to dig themselves further into the Tory-created crisis in the NHS.
The belated acknowledgement that Kenneth Clarke's cash limits were set to cause a disaster in frontline services this winter led to the announcement of an additional, one-off injection of £300 million.
Although a welcome concession, and a considerable extra amount to be spent in just six months, we Chole ner in mine toet me combined debts of Trusts and Health Authorities are projected at around £700m, and Health Minister Alan Milburn has declared that all these bodies must now balance their books by April 1 - effectively calling for deeper and more rapid cuts in almost every area.
Health Secretary Frank Dobson insisted that the extra money would be targeted to ensure that emergency services remained open throuch the winter months and to speeding the discharge of elderly patients from hospital beds.
Unfortunately the support of frail elderly patients after their discharge falls on council social services, many of which are still slashing back services as part of 1997/98 budget cuts averaging £2.5 million per authority. Some have already run out of money to support elderly patients in residential or nursing homes: Oxfordshire alone has a waiting list of 100, which is predicted to double as £10m is cut from social service spending over two years.
In fact nobody has yet received any of the extra NHS cash. A third of the money has been earmarked to pay off overspends on GP prescribing budgets, leaving relatively small amounts in each region, for which health authorities had to submit detailed "bids" by November I, consuming even more time and energy.
This process could leave whole areas receiving none of the extra cash, while even those which win out will get relatively little compared with the deficits they face. Oxfordshire is £10m in the red, Worcestershire £18m, and individual Trusts are looking at massive cuts: as Wellhouse Trust and Forest Healthcare in north London each face cuts of £7m and £5m.
These immense financial pressures are driving wholesale bed closures, cuts in waiting list services and complex Trust "mergers" which will close still more frontline beds. In South West London alone more than 200 beds have closed since last winter, bringing the danger of even longer agony on trolleys for patients requiring emergency admission this winter.
Meanwhile the defensive and secretive attitude of the new government on health policy issues is underlined by the refusal to publish the report of the Independent Review into London's NHS commissioned during the summer by Alan Milburn.
The report, completed on October 31, has been given directly to ministers, who have said they will not publish it until at least January, although it is expected that selective "leaks" to trusted journalists (quite possibly the Guardian, which supports the closure of London hospitals) will enable them to test public reaction to any controversial proposals.
The delay will mean even more beds will already have closed before the report is unveiled: already the promised "moratorium" on London hospital closures has become a laughing stock, with Queen Mary's, Roehampton, Guy's Hospital and Queen Elizabeth's children's hospital all rushed towards closure while the Review panel was deliberating.
London Health Emergency has urged the immediate publication of the London Review, and warned of the dire consequences if any further acute hospital beds are allowed to close in the capital. tra £300m as a mandate overspend where necessary to ensure that services are maintained - and send the bill to Alan Milburn.
The climate of cuts and crisis is likely to increase the frustration and anger of NHS staff when their pay round begins early next year. Labour could yet find that their attempt to uphold Tory spending limits lights the fuse to public sector militancy.
THE TOTAL political naivete of NHS consultants is underlined by two recent reports calling for fewer, bigger hospitals.
One is published by the Royal College of Surgeons and the other by the BMA.
The RCS calls for general hospitals to serve much larger catchment populations. Their plans could halve the number of acute hospitals.
But while they call for more consultants, the Royal College do not even mention the numbers of beds that would be needed: as a result, their proposals are being eagerly exploited by Trust and health authority bosses seeking to cut costs through mergers and bed closures.
There is a real danger that these abstract and impractical ideas could trigger even greater cutbacks in beds -reducing hospitals to no more than emergency care.