NHS chiefs plotting closures across the country to tackle £460m black hole ‘

HEALTH bosses are preparing to announce a ‘glut’ of service closures this autumn in a bid to control the NHS financial crisis, it emerged last night.

Officials have been told to draw up a list of services which are ‘not clinically and financially sustainable’ – with the aim of closing struggling units or shifting them to bigger hospitals.

Every hospital trust in England was sent a letter last month by Bob Alexander, director of resources at NHS Improvement, the health services’ financial watchdog.

It told trust bosses to identify departments which could be ‘re-provided’ by other institutions. Hospital chief executives were given a deadline of 31 July to provide details.

But final plans are to be drawn up by the end of November, with the aim of rapidly making closures so savings can be made before the financial year ends next March. In other dramatic NHS developments: NHS chiefs reported a £461million deficit in the first quarter of the year;

Ambulance services in the North West were told to stop taking children to Fairfield General Hospital A&E, Bury, also due to shortages;

Basildon and Brentwood clinical commissioning group published draft plans to stop funding weightloss surgery for obese patients;

The waiting list for elective care reached the highest level on record, with 3.45million patients waiting for operations and appointments.

Last night, experts warned that any decision to close A&E units or specialist services could fuel the ‘sense of crisis’ already building in the NHS. Chris Hopson, chief executive of NHS Providers which represents hospital trusts, said he expected to see announcements of closures and mergers in the coming months. We would expect a glut of those decisions coming forward, because our guys have been specifically asked to identify them,’ he said.

Bosses were ordered to identify units either short of senior consultants, running over-capacity or relying on too many agency staff.

Specialist services such as dermatology, rheumatology or urology, which require highly skilled doctors, are thought to be the most likely to close, particularly at small district general hospitals. Experts fear that even some A&E units may be closed or merged, as doctors brace themselves for what is forecast to be a very difficult winter for the NHS. NHS England is expected to announce plans by the end of November to shift units from struggling hospitals to larger hospitals which are better staffed.

A letter to all hospital bosses, detailed in a report by watchdog NHS Improvement, asked them to identify ‘opportunities for consolidation and re-provision’.

It said: ‘It is essential that you as chief executives provide the leadership and support to ensure we take forward these improvements at pace. There is considerable potential ... to go further in re-providing services that are not clinically and financially sustainable, for instance where there is insufficient capacity and/or a high reliance on use of temporary and agency staff.’

Mr Hopson said: ‘Our members tell us very clearly that they are struggling to keep services open because of workforce shortages.’

But Richard Murray, director of policy at The King’s Fund health think tank, said closing hospital units was ‘politically toxic’ and may not save much.

‘The idea that there is a pot of gold behind this is simply not true,’ he said. ‘To announce that you can’t staff a service any more develops a real sense of crisis.’

He pointed to the example of Chorley Hospital in Lancashire, which has temporarily closed its A&E services because of staffing shortages.

Mr Hopson said he believed the NHS had reached ‘breaking point’ – and the Government and NHS England needed to take urgent action. He added: ‘Please NHS, either put more funding in – if you are not prepared to do that, you have got to make a conscious decision about where we allow things to slide. What you can’t do is allow us to do the impossible and then beat us up when you fail to deliver it.’

NHS accounts published yesterday showed that across the service, a deficit of £461million was recorded between April and the end of June. This is far lower than the £930million declared at the same point last year – but had been achieved only thanks to a £1.8billion funding boost.

Dr Mark Porter, chair of the British Medical Association, said: ‘These figures are the latest in a spate of reports that show our health service is reaching a crisis point.’

A spokesman for NHS Improvement said: ‘It is an essential part of the planning process for local areas to identify which services could be unsafe, underused or unsustainable.

‘It is absolutely right that decisions on the future of health services are taken locally in consultation with the people who use those services. That planning process is still going on and no decisions have been taken.’

A Department of Health spokesman said: ‘The NHS is making progress towards balancing the books, but there is no room for complacency.’

To announce that you can’t staff a service any more develops a real sense of crisis Richard Murray, King’s Fund health think tank