The “phoney war” preceding hostilities in the second world war allowed people to discuss and agree on survival strategies. Citizens were fearful but at least all were in it together and treated equally. The denial, which is highlighted by the Nuffield Trust and the Kings Fund, is not allowing the discussion. Politicians (mainly) and the Media (slightly) are to blame.
Increasing numbers of patients will be left to endure “crippling pain” as rationing spreads across the NHS, one of Britain’s most senior surgeons has warned.
Stephen Cannon, Vice President of the Royal College of Surgeons said bans on all but the most urgent treatment would become “commonplace” without major changes to the funding of the health service.
The NHS is in the grip of the worst financial crisis in its history, with increasing restrictions on cataract surgery and lengthening waiting times for hip and knee operations in most areas.
Yesterday St Helens clinical commissioning group in Merseyside took the unprecedented step of making plans to suspend all non-urgent treatment for four months, in an attempt to tackle its overspend.
In a letter to The Telegraph, Mr Cannon, an orthopaedic surgeon, said such bans would become widespread without a “realistic” increase in funding.
He also called for changes in the way existing funds are spent, to divert more money away from bureaucracy towards front-line care.
“This is not a one-off, this is a growing problem across the NHS,” he said. “We are deeply concerned. It is bad enough having to put up with crippling arthritis as waiting times get longer, but these sorts of delays can mean the hip crumbling away so the patient can’t even take a step. It also means that when patients do have surgery, it is infinitely more complex,” the surgeon said.
“I am concerned that we could end up going back to the days when patients waited two or three years for operations,” he added, warning that many patients were being left in “severe discomfort and pain”.
Mr Cannon called for extra funding for the NHS to cope with rising demand from an ageing population. But he also said too much money was being spent on bureaucracy – including on long wrangles over which patients would be funded.
“We are seeing decisions now being made purely on a financial basis, when these should be clinical judgements, made in the interests of patients,” he said.
“These rationing processes are often adding in an extra layer of bureaucracy, which is using up more resources,” he said.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, said blanket suspensions of “non-urgent” treatment risked lives.
Diseases such as cancer were often only detected when doctors investigated ailments which had not been identified as urgent, he said.
“This is an unacceptable decision which highlights the incredible financial pressure facing general practice and its impact on patient care,” he said.
“What apparently may not be urgent at first presentation and is therefore not referred could turn out to be very serious in the long term. Many cases of cancer are subsequently diagnosed following routine referrals of patients who have undifferentiated symptoms early on in their illness.”
Geoffrey Appleton, lay chairman of St Helens CCG said: “We would prefer not to be in this position but we are by no means alone as an increasing number of CCG’s are reporting similar financial challenges. Our funding gap is so large we know these measures alone will not bring a resolution and we are faced with the prospect of proposing to suspend, reduce or withdraw certain services.”
Its proposals will now go to public consultation. Because the CCG was recently rated “inadequate” by NHS England, any plans will have to be agreed by its local health officials.
Last week, a think-tank said “unpalatable” decisions about rationing lie ahead unless the NHS achieves unprecedented levels of efficiency savings, or receives a funding boost.
Three in four CCGs are now operating restrictions on cataract surgery, limiting them to those in most desperate need, using criteria such as whether the patient has suffered falls as a result of their vision loss.
Earlier this year the NHS declared a deficit of £2.45bn – the worst in its history.
As the NHS finances have deteriorated, health trusts have spent record sums on “turnaround” managers employed on “off-payroll” deals.
Earlier this month, an investigation by The Telegraph revealed that such managers have been paid rates of up to £60,000 a month by cash-strapped trusts.
An NHS England spokesman said: “Decisions when prioritising resources are always very difficult for commissioners but it is up to CCGS to make the best decisions for their area and work with hospitals to 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 18 week target is a national objective which all CCGs and hospitals should be striving to meet.”
Grantham and District Hospital is considering plans to restrict its A&E hours after becoming “seriously affected” by a “national shortage of appropriately trained doctors to work in A&Es”.
In a statement it said: “We have reached a crisis point and we may put patients at risk if we don’t act.”
Dr Clifford Mann, president of the Royal College of Emergency Medicine, said there were too few A&E doctors in the country to meet patient demand.
“The wider picture is there is a real crisis in emergency medicine as our workforce numbers are not growing fast enough to keep pace with rising numbers of patients attending A&E Departments,” he said.
Meanwhile NHS managers at University Lincolnshire Hospitals NHS trust are considering closing an Accident & Emergency department at night after reaching “crisis point”.