Health matters: Cuts kill people /FRFI 231 Feb/Mar 2013

The NHS is breaking down. A combination of the £20bn cuts programme and the process of privatisation is making hospitals and services more and more dangerous as staffing levels fall – there are already 7,000 fewer nurses in post compared to 2010. With the likelihood of flatline funding from 2016 to 2020, equivalent to a cut of £50bn, the situation will get worse, and the abject failure of the Care Quality Commission (CQC) shows that people must take matters into their own hands if the NHS is to be saved. The campaign to defend Lewisham hospital is an illustration of what is necessary.

In order to stand still, funding for the NHS needs to increase by 4% per annum above the rate of inflation. The government has made it clear that this will not happen. As the Department of Health Director of Policy, Strategy and Finance, Richard Douglas, admitted in 2012, ‘the drive to find further efficiency savings in the NHS will continue after 2015 with the total savings rising from £20 billion to a possible £50 billion by 2019-20’. The Clinical Commissioning Groups set up by the Health and Social Care Act will be forced into seeking savings – they will be rationing, not commissioning.

The CQC: a record of failure

The CQC was established in 2009 to regulate the quality in care and nursing homes and NHS bodies. Its record for inspecting care homes and enforcing action where there have been safety problems has been constantly exposed as poor. It failed to uncover the appalling record at Stafford Hospital where hundreds of people were killed by shocking neglect in pursuit of Foundation Trust status. Dame Jo Williams, its chair, had to resign after she raised questions about the mental health of a whistle-blower, Kay Sheldon, who had complained about the bullying culture within the Commission. Its first chief executive was Cynthia Bower who had previously been CEO of NHS West Midlands, the strategic health authority which covered Stafford. Her position was made untenable when the Healthcare Commission, the NHS predecessor to the CQC, reported in March 2009 with criticisms of NHS West Midlands for failing to see and deal with the problems at Stafford hospital. She eventually resigned in February 2012.

What is evident is that the CQC is not fit to defend the interests of patients. Instead it operates in secret collusion with the organisations it is supposed to monitor. This became evident when the CQC was forced to release information it had kept secret about inadequate staffing levels at 17 trusts. It required Freedom of Information requests to get this made public. The staffing levels in these hospitals, which include both acute and mental health, were assessed as so low that they were unsafe and a danger to patients. No chief executive, no medical director, no nursing director, no chair has resigned from any of these organisations as a consequence.

The refusal of senior managers in the NHS to take responsibility for their actions is clear from the experience at Stafford General Hospital. Up to 1,200 people died unnecessarily because managers prioritised cutting costs to achieve Foundation Trust status. Only one of the hospital’s executive has been disciplined by their professional body: several have been re-employed in senior positions in the health service and others by health organisations as external consultants and advisers. This included the Trust’s chief executive who declined to give evidence at the official enquiry on the grounds of stress.

The situation at Worcester Acute NHS Hospital Trust was also dreadful. In the words of the lawyer who represented families acting over the care their relatives received, ‘The failings we uncovered were appalling – vulnerable patients were left starving and thirsty, with drinks left out of reach, buzzers ignored and people left to sit in their own waste by the very people meant to be caring for them.’ One man starved to death. The hospital will pay out a miserable £410,000 to the 38 families affected by the serious malpractice and negligence between 2002 and 2010. Health bosses have not admitted legal liability. The situation across the NHS is bound to get worse as staffing cuts multiply in the coming years.

Private companies expand

105 private firms and 140 NHS organisations (mainly hospital trusts) had been granted ‘Any Qualified Provider’ (AQP) status by October 2012, allowing them to provide services in the NHS. Private companies include: Specsavers (adult hearing contracts in over 33 places), Richard Branson’s Virgin Care (awarded AQP status in ten areas it applied for and plans to offer dermatology, ophthalmology, ultrasound, podiatry, pain services and fracture clinics) and InHealth, which has already established services in 95 locations and has plans for another 100. Care UK has 35 new contracts, diagnostic services, elective surgery, and is set to earn £190 million a year. These companies are picking the services where the best return is guaranteed and can pull out at any time if they cannot make a profit.

In order to assist these private companies, Monitor, the economic regulator of the NHS which is supposed to ‘protect and promote the interest of people who use the NHS’ is supporting the government’s plans to exempt private companies providing NHS services from paying corporation tax on the ground that they would be disadvantaged compared to NHS organisations which, as non-profit making organisations, are exempt. This will simply put more profits in the hands of shareholders. In addition many NHS trusts are burdened by huge PFI repayments. Because of this, up to 60 hospitals may go bankrupt in the coming years. Given this scale of problem, Monitor and the NHS Trust Development Authority are planning a £300m contract for a special administration regime. A likely winner is McKinsey, which has already received millions for administering Mid-Staffordshire and South London Healthcare Trusts.

The fight for Lewisham hospital

On 26 January tens of thousands of people marched through Lewisham in opposition to proposals to drastically cut services at their local hospital. The protest was the latest step in a campaign set up following the publication of a report by the South London Healthcare Trust (SLHT) special administrator Matthew Kershaw in November 2012, proposing the break-up of the SLHT and the merging of many of Lewisham Hospital’s services with those at Queen Elizabeth Hospital, Woolwich (QEH). Lewisham is set to lose its A&E, maternity, paediatrics and emergency surgery. Half the site will be closed and sold off. This is despite the fact that Lewisham has nothing to do with SLHT or its problems which arose from onerous PFI repayments. Kershaw proposes that SLHT’s vast £207m debt is written off and the new Trusts would have an annual subsidy for the next 20 years to ensure full PFI repayments.

QEH would become responsible for the A&E needs of 750,000 people from Lewisham, Greenwich and Bexley. No provision has been made for the 30,000 emergency admissions and complex cases every year that will now need to go out of area. Access to QEH is very difficult, and there are no provisions for changing this. It is the people of Lewisham who will suffer, and they are making their feelings clear on the streets of Lewisham and in packed meeting halls. 90 senior doctors have published detailed documents rejecting the administrator’s plans and Matthew Kershaw has needed a police escort whenever he has turned up to explain his proposals. The opposition presents a real problem for Health Secretary Jeremy Hunt who has to either accept or reject the report by 1 February. If he accepts it, the struggle to save Lewisham hospital will intensify. If he rejects it, the whole special administration process and ConDem NHS policy will be thrown into chaos.

Hannah Caller and Robert Clough

For further information on the campaign and how to get involved, go to www.savelewishamhospital.com

Fight Racism! Fight Imperialism! 231 February-March 2013

Lewisham Hospital and the PFI parasites – Feb 2013

Lewisham Hospital is being sacrificed to parasites. The government’s plans to remove its Accident and Emergency service, maternity wards, paediatric and other services in order to provide private companies with extraordinary profits, which furnish the pleasures of multi-millionaires.

The South London Health Care Trust (SLHT) has run up a deficit of £15 million over the past 3 years. In 2012 the cost of servicing its debt is estimated to have been £61m – nearly 15% of its income. The SLHT total debt burden exceeds £2bn.

In 1995 a PFI (Private finance initiative) contract was put out to tender for the Princess Royal Hospital in Bromley and awarded to the consortium United Healthcare (Farnborough Hospital Ltd) by the Labour government in 1998. United Healthcare consists of Barclays Private Equity, Taylor Woodrow and a City fund management company called Innisfree. In return for their initial outlay of £118m for providing services ranging from power to medical supplies the consortium will receive £1.2bn over 5 years; an over 10-fold return. According to the National Audit Office the rate of return for the contractors is 70.6% - that is per year. If we put any savings we might have in a bank we would be lucky to get % interest, Tesco might make 6% on sales turnover. With the prospect of an over 10-fold return over 5 years capitalists turn into ravenous wolves (a 10-fold return is 1,000%) – and the NHS and schools etc are in grave danger.

To try and deal with the Princess Royal’s deficit it was merged with 2 other south-east London hospitals, including the PFI-funded Queen Elizabeth Hospital in Woolwich, in 2009. The Queen Elizabeth is also PFI-funded and is part of the Innisfree portfolio of investments. The companies – Barclays, Taylor Woodrow and Innisfree – have invested about £210m in the SLHT and anticipate getting £2.5bn back; another over 10-fold return on the initial outlay. The 3 companies operate multi-nationally – Taylor Woodrow in construction.

Last summer the government appointed Matthew Kershaw as NHS Special Administrator to deal with the bankrupt SLHT. He proposed the merger of Queen Elizabeth and Lewisham hospitals. Lewisham Hospital is a solvent independent trust, but its rundown and closure are intended to allow continuing payments on the Queen Elizabeth Hospital’s PFI contracts, and this is the government’s priority for the use of our taxes.

Innisfree (presumably named after a WB Yeats’ poem) was founded in 1995 – the same year as the Princess Royal contract was put out to tender. Its website states that it employs 26 people. Innisfree channels funds from pension funds, insurance companies, local authority pension funds, endowments and private individuals into projects in Britain, Europe, the USA and Canada, from which it derives its profits. Innisfree’s website states that the total worth of its projects is £16.4bn in capital value. These include at least 27 hospitals, 269 schools, the Whitehall HQ of the Ministry of Defence, a Scottish motorway and a Welsh jail. The website lists them. More than 700 hospitals, schools and other public sector schemes in Britain have been put under PFI schemes.

The head of Innisfree is David Metter, whose estimated wealth in 2011 was £60m and whose income in 2010 was £8.6m. David Metter is chair of the Public Private Partnership Forum, which lobbies for the PFI business; the personification of parasitism. Asked whether he pays taxes in the UK, Mr Metter did not reply. He owns a £5m villa in Little Venice in London. Innisfree owns a school in Birmingham where parents tried to start an after-hours club to keep their children off the street but could not because Innisfree charges £70 an hour for a caretaker! At this time of year David Metter and his PFI associates like to go skiing in Chamonix in the French Alps, below Mont Blanc. Cost of a hotel room? About £420 a night! Along with his Little Venice villa, Mr Metter also owns a family home in France. These are the rewards for being a parasite in Britain today.

Trevor Rayne

Sources: The Daily Telegraph, The Independent, The Guardian and the Innisfree web site. 

Lewisham Hospital and the PFI parasites – Feb 2013

Lewisham Hospital is being sacrificed to parasites. The government’s plans to remove its Accident and Emergency service, maternity wards, paediatric and other services in order to provide private companies with extraordinary profits, which furnish the pleasures of multi-millionaires.

The South London Health Care Trust (SLHT) has run up a deficit of £15 million over the past 3 years. In 2012 the cost of servicing its debt is estimated to have been £61m – nearly 15% of its income. The SLHT total debt burden exceeds £2bn.

In 1995 a PFI (Private finance initiative) contract was put out to tender for the Princess Royal Hospital in Bromley and awarded to the consortium United Healthcare (Farnborough Hospital Ltd) by the Labour government in 1998. United Healthcare consists of Barclays Private Equity, Taylor Woodrow and a City fund management company called Innisfree. In return for their initial outlay of £118m for providing services ranging from power to medical supplies the consortium will receive £1.2bn over 5 years; an over 10-fold return. According to the National Audit Office the rate of return for the contractors is 70.6% - that is per year. If we put any savings we might have in a bank we would be lucky to get % interest, Tesco might make 6% on sales turnover. With the prospect of an over 10-fold return over 5 years capitalists turn into ravenous wolves (a 10-fold return is 1,000%) – and the NHS and schools etc are in grave danger.

To try and deal with the Princess Royal’s deficit it was merged with 2 other south-east London hospitals, including the PFI-funded Queen Elizabeth Hospital in Woolwich, in 2009. The Queen Elizabeth is also PFI-funded and is part of the Innisfree portfolio of investments. The companies – Barclays, Taylor Woodrow and Innisfree – have invested about £210m in the SLHT and anticipate getting £2.5bn back; another over 10-fold return on the initial outlay. The 3 companies operate multi-nationally – Taylor Woodrow in construction.

Last summer the government appointed Matthew Kershaw as NHS Special Administrator to deal with the bankrupt SLHT. He proposed the merger of Queen Elizabeth and Lewisham hospitals. Lewisham Hospital is a solvent independent trust, but its rundown and closure are intended to allow continuing payments on the Queen Elizabeth Hospital’s PFI contracts, and this is the government’s priority for the use of our taxes.

Innisfree (presumably named after a WB Yeats’ poem) was founded in 1995 – the same year as the Princess Royal contract was put out to tender. Its website states that it employs 26 people. Innisfree channels funds from pension funds, insurance companies, local authority pension funds, endowments and private individuals into projects in Britain, Europe, the USA and Canada, from which it derives its profits. Innisfree’s website states that the total worth of its projects is £16.4bn in capital value. These include at least 27 hospitals, 269 schools, the Whitehall HQ of the Ministry of Defence, a Scottish motorway and a Welsh jail. The website lists them. More than 700 hospitals, schools and other public sector schemes in Britain have been put under PFI schemes.

The head of Innisfree is David Metter, whose estimated wealth in 2011 was £60m and whose income in 2010 was £8.6m. David Metter is chair of the Public Private Partnership Forum, which lobbies for the PFI business; the personification of parasitism. Asked whether he pays taxes in the UK, Mr Metter did not reply. He owns a £5m villa in Little Venice in London. Innisfree owns a school in Birmingham where parents tried to start an after-hours club to keep their children off the street but could not because Innisfree charges £70 an hour for a caretaker! At this time of year David Metter and his PFI associates like to go skiing in Chamonix in the French Alps, below Mont Blanc. Cost of a hotel room? About £420 a night! Along with his Little Venice villa, Mr Metter also owns a family home in France. These are the rewards for being a parasite in Britain today.

Trevor Rayne

Sources: The Daily Telegraph, The Independent, The Guardian and the Innisfree web site. 

NHS emergency - Save Lewisham hospital/FRFI 230 Dec 2012/Jan 2013

FRFI 230 December 2012/January 2013

On 8 November 2012, hundreds of people attended a public meeting to oppose the proposed closure of A&E at University Hospital Lewisham Trust and the reduction of its maternity services. So many people turned up that there had to be an overflow meeting, which itself was packed. There was deep anger at the proposals: for many years there had been pressure to combine Lewisham Hospital with nearby Greenwich Hospital, but these plans stalled when a consultation in 2007 calculated that the Private Finance Initiative (PFI) costs borne by the two hospitals made a merger a financial non-starter. Instead Greenwich was levered into South London Healthcare Trust (SLHT) along with Queen Mary Sidcup and Bromley Hospital. Bromley Hospital also had a huge PFI debt: the upshot was that SLHT was committed to £69m repayments per annum to its PFI creditors, 14% of its income. From the outset it was doomed to fail, and it is now to be dissolved after a bare three years’ existence. It is now proposed to break up SLHT and merge Lewisham with Greenwich, closing Lewisham’s A&E services and reducing its emergency and complex surgery and maternity services.

The fight against the proposed closures in Lewisham will be a vital one given the lack of meaningful opposition to the government’s Health and Social Care Act. A combination of huge PFI costs and the need to meet £20bn budget cuts has left 21 other hospitals facing bankruptcy. In the words of the Department of Health they are ‘clinically and financially unsustainable’ and need ‘restructuring’. Many of them are in London where four other A&E units are earmarked for closure in Charing Cross, Ealing, Hammersmith and Central Middlesex. There will now be a concerted push to impose a capitalist solution to the problem: merge hospital Trusts and as part of the process ‘rationalise’ (ie, cut) A&E and maternity departments. 75% of hospital Trusts are considering mergers: an expensive and disruptive process, but one which offers potential pickings for private providers.

To offset the pressure from meeting the £20bn cuts target – expected to rise to £50bn for the three years from 2015 – Trusts are seeking to expand their private work. The ConDem’s Act allows Foundation Trusts to obtain up to 49% of their income from private patients. Buckinghamshire Healthcare Trust aims to double its private income over the next year, Chelsea and Westminster Hospital in London has expressed its intentions to increase private patient work and Wrightington hospital in Lancashire is establishing a new private patient unit. As we have warned, a two-tier system is being put in place: those who can pay will get better and quicker health care even from hospitals that remain in the NHS.

Selling off services

The combination of the £20bn budget cuts demanded by the previous Labour government and the ConDem’s Act has accelerated the pace of privatisation. Under the Act’s ‘any qualified provider’ policy, the private and voluntary sector is stepping in to take over large areas of health care, particularly community-based services, as they are put out to tender under EU rules. At the beginning of October 2012, contracts for nearly 400 NHS services were signed, including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children and primary care psychological therapies for adults. Non-emergency ambulance services in the northwest are being taken over by the bus group Arriva. These contracts are worth a quarter of a billion pounds and have drawn bids from 37 private healthcare and outsourcing companies. In 2013, at least another £750m of NHS services will be opened up for competition.

Private companies are unlikely to want to take over entire hospitals: there is too much risk in running emergency services, and hospitals provide a focal point for opposition when services are cut and staff sacked. At present, therefore, they are far more interested in simple elective operations: privately-run independent sector treatment centres are now doing 17% of hip replacements (11,500 operations) and 17% of hernia repairs (9,000) in England annually.

However, across the country, community services are worth about £15-20bn per annum, and this is where outsourcing and private health care companies are being most predatory. Earlier this year, Virgin won the contract worth up to £650m to run community services in north west and south west Surrey. It is now the preferred bidder for children’s services in Devon, a contract worth £140m. Serco has recently won the £140m contract to run community services in Suffolk. Practically its first step has been to cut 140 jobs. This includes clinical staff such as health visitors, although unlike administrative staff they will not be made compulsorily redundant. This will be the pattern for the future: once a company has won the tender it can sack as many staff as it likes, change working conditions, and do whatever it requires to make a profit, in the anticipation that the dispersed nature of the services undermines effective opposition.

The consequence of this for local services has been shown by Serco’s running of Cornwall’s out-of-hours service. Apart from lying about its data to cover up its failure to meet agreed targets, Serco ran the service by filtering people’s calls using staff with no medical or nursing training operating computer-generated scripts. The result was that A&E department attendances rose at the Royal Cornwall Hospitals Trust so that it was unable to meet its own targets. Serco profited at the expense of the local NHS hospital.

Fighting back

The fight to save Lewisham Hospital emergency services along with Charing Cross A&E has the possibility of becoming a turning point in the fight to save the NHS. A failure to mobilise in their defence will serve as a green light for cutting emergency services across the whole of London, the objective of management reviews for years. Now is the time to act, and demand an end to all hospital cuts across London and the rest of England, and the cancellation of all PFI debts.

For further information see:

www.savelewishamhospital.com and www.lewishamkonp.org

www.saveourhospitals.net

Robert Clough & Hannah Caller

ConDem health reforms - The end of the NHS in England /FRFI 229 Oct/Nov 2012

Fight Racism! Fight Imperialism! 229 October/November 2012

ConDem government policy for the NHS has become absolutely clear with the appointment of Jeremy Hunt as Health Secretary: it is to reduce state-run health care services to a basic minimum. Hardest hit will be the working class, the elderly, disabled people, the chronically ill and those suffering from diabetes or cancer. Quality and level of care will come at a cost to be met through a widening system of top-up payments – a two-tier system. Meanwhile state-run hospitals and primary care or GP services will be step by step taken over by private monopolies and run for profit. The end of the NHS as a universal system funded by taxation will be a savage blow for the working class. HANNAH CALLER and ROBERT CLOUGH report.

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