Fog clears on NHS massacre

John Lister, Director London Health Emergency

London’s NHS could face £5 billion worth of cuts over the next few years. The future of a third of the capital’s 16,000 hospital beds, many front-line clinical services, several whole hospitals and thousands of health workers’ jobs are at stake.

Primary care trust bosses have been linked up into five secretive “sectors” holding confidential meetings to hatch proposals.

Broad facts and some of the details are clear, even though NHS London has stubbornly refused to publish the secret McKinsey briefing on which many of the planned cuts are based.

So hats off to the British Medical Association which has broken the silence of London’s health unions and publicised the scale of the threat.

It has even called a public meeting on February 25 to kick off a campaigning response across the capital.

BMA London Region has published a report researched for them by yours truly, London’s NHS On the Brink, which sounded the alarm warning that many of its members’ jobs are at risk along with thousands of nurses, professionals and support staff.

Since the report was first drafted at the end of October, the situation has become even more serious.

North-west


North-west London has tried to keep the details of its proposals under wraps, but leaked documents show it is planning to cut back from nine district general hospitals to just three “major acute hospitals,” one of which is certain to be St Mary’s in Paddington.

This leaves up to six busy hospitals facing a downgrade to “local hospital” status – and it is already clear that Hounslow’s West Middlesex, Ealing and Central Middlesex Hospital in Park Royal are prime targets for downgrading.

South-west


In south-west London leaked pages of the proposals which are being held back from public view show that just one hospital – St George’s in Tooting – will be designated “major acute.”

Kingston, Mayday in Croydon and St Helier hospitals are all facing a downgrade with loss of services. A local south-west London campaign is launching this week, as health unions attempt to link up and defend all the services at risk.

North-central


North-central London is already embroiled in a big fight over the shotgun marriage between two inner-London trusts, Hampstead’s Royal Free and Islington’s Whittington Hospital, with the likely closure of the Whittington’s accident and emergency unit.

More service cuts are planned at the already reduced Chase Farm in Enfield.

North-east


North-east London has set the pace, publishing a consultation document saying little or nothing in concrete terms at the end of November, but then sneaking out a 192-page “pre-consultation business case” on the Health for North East London website just before Christmas, trusting that none of the media would be looking.

The business case would leave the seven boroughs of north-east London with just two “major acute” hospitals, one at the Royal London in Whitechapel (part of a joint £1 billion private finance initiative scheme with Bart’s) and one out in Romford, 17 miles away (another PFI hospital).

Under the scheme 832 beds would close, including over 200 at the new Bart’s and London Trust – in buildings that have not yet even been completed.

Other hospitals in the sector would be downgraded to “local hospitals” (Whipps Cross, Homerton, Newham) or virtually closed (King George’s in Ilford, which is projected to lose 444 of its 496 beds, with the sell-off of two-thirds or the site and £6m set aside for redundancies). There is already a vocal campaign up and running to defend King George’s.

But it’s not only hospitals, with a £500m combined efficiency saving required for them to stay afloat, that will feel the squeeze.

Community services, primary care and mental health could all be subjected to competitive tendering designed to slash between £200m and £500m from spending. Other services will simply be “decommissioned.”

Health workers are very much in the frame for the cuts. Hospitals would face a 3 per cent per year reduction in the “tariff” that determines how much they get paid for patient care.

And with soaring overheads and income sharply reduced, trusts would be forced to seek economies by sacking doctors, nurses and support staff.

The north-east London business case looks to cut up to 37 per cent from nursing costs and up to 43 per cent from spending on doctors.

Other overheads are to be cut by over a third – a particularly severe problem for trusts which have any large-scale PFI borrowing, as they are committed to decades of index-linked service payments regardless of the trust’s ability to pay.

But if north-east London has been the first out of the blocks it just gives an idea of the type of thinking to come from other sectors of London and the rest of the country.

Where London leads, the trusts follow

Outside the capital the plans seem to be at a more tentative stage. Figures collated by London Health Emergency (LHE) from strategic health authority (SHA) websites show targets for “efficiency savings” – aka cuts in spending – totalling £15 billion in seven of the 10 SHAs.

LHE estimates suggest that the remaining three SHAs could bring the total to £20 billion or more.

With 15 per cent of the English population London seems set to suffer at least 25 per cent of the spending cuts, with cuts averaging £670 for every man, woman and child in the capital, compared with a likely England average of £400 per head.

But the ideas that have emerged seem to be broadly similar. The SHAs have agreed on the scale of the cuts required and appear to be working to very similar rules as McKinsey, although one or two SHAs hotly deny this.

Some offer an interesting phrase here and there – NHS North West has talked of “world-class decommissioning.”

One common thread around the country is the push to switch large numbers of outpatient appointments and the least serious accident and emergency cases out of hospitals and into supposedly “cheaper alternative settings.”

But there is little if any evidence at all that such a huge reorganisation is either physically possible or in any way cheaper than using existing hospital facilities.

As if to remind us of the potential extra costs, Sir Richard Branson is reportedly dusting off his previously shelved plans for a network of lucrative Virgin “polyclinics” to be leased to the NHS, while the running costs of new, super-sized health centres on the model proposed by Lord Darzi are reportedly “jaw dropping,” being many times the cost of conventional GP services.

While some SHAs have so far given no hint of how they will seek their “efficiency savings”,,the urgency of the situation is growing. The election is just 10 weeks or so away, and immediately afterwards SHAs, primary care trusts and trusts will again be obliged to focus on balancing the books.

A new report from management consultants Tribal suggests that front-line NHS hospitals could face staggering combined deficits of around £7.5 billion a year by 2015, requiring a 15-20 per cent improvement in efficiency just to break even.

The brutal market and economic forces unleashed within the NHS by new Labour’s “reforms” coupled with the spending squeeze are forcing trusts to drive down costs at the same time as they reduce hospital activity volumes. The combination could question the viability of “a significant number” of hospitals, warns Tribal.

In Leeds, Leicester, Derby, Slough, Portsmouth and London, and in a growing list of NHS trusts hundreds of jobs at a time are being axed as improbably large cuts are imposed over the next 12 months. Leicestershire Hospitals alone are attempting to cut £58m of spending at over £5m per month, with 700 jobs to go.

This is the wake-up call. The phoney war has only weeks to go. Many of today’s secret plans will be action plans after May 6. They have been kept under wraps because PCTs know how unpopular they will be – they can be challenged and defeated if the public are told what is happening.

It’s time for health workers, their unions, local campaigners, politicians, pensioners and community groups to get up, out and fighting to defend our NHS against the biggest cuts it has ever faced. And let’s all thank the BMA for getting the message first and passing it on.

John Lister is information director for Health Emergency

From the Morning Star



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