Too successful: the hospitals forced to introduce minimum waiting times
(Filed: 07/08/2006)
Hospitals across the country are imposing minimum waiting times - delaying the treatment of thousands of patients.
Blessing given: Patricia Hewitt
After years of Government targets pushing them to cut waiting lists, staff are now being warned against "over-performing" by treating patients too quickly. The Sunday Telegraph has learned that at least six trusts have imposed the minimum times.
In March, Patricia Hewitt, the Secretary of State for Health, offered her apparent blessing for the minimum waiting times by announcing they would be "appropriate" in some cases. Amid fears about ?1.27 billion of NHS debts, she expressed concern that some hospitals were so productive "they actually got ahead of what the NHS could afford".
The minimum waiting times, however, dismayed Katherine Murphy, of the Patients' Association, who said last night: "This all stems from bad financial planning and management. No wonder there is a crisis. If staff are available for an operation, they should be utilised."
Andrew Lansley, the shadow health secretary, added that the minimum waiting times shed new light on the Government's target that patients should wait no longer than six months. "It is outrageous that the purpose of the Government's targets is not so much to drive down waiting times, as to impose a six-month wait."
The measures also seem certain to add to the anger that erupted last week after Ipswich Hospital in Suffolk admitted it had forfeited ?2.4 million because it treated patients too quickly, having already agreed a 122-day minimum waiting time with East Suffolk Primary Care Trust (PCT), its funding body. The hospital finished the last financial year ?16.7 million in the red.
Douglas Seaton, 60, a consultant physician who worked with the restraints of the minimum waiting times before retiring from Ipswich Hospital in June, said: "In the last year, we have seen disastrous strains. The senior managers are following political instructions. The Government is holding the reins and it is not working."
A spokesman for the hospital and the PCT insisted that no one was denied urgent treatment, adding: "This is a local issue. It doesn't have national significance."
The Sunday Telegraph has learned of five further minimum-waiting-time directives. In May, Staffordshire Moorlands PCT, which funds services at two hospitals and is more than ?5 million in the red, introduced a 19-week minimum wait for in-patients and 10 weeks for out-patients. A spokesman said: "These were the least worst cuts we could make." In March, Eastbourne Downs PCT, expected to overspend by ?7 million this year, ordered a six-month minimum wait for non-urgent operations. Also in March, it was revealed that Medway PCT, with a deficit of ?12.4 million, brought in a nine-week wait for out-patient appointments and 20 weeks for non-urgent operations.
Doctors are also resigning. One gyn?cologist said that he spent more time doing sudoku puzzles than treating patients because of the measures. Since January, West Hertfordshire NHS Trust, with a deficit of ?41 million, has used a 10-week minimum wait for routine GP referrals to hospital. Watford and Three Rivers PCT, ?13.2 million in the red, has introduced "demand management": no in-patient or day case is admitted before five months.
There is no evidence that in any of these cases, emergency treatment or cancer care was delayed.
Elsewhere, serious financial tensions are emerging between hospitals and the PCTs paying them.
In June, the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust claimed it might have to send patients back to their GPs because of insufficient funding from Bournemouth Teaching PCT. The dispute was resolved, but not before the PCT told the Health Service Journal that it was "disappointed that the Foundation Trust refused to slow the pace of its work. Much of this overperformance could have been avoided."
Sue Slipman, the director of the Foundation Trust Network, which represents all 32 existing foundation trusts and 10 trusts preparing for foundation status, warned of nine similar disputes over funding worth a total of ?28 million.
Michael Dixon, the chairman of the NHS Alliance, representing PCTs, blamed the inflexibility of the Government's Payment by Results system. "PCTs are operating with one arm tied behind their back. Whereas hospitals are able to do more operations, PCTs are unable to negotiate the rate they'll pay for the extra work because it's fixed."
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