Sunday. 20 April 2014

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Hospital cuts to follow-up treatment ‘risk lives’

Leading consultant damns ‘insane’ policy and minister’s new NHS ‘goals’

Efficiency savings in the UK’s health service are forcing hospitals to slash follow-up appointments – putting patients’ lives in danger. That is the claim made to Exaro by a leading consultant in comments that have won support from other health-care specialists.

The attack from the medical world on the practice of cutting back follow-up appointments is set to undermine proposals unveiled two days ago by Andrew Lansley, the health secretary, aimed at improving confidence in the National Health Service.

It’s all hot air. It will not change anything

Dr Andrew Bamji, consultant rheumatologist

Dr Andrew Bamji, a consultant rheumatologist formerly at Queen Mary’s Hospital Sidcup in Kent, told Exaro that slashing follow-up appointments was “unethical” and “insane”. In addition, he said that it would increase costs for the health service.

A past president of the British Society for Rheumatology, which represents clinicians who treat people with arthritis and other musculoskeletal conditions, he said that the practice could lead to patients’ deaths. He is especially worried about those taking drugs that require close monitoring for potentially dangerous side-effects.

“If you have a patient on a toxic drug and it requires monitoring, but the patient, for one reason or another, is not being properly monitored, then there is a possibility that they might die,” he said.

He gave the example of methotrexate, a drug used in the treatment of cancer and rheumatoid arthritis. If patients are not monitored regularly by a specialist, he said, the drugs can cause blood or liver problems with potentially fatal consequences.

His criticism, which won support from key health-care specialists, raises questions about Lansley’s plan to create a system to assess success in the NHS based on the quality of care that patients receive.

Lansley set out 60 goals that will replace the previous Labour government’s system of targets and will be used to define success in the NHS.

The goals include a commitment to prevent unnecessary early deaths, a pledge to enhance the quality of life for people with long-term conditions, and a drive to ensure that people have a positive experience when using the health service.

Bamji said: “It’s all hot air. It will not change anything.”

“Improving the experience of patients with long-term conditions is fine if that translates into saying that you are going to abandon this ridiculous business of not letting specialists follow up patients.”

“But, if it does not actually specifically say that, then we are going to go on with the same old problems.”

“He [Lansley] has this idea still that you go into the health service, you have something done and then you recover. Well, long-term conditions are not like that. Long-term conditions such as rheumatoid arthritis require continuing monitoring and you may recover, you may go into remission, but you may only be just about kept under control. This is not quite the same thing as recovering. You need still to be monitored.

“If he were to say… we are going to abolish all ‘new to follow-up’ ratios targets, then that would be fine. But, unless he specifically says that, as far as I am concerned, it is hot air.”

Although the government has pledged to increase health spending in real terms from £103.8 billion in the last financial year to £114.4 billion by 2014-15, the Department of Health wants the NHS to make £20 billion of efficiency savings over the next four years.

No targets to cut follow-up appointments have been set nationally. However, a survey carried out by Exaro showed that most hospital trusts are telling consultants to cut the number of follow-up patients seen in each clinic compared to the number of new patients.

Out of 90 hospital trusts surveyed, 56 are enforcing their own fixed targets on the number of follow-up appointments for departments.

A spokesman for the Department of Health said: “All patients with a clinical need for a follow-up appointment in hospital should have one. The department has not set up targets to reduce the number of follow-up appointments for patients, and we have no plans to do this.”

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