Fighting to save Whittington NHS Hospital /FRFI! 239 Jun/Jul 2014

Fight Racism! Fight Imperialism! 239 June/July 2014

Whittington Hospital is a local general hospital with a maternity wing and an A&E department that serves 40,000 patients a year; it has the reputation of being the safest hospital in the country. Its situation on Highgate Hill, which is a prime site two miles from the City of London, has long tempted private interests to grab the land for development. Unfortunately for them, the land is granted by ancient charter for the purposes of hospital welfare only.

The Defend Whittington Hospital Coalition was set up in 2009 because the hospital board had plans to close the A&E and maternity departments and sell off some of the older buildings and land to the private sector, possibly for the building of a private hospital. Since that date there has been turmoil at the hospital with the departure of at least ten top directors and consultants and at least three plans for reduced services leaked to the media.

The public has responded to these threats of closure or shrinkage of services with meetings and marches. A five-thousand strong demonstration against the loss of A&E in April 2010 was supported by three Labour MPs, the Conservatives, Lib Dems and Green Party as well at Unison, Unite the Union, the NUT, PCS, local community groups. The then Labour Government Health Secretary Andy Burnham was forced to put an end to the sell-off plans.

North London Fight Racism! Fight Imperialism! has continued to attend the Defend the Whittington Hospital Coalition meetings but has had to campaign on the streets and in the community to create a forum for political opposition to privatisation of the NHS through the Private Finance Initiative (PFI) and the creation of foundation trusts. The Whittington Hospital Coalition is very reluctant to condemn the privatisation policies of the last Labour government or to talk about the well-documented collusion of the trades unions in outsourcing and job cutting. Protecting the electoral interests of the Labour Party puts a severe limit on effective campaigning to defend public services and the NHS.

We have held regular street meetings and stalls in the locality and have collected thousands of signatures on a petition with principled demands to save the NHS and the Whittington. Our petition says that the government continues to bail out banks and fund imperialist wars while cutting and privatising the NHS. PFI is destroying many hospitals with unaffordable debt.

The Whittington Hospital is run by Uniparts Group and employs accountancy corporation Ernst & Young to plan its future. The hospital board is set to cut services by £18m a year. Private medical companies are being invited to tender for services. Plans keep changing, but we demand that Whittington Hospital remains a safe general NHS hospital with A&E and maternity provision.

Susan Davidson


Mental health: services ground down/ FRFI! 239 Jun/Jul 2014

Fight Racism! Fight Imperialism! 239 June/July 2014

In May, a woman was admitted to the acute mental health ward on Merseyside where I work as a full time nursing assistant. She had tried to kill herself using an overdose of prescription medication and a bottle of vodka. We found out that she had been financially supporting her daughter, who has two disabled children and had got into thousands of pounds worth of debt – because the disability benefits had been stopped. Now, without any prospect of getting the money to pay off her debts, the woman had attempted suicide in an effort to get away from the relentless tyranny of telephone calls and letters demanding repayments. She was on our ward as a direct result of poverty and welfare benefit cuts.

Her case shames me, both as a mental-health worker and as a citizen in our so-called society. In a true and functioning society no one is left behind. Not our patient, not her daughter, and not her grandchildren. The disabled grandchildren have been failed due to the cut in the benefits which were there to sustain and support them. Their mother is failed because her needs as the carer of these children have been ignored. Our patient was failed because it fell to her to pick up the bill for the needs of her disabled grandchildren, while her basic needs as a human being had been ignored.

When an individual must attempt suicide in order to gain a temporary respite from their financial problems, this is a complete failure of society on every level. But this conclusion is reached before we even look at the sort of care that this woman received while in acute mental health services. In my job I witness cases such as this on a daily basis. Due to the continuing decline in the provision of social and care services by local councils – a result of drastic cuts in spending – acute mental health workers must now also serve as social workers, amongst the myriad other roles the cuts in NHS spending have forced us to assume.

The entirety of the NHS is beginning to crumble under the weight of the government funding cuts. Month by month the conditions for both patients and front line staff worsen noticeably as more money is saved by slashing Trust budgets. These changes are endemic throughout the country.

In my own experience on the unit, not only are the acute wards continually understaffed with nursing assistants, but some wards, including mine, are now expected to run without a ward clerk to deal with administration. Wards go for shift after shift without a domestic to clean the place. Most worryingly of all in the last year there have been several instances where there have been only three qualified staff nurses on night shift to cover the four separate wards on the unit. Running an acute ward overnight without a qualified nurse to hold the clinic keys, administer medication and take responsibility for decisions about the care of the patients should be unthinkable. Two years ago it would have been unheard of. But now it is becoming more frequent. Standards of care are being lowered dramatically.

The cuts in mental health services are 20% more severe than those to other services. This is happening for two reasons: first, because mental health is still considered separate and lesser than physical health, and second, because the mental health patients who suffer from the cuts to services have no voice in society and are therefore easily ignored. This is backed up by statistics from the Disability Rights Commission: people suffering from mental health problems will die on average 5–10 years younger than those without mental health problems, often from preventable illnesses missed because routine checks were not carried out. People suffering from the most serious mental illnesses, schizophrenia for example, will die an average of 20 years younger than those with no mental health problems.

But to say that those who suffer from mental ill health are a marginalised section of society does not go far enough. The majority of patients I see in mental health services are already from an impoverished section of society that is conveniently forgotten. The issues of poverty, homelessness, drug and alcohol addiction, domestic violence, gang violence and crime are all inextricably linked with mental health in a way that is immediately obvious on an adult acute ward. Patients from more deprived economic backgrounds vastly outnumber those from wealthier backgrounds. No wonder a recent report found that poverty and poor mental health go hand-in-hand: mental health problems are twice as prevalent in deprived areas of London (20%) than in the least deprived areas.

With regards to the patient I mentioned at the beginning of this article: after being assessed by psychiatrists on my ward she was diagnosed as having no mental health problems whatsoever – her attempted suicide therefore a desperate act in response to her impossible circumstances. As she did not suffer from a mental illness, she was discharged back home to her troubles after a week’s respite on the ward, the only support being the contact details of a debt advisor.


Health Service: remorselessly deepening crisis /FRFI! 239 Jun/Jul 2014

Fight Racism! Fight Imperialism! 239 June/July 2014

Every politician knows that the NHS faces financial collapse in 2015. As a proportion of GDP, health spending reached a peak of just under 9% in 2009; it is now predicted to fall to under 8%. The scale of service cuts required to meet a £20bn funding gap for 2011-14 is already huge, with soaring waiting lists and extended A&E waiting times. With flat-level funding expected for the three years from 2015/16, the overall gap will reach a massive 23%. General practice services are facing disintegration with some practices unable to offer a consultation for two weeks. NHS Monitor is requiring foundation trusts to rework two-year financial plans submitted in April because their assumptions are unrealistically optimistic. These are the consequences of slashing state welfare: the ruling class may be sitting on ever-growing and obscene levels of wealth, but it will always ensure less and less is spent on the working class. Hannah Caller and Robert Clough report.

It is estimated that funding for general practice is due to fall by 17% in real terms by 2017/18, or £1.59bn. However, the Royal College of General Practitioners expects that over the same period the number of patient consultations will rise by 20%, from 340 million in 2012/13 to 409 million. Currently the funding for general practice is 8.39% of the NHS budget; this will be cut to 7.29%. The share of funding spent on general practice has been falling since 2005/06. To stand still, general practice would need £11.47bn or 9.81% of the projected NHS budget of £116.86bn by 2017/18. This will be disastrous for the care that people will receive: around 90% of contact with people in the NHS is in general practice. The Labour Party is suggesting it will add a pitiful £100m to the primary care budget to ensure everyone has a GP appointment within 48 hours.

Too few nurses
The Royal College of Nurses have shown that there are 20,000 frozen nurse posts and that the senior nursing roles, including clinical nurse practitioners, are the posts most likely to be frozen or cut because they have the highest salaries. There have been 3,000 nursing posts cut from mental health services – not just frozen. There are legally binding minimums for staffing levels in airplanes, creches and football grounds. The National Institute of Clinical Excellence (Nice) has started a consultation over a proposal that there be a minimum of one nurse per eight patients on hospital wards. This has no evidence base, would be no more than a recommendation, and in many cases would not allow a nurse to give sufficient time for adequate care every hour of their shift. It is no more than fig-leaf to cover up for deteriorating services.

None of the bourgeois parties is prepared to say taxes must rise to pay for an adequate NHS, despite the fact that a recent poll reported that 80% were in favour of such a step. The ConDem coalition has invited Labour MP Frank Field to flesh out a proposal to raise national insurance contributions by 1% instead. This would in effect be a regressive tax, penalising the poor the most, particularly when Field has said this would be linked to income tax cuts. The regressive character of his plans are particularly evident for those now over pension age: they would be asked to continue to pay national insurance, if they wanted free care – otherwise they would have to start paying for health services. Other proposals include charges for GP visits ranging between £10 and £25.

The solutions offered by politicians in power and in opposition are not human solutions that prioritise people and their health, but are capitalist measures encouraging privatisation and competition, and while giving the appearance that the NHS is properly supported in the run up to the general election.

Big Pharma rip-off /FRFI! 239 Jun/Jul 2014

Fight Racism! Fight Imperialism! 239 June/July 2014

The independent NHS watchdog, the National Institute for Clinical Excellence (NICE), decided that a new breast cancer drug, Kadcyla, developed by Roche is too expensive. It costs more than £90,000 per patient per year to extend life by 5.8 months. The decision was criticised by Roche and some breast cancer charities, but the episode is the latest in a series of revelations showing how the pharmaceutical industry (Big Pharma – multinational monopolies including Roche, Bayer, Novartis, Astra Zeneca, GlaxoSmithKline, Pfizer, and Merck) is ripping us all off. The Tamiflu saga, where the UK government paid Roche close to £500m for a drug no more effective than paracetamol, shows the level of robbery. With the NHS facing budget shortfalls as it is privatised by stealth, and with cancer rates set to double between 2002 and 2020, Big Pharma profiteering is unsustainable and things are coming to a head.

Read more ...

NHS?fragmented, privatised and on the brink/ FRFI 238 Apr/May 2014

Fight Racism! Fight Imperialism! 238 April/May 2014

March against the partial sell-off of Whittington Hospital in north London - March 2013

The NHS faces a real possibility of collapse before the 2015 general election. Two factors will have led to this situation: real cuts in NHS funding and the fragmentation of services that has been the consequence of the 2012 Health and Social Care Act. A programme of impossible savings is pushing many foundation hospital trusts towards bankruptcy. Clinical commissioning groups, responsible for buying health care services for their local population, are signing contracts left right and centre with private companies. At least £6bn worth of work is out to tender in the NHS in England. Financial pressure to make savings of £30bn by 2021 will mean that trusts that don’t make money can expect to be closed, aided by the new powers that the Health Secretary has now enshrined in law with Clause 119 of the 2014 Care Act. A market in health care inevitably leads to priorities that are not in the interest of people’s health care.

The financial situation of NHS trusts has deteriorated over the last three years as funding has failed to keep pace with NHS inflation. It is further threatened by NHS England’s proposal to move £2bn from hospital budgets to out-of-hospital care, and a possible extra £1bn in employer pension contributions. In July 2013 in England, 38 of 61 non-foundation hospital trusts had financial deficits with five in special measures, while five of 99 foundation hospital trusts were under investigation and 20 were in special measures. This means two-thirds of acute NHS trusts and a quarter of foundation trusts are struggling. Latest planning guidance from Monitor, the NHS financial regulator, shows a financial shortfall of 6.6% in 2015/16.

Specialist services such as chemotherapy and cystic fibrosis treatment, which are commissioned nationally by NHS England, are overspent this financial year so far by £366m, 3.8% over budget. Provisional estimates show that the cost pressure on these services will rise at 10% per year until 2021. One in three acute NHS trusts in deficit are hospitals built under the PFI scheme, making financial solvency nearly impossible as repayments increase year on year while income is falling.

David Nicholson, outgoing chief executive of NHS England, warns that billions of extra pounds are needed to allow the NHS to survive. He suggests centres providing some specialist services be cut from 300 to 15-30, and a reduction to no more than 40-70 major emergency centres across the country. He says this doesn’t mean other hospitals lose their A&E, they will just no longer deal with the most serious cases. Chase Farm hospital in north London had its A&E department closed in December 2013 after the defeat of a long struggle to save it along with the maternity unit. It is left with a 9am-9pm urgent care service while services have been centralised at Barnet and North Middlesex hospitals. In January, a three-year-old child, who was taken to Chase Farm by his mother unaware of this closure, died in the process of being transferred by ambulance to the North Middlesex Hospital. More tragedies of this kind are inevitable where closures mean fewer access points to critical care.

Care Quality Commission, batting for private providers

The Care Quality Commission (CQC) is the quality regulator of hospitals, all of which have to achieve foundation trust status by this year under the Health and Social Care Act. Between January and March 2014, the CQC inspected 19 hospital trusts in England. Each inspection team has up to 35 people which look at eight areas of the hospitals and ask five questions: is the quality of care safe, effective, caring, responsive and well-led? Just as schools have Ofsted inspection and end up with a rating, so will hospitals, which will come out either outstanding, good, requires improvement or inadequate. Failing to get a good report brings severe penalties, so to ensure the best rating, hospitals are turned upside down before and during an inspection, with teams of managers and clinicians whipped into a frenzy of presentations, meetings, memos and focus groups.

However, the CQC will no longer be concerned just with service quality – at least not if its chair David Prior, a former chief executive of the Conservative Party, has his way. On 1 February he wrote in the Sunday Telegraph that ‘We need more competition to drive up standards of care; more entrants into the market from private-sector companies, the voluntary sector and other care providers’, and announced that European or US hospital chains could be given the chance to take over NHS hospital trusts in England which run into financial difficulties. He also described waiting targets as out of date. On 23 March, the Sunday Times reported that more than 3,700 patients waited more than 104 days for treatment in 2013 in breach of waiting targets, and that almost a third of trusts (30%) are breaching a government target of 85% of patients receiving treatment within 62 days of an urgent GP referral.

Foundation status is granted to hospitals by Monitor, the economic regulator. Monitor’s present interim chair is another Tory politician, Baroness Hanham. Foundation trusts can generate income through joint ventures with large corporations, selling land and buildings and using staff and services for private medicine. If the hospital doesn’t get enough revenue, it can be closed down irrespective of the needs of the local population. But if it has a private finance initiative (PFI) scheme, then special measures will be implemented to protect it. Hence Lewisham hospital in south London had its A&E services threatened with closure to fund the South London Hospital Trust where there were three hospitals and six PFI schemes, consuming over 16% of the Trust’s income. Following a campaign to save Lewisham hospital, the High Court ruled in 2013 that Health Secretary Hunt had acted unlawfully in proposing to cut Lewisham services. In response, Hunt inserted Clause 119 into the Care Bill which has now become law. This gives special administrators appointed by the health secretary power to enforce any local changes to, or reconfigurations of, NHS services. Special administrators have no duty to plan health services on the basis of need in the area: their duty is to ensure that trusts can pay their debts and remain financially viable organisations.

Mental health services slashed

Monitor and NHS England have just recommended cutting funding for mental health services by 20% more than funding cuts for acute hospital-based services. Mental health is already underfunded, getting 13% of the NHS budget but accounting for 28% of health service need. These cuts are life-threatening and breach the Health and Social Care Act to treat mental and physical health care equally. For the young and the elderly it is also bleak, as child and adolescent mental health services are being underfunded and of Britain’s ten million people over 65, one in five are likely to need mental health services. One in ten children in London – 110,000 – are thought to have a clinically significant mental health problem. Older people are additionally affected with an underfunded service, rising demand and the cuts affecting health services in general. As with every other aspect of austerity, it is the working class who will suffer the consequences as NHS services disintegrate.

Hannah Caller & Robert Clough

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  1. Mental health problems equal discrimination and poverty / FRFI 236 Dec 2013/Jan 2014
  2. Lewisham Hospital victory for campaigners/FRFI 235 Oct/Nov 2013
  3. Health matters/FRFI 234 Aug/Sep 2013
  4. We want our NHS back
  5. NHS emergency services face collapse/ FRFI 233 Jun/Jul 2013
  6. Health matters: Cuts kill people /FRFI 231 Feb/Mar 2013
  7. Lewisham Hospital and the PFI parasites – Feb 2013
  8. Lewisham Hospital and the PFI parasites – Feb 2013
  9. NHS emergency - Save Lewisham hospital/FRFI 230 Dec 2012/Jan 2013
  10. ConDem health reforms - The end of the NHS in England /FRFI 229 Oct/Nov 2012
  11. Banks get bailed out, hospitals go to the wall / 228 Aug/Sep 2012
  12. Health privatisation gathers pace
  13. Health and Social Care Bill - The taste of things to come /FRFI 226 April/May 2012
  14. NHS sinks deeper into crisis / FRFI 225 Feb/Mar 2012
  15. Health care secondary to profits/ FRFI 224 December 2011/January 2012
  16. Stop the NHS sell-off / FRFI 223 Oct / Nov 2011
  17. The Plot Against the NHS - Review - Sep 2011
  18. The end of free universal health care? / FRFI 222 Aug/Sep 2011
  19. Profiteering and Abuse in Care – Demand Decent Services as a Right! - 10 Jun 2011
  20. NHS – open for business, closed for treatment / FRFI 221 June/July 2011
  21. Kill the Bill – not the NHS! /FRFI 220 April/May 2011
  22. ConDems propose privatisation of the health service / FRFI 219 Feb/Mar 2011
  23. NHS: Opposition grows as chaos looms / FRFI 218 Dec 2010 / Jan 2011
  24. How the Coalition plans to abolish the National Health Service / FRFI 216 Aug/Sep 2010
  25. Health Coalition wields the knife / FRFI 215 Jun/Jul 2010