Operations and treatments cut back as NHS orders hospitals to save money

Access to hospital treatments is being restricted in many areas of England as the NHS struggles to balance its books, the BBC has learnt.

Regional health boards have ordered some hospitals to cut back on the number of patients they are seeing, meaning hundreds of thousands of patients could have to wait longer for treatment.

The rationing measures are being applied mainly to private firms doing NHS work, but multiple NHS hospitals are understood to be affected too.

NHS managers said they were between a "rock and a hard place" trying to juggle balancing the books with tackling the hospital backlog, which currently stands at 7.4 million.

Reducing waits for things like hip and knee operations and hitting the 18-week waiting time target is the government's number one priority for the health service.

But documents seen by the BBC show integrated care boards, which are in charge of spending on behalf of NHS England, asking hospitals to make patients wait longer and reduce the numbers they treat until the end of the financial year.

One asked a private provider to reduce activity by nearly 30% and to make patients wait eight weeks longer, on average, while stopping taking on new referrals for a period as a way to cut back on the amount being done.

A surgeon at a private hospital said they had had to cancel all their scheduled NHS operations for the coming weeks, with some patients only given a few days' notice.

They told the BBC: "I had a full day of joint surgery planned this week and patients were just told a few weeks before that their life-changing operations would not be taking place.

"Many of them had been waiting over 40 weeks for treatment. It's devastating for them."

A letter by Circle, one of the biggest private hospital providers in the country, to its doctors said at some sites they may have to stop seeing NHS patients altogether.

Daniel Elkeles, of NHS Providers, which represents NHS hospitals, said restrictions were also being placed on some NHS hospitals, calling it a "real concern".

"If the government really wants them to deliver the 18-week target they would have to go flat out and use all available capacity and that will mean needing additional funding."

Regional health boards are using what are known as activity management plans to push individual hospitals into reducing the number of patients they see.

They are predominantly being used when hospitals are treating more patients than expected.

They can also be used to push hospitals into treating more when activity levels are below expected.

The BBC has seen evidence or had confirmation from a host of health boards that restrictions have been put in places in parts of the north west, north east, south west, Yorkshire, the East Midlands and East Anglia.

A number of health boards refused to provide the BBC with information – and senior NHS sources said they expected many of England's 42 regional boards were now placing restrictions on individual hospitals in their areas.

They said they expected the number of hospitals affected would almost certainly grow before the end of the financial year, adding strike action by resident doctors had not helped with the NHS estimating the walkouts this year have cost hospitals more than £500m.

It is estimated the orders in place against the private hospitals that have reported so far could lead to 140,000 fewer patients starting treatment by the end of March. But given some NHS hospitals are affected and not all the restrictions placed on private hospitals are thought to have been been declared that could be an underestimate.

David Hare, of the Independent Healthcare Providers Network, said: "Given it is patient choice driving demand for treatment in the independent sector - and the scale of the challenge in getting NHS waiting lists down - we‘ve been surprised by the extent of the proposed slowdown, which will leave significant amounts of available capacity going unused across both the independent sector and the NHS.”

Rachel Power, chief executive of the Patients Association, said: "These reports are deeply alarming and poses a serious risk to patients' ability to access the treatment they urgently need.

"Calling it 'activity management plans' distracts from what this really is, another barrier standing between patients and timely care.

"It won't just delay treatment - it will worsen conditions, reduce quality of life and lead to harm that could harm that could have been prevented."

Sarah Walter, of the NHS Confederation, which represents regional health boards, said her members were having to make some "difficult decisions".

"The NHS faces an unprecedented financial challenge which has resulted in system leaders having to make some very tough decisions over how limited funding and tight budgets should be spent.

"Leaders are caught between a rock and a hard place of being tasked with balancing their books and hitting the elective care target."