ON 31st July 2008 the Independent Reconfiguration Panel (IRP) produced their report on the future of health services in Barnet, Enfield and Haringey.
In it they completely back the proposals of the Barnet, Enfield and Haringey (BEH) Primary Care Trusts (PCTs) to close Chase Farm Hospital as an acute District General Hospital.
The title of the report was ‘Advice on the Proposals for changes to the distribution of services between Barnet, Chase Farm and North Middlesex Hospitals and the associated development of community and primary care services’.
It was submitted to the Secretary of State for Health Alan Johnson and made public on Thursday 4th September.
IRP members who took the lead in this review were: Ailsa Claire, (Chief Executive of Barnsley PCT), Ray Powles (CBE, Head of Haemato-oncology at Parkside Oncology Clinic, a large private clinic in Wimbledon, an academic previously at the Royal Marsden Hospital), Paul Roberts (Chief Executive of Plymouth Hospitals NHS Trust ) and Sanjay Chadha, (Justice of the Peace, Havering, and member of some Multiple Sclerosis Society committees).
The main BEH reviewers therefore were two chief executives of PCTs as managerial reviewers, a JP as lay reviewer and a clinician heavily into private medicine as clinical reviewer.
The IRP, despite its name is not independent. It is government appointed and government funded.
The report states that their remit was to consider the needs of patients, public and staff, taking ‘into account safety, sustainability and access’.
They make clear that they were guided in their recommendations by two Department of Health (DoH) reports: ‘Consulting the Capital’, produced by the Joint Committee of London PCTs, and ‘A High Quality of Health for All’, containing the final report of the Darzi NHS Next Stage Review of the NHS in England (DoH June) and ‘Healthcare for London’.
These government reports favour closing acute comprehensive District General Hospitals (DGHs) and replacing them with so-called ‘care closer to home’ in polyclinics, urgent care centres, and elective surgery centres.
At present, 950,000 patients from Barnet Enfield and Haringey, and from Broxbourne and Hertsmere in South Hertfordshire, are served by three hospitals: Barnet Hospital, Chase Farm Hospital and North Middlesex Hospital.
The first stage of Barnet Hospital was built with £33 million of public finance and was completed in 1997. The second stage was built and managed through a private finance initiative (PFI) partnership with Metier consortium (formed by Bouygoes, a Paris-based conglomerate, and Siemens.) The hospital was opened in 2003.
Bouygues consortium is now financing and building a new hospital next to the North Middlesex Hospital (NMH), due to be completed in January 2011 and costing £110 million.
The proposals for Chase Farm Hospital (CFH) put forward by the BEH PCTs on 11 December 2007, are essentially to turn CFH into a community hospital like Edgware (Edgware DGH was closed in 1999 when Barnet and Chase Farm became one Hospital Trust).
Option 1, chosen by the PCTs and endorsed by the IRP, proposes: ‘Planned care would be expanded on the Chase Farm site to incorporate planned inpatient surgery moving in from Barnet site and some from the North Middlesex Hospitals for treatment other than major surgery.’
This means that all the acute services would leave CFH – A&E, emergency medicine and surgery, paediatrics, consultant-led maternity unit, acute gynaecology, and intensive care.
CFH would therefore no longer have an Accident and Emergency Department backed up by a fully functioning acute hospital with acute inpatient beds and 24-hour operating theatres, emergency surgery and anaesthetics, 24 hour x-ray and imaging facilities.
Patients with acute surgical conditions such as appendicitis or fractured hip or acute medical conditions such as heart attack or acute pneumonia, could no longer be admitted and treated there.
The acute medical and surgical wards would close, inpatient wards for babies and children and mothers giving birth would go.
The nursing staff and junior doctors required to staff these wards would be dispersed, as would many of the consultants.
These acute services would be transferred to Barnet and North Middlesex Hospitals.
The PCTs told the reviewers that 80% of the patients that currently use CFH A&E department would be equally well served by an urgent care centre!
Urgent care centres are staffed by nurses or GPs mainly, they cannot be compared with an A&E backed up by all the departments of an acute hospital.
It proposes the provision of a number of urgent care centres in the area.
London Ambulance Service (LAS) has indicated that two more ambulances would be needed to transport emergency patients to Barnet and NMH. The PCTs have agreed to fund them.
LAS said that 88% of the blue light patients which currently attend CFH would go to NMH instead.
The report proposes a stand-alone midwife-led unit on the Chase Farm site.
At the moment, the number of deliveries at the three hospitals is fairly equally divided, with over 3,000 at each of the three sites.
The reason given for centralising the consultant-led obstetric services at Barnet and NMH was to co-locate them with the paediatric and neonatal services.
The paediatricians had apparently told the reviewers that they only wanted two paediatric and neonatal units in the area, that they did not have enough doctors and nursing staff and that if they left Barnet to come to an emergency at CFH, Barnet then suffered the lack of on-site specialist consultant cover.
Once again, the lack of funding of a paediatric unit, is being used as the main clinical excuse for closing a high quality consultant-led maternity unit and thereafter a whole hospital.
The reviewers argued that it is difficult to recruit doctors and that European working time directives reduce doctors’ hours of work.
However, there is no shortage of doctors who want to train in paediatrics or obstetrics and, in fact, doctors are queuing up for consultants’ posts in obstetrics and gynaecology. All that is required is the funding.
The other reason being cited for the closure of the consultant-led maternity unit at CFH is the government’s new requirement that all obstetric units should be larger so that there can be 98 hours of dedicated consultant presence.
There are many obstetricians and gynaecologists however who do not agree that bigger units are necessarily better with or without the 98 hours of coverage.
The report admits there was opposition from midwives for a stand-alone midwife led unit.
There is definite risk to mothers and babies from a midwife-led birthing unit unsupported by a consultant-led maternity unit on site.
The PCTs told the reviewers that under the proposed changes, 25% of existing patients will be treated closer to their homes, 63% will still attend Chase Farm for their care and only 12% (133 people per day) would have to travel to another hospital.
The report admits that the biggest single issue of concern among the public of Enfield and those living in Hertfordshire to the north, was transport.
So clearly, the people of Enfield and Herts consider that many of them will have to find the means to travel to Barnet and NMH.
The report also admitted that Haringey and Enfield PCTs have had financial difficulties and still have to address ‘historic deficits’.
They warn about the costs of the changes especially as the PCTs have promised to ‘double run’ services; i.e not to close CFH services until alternatives are in place.
‘There was lack of detail on the costs of the new primary care improvement programmes’ such as large healthcentres (polyclinics) and urgent care centres.
‘It is also clear that the capital plans in the pre-consultation case business-plan do not have a clear source of funding. This is also a matter of concern to the panel’(!)
The report whitewashes the fake consultation carried out by the PCTs with the residents of the area and accepts the fact that the PCTs decided what they wanted from the start and did not listen to all the protests and opposition.
The fact that only 13,000 people replied to a consultation document out of 950,000 residents, they found quite satisfactory.
They also failed to report the result – that over half of the replies were in favour of saving CFH, the biggest group, and that therefore the people’s wishes were ignored.
The report’s final recommendation calls for the lead PCT to ensure that a ‘Gateway Review’ is undertaken before any further steps are taken.
The Gateway process involves bringing in the Office of Government Commerce (OGC) which: ‘manages on behalf of its public sector customers, the corporate commercial relationship with strategically important suppliers to government and maintains intelligence on market and suppliers’.
Current ‘strategically important suppliers’ are: Accenture Atos Origin, BT, Cable and Wireless, Capgemini, Capita, CSC, Deloitte, EDS, Fujitsu Services, Hedra, HP, IBM, KPMG, Logica , PA Consulting PwC, Siemens Information Solutions and Services, and Tribal.
The moves by Barnet and Enfield Hospitals PCTs to close down CFH were announced in 2005.
Whereas all the ‘reconfigurations’ of other hospitals in London were put on hold until the Healthcare for London plans were announced in 2007, the BEH ‘clinical strategy’ closure plans were accelerated with a special report from Lord Alberti, the government’s ‘Emergency Tzar’ in Spring 2007. CFH was to be the trailblazer.
In September 2007, Lord Darzi, the author of the The Healthcare for London plan, told the press that half to two thirds of London’s District General Hospitals would be run down or closed and that NHS GPs would be phased out in favour of 150 polyclinics.
The IRP personnel, carefully selected as pliable servants of the government’s privatisation policies, naturally endorsed the PCT’s closure plans.
Queen Marys Hospital, Sidcup has been selected for the same treatment, so that the other PFI hospitals in outer South East London, QE Woolwich, and Princess Royal at Bromley can be maintained.
Other hospitals immediately threatened include: Epsom/St Heliers in Southwest London and King George in Ilford.
There has been a tremendous three-year fight by the residents of Enfield to save CFH, involving the election of Save Chase Farm local councillors, huge marches, petitions, attending of Health and Scrutiny meetings and lobbies at Westminster, culminating in presenting information to the IRP.
In the last 18 months the North East London Council of Action has organised monthly pickets and two demonstrations.
The Labour government is accelerating the pace of its privatisation reforms of public services in the face of the economic crisis, as a lifeline to big business.
The trade unions must answer this onslaught with national trade union industrial action to halt the privatisation of the public services and defend public sector pay.
Councils of Action need to be built in every area involving residents, staff and all trade unionists to organise physical action such as occupation, to keep hospitals open.
Mass action is required to remove this right-wing Labour government and replace it with a workers government and socialism.
