NHS cuts 'put special care cases at risk'

Government attempts to cut NHS bureaucracy will put the care of patients with complex conditions at risk, Britain's top specialist hospitals have warned Stephen Dorrell, the Secretary of State for Health.

In an attempt to cut the pounds 22m administrative bill for sending patients to hospitals with which health authorities do not have contracts, the NHS Executive is proposing that from next April district general hospitals should control the budget referrals to specialist hospitals.

The so-called tertiary referrals could involve a consultant at a district general hospital sending a patient on for highly specialised assessment and treatment at hospitals such as Great Ormond Street and Moorfields eye hospital in central London, and specialist centres in neurology, orthopaedics and cardiac care.

At present, that money is controlled by health authorities. But the NHS Trust Federation is warning that giving the cash direct to district general hospitals could well lead to consultants facing pressure from managers not to send patients on for second opinions, or to doctors being encouraged to attempt complex treatments themselves.

The protests are being led by the specialist hospitals, whose senior staff fear their future may be put at risk as they lose business. But the implications are so serious that they have been backed by the NHS Trust Federation, which represents all 450 NHS Trusts.

"Consultants in secondary units with relatively tight budgets might, for financial reasons, be encouraged to undertake work which would be more appropriately undertaken in a specialist unit," the federation has told the department. Local hospitals might also be tempted to establish their own units for conditions which are too rare to allow local consultants to build up the necessary expertise. The change also "has the potential to compromise the patient's right to a second opinion", the federation has warned the department.

Dr Alan Davison, chief executive of the Royal National Orthopaedic Hospital, said he believed the proposal was "disastrous" both in terms of extra paperwork from a move intended to cut bureaucracy "and because of the undue influence it will bring on doctors' decisions on whether to refer".

The Royal National received patients needing specialist orthopaedic and spinal assessments and treatment from consultants in 150 different hospitals over the past four months alone, he said. With rare conditions, "there is good evidence that people who do things often do them well. But you can easily imagine a financially motivated chief executive, or a consultant whose budget is tight, being tempted to try something themselves rather than spend the money referring a patient on for what would in fact be the best treatment".

He also argued that a move aimed at cutting bureaucracy would paradoxically increase it. Many of the referrals to specialist hospitals are one-off, outside existing contracts. But each also holds contracts for a given volume of cases with some local health authorities. In future, every case will have to be billed separately.

Robert Creighton, Great Ormond Street's chief executive, said the proposals has caused "extreme concern about the quality of patient care and future viability of specialist units". There were bound to be temptations to retain work which could include the treatment of rare cancers, spinal surgery and other treatment which ought to be done in specialist centres.