A FIFTH of Oxfordshire hospital patients would need to forfeit their treatment to ensure NHS managers balance their books.

This is the observation of Thames Valley Health Authority chief executive Nick Relph, who has spoken candidly for the first time about how the region is underfunded by the Department of Health.

The outgoing chief executive, who will leave in July when TVHA is dissolved to make way for the larger Central South HA, said that the formula used for NHS funding was so discriminate that essential health services were under threat.

Mr Relph's comments in a TVHA board report follow warnings that severe cost-cutting would be needed to reduce a forecast £82m deficit in Oxfordshire.

He said: "The funding available in Thames Valley means that tough choices will need to continue to be made. What might be considered core services elsewhere will have to be critically examined to see if they are affordable."

He said that the National Funding Formula, which uses population, deprivation and health figures to calculate NHS finances across England and Wales, would leave Thames Valley with the lowest amount of cash per head for 2007-8.

While people in Oxfordshire, Berkshire and Buckinghamshire would receive £1,125 each, the English average would be £1,388 per head, while the highest funded health authority would receive £1,641 per head more than £1bn extra.

As a result, Oxfordshire alone was spending 21 per cent too much on all hospital care, 14 per cent more than it should on drugs and 11 per cent over budget for community services, like GPs, dentistry and district nurses.

Mr Relph said: "This is because the calculation of fair shares funding nationally assumes that Thames Valley has a low level of health need.

"There can be little argument that in an affluent area with practically full employment more deprived communities elsewhere in the country should receive a higher level of funding. However, the scale of the distribution is very significant."

He added: "Whilst the principle behind distribution towards greater need is valid, the distributive impact of the formula is so significant that it must now be asked whether the impact is too great and leaves some parts of the country with such a low funding level that the range of care provided has to be constrained."

Mr Relph also stood up for managers who have been blamed for the cash crisis by Health Secretary Patricia Hewitt.

And he warned that heavy use of Private Finance Initiatives to fund new buildings meant "flexibility for the local NHS is reduced" as money is set aside to cover costs.

Meanwhile, it has emerged that one in ten patients fail to turn up to appointments at Oxfordshire's hospitals costing the NHS hundreds of thousands of pounds every year.

A survey of NHS trusts has revealed that 48,000 people did not attend out-patient consultations at the John Radcliffe Hospital, Radcliffe Infirmary, and Churchill Hospitals, Oxford, and The Horton, Banbury, during 2005-6.

The hospitals, overseen by the Oxford Radcliffe Hospitals NHS Trust, organise about 514,000 appointments every year.

Another 15,000 no-shows were recorded by Oxfordshire Ambulance Trust's patient transport service, making up seven per cent of the 214,000 patients its staff take to and from hospital appointments every year.

But both trusts denied the survey's estimates that the last-minute cancellations cost £6.3m.