Patients to face tough curbs on hospital access

But details of an emergency package of cuts imposed following a worsening in the county’s dire financial position offer a key indicator of what patients can expect when the wide-ranging strategy is announced next month.

The problems facing the NHS in the county are among the most intractable in England. It has already received more than £100m in extra NHS funding since 2007 to cover overspending and is due to be a further £19m overspent by March.

New GP-led clinical commissioning groups will take over in April under the Government’s controversial NHS reforms but there are already concerns the new organisations will be saddled with previous debts amid expectations they will overspend again in 2013-14.

The scale of the task facing the local NHS was exposed in a landmark report last year which found too many people were being needlessly referred for expensive hospital care. It called for an enhanced role for community hospitals and better care of the elderly to prevent ill-health and reduce delayed discharges from hospital.

But alongside this there is a growing outcry in the county over the national NHS funding formula which gives deprived areas more cash to the detriment of more affluent North Yorkshire.

Writing in today’s Yorkshire Post, David Harbourne, a former non-executive director at NHS North Yorkshire and York, points to figures which show NHS funding per head is lower in the county than anywhere else in the North.

This is despite more local people being elderly which he says meant 30 per cent of people admitted to hospital in Scarborough and York last year were over 75 compared with 23 per cent in the region.

But without any dramatic and sudden change in the formula – and critics point out similar areas such as Devon, Dorset and Norfolk manage with reduced funding – the financial problems will remain, prompting plans for sweeping changes which are expected to see district general hospitals in the county downsized significantly.

The measures will not, however, address short-term financial difficulties which have prompted a new round of cuts to accelerate moves to save cash. Their key drive is to prevent patients visiting hospital and instead be dealt with more cheaply by their GP and other health staff providing care at home or in the community.

Latest figures reveal there have already been dramatic falls in hospital access. In the Hambleton, Richmondshire and Whitby area, GP referrals fell 2.7 per cent in the six months to September compared with the year before, numbers of outpatients attending hospital for the first time were down by 7.2 per cent, while planned inpatient procedures were down by 12 per cent.

The new round of cuts will in particular target follow-up outpatient care. Rates vary significantly but on average hospital specialists in North Yorkshire see 2.4 outpatients for follow-up appointments for every new patient.

Draconian new limits being imposed from January to March will limit this to one follow-up patient for every new patient overall, effectively reducing the number of follow-ups seen by more than half to save £2m by March – and meaning patients will see far less of their specialist than in the past.

Health chiefs admit they will struggle to sustain the restrictions in 2013-14 but plan to make the reductions permanent from April 2014.

In the Harrogate and Ripon area, they hope the measure will deliver savings of £900,000 by March on the bill for follow-up care which comes to £9.6m a year.

In Scarborough and Ryedale, officials plan to agree new restrictions in initial hospital access to orthopaedic treatment, for ear, nose and throat problems, eye complaints and general surgery, while patients who smoke will be sent to stop-smoking services before being referred for non-urgent care. In moves which will place unprecedented limits on GPs, doctors will need a second colleague to approve all hospital referrals while reviews will be carried out of referral patterns by individual practices.

In the Vale of York, hospital referrals made by trainee GPs or locum doctors will also need to be signed off by a second GP and agreements will be made with hospital doctors over specific procedures and patients where routine follow-up appointments will not be required.