THE Special Trust Administrator’s plan for South London Healthcare Trust (SLHT ) and the NHS in South East London, aims to close Lewisham hospital as an acute District General Hospital (DGH).
The plan is to strip out A&E, acute medical and surgical admissions, inpatient paediatrics and probably obstetrics, and the intensive care unit, leaving a ‘cold’ site for the private sector.
Imposing the Unsustainable Provider Regime (UPR) on SLHT in July 2012 was a last act of vandalism of Andrew Lansley, former Secretary of State for Health.
The trust was formed by the merger of Princess Royal Hospital Bromley (PRU) and Queen Elizabeth Hospital Woolwich and (QEH) and Queen Mary’s Hospital, (QMH) Sidcup in 2009.
The ‘failure regime’ was developed under the Labour government in 2006, and has been seized by the coalition government as a lethal weapon.
The UPR ‘hit squad’ accelerates the task of closing hospitals and cutting and privatising what is left. It has the following features.
Rapid time lines and irreversible decision making.
The Special Trust Administrator (STA) made a draft report from 16th July to 29th October 2012. Consultation is taking place from the 2nd November to 30th December. The final report is due on the 7th January 2013 and Jeremy Hunt’s decision is published on 1st February and is final.
There will be no room for community scrutiny panels, lobbying or appeals to the Independent Reconfiguration Panel. The whole process will have been truncated into six short months.
The pretext of bankruptcy.
The so-called ‘financial unsustainability’ of SLHT can be manufactured to remove any unwanted NHS trust, and sell it off.
Given that trust boards have been forced to rebuild hospitals with unaffordable PFI new builds, and the commissioners impose 4% annual QIPP savings, cut commissioning contracts, reduce tariffs and impose financial penalties for not reaching targets, almost any trust can be rendered bankrupt.
16% of annual revenues or £35m at PRU and £34m at QEH are the annual payments for PFI buildings, leaving the merged SLHT with a £207m debt in 2011/12.
The production of a rapid comprehensive reconfiguration plan with commissioners on board
The Special Trust Administrator (STA) Andrew Kershaw, drew up his 78 page report with 12 appendices. A greased machine slid into place involving the setting up of 15 committees complete with ‘patients’ and ‘clinical advisory’ groups.
This was not the work of novices. The management consultants McKinseys were already advising SLHT on how to cut its deficits, then got the £2m nine month contract to advise the STA on his report.
The committees were peopled with those from McKinseys such as Dr Penny Dash and ‘clinical leaders’ who can be relied on to support the privatisation and reconfiguration plans such as Ruth Carnall CE NHS London, and Dr John Coakley, Homerton and CEs and Medical Directors of the all the Trusts in SE London, the PCT cluster representatives, and the chairmen of the six new Clinical Commissioning groups (CCGs) of Bexley, Bromley, Lambeth, Greenwich, Lewisham and Southwark.
The reconfiguration of an entire region.
The STA plan which appears to deal with a single trust bancrupty is in fact a colossal plan to reconfigure services in all six boroughs of South East London with a population of 1.7m and a budget of over £3bn.
The range, depth and speed of the proposed changes are unprecedented. It involves;
1. the ending and dispersal of SLHT.
2. The merging of QEH with what is left of Lewisham healthcare trust and its community services;
3. Options for PRU, which include take-over by Kings and its partners, or an outside tendering.
The latter could involve a Hinchingbrook type management take-over by a private company or could mean selling off management AND provision to a private company so that staff would lose their NHS pay and pensions.
4. Selling off land at QMH and Lewisham sites and Orpington Hospital and ending the lease on Beckenham Beacon.
5. The scrapping of the £207m historic debt in April 2013, and the pledge that the PFI payments are honoured by the government till the end of their contracts.
6. Establishing the Lewisham site as a cold site with the biggest independent surgery centre in the country doing hips and knees and other non complex elective surgery with an Urgent care centre, some rehab beds, outpatients and diagnostics, attractive to independent sector providers.
7. Inviting private providers to procure services to run radiotherapy, endoscopy, rehabilitation, inpatient mental health and other services on the Bexley Health Campus replacing QMH.
8. Shifting resources out of hospitals and into GP and community care, so that the patients can care for themselves ‘in their own homes’ and shop around using their independent patient budgets for care in the community.
9. A large reduction in hospital beds.
10. A change in ‘culture’ at SLHT, requiring a massive increase in productivity of staff and the loss of 140 whole time equivalents of medical staff in order to save £20m, losses of nurses to save £14m, scientific and technical staff to save £4m, and outsourcing pathology and pharmacy to the private sector to save £2m, including the imposition of seven day week working.
All this to be accomplished in three years.
The implications are clear. The UPR regime is being got ready for other trusts, such as St Heliers in SW London, Barking and Havering, and Mid Yorkshire, as a warning that they will not be ‘bailed out’.
This new ruthless UPR instrument is being honed to be used all over the country to bypass the remnants of any democratic scrutiny and impose mass DGH closures as part of wholesale regional reconfigurations in record quick time.
The coalition government, sensing the lack of fight by the trade unions, is surging ahead attempting to smash up much needed DGHs, in an attempt to set up their private company friends in their private treatment centres, commercial polyclinic GP centres and ‘care in the community’ clinics, and even hand them whole hospitals, in a fait accompli, before the labour movement has mobilised to stop them.
The PCT clusters with NHS commissioning board (NCB) approval are pushing through the management consultants plans. To the contempt of their colleagues, the new CCG chairmen are rubber stamping these plans.
The hand-picked ‘clinical leaders’ are doing their job and assisting their masters, while the ‘new culture’ of job losses and speed up is being imposed on their colleagues.
The latest part of the ‘new culture’ is seven day working with NCB Medical Director Sir Bruce Keogh, telling the medical profession to scrap their contracts and do elective work on weekends for the new commercially-run, Tesco style, NHS.
The Way Ahead
It is clear that the unions must call a halt to all this. Instead of hiding under the table, as they did during the passage of the Health Act, they have to defend NHS hospitals, and defend the contracts terms and conditions of their members. The disgrace of the debacle over pensions should not be repeated.
The large demonstrations to keep Ealing, Lewisham and Charing Cross hospitals and A&Es open, shows how strongly the public feels in support of their local hospitals.
Over 200 doctors have written in opposition to the planned changes at Lewisham.
But that is not enough to stop this government, which aims to establish its changes by 2015.
The time to fight is now. Councils of Action need to be set up in every area, involving staff, unions, residents and campaign groups to work for industrial action to defend every job and for occupations to stop services being taken away and keep hospitals open and running.
The NHS was nationalised in 1948. It belongs to the people.
We pay for it through our taxes. It has served us well for 64 years and no Tory/LibDem coalition government has the right to take it away from us. This coalition government must be brought down and defeated by a general strike.
Our actions must lead to a workers’ government to bring all our public services back into public ownership and reverse the effects of the Health Act and the cuts.
A general strike to defend all public services is overdue. Those union leaders that will not fight to defend our service and our jobs must be challenged and replace by those who will.
