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NHS pledge watered down

First Edition

A GOVERNMENT guarantee that patients with urgent and possibly life-threatening conditions will be given priority on NHS waiting lists has been heavily watered down.

Doctors and managers are being told that instead of promising to see urgent cases within a month, they should 'seek to ensure' they are dealt with promptly 'within available resources'.

That applies even when 'delay in investigation or treatment would pose an unacceptable risk to life'.

Doctors' leaders yesterday put a brave face on the guidance, which was released without any announcement by Sir Duncan Nichol, chief executive of the NHS. They point out that it states that doctors, not managers, decide whether a patient needs urgent treatment. Professor Leslie Turnberg, president of the Royal College of Physicians, said that it might mean the Government failing to keep its Patient's Charter promises to treat all patients within two years.

A guarantee that urgent cases would be seen within four to six weeks was foreshadowed by Virginia Bottomley, Secretary of State for Health, at the Conservative conference last October. She was under heavy pressure after doctors claimed that patients with worsening conditions were being made to wait, and those with minor ailments treated, to meet the Patient's Charter target.

She said then: 'I hope we can come to an agreement with the profession and the service as to what constitutes a definition of an urgent case.' Later, journalists were told that urgent cases would be dealt with in four to six weeks. Sir Duncan's letter comes after weeks of talks with the Royal Medical Colleges' Conference and reminds purchasers and providers 'of the need to ensure that appropriate clinical priority is given to patients on waiting lists'. It says: 'It is particularly important that urgent cases on waiting lists, for whom delay in investigation or treatment would pose an unacceptable risk to life or risk of major morbidity, are treated promptly.' But it adds, in italics: 'District Health Authority and GP fundholder purchasers in discussion with their providers and the clinicians involved should seek to ensure that this objective is met within available resources.'

Finally it states that 'the decision as to whether a patient needs treatment urgently or not will properly be for the doctors involved in the patient's care'. Professor Turnberg said yesterday: 'GPs and hospital doctors now know that if they have cases that should not wait even a relatively short time for treatment, they should go ahead and treat them. 'Urgent cases, where the patient could risk damage if they have to wait, do take priority over waiting-list initiatives.

'That may mean that without more money the Government may not be able to hold to its Patient's Charter targets. But if you ask patients whether they would rather wait a month longer for a non-urgent condition or delay investigation and treatment of a condition which could be urgent, they would not pause for thought.'

James Johnson, deputy chairman of the British Medical Association's hospital doctors' committee, said the new guidance 'does at least assert that it is a clinical judgement over what is an urgent case.'

David Blunkett, Labour's health spokesman, accused Mrs Bottomley yesterday of 'fudge'. He said: 'This can even be read to say that life-threatening conditions may have to wait if resources are short. The Government has a plain responsibility to produce guidelines which ensure that priority cases are always treated ahead of the less important.'