IT has been a bumper year for Nick Dodd. He has received another handsome pay rise, taking his salary to £140,000. The amount, says Dodd, is surprising in its generosity.
He is not alone in his good fortune. Nearly a third of Dodd’s consultant colleagues at the Ipswich hospital are receiving more than £100,000.
“My salary went up 28% in a year,” said Dodd, a senior haematologist specialising in blood cancers. “Paying these rates is a big problem for hospitals.”
Dodd, 55, highlighted the issue of the escalating NHS wage bill last week when I revisited the hospital. I spent a month “on the front line” there before last year’s general election. Last week, with the NHS facing a debt crisis, I returned.
I found staff absorbing the news that, for the first time in more than a decade, next year’s hospital budget will be cut. That is when Gordon Brown’s NHS spending boom is set to end. Not only will £4m be shaved from Ipswich’s £174m budget for 2005/06, but £8m of debt will have to be repaid.
Within these constraints, it is far from clear how the 800-bed Suffolk hospital will meet the expanding demand for healthcare while paying its spiralling wage bill.
Not only that, but drug costs are rising 20% a year, said Dodd. Many patients are old and require growing quantities of sophisticated medication. “It has to end somewhere,” said Dodd. “The western world has got to decide how much it is prepared to spend on keeping people alive into unproductive old age.”
This is the crunch facing the NHS. Within 15 years, retired people in Britain will outnumber those working. How the country can cater for ever-increasing demand for healthcare is a question no politician dares to ask openly, fearful of having the words “rationing” or “postcode lottery” flung at them.
When I was in Ipswich a year ago, I saw a good hospital often working miracles. But underneath the pressures leading to a slow, inexorable decline were evident. A year on the prognosis is starting to look bleak.
FOR the patients benefiting from all the spending, however, these problems look far off.
Peter Brooks, a retired fireman, is typical of those who a few years ago would not even have been a candidate for surgery. His life-saving, eight-hour operation cost tens of thousands of pounds and involved removing the cancerous top half of his stomach and the bottom of his oesophagus. His lung was partially collapsed so the rest of the stomach could be moved into his chest and fixed to the shortened food pipe.
Brooks, 77, a former athlete, has been in hospital three weeks. This weekend he is due to go home and, according to staff, will probably return to almost perfect health.
“Only 10 or 15 years ago, half the people in here would already be dead, and in other countries where I have worked recently, they would not even have been eligible for treatment,” said Susie Barker, 37, a senior nurse who has returned from jobs in hospitals in South Africa and the Middle East to be nearer her elderly parents.
At least 40% of Ipswich’s beds are occupied by patients over 80. “Big operations on very elderly people are not rare,” said Barker. “We have just discharged a 90-year-old who had a complex bowel operation. You can’t tell them they can’t have the treatment.”
Despite these feats, there have been attempts to ration healthcare. Last autumn, orthopaedic surgeons at the hospital led by Clare Marx, a senior consultant, caused uproar when they said they would no longer replace the joints of obese patients as they wear out quickly and are not cost-effective.
Such gestures do little to rein in burgeoning demand. The number of operations carried out has risen 10% in the past year to almost 70,000, many of them complex procedures saving the lives of elderly people.
Meanwhile, local primary care trusts, who pay for operations, think they have hit on a device to ease the pressure. They have set up what they call a “referral centre in the community” which will, for example, offer physiotherapy to people with crumbling joints to keep them off surgical waiting lists for a few extra months.
This may not be ideal for the patients, but the decision is understandable. Two of the three primary care trusts (PCTs) buying healthcare for the population of East Suffolk are among the top five with the worst debts in the country. They are £26m overspent on a joint budget of £350m.
Some relief may come from bureaucratic savings to be made in a health service reorganisation later this year. The 28 strategic health authorities will be cut to about 10 while the number of PCTs is expected to halve to 150. The NHS calculates it can shed 6,000 administrative jobs and save £250m a year. Suffolk’s five PCTs are likely to be merged into one.
Such one-off savings may help in the short-term, but will do little to ease the underlying pressures on the NHS.
The Ipswich hospital serves a population of 300,000, but 418,000 patients were treated last year, 10% more than the year before, part of a seemingly unstoppable upwards trend.
Funds may be plentiful for now, but the King’s Fund, a health think tank, calculates that the boom in the NHS budget, due to hit £90 billion next year, has produced only 2% greater productivity. Meanwhile the service is expected to see a shortfall of £800m for this financial year.
Last week Sir Nigel Crisp, NHS chief executive, left with a £3.2m pension fund and the promise of a peerage. He was widely assumed to have been forced out by Patricia Hewitt, the health secretary, but it is expected he will say little about the service’s problems.
Over the coming years the question is going to recur with growing frequency: should patients be denied treatment? Nobody would question the need for the NHS to care for Ben Dak, an 11-year-old with muscular dystrophy being treated for a broken leg and facing a lifetime of care.
Equally it is the stream of NHS funds which has allowed Emma Nicholson, 22, to spend more than a year in hospital but emerge with a cure for her rare blood pressure condition which led to her fainting dozens of times a day and suffering a litany of broken bones from falls.
Instead of life in a wheelchair and a strict medication regime, which involved consumption of half a kilo of salt a day, Nicholson is now receiving regular infusions of a protein called human serum albumin, which acts as a sponge to maintain liquid, and therefore pressure, in her blood circulation.
She has now completed an English degree, has started a job and is walking confidently. “I can’t believe how lucky I am,” she said. “I’ve got my life back.”
Few staff are as outspoken as Dodd about the need to curb demand for healthcare. For most, even thinking about rationing makes them uneasy.
Last week Peter Mills, clinical director for theatres and anaesthetics, replaced the hip of a 90-year-old who asked for the operation because of pain, although he had no broken bones. “The GPs refer the patients in and it would take a fairly ruthless chief executive to say we were going to set an age limit on cost grounds,” said Mills.
Ipswich is a clean, happy hospital and patients are well cared for, but there are still more than 6,000 people waiting up to six months for operations.
Andrew Reed, its chief executive, is one of a new breed of NHS managers bringing in private sector discipline to save money. Sixty jobs in administration have already gone and he plans further cost-cutting such as reducing the £4.5m sick leave bill.
On one thing Reed is adamant, however. He does not countenance the possibility of cutting services to balance the books. “This is a good, popular hospital serving a distinct geographical area,” he said. “It can definitely continue doing what it is doing.
“It is true that in the past the debts have been magicked away. The move to use private sector accounting practices is, of course, exposing more of the underlying problems.”
How these underlying problems will be addressed once cost-cutting and bureaucratic tinkering have been exhausted, neither Reed nor many others in the NHS care to address.
HEWITT ADMITS LABOUR UNDERESTIMATED NHS WAGE COSTS – WHICH MAY LEAD TO JOB CUTS The health secretary, Patricia Hewitt, has admitted that generous pay settlements for nurses and doctors have cost more than the government allowed for, writes Isabel Oakeshott.
Hewitt has also warned that National Health Service trusts battling mounting deficits may have to cut staff.
Average salaries for GPs have now passed £100,000 a year, while nurses have enjoyed pay rises of 15% over the past three years.
Speaking this weekend, Hewitt said it had been right to negotiate new pay agreements with family doctors and hospital consultants, adding that she was “proud of” the new agreement struck with nurses. However, she admitted that these were all costing “rather more than either we, or indeed the trade unions and professional associations, anticipated”.
Hewitt said trusts facing heavy deficits had to ensure they were not employing too many staff. She warned NHS workers that there were “quite challenging” times ahead, with little prospect of further pay rises.
Hewitt claimed there had been some “clinical resistance” to the government’s drive to overhaul the health service, with some doctors reluctant to embrace new practices.
She praised the “production line” method of operations in France, where some surgeons are so efficient they perform twice as many procedures in one day as their counterparts in the UK. Their methods were highlighted by The Sunday Times.
