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Cancelled ops will cost hospitals
HEALTH Secretary John Reid has confirmed hospitals would effectively be fined for cancelling operations and failing to offer patients a new date for surgery. Dr Reid was speaking in the wake of the row over Margaret Dixon, from Cheshire, whose shoulder operation has been cancelled several times since she broke it in August.
From later this year, hospitals which fail to offer a new surgery date within 28 days of a cancelled op will see patients transferred to a different hospital, with the cash to pay for the operation following them, said Dr Reid.
The move is the final stage in the Government's programme of changes to introduce greater patient choice into the NHS. Dr Reid said for 60 years, NHS hospitals had been able to hold onto the cash to pay for operations whether they carried out the procedure or not.
He told ITV1's Dimbleby programme: "If your operation is cancelled, you have to be given one within 28 days. If the hospital can't give you that within 28 days, then you must be offered one at another hospital. "Coming into effect this year, the money will follow you to whichever hospital you go to. In other words, the hospital that cancels the operation will lose the money.
"It's not going to get paid for operations it hasn't done - for 60 years, that's been the case. It is the extension of patient choice that has been planned to come in this year in its final element. "I am introducing choice, where you say to the local hospital on cancellations or anything else: 'I don't want to take it. I'm going to go somewhere else to get a better, quicker, faster operation'. I'm going to make sure that the money follows you."
Dr Reid insisted Mrs Dixon's case was "exceptional", as she not only needed surgery on her broken shoulder but also suffered from unrelated conditions including diabetes, obesity, renal failure and heart problems.
Should hospitals be fined for cancelling operations? We say something has got to be done. NHS facilities are being used to offer private treatment. The same doctors and surgeons are profiting from the long waiting lists, where patients who cannot afford private treatment, are being forced to take out loans, or use all their savings to pay privately, after months of waiting and no sign of an operation ever taking place.
We say why not sue the Government for taking compulsory NHS contributions and then failing to provide an adequate service. If your insurance company failed to repair your damaged car, you would sue them. What is the difference?
Analysis: How cancelled operation highlights critical care bed bottleneck 04 March 2005
The furore over Margaret Dixon's cancelled operations has triggered a bitter political row but it has also highlighted key issues surrounding patients' treatment on the NHS.
The surgery planned for Mrs Dixon at Warrington General Hospital may have been routine but cases such as hers present one of the most difficult challenges for the NHS. The operation to reconstruct her shoulder would have been straightforward in a healthy patient, but Mrs Dixon has other medical problems which make it risky in her case.
Before surgery could go ahead, hospital managers had to guarantee a high dependency bed would be available so that she could get the specialist nursing care necessary for a patient in her condition. But emergency patients have to take priority. Her operation was repeatedly cancelled to give priority to emergency patients, putting immense strain on her and her family. Mrs Dixon's case exposes the shortage of critical care beds (high dependency and intensive care beds combined). The Department of Health claims the number has grown by 34 per cent to 3,160 since July 2000. But Britain lags behind other European countries such as Germany, Switzerland and the Netherlands, which have more than twice the provision of critical care beds.
Future patients may fare better than Mrs Dixon. Cheshire and Merseyside Strategic Health Authority said yesterday it was to spend up to £3m to build a new critical care unit at Warrington hospital. Staff shortages have also been blamed for the cancellation of 17,402 operations in the three months to December last year, an increase on the previous quarter, in line with seasonal trends, but - say the Department of Health, part of an overall downwards trend.
The Tories claim that cancelled operations are running 67,000 higher than six years ago. On most indicators the NHS is improving under Labour, although problems remain. Waiting times, delayed discharges, cancer and heart disease deaths, ambulance response times and speed of referrals have all improved. What is less clear is whether these improvements show value for money for the billions invested.
So how has Labour fared on the key NHS issues?
WAITING TIMES
Hospital waiting lists have fallen by more than a third in the past six years and are at their lowest level for more than a decade. The number of people waiting more than six months for admission has halved, 96 per cent of patients are seen within four hours in accident and emergency departments and 99 per cent are offered an appointment with a GP within two days.
The NHS is on course to meet its most challenging target - that no patient should wait longer than six months for hospital treatment by this December, which was once dismissed by critics as a pipe dream. The main bottleneck is delays in diagnostic tests.
STAFFING
The NHS workforce has grown by 3.7 per cent a year over the past five years to 1.3 million. This includes 56,700 more nurses than in 1999, 5,400 more consultants and 1,900 more GPs. However this has not been enough to meet the government targets for cutting waiting lists, and extra doctors and nurses have been recruited from overseas to lift surgery rates.
MRSA
One of the key failings NHS has been the escalating hospital-acquired MRSA infectionrate, which was given as the cause of death for 955 patients in 2003, a threefold rise on 1997. This is almost certainly an underestimate, as doctors are not req- uired to record MRSA on death certificates. Deaths due to the bacterial infection have risen 15-fold since 1992. Britain has one of the highest rates in Europe.
FUNDING
Spending on the NHS has risen from £43bn in England in 2000/1 to almost £70bn in 2004/5, the largest and longest sustained rise in its history. Growth is set to continue at a similar rate until 2008 but economic forecasts suggest it will then begin to slow. The only certainty in health is that demand will accelerate.
POLITICAL TREATMENTS
Jennifer Bennett
"The War of Jennifer's Ear" became an infamous political own goal. Labour seized the case of five-year-old Jennifer Bennett ahead of the 1992 election, highlighting her 11-month wait for an operation to alleviate a painful "glue ear". The party never intended her identity to be known but the Bennetts were sucked into a political storm when her medical notes were leaked, with the complicity of the Tories. A nervous Neil Kinnock appeared on the family doorstep. The pressure caused her parents to divorce. They refuse to discuss the case.
Rose Addis
Another opposition leader to emerge bloodied was Iain Duncan Smith, then Tory leader, in January 2002. He jumped on a newspaper story about Rose Addis, 94, who had fallen and cut her head, telling MPs she had been left for three days at Whittington Hospital in north London, "caked in blood" after staff refused to wash her. But hospital authorities suggested she refused treatment from staff on the ground of their race. The hospital's medical director, a Labour Party campaigner, accused Mr Duncan Smith of not checking the facts.
Mavis Skeet
The 74-year-old was due to have surgery in December 1999 to determine whether her cancer of the oesophagus had spread, but the operation was cancelled four times in five weeks because of staff illness and a lack of beds in a flu crisis. In January 2000 doctors said that the cancer was inoperable; she died five months later. Her daughter, Jane Skeet, said she would have had a greater chance of surviving with an early operation, and wrote to Tony Blair: "How can you justify the loss of a life because of the lack of a suitable bed?"
Sharon Storer
Tony Blair's visit to Birmingham's Queen Elizabeth Hospital in May 2001 was supposed to have been a carefully orchestrated PR stunt ahead of the general election, but it turned into a disaster when he was accosted by Sharon Storer, who said her partner, Keith Sedgwick, was kept in an unsuitable ward for 24 hours before being seen by a specialist. Mr Sedgwick, 51, continues to have treatment for his non-Hodgkin's lymphoma and is cared for full-time by Ms Storer at their home near Stratford-upon-Avon.
Big
variations in NHS waiting times
The College of Health helps callers reduce waiting times for their operations by collecting data from around half of the UK's 360 NHS trusts.
The college's data shows wide discrepancies in treatment times for the main surgical specialities. In some cases patients in one part of the country are waiting twice as long for an operation as residents elsewhere.
Big variation
Among the findings released by the college are:
About one in five callers this year changed hospitals to have their operation, and some got an earlier date by directly contacting the relevant hospital or health authority, the college said. College spokeswoman Jessica Bush said: "It is possible for fund-holding GPs to seek operations for their patients outside their region. "We help people get treated more quickly, either through the NHS or privately."
College of Health director Marianne Rigge said there were many reasons for the discrepancy in waiting times. Some units had run out of cash and told their surgeons not to operate on patients until they had been waiting 18 months, and others had difficulty recruiting sufficient specialist nurses. "Variation in waiting times is not a new thing, but it is extraordinarily frustrating for patients," she said.
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