Help, help, I'm being restructured! (NHS cuts in mental health)

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Ramona
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Jan 15 2007 22:45
Help, help, I'm being restructured! (NHS cuts in mental health)

I've not been on libcom for a while since I started working full-time (and sleeping part time, and doing little else), and I've been in my job for exactly two months now. I've started working for the NHS at a "challenging" time, and it's an even more "challenging" time for mental health services and Occupational Therapy specifically.

The trust I work for has massive deficits, and they're trying desperately to save money through the hilariously titled Mental Health Improvement Project (a very odd way of naming the process that aims to "improve" service provision by cutting back as many front-line staff and services as possible whilst still making out like we're trying to help people). I get the idea that the overall picture is similar across the NHS and public services in general right now - freezing posts, deleting posts and redeploying people, downgrading existing posts to lower payscales, making people take on extra duties etc. My department is undergoing some major "improvements" right now, and we're coming towards the end of our consultation process.

We're a tiny department, with six qualified occupational therapists and five unqualified activity workers - I'm an unqualified activity worker. At the moment, I work on an acute ward and am not in the nursing numbers, which means I'm not responsible for any patients and can spend my entire day planning and facilitating activities for the patients, many of whom cannot leave the ward and are likely to get bored and frustrated. Now, in an effort to save a lot of money, we're having two of our qualified posts cut entirely, and the unqualified activity workers (me) will have to go into the nursing shift and take on four patients (which means one less member of staff on the ward per shift, and thus less people to pay).

So, we're pissed off that we're going to have to take on a whole new job (having allocated patients means we have to attend to them specifically, we're going to have to do control and restraint when people kick off, and lots of other stuff) and still be expected to run activities. As it is, we can spend more face-to-face time with the patients than any of the nurses, and we get to have an infomal friendly relationship cos we're not the ones giving them medication or restraining them, and we're going to loose that relationship. And the patients are going to loose having someone around all day who's sole purpose is to make them feel at ease and entertain them.

Our managers, as you may expect, are being fucking wet and saying it's up to us to make sure we get enough time to run groups, and they've botched the consultation process - they told us about the consultation meeting the day before it happened so we had no time to meet independently before we went in there, and - surprise surprise - they also didn't give Unison enough notice to send a rep along to our meeting. They were of course very apologetic about this, but they were under so much pressure, blah fucking blah...

Today, us five activity workers got together to draft our response to the consultation, and spent about 2 hours getting very angry and irate, which was fun. I was really pleased at how militant the others were about it, and we've come up with a whole list of points that we want to be addressed. We're going to try and get the hospital user's forum to respond too, cos they like us (we're the good guys, see). But it also feels kind of hopeless, there's no way they're going to back down cos they'll save £15k for each of us when we go into the numbers but hopefully we'll manage to get some concessions (i.e. time off each week to go shopping for the stuff we need to use on the ward, having less allocated patients etc). So yeah we're putting up a fight to try and get some scraps thrown at us, ah well.

The thing is it feels like we can't hope for anything more - there's only five of us, two of whom have been unionised since the start, and me who really is goign to send that form to Unison tomorrow, honest... so I doubt we can hope for much from them. The qualified staff don't want to kick up too much of a fuss because they're having competative interviews and want to look responsible. It's shit, and none of us want to do it, and we've all agreed that we're gonna help each other out as much as possible when the change happens which is cool cos we work pretty much in isolation now. I'm still on probation and will be for the next four months, as is one of the others, so we kind of feel like we just have to grin and bear it. Ah well.

That's my news anyway.

magnifico
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Jan 15 2007 23:03

That's well shit.

We've had loads of mental health cuts round here, various campaigns against them involving staff, users and others, doesn't seem to make fuck all difference to anything. The only way I've been able to think of to turn it into some kind of positive is to try to publicise what's going on as much as possible - they'd prefer to get on with all these cuts and 'restructurings' without anyone knowing, cos there comes a point when people won't take any more - I like to think that even if you try and fail to stop this kind of thing at least you're giving all the people you get the message out to one more reason to hate capitalism.

When I began my occupational therapy training a year and a half ago our lecturers were all full of how many jobs there'd be for us when we qualified and how desperate everyone was for OTs - funnily they've gone a bit quiet on that score recently.... sad

magnifico
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Jan 15 2007 23:09
Quote:
the consultation process - they told us about the consultation meeting the day before it happened so we had no time to meet independently before we went in there

As I'm sure you noticed, 'consultation' for this kind of thing takes the cuts as a given - the consultation is around who/what will be cut, not whether or not it should happen at all.

i used to work as a nursing assistant and it was always nice to have the OTs and TIs able to do fun things with the patients cos we often didn't have time. Sounds like you do a great job, hope you manage to keep some time for that sort of thing, best of luck!

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Jan 15 2007 23:09

Hi

Quote:
I like to think that even if you try and fail to stop this kind of thing at least you're giving all the people you get the message out to one more reason to hate capitalism.

Outside of the leftist milieu, problems with the NHS are seen as a failure of socialist principles, not “capitalist” ones.

Love

LR

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Jan 15 2007 23:15

You know it sounds silly but I kind of felt unsure about publicising the cuts, for fear of uh getting into trouble embarrassed We've got the service user's forum on Wednesday so I'm gonna try and make sure I can get some patients from my ward along to that and hopefully discuss it there. I think the psychologists are on our side too, they're being cut too so basically there's gonna be hardly any therapuetic services at all. But hey that's OK we'll just dose them up on anti-psychotics and lorazepam and make sure they're in bed all day and not causing any problems.

As for OT posts - I know, it's fucking depressing isn't it? I wanted to train as an OT, but now I'm thinking 2-3 years training to possibly end up in exactly the same band 3 job (one of my colleagues is a qualified OT and is in the same job as me...) at the end of it doesn't quite seem worth it. I mean there are jobs, and everyone keeps saying "oh it'll get better" so maybe they're right.

magnifico
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Jan 15 2007 23:18
LR wrote:
Outside of the leftist milieu, problems with the NHS are seen as a failure of socialist principles, not “capitalist” ones.

I think you're right with regard to real or perceived 'innefficiencies' in the NHS, however I don't think many people see slashing the NHS/wider welfare state to peices as a socialist-type policy, which is what is now happening.

magnifico
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Jan 15 2007 23:26
zobag wrote:
You know it sounds silly but I kind of felt unsure about publicising the cuts, for fear of uh getting into trouble embarrassed We've got the service user's forum on Wednesday so I'm gonna try and make sure I can get some patients from my ward along to that and hopefully discuss it there. I think the psychologists are on our side too, they're being cut too so basically there's gonna be hardly any therapuetic services at all. But hey that's OK we'll just dose them up on anti-psychotics and lorazepam and make sure they're in bed all day and not causing any problems.

As for OT posts - I know, it's fucking depressing isn't it? I wanted to train as an OT, but now I'm thinking 2-3 years training to possibly end up in exactly the same band 3 job (one of my colleagues is a qualified OT and is in the same job as me...) at the end of it doesn't quite seem worth it. I mean there are jobs, and everyone keeps saying "oh it'll get better" so maybe they're right.

In Northampton the therapy staff & patients protested a lot, even the consultants came out with a well publicised damning report on how disasterous the cuts would be. It's hard to see how the workforce could've resisted the cuts any more without taking some kind of direct action - but it didn't make any difference. The problem is we're fighting all of these attacks as if they were single issues whilst the ruling class know full well that they're not.

A few people have suggested to me that OT job prospects will get better because the government is keen to get people out of (physical and mental) hospitals and into the 'community', which is something OTs can be involved in more than a lot of other professions. Even if it is true though the fact is that this policy will be driven by financial reasons, so we'd be trying to treat people in a community setting who in reality need the support of being in a hospital. Not sure how I feel about aiding and abbetting the gov't in presenting a cut in services as a clinical improvement sad

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Jan 15 2007 23:31

Hi

Quote:
I don't think many people see slashing the NHS/wider welfare state to peices as a socialist-type policy, which is what is now happening.

The deficits demonstrate what happens when socialist-type planning operates without a nationalised central bank. The alternatives are high inflation or revolution.

The trusts were given money based on projected demand that never materialised. When they gave their performance returns back to the government to show how much they’d actually done, the government wanted some of their money back. Trouble is the trusts have spent the money on the bureaucracy’s final salary pensions. Or something like that.

Love

LR

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Steven.
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Jan 15 2007 23:58

Zobag - the same thing is happening with my council's restructuring. I started this thread.

Is it just your one department, leaving the rest of the hospital alone for now? At least at my place the cuts are hitting all 10,000 of us at once, so there's more possibility for resistance. One thing we voted for at a Unison meeting (but still nothing has happened about...) was a boycott of vacant (mostly frozen) posts. This type of low-grade direct action could hit them hardest, at little risk to you lot. I have discussed it informally with one coworker on my time and we said we would both do it regardless of the union if we were asked to cover.

Keep us informed eh?

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Jan 16 2007 00:11

Well they're cutting services across the whole trust, and in our hospital they're cutting OT posts, some Band 5 (i.e. newly qualified) nursing posts and I think some psychology posts. They've also cut our specialist in-patient provision for the under 30s who are in their first episodes of psychosis, but I don't think that's directly cut any posts.

Thing is, it's very difficult to not cover frozen nursing posts as they'll just book bank staff, and to not cover four patients per shift just wouldn't be workable. The only people who are in a position to boycott frozen posts are the qualified OTs. I might be able to suggest it, but I doubt they'll do it.

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Jan 16 2007 00:19

Have there been any hospital or trust-wide union meetings about the cuts? Or did the unions agree to them you know? In Hackney at least they're trying to merge wards to make cuts, I've seen trots out with petitions, some local SWP might know more info, they'll certainly have contact with militants. Might be worth getting in touch with them (shudder).

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Jan 16 2007 00:25

Crikey.

I'm not up to date with what's been happening Union-wise (although my suspicion is - not a lot) cos I've not actaully joined yet (although I did just put the form in the envelope, one step closer to communism), so I ought to find out really. Most of this is being done very much on the quiet and all linked into this "Improvement Project" shit. Also, our trust wants to be a Foundation Trust which means we have to get our budget in order. That's another thing I need to find out more about, cos I'm pretty sure foundation trusts are Not A Good Thing.

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Steven.
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Jan 16 2007 00:30

Yeah, I mean I wouldn't put any hope in the union situation really. At my place it seemed like nothing was going on till I went to the mass meeting. But then not a lot's happened since, I think it's been left in the hands of the branch for now... But still it was good telling people in my dept there was a big meeting which voted overwhelmingly for a boycott, strike, etc.

ftony
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Jan 16 2007 15:30
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I just put the form in the envelope, one step closer to communism

tagline!

but seriously, glad you're still around, i was wondering where my nearly-neighbours had gone...

magnifico
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Jan 16 2007 19:07
zobag wrote:
our trust wants to be a Foundation Trust which means we have to get our budget in order. That's another thing I need to find out more about, cos I'm pretty sure foundation trusts are Not A Good Thing.

Certainly not. I know quite a lot about this, I'll try and get it down in the next few days and pm it to you, or maybe put it on this thread or something. In a nutshell it makes the hospital independent of the NHS and private in all but name.

Good luck with all this!

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Jan 16 2007 19:50

Oh fucking hell, that's crap. Yeah any info re. foundation trusts would be good.

Today, I had my ward manager (who isn't responsible for me, yet) asking me what our response to the consultation was, and he was surprised when I said I was against it. I am not looking forward to having to deal with him once the cuts go through, cos he thinks my job is "easy" and a "waste of resources". I'd like to see him spending two hours engaging five floridly psychotic and paranoid patients in an arts session. Knobber.

And we've been told by our service manager that they're going to give us a response to the consultation the day after it closes. So they're meant to consider our responses and complaints and answer them all in one day. Something tells me they're not taking it very seriously... We've been told to hand in our response early to give them time to reply, but we're gonna hold out because we're childish and want to piss them off. That'll show em. Yeah.

magnifico
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Jan 16 2007 23:35

What a twat, suprised that you're pissed off with your area of work being cut to fuck. And how can they justify getting rid of OTs and psychologists from a mental health unit anyway, surely the whole point of such a unit is for those types of therapy to go on. Cock.

Yeah the consultations are purely a legal requitrement, no more, no less. The only way the cuts can be prevented if someone tried to stop them in court (as is happening in northants) is with the charge that concerns from staff/patients/whoever were not taken into account when the decisions were made. By having 'consultations' they give themselves a defence against this charge should it end up in court. They don't have to have given a fuck about your concerns, they just have to have heard them. This is the only reason they do this.

Quote:
We've been told to hand in our response early to give them time to reply, but we're gonna hold out because we're childish and want to piss them off. That'll show em. Yeah.

circle A !!

I've got loads of work on but should have some time on Thursday to try and explain some foundation stuff in intelligible language. If you fancy trying to wade through some extremely useful but rather heavy academic-type stuff before then this is a great paper on them:-

http://www.keepournhspublic.com/pdf/PollockInplaceofBevan.pdf

lem
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Jan 17 2007 00:22

Yeah, as sopmeone who has been "floridly psychotic" I have to say that I did find it easier to talk to some of the staff than the other patients. Just trying to be supportive!

To dearil slightly, I actually went to a job interview in the exact same hospital as I was sectioned in, a week before I was. That confused me!

The only thing I cared about when I was there was getting out and being allowed outside for a ciggarette. If any of them trust you (how would you tell confused) then try talking about why they are still there. I shouldn't give advice out, but there you go.

They have since made the whole grounds non-smoking! Bastards, I am never going back, now.

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Jan 17 2007 16:14

One thing with consultations, if you put in your stuff early then they have to actually respond to it. I doubt they'll listen to you but it means that they cannot dismiss it on the grounds that it was submitted too late.
There just isn't going to be an NHS in a few years is there?
I just had to pay 60e to see a doctor and get some antibiotics, it's the future and I don't like it.

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Jan 18 2007 22:38
lem wrote:
Yeah, as sopmeone who has been "floridly psychotic" I have to say that I did find it easier to talk to some of the staff than the other patients. Just trying to be supportive!

To dearil slightly, I actually went to a job interview in the exact same hospital as I was sectioned in, a week before I was. That confused me!

The only thing I cared about when I was there was getting out and being allowed outside for a ciggarette. If any of them trust you (how would you tell confused) then try talking about why they are still there. I shouldn't give advice out, but there you go.

They have since made the whole grounds non-smoking! Bastards, I am never going back, now.

Yeah the smoking issue, and the going outside thing are two big issues where I am too, and they're both going to be affected (negatively) soon. They're closing the smoking room in July so people won't be able to smoke anywhere in the grounds, so if you're a patient who's got no leave from the hospital you're fucked. So there'll be nowhere to smoke, little else to do cos the activity provision will be so drastically cut, and no one to take people out on their leave cos all the staff have to stay on the ward.

But hey that doesn't matter, we'll just wait till people get really frustrated and lash out, then give them haloperidol under restraint and extend their sections, and wonder why their health isn't improving. Makes sense to me.

Re. talking to people about why they're still there - I tend to do a lot of that anyway and I co-facilitate a leaving hospital group with the psychologist, and I try and put people in touch with advocacy when it's appropriate.

I've drafted a response to the consultation which I've had to hand on to the others to finish cos i'm on leave, so I hope it'll be ok. We had a service user forum yesterday where the service manager got grilled about all this, I was quite enjoying her trying to save face in front of patients who were articulating their concerns about the restructure much more frankly than we have so far, so it was nice to get some support. She tried to weasel out of it, but everyone at the meeting ended up having a go about it. haha. It also came out that she'd "forgotten" to forward the consultation document to the chair of the User Group, and also forgotten to invite him to the consultation meeting. I nearly bit my lip right off.

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Jan 25 2007 23:53

Well, our consultation period is up, and we had a meeting with our service manager and line manager yesterday. We met up beforehand, and made sure none of us were gonna be singled out for anything in our written response (we decided on it together but I wrote up most of it, and it was rather uh confrontational in parts so we needed to make sure we were all going to stick together and defend it as a collective response). We went into the meeting with knots in our stomachs and stoney faces, expecting to hear the worst news and get bollocked for our response, but we got EVERYTHING we asked for (well, except for the bit where we asked them to scrap the whole idea but hey).

We asked to do no more than 3 shifts in the numbers per week, and we'll be doing 3 shifts.

We asked to make sure that we won't be working in the numbers at weekends, when there's even lower numbers, an d we won't be working weekends in the numbers.

We asked for protected time on each shift to run activities, which we will get, and this will be the same amount of time on each ward.

We asked to keep our budgets, supervision and line management with the Occupational Therapy department instead of with ward managers, and we got that too.

We asked for ward managers to meet with OT to come up with various protocols to protect our role, and they've pushed back the start of the change to allow for this.

And there's other little details we've won as well, so we were pleasantly surprised.

It's not the end of it though, they're still cutting 2 qualified OT posts, and despite all the assurances we're probably still going to have day-to-day battles to protect our roles. It's also subject to review at any time in the next financial year, which looks likely considering we're in full swing towards Foundation Trust status, but for now, at least, we're going to do ok.

magnifico
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Jan 26 2007 08:07

Nice one! Those concessions you got sound like they'll make a big difference from what it sounds like was originally going to happen, well fought! It's good to hear, at all the cuts in this area I'm not aware of anyone being remotely listened to, their 'consultations' seemed more like some kind of piss-take where they invite people to talk to them then tell us all to fuck off. I know we're in a kind of a sad situation when an exercise in damage limitation feels like some kind of victory but you've heartened me a bit anyway cool

I think you're right that they'll be coming back for the rest of these changes, maybe waiting till all the fuss has died down and they think you're less aware of the need to stick together and fight this stuff before gradually eroding the concessions you've won. The most likely route I would guess would be to reduce nursing staff and then argue that they need you to spend more time on nursing stuff 'cos they're understaffed - keep your eyes open...

But congrats cool

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Joseph Kay
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Jan 26 2007 08:16

nice one zobag! another small victory for collective action smile

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Steven.
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Jan 26 2007 12:42

Well done zobag. I'm sure they can "agree" to certain stuff now and later try to go back on it, but yeah nice one, keep us informed!

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the button
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Jan 26 2007 12:46

Also keep an eye out for management having one-to-one "cosy chats" with people, trying to work out the level of unity among the workforce in support of your demands.

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Jan 26 2007 20:24

Yeah, I'm not holding my breath thinking it'll all be ok from now on. The one thing that does comfort me is how passionate my four co-workers were about this, none of us were waivering at all which is really good. As for cosy chats, very good point. We're lucky that we don't actually have much to do with either our actual manager or our ward managers at the moment, and once all the cuts have been made we're not going to have supervision with our manager either, so they aren't really keeping an eye on us much at the moment...

Quote:
I know we're in a kind of a sad situation when an exercise in damage limitation feels like some kind of victory but you've heartened me a bit anyway

I know exactly what you mean!

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Jan 30 2007 14:36

There appears to be a strike in Manchester over just this now:
http://libcom.org/forums/north/manc-health-strike

Edit - also magnifico wrote this very helpful guide!
http://libcom.org/forums/organise/zobags-guide-to-foundation-trusts

fort-da game
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Jan 31 2007 09:43

I have overheard that all non-urgent operations in east anglia have been suspended, the only way to get an operation is to have them re-classified as urgent on referral.

Well, I’m losing my job in april because of all this. I hope they get in a new bunch of creative accountants to restructure the crisis so they can take me back on again.

You know there really is a financial crisis when a memo goes round requesting lights be turned off when rooms are not in use. Still, as long as my £6.30 an hour is re-focused on the point of delivery I guess the reforms must be moving in the right direction.

P.

magnifico
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Jan 31 2007 12:01

Wow! Dr Cous Cous is a real doctor! cool

Sorry to hear about your job - anything going on to try to save it? sad

And I presume you're being sarcastic here?:-

Dr Cous Cous wrote:
Still, as long as my £6.30 an hour is re-focused on the point of delivery I guess the reforms must be moving in the right direction.

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Jan 31 2007 12:26
John. wrote:
Yeah, I mean I wouldn't put any hope in the union situation really. At my place it seemed like nothing was going on till I went to the mass meeting. But then not a lot's happened since, I think it's been left in the hands of the branch for now... But still it was good telling people in my dept there was a big meeting which voted overwhelmingly for a boycott, strike, etc.

I realise this is a bit different than what is happening in Trusts, but I note that Unison don't appear to have updated their website since the privatisation of NHS Logistics in October 2006:
http://www.unison.org.uk/healthcare/NHSlogistics/

Seems like Unison are comforting themselves that they already have representation in DHL where the NHS jobs will be transferred too (although not in Novation, the US supply chain organisation that is partnered with DHL).

More info:
http://www.indymedia.org.uk/en/2006/10/353042.html

If any one know of action in this area I'd be interested to know (by PM if it's sensitive).

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little_brother
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Jan 31 2007 12:35

This is more Trust related - 2.5million to a private surgery unit for doing nothing. 'Patient choice' is against treatment centre but they still get paid due to a agreed minimum contract! At the same time the restructured (merged) hospital Trust is shedding 100's of jobs.

Quote:
NHS PATIENTS 'WON'T GO PRIVATE' - Nottingham Evening Post, 29 January 2007

Health bosses are still struggling to get NHS patients to choose to have their hip and knee ops at a private centre. Only 11 operations went ahead on Nottingham patients at Barlborough independent sector treatment centre in November.

This is just under a third of the work it was supposed to carry out for Nottingham City Primary Care Trust that month. Because of its funding contract, the trust is still paying for the operations not done. Health trusts signed a five-year contract to spend a set minimum amount on hip and knee replacements at the centre, at junction 30 of the M1.

The idea was to take the pressure off waiting lists at the Queen's Medical Centre and City Hospital. But it is thought patients were not keen to travel to the centre and would prefer to be treated in the city.

Nottingham City and County primary care trusts paid £3.97m for procedures in 2005 - but more than £2.5m worth of operations were never performed.