New payment rules 'threaten NHS operations

The five specialist orthopaedic hospitals in England may have to abandon complex surgery on hips and bones because of a bizarre twist in the government's rules to turn the NHS into a competitive market, chief executives warned last night.

In a private briefing paper for MPs, they said patients are set to become the victims of the health secretary Patricia Hewitt's new system of payment by results.

They observed that much routine orthopaedic surgery is being diverted into private sector treatment centres, leaving the five NHS centres of excellence to concentrate on more highly skilled work. However, they said the national price list for every type of operation did not recognise the extra costs of more difficult work.

For example, a woman recently underwent a four-hour hip operation followed by eight days of in-patient physiotherapy, which cost £13,791. But the Department of Health was willing to pay only £4,967.

The briefing - disclosed in the Health Service Journal - warned of "a serious threat to patients". It said: "This situation could result in trusts being forced to end provision of vital specialist services - ones that are not available in normal acute trusts."

The five hospitals are: the Royal National Orthopaedic hospital at Stanmore, Middlesex; the Nuffield Orthopaedic centre in Oxford; Robert Jones and Agnes Hunt hospital in Oswestry, Shropshire; Royal Orthopaedic hospital in Birmingham; and Wrightington hospital in Wigan.

A health department spokesman said: "We are consulting on whether we can further differentiate more complex cases from routine procedures so that specialist services are rewarded fairly."