A report by the UK think-tank King’s Fund has found that rationing of care is taking place due to severe financial cuts, as there is “clear evidence that access to and quality of patient care has suffered” in some areas.

The report examined the impact of the financial squeeze in four areas of care that cover a wide rage of patients: district nursing, hip replacement operations, sexual health services and neonatal care.

These areas are now receiving 1.2% in annual budget increases, less than the average 3.7% in the past. This has also led to longer waits and the rationing of care that the King’s Fund believes will only lead to further problems in the future.

Shortage of district nurses, neonatal care struggling

For district nurses who conduct home visits for the terminally ill and housebound elderly, dying patients are reportedly waiting up to eight hours to receive pain relief. A manager of a hospice said that “for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact.”

“It’s a frightening time for patients and we are seeing an increasing volume of calls coming through to our advice line where people are in genuine distress,” the manager added.

The funding crisis has also diminished the number of district nurses available from 12,620 in 2003 to just 4,358. Heavier workloads are also contributing to 20% vacancy rates in some places.

The shortage of nurses has prompted some NHS bodies to restrict their eligibility criteria for patients seeking help, refusing it for anyone who is not completely housebound. The report warns that the pressures would result in visits that are more task-focused, providing less opportunity for thorough assessments.

The report also revealed that neonatal care is under significant pressure and is struggling to cope with the rising birth rate. Many neonatal units are severely short of specialist doctors and nurses and this may be affecting the “long-term development” of babies.

Sexual health services face 20% cuts, hip surgeries refused

Sexual health services faced cuts of up to 20% especially in testing for and treatment of sexually transmitted infections. According to the report, this has resulted in fewer clinics and staff members and reduced prevention and outreach services.

This will put the general populace at greater risk of infection, with statistics already showing the rates of syphilis and gonorrhoea increasing above 50% in four years.

The report also found that the numbers of NHS-funded hip replacements have decreased for the first time since 2000, even though demand is increasing due to the ageing population. This was influenced by the decision of several NHS clinical commissioning groups to allow surgery only on conditions such as losing weight for obese patients or giving up smoking.

Patients are also being made to wait longer than the recommended maximum 18 weeks. Some trusts have been refusing to carry out surgery unless the patients are not able to sleep or are taking strong painkillers at least five times a day.

Underfunded NHS at breaking point

“As this report shows, patients are unfairly suffering the consequences of a deliberately underfunded NHS at breaking point,” said Dr Mark Porter, chair of council at the British Medical Association.

Phillip Hammond, the Chancellor of the Exchequer, in his Budget last week, said £325 million of funding would be given to sustainability and transformation plans, which has proved controversial in some regions as they will lead to the closure of some NHS hospitals, A&E departments and other services.

Ruth Robertson, lead author of the report, said that some of the cuts were going “unseen”.

“If the NHS wants to transform care and keep patients healthy and out of hospital it will need to invest more in community and public health services.” MIMS

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