”

John Black, president of the Royal College of Surgeons, described the figures as “worrying”.

He said: “Patients must be seen on a clinical need, rather than a financial basis. Any cost savings this may bring in the short term will be negated as these patients present with more serious conditions further down the line.”

However, the Department of Health said official hospital statistics for all trusts in England indicated that NHS activity went up in 2010, not down.

For example, from April to October 2010 there were 41,863 hip operations, compared to 39,114 for the corresponding six months in 2009; while the figures for knee operations were 45,463 and 43,454 respectively.

A spokesman said: “There is no justification for asserting that quality of care is slipping. Official figures show that the NHS is delivering more for patients and that waiting times are stable.”

From: http://www.telegraph.co.uk/Hospitals-cutting-operations-while-waiting-times-rise