A series of services may no longer be provided by the NHS and waiting times could soar unless it gets more money, health officials have indicated.
During a discussion on the financial constraints, NHS England officials set out which services they intended to “protect” within current funding.
These include urgent and emergency care and improvement plans for general practice, mental health and cancer care.
But other aspects of care, such as elective surgery or fertility treatment, 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”.
Sir Malcolm Grant, chairman of NHS England, told the national body’s board meeting that 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.
NHS England board papers say: “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.”
Once the Department of Health and others agree to the NHS’s list of priority services – including dealing with current deficits, urgent and emergency care and plans to improve GP services, mental health and cancer care – then the NHS will begin to look at what else it is being asked to provide.
NHS England said plans would be made with patient groups, the public and frontline NHS leaders and staff as well as the Department of Health.
It said it would provide an update at its next board meeting on February 8.
An operating plan for the next financial year would be agreed on March 29, it added.
The discussion formed part of NHS England’s board meeting after the health service was not given the funds it requested in last week’s Budget.
The Treasury pledged more money for the NHS in England, with the specific aim of helping the health service “get back on track” amid rising waiting lists and A&E targets.
Chancellor Philip Hammond acknowledged the NHS was “under pressure” as he committed resource funding of £2.8 billion to the NHS in England.
This includes £350 million to cope with pressures over the coming winter, £1.6 billion in 2018/19 and the rest the year after.
Professor John Appleby, chief economist at health think tank the Nuffield Trust, said: “It is clear from today’s board meeting that the big question emerging from last week’s Budget is how far waiting lists for routine operations like hip and knee replacements are allowed to grow in order to preserve and improve other services like A&E and cancer care.
“With the NHS under severe financial pressure and, as NHS England acknowledges, already spending money it doesn’t have to keep the show on the road, today’s meeting puts down a clear marker that something will have to give.
“As we and the other health think tanks have warned, the budget settlement fills around just half of the funding gap for next year.”
Shadow health secretary Jonathan Ashworth said: “NHS England’s unprecedented confirmation that NHS constitution waiting times standards ‘will not be fully funded and met next year’ is the direct result of Philip Hammond’s failure to give the NHS the funding it needed in the recent Budget.
“Today 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.
“This is the real debilitating impact on patients’ quality of life as a result of Tory austerity. What’s more, there are serious questions about the legality of effectively abandoning a standard of care enshrined in the NHS constitution.
“As a matter of urgency (Health Secretary) Jeremy Hunt must now tell us whether he intends to amend the law and the NHS constitution through legislation and publicly accept his Government’s funding squeeze is jeopardising legally guaranteed standards of patient care.”
Professor Derek Alderson, president of the Royal College of Surgeons, said: “It is disappointing that the progress the whole NHS has made over the last decade on planned waiting times, such as for heart and brain surgery, now risks being lost.
“We accept that difficult decisions will need to be made but we believe more of the money released by the Government should be targeted at waiting times in the NHS before they deteriorate further.
“Rationing and delaying surgical treatment are false economies. For example, current commissioning group policies designed to delay surgical access for obese patients and smokers only defers treatment and potentially adds costs through increased use of painkillers, physiotherapy and welfare support for out-of-work patients.
“The RCS does not accept that such policies either save money or help patients.”
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.
“We have now reached a point where the NHS Constitution will be routinely breached, and NHS services are being withdrawn.
“The confirmation that NHS England will consult on plans to restrict the availability on prescription of items that can be purchased over the counter is the latest example of its drive to cut spending – an exercise that will be difficult, and have complex consequences, including very probably for the relationship between GPs and their patients.
“NHS England should not have been placed in this impossible position by political decisions – its funding recommendations in the Five Year Forward View should have been implemented, but were not.
“Equally it should not be left to make decisions about which NHS services to withdraw by itself. Parliament and ministers must get a grip of this situation urgently.”
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.”
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