Patients will be denied treatment, waiting times for operations will lengthen and A&E and maternity units may be shut under secret NHS plans to impose unprecedented cuts to health spending in London.



According to an internal NHS document seen by the Guardian, doctors in five London boroughs will have to spend less on drugs, fewer patients will be referred to hospital and support for people with severe health needs will be cut as part of the plan.

It outlines the “difficult choices” NHS bosses nationally are forcing the 10 hospital trusts in north-central London to make in the next few months in order to plug a £183.1m gap in their finances.

The 31-page document was circulated among dozens of top NHS officials in the area on 25 May. It outlines how the “capped expenditure process” will hit the provision of NHS care to the 1.44 million people who live in the boroughs of Camden, Islington, Haringey, Barnet and Enfield.

It admits that pushing through such cutbacks will be unpopular and hard to explain – and result in poorer care. “We recognise that these choices may be difficult for a number of reasons [because they include] … options that impact on quality of care [and] options that would be difficult to implement,” it says.

The hospitals that have been told to implement draconian cost-cutting measures include some of the NHS’s best-known names, such as the Royal Free, University College London and Great Ormond Street children’s hospital.

North Central London (NCL) is one of 14 areas of England where NHS England and NHS Improvement, the service’s twin regulators, are forcing hospital trusts to make far-reaching cuts during 2017-18 as part of the “capped expenditure process”. They have told local NHS leaders to “think the unthinkable” in their quest for savings.

Facebook Twitter Pinterest Part of the NHS document. Photograph: Handout

The 14 have been chosen because they are expected to record some of the service’s biggest deficits and thus risk busting this year’s budget for the NHS as a whole. The NCL document says that “submitted operating plans [by the 10 trusts for 2017-18] show an overall gap to system control total of £80.5m. In addition, there are further risks/gaps in plans, currently assessed at £102.6m” – a £183.1m deficit overall.

Disclosure of the plans has sparked furious opposition. NHS Providers, which represents hospital trusts, said restricting care and closing hospital units was “neither realistic nor reasonable”.

Restricting care in the ways envisaged by NHSE and NHSI will have such a dramatic effect on patients that it threatens the NHS’s ability to treat illness in the way it has done since its creation in 1948, it added.

“Some of the proposals could challenge fundamental expectations shared by NHS staff and the public about what the health service is there to provide. We can not do that without a full and proper debate”, said Saffron Cordery, the organisation’s director of policy and strategy.

Labour accused the government of inflicting huge cuts on the 14 areas because it is starving the NHS of the money it needs to do its job properly.

“Theresa May’s underfunding of our NHS now means services cut and rationed, patients forced to wait longer for treatment, and a postcode lottery where healthcare varies depending on where you live. These ‘capped expenditure process’ plans are in reality a Tory NHS ‘hitlist’ drawn up in secrecy during the election campaign,” said Jonathan Ashworth, the shadow health secretary.

“Now we learn detailed proposals for north London involve shocking restrictions on care quality and access for patients. This weak and unstable Tory government expects NHS bosses to put finances ahead of the best interests of patients,” he added.

The document stresses that, although no final decisions about which cuts will be implemented have yet been made, the options being discussed would result in:

• Patients having to wait longer than the maximum 18 weeks for planned operations. “Extending referral to treatment” waiting times is one of the “difficult choices” under consideration.

• An increase in the rationing of care through patients being denied access to certain but still unspecified types of surgical treatments, which the NHS sees as “procedures of low clinical effectiveness” (POLCE) that are not worth performing. Adding more procedures to this list is another option.

• Hospital units being downgraded or shut altogether as a result of “potential service consolidation” across the 10 trusts leading to the centralisation of key services in fewer places. This could threaten the viability of smaller hospitals in NCL, notably North Middlesex in Enfield, which has faced serious staffing problems in recent years.

• A £2m cut to the financial support given to patients with serious, long-term medical problems and disabilities under the Continuing Healthcare scheme, including people with brain damage.

• Unspecified new limits to treatment for patients with back pain and other musculo-skeletal conditions on top of the “ambitious reductions in MSK activity” already occurring this year.

• NHS trusts putting less money into the Better Care Fund, the flagship government scheme designed to relieve pressure on hospitals by avoid unnecessary overnight stays by providing better social care support for mainly older people.

• Job losses in the 10 trusts as a result of a planned “reduction in admin costs”.

The Royal College of Surgeons said the cuts could have a “devastating” impact on patients and would cost more in the long run.

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“While the details of these proposals are yet to be seen, we understand deliberately longer waits for treatment are being considered. Patients could also face a waiting time postcode lottery as the capped expenditure process is applied to areas tackling the most extreme financial difficulties,” a spokesperson said.

“For someone waiting in pain and discomfort, possibly unable to work, such proposals could be devastating. They are also a false economy as the NHS will continue to pay for medication, physiotherapy and support while such patients wait to qualify for treatment.”



Both NHS England and the Department of Health refused to comment.

