The health service will curb treatment for conditions such as hearing loss and dementia after its head set out the first explicit limits on what patients should expect.
Simon Stevens, the chief executive of NHS England, effectively ripped up waiting-time targets for routine surgery, rebuffing demands from ministers as he said that cancer, mental health and GP care should take priority.
Patients were told to stop expecting the NHS to treat coughs, indigestion and other minor conditions, with GPs encouraged to send people away without prescriptions for medicines they could buy over the counter.
A list of 36 conditions that do not need to be treated has been drawn up in plans to save £190 million by getting patients with sore throats, acne or dandruff to look after themselves. Mr Stevens said this would “make taxpayers’ money go further” as he emphasised an efficiency drive.
His bluntness over unaffordable treatments is likely to exacerbate a public feud with the government over NHS funding. In last week’s budget, the health service was given a boost of £1.6 billion for 2018-19 and £900 million for 2019-20, with clear instructions to use this to bring down waiting times.
Mr Stevens has insisted this is not enough to fund everything asked of the NHS, pointing out that after adjusting for the ageing population the sums amount to a rise of 0.9 per cent per person next year and a reduction of 0.4 per cent per person in 2019-20.
At a board meeting yesterday, Sir Malcolm Grant, the chairman of NHS England, said: “We should not set out blindly imagining that our staff can do everything. There are going to have to be tough decisions and trade-offs.” Mr Stevens argued that A&E, cancer, mental health and GP care should be protected, meaning “tricky judgments” about what else to cut.
For the first time, Mr Stevens said that new guidance issued by the National Institute for Health and Care Excellence (Nice) could not be implemented next year unless funding was agreed in advance — a decision that threatens best-practice advice due next year on conditions from sight and hearing loss to arthritis and dementia care.
Whereas Nice rulings on drugs are legally binding, guidelines on the most effective treatments are not, and local areas are likely to see the admissions as a green light for tighter rationing.
Rachel Power, chief executive of the Patients Association, said: “Having our healthcare whittled away in one of the richest nations in the world can’t possibly be acceptable.”
Mr Stevens said that “waiting times standards, in the round, will not be fully funded and met next year”, putting him in conflict with ministers before discussions over a formal 2018-19 mandate for the NHS.
Government sources dismissed his warnings as grandstanding, insisting that there were other areas to cut in a £110 billion annual budget. The Department of Health said: “We expect NHS England will use that [budget] money to make sure every patient gets the treatment they require in a timely way.”
The goal of treating 92 per cent of patients waiting for non-urgent surgery within 18 weeks has not been met for more than a year and internal NHS calculations suggest that it will cost £2.5 billion to clear waiting lists. Jonathan Ashworth, the shadow health secretary, said there were “serious questions about the legality of effectively abandoning a standard of care enshrined in the NHS constitution”.
Mr Stevens also presented draft plans to reduce the £645 million a year that the NHS spends on drugs that can be bought on the high street, pointing out that paracetamol costs four times as much on prescription as in supermarkets. However, Don Redding, of the charity coalition National Voices, said: “These plans could mean that some treatments are only available to those who can afford them.”
Ailments to treat yourself
Aches and sprains such as headaches and period pains
Cold sores
Colic in babies
Constipation
Coughs, colds and blocked noses
Dandruff
Diarrhoea
Earwax
Haemorrhoids
Indigestion
Insect bites
Mild acne
Mild to moderate hay fever
Mouth ulcers
Sore throat
Sunburn
Travel sickness
Warts and verrucas
