NHS London has ordered PCTs and NHS trusts to draw up plans for cuts worth billions.
NHS London (London’s Strategic Health Authority) produced a report in June 2009 laying out their strategy for the next five years in the light of the Department of Health’s (DH’s) proposed funding cuts of £20bn by 2014.
The report was leaked to Health Service Journal (HSJ 10.9.09 p 6&7) and the Sunday Telegraph.
Under the heading ‘London acutes could see workload cut by 72 per cent’ HSJ quotes the following proposals from NHS London’s leaked report.
McKinsey and Co made the analysis and the recommendations.
• there could be a 42 per cent cut in the annual income of acute trusts by 2016-17.
• PCTs in London will be left with a funding deficit of up to £5.1bn if the forecast cuts go ahead, taking account of inflation.
Even if the tariffs are reduced by 3-4% the funding deficit will amount to £2bn.
NHS London proposes
1. ‘RECONFIGURATION’ & CLOSING HOSPITAL BEDS
‘It says that plans to shift more care out of hospitals and into GP practices and polyclinics will lead to hospitals needing just two thirds of the beds they would need under current levels of care.
‘Healthcare for London already has a London plan which is already underway and involves increasing the amount of care delivered through “polysystems” of joined up GP practices and health centres, with acute and trauma care centralised at selected acute hospitals.’
Huge cuts the ‘catalyst’ to reconfigure on a massive scale
The report says ‘Real change will be rapidly needed as the current system will no longer be affordable soon.
‘Seizing the changing external economic environment as a catalyst and driver for radical shifts in how services are provided and delivered will be critical.’
2. Cutting the funding by cutting the tariffs and capping the tariffs.
It is proposed that the payments by results tariffs (PBR) for each separate procedure be reduced, so that hospitals receive less money for each item performed.
The latest news (22.10.09 HSJ) is that the Department of Health (DH) is considering capping the tariffs as well.
This means that the commissioners will dictate a LIMIT on the number of procedures which the hospitals can do.
Up till now trusts have got round the cuts in tariffs by performing more work. This would be prevented with the consequence that many trusts would not be able to survive financially.
3. DECOMMISSIONING
The report calls for decommissioning what are called ‘Low value interventions’.
By this is meant certain operations and outpatient appointments. ‘Thirty per cent of outpatient appointments will be stopped altogether’ in London (Sunday Telegraph 26.9.09)
The national McKinsey apparently report listed 33 operations that are ‘unnecessary’, including inguinal, femoral and umbilical hernia repairs, hysterectomies for bleeding. (HSJ 10.9.09 p10)
No doubt, these will all be added to the above list as the changes are ‘aggressively’ pursued.
The national report calls for a 46 per cent cut in outpatient referrals to General medicine, 29 per cent in Dermatology, 15 per cent in Trauma in Orthopaedics, 20 per cent in General Surgery, 19 per cent in Ophthalmology (HSJ 10.9.09 p 13)
4. CUTTING A&E CARE
(iii) ‘eliminating costly and unnecessary service overlaps, e.g. those between out of hours care, extended hours, urgent care, and accident and emergency.’ (HSJ)
‘In London NHS trusts have been told to divert more than half of A&E patients, and those seeing specialists to cheaper “polyclinics” run by groups of GPs.
‘Sixty per cent of activity which now takes place in A&E departments should happen in community clinics within five years’. (Sunday Telegraph 26.9.09)
The plan is that commercial walk in centres and urgent care centres, will be dotted over London, and polyclinics and GPs must stay open till 8pm, and that other agencies cover Out of Hours overnight calls so that there can be a whole scale closure of proper hospital A&E departments.
The fact that none of these agencies can provide the quality of care that comes with having the full back-up of all hospital departments, does not concern them.
5. THE 72 per cent CUT IN LONDON HOSPITAL WORK
‘It is these changes which if pursued “aggressively”, which will lead to a 72 per cent reduction in patient volumes in the capital’s hospitals.’
They estimate that ten per cent of inpatient activity will have gone by 21016/17.
So one has to assume that large chunks of outpatients, endoscopies, day case surgery, A&E patients, i.e all the elective or semi elective work that hospitals do, will be eliminated and farmed out to the commercial sector.
The 42 per cent cut in
London hospitals income to come from
• treating fewer patients
• increased productivity (i.e. making staff redundant)
• selling off land buildings and assets.
‘Some of the resulting 42 per cent cut in hospital income will be offset by lower hospital costs as they will be treating fewer patients but it says “without significant productivity improvements” and “elimination of fixed costs” and “overheads” London hospitals could still face a funding gap…’
Consultation
‘The proposals have been widely consulted on and the report says they are necessary to make the increasing demand on London’s healthcare affordable, as well as to improve quality.’
It will come as news to NHS staff in London that they have been consulted about any of this.
What this means in practice
There is a discussion going on in the board rooms of the PCTs and acute trusts as to how to carry out the above NHS London strategy.
In North East London, PricewaterhouseCoopers are doing an investigation into the possible merger of the Homerton, Newham and Whipps Cross Hospitals.
It has been obvious for a long time that the reconfiguration was being performed around PFI newbuilds; Barts and the London. (£1.2bn SkanskaPFI) University College Hospital in central London and Queens Romford.
Chase Farm is earmarked for closure as an acute District General Hospital (DGH) in N London, with North Middlesex and Barnet both PFIs, being salvaged but no guarantee that both of them will become ‘acute major’ hospitals.
The number of district general hospitals (DGHs) which can become ‘acute majors’ is to be minimised.
Those that don’t make it will be turned into Darzi ‘Local hospitals’ with loss of in-patient paediatrics and consultant-led maternity units plus or minus A&E departments.
This could affect excellent busy DGHs like the Whittington and Whipps Cross.
NHS London is actively considering reducing the number of tertiary units in the capital which provide such specialist services as cardio thoracics and hepato biliary work. They call the provision of more than one of these units ‘duplication’.
Has anyone at the SHA ever tried ringing round London trying to get a patient with GI bleeding and liver disease into a hepato biliary unit.
It can take hours, because they never have any beds, or they never have any ITU beds or both.
Thank goodness there is more than one to try.
Clinicenta has just been given a £24m contract to do day surgery in London and GPs have been sent letters from the PCTs telling them to preferentially send patients there instead of to their local hospitals.
The north London letter says ‘Dear Doctor, Please find attached a very important letter from. . . (the commissioners) regarding the uptake of Innhealth and Clinicenta contracts that NHS London has negotiated on behalf of all London PCTs.
‘The latest activity data indicates that a large number of practices are not using the services which means that unless this changes, the PCT will suffer a substantial loss of funding. . . . . .Thanking you in advance for your anticipated cooperation in this matter.’
Innhealth and Clinicenta are commercial companies doing NHS work for profit for shareholders.
More patients are to end up in polysystems, and commercial ISTCs and urgent care centres.
What this amounts to is a massive onslaught on hospital care in London.
Way forward
If ever there was a time when the BMA and the other health unions should move themselves to campaign to defend the NHS as a publicly provided service it is now.
There was a unanimous vote at the TUC conference this year for Unison’s motion against the privatisation of the NHS and NHSTogether was to be revamped (TUC and all the health unions).
These union leaders have obviously decided to sit on their hands and do nothing as the NHS is wrecked.
It is no good saying that Andy Burnham told the Kings Fund that NHS providers would be the preferred providers. They are clearly not!
The ARM this year voted almost unanimously for Campaign Motion 170, which rejected the commercialisation of the NHS into competing businesses and called for a public information campaign and for the restoration of proper funding of NHS GP practices, DGHs and publicly provided community care.
What an indictment of the unions, that it takes the National Pensioners Convention to call a march and rally through central London on the 10th April 2010 from the Embankment to Trafalgar Square “Defend the Welfare State and all Public Services” It should be called this year by NHStogether.
Hospitals like postservices and schools need to be occupied to keep them open. Local staff and users need to come together in Councils of Action to organise this.