Britain’s NHS falls short in providing services

By Dr. Ananya Mandal, MDDec 20 2010

British patients are being denied routine procedures varying from hip replacements, to cataract removal and wisdom tooth extraction as trusts are cutting back on surgeries and diagnostic procedures to save money. There is also a restriction preventing patients undergoing procedures for lifestyle reasons and those considered “low priority”. This includes obesity surgeries, mild varicose veins, fertility treatments, back injections for pain, hip and knee replacement in obese patients etc.

The Ministers have however assured that front line services should be protected and the savings needed can be found from management costs and efficiencies. Doctors and nurses said the ‘grim’ results undermine the ‘myth’ that front line services are being protected and warned they were just the ‘tip of the iceberg’. It is estimated that the condition would worsen come 2011 as the NHS struggles to save £20bn over the next four years. This discrepancy points to the growing demand and increasing costs. From April 2011 the amount of money hospitals receive for each type of treatment will be cut by 1.5 per cent. This may mean that managers will refuse to provide treatments that they make a loss on. These cutbacks will be seen in 20 out of the 145 primary care trusts in England. Fifteen PCTs have said they are not cutting services and 11 were still undecided.

Dr Mark Porter, Chairman of the British Medical Association’s Consultants Committee said, “Each of these examples undermines the myth that the NHS has been protected from the financial crisis. These are all services that patients value… They are by and large not being axed for clinical reasons, but as an inevitable consequence of the massive cost savings that have been imposed on the NHS… Despite the continuing claims of real terms increases for the NHS, the reality on the ground is very different. The scale of the financial challenge facing the service is such that this is likely to be the tip of the iceberg…While further cuts are inevitable, it is crucial that clinicians are allowed to feed into the process, and put forward ideas for improving efficiency that do not undermine quality or harm patients.”

David Stout, director of the NHS Confederation’s PCT Network added, “Primary care trusts (PCTs) have the difficult job of putting in place the right health services to meet the needs of their local population while operating within a fixed budget. This inevitably involves deciding priorities…Those PCTs facing financial pressures have to put in place measures to reduce access to some services where they have found no alternative ways of reducing expenditure. None of these decisions will be taken lightly and it is important that any decision about funding of services are openly communicated and consulted on with patients, staff and local communities… Management costs are a relatively small proportion of overall health service spend and the NHS compares favourably with most health care systems across the world. Nevertheless PCTs are all reducing management costs in line with Government policy. In the short-term however this affects PCTs budgets as a result of redundancy costs.”

Royal College of Nursing Chief Executive & General Secretary, Dr Peter Carter, said, “These grim findings are further evidence that there is a huge gulf between the Government’s promise to protect the front line and what is actually happening on the ground… Some trusts are making short term decisions to plug the holes in their budgets and instead of protecting patient care, are cutting jobs and services at an increasingly alarming rate. We have already identified 27,000 posts are earmarked to be cut across the UK… Trusts need to take a long term strategic approach to improving care and services rather than shedding jobs by stealth and limiting and closing important services.”

In response a Department of Health spokesman said, “The NHS must cut back on bureaucracy, not on front line care… We have been very clear that NHS organizations should not interpret efficiency savings as budget and service cuts. Every penny saved from efficiency savings - including a 45 per cent reduction in management costs – needs to be invested back in to patient care… We would expect the NHS to make decisions locally based on the clinical needs of their patients and with regard to the need to make the most efficient use of funding… No one should experience undue delay at any stage of their treatment… We are making more and more information available to patients so that they can vote with their feet and choose the service that delivers for them.”