Old will bear brunt of NHS shortfall

Old people, the mentally ill and the disabled are those who will have to bear the brunt of any shortfall in health funding, health managers said yesterday.

The National Association of Health Authorities and Trusts has estimated English trusts need at least pounds 200m, less than 1 per cent of total NHS spending, to see them through to the end of the financial year in March. The NHS Trust Federation says that to avoid extending waiting lists or other cutbacks pounds 300m extra is needed.

If these assessments prove accurate patients needing non-urgent surgery, such as hip replacements, would see their appointments deferred and the length of time they have to wait for their operations increased. Community care would also suffer. Hospital trusts would postpone paying their suppliers and put off planned building work.

But health trusts will try to sustain accident and emergency, cardiac and children's services and ambulances are unlikely to be turned away. "Trusts providing acute care are acutely aware of the political sensitivities," said one manager cryptically.

Health trusts cannot end the year in deficit so, failing any increase in their budgets, they would obliged to make savings in the five months that are left.

Many trusts have already exceeded the budgets for treatment allocated to them for the whole of 1996-97. If they continue to treat patients at current rates, they run into the red. Though still only partially complete a survey of NHS trusts conducted jointly by the Chartered Institute of Public Finance and Accountancy and the Health Financial Managers' Associations, has found a third reporting a very difficult situation.

According to health analysts the root cause of this is the Government's decision to base the pounds 33bn (for England) NHS budget on its estimate of spending rather than what trusts and authorities had spent by March last. Some experts say the system started the year pounds 180m short of what it needed to maintain last year's care.

After allowing for inflation, the amount of real growth in NHS spending for 1996-97 was minimal, which contradicted the Government's promise of growth.

Professor Chris Ham, of Birmingham University, an expert on health finance, said: "Needs and demand have continued growing, so it is not surprising that hospitals are running into serious problems."