NHS hospitals have been ordered to hand over swathes of operations to the private sector to ease a looming winter crisis, according to leaked memos.
Health officials have also instructed hospitals to discharge thousands of patients in a bid to reduce record levels of crowding, while managers have been banned from declaring “black alerts”.
NHS trusts have been told to take a series of measures to dramatically reduce bed occupancy levels in an attempt to ensure that wards can cope as pressures mount.
Patients groups said the situation was “frightening”, while charities described the measures as an “extremely worrying” reflection of a system under “extraordinary pressure”.
The instructions from health officials come as hospitals are the most crowded they have ever been in the run-up to winter.
A memo from NHS England and regulators NHS Improvement, seen by the Telegraph, orders hospital trusts to take sweeping measures to bring occupancy down to a recommended safe limit of 85 per cent.
Hospitals have been ordered to “maximise elective activity” in the run-up to Christmas using the independent sector and schemes which pay NHS consultants lucrative overtime rates.
The plans have been drawn up so NHS trusts can cut the number of operations they perform – freeing up more beds for urgent patients – without lengthening waiting lists.
Under such schemes, consultants have been paid rates of up to £1,000 a shift
But the schemes and heavy use of the private sector is likely to add to financial pressures on the NHS, which last year recorded the highest deficit in its history.
It comes as a separate leaked document shows that GPs are coming under pressure to provide emergency home visits.
Local doctors groups are being asked to establish “A&E Delivery Boards” and to draw up rotas of medics able to respond to 111 requests for urgent care at home, which is currently reserved for those who are housebound.
The boards are ostensibly responsible for easing winter pressures, but the new NHS England best practice guidelines state the measures should remain in place all year round because of the unprecedented demand.
Latest official figures – for the three months ending in September – show NHS trusts have the highest levels of occupancy ever recorded in the run-up to winter with an average of 89.1 per cent of acute and general beds full, compared with 87 per cent in the same period last year.
It follows record levels of bedblocking, with high numbers of patients stuck in hospital for want of care at home.
The memo from health officials, sent to all NHS trust chief executives last month, calls for actions aimed at “lowering acute bed occupancy to 85 per cent from 19 December to 16 January.”
Such measures include farming planned surgery out to the private sector, and discharging patients earlier.
“These plans will have to have full regard to both elective targets and financial delivery, as such systems will be expected to maximise activity either side of the period in an affordable way and where necessary using waiting list initiatives and the independent sector to ensure that elective throughput is not adversely affected,” the memo states.
A number of NHS trusts already have contracts with private providers, but will now be expected to ramp up activity, or agree new short-term deals.
Under waiting list initiatives, consultants can earn around £1,000 a shift on premium rates for performing an extra session in an evening or afternoon.
Dr Mark Porter, chairman of the British Medical Association, which has criticised the “creeping privatisation of the NHS” said last night: “This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand.
“Unmanageable pressures are now facing the NHS all year round, winter or not, and this has been made worse by cuts to social care provision.”
Caroline Abrahams, charity director at Age UK, said the signals from health officials were signs of desperate measures, with hospitals under “extraordinary pressure” even before winter set in.
Hospitals had little hope of freeing up hospital beds, because social care was “in crisis” with too little funding to keep up with demand, she said.
Tim Farron, Lib Dem leader, said: “Using the private sector like this, on this scale only runs down the NHS and will cost the taxpayer more in the long run.”
“The NHS needs more cash and this government are trying to pull the wool over people’s eyes by pretending otherwise.”
NHS hospitals have also been sent separate guidance, requiring them to stop using terminology such as “black alert” to warn the public of impending crisis.
Instead, NHS England has devised a new system of Operational Pressure Escalation Levels (OPELs), which are numbered.
Health officials said the four point scale was an attempt to ensure consistency when hospitals under strain, and needed extra help or for patients to be diverted.
But patients groups said the diktat was an attempt to spin the NHS out of crisis, by hiding the true scale of problems from the public.
The guidance from NHS England, published last month, orders hospitals to follow a national framework to track pressures, and whether help is needed to protect patient safety.
In recent years, most trusts have issued a “black alert” if they are becoming unable to cope with strain, and require ambulances to be diverted, with “red alerts” issued when services are struggling, and “amber” and “green” status declared at other times.
The new instructions instead require NHS trusts to follow the four point OPEL scale to track pressures, where OPEL 1 means services are working normally, and OPEL 4 means organisations are unable to deliver comprehensive care, with increased potential for patient care and safety to be compromised.
The levels are used to determine how much help is needed from local, regional and national services.
Joyce Robins, from Patient Concern, said the situation had become “frightening”.
An NHS England spokesman said: “Anyone who needs to be in hospital or in another care setting over Christmas, will be. Our ambition to reduce bed occupancy in hospitals over the festive period is about timely discharge and getting people to the most appropriate care setting ahead of the holidays, so there is capacity for early January when we know pressure is greatest.”
Why is the NHS under so much pressure?
An ageing population. There are one million more people over the age of 65 than five years ago
Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years
This has caused record levels of bedblocking, meaning elderly people with no medical need to be in hospital are stuck there. Latest quarterly show occupancy rates are the highest they have ever been at this stage of the year, while days lost to bedblocking are up by one third in a year
Meanwhile rising numbers of patients are turning up in A&E – around four million more in the last decade, partly fuelled by the ageing population
Shortages of GPs mean waiting times to see a family doctor have got longer, and many argue that access to doctors since a 2004 contract removed responsibility for out of hours care
Autumn Statement: Missed opportunity for NHS?
24 November 2016
- From the sectionHealth
The NHS and social care were barely mentioned in the chancellor’s Autumn Statement, and health groups and think tanks lined up to condemn Philip Hammond within minutes of him sitting down in the Commons.
So was there a failure to resolve a looming crisis? Or did Philip Hammond simply feel that in a difficult financial climate, there were other more pressing priorities?
Warnings about cuts in social-care spending in England and the impact on the health service have become more intense in recent weeks.
There has been a steep rise in the number of patients fit to leave hospitals, but who continue to occupy beds because of problems arranging social care.
That has concentrated minds, and NHS leaders indicated they were prepared to accept there would be no new money for health as long as social care, run by local authorities, received a financial boost.
But that did not materialise. The pleas had fallen on deaf ears.
“Missed opportunity” was a verdict on the statement much repeated by health think tanks and medical profession leaders.
The Royal College of Emergency Medicine even warned government inaction would put lives at risk.
Social-care chiefs warned the chancellor’s failure to act would mean more care homes closing and growing gaps in the market.
In response to Labour claims in the Commons that there was “looming chaos” for health and social care services in England, Mr Hammond said there was a programme of investment in the NHS being delivered.
Lack of social care is putting pressure on hospital beds. MONKEYBUSINESSIMAGES
He repeated the government line that an extra £10bn annually was being allocated to the NHS budget by the year 2020-21.
He said the government would work with service leaders to ensure the money was spent effectively, underlining his view that it was not so much about the volume of investment as how it was deployed.
The new clashes over money for the NHS came as the UK Statistics Authority called for more clarity by the government in its references to the extra investment.
The stats watchdog observed that the £10bn increase for “NHS funding” in England was over a six year period from 2014-15.
However, total health spending, including public health, which has seen cuts, has not grown as fast.
The Statistics Authority noted that, according to Treasury figures, over a four-year period up to 2019-20 it would increase by £2.9bn.
Ed Humpherson of the UK Statistics Authority, said he would ask the Treasury to present estimates for NHS England and total health spending separately.
He has urged officials to “ensure clarity around sources, time periods and what is being measured”.
The stresses and strains on NHS finances have been well documented, and the debate about how much money the government is investing to help tackle the problems is rising up the political agenda.
A report from the National Audit Office highlighted again the financial pressures and argued that the problems were “endemic and not sustainable”.
The NAO report, unusually, confirmed the view there were tensions at the highest levels of Whitehall.
It talked of perceived differences between the government line that funding had been adequate and in line with what health service leaders asked for and NHS England itself.
There was an eye-catching conclusion: “Confronted as NHS England is by the pressures of rising demand for services, these signs of differences do not help build a confident feel about the future of the NHS.”
Those “differences” seem unlikely to fade away.
The NHS England leadership that had called for more funding for social care only to be disappointed will hardly be thrilled by the Autumn Statement.
The chancellor may find he has a lot more explaining to do.
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