NHS may stop providing series of services without more funds, officials suggest

A series of services may no longer be provided by the NHS and waiting times could soar unless the health service gets more money, officials have indicated.

During a discussion on financial constraints, NHS England leaders set out which services they intended to “protect” with current funding.

But other aspects of care could come under discussions on “what can be expected from the remaining available funds”, NHS England board papers suggest.

Innovative treatments should only be recommended for widespread NHS use if they come with an “agreed affordability and workforce assessment”, the board papers state.

And waiting targets could be missed without cuts to other services, the papers suggest.

But, speaking at the health think tank The King’s Fund, Health Secretary Jeremy Hunt said the Government was “absolutely committed to NHS constitutional standards”.

Earlier, during a discussion of the “implications” of last week’s budget, Sir Malcolm Grant, chairman of NHS England, told the national body’s board meeting the “tightness of the settlement” would be a “catalyst for change”.

“There are going to have to be some tough decisions and trade-offs,” he said.

It is the latest twist in a row over funding between Whitehall and the health service.

But The King’s Fund said politicians and health leaders needed to “avoid adopting adversarial positions which will undermine public confidence in their stewardship of the NHS”.

Patient groups described the move from NHS England as “extraordinary”.

The board papers state: “Our nurses, doctors and other frontline staff routinely ‘go the extra mile’ for their patients.

“It would, however, be unfair to set unattainable goals which staff would then be criticised for not meeting. In part, this therefore means more scrutiny of unfunded new expectations that are loaded on to the NHS.

“For example, new advisory Nice (National Institute for Health and Care Excellence) guidelines can only expect to be implemented locally across the NHS if in future they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up.

“Short waits for routine non-urgent elective care matter, and we should do all we can to increase elective activity volumes next year.

“However, even with some increased volume, and even assuming this year’s unprecedented elective demand management success continues, our current forecast is that – without offsetting reductions in other areas of care – NHS constitution waiting times standards, in the round, will not be fully funded and met next year.”

But Mr Hunt later told The King’s Fund’s annual conference: “The Government is absolutely committed to NHS constitutional standards. That’s why we’ve now announced an increase for the NHS in the budget.

“But our absolute determination is to move back towards hitting those standards, which we’re not hitting all of at the moment, we recognise that.

“Part of that is a funding issue, part of it is a capacity issue and I think we will have constructive, sensible discussions with NHS England to find a way forward to lead our objective, which is to get back to meeting those standards.”

NHS England said once the Department of Health and others agree to the NHS’s list of priority services – including urgent and emergency care, reducing the current deficit and improvement plans for general practice, mental health and cancer care – health service leaders will begin to look at what else it is being asked to provide.

NHS England said it would provide an update at its next board meeting on February 8 and an operating plan for the next financial year would be agreed on March 29.

Labour raised concerns about the “unprecedented” remarks on waiting time standards.

Shadow health secretary Jonathan Ashworth added: “NHS bosses have effectively conceded that the 18-week target for treatment can’t be met given continued underfunding of the NHS.

“This will mean more and more patients waiting longer and longer in pain, discomfort and distress for elective operations.

“What’s more, there are serious questions about the legality of effectively abandoning a standard of care enshrined in the NHS constitution.”

Rachel Power, chief executive of the Patients Association, said: “There will be longer waits for elective surgery, and therefore more pain and worse outcomes for many.

“NHS England has also said it is unable to implement best practice as advised by Nice on a routine basis – an extraordinary state of affairs.”

The Royal College of Surgeons said rationing and delaying surgical treatment are “false economies”.

And The British Medical Association said patients are “unfairly suffering the consequences of a clearly underfunded service”.

A Department of Health spokeswoman said: “We are supporting the NHS with an extra £2.8 billion by 2019/20 to make progress on A&E and waiting time performance, including £335 million this year to help with winter pressures.

“We expect NHS England will use that money to make sure every patient gets the treatment they require in a timely way.”