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
