Protest last May against the closure of the Maudsley  Emergency Clinic in Camberwell
Protest last May against the closure of the Maudsley Emergency Clinic in Camberwell

A ‘service reconfiguration’ for  Outer South East London Service is being proposed.

Outer South East London comprises the boroughs of Greenwich, Lewisham, Bexley and Bromley. The population of this area is around one million.

They lie close to the inner London Boroughs of Southwark and Lambeth. The teaching hospitals of Kings College NHS Foundation Trust (NHSFT) and Guy’s and St Thomas’ NHSFT provide tertiary health services for South East London.

There are four district general hospitals (DGHs) in the four boroughs at present; Greenwich has Queen Elisabeth (QEH) Woolwich. Bromley has Princess Royal University Hospital (PRU). Lewisham has University Hospital Lewisham (UHL) and  Bexley has Queen Mary’s Hospital (QMH) in Sidcup.

These provide comprehensive services i.e. A&E, general medical services including emergency in-patient beds and elective out-patient care, general surgical and orthopaedic services including emergency in-patient beds and elective out-patient care, paediatric in-patient beds and out-patient clinics, consultant-led maternity units with intensive care for babies.

They therefore have 24-hour cover for anaesthetics, surgery, intensive care and X-ray and imaging and path labs.

The review is looking at emergency care, urgent care, elective care, services for woman and children, and ‘care outside hospital’, not mental health services.

The initiative for commissioning this review has come from ‘NHS London’. NHS London is the Strategic Health Authority for London. It asked the National Clinical Advisory Team (NCAT) to perform the review.

People can find out what the changes are that the PCTs want to carry out and the reasons that they give in ‘A picture of Health – for Bexley, Bromley Greenwich and Lewisham’ ( <>) From that website the review report of the NCAT can be accessed.

However, on studying these documents, patients will find no good reasons given for any of the proposed changes. They will find that the authors have started from the diktats laid down from the Department of Health and simply imposed them on outer South East London.

They will find that in essence, they propose that only two of the four hospitals, those in Greenwich (QEH) and Bromley (PRU) are to definitely remain as acute hospitals with all emergency facilities present.

Neither of them will perform high volumes of elective surgery.

Queen Mary’s Sidcup would lose emergency facilities completely and become a ‘cold’ i.e. an elective site. It would have an elective surgicentre.

The three proposed options all concern the fate of  Lewisham Hospital;

Option 1, would turn  Lewisham into what Lord Darzi calls a ‘Local Hospital’. It would have an A&E department, but it would not have 24 hours surgery, or intensive care on site.

The consultant-led maternity unit and paediatric unit would be removed. It would admit medical emergencies but not surgical ones. There would be an elective surgicentre.

Option 2. would allow Lewisham to remain as an acute hospital with A&E, maternity and paediatrics, 24 hour surgery, anaesthetics, intensive care and imaging, similar to the status of QEH in Greenwich and the PRU in Bromley.

There would be this difference. Lewisham would have an elective surgicentre.

Option 3. Lewisham would become similar to the proposed non acute ‘cold’ site at QMH Sidcup. It would lose A&E, maternity paediatrics, 24 hour surgery and anaesthetics, intensive care and imaging. Lewisham would have an elective surgicentre.

They propose that all four hospitals should have something called an ‘urgent care centre’ on their site.

Urgent care centres are walk-in centres usually manned by nurse practitioners.

They are not comparable to proper A&E departments.

They are frequently contracted out to private companies. The NCAT also proposes four other urgent care centres at Beckenham Beacon, Deptford, Eltham and East Greenwich.

The NCAT report, written by the DofH’s emergency Tsar Sir George Alberti, and Lis Nixon, furnishes more information, but is simply a complicated apology for the decisions already taken.

It favours option 3 for Lewisham phase in over five years.

It emerges that QEH in Greenwich and PRH in Bromley are PFI hospitals. The PCTs must provide huge annual payments to them for the next 30 plus years. Hence these must have a high flow of patients and receive tariffs on payments by results. They therefore are to be preserved as acute hospitals.

Also, Lewisham (UHL) hospital has a new PFI block. It is no coincidence that every scenario proposes that Lewisham hospital should do elective surgery.

The PFI block will be the surgicentre. In the course of time this will be tendered to the private sector  and become the Independent (i.e. private) Sector Treatment Centre (ISTC) in South East London. This explains why the former two hospitals will lose elective surgery. The Lewisham ISTC must be kept in business.

Queen Mary’s Sidcup ‘will specialise in planned surgery’. This is code for the proposal that there will be a second ISTC in Sidcup.

‘A picture of health’ states the ‘principles’ guiding the decisions.

l ‘that services should be provided nearer to home for example with more provided in GP surgeries and that lengthy stay in hospitals should be minimised.’

This is another way of saying that hospital services will be drastically reduced. Patients will be thrown out of hospital as soon as they have had their operations or had their babies and have to look after themselves at home.

The GP will have to sort out more complex medical problems because referrals to consultants in hospital out-patients will in the future be reduced. So the more specialist opinion of consultants will be denied to many patients.

l ‘that to provide up-to-date care healthcare we need more specialist units. These enable clinicians to specialise more and provide better consultant cover. To achieve this would mean concentrating some services in fewer locations, including A&E and maternity.’

This statement is a pitiable cover up for the fact that they propose to close A&E departments, and maternity units, paediatrics units, 24 emergency general and orthopaedic surgery, 24 hour anaesthetics and intensive care, and 24 hour imaging and path labs from at least one of the four hospitals.

If option 3 were adopted, then two of the four hospitals would lose these acute consultant led services.

To pretend that because patients would have to travel a lot further to access these services, will automatically make them superior, is testing our belief.

All that they are proposing is rationalisation; seeing more patients in fewer bigger units.

There is no guarantee that this will make the services of higher quality. There is no evidence that bigger units are necessarily better in terms of patient outcomes.

What it will guarantee, is that overall these services will be cheaper to run. Overall, there will be fewer staff employed in them. It will mean that patients from Bexley will have much longer ambulance journeys to cover in the event of emergency, putting their lives at risk.

l ‘to separate planned surgery from emergency care, which helps fight infection and prevents operations being postponed due to emergency cases.’

This is the old wives’ tale that has been put into circulation, ever since the Independent Sector Treatment Centre (ISTC) programme of the government was launched in 2002.

In order to justify spending billions inviting in private companies to set up ISTCs, as separate facilities for the simpler elective surgery cases, in competition with NHS hospitals, we have heard these arguments.

There is no reason why NHS hospitals cannot perform all elective surgery as they have done for the last 30 years.

All NHS hospitals need is sufficient funds to maintain bed numbers and employ staff. NHS hospitals have always been starved of funds and found themselves constantly cancelling elective operations, because emergency patients have to be found beds.

If the money which the government is now pouring into private ISTCs and polyclinics were instead directed to improve existing NHS services, then there should be no need for waiting lists.

‘A picture of health’ gets down to brass tacks under the heading of ‘Money’.

‘Together, the NHS in four boroughs of Bexley, Bromley, Greenwich and Lewisham has been spending more than its budget. The overspend at around £400,000 per week, cannot be allowed to continue.

‘Each option was tested to ensure it was financially viable. So all the options proposed will mean that costs are brought back into line – as well as improving the quality of care.’

There is no detailed breakdown of where the money is going.

Probably a very large part of the budget of Greenwich, Bromley and Lewisham’s PCTs is being drained away on the massive PFI payments for QEH and PRU and the PFI block at Lewisham.

There have been many studies to show that PFI newbuilds are almost unaffordable and that many existing health services are closed down in order to pay for them.

This already happened at QEH Woolwich in which it had to close a surgical ward in order to assist in the PFI payments.

Contracting out new ISTCs in QMH and Lewisham, and at least eight ‘urgent care centres’ to the private sector will also be expensive.

In conclusion:

One of the main reasons for the proposed ‘reconfiguration’ of services in outer South East London is to do with paying for the current PFIs at QMH, PRU and Lewisham and future private contracts for ISTCs at Lewisham and QMH and eight urgent care centres.

High quality consultant-led acute services are being sacrificed to further Gordon Brown’s Darzi privatisation plan for London.

Patients are going to suffer a massive loss of acute hospitals’ services and reduced GP care, in return for inferior care in privatised facilities. Lives are being put at risk on the altar of contracts for the private sector.

These plans must be defeated by trade union and community action.

There has to be the biggest ever campaign to mobilise the residents patients staff and trade unions in South East London to keep all the outer South East London Hospitals open as fully functioning District General Hospitals with all acute services at each site. The privateers must be kept out.

These issues must be taken up in the unions nationally and joint action with the other public sector unions organised to get rid of this government.