Fears over hospital readmissions
Hospital readmissions are on the rise, prompting claims ministers are pressuring the NHS to release patients early to help cut waiting times.
Government figures, obtained by the Conservatives, showed that the number of emergency readmissions had risen by nearly a third since 2002.
Shadow health secretary Andrew Lansley said hospitals were discharging people too early
because of NHS targets.
The government said readmissions were often unrelated to the earlier visit.
In the last quarter of 2002-3, 5.5% of patients were readmitted as emergency cases less than a month after being released.
By the last quarter of 2005-6, this had risen to 7.1%.
It comes as hospitals grapple with achieving the latest waiting time target - 18 weeks from GP referral to hospital treatment by 2008.
Patients are currently seen within six months, but that is from the point of diagnosis, which is
often months after referral.
Mr Lansley said: "On the face of it hospitals may be discharging patients sooner than they should be.
"High bed occupancy rates and the government's push to achieve waiting time targets may be responsible for compromising patients' safety in this way."
And Liberal Democrat health spokesman Steve Webb said: "The financial crisis in the NHS means that doctors and managers are being put under huge pressure to cut the length of time that people stay in hospital.
"These figures show what can happen when financial pressures get in the way of clinical priorities.
"It is a false economy to send people home too soon only to have them readmitted at a later stage."
Friday, March 23, 2007
GPs refuse to be OOH scapegoat.
Doctors' leaders and grass-roots GPs have warned that any attempts by ministers to extend GPs' working hours will fail if not properly funded. Struggling GP out-of-hours (OOH) services and overstretched hospital A& E departments could lead to pressure on GPs to open later in the evenings and on Saturday mornings. The warning follows the publication last week of a report by the Commons Public Accounts Committee that severely criticises the running of OOH services since PCOs took over responsibility for them in 2004. It says they are not serving patients well, with access to advice and treatment 'often extremely difficult and slow'. The report also describes the DoH's preparations for the introduction of the PCO-run services as 'shambolic' and 'thoroughly mishandled'. It is costing £70m more a year to run OOH services than expected. But GPC negotiator Dr Peter Holden said any back-door attempt by the Government to extend GPs' involvement in OOH would only be acceptable if it was properly funded.
http:/ / www.doctorupdate.net/ du_ news/ newsarticle.asp ?ID=17351
THIS OOH COVER THAT G.P'S PROVIDE IS RIDDLED WITH ERRORS, THERE IS ONE BEING INVESTIGATED LOCALLY, UNFORTUNATELY THE PCT ARE "DRAGGING THEIR HEELS" IN THIS PROCESS - WHEN THE DETAILS EMERGE, THEN THE PUBLICS TRUST IN THE PCT AND THE NOTION OF CARE BEING PROVIDED BY G.P'S OOH & TREATMENT IN THE COMMUNITY WILL GO OUT THE WINDOW..............IT WON'T WORK
AND WONT BE ACCEPTED.........
Tuesday, March 20, 2007
Hospital car parks make millions
Campaigners say the money made by NHS trusts from car parking charges is shameful as some trusts' income tops £2m a year.
According to the list released by the Estates Return Information Collection, 30 trusts are making more than £1m each from their car parks.
But the top earners were Southampton University Hospitals at £2.41m and Cambridge University Hospitals, £2.26m.
Overall, the NHS took £95m in charges but 74 trusts did not supply figures.
WHAT A SCANDAL, ESPECIALLY - ADDENBROOKE'S..............SHAME ON YOU
Campaigners say the money made by NHS trusts from car parking charges is shameful as some trusts' income tops £2m a year.
According to the list released by the Estates Return Information Collection, 30 trusts are making more than £1m each from their car parks.
But the top earners were Southampton University Hospitals at £2.41m and Cambridge University Hospitals, £2.26m.
Overall, the NHS took £95m in charges but 74 trusts did not supply figures.
WHAT A SCANDAL, ESPECIALLY - ADDENBROOKE'S..............SHAME ON YOU
Thursday, March 15, 2007
Social care hit by NHS deficits
By Branwen Jeffreys
BBC News, health correspondent
Social care for vulnerable people is being squeezed as a result of NHS deficits, according to the Local Government Association.
The LGA says costs are being shunted to social services departments as the NHS in England aims to balance its books.
A survey of 60 councils which run social services found two thirds say NHS debts are affecting them.
Forty per cent of the councils surveyed by the LGA said the knock on effect of the financial pressure in the NHS was worse than in previous years.
When the organisations were asked what the NHS had done in their area to affect them, half said beds had been closed, and a quarter said there had been a reduction in district nurse numbers.
Another 14% said there were increased waiting times for NHS services, such as admission to hospital while 13% said community hospitals had been closed.
In addition, more than a third of the councils in the LGA survey say they are having to take responsibility for more cases normally dealt with by the NHS.
IF THIS IS HOW THE PCT'S ARE GOING TO BALANCE THEIR BOOKS THE COUNCIL TAX PAYER WILL BE ASKED FOR MORE AND COUNCIL SERVICES WILL HAVE TO BE CUT..................
SHAMEFULL AND IF THE NHS WAS FAIRLY FUNDED FOR ALL THEN THIS WOULD NOT BE THE CASE..............COUNCILS PICKING UP THE NHS RESPONSIBILTY................SHAME ON YOU PATRICIA HEWITT............THE WRECKER OF THE NHS.............
By Branwen Jeffreys
BBC News, health correspondent
Social care for vulnerable people is being squeezed as a result of NHS deficits, according to the Local Government Association.
The LGA says costs are being shunted to social services departments as the NHS in England aims to balance its books.
A survey of 60 councils which run social services found two thirds say NHS debts are affecting them.
Forty per cent of the councils surveyed by the LGA said the knock on effect of the financial pressure in the NHS was worse than in previous years.
When the organisations were asked what the NHS had done in their area to affect them, half said beds had been closed, and a quarter said there had been a reduction in district nurse numbers.
Another 14% said there were increased waiting times for NHS services, such as admission to hospital while 13% said community hospitals had been closed.
In addition, more than a third of the councils in the LGA survey say they are having to take responsibility for more cases normally dealt with by the NHS.
IF THIS IS HOW THE PCT'S ARE GOING TO BALANCE THEIR BOOKS THE COUNCIL TAX PAYER WILL BE ASKED FOR MORE AND COUNCIL SERVICES WILL HAVE TO BE CUT..................
SHAMEFULL AND IF THE NHS WAS FAIRLY FUNDED FOR ALL THEN THIS WOULD NOT BE THE CASE..............COUNCILS PICKING UP THE NHS RESPONSIBILTY................SHAME ON YOU PATRICIA HEWITT............THE WRECKER OF THE NHS.............
Worry over NHS care in community
Moving care from hospitals into the community - a key government policy - will not always save money and may put patient safety at risk, a report warns.
The National Primary Care and Development Centre report is described in Pulse magazine.
The analysis raised concerns over GPs doing minor surgery, and the cost of specialist care in the community.
The Department of Health said the public supported moves to provide care closer to home.
A white paper published in January last year set out plans to move care away from hospitals and into the community by encouraging GPs to carry out more specialist services.
Doctors 'at war'
Professor Martin Roland, director of the centre, analysed the proposals.
He told the BBC: "While there were good examples where care was moved and a high quality
was maintained - such as diabetes care - there were also examples of things such as minor surgery, where there were significant quality problems."
In general, the report also says moving minor surgery out to GPs had "little impact on
waiting times".
GP specialists had not always been properly monitored or integrated into local health services,
said Professor Rowland
Initiatives such as having specialist clinics in the community or putting diagnostic equipment into GPs' surgeries might not be cost-effective because patients could be dealt with
more efficiently in hospital, the report warned.
Professor Roland said: "It simply relates to the greater economies of scale that can be achieved in hospitals."
He added that, because GPs' salaries are higher than that of the average hospital doctor, asking them to carry out work in their practices could be more expensive.
The report showed there was not a "one size fits all" solution, he went on.
Moving care from hospitals into the community - a key government policy - will not always save money and may put patient safety at risk, a report warns.
The National Primary Care and Development Centre report is described in Pulse magazine.
The analysis raised concerns over GPs doing minor surgery, and the cost of specialist care in the community.
The Department of Health said the public supported moves to provide care closer to home.
A white paper published in January last year set out plans to move care away from hospitals and into the community by encouraging GPs to carry out more specialist services.
Doctors 'at war'
Professor Martin Roland, director of the centre, analysed the proposals.
He told the BBC: "While there were good examples where care was moved and a high quality
was maintained - such as diabetes care - there were also examples of things such as minor surgery, where there were significant quality problems."
In general, the report also says moving minor surgery out to GPs had "little impact on
waiting times".
GP specialists had not always been properly monitored or integrated into local health services,
said Professor Rowland
Initiatives such as having specialist clinics in the community or putting diagnostic equipment into GPs' surgeries might not be cost-effective because patients could be dealt with
more efficiently in hospital, the report warned.
Professor Roland said: "It simply relates to the greater economies of scale that can be achieved in hospitals."
He added that, because GPs' salaries are higher than that of the average hospital doctor, asking them to carry out work in their practices could be more expensive.
The report showed there was not a "one size fits all" solution, he went on.
Wednesday, March 14, 2007
NHS workforce 'falls by 11,000'
The number of people working in the NHS fell by 11,000 in the last quarter of 2006, official figures reveal.
Health unions said the loss across the UK, revealed in Office for National Statistics, would "inevitably have a negative impact on patient care".
James Johnson, head of the British Medical Association said NHS trusts were under pressure to balance their books, leading to posts being cut.
And nurses' leaders warned workforce cuts would damage patient care.
Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), added: "These alarming figures confirm what the RCN has long been warning - that deficits are leading to serious cuts in the NHS workforce.
"This can only have a damaging impact on patients and services. That's why we are urging the government to work with us to replace short-term cuts with a long-term recovery plan."
Mr Johnson added: "This is devastating for the staff who are made redundant and demoralising for those who are left to cover the work.
"Although the majority of job losses are non-medical, they will inevitably have a negative impact on patient care."
SHAME ON THE GOVERNMENT................HOW MANY MORE WILL GO?
The number of people working in the NHS fell by 11,000 in the last quarter of 2006, official figures reveal.
Health unions said the loss across the UK, revealed in Office for National Statistics, would "inevitably have a negative impact on patient care".
James Johnson, head of the British Medical Association said NHS trusts were under pressure to balance their books, leading to posts being cut.
And nurses' leaders warned workforce cuts would damage patient care.
Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), added: "These alarming figures confirm what the RCN has long been warning - that deficits are leading to serious cuts in the NHS workforce.
"This can only have a damaging impact on patients and services. That's why we are urging the government to work with us to replace short-term cuts with a long-term recovery plan."
Mr Johnson added: "This is devastating for the staff who are made redundant and demoralising for those who are left to cover the work.
"Although the majority of job losses are non-medical, they will inevitably have a negative impact on patient care."
SHAME ON THE GOVERNMENT................HOW MANY MORE WILL GO?
Out-of-hours GP reforms attacked
The government "thoroughly mishandled" the introduction of the new system for out-of-hours health care in England, say MPs.
A public accounts committee report found that preparations were shambolic, and that only GPs had done well out of the new arrangements.
It said the service was now starting to improve, but performance was still not good enough.
The Department of Health said the changes had benefited most patients.
Prior to April 2004, GPs were responsible for providing out-of-hours care between 6.30pm and 8am on week days, and over the weekend.
Under the new system they were able to opt out of this responsibility in return for giving up an average of £6,000 per year.
Responsibility for out-of-hours care would then pass to the local primary care trust.
One leading member of the British Medical Association negotiating team has admitted that they were shocked at just how good the deal being offered was for doctors.
GOOD ON THE G.P'S FOR CATCHING OUT THE GOVERNMENT...............
IT IS DETRIMENTAL FOR PATIENTS AND DID NOT ALLOW FOR THE INTELLIGENCE
OF THE G.P'S IN THE UK
I HAVE GREAT RESPECT FOR MINE AND HE WORKS 3 DAY A WEEK NOW, NO OUT OF
HOURS WORK.............NICE IF YOU CAN GET IT
THERE IS AN OUT OF HOURS GP SERVICE BUT IT IS NOT REALLY UP TO SCRATCH,
IF A DOCTOR IS AVAILABLE TO BE SEEN, SO WHAT DO YOU DO..........GO TO A&E
IF THE GOVERNMENT HAS GOT THIS SO WRONG AND THE PCT CANNOT PROVIDE
A DECENT OUT OF HOUR SERVICE THEN...........
HOW CAN THE PEOPLE TRUST THEM TO PROVIDE THE "NEW" CARE SYSTEM OF
TREATMENT IN THE COMMUNITY..................THEY DON'T AND WON'T....................
BECAUSE THE SERVICE IS NOT AVAILABLE AND CAN'T BE AFFORDED ........
The government "thoroughly mishandled" the introduction of the new system for out-of-hours health care in England, say MPs.
A public accounts committee report found that preparations were shambolic, and that only GPs had done well out of the new arrangements.
It said the service was now starting to improve, but performance was still not good enough.
The Department of Health said the changes had benefited most patients.
Prior to April 2004, GPs were responsible for providing out-of-hours care between 6.30pm and 8am on week days, and over the weekend.
Under the new system they were able to opt out of this responsibility in return for giving up an average of £6,000 per year.
Responsibility for out-of-hours care would then pass to the local primary care trust.
One leading member of the British Medical Association negotiating team has admitted that they were shocked at just how good the deal being offered was for doctors.
GOOD ON THE G.P'S FOR CATCHING OUT THE GOVERNMENT...............
IT IS DETRIMENTAL FOR PATIENTS AND DID NOT ALLOW FOR THE INTELLIGENCE
OF THE G.P'S IN THE UK
I HAVE GREAT RESPECT FOR MINE AND HE WORKS 3 DAY A WEEK NOW, NO OUT OF
HOURS WORK.............NICE IF YOU CAN GET IT
THERE IS AN OUT OF HOURS GP SERVICE BUT IT IS NOT REALLY UP TO SCRATCH,
IF A DOCTOR IS AVAILABLE TO BE SEEN, SO WHAT DO YOU DO..........GO TO A&E
IF THE GOVERNMENT HAS GOT THIS SO WRONG AND THE PCT CANNOT PROVIDE
A DECENT OUT OF HOUR SERVICE THEN...........
HOW CAN THE PEOPLE TRUST THEM TO PROVIDE THE "NEW" CARE SYSTEM OF
TREATMENT IN THE COMMUNITY..................THEY DON'T AND WON'T....................
BECAUSE THE SERVICE IS NOT AVAILABLE AND CAN'T BE AFFORDED ........
Tuesday, March 13, 2007
Hewitt hands over NHS decision
John Carvel, social affairs editor
Tuesday March 13, 2007
The Guardian
Patricia Hewitt, the health secretary, set up an independent inquiry yesterday into plans to axe NHS maternity units in north-west England that provoked a mutiny by her cabinet colleague Hazel Blears.
Ms Blears, the Labour party chair and a candidate to become deputy leader, is campaigning against a decision by regional health chiefs to close a maternity unit in her Salford constituency.
At least 13 members of the government who support the principle of reorganising NHS services oppose loss of facilities in their own back yards.
Ms Hewitt can approve or reject NHS reorganisations and usually takes decisions off her own
bat. But she would have provoked outrage among NHS managers in the north-west if she had reprieved maternity units in Salford and Bury, where Ivan Lewis, a junior health minister, is campaigning against closure.
And she would have caused dismay among Labour MPs if she had rubber-stamped the decision, leaving them no avenue to press constituents' concerns.
Ms Hewitt resolved the matter by referring all proposed changes in Greater Manchester to the Independent Reconfiguration Panel, set up in 2003 to advise on the most controversial NHS changes. It will report by June 26.
WHATS THIS ALL ABOUT..................LETTING SOMEONE ELSE TAKE THE CAN FOR
CLOSING MATERNITY UNITS..............TYPICAL OF THIS WOMAN...........................
SHE RUINED MG ROVER WHILE SHE WAS IN CHARGE OF THE DTI........................
NOW THE NHS GETS THE SAME TREATMENT...........GET RID OF HER SHE IS
DANGEROUS.......
John Carvel, social affairs editor
Tuesday March 13, 2007
The Guardian
Patricia Hewitt, the health secretary, set up an independent inquiry yesterday into plans to axe NHS maternity units in north-west England that provoked a mutiny by her cabinet colleague Hazel Blears.
Ms Blears, the Labour party chair and a candidate to become deputy leader, is campaigning against a decision by regional health chiefs to close a maternity unit in her Salford constituency.
At least 13 members of the government who support the principle of reorganising NHS services oppose loss of facilities in their own back yards.
Ms Hewitt can approve or reject NHS reorganisations and usually takes decisions off her own
bat. But she would have provoked outrage among NHS managers in the north-west if she had reprieved maternity units in Salford and Bury, where Ivan Lewis, a junior health minister, is campaigning against closure.
And she would have caused dismay among Labour MPs if she had rubber-stamped the decision, leaving them no avenue to press constituents' concerns.
Ms Hewitt resolved the matter by referring all proposed changes in Greater Manchester to the Independent Reconfiguration Panel, set up in 2003 to advise on the most controversial NHS changes. It will report by June 26.
WHATS THIS ALL ABOUT..................LETTING SOMEONE ELSE TAKE THE CAN FOR
CLOSING MATERNITY UNITS..............TYPICAL OF THIS WOMAN...........................
SHE RUINED MG ROVER WHILE SHE WAS IN CHARGE OF THE DTI........................
NOW THE NHS GETS THE SAME TREATMENT...........GET RID OF HER SHE IS
DANGEROUS.......
Well, it's been a few days since my last post, I have been really busy.
I was asked to organise a Rally/March for the Trade Unions at Hinchingbrooke Hospital, and also
there have been meetings to attend on behalf of these bodies too.
The Rally/March is going ahead and it starts at 11:00 on the 17th March 07, with speeches by
activists at 11:30 followed by a march to the hospital at 12:00
I was asked by the Police to restrict this event to Activists of all Trade Unions and we are basing this on the MHS Together framewaork, but the Police asked me to consider a Community March.
So the result of this is that I have one organised
The date is..................28th April 2007
The time...............meet at 11:00
Speeches ....................11:30
Marching starts..........12:00
This is being organised to allow the People of Cambridgeshire to have been to the Public Consultations and seen the Consultation document and hopefully digested and picked
out the flaws contained within.
The real deal is 99.9% services retained (by using consultants who network between hospitals)
25% cut in activity (38,500 proceedures/patients not seen)
20% job losses (400 staff)
Now the spin says that the patients/proceedures will be done in the community, but in reality
with the commisioning projections and the policy not to treat certain problems, it realy means that these won't be done at all and no community provision will be in place
The spin for Job losses is there will be no redundancies just Natural wastage, I'm sure there are not 400 staff members who will be retiring ot leaving their job in the next 2 years, what it
really says is we have no redundancy budget, so we will over work the current staff till they leave and then we should have the master plan in place for the staff that are left.
SO THE PUBLIC NEED TO HAVE THEIR SAY..........................
TELL THE PCT TO STOP CUTTING SERVICES AND LOBBY FOR THE RIGHT LEVEL
OF FUNDING..................WE CURRENTLY GET £1000 PER PERSON YET CAMDEN GET'S
£2000 PER PERSON..................AND UNFAIR SYSTEM THAT NEEDS A LEVEL PLAYING
FIELD, IF WE MANAGE OUR BUDGETS THEN WE CAN INVEST IN FUTURE HEALTHCARE OR OTHER AREAS AS SPECIALIST TREATMENTS, NOT MAKE THE PATIENTS AROUND HERE SUFFER BECAUSE THE CASH ISN'T AVAILABLE
SO.................... 28TH ARPRIL 07 IS ON...............
I was asked to organise a Rally/March for the Trade Unions at Hinchingbrooke Hospital, and also
there have been meetings to attend on behalf of these bodies too.
The Rally/March is going ahead and it starts at 11:00 on the 17th March 07, with speeches by
activists at 11:30 followed by a march to the hospital at 12:00
I was asked by the Police to restrict this event to Activists of all Trade Unions and we are basing this on the MHS Together framewaork, but the Police asked me to consider a Community March.
So the result of this is that I have one organised
The date is..................28th April 2007
The time...............meet at 11:00
Speeches ....................11:30
Marching starts..........12:00
This is being organised to allow the People of Cambridgeshire to have been to the Public Consultations and seen the Consultation document and hopefully digested and picked
out the flaws contained within.
The real deal is 99.9% services retained (by using consultants who network between hospitals)
25% cut in activity (38,500 proceedures/patients not seen)
20% job losses (400 staff)
Now the spin says that the patients/proceedures will be done in the community, but in reality
with the commisioning projections and the policy not to treat certain problems, it realy means that these won't be done at all and no community provision will be in place
The spin for Job losses is there will be no redundancies just Natural wastage, I'm sure there are not 400 staff members who will be retiring ot leaving their job in the next 2 years, what it
really says is we have no redundancy budget, so we will over work the current staff till they leave and then we should have the master plan in place for the staff that are left.
SO THE PUBLIC NEED TO HAVE THEIR SAY..........................
TELL THE PCT TO STOP CUTTING SERVICES AND LOBBY FOR THE RIGHT LEVEL
OF FUNDING..................WE CURRENTLY GET £1000 PER PERSON YET CAMDEN GET'S
£2000 PER PERSON..................AND UNFAIR SYSTEM THAT NEEDS A LEVEL PLAYING
FIELD, IF WE MANAGE OUR BUDGETS THEN WE CAN INVEST IN FUTURE HEALTHCARE OR OTHER AREAS AS SPECIALIST TREATMENTS, NOT MAKE THE PATIENTS AROUND HERE SUFFER BECAUSE THE CASH ISN'T AVAILABLE
SO.................... 28TH ARPRIL 07 IS ON...............
Friday, March 02, 2007
Full scale of NHS cutbacks revealed
By Graeme Wilson, Political Correspondent
The Independent
The full scale of impending hospital closures was laid bare last night as it emerged that three out of four trusts are already restricting patients' access to treatment as they battle soaring deficits.
Fears about the number of closures intensified as Patricia Hewitt, the Health Secretary, sent NHS managers a guide on how best to handle decisions to shut down hospitals and units - a document that opposition politicians immediately branded a "spin" blueprint.
At the same time, a survey of NHS trust chief executives revealed the impact of the health service's financial crisis on front-line care.
The survey, published in today's Health Service Journal, shows that 73 per cent of primary care trusts, which run GP clinics and health centres, are already restricting access to treatments. Half are also delaying operations.
Seven out of 10 chief executives said "patient care will suffer" as a result of short-term financial decisions to cut deficits, while 61 per cent of acute hospital trusts said they were already closing wards.
Almost half of all trusts said that they had made, or intended to make, redundancies this year.
Morale appears to be at rock bottom, with 86 per cent saying that managers were "battered and bruised" by endless reorganisations.
Miss Hewitt published her guide on closures amid growing panic in Whitehall about the looming public backlash as trusts across the country announce plans to cut services over the coming months.
But the opposition immediately accused ministers of "a cynical exercise" in spin as it emerged that the guide includes proposals on "media handling" and urges trusts to use words such as "adapting" or "evolving" services when talking about cuts.
Dozens of accident and emergency units, maternity units and community hospitals are facing the threat of being shut down or downgraded as part of the Government's plans to "reconfigure" the health service.
Many Labour MPs fear the cutbacks will cost them their seats, prompting four Cabinet ministers to join local protests against planned closures in their own constituencies.
In a covering letter to the guide - which has been sent to all 10 Strategic Health Authorities in England - David Nicholson, the NHS chief executive, said it was vital that managers did not "shy away from major service changes that address financial difficulties".
Miss Hewitt's new blueprint on closures, written by Sir Ian Carruthers, the former chief executive of the NHS, stresses that trust managers must do more to sell their closure plans to local people. The report conceded that closures would "lead to a loss of public confidence" and that reconfiguration had "become a euphemism for closures and downgrading of hospitals".
It argued that NHS managers could limit the damage by developing clear media strategies, using the right language and trying to get some senior doctors to back their plans.
Managers are warned that the media can often run "damaging" stories on closure plans.
"Effective media handling plans, regular engagement of local journalists, care in explaining the case for change and a strong local voice to challenge misleading media stories that worry patients unnecessarily can help mitigate this," it said.
Language is crucial and managers are urged to use words such as "adapting, developing, evolving and specialising. If a service is changing to improve the health outcomes for patients and save lives, this isn't a downgrading of the service."
Managers are also advised to argue that closures will be compensated for by better services in local health centres or GP clinics.
The new guide was condemned last night by the Conservatives and Liberal Democrats.
Andrew Lansley, the shadow health secretary, said: "Nothing in this long-winded document will offer any comfort. It is all about advising NHS bureaucracy how it can better sell decisions. It offers no real evidence for how services can and should be improved.
"The Department of Health should be less concerned with spin and more concerned with substance."
Norman Lamb, the Liberal Democrat health spokesman, said: "This is a cynical exercise and their cover has been blown. It demonstrates that despite claims that decisions are made locally, everything is driven from the centre. Even the spin is sent down from Whitehall."
Dr Mark Porter, the deputy chairman of the British Medical Association's consultants' committee, said changes in services needed to be about improving patient care.
"The BMA is not opposed to reconfiguration if it is done for good, sound clinical reasons. But we have been worried that finances and not patients' needs have been the driving force behind some plans," he said.
By Graeme Wilson, Political Correspondent
The Independent
The full scale of impending hospital closures was laid bare last night as it emerged that three out of four trusts are already restricting patients' access to treatment as they battle soaring deficits.
Fears about the number of closures intensified as Patricia Hewitt, the Health Secretary, sent NHS managers a guide on how best to handle decisions to shut down hospitals and units - a document that opposition politicians immediately branded a "spin" blueprint.
At the same time, a survey of NHS trust chief executives revealed the impact of the health service's financial crisis on front-line care.
The survey, published in today's Health Service Journal, shows that 73 per cent of primary care trusts, which run GP clinics and health centres, are already restricting access to treatments. Half are also delaying operations.
Seven out of 10 chief executives said "patient care will suffer" as a result of short-term financial decisions to cut deficits, while 61 per cent of acute hospital trusts said they were already closing wards.
Almost half of all trusts said that they had made, or intended to make, redundancies this year.
Morale appears to be at rock bottom, with 86 per cent saying that managers were "battered and bruised" by endless reorganisations.
Miss Hewitt published her guide on closures amid growing panic in Whitehall about the looming public backlash as trusts across the country announce plans to cut services over the coming months.
But the opposition immediately accused ministers of "a cynical exercise" in spin as it emerged that the guide includes proposals on "media handling" and urges trusts to use words such as "adapting" or "evolving" services when talking about cuts.
Dozens of accident and emergency units, maternity units and community hospitals are facing the threat of being shut down or downgraded as part of the Government's plans to "reconfigure" the health service.
Many Labour MPs fear the cutbacks will cost them their seats, prompting four Cabinet ministers to join local protests against planned closures in their own constituencies.
In a covering letter to the guide - which has been sent to all 10 Strategic Health Authorities in England - David Nicholson, the NHS chief executive, said it was vital that managers did not "shy away from major service changes that address financial difficulties".
Miss Hewitt's new blueprint on closures, written by Sir Ian Carruthers, the former chief executive of the NHS, stresses that trust managers must do more to sell their closure plans to local people. The report conceded that closures would "lead to a loss of public confidence" and that reconfiguration had "become a euphemism for closures and downgrading of hospitals".
It argued that NHS managers could limit the damage by developing clear media strategies, using the right language and trying to get some senior doctors to back their plans.
Managers are warned that the media can often run "damaging" stories on closure plans.
"Effective media handling plans, regular engagement of local journalists, care in explaining the case for change and a strong local voice to challenge misleading media stories that worry patients unnecessarily can help mitigate this," it said.
Language is crucial and managers are urged to use words such as "adapting, developing, evolving and specialising. If a service is changing to improve the health outcomes for patients and save lives, this isn't a downgrading of the service."
Managers are also advised to argue that closures will be compensated for by better services in local health centres or GP clinics.
The new guide was condemned last night by the Conservatives and Liberal Democrats.
Andrew Lansley, the shadow health secretary, said: "Nothing in this long-winded document will offer any comfort. It is all about advising NHS bureaucracy how it can better sell decisions. It offers no real evidence for how services can and should be improved.
"The Department of Health should be less concerned with spin and more concerned with substance."
Norman Lamb, the Liberal Democrat health spokesman, said: "This is a cynical exercise and their cover has been blown. It demonstrates that despite claims that decisions are made locally, everything is driven from the centre. Even the spin is sent down from Whitehall."
Dr Mark Porter, the deputy chairman of the British Medical Association's consultants' committee, said changes in services needed to be about improving patient care.
"The BMA is not opposed to reconfiguration if it is done for good, sound clinical reasons. But we have been worried that finances and not patients' needs have been the driving force behind some plans," he said.
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