• NHS cuts put more hospitals at risk of Mid-Staffs failures

  Friday 26th February 2010
  
  THE SHOCKING failures of management and care at Stafford Hospital revealed in yesterday's report into the scandal could be echoed in other hospitals up and down the country if ministers insist on pushing through the massive cutbacks in spending and impossible "efficiency savings" that are now being discussed, warns pressure group Health Emergency.
  
  A key factor in the chronic lack of nursing and other staff, and desperately poor staff training at Mid Staffordshire Trust was the 150 jobs that were axed in a £10m cost-cutting operation to ensure that the Trust brought its finances into balance - to secure Foundation Trust status.
  
  Nurse and medical staffing were slashed to well below safe minimum levels - and the Trust was rubber-stamped as a Foundation shortly before its appalling levels of care were belatedly identified by the Healthcare Commission.
  
  But dozens, if not hundreds of NHS and Foundation Hospitals are facing cuts much larger than £10m, and much larger cuts in staffing as the squeeze on NHS spending takes effect from 2010-11. Some Trusts such as Leicestershire, Leeds, Derby, Heatherwood and Wexham, and the Royal Free are already axing hundreds of jobs.
  
  Many more have yet to announce how they aim to deliver the required "efficiency savings" and balance their books while Primary Care Trusts concentrate on diverting as many patients as they can away from hospitals, and slash the "tariff" of payments for treating patients.
  
  Health Emergency's Information Director John Lister said:
  
  "Health Secretary Andy Burnham has correctly argued that lessons have to be learned from the Mid Staffordshire scandal: but it makes no sense to keep on having inquiries about it if more and more Trust managers are simply going to be forced into the same desperate situation as the Stafford Hospital management.
  
  "There is a real danger that the mounting NHS pressure to deliver huge, quite unprecedented demands for "efficiency savings" and spending cuts - on a level never ever achieved in the NHS in its 62-year history - will drive more managers to seek similar irresponsible savings at the expense of patient care.
  
  "If ministers - and the opposition politicians cynically trying to cash in on this tragic situation - really want to reassure the public that no such thing will happen again, we need them to take the pressure off managers, and back-track on the savings targets and cash allocations for the NHS.
  
  "We need all the main parties to commit NOW to increase NHS spending by a minimum of 4% per year in real terms. If tens of billions can be created and spent on "quantitative easing" to benefit the bankers, no voter will object to some of the same generosity being shown to prevent unacceptable and dangerous cuts to our NHS."

• Thirteen London Hospitals set to lose services:
  Big turn-out expected at London-wide rally called by BMA

  Monday 22nd February 2010
  
  EMBARGO: Not for publication before 12.00 noon Weds February 24 2010
  
  AT LEAST THREE of the SIX district general hospitals that are due to see services scaled down or closed in North West London have now been identified in the 'Integrated Strategic Plan' drawn up behind closed doors by Primary Care Trusts. This brings the London-wide total of hospitals known to be at risk to THIRTEEN.
  
  The 72-page NW London document makes clear that it seeks to "reduce the level of acute services on the Ealing [Hospital] site" (page 51), while it reports that "the Board of West Middlesex Hospital Trust have recently clarified that they do not believe that their organisation has an independent future". Central Middlesex Hospital, too is identified as facing further downgrading of services to reduce it to a "local hospital". (page 51)
  
  With just three "major acute" hospitals to service the NW London population of 1.9 million in eight boroughs, it is clear that three more must be scaled down, raising fears that Hillingdon Hospital, too, and key services at Chelsea and Westminster and Hammersmith hospitals could be scaled back, leaving just St Mary's, Northwick Park and Charing Cross as "major acute" hospitals, and long journeys for patients from many parts of outer London needing hospital care.
  
  The North West London cutbacks are part of a programme launched by NHS London which it admits could axe up to a third of hospital beds in London. From the most recent Department of Health bed figures from the capital, that could mean a massive 5,600 front-line beds to close from a total of 16,868. Also under threat or facing virtual closure as district hospitals are Chase Farm, the Whittington, King George's Hospital, Ilford, Queen Mary's Sidcup and one other hospital in South East London, and Kingston, Epsom & St Helier and Mayday hospitals in South West London.
  
  This could mean tens of thousands of the most seriously ill patients in the capital being obliged to travel much further to access hospital care.
  
  The figures were highlighted last month in a critical BMA report 'On the Brink', which links the large scale cuts to NHS London's goal of cutting over £5 billion from health spending in the capital by 2017 as the growth in NHS funding grinds to a halt.
  
  It points out that NHS London is seeking to divert more than half of all outpatient work in the capital (5 million appointments), and nearly two thirds of A&E activity (almost 2 million) to experimental "polysystems", few of which as yet exist. This switch of millions of patients from hospital departments to primary care would mean London's hospital budgets would be slashed by upwards of £1 billion a year, an average reduction of almost £40m for each of the capital's 26 acute Trusts and Foundation Trusts - easily enough to force many of them out of business.
  
  The NHS London plans are based on controversial estimates contained in a document by US-based management consultants McKinsey which is being kept secret, preventing any scrutiny of the assumptions and the data they have used.
  
  On the Brink author John Lister said:
  "Campaigns are springing up all over London as local people wake up to the threat posed to their local health services. Redbridge campaigners have been protesting for months now, as have Chase Farm. The campaign to save the Whittington Hospital is growing rapidly. And South West London campaigners have already joined forces and launched a combined fight to defend all of the local hospitals that are threatened.
  
  "This is a problem that will gnaw away at the support of whichever party wins the election, with a succession of high-profile and possibly chaotic changes and cutbacks in the NHS, tearing the heart out of the existing hospital network, and axing thousands of health workers' jobs.
  
  "Whenever hospital services in London have been threatened over the years there has been a strong campaign to save them. What we don't yet know is where many local MPs and councillors stand on the potential closure of local services. They have to decide. Will they fight with local people - or against them?"
  
  
  NOTE TO EDITORS:
  
  The BMA Public Meeting has been called for 7pm on Thursday February 27, at BMA House in Tavistock Square, WC1. John Lister will be among the platform speakers.

• CAMPAIGNERS DEMAND PUBLICATION OF SECRET LONDON NHS PLAN

  Thursday 11th February 2010
  
  Campaign group London Health Emergency today demanded the publication of a secret hospital strategy document which could see the closure or downgrading of at least 11 of the capital's 31 Accident and Emergency departments.
  
  Last night, a leaked document passed to the BBC outlined plans that could see the axing and down-scaling of services at five hospitals in North West London alone leaving just three major centres to cover the area.
  
  In South West London there are growing fears that Kingston, St Helier in Carshalton and Mayday in Croydon will all see front-line services closed or downgraded with the hospitals becoming satellite units of St George's in Tooting. A new cross-South West London campaign to fight the plans will be launched next week.
  
  In South East London, the threat to Queen Mary's in Sidcup is already well documented, but campaigners fear that one more hospital may be added to the closure programme as the scale of the financial cuts required stacks up.
  
  In North East London a "business plan" already out to consultation proposes the effective closure of King George's in Ilford and massive bed cuts at Whipps Cross, Barts and the London and the Homerton. Active campaigns are already challenging these plans.
  
  To the north of the capital, campaigners continue to fight the closure of services at Chase Farm in Enfield, and plans to merge the Whittington with the Royal Free with the loss of A&E at the Whittington.
  
  Geoff Martin, Chair of pressure group London Health Emergency said:
  
  "Last night's leak from the North West London review, added to information leaking out in South West London, published details in NE London, and what we know about other parts of the capital, exposes the fact that the biggest closure programme ever cooked up for London's hospitals is being stitched together -- behind closed doors.
  
  "We are demanding that NHS London end the leaks and speculation by publishing all of the working documents on the London sector reviews and we have submitted a Freedom of Information request today on exactly those lines.
  
  "It is a scandal that the future of up to a third of London's A&E departments is being carved up in secret meetings despite the fact that these are life or death services paid for by Londoner's out of their taxes. Londoner's need to wake up and realise just what is going on, and just what is at stake, if we don't call the faceless, well-paid NHS London bureaucrats to account."

• Ministers dismiss Commission findings: now dismiss the Commission!

  Friday 5th February 2010
  
  Health campaigners have welcomed the news in the Health Service Journal that the Department of Health has dismissed as "anecdote" a report from the "Cooperation and Competition Panel" set up by previous Health Secretary Alan Johnson.
  
  The panel had been asked to intervene after Great Yarmouth and Waveney Primary Care Trust made clear that a £25m a year contract to run community services would only be open to NHS tenders. Various private sector companies, right wing and pro-market academics and so-called "social enterprises" have complained that this is in conflict with the Department's own principles and rules on competition.
  
  The PCT has argued that they were only following the new policy announced by current Health Secretary Andy Burnham last autumn, when he announced that the NHS would be the "preferred provider" of services unless there were insuperable failures in the quality of care.
  
  But despite changing the policy in a more sensible direction, Burnham has left in place much of the apparatus to implement the opposing policy: this includes the Cooperation and Competition panel, chaired by a leading private health boss, Lord Carter of Coles, and staffed almost exclusively with people from the private sector with little if any record of constructive involvement with public services.
  
  Worse, the competition policy that the Panel was set up to police is now part of the huge and costly bureaucratic structure of "World Class Commissioning", which has soaked up management time and involved Strategic Health Authorities and Primary Care Trusts spending millions on appointing otherwise useless Commercial Directors and other layers of management required to establish and monitor a complex "market" in health care.
  
  Calling for the Panel to be scrapped as the first of a series of major cost savings that would also improve efficiency in the NHS, Health Emergency information director John Lister said:
  
  "We're told the NHS faces cuts of £15-£20 billion over the next few years to balance the books as the growth in spending grinds to a halt. So surely the most sensible way to save large sums would be to strip out all of these surplus and unproductive bureaucrats, and the costly management consultants that have been employed to do much of their work: none of them contribute in any way to patient care.
  
  "The market-style reforms have been an expensive fiasco. Andy Burnham has at last begun to recognise this, but he should go the next step to save money in a way that every health worker and patient would happily support.
  
  "Boot out the over-paid bureaucrats, and the over-priced private providers, and concentrate on allowing the NHS to deliver top quality services with the minimum of overhead costs."

• One third of London's hospital beds at risk - official

  Saturday 23rd January 2010
  
  Up to a third of hospital beds in London could be forced to close under drastic new plans being hatched up by NHS London - and that's according to their own summary of their proposals. From the most recent Department of Health bed figures from the capital, that could mean a massive 5,600 front-line beds to close from a total of 16,868.
  
  This could mean a dozen or more popular, busy hospitals being forced to close their doors and tens of thousands of the most seriously ill patients in the capital being obliged to travel much further to access hospital care.
  
  NHSL's assistant director of strategy Sam Higginson gave the shock figures yesterday, responding to a critical BMA report 'On the Brink', which warns of large scale cuts as health chiefs aim to cut over £5 billion from spending by 2017 and the growth in NHS funding grinds to a halt.
  
  The report was researched for the BMA from Primary Care Trust and other published papers by Health Emergency's Information Director Dr John Lister. It points out that NHS London is seeking to divert more than half of all outpatient work in the capital (5 million appointments), and nearly two thirds of A&E activity (almost 2 million) to experimental "polysystems", few of which as yet exist.
  
  This switch of millions of patients from hospital departments to primary care would mean London's hospital budgets would be slashed by upwards of £1 billion a year, an average reduction of almost £40m for each of the capital's 26 acute Trusts and Foundation Trusts - easily enough to force many of them out of business. But to make matters even worse NHS London wants annual cuts in the "tariff" that fixes the amount hospitals receive for delivering patient care. And it's not just hospitals under the axe: NHS London wants to slash the workforce in primary care and community services by two thirds (66%), and even cut the length of GP appointments from an average 12 minutes to just 8.
  
  But it's not clear how reorganising services for minor injuries and outpatients could make it possible to close thousands of INPATIENT beds for those with the most serious health problems. Nor has NHS London shown any evidence to prove that their new proposals would be cheaper, more efficient or deliver better care than the existing hospital services they are threatening with extinction. Their plans are based on controversial estimates contained in a document by US-based management consultants McKinsey - and it is being kept secret, preventing any scrutiny of the assumptions and the data they have used.
  
  On the Brink author John Lister said:
  "This is not just a future problem. Most of the capital's 31 Primary Care Trusts which hold the purse strings for health services are already facing hefty overspending, and looking for ways to impose cuts as soon as the General Election votes have been counted.
  
  "Plans like those we have already seen for the effective closure of acute services at King George's Hospital, Ilford, Chase Farm in Enfield, and Queen Mary's Hospital, Sidcup, and the downsizing of Islington's Whittington Hospital will be followed by many similar cuts across London. Nowhere is safe from these reckless proposals.
  
  "This is a problem that will gnaw away at the support of whichever party wins the election, with a succession of high-profile and possibly chaotic changes and cutbacks in the NHS, tearing the heart out of the existing hospital network, and axing thousands of health workers' jobs.
  
  "Changes on this scale have never before been imposed in any health system in the world. They threaten to leave the capital desperately short of hospitals and health care.
  
  "I am challenging NHS London to publish the secret McKinsey document for public scrutiny, produce evidence to prove that their plans would save money or improve services, and show how the heavy cost of creating a new network of polyclinics would be funded.
  
  "Without sight of the document that is driving these plans nobody can scrutinise the assumptions or the logic underlying the NHS London proposals, which seem to be taking far-reaching decisions on pure guesswork.
  
  "The people of London deserve better than a cull of a third of their hospital beds and the closure of many popular local hospitals on the basis of secret figures which appear to have been calculated on the back of a fag packet in secret by US-based management consultants."
  
  
  On the Brink is published by the BMA's London Regional Council. Their webpage can be found at:
  http://www.bma.org.uk/representation/local_representation/regional_councils/lrcreportlondonsnhsonthebrink.jsp
  
  The report's Executive summary can be found at: http://www.bma.org.uk/images/onthebrinkexecutivesummary2010_tcm41-193387.pdf
  
  The Full On the Brink Report, which includes a full PCT by PCT analysis of the growing problems around the capital, is available:
  http://www.bma.org.uk/images/onthebrinkreport2010_tcm41-193388.pdf

• GP shake-up: campaigners challenge Burnham to come clean

  Friday 18th September 2009
  
  Health Secretary Andy Burnham is being challenged to name the sources of his latest controversial proposals to shake up GP services, and explain the full implications of the plan described as "allowing patients to choose their GP", effectively scrapping any fixed boundaries for GP practices.
  
  The proposal is being sold as a way to allow flexibility for people of working age who wish to register with a doctor close to their workplace, or for "busy mums" who may wish to register at a practice near her children's school.
  
  But the proposals would offer little benefit for those who are most heavily dependent on primary care services - older people, and the chronic sick, many of whom have mobility problems, low incomes, and lack a car or the money for taxis to travel further for treatment.
  
  And while controversy still rages over the GP contract which allowed doctors to buy themselves out of the obligation to offer "on call" services overnight, Burnham's plan would involve scrapping another essential aspect of primary care: the legal obligation on GPs to visit patients on their list at home.
  
  It seems certain that this would involve the privatisation of home visiting services, creating even more problems of ensuring quality and public scrutiny than the costly and problematic out of hours deputising services, which already depend heavily on doctors expensively flown in from Poland, Germany and other European countries to work casual shifts.
  
  Health Emergency's Information Director John Lister said:
  
  "We believe this policy is yet another example of back-door privatisation by New Labour.
  
  "But the question is where have all these policies been coming from? There is no public pressure to privatise GP services - or any other NHS services. Quite the opposite - almost all of these plans are being pushed through without proper discussion or debate because ministers like Andy Burnham know they would be unpopular.
  
  "And at a time when the costs of bureaucracy in Primary Care Trust are already soaring, with a massive expansion of admin and managerial staff, this new scheme will involve even more wasteful bureaucracy, and divert even more resources away from patient care.
  
  "Press reports suggest that this idea comes from Lord Darzi - a surgeon with no experience of primary care. Others tell us it was dreamed up by some back-room policy wonk in Burnham's office.
  
  "Whoever was responsible, we know it was not doctors, the health unions or the public - the people Andy Burnham should look to if he wants a sensible policy."

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