Acute hospitals may close, NHS chief warns
· Biggest deficit problem in East Anglia
· Managers 'afraid' to reveal extent of cash problems
Wednesday June 14, 2006
Closure of big NHS acute hospitals may be required to eliminate the NHS's £512m deficit, the health service's acting chief executive has told the Guardian in his first interview since taking control 100 days ago.
Sir Ian Carruthers said strategic health authorities across England are drawing up plans to improve services without overspending their allocations.
In some areas, hospitals might close the A&E department, requiring local people to travel further in an emergency to a neighbouring NHS trust. Specialist departments such as orthopaedics or cancer treatment might be concentrated in fewer specialist units. "There will be major change in all district general hospitals. That is inescapable because of the direction of travel in the white paper."
But Sir Ian, who took over as chief executive when Sir Nigel Crisp stepped down in March, did not rule out more drastic action. When asked if big general hospitals would have to close, he conceded: "I can think of very few instances where we are talking about closing whole hospitals. You never say never, but I can think of very few where that would be the case." He said the problems facing the NHS were "the most challenging in its history."
Sir Ian would not name the most likely candidates for closure, but pointed to East Anglia as the region where the NHS had the biggest deficit problem.
The NHS in England had a net deficit of £512m in 2005-06, equivalent to 0.8% of its turnover. But in the eastern region the overspend was more than four times higher, equivalent to 3.3% of turnover.
Accounts show that Queen Elizabeth hospital in King's Lynn had a deficit of £11m, West Suffolk £11.8m and Ipswich £11.9m. Primary care trusts in the area with big overspends included Cambridge City £13.7m, North Norfolk £12.2m, Suffolk West £11.4m and Broadland £8.8m.
The biggest deficit in England was at Surrey and Sussex Healthcare trust which overspent by £40.8m.
Sir Ian said the chief executives of strategic health authorities are drawing up local development plans, identifying which services need to be reconfigured. The Department of Health will announce the results later this year.
He will tell health service managers at the NHS Confederation in Birmingham tomorrow to "knuckle down to the job in hand". There should be no delay in getting a grip on budgets and increasing productivity. "We need to be judged by what is done, rather than what is said."
The conference will be warned by Dame Gill Morgan, the confederation's chief executive, that the NHS is in the grip of a "malign culture" of secrecy and blame. She will say managers fear owning up to problems before they became serious because they think they will be bombarded by instructions and advice.
"Managers are being judged by a narrower and narrower set of indicators. If they fail to reach them, they can be dismissed. People come and shout at you. Or you can be overwhelmed with help," she said last night. "We have a major system problem and it is caused by a blame culture. We have got better at telling patients when things are wrong, but we've slipped up as an organisation by not being transparent with each other."
The government became aware of the NHS's financial difficulties last autumn when ministers were shown the half-year results.
The department should have known long before, but organisations in the front line did not like to admit they were in trouble. She said: "If we stifle honesty and managers are afraid of speaking publicly or telling the next level up that there is a problem, we are not going to improve the service."
A confederation survey of 199 chief executives found 82% believe the current problems of the NHS have been compounded by a lack of trust and transparency across all levels of the service.
Dame Gill said the NHS had to explain why 92% of patients are pleased with the service, but only 40% of staff are happy with the quality of their establishment.
Sir Ian added: "I don't believe there is anywhere that can't be put right, but in many places there are great challenges ... People should now have the feeling when they come up with these difficult issues that support is there. From the prime minister downwards, we are all saying it is there. We now need to demonstrate it is as well."

was mdicine NOT in trouble