Primary care trusts should delay treatment to cut deficits, minister says

London

Rebecca Coombes

Primary care trusts should tell hospitals to “go slow” and delay inpatient treatments for up to six months in a bid to cut financial deficits to zero before the end of the financial year, the health secretary has said.

Patricia Hewitt, under questioning from the parliamentary health select committee last week, said all trusts were expected to balance their books before the end of March, even if that meant deliberately delaying operations. The government’s target on waiting times is that by the end of this month no patient should be waiting longer than six months for inpatient treatment.

Ms Hewitt said that even if hospitals had the capacity to cut waiting times even further it would “make sense” for financially troubled trusts to maintain these waits while deficits were reduced.

She said, “In some parts of the country hospitals could go faster than we have asked them to; some would dearly love to get rid of waiting lists. But … it will make sense for PCTs [primary care trusts] to say to hospitals to slow down. That would still mean a maximum six months’ wait for inpatient treatment. But I’m not prepared to say that trusts should go beyond that if they have financial problems. Trusts have to live within their means.”

The NHS is currently forecasting debts of around £620m ($1090m; €920m) for the current financial year, although the government aims to reduce the deficit to £200m by the end of the year. Ms Hewitt said she seriously expected trusts to reduce deficits.

“We are not planning for failure here … we are not sitting here with a plan B. That would send a message to these organisations that they can carry on as they are. I understand the anxiety of patients living in these areas,” she said. About 5% of NHS trusts are carrying the bulk of the forecasted deficit.

But Katherine Murphy, spokeswoman for the Patients Association, said after the hearing, “This is of grave concern for patients. It means some will have to continue suffering and have their quality of life impeded. We are paying NHS managers handsomely to manage the NHS budget; why can’t it be done efficiently, and why is it that the vulnerable are affected each time?”

MPs pointed out that Ms Hewitt’s recent intervention over the drug trastuzumab (Herceptin) would force trusts to spend money they hadn’t budgeted for. The Labour MP Charlotte Atkins asked why Ms Hewitt had told North Stoke Primary Care Trust last month to fund treatment with the drug for a patient with breast cancer. It will cost the trust, which has already overspent, more than £40<thin>000 over the next two years.

Ms Atkins said, “This is a PCT that is already having to ask the hospital to delay treatment on 500 patients. Is this a fair position to put PCTs in?”

But Ms Hewitt said trastuzumab was an unusual case, because the early result of its clinical trial had been so remarkable.

“Early results appear to show results—in terms of lives saved—as good as the breast cancer screening programme, that is 1000 lives saved a year. It’s plain that PCTs should not be refusing a request solely on the grounds of funding where a clinician believes it is the best treatment. Of course, it’s difficult when PCTs are already under financial pressure, but one of the reasons they exist is to help the NHS make some difficult decisions.”

Ms Atkins countered that trastuzumab was not the “first and last wonder drug” that trusts would be expected to find money for in the future.