THE government is activating a mass hospital closure programme.
30 to 40 ‘failing’ NHS trusts could be handed over to new management, which could include private sector companies, said the press yesterday (News Line 27-10-2008)
18 hospital trusts, 13 PCTs and three ambulance trusts have been identified as being most at risk of being designated unsustainable.
This refers to proposals that have been developed since June 2008, which were contained in the (Health Minister Lord) Darzi NHS Next Stage Review ‘A quality of Health for All’.
This document contains a savage plan to financially penalise hospitals and other trusts if they cannot meet certain quality standards.
The main reason why a hospital may not meet these proposed quality standards, such as patients reported outcomes ( PROMS), rates of hospital acquired infections (HAIs) and cleanliness standards, is because of lack of funds in the first place.
Hospitals with so-called deficits, have to make turnaround cuts. They therefore cut nursing establishments, replace trained staff with cheaper non-trained staff, and have 100% bed occupancy so that they can get more patients in to get more Payment By Results (PBR) tarriffs.
These factors of necessity make them more prone to hospital acquired infections.
The Darzi plans propose to give tariff overlays for high quality care, and lower PBR tariffs for poor quality care. This would mean that the trust with the most problems would receive even less money and would lead to a spiral of falling standards and more debts so that the trust would end up failing clinically and financially and then be deemed ‘underperforming’ and then seriously ‘underperforming.’
‘A consultation on a regime for unsustainable NHS providers’ was published by the Department of Health on 9th September. This would give seering new powers to the DoH to close down ‘failing hospitals. New legislation is designed to enable a ‘Trust Special Administrator’ to enter a clinically or financially ‘unsustainable’ hospital, take some soundings, and organise its closure, its transfer to new management or to a private sector provider in just 120 days – with the permission of the Secretary of State for Health.
An unsustainable NHS provider could be taken over by another Foundation trust, handed over to a private management or organisation, or stripped of its acute services leaving just the profitable bits on PBR, i.e the elective services.
This is essentially what is proposed for Chase Farm Hospital in Enfield in the plans for reconfiguring Barnet, Enfield and Haringey’s services. The remaining urgent care centre, surgical centre, (plus or minus a polyclinic), would all be tendered out to the private sector.
Health Service Journal (HSJ), a management journal, summarised the effects of the accompanying DoH ‘impact assessment’ of the proposed regime for ‘unsustainable’ NHS providers. It said (18.9.08):
‘Up to 92 trusts may be culled over 20 years . . .
‘The Department of Health expects to cull up to six hospital trusts a year under its new failure regime, figures in its impact assessment reveal.
‘The document shows the DoH expects to save £200m a year under the plans . . . This would be achieved through reconfiguring services more rapidly and sacking failing trusts’ boards, leaving them to be merged or run by more successful trusts.
‘The impact assessment does not assume the cull will stop at the six most troubled today. It estimates that 2.1 per cent of NHS and Foundation trusts will fail every year: the equivalent of 5.6 organisations in the first year and 92 across the model’s 20 year duration.’
The article points out that the powers of the trust administrator would override the duty to consult under the NHS Act 2006.
Even Nigel Edwards, the director of the NHS confederation and a stalwart supporter of government policy, was reported as saying that there was a risk that the regime could be used to ‘subvert the democratic process’ by imposing reconfiguration.
Supporters of Chase Farm Hospital will laugh at the idea that there ever was a democratic process for reconfiguration in the first place.
The HSJ editorial of 18.9.08 comments: ‘A failure regime has always been spoken of as something to be used only rarely, but this paper transforms it into a routine mechanism for killing trusts off – close to one every couple of months.’
It ends ‘. . . managers should be forgiven for thinking it amounts to a mechanism for the widespread, centrally dictated reconfiguration of services.’
The process has already started. On the 16th October the Health Care Commission (HCC) published its NHS ratings. This looks at so called ‘quality of standards’, and ‘use of resources’.
London was said to be the only area of the country in which performance for quality of services declined, with 48% scoring excellent or good compared to 55% last year. The areas involved were A&E waiting times, access to GPs, waiting time from referral to treatment and breast cancer screening.
The Commission concluded that action was needed to address these concerns in London and ‘should focus on encouraging PCTs to work together to commission services, improving access to GPs and reconfiguring hospital services where this would benefit patients.’
The HCC warned that almost a third of NHS hospitals risked being refused a license to operate because they were not meeting core standards of record keeping, cleanliness, safety and effectiveness. NHS hospitals and trusts will have to be on a register by April 2010. Sir Ian Kennedy, chairman of the HCC said ‘If they don’t meet these core standards then the Care Quality Commission could withdraw registration or impose tough penalties such as fines or operating conditions.’ FT (16.10.08 )
This is the culmination of New Labour’s NHS plan 2000. In the present conditions of credit crunch and the crashing of the banks, the cull will not be 92 trusts in 20 years but in a much shorter period of time, if we allow this to happen.
There is not a moment to lose. The unions must mobilise to stop this wholesale closure of NHS hospitals and GP surgeries.
Chase Farm Hospital and all the other threatened hospitals must be kept open and properly funded. This government must be brought down and be replaced with a worker’s government which will nationalise the banks and all the major industries and bring back into public ownership all the services, transport and education, and restore the NHS as a publicly provided service.
