Cuts forcing patients to wait for treatment, NHS admits

In some cases hospitals are being told to delay treatment in order to save money, while in others GPs are telling patients they cannot be operated upon until their conditions worsen.

The Primary Care Trust Network, an umbrella group that represents health service managers who buy treatment, admits the moves are “undesirable” and will be “unpopular” with the public.

But managers insist they are only acting “reluctantly” as a result of “financial constraint”, and deny allegations by private providers that they are biased against them.

It comes as the NHS struggles to make an unprecedented £20billion of savings over the next three years, at the same time as the Government imposes a radical reorganisation of commissioning and management structures.

Already, NHS patients can be treated for non-emergency operations such as hip and knee replacements in private hospitals in order to speed up treatment.

But it is claimed that Primary Care Trusts, which currently commission care, are finding ways to delay referrals and reduce demand for services in order to save money.

An official tribunal called the Co-operation and Competition Panel is looking into allegations that NHS managers are trying to reduce the amount of business private providers receive.

In a submission to the panel, the PCT Network denied it was discriminating against the private sector – but it did admit that managers are rationing treatment to save money.

This includes increasing waiting times between referral and treatment, to slow down the number of patients being treated and thus the amount of money being spent in the health service, and increasing the threshold of pain or illness that patients are in before they qualify for treatment, so that fewer have to be seen.

Its letter, written by David Stout, Director of the PCT Network, says: “From the information we have received from PCTs, it is the case that in a context of financial constraint, a number have reluctantly decided to temporarily reduce activity levels this year to help contain costs, by asking providers to extend (or not further reduce) their waiting times (while keeping them within the constitutionally required 18-weeks) or imposing in-year caps on (in effect deferring) activity.

“PCTs, working with their practice-based commissioners, are also rightly reviewing referral thresholds and guidelines, and adopting a variety of different referral management processes to help maintain adherence to these, to ensure that patients who need and will benefit most from secondary interventions are prioritised for treatment.”

But he added: “Where choice of provider is appropriate, patients are still being offered this once a decision to refer has been taken, albeit with a longer waiting time or higher treatment threshold.

“For this reason, while the PCTs acknowledge that these actions are undesirable and may be unpopular with patients and providers, they do not believe they are breaching the rules which require commissioners to be transparent and non-discriminatory and to promote choice of provider where appropriate.”

David Worskett of the NHS Partners Network, which represents private firms that treat NHS patients, told the BBC: “It is absolutely the case that in this period of transition that independent sectors are facing significant difficulties. The practices seem to be bias against the independent sector.”

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Hospital surgery puts dozens of patients at risk of CJD

He said: ''In this incident we do not have a single confirmed case of CJD. However, we do have one patient who was at high risk and 38 people at extremely low risk.

''We know all the surgical instruments used on this group of patients were cleaned, disinfected and sterilised normally. However, it is possible that the proteins which cause CJD, known as prions, survived these routine sterilisation procedures so an extremely small risk of transmission remains.''

The original operation involving the ''index case'' occurred in 2007 at one of ABMU's four main hospitals in South Wales - Singleton and Morriston in Swansea, Neath Port Talbot and Princess of Wales Hospital in Bridgend.

Dr Hoffman said at the time of the surgery the index case's high risk of developing CJD was not known by doctors at the hospital or the GP.

Once the high risk of the patient was identified in 2009 - before another operation - PHW contacted the UK CJD incidents panel made up of experts from around the UK.

Health officials then investigated what instruments had been used in the original operation and their subsequent usage.

It was in February this year that the panel said the health board should contact the 38 patients involved.

PHW said it would not provide any further details on the index case, such as what hospital or the age or sex of the person, in case it identified them.

However, in explaining why the number of those who are now at risk was a relatively low number - given the number of operations ABMU had performed in the two-year time period - Dr Hoffman explained it was because the the operations were of a ''specialist'' nature.

Of the 38 people who are at ''low risk'' - 37 were from Mid and West Wales and one was from North Wales.

Dr Hoffman would not be drawn on whether the 38 had donated blood since the operations, but confirmed Public Health Wales had contacted the Welsh Blood Service.

But he stressed the likelihood of someone contracting CJD "from a contact of a contact" was highly unlikely.

"All patients at risk have been contacted and there is no risk to anybody else," said Dr Hoffman. "People who have had any type of surgery in the ABMU area since 2007 but have not been contacted by us have no reason at all to worry."

Dr Hoffman said he personally spoken to two of the patients and they were obviously "worried and upset".

"We do understand that it's very upsetting for the patients to live with this uncertainty for years to come," he added.

"Our advice is they should carry on to live their lives as before."

CJD is a rare disease that affects the structures of the brain and causes incurable neurological symptoms. There is no cure or treatment.

PHW said anyone who is aware they are at increased risk of CJD should not donate blood or organs and should always inform their surgeon or doctor before undergoing "any health procedure".

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