NHS consultants warn of dire cash crisis

BMJ 1996; 313 doi: (Published 19 October 1996) Cite this as: BMJ 1996;313:964

British consultants have warned that the NHS will be reduced to treating emergencies only this winter if the underfunding is not tackled.

At an emergency debate at last week's meeting of the BMA's Central Consultants and Specialists Committee (CCSC) senior hospital doctors gave evidence of health authority and fundholding deficits, rising waiting lists, cancelled procedures, and staff shortages. The BMA called on the prime minister, John Major, to acknowledge the crisis.

Surgeons at the Queen's Medical Centre in Nottingham have been told to stop all routine surgery and investigations for the patients of fundholders in south Derbyshire and non-fundholders in Nottingham because both the fundholders and the authority have run out of money. “So much for the single tier health service,” Professor Brian Hopkinson said.

The committee was given examples of money being saved by dispensing with agency nurses, by asking nurses to work for a shorter time, and by not covering the absences of secretarial staff. Equipment was not being replaced when needed, which affected the quality of the service. Fundholders who ran out of money were forming their own waiting lists and cancelling their patients' follow up hospital appointments.

Dr Peter Holden, a fundholding general practitioner in Derbyshire, admitted that once he and his colleagues were in the black again the hospital service might no longer be available. He urged his patients to write to their members of parliament and health authority chief executives about the underfunding.

Mr James Robertson, an orthopaedic surgeon in Southampton, said that his unit had been told to use cheaper prostheses. There was a waiting list of six months for physiotherapy in one area and 18 months in another. He likened the position to a pack of cards. With 22 nurses short his unit was allowed to recruit nine. Five came for interview, by which time a further 14 had left.

The CCSC's chairman, Mr James Johnson, a vascular surgeon on the Wirral, said that the stories were nothing short of horrendous. “What purchasers need to recognise is that you cannot simply open and shut wards at will to control the money flow. When you want to reopen services you find that the skilled staff are no longer available. In the meantime, patients who are not emergencies but who genuinely need treatment are waiting in pain and distress.”

After the meeting the chairman of council, Dr Sandy Macara, said, “I am infuriated by the bland indifference of armchair commentators who claim there is enough funding within the NHS. Our patients know that is not true.” A spokeswoman from the National Association of Health Authorities and Trusts said that the association had also called for increased funding. She agreed that it would be a difficult winter but said that trusts and health authorities were gearing themselves up to cope.

Last week the London newspaper Evening Standard reported that only a handful of the 16 health authorities in the capital expected to balance their books this year. Three were facing deficits of between £14m and £19m, and several chief executives were forecasting their toughest winter, with overstretched emergency departments and a shortage of beds.—LINDA BEECHAM, BMJ

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