DISTRICT General Hospitals are being destroyed.
Bruised and battered from every direction with reforms, £900m direct cuts are the knock out blow with which to finish off the District General Hospitals (DGHs).
Without beds, staff, theatres and Accident and Emergency departments (A/Es), DGHs do not have the capacity to provide services, which are then redirected into the corporate private sector.
The plan is to close dozens of DGHs. Ian Carruthers acting Chief Executive of the Department of Health (DoH) has told the managers to ‘roll up their sleeves’ and make the cuts.
Prime Minister Tony Blair said on April 18: ‘We have reached crunch point where the process of transformation from one system to another is taking place’, alluding to private providers, ‘patient choice’, practice based commissioning (PBC), and payments by results (PBR).
The ‘new system’ is publicly funded, but has private provision, with the big healthcare corporations such as United Health, Capio, Netcare, Alliance Medical and others providing clinical care.
This is what Blair meant when he said, on May 8, he wanted to stay on to see through the ‘second phase of NHS reforms’.
Direct Cuts
Over 8,000 beds have been closed, more than 7,000 jobs have been lost, with 13,000 more to go.
Managements are walking in to medical staff committees, announcing that they have huge deficits, and that services must be closed.
These are ‘good old fashioned . . . well . . . cuts’, according to the Health Service Journal (25.5.06.). City accountancy firms are being brought in at great expense, to enforce them.
Beds, jobs, theatres, A/Es are being axed. Managements say they are studying every service to see if it makes a profit at tariff. If it does not, it may be terminated. Forms have to be filled in for every biopsy/sigmoidoscopy taken in a clinic, in order to charge.
In some hospitals, consultants cannot refer patients to other consultants. It has to go to a referral panel, or back to the GP.
Care is being disintegrated and every separate bit is being charged for, logged, coded, and billed.
Consultants are having their Programmed Activities (PAs) cut to 10 per week, with services they were performing disappearing.
Management announce charges to patients for drugs and increases for car parks.
The proportion of trained nurses on the wards is being reduced, with plans for less doctors on call at night.
Management interference with clinical judgement has become intolerable. Surgeons are being bullied to perform all laparoscopic cholecystectomies as day cases, to cut lengths of stay, to agree to nurse discharge of patients, to stop treating patients as individuals and adhere to reams of benchmarked guidelines.
Trusts with Private Finance Initiatives (PFIs) like Queen Elizabeth Woolwich and University College London Hospitals (UCLH), saddled with huge repayments for the next 35 years, close services to pay back the debt.
Managements act like little Hitlers, knowing that if they do not make the cuts, they will be sacked and private management drafted in.
When bemused surgical staff remonstrate that closing operating theatres will remove clinicians ability to provide surgical services to the local population, they are told that the government wants 15 to 20 per cent of elective surgery to go to the private Treatment Centres (ISTCs).
All over the country excellent surgical units are closing and losing trainees so that NHS patients can be diverted via ‘patient choice’ to private treatment centres, paid for up front with government block contracts.
Elective diagnostics is being removed. New PFI hospitals are being built with small imaging departments, so that elective work is outsourced.
Medical outpatients are being threatened with the shifting of dermatology, rheumatology and diabetes into the ‘community’.
When clinicians question this onslaught, management say: ‘PCTs are only commissioning so much care. It is government policy and we have to accept it’!
It is government policy, but do we have to accept it? No!
The district general
hospital must be defended.
The DGH is one of the highest gains of the NHS.
The NHS was a revolutionary new model of care in the world, in which the hospitals were nationalised and formed into a cooperating network providing access to specialist care, for the whole population.
It was comprehensive from cradle to grave, preventative and curative and comprised community, primary, and secondary care, planned for the clinical needs of the population. It was publicly provided, funded from taxation, and free at the point of use.
The DGH brought under one roof the specialist services for its catchment area, emergency and elective, in- patients and outpatients, medicine surgery, anaesthetics and Intensive Care, Obstetrics and Gynaecology (obs/gynae), Paediatrics and Geriatrics, imaging and pathology, etc.
This tremendous integration of care was extremely efficient, providing care in one place for every aspect of the patients’ condition, comprehensively and with continuity of care.
The DGH doubles as a huge school which trains medical students, doctors, nurses and paramedics.
Blair is the Luddite
What they are proposing is the end of safe, consultant-led, local hospitals.
Our Health Our Care Our Say: A New Direction for Community Services (DoH Jan 06) proposed the transfer of day surgery, diagnostics, stepdown care and outpatients from hospitals and into ‘a new generation of community hospitals, run by the private sector for catchment areas of 100,000, staffed by GP Specialists (GpSpis) and other ‘practitioners’. £4bn a year is leaving NHS hospitals for ‘specialist community care’.
Strengthening of Local Services, the Future of the Acute Hospital, a report produced by DoH bureaucrats and tame clinicians, surrogates for government policy, proposes ‘networks’ taking over traditional DGH roles and eventually the subsuming of the DGH into Private Public Partnership, or Joint Venture Services (JVS), with the private sector. (Reference and resource report. National Leadership Network, Local Hospitals Projects 21.3.06.)
At no point do they give any clinical reasons why hospital services should not continue being delivered by hospitals, because there are none! Their starting point is that plurality, the market, PBC and PBR are here to stay and must be accepted.
It admits ‘. . the relationship between local NHS hospitals and ISTCs . . . could allow “cream skimming” by independent providers and “dumping” of higher risk patients on the local NHS.’
It speaks of the need to provide a growing proportion of what have traditionally been viewed as ‘hospital’ services in other settings closer to the patient – and to do so at a significant scale.’
It proposes local hospitals without proper emergency services. Trauma and emergency surgery and possibly paediatrics, obs/ gynae, specialist surgery will be managed across ‘accountable networks’ and not necessarily in the hospital.
This immediately downgrades any casualty department, and any maternity unit and will be used as an excuse for closing these down. Hospitals without such departments will wither away.
‘Over time key resources (such as specialised staff and crucial service specific assets might be increasingly provided by networks and collaborative ventures, rather than by individual hospital trusts. . .)
They are flying a kite for ‘new employment models . . .
‘These would involve removing key clinical staff from the direct employment of individual trusts and Foundation Trusts (FTs) and instead to employ them via an overarching organisation which would contract across traditional care boundaries to provide clinical input.’ Such networks could be franchised out to private companies.
They discuss the advantages of ‘decoupling staff from institutions’ and how much easier this would make it to reconfigure i.e. cut services.
They want to decouple doctors from their hospitals, and their patients.
The reason they are cutting emergency-type services is that they are costly – ‘several key services areas become increasingly impossible to staff or sustain on a 24 hour basis at every local hospital . . .’
– and that private companies are not interested in them.
It is obvious that they plan to reduce large numbers of acute DGHs to sink hospitals with or without A/E or proper emergency back up services.
Then they discuss the minimal cover an A/E can manage with, and go on to discuss patient safety, aware that what they are proposing is potentially unsafe.
Training in DGHs is to end
‘These changes present an opportunity to move away from the increasingly unsustainable traditional training model, towards one in which a more limited set of providers focuses on high quality training, leaving others free to focus on service delivery.’
Emergency service, 24-hour cover, training in DGHs are all unsustainable and untenable. Why?
Because it means preserving the old model, which they are determined to destroy.
Why is Blair destroying the DGH?
It is because it represents high quality, highly efficient hospital care, consultant-led and popular with local people and GPs and maintains NHS standards, and the DGH acts as a barrier to the introduction of corporate private medicine.
While they still exist it is hard for the multinationals to get a toe hold. They have to be broken up and destroyed. Direct cuts are the quickest most brutal way.
We need action and we need it now
The BMA leaders must stop helping ministers to bring in the reforms.
They should break off relations and fight for the service. If they will not they should go.
Doctors should lead the fight to stop A/E, bed and theatre closures, and staff redundancies. It is nurses today and us tomorrow.
Already International Medical Graduates are being turfed out under new immigration laws, and Modernising Medical Careers will lead to a new lost tribe of Senior House Officers (SHOs).
The BMA should link up with the other health and public sector unions, and organise a day of action, industrial action, providing emergency cover only, and call on all TUC-affiliated unions to call strike action to stop the cuts and privatisation, and defend the NHS. Their members all rely on NHS hospitals.
We should learn from the French!
We should join up with the public, who are fighting to defend their local hospitals.
We need a leadership in our union which will fight to defend the high standard of health service and training that we have had and not be afraid to take on this government.
The multinationals must be kicked out.
Defend NHS hospitals!
Defend the NHS.
Stop the privatisation ‘reforms’!