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An NHS body has run so short of money that it has banned patients in its area from having non-urgent surgery for up to 102 days in an unprecedented move that doctors have condemned as unfair and damaging.
Around 1,700 patients will be affected by West Kent clinical commissioning group’s (CCG) attempt to save £3.2m by delaying non-urgent operations from 20 December last year until the new financial year starts in April.
The CCG has introduced what the Royal College of Surgeons says is the longest ban in health service history on patients undergoing surgery to relieve pain, immobility, disability and other problems. The 1,700 patients include those waiting to have a new hip or knee fitted.
It is the latest example of cash-strapped CCGs implementing controversial restrictions on patients’ access to treatment which doctors have agreed they need. It follows a series of rows over the growing number of England’s 209 CCGs rationing care, including to smokers and those who are obese.
West Kent CCG has decided to suspend non-urgent surgery to help ensure that it does not bust its £616m annual budget. It pays for and supervises the care received by 463,000 people in Maidstone, Tunbridge Wells and surrounding areas.
Clare Marx, the president of the Royal College of Surgeons, warned that the move would prolong patients’ suffering. “West Kent CCG’s suspension of non-urgent surgery until April is unprecedented and unfair. Patients, some of whom may be in severe discomfort or pain, should not be made to wait longer for treatment because the CCG has run out of money and surgical patients are perceived as easily postponed,” said Marx.
The policy could mean that patients’ health worsens further while they wait for a date for their procedure, and would waste valuable NHS resources and cost the CCG more in the long run, she added.
"The CCG is trying to make short-term savings, which may have major consequences for patients. While patients wait for treatment, their conditions could deteriorate, sometimes making treatment more complex and costly in the long term. In addition, standing down surgeons and their teams is inefficient and a waste of scarce resource. Clinical decisions must not be made purely on a financial basis,” Marx said.
The Department of Health criticised the move. A spokeswoman said: “Blanket restrictions on treatment are unacceptable. The clinical needs of a patient, and the urgency with which they require treatment, must come first as determined by doctors with local knowledge and expertise to best serve the needs of their population. We know the NHS is busy that’s why we’re giving it more money – £4bn this year - to fund its own plan for the future.”
Recent CCG board papers show that it agreed and began the policy in December because so many more patients than expected were seeking care that it was at risk of overshooting its budget.
Hospitals are being “asked to reduce non-urgent elective care until the end of the financial year. This will inevitably mean delays in treatment for some patients”, it said. It hopes to save £2.1m by not sending patients for surgery at Maidstone and Tunbridge Wells NHS trust and another £1.1m by limiting the number of patients sent to private health firms.
The CCG is also considering limiting patients’ access to cataract removals and in-vitro fertilisation as part of a raft of measures designed to shore up its rocky financial position. In addition, it is following a lead set by other CCGs and making smokers and obese patients wait for a wide range of surgery until they have quit smoking or lost weight.
“For a hip or a knee replacement, some individuals, although suffering continued discomfort, would be able to wait longer for their operation without there being an adverse outcome for their health,” said Ian Ayres, the CCG’s accountable officer.
"We are working with our providers to identify exactly which patients will be affected, but estimate the number of patients affected to be in the order of 1,700. We have not prescribed in advance a list of procedures or patients to be delayed. Anyone who has had a procedure booked will be treated. No one will have their operation or procedure cancelled as a result of this policy.
“Patients will continue to be referred by their GP outpatient appointment and be seen by a consultant. A judgment will then be made as to whether the required procedure is urgent, or non-urgent and could wait. Therefore, no one with an urgent healthcare need will be made to wait.”
The move comes against a backdrop of fast-deteriorating CCG finances. The 209 CCGs were meant to end 2016-17 with an £800m surplus, which was then going to be used to prop up the ailing finances of NHS hospital trusts. But NHS England recently disclosed that CCGs had overspent by £300m in the first six months of the year, casting serious doubt over their ability to meet that target.
Sally Gainsbury, an NHS finances expert at the Nuffield Trust health thinktank, said the NHS’s overall finances for this year would be put at risk if CCGs did not deliver the requested £800m surplus. “If they don’t underspend by £800m then the NHS system is bust,” she said, because that sum has been earmarked to help ensure hospitals’ collective deficit in 2016-17 is much less than last year’s record £2.45bn.
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