On 31 July, the High Court found that the Secretary of State for Health, Jeremy Hunt, had acted unlawfully when he decided to cut two-thirds of services and close departments at Lewisham Hospital in southeast London. He had exceeded his powers when he parachuted in a Trust Special Administrator to make cuts in Lewisham to save the neighbouring South London Healthcare Trust and rescue two bankrupt Private Finance Initiative (PFI) hospital contracts in the region. On 21 August, the government confirmed it will appeal against the judgment and implied it may investigate changes to the law to prevent similar challenges to its plans in the future. The High Court ruling is a victory for all those who campaigned in Lewisham and for all those who continue to fight for services that are being taken away or pared down around the country. Had it not been for the campaign, the government would have got away with unlawfully destroying health services. This case also makes it clear that providing excellent services and meeting local needs are no safeguard against government-imposed cuts.
In Essex, two other hospital Trusts with huge PFI projects are creating financial problems. Queen’s Hospital in Romford cost £230m to build under a PFI scheme and is now forcing the part-closure of A&E and other acute services at nearby King George’s Hospital in Ilford. Both are part of Barking, Havering and Redbridge NHS Trust.
The hospital nearest to King George’s is Whipps Cross in Leytonstone. Its services are also under threat following a merger with Newham and Barts and the Royal London Hospital, to create Barts Health covering east London. This is now the biggest Trust in England. Within two months of the new financial year, it had accumulated a debt of £16m, and continues to lose £2m per week. This means it is nowhere near a savings target of £77.5m for 2013-14, 6% of its £1.25bn annual budget.
The source of its financial problems is a PFI scheme that saw the rebuilding of the Royal London Hospital and the redevelopment of Barts. The whole scheme cost £1bn, and annual repayments are currently £115m, over 14% of the annual turnover of the old Barts and the London Trust. These repayments are scheduled to increase over the years, so that in the end, the £1bn PFI hospital will cost £7bn. The debt drove the merger with Newham and Whipps Cross, and has created a bankrupt Trust that will savage services to get anywhere near the savings needed. Whipps Cross will axe 323 nursing and administrative jobs and impose pay cuts on 1,000 nurses and low-paid support workers. The Royal London was unable to admit any patients for 48 hours in the second week of September because it had no beds available. In the last 25 years, the total number of hospital beds in England has been cut by over half, from 282,918 in 1988-89 to 136,486 by April 2013. PFI hospital schemes always involve cutting bed numbers, typically by up to 30%. Across the NHS, PFI repayments have increased by nearly £200m in two years, from £459m in 2009-10 to £628.7m in 2011-12, leaving 20 Trusts in serious trouble with huge implications for staff and the health of the people using the service. It is clear that services will be sacrificed to pay off PFI debts.
This is all taking place in a situation of financial meltdown where the NHS faces a £30-50bn funding gap by 2020. The consequences are already proving to be devastating. By 2016, the NHS is forecast to be 47,000 nurses short just as study after study shows ward nurse staffing shortages are undermining patient safety. In September, Jeremy Hunt announced that 20 more hospitals in England will be put into special measures, following 11 Trusts already deemed to be failing.
Rather than fund decent and safe services with enough staff, the government is creating more and more layers of inspection with the appointment of two inspectors of hospitals and primary care. Professor Steven Field has been given the job as the first inspector of primary care. His tick list includes making sure 8,000 practices answer their phones between 08:23 and 08:27, ensuring disabled parking exists and that opening hours are appropriate and so on. This will require an army of inspectors costing some £30m, on top of the army inspecting hospitals and those staffing the Care Quality Commission, Monitor and NHS England. 48 senior executives at NHS England earn over £142,500, the annual salary of the prime minister. A total of 291 have a salary of over £100,000, so that almost one in 20 of the organisation’s 6,115 staff earns a six figure sum.
This bureaucracy is part and parcel of the government’s Health and Social Care Act, the alleged purpose of which was to enable GPs to lead the commissioning of health care services through Clinical Commissioning Groups (CCG). However, figures obtained under the Freedom of Information Act from 74 CCGs in England show that a third of their boards have had a GP member resign and, overall, 43% of CCG board membership is made up of GPs as opposed to 49% when they were set up. They are reverting to the old Primary Care Trust model as GPs cannot spend that time outside their surgeries.
However the government spins it, whatever management gimmick it puts in place, the NHS is grinding to a halt. Now more than ever is the time to take to the streets to highlight this, in the knowledge that campaigning works and the responsibility for the future of health care lies with us, the people who need it.
Hannah Caller
Fight Racism! Fight Imperialism! 235 October/November 2013
