News

Thousands untreated in NHS shake-up

An estimated 10,000 people had their applications for hospital treatment turned down by district health authorities (DHAs) in 1991/92, according to the National Association of Health Authorities and Trusts (NAHAT).

The 154 hospitals polled in the NAHAT survey, which also questioned 96 DHAs, said the main reason for this was lack of funds.

The 10,000 were extra-contractual referrals (ECRs), people who need treatments which fall outside the block contracts agreed between health authorities and providers. Such treatments need explicit agreement fron the DHA before they can go ahead. A minority of ECRs are emergency cases, but these were people denied treatment at the hospital of their choice.

According to the health authorities, the main reason for denial of treatment was that the treatment being sought could be obtained elsewhere under an already existing contract. Around one fifth of those whose applications were turned down were eventually treated at other hospitals. Lack of funds cane sixth on the health authorities’ list of reasons for turning down applications.

Some districts, particularly ones covering major cities, were worse hit than others. The Guardian reported that one London teaching hospital had to turn down 20 per cent of ECRs due to lack of funds.

Among the stop-gap measures taken by DHAs to cover the people denied treatment was the deferral of treatment for a year, thus creating a new ECR waiting list to add to already existing NHS waiting lists. The NAHAT survey pointed out that the ECR shortfall would decrease with the rise in the number of GP fundholders.

Possible solutions actively being considered include abolition of the need for DHA approval for ECR treatment, which would further weaken the financial power of health authorities.

The survey also reveals increasing government control over NHS finance. For example, treatment prices for 1991/92 varied by district according to the level of capital charging set by the government. NAHAT says that in 1991/2 health authorities were given extra funds to cope with the changes in the NHS, and warns that these are unlikely to be forthcoming in future years.