Pace hots up as Tory Health & Social Care Act shows its teethMonday 4th November 2013
October was one of those months: the big news just kept on happening, and the growing crisis gripping the NHS has become more and more obvious.
To make matters worse, an architect of Labour's costly market-style "reforms," former Blair advisor Simon Stevens - who has for nine years been a high-flying director of the biggest US health insurer UnitedHealth - has now been appointed to replace Sir David Nicholson as chief executive of NHS England.
The rapid descent into market chaos seems set to accelerate further.
The pace was already hotting up. Early in the month, the NHS Confederation threw down its "challenge" to politicians, demanding they sign up to support swingeing and unpopular local cuts and "reconfigurations" in hospital services in the run up to the 2015 election.
The Confed warns that unless they do so, and MPs stop defending their local hospitals and start attacking their own voters' services, the NHS stands little chance of making the massive cutbacks needed to bridge a growing gap between the miserable frozen budgets set by George Osborne and the rising pressures and demand.
The current "challenge" of saving £20 billion by 2015 (for which most savings have so far come from effectively cutting the pay of over 1 million NHS staff) is to be followed by an even steeper "challenge" of saving another £30m by 2020.
In case you are wondering where it went, most of the money "saved" so far has been clawed back by the Treasury, not reinvested in the NHS.
The Confed threat was followed by the medical director of the obscure new 'London Area Team' of NHS England, Dr Andy Mitchell, who emerged from the shadows to claim that London's hospital services were "unsustainable," and that swift action is needed to close half its A&E units and many of its maternity and children's services.
On closer examination it was clear Dr Mitchell was concerned first and foremost with finances, since his warning was that action had to be taken to prevent London's NHS running up a £4 billion deficit by 2020, and he went on to argue that the capital's trusts could "not afford" to staff wards safely.
This blunt statement at least cut through the usual rigmarole in which NHS bureaucrats seeking to drive through cuts insist time and again that the cuts they are proposing are "clinically led". In this case the only real clinical element was it was a doctor insisting on the need for financial balance, and for services and patient to be cut to fit the budget.
This comes alongside the continuing claim by the government and a rag-bag of so-called think-tanks and professional bodies that the NHS has to close A&E units "to save lives" - although these arguments stop dead in constipated silence when the question arises of how the remaining A&E units, and the hospitals to which they are attached, could possibly cope with the additional tidal wave of seriously ill patients who would be brought from ever-greater distances needing treatment - and beds. There is clearly no spare money to rebuild and expand on the scale required.
In Worcestershire, where on average 99% of hospital beds were occupied in early 2013, cash saving plans are seeking to close beds and services in Redditch and Bromsgrove to centre them in Worcester.
There is no serious consideration about the journey times and the problems for elderly and low-income patients who would be forced to make ever-longer journeys to access care: instead we are constantly told about the services that will available to those with the most trivial needs, who would still be catered for locally in "urgent care centres".
There are constant blustering assertions that hospital care could be replaced by community-based care - but on closer examination there is little if any evidence that this can be done, or that there are any real plans to do it where hospitals are scheduled for downgrading, or that proper community based services are any cheaper than existing hospital care. There is even less evidence that this is what patients would prefer to local access to hospital.
In place of concrete plans for expanded community services, all we get, everywhere, is fine words, aspirations and wishful thinking: that's not much use to deal with tens of thousands of poorly patients.
Meanwhile we have been told that hospital budgets will lose another £2 billion per year from 2015, which will be carved out of NHS spending and allocated to social care, where budgets have been brutally slashed by desperate councils facing Osborne's 28% cuts.
A stark reminder of the limits of community-based care came with some stark warnings during the month that year upon year of cutbacks in mental health budgets had reduced beds to dangerous, crisis levels. This is after years of transforming many services from hospital to the community.
There have been days this year in London - and even in the whole of the country - in which there have been NO mental health beds - either in the NHS or private sector - available for those with serious needs. Many other days have seen patients in distress dispatched after long delays on lengthy journeys to beds in other cities, many of them hundreds of miles from their homes and family.
Despite the headlines and crocodile tears from ministers the squeeze on mental health continues.
The competitive market in health care has also gone badly wrong, with the Competition Commission now wading in to block Trust mergers and reconfigurations, private hospital firms forcing the regulator Monitor to investigate where they are not awarded contracts, and Clinical Commissioning Groups ludicrously blocked by the HSC Act from meeting together to plan services.
Meanwhile patient "choice" and competition could be wiped out by a new private monopoly in Cambridgeshire, where the Clinical Commissioning Group is pressing ahead with a hugely complex plan to put whole pathways of care out to tender. The existing, successful NHS provider is no longer among the bids - raising the grim prospect of Virgin scooping up a monumental 5 year £800m contract.
In Bedfordshire too, the CCG is set to hand a similarly complex £120m contract for musculoskeletal services to a privately-led consortium which includes a company owned by almost half of Bedfordshire's GP practices.
As the fragmented, divisive, wasteful competitive market system set up by the Health & Social Care Act began to display its nonsensical side, Jeremy Hunt tried to smuggle through even more draconian legislation to allow "special administrators" to carve up local services as well as bankrupt trusts - in a clause tagged on to the Care Bill in the House of Lords.
Even if he gets his way, it will come too late to rescue Hunt from the embarrassment of losing his appeal against the court ruling that prevented him rubber-stamping the closure of most services at Lewisham Hospital.
And increased powers for the administrator would not help force through the closures in North West London, some of which have been delayed by the Independent Reconfiguration Panel.
The IRP found that there were no convincing plans for community and other services to replace the closure of A&E and services at Ealing and Charing Cross Hospitals - and ordered the A&Es to be "sustained" until alternative services were in place.
Desperate NHS hospital managers have begun hoping for the public to turn their backs on the NHS, and allow them to drive through unpopular cuts.
A shameful article by the chief executive of the Foundation Trust Network, Chris Hopson in the Health Service Journal (and echoed in a wretched Guardian article) celebrated the first small signs of weakening public affection for the NHS, as ministers, the BBC and the right wing press delight in stories of poor care and service failures.
An opinion poll had found fewer people (60%) supporting the view that "the NHS is a symbol of what is great about Britain and we must do everything we can to maintain it" and a larger minority (30%) have been bludgeoned by the right wing media into believing that "the NHS was a great project for its time but we probably can't maintain it in its current form".
By most readings, that's still a substantial majority behind the NHS, despite all the bad headlines and cutbacks. Numbers could be pushed up even further if Labour set its face against further cuts and gave hope some services might be restored rather than closed.
Remember, we are still many, they are few.
Let's fight on, while there's an NHS to defend.
Cash crisis behind new calls for London hospital closuresSunday 13th October 2013
Panic-mongering statements by NHS England claiming that London's hospitals are "unsafe" and that the system is "unsustainable" are a cynical bid to stampede Londoners into accepting hospital closures, according to London's longest-running campaign to defend the NHS.
The controversial claims have been made by Dr Andy Mitchell, in a Sunday Times article in advance of the publication of a far-reaching report. Dr Mitchell is Medical Director of NHS England's shadowy "Local Area Teams" which have now replaced NHS London.
But while they will be used by the right wing press as a new way of driving through current - hugely unpopular - plans to axe up to nine of the capital's 27 A&E units and additional maternity and other services, the claims that services are 'unsustainable' are now coupled with calls for EVEN MORE A&E closures.
According to NHS England up to half the A&E units should close, along with paediatric and maternity units. But even as these announcements are being made cutbacks are already taking place in other services: the capital faces a dire shortage of mental health beds and primary care services too are being slashed to save money.
Rejecting this approach, London Health Emergency's director Dr John Lister, who has followed health care in the capital for almost 30 years, said:
"This is not a health crisis but a financial crisis. The problem has been entirely manufactured by unrealistic government spending limits as they slash public services to pay back the billions used to bail out the banks.
"Ministers have been warned time and again that cuts this big in NHS spending are unprecedented anywhere in the world. We can now see that they threaten the end of a viable NHS in London and elsewhere. To close so many emergency services would require huge investment to provide adequate beds were available in the surviving hospitals, in ambulance services, and in alternatives to hospital. But all of these are actually being cut.
"This case may be argued by a medical director, apparently citing "clinical" concerns: but the argument for these cuts is not clinical but financial. What doctor could sensibly accept the possibility that London cannot afford to staff its hospitals safely?
"NHS England admit that maintaining the present system with "zero financial growth" would bring a London shortfall of £4 billion by 2020 and a national deficit of £30 billion. A sensible answer would be to increase spending to sustain health care, not wreck the NHS to impose an artificial balance.
"And don't let anyone imagine the private sector offers any solution or escape: the services at risk here are precisely the high risk and costly services the private sector will not provide because they make no profit. If London's A&Es are cut back wealthy Tory voters will die alongside the poor in the delays and chaos that would follow".
NOTE TO EDITORS: The developing crisis in London is being investigated by the Peoples Inquiry into London's NHS, with public hearings in all parts of the capital in the next two months.
FURTHER DETAILS and COMMENT: John Lister 07774 264112, email@example.com @JohnRLister
Lessons from LewishamFriday 2nd August 2013
Lewisham Hospital campaigners and Lewisham Council have notched up a major victory for local democracy with their successful pursuit of a judicial review against plans to slash two-thirds of their hospital services.
The High Court ruling found that both the trust special administrator, trying to find cuts to balance the books of the floundering South London Healthcare Trust and rescue its two bankrupt PFI hospital contracts, and Health Secretary Jeremy Hunt had exceeded their powers.
Mr Justice Silber also declared that Hunt's decision to rubber-stamp the administrator's plan to hack back on Lewisham's services had broken his own government's pledge not to implement cuts that were not supported by local GP commissioners.
The case shows how little democratic control there is over NHS England.
After all the rigmarole of "consultation" had proved itself useless, only stubborn local resistance and a costly legal challenge has prevented Hunt from steamrolling through brutal cuts for which there is no legal basis.
He would have got away with it if not for those pesky campaigners.
The judgement is already inspiring other campaigners to consider legal action to challenge cuts which they see as unacceptable.
But there were key features which made Lewisham special - not least the sheer scale of the popular movement opposing the cutbacks from their first announcement, and the willingness of Lewisham's Labour council to support its own residents in seeking to defend local hospital care.
The worrying thing is that the legal judgement hangs purely on legal points and the precise wording of legislation - it does not address the likely consequences for patients of the cutbacks and reorganisation of South London Healthcare Trust.
Nor did the judge pay any attention to the powerful clinical evidence produced by consultants at Lewisham Hospital which showed the excellence of the services that the administrator wanted to close down, and what the consequences of these cuts would be in one of London's most deprived boroughs.
He took notice of the views of Lewisham GPs and the local clinical commissioning group not so much on the clinical concerns but on the simple fact that they remained unconvinced by the plan and opposed to the cutbacks in Lewisham.
The Department of Health immediately stated that it would appeal and attempt to reverse the ruling - and if necessary change the law to prevent any similar setbacks.
So it's clear that Lewisham has been given a limited reprieve that could still be only a stay of execution.
Meanwhile the sweeping powers which the administrator is given under 2006 and 2009 legislation establishing the "unsustainable providers regime" can even now still be used to impose far-reaching cutbacks on other trusts - as long as no other trusts are affected.
In other words it's possible in other situations for equally bad plans to be implemented with no possibility of a similar judicial intervention.
It's also clear that excellence and meeting local clinical need are no defence of services where financial pressures are driving cuts.
Mid Staffordshire Hospitals, the first foundation trust to be subjected to a South London-style carve up by the trust special administrator, is 20 miles from the nearest alternative hospital.
It has been delivering high-quality services, praised by inspectors and by patients.
But the administrator now plans to save money by closing its maternity and paediatric services, which have never been criticised, along with much of its emergency care, leaving only a scaled-down shell of a hospital awaiting the next round of cash-driven cutbacks.
It seems the only guarantee of hospitals remaining intact is for them to have signed up in the past to ruinously unaffordable PFI schemes, making them effectively "black holes" sucking in every available health budget in the surrounding area.
Indeed, far from saving money, the administrator's plan for South London Healthcare, including writing off back debts and subsidies for the PFI deals in Queen Elizabeth Hospital and Princess Royal University Hospital, is set to cost taxpayers almost £1 billion extra over the next 20 years - for reduced services.
It's not clear how the scheme could be remodelled if the court's ruling stands.
Across the country more PFI deals are also going to have to be massively subsidised to keep trusts afloat.
Across the river from south-east London, two more massive PFI projects are creating huge financial problems in north-east London.
The cost of the £230 million Queens Hospital in Romford is forcing virtual closure of A&E and acute services at the Barking Havering & Redbridge Hospitals Trust's other main hospital site, the 20-year-old King George's Hospital in Ilford.
These plans are being forced through despite massive local opposition and despite the desperate shortage of A&E capacity and acute beds in the trust.
One hospital likely to feel the consequences of closing A&E at King George's is Whipps Cross Hospital in Leytonstone, which serves the borough of Waltham Forest and is the next hospital around the north circular from Ilford.
But Whipps Cross, too, is now in danger, not so much from its own long-standing financial problems but as a result of its merger with Newham and Barts & the London hospitals to form one massive, hugely indebted new trust, Barts Health.
Just two months into the financial year the trust, England's biggest, is already £15.7m in the red and losing £2m a week.
It is falling well short of its massive £77.5m target for cash savings this year - over 6 per cent of its £1.25bn budget.
Barts Health now says it is "putting itself into turnaround" to avoid being put "into administration."
Again the financial problems of Barts Health centre on PFI - in the form of the colossal bills for the new London Hospital in Whitechapel and the redevelopment of the historic Bart's Hospital, which together cost a staggering £1bn, with the first full year of inflation-linked payments £115m this year, rising each year to 2048.
These unitary charge payments alone are over 14 per cent of the annual turnover of the old Bart's & London Trust. The need to find other resources to help cover this cost was certainly the key factor in the merger last year with the financially troubled Whipps Cross and the struggling Newham Trust to create one massive, essentially bankrupt trust covering much of inner north-east London.
Of course managers - and no doubt ministers past and present - are in denial, and vehemently reject any suggestion that the £7bn-plus cost of a £1bn PFI hospital is a factor in the problem at Barts.
They are blaming all kinds of things - increased demand for A&E services, shortfalls in elective services, staff shortages leading to inflated agency staff bills and the continued relentless £20bn national squeeze on NHS spending.
All these are added problems - but campaigners have warned since the 1990s that the Barts & London PFI plan was unaffordable. They were right.
And if these and similar PFI payments and cash pressures are not going to tear the guts out of our NHS up and down the country, campaigners learning from Lewisham must not rely on legal action but keep up the old-fashioned protest and mass demonstrations.
Bad decisions will go through unless local people grasp the need to fight back hard, and keep on fighting.
Campaigners need to keep on winning because the moment they lose and a hospital closes services, there will be no way back. Once it's gone, it's gone.
PFI "smelly white elephant in the room" in Barts Health financial meltdownThursday 18th July 2013
Desperate measures by bosses of Barts Health, England's biggest hospital trust mean that scarce NHS funds will be squandered on a doomed attempt to get a costly "turnaround team" to tackle a £2m per week deficit.
Just 2 months into the financial year the trust, which runs Barts & The London, Whipps Cross and Newham hospitals, is already £15.7m in the red and falling well short of its massive £77.5m target of cash savings this year - over 6% of its £1.25billion budget.
The trust has said it is "putting itself into turnaround" to avoid being put "into administration". What this means is that the board is desperate to avoid being subjected to the draconian measures of "unsustainable provider regime" and the resulting brutal attentions of a Special Administrator, as happened recently to South London Healthcare Trust, with devastating consequences for services in SE London.
But, like South London Healthcare, at the core of the financial problems of Barts is the controversial Private Finance Initiative (PFI) in the form of the colossal bills for the new London Hospital and the redevelopment of Bart's Hospital, which together cost a staggering £1 billion. This is the first full year of "unitary charge" payments on the PFI contract, which begin at £96.5m and increase each year to the final payment of £223m in 2048.
The unitary charge payments alone amounted to a massive 12% of the annual turnover of the old Bart's & London Trust, and the need to find other resources to help cover this cost was certainly the key factor in the merger last year with the financially-troubled Whipps Cross and the struggling Newham Trust to create one massive, essentially bankrupt Trust covering much of inner NE London.
As was the case with South London, managers (and no doubt ministers past and present) will vehemently reject any suggestion that the £5.3 billion cost of a £1 billion PFI hospital is a factor in the problem at Barts.
They are blaming increased demand for A&E services, shortfalls in elective services, staff shortages leading to inflated agency staff bills and the £20 billion national squeeze on NHS spending.
Dr John Lister, Director of pressure group London Health Emergency, who has analysed the NHS in London for almost 30 years said:
"Everyone is pretending it's not there, but PFI remains the smelly white elephant in the room. We have warned since the 1990s that the Barts & London hospital plan was unaffordable.
"PFI is the reason why - no matter how many management consultants are paid thousands of pounds a day, or what horrific plans an administrator might hatch up - there is no solution to the financial problem within the Bart's Trust without wholesale cuts in services and staffing that would potentially put patient care and safety at risk.
"The special administrator for South London Healthcare effectively recognised this: he could not solve that problem within the Trust itself. In fact his package will cost the taxpayer upwards of £750 million over 20 years. It rescues the two PFI hospitals and guarantees payments to the PFI shareholders - but savages services in the neighbouring Lewisham Hospital and inflicts cuts elsewhere in SE London.
"The financial problems at Barts Health are much bigger even than South London: so any 'solution' will be more drastic. And since PFI contracts are seen as inviolable, this is almost certain to mean massive cuts in Newham and or Whipps Cross.
"PFI has always been an extremely a costly way of building new hospitals, at the expense of other services. It is destabilising trusts and services across England. If ministers don't act on this and go to the root of the problem, Bart's will be the latest and the biggest in what will be a series of massive financial disasters in which the only beneficiaries will be bankers, management consultants and lawyers."
FURTHER DETAILS AND COMMENT: Dr John Lister 07774 264112, firstname.lastname@example.org
MORE INFORMATION on South London Healthcare available: http://www.healthemergency.org.uk/challengingpfi.php
Urgent action needed to rescue NHS!Sunday 23rd June 2013
Unions call for Sept 29 demo, Manchester
Three years into the Tory-led coalition government, and the damage inflicted on the NHS is beginning to revive memories of the dark days of Thatcher in the late 1980s. Waiting times and cancellations are up, public satisfaction is down, and the far-reaching proposals of the Francis Report to remedy quality failings have almost all been dumped in a ministerial bin.
Emergency services are struggling to cope with rising demand: ambulances take longer to arrive, some of them staffed with cheaper, less well qualified private sector crew - and face longer journeys to hospitals as A&E units close. Ambulances are already queuing at peak times outside big hospitals waiting to hand over patients as A&E units clog up, with no beds free to admit the most seriously ill, while hospitals struggle to discharge patients as endless cuts in local government again hit social care.
Elective operations and even cancer treatment are cancelled or delayed by the lack of beds.
Yet despite the lack of evidence to support them, still more plans are relentlessly rolled out to close A&E units, downgrade them to "Urgent Care Centres" forcing those with most serious illness to travel furthest, axe even more acute hospital beds and "reconfigure" hospital services to save money towards a massive £20 billion target - with the savings being cynically scooped back into the Treasury to pay for tax cuts to the rich.
The pressure is greatest in emergency care, where seven out of ten hospitals lose money on services, and where any extra patients above 2009 caseload are paid for at just 30% of the tariff cost: but axing A&E also kick-starts the process of closing whole hospitals as related services close one after another.
Many of the newest hospitals, saddled with massive, rising, long-term unaffordable overhead costs from the Private Finance Initiative, are struggling to avoid bankruptcy, and one Trust, South London Healthcare, has already gone bust, dragging down the neighbouring Lewisham Hospital. The package to rescue the two disastrous PFI schemes at the root of South London's woes will axe most of Lewisham Hospital and cost upwards of £700m: the two PFI hospitals cost just £214m to build.
Ministers' energy has been focused on privatisation - at the heart of the Health & Social Care Act - and not access to health care. Cambridgeshire is planning the first £1 billion privatisation of services. Virgin, Serco and other multinationals are licking their lips at the profitable prospects ahead. Top NHS Foundation Trusts are using new "freedoms" to expand their private wings, even as budgets for NHS care are cut back.
The squeeze on the NHS is a vital part of the Tory strategy to expand private medicine and open up more of the £100bn NHS budget to private corporations.
Hospital cuts & closures up and down the country are the sharp end of this Tory offensive, generating the most public awareness. That's why it's vital that the broadest possible movement unites to defend our hospital services: huge protests at cuts in Ealing, Islington (Whittington), Lewisham and Stafford have shown the way.
The Thatcher years were bad: but at least we then had a united opposition, and did not need to wait for Labour to make up its mind which cuts to support. We need a clear line now, to unite the vast majority from all parties: an NHS for patients, not profits! No to any closures of A&E, maternity or hospitals; drop the £20 billion cuts target; scrap PFI; halt privatisation, and bring services back in house.
Despite Tory efforts & the LibDems, it's still mostly OUR NHS. But we have to fight to keep it that way, or your health will become somebody's business. Let's Keep Our NHS Public!
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