AN "alarming" programme of health cuts at Selby and York Primary Care Trust emerged today as the organisation battles to balance its books in the face of £23 million of debts.

The trust plans to deal with some outpatients by email and telephone, reduce emergency admissions and cut the number of beds at Selby Hospital in its quest to achieve "financial balance in 2005/06".

The Evening Press reported, yesterday how Penny Jones, the PCT's acting chief executive, warned that cuts were on the agenda for 2006 - with York Hospital inevitably being hit.

As the scale of the PCT's money-saving plans became evident today, GPs slammed the trust branding its plans "absolutely scandalous".

The cuts emerged in a letter to GPs sent by Mrs Jones shortly before Christmas. It reveals the trust is planning to be £23.7 million in debt at the end of the financial year - but is some £2.4 million adrift of its target.

Mrs Jones today told the Evening Press the cuts were required to balance the books and were in areas which attempted to minimise the impact to patients.

But critics argue some of society's most vulnerable groups could be affected by the shake-up, which include:

Cutting back the number of outpatient appointments offered to patients during the final quarter of the financial year "to bring the contract back into line".

This means the PCT will book "as many patients as possible" into clinics from April - but ensuring they wait no more than 13 weeks for an appointment.

"Where possible, we will introduce alternatives to an outpatient appointment through... the provision of telephone, email and written advice," Mrs Jones wrote.

Minimising the number of patients admitted as emergencies to hospital.

Mrs Jones' letter states: "The rise in emergency admission beyond the levels budgeted for in our contract with York Hospitals NHS Trust represents the single biggest risk to the PCT."

She said: "It is therefore imperative that the PCT does everything that it can to minimise the number of patients admitted as emergencies to hospital, ensure those patients who are admitted, are discharged or transferred from an acute setting as soon as it is appropriate to do so."

Cutting eight beds on Castle Ward at Selby Hospital with a "view to discussing further reductions in capacity in non-acute rehabilitation services".

Ceasing the use of agency staff with "immediate effect" and imposing a vacancy freeze.

The Evening Press has already reported how York Hospital was asked to delay routine operations until the next financial year, because treating patients speedily was putting increased pressure on the budget.

Mike Proctor, director of nursing at York Hospital, said the cuts would create "some significant challenges and concerns for us".

He said: "We understand the financial position of the PCT and want to work with them jointly on a solution.

"Inevitably this creates some significant challenges and concerns for us, in terms of protecting the improvements we have achieved in patient services and our own financial situation.

"We will work with our PCT colleagues to seek a shared way through this difficult problem. We do believe that there are legitimate ways to reduce the number of patients admitted to hospital as emergencies or seen in our outpatients department.

"But this needs time to be developed properly, and the sign-up of the clinical community, especially GPs and hospital consultants, to ensure the alternatives are at least as good for patients as an admission to hospital would be."

Mrs Jones said: "We are trying to work with GPs on this. What we are trying to get across is that we need to get the budget back in

balance. While I accept everything has an impact on patients, we can't afford to pay the hospital trust any more than we do. Some of the things we are doing are happening in other places.

"You want to work in an environment where you can get people treated as quickly as possible. The reality of the situation we have got is that we have to get the books into balance.

"This is a very challenging time. We are genuinely trying to work with others in the NHS."

Robin McIlroy, of the York-based Patients' Forum, said: "We are concerned patients are treated appropriately, and we are also aware of the financial pressures the trust is under.

"We don't want to see people suffer as a result of financial restrictions but we understand the trust has a very difficult

situation. It is appropriate to try and minimise the impact on patients."

Plans are 'scandalous' say GPs

ANGRY doctors today branded PCT cutbacks "absolutely scandalous".

York GP Brian McGregor, a member of the North Yorkshire Local Medical Committee, claimed GPs had not been consulted over several controversial changes in services.

He also said some cuts had been imposed because PCT chiefs refused to cover

district nurse illness.

He said: "The PCT say they've consulted with GPs, but they haven't. We do not support several of the moves they've put out. Some of the suggestions we found extremely unpalatable and unreasonable, and GPs have said 'no' to them. They will not happen now.

"They're a knee-jerk reaction to the fact that they (the PCT) know they've overspent."

One York GP, who did not want to be named, said: "The only thing they (the PCT) care about is money - they don't care about patients. They don't care about services and they certainly don't care about the stress they're putting on their staff."

Another, who also wished to remain anonymous, said: "It is absolutely scandalous. It's a complete misjudgement.

"We have started talking about postponing things to the next financial year and it's only the beginning of January!"

Dr McGregor said the PCT was in a difficult position and said central NHS funding had been a major contributor.

He said: "We suffer in this area because of the amount of work we do, and we're (the regional NHS) not paid enough to be unhealthy in York.

"If we were in Hull, we would break even because they are paid more per head of population. If we were in Bradford, we would be under-spent. York and North Yorkshire are seen as too well-off to be ill."

He also claimed York Hospital could be pushed into the red by the PCT's actions.

He said: "The problem is that if the PCT cuts back, the acute trust (York Hospitals NHS Trust) is going to go into deficit because the hospital trust gets paid for the work it does. The debt for the area is going to either sit with the PCT or the hospital - one of them has to be in debt."

Mike Proctor, director of nursing at York Hospital, said it was too early to comment on whether the hospital would be forced into debt.

Number of beds cut on Selby wards

THE number of beds at Selby's hospital is being cut by more than a fifth, due to the cash crisis facing local health bosses.

Eight out of 39 beds at Selby War Memorial Hospital are to be lost in the cost-cutting measure. The health authority says it cannot afford to recruit more staff, so must instead reduce capacity.

The lost beds will all be in the hospital's Castle Ward, which currently has 20 beds. The ward is run by the Selby and York Primary Care Trust, on behalf of the York Hospitals Trust.

The reduction has already begun, and outgoing patients will not be replaced in the ward until the number of beds is down to 12.

The PCT requested the reduction from the York Hospitals Trust, due to its well-publicised financial problems. The PCT is currently more than £9 million in debt.

Its director of health and social care, Heather Rice, said: "The PCT's first priority is to run safe and secure services using our existing staff and resources; reducing the number of beds will ensure we can continue to do so. We are currently unable to recruit more staff because of the financial challenges we face."

A PCT spokesman said if the trust's financial position improves, the beds may be restored, but he said they would be lost indefinitely and certainly not replaced in the foreseeable future.

Selby MP John Grogan said: "Clearly like anybody else the Trust has to live within its means but I shall be meeting with them early in the New Year to satisfy myself that they now have a financial plan strong enough to ensure that these beds become available again as soon as possible."

Ms Rice said a number of patients in Castle Ward are "delayed transfers of care" patients, who can be discharged from hospital.

She said: "The PCT is committed to providing the right care, in the right place at the right time and it is sometimes more appropriate to offer care in community settings, or offer high levels of support in the patient's own home, rather than keeping them in hospital."

A spokeswoman for York Hospitals Trust said: "The decision by the PCT to reduce the number of beds in operation at Selby War Memorial Hospital will mean that some patients normally transferred to Selby will remain at York Hospital. These are elderly care patients. We will ensure that these patients are cared for appropriately."

We asked patients what they thought about the cuts

David Taylor, 54, retired jockey of Tadcaster, said: "I am concerned. I sympathise with York Hospital. I can't fault the staff. I have been in and out of hospital with injuries. It is a shame what the Government is doing."

Barbara Payne, 66, a retired sheltered housing scheme manager of York, said: "I have worked all my life and paid tax, yet we are not getting what we need. On any day York Hospital is heaving."

Paul Payne, 46, a ground worker, of York, said: "When you pay tax and insurance and you aren't getting the service, it is disgusting. I am waiting to get treatment for arthritis and it is taking forever. The staff are excellent."

David Allen, from the York area, said: "It must be a nightmare to run any big establishment. With a lot of management decisions you are damned if you do too much because you are wasting money and damned if you don't."

Updated: 16:30 Thursday, January 05, 2006