Queues reveal 'two-tier' NHS

DONALD MACINTYRE and COLIN BROWN

New figures which reveal startling discrepancies between the waiting times for patients of GPs who are fundholders and those who are not will be used by Labour today in support of their charges that there is a "two- tier" NHS.

An internal bulletin shows that trust patients of non- fundholders in one Sheffield hospital are having to wait twice as long for heart operations and more than four times as long for hip replacements - a year as opposed to three months - than patients of fundholders.

Harriet Harman, the shadow Health Secretary, will also produce evidence from Glasgow Royal Infirmary that hospital managers have consulted surgeons over fears that they could lose funds to other NHS trusts because fundholders are demanding "very rapid" appointments for their patients.

Stephen Dorrell, the Secretary of State for Health, who will open a Government attack on Labour in the Commons today, said last October: "The role of fundholding is not to allow a two-tier service - it is to reinforce initiative and strengthen commitment to innovation."

But the new figures from Central Sheffield University Hospitals NHS Trust leaked to Ms Harman last night appear to expose for the first time the extent to which a gap is opening in urban areas between patients of fundholders and patients of "traditional" GPs.

Examples of the disparities, listing the waiting time in weeks for non- fundholding GPs and fundholders respectively, include cardiology (26, 12); dermatology (26, 9); neurology (38, 14); neurosurgery (23, 9); hearing services (43, 5); histology (17, 7); orthopaedic (elect) (52, 12).

Ms Harman said last night that the figures strongly reinforced mounting anecdotal evidence of a national pattern in which patients of fundholders were getting into hospital markedly more quickly than those of non-fundholding GPs in sharp contrast to the claims of Mr Dorrell that this was not the intention.

She added: "The period which a patient has to wait for an operation should be a matter of clinical need and not a question of who the purchaser is." Ms Harman said the new evidence meant that the Government's decision to allot its debate today to the subject of fundholding would backfire.

Mr Dorrell is expected in his speech to step up pressure on Ms Harman over what the Government believe is a highly ambiguous attitude to GP fundholding - not least by drawing attention to the number of fundholding doctors in Labour constituencies, including Ms Harman's. Ministers see the promise to "replace" current fundholding as another example of Labour "hypocrisy".

But Ms Harman says in a briefing paper that instead of fundholding, which she argues has created a bureaucracy costing pounds 212m, Labour will install GP commissioning - under which GPs and health authorities will team up to commission health care - and "clinical need is the sole criterion for admission to hospital for all patients".

The document, Reviewing the NHS, says that under Labour GPs will be given "substantial new powers" including the right to "refer their patients to the hospital or specialist they want".