The ban on non-urgent admissions to hospitals with actual or threatened budget deficits will begin to bite throughout the north-west Thames health region as the new financial year begins in April. It is expected to spread elsewhere as the brakes are taken off the 'steady state' or interim phase of the market-led overhaul of the NHS imposed by the Government two years ago.
Until now, health authorities have been allowed to use contingency funds to bail out hospitals with the worst financial problems, enabling them to go on treating above contracted levels.
However, hospital and district health chief executives in the north-west Thames region are under instruction to take immediate action to 'manage activity back into line' in future to prevent overspending.
The edict comes in a letter sent to them 'in strictest confidence' by Nigel Beverley, one of the six NHS regional executive directors, which has been obtained by the Independent. It states: 'The provider (hospital or community health unit) is responsible for achieving financial targets even if this means capping activity at contract levels and refusing referrals.'
Doctors should be involved in discussions about how to restrain activity 'as appropriate', it says.
The document provides the most explicit official warning yet that the Government will no longer tolerate hospitals treating non-urgent patients without specific advance guarantees of payment from purchasers. These are the district health authorities, and also the small but growing number of family doctor fundholders.
Mr Beverley's instruction, whose effects will be felt in the north-west of London, Bedfordshire and Hertfordshire, was issued on 21 December. One week earlier an elderly woman, severely injured in a road accident, died in one of the region's hospitals after doctors and managers had prolonged discussions over who should pay for her treatment.
An independent inquiry began taking evidence this week into the death of Martha Taylor, aged 78, shortly after her transfer to Harefield Hospital, west London, from Barnet general hospital casualty unit. She had been admitted to the Barnet hospital seven hours earlier with a broken leg and two broken ribs. She died of a ruptured aorta.
Disclosure of the management letter has come to light after several surveys this week showing lengthening delays for routine operations in many parts of Britain, and pessimism among NHS managers over funding prospects. The East and North Hertfordshire health authority also admitted that it would be unable to make any contracts for non-urgent operations from April.
Further evidence of hardening attitudes in government against 'inefficiency and waste' in the health service came at a closed meeting last week of around 100 third wave NHS trust chairmen, with Virginia Bottomley, Secretary of State for Health. According to sources present at the meeting, Mrs Bottomley said that hospitals that completed their contracted workload for the year within the first nine months were 'overstaffed'.
Hospital consultants plan to ask Mrs Bottomley on 15 February to explain evidence that patients of GP fundholders get preferential hospital treatment.