How to be an "expert patient" and save your hospital money

British health secretary, Patricia Hewitt, in an attempt to resolve the financial quagmire the National Health service has got itself into, is demanding that in future financial management be put ahead of clinical objectives.

It is hoped that a "semi-privatised" scheme that trains patients to avoid hospital or their GP, will help rescue the NHS from its ongoing cash crisis.

It is believed that the 'Expert Patient Programme', which has cut hospital visits by 16 per cent in trial areas, is to have its budget tripled before becoming a not-for-profit company.

The new financial regime will mean that health trusts will survive on their ability to attract patients under a system of payment by results that threatens the income of poor performers.

Ms Hewitt believes that the best way to expand the Expert Patient Programme rapidly is to allow NHS managers or outside providers to take over from the state control, and a budget increase from £6 million a year to £18 million is intended to facilitate this process.

The notion of giving finance a higher priority than clinical objectives will almost certainly enrage the medical fraternity.

The first rulebook for NHS managers is expected to be issued this week in an effort to eliminate the financial deficits threatening to destabilise reform plans for hospitals and primary care services.

Ms Hewitt says she is determined to eliminate a "handout culture" she thinks may have been responsible for a quarter of trusts slipping into the red in 2005/6, leading to a projected overspending of £948m by the end of March.

Apparently many hospital trusts have resorted to emergency measures to cut spending, such as postponing operations until the new financial year, freezing staff vacancies and withholding tax and national insurance payments.

Hewitt is expected to issue the "Business Arrangements" manual explaining how NHS finances should be controlled during 2006/7, when her reforms are guaranteed to create unprecedented instability in the health service.

Excellence in financial management is apparently to be the order of the day with a prerequisite for high quality sustainable services, and hospital trusts will not be allowed to tolerate inefficiency on the assumption that the NHS will ultimately bail them out.

Before now hospitals could accurately predict the number of patients they would be expected to treat, and agreed contracts with local primary care trusts guaranteeing most of the income they needed to do the work.

Patients however can now choose from a list of usually at least four local NHS trusts where they are entitled to free treatment, and if hospitals do not attract enough patients their income suffers.

A national tariff was set last April for all non-emergency operations, and if a hospital spent more than the norm for a particular procedure, it lost money on every patient treated.

The government has already warned that this system of payment by results will be extended in April.

Ms Hewitt aims to establish a national tariff for every hospital activity, apart from critical care for a tiny minority of the most seriously ill patients.

At the core of the proposals is training patients how to "self-care".

Incentives will be created to keep patients out of hospital if they can be cared for better, or more economically, by GPs and healthcare staff in the community.

The Expert Patient programme works by running training courses for patients with chronic conditions such as diabetes, asthma, multiple sclerosis and arthritis.

They learn how to treat themselves when previously they would have gone to their doctor or the hospital accident and emergency department, and to avoid such emergencies altogether by looking after themselves better.

Apparently six months into the trials of the programme, GP consultations fell by 7 per cent, while local outpatient visits and emergency care attendances dropped by 10 per cent and 16 per cent respectively.

Hospital admissions among those on the scheme were also reduced by 13 per cent.

Patients said that they became better at controlling symptoms, more confident, and better at using information from books and support groups.