John Lister, Director Health Emergency, looks at the devastation caused to the NHS by privatisation and cuts.
London is the storm centre for the tornado of cuts that are beginning to take a toll of beds, jobs and services in England’s NHS — but other cities are also feeling the brunt already, or bracing themselves as plans are drawn up to balance the books of struggling NHS Trusts.
In the capital, Whittington Hospital is the latest to face devastation, with plans that would effectively reduce it to little more than a clinic: but every corner of London is facing cuts in beds, A&E and key services as the government’s £20 billion cash squeeze takes hold.
In West London, four A&E units from the current nine face closure — as part of cuts that would also close 28% of beds across the eight boroughs. The bed cuts, set out in a strategy document that did not go to public consultation, are set to undermine services not only in Ealing, Charing Cross, Hammersmith and Central Middlesex hospitals, where the A&Es are under threat, but also in the hospitals that are supposed to receive the extra caseload when they’re gone — Northwick Park, West Middlesex and Chelsea & Westminster, which each face a loss of a third of their beds.
In North London Chase Farm A&E, which Andrew Lansley and David Cameron cynically promised to save back in 2009-10, is again facing the axe, with more services to go in the proposed merger between Barnet & Chase FarmTrust with the Royal Free.
In North East London King George’s Hospital in Ilford faces devastation as its A&E and almost all services are closed and the site sold off to help pump cash into the bankrupt PFI-funded Queens Hospital in Romford. But Queens is already limiting admissions and unable to cope with its caseload. More cuts are likely in the newlymerged Bart’s mega-trust combining Bart’s and the London Hospital with Newham and Whipps Cross, and saddled with the massive costs of the £1 billion PFI-funded London Hospital.
‘We will be left with little more than an Urgent Care Unit. Patients will still have to be transported to other hospitals because we will no longer have acute provision here’. Dr Chidi Ejimofo, Lewisham A & E Consultant.
In South East London, Jeremy Hunt has rubber-stamped brutal plans by the Trust Special Administrator to close most front line services at Lewisham Hospital, a viable, successful Hospital Trust that is being carved up as a result of the bankruptcy of the neighbouring South London Healthcare Trust — which in turn has been brought down by the unaffordable costs of two PFI hospitals. PFI is rescued at the expense of patient care.
These cuts are a test run for the draconian powers handed to the Administrator under the ‘unsustainable provider regime’ drawn up by Labour in 2007. If the continuing fight by Lewisham campaigners, who have put tens of thousands on the streets, is unsuccessful, we can expect more Trusts to be subjected to this brutal treatment.
In SW London health bosses have been trying for years to push through cuts in Epsom & St Helier Trust, but have now announced that two A&E units out of five need to close as part of their ‘efficiency savings’. Kingston Hospital and Croydon’s University Hospital are also under threat as services are ‘centralised’ at the congested St George’s Hospital.
In total thousands of beds are at risk and more whole boroughs face the loss of their current access to A&E services. Journey times and delays will lengthen for the most seriously ill A&E patients who have to travel to other hospitals – as London Ambulance Service figures show emergency services stretched to the limit.
‘As a GP I can state categorically that these proposals are going to cost lives.’ Dr Louise Irvine, Lewisham GP.
Each of the cuts is explained away on the false promise that new models of care will mean patients will be cared for in the community, while ever larger and more fanciful claims are made for the numbers of A&E patients who, we are told, could be safely treated in an Urgent Care Centre instead.
But a closer look at the plans reveals that there are no concrete proposals for new or expanded community health services. In fact community services are being cut back – as are mental health services, all as part of the same drive for cash savings. A&E consultants and academics who have studied the issue reject the claims that up to 75% of A&E cases could be safely treated in free-standing Urgent Care Centres.
There are no serious overall plans for the capital. Cuts are taking place in neighbouring areas, with no realistic provision for increased services where care is “centralised” to ensure care is available for those who need it most. Specialist teams are being broken up, training disrupted, and centres of excellence destroyed. Instead all local people are offered is empty words.
Clinical arguments are being ignored: GPs are being ignored, local people are being ignored and always a blind eye is turned to the complete lack of evidence that any of the proposals for community based care can actually deliver what is promised.
And it’s a one way street: once services and hospitals are cut back, plans also mean the buildings will be bulldozed or flogged off, with the land. The lost services cannot be replaced where they are. There is no way back. 60% of the Lewisham site is to be sold off, 66% of King George’s, 50% of the Whittington.
Of course it’s not only London: Greater Manchester is facing similar threats, Peterborough and Mid Yorkshire are mired in PFI-driven crises, and up to 60 struggling Trusts could face the horrors of an administrator carving up their services.
This vandalism means there is a simple choice for local people: fight now, and keep fighting to keep these services intact, or lose them forever – with the cash savings swallowed up by the Treasury to help pay the debts run up by the bankers.
We should also get tough with managers who spin us a load of lies and waffle instead of standing up for local services. The Francis Report strongly condemns the Mid Staffordshire Hospital Trust Board for making cuts without assessing the risk they posed to patient care.
But they were also criticised for making cuts when they should have known that they were being asked to deliver care with inadequate funding. They should have spoken up loudly, says Francis. We want them to stand up and speak up alongside campaigners in London too, and not be the axemen driving through cuts for George Osborne and the bankers.
So where in this is Labour? With some despicable exceptions, local MPs have been drawn in to most of the campaigns, but there is depressingly little display or urgency or anger from Labour’s front bench. Worse, shadow ministers are still doggedly defending PFI, and even arguing that they cannot give blanket support to anti-cuts campaigns because they would be making cuts if they were in government.
On the Francis Report there have been feeble apologies but none of the serious rethink of policy and priorities that might convince sceptical voters and health workers that a newly elected Labour government would do things any differently.
Unless Ed Miliband’s team start shaping up and behaving like a serious opposition they will allow the Tories to use these new brutal cuts to discredit them. Cameron and Lansley promised to end closures and stop the cuts: why can’t Labour do at least the same – and preferably link up with those campaigning to defend the NHS. email@example.com