FULL REPORT: �100M cuts to NHS budget

CUTS to save �100million a year across health services in Cambridgeshire have been announced. The budget slashes will affect services at Hinchingbrooke and Addenbrooke s because some procedures will be done away from the hospitals. NHS Cambridgeshire has

CUTS to save �100million a year across health services in Cambridgeshire have been announced.

The budget slashes will affect services at Hinchingbrooke and Addenbrooke's because some procedures will be done away from the hospitals.

NHS Cambridgeshire has announced the cuts in the light of the economic downturn.

The primary care trust had expected a significant increase on its current budget of �750million a year.

Last year, it predicted that it would need �950million by the financial year 2013-14. Now, that budget has now been revised down to �850million, meaning hacking back throughout the system.

To bridge the shortfall, NHS managers have outlined a series of measures. They say these are designed to improve the efficiency of the healthcare system while maintaining current levels of patient care.

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Despite the financial pressures, the Cambridgeshire Primary Care Trust wants to maintain service levels in four priority areas: promoting health and preventing disease; older people's health and care; safe, sustainable and affordable health services; and patient experience and customer care.

Dr Dennis Cox, a Cambridgeshire GP and the chairman of NHS Cambridgeshire's professional executive committee, said changes were essential to deal with hospital admissions, which have risen by 3.5 per cent in the past year.

He said: "It's about helping our health service work in a smarter and more efficient way. We need to look at the way we provide services so patients get good quality care more efficiently.

"We have good hospitals, so we are starting from a healthy position, but they are under strain. We need to get them back to doing what only hospitals can do.

"It's not efficient to have two people carrying out a simple consultation in a hospital, when that could be done elsewhere."

One plan is for GPs (in groups of practices) to commission treatments for patients - rather than that being done by the primary care trust. The GP groups would each be 'buying services' on behalf of between 50,000 and 100,000 patients. The idea is that more procedures could be carried out at the GP surgery.

Each cluster will have responsibility for commissioning health services for its patients, with the first wave - which NHS Cambridgeshire hopes will include 15-20 per cent of practices - coming into operation on a voluntary basis from April 2010.

The new plan recognises that centralised commissioning has failed to move activity from hospitals to community settings, and has instead brought about the opposite.

The policy was a key component of the Hinchingbrooke Hospital rescue plan that started in 2007, when the idea was to reduce hospital activity by 20-25 per cent. In fact, the number of procedures at Hinchingbrooke has risen.

Cluster commissioning aims to restore the power to GPs who make the everyday decisions for their patients.

Other measures to cut unnecessary expenditure include streamlining referral procedures so that only patients requiring hospital-based care are referred there, and moving away from the "payment by results" system which encourages hospitals to take on extra activity. This is expected to save �12.5million.

Improving services for patients with long-term conditions is also essential, with the focus on diabetes, stroke care and chronic obstructive pulmonary disease (such as bronchitis and emphysema). This will include educating and training patients to manage their disease and avoid unnecessary hospital admissions.

Preventive measures will also be stepped up, encouraging people to exercise more and smoke and drink less.

The final step is described as "Getting more for every pound spent" - expected to save the PCT �44.38million by 2013-14. This includes an anticipated �11million saved on prescribing drugs, and �10.7million on primary care and community service changes.

Look after yourself and save the NHS cash

The new strategic plan will change the way the NHS treats sufferers of long-term conditions such as diabetes and bronchitis and emphysema.

Dr Dennis Cox said: "A COPD sufferer might expect to be admitted once or twice a year during the winter. They will be given oxygen and rest, and be discharged very swiftly - but at a cost of �2,000 per admission.

"But a training course, in which patients are taught to manage their disease, reduce risks and improve their fitness, costs just �300.

"By education and prevention we can ensure that our patients stay healthier and prevent unnecessary admissions to hospital."

Diabetes: A hospital consultation could cost the NHS �150, compared to �50 in a community clinic. A �300 diabetes education course could train a patient to look after diabetes better and avoid a �2,000 hospital admission.

Skin care: Removing a skin cyst could cost up to �600 in hospital, but only �100 by a GP surgeon. A photograph of an abnormal mole e-mailed to a consultant might avoid a �150 appointment with the consultant.

Care of the elderly: A �100 falls prevention course could avoid a �6,000 admission to hospital following a fractured hip.

Extra care nursing in an old people's home at a cost of �2,000 might avoid an admission to hospital which cost �6,000.