Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in an area in which four cabinet ministers are local MPs, the Guardian can reveal.
NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty – the insertion of stents to tackle blocked arteries – despite the evidence that both procedures reduce the risk of patients dying.
The disclosure came as senior Tory MP Sarah Wollaston, the chair of the Commons health select committee, urged ministers to scrap the “capped expenditure process” – the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in a bid to save £500m – because it involves “draconian” cuts to services that will hit patient care.
“I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS,” she told the Guardian.
“The kind of issues that are being discussed [in the 14 areas subject to the CEP] would involve draconian measures that would have an impact on public health and services. [And] I do have concerns about ultimately patient safety.”
Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass.
Cutting the number of people who have either is one of a range of options which NHS bosses in Surrey and Sussex are considering in order to save £55m more under the CEP by March 2018 than the £106m of “efficiency savings” already agreed.
NHS bodies in Surrey and Sussex privately admit that fewer people will have those procedures as part of their plan to save the £55m by reducing “huge variation” in patients’ chances of having one, depending on which hospital they are treated at and which cardiologist they see. “We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor.
In future an unknown number of patients at risk of a heart attack will be monitored by “watchful waiting” rather than given an angiogram or angioplasty, the doctor explained.
Senior NHS sources in the area have disclosed that they are also being forced to consider proposals to:
- Ration knee arthroscopy operations, cataract removals and tonsillectomies
- Introduce “lifestyle rationing” so that patients who are obese and smoke will have to lose weight and stop smoking before they can have, for example, a knee replacement to treat their arthritis
- Shut beds or even whole wards in community hospitals
- Restrict patients’ access to hearing aids and IVF treatment
“We have been told to leave no stone unturned and think the unthinkable [in the quest to save the £55m],” one local senior NHS figure said, speaking anonymously.
“It’s quite delusional to think we can take out the £106m already planned and now this extra £55m so quickly. But NHS England have told us to do this. The trouble is that, after making lots of efficiency savings in recent years, there is very little fat to take out,” the official added.
The chancellor, Philip Hammond (Runnymede and Weybridge), and the health secretary, Jeremy Hunt (South West Surrey), both represent Surrey in parliament, as do Michael Gove (Surrey Heath), the environment secretary, and Chris Grayling (Epsom and Ewell), the transport secretary. When the Guardian asked all four to comment, all declined to offer a view on the £55m cuts plan, the existence of which had been kept secret
NHS organisations in Surrey and Sussex tasked with pursuing the savings drive confirmed that access could be reduced to many different types of care. “We have been looking at all treatments and procedures provided across our area,” they said in a joint statement.
“There is considerable variation in the thresholds and criteria applied before patients are referred for treatment. We want to ensure that referral decisions are based on the latest clinical evidence of what works and are applied consistently, delivering the best value for money for the public and fairness for patients.”
The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18 … collectively, the plans would overspend by £55m against the financial ‘control total’ that has been set by NHS England and NHS Improvement,” they added.
Heart specialists warned that patients’ health could suffer if decisions about who had either procedure was made on anything other than purely medical grounds. “Any restriction on angiography or angioplasties should be based on clinical criteria and guidelines to ensure no adverse effect on patient care and health,” said Prof Sir Nilesh Samani, the medical director of the British Heart Foundation.
The British Cardiology Society, which represents heart specialists, underlined the importance of both procedures as measures to help save lives. A spokeswoman said: “Cardiovascular disease remains a significant burden to the UK and requires appropriate investigation and management to reduce mortality and morbidity. Despite significant reductions in mortality through medical and invasive treatments both primary and secondary preventive strategies remain important.”
The Royal College of Surgeons said introducing “lifestyle rationing” was “wrong”. A spokesman said: “There is no clinical guidance from NICE, the Royal College of Surgeons and other surgical associations to support restrictions for routine surgery on the basis of whether patients smoke or are overweight.
Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health thinktank.
“Many of these cutbacks in procedures will only save money in the short term. If they go ahead, this will mean putting off treating patients whose hip and eye conditions will worsen and must be treated eventually. Getting savings out will also require cutting staff,” he said.