By Martin Beckford, Health Correspondent
10:00PM BST 28 Jul 2011
Health service trusts are “imposing pain and inconvenience” by making patients wait longer than necessary, in some cases as long as four months, the study found.
Executives believe the delays mean some people will remove themselves from lists “either by dying or by paying for their own treatment” claims the report, by an independent watchdog that advises the NHS.
The Co-operation and Competition Panel says the tactic is one of a number used by managers that “excessively constrain” patients’ rights to choose where to be operated upon, and damage hospitals’ ability to compete for planned surgery.
It claims unfair practices are “endemic” in some areas of England and pose a “serious risk” to the Government’s drive to open up the health service to competition.
But managers, who are already rationing surgery for cataracts, hips, knees and tonsils, say they must restrict treatment as the NHS is under orders to make £20 billion of efficiency savings by 2015.
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Lord Carter of Coles, chairman of the panel, said: “Commissioners have a difficult job in the current financial climate, but patients’ rights are often being restricted without a valid and visible reason.”
Katherine Murphy, chief executive of the Patients Association, said: “It is outrageous that some primary care trusts are imposing minimum waiting times. The suggestion that it could save money because patients will remove themselves from the list by going private or dying is a callous and cynical manipulation of people’s lives and should not be tolerated.”
Since 2006, NHS patients who need routine elective care have had the right to choose between at least four hospitals including privately-run units. But there have been claims that trusts, the local bodies that pay for treatment, restrict choice and favour some hospitals to balance their books. The panel investigated whether the allegations were true.
It found “many examples of PCTs excessively constraining patients’ ability to choose, and providers’ ability to offer routine elective care services”.
Managers restricted GPs’ ability to refer patients to some hospitals by imposing “caps” on the number a provider would be paid to treat and by imposing minimum waiting times, its report said.
Under government targets, patients should be treated within 18 weeks of referral by a GP. But even when surgeons could see them far sooner, the study found that some trusts made hospitals wait as long as 15 weeks before operating. The tactic forced private hospitals, which were more likely to be able to treat patients quickly, to operate as slowly as overcrowded NHS units in an “unfortunate levelling down”.
Some managers insisted that longer waiting times would lead to overall savings as “experience suggests that if patients wait longer then some will remove themselves from the list”. Interpreting this statement, the panel noted: “We understand that patients will 'remove themselves from the waiting list’ either by dying or by paying for their own treatment at private sector providers.”
It said that minimum waiting times should only be used as a “last resort” and told trusts to publish their policies on the home page of their websites.
The panel also found that trusts tended to give elective business to their local NHS hospital, rather than allowing choice, in order to ensure its other services such as casualty departments remained financially viable.
The findings come as the NHS is under pressure from increasing demand and tighter budgets. Waiting times have lengthened since last year’s general election and more trusts are increasing the number of procedures of “low clinical value” they turn down or insisting that patients’ conditions worsen before they are seen.
Labour yesterday unearthed Treasury figures that show health spending totalled £101.985 billion in 2010-11, down from £102.751 billion in the last year of Labour, despite David Cameron’s pledge that “the money going into the NHS will actually increase in real terms”. The Tories pointed out that the fall represented the last part of the previous government’s five-year spending plan.
Ministers welcomed the competition panel’s study. Paul Burstow, the care services minister, said: “This report illustrates exactly why we need to modernise the NHS and increase choice for patients.
“Trusts will want to take a hard look at practices in light of this report and ensure they are always in the best interest of patients and the taxpayer.”
Under the Health and Social Care Bill, which has been watered down in the face of opposition from the medical profession and Liberal Democrats, power to buy treatment will be handed from trusts to new bodies led by GPs.
The new Clinical Commissioning Groups are intended to be more accountable to patients, while the number of sectors where choice and competition apply is being extended. David Stout, director of the NHS Confederation’s primary care trust network, said: “Today’s report rightly acknowledges that each situation will be different and the extent that any benefits outweigh the loss of choice should be considered on a case-by-case basis.”
He added: “Commissioners will still be left to decide the right course of action when faced with trade-offs between patient choice and value for money. The suggestion that many current trust decisions are not justifiable on these grounds is largely unsubstantiated by the detail in the report as the CCP has not investigated specific cases in detail.”
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