Lansley 'must let NHS trusts control cuts'

Health Secretary to ban hospitals from imposing minimum waiting times for non-urgent treatment

Health trusts are to be banned from rationing NHS operations and imposing minimum waiting times to cut costs, the Heath Secretary, Andrew Lansley, will announce today.

Stung by revelations that hip replacements, cataract surgery and tonsil removal are now being routinely limited to help save £20bn over the next four years, Mr Lansley has moved to ban the practice. Primary care trusts will also be prevented from imposing arbitrary waiting times for certain procedures in the hope that making patients wait longer will force some to seek private treatment.

The Health Secretary said any PCT found to be in breach of the new rules after the end of March will be subject to Department of Health intervention – including removing senior management. But privately NHS commissioners have warned his decision could be counter-productive as health trusts still have to find savings in their budgets and will be forced to cut other areas.

The new rules will not apply to the new GP commissioning groups which are due to take over the role of PCTs in 2013. Aides to Mr Lansley argue that, under the new regime, the healthcare watchdog, Monitor, will have the power to force commissioners to provide timely treatment. They add that, as doctors will be in charge of commissioning, they will have no incentive to ration the care patients receive.

In July, an inquiry by the Co-operation and Competition Panel found that some PCTs were imposing minimum waiting times of up to 15 weeks for surgery regarded as non-urgent, just short of the 18-week upper limit, to save money.

The watchdog said trusts believed that longer waits would lead some patients to "remove themselves from lists", which meant they would either die or go private before the NHS saw them.

The CCP found that PCTs were also imposing arbitrary caps on the amount of treatment they would pay for – meaning that key treatments such as hip replacements, cataract removals and knee surgery were being rationed even if the patients needed them.

According to responses from 111 trusts to Freedom of Information requests, 64 per cent of PCTs have introduced rationing policies for non-urgent treatments and those of limited clinical value in the past 18 months. One in three PCTs has also added procedures to lists of treatments they no longer fund because they deem them to be non-urgent or of limited clinical value.

Announcing the move, Mr Lansley claimed the practice of rationing had begun long before the Conservatives came into power. He said: "No right-thinking person could understand how anyone could delay a patient's treatment unnecessarily. If patients need treatment, they should get it as soon as possible."

But Elizabeth Wade, head of commissioning policy for the PCT Network which represents health trusts, said some control over NHS costs was necessary. "Where there is poor commissioning practice, we should not support it. Nobody wants decisions on patient care taken in an arbitrary fashion purely based on cost.

"But with the NHS expected to reduce its spending by £20bn over the next four years while demand for services continues to increase, effective planning is more important than ever.

She added: "If the Government intends to take action to prevent commissioners being able to take decisions about local priorities, it must acknowledge the impact this will have on PCTs' ability to plan services."

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