If you need a hip replacement you will soon be able to choose where and when to have it done with no interference from the Primary Care Trust (PCT) – or, in the future, from GP-led Clinical Commissioning Groups that will replace PCTs in 2013. That’s the result of a ruling by the health secretary, Andrew Lansley, making it plain that in the government’s eyes patient choice trumps everything else.
Lansley’s ruling this week follows the recommendations of the Co-Operation and Competition Panel in July when they addressed a complaint from a private health care provider, Circle Health, that NHS Wiltshire and the adjacent PCT (Bath and North East Somerset) were making unfair restrictions on their access to patients for elective surgery like hip and knee replacements.
The new ruling bans PCTs from enforcing minimum waiting times on referrals and putting caps on the number of operations a provider can carry out – actions that “do not take account of the healthcare needs of individual patients.”
In the paper entitled ‘Patient Choice’, which details the acceptance of the Panel’s nine recommendations following Circle Health’s complaint, there’s just one reference to the cost of this new policy: “The Department [of Health] agrees that it is not in patients’ interests for commissioners to restrict choice of provider on the basis of their relative costs….”
In publishing the new rules, Lansley said: “PCTs have to manage resources carefully but they must do so without restricting patient choice.” The new rules are to be brought in as quickly as possible, but must be in place by 31 March 2012.
The good news is that this will avoid the NHS Wiltshire having to find between four and eight million pounds from this year’s budget to accommodate these rules. But the impact of the ruling on next year’s NHS Wiltshire budget will be considerable.
It is also noted that the Health Secretary did not impose fines on NHS Wiltshire and on Bath & North East Somerset PCT. Perhaps this is a sign that some in the Department of Health recognise how difficult managing the costs of treatment really is – and how difficult it will prove for the new Clinical Commissioning Groups.
Even if NHS Wiltshire’s ongoing campaign to make the savings ordered by the government is totally successful, it already looks as though there may be a £23million gap in 2012-2013 between expenditure and income. And that’s without taking account of these new ‘patient choice’ rules.
Twenty-three million pounds will probably be well below five per cent of NHS Wiltshire’s income for next year – depending on whether the uplift the government provides is a real or an unreal increase. But it’s not the only pressure the commissioners will face.
It is certain to impact on NHS Wiltshire’s careful plans to pay off the debt it inherited when it was formed in 2006. At the end of March 2009 this debt stood at £27,415,000. By the end of this financial year it is expected to be £16,990,000.
But the costs of the coalition government’s major NHS reorganisation, the negligible increase in the budget decreed by the government for 2011-2012, the unforeseen costs of the new patient choice ruling and the expectation that the government will find new challenges that have to be met without extra funding (like Lansley’s new move against waiting times), will make for what one non-executive director called “a really awful” final year for the PCT’s finances.
And as far as putting the patient first is concerned, the financial squeeze may well mean there will be ‘a big step down in activity from this year to next year’ – which is a polite way of saying there will have to be cuts in services.
For more on the background to this ruling go to our original story on Circle Health’s complaint and the Panel’s ruling.