Only 24 hours to save the NHS

The financial crisis gripping the NHS has been laid bare in an extraordinary email sent from a senior civil servant in the Department of Health, which tells officials to ignore ministers' promises on spending. It also threatens staff with disciplinary action if they disobey an order to freeze new investment.
The email - details of which have been obtained by The Observer - was sent at the end of last month from the office of Sir Liam Donaldson, the chief medical officer.

It promises to sound the death knell for a range of public health programmes set up to tackle everything from alcohol abuse and cancer screening to sexually-transmitted diseases and obesity. Health experts believe the spending freeze could even hit attempts to reduce deadly MRSA outbreaks in hospitals and affect contingency planning in the event of an outbreak of bird flu.

The email warns that any department staff failing to follow the orders will 'commit a disciplinary offence'.

Written by Sarndrah Horsfall, Donaldson's chief of staff, the email tells officials that NHS finance director Richard Douglas 'has imposed an embargo on all programme staff'. It orders an 'embargo on all new commitments' for this year and 'all future years' covering 'all programme budgets (capital and revenue)'.

The memo flies in the face of reassurances by the Health Secretary, Patricia Hewitt, and the NHS chief executive, Sir Nigel Crisp, over health funding. The government has said local hospital trusts must sort out their financial problems and that overall NHS care is improving.

Hewitt has been forced to defend staff lay-offs, mounting financial deficits in NHS hospital trusts and an official policy of delaying operations to save money. This week, she will urge hospital staff to tackle waste and inefficiency.

News of the spending freeze emerges as The Observer reveals widescale cutbacks in the NHS. These include:

· GPs not referring patients for routine surgery across Swindon in Wiltshire for the next month.

· No hernia operations for patients in Oxfordshire.

· A cut in the number of beds at Airedale hospital, near Skipton, North Yorkshire.

The mounting crisis has triggered an outbreak of buckpassing, with Downing Street said to be unhappy with the way the Department of Health has handled the problems.

But one paragraph of the leaked email will prove highly embarrassing for the government. It suggests that any public announcement by a minister promising extra funding should be disregarded. It was this that so angered an official at the department that details of its contents were passed to The Observer

The email states: 'Commitment to spend by virtue of an announcement, including ministerial announcements, is not considered a commitment in this context.'

Opposition politicians said the email proved that headline-grabbing proposals by ministers are worthless.

Andrew Lansley, the shadow health secretary, said: 'What is disturbing about this disclosure is that key public health priorities will suffer. It appears pre- and post-election promises by ministers will prove not worth the paper they are printed on.' Lansley believes the email reveals the true state of NHS finances.

'Patricia Hewitt has been complacent about the scale of the financial problems facing the health service and this shows the problems are much greater than she has acknowledged,' he said.

Professor David Turner, chairman of the UK Public Health Association, said the contents of the email left him 'dispirited and depressed'. 'Despite promises by ministers that public health would be one of their top priorities,' he said, 'it seems once again it will be hit hard.'

The email also raises questions about existing spending commitments. It tells staff that, unless a contract is completely signed off, with all the finances finalised, then the investment should be stalled.

The department refused to give details of what programmes the spending freeze would hit or what ministerial announcements are to be ignored, although a spokeswoman confirmed the email had been sent.

Liam Byrne, the junior health minister responsible for community care, is understood to have been warned recently against making promises that could not be kept.

Last month, public health minister Caroline Flint announced a programme to deal with alcohol problems at an early age. Flint announced this to counter fears over binge drinking after the government's decision to relax licensing laws.

Insiders at the department have confirmed that this programme is now at risk. They also point to similar announcements by ministers to set up a programme to tackle the rapidly growing incidents of sexually transmitted diseases such as chlamydia.

This is now also thought to be at risk as is the plan to set up a national programme to screen for bowel cancer. One insider who received the email said the tone of the memo particularly annoyed officials. Under a paragraph entitled 'Discipline and Enforcement', it states that any staff 'entering into new contracts on contravention of the embargo' will 'commit a disciplinary offence'.

A spokeswoman for the department refused to comment on what she described as a 'leaked document'. She said: 'The Department of Health is reviewing spending plans for the year against available resources. It still remains the department's intention to meet its existing commitments.'
(from Antony Barnett and Solomon Hughes at The Observer )