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NEWS: Rebecca Coombes Primary care trusts should delay treatment to cut deficits BMJ 2005; 331: 1426 [Full text]

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Treatment Delays will increase not cut deficits

John J Turner   (19 December 2005)

Treatment Delays will increase not cut deficits 19 December 2005
John J Turner, Consultant Physician University Hospital Aintree, Liverpool L9 7AL Send response to journal: Re: Treatment Delays will increase not cut deficits	Rebecca Coombes in this week's BMJ reports the Health Secretary instructing Primary Care Trusts to tell hospitals to delay elective surgery to cut deficits. This follows the previous week's spurious life style rationing policy of some PCTs. I am fortunate to have had both a knee and a hip replacement with life transforming results but may well have failed the shaky treatment criteria in Suffolk. This central control freakery seeks to circumvent good professional decision making by Clinical staff and hand it to PCTs and Health Authorities. Clinical cost and benefit needs good evaluation in the best interests of patients but has the objective judgement of the loftily named National Institute of Clinical Excellence now been compromised by Department of Health interference. The true costs of lifestyle linked rationing are likely to be high with many hidden costs as usual underestimated and creating a complexity of appeals and counter appeals. BMI measurement is useful in population studies but can be seriously misleading as a basis for surgical refusal in individual patients. The end of year book balancing exercise of Alice in Wonderland health economics is now being played. Hospital Trusts are implementing the policy of postponing and delaying elective surgery to cut end of year deficits. Theatre teams, Surgeons and Anaesthetists are made temporarily idle [but still paid] and the postponed surgery will be picked up at a higher true cost in in next year's budgets. This results not in savings but in double charging, first the fixed costs of not doing it followed by the inflationary actual costs of repurchasing under expensive 'waiting list initiatives'. John J Turner Competing interests: None declared