Green Left
LINK has published a valuable post by John Lister of
Health Emergency on the background to the proposals on hospital reorganisations which include NW London NHS proposals which include an apparently non-negotiable decision to close Central Middlesex A&E:
The
phony war is over. With Andrew Lansley's Bill now on the statute book,
the gloves are off, and the extended standstill in the process of cuts
in pursuit of the £20 billion "efficiency" target has come to an end.
But don't be fooled: this is no cock-up. It is all planned to happen.
One
after another, desperate hospital trusts are revealing glimpses of
their real financial situation. And accident and emergency units are at
the top of their list as they start to close and cut - not because much
can be saved by simply closing them - but as a crucial first step to
dismantling and closing whole hospitals.
With A&E goes
maternity, paediatrics, ITU, High Dependency Units and Coronary Care.
With maternity goes women's care. With the loss of trauma goes
orthopaedics. Emergency surgery is pronounced "unsafe" or
"unsustainable" and removed.
Each element takes a range of
supporting services with it, until the hospital is allowed to wither
away: and each cutback also makes it harder to recruit medical staff and
qualified nurses, opening up arguments that further cuts are required
because staffing levels are "unsafe".
To cap it all, trendy
arguments are wheeled out by the King's Fund, McKinsey and other hired
hands suggesting that new "settings" can deliver services more
efficiently and effectively than hospitals: the only snag is that these
"settings" and services exist only on paper, lacking evidence they work,
and of course the funds, facilities, staff and any political commitment
to make them a reality.
Each A&E closure is dressed up and
presented as a "clinical" decision: but we know they're being cynical.
Vague promises of services "closer to home" end up with the closure of
local hospitals that local people value and depend upon, but nothing to
replace them.
The reason we know this is because, alongside
A&E units, they're also cutting community services and cutting
mental health - and the consultation documents on the closures keep
referring to the "cash gap", the level of savings they say they need to
make.
The list of cuts is growing longer week by week. In London
we know that four A&E units - Ealing, Central Middlesex, Charing
Cross and Hammersmith - face the axe in northwest London, St Helier
hospital in Southwest London is to be run down, King George's hospital
in Ilford, and of course Chase Farm in Enfield.
Across the
country there are more: hospitals in Stafford, Rugby, Kidderminster,
Redditch, Trafford General in Greater Manchester, Newark, Northallerton
and Hartlepool. Among the A&E casualties are some brand new units
built with the Private Finance Initiative [PFI]: Central Middlesex cost
£62m less than 10 years ago: Bishop Auckland hospital, another PFI, is
also to lose its A&E. But also on the hit list are hospitals unlucky
enough to have been merged with PFI hospitals, or run by them.
Best
known of these is Queen Mary's hospital in Sidcup. It has already been
largely dismembered in a futile attempt to balance the books of the
South London healthcare trust, which is wrestling with ruinous bills for
two hospitals, which cost about £210m to build, have been on the brink
of bankruptcy for years, and are now dragging down health services for a
million people in southeast London. After paying over £500m, there's
another £2 billion still to pay.
Administrators have now been
brought in to drive through rapid and drastic cuts, although it's still
not clear what could be done to tackle such massive debt. Even if all
services closed and all clinical staff were sacked, the Trust would
still have a massive PFI bill to pay for 20 years: and no nearby
hospitals have any spare capacity to treat the tens of thousands of
patients displaced from Bromley, Greenwich and Bexley.
The curse
of PFI is also driving cuts in Dewsbury in Yorkshire, which was unlucky
enough to be merged into the Mid-Yorkshire hospitals trust, whose a
newly completed £320m PFI deal fell immediately and deeply into crisis.
Dewsbury could lose its A&E, while Pontefract's brand new urgent
care centre has already been scaled back, and the main hospital in
Wakefield, short of beds, struggles to cope.
But for managers
these cuts are too small, and take too long to meet the massive £20
billion cuts target, which is ridiculously being called the 'Nicholson
Challenge', when in reality it should be called the Banker's Bonus, the
Lansley Bequest, or the Tax Dodgers' Legacy. The cuts were triggered by
the banking crisis, deepened by Lansley as part of his plan to run down
public sector provision in health and make room for private sector
providers, and continue despite the fact that uncollected tax alone adds
up to £120bn a year, six times the £20 billion target for cuts by 2014.
So
bosses are looking to cut jobs - and even going beyond the current pay
freeze to cut pay, with Trusts in the South West seeking to tear up the
national Agenda for Change pay scales and threatening heavy tactics to
impose pay cuts, and other bosses looking to downgrade staff to cut
wages - in some cases by over £2,000 a year.
Job cuts are also
on the way - even as we wait to hear the outcome of the inquiry into
Mid-Staffordshire hospitals, where trust managers cut too deeply into
nurse and medical staffing - with notoriously lethal results. And many
trusts are now making cuts much bigger than the £10m that destabilised
Mid Staffs.
While savage cuts undermine local services and the
quality of care in those services which survive, the rush for private
contracts is hotting up, in a new bonanza for the likes of Virgin
Healthcare, Serco and other companies looking to cash in - slicing off
attractive portions of NHS funded services, while leaving all the
complex, costly and risky tasks to what remains of the public sector.
Virgin
has now picked up lucrative contracts in community health care, and
primary care, and even sexual health services and child health in Devon.
Serco, too, is moving in anything they can get their hands on. That
company's conspicuous failure to deliver on its contract to deliver out
of hours primary care in Cornwall raises questions not only about Serco
(pocketing the difference from chronic under-staffing) but also about
completely ineffectual regulation and monitoring of private sector
contracts by PCTs now, and by CCGs from next year .
Behind the
scenes profitable consultancy firms like McKinsey and Ernst & Young
are helping themselves to lavish contracts and lining up to take over a
growing share of the work running the new Clinical Commissioning Groups
(CCGs) and their £60 billion budgets.
And while NHS budgets are
frozen and falling against inflation, with less money each year for each
treatment they deliver, NHS Foundation Trusts are also being freed to
boost their budgets with private medicine: up to 49% of income can come
from private sources .
While the private contracts are awarded
behind the scenes, angry people up and down the country are beginning to
mobilize to challenge the closures of local services. They may not
really understand privatisation in the NHS or anything about Lansley's
Bill, but Mr and Mrs Middle England do know and care about the loss of
local emergency services and how long it would take them to go to the
next hospital across if their local A&E is closed. This offers a
basis of common ground for campaigns to link the issues of cuts
privatisation and Lansley's Act.
Campaigns are cranking up.
Consultations already just beginning on the cuts, and already public
opinion is hardening against them. Some ministers with endangered
hospitals in their constituencies are running for cover.
Campaigners
have to press their local MPs, councillors, community organizations and
CCGs to take a firm stand against these cuts.
Take every chance
to challenge, block and delay every cut: they are all driven by a cash
squeeze the coalition could resolve tomorrow if they collected the tax
that's owed from their rich friends. Some are also driven by PFI: and
ministers could sort this out as well, but prefer to leave the gravy
train running for their friends in the private sector and watch the NHS
squirm.
The cuts are deliberate, the crisis consciously created
to open up our most popular public service to profiteers. Don't let them
get away with it.
It's time to take a stand, reject the
specious "clinical" case for cash-driven closures, and fight for our
hospitals. Remember once it's gone, it's gone.
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