Are West Herts patients facing operation hold-ups due to back-door financial wranglings?

PATIENTS needing hospital treatment from a list of conditions which require funding approval are being rationed by the back door according to a leading local politician.

Last November the Herts Advertiser revealed that the Hertfordshire Primary Care Trust (PCT) had listed 18 procedures for which they had to give agreement in advance before they could be carried out.

They include hysterectomies, elective hip and knee surgery, cataracts, back injections, hand surgery, tooth extraction, varicose veins and epidurals for chronic pain.

It was introduced because of the financial challenges facing the PCTs as a result of a considerable overspend against the budget.

But St Albans council leader, Robert Donald, is concerned that the system is not transparent and being rationed by the back door because the PCT rather than consultants and specialists are deciding whether or not an operation can be carried out.

He said he had seen the formal letters which were being sent out to patients once they had been referred saying they required treatment but it might not be possible because of financial constraints.

He went on: “Then there is to-ing and fro-ing between the hospital and the PCTs as to what is going to happen. If someone who needs one of the procedures gets a letter, they then go into a process between the hospital and PCT which I suspect the GP also becomes involved in.

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“It has a huge impact and goes backwards and forwards until a financial decision is made. There can be delays of up to two to three months.”

Cllr Donald said it was also impacting on the West Herts Hospitals Trust which was losing income from the PCT because operations were not going ahead.

But the PCT denied there was a problem or that recommendations by clinicians were being questioned by lay people.

Public health consultant, Dr Louise Smith, confirmed that since last November hospitals and GPs in the county had been asked to seek prior approval from the PCT before they treated patients with certain conditions.

She went on: “The reason we are doing this is so that we can make absolutely sure that patients are receiving the most appropriate treatment for their individual condition at the right time and in the right place. We can also ensure that national guidance for treatments that may have limited clinical benefit is more rigorously adhered to.

She went on: “This does not mean that we are questioning the decisions made by clinicians. It does mean that we are asking them to confirm they have clinical evidence for treatments.”

Dr Smith said that applications were reviewed quickly by clinically-qualified PCT staff and were usually processed with 48-72 hours so patients should not notice any delay in their treatment.

She added: “From mid November 2009 to mid May 2010, more than 12,000 referrals from consultants, GPs, the independent sector and others have gone through the prior approvals process.”

A spokesperson for the West Herts Hospitals Trust said they had seen a reduction in the number of patients they were treating in some areas but as a whole had not seen a significant change in the number of patient referrals.