NHS ‘rationing patient access to hit targets’

MPs have raised concerns that the NHS is meeting its saving targets by rationing patients’ access to services.
Margaret Hodge, chairman of the Commons Public Accounts Committee.Margaret Hodge, chairman of the Commons Public Accounts Committee.
Margaret Hodge, chairman of the Commons Public Accounts Committee.

In a report, the powerful public accounts committee warns the toughest efficiencies in a £20bn
cost-cutting drive have yet to be made, as they raise doubts about the scale of those already delivered.

MPs call on the Department of Health to “urgently” make the case for plans to transform services including highly controversial reconfigurations of hospital care which they describe as the more “challenging and risky” part of the efficiency drive.

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They said the NHS appeared to have made a positive start in making savings but they could not be “fully confident” in those already delivered after finding only 60 
per cent of efficiencies worth £5.8bn in 2011-12 could be substantiated.

They said the NHS was making savings by reducing demand for health services, particularly in hospitals, but there were “widespread concerns” from patient groups and doctors that access to treatment including cataract, hip and knee surgery was being rationed, while there were additional fears the quality of care could also be hit.

Committee chairman Margaret Hodge said: “The NHS has achieved its financial savings target, but this has in large part come from freezing wages.

“We are concerned that other savings are being achieved by rationing patients’ access to certain treatments. These procedures are described as being ‘of low clinical value’, but people waiting for these operations suffer pain and a poorer quality of life.

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“Furthermore, the finances of some trusts are fragile, and there is a risk they may resort to simple cost-cutting rather than finding genuine efficiency savings.

“As the Francis report on the Mid-Staffordshire NHS Trust showed, financial pressures may already be causing some hospital trusts to cut staff with damaging effects on the quality and safety of care.

“The NHS must fundamentally change the way that healthcare is provided to secure the level of savings needed in the future, for example by moving services out of hospitals and into the community.

“We are not satisfied that the department and the NHS Commissioning Board is doing enough to help the NHS transform services.

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“Local people are understandably resistant when proposals are made to close their local hospital or reduce the range of services it provides. It is down to the department to make a clear case for change from the patient’s point of view, demonstrating the benefits in terms of the quality and safety of care as well as cost savings.

“Unless this is done urgently, the department will continue to face resistance to change and the NHS will struggle to deliver the savings it needs.”

Royal College of Surgeons’ president Prof Norman Williams said: “Despite assurances that patients would not be denied treatment because of the NHS savings drive, we are concerned that today’s important report highlights that this is still happening.

“Such a short-term approach creates a false economy and could well lead to higher costs as patients may then need longer, more complex treatment.”

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Royal College of Nursing chief executive Peter Carter said: “Not only are certain treatments being rationed, we are also concerned that nursing care itself is starting to be rationed.

“Of course the NHS has to be financially healthy, but this won’t be achieved in the long term if trusts are living on the edge, either financially or in terms of care.”

A Department of Health spokesman said: “We have been absolutely clear that access to NHS services should not be restricted on the basis of cost.

“Decisions on treatments should be made by clinical experts based on the needs of each patient.”