BY ANNA ATHOW BMA COUNCIL MEMBER
In London the 31 Primary Care Trusts (PCTs) have been amalgamated into seven clusters; Outer North East London, East London and the City, North Central London, Outer North West London, Inner North West London, South West London and South East London.
These PCT clusters commission hospital, GP and community care in their areas.
London PCTs made £397m of cuts in 2010-11, £362m of which came from acute hospitals.
NHS London, the strategic health authority (SHA), says that all the PCTs have been ‘overperforming’ on secondary care contracts, meaning that their hospitals have been treating too many patients.
The worst offenders for ‘overspending’ include, Barnet and Enfield and Haringey PCTs, (where they plan to close Chase Farm Hospital) Harrow and Hounslow PCTs (where they are running down Central Middlesex) and Waltham Forest and Barking&Dagenham PCTs (where they plan to close King George’s hospital).
How have these cuts been achieved? Or in some cases not achieved.
NORTH CENTRAL LONDON CLUSTER consists of the Barnet, Enfield, Haringey, Camden and Islington PCTs and contains the following acute hospital trusts; Royal Free, Barnet and Chase Farm, North Middlesex, Whittington, University College.
Chase Farm Hospital (CFH) is under threat of closure immediately. For the last five years, NHS London has planned to remove paediatrics, maternity and the A&E departments as a prelude to closing the entire hospital as a functioning District General Hospital (DGH) with acute inpatient beds, 24 hour operating theatres and Intensive Care unit.
They want to reduce it to an elective treatment centre and walk-in centre, rehabilitation, outpatients and diagnostics, which would be tendered out to the private sector.
Barnet hospital’s £70m PFI was built in 2003. It has just been revealed that the firms that invested in the PFI have sold their shares to HSBC bank, giving them a 67 per cent profit on their original investment. The bank’s infrastructure company now has complete ownership, and is making a fortune as it is registered in the tax haven Guernsey.
Since October 2010, Barnet and CFH Trust have been planning 250 job cuts to address their ‘deficit’.
For 2011/12, the North Central cluster has asked them to make cuts of £43m in their spending, out of a turnover of £346m, a crippling 12 per cent reduction.
There has been a vigorous ongoing campaign to keep the hospital open including demands for an occupation by NE London Council of Action.
North Middlesex Hospital has a just completed £120m PFI scheme, which will take 34 years to pay for at escalating cost. The unitary annual charge is an unaffordable £20m per year. It has not so far achieved FT status.
The Royal Free Hospital trust which is a major teaching hospital in Hampstead has announced that they must make £40m cuts this year. They propose to axe 450 posts, almost ten per cent of the staff including the posts of 17 doctors and 107 nurses.
The Chief Executive of University College Hospital ( UCLH ) Foundation Trust, Sir Robert Naylor, just announced that the hospital would be eliminating 360 posts including frontline staff.
He said: ‘If we have fewer contracts from the PCT to treat patients, and we do less work, then we must have fewer staff. Any business runs like that.’
A heavy drain on their finances is the £422m UCLH PFI build completed in 2005, which will eventually cost £2.5bn, and is being paid off at £64m per year for 40 years.
Whittington Hospital has just appointed a new Chief Executive (CE), who says that she wants to consider charging patients for some elective treatments, so that ‘optional’ NHS surgery could be privatised.
She aims to achieve the financial requirements for Foundation Trust (FT) status by 2013. The hospital has taken over Haringey and Islington community services and their 1,500 staff, and has become Whittington Health.
OUTER NORTH EAST LONDON CLUSTER includes the four PCTs; Waltham Forest, Barking and Dagenham, Redbridge and Havering, with acute hospitals; Queens Hospital Romford, King George (KGH) Ilford, and Whipps Cross.
There has been a long-standing plan by NHS London to run down KGH, along the same lines as CFH. The paediatric unit has already been removed from KGH and the plan is to remove A&E and maternity to Queens, against bitter local opposition.
The two trusts have been merged to form Barking, Havering and Redbridge Trust. (BHRT).
Queens was built as a £239m PFI, but will cost a further £835m to pay off. It is one of London’s financially ‘challenged’ trusts. The maternity unit received a damning report in April from the Care Quality Commission (CQC) following a maternal and newborn death.
The new CE, Averil Dongworth, has promised that 50 more midwives would be employed, which reveals the extent of the staffing crisis. BHRT are planning 100 redundancies in the next four years.
KGH, built 18 years ago with no PFI, is being run down to subsidise Queens.
A new community hospital at Barking is being built, with no inpatients, and the urgent care centre is being tendered out.
EAST LONDON AND THE CITY CLUSTER includes Newham, Tower Hamlets and City and Hackney PCTs, with acute hospitals; Barts & the London, Newham University Hospital and Homerton Foundation Trust,
Barts & the London NHS trust is a merger of St Bartholemews Hospital, Royal London Hospital, Whitechapel, and the London Chest Hospital.
The £1bn PFI will cost £5.3bn by 2048, costing £100m a year to repay, 15 per cent of annual income. One floor of the new cancer centre at Barts cannot be opened because of the expense.
In February, the trust reported that it would be cutting 635 staff over the next two years, in order to save £30m. Two hundred of these would be compulsory redundancies. Nearly ten per cent of nursing posts would go and 100 beds would be lost. Some nurses would be replaced by cheaper unregulated healthcare assistants.
Barts admitted they will be cutting the proportion of trained to untrained nurses, from eight to two, down to seven to three, and on general wards they would reduce qualified nurse to patient ratios. Admissions would be cut and day care increased.
Whipps Cross hospital in the borough of Waltham Forest, is instructed to make savings of £21.3m and cut 142 staff. It is on the SHA’s list of financially challenged trusts.
It is in the process of being merged with Newham Hospital and Barts & the London.
NHS London estimated that £19m could be saved in this way, due to scaling down administration, possibly renegotiating the PFI, and selling off land. Many are fearful that the London Chest hospital could be sold off.
Newham Hospital had a ‘deficit’ of £8.4m at the financial years end in March, and is said to be ‘significantly behind plan’ for savings and can not achieve FT status. It is cutting 90 jobs in 2011.
• Continued tomorrow
