01 June 2007
Health professionals have reacted angrily to news that the NHS 'underspent' by around £500m last year as it attempted to recover its £547m deficit, claiming patients and staff have suffered as a result.
Their claims came as official figures showed a 22% increase in the rate of patients being readmitted into hospital within a month of discharge – raising concerns that NHS reforms and financial cutbacks have led to inappropriately speedy discharge of some patients.
Sam Everington, acting chair of the British Medical Association, said: 'We know that some trusts must have unnecessarily cut back on services to patients, such as reducing operating lists and clinics, closing wards, cutting education and training budgets, and making staff redundant.'
Everington was responding to reports that the early 2006/07 financial returns from strategic health authorities suggested that the NHS had underspent its budget last financial year by a net £457m. But a senior source told Public Finance that figure was 'no surprise'.
In fact, the figure almost precisely matches the sum estimated by the Department of Health in its third-quarter financial report, published in March 2007, and in financial statements shortly after that.
They explained that although the NHS was heading for a £437m overspend, that would be balanced out by a controversial £450m 'contingency fund', hewn in part from public health and training budgets.
The contingency fund was returned to strategic health authorities on March 28, nominally turning an anticipated £437m overspend into a £13m surplus.
On the same date, Health Secretary Patricia Hewitt announced that the practice of deducting 'resource accounting and budgeting adjustments' from overspending NHS trusts was being 'reversed'. This meant a further £178m was returned to 28 NHS trusts that suffered Rab deductions at the beginning of 2006/07, following their overspending in 2005/06.
That brought the NHS surplus nearer to £191m. But a further £300m was then also returned to primary care trusts by SHAs which had 'top-sliced' a total of £1,114m from PCT budgets at the beginning of the financial year to balance out overspending elsewhere. That brings the likely underspend to £491m – close to the net figure reported in recent SHA board meetings.
A DoH spokeswoman said: 'The NHS ended 2005/06 with a deficit of over £500m. This was unacceptable, and we introduced new rigour and discipline in order to put the NHS on a sound financial footing for the future. The latest forecast figures for the first nine months of 2006/07 showed that the NHS as a whole was on track to balance its books by the end of the year.
'We said at the time we were confident the NHS would show a surplus. We will publish the end-of-year figures shortly.'
But figures published on May 30 cast further questions over the DoH's NHS reform and financial strategy as they revealed that the percentage of patients needing emergency readmission into hospital within 28 days of their initial discharge increased by over 22% between 1998 and 2006.
The new figures – published by the National Centre for Health Outcomes for the NHS Information Centre – revealed that in 1998/99 seven out of 100 patients discharged from hospital required emergency readmission within 28 days.
In 2005/06 the figure had risen to 8.6 patients for every 100 discharged – a 22% rise.
The fastest deteriorations came in 2003/04, 2004/05 and 2005/06, which coincides with the NHS's financial troubles.
Dr Helena McKeown, chair of the BMA's community care committee, told PF: 'Hospitals run best when they are not full to 100% capacity because they need spare beds to cope with crises such as flu outbreaks or infections, but they don't have that spare capacity any more because beds have been reduced and the appropriate care packages are not available in the community.'
McKeown said that was in part due to financial cutbacks and in part due to the move towards a new model of care, based outside of hospital, which had not been adequately funded through investment in community and social services.
Health minister Andy Burnham admitted the figures were worrying: 'This rise in emergency readmissions is a cause for concern and we need more research to help us understand the often complex underlying causes…[and] better understand what can be done to reverse the trend.
'In the meantime, official guidance makes it clear that discharge must be properly planned, appropriate community services should be in place, and patients should not be discharged until it is safe to do so.'
PFjun2007
