Health service waiting times 'may lengthen'

The National Health Service is facing its toughest time financially for years with the possibility that some waiting times will lengthen, Alan Langlands, chief executive of the NHS, warned yesterday.

And while he said that the health service was far better placed to cope than in the winter of 1987 - the occasion of the last great NHS financial crisis when 4,000 beds shut forcing the Government into its NHS review - he told NHS managers that "difficult choices will have to be made" in the year ahead.

Money is so tight that no new targets for cutting waiting times have been set for next year. The NHS was told formally told for the first time yesterday that meeting the demand for emergency care is its "first responsibility". While Mr Langlands said he did not think it was "inevitable at all" that waiting times would lengthen, they would "vary in different places".

Managers and the NHS executive, however, "will want to hold on to the hard won achievements of the past few years. We don't want to lose ground", he said at the launch of next year's NHS planning guidance at the annual conference of the Institute of Health Services Management in Birmingham.

"We are facing the toughest year we have faced for a long time," he said. Between 1990 and 1993 the NHS had enjoyed substantial growth as the NHS reforms were introduced. Settlements in the past two years had been less generous, but the service had gained from lower than expected inflation. This year growth was only 1.1 per cent in the face of rising emergency demands, a still ageing population and other pressures. It would be both "tight" and "tough", he said.

"There is much less room for manoeuvre than we would like," he added, warning that there were "no quick fixes" and no "hidden pot of gold" available.

He promised support, however, for managers "who have to pace developments and make the sort of trade -offs between competing priorities which may be required in some places."

His warning follows acute pressures last winter on both emergency services and intensive care beds for adults and children. The service then had "coped remarkably well". Of the coming year, he said: "I think we can cope and we will cope." Overstating the pressures "certainly at the moment" would "simply get in the way of managing them".

Asked if the situation was as bad as 1987, Mr Langlands, who has just had his contract as NHS chief executive extended to 2000, said: "I don't know, but we are in a completely different situation." Today's NHS was much better placed to manage the situation creatively, he said.

His comments came as James Johnson, chairman of the British Medical Association's consultants' committee told its annual conference in London that the shortage of intensive care beds had become "a national scandal" with safety margins cut to the level of "Third World medicine". He said that Stephen Dorrell, the Secretary of State for Health, had called for more beds but had not provided the one thing needed - money to fund them.

Harriet Harman, Labour's health spokeswoman, told the conference that she "well understood" the service was facing a "severe and immediate" funding crisis. But Labour, however, would give no specific figures on its spending plans before its first Budget.