THE health services in England and Wales and Northern Ireland are in massive crisis. In February, The Francis report on Mid Staffordshire hospital (MSH) exposed, again, how the trust was driven to cut staff in order to save money to become a foundation trust (FT), resulting in 1,200 excess deaths from 2005 to 2008. But this has only lifted the lid on systemic problems. New scandals are surfacing.
At Furness General Hospital, 30 families have taken legal action over deaths and injuries to mothers and babies from 2008. It appears that internal and Care Quality Commission (CQC) reports were covered up, so that the hospital could obtain FT status.
Families are also taking legal action against Basildon Hospital for the treatment of their relatives. It is suggested there could be 14 more hospitals with excess death rates.
The official line from government and the new health service management, is that ‘failing hospitals’ must be closed. Secretary of State for Health, Jeremy Hunt, has proclaimed the source of the problems to be a lack of compassion from medical and nursing staff, and their failure to whistle blow!
In fact, it is the gigantic chaos forced on the NHS by successive governments, in the form of cuts and privatisations, which are responsible for these awful deteriorations of care. These were the huge funding cuts, consisting of the 2005/6 ‘turnaround’ and the ongoing £20bn McKinsey cuts imposed since 2010 on the one hand, and the constant privatisation measures which led up to the legal imposition of the open market and commissioning reorganisation in the Health and Social Care Act of March 2012.
This ‘creative destruction’ is now reaching its peak with the Tory coalition hell-bent on imposing an American-style marketised healthcare system – with far fewer acute hospitals, and Kaiser Permanente-style ‘integrated’ care opening the door for patient charges and the end of universal healthcare.
The government has laid aside £300m to pursue special administrator failure regimes, to close up to 60 District General Hospitals (DGHs).
Hunt’s response to the scandals is to institute Ofsted-like inspections, to produce ratings. A warning, and then if problems are not rectified in a few months, a referral to administration will be instituted.
We saw the role of the Trust Special administrator in regard to South London Healthcare Trust, which was drowning in PFI debts. McKinseys drew up the plan to reconfigure the whole of SE London’s healthcare and recommended that Lewisham close as an acute DGH.
Mid Staffs Hospital was the second to go into administration, with Monitor calling in Ernst and Young who’s report recommended a similar dismemberment of that hospital.
Now the A&E crisis has blown up, as patients clamber to the last port of call, as they desperately try and access proper medical care. A&Es are all full to bursting, understaffed and clogged up, as their hospitals have not got enough beds. A rise in mortality has accompanied overcrowding. Patient attendances at A&E have steadily risen and there has been a hike in emergency admissions to hospital of 40% between 2003/4 and 2010/11.
GPs are overworked, so that patients may wait for appointments and only get 10 minutes consultation. Performance management targets force GPs not to refer patients to hospital, and the new contract is loaded with perverse incentives. Out of Hours care is dangerously under-performing in many areas. The new 111 Triage system, of clerks with tick boxes, is not fit for purpose and has resulted in deaths. There have been huge cuts in mental health and social services.
Central to the problem is the running down or closures of at least 32 DGHs since 2007.
The government is trying to pin the A&E crisis on doctors’ current working hours! They argue that if only there were ‘consistent’ consultant working in hospital at unsocial hours and at weekends, the problems would be solved. Of course increased cover could be arranged tomorrow, by employing more staff, but this would not fit with the government’s cost-reduction plans.
Sir Bruce Keogh, NHS England’s Medical Director, calls for 24/7 working on the model of commercial companies like Tescos.
Behind the façade of concern for emergency patients, the plan is to institute 7-day elective services, to make hospitals more attractive for private providers.
The story goes that if only there were a few centralised specialised hospitals with doctors working 24/7, and all the DGHs were closed, then patient care would be so much better and how much more cost-effective this would be.
Yet, the first hard evidence has came through at Newark showing that the closure of its A&E has significantly increased mortality rates for Newark’s emergency patients, with their transfer to distant over-full hospitals.
As for Clinical Commissioning Groups, section 75 of the Health Act makes clear that competitive tendering will be forced on them.
All over the country campaign groups have been set up to keep DGHs open and defend services.
The BMA should be leading this fight head-on to defend hospitals from closure, to combat the £20bn cuts and the huge swathes of privatisation. Occupations and joint industrial action with other unions should be used to defend jobs.
The miserable record of ‘critical engagement’ with the Health Bill, and minimal struggle over pensions, must be changed and the desperate plan to force new council members to sign up to gagging clauses should be quashed.
We have to make sure that changes to hospital doctors’ contracts are not railroaded through in a similar manner to that of GPs. The membership must have the right to maintain the status quo with no secret negotiations.
The Tory coalition is now desperately trying to prop up the banks by destroying the post-war Welfare State. Huge cuts to the health budget will be used to fund new wars in the Middle East.
We must defend our universal public health service. We cannot stand by and watch it being smashed up as the big corporations move in to steal it.
This BMA ARM must decide on emergency industrial and political action to mobilise all trade unions and millions of people to defend the NHS by putting this rotten coalition regime out and by bringing a real socialist government in.
Come to our News Line meeting on Tuesday at 6.00-8.00pm at the Quakers Meeting Hall, 7, Victoria St. EH1 2JL.
