NHS in critical state, say doctors

The medical directors of a major London teaching hospital have warned the Secretary of State for Health that their trust cannot continue to provide a proper standard of care for patients unless the financial pressures on it are eased.

In an open letter to Frank Dobson which highlights the critical state of the National Health Service, the two senior consultants from Northwick Park and St Marks NHS Trust in Harrow, north-west London, say that like many other hospitals they have had to find millions of pounds worth of cost savings in the face of growing demand, with no prospect of improvement in the coming years.

"We are convinced we cannot continue to make further recurrent savings without destroying the service and those who provide it. We do not seek confrontation but we, and most other hospital doctors, are not prepared to destroy what we have all worked so hard to achieve."

The letter, dated 3 June, appears today as an article in the British Medical Journal which says it decided to publish it "because we think it reflects the concerns of many hospital doctors in Britain today". An accompanying leader says its demands for action "can no longer be ignored".

However, Mr Dobson yesterday gave no hint that he was minded to help. In an uncompromising speech to the Institute of Health Services Management annual conference in Cardiff, he said waiting lists and waiting times were rising and 69 of 100 health authorities and 125 of 425 trusts had started the year in debt but he still wanted more savings. These would be on top of the pounds 100m reductions in management costs already announced.

He said: "I am now asking you to look at other immediate ways of saving money and putting it to better use. That is what good managers are constantly on the lookout for."

Announcing an extra pounds 5m for paediatric intensive care, Mr Dobson said priority must be given to treating emergencies so that patients were not left "waiting 24 hours on trolleys in minor injuries clinics". But Karen Caines, director of the institute, said the clear implication was that waiting lists for routine work will grow. "This is just another form of rationing. Hospitals will be putting up the closed sign to anyone who does not arrive in an ambulance," she said.

The letter to Mr Dobson from Professor Peter Richards, medical director of Northwick Park, and Dr Michael Gumpel, chairman of the medical staffs committee, says emergency admissions are rising, more people are turning up at accident and emergency departments and there is consequently less capacity to deal with non-urgent patients, which provide a major part of the trust's income.

To deal with the emergencies, routine patients have to be turned away and operations cancelled. The shortcomings of community care mean an increasing number of beds are blocked by elderly patients awaiting discharge. Despite efforts to cut unnecessary spending and increase income "we have been forced to cut, cut and cut again", the doctors write.