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
Robert Clough & Hannah Caller
FRFI 230 December 2012/January 2013
