Government implements cuts in South East London Healthcare Trust

Rick Wilson

On January 31, Conservative Secretary of State Jeremy Hunt announced that the government would press ahead with the dissolution of the South London Healthcare Trust (SLHT), implementing serious cuts to heath services.

In July last year the coalition government appointed Mathew Kershaw as Trust Special Administrator (TSA) for SLHT, on the basis that this was necessary to address the Trust’s annual deficit of £65 million. This shortfall is essentially the added charges and interest from Private Finance Initiative (PFI) schemes set up under the last Labour government. Cost over-runs on privately built hospitals have saddled the Trust with an estimated liability of £1,954 million (approximately one-third of which has been paid).

Kershaw delivered his recommendations to the Secretary of State on January 7.  He aimed to have SLHT dissolved by the start of October and its three hospitals–Queen Elizabeth Hospital in Woolwich, Queen Mary’s in Sidcup and Princess Royal in Bromley–merged into neighbouring trusts.  The plan was to make up £74.9 million through “efficiencies” across these hospitals, and to sell off any vacant or “poorly utilised” buildings.  Kershaw did recommend one bailout–he intended the Department of Health should meet the excess costs of the PFI buildings. In addition, a broader plan to restructure the NHS across South East London was proposed. This scheme for widespread closures and selloffs included Lewisham Hospital, which is not part of SLHT.

There has been substantial opposition to these cuts. Around 25,000 people marched against cuts in Lewisham on January 26, and a petition bearing 50,000 signatures was delivered to the Department of Health on 30 January. These efforts took place within the Save Lewisham Hospital campaign.  While material from the campaign claims to oppose “services cuts in Lewisham, Greenwich, Bexley and Bromley” and “the destruction of the NHS”, its main focus has been to argue that Lewisham, being outside the SLHT and solvent, should be exempt from those cuts. The campaign aims to pressure the government into changing course, and boasts of alliances with Conservative, Liberal Democrat and Labour Party MPs.

Whatever local manoeuvres individual MPs employ in the hopes of snaring votes, their parties are all working to destroy the NHS. The last Labour government began £20 billion of “efficiency savings” across the NHS and the new coalition government is determined to complete and deepen these attacks.  Privatisation, already present in support services, will be stepped up from April after the Health and Social Care Act renounced the government’s “duty to provide” a comprehensive health service and replaced it instead with a “duty to arrange” health care.

With public opposition trapped in the Save Lewisham campaign, Hunt was free to accept a very slightly amended version of Kershaw’s recommendations.  A report by NHS Medical Director, Professor Sir Bruce Keogh, was used as a clinical cover for the cuts in South East London. Keogh backed the changes, but warned Hunt that this would risk “inadvertent underprovision at hospitals receiving displaced Lewisham activity,” particularly with “acute medical emergencies” [emphasis added].

Keogh approved downgrading the Accident and Emergency (A&E) service at Lewisham and redirecting one quarter of its cases–the most serious, carried in “blue light” ambulances–to other hospitals. As a consequence, the hospital’s maternity service will be reduced to a midwife-led birthing centre with 10 percent of its current capacity. The high-quality paediatric care ward at Lewisham will remain, with “rapid transfer protocols” for children requiring intensive care.

Keogh has moved to distance himself from the reviled Hunt. Hunt claimed in parliament that Keogh had advised him the plans “could save up to 100 lives every year”. This claim was not in Keogh’s report and Keogh denies making it.

Lewisham currently handles around 110,000 A&E patients and 4,400 births each year. Hunt’s measures will see some 80,000 less serious A&E cases treated at Lewisham. Many patients will now be sent to King’s College Denmark Hill, or Queen Elizabeth Hospital Woolwich. Both hospitals are now expected to handle more than 8,000 births a year and to have to “double-staff” the units. There have already been complaints that hospitals, including King’s College, had had to turn away pregnant women on 37 occasions over 18 months because their maternity wards were full. Increased pressure has led to a fourfold rise in cancelled operations at King’s since 2009/10.

Concerns about patients travelling long distances were answered with misleading statistics on small projected changes in average journey times across the region. No figures were provided on the increase in journey times for patients who would previously have been treated at Lewisham. A trip by car between University Hospital Lewisham and Queen Elizabeth Hospital takes 13 minutes in good conditions, while journeys by public transport take over half an hour. Delays in access to intensive care will inevitably have deadly consequences.

Save Lewisham Hospital campaigners have shouted their defiance, but are offered little more than to watch a legal challenge from Labour-dominated Lewisham Council against the statutory power of the TSA to make recommendations on Lewisham Hospital. Even if successful this would only redraw, not halt, the cuts in South East London. It would also present no challenge to Labour’s PFI programme.

Campaigners recognise that they confront an assault against the NHS as a whole. Lewisham Hospital consultant and campaigner John O’Donohue told the Evening Standard that Hunt’s comments in parliament were “based on very false evidence” and will be used “time and time again to justify local hospital closures.” They will “play the ‘local safety’ card”, he said, “but there is no evidence for it”.

Hunt is aiming to serve 21 other NHS Trusts with the same treatment as SLHT. The attacks on health care cannot be fought with regional pressure actions like the Save Lewisham Hospital campaign.  The fate of the NHS must not be left in the hands of the parties that have plotted its demise.  The Socialist Equality Party calls on working people to join its fightback campaign at nhsfightback.org.